Preparedness of primary health care facilities on implementation of essential non-communicable disease interventions in osun state south-west Nigeria: a rural-urban comparative study.

BACKGROUND: Global response to the growing burden of non-communicable diseases (NCDs) in developing countries includes the development of WHO Package of Essential Non-communicable Disease Interventions (WHO PEN) for Primary Health Care (PHC). The study assessed the level of preparedness of PHC facilities on implementation of essential NCD interventions in rural and urban Local Government Areas (LGAs) of Osun State, Nigeria. METHODS: The study was a comparative cross-sectional survey. Information was collected from heads of 33 rural and 33 urban PHC facilities and through direct observation on the domains of staff training, basic equipment, diagnostics and essential medicines for cardiovascular diseases, diabetes and chronic respiratory diseases (CRDs) using a semi-structured interviewer administered questionnaire. RESULTS: Manual sphygmomanometer was found in similar proportions (84.8%) of PHC facilities in rural and urban LGAs. Glucometer was available in 45.5% of the PHC facilities in urban and 33.3% of the PHC facilities in the rural LGAs, the difference was not statistically significant (χ2 = 1.015; p = 0.314). Basic equipment for CRDs were not available in majority of PHC facilities in both locations. Moduretic tablets were the most reported essential NCD medicines, available in 15% of PHC facilities in rural LGAs and none in urban LGAs. The anti-diabetic medicines were not available in any of the PHC facilities in both locations. More than 90% (≥ 30) of the PHC facilities in both locations were not prepared to implement essential interventions for each NCD across domains of staff training and essential medicines. Overall, 97.0% of the PHC facilities in the rural LGAs and all the PHC facilities in urban LGAs were not prepared on implementation of essential interventions for the three NCDs. CONCLUSION: The level of preparedness of the PHC facilities on implementation of essential NCD interventions in the rural and urban LGAs of Osun State is very low. Government needs to strengthen the PHC system by providing needed essential medicines, basic diagnostics, equipment, and training of clinical health care workers for implementation of essential NCD interventions in the state.

A qualitative inquiry into pregnant women's perceptions of respectful maternity care during childbirth in Ibadan Metropolis, Nigeria.

Women's perceptions of respectful maternity care (RMC) are critical to its definition and measurement globally. We evaluated these in relation to globally defined RMC norms. We conducted a descriptive study involving eight focus group discussions with 50 pregnant women attending antenatal clinic at one primary and one secondary health facility each in the North-west and South-west local government areas of Ibadan Metropolis, Nigeria. One focus group each with primigravidae and multiparas were held per facility between 21 and 25 October 2019. Shakibazadeh et al's 12 domains of RMC served as the thematic framework for data analysis. The women's perceptions of RMC resonated well with seven of its domains, emphasising provider-client inter-personal relationships, preserving their dignity, effective communication, and non-abandonment of care, but with mixed perceptions for two domains. However, their perceptions deviated for four domains, namely maintaining privacy and confidentiality; ensuring continuous access to family support such as birth companions; obtaining informed consent; and respecting women's choices about mobility during labour, food and fluid intake, and birth position. The physical environment was not mentioned as contributing to an experience of RMC. Whilst the perceptions of the Nigerian women studied about RMC were similar to those accepted internationally, there were significant deviations which may be related to cultural differences and societal disparities. Different interpretations of RMC may influence women's demand for such care in different settings and challenge strategies for promoting a universal standard of care.

Directly observed and reported respectful maternity care received during childbirth in public health facilities, Ibadan Metropolis, Nigeria.

Respectful maternity care (RMC) is believed to improve women's childbirth experience and increase health facility delivery. Unfortunately, few women in low- and middle-income countries experience RMC. Patient surveys and independent observations have been used to evaluate RMC, though seldom together. In this study, we assessed RMC received by women using two methodologies and evaluated the associated factors of RMC received. This was a cross-sectional study conducted in nine public health facilities in Ibadan, a large metropolis in Nigeria. We selected 269 pregnant women by cluster sampling. External clinical observers observed them during childbirth using the 29-item Maternal and Child Health Integrated Program RMC observational checklist. The same women were interviewed postpartum using the 15-item RMC scale for self-reported RMC. We analysed total RMC scores and RMC sub-category scores for each tool. All scores were converted to a percentage of the maximum possible to facilitate comparison. Correlation and agreement between the observed and reported RMC scores were determined using Pearson's correlation and Bland-Altman analysis respectively. Multiple linear regression was used to identify factors associated with observed RMC. No woman received 100% of the observed RMC items. Self-reported RMC scores were much higher than those observed. The two measures were weakly positively correlated (rho = 0.164, 95%CI: 0.045-0.278, p = 0.007), but had poor agreement. The lowest scoring sub-categories of observed RMC were information and consent (14.0%), then privacy (28.0%). Twenty-eight percent of women (95%CI: 23.0% -33.0%) were observed to be hit during labour and only 8.2% (95%CI: 4.0%-18.0%) received pain relief. Equitable care was the highest sub-category for both observed and reported RMC. Being employed and having completed post-secondary education were significantly associated with higher observed RMC scores. There were also significant facility differences in observed RMC. In conclusion, the women reported higher levels of RMC than were observed indicating that these two methodologies to evaluate RMC give very different results. More consensus and standardisation are required in determining the cut-offs to quantify the proportion of women receiving RMC. The low levels of RMC observed in the study require attention, and it is important to ensure that women are treated equitably, irrespective of personal characteristics or facility context.

Organisational and individual readiness for change to respectful maternity care practice and associated factors in Ibadan, Nigeria: a cross-sectional survey.

OBJECTIVES: This study assessed health providers' organisational and individual readiness for change to respectful maternity care (RMC) practice and their associated factors in Ibadan Metropolis, Nigeria. DESIGN: A cross-sectional survey using standardised structured instruments adapted from the literature. SETTING: Nine public health facilities in Ibadan Metropolis, Nigeria, 1 December 2019-31 May 2020. PARTICIPANTS: 212 health providers selected via a two-stage cluster sampling. OUTCOMES: Organisational readiness for change to RMC (ORCRMC) and individual readiness for change to RMC (IRCRMC) scales had a maximum score of 5. Multiple linear regression was used to identify factors influencing IRCRMC and ORCRMC. We evaluated previously identified predictors of readiness for change (change valence, informational assessments on resource adequacy, core self-evaluation and job satisfaction) and proposed others (workplace characteristics, awareness of mistreatment during childbirth, perceptions of women's rights and resource availability to implement RMC). Data were adjusted for clustering and analysed using Stata V.15. RESULTS: The providers' mean age was 44.0±9.9 years with 15.4±9.9 years of work experience. They scored high on awareness of women's mistreatment (3.9±0.5) and women's perceived rights during childbirth (3.9±0.5). They had high ORCRMC (4.1±0.9) and IRCRMC (4.2±0.6), both weakly but positively correlated (r=0.407, 95% CI: 0.288 to 0.514, p<0.001). Providers also had high change valence (4.5±0.8) but lower perceptions of resource availability (2.7±0.7) and adequacy for implementation (3.3±0.7). Higher provider change valence and informational assessments were associated with significantly increased IRCRMC (ß=0.40, 95% CI: 0.11 to 0.70, p=0.015 and ß=0.07, 95% CI: 0.01 to 0.13, p=0.032, respectively), and also with significantly increased ORCRMC (ß=0.47, 95% CI: 0.21 to 0.74, p=0.004 and ß=0.43, 95% CI: 0.22 to 0.63, p=0.002, respectively). Longer years of work experience (ß=0.08, 95% CI: 0.01 to 0.2, p=0.024), providers' monthly income (ß=0.08, 95% CI: 0.02 to 0.15, p=0.021) and the health facility of practice were associated with significantly increased ORCRMC. CONCLUSION: The health providers studied valued a change to RMC and believed that both they and their facilities were ready for the change to RMC practice.

Practice, Perceptions, and Prospects of Mammography Screening in Nigeria: Insights From a National Survey of Female Health Workers.

BACKGROUND: Mammography, the most preferred tool for breast cancer screening, has very poor uptake in Nigeria, even among health workers. No nationwide study has been done to ascertain this. This study sought to determine the current perceptions and practices of Nigerian female health care practitioners on mammography screening across different types and levels of health care institutions in the country's 6 geopolitical zones. METHODS: This cross-sectional online survey was conducted using Google Forms distributed among Nigerian female health workers via online professional associations and networks. Descriptive and inferential statistics were done using SPSS version 20. RESULTS: A total of 562 respondents, with mean age of 41.30 ± 9.8 years, were surveyed. About half (50.3%) were doctors, with majority practicing in southern Nigeria. A mammography screening utilization rate of 15.4% was found, with majority having their first mammography long after attaining the age of eligibility. As of the time of the survey, only 24.8% of tertiary health workers had access to functional mammography machines at their place of work. Majority of female doctors (78%) never refer eligible patients for mammography, although nearly all (98.6%) were willing to do so. About 54% of those who have had a previous mammography screening vs. 17% who have not had 1 would recommend it to others. Majority of respondents recommended annual mammography from the age of forty at a subsidized cost. CONCLUSION: Nigerian female health workers have limited access to mammography and consequently do not screen often. Efforts must be made to make 'charity begin at home'.

Perceived Effect of Occupational Safety Measures on Workers' Performance in Warri Refining and Petrochemical Company, Delta State, Nigeria.

INTRODUCTION: Occupational safety measures when put in place in organizations are expected to increase the productivity of employees and drive organizations to better performance. This study was aimed at assessing the perception of workers at the Warri Refining and Petrochemical Company (WRPC) on the effect of implemented occupational safety measures on their individual and organizational performance. MATERIALS AND METHODS: The study was cross-sectional in design conducted at the WRPC, Delta state, Nigeria, among 236 workers of the WRPC selected via a simple random sampling technique across different job cadres (junior, senior, and management) in the organization. Data were collected using a semi-structured self-administered questionnaire and analyzed using the descriptive and inferential statistical tests of the SPSS version 20 with statistical significance set at P < 0.05. RESULTS: The mean age of respondents was 43 ± 2.26 years with a male-to-female ratio of 1.8:1. More than 50% of the respondents attested that occupational safety measures had been well implemented at the WPRC. Almost all the respondents, 219 (92.8%) and 224 (94.9%), agreed that occupational safety measures in place and trainings on safety measures had improved individual worker's performance, respectively. Respondents' length of service and job cadres were significantly associated with their perceived effect of the existing occupational safety measures at the WRPC on individual worker and organizational performance (P < 0.001). They were also significantly associated with their perceived effect of the neglect of these safety measures on high labor turnover rate (P < 0.001). CONCLUSION: Occupational safety measures were perceived to have positively affected workers' and organizational performance.

Work Practices and Health Problems of Spray Painters Exposed to Organic Solvents in Ile-Ife, Nigeria.

BACKGROUND: Automobile spray painters in Nigeria are exposed to organic solvents due to the hazardous nature of their work. Inadequate use of personal protective equipment (PPE) may intensify exposure to high levels of chemical hazards with resultant health problems. OBJECTIVES: The present study assessed PPE use and work practices and compared work-related health problems of spray painters and controls in Ile-Ife, Nigeria. METHODS: A cross-sectional study was conducted among 120 spray painters and 120 controls (electronic technicians). Data on socio-demographics, work practices, knowledge about organic solvent-related hazards and self-reported health symptoms were obtained using a semi-structured questionnaire. Clinical examinations were performed for all respondents and the composition of organic solvents in paints and paint products were derived from material safety data sheets. RESULTS: All respondents were male, and the mean age was 32.7±13.8 years for painters and 33.9±15.5 years for controls. Few (7.5%) painters perceived their use of PPE to be adequate. All spray painters worked in enclosed workshops and N-butyl acetate was the most commonly used organic solvent. Spray painters reported excessive tear production, recurrent cough, and short-term memory loss more frequently than controls (P<0.05). In addition, 89% of painters noticed paint-stained sputum immediately after spray painting. The prevalence ratio of respiratory symptoms was higher in spray painters than controls (prevalence ratio=21.0, CI=2.9-153.6). On clinical examination, more spray painters had corneal opacity and dry skin when compared with controls (P<0.05). CONCLUSIONS: Spray painters in the study area worked amidst chemical hazards and had poor use of PPE. Exposure to organic solvents may be responsible for the higher prevalence of self-reported health problems among spray painters. Interventions to enforce the use of PPE and improve the knowledge of organic solvent-related hazards among spray painters are essential. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: Ethical approval to conduct the study was obtained from the Health Research and Ethics Committee of the Institute of Public Health, Obafemi Awolowo University, Ile-Ife Nigeria (HREC No: IPHOAU/12/463). COMPETING INTERESTS: The authors declare no competing financial interests.

Knowledge, Attitude, and Practice of Health Workers in a Tertiary Hospital in Ile-Ife, Nigeria, towards Ebola Viral Disease.

Background. Health workers are more prone to Ebola viral disease (EVD) than the general population. This study assessed the preparedness of health workers in the control and management of EVD. Methods. A descriptive cross-sectional study. Consenting 400 health workers completed a semistructured questionnaire that assessed participants' general knowledge, emergency preparedness, and control and management of EVD. Data were analysed using descriptive and inferential statistics. Results. The mean age (SD) was 34.5 ± 8.62 years ranging from 20 to 59 years. Most participants were medical doctors (24.6%) and nurses (52.2%). The majority had practised <10 years (73.8%) and were aware of the EVD outbreak in the West African subregion (85.5%). Colleagues (40%) and radio (37.2%) were their major sources of information. Only 42% had good knowledge while 27% knew that there was no vaccine presently to prevent EVD. About one-quarter (24.2%) had low risk perception. The majority (89%) felt the hospital infection control policy was inadequate to protect against EVD. The only predictor of good knowledge was participants' occupation. Conclusion. There is knowledge gap and poor infection control preparedness among respondents. Thus, knowledge and practices of health workers towards EVD need improvement.