It is concluded that the mean SPL and PD of newborns in Port Harcourt are 3.17 cm and 1.07 cm, respectively. A PL of <2.3 cm should be taken as representing micropenis.

Background: The Expanded Program on Immunization was launched in Nigeria in 1980 but the target for immunization coverage has been elusive. As part of its social responsibilities the Shell Petroleum Development Company (SPDC) supported immunization activities in the Niger Delta region of the country. In this study a cross sectional study was carried out to estimate the coverage of BCG, OPV, DPT and measles vaccines and, to determine the predictors of full immunization coverage among children aged 12 to 23 months in selected SPDC supported communities in the Niger Delta. Using modified cluster randomization, 2432 children were included in the study. Results: Of 2432 children studied 1585 (65.2%; 95% CI: 61.9% to 68.5%) were fully immunized with the four vaccines; 2323 (95.5%) had received at least one dose of a vaccine (card and history). About one third (36.6%) of the children aged 12 to 23 months with immunization card were fully immunized by their first birthday. The proportion of children fully immunized with valid doses of vaccines by one year was 19.9% (485 of 2432) based on card only. One hundred and nine (4.5%) had never received immunization. Major reason for failure to be immunized was fear of side reactions. Main predictor for full immunization was availability of a health facility in the community. Discussion: The coverage of immunization was high in the study area; but the proportion of valid doses administered was low. Training of health workers and strategic behavioral communication to dispel fears of side reactions are recommended

Introduction: Neonatal morbidity and mortality are high in Nigeria. The establishment of more centers that could offer adequate management of high-risk pregnancies and neonates is essential. Objectives: This study seeks to describe sick newborn care at the cottage hospital level in Southern Nigeria with the aim of drawing lessons that may be useful to similar environments. Subjects and Methods: A description of facility upgrading and staff training in perinatal care at a public-private partnership cottage hospital with a robust community health insurance scheme in Nigeria is made. A retrospective descriptive study of the morbidity and outcomes of admitted neonates in the facility between March 2016 and February 2017 was made. Results: Out of 3630 babies born in the facility (302 per month), 189 were admitted, yielding an admission rate of 52.1/1000 live births. The main morbidities were neonatal hypoglycemia (32.4%), preterm low-birth weight (24.9%), neonatal sepsis (22.8%), and neonatal jaundice (12.7%). Sixteen of the 109 neonates died giving a mortality rate of 8.5%. The main causes of deaths were birth asphyxia (7 or 43.8%), meconium aspiration (6 or 37.5%), and congenital malformation (3 or 18.8%). Conclusion and Recommendations: The neonatal admission and mortality rates are quite low in this cottage hospital and similar to the situation even in developed environments. This salutary scenario is probably due to good antenatal and perinatal care, and a robust community health insurance scheme which enhances services uptake and public–private partnership which engenders infrastructure expansion and maintenance. This model is recommended for the hospitals in our region.

Objectives/Scope The vast majority of 170 million Nigerians have no access to affordable and quality assured health care. The government provided medical facilities are mostly over-stretched and most Nigerians pay out of pocket for basic health care. The Shell Petroleum Development Company of Nigeria Limited embraced the concept of Public Private Partnership as a strategic approach to Corporate Social Responsibility in the health sector. In 2010, SPDC in collaboration with the Rivers State government upgraded the Obio health center to a cottage hospital and worked with the local community to catalyse the Obio Community Health Insurance Scheme. The partners in the CHIS agreed an annual premium of N7,200 [about$36] per participant for access to essential primary and secondary health care, with special focus on maternal and child health. Methods, Procedures, Process As the insurance package covers more than 95% of community health care needs, patients seen daily increased from 20 to 147 per day. Patients spent long hours on visits leading to dissatisfaction. In 2012, Lean methodology was deployed to address this problem. The outpatient transit time starts from the time the patient reports to the reception, goes through the medical records, vital signs, consultations, laboratory investigation (if necessary), and pharmacy, till discharge. With the use of Lean tools such as value stream mapping, lack of standardisation of key activities at transit points was found to be causing proportionate delay in patients waiting time. 5S exercise was carried out, Standard Operating Procedures and visual measures were developed and deployed with onsite trainings. Results, Observations, Conclusions These led to 78% reduction in transit time, hospital handling more patient flow per day and improved customer satisfaction. Novel/Additive Information Lessons learnt include using leadership Gemba visits and inculcating Lean thinking among hospital staff to improve operational efficiency and bring about a culture change.

The weak structure of the health system in Nigeria, its lack of vertical and horizontal integration, slow deployment of evidence-based decisions to impact health outcomes and weak synergy between government and other stakeholders, has led to minimal innovations in health care services. The introduction of community-based health insurance scheme (CHIS) at Obio Cottage Hospital changed the processes of service. The increased number of clients led to opportunities for innovation across the spectrum of health care. This included the ‘Green hospital energy’ initiative which reduced cost of power from an average of $300 - $1500/month to $180 – $500/month, increased facility utilization to an average of 340 patients /day. LEAN process led to a 51% reduction in patient transit time from mean of 3.8hours to 1.7 hours. There was also a 53% improved process efficiency through a cut down in process steps from 72 to 35 and introduction of the aired-oven which reduced specimen processing from 2hours 25mins to 13 minutes. CHIEASY reduced the lengthy registration process including curtailing the manual handling of client records. It provided an electronic and authentication system to track enrolment and financial accountability thus improving quality of care. Remote health through Vsee saved lives and cut cost of 10 patients diagnosed through video and audio report. These innovations brought about general clients' satisfaction and increased demand in health care in the facility. Healthcare innovations to clients have multiplier effects in the provision of safe, timely, sustainable and quality-assured health care services and can be delivered at minimal costs. This analysis aimed to examine the use of innovative methods in improving efficiency in service delivery in a resource limited setting