Water, Sanitation and Hygiene in Lower-Level Health Care Facilities of Dar es Salaam Region in Tanzania: Status towards Achieving the Sustainable Development Goals and Way Forward

Background: Improving Water, Sanitation and Hygiene in health care settings is a critical prerequisite for achieving national health goals and Sustainable Development Goals (SDGs). The World Health Organization (WHO) has set a target for each United Nations member state to reach by 2030. Each member state is required to reach by 2022, 2025 and 2030 at least 60%, 80% and 100%, respectively of basic level of service of the five elements which are water, sanitation, hygiene, waste management and environmental cleaning. Methods: This study aimed to evaluate and document the current state of basic water, sanitation, and hygiene services in all lower-level health care facilities in the Dar es Salaam region of Tanzania as of July 2022. A cross-sectional study was conducted in 99 public dispensaries in the Dar es Salaam region’s five councils: Ubungo, Kigamboni, Kinondoni and Temeke Municipalities, and Ilala City. The interviewee form and observational checklists were both digitalized using the Kobo tool software. The respondents were health care facility in-charges or nurse in-charges. Data were downloaded, validated, and imported to Stata version 15 for analysis. Results: The basic WASH level per JMP is far below the target in 2022. Each member state by 2022 is required to reach at least 60% of the basic level of service of each element. We found a low coverage of basic WASH in the 99 dispensaries included in this study. The basic WASH coverage was met in only 10 (10.1%) of the dispensaries, while the remaining 89 (89.9%) dispensaries fall on limited WASH services. Conclusion: This study revealed lower coverage of basic WASH services in dispensaries. An urgent need is required to improve the status of WASH in all the dispensaries and facilitate the provision of quality health care services, patient safety and reduce health care associated infections.

Phenotypic Characterization and Prevalence of Carbapenemase-Producing Acinetobacter baumanii Isolates in Four Health Facilities in Cameroon

Background and Objective: Nowadays, the clinical utility of carbapenems is threatened by the emergence of resistant bacteria, favored by its increasing use. According to the WHO, Acinetobacter baumannii: nosocomial infection agent, tops the list of priority antibiotic-resistant pathogens, considered to be the riskiest for humans. This study sought to determine the prevalence of carbapenemase-producing Acinetobacter baumannii strains in four health facilities in the Center and Littoral regions of Cameroon and the associated risk factors. Materials and Method: An analytical cross-sectional study was conducted over a six-month period from January to June 2022. All suspicious A. baumanii isolates obtained from pathological samples at the bacteriology laboratory of the different health facilities were systematically collected and re-identified. Re-identification and antimicrobial susceptibility Testing (AST) were performed using the VITEK 2 System and the Kirby-Bauer method according to the guidelines of the Clinical and Laboratory Standards Institute (CLSI). Detection and phenotypic characterization of carbapenemases was performed according to adequate standard procedures. Results: A total of 168/226 clinical isolates of Acinetobacter baumannii were confirmed after re-identification, among which 52.69% derived from male patients, 55.09% from participants aged between 10 - 39 years old, and 46.71% from pus samples. A very high resistance rates to all families of antibiotics was noted, except to colistin (10.2%). 40.12% of these isolates produced carbapenemase, represented by 62.69% of class B and 37.31% of class A. Carbapenemase production was observed only at HMR1, Centre region and at Laquintinie hospital, Littoral region with 53.33% and 50% respectively, even if there is no significant difference (P = 0.81). In addition, frequent hospitalisation was significantly associated to the production of carbapenemase among A. baumanii (Adjusted-OR = 16.53, P-value 0.0001). Conclusion: This study highlighted the emergence of carbapenemase-producing Acinetobacter baumannii which is increasingly growing. Continuous drug-resistant monitoring and preventive measures could help to prevent and curb the dissemination of A. baumanii resistance genes, especially in health settings.

Evolution of the Quality of the Partogram in 96 Health Care Facilities of 3 Provincial Health Divisions in the Democratic Republic of the Congo

The partogram is an accurate labor monitoring tool for reducing maternal and perinatal mortality due to prolonged labor and dystocia. The aim of this study is to assess how the quality of the partogram has evolved in health care institutions (HCI in short) that have benefited from the primary health care support project (ASSP in short) after formative supervision. This is a descriptive study by periodic clinical audit between 2020 and 2022, carried out in 96 HCI in 3 provincial health divisions (DPS in short) of DR Congo. Each photographed partogram page was sent to the project’s central level for review by a team of experts (3 obstetric gynecologists and 3 midwives). The compliance rate for completing partograms in the 96 health facilities of the 3 DPS was 86.8%. The rate of traceability of labor continuity was 88.2%, and that of traceability of acts, incidents and treatments during labor was 87.1%. Finally, the compliance rate for filling out partograms in the immediate post-partum period was 81%. A clear improvement was noted between the January 2020 and March 2022 assessments.

Perceptions on Public Health Facilities by Slum Dwellers in the Metropolitan Cities of India

Rapid urbanisation and quest for better livelihood, push-pull factor of occupations education, policy changes attract large scale rural population to urban areas. It is well documented that in spite of better public health facilities including tertiary care hospitals which are available in the urban areas but the services are underutilised by the urban poor. Aim: Hence, in this paper, it is attempted to comprehend the reasons for underutilisation of available public health facilities and to compare the difference with non-slum areas of the major metropolitan cities of India. Methods: A secondary data from National Family Health Survey-III for five major metropolitan cities namely, Delhi, Hyderabad, Mumbai, Kolkata and Chennai is used for the analysis. Slum data which are classified by both the agencies, that is census of India and NFHS-III as slum households only considered for analysis. Results: In Mumbai slums about 90% of the households are having water sources from public tap or piped to yard followed by Hyderabad having better water supply and Chennai slum dwellers having minimum access to good water sources. About 11.4% of the households do not know where their toilet drainage is connected. There is a significant (P 0.05) 75% to 79%, Kolkata and Chennai have parallel high proportion, that is more than 95% (P > 0.05) and Mumbai stands as median percent age as 89.6. Apart from Delhi, about 40% to 45% of the slum population is in the opinion of “long waiting time” in the government hospitals, and the same trend of proportions is observed for “poor quality of service”.

Quality of Intrapartum Care: Direct Observations in Selected Health Facilities in Zambia

Approximately 303,000 women die annually while giving birth, worldwide, and more than 99% of the deaths occur in developing countries. In Zambia, a developing country situated in sub-Saharan Africa, most of the maternal mortalities occur during the intrapartum and immediate postpartum periods, arising from postpartum hemorrhage, sepsis, obstructed labor, and hypertensive disorders. Aim: The aim of this study was to assess the quality of intrapartum services provided in health facilities in the country. Methodology: Guided by a descriptive cross sectional design, data were collected from 264 women in labor using a World Health Organization validated observation checklist. Convenience sampling was used to recruit the women, while multistage sampling was used to select four health facilities. The Social Package for Social Sciences, version 23 was used to analyze the data. Results: One health facility met the World Health Organization 80% minimum standard in four out of the five categories used to measure quality in intrapartum care, while the other three met the minimum standard in one category each. Conclusion: Low numbers of midwives, inadequate supplies and equipment were major obstacles to following national and international agreed standards for providing optimal care during intrapartum period. Recommendations: There is need for local and national stakeholders in Zambia to urgently address the structural barriers that were observed, as well as invest in sufficient numbers of adequately trained and motivated midwives.

Effects of China's National Essential Medicines Policy on the Use of Injection in Primary Health Facilities

The overuse of injection exists more than 20 years since economic reform in China.It is a persistent problem and seems becoming a new challenge in the new health reform period.This study was designed to assess the effect of national essential medicines policy(NEMP) on injection use at primary health facilities in China by investigating their prescription information.Questionnaires were designed and disseminated to collect empirical data on injection use at 120 primary health facilities in 6 provinces from January to September in 2010 and 2011.The injection use was measured as the indicator as the percentage of prescriptions with one or more injections.The results showed that the percentage of prescriptions with one or more injections was decreased from 38.91% to 36.82%(2 =11.158,P=0.001) in the all survey areas during the NEMP reform.The difference in level of the injection use in 2011 was significant among the eastern,central and western regions(2 =223.584,P=0.000);level of the injection use in western region was the lowest(27.73%),while that in the central region was the highest(43.10%).The level of the injection use in 2011 among different provinces was also of great difference(26.00%-58.25%,range:32.25%).The level of the injection use in 2011 was still much higher than the standard suggested by WHO for developing countries(13.4%-24.1%).It was concluded that NEMP has improved injection use in China,but the injection abuse situation remains serious,indicating that one of the priorities to the next stage of NEMP is to promote the rational use of drugs,especially the injection use.

The Current Status and Challenges Regarding Tuberculosis Infection Control in Health Care Facilities in China

Health care facilities are a high-risk environment for generating and spreading respiratory infectious diseases such as tuberculosis （TB）. The TB prevention and treatment staff in health care facilities are responsible for the identification, diagnosis, treatment, supervision, and management of TB patients .

Online and Offline Android Based Mobile Application for Mapping Health Facilities Using Google Map API. Case Study: Tanzania and Kenya Borders

The evolution of technology in 1990s resulted in the enormous growth of smartphones and the propagation of mobile applications (App) that marked new opportunities for healthcare centers and medical education. Apps have altered health services from patient’s health monitoring to specialist’s appointments and consultations from specialized health facilities. It can be argued that a healthy society can bring forth sustainable economic development to its full potential while an unhealthy society cannot. However, a free movement of people, labour and right to residence which was built across East Africa (EA) borders enabled Tanzania and Kenya borders to have enormous interactions. Subsequently, increase the risk of highly communicable diseases such as Tuberculosis and Sexually transmitted infections in such a way that medical attention is unavoidable along the borders. Statistically, Android Operating System (OS) owns 83% of Africa’s mobile OS market. In addition, 25,794,560 internet users reported by Tanzania Communications Regulatory Authority (TCRA) together with the 22.86 million internet users provided by Kenya Digital which is equivalent to 46% and 43% of internet penetration in year 2020, disclose the need for Android mobile application for mapping health facilities both online and offline using Google map API, which will solve residents’ need to healthcare services on the presence or shortage of internet connections;using either Swahili or English language via Smartphone devices. The App incorporates Monitoring and Evaluation (M & E) tool for tracking application usage which will ease Admin’s task to generate daily and monthly reports in Excel and Comma-Separated Values (CSV) formats. The developed system received positive feedback from EA citizens and residents in the Arusha region and Namanga border crossing where 90.2% of the system evaluation conducted between Dec 2020 and Apr 2021 agreed upon App usage.

Access to Supportive Health Services for People with Physical Disabilities: A Case of Health Facilities in Singida Rural District, Tanzania

Background: It is estimated that above one billion people (15%) of the world’s populations are living with disabilities. The poor and unfriendly infrastructure at health facilities is the core challenge for people with physical disabilities in accessing healthcare. This study aimed to explore at what extent the existing infrastructure and design of health facilities in Singida rural district, Tanzania supports people with physical disabilities to access healthcare. Methods: A cross sectional health facility-based assessment of all thirty-two functioning health facilities in the district was done between June and December 2020 using observational checklist and key informants’ interviews consist of measurement procedures of the architectural condition of health facilities. Observation checklist was designed based on standard of health facilities in Tanzania, national guideline for safe care standards for dispensaries, health centers and district hospital of 2014 and national guideline for water, sanitation and hygiene in healthcare facilities of 2017. Data were analyzed by SPSS-26 using descriptive statistics to obtain frequencies tables, percentage and figure. Qualitative data were analyzed by using NVivo-12 software. Results: The study revealed that there was no signage, entrance area, parking and toilets designated for people with physical disabilities in all health facilities. There was no special seat, examination table/bed and special weight scale for people with physical disabilities in all facilities. Also, the doors were not wide enough to support wheelchair user to maneuver in all health centers and dispensaries. In addition, door handles were not user friendly for wheelchair users. In fact, only the hospital and health centers had wheelchairs while 27 (96.4%) of all dispensaries had no wheelchairs. Furthermore, ramp and pathways were not available in all dispensaries. All health facilities had stairs but the challenge was most of the staircases had no floor located before the steps. Conclusion: The study revealed that the infrastructures in most healthcare facilities pose challenges to people with physical disabilities when they access healthcare services. These findings call for need of improving health facilities’ infrastructure to accommodate people with physical disabilities and this should be given a priority.

Health Facilities Readiness to Implement Standard Precautions for Infection Prevention and Control in Tanzania: Lesson Learnt from SARA Reports

Introduction: Standard Precautions are a set of measures applied in the care of all individuals/patients regardless of their infectious status aiming at preventing healthcare workers and patients from infections, preventing environmental contamination and spread of infections to the community. Many health facilities have not implemented them to an acceptable level. The purpose of the study is to report progress of improvement in health facilities readiness to implement standard precautions for infection prevention and control based on SARA reports. Methods: We generated mean scores of all standard precautions each year and calculated their standard deviations, variances and confidence intervals. One-way ANOVA was used to determine if the mean scores were equal. Finally, the trend of improvement in health facilities readiness to implement the standard precautions was generated. Results: A total of nine standard precautions were reported in SARA reports for 2012, 2017 and 2020. The mean scores of the standard precautions were 52.22% in 2012, 64.55% in 2017 and 69.66% in 2020. The overall trend showed an increase in health facilities readiness to implement standard precautions, although the mean scores were not statistically different (p-value 0.3217). Conclusion: SARA surveys conducted in Tanzania in 2012, 2017 and 2020 have shown an overall increase in health facilities readiness to implement standard precautions. Safe final waste disposal was being done in fewest facilities while single-use or auto-disable syringes were in most facilities that were sampled in all years. SARA surveys may be a useful way to evaluate Infection Prevention and Control adherence in health facilities.

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.

Assessment of Active Case Search of COVID-19 in Healthcare Facilities during the Third Wave of the Pandemic in Ekiti State, Nigeria

Early case detection and isolation of patients infected with highly infectious diseases through active case search (ACS) are important for early commencement of treatment and control of the disease within a population. This study aimed to assess the ACS of COVID-19 in healthcare facilities during the third wave of the pandemic in Ekiti State, Nigeria. This cross-sectional study was conducted in all healthcare facilities in Ekiti State. All cadres of local government primary healthcare workers were trained to carry out the ACS using semi-structured interviewer-administered questionnaire uploaded on android phone software open data kit (ODK). ACS was conducted between June and September (epidemiological week 23 to 36), 2021 and the collected data were analyzed using IBM SPSS version 23.0. P-value < 0.05 was taken as significant. The number of ACS visits for COVID-19 increases with epidemiological week progression, but the highest was in week 32 (9.9%). Cases of suspected COVID-19 in the healthcare facilities in the last one week were reported in more than half (58%) of the visits and 57.8% of those reported, documented between 1 - 4 cases. Also, out of those that were reported, 42% of them missed (not line listed) at least one suspected case of COVID-19. The private health facilities missed more cases of COVID-19 (54.3%) than other categories of health facilities (p < 0.001). The health educators and local government immunization officers (LIO) than other cadre of healthcare workers found most missed cases (57.1% and 51.4% respectively) in their visits (p < 0.001). The health educator as well as the LIO detected the highest proportion of missed suspected cases which shows that disease surveillance officers alone may not be adequate for ACS, there is a need to involve other local government team member.

Role Expectation of Nurse Managers in Geriatric Health Services Facilities

Back ground: The characteristics of geriatric health services facilities (GHSF) in Japan include provision of care focused on the life of the residents, and there is a need for cooperation between care workers and physical therapists responsible for the care. Thus, it is expected that a nurse manager occupies specific roles suited for the above characteristics that are different from those of medical facilities. Thus, we aimed to clarify the role expected of nurse managers via a questionnaire survey administered to nurses and care workers in GHSF. Methods: We used a descriptive, cross-sectional design. The study was conducted in 56 GHSF all over Japan. The instrument used for data collection was a questionnaire. The questionnaires consisted of 35 items for determining role expectation of nurse managers, the background information of respondents. The role of nurse managers was analyzed using principal factor analysis (promax rotation). Findings: A total of 259 nurses and care workers participated in this study. We extracted 34 items by factor analysis, which were classified into three factors (promotion of home nursing, management of medical care, and environment creation for collaboration and education). Among care workers, four factors consisting of 33 items were extracted. Factors one, two, and three were similar to those of nurses;“intervention to ethical problem” was extracted as the additional fourth factor. Conclusion: The roles required for nurse managers in GHSF are the promotion of home nursing, which is the original role of the health services facilities, exhibition of the specialty as a healthcare professional, creation of a work environment that promotes mutual understanding for collaboration with other professionals, and enhancement of the education and training system.

Patients’ Preferences of Healthcare Facilities for Quality Healthcare Services in Akwa Ibom State: A Game Theory Approach

The purpose of this work is to apply Game theory approach to determine patients’ preferences of healthcare facilities for quality healthcare in Akwa Ibom State. Cross-sectional descriptive study and purposive sampling technique were adopted in order to collect the relevant data. Factors influencing patients’ preferences of health care facilities between public and private hospitals in Akwa Ibom State were assessed using a set of questionnaires which were distributed to 9976 patients in University of Uyo Teaching Hospital, Uyo, Akwa Ibom State. A two-person zero sum game theory approach was applied. Perception of quality healthcare services received by respondent’s preferred facilities between public and private hospitals was examined. Also the reasons for patients’ persistence of their preferred facilities were evaluated using questionnaire. The optimal strategy and the value of the game were determined using the factors influencing patients’ preferences of healthcare facilities, and analysed with two-person-zero-sum game. Facility that gives their clients the best satisfaction was identified. The data collected through questionnaire were analysed using the rules of dominance in a two-person-zero-sum game and TORA statistical software was employed. The result shows that the value of the game, v = 330 which implies that the game is favourable to public hospital. The result also showed that patients preferred public hospitals due to costs of services with probability one (1), while private hospitals attributed their preferences to attitude of healthcare providers with probability one (1).

The Epidemiological Profil of Digestive Cancers in Secondary and Tertiary Health Care Facilities in Cameroon

Background: Cancers have been a major public health problem in developing countries in recent years. The aim of this study was to determine the epidemiological profile of digestive cancers in secondary and tertiary health care facilities in Cameroon. Methodology: This was a cross sectional and descriptive study conducted over a period of 12 months in 14 health structures over the national territory. Included in our study were patients aged 15 and above with a histologically proven digestive cancer, patients with a clinical, biological and morphologic evidence of a digestive cancer. Socio-demographic (age, gender, region of origin, profession), clinical (symptoms on diagnosis, personal and family past history, consumption habits, tumour location) and paraclinical data were recorded on a pretested questionnaire. Data was analysed using SPSS version 20.0. Quantitative data was expressed as means with their corresponding standard deviations. Chi square was used for correlation between variables. A P value 0.05 was considered statistically significant. Results: Five hundred and eighty-two cases of digestive cancers were recorded out of 37,780 consultations/admissions during the study period giving a prevalence of 1.5% with a male predominance (58.1%). The mean age was 53.11 ± 17.26 years (15 - 99) with 33.8% of them below 45 years of age. Tumours were predominantly localized in the liver (43.5%) and colon (24.9%). Adenocarcinoma was the most common histological type in 44.5% of all cases. Alcohol consumption was found to be associated with colorectal cancer (p = 0.028) while tobacco consumption was found to be significantly associated with oesophageal cancer (p ≤ 0.001) and gastric cancer (p = 0.0047). Conclusion: A third of patients with digestive cancers were aged less than 45 years suggesting an early onset of these cancers in our setting. Relatively low prevalence with the liver being the most common site of localisation in our setting.

2019—2021年潍坊市基层卫生服务机构收支水平和结构

目的以山东省潍坊市为例,分析2019—2021年基层卫生服务机构收支水平和结构的变化趋势及不同特征机构的差别,了解突发重大传染病疫情给基层卫生服务机构带来的挑战,为进一步加强基层卫生体系建设提供建议。方法收集潍坊市2019—2021年基层卫生服务机构数据,分析收入总额和结构、支出总额和结构、收支结余的变化趋势,以及不同特征基层卫生服务机构的收支变化差别。结果2019—2021年,潍坊市基层卫生服务机构的总收入保持增长趋势,2019—2020年医疗业务收入增长率相对较低。基层卫生服务机构支出增长率逐年提高,公共卫生支出增长率明显高于医疗支出增长率。3年间,基层卫生服务机构亏损减少并得到扭转。医疗收入受影响最大的是医疗服务能力较低的机构。财政补助收入变化程度最大的是覆盖人口数多、承担公共卫生工作量较多的机构,并且这类机构亏损最严重。结论医疗业务收入增长受疫情冲击最大,此时,财政补助收入的高增长率对维持机构经济平稳运行起到重要作用,但财政补助投入仍需要长效机制的支持。在高公共卫生支出背景下,须关注公共卫生工作量大的基层卫生服务机构的亏损问题。财政投入在发挥兜底功能的同时,应着重用于提高基层卫生服务机构的医疗业务能力。

Network Analysis of Road Traffic Crash and Rescue Operations in Federal Capital City

Abuja is witnessing an upsurge of victims from Road Traffic Crash (RTC) which is mostly due to the attendant rapid increase in the volume of vehicles, traffic jams, bad driving, over speeding, insufficient road signs and bad conditions of vehicles that ply the roads. The problem is compounded by a lack of early emergency response. Geographic Information System (GIS) based travel time model was applied in the street network analysis to identify RTC black spots that are outside the close reach of Federal Road Safety Commission (FRSC) rescue points/health facilities in Federal Capital City (FCC). Five minutes, Ten minutes and Fifteen minutes travel times were used as the impedance factor. Remote Sensing and GIS techniques were used to carry out network analysis. This was achieved by conducting the closest facility operation in the ArcGIS network analyst extension using the time of travel from each FRSC zebra point location to the RTC black spot zones/health facility. The results were presented on road network maps and bar graphs. The areas where quick response and medical facilities are insufficient were identified. It was concluded that the available health centres can sufficiently service RTC black spots in FCC, but the FRSC zebra points are insufficient which renders rescue operations inefficient and thereby exposes RTC victims to more danger. In order to ensure that there is sufficient coverage for response times, it was suggested that additional zebra points be created.

Design and Simulation of an Inverter Drive System with a Display for a Renewable Energy System in the Rural Isolated Communities of Uganda

In medical diagnostics, therapeutic, laboratory, intensive care unit devices, and machines application, two form of Electrical Energy is utilized. Alternatives current (AC) and Direct current (DC) form. In this paper an inverter driver system with a display model is made using MATLAB and its specific tool box of Simulink, the process will involve converting single phase alternating current power to direct current using rectifier made from ordinary normal diodes then converted to three phase using three-arm insulated gate bipolar transistors this is commonly known as inverter bridge which is sufficient enough to run three phase loads depending on the application requirement. The system uses a five-level inverter with low levels of distortions and ripples in the equipment output, this increase and improves the performance of the system. Using carefully selected passive and active elements such as capacitor resistors, inductors, diodes, and transistor system in inverter, decreases the number of switches and boosts the efficiency of the system. This inverter drive system helps us to run three phase machines in the health facility at the same frequency of single phase. The inverter system allows a smaller smoothing capacitor in the DC-AC link as proposed. Large smoothing capacitors are conventionally essential in such converters to absorb power ripple at twice the frequency of the power supply. The proposed network topology consists of an indirect matrix converter and an active snubber to absorb the power ripple, and does not necessitate a reactor or large smoothing capacitor. Simulation result is shown using MATLAB software and used to verify system operation principle as well as circuit development and their control mechanism for a single-to-three-phase power inverter system. The results from experiment show that for a 1 kW-class prototype circuit system, the power ripple at twice the frequency of the power supply can be adequately suppressed using a buffer capacitor of low values.

Choice of place for childbirth among pregnant women accessing antenatal care at Nnamdi Azikiwe University Teaching Hospital,Nnewi,Nigeria:a descriptive study

Objective:This study determined choice of place of delivery among women accessing antenatal care clinic s in Nnamdi Azikiwe University Teaching Hospital(NAUTH)Nnewi in Anambra state.Methods:A descriptive survey was conducted with three hundred and twenty-two pregnant women who registered for antenatal care at Nnamdi Azikiwe University Teaching Hospital,Nn ewi.Data were collected using a self-structured questionnaire and analyzed with a Chi-square test of association and Fisher’s exact test were used to test the hypothesis at 5%level of significance.Results:Findings from the study showed that 39.75%of the pregnant women chose private hospital s as their place of delivery,37.27%chose NAUTH,6.52%and 7.14%chose other government hospitals and home delivery,respectively.There was a significant difference between education level and occupation of the participants in the choice of place of childbirth.Privacy,finance,distance and approach of health workers were significant predictors of choice of delivery place among the women.Conclusion:Health planners need to recognize the determinant choice of delivery place as more efforts should be given to educate women and empower them.However,utilization of tertiary health facilities for childbirth m ay increase if the privacy of pregnant women is maintained,health workers relate well with clients and the cost of health care services is reduced.