Présence des accoucheurs qualifiés : les défis clé au progrès dans l'accomplissement des ODM – 5 au nord central du Nigéria

The importance of skilled attendance at delivery, as reflected in the MDG 5, is being promoted in developing countries to address the high maternal/perinatal morbidity and mortality. Evaluation of personnel skills and availability of material resources are central to elimination of barriers to delivery of basic Emergency Obstetric Care (EOC) to the community. We designed a semi-structured, interviewee-administered questionnaire for 54 certified Nurse-Midwives working in Primary Health Care (PHC) clinics in Nasarawa State, central Nigeria, and examined their knowledge and competencies in the five major areas responsible for maternal mortality in sub-Saharan Africa, including power supply, referral linkages and motivation to work. Majority 51 (94.4%) of PHCs neither used the Partograph nor performed manual vacuum aspiration. Referral systems and feedback mechanisms were practically non-existent, 38 (70.4%) of facilities were >5km from the nearest referral centre, with 14(29.5%) connected to the national grid. Majority (68.5%) of respondents would want to work abroad. The quality of skilled attendance is low and basic EOC facilities are lacking, a situation further threatened by potential emigration to greener pastures. Governments and development partners need to address facility and skilled manpower shortages in developing countries to make a modest attempt at meeting the MDG on maternal health.L'importance de la présence du personnel qualifié pendant l'accouchement, tel que cela figure dans les ODM–5 est reconnue et encouragée dans les pays en voie de développement pour aborder la haute mortalité et la morbidité périnatale. L'évaluation de la compétence du personnel et la disponibilité des ressources matérielles jouent un rôle essentiel dans l'élimination des obstacles à la prestation des services obstétriques d'urgence de base (SOUB) à la communauté. Nous avons formulé un questionnaire semi–structuré pour 54 sages–femmes qui travaillent dans des cliniques des services médicaux primaires (SMP) dans l'état de Nassarawa, dans la région centrale du Nigéria. Nous avons étudié leur connaissance et compétences dans les cinq domaines principaux qui sont responsables de la mortalité maternelle en Afrique sub–saharéenne y compris l'alimentation électrique, les liaisons des services d'orientation des malades vers un spécialiste et la motivation pour travailler. La majorité des SMPs (94,4%) n'ont pas utilisé le partographe et ils n'ont pas fait l'aspiration pneumatique manuelle. Il n'existait pratiquement pas de systèmes d'orientations vers les spécialistes et des mécanismes pour des réactions. 38(70,4%) établissements étaient situés à>5km du centre des orientations le plus proche, alors que 14 (29,5%) étaient reliés au réseau électrique national. La majorité (68,5%) des interviewés aimeraient travailler à l'étranger. La qualité du personnel qualifié est basse et les structures de base manquent, une situation qui est davantage menacée par la possibilité de la migration ver les cieux plus cléments +++++v Il est nécessaire que les gouvernements et les partenaires en matière de développement abordent les problèmes du manque de structures et de personnel dans les pays en voie de développement afin d'essayer, d'une manière modeste, d'accomplir les ODMs dans le domaine de la santé maternelle

Assessment of the bone quality of black male athletes using calcaneal ultrasound: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Lifestyle, genetics and environmental factors are established determinants of bone density. We aimed to describe the bone characteristics of competitive top-ranked Nigerian male athletes using calcaneal ultrasound and to assess whether intensive training promotes higher bone density in an environment with reportedly low calcium intake; to compare the bone characteristics of footballers with runners and other sportsmen; and to assess the correlation of stiffness index (SI) with activity level, since energy expenditure correlates with length of training and by extension, magnitude of skeletal loading.</p> <p>Methods</p> <p>We recruited 102 male athletes: these included football (n = 68), running (n = 15), handball (n = 7), taekwando (n = 6), cycling (n = 2), judo (1), badminton (1) and high jump (1). Anthropometric data were first recorded on a structured form and energy expenditure was indirectly estimated with a validated questionnaire. Bone density was assessed using the Lunar Achilles+ calcaneal ultrasonometer.</p> <p>Results</p> <p>The mean age of athletes was 25 ± 6 years. The means of BMI and energy expenditure were 21.9 ± 2.0 kg/m²and 35.0 ± 13.7 kcal/kg/day, respectively. Footballers were younger (p < 0.001) and heavier (p < 0.001) than runners. Football was a significant determinant of BUA independent of age, BMI and energy expenditure (p = 0.001). Football was also a significant determinant of SOS independent of age, height, weight and BMI (p < 0.001). The mean SI was 127 ± 16 and the median T-score was 0.82 (-1.88, 3.35). The mean SI of footballers (130 ± 15), runners (130 ± 12) and other sportsmen (115 ± 18) differed significantly (p = 0.001). Multivariate analyses revealed that football (p < 0.001) and running (p < 0.001) were significant determinants of SI independent of age and BMI. Footballers when compared with other sportsmen had a higher mean SI independent of age and BMI (p < 0.001). Age was not correlated with SI. The median T-score of footballers, 0.94 (-1.0, 3.35) was higher than that of other sportsmen.</p> <p>Conclusion</p> <p>Repetitive skeletal loading at the heel has the potential to improve bone density in black male athletes. The magnitude of increase may be higher in medium impact sports such as soccer and running compared with low or non-impact sports such as judo or taekwando, and is independent of age and BMI. However, future longitudinal data will be required to support our observations.</p