Manpower capacity and reasons for staff shortage in primary health care maternity centres in Nigeria: a mixed-methods study.

BACKGROUND: The heart-breaking maternal and neonatal health indicators in Nigeria are not improving despite previous interventions, such as 'Health for all' and 'Millennium Development Goals. The unattained health-related goals/targets of previous interventions put the success of the new Sustainable Development Goals in doubt if the existing paradigm remains unchanged. Thus, mere branding of health policies without improving what constitutes the health system such as manpower capacity and quality as well as staff-patients ratio will be wasteful efforts. This issue of global public health concern provided an indication for describing the capacity of manpower and reasons for staff shortage in primary level of health that are providing maternity services to women and their new-borns in Nigeria. METHODS: This is an embedded mixed-methods study. Its quantitative strand collected data with the aid of a structured questionnaire from 127 health workers across the 21 purposively selected primary health care centres in five local government areas. Descriptive statistics were employed for analysis. The qualitative strand of the study collected data through in depth interviews from medical officers of health or their representatives. The tape recorded and transcribed data were thematically coded, while reporting was by direct quotes. The mixing of the data from both strands was done in the discussion section. RESULTS: Twenty-nine (22.8%) of the health workers were between ages 51-58; 111 (87.4%) were married, while 44 (34.6%) had worked for duration of 21-33 years in service. Evidences of incompetence were observed among the health workers. A total of 92 (72.4%) had been performing episiotomies on women in labour. Similarly, 69.8% had been repairing vaginal traumas. Nine (7.1%) knew the necessary steps of controlling postpartum vaginal bleeding, while 115 (91.3%) of them had not been trained in Life-Saving Scheme and post-abortions care. CONCLUSION: The shortage of manpower, disproportional skilled/semi-skilled ratio, lack of framework for staff recruitment, staff incompetence and inappropriate childbirth practices show that women were not receiving quality maternal and neonatal cares at the maternity centres.

Self-Care Symptom-Management Strategies amongst Women Living with HIV/AIDS in an Urban Area in Kwazulu-Natal

People living with HIV and AIDS experience a number of symptoms such as fatigue; nausea and vomiting; fever and anxiety during the various stages of the illness. This has a negative effect on their quality of life. Women are the most commonly infected group and are at greater risk of acquiring HIV than men. In addition to their vulnerability; women have other responsibilities in society and expectations from society to fulfil. Women's health-seeking and health practice behaviours are often hindered by a number of factors; including family responsibilities; poverty and fear. This paper presents the findings of a qualitative study aimed at exploring the self-care symptom-management strategies used by women living with HIV and AIDS in an urban area in KwaZulu- Natal in 2006. Eleven participants were selected through a purposive sampling method until saturation was reached. Individuals were assessed in depth; using the symptom-management strategy interview. Qualitative content analysis was used to examine the transcribed interviews; using a deductive approach based on the categories of self-care symptom-management strategies. Various physical and psychological symptoms and a number of self-care symptom-management strategies were reported by the participants and these included taking medication and seeking help. The study makes recommendations on how to improve women's ability to employ a self-care strategy in managing their HIV- and AIDS-related symptoms