Improving Human Resource for Health in Rural Northern Nigeria

Inadequate number of health workers in rural areas is a major concern in many countries. It causes underutilization, prevents equitable access of health services, and is a barrier to universal health coverage. To increase the number and improve retention of health workers in rural areas, the World Health Organization (WHO) issued global recommendations to improve the rural retention of the health workforce. This paper presents the experiences of adopting and implementing the WHO recommendations in four states in Northern Nigeria. It highlights the results, challenges and lessons learnt with the implementation. We used an implementation research approach and evaluated the implementation at three stages: the pilot; full implementation; and immediate post exit. A total of 477 midwives were recruited and deployed to rural health facilities over a period of four years. Of these, 196 (41%) were in Jigawa, 126 (26.4%) in Yobe, 78 (16.4%) in Zamfara and 77 (16.1%) in Katsina. Midwives’ retention rates increased gradually over the four years. In three (Jigawa, Katsina and Zamfara) of the four states, midwives’ retention rates increased from 69.2% in Jigawa in 2013 to 98% in 2016; from 53.3% in Katsina in 2013 to 100% retention in 2016. Zamfara made the most progress with a poor retention rate of 42.8% in 2013 to 100% retention rate in 2016. In Yobe state, the retention rate of 47% in 2013 gradually increased to 100% in 2015. This however slightly dropped to 90% in 2016 as a result of the deteriorating security situation in 2015. Other effects of the initiative included: heightened determination of states to increase the production of indigenous midwives; reversal of policy directives that banned the recruitment of health workers including midwives; and to provide incentives such as safe and comfortable accommodation

The incidence of pregnancy hypertension in India, Pakistan, Mozambique, and Nigeria: A prospective population-level analysis.

Background: Most pregnancy hypertension estimates in less-developed countries are from cross-sectional hospital surveys and are considered overestimates. We estimated population-based rates by standardised methods in 27 intervention clusters of the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials. Methods and findings: CLIP-eligible pregnant women identified in their homes or local primary health centres (2013–2017). Included here are women who had delivered by trial end and received a visit from a community health worker trained to provide supplementary hypertension-oriented care, including standardised blood pressure (BP) measurement. Hypertension (BP ≥ 140/90 mm Hg) was defined as chronic (first detected at \u3c20 weeks gestation) or gestational (≥20 weeks); pre-eclampsia was gestational hypertension plus proteinuria or a pre-eclampsia-defining complication. A multi-level regression model compared hypertension rates and types between countries (p \u3c 0.05 considered significant). In 28,420 pregnancies studied, women were usually young (median age 23–28 years), parous (53.7%–77.3%), with singletons (≥97.5%), and enrolled at a median gestational age of 10.4 (India) to 25.9 weeks (Mozambique). Basic education varied (22.8% in Pakistan to 57.9% in India). Pregnancy hypertension incidence was lower in Pakistan (9.3%) than India (10.3%), Mozambique (10.9%), or Nigeria (10.2%) (p = 0.001). Most hypertension was diastolic only (46.4% in India, 72.7% in Pakistan, 61.3% in Mozambique, and 63.3% in Nigeria). At first presentation with elevated BP, gestational hypertension was most common diagnosis (particularly in Mozambique [8.4%] versus India [6.9%], Pakistan [6.5%], and Nigeria [7.1%]; p \u3c 0.001), followed by pre-eclampsia (India [3.8%], Nigeria [3.0%], Pakistan [2.4%], and Mozambique [2.3%]; p \u3c 0.001) and chronic hypertension (especially in Mozambique [2.5%] and Nigeria [2.8%], compared with India [1.2%] and Pakistan [1.5%]; p \u3c 0.001). Inclusion of additional diagnoses of hypertension and related complications, from household surveys or facility record review (unavailable in Nigeria), revealed higher hypertension incidence: 14.0% in India, 11.6% in Pakistan, and 16.8% in Mozambique; eclampsia was rare (\u3c0.5%). Conclusions: Pregnancy hypertension is common in less-developed settings. Most women in this study presented with gestational hypertension amenable to surveillance and timed delivery to improve outcome

A new damping modelling approach and its application in thin wall machining

In this paper, a new approach to modelling the damping parameters and its application in thin wall machining is presented. The approach to predicting the damping parameters proposed in this paper eliminates the need for experiments otherwise used to acquire these parameters. The damping model proposed was compared with available damping models and experimental results. A finite element analysis and Fourier transform approach has been used to obtain frequency response function (FRF) needed for stability lobes prediction. Several predicted stable regions using both experimental and numerical FRF’s for various examples gave a good comparison.Engineering and Physical Sciences Research Counci

Impact of mothers’ socio-demographic factors and antenatal clinic attendance on neonatal mortality in Nigeria

Neonatal death is often referred to maternal complications during pregnancy, and other exogenous factors that exist around the time of birth or shortly after birth. The United Nations Sustainable Development Goals (UNSDG)-Goal 3, Targets 3.2 aimed at ending preventable deaths of newborns by demanding that all countries should reduce neonatal mortality to 12 per 1000 live births by 2030. The objective of the study was to examine the relationship between mothers’ socioeconomic and demographic factors on neonatal deaths in Nigeria. The study used quantitative data from the 2013 Nigeria Demographic and Health Surveys (NDHS). The data analyzed consisted of 26,826 women aged 15–49 years who had a live or dead birth within the 5 years preceding the survey. STATA 12 computer software was used to carry out data analyses. Data analyses were at univariate (frequency distribution), bivariate (chi-square) and due to the dichotomous nature of the outcome variable (i.e., whether a child was born alive or dead during the delivery; coded as (1, 0), a binary logistic regression was carried out to examine the relationships between various socio-demographic factors, antenatal clinic attendance and neonatal mortality in Nigeria. The results, among others, revealed that background factors of the women such as age, region, residence, education, and wealth status have a significant association with neonatal mortality (P < 0.05). The study also found that adequate antenatal clinic attendance helps to reduce neonatal deaths. The study recommended that women should be encouraged to observe regular antenatal clinic visits during pregnancy and also go for institutional delivery for possible reduction of neonates and infant deaths in Nigeria