Where do delays occur when women receive antenatal care? A client flow multi-site study in four health facilities in Nigeria

Objectives: The objective of the study was to identify where delays occur when women present for antenatal care in four Nigerian referral hospitals, and to make recommendations on ways to reduce delays in the course of provision of antenatal care in the hospitals.Design: Prospective observational studySetting: Four Nigerian (1 tertiary and 3 secondary) HospitalsParticipants: Women who presented for antenatal care.Interventions: A process mapping. The National Health Service (NHS) Institute Quality and Service Improvement Tool was used for the assessment.Main outcome measures: The time women spent in waiting and receiving antenatal care in various departments of the hospitals.Results: Waiting and total times spent varied significantly within and between the hospitals surveyed. Mean waiting and total times spent were longest in the outpatients’ departments and shortest in the Pharmacy Departments. Total time spent was an average of 237.6 minutes. χ2= 21.074; p= 0.0001Conclusion: There was substantial delay in time spent to receive care by women seeking routine antenatal health services in the four secondary and tertiary care hospitals. We recommend managers in health facilities include the reduction of waiting times in the strategic plans for improving the quality of antenatal care in the hospitals. This should include the use of innovative payment systems that excludes payment at time of service delivery, adoption of a fast-track system such as pre-packing of frequently used commodities and the use of new tech informational materials for the provision of health education.Funding: The Alliance for Health Policy and Systems Research, World Health Organization, Geneva; Protocol IDA65869.Keywords: Delays; Waiting time; antenatal; Hospitals; Women; Maternity care; Process mapping; Nigeria

Prevalence and risk factors for maternal mortality in referral hospitals in Nigeria : a multicenter study

This study determines maternal mortality ratios (MMR) and identifies risk factors for maternal deaths in referral health facilities in Nigeria. Results show an MMR of 2,085 per 100,000 live births in hospital facilities. Efforts to reduce MMR requires the improvement of emergency obstetric care; public health education so that women can seek appropriate and immediate evidence-based pregnancy care; the socioeconomic empowerment of women; and the strengthening of the health care system. In the past ten years contraceptive prevalence rates have remained low at 10%; antenatal attendance has remained at 64%, skilled birth attendance of 33% is one of the lowest in sub-Saharan Africa.World Health Organizatio

Living arrangements and nutritional status of under-five children in Sub-Saharan Africa

Despite efforts aimed at improving the nutritional status of children under-five years, only a slow progress has been made in Sub-Saharan Africa (SSA). Using data from the latest Demographic and Health Surveys of 17 countries in SSA, we illuminate the association between living arrangement and the nutritional status of 144,765 children under five years. Results showed that living with only the father compared to both parents was associated with a higher risk of malnutrition in SSA [OR:1.18, CI:1.03-1.30] while not living with both parents was associated with a higher risk of malnutrition in West Africa [OR:1.25, CI:1.02-1.54]. Lower risk of malnutrition was observed among children residing in households headed by their mother compared to those headed by their father in West Africa [OR:0.76, CI:0.66-0.87] and SSA [OR:0.83, CI:0.77-0.90]. These results suggest that with whom and where children live as well as biological relationships are vital in improving children’s nutritional status in SSA

Prevalence and determinants of condom use among the youth in Malawi: evidence from the 2015/16 Malawi Demographic and Health Survey

Abstract Background Unprotected sexual intercourse among the youth is common in Malawi. This has led to high rates of sexually transmitted infections (STIs), Human Immunodeficiency Virus (HIV), and unplanned pregnancies. The study investigated the prevalence and the determinants of male and female condom use for the prevention of sexually transmitted infections and unplanned pregnancies among the youth in Malawi. Methods The 2015/2016 Malawi Demographic and Health Survey (MDHS) data were used among 15 to 24-year-old male and female who had sexual intercourse four months preceding the survey. A total of 1543 male and 5143 female were selected from 3226 male and 10,367 female respectively and analyzed with SPSS version 20 using.descriptive, bivariate, and logistic regression. Results The study found a low prevalence (27.1%) of condom use among the youth in the last sexual intercourse within four months before the survey. More male (55.8%) used condoms than female (18.5%). The significant predictors of condom use among the male and female youth were: being sexually active (OR 0.39 CI 0.33–0.47), aged 20–24 (OR 0.80 CI 0.68–0.95), ever married (OR 0.07 CI 0.06–0.08), coming from central region (OR 0.56 CI 0.40–0.77), and southern region (OR 0.59 CI 0.42–0.83), residing in the rural area (OR 0.74 CI 0.61–0.90) and ever tested of HIV (OR 1.29 CI 1.03–1.55). Conclusion Having established low prevalence of condom use among the youth in Malawi, there is a need to scale up programs and policies that target the youth to practice safe sex, which will assist in addressing the challenges of STIs, including HIV, and preventing unplanned pregnancies in Malawi

Outcomes of a multifaceted intervention to improve maternal satisfaction with care in secondary hospitals in Nigeria

Background: Data in Nigeria suggests a high level of dissatisfaction among women attending maternity care in health facilities due to long wait times, disrespectful care, and poor attention by healthcare personnel. Objective: To examine the effectiveness of a multifaceted intervention in improving self-reported indicators of maternal healthcare satisfaction by women who use referral facilities in two regions of Nigeria. Method: The design was quasi-experimental and consisted of two intervention facilities and two control facilities. The interventions included strategic planning, staff re-training, a computerized appointment system, health education/feedback, maternal death reviews and surveillance, and advocacy. A random sample of 2262 women was selected (1205 in the intervention sites and 1057 in the two control sites) to respond to a 24-item questionnaire on service satisfaction as they exited the health facilities. Adjusted Poisson and binary regression analyses were used to assess and compare proportions of reported satisfaction by women between the intervention and control sites. Results: Women in the intervention sites were 54% more likely than those in control sites to report overall satisfaction with services. They were significantly less likely to report inadequate security arrangements in accessing the health facilities (p < .1); and three times more likely to agree that health workers were extremely thorough and careful in attending to them (p < .1). Conclusion: The interventions had positive effects on improving women’s satisfaction with care. The findings from this study have implications for the design and implementation of interventions that address women’s concerns relating to the provision of care and consequently improve service utilization

Epidemiological trends of Lassa fever in Nigeria, 2018-2021.

BackgroundLassa fever is a viral haemorrhagic fever endemic in Nigeria. Improved surveillance and testing capacity have revealed in an increased number of reported cases and apparent geographic spread of Lassa fever in Nigeria. We described the recent four-year trend of Lassa fever in Nigeria to improve understanding of its epidemiology and inform the design of appropriate interventions.MethodsWe analysed the national surveillance data on Lassa fever maintained by the Nigeria Centre for Diseases Control (NCDC) and described trends, sociodemographic, geographic distribution, and clinical outcomes. We compared cases, positivity, and clinical outcomes in the period January 2018 to December 2021.ResultsWe found Lassa fever to be reported throughout the year with more than half the cases reported within the first quarter of the year, a recent increase in numbers and geographic spread of the virus, and male and adult (>18 years) preponderance. Case fatality rates were worse in males, the under-five and elderly, during off-peak periods, and among low reporting states.ConclusionLassa fever is endemic in Nigeria with a recent increase in numbers and geographical distribution. Sustaining improved surveillance, enhanced laboratory diagnosis and improved case management capacity during off-peak periods should remain a priority. Attention should be paid to the very young and elderly during outbreaks. Further research efforts should identify and address specific factors that determine poor clinical outcomes