Evaluation of the feasibility of a midwifery educator continuous professional development (CPD) programme in Kenya and Nigeria: a mixed methods study.

BACKGROUND: Midwifery education is under-invested in developing countries with limited opportunities for midwifery educators to improve/maintain their core professional competencies. To improve the quality of midwifery education and capacity for educators to update their competencies, a blended midwifery educator-specific continuous professional development (CPD) programme was designed with key stakeholders. This study evaluated the feasibility of this programme in Kenya and Nigeria. METHODS: This was a mixed methods intervention study using a concurrent nested design. 120 randomly selected midwifery educators from 81 pre-service training institutions were recruited. Educators completed four self-directed online learning (SDL) modules and three-day practical training of the blended CPD programme on teaching methods (theory and clinical skills), assessments, effective feedback and digital innovations in teaching and learning. Pre- and post-training knowledge using multiple choice questions in SDL; confidence (on a 0-4 Likert scale) and practical skills in preparing a teaching a plan and microteaching (against a checklist) were measured. Differences in knowledge, confidence and skills were analysed. Participants' reaction to the programme (relevance and satisfaction assessed on a 0-4 Likert scale, what they liked and challenges) were collected. Key informant interviews with nursing and midwifery councils and institutions' managers were conducted. Thematic framework analysis was conducted for qualitative data. RESULTS: 116 (96.7%) and 108 (90%) educators completed the SDL and practical components respectively. Mean knowledge scores in SDL modules improved from 52.4% (± 10.4) to 80.4% (± 8.1), preparing teaching plan median scores improved from 63.6% (IQR 45.5) to 81.8% (IQR 27.3), and confidence in applying selected pedagogy skills improved from 2.7 to 3.7, p < 0.001. Participants rated the SDL and practical components of the programme high for relevance and satisfaction (median, 4 out of 4 for both). After training, 51.4% and 57.9% of the participants scored 75% or higher in preparing teaching plans and microteaching assessments. Country, training institution type or educator characteristics had no significant associations with overall competence in preparing teaching plans and microteaching (p > 0.05). Qualitatively, educators found the programme educative, flexible, convenient, motivating, and interactive for learning. Internet connectivity, computer technology, costs and time constraints were potential challenges to completing the programme. CONCLUSION: The programme was feasible and effective in improving the knowledge and skills of educators for effective teaching/learning. For successful roll-out, policy framework for mandatory midwifery educator specific CPD programme is needed.

Alpha Amylase Inhibitory Potential and Mode of Inhibition of Oils from Allium sativum (Garlic) and Allium cepa (Onion).

BACKGROUND: Alpha amylase inhibitors are used in the treatment of type II diabetes mellitus. Allium sativum and Allium cepa, widely consumed as spices have several medicinal uses which include their traditional use in the management of diabetes. This study was conducted to investigate the alpha amylase inhibitory potential and mode of inhibition of A. sativum and A. cepa oils. METHOD: Oil was extracted from dried bulb of A. sativum and A. cepa by Soxhlet extraction. The α-amylase inhibitory potential of the 2 oils were evaluated. The mode of inhibition of the oils were determined from the lineweaver-burk plot and the kinetic parameters obtained from the lineweaver - burk plot. RESULT: A. sativum oil had 58.13 ± 1.09 and 69.8 ± 1.11 percent inhibition at 5.0 and 7.0% concentrations respectively while A. cepa oil had 55.45 ± 1.35, 59.73 ± 1.11 and 65.21 ± 1.11 percent inhibition at 5.0, 7.5 and 10% concentrations respectively. The IC50 values for A. sativum oil, A. cepa oil and acarbose were 3.0 ± 0.02%, 4.4 ± 0.03% and 14.1 ± 0.09% respectively. The lineweaver - burk plot showed that the Vmax of the 2 oils did not change when compared with that of the no inhibitor (no oil) but the Km increased. CONCLUSION: These findings indicate that A. sativum and A. cepa oils are competitive inhibitors of α- amylase and can both be used in the treatment of type II diabetes mellitus. A. sativum oil is a better inhibitor than A. cepa oil.

Demographic factors associated with HIV infection between low and high prevalence areas in Nigeria, 2015.

INTRODUCTION: Sub-Saharan Africa accounts for 66% of 36.7 million individuals living with HIV in 2015 with Nigeria having the second highest prevalence in Africa. The study aimed to find the prevalence and socio-demographic factors associated with HIV infection and compare these findings between high and low prevalence areas. METHODS: We conducted a cross-sectional study among adults aged 15 to 49 years from March to April 2015. We administered a questionnaire to collect linked anonymous data on socio-demographic and socio-cultural characteristics and screened all respondents for HIV infection. We defined a high HIV prevalence area as area with prevalence consistently above 5% and an area with prevalence consistently below 2% as low prevalence area. We performed univariate, bivariate and logistic regration analysis to assess factors associated with HIV infection. RESULTS: We screened and interviewed all 480 respondents. Majority 344 (71.7%) were females, mean age was 30.1 years (±7.4 years), high proportion were employed 246 (51.2%). In high HIV prevalence area, aged <30 years (Adjusted Odd Ratio (AOR) = 4.2, 95% Confidence Interval (CI) = 1.1-20.4) and being employed (AOR= 3.7, 95% CI=1.0-58.8) increased the likelihood of HIV infection. In low HIV prevalence area, lack of education (AOR=7.1, 95% CI= 0.9-32) was the only predictor of HIV infection. CONCLUSION: Interplay of socio-demographic factors was responsible for differences in HIV prevalence. To further decrease prevalence in low prevalence areas (below 1%), government should make universal basic education mandatory and in high prevalence areas, interventions should target the young and the employed.

Experiences with facility-based maternal death reviews in northern Nigeria.

OBJECTIVE: To evaluate the effectiveness of the maternal death review (MDR) system and process in improving quality of maternal and newborn health care in northern Nigeria. METHODS: A combination of quantitative and qualitative methods was used, including review of MDR forms and of health management information system data on maternal deaths (MDs), as well as semi-structured interviews with members of 11 MDR committees. RESULTS: Facility-based MDRs were initiated in 75 emergency obstetric and newborn care facilities in northern Nigeria and were initially conducted in the 33 hospitals; however, the process stopped after some time and had to be revitalized. Main reasons were transfer of key members of MDR committees, lack of supportive supervision, and shortage of staff. Ninety-three (12.1%) of 768 identified MDs were recorded on MDR forms and 52 (6.7%) had been reviewed. MDRs resulted in improved quality of care, including mobilization of additional resources. Challenges were fear of blame, shortage of staff, transfer of MDR team members, inadequate supportive supervision, and poor record keeping. CONCLUSION: MDR requires teamwork, commitment, and champions at health facility level to spearhead the process. MDR needs to be institutionalized in the Ministry of Health, which provides oversight, policy guidance, and support, including supportive supervision.