Back Background ground Studies have demonstrated that trained community health workers can improve access to quality health services for under five children. Under the World Health Organization's Rapid Access Expansion Progamme, integrated community case management of childhood illnesses (iCCM) was introduced in Abia and Niger States, Nigeria in 2013. The objective of the program was to increase the number of children 2-59 months receiving quality life-saving treatment for malaria, pneumonia and diarrhoea by extending case management through community-oriented resource persons (CORPs). We present findings from household surveys comparing baseline and endline data to assess changes in sick child care-seeking, assessment, and treatment coverage provided over the project period in Abia State. Methods Methods A baseline household survey was conducted in May 2014 and an endline survey in February 2017. The surveys used multi-stage cluster sampling of primary caregivers of children aged 2-59 months who had been recently sick with diarrhoea, fever, or cough with difficult breathing. R Results esults Care-seeking from an appropriate provider improved significantly from 69% at baseline to 77% at endline (P<0.01). At baseline, patent and proprietary medicine vendors (PPMVs) (55%) and health centers (34%) were the main providers of care for iCCM services; by endline, CORPs became the main source (48%), followed by PPMVs (36%) and health centers (25%). C Conclusions onclusions Overall, the findings demonstrate improvements in care-seeking. Care-seeking practices shifted over the course of the project, with more caregivers seeking care from CORPs by the end of the project. The findings suggest that scaling up iCCM in Nigeria may improve access to appropriate treatment for under five children living in hard-to-reach areas.

The vision of Nigeria’s immunization program is to reach and sustain routine immunization coverage of greater than 90% for all vaccines by 2020. In order to achieve this, Abia state embarked on a unique private-public partnership (PPP) between private health facilities and the Abia state ministry of health. The aim of this partnership was to collaborate with private health facilities to provide free childhood immunization services in the state - the first of its kind in Nigeria. This is a retrospective study of the 2011 Abia state, Nigeria monthly immunization data. In the 4 local governments operating the PPP, 45% (79/175) of the health facilities that offered immunization services in 2011 were private health facilities and 55% (96/175) were public health facilities. However, 21% of the immunization services took place in private health facilities while 79% took place in public health facilities.Private health facilities were shown to have a modest contribution to immunization in the 4 local governments involved in the PPP. Efforts should be made to expand PPP in immunization nationally to improve immunization services in Nigeria.

Purpose: Clinical pathways are a means of translating universal clinical guidelines into local protocols to inform clinical practice. This study aimed to evaluate the effectiveness of using a blended learning approach for providing instruction and building competency on the development of breast cancer clinical pathways, using the guidelines from the National Cancer Control Network (NCCN). Methods: A one-group pretest-post test design was used for this study. Participants included healthcare providers and students in Nigeria, who were recruited through social media and professional organizations. The intervention was an online course delivered through Google Classroom, followed by two-day workshops at three locations. Data collection involved pre and post-tests scores from the online course, self-reported evaluation, as well as objective grading of in-person group projects. Results: Over 400 individuals joined the online course while 90 participated in the in-person workshops. Most participants (259/408, 63%) had no prior experience with online education, with an average age of 27.46 (±9.25) years. Data analysis revealed significant increases in mean knowledge scores across all groups from pretest (M=12.76, SE = 0.60) to post test (M =17.25, SE =0.38) p<0.001. Self-reported evaluation showed higher scores regarding chemotherapy administration for blended learning participants. Objective competence scores in developing clinical pathways ranged from 63% to 87%, across three sites. Conclusion: Findings reveal that both an online course alongside in-person workshops can be effective strategies for improving the knowledge and competence respectively of healthcare professionals on clinical pathways development. Participants in the blended learning component demonstrated significantly greater improvement in self-reported confidence scores. We recommend further studies to compare the relative strengths and limitations of these strategies.

10539 Background: Most Nigerian clinicians lack adequate skills and resources in screening, diagnosis, and managing women with breast cancer. The absence of locally-sensitive clinical pathways in hospitals in Abia State impact patient outcomes and clinicians job satisfaction. Blended learning (BL), a combination of online and face-to-face teaching methods, has been used in other settings to improve the competencies of clinicians. Research seeks to develop and evaluate a BL course that will train clinicians in Abia State on using NCCN breast cancer management guidelines, and to develop and implement locally-sensitive clinical pathways. Methods: The course is divided into four online modules delivered via Google Classroom and a workshop module to be delivered in 3 cities. Course evaluation involves an objective-focused method, following a mixed-methods design. Data collection includes pre-and-post-tests, course evaluation and focus group discussions. Data analysis involved descriptive statistics and t-test. Comments deductively analyzed to identify common themes. A sample size of 107 individuals is required to identify a moderate effect size for the BL course. Results: Forty-three participants (physicians=15, Nurses=28) have been recruited for cohort 1, with average age of 44 (±9.9) years. Most participants have never taken an online class (65%) but use mobile phones (60%) to access the course. With a maximum of 20 points in each test, there is a pattern of improvement in the post-tests performance compared with the pre-tests. Table shows mean scores. Most participants have expressed satisfaction with the course. Conclusions: Results show improvement in learning. More participants are being recruited. The workshops will hold at after the online modules.[Table: see text]

e14132 Background: Beyond the National Cancer Control Plan, most States in Nigeria do not have State cancer control policies. Using the multiple perspectives analysis framework, this research sought to explore the perspectives of patients diagnosed with cancer, healthcare providers and health policymakers regarding cancer policy in Abia State. Methods: A concurrent mixed methods action research design was used. Sample included individuals aged ≥18 years who were diagnosed with cancer (patients), provided cancer treatment (providers) or made health policy (policymakers) in the State. Data were collected using surveys and key informant interviews. Data analysis involved descriptive statistics, chi-square test and a deductive thematic analysis. Results: Participants were 29 patients, 50 providers and 33 policymakers (n = 122), with an average age of 45 (±11) years. Challenges identified by ≥60% of participants were: low public awareness (75.9%); limited availability of treatment options (62.6%); lack of treatment pathways (92.8%); lack of local cancer data (95.2%); and, absence of support groups for patients (88.0%). Each group of participants (n = 3) rated cancer 9 out of 10 as a public health priority. Some qualitative themes were: low cancer awareness, delays in cancer treatment and financial burden on patients. “One thing I’d like to include in the policy is to make cancer a reportable disease in the State.” -Policymaker. Most participants (80%, 90/112) recommended that health insurance should fund ≥16% of cancer control activities, although policymakers were more likely to make quarterly insurance contributions than patients (7 out of 10 vs. 5 out of 10). Conclusions: Cancer control was an important issue for people in the State. Inadequate prevention services with a background of > 3-month diagnostic delays, characterized cancer control in Abia State. Future cancer control policy should emphasize cancer prevention, the creation of local clinical pathways and a blended financing model. [Table: see text]