Upgrading obstetric care at a secondary referral hospital, Ogun State, Nigeria. The Lagos PMM Team.

PRELIMINARY STUDIES: A 1991 inventory at the State Hospital, Ota, in Ogun State, Nigeria, showed inadequate surgical equipment, drugs, blood and power supply. A time-motion study indicated substantial delays in receiving obstetric care. INTERVENTIONS: In 1994, medical officers and midwives were given refresher courses in emergency obstetric skills. In 1995, the surgical theater, labor ward and laboratory were provided with the necessary supplies and equipment. A reliable electrical supply was set up, but problems were encountered in establishing blood services. Subsequent community interventions focused on improving access and reducing delay in seeking care. RESULTS: The annual number of women with complications seen, which had been declining--from 123 in 1992 to 55 in 1994--increased to 91 in 1995. Case fatality rate (CFR) due to major direct obstetric complications did not change appreciably, i.e. it was 6.6% in 1995, as compared with 7.3%, 8.3% and 7.3% for the years 1992-1994, respectively. COSTS: The cost of hospital improvements was approximately US $46,000. CONCLUSIONS: The facility improvements were completed only recently in mid-1995. It is hoped that improved services will result in reductions in CFR and motivate more women with complications to seek hospital care, despite difficult economic conditions prevailing in Nigeria.

School teachers as primary health care workers.

Staff of preschool and primary schools in Lagos attended a one week course run by the Institute of Child Health and Primary Care to teach them some Primary Health Care skills so that they can recognize common illnesses in children and provide some preliminary care before referral. The course was well rated by participants and follow up showed that the skills had been useful to them and their various establishments. The model is recommended for replication elsewhere.

PIP: This paper discusses the attempt to increase coverage of health care delivery for preschool/school aged children by using their teachers as 1st contacts for primary health care (PHC) before referrals were made. 26 teachers from preschool and primary schools in Lagos, Nigeria attended a 1 week course run by the Institute of Child Health and Primary Care to teach them PHC skills before referrals. At the end of the course participants had to: 1) recognize common illnesses in children; 2) identify children needing immediate referrals to the hospital; 3) take temperature, sponge a child with a fever, sterilize an infant's feeding utensils using hypochlorite solution, assess the nutritional status of children; 4) list the various components and prepare a weaning diet; and 5) discuss the nutritional needs for preschool and school-aged children. All the participants improved their performance on the post-test. A year later participants and their employers were given short questionnaires. The employers rated the teachers' performance as very good and were willing to send them back for more training. The teachers were most useful in their establishments in dealing with: measles, fevers, convulsions, cuts and wounds, difficult breathing, diarrhea and vomiting, tepid sponging and temperature taking. This model is recommended for replication elsewhere. (Author's modified).