Where do delays occur when women receive antenatal care? A client flow multi-site study in four health facilities in Nigeria

Objectives: The objective of the study was to identify where delays occur when women present for antenatal care in four Nigerian referral hospitals, and to make recommendations on ways to reduce delays in the course of provision of antenatal care in the hospitals.Design: Prospective observational studySetting: Four Nigerian (1 tertiary and 3 secondary) HospitalsParticipants: Women who presented for antenatal care.Interventions: A process mapping. The National Health Service (NHS) Institute Quality and Service Improvement Tool was used for the assessment.Main outcome measures: The time women spent in waiting and receiving antenatal care in various departments of the hospitals.Results: Waiting and total times spent varied significantly within and between the hospitals surveyed. Mean waiting and total times spent were longest in the outpatients’ departments and shortest in the Pharmacy Departments. Total time spent was an average of 237.6 minutes. χ2= 21.074; p= 0.0001Conclusion: There was substantial delay in time spent to receive care by women seeking routine antenatal health services in the four secondary and tertiary care hospitals. We recommend managers in health facilities include the reduction of waiting times in the strategic plans for improving the quality of antenatal care in the hospitals. This should include the use of innovative payment systems that excludes payment at time of service delivery, adoption of a fast-track system such as pre-packing of frequently used commodities and the use of new tech informational materials for the provision of health education.Funding: The Alliance for Health Policy and Systems Research, World Health Organization, Geneva; Protocol IDA65869.Keywords: Delays; Waiting time; antenatal; Hospitals; Women; Maternity care; Process mapping; Nigeria

Kematangan Emosi Pada Pria Dan Wanita Yang Menikah Muda

Penelitian ini bertujuan untuk menguji secara empiris perbedaan kematangan emosi pada pria dan wanita yang menikah muda. Penelitian ini dilakukan terhadap 25 orang pria dan 25 orang wanita yang berusia antara 18 sampai dengan 24 tahun yang menikah muda. Dari 56 item disebarkan diperoleh 34 item yang valid. Nilai korelasi yang didapat berkisar antara 0.307 sampai 0.752 sedangkan koefisien reliabilitas sebesar 0.884. Uji hipotesis menggunakan uji beda U Mann-Whitney, karena tidak terpenuhinya kriteria uji statistik parametrik. Berdasarkan analisis data diperoleh skor t sebesar -3.061 (p < 0.01). Hasil tersebut menunjukkan adanya perbedaan kematangan emosi yang sangat signifikan pada pria dan wanita yang menikah muda

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

HIV in Pregnancy: Experience at Abeokuta, Nigeria

Background: The human immunodeficiency virus (HIV) pandemic remains a major threat to public health. Measures to minimize mother to child transfusion remain a major focus of research. Objectives: To determine the prevalence of HIV in pregnancy in our obstetric clinic population and evaluate the effects of HIV infection on the course and outcome of pregnancy. Materials & Methods: A case-control study of all HIV-positive pregnant women who delivered at the Federal Medical Centre, Abeokuta between January, 1997 and June, 2000. Selected characteristics including age, parity, gestational age at booking, weight gain in pregnancy, duration of pregnancy and the infants characteristics were compared between seropositive and negative women. Results: Sixteen women had HIV infection among a total of 2,442 women booked during the study period. The prevalence of HIV infection in pregnancy was 0.7%. Following diagnosis, eight of the HIV positive women defaulted from ante-natal care None opted for anti-retroviral therapy. There were no statistically significant differences in the haematocrit at booking (p=0.9), the weight gain in pregnancy (p=0.2), birth-weights between the two groups. All the women had vaginal deliveries. There were significant differences in the infants Apgar scores and perinatal mortality rates were higher in the HIV positive group. All the mothers chose to breastfeed their infants. Conclusion: HIV infection in this population is associated with birth asphyxia and a high perinatal mortality rate. The survivors are also at great risk of vertical transmission during breast-feeding. Key Words: HIV, Pregnancy, Vertical Transmission, Birth Asphyxia. [Trop J Obstet Gynaecol, 2002, 19: 21-24]

Rating of aspects of quality of emergency obstetrics care by the Key Informants in the Hospitals (lowest rating = 1, highest = 5 per category).

<p>Rating of aspects of quality of emergency obstetrics care by the Key Informants in the Hospitals (lowest rating = 1, highest = 5 per category).</p

Map of Nigeria showing the geopolitical zones, states and study sites.

<p>Map of Nigeria showing the geopolitical zones, states and study sites.</p

Aspects of emergency obstetrics care to be improved–recommendations by key informants.

<p>Aspects of emergency obstetrics care to be improved–recommendations by key informants.</p

Assessing the knowledge and skills on emergency obstetric care among health providers: Implications for health systems strengthening in Nigeria.

ObjectiveTo assess the existing knowledge and skills relating to Emergency Obstetrics Care (EMOC) among health providers in eight referral maternity hospitals in Nigeria.Study designA cross-sectional study of skilled health providers (doctors, nurses and midwives) working in the hospitals during the period.SettingSix general hospitals (4 in the south and 2 in the north), and two teaching hospitals (both in the Northern part) of the country.PopulationAll skilled providers offering EMOC services in the hospitals during the study.MethodsA pre-tested self-administered questionnaire was used to obtain information relating to socio-demographic characteristics, the respondents' knowledge and skills in offering specific EMOC services (as compared to standard World Health Organization recommendations), and their confidence in transferring the skills to mid-level providers. Data were analyzed with univariate, bivariate, binary and multinomial logistic regression analyses. Main outcome measures: knowledge and skills in EMOC services by hospital and overall.ResultsA total of 341 health providers (148 doctors and 193 nurses/midwives) participated in the study. Averagely, the providers scored less than 46% in a composite EMOC knowledge score, with doctors scoring considerable higher than the nurses/midwives. Similarly, doctors scored higher than nurses/midwives in the self-reporting of confidence in carrying out specific EMOC functions. Health providers that scored higher in knowledge were significantly more likely to report confidence in performing specific EMOC functions as compared to those with lower scores. The self-reporting of confidence in transferring clinical skills was also higher in those with higher EMOC knowledge scores.ConclusionThe knowledge and reported skills on EMOC by health providers in referral facilities in Nigeria was lower than average. We conclude that the in-service training and re-training of health providers should be included in national policy and programs that address maternal mortality prevention in referral facilities in the country.Trial registrationNigeria Clinical Trials Registry 91540209