Clients' perception of the quality of primary health service and its predictors in Rivers State

Introduction: Most patients in Rivers State seek health care from primary health centres which recently had undergone modernization. However not enough is known of their perception on the quality of service delivery. This study assessed perceived quality of primary health care and identified predictors in the context of Rivers State.Method: Cross-sectional survey using multi stage sampling approach. A multi scale instrument - Outpatient Assessment of Health care questionnaire was used to obtain feedback from 423 adult patients visiting three randomly selected primary health centres, representing the three senatorial districts in Rivers State. Outcome measured were patients' satisfaction with doctors and nurses' communication, health care environment, health and medication communication as well as their global rating of the centres. Predictors of perceived quality of PHC were explored using regression analyses with p-value < 0.005 considered significant.Results: Mean age of the respondents was 29.6 ± 5.9 years with majority being female (92.1%), self-employed (47.0%) and married (90.1%). Majority (67.5%) of the respondents were satisfied with the care they received at the health centres, with mean satisfaction scores of 3.41, 3.45, 3.16 and 3.48 out of a possible maximum of 4 for doctors, nurses, environment and consultation domain respectively. Less proportion of the respondents (59.9%) were satisfied with the quality of information about prescribed medications. Predictors of high rating in this study were older age (standardised β = 0.22, 95% CI: 0.14 – 0.29, P<0.001), consultation with doctors (p = 0.001), free health care (p<0.001), higher self rated health status (p < 0.001) and being a first time visitor to the health Centre (p<0.001).Conclusions: Although patients are generally pleased with services at health centres but there is need to improve the clarity of information given on prescribed medications. Some negative predictors which are within the remit of the health system should form the focus for quality improvement.Keywords: Quality assessment, Patients' Perception, Predictors, Primary health care, Rivers state, Nigeri

Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014

BACKGROUND: Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. METHODS: PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period. RESULTS: We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies. CONCLUSIONS: The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence

Hypertension in older adults: Experience in a community-based screening programme in south-east Nigeria

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Perception of Routine HIV Counselling and Testing for Prevention of Mother-to-child Transmission of HIV Infection in Rivers State, South-South, Nigeria

Nigeria is ranked the second most HIV/AIDS affected country in the world with 3.5million adults living with the virus and a very high prevalence among young girls and women of the reproductive age groups. IntroducingHIV counselling and testing services within existing maternal and child health care package is therefore, a priority intervention for the prevention of mother-to-child transmission of the HIV virus in Nigeria, because it provides opportunity for informed decision-making about options for delivery and infant feeding. This study is aimed at determining the perception, acceptance and satisfaction with the HIV counselling and testing services offered in PMTCT centres in Rivers State, Nigeria. A cross-sectional survey was conducted among pregnant women attending antenatal clinics at three PMTCT centres in the State, using a semi-structured and pre-tested questionnaire adapted from the National Guidelines for VCT services in Nigeria. Acceptance rate of HIV testing was high (89%), and the degree of satisfaction with services provided was also high (98.6%). However, three major barriers to accessing the services were identified as distance from home 31.7%, cost of transportation to clinics 20.1% and long waiting time to receive test results (16.5%). Overall, 98.1% would recommend the services to other pregnant women. Women were mostly satisfied with the pre-test counselling for HIV and there was high acceptance of HIV testing among pregnant women attending antenatal clinics in Rivers State. This is calling for the training of more counsellors to meet the different individual counselling needs and to scale up PMTCT services to the primary health centres, nearer to the people for maximum benefits.Key words: Perceptions, VCT, PMTC services, Rivers State, Nigeri

Uptake of prevention of mother-to-child transmission (PMTCT) of HIV services among pregnant woman in Rivers State, Nigeria: A preliminary assessment

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Attitudes of antenatal women towards the involvement of medical students in their care

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Young people\'s sexual risk behaviour and vulnerability to HIV/AIDS in the Niger Delta region of Nigeria

Background: The magnitude and pattern of risk behaviour and awareness of vulnerability of HIV/AIDS in Bayelsa and Rivers State of the Niger Delta region, Nigeria are unknown. Methods: A cross-sectional design was used to study 533 subjects selected from 55 communities in six Local Government Areas (LGAs) by a four-level, multi-stage sampling technique. A pre-tested, structured, interviewer-administered questionnaire was employed to collect information. Results: The mean age of the subjects was 18.4 (±3.6) years. More than half (59.4%) were males and the majority had at least a secondary education (86.7%) and were single (95.1%). Most of them (82.2%) were aware of sexually transmitted infections, and 77.9% were aware that condoms prevent transmission of HIV. Seventy-one percent of the young persons were sexually experienced (i.e. previously had sex), 12.9% admitted they had previously had sex in exchange for money, and 63.4% reported ever using a condom. Median age of sexual debut (sexarche) was 15.7 years. Most (82.1%) of the sexually experienced were currently sexually active reporting sexual intercourse within the 6 months preceding survey. Nearly half (47.1%) of these had sex with a casual and/or commercial sex worker without a condom. Conclusion: Young people are adopting sexual practices that are essentially high-risk, with severe implications for regional and national socio-economic development. This underscores the fact that they know only little and lack skills to protect themselves from being infected with HIV infections, even when they are sexually active. There is therefore need to advocate for and support initiatives that address reproductive health needs of young people in the Niger Delta region. Port Harcourt Medical Journal Vol. 1 (3) 2007: pp. 161-16