Rural-urban differences in utilization of antenatal and delivery services in Ebonyi State, Nigeria.

BACKGROUND: The high maternal death burden in developing countries when compared to the developed could be attributed to differences in use of antenatal and skilled delivery care. AIM: To assess the differences in utilization of antenatal and delivery services in urban and rural communities of Ebonyi state, Nigeria. METHODS: A cross-sectional comparative study design was used. Two stage (cluster) sampling technique was used to select 660 women in 4 of 13 local government areas in the state. The respondents were women who were permanent residents of communities and have delivered in last one year. Outcome measure was good utilization of antenatal and delivery services and was assessed by proportion of respondents who obtained antenatal and delivery from a skilled provider and also made at least four antenatal visits. RESULTS: The mean age of respondents was urban, 29.6 ± 6.2 and rural, 28.6 ± 5.1 years. Majority in urban, 51.8% utilized tertiary health facility for antenatal care while in rural, 77.9% used primary health centers (P < 0.001). Comparable proportions in urban, (77.3%) and rural, (79.1%) had good use of antenatal and delivery services (P = 0.572). Predictors of good use of antenatal and delivery services in urban included having one child (AOR = 4.8; 95%C1: 1.4--17.0), having attained tertiary education, (AOR = 2.6; 95%C1: 1.2--5.5), being in low socioeconomic class, (AOR = 0.4; 95%C1: 0.2--0.7), and having good knowledge of danger signs, (AOR = 2.6; 95%C1: 1.3--5.4). In rural, predictors included having one child, (AOR = 2.8; 95%C1:1.1--7.1), being unmarried, (AOR = 0.3; 95%C1: 0.1--0.9), and having good knowledge of danger signs (AOR = 3.7; 95%C1: 1.8--7.5). CONCLUSION: Utilization of antenatal and delivery services in health facilities in study area was high but there is room for improvement. There is need to plan specific interventions aimed at improving utilization of maternal health services by some groups like urban poor and unmarried mothers, especially teenagers. Emphasis should also be placed on improving community understanding of danger signs of pregnancy.

The prevalence of osteoporosis among antenatal clinic attendees in a rural mission hospital in South-East Nigeria.

INTRODUCTION: Osteoporosis is a global public health problem characterized by reduction of bone mineral density (BMD). This study aimed to assess the prevalence of osteoporosis among antenatal clinic attendees in a rural Southeastern hospital. MATERIAL AND METHODS: This was a cross-sectional study of booking Antenatal Clinic Attendees at Mile 4 Catholic Hospital, Abakaliki, between October 2014 and February 2015. The study participants were selected through systematic random sampling. The BMD of the right calcaneal bone of the participants was measured using the OsteoPro, a Quantitative ultrasound scan. RESULTS: A total of 327 eligible women participated in the study. The average age of the participants was 29 ± 4.5 years. The average parity was 2 ± 1.6 childbirths. The mean T-score was -1.19 ± 4.9. Osteoporosis and osteopenia were recorded in 119 women (36.4%) and 56 women (17.1%), respectively, whereas 152 (46.5%) were within normal range. History of regular exercise by the respondents is statistically significant on the reduction of osteopenia and osteoporosis (P ≤ 0.05). The history of ever use of calcium supplementation by the study participants in the index pregnancy did not have any significant effect on the reduction of osteoporosis. CONCLUSION: There is a high prevalence of osteoporosis among pregnant women in Southeast Nigeria. This may be due to the predominant poor adherence and low dose of calcium supplementation among pregnant women in this environment. Therefore, there is an urgent need for sensitization on this public health problem.

Pulmonary problems among quarry workers of stone crushing industrial site at Umuoghara, Ebonyi State, Nigeria.

BACKGROUND: Respiratory problem is one of the major health hazards in dust-exposed workers; it is a major cause of morbidity and mortality all over the world. OBJECTIVE: To determine the prevalence of respiratory problems and lung function impairment among quarry workers in Ebonyi State, Nigeria. METHODS: Respiratory problems and lung function were studied in 403 quarry workers aged 10-60 years. Respiratory problems were investigated with a questionnaire based on international models adapted for the study population. Lung function was assessed by spirometry and chest roentgenography. RESULTS: The respiratory problems found were chest pain (47.6%), occasional cough (40.7%), occasional shortness of breath (6.5%) and wheezing (5.2%). The mean±SD FEV1 and FVC values were significantly decreased with length of exposure-respectively, 3.52±0.77 and 3.91±0.72 L for <5 years; 2.79±0.68 and 3.09±0.87 L for 5-10 years; and 2.03±0.92 and 2.86±0.83 L for >10 years of exposure. Moreover, the mean±SD FEV1 and FVC values of smoker (3.37±0.81 and 3.56±1.02 L, respectively) were significantly (p<0.05) lower than that of non-smokers (3.68±1.02 and 3.89±0.99 L, respectively) working in the quarry site. CONCLUSION: Chronic exposure to dust due to stone quarrying may increase the risk of respiratory problems and impaired lung function-cigarette smokers are at higher risk.

The status of tuberculosis infection control measures in health care facilities rendering joint TB/HIV services in "German Leprosy and Tuberculosis Relief Association" supported states in Nigeria.

OBJECTIVE: To assess the status of tuberculosis (TB) infection control practice in health care facilities implementing joint TB/HIV activities. MATERIALS AND METHODS: A descriptive survey triangulating self-administered questionnaire (facility survey to Infection Control Officer, individual health worker to general health workers), review of facility case notes and participant observation techniques was carried out. Twelve health facilities from southern Nigeria were assessed. RESULTS: (1) Administrative and work practice control measure: Only 1 (8.3%) facility had a documented TB Infection control policy; 2 (16.7%) facilities had Infection Control Committee; 5 (41.7%) facilities had Infection Control Officer; 2 (16.7%) asked questions at the health records about cough; 1 (8.3%) facility had health workers intermittently checking for patients with cough in the waiting hall; and 2 (16.7%) facilities had Infection Control Officers who have attended some training on infection control. No facility had Information, Education and Communication (IEC) materials reminding patients and health workers of the possibility of TB transmission in the health care setting. While 86.4% of TB patients were screened for HIV, only 54.7% of HIV patients were tested for TB. (2) Environmental control measures: All the waiting halls were well ventilated. Though 66.7% of the consulting rooms were well ventilated, 25% of them were over crowded; 58.3% of the facilities managed sputum smear positive TB patients in the same ward with HIV-positive and other vulnerable patients; no facility had air cleaners. CONCLUSION: Implementation of the different aspects of the administrative control and work practice component of TB infection control measure range from 8.3% to 41.7% of the facilities. Urgent measures should be taken to reverse this trend in the face of TB burden due to HIV.

The perception of health professions on causes of interprofessional conflict in a tertiary health institution in Abakaliki, southeast Nigeria.

BACKGROUND: Interprofessional conflict in university teaching hospitals in Nigeria is on the increase. This study was aimed at assessing the health professions' perception of factors responsible forconflict. METHODOLOGY: A cross-sectional descriptive survey among six health professions. RESULTS: The perceived causes of conflict include differential salary between doctors and others, physician intimidation and discrimination of other professions, "inordinate ambition" of the other professions to lead the health team, and envy of the doctor by the other professions. Doctors differed significantly from the other professions on the role of each of these in causing conflict. Mutual respect for each other's competence, proper remuneration and clear delineation of duties for all, and other groups appreciating the salary differential between them and doctors were perceived as means of resolving the conflict. While all accepted mutual respect and proper remuneration as effective, other health workers differed significantly from doctors on the effectiveness of appreciating salary differential between them and doctors in resolving the conflict. CONCLUSION: Differential salary between the doctor and the other health workers is the main factor perceived to cause interprofessional conflict. The government and all health professions should accept, and maintain the relativity in salary differential between doctors and other health professions.

The Perception of Health on Causes of Inter professional Conflict in a Tertiary Health Institution in Abakaliki; Southeast Nigeria

"BACKGROUND: Interprofessional conflict in university teaching hospitals in Nigeria is on the increase. This study was aimed at assessing the health professions' perception of factors responsible for conflict. METHODOLOGY: A cross-sectional descriptive survey among six health professions. RESULTS: The perceived causes of conflict include differential salary between doctors and others; physician intimidation and discrimination of other professions; ""inordinate ambition"" of the other professions to lead the health team; and envy of the doctor by the other professions. Doctors differed significantly from the other professions on the role of each of these in causing conflict. Mutual respect for each other's competence; proper remuneration and clear delineation of duties for all; and other groups appreciating the salary differential between them and doctors were perceived as means of resolving the conflict. While all accepted mutual respect and proper remuneration as effective; other health workers differed significantly from doctors on the effectiveness of appreciating salary differential between them and doctors in resolving the conflict. CONCLUSION : Differential salary between the doctor and the other health workers is the main factor perceived to cause interprofessional conflict. The government and all health professions should accept; and maintain the relativity in salary differential between doctors and other health professions."

Outcome of Pregnancy in Adolescent Mothers in Mile Four Hospital; Abakaliki; Ebonyi State

Background of the study: This study was undertaken because of the observed worrisome high number of adolescent mothers who delivered in the Mile IV Hospital; Abakaliki. Objectives: The study was undertaken to determine the hospital incidence of adolescent pregnancy and their pregnancy outcomes. Materials and methods: All adolescent pregnancies booking over a one year period were followed up till delivery. The outcome measures were antenatal complications; foetal presentations; mode of delivery; postpartum complications; foetal outcomes and birth weight. Results: The hospital incidence of adolescent pregnancy was 5. Sixty-eight percent of the mothers were married. Malaria in pregnancy was expectedly the leading antenatal complication and the Caesarean Section rate was 11. The relative risk for episiotomy in this group of mothers was 0.25. The maternal mortality rate was 1000 per 100;000 and the perinatal mortality rate was 106.8 per 1000 births. Conclusions: This study shows that the incidence of adolescent pregnancy is high in the centre. The rates of interventional deliveries and episiotomies are increased and the perinatal outcomes are poor. There is the need to discourage the existing cultural feature of childhood marriage in some parts of the State

Concurrent use of multiple antenatal care providers by women utilising free antenatal care at Ebonyi State University Teaching Hospital, Abakaliki.

Observation has revealed that women who book at Ebonyi State University Teaching Hospital, Abakaliki, concurrently use multiple antenatal care givers (formal and non-formal). This study was therefore conducted to identify the other sources of antenatal care for the women and to examine them in relation to their socio-demographic characteristics. A total of 200 antenatal women chosen from two randomly selected booking clinics were interviewed using a structured questionnaire. The results show that 25% and 30.5% respectively from the two clinics were concurrently using formal and unorthodox ANC givers. Age and education were significantly related to the practice (p < 0.0002 and p < 0.02 respectively). These findings suggest that free services alone may not be enough to make women attend ANC in the hospital. A larger study, especially investigating patient's perspective of the quality of care, is recommended.