Clients' knowledge, perception and satisfaction with quality of maternal health care services at the primary health care level in Nnewi, Nigeria.

BACKGROUND: Clients' knowledge, perception of and satisfaction with the quality of maternal health services (QMHS) enables maternal health programs to assess the impact of their services from the clients' perspective. OBJECTIVE: The objective of this study is to assess the knowledge, perception of and clients' satisfaction with the QMHS at the primary health care (PHC) level in Nnewi, Nigeria. MATERIALS AND METHODS: This was a cross-sectional survey. Using multistage sampling technique, 280 women utilizing maternal health services from randomly selected PHC facilities in Nnewi, Nigeria were selected for the study. Data were collected using a mix of quantitative and qualitative methods. Quantitative data were analyzed using Statistical Package for Social Sciences version 16, while qualitative data were reported verbatim, analyzed thematically and necessary quotes presented. RESULTS: A total of 280 women were studied. The mean age of the respondents was 29.2 ± 5.9 years. 231 (82.5%) were married. 89 (31.8%) did not report any knowledge about QMHS. Level of satisfaction was not different among women of different socioeconomic groups ( P > 0.05). Sociodemographic characteristics of clients were not found to be associated to the perception of waiting time: ( P > 0.05). The attitude of health care providers toward the clients was reported as good. CONCLUSIONS: Despite the poor quality of services provided, this study showed that client's knowledge of quality of services was good. Furthermore cost, local language used, staff attitude and interaction with clients was acceptable and may be the reason for high level of satisfaction reported.

Pattern of clinical presentation of eclampsia at Nnamdi Azikiwe University Teaching Hospital, Nnewi, Southeastern Nigeria.

BACKGROUND: Eclampsia contributes significantly to maternal and perinatal mortalities globally. The objective of this study is to review the pattern of Eclampsia in Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria. METHOD: A retrospective study that reviewed records from labour ward and the Medical Records Department, of cases of Eclampsia managed at NAUTH over a ten year period 1st January-31st December, 2009. RESULTS: There were 57 cases of Eclampsia out of a total of 6,262 deliveries within the study period, giving a prevalence of 0.91%. The highest prevalence of 0.24% occurred in 2009. It was most common, 14 (30.4%), in the 25-29 year age group. The nulliparous women, 28 (61%) were more commonly affected. The prevalence was higher in the un-booked patients (89%), and antepartum Eclampsia was the commonest type (76%). Twenty one (45.7%) patients had three or more convulsions prior to the institution of therapy. Headache, oedema, and blurring of vision were the commonest symptoms, 74%, 71%, and 65% respectively. CONCLUSION: Eclampsia occurred mainly in un-booked and primigravid patients in this study. Early registration of pregnant women, especially primigravid, in health facilities for effective antenatal care and supervised hospital delivery will significantly reduce the prevalence and complications of Eclampsia.

Determinants of subjective health status of HIV positive mothers in NAUTH Nnewi.

BACKGROUND: Acquired immune deficiency syndrome (AIDS) caused by human immune deficiency virus (HIV), once dominated by infected males has become feminized especially in sub-Saharan Africa where the majority of adults living with the condition are females. Positive life styles, belonging to social support groups and stigma-free HIV services by providers may have good impact on the quality of life of HIV-positive mothers. This study was aimed at assessing the determinants of subjective health status of HIV-positive mothers accessing prevention-of-mother-to-child-transmission (PMTCT) of HIV services in Nnamdi Azikiwe University Teaching Hospital (NAUTH) Nnewi. METHODS: This is a descriptive study in which 288 consenting HIV positive mothers were selected using the systematic sampling technique. Data on demographics, life style, social support, contraceptive use and subjective feeling about current health status were collected from the subjects using a pre-tested, structured, interviewer-administered questionnaire. RESULTS: The mean age of the respondents was 30.46 +/- 4.86 years. Majority (89.2%) of them were married while 55.2% were traders. A significantly higher proportion of the mothers on highly active anti retroviral therapy (HAART) (70.8%) than non users (29.2%) described their current health status as 'excellent' (p<0.001). Also a significantly higher proportion of condom users (99%) than pill users (1%) described their health status as 'excellent' (p<0.02). The same significantly higher proportions of 'excellent' response were given by subjects who engage in social support activities (p<0.001), who practice good feeding (p<0.01) andpersonal hygiene (p<0.01). CONCLUSION: Access to family planning services and HAART, participation in support group activities and positive lifestyle practices tend to improve subjective health status and should be comprehensively encouraged among the HIV positive mothers.

Knowledge and perception of the Nigerian Abortion Law by abortion seekers in south-eastern Nigeria.

One in four pregnancies worldwide is voluntarily terminated. Approximately 20 million terminations are performed under unsafe conditions, mostly in developing countries with restrictive abortion laws. A total of 100 consecutive abortion-seekers were interviewed, to ascertain their knowledge and perceptions on the Nigerian Abortion Law. The majority (55.0%) of the respondents were students. Most of them (97%) had at least secondary education and the majority (62.0%) were within the 20-24 years age range. Only 31.0% of the women interviewed were aware of the Nigerian Abortion Law. While 16% perceived the law as being restrictive, 2% opined that' it was alright'; 1% perceived it as very restrictive and 12% had no opinion on the abortion law. Knowledge of the abortion law had no significant relationship with either the educational level of the respondent or the number of previous pregnancy terminations and overall demand for abortion services. It is necessary to ensure a wide dissemination of the abortion law and its provisions to the Nigerian public, in order to arm them with the necessary information to participate actively in debates on abortion law reforms.

Perception of quality of care in HIV/AIDS programmes among patients in a tertiary health care facility in Anambra State.

BACKGROUND: Continuous quality improvement is linked to the use of timely and useful feedback from clients in Human Immuno-deficiency Virus (HIV) care. HIV experts and care professionals agree that consumer involvement, such as patient satisfaction survey, is an essential part of HIV care and policy making today. The introduction ofAnti-Retroviral Treatment (ART) services in Nigeria has significantly impacted positively on the overall well being of People Living with HIV and Acquired Immune Deficiency Syndrome (PLWHA). However, there is little understanding of their satisfaction and perception of quality of care provided. Consequently, this study was carried out to assess patients' satisfaction with ambulatory HIV/AIDS care in a tertiary health facility in Anambra State. METHODS: The study design is cross-sectional. A total of 150 patients from Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi were selected using systematic sampling technique from the daily AntiRetroviral (ARV) clinic register obtained from the medical records department of the centre. Data were collected using a structured interviewer-administered questionnaire and analyzed using SPSS version 13. RESULTS: The mean age of the respondents was 38.3 +/- 9.1. Majority (50.7%) of the patients was married, and most of them (74.7%) were semi-skilled workers. There was a statistically significant difference in the numbers of those who spent >240 naira for transportation to the clinic, compared to those who spent < or = 240 naira (98 versus 52). Similarly, the number of subjects that spent >30 minutes are significantly larger than the number that spent < or = 30 minutes to reach the clinic (142 versus 8). Also significantly greater number of participants spend >750 naira than those who spend <750 naira on non-HIV related laboratory (20 versus 9) tests. PLWHAs in this facility were least satisfied with access to care, while they expressed greatest satisfaction with good patient care and quality of service by staff. The overall satisfaction score of the subjects was 4.04 +/- 0.33. CONCLUSION: HIV patients' overall satisfaction with the services provided to them was quite high. Therefore, there is need to sustain the current level of quality of care provided to the patients and if possible improve upon it. However, efforts should be made to further decentralize ART services to make them more accessible to the growing number of PLWHAs needing care and support.

Impact of reproductive health on socio-economic development: a case study of Nigeria.

The link between reproductive health, sexual and reproductive right, and development was highlighted at the International Conference on Population and Development held in Egypt. Developmental disparities are related to socio-economic differences which have led to the identification of distinct socio-economic classifications of nations. Human development represents the socioeconomic standing of any nation, in addition to literacy status and life expectancy. Africa accounts for 25% of the world's landmass but remains the world's poorest continent. Nigeria, the most populous country in Africa, has policies and programmes geared towards the improvement of its socio-economic standing and overal development, with little positive result. Reproductive health is a panacea towards reversing the stalled socio-economic growth of Nigeria as evident from the linkage between reproductive health and development, highlighted in Millennium Development Goals 3, 4, 5 and 6. Fast tracking Nigeria's development requires implementation of reproductive health policies and programmes targeted on women and children.

Effect of government-community healthcare co-financing on maternal and child healthcare in Nigeria.

BACKGROUND: Effective maternal and child healthcare delivery requires a proper and adequate funding of the health sector. OBJECTIVE: To determine the effect of government-community healthcare co-financing on maternal and child healthcare services' delivery. METHODS: A descriptive, cross-sectional study with an intervention component, conducted amongst 240 women from Igboukwu (intervention area), and Ekwuluobia (control area), of Anambra State of Nigeria. RESULTS: The biosocial characteristics of the respondents were essentially similar. Better utilization of health services occurred in the intervention area post-intervention. Quality of service from intervention clients' perspective showed significant improvement post-intervention. Distance less than five km, transportation cost less than N40, and maternal education above secondary level impacted positively on utilization of maternal and child health services. Acceptability of the scheme was better for the intervention facility evident from the higher number of respondents showing "willingness to join", and "willingness to pay". CONCLUSION: Health sector funding partnership, positively impacts on maternal and child health services. Government's total commitment, backed with legislation, and community mobilization, will sustain the scheme.

Abortion treatment by health professionals in south-eastern Nigeria.

Studies assessing the various modes of treatment for abortion and its associated complications remain relevant in the generation of data that will aid policy formulation for abortion management. This descriptive cross-sectional study was undertaken to determine the common methods of, together with the complications associated with, abortion treatment among healthcare practitioners in south-eastern Nigeria. There were 230 males and 207 females, with a mean age of 38.23+10.4 years. General practitioners accounted for 214 (49.0%) respondents; nurses, 161 (36.8%); specialist doctors, 56 (12.8%); resident doctors, 5 (1.1%); and community health officers, 1 (0.02%). As high as 388 (88.8%) of the respondents had treated abortion. Manual vacuum aspiration (MVA), and sharp curettage were the commonest methods of treatment accounting for 36.0% and 34.1%, respectively, while medication treatment was employed by 15.0% of the respondents. Only 41.0% of the respondents had been formally trained on the use of MVA. Some 285 (65.2%) of the respondents recorded complications during abortion treatment and these included incomplete evacuation, 30.2%; haemorrhage, 26.0%; and infection, 22.2%. A significantly higher number of complications occurred following sharp metal curretage compared to MVA, and includes incomplete evacuation, 54 (62.5%) vs 33 (38.0%) (p<0.05); and haemorrhage, 32 (43.2%) vs 15 (20.5%) (p<0.05). Syncope, 2 (100%) and uterine perforation, 23 (100%) occurred solely from sharp metal curettage. Building capacity of health professionals on the use of MVA, and ensuring the universal access to the equipment will enable safer abortion treatment and reduce maternal morbidity and mortality from abortion-related complications.

Awareness and practice of post abortion care services among health care professionals in southeastern Nigeria.

This study investigates knowledge and practices of post abortion care (PAC) services among health care professionals in the Anambra State of southeastern Nigeria. This was a prospective, cross-sectional, questionnaire based study conducted between 1 June and 30 September, 2006. The study involved a multi-staged sampling of all registered health facilities in Anambra State, with the selection of 60 health facilities from which 450 participants were recruited. A pre-tested, structured questionnaire was employed to obtain information from the studied respondents. Obtained data were analyzed using Epi-Info version 2001. A total of 437 questionnaires out of 450 administered were accurately completed, giving a response rate of 97.1%. The respondents were comprised of general practitioners (214, 49.0%), nurses (161, 36.8%), specialist doctors (56, 12.8%), and resident doctors (5, 1.1%). The mean age of the respondents was 38.2 +/- 10.5 years. Most participants (203, 52.6%) were males; the majority (282, 64.5%) were working in the rural areas of the State, including mission hospitals (165, 37.8%) and general hospitals (145, 33.3%). Three hundred thirty respondents (75.5%) were aware of PAC services. Twenty-seven (6.2%) and 28 (6.4%) of respondents were aware of community partnership and family planning services, respectively, as elements of PAC. Although the majority of respondents (302, 69.1%) treated abortion complications, only 155 (35.5%) used a manual vacuum aspirator. Three hundred thirty-eight (88.8%) offered counseling services, and 248 (56.8%) provided referrals to other reproductive health services.

Integrating maternal health services into a health insurance scheme: effect on healthcare delivery

Healthcare delivery is a foremost important basic social services.This study reviews the influence of the integration of maternal health services into the Anambra State of Nigeria government-community health care financing scheme on health service delivery at primary health care level in Igboukwu; Aguata Local Government Area of Anambra State; Nigeria.A descriptive; cross-sectional study with an intervention component; conducted amongst 120 women of reproductive age group at Obiuno health centre; Igboukwu.Mean age of respondents was 30.5 +/- 6.0 years with majority; 44 (36.7); in the age range of 26-30 years. Almost half; forty eight (40); of the participants are of post secondary educational status; 60 (50) are civil servants. Utilization of maternal health servicesantenatal and delivery services; were significantly better at the late intervention period when compared to the early intervention period. Quality of service from clients' perspective also showed significant improvement at the late intervention period. There was an overall greater availability of maternal health service equipments; drugs and consumables; and medical records in the health facility later during the scheme.Community based health insurance schemes that focus on maternal health services ensure the provision of adequate funds for maternal health services that cover a great proportion of the rural communities

Menstrual characteristics amongst south-eastern Nigerian adolescent school girls.

BACKGROUND: Information on pattern of menstruation and its implications is lacking amongst adolescents in Nigeria. OBJECTIVE: To examine the characteristics of menstruation amongst adolescent Igbo school girls with respect to the biosocial characteristics, the pattern of menstruation, associated complications, and the source of information on menstruation. METHODS: A descriptive cross-sectional study of 550 students recruited from a multi-sampling of 50 secondary schools in Onitsha, Anambra State, Nigeria, using pre-tested, semistructured, and interviewer administered questionnaires. RESULTS: Four hundred and sixteen (75.6%) respondents were aged 15-17 years; 338 (61.4%) of whom were Catholics. Menarcheal age range of respondents was 11-16 years, with a mean age of 13.40 +/- 1.15 years. Menstruation was regular in 410 (74.5%), and irregular in 124 (22.5%) of respondents. Duration of menstrual flow ranged between two and eight days, although a four-day flow occurred most commonly, 268 (53.6%). Abdominal pain, (66.2%), and waist pain, (38.5%), constituted the major problems associated with menstruation, followed by depression, (24.4%); vomiting, (6.9%); school absenteeism, (4.5%); anorexia, (1.8%); weakness, (1.5%); and increased appetite, (1.1%). The commonest source of information on menstruation (prior to menarche) amongst respondents was from the mother, 48.4%, followed by elder sister, and friends --14.2%, and 8.7% respectively, while the teacher constituted the least source, 1.1%. CONCLUSION: The characteristics of menstruation in this study do not differ considerably from what obtains amongst other adolescent girls. Associated complications may have profound psychosocial impact on the growing adolescent girl, requiring address, best achieved through the empowerment of mothers and teachers under a comprehensive family life education scheme.

Ethical considerations in women's sexual and reproductive health care.

BACKGROUND: The concept of reproductive health, which adopts a holistic approach to the management of reproductive disorders, was developed in 1994 at the International Conference on Population and Development. This together with the adoption of a right-based approach to the relationship between reproductive health and population and development and the emergence of the concept of sexual and reproductive right marked a turning point in contemporary global health care initiative. Sexual and reproductive healthcare raises ethical questions that fall within the purview of bio-ethics. OBJECTIVE: To review ethical issues related to women's sexual and reproductive healthcare. METHODOLOGY: A critical review of available literature on the subject matter was conducted. FINDINGS: Four key principles form the basis of Bioethical analysis--respect for person, beneficence, non-maleficence, and justice, applicable at four different levels microethical, macroethical, mesoethical, and megaethical levels each of which can be employed in the ethical analysis of sexual and reproductive health care. Medical practitioners caring for women, for the fact that they work in areas of a woman's body that are of particular psychosocial sensitivity, are expected to adhere to strict ethical principles in their practice. The International Federation of Gynaecology and Obstetrics (FIGO) in collaboration with the Society of Gynaecology and Obstetrics of Nigeria (SOGON) has developed a human right based code of ethics related to sexual and reproductive health care to guide medical practitioners caring for women in their daily practice. CONCLUSION: An understanding and proper application of the ethical principles is expected to enable these medical practitioners to actualize the ultimate and desired goal of uplifting the sexual and reproductive healthcare and right of women.

Knowledge and practice of universal precautions against blood borne pathogens amongst house officers and nurses in tertiary health institutions in Southeast Nigeria.

PURPOSE: To examine the knowledge and practice, as well as factors influencing universal precautions practices amongst Nigerian House officers and Nurses. METHODS: A Cross-sectional descriptive study. Sample selection was by stratified random sampling. Information was elicited using pretested, structured, self-administered questionnaire. Data were analyzed using EPI-info. RESULTS: Most Doctors, 66.6%, were aged 26-30 years while the Nurses, 41.1%, were aged 40 years. 57.6% of the Doctors were males, while 85.7% of the nurses were females. Knowledge of universal precautions measures was high for both categories of respondents--97.0% for doctors and 92.0% for nurses, although practice was better for the nurses, 75.0%, compared to the doctors, 15.2%, p < 0.05. The most important factor influencing universal precautions practice is the lack of provision of adequate protective equipments. Other factors, all of which show significant difference between the doctors and nurses (p < 0.05), include carelessness; lack of display of universal precautions guidelines; emergency nature of the procedure; insufficient water supply; patient perceived to be at low risk of blood borne pathogens; pressure of time; and universal precautions equipments interfering with technical skills. CONCLUSIONS: Although knowledge of universal precautions is high for both house officers and nurses, practice is however better amongst the latter than the former. The effective knowledge and practice of universal precautions amongst hospital workers are of absolute necessity to prevent infections from blood and body fluid pathogens.