Implementing components of the PHC for PE/E model in Nigeria: A cost analysis

Between 2016 and 2018, the Population Council, in partnership with the Nigerian Federal and State Ministries of Health, implemented an intervention to confront pre-eclampsia/eclampsia (PE/E) in three states—Cross River, Ebonyi, and Kogi. This was part of the Ending Eclampsia project, a five-year USAID investment that implemented aspects of the Primary Health Care (PHC) PE/E Model in Bangladesh, Nigeria, and Pakistan. The intervention in Nigeria was comprised of five components of the PHC for PE/E Model: 1) Task sharing to detect and manage PE/E (MgSO4 and referral) with PHC providers; 2) Introducing antihypertensive drug provision at the PHC level; 3) Engaging women’s groups to increase ANC uptake; 4) Logistic Officer training to reduce PE/E commodity stockouts; and 5) Health education messages. This brief describes the true cost for implementing each component in Nigeria. This implementation cost analysis serves as a starting point for those considering implementation of different components of the PHC PE/E Model

Assessing quality of care and outcomes for women and their Infants in Nigeria after pregnancies complicated by hypertensive disorders

Hypertensive disorders in pregnancy (HDPs) are the leading cause of maternal mortality in Nigeria—now killing more women than postpartum hemorrhage. Various factors, including lack of capacity among lower-level health-care providers to detect, manage, and refer complications, have been indicated as reasons for most of these deaths. A landscape analysis of pre-eclampsia/eclampsia (PE/E) in Nigeria identified a lack of further information after delivery about the women who experienced HDPs. In this study, the Ending Eclampsia project recruited women with HDPs around the time of childbirth, and prospectively followed them for up to one year postpartum. The study evaluated the care these women received during the first six to eight weeks after delivery, for both themselves and their infants. Health statuses were assessed, and any patterns of morbidity were identified in the year after these deliveries. The magnitude of the gaps in care during the postnatal period, for both the women and their infants, is evaluated in this report, along with an examination of the pattern of morbidities and mortalities in this cohort of women during the year of monitoring

Landscape analysis of pre-eclampsia/eclampsia in Nigeria

The Population Council’s Ending Eclampsia project, with support from USAID, seeks to expand access to proven, underutilized interventions and commodities for the prevention, early detection, and treatment of pre-eclampsia and eclampsia (PE/E) and to strengthen global partnerships. The Council conducted a landscape analysis on PE/E in Nigeria in 2015. Its main objectives were to understand the level of programmatic and policy support for PE/E prevention and treatment; to analyze gaps in providers’ competence to prevent, detect, and manage PE/E; to determine capacity at primary health facilities to manage PE/E; to assess community awareness, beliefs, and experiences around PE/E; to understand the research conducted on PE/E in the last 15 years; and to determine priority areas for research and programmatic interventions. This landscape report provides highlights of the landscape analysis in Nigeria and suggests priority areas for intervention

Post-intervention analysis of pre-eclampsia and eclampsia in three Nigerian states

In the last three decades, global maternal mortality has decreased by almost 45 percent, but approximately 830 women still die daily from largely preventable pregnancy complications. Since 2015, the Ending Eclampsia project, with support from USAID, has been working to expand proven, underutilized interventions and commodities for pre-eclampsia/eclampsia (PE/E) prevention, early detection, and treatment, and to strengthen global partnerships for care of hypertensive disorders in pregnancy (HDP), of which PE/E are the severest forms. A systematic review of the literature identifies a number of articles reporting PE/E burdens within set populations, common risk factors, adverse outcomes, and mortality rates, but few discuss implementation research (IR) to improve PE/E prevention, detection, and timely management. Following the literature review and subsequent analysis of antenatal care and PE/E in seven Nigerian states in 2015, the project intensified its activities and IR in Cross River, Ebonyi, and Kogi states, emphasizing task sharing with primary health-care providers for the detection and management of HDP. This endline report describes the IR approach of the Population Council in Nigeria from 2016 to 2018 and its results

RETRATO SIN IDENTIFICAR [Material gráfico]

Copia digital. Madrid : Ministerio de Educación, Cultura y Deporte, 201

Mise en œuvre des composantes du modèle ssp pour la PE / E au Nigéria : une analyse des coûts

Entre 2016 et 2018, le Population Council, en partenariat avec les Ministères de la Santé fédéraux et des États du Nigéria, a mis en œuvre une intervention visant à lutter contre la pré-éclampsie/éclampsie (PE/E) dans trois États: Ebonyi, Cross River et Kogi. C’était dans le cadre du projet Ending Eclampsia, un investissement quinquennal de l\u27USAID qui a mis en œuvre des aspects du modèle de soins de santé primaires (SSP) pour le modèle PE/E au Bangladesh, au Nigéria et au Pakistan. L\u27intervention au Nigéria comprenait cinq composantes de SSP pour le modèle PE/E: 1) le partage des tâches avec des prestataires de SSP en vue de détecter et de prendre en charge la PE/E (MgSO4 et référence); 2) l’introduction de la fourniture de médicaments antihypertenseurs au niveau des SSP; 3) la mobilisation des groupes de femmes en vue d’accroître l’utilisation des soins prénatals; 4) la formation des agents logistiques en vue de réduire les ruptures de stock de produits PE/E; et 5) les messages d\u27éducation sanitaire. Ce bref décrit le coût réel de la mise en œuvre de chaque composant au Nigéria. Cette analyse des coûts de mise en œuvre sert de point de départ à ceux qui envisagent de mettre en œuvre différentes composantes du modèle SSP pour la PE/E. --- Between 2016 and 2018, the Population Council, in partnership with the Nigerian Federal and State Ministries of Health, implemented an intervention to confront pre-eclampsia/eclampsia (PE/E) in three states—Cross River, Ebonyi, and Kogi. This was part of the Ending Eclampsia project, a five-year USAID investment that implemented aspects of the Primary Health Care (PHC) PE/E Model in Bangladesh, Nigeria, and Pakistan. The intervention in Nigeria was comprised of five components of the PHC for PE/E Model: 1) Task sharing to detect and manage PE/E (MgSO4 and referral) with PHC providers; 2) Introducing antihypertensive drug provision at the PHC level; 3) Engaging women’s groups to increase ANC uptake; 4) Logistic Officer training to reduce PE/E commodity stockouts; and 5) Health education messages. This brief describes the true cost for implementing each component in Nigeria. This implementation cost analysis serves as a starting point for those considering implementation of different components of the PHC PE/E Model

Training-of-trainers of nurses and midwives as a strategy for the reduction of eclampsia-related maternal mortality in Nigeria

Background: Preeclampsia and eclampsia (PE/E) are major contributors to maternal and perinatal mortality in Nigeria. Despite the availability of current curriculum at Nigerian schools of nursing and midwifery, the knowledge on the management of PE/E among the students has remained poor. In order to reduce maternal and perinatal mortality in developing countries, targeted training and supportive supervision of frontline health care providers have been recommended. Methodology: A total of 292 tutors from 171 schools of nursing and midwifery participated in the training of the trainers' workshops on current management of PE/E across the country. Pre- and post-test assessments were administered. Six months after the training, 29 schools and 84 tutors were randomly selected for follow-up to evaluate the impact of the training. Results: Significant knowledge transfer occurred among the participants as the pretest/posttest analysis showed knowledge transmission across all the 13 knowledge items assessed. The follow-up evaluation also showed that the trained tutors conducted 19 step-down trainings and trained 157 other tutors in their respective schools. Subsequently, 2382 nursing and midwifery students were properly trained. However, six of the monitored schools (24.2%) lacked all the essential kits for teaching on PE/E. Conclusion: Updating the knowledge of tutors leads to improved preservice training of the future generation of nurses and midwives. This will likely result in higher quality of care to patients and reduce PE/E-related maternal and perinatal mortality. However, there is need to provide essential training kits for teaching of student nurses and midwives

Exploring survivor perceptions of pre-eclampsia and eclampsia in Nigeria through the health belief model

Background: In Nigeria, hypertensive disorders have become the leading cause of facility-based maternal mortality. Many factors influence pregnant women’s health-seeking behaviors and perceptions around the importance of antenatal care. This qualitative study describes the care-seeking pathways of Nigerian women who suffer from pre-eclampsia and eclampsia. It identifies the influences – barriers and enablers – that affect their decision making, and proposes solutions articulated by women themselves to overcome the obstacles they face. Informing this study is the health belief model, a cognitive value-expectancy theory that provides a framework for exploring perceptions and understanding women’s narratives around pre-eclampsia and eclampsia-related care seeking. Methods: This study adopted a qualitative design that enables fully capturing the narratives of women who experienced pre-eclampsia and eclampsia during their pregnancy. In-depth interviews were conducted with 42 women aged 17–48 years over five months in 2015 from Bauchi, Cross River, Ebonyi, Katsina, Kogi, Ondo and Sokoto states to ensure representation from each geo-political zone in Nigeria. These qualitative data were analyzed through coding and memo-writing, using NVivo 11 software. Results: We found that many of the beliefs, attitudes, knowledge and behaviors of women are consistent across the country, with some variation between the north and south. In Nigeria, women’s perceived susceptibility and threat of health complications during pregnancy and childbirth, including pre-eclampsia and eclampsia, influence care-seeking behaviors. Moderating influences include acquisition of knowledge of causes and signs of pre-eclampsia, the quality of patient-provider antenatal care interactions, and supportive discussions and care seeking-enabling decisions with families and communities. These cues to action mitigate perceived mobility, financial, mistrust, and contextual barriers to seeking timely care and promote the benefits of maternal and newborn survival and greater confidence in and access to the health system. Conclusions: The health belief model reveals intersectional effects of childbearing norms, socio-cultural beliefs and trust in the health system and elucidates opportunities to intervene and improve access to quality and respectful care throughout a woman’s pregnancy and childbirth. Across Nigerian settings, it is critical to enhance context-adapted community awareness programs and interventions to promote birth preparedness and social support

Obstetric knowledge of nurse-educators in Nigeria: Levels, regional differentials and their implications for maternal health delivery

Objective: To assess the knowledge of nurse-midwife educators on the major causes of maternal mortality in Nigeria. Setting: Schools of nursing and midwifery in Nigeria. Method: A total of 292 educators from 171 schools of nursing and midwifery in Nigeria were surveyed for their knowledge of the major causes of maternal mortality as a prelude to the design and implementation of a train-the-trainer intervention geared towards improved maternal health-care delivery. Results: There was paucity of knowledge across all major causes. Only 57.2% and 62.7% of educators could diagnose pre-eclampsia and severe pre-eclampsia, respectively. While 86% knew about magnesium sulphate (MgSO4) as the ‘gold standard’ for treating eclampsia, only 16.8% knew of calcium gluconate as an antidote to MgSO4 toxicity. Of the educators, 63.7% could not describe the components of active management of third stage of labour, while 29.5% were not aware of uterine atony as a cause of postpartum haemorrhage. Furthermore, 65.4% believed that misoprostol is the preferred oxytocic for hospital delivery. Other potentially harmful knowledge gaps were also found, such as 47.3% of the participants reporting that they would perform episiotomies on all primigravidae. Conclusion: Nurse/midwife educators in Nigeria are not as knowledgeable as previously thought, especially concerning the causes of maternal mortality. In order to scale up the quality of obstetric care, updated pre-service curricula should be implemented fully while in-service appraisal and continuing education should be introduced

Exploring survivor perceptions of pre-eclampsia and eclampsia in Nigeria through the health belief model

BACKGROUND: In Nigeria, hypertensive disorders have become the leading cause of facility-based maternal mortality. Many factors influence pregnant women's health-seeking behaviors and perceptions around the importance of antenatal care. This qualitative study describes the care-seeking pathways of Nigerian women who suffer from pre-eclampsia and eclampsia. It identifies the influences - barriers and enablers - that affect their decision making, and proposes solutions articulated by women themselves to overcome the obstacles they face. Informing this study is the health belief model, a cognitive value-expectancy theory that provides a framework for exploring perceptions and understanding women's narratives around pre-eclampsia and eclampsia-related care seeking. METHODS: This study adopted a qualitative design that enables fully capturing the narratives of women who experienced pre-eclampsia and eclampsia during their pregnancy. In-depth interviews were conducted with 42 women aged 17-48 years over five months in 2015 from Bauchi, Cross River, Ebonyi, Katsina, Kogi, Ondo and Sokoto states to ensure representation from each geo-political zone in Nigeria. These qualitative data were analyzed through coding and memo-writing, using NVivo 11 software. RESULTS: We found that many of the beliefs, attitudes, knowledge and behaviors of women are consistent across the country, with some variation between the north and south. In Nigeria, women's perceived susceptibility and threat of health complications during pregnancy and childbirth, including pre-eclampsia and eclampsia, influence care-seeking behaviors. Moderating influences include acquisition of knowledge of causes and signs of pre-eclampsia, the quality of patient-provider antenatal care interactions, and supportive discussions and care seeking-enabling decisions with families and communities. These cues to action mitigate perceived mobility, financial, mistrust, and contextual barriers to seeking timely care and promote the benefits of maternal and newborn survival and greater confidence in and access to the health system. CONCLUSIONS: The health belief model reveals intersectional effects of childbearing norms, socio-cultural beliefs and trust in the health system and elucidates opportunities to intervene and improve access to quality and respectful care throughout a woman's pregnancy and childbirth. Across Nigerian settings, it is critical to enhance context-adapted community awareness programs and interventions to promote birth preparedness and social support