Referral and counter-referral practices in obstetric emergencies among health-care providers in selected health facilities in Plateau state,Nigeria

Objective:This study aimed to examine the referral and counter-referral practices in obstetric emergencies among health-care providers in selected health facilities in Plateau state of Nigeria.Materials and Methods:A concurrent embedded descriptive mixed method consisting of both quantitative and qualitative methods was adopted for the study.Participants(104)were recruited using multistage sampling and 8 participants using purposive sampling techniques for quantitative and qualitative aspects of the study,respectively.The three-phase delay model directed the study.A self-developed structured questionnaire and an in-depth interview guide were used to elicit quantitative and qualitative responses from the participants.Quantitative instrument was tested for reliability,while the qualitative instrument went through the rigors of qualitative data.Results:Findings revealed low level of referral and counter-referral practices as only 19(18.27%)and 30(28.85%),respectively,of care providers referred patients above 10 times in a year.The study also revealed inadequate human and material resources for referrals and counter-referrals.The mean on barriers to referral was 2.90,which was above the cutoff of mean of 2.50,which indicates that the barriers are militating against referral and counter-referral in obstetric emergencies.Conclusions:Low levels of referral and counter-referral practices are identified with inadequate resources among others posing as barriers.Therefore,provision of standard operational procedures/protocols in every health-care facility as well as provision of adequate material and skilled human resources among others is recommended to enhance referral and counter-referral network in obstetric emergencies.There is also a need for teamwork and synergy among all stakeholders in the referral chain.

Midwives’ utilization of nonpharmacological pain relief measures for labor pain management: A descriptive cross-sectional study

Objectives:This study sought to examine midwives’utilization of nonpharmacological pain relief measures in labor pain management and to test the relationship between midwives’knowledge and utilization of nonpharmacological pain relief measures for labor pain management in secondary health facility in Calabar,Cross River State,Nigeria.Materials and Methods:A descriptive cross-sectional design was used for the study.The study was rooted in Katherine Kolcaba’s Comfort theory.Totally,67 participants were recruited for the study using the purposive sampling technique.A self-made structured questionnaire was used to obtain participants’information on knowledge,utilization,and predictors of nonpharmacological pain relief measures.Results:Although 41(61.2%)of the participants had knowledge about nonpharmacological pain relief measures,few did not know some of the cognitive-behavioral and environmental measures in labor pain management.There was 35.8%(24/67)for utilization of cognitive-behavioral measures and 55.2%(37/67)for psychological/emotional measures for labor pain management by respondents,respectively.Fifty(74.6%)of respondents agreed that predictors such as lack of knowledge,lack of updates and training,work experience,best practice guidelines,and equipment were hindrances to utilization.There was statistically significance in relationship between the level of knowledge and utilization of nonpharmacological pain relief measures(r=0.6,P<0.05).Conclusion:The utilization of nonpharmacological measures for labor pain management is low,thus it is recommended that frequent education,training updates on effective labor pain management,provision of clinical guidelines on labor pain management,and enrichment of midwifery training curriculum are imperative to ensure quality labor pain management and positive health outcome.

Treatment of Uncomplicated Malaria among Under-Five Children: A Systematic Review

Most uncomplicated malaria dominated countries have embraced the recommended first-line treatment of uncomplicated malaria. Artemisinin-based combination therapies such as Artemether-Lumefantrine, Artesunate + Amodiaquine and Dihydroartemisinin-Piperaquine have shown to be effective with Artemether-Lumefantrine and considered the most effective and approved by WHO. The study collected and reviewed recent randomized controlled trials for the treatment of uncomplicated malaria under five children. Eligibility criteria for the selected studies were based on the use of tools such as PICO (T) and data extraction tools such as REPOSE guidelines, PRISMA statement and eligibility criteria. This study includes only RCTs on the treatment of uncomplicated malaria under 5 s. Data was analyzed through comparative-narrative analysis. This study found 8 studies. Selected studies had a total of 10,682 participants within the age range of 0 - 59 months with the diagnosis of uncomplicated malaria and an MCP range of 2000 - 200,000 treated with different antimalarial drugs. Artesunate + Amodiaquine and Dihydroartemisinin-Piperaquine and Artemether-Lumefantrine drugs were found to be consistent in the treatment of uncomplicated malaria under 5 s within three days. Findings show that Artemether-Lumefantrine, Artesunate + Amodiaquine and Dihydroartemisinin-Piperaquine were the best drugs of choice due to their fast rate in fever reduction and parasite clearance. The efficacy of Artesunate + Amodiaquine and Dihydroartemisinin-Piperaquine is comparable to Dihydroartemisinin-Piperaquine. The study concludes that Artesunate + Amodiaquine and Dihydroartemisinin-Piperaquine can also be drugs of choice along with the well-known and utilized Artemether-Lumefantrine combination because of the fever reduction and parasite clearance within the first three days duration.