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.

Assessment and validation of the Community Maternal Danger Score algorithm

Background:High rates of maternal mortality in low-and-middle-income countries(LMICs)are associated with the lack of skilled birth attendants(SBAs)at delivery.Risk analysis tools may be useful to identify pregnant women who are at risk of mortality in LMICs.We sought to develop and validate a low-cost maternal risk tool,the Community Maternal Danger Score(CMDS),which is designed to identify pregnant women who need an SBA at delivery.Methods:To design the CMDS algorithm,an initial scoping review was conducted to identify predictors of the need for an SBA.Medical records of women who delivered at the Federal Medical Centre in Makurdi,Nigeria(2019-2020)were examined for predictors identified from the literature review.Outcomes associated with the need for an SBA were recorded:caesarean section,postpartum hemorrhage,eclampsia,and sepsis.A maternal mortality ratio(MMR)was determined.Multivariate logistic regression analysis and area under the curve(AUC)were used to assess the predictive ability of the CMDS algorithm.Results:Seven factors from the literature predicted the need for an SBA:age(under 20 years of age or 35 and older),parity(nulliparity or grand-multiparity),BMI(underweight or overweight),fundal height(less than 35 cm or 40 cm and over),adverse obstetrical history,signs of pre-eclampsia,and co-existing medical conditions.These factors were recorded in 589 women of whom 67%required an SBA(n=396)and 1%died(n=7).The MMR was 1189 per 100,000(95%CI 478-2449).Signs of pre-eclampsia,obstetrical history,and co-existing conditions were associated with the need for an SBA.Age was found to interact with parity,suggesting that the CMDS requires adjustment to indicate higher risk among younger multigravida and older primigravida women.The CMDS algorithm had an AUC of 0.73(95%CI 0.69-0.77)for predicting whether women required an SBA,and an AUC of 0.85(95%CI 0.67-1.00)for in-hospital mortality.Conclusions:The CMDS is a low-cost evidence-based tool that uses 7 risk factors assessed on 589 women from Makurdi.Non-specialist health workers can use the CMDS to standardize assessment and encourage pregnant women to seek an SBA in preparation for delivery,thus improving care in countries with high rates of maternal mortality.

Nurse Mentor Training Program to Improve Quality of Maternal and Newborn Care at Primary Health Centres: Process Evaluation

Quality of maternal and newborn care could be improved if health care providers’ knowledge and competencies as well as system level constraints are addressed. However, due to several barriers staff nurses who form the frontline of health care workforce have limited access to enhancing their clinical knowledge and competencies. To address this gap, a new cadre of nurse mentors (NMs) for the public health system were trained by specialists from a teaching hospital in a special 5-week training course. This included 54 hours of theory and 110 hours of practical in clinical obstetric and newborn care, apart from mentoring, quality improvement and health systems issues. The nurse mentors were assigned to support staff nurses in the primary health care centres (PHCs) in eight northern Karnataka districts. Each NM covered 6-8 PHCs monthly for 2 - 3 days and thus a total of 385 PHCs were reached. They received support in the field through supportive supervision visits done by the specialists who had trained them, as well as by refresher training and clinical postings to the district hospitals. This paper presents impact of the training program on change in immediate and long term knowledge and competency scores of nurse mentors. Their baseline knowledge scores changed from 44.3 ± 12.7 to 72.1 ± 13.8 immediately after the training in obstetric and from 18.2 ± 19.1 to 66.4 ± 14.9 in newborn (p p p > 0.05). Skills score soon after training increased from 62.2 ± 13.2 to 69.6 ± 12.5 in obstetric after a 1 year period and from 52.6 ± 9.3;63.5 ± 14.4 in newborn (p < 0.001) content areas respectively. These findings have implications for those interested in improving quality of maternal and child care through nurse-dependent health delivery systems.