Association of the client-provider ratio with the risk of maternal mortality in referral hospitals: a multi-site study in Nigeria

Okonofua, Friday; Ntoimo, Lorretta; Ogu, Rosemary; Galadanci, Hadiza; Abdus-Salam, Rukiyat A; Gana, Mohammed; Okike, Ola; Agholor, Kingsley; Abe, Eghe; Durodola, Adetoye; Randawa, AJ

doi:10.1186/s12978-018-0464-0

Cited by 14 publications

(17 citation statements)

References 20 publications

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“…Consistent with our findings, the CPED revealed that primary healthcare settings in rural areas are disproportionately lacking in both equipment and human resources. Maternal deaths have been shown to decrease significantly when women were treated by diverse healthcare personnel [58].…”

Section: Discussionmentioning

confidence: 99%

Men’s perception of barriers to women’s use and access of skilled pregnancy care in rural Nigeria: a qualitative study

et al. 2019

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Background Greater paternal engagement is positively associated with improved access to and utilization of maternal services. Despite evidence that male involvement increased uptake of maternal and child services, studies show that few men are participating in MNCH programs. Community leaders have long been engaged in public health promotion in rural settings and have been shown to mobilize communities to enhance changes in cultural practices related to public health. With the ultimate goal of increasing men’s involvement in maternal health, this study seeks to understand men’s perceptions of community and health systems barriers to maternal access and usage of skilled care in rural Edo, Nigeria. Methods This qualitative study involved the analysis of data collected from community conversations with male elders in Etsako East and Esan South East Local Government Areas of Edo State, Nigeria. Community conversations participants ( n = 128) comprised of elders between the ages of 50–101. A total of 9 community conversations were conducted. Discussions were audio recorded, transcribed and imported into Atlas.ti 6.2 for content analysis. Results Men’s perceptions of barriers to maternal use of skilled care are presented in two overarching themes: community systems and health systems. Three sub themes were generated as community systems barriers to maternal healthcare use, they include: gender roles, traditional treatment and policy changes. Three sub themes emerged under health system barriers and they include: cost of health facilities, dissatisfaction with facilities and distance from facilities. Conclusion Findings suggest that community elders are not only in a good position to influence men’s behavior, they are also a source of information to policy makers on strategies to overcome barriers to maternal health, especially at the community level. Furthermore, community elders need support to enact regulations that will promote men’s involvement in maternal health, thereby increasing maternal use of skilled care.

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Section: Discussionmentioning

confidence: 99%

Men’s perception of barriers to women’s use and access of skilled pregnancy care in rural Nigeria: a qualitative study

et al. 2019

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“…This is, unfortunately, not the case in Nigeria due to an inequitable distribution and shortage of appropriate cadres of health workers. 4 Strategies to effectively address gaps in HRH hiring, deployment, and retention, at national and state levels, are needed to optimize FLHWs-their quality, quantity, distribution, and skills-in Nigeria. Little is known about the documentation and implementation of policies and processes for FLHW hiring, deployment, and retention, and important contextual factors, particularly in Cross River and Bauchi, are poorly understood.…”

Section: Justification For the Studymentioning

confidence: 99%

“…There is insufficient availability of skilled health workers in Nigeria due not only to shortages but inequitable distribution of appropriate health workforce cadres in favor of urban areas. 4 Nigeria's Federal Ministry of Health (FMoH) developed a comprehensive National HRH Policy (2006) as well as national HRH strategic plans (2008)(2009)(2010)(2011)(2012)(2009)(2010)(2011)(2012)(2013)(2014)(2015) to guide HRH policy and response with renewed focus on comprehensive and integrated HRH management. 5,6 The framework of the National Strategic Health Development Plan (NSHDP, 2010-2015) provided a better coordinated health sector response to HRH needs such as availability and equitable distribution of a skilled and well-motivated health workforce.…”

Section: Introductionmentioning

confidence: 99%

An assessment of human resources for health hiring, deployment and retention, procedures and practices in Cross river and Bauchi states, Nigeria

Dirisu¹,

Akinola²,

Okereke³

et al. 2019

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“…Our initial formative research in eight referral hospitals in four geo-political zones of the country identified several factors that were perceived by women and health providers as associated with poor quality antenatal, delivery and postnatal care in the hospitals. These included 1) the lack of official commitment to quality care [ 16 ];2) limited ‘providers’ skills and knowledge [ 17 ]; 3) long waiting hours in the antenatal clinics [ 18 ]; 4) abusive care by providers and poor ancillary services [ 19 ], and 5) heavy provider workloads [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Outcome of multifaceted interventions for improving the quality of antenatal care in Nigerian referral hospitals

et al. 2020

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Background The study was designed as quasi-experimental research to investigate the effectiveness of multifaceted interventions for improving the quality of antenatal care in referral hospitals in Nigeria. Two referral hospitals (the Central Hospital in Benin City, South-South Nigeria, and the General Hospital in Minna) served as intervention sites, while two hospitals in comparable locations, (the Central Hospital Warri and the Suleja Hospital Abuja) were the control hospitals. Methods Intervention activities consisted of the introduction of a strategic plan with the shared vision of reducing maternal mortality by 50% in 1 year in the hospitals; staff training and re-training; the establishment of an automated appointment system; composite health education involving couples and providers; advocacy with policymakers; and the implementation of maternal death reviews and surveillance. These activities were implemented in the intervention hospitals over 21 months (October 2017 to June 2019). Exit interviews of pregnant women at intervention and control sites by trained interviewers were used to assess the quality of antenatal care after their visit, A total of 777 women were interviewed (427 in the intervention sites and 350 in the control sites). Data were analyzed with univariate and multivariate Poisson and logistic regression to determine the extent to which health providers in the clinics completed the 18 signal functions identified in the WHO assessment tool. Results The regression analyses showed the interventions were effective in improving six quality indicators (QIs) for counseling and information sharing. The difference between intervention and control sites on these QIs was significant at < 0.05. On the contrary, the interventions were less effective for maternal and fetal measurements; and disease testing and management QIs. Conclusion The positive effects of the interventions are likely due to the effectiveness of the training and health education components. The lack of intervention impact observed for maternal and fetal measurements may be due to the high workload of care staff and inadequate clinic supplies, which we did not address. We conclude that interventions that address the quality of antenatal care in low-resource settings should focus on improving all elements of care, including adequate staffing and mobilization of material resources. Trial registration This study was registered in the ISRCTN on August 14th, 2020. Trial Registration Number. SRCTN17985403. Retrospective registration. The reason for the retrospective registration is the current non-recognition of the Nigeria Clinical Trials Registry (NCTR); which is currently not an ICMJE or WHO ICTRP approved registry. (This study was registered in the Nigeria Clinical Trials Registry on April 14th, 2016. Trial Registration Number NCTR No: 91540209).

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Association of the client-provider ratio with the risk of maternal mortality in referral hospitals: a multi-site study in Nigeria

Cited by 14 publications

References 20 publications

Men’s perception of barriers to women’s use and access of skilled pregnancy care in rural Nigeria: a qualitative study

Men’s perception of barriers to women’s use and access of skilled pregnancy care in rural Nigeria: a qualitative study

An assessment of human resources for health hiring, deployment and retention, procedures and practices in Cross river and Bauchi states, Nigeria

Outcome of multifaceted interventions for improving the quality of antenatal care in Nigerian referral hospitals

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