COVID-19 Infection Prevention and PPE Use: A Cross-Sectional Survey of Maternity Health Care Workers' Perspectives and Practices in a Tertiary Hospital, Nigeria.

BACKGROUND: Maternity healthcare workers play an important role in curbing maternal and perinatal morbidity and mortality rates. They must be supported to protect themselves from the adverse impact of Covid 19 infection. This study assessed the knowledge, attitude and practice of maternity health care workers towards personal protective equipment (PPE) in preventing coronavirus infection. METHODOLOGY: This was a prospective cross-sectional survey of consecutively consenting 380 maternity healthcare workers in a tertiary health institution in southwestern Nigeria between September 2021 and December 2021. A self-administered questionnaire was used to capture socio-demographic data and assess the survey participant's knowledge, attitude and practice as regards Covid-19 infection and transmission prevention and PPE use. RESULTS: Only 22.1% (n = 84) of the respondents considered the pandemic a high health risk; 46.1% (n = 175) considered it a low health risk whilst 31.8% (n =121) of the MHWs considered its risk as moderate. The knowledge of the complete PPE inventory varied significantly with education status (p< 0.0001), 90.1% of the MHWs with knowledge of full inventory had tertiary education, proximity to patients during work (p<0.0001, 80% proximity), and work stations (p < 0.0005, 68.4% clinics). When utilizing PPEs 88.2% (n = 335) reported varying forms of discomfort and only 10.8% (n = 41) reported nil discomfort associated with its use. The commonly reported complaints were increased body heat, skin rashes, excessive sweat, and breathing difficulties. CONCLUSION: There is a need to continually educate, train and retrain medical health workers on the need for the provision and proper use of personal protective equipment.

CONTEXTE: Le personnel soignant de la maternité joue un rôle important dans la réduction des taux de morbidité et de mortalité maternelles et périnatales. Il faut les aider à se protéger contre les effets néfastes de l'infection par le Covid 19. Cette étude a évalué les connaissances, l'attitude et la pratique des travailleurs de la santé en maternité à l'égard de l'équipement de protection individuelle (EPI) dans la prévention de l'infection par le coronavirus. MÉTHODOLOGIE: Il s'agit d'une enquête transversale prospective menée auprès de 380 agents de santé maternelle consentants dans un établissement de santé tertiaire du sud-ouest du Nigéria entre septembre 2021 et décembre 2021. Un questionnaire auto-administré a été utilisé pour recueillir des données sociodémographiques et évaluer les connaissances, les attitudes et les pratiques des participants à l'enquête en ce qui concerne la prévention de l'infection et de la transmission du Covid-19 et l'utilisation des EPI. RÉSULTATS: Seuls 22,1 % (n=84) des personnes interrogées considèrent la pandémie comme un risque sanitaire élevé ; 46,1 % (n=175) la considèrent comme un risque sanitaire faible, tandis que 31,8 % (n=121) des travailleurs sanitaires considèrent que le risque est modéré. La connaissance de l'inventaire complet des EPI varie de manière significative en fonction du niveau d'éducation (p< 0,0001), 90,1 % des travailleurs sanitaires connaissant l'inventaire complet ayant un niveau d'éducation supérieur, la proximité des patients pendant le travail (p< 0,0001, 80 % de proximité) et les postes de travail (p< 0,0005, 68,4 % de cliniques). Lors de l'utilisation des EPI, 88,2 % (n= 335) ont signalé des formes variées d'inconfort et seulement 10,8 % (n= 41) ont déclaré n'avoir ressenti aucun inconfort lié à leur utilisation. Les plaintes les plus fréquentes sont l'augmentation de la chaleur corporelle, les éruptions cutanées, la transpiration excessive et les difficultés respiratoires. CONCLUSION: Il est nécessaire d'éduquer, de former et de recycler en permanence les travailleurs de la santé sur la nécessité de fournir et d'utiliser correctement les équipements de protection individuelle. Mots-clés: COVID-19, Obstétrique, Personnel médical, Équipement de protection individuelle.

Effectiveness and safety of membrane sweeping in the prevention of post-term pregnancy: a randomised controlled trial.

There is a rising concern with increasing rates of pharmacologically induced labour and its complications. Membrane sweeping is a simple and less invasive means of initiating spontaneous labour onset. We compared the safety and efficacy of membrane sweeping. A total of 186 women (62 in each arm) were recruited at the antenatal clinic at 39 weeks. The intervention groups had membrane sweeping once and twice weekly respectively while the control arm had no membrane sweeping. They were all monitored and followed up till delivery. The trial was registered with the South Africa registry www.pactr.org (PACTR202112841108933) The incidence of prolonged pregnancy was 32.3%, 19.4% and 11.7% among the control, once-weekly, and twice-weekly groups respectively. The sweeping to the delivery interval was significantly shorter for the twice-weekly group (7.4 days) compared to once weekly (8.8 days) and the control group (10.6 days). There were significantly higher odds of spontaneous labour onset in the twice-weekly group (HR 1.53, p = .029) compared to the control group (HR 0.65, p = .033) and the once-weekly group using once weekly as reference. Membrane sweeping is a safe and effective means of preventing prolonged pregnancy. Twice-weekly sweeping of foetal membranes is more effective than once-weekly or no sweeping without added adverse feto-maternal outcomes.IMPACT STATEMENTWhat is already known about the subject? There is no evidence supporting any increase in maternal or foetal morbidity suggesting that membrane sweeping is a safe procedure to offer to all low-risk pregnant women so as to initiate spontaneous labour onset.What do the results of the study add? Membrane sweeping twice weekly after 39weeks for low-risk pregnant women is more effective than once weekly or no sweep with no added adverse maternal or perinatal risks.What are the implications of these findings for clinical practice and or further research? Twice-weekly membrane sweeping is encouraged in selected patients to reduce the risks associated with post-term pregnancy.