Knowledge of Helping Babies Breathe Programme and the Determinants among Trainees in Edo State.

BACKGROUND: Neonatal deaths contribute up to 32% of early childhood deaths in Nigeria. Most neonatal deaths (75%) occur during the first week of life. Helping Babies Breathe (HBB) programme is an intervention launched in 2010 by The American Academy of Paediatrics and found to be effective in reducing neonatal mortality by 47%. The aim of this study was to assess the knowledge of HBB training programme and their determinants among Health Care Workers (HCWs) attending a training programme in Benin City. METHOD: This was a cross-sectional study involving 134 HCWs attending a HBB training programme in Edo State. A standardized questionnaire was used to assess knowledge of trainees prior to and at post-training. Chi-square and binary logistic regression were used to test association and identify determinants of HBB knowledge. RESULTS: A total of 134 trainees participated in the study. The majority of The HCWs (62.7%) had good knowledge. Following training, all HCWs (100%) had good knowledge of HBB training Programme. Job title/Profession (p=0.007) and qualification (p=0.030) of HCWs were significant determinants of knowledge of HBB. However, after controlling for confounders; Job title was the only significant determinant of knowledge of HBB (OR: 0.603; p=0.014; CI:0.403-0.902), with medical officers more likely to have good knowledge, compared to other HCWs, including paediatric resident doctors. Community health extension workers and nurse assistants had very poor knowledge compared to other HCWs. CONCLUSION: Job title was the only significant determinant of knowledge of HBB, as doctors working as medical officers are more likely to have good knowledge than other HCWs, including paediatric resident doctors. Community health extension workers and nurse assistants had very poor knowledge compared to other HCWs.

CONTEXTE: Les décès néonatals contribuent à hauteur de 32 % des décès d'enfants en bas âge au Nigeria. La plupart des décès néonatals (75%) surviennent au cours de la première semaine de vie. Le programme «Helping Babies Breathe ¼ (HBB) est une intervention lancée en 2010 par l'American Academy of Pediatrics, qui s'est avérée efficace pour réduire la mortalité néonatale de 47 %. Cette étude vise à évaluer les connaissances sur le programme de formation HBB et leurs déterminants parmi les travailleurs de la santé (TS) participant à une formation à Benin City. MÉTHODE: Il s'agit d'une étude transversale impliquant 134 TS assistant à un programme de formation HBB dans l'État d'Edo. Un questionnaire standardisé a été utilisé pour évaluer les connaissances des stagiaires avant et après la formation. Le test du chi-carré et la régression logistique binaire ont été utilisés pour tester l'association et identifier les déterminants des connaissances sur le HBB. RÉSULTATS: Un total de 134 stagiaires ont participé à l'étude. La majorité des TS (62,7 %) avaient de bonnes connaissances. Après la formation, tous les TS (100 %) avaient de bonnes connaissances du programme de formation HBB. Le poste/profession (p=0,007) et la qualification (p=0,030) des TS étaient des déterminants significatifs des connaissances sur le HBB. Cependant, après avoir contrôlé les facteurs de confusion, le poste occupé était le seul déterminant significatif des connaissances sur le HBB (OR : 0,603 ; p=0,014 ; IC : 0,403-0,902), les médecins exerçant en tant qu'officiers médicaux étant plus susceptibles d'avoir de bonnes connaissances par rapport aux autres TS, y compris les résidents en pédiatrie. Les agents de santé communautaire et les assistants infirmiers avaient des connaissances très faibles par rapport aux autres TS. CONCLUSION: Le poste occupé était le seul déterminant significatif des connaissances sur le HBB, les médecins travaillant comme officiers médicaux étant plus susceptibles d'avoir de bonnes connaissances que les autres TS, y compris les résidents en pédiatrie. Les agents de santé communautaire et les assistants infirmiers avaient des connaissances très faibles par rapport aux autres TS. MOTS-CLÉS: État d'Edo, Cours de soins essentiels aux nouveau-nés, Formation des agents de santé, Programme "Aider les bébés à respirer", Connaissance du programme "Aider les bébés à respirer", Mortalité néonatale.

Epidemiological description of and response to a large yellow fever outbreak in Edo state Nigeria, September 2018 - January 2019.

BACKGROUND: Edo State Surveillance Unit observed the emergence of a disease with "no clear-cut-diagnosis", which affected peri-urban Local Government Areas (LGAs) from September 6 to November 1, 2018. On notification, the Nigeria Centre for Disease Control deployed a Rapid Response Team (RRT) to support outbreak investigation and response activities in the State. This study describes the epidemiology of and response to a large yellow fever (YF) outbreak in Edo State. METHODS: A cross-sectional descriptive outbreak investigation of YF outbreak in Edo State. A suspected case of YF was defined as "Any person residing in Edo State with acute onset of fever and jaundice appearing within 14 days of onset of the first symptoms from September 2018 to January 2019". Our response involved active case search in health facilities and communities, retrospective review of patients' records, rapid risk assessment, entomological survey, rapid YF vaccination coverage assessment, blood sample collection, case management and risk communication. Descriptive data analysis using percentages, proportions, frequencies were made. RESULTS: A total of 209 suspected cases were line-listed. Sixty-seven (67) confirmed in 12 LGAs with 15 deaths [Case fatality rate (CFR 22.4%)]. Among confirmed cases, median age was 24.8, (range 64 (1-64) years; Fifty-one (76.1%) were males; and only 13 (19.4%) had a history of YF vaccination. Vaccination coverage survey involving 241 children revealed low YF vaccine uptake, with 44.6% providing routine immunisation cards for sighting. Risk of YF transmission was 71.4%. Presence of Aedes with high-larval indices (House Index ≥5% and/or Breteau Index ≥20) were established in all the seven locations visited. YF reactive mass vaccination campaign was implemented. CONCLUSION: Edo State is one of the states in Nigeria with the highest burden of yellow fever. More males were affected among the confirmed. Major symptoms include fever, jaundice, weakness, and bleeding. Majority of surveillance performance indicators were above target. There is a high risk of transmission of the disease in the state. Low yellow fever vaccination coverage, and presence of yellow fever vectors (Ae.aegypti, Ae.albopictus and Ae.simpsoni) are responsible for cases in affected communities. Enhanced surveillance, improved laboratory sample management, reactive vaccination campaign, improved yellow fever case management and increased risk communication/awareness are very important mitigation strategies to be sustained in Edo state to prevent further spread and mortality from yellow fever.

Knowledge and Skills of Health Care Workers Implementing Integrated Maternal, Newborn and Child Health Strategy in Edo State, Nigeria.

BACKGROUND: The Integrated Maternal, Newborn and Child Health (IMNCH) strategy which advocates for integrated care of mother and newborn requires skilled health care workers (HCWs) for effective implementation. This study assessed the capacity of HCWs in Primary Health Care (PHC) facilities in Edo State to implement the IMNCH strategy. METHODS: This cross-sectional study involved 333 HCWs drawn from PHC facilities in Edo State using multistage sampling technique. Data was collected by structured self-administered questionnaire and analysed using IBM SPSS version 21.0. Descriptive and inferential statistics were done with level of significance set at p<0.05. RESULTS: One hundred and seventy-four (52.3%) of the respondents had good knowledge of IMNCH strategy, 223 (67.0%) had good practice of focused antenatal care (FANC) while 92 (27.6%) had good of routine and basic emergency obstetric care (BEOC) including essential newborn care (ENC). Respondents' designation was the only significant predictor of knowledge of IMNCH strategy (aOR=5.03, 95%CI=2.92-8.67, p<0.001). Respondents' designation (aOR=6.50; 95%CI=3.11-13.99, p<0.001) and good knowledge of IMNCH strategy (aOR=0.21, 95%CI=0.12-0.38, p<0.001) were the significant predictors of good practice of FANC. Respondents' designation (aOR=6.13, 95%CI=3.27-11.48, p<0.001) and good knowledge of IMNCH strategy (aOR=0.28, 95%CI=0.14-0.54, p<0.001) were the significant predictors of good practice of routine and BEOC including ENC. CONCLUSION: The study found overall good knowledge of IMNCH strategy, good practice of FANC but poor practice of routine, basic emergency obstetric and newborn care among HCWs in PHC facilities in Edo State. Engaging more skilled HCWs and continuous professional training of employed staff is recommended for effective implementation of the IMNH strategy.

CONTEXTE: La stratégie de la santé intégrée de la mère, du nouveau-né et de l'enfant (IMNCH), qui préconise des soins intégrés pour la mère et le nouveau-né, exige des travailleurs de la santé qualifiés pour une mise en œuvre efficace. Cette étude a évalué la capacité des travailleurs de la santé dans les établissements de soins de santé primaires (SSP) de l'État d'Edo à mettre en œuvre la stratégie IMNCH. MÉTHODES: Cette étude transversale a impliqué 333 travailleurs de santé sélectionnés dans les établissements de soins primaires de l'État d'Edo en utilisant une technique d'échantillonnage à plusieurs degrés. Les données ont été collectées au moyen d'un questionnaire structuré auto-administré et analysées avec IBM SPSS version 21.0. Des statistiques descriptives et inférentielles ont été réalisées avec un niveau de signification fixé à p<0,05. RÉSULTATS: Cent soixante-quatorze (52,3%) des répondants avaient une bonne connaissance de la stratégie IMNCH, 223 (67,0%) avaient une bonne pratique des soins prénataux ciblés (FANC) tandis que 92 (27,6%) avaient une bonne pratique des soins obstétricaux d'urgence de routine et de base (BEOC), y compris les soins essentiels au nouveauné (ENC). La désignation des répondants était le seul prédicteur significatif de la connaissance de la stratégie IMNCH (aOR=5,03, 95%CI=2,92-8,67, p<0,001). La désignation des répondants (aOR=6,50 ; 95%CI=3,11-13,99, p<0,001) et une bonne connaissance de la stratégie IMNCH (aOR=0,21, 95%CI=0,12-0,38, p<0,001) étaient les prédicteurs significatifs d'une bonne pratique des FANC. La désignation des répondants (aOR=6.13, 95%CI=3.27-11.48, p<0.001) et la bonne connaissance de la stratégie IMNCH (aOR=0.28, 95%CI=0.14-0.54, p<0.001) étaient les prédicteurs significatifs de la bonne pratique de la routine et du BEOC incluant l'ENC. CONCLUSION: L'étude a révélé une bonne connaissance générale de la stratégie IMNCH, une bonne pratique des FANC mais une faible pratique des soins de routine, des soins obstétriques d'urgence de base et des soins aux nouveau-nés parmi les travailleurs de santé dans les établissements PHC de l'état d'Edo. L'engagement d'un plus grand nombre d'agents sanitaires qualifiés et la formation professionnelle continue du personnel employé sont recommandés pour une mise en œuvre efficace de la stratégie IMNH. MOTS CLÉS: IMNCH ; Mise en œuvre ; Agents de santé ; Soins de santé primaires, État d'Edo.

Transmission Based Precaution Practices among Nurses in Edo State, Nigeria during COVID-19 Pandemic.

The novel covid-19 pandemic is a highly infectious disease without known specific treatment and vaccine. Transmission based precautions are important in the fight against the virus. This study investigated the level of transmission-based precautions practiced, the predictors of correct practices, and the challenges experienced by nurses in public health facilities in Edo State during the outbreak of the Covid-19 pandemic. The study employed a descriptive cross-sectional survey to elicit responses from 367 front line nurses using a Google online questionnaire. Data analysis involved descriptive statistics and logistic regression analysis. The majority 314(85.6%) of the respondents maintained a good level of transmission-based precautions practice. Hand hygiene was performed by 327(89.1%) of the respondents. Academic qualification was a significant predictor of good practice in favour of respondents with a degree in nursing. Challenges identified were lack of financial motivation, fear of infecting family members and fear of contracting the virus (93.5%). It was concluded that nurses in Edo State Nigeria have good transmission- based practices in relation to covid-19 however efforts should be made to ensure 100% compliance and sustain practices.

Why rural women do not use primary health centres for pregnancy care: evidence from a qualitative study in Nigeria.

BACKGROUND: While Primary Health Care has been designed to provide universal access to skilled pregnancy care for the prevention of maternal deaths in Nigeria, available evidence suggests that pregnant women in rural communities often do not use Primary Health Care Centres for skilled care. The objective of this study was to investigate the reasons why women do not use PHC for skilled pregnancy care in rural Nigeria. METHODS: Qualitative data were obtained from twenty focus group discussions conducted with women and men in marital union to elicit their perceptions about utilisation of maternal and child health care services in PHC centres. Groups were constituted along the focus of sex and age. The group discussions were tape-recorded, transcribed verbatim and analyzed thematically. RESULTS: The four broad categories of reasons for non-use identified in the study were: 1) accessibility factors - poor roads, difficulty with transportation, long distances, and facility not always open; 2) perceptions relating to poor quality of care, including inadequate drugs and consumables, abusive care by health providers, providers not in sufficient numbers and not always available in the facilities, long waiting times, and inappropriate referrals; 3) high costs of services, which include the inability to pay for services even when costs are not excessive, and the introduction of informal payments by staff; and 4) Other comprising partner support and misinterpretation of signs of pregnancy complications. CONCLUSION: Addressing these factors through adequate budgetary provisions, programs to reduce out-of-pocket expenses for maternal health, adequate staffing and training, innovative methods of transportation and male involvement are critical in efforts to improve rural women's access to skilled pregnancy care in primary health care centres in the country.

Prevalence of Soil-transmitted Helminths in Primary School Playgrounds in Edo State, Southern Nigeria.

Schoolchildren in primary schools are mostly at risk of acquiring soil-transmitted helminths (STHs) infections due to their habits (geophagy, onychophagy and playing with barefoot). Profiling soil parasites on school playgrounds is expected to provide an insight to an array of parasites schoolchildren are constantly at risk of acquiring; and this information could guide on intervention programmes. Soil samples from sixteen primary school playgrounds in Edo State (South-South, Nigeria) were collected over a six-month period both in the dry (January, February and March) and wet (May, June and July) seasons in 2018 and early 2019. Samples were processed and analysed following standard parasitological procedures. Of the 576 soil samples collected, 318(55.2 %) were positive with one or more soil parasites. Generally, the predominant parasites recovered from the total number of soil samples collected were: Ascaris 127(22 %), Strongyloides 111(19.27 %) and hookworm 50(8.68 %). Ascaris was most preponderant in the dry season, while Strongyloides was the most occurring in the wet season. The mean differences in the parasite load for Ascaris and hookworm between dry and wet seasons were not significant; while for Strongyloides it was higher in the wet than dry season. These results could be a consequence of observed poor state of toilet/sanitary facilities as well as the lack or poor state of basic infrastructure like proper drainage and waste disposal systems in the host communities. There is therefore urgent need to interrupt the STHs transmission cycles in the environment and possibly in schoolchildren by instituting sustainable intervention programmes within schools located in STHs endemic regions like southern Nigeria.

Predictors of women's utilization of primary health care for skilled pregnancy care in rural Nigeria.

BACKGROUND: Although Primary Health Care (PHC) was designed to provide universal access to skilled pregnancy care for the prevention of maternal deaths, very little is known of the factors that predict the use of PHC for skilled maternity care in rural parts of Nigeria - where its use is likely to have a greater positive impact on maternal health care. The objective of this study was to identify the factors that lead pregnant women to use or not use existing primary health care facilities for antenatal and delivery care. METHODS: The study was a cross-sectional community-based study conducted in Esan South East and Etsako East LGAs of Edo State, Nigeria. A total of 1408 randomly selected women of reproductive age were interviewed in their households using a pre-tested structured questionnaire. The data were analyzed with descriptive and multivariate statistical methods. RESULTS: The results showed antenatal care attendance rate by currently pregnant women of 62.1%, and a skilled delivery of 46.6% by recently delivered women at PHCs, while 25% of women delivered at home or with traditional birth attendants. Reasons for use and non-use of PHCs for antenatal and delivery care given by women were related to perceptions about long distances to PHCs, high costs of services and poor quality of PHC service delivery. Chi-square test of association revealed that level of education and marital status were significantly related to use of PHCs for antenatal care. The results of logistic regression for delivery care showed that women with primary (OR 3.10, CI 1.16-8.28) and secondary (OR 2.37, CI 1.19-4.71) levels education were more likely to receive delivery care in PHCs than the highly educated. Being a Muslim (OR 1.56, CI 1.00-2.42), having a partner who is employed in Estako East (OR 2.78, CI 1.04-7.44) and having more than five children in Esan South East (OR 2.00, CI 1.19-3.35) significantly increased the odds of delivery in PHCs. The likelihood of using a PHC facility was less for women who had more autonomy (OR 0.75, CI 0.57-0.99) as compared to women with higher autonomy. CONCLUSION: We conclude that efforts devoted to addressing the limiting factors (distance, costs and quality of care) using creative and innovative approaches will increase the utilization of skilled pregnancy care in PHCs and reduce maternal mortality in rural Nigeria.