Perceptions of working conditions amongst health workers in state-owned facilities in northeastern Nigeria

Background: The health care sector depends to a large extent on human labor. Poor worker motivation can greatly affect health outcomes and patient safety. There is little information on the health workers\u2032 perceptions of working conditions in resource-poor settings. Method: Three state-owned facilities in each state were selected by simple random sampling technique. The selected facilities were visited on weekdays between 9 and 10 a.m. A self-administered structured questionnaire was given to all health care workers on duty in the facility at the time of visit. Results: A total of 299 questionnaires were returned. The response rate was 85.43%. Two hundred four (68.2%) workers experienced general satisfaction with their current jobs. The relationships between general job satisfaction and presence of conflict at work ( P = 0.001), freedom of expression ( P > 0.001), managerial support for staff welfare ( P > 0.001), managerial support for staff career development ( P > 0.001), availability of tools and consumables in the workplace ( P > 0.001) and progress towards personal professional goals ( P = 0.001) were statistically significant. Conclusion: The level of general job satisfaction was high. Though salaries were important, presence of conflict at work, freedom of expression, managerial support for staff welfare, managerial support for staff career development, availability of tools and consumables in the workplace and progress towards personal professional goals appear to play a role in worker motivation

Emergency obstetric care resources availability and service provision in Zaria LGA, Kaduna State

Background: At least four out of ten women will develop unpredictable complications during pregnancy, childbirth and time after delivery which if not treated, contributes to the high observed maternal mortality worldwide. Access to Emergency Obstetric Care (EmOC) has been identified as one of the key strategies for maternal mortality reduction. This study assessed the availability of EmOC resources and service provision in Zaria Local Government Area (LGA) of Kaduna State, North Western Nigeria. Methods: Using a cross-sectional descriptive study, twenty public and private health facilities that offered antenatal care and delivery services in Zaria LGA of Kaduna State were studied in July 2012. Data was collected on availability of EmOC resources and services using checklist and interviewer-administered questionnaire. Results: None of the primary health care facilities had up to four midwives recommended for 24 hours delivery services, while five of the eight secondary health facilities (62.5%) had at least four midwives. There was dearth of equipment and drugs for EmOC service provision as only 10.0% primary health facilities and 40.0% of secondary health facilities had adequate equipment and drugs to provide EmOC service. Only two secondary health facilities (25%) performed signal functions recommended for comprehensive EmOC facility and additional three secondary health facilities (37.5%) performed signal functions recommended for basic EmOC facility, however, none of the primary health care facilities performed signal functions recommended for Basic EmOC facility. Availability of equipment was the only factor found to be significantly associated with EmOC service provision in the facilities (p = 0.032), but when stratified based on level of care (primary and secondary), no significantly associated was found (p = 0.429). Conclusion: Health facilities in Zaria LGA lacked adequate resources to provide EmOC services and EmOC service provision was abysmally low. Health planners and policy makers should step up interventions for providing the necessary resources to accelerate the attainment of Millennium Development Goal 5 (MDG 5)

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Perceptions of working conditions amongst health workers in state-owned facilities in northeastern Nigeria

Background: The health care sector depends to a large extent on human labor. Poor worker motivation can greatly affect health outcomes and patient safety. There is little information on the health workers′ perceptions of working conditions in resource-poor settings. Method: Three state-owned facilities in each state were selected by simple random sampling technique. The selected facilities were visited on weekdays between 9 and 10 a.m. A self-administered structured questionnaire was given to all health care workers on duty in the facility at the time of visit. Results: A total of 299 questionnaires were returned. The response rate was 85.43%. Two hundred four (68.2%) workers experienced general satisfaction with their current jobs. The relationships between general job satisfaction and presence of conflict at work ( P = 0.001), freedom of expression ( P > 0.001), managerial support for staff welfare ( P > 0.001), managerial support for staff career development ( P > 0.001), availability of tools and consumables in the workplace ( P > 0.001) and progress towards personal professional goals ( P = 0.001) were statistically significant. Conclusion: The level of general job satisfaction was high. Though salaries were important, presence of conflict at work, freedom of expression, managerial support for staff welfare, managerial support for staff career development, availability of tools and consumables in the workplace and progress towards personal professional goals appear to play a role in worker motivation

Comportement de fécondité chez les hommes et les femmes dans trois communautés dans l’état de Kaduna, Nigéria.

The UN Millennium Project aims to reduce poverty, hunger, and disease while promoting education, health, gender equity, and environmental sustainability. Fertility is not mentioned anywhere within the eight goals, but population growth rates profoundly impact the achievability of all goals by increasing the budgets required to meet the population’s basic needs. This paper describes the fertility patterns of men and women in three communities in Kaduna State, Nigeria. The findings reveal a total fertility rate (TFR) of 7.97, which surpasses the TFR of 7.3 reported from northwest Nigeria in the 2008 NDHS. Among both men and women, desired family size was high, with 37% of women citing 5-9 children as ideal and 32% citing 10-14 children as ideal. Fewer than 20% of women wanted less than five children, but as education increased, desired fertility significantly decreased. Among men there were significant associations between age, educational status, number of current wives and religion with the mean number of children ever fatheredLe projet du millénaire des NU a comme objectif de réduire la pauvreté, la faim et la maladie tout en promouvant l’éducation, l’équité en matière des sexes et la durabilité de l’environnement. La fécondité n’a pas été mentionnée parmi les huit objectifs, mais le taux de croissance de la population influent beaucoup sur l’accomplissement de tous les objectifs en augmentant les budgets nécessaires pour répondre aux besoins essentiels de la population. Cette étude décrit les caractéristiques de la fécondité chez les hommes et les femmes dans trois communautés dans l’état de Kaduna, Nigéria. Les résultats ont révélé un taux de fécondité total (TFT) de 7,97 qui dépasse le TFT de 7,3 qui a été signalé au nord-ouest du Nigéria dans L’ENDS de l’année 2008. Parmi les hommes et les femmes, la taille familiale désirée est élevée, 37% des femmes citant 5-9 enfants comme étant le nombre idéal et 32% ont cité10-14 enfants comme étant idéal. Moins de 20% voulaient avoir moins de cinq enfants, mais au fur et à mesure que l’éducation s’est accrue, la fécondité désirée s’est baissée de manière significative. Chez les hommes, il y avait des associations importantes entre l’âge, le niveau de l’instruction reçue, le nombre de femmes du moment et la religion avec le nombre moyen d’enfants qu’ils ont jamais engendré

Oral amoxicillin compared with injectable procaine benzylpenicillin plus gentamicin for treatment of neonates and young infants with fast breathing when referral is not possible: a randomised, open-label, equivalence trial

Background: WHO recommends referral to hospital for possible serious bacterial infection in young infants aged 0–59 days. We aimed to assess whether oral amoxicillin treatment for fast breathing, in the absence of other signs, is as efficacious as the combination of injectable procaine benzylpenicillin–gentamicin. Methods: In a randomised, open-label, equivalence trial at five sites in DR Congo, Kenya, and Nigeria, community health workers followed up all births in the community, identified unwell young infants, and referred them to study nurses. We randomly assigned infants with fast breathing as a single sign of illness or possible serious bacterial infection, whose parents did not accept referral to hospital, to receive either injectable procaine benzylpenicillin–gentamicin once per day or oral amoxicillin treatment twice per day for 7 days. A person who was off-site generated randomisation lists using computer software. Trained health professionals gave injections, but outcome assessors were masked to group allocations. The primary outcome was treatment failure by day 8 after enrolment, defined as clinical deterioration, development of a serious adverse event including death, persistence of fast breathing on day 4, or recurrence up to day 8. The primary analysis was per protocol and we used a prespecified similarity margin of 5% to assess equivalence between regimens. This study is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12610000286044. Findings: From April 4, 2011, to March 29, 2013, we enrolled 2333 infants aged 0–59 days with fast breathing as the only sign of possible serious bacterial infection at the five study sites. We assigned 1170 infants to receive injectable procaine benzylpenicillin–gentamicin and 1163 infants to receive oral amoxicillin. In the per-protocol analysis, from which 137 infants were excluded, we included 1061 (91%) infants who fulfilled predefined criteria of adherence to treatment and adequate follow-up in the injectable procaine benzylpenicillin–gentamicin group and 1145 (98%) infants in the oral amoxicillin group. In the procaine benzylpenicillin–gentamicin group, 234 infants (22%) failed treatment, compared with 221 (19%) infants in the oral amoxicillin group (risk difference −2·6%, 95% CI −6·0 to 0·8). Four infants died within 15 days of follow-up in each group. We detected no drug-related serious adverse events. Interpretation: Young infants with fast breathing alone can be effectively treated with oral amoxicillin on an outpatient basis when referral to a hospital is not possible. Funding: Bill & Melinda Gates Foundation grant to WH

Simplified antibiotic regimens compared with injectable procaine benzylpenicillin plus gentamicin for treatment of neonates and young infants with clinical signs of possible serious bacterial infection when referral is not possible: a randomised, open-label, equivalence trial

Background: WHO recommends hospital-based treatment for young infants aged 0–59 days with clinical signs of possible serious bacterial infection, but most families in resource-poor settings cannot accept referral. We aimed to assess whether use of simplified antibiotic regimens to treat young infants with clinical signs of severe infection was as efficacious as an injectable procaine benzylpenicillin–gentamicin combination for 7 days for situations in which hospital referral was not possible. Methods: In a multisite open-label equivalence trial in DR Congo, Kenya, and Nigeria, community health workers visited all newborn babies at home, identifying and referring unwell young infants to a study nurse. We stratified young infants with clinical signs of severe infection whose parents did not accept referral to hospital by age (0–6 days and 7–59 days), and randomly assigned each individual within these strata to receive one of the four treatment regimens. Randomisation was stratified by age group of infants. An age-stratified randomisation scheme with block size of eight was computer-generated off-site at WHO. The outcome assessor was masked. We randomly allocated infants to receive injectable procaine benzylpenicillin–gentamicin for 7 days (group A, reference group); injectable gentamicin and oral amoxicillin for 7 days (group B); injectable procaine benzylpenicillin–gentamicin for 2 days, then oral amoxicillin for 5 days (group C); or injectable gentamicin for 2 days and oral amoxicillin for 7 days (group D). Trained health professionals gave daily injections and the first dose of oral amoxicillin. Our primary outcome was treatment failure by day 8 after enrolment, defined as clinical deterioration, development of a serious adverse event (including death), no improvement by day 4, or not cured by day 8. Independent outcome assessors, who did not know the infant\u27s treatment regimen, assessed study outcomes on days 4, 8, 11, and 15. Primary analysis was per protocol. We used a prespecified similarity margin of 5% to assess equivalence between regimens. This study is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12610000286044. Findings: In Kenya and Nigeria, we started enrolment on April 4, 2011, and we enrolled the necessary number of young infants aged 7 days or older from Oct 17, 2011, to April 30, 2012. At these sites, we continued to enrol infants younger than 7 days until March 29, 2013. In DR Congo, we started enrolment on Sept 17, 2012, and continued until June 28, 2013. We randomly assigned 3564 young infants to either group A (n=894), group B (n=884), group C (n=896), or group D (n=890). We excluded 200 randomly assigned infants, who did not fulfil the predefined criteria of adherence to treatment and adequate follow-up. In the per-protocol analysis, 828 infants were included in group A, 826 in group B, 862 in group C, and 848 in group D. 67 (8%) infants failed treatment in group A compared with 51 (6%) infants in group B (risk difference −1·9%, 95% CI −4·4 to 0·1), 65 (8%) in group C (−0·6%, −3·1 to 2·0), and 46 (5%) in group D (−2·7%, −5·1 to 0·3). Treatment failure in groups B, C, and D was within the similarity margin compared with group A. During the 15 days after random allocation, 12 (1%) infants died in group A, compared with ten (1%) infants in group B, 20 (2%) infants in group C, and 11 (1%) infants in group D. An infant in group A had a serious adverse event other than death (injection abscess). Interpretation: The three simplified regimens were as effective as injectable procaine benzylpenicillin–gentamicin for 7 days on an outpatient basis in young infants with clinical signs of severe infection, without signs of critical illness, and whose caregivers did not accept referral for hospital admission. Funding: Bill & Melinda Gates Foundation grant to WH