Availability and Utilization of Emergency Obstetric Care Services in Three Communities in Kaduna State, Northern Nigeria

Maternal mortality ratios often reflect on the quality and availability of emergency obstetric care (EmOC) services. Ten health facilities in Kaduna State were assessed to determine their capacity to provide EmOC. Each community had the recommended number of both primary and secondary health facilities per population. All secondary health facilities had 24-hour services staffed by at least one doctor and one nurse/midwife per shift, and were able to perform most signal functions of EmOC in the three months preceding the survey. However, no primary health centres (PHC) were open 24 hours, and their performance of EmOC in the three months preceding the survey was near zero. Thus the presence of functional secondary hospitals is not enough to reduce maternal mortality in communities where women have to overcome numerous barriers to reach a hospital. If shortages of personnel, equipment and supplies in PHCs were resolved, 24-hour services could lead to a sharp reduction in maternal and infant mortality among rural women in northern Nigeria (Afr. J. Reprod. Health 2010; 14[3]: 83-88).Key words: Emergency obstetric care, primary health care, maternal mortality, rural communities, northern Nigeria

Community-level Distribution of Misoprostol to Prevent Postpartum Hemorrhage at Home Births in Northern Nigeria

In Nigeria, most deaths due to postpartum hemorrhage (PPH) occur in the absence of skilled birth attendants. A study using community mobilization and the training of community drug keepers to increase access to  misoprostol for PPH prevention was conducted in five communities around Zaria in Kaduna State, Nigeria. Community-oriented resource persons (CORPs) and traditional birth attendants (TBAs) recruited and counseled pregnant women on bleeding after delivery, the importance of delivery at a health facility, and the role of misoprostol. Drug keepers stored and dispensed misoprostol during a woman’s third trimester of pregnancy. TBAs and CORPs enrolled 1,875 women from January through December 2009. These results are based on 1,577 completed postpartum interviews. Almost all women delivered at home (95%) and skilled attendance at delivery was low (7%). The availability of misoprostol protected 83% of women who delivered at home against PPH who otherwise would not have been protected. Policymakers working in similar contexts should consider utilizing commuity-level distribution models to reach women with this life-saving intervention. Afr J Reprod Health 2014; 18[2]: 166-175).Keywords: misoprostol, community-level distribution, Nigeria, maternal mortality Au Nigeria, la plupart des décès dus à une hémorragie du post-partum (HPP) se produisent en l'absence d'accoucheuses qualifiées. Une étude à travers la mobilisation communautaire et la formation des gardiens de drogues dans la communauté pour améliorer l'accès à misoprostol pour la prévention de l'HPP a été menée dans cinq communautés à l’alentour de Zaria dans l'État de Kaduna, au Nigeria. Les experts orientés vers les communautés (EOVC) et les accoucheuses traditionnelles (AT) ont été recrutés et ont conseillés aux femmes enceintes sur les saignements après l'accouchement, l'importance de l’accouchement dans un établissement de santé, et le rôle de misoprostol. Les gardiens de médicaments ont stocké et distribué misoprostol au cours du troisième trimestre de la grossesse de la femme. Les et les accoucheuses traditionnelles et les EOVC ont inscrit 1875 femmes de janvier à décembre 2009. Ces résultats sont basés sur 1 577 entrevues post-partum déjà terminées. Presque toutes les femmes ont accouché à domicile (95%) et l'assistance à l’accouchement par le personnel qualifié était faible (7%). La disponibilité de misoprostol a protégé 83% des femmes qui ont accouché à domicile contre l’HPP qui, autrement, n'auraient pas été protégées. Les décideurs qui travaillent dans des contextes similaires devraient envisager d'utiliser des modèles de distribution au niveau de la communauté pour atteindre les femmes à travers cette intervention de sauvetage. Afr J Reprod Health 2014; 18[2]: 166-175).Mots clés: misoprostol, distribution au niveau de la communauté, Nigeria, mortalité maternelle

Astronomically forced saline lake deposition and paleoclimatic response in the Huanggang Basin during the Paleogene, Eastern China

Halite is a type of evaporite that can be processed into refined salt for food processing, and used as an important raw material in the chemical industry. However, our understanding of the astronomical forcing pattern on halite formation at the sedimentary basin scale is still limited. Here, we present a halite-rich lacustrine record from the middle-late Eocene through the early Oligocene of the Dawenkou Formation in the Huanggang Basin, Eastern China. A ∼ 6.5-Myr-long floating astronomical time scale was constructed based on a 405-kyr orbital eccentricity cycle tuning of gamma-ray (GR) series measured from the Upper and Middle members of the Dawenkou Formation. Our results indicate that halite intervals in the Middle Member of the Dawenkou Formation correspond well with the minima of the 100 kyr orbital eccentricity, suggesting the short eccentricity-induced climatic cycles forcing of halite formation by impact on seasonal contrasts. Our work provides essential context for understanding the pattern of halite deposits from the aspect of climate cycles at the sedimentary basin scale

Antimicrobial Stewardship Implementation in Nigerian Hospitals: Gaps and Challenges

Background: Antimicrobial resistance (AMR) is a major clinical challenge globally. It is mainly a consequence of inappropriate prescribing and use of antibiotics. Antimicrobial stewardship (AMS) ensures that antibiotics are prescribed and used appropriately. This study assessed AMS practice in selected Nigerian hospitals.Methodology: This was a cross sectional survey of 20 Federal, State and Private tertiary hospitals randomly selected from the six geopolitical zones of Nigeria. Using an adapted WHO tool on AMS, data were collected from each hospital as regard the existence of AMS committee, Accountability and Responsibility, AMS actions, Education and Training, Monitoring and Evaluation, Infection Prevention and Control (IPC) practice, facilities to support AMS, and challenges to AMS implementation. Gaps and challenges to the implementation of the AMS among the hospitals were identified.Results: Only 6 (30%) of the 20 hospitals had AMS committees while 2 (10%) had any evidence of leadership commitment to AMS. All the hospitals had laboratory facilities to support culture and sensitivity testing. There were no regular AMS-related education or training, monitoring, evaluation or reporting activities in the hospitals, except in 7 (25%) that had participated in the global point prevalence survey (Global-PPS) of antimicrobial use and resistance being hosted by the University of Antwerp, Belgium. Challenges impeding AMS activities included lack of human and financial resources, prescribers’ opposition, lack of awareness and absence of AMS committees. Most of the gaps and challenges bordered on seeming lack of knowledge and inadequate communication among prescribers and other stakeholders.Conclusion: There is need for intense education and training activities for prescribers and other stakeholders, including but not limited to hospital administrators. Keywords: Survey, Antimicrobial Stewardship, Antimicrobial Resistance; Nigeria   French title: Mise en œuvre de la gestion des antimicrobiens dans les hôpitaux Nigérians: lacunes et défis Contexte: La résistance aux antimicrobiens (RAM) est un défi clinique majeur à l'échelle mondiale. C'estprincipalement une conséquence d'une prescription et d'une utilisation inappropriées d'antibiotiques. La gestion des antimicrobiens (AMS) garantit que les antibiotiques sont prescrits et utilisés de manière appropriée. Cette étude a évalué la pratique de l'AMS dans certains hôpitaux Nigérians. Méthodologie: Il s'agissait d'une enquête transversale de 20 hôpitaux tertiaires fédéraux, d'État et privéssélectionnés au hasard dans les six zones géopolitiques du Nigéria. À l'aide d'un outil OMS adapté sur l'AMS, des données ont été collectées auprès de chaque hôpital en ce qui concerne l'existence d'un comité AMS, la responsabilité et la responsabilité, les actions AMS, l'éducation et la formation, le suivi et l'évaluation, la  pratique de prévention et de contrôle des infections (IPC), les installations pour soutenir l'AMS. et les défis de la mise en œuvre de l'AMS. Les lacunes et les défis liés à la mise en œuvre de l'AMS parmi les hôpitaux ont été identifiés. Résultats: Seuls 6 (30%) des 20 hôpitaux avaient des comités AMS tandis que 2 (10%) avaient des preuves d'engagement du leadership envers l'AMS. Tous les hôpitaux disposaient d'installations de laboratoire pour soutenir la culture et les tests de sensibilité. Il n'y avait pas d'activités régulières d'éducation ou de formation, de suivi, d'évaluation ou de rapportage liées à la MGS dans les hôpitaux, sauf dans 7 (25%) qui avaient participé à l'enquête mondiale sur la prévalence ponctuelle (Global-PPS) de l'utilisation et de la résistance aux  antimicrobiens organisée par l'Université d'Anvers, Belgique. Les défis entravant les activités de l'AMS  comprenaient le manque de ressources humaines et financières, l'opposition des prescripteurs, le manque de sensibilisation et l'absence de comités AMS. La plupart des lacunes et des défis se limitaient à un manque apparent de connaissances et à une communication inadéquate entre les prescripteurs et les autres intervenants.Conclusion: Des activités d'éducation et de formation intensives sont nécessaires pour les prescripteurs et autres intervenants, y compris, mais sans s'y limiter, les administrateurs d'hôpitaux. Mots clés: enquête, gestion des antimicrobiens, résistance aux antimicrobiens; Nigeria   &nbsp

Corrigendum: Antimicrobial Stewardship Implementation in Nigerian Hospitals: Gaps and Challenges

No Abstract

Causes of death of women in the reproductive age group

Background: Maternal mortality is a major cause of death of women in the reproductive age group and its reduction is the focus of Millennium Development Goal 5 (MDG 5). The objective of the study was to determine the causes of death of women in the reproductive age group with emphasis on maternal deaths. Method: Two hundred and forty one cases of death of women in the reproductive age group from 1st December, 2005 to 30th November, 2007 were reviewed for age, tribe, occupation, religion, cause of death, duration of hospital stay and risk factors associated, using the death registers and case files. Result: Of the 241 cases of death recorded within the two year review period among women of the reproductive age group, a total of 234 had their causes of death specified and of these; infectious and parasitic diseases including HIV/AIDS were the commonest cause of death accounting for 32% (75) of deaths, while maternal deaths contributed 19.8%. Other common causes of death were neoplasms (22.3%), diseases of the circulatory system (10.7%). The overall maternal modality ratio was 2,598/100,000 live bidhs with wide variation between the two years studied. The direct causes of maternal modality accounted for 52.4% of cases while the indirect causes accounted for 47.6%. Direct causes of maternal mortality were hypertensive disorders of pregnancy (18.2%), haemorrhage (11.4%), puerperal sepsis including septic abortion (11.4%), and obstructed labour with or without ruptured uterus (11.4%). Conclusion: Infectious and parasitic diseases especially HIV/AIDS and tuberculosis were the leading causes of death of women in the reproductive age group contributing significantly to maternal mortality, which exerts a heavy toll on survival of women in this age group. Strategies to comprehensively address the reproductive health problems of women should be instituted

Reasons and outcome of paediatric referrals from first-level health facilities in Sabongari, Zaria, Northwestern Nigeria.

Background: Referral is a crucial component of primary care and when appropriately carried out is believed to result in favourable outcome of illnesses. This study sought to determine the reasons and outcomes of Paediatric (under-five) referrals from first-level health facilities, and the factors influencing the outcomes. Methods: A cross-sectional descriptive study was carried out in six sampled public first-level health facilities in Sabon Gari Local Government Area of Kaduna State in the Northwest zone of Nigeria. A total of 106 under-five children referred during the sixteen-week study period from the six sampled health facilities were studied. Structured questionnaires and a two-way referral form were designed and used for data collection and the children followed up to determine the type of care received and its outcome. Results: Diarrhoea was the most common reason for referral (34%) followed by convulsion (10.4%), difficulty in breathing (8.5%) and surgery (8.5%). The most important reason for the decision to refer was for better diagnosis and treatment (70.8%). The referral compliance rate was 37.8%. Of those that complied, 31 (83.8%) of them recovered, 6 (16.2%) died and none had a disability (P > 0.05). Of the 61 (62.2%) of the referrals that did not comply, the majority (65.6%) of them were treated by traditional healers while 34.4% were managed at home using home-based remedies. The compliant referrals were found to significantly have more favourable outcomes than the non-compliant cases. Factors that influenced the referral outcomes included compliance, transport difficulty, financial constraints and husband's consent. Conclusion: Referral to a higher level of care where there are better facilities for diagnosis and treatment generally improve the chances of a favourable outcome.There is a need for adequate investment in resources at first-level health facilities to make referrals worthwhile and more effective

Estimation of Maternal Mortality using the Indirect Sisterhood Method in Three Communities in Kaduna State, Northern Nigeria

The maternal mortality ratio (MMR) is a good indicator of national development but its calculation is challenging. Estimation can be expensive, labour-intensive and time consuming. Incomplete vital registration of maternal deaths further compounds the difficulty. This scenario necessitates the exploration of other means of estimating maternal mortality, usually indirect techniques. This study estimated the MMR, the percentage of deaths due to maternal causes, and the lifetime risk of maternal death in three rural communities in Zaria emirate, using the indirect sisterhood method. Respondents were mostly Hausa Muslim individuals from 15-49 years of age with a Quranic education. Maternal causes accounted for 46.8% of all deaths, with a 1:13 lifetime risk of dying from maternal causes, and an MMR of 1400 per 100,000 live births. Achieving the fifth MDG will require accurate estimates of maternal deaths. Community-based and survey-based methods such as the sisterhood method are valuable tool in rural area that lack reliable data (Afr. J. Reprod. Health 2010; 14[3]: 77-81).Key words: Sisterhood method, maternal mortality, rural communities