Knowledge and utilization of malaria preventive measures among pregnant women at a tertiary hospital in Nigeria’s federal capital territory

Objective: To determine the knowledge and utilization of malaria preventive measures as well as barriers to the utilization of these measures by pregnant women.Materials and Methods: The study was a prospective cross-sectional survey involving pregnant women at the booking clinic of the University of Abuja Teaching Hospital between May and August 2010. Close-ended pre-tested structured questionnaires were administered by interviewer method to 403 consecutive consenting women.Results: The knowledge of malaria and its preventive measures in pregnancy was 71.5%. There was a statistically significant association between knowledge of malaria and educational status (X2 = 16.053, P = 0.035). Intermittent preventive treatment was used by 15.9% of the respondents. Insecticide-treated net ownership was 42.6%; however,its use declined from 28.5% before pregnancy to 24.6% during pregnancy.Conclusion: There is adequate knowledge about malaria and its preventive measures in pregnancy, but the utilization of these measures is poor. There is need for concerted efforts at addressing the barriers to utilization of these effective interventions.Key words: Knowledge, malaria in pregnancy, Nigeria, preventio

What Are the Contextual Enablers and Impacts of Using Digital Technology to Extend Maternal and Child Health Services to Rural Areas? Findings of a Qualitative Study From Nigeria

Background: Strengthening health systems to improve access to maternity services remains challenging for Nigeria due partly to weak and irregular in-service training and deficient data management. This paper reports the implementation of digital health tools for video training (VTR) of health workers and digitization of health data at scale, supported by satellite communications (SatCom) technology and existing 3G mobile networks. Objective: To understand whether, and under what circumstances using digital interventions to extend maternal, newborn and child health (MNCH) services to remote areas of Nigeria improved standards of healthcare delivery. Methods: From March 2017 to March 2019, VTR and data digitization interventions were delivered in 126 facilities across three states of Nigeria. Data collection combined documents review with 294 semi-structured interviews of stakeholders across four phases (baseline, midline, endline, and 12-months post-project closedown) to assess acceptability and impacts of digital interventions. Data was analyzed using a framework approach, drawing on a modified Technology Acceptance Model to identify factors that shaped technology adoption and use. Results: Analysis of documents and interview transcripts revealed that a supportive policy environment, and track record of private-public partnerships facilitated adoption of technology. The determinants of technology acceptance among health workers included ease of use, perceived usefulness, and prior familiarity with technology. Perceptions of impact suggested that at the micro (individual) level, repeated engagement with clinical videos increased staff knowledge, motivation and confidence to perform healthcare roles. At meso (organizational) level, better-trained staff felt supported and empowered to provide respectful healthcare and improved management of obstetric complications, triggering increased use of MNCH services. The macro level saw greater use of reliable and accurate data for policymaking. Conclusions: Simultaneous and sustained implementation of VTR and data digitization at scale enabled through SatCom and 3G mobile networks are feasible approaches for supporting improvements in staff confidence and motivation and reported MNCH practices. By identifying mechanisms of impact of digital interventions on micro, meso, and macro levels of the health system, the study extends the evidence base for effectiveness of digital health and theoretical underpinnings to guide further technology use for improving MNCH services in low resource settings. Trial Registration: ISRCTN32105372

Papanicolaou Smear in Abuja Revisited

Background: Papinicolaou smear has been established as a cost effective screening method for Carcinoma of the cervix and had been used with celebrated successes in developed societies. Its utilization has remained abysmally low in Africa with attendant alarming rate of overt advanced cancer among her female population. Recent government public outreach programs abound and there is need to evaluate the effectiveness of these campaigns on the outcome of smear results with a view of future adjustment in outreach strategy.Objectives: To review the results of Pap smears conducted in University of Abuja Teaching Hospital with a view of documenting the prevalence of positive smears among the study population.Materials and Method: A three year retrospective study of Pap smears that were carried out at the University of Abuja Teaching Hospital between January 1, 2010 and December 31, 2012. The records of the patients were retrieved from medical record Department and analysed for age of the patient, parity, educational status, marital status, findings on vaginal examination, indication for pap smear and Pap smear results. The results were presented and discussed using simple percentages.Results: One thousand two hundred and seventy four (1274) women had cervical smears during the study period. Ninety eight percent of patients were having their cervical screening for the first time at the mean age of 39.13±9.7 years. Positive Pap smear result was obtained in 39.5% of symptomatic and 24.4% of asymptomatic patients while Negative smears were recorded in 63.8% of the patients. Human Papilloma Virus (HPV) changes occurred in 5.7%, while atypical cells of undetermined significance (ASCUS) were observed in 4.9% of the patients. Low grade squamous intraepithelial lesions (LSIL) were the commonest cervical smear abnormality observed in 9.6% of the patients.Conclusion: The mean age at first screening remain high with corresponding high rate of abnormal smear in both symptomatic and asymptomatic patients. The provider initiated counseling and testing is encouraged for early identification and treatment of precancerous lesions of Carcinoma of Cervix. Development and strict adherence of a National guideline for free routine screening of all women of reproductive life may increase the uptake.Key words: Cervical cancer, Screening, Pap smear, Utilization

Innovative Application of Digital Health Solutions to Strengthen Health Systems and Improve Health Outcomes in Rural Populations of Abuja, Nigeria

Objective To evaluate the impact of a novel e-health intervention that used satellite connectivity infrastructure (SatCom), video training apps (VTR), and data management tools (ClinPak) enabled mobile tablet computers for frontline health workers' training /data management towards achieving improvements in maternal, newborn and child health care service delivery in rural communities in Abuja, Nigeria. Methods E-Health innovations were deployed to 29 primary health centers in Gwagwalada local government area (LGA), Abuja (intervention LGA) while these interventions were not deployed to 29 PHCs in Kuje Local government area, Abuja which was the non-intervention LGA for a period of 24 months (March 2017-March 2019). A mixed-methods study design was used to evaluate the impact of novel E-Health tools implementations on maternal, newborn, and child health services delivery in the rural communities in Abuja, Nigeria by comparing findings at baseline and end line. Results There was an increase in the rate of utilization of MNCH services, client’s satisfaction and health workers confidence and competence to provide MNCH related services in the intervention LGA at endline when compared to baseline. Data management also improved with the use of the e-health tool with the additional benefit of utilization of the data for decision making and governance in the PHCs. Conclusion E-health innovations when implemented at scale with the involvement of relevant stakeholders improved MNCH service delivery in PHCs in Abuja, Nigeria. The importance of political will by the government at local, state, and national level for further programmatic scale-up and sustainability cannot be over-emphasized

Fetal outcome of twin gestations in a Nigerian Teaching Hospital

BACKGROUND: Although twin gestation is associated with increased perinatal morbidity and mortality, optimal management of this high risk pregnancy is associated with improved outcome for the mother and her baby. Globally, Nigeria has the highest incidence of twinning. This makes studies on twin gestation important, especially on the outcome of the babies which is reflection of the type of care received during the antenatal and intrapartum period.STUDY OBJECTIVE: This study was designed to determine the fetal outcomes of twin deliveries in a tertiary hospital in Nigeria's Federal Capital Territory.METHOD: This was a retrospective study of babies following twin pregnancies delivered in the hospital from 1st January 1998 to 31st December 2007.RESULTS: Out of the 600 babies reviewed, 10.2% were still births giving a still birth rate of 102 per 1000 births. . Majority of the stillbirths (73.8%) occurred amongst the unbooked mothers and was higher amongst the second twins. More of the booked mothers had their babies delivered at term compared to the unbooked ones, 115(38.3%) Vs 66(22.0%).There was a statistically significant association between gestational age at delivery and booking status of the paturients. (X2=16.257, P=0.001).The mean fetal weight was 2.395 kg±0.63. There was no statistically significant difference when the weights of the first and second twin were compared. (t=0.343, P=0.732). Out of the 539 babies born alive, 85.0% had good Apgar score of = 7 in 5 minutes, 13.0% of the first twins had moderate birth asphyxia compared to 16.0% of the second twins. The female to male ratio was 1:1.1.CONCLUSION: Twin gestation is associated with low birth weights and high still birth rate in this centre. Fetal outcome is better in the first twin compared to the second twin. Outcome for babies whose mothers were booked were better compared to the unbooked. Quality antenatal care and intrapartum management will help improve fetal outcome.KEY WORDS: Twin pregnancy, fetal outcome, Abuja, Nigeri

Child mortality from sickle cell disease in Nigeria: a model-estimated, population-level analysis of data from the 2018 Demographic and Health Survey

Background Child mortality from sickle cell disease in sub-Saharan Africa is presumed to be high but is not well quantified. This uncertainty contributes to the neglect of sickle cell disease and delays the prioritisation of interventions. In this study, we estimated the mortality of children in Nigeria with sickle cell disease, and the proportion of national under-5 mortality attributable to sickle cell disease. Methods We did a model-estimated, population-level analysis of data from Nigeria's 2018 Demographic and Health Survey (DHS) to estimate the prevalence and geographical distribution of HbSS and HbSC genotypes assuming Hardy-Weinberg equilibrium near birth. Interviews for the survey were done between Aug 14 and Dec 29, 2018, and the embedded sickle cell disease survey was done in a randomly selected third of the overall survey's households. We developed an approach for estimating child mortality from sickle cell disease by combining information on tested children and their untested siblings. Tested children were aged 6–59 months at the time of the survey. Untested siblings born 0–14 years before the survey were also included in analyses. Testing as part of the DHS was done without regard to disease status. We analysed mortality differences using the inheritance-derived genotypic distribution of untested siblings older than the tested cohort, enabling us to estimate excess mortality from sickle cell disease for the older-sibling cohort (ie, those born between 2003 and 2013). Findings We analysed test results for 11 186 children aged 6–59 months from 7411 households in Nigeria. The estimated average birth prevalence of HbSS was 1·21% (95% CI 1·09–1·37) and was 0·24% (0·19–0·31) for HbSC. We obtained data for estimating child mortality from 10 195 tested children (who could be matched to the individual mother survey) and 17 205 of their untested siblings. 15 227 of the siblings were in the older-sibling cohort. The group of children with sickle cell disease born between 2003 and 2013 with at least one younger sibling in the survey had about 370 excess under-5 deaths per 1000 livebirths (95% CI 150–580; p=0·0008) than children with HbAA. The estimated national average under-5 mortality for children with sickle cell disease born between 2003 and 2013 was 490 per 1000 livebirths (95% CI 270–700), 4·0 times higher (95% CI 2·1–6·0) than children with HbAA. About 4·2% (95% CI 1·7–6·9) of national under-5 mortality was attributable to excess mortality from sickle cell disease. Interpretation The burden of child mortality from sickle cell disease in Nigeria continues to be disproportionately higher than the burden of mortality of children without sickle cell disease. Most of these deaths could be prevented if adequate resources were allocated and available focused interventions were implemented. The methods developed in this study could be used to estimate the burden of sickle cell disease elsewhere in Africa and south Asia. Funding Sickle Pan African Research Consortium, and the Bill & Melinda Gates Foundation