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

Barriers to and determinants of the use of intermittent preventive treatment of malaria in pregnancy in Cross River State, Nigeria: a cross-sectional study

BACKGROUND: Malaria in pregnancy (MIP) has serious consequences for the woman, unborn child and newborn. The use of sulfadoxine-pyrimethamine for the intermittent preventive treatment of malaria in pregnancy (SP-IPTp) is low in malaria endemic areas, including some regions of Nigeria. However, little is known about pregnant women’s compliance with the SP-IPTp national guidelines in primary health care (PHC) facilities in the south-south region of Nigeria. The aim of this study was to identify the barriers to and determinants of the use of SP-IPTp among pregnant women attending ANC in PHC facilities in Cross River State, south-south region of Nigeria. METHODS: A cross-sectional survey was conducted in 2011 among 400 ANC attendees aged 15–49 years recruited through multistage sampling. Binary logistic regression was used to determine the factors associated with the use of SP-IPTp in the study population. RESULTS: Use of SP-IPTp was self-reported by 41 % of the total respondents. Lack of autonomy in the households to receive sulfadoxine-pyrimethamine (SP) during ANC was the main barrier to use of IPTp (83 %). Other barriers were stock-outs of free SP (33 %) and poor supervision of SP ingestion by directly observed treatment among those who obtained SP from ANC clinics (36/110 = 33 %). In the multivariate logistic regression, the odds of using SP-IPTp was increased by the knowledge of the use of insecticide treated nets (ITNs) (OR = 2.13, 95 % CI: 1.70–3.73) and SP (OR = 22.13, 95 % CI: 8.10–43.20) for the prevention of MIP. Use of ITNs also increased the odds of using SP-IPTp (OR = 2.38, 95 % CI: 1.24–12.31). CONCLUSIONS: Use of SP-IPTp was low and was associated with knowledge of the use of ITNs and SP as well as the use of ITNs for the prevention of MIP. There is a need to strengthen PHC systems and address barriers to the usage of SP-IPTp in order to reduce the burden of MIP. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12884-016-0883-2) contains supplementary material, which is available to authorized users

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

Factors affecting the delivery, access, and use of interventions to prevent malaria in pregnancy in sub-Saharan Africa: a systematic review and meta-analysis.

BACKGROUND: Malaria in pregnancy has important consequences for mother and baby. Coverage with the World Health Organization-recommended prevention strategy for pregnant women in sub-Saharan Africa of intermittent preventive treatment in pregnancy (IPTp) and insecticide-treated nets (ITNs) is low. We conducted a systematic review to explore factors affecting delivery, access, and use of IPTp and ITNs among healthcare providers and women. METHODS AND RESULTS: We searched the Malaria in Pregnancy Library and Global Health Database from 1 January 1990 to 23 April 2013, without language restriction. Data extraction was performed by two investigators independently, and data was appraised for quality and content. Data on barriers and facilitators, and the effect of interventions, were explored using content analysis and narrative synthesis. We conducted a meta-analysis of determinants of IPTp and ITN uptake using random effects models, and performed subgroup analysis to evaluate consistency across interventions and study populations, countries, and enrolment sites. We did not perform a meta-ethnography of qualitative data. Ninety-eight articles were included, of which 20 were intervention studies. Key barriers to the provision of IPTp and ITNs were unclear policy and guidance on IPTp; general healthcare system issues, such as stockouts and user fees; health facility issues stemming from poor organisation, leading to poor quality of care; poor healthcare provider performance, including confusion over the timing of each IPTp dose; and women's poor antenatal attendance, affecting IPTp uptake. Key determinants of IPTp coverage were education, knowledge about malaria/IPTp, socio-economic status, parity, and number and timing of antenatal clinic visits. Key determinants of ITN coverage were employment status, education, knowledge about malaria/ITNs, age, and marital status. Predictors showed regional variations. CONCLUSIONS: Delivery of ITNs through antenatal clinics presents fewer problems than delivery of IPTp. Many obstacles to IPTp delivery are relatively simple barriers that could be resolved in the short term. Other barriers are more entrenched within the overall healthcare system or socio-economic/cultural contexts, and will require medium- to long-term strategies. Please see later in the article for the Editors' Summary