Childbirth Practices in the Akpabuyo Rural Health and Demographic Surveillance System

Maternal and neonatal mortality remain high in Nigeria. The State and Federal governments have adopted several strategies to prevent maternal and infant deaths such as the Cross River State Free Health Services to pregnant women and infants, and the National Midwives’ Service Scheme. This study assessed pregnancy and childbirth practices of Nigerian women in rural communities located in Akpabuyo in the Niger Delta region of Nigeria. Women who were pregnant or had recently given birth in a population of 5,668 people under surveillance in some rural communities of Akpabuyo were interviewed to obtain information on pregnancy and childbirth practices. Validated semi-structured questionnaires were administered by well-trained field workers. Completed questionnaires were entered into electronic data forms in OpenHDS software and exported to STATA for analysis. Results showed that, 39.5% of women reported that they had sought prenatal care from a traditional birth attendant (TBA). 84.6% of all births occurred outside the formal health system with the majority attended by TBAs. Only 15.4% of births occurred in hospitals or health centres. The implements used to cut the umbilical cord were knives (46.2%), new razor blades, old razor blades, sharp stone and scissors. The materials used for treating the umbilical cord were mostly methylated spirit (63.1%); other treatment materials were“western medicine”, “black powder” and others including herbs and earth. The study concluded that, childbirth practices that pose significant risk to maternal and newborn health remain common in these rural communities. Majority of births were attended by TBAs despite free delivery services available at the formal health facilities. TBAs should be assisted to enhance their role in health care delivery. Effort should be made to increase public awareness and interest in facility-based services. Keywords: Maternal health, neonatal infection, longitudinal data, pregnancy

Optimum hardware, software and personnel requirements for a paperless health and demographic surveillance system: a case study of Cross River HDSS, Nigeria

Health and Demographic Surveillance Systems (HDSS) are a robust and rigorous data collection, validation, storage, analysis and reporting platforms for community-based data on vital events. These processes make high demands on paper and man-hours with attendant implications on running costs and environmental impact. However, with the rapid development of ICT and increasing affordability of computing devices, some of the manual processes can be replaced with ICT tools. This paper presents a case study of the Cross River HDSS in Akpabuyo Southern Nigeria with a view to highlighting the essential personnel, hardware and software requirements for running an IT-based paperless HDSS in low income settings. The DSA comprised of 22 contiguous EAs of 1370 households. The case study entailed four update rounds, each of which involved field workers visiting households and obtaining information on vital events. The first update round was purely paper-based involving the use of large collections of paper forms for interviews. The last three rounds were IT-based, devoid of paper questionnaires and ran on web-based open source software. Hardware was a set of high-end servers, desktops, tablet PCs and android phones for data collection.   The case study demonstrated the feasibility of running a paperless IT-based HDSS in a resource-poor setting using free and open source software, such as the web-based OpenHDS, MySQL, ODK, MirthConnect, etc. This overcomes the limitations of the popular HRS2 in terms of costs, complexities, and lack of compatibility with changing hardware and system software configurations. However, running IT-based paperless HDSS threw up some challenges, such as cases of poor internet connectivity, absence of GSM network connectivity using mobile devices, and having the right mix of staff with sufficient IT skills. This paper recommended solution strategies for overcoming these challenges. The need for the development of new set of protocols for data quality in a paperless HDSS is also discussed.   Keywords: Health, demographic surveillance system, information technology, paper, environment, enumeration area

Poverty Alleviation Programmes in Nigeria: Reflections on Methodology

Policies and programmes aimed at addressing poverty have been initiated and pursued since Nigeria’s political independence in 1960. Most of these policies and programmes have had minimal or no significant effect in changing the well-being of the rural poor. The paper takes a critical reflection on methodology adopted in poverty alleviation programmes since 1960 in Nigeria. In it, we have argued that past poverty alleviation policies and programmes have been elitist and non-participatory, especially by the target population. In most cases the designs for poverty alleviations are characterized by improper conceptualization, grandiosity and lack of social justice even in implementation. Based on the findings, we recommended that poverty alleviation policies and programmes must involve the people (target group) from the initiation to the execution stages. We suggested a paradigm shift in the process of policy making and implementation to involve the local people (those at the grassroot), based on participatory development approach. This approach will make for sustainable development.Keywords: Poverty, alleviation programmes, theoretical reflection