Clinical audit of intra-partum care at secondary health facilities in Nigeria.

OBJECTIVE: Intra-partum care has a significant influence on birth outcomes. Gap however exists between evidence and practice. This study documented pattern of intra-partum monitoring among birth attendants in public secondary healthcare facilities and related findings to quality of care provided. METHOD: Intra-partum monitoring records of vaginal examination, fetal heart and blood pressure were reviewed. Research assistants extracted information and documented same in appropriate section of Safe Motherhood Needs Assessment forms. Monitoring records were categorized into optimal and sub-optimal care. Proportions were calculated for parturients who received either optimal or sub-optimal care. Chi-square test of statistics was used to explore differences. Level of significance was p < 0.05. RESULT: Areview of 349 records of paturients was carried out. Their mean age was 23.4 +/- 3.3 years. Pregnancy outcome was a live-birth in 329 (97.3%). Optimal care of vaginal examination, fetal heart monitoring and blood pressure measurement was provided in 243 (71.9%), 73 (21.6%) and 52 (15.4%) parturients respectively and diminished significantly as labour progressed. CONCLUSION: Intra-partum care provided by birth attendants was generally sub-optimal and use of the monitoring records to influence birth outcome is doubtful. Improvement in record keeping practices and skills in intra-partum monitoring for decision making, are suggested.

The knowledge, attitude and practices of the reporting of notifiable diseases among health workers in Yobe State, Nigeria.

Effective surveillance is the key to effective disease control in the community. In Nigeria, it is weak with duplication of data collection and multiple reporting channels. There is also lack of clarity with regards to data submission responsibilities. However, the knowledge of reporting requirements and responsibilities among health personnel has not been examined adequately as a cause of under reporting. This study was designed to assess the knowledge of health workers about disease surveillance. A cross sectional study was conducted in six randomly selected local government areas in Yobe State, North Eastern Nigeria. A total of 144 health personnel from 88 health facilities were administered a pre-tested semi-structured questionnaire and a checklist by trained research assistants. The result showed that only fifty-five (38.2%) of the respondents were aware of the national disease surveillance system. Their mean score regarding immediate notifiable diseases was 0.8 +/- 1.23 SD (maximum of 10). Thirty nine (70.9%) reported to have ever reported, while 16 (29.1%) have never reported any of the notifiable conditions. Only 12 (21.8%) of the respondents claimed to have ever received feedback on the reports they forward to higher authorities and more than 92% of the health facilities lack the DSN 001 and 002 forms. Most of the respondents 47 (85.5%) that were aware of the reporting requirements listed lack of training on disease surveillance as one of the factors affecting disease reporting. This shows that lack of knowledge of reporting requirement was identified as a major factor affecting disease surveillance among the respondents. The training and retraining of health workers responsible for data generation, collection and forwarding in health facilities on disease notification, regular feedback on diseases reported and provision of forms were recommended in order to improve the disease surveillance system.

Village health workers' and traditional birth attendants' record keeping practices in two rural LGAs in Oyo State, Nigeria.

Village health workers (VHWs) and Traditional Birth attendants (TBAs) provide health care services to the communities in which they live, improving access to health care as well as serving as an important link between the periphery (the communities) and the health sector. The data this category of workers generates about their communities will strengthen primary health care management information system in Nigeria. The objective of this study was to assess the knowledge, attitude and practices of VHWs and TBAs regarding record keeping in Ibarapa Central and Akinyele local government areas (LGAs) of Oyo State, Nigeria. Using a pre-tested, semi structured questionnaire and an observation checklist, trained research assistants visited and interviewed all the active, registered VHWs and TBAs in the two LGAs. Results showed that there were a total of 62 and 102 active VHWs/TBAs in Ibarapa Central and Akinyele LGAs respectively with most of them being farmers aged between 30-59 years. Over two-thirds in both LGAs knew the uses of record keeping for monitoring and evaluation purposes and most of them felt that keeping records was easy. Sixty-one percent of the respondents in Ibarapa Central and 96% of those in Akinyele LGA reported keeping records of their health activities. Of those who kept records, two thirds in Ibarapa Central and almost all (96%) in Akinyele LGA reported forwarding the records they keep. The type of records they keep was mostly on patients' treatment and (in Akinyele) delivery records using an exercise book. Most did not have the VHW/TBA record of work or the community profiles (wall chats) developed and recommended by the Federal Ministry of Health (FMOH) because they were not supplied. The factors associated with record keeping included duration as a VHW/TBA, previous training on record keeping, receiving feedback. Recommendations made included ensuring availability of materials and periodic training and re-training of the VHWs/TBAs by the LGAs, and regular provision of feedback by the National Primary Health Care Development Agency (NPHCDA).

Voluntary health workers' knowledge, attitude and practices regarding record keeping in Akinyele LGA of Oyo State, Nigeria.

Lack of basic health data for monitoring and evaluation of health services continue to affect the planning, implementation and evaluation of health services in Nigeria. This has contributed to the poor health status and inefficient health services in the country. In the primary health care management information system (PHCMIS), Voluntary Village Health Workers (VHWs) and Traditional Birth Attendants (TBAs) are responsible for collecting information at the community/village level. Trained research assistants administered a pretested semi structured questionnaire and filled an observation checklist to all the voluntary health workers in Akinyele LGA of Oyo State in a cross-sectional survey conducted to assess their record keeping practices as well as their knowledge of and attitude towards it. Results showed that almost half of the respondents had no formal education and a similar proportion had been VHWs for between over 10 years. Over eighty per cent knew the uses of record keeping for monitoring and evaluation purposes. Their attitude towards it was positive and almost all felt it was easy to keep records. Ninety six percent keep records of their health activities and most forward them. It was observed that only 11 (10.8%) respondents had the VHW/TBA record of work produced and recommended by the Federal Ministry of Health because they were reportedly not supplied to them. The factors that were associated with record keeping practices were positive attitude towards record keeping, duration of work as a VHW/TBA, prior training on record keeping and receiving feedback on records kept. Recommendations made included periodic training and retraining of the VHWs on record keeping, ensuring consistent supply of record forms and providing regular feedback on records kept to the VHWs.

Morbidity in rural southwestern Nigeria: a one year follow up of voluntary health worker consultations in Idere, Oyo State, Nigeria.

There is paucity of information on morbidity pattern at the community level in Nigeria. Available literature shows that most are based on hospital data from which rates cannot be generated. In addition, the low access to hospitals in the country especially in rural areas, coupled with inappropriate health care seeking behaviour in the community limits the usefulness of information derived from hospital data. This study was aimed at determining disease patterns in a rural community in Nigeria using the records of voluntary health workers. We followed up a well-defined rural community for one year and collated records of active voluntary health workers (VHWs) who provide health care to these communities. Results showed that Malaria, upper respiratory tract infections (URTI), diarrhoea, measles and accidents were the most common ailments for which the community members sought health care. The annual morbidity rates were malaria 25.4%, URTI 6.0%, accidents 3.2%, and diarrhoea 2.7%. Rates generally decrease with increasing age, except for accidents, for which the rates were highest amongst school-aged children (5-14 years) and lowest amongst adults. Recommendations made include strengthening malaria control efforts, improving routine immunization coverage and providing health education regarding accident prevention.