Determinant of Small and Medium Enterprises (SMEs) Low Participation in Public Procurement in Lagos, Nigeria

It is an established fact that Small and Medium Enterprises (SMEs) are crucial to economic development of any nation. SMEs participation in every sphere of economic activities including public procurement is one of the ways the sector can promote economic development of the country. However, SMEs sometimes are usually reluctant to sell to government. This study identified and classified into eight themes factors responsible for the low participation of SMEs in public procurement in Lagos State, Nigeria. Data were collected with questionnaires from 193 SMEs Chief executives. Data generated were analyzed using ranking method. The study revealed that perceived lack of transparency in public procurement proceedings, disproportionate eligibility criteria and burdensome nature of public procurement are the major reasons SMEs are reluctant to participate in public procurement in Lagos, Nigeria. It was concluded that transparency is vital in public procurement for SMEs to adequately participate in the process. The study recommended that in order to boost SMEs participation in public procurement transparent procurement management must be guaranteed. Keywords: Determinant; SMEs; Public procurement; Contract; Eligibility criteria.

Expectations and experiences of urban and rural in-school adolescents of Adolescent Reproductive Health Services in Oyo state

ABSTRACT Introduction: Reproductive health information and services are fundamental to health, well-being and opportunities for women and young people, yet throughout the world, women and youths do not have access to quality reproductive health care thereby exposing them to unplanned pregnancy, teen birth, induced abortion as well as increased exposure to sexually transmitted diseases, HIV inclusive. This study is meant to explore the expectation of adolescents of an adolescent reproductive health services as well as to assess the experiences of those who had visited an ARHS at the centers. Methodology: It was a descriptive cross-sectional prospective study, analytic in design using a multistage sampling technique where 452 secondary school pupils in both rural and urban communities were interviewed using a pretested validated questionnaire. Data was analyzed using SPSS version 21. Chi square was used to test for association between both rural and urban adolescents in issues relating to their expectation and experiences, with p value of <0.05. Results: More of the respondents in the urban communities (73,32.4%) have the expectation that Adolescent Reproductive Health Services (ARHS) should be provided in an existing health service with special attention to adolescents while a larger percentage of those who preferred a special adolescent health institution were from the rural communities (122, 54.2%) which was statistically significant with a p value of 0.001. More of respondents from the rural communities also expect that contraception services should be provided in an ARHS center while life skill services are expected by more of the respondents from the urban communities (122, 55.6%). More of the rural community respondents (57,25.3%) expect that fee at the ARHS centers should be provided at a subsidized rate while more of the urban dwellers have the expectation that services provided should be free of charge. For respondents who had been to an ARHS center, more of the urban respondents were attended to by a Medical doctor and a large percentage (34, 94.4%) of those who had visited ARHS center before professed to be satisfied with the services rendered there. Conclusion: Expectations from adolescents from ARHS are very high. However, most of them prefer a free of charge service as well as a service area nearer to residential area. Confidentiality and having a young health professional at the service centers cannot be overemphasized in the provision of quality ARHS. Keywords: expectation, experiences, rural, urban, adolescents, reproductive healt

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Awareness and attitude of health care workers in a teaching hospital in southwestern Nigeria towards nosocomial infections

Despite advances in health care system, Nosocomial infections (NIs) still remain a preventable disease threatening public health. This study assessed awareness and attitude of health care workers in LAUTECH teaching Hospital Osogbo towards Nosocomial infections. Descriptive cross sectional study among hospital workers using multistage sampling method was used. Research instruments were semi structured self administered and pre-tested questionnaires, and data analyzed using the SPSS software. Eighty three (91.2%), 77 (84.6%) and 59 (64.8%) of the health workers were aware of patients, hospital staff and hospital environment, respectively as causes of nosocomial infections. Thirty one (34.1%) were aware of presence of their hospital policy on control of nosocomial infections, while 36(39.6%) were aware of presence of infection control committee in the hospital. Twelve (13.2%) has ever notified nosocomial infection. Preventive practices towards nosocomial infections were favourable for hand washing, and unfavourable for self reporting to the staff clinic when sick. There is no significant association between ever reported or willingness to report nosocomial infections and awareness of hospital policy or presence of infection control committee in the hospital (P &gt; 0.05). There is a need to raise awareness on nosocomial infections among health care workers as well as preventive measures against these infections

HIV Preventive Measures among Adolescents Attending Secondary Schools in an Urban Community in Southwestern Nigeria

Many studies carried out among adolescents in Nigeria generally report the practice of preventive measures against HIV to be poor. This study was carried out to assess the HIV/AIDS preventive measures among adolescents attending secondary schools in an urban community in Southwestern Nigeria. This was a descriptive cross sectional study, carried out among in-school adolescents in Osogbo metropolis, Southwestern Nigeria. The multi-stage sampling technique was used to select the respondents and data was collected with pre-tested, semi-structured questionnaires which were self administered and supervised by trained research assistants. A total of 370 questionnaires were administered and analysed using Statistical Package for Social Sciences (SPSS) version 16. Majority knew that HIV/AIDS could be prevented by not sharing sharp objects (305, 82.4%) and the use of condom (277, 74.9%). Three hundred and twenty nine (88.9%) of the respondents were aware of condom while 205 (55.4%) were aware of HIV Counselling and Testing (HCT). Seventy four (20.0%) respondents were sexually exposed, and only 21 (5.7%) of the respondents had ever used condoms before. Only 15 (4.1%) of the respondents had had HCT before and 189 (51.1%) had had sex education before. Most of the respondents were aware of the disease called AIDS, but their comprehensive knowledge about the disease and its prevention was not correspondingly high. Twenty percent of the respondents were sexually exposed but their HIV preventive practice was generally poor; there was poor and inconsistent condom usage, poor uptake of HCT and sex education and a poor perceived self efficacy among nearly half of the respondents. The stakeholders in adolescent reproductive health should work towards the provision of straightforward and elemental information about sex, and related practical issues that normally affect adolescents, like contraception, abortion and sexually transmitted infections to adolescents. [Med-Science 2014; 3(4.000): 1614-26

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways