Strengthening Primary Health Care Services in Rural Nigeria: The Potential of Using Midwives as Skilled Birth Attendants

Introduction: The study objective was to assess the potential of using midwives as skilled birth attendants in providing access to maternal health services in rural Nigeria using the Subsidy Reinvestment and Empowerment programme on Maternal and Child Health (SURE P MCH). Method: Baseline survey of 1000 primary health care (PHC) facilities located across all states in the country was conducted before the programme started in 2012. Improvements made on the core indicators for maternal health services were assessed after a follow-up survey. The survey results were also compared to data from rural areas from the 2013 National Demographic Health Survey (NDHS) report. Findings: Total number of antenatal care (ANC) visits at follow-up survey increased by 42%, new ANC visits increased by 39% and four or more ANC visits increased by 30%. Births by skilled birth attendants were up by 56%, postnatal visits increased by 33% and number of women using contraceptive methods increased by 66%. When compared to data from the 2013 NDHS, access to skilled birth attendant and use of modern contraceptives were significant at p<0.0001. Access to antenatal and postnatal services were not significant. The median scores for the core indicators from the geographical zones were significant at p<0.05. Key Conclusions and Implications for practice: Women are more likely to have more supervised births and use more contraceptives in rural facilities when midwifery services are present. The programme model has the potential to strengthen and improve access to maternal health services in rural communities where the need is greatest. Keywords: Midwives; Rural health facilities; Maternal healt

African Medical Theory and Practices

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Determinants of patient delay in seeking treatment among pulmonary tuberculosis cases in a government specialist hospital in Ibadan, Nigeria

Patients delay in seeking care increases the transmission of pulmonary tuberculosis and hence the burden of the disease. This study investigates the pattern and determinants of patients delay in seeking treatment among pulmonary tuberculosis cases attending a Government Chest Clinic in Ibadan, Nigeria. A descriptive cross sectional study was employed. A face to face interview of 102 newly diagnosed tuberculosis patients at the clinic was conducted using a structured questionnaire. The mean age of respondents was 45.4 ±13.5 years and 61(59.8%) were females. The overall median delay in seeking treatment among study subjects was 60 days (range 3 to 180 days), with 61.8% patients delaying for more than 30 days. Binary logistic regression model showed that female sex (OR=5.3), place of residence (OR=3.9), outside Ibadan vs. within Ibadan), age group >45 vs. ≤45 years (OR=2.4) and reported stigma (OR=7.6) were significantly associated with longer patients delay. The results showed that delay among patients in seeking care is common and some groups of patients may be experiencing problems in seeking care in our environment

The drug war is a flat circle : drug prohibition as a neoliberal project

Despite mounting evidence of neoliberalism’s failures in domains of society, economy, and ecology, neoliberal governance has grown more dominant and pervasive. Neoliberalism’s failures are matched by its capacity, both material and ideological, to inhibit or eliminate alternatives. Instead of Schumpeterian creative destruction, neoliberalism offers governance through the destructive foreclosure of alternatives. The persistence of drug prohibition shares in the broader neoliberal pattern of governance through alternative-foreclosing policy disasters, and has been instrumental in the pattern’s development. This connection is expressed in two especially prominent ways: (1) the creation and empowerment of organizations which bear material interest in continuing both the illicit drug trade and the policy of drug prohibition, and (2) the simultaneous obfuscation and reproduction of historical forms of oppression, including racial capitalism and Eurocoloniality. Consequently, attempts to challenge drug prohibition on the grounds of its failure to meet its declared objectives – improving public health and safety – fail in-part because they miss the ways drug prohibition serves broader neoliberal governance. Considering different proposals for drug policy reform, I demonstrate that effective drug policy reform necessitates contesting or uprooting the neoliberal foundations of drug prohibition.Arts, Faculty ofPolitical Science, Department ofGraduat