Adherence to Practice Guidelines in the Implementation of Emergency Obstetric and Newborn Care in Referral Hospitals in Osun State, Nigeria.

Introduction: While practice guidelines support clinical decision-making for optimal patient outcomes, there is often nonadherence to practice guidelines in implementing evidence-based interventions. Objectives: This article aimed to assess adherence to practice guidelines in emergency obstetric and newborn care (EmONC) and the outcome of pregnancy in cases of obstetric complications in referral hospitals. Method: The study employed a descriptive design. A purposive sampling technique was used to select the three tertiary hospitals and six out of nine state hospitals in Osun State. A data extraction form developed based on a fidelity framework was used to collect data on Adherence from 264 cases of obstetric complications. Descriptive statistics, such as frequency and percentage, and inferential statistics, such as chi-square, were done with the significance level set as p < .05. Results: Findings showed low adherence to practice guidelines in 70.8% of hemorrhage care, 52.0% of fetal distress care, 60.0% of prolonged obstructed labor care, and 44.4% of preeclampsia/eclampsia care. The study's findings also showed that 64.3% of cases of prolonged/obstructed labor, 54.9% of cases of fetal distress, and 46.7% of all cases of obstetric complications were referred out at the state hospitals. Neonatal mortality in state and tertiary hospitals was 3.7% and 21.7%, respectively, which was significantly different (p < .001). Conclusion: There was low adherence to practice guidelines for the implementation of EmONC in state and tertiary hospitals, and a significant number of cases of obstetric complications were referred out in the state hospitals. The low adherence to practice guidelines and numerous referrals truncate the successful implementation of EmONC and hinder women and newborns from receiving optimal care for obstetric complications. There is a need to develop strategies that promote adherence to practice guidelines in implementing EmONC.

Understanding context in the implementation of emergency obstetric and neonatal care in health facilities in Osun State, Nigeria- a mixed-methods study.

BACKGROUND: Successful implementation of Emergency Obstetric and Neonatal Care (EmONC) is likely to improve pregnancy outcomes and is essential for quality maternity care. Context in implementation is described as factors that enabled or disabled implementation of interventions. While the context of implementation is important for the effectiveness of evidence-based interventions, the context of EmONC implementation has not been widely studied in Nigeria. METHODS: The research design was cross-sectional descriptive. A mixed-methods approach was used to assess and explore the context of implementing EmONC in referral centres in Osun state. A purposive sampling technique was used to select the three tertiary health facilities in Osun State and six secondary health facilities from the six administrative zones in the State. A total of 186 healthcare providers in these referral centres participated in the quantitative part of the study, and eighteen in-depth interviews were conducted for its qualitative aspect. An adapted questionnaire from Context Assessment Index and an interview guide were used to collect data. Quantitative data were analysed using descriptive and inferential statistics at 0.05 significance level, while qualitative data were analysed using the thematic approach. RESULTS: The percentage mean score of context strength in EmONC implementation was 63% ± 10.46 in secondary and 68% ± 10.47 in tertiary health facilities. There was a significant difference in the leadership (F (1, 184) = 8.35, p < 0.01), evaluation (F (1, 184) = 5.35, p = 0.02) and overall context (F (1, 184) = 6.46, p = 0.01) of EmONC implementation in secondary and tertiary health facilities. Emerging themes in EmONC context were: Resources for EmONC implementation; Demand for EmONC; Efficiency of funding; Institutional leadership; and Performance evaluation. CONCLUSIONS: The context of EmONC implementation in the referral health facilities was generally weak. The secondary health facilities' weaknesses were worse compared to the tertiary health facilities. The five key contextual factors could inform strategies for improving EmONC implementation in health facilities to ensure improved access to care that will reduce deaths from obstetric complications in Nigeria.

Acceptability, appropriateness and feasibility of webinar in strengthening research capacity in COVID-19 era in Nigeria.

Introduction: The challenges posed by the COVID-19 pandemic have necessitated the increasing use of online virtual training platforms. The objectives of the study were to assess the acceptability, appropriateness and feasibility of virtual space in strengthening the research capacity in Nigeria. Materials and Methods: Data were collected through an adapted online questionnaire from participants following a 2-day webinar. Both descriptive and inferential (bivariate and multivariate) analyses were done. Results: The findings of the study revealed that 55.2% of participants (n = 424) were males and 66.0% (n = 424) were early career researchers. Two hundred and thirty-six participants (55.7%) (n = 424) reported very good acceptability, 67.9% (n = 424) reported very good appropriateness while 54.7% (n = 424) reported good feasibility of webinar for research capacity strengthening. The rating of knowledge obtained from the webinar as 'excellent' increased the odds of acceptability (odd ratio [OR] = 38.30; P < 0.001), appropriateness (OR = 15.65; P < 0.05), and feasibility (OR = 20.85; P < 0.05). Furthermore, the preference for zoom and other online platforms for learning increased odds of acceptability of the webinar (OR = 2.29; confidence interval [CI]: 0.97-57.39; P < 0.05), appropriateness (OR = 2.55; CI: 1.10-5.91; P < 0.05) and feasibility (OR = 2.34; CI: 0.96-5.74; P < 0.05). Conclusion: The study concluded that webinar was acceptable, appropriate and feasible for strengthening research capacity, although poor internet connectivity and cost of data were the major challenges in Nigeria. However, a learner-centred approach in contents' delivery that ensures optimal learning has the potential of enhancing research capacity strengthening via virtual space.

Influence of Structured Training Programme on Healthcare Workers' Knowledge of Recommended Postnatal Care Services in Nigeria.

Introduction: The lack of continuous training of maternal and child healthcare providers has been identified as one of the factors contributing to the poor quality of maternal and child healthcare services in Nigeria. Objectives: The study aimed to evaluate the level of postnatal care-related knowledge among healthcare workers in Osun State and the impact of a structured training program on their learning. Method: A quasi-experimental research design using pre-test and post-test control groups was utilized in this study. One hundred and sixty-one healthcare workers were recruited from six Local Government Areas (LGA) and randomized into intervention and control groups. The healthcare workers in the intervention group (n = 82) were exposed to a 3-day structured training program. A structured questionnaire was used to collect data before, immediately, and 3-months after the training. Data were analyzed using descriptive statistics, multiple linear regression, t-test, and repeated measure analysis of variance (ANOVA) with posthoc pairwise comparison. Results: The mean ages of healthcare workers in the intervention and control groups are 40.96 ± 6.91 and 42.52 ± 7.58, respectively. At baseline, the mean knowledge score of the intervention and control groups were 60.0 ± 11.6 and 63.7 ± 10.4, respectively. There is a significant difference in the mean knowledge score of healthcare workers in the intervention group compared with those in the control group immediately after the training (t = 12.04, p < .001) and after 3-months of data collection training (t = 5.92, p < .001). A multivariate linear regression confirmed the positive effect of group membership (intervention vs. control) on the post-test knowledge among respondents (p < .001). Conclusion: An educational training significantly improved the knowledge of healthcare workers on the recommended postnatal care.

Assessment of integration of emergency obstetric and newborn care in maternal and newborn care in healthcare facilities in Osun State, Nigeria.

The integration of emergency obstetric and newborn care (EmONC) into maternal and newborn care is essential for its effectiveness to avert preventable maternal and newborn deaths in healthcare facilities. This study used a theory-oriented quantitative approach to document the reported extent of EmONC integration, and its relationship with EmONC training, guidelines availability and level of healthcare facility. A descriptive cross-sectional study was conducted among five hundred and five (505) healthcare providers and facility managers across the three levels of healthcare delivery. An adapted questionnaire from NoMad instrument was used to collect data on the integration of EmONC from the study participants. Ethical approval was obtained and informed consents taken from the participants. Both descriptive (frequency, percentage, mean and median) and inferential analyses (Kruskal Wallis and Mann Whitney tests) were done with statistical significance level of p<0.05 using STATA 14. The mean age of respondents was 38.68±8.27. The results showed that the EmONC integration median score at the three levels of healthcare delivery was high (77 (IQR = 83-71)). The EmONC integration median score were 76 (IQR = 84-70), 76 (IQR = 80-68) and 78 (IQR = 84-74) in the primary, secondary and tertiary healthcare facilities respectively. Integration of EmONC was highest (83 (IQR = 87-78)) among healthcare providers who had EmONC training and also had EmONC guidelines made available to them. There were significant differences in EmONC integration at the three levels of healthcare delivery (p = 0.046), among healthcare providers who had EmONC training and those with EmONC guidelines available in their maternity units (p = 0.001). EmONC integration was reportedly high and significantly associated with EmONC training and availability of guidelines. However, the congruence of reported and actual extent of integration of EmONC at the three levels of healthcare delivery still need validation as such would account for the implementation success and maternal-neonatal outcomes.

Lifestyle practices and menopause-related symptoms among women in rural communities of Ado-Ekiti local government area, Nigeria.

OBJECTIVE: Lifestyle modification is consistently recommended for healthy living during menopause; nonetheless, there is paucity of data on menopausal experiences and lifestyle practices of women in rural communities of Nigeria. This study assessed the lifestyle practices of menopausal women, their experiences of menopause-related symptoms and the influence of lifestyle practices on their experiences of menopause-related symptoms. METHOD: A descriptive cross-sectional design was used in this study. Systematic random sampling was used to select 271 menopausal women at household level in rural communities of Ado-Ekiti Local Government Area in Ekiti State, Nigeria. A self-developed structured questionnaire was used to assess lifestyle practices while modified menopause rating scale was used to assess menopausal-related symptoms of the women. Data were analysed using descriptive and inferential statistics in SPSS version 22 at 0.05 level of significance. RESULTS: Findings revealed that 58.3% had poor lifestyle, while 41.0% and 0.7% had moderate and good lifestyle, respectively. Findings showed that 66.4% of the women experienced moderate menopause-related symptoms, while 15.5% and 0.4% of the women had severe and very severe menopause-related symptoms respectively. Result of the multiple regression indicated that Exercise (ß = 0.22, t = 3.63, p = .01), Nutrition (ß = 0.13, t = 2.23, p = .02) and Substance use (ß = 0.04, t = 2.25, p = .02) were major predictors of menopause-related symptoms. CONCLUSION: The study concluded that positive lifestyle modification could help reduce menopausal-related symptoms.