Sociodemographic Correlates of Integrated Maternal, Newborn, and Child Health Services Utilization Among Childbearing Mothers in Nigeria.

Background Some social and demographic factors might limit the ability of childbearing mothers (CBMs) to use healthcare services for themselves and their children, thereby exposing them to maternal, infant, and child morbidity and mortality. This study aimed to investigate the sociodemographic correlates of the utilization of integrated maternal, newborn, and child health (IMNCH) services by CBMs in Benue State, Nigeria. Methodology A community-based, correlational survey study was conducted among a random sample of 1,200 CBMs. Face-to-face interviews were conducted using a pretested, structured questionnaire, the Integrated Maternal, Newborn, and Child Health Services Utilization Questionnaire (IMNCHSUQ), and study participants were chosen using a multistage sampling procedure. Of the IMNCHSUQ issued, only 896 copies had complete data, which were used for the analysis. The data collected were analyzed using SPSS version 25.0 (IBM Corp., Armonk, NY, USA). The data were evaluated using the mean, standard deviation, and point-biserial correlation, and the null hypotheses were tested using linear regression at the 0.05 level of significance. Results The majority of the CBMs were married (79.7%) and unemployed (66.0%) while the predominant age group was between 15 and 24 years (42.7%). CBMs had a high level of utilization of IMNCH services (x= 3.30, SD = 0.94). The sociodemographic factors studied had little or no influence on the utilization of IMNCH services among CBMs. The most significant demographic predictor was the place of residence. Marital status, educational level, parity, and age were also found to be significant predictors in a few services. Conclusions Uneven distribution of IMNCH centers may be a major cause of the failure of CBM's lack of utilization of IMNCH services, especially in rural settlements with sparse distribution of facilities.

Influence of Cultural Beliefs on the Utilization of Integrated Maternal, Newborn, and Child Health Services in Benue State, Nigeria.

Background The maternal mortality ratio in Nigeria is high at 576 per 100,000 live births. The health policy is in favor of health advocacy programs that promote the utilization of integrated maternal newborn and child health (IMNCH) services in local primary health centers by childbearing mothers. Cultural factors, however, have been shown to limit the widespread adoption of these services. The purpose of this study was to investigate the influence of cultural beliefs on the utilization of IMNCH services by child-bearing mothers (CBMs) in Benue state. Methods A community-based correlational survey research was conducted on a random sample of 1,200 CBMs. A multistage sampling technique was used to select the study participants and a pretested, structured questionnaire was used to collect data through face-to-face interviews. Only 896 copies of the distributed Integrated Maternal Newborn and Child Health Services Utilization Questionnaire (IMNCHSUQ) had complete information and were used for analysis. The collected data were managed and analyzed using SPSS version 25 (IBM Corp., Armonk, NY). Mean, standard deviation, and point-biserial correlation were used to answer the research questions while linear regression was used to test the null hypotheses at a 0.05 level of significance. Results The majority of the CBMs were married (79.7%) and unemployed (66.0%) while the predominant age group was between 15 and 24 years (42.7%). CBMs had a high level of utilization of IMNCH services (X ®=3.30, SD=0.94); there was a positive moderate relationship between IMNCH utilization and cultural factors (rbp=.43, ρ= 0.000). Results also suggest that cultural factors were significant predictors of IMNCH services utilization in Benue State, Nigeria. Conclusion Any health education program for maternal and child health in Benue State should take cognizance of the cultural values, beliefs, and norms of the people to sustain positive ones while discouraging values and norms detrimental to the health and well-being of CBMs and their children.

Prevalence of loneliness and association with depressive and anxiety symptoms among retirees in Northcentral Nigeria: a cross-sectional study.

BACKGROUND: Retirees face numerous challenges, including disassociation from persons in their social networks in Nigeria. Perceived social isolation or loneliness could impair the quality of life in old age, and lead to mental disorders. However, it is uncertain whether perceived loneliness has an independent association with depressive and anxiety symptoms and comorbid conditions in Nigerian retirees. Therefore, we aimed at examining the association between perceived loneliness, depressive and anxiety symptoms, including comorbid conditions among retirees in Northcentral Nigeria. METHODS: This community-based cross-sectional study enrolled retirees aged 60 years and above in different pension zones from February 2019 to August 2019. A two-stage sampling procedure was used to select the study participants. Data on perceived loneliness, depressive, and anxiety symptoms were collected using the 8-item University of California, Los Angeles Loneliness Scale (ULS-8), and the DASS 21-depression and anxiety subscales, respectively. We collected information on the demographic characteristics using a well-validated structured questionnaire. Descriptive statistics, binary and multivariable logistic regression were used to examine the independent associations between loneliness, depression, anxiety, and anxious depression. P-values below 0.05 were considered statistically significant. RESULTS: The mean age of participants was 71.3 (± 6.01) years, and 54.4% were men. The prevalence of loneliness, depression, anxiety, and anxious depression was 21.8, 52.0, 27.7, and 20.5%, respectively. Retirees with depression or anxiety symptoms perceived that they were lonelier than those without depression or anxiety. The multivariable logistic regression model showed that female gender (AOR 1.49; 95% CI (1.09, 2.00), having secondary education (AOR 2.24, 95% CI (1.40, 3.57) and having higher education (AOR 3.82, 95%CI (2.37, 6.16) were significantly associated with depression. Also, lonely retirees are 1.19 times (AOR 1.19; 95% CI (0.84, 1.69) more likely to be depressed compared to retirees that are not lonely, and the anxious depressed retirees are 314.58 times (AOR 314.58; 95% CI (508.05, 1941.70) more likely to be depressed than those without anxious depression. CONCLUSION: The prevalence of loneliness, depression, anxiety, and anxious depression were relatively high among the older retirees. Female gender and advanced age were significantly associated with perceived loneliness, depression and anxiety.

The role of management on costs and efficiency in HIV prevention interventions for female sex workers in Nigeria: a cluster-randomized control trial.

BACKGROUND: While the world has made much global progress toward the reduction of new HIV infections, HIV continues to be an important public health problem. In the face of constantly constrained resources, donors and grantees alike must seek to optimize resources and deliver HIV services as efficiently as possible. While there is evidence that management practices can affect efficiency, this has yet to be rigorously tested in the context of HIV service delivery. METHODS: The present protocol describes the design of a cluster-randomized control trial to estimate the effect of management practices on efficiency. Specifically, we will evaluate the impact of an intervention focused on improving management practices among community-based organizations (CBOs), on the costs of HIV prevention services for female sex workers (FSW) in Nigeria. To design the intervention, we used a qualitative, design thinking-informed methodology that allowed us to understand management in its organizational context better and to develop a user-centered solution. After designing the suite of management tools, we randomly assigned 16 CBOs to the intervention group, and 15 CBOs to the control group. The intervention consisted of a comprehensive management training and a management "toolkit" to support better planning and organization of their work and better communication between CBOs and community volunteers. Both treatment and control groups received training to record data on efficiency-inputs used, and outputs produced. Both groups will be prospectively followed through to the end of the study, at which point we will compare the average unit cost per FSW served between the two groups using a quasi-experimental "difference-in-differences" (DiD) strategy. This approach identifies the effect of the intervention by examining differences between treatment and control groups, before and after the intervention thus accounting for time-constant differences between groups. Despite the rigorous randomization procedure, the small sample size and diversity in the country may still cause unobservable characteristics linked to efficiency to unbalanced between treatment and control groups at baseline. In anticipation of this possibility, using the quasi-experimental DiD approach allows any baseline differences to be "differenced out" when measuring the effect. DISCUSSION: This study design will uniquely add to the literature around management practices by building rigorous evidence on the relationship between management skills and practices and service delivery efficiency. We expect that management will positively affect efficiency. This study will produce valuable evidence that we will disseminate to key stakeholders, including those integral to the Nigerian HIV response.Trial registration This trial has been registered in Clinical Trials (NCT03371914). Registered 13 December 2018.

Effects of a rational-emotive health education intervention on stress management and irrational beliefs among technical college teachers in Southeast Nigeria.

BACKGROUND: Stress is the product of how an individual reacts and adapts to the specific demands and threats they encounter while carrying out given tasks. The main purpose of this study was to investigate the effects of a rational-emotive health education intervention (REHEI) on stress management, and irrational beliefs in a sample of technical college teachers in Southeast Nigeria. METHOD: The study design was a pretest-posttest control group. Repeated measures analysis of variance, paired t test and Mann-Whitney U tests were used to analyze the data collected. RESULTS: The REHEI significantly reduced teacher stress in those teaching staff exposed to the treatment intervention, relative to a waitlist control group. Furthermore, the REHEI program significantly decreased irrational beliefs about teaching in those teaching staff exposed to the treatment intervention compared to a waitlist control group. CONCLUSION: The REHEI program can be used to coach teachers on how to manage and cope with stress and overcome irrational beliefs in teaching.

Adult surgical emergencies in a developing country: the experience of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra State, Nigeria.

The goal of this study was to examine the adult surgical emergencies seen at the Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, with a view to proffering preventive solutions where appropriate and improving outcome. From the register of patients seen at the Casualty department and from the operations register in the main operation room of NAUTH, names and hospital numbers of adult patients treated as emergencies over a 5-year period, from 7 September 1998 to 6 September 2003, were obtained. The hospital folders were then retrieved from the Records Department. From each folder, the following details about each patient were extracted: age, sex, diagnosis at presentation, causative factors, treatment given, and outcome. A total of 902 adult patients were treated during the period. The commonest emergency operation was appendectomy for acute appendicitis in 139 patients (97 women and 42 men), followed closely by road traffic accidents (RTAs) involving 137 patients (103 men and 34 women). Gunshot injuries, which resulted mainly from armed robbery attacks, accounted for 127 cases. More men (113) sustained gunshot injuries than women (14). Of the 92 cases of acute intestinal obstruction seen, 62 occurred in women and 30 in men. Some 126 men presented with acute urinary retention, and two others presented with priapism. Governments at various levels should provide modern diagnostic tools for the accurate preoperative diagnosis of surgical emergencies in hospitals. Governments should also inculcate strict discipline into drivers using the highways, particularly in relation to abuse of alcohol and drugs. Good roads and adequate security should be provided for the people. The need for Pre-Hospital Care for the efficient evacuation of accident victims is emphasized. These measures will help to improve the management and outcome of surgical emergencies, and decrease the number of surgical emergencies resulting from RTAs and gunshot wounds.

Computerized patient record: are we prepared for our future practice?

OBJECTIVE: To survey members of The American Dietetic Association (ADA) regarding care documentation systems, computerization of patient care records, and factors to be considered in developing a documentation system compatible with a computer-based patient record. DESIGN: The survey instrument was developed in conjunction with a survey consultant/statistician, then mailed to the study sample. SUBJECTS/SETTING: The sample of 500 was drawn from three ADA dietetic practice groups expected to include a high percentage of clinical practitioners. STATISTICAL ANALYSIS PERFORMED: Basic frequency displays were used on all questionnaire items. Pearson correlation coefficients were used among numeric variables, and oneway analysis of variance was used for categoric variables with quantitative variables. RESULTS: A total of 171 usable surveys were returned (34%), primarily from dietitians working in an acute-care inpatient environment. The SOAP format (subjective, objective, assessment, and plan) was used by 60% of respondents to document nutrition assessments, although a number of other documentation formats were reported. Most commonly used data in nutrition decision making were medical diagnosis, diet order, anthropometric data, and laboratory values. Most commonly used outcomes measures included laboratory values, tolerance of the nutrition regimen, weight changes, and intake changes. Only 15% of respondents reported that they currently used a computerized patient record. Ninety-three percent of respondents favored standardized nutrition diagnoses, and 95% believed standardized nutrition interventions would prove useful. APPLICATIONS/CONCLUSIONS: We recommend that dietitians evaluate, standardize, and streamline their documentation to prepare for implementation of computerized systems. The diagnoses and interventions presented in this study could be a starting point.

Relationship of nutritional status to length of stay, hospital costs, and discharge status of patients hospitalized in the medicine service.

OBJECTIVE: This study was conducted to determine the relationship, if any, between nutritional status, length of stay (LOS) in hospital, discharge placement, readmission rates, and hospital costs and charges in patients hospitalized in the medicine service. DESIGN: Data regarding medical diagnosis, LOS, hospital costs, charges, discharge destination, and readmission rates were collected prospectively from medical records and through patient interviews on patients admitted to the medical service who were classified to be at risk or not at risk for malnutrition on the basis of established criteria (weight for height < 75% ideal body weight, admission serum albumin level < 30 g/L, or > or = 10% unintentional weight loss within 1 month before admission). SUBJECTS: All patients admitted directly to any of three medicine units during December 1994 who met study criteria were included in the study. Off-service patients, transfer patients, and patients discharged before screening (usually admitted and discharged within 72 hours) were excluded. Data were collected on 173 patients. STATISTICAL ANALYSIS PERFORMED: At-risk and not at-risk patients were compared for LOS, costs and reimbursement, and discharge placement (to home, to home with home health care services, or to another facility for further care). Two sample t tests and alpha survival analysis technique were used to compare continuous variables between the two study cohorts. Nonparametric tests were used for LOS and readmission data. chi 2 Tests were used for categoric variables. An alpha level of .05 was used throughout to determine statistical significance. RESULTS: Median LOS in the not-at-risk population (n = 56) was significantly greater than in the not-at-risk population (n = 117): 6 days (25th percentile = 4 days, 75th percentile = 8 days) vs 4 days (25th percentile = 3 days, 75th percentile = 7 days) (P < .01). Mean hospitalization cost per patient was also higher in the at-risk group ($6,196 vs $4,563, P < .02). Readmission rate per month of follow-up was not significantly different. At-risk patients were significantly less likely to be discharged home with self-care (23[41%] vs 77 [66%], P < .05). At-risk patients were significantly more likely to use home health care service than not-at-risk patients (17[31%] vs 14 or [12%], P < .001). APPLICATIONS: Patients at risk for malnutrition had significantly higher LOS, costs, and home health care needs, despite the fact that 51, or 91%, received nutrition intervention while hospitalized. Further research should explore the use of nutrition screening and intervention before, during, and after hospitalization to ensure that appropriate nutrition intervention, as indicated by medical patients' clinical condition and nutritional risk status, is initiated and continued.

Protein catabolic rate in patients with acute renal failure on continuous arteriovenous hemofiltration and total parenteral nutrition.

Continuous arteriovenous hemofiltration (CAVH) has been used to provide nutrition support to critically ill patients in acute renal failure (ARF). Limited information exists regarding protein needs of these patients. Nineteen postoperative patients in ARF and on CAVH and total parenteral nutrition (TPN) were studied (10 men; 9 women; mean age, 65 yr) to determine protein needs (protein catabolic rate; PCR), urea nitrogen appearance (UNA), and total nitrogen appearance (TNA). TPN was adjusted to meet the needs estimated by the Harris-Benedict and Long equations. A total of 38 24-h studies were conducted on the 19 subjects. TNA, UNA, and PCR were determined by direct measurement of body losses and calculation of body pool nitrogen changes. Patients received an average of 93.9 +/- 30.5 g of protein (1.4 g/kg) and 2,600 +/- 534 kcal/day in TPN. Mean PCR was 117.5 +/- 42.8 g/day; UNA was 18.3 +/- 6.9 g/day. TNA and UNA were strongly correlated (r = 0.99; P < 0.001). PCR was less strongly correlated with estimated protein needs (r = 0.35; P = 0.03). A regression equation was developed describing the relationship between TNA and UNA as follows: TNA = 1.895 + 0.9444 (UNA) or UNA = 0.1602 (PCR) - 0.916. On the basis of this study, CAVH permits the provision of adequate nutrition support to critically ill, unstable patients. It appears that the protein needs of patients in ARF on CAVH can be accurately estimated by determining UNA through the measurement of urea losses and urea body pool changes and by regression equations to calculate PCR.(ABSTRACT TRUNCATED AT 250 WORDS)