knowledge and attitude of child bearing age women toward antenatal care

Background to the study

Antenatal care service is an important goal concerning in the health status of the pregnant women during their reproductive period and its health beneficial accounting for nearly one quarter of all pregnant worldwide Terry TL (1942)

Through the antenatal care service attempts have been made to identify pregnant women not at risk and those at risk group based on their previous pregnant or currently historical or clinical factors and steps are planned to prevent it in this allegedly high-risk group of women to reduce adverse pregnancy outcomes Lincetto et al (2013).

Unfortunately, adverse pregnancy outcome can occur even in women without identifiable risk factors. Numerically, more pregnant women without risk factors have seen to end up with serious adverse outcome compared to those with risk factors during the attendance of antenatal care service Villar J, bergsj P (2002). In order to prevent pregnancy adverse outcome world wide as well as in developing countries, interventions should therefore be targeted at all pregnant women attending antenatal care service and during childbirth Dowswell T, et al. (2013).

Early attendance intervention at the antenatal care service in those with and without risk group pregnant women seems to beneficially in relation of their health  and this intervention that has been promoted as an effective intervention in preventing adverse pregnant outcome Adewoye KR, Musa IO, Atoyebi OA, Babatunde OA (2013).

The need of implementing knowledge, attitude and practice of ANC intervention in pregnant women it has been showed that as a package comprising the following interlocking system includes interventions, early screening, administration of a preventive prophylactic therapy and curative of the various detected risk conditions effectively on the basis of reduced maternal complications Zegey AM, Bitew BD, Koye DN (2013).

Additionally, antenatal care service is not a single intervention; instead, it represents a series of assessments and interventions over time that is not uniformly applied effectively by different health care providers found in developing countries Hajela S (2014).

Although not only  the “quantity” of antenatal care service  is relatively easy to measure through the required  timing and number of visits adjusted for gestational age at delivery but also the “quality” of antenatal care service  and the effectiveness of individual components on outcome are quite difficult to measure. However, the major goal of antenatal care service is to ensure the birth of a healthy baby with minimal risk for the mother.

Despite high ANC attendance in Nigeria, only 14% of pregnant women start ANC during the first trimester as per the national guidelines. The median number of months that women are pregnant at their first visit is 5.4 months. One third of women do not seek ANC until their sixth month or later Tekelab T, Berhanu B (2014). However, early booking has an advantage for proper pregnancy information sharing and pregnancy monitoring

Statement of the problem

In spite of the fact that exercise programs during pregnancy and after childbirth are designed to minimize impairment and help the woman maintain or regain function while she is preparing for the arrival of the baby and then caring for the infant, it is submitted that women are not meeting the exercise recommendations of the previous studies. A myriad of factors not limited to beliefs and attitudes of women with respect to exercise in pregnancy, level of knowledge, level of education, safety concern of the pregnant woman and her physician , race/ethnicity, and previous involvement in regular exercise have been implicated as important factors predisposing to exercise engagement or phobia among pregnant women.Some identifying factors that affect beliefs and behaviors would objectively encourage a change in attitude. Therefore, an assessment of knowledge and attitude about exercise in pregnancy may help to determine whether or not women will participate in exercise during and after pregnancy. This study was designed to assess knowledge and attitude of Nigerian pregnant women towards antenatal exercises.

Purpose of the study

The main objectives of this study is to investigate the knowledge and attitude of child bearing age women toward antenatal care.

The study have the following specific objectives;

  1. To assess the extent to which level of maternal awareness influences women’s attendance to antenatal care services in Nigeria
  2. To determine how cultural beliefs towards modern reproductive services influences women’s attendance to antenatal care services in Nigeria
  3. To establish how economic status influences women’s attendance to antenatal care services in Nigeria

Research Questions.

  1. To what extent does the level of maternal awareness influence women’s attendance to antenatal care services in Nigeria
  2. How do cultural beliefs towards modern reproductive services influence women’s attendance to antenatal care services in Nigeria
  3. How does economic status influence women’s attendance to antenatal care services in Nigeria

  Significance of the study

 

The study is a major step forward in objectively improving the maternal health across the marginalized groups comprising of immigrants especially in Lagos state Nigeria through the identification and subsequent development of appropriate antenatal service provision programs. These programs will enable these communities change attitudes thus reducing the rate of maternal morbidity and mortality among Nigeria women.

The findings of this study will be useful to maternal health care providers who are key stakeholders in the realization of the Millennium Development Goal in relation to the antenatal care.

The Ministry of Health and other health institutions can also use this study to clearly understand the antenatal needs of Nigeria women.

This study also tried to fill the gaps in understanding the status of Nigeria women using Health care services for delivery by identifying determinants of facility delivery in Lagos state and their change over time. By doing so, the findings could inform interventions aimed at improving institutional service provision improvements

  Definitions of significant terms

 

Traditional Birth Attendant- a person who assists the mother during childbirth and who initially acquired her skills by delivering babies herself or through an apprenticeship to other TBAs (WHO 1992)

Awareness- the ability to perceive, to feel, or to be conscious of events, objects, thoughts, emotions, or sensory patterns

Reproductive health- a state of physical, mental, and social well-being in all matters relating to the reproductive system, at all stages of life.

Economy – the wealth and resources of an individual, a country or region, especially in terms of the production and consumption of goods and services.

Maternal death- the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.

 

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Apr 09

KNOWLEDGE AND PERCEPTION OF HEALTH WORKERS ON TRANSMISSION AND PREVENTION OF CORONAVIRUS

KNOWLEDGE AND PERCEPTION OF HEALTH WORKERS ON TRANSMISSION AND PREVENTION OF CORONAVIRUS

INTRODUCTION

1.1  Background to the Study

Health related infections are the major problems of public health in many nations of the world, which ultimately cause an increase in the morbidity, mortality, and additional costs in health care settings (Mauldin et al 2010; Defez et al, 2008 and Llata et al, 2009). Ensuring hand hygiene is therefore one of the basic means preventing the spread of such infections. In 1983, Semmelweis highlighted that cleansing of contaminated hands with antiseptic products before and after contact with patients may reduce health related infections (Semmelweis I. 1988). Thereafter, Centre for Disease Control and Prevention published the first formal guidelines on hand washing practices in hospitals (Garner JS, Favero MS. 1986), followed by guidelines from the Association for Professionals in Infection Control and Epidemiology (APIC) (Larson et al, 1995).

corona viruses are common viruses that most people get sometime in their life and may also infect animals. Human coronaviruses (hCoV) which has been globally trending for over a month now usually causes upper respiratory tract illnesses. Severe Acute Respiratory Syndrome (SARS-CoV) that occurred way back in 2003 served as a reminder to this newly emerging zoonotic coronaviruses which has the potential to transmit from person to person and to cause severe human illnesses. Novel coronavirus (nCoV), described as Middle East Respiratory Syndrome coronavirus (MERS-CoV), is a particular strain different from any other known hCoV with a possibility of zoonotic transmission. However, Centre for Disease Control and Prevention (2014) revealed that investigations was carried out to figure out the reservoir and source of infection, route of transmission to humans, symptoms, prevention, severity and clinical effects with gradually increasing number of reported cases on daily basis.

There has been a rapid international response following the news of this new virus from Wuhan, China on the 12th of February 2020 which has now spread to every nook and cranny of the world. An interim case definition was developed rapidly by WHO to ensure that a systematic approach is followed for appropriate identification and investigation of suspected cases. The body has also made arrangement for disbursing huge amount of money for the prevention and cure of this pandemic disease now known as COVID-19 to the high risk affected nations of the world.

Understanding the knowledge, attitudes, and perception of health workers on transmission and prevention of COVID-19 is essential to bring forth a sustained change in behaviors of individuals and institutions and to improve such practices when designing interventions. This is why health workers and the government are clamouring for hand hygiene. This can be achieved by frequently washing of the hands. Several factors are involved in hand hygiene behavior such as attitude, perceived social norm, perceived behavioral control, perceived risk for infection, hand hygiene practices, perceived role model, perceived knowledge, and motivation (Larson et al, 2000). Despite the number of published studies on hand hygiene, many questions concerning attitudes and knowledge of health care workers (HCWs) remain unanswered. This is particularly true in primary care settings where the volume of patients and complexities of cultural, institutional, and health policy factors can influence the practice of hand washing. Various studies have confirmed an inverse relation between intensity of patient care and adherence to hand hygiene practice (Pittet et al, 2004; Harbarth et al, 2001 and Arenas et al, 2005). Additionally, the current burden of the spreading Middle East respiratory syndrome coronavirus (MERS-CoV) implied an action to review our basic strategies in hand hygiene practice. In a descriptive study (47 cases), MERS-CoV was found to be associated with substantial mortality in admitted patients who have medical co morbidities. This brings about adequate infection control measures among health workers, for example, hand hygiene. Hence, knowledge, attitudes, and perception of hand hygiene will continue to be a major concern and are important to examine to bridge the theory practice gap.

The discovery of this new virus mandates it for China to demonstrate to rest of the world how vigilant and prepared they are to prevent the global spread of a new infection and protect both global health and the wellbeing of their own peoples. The countries of the region need to be vigilant and put in place enhanced public health surveillance plan for identifying suspected cases using WHO’s recommended case definition and investigation protocol (Malik et al., 2012). The US, UK, Germany, Italy and even Nigeria are currently battling with COVID-19 pandemic. It has taken a great concern at the governmental and public levels as it led to a number of human infections and deaths. Since February 12, to March 26, 2020; the total number of infected cases with COVID-19, as reported by worldometers, reached 478,446 of global cases of which 21,524 cases have died and a total of global recovery stands at 115,668.

We need to better understand the public health implication of emergence of this new respiratory virus from China to understand the exposure risks. The current situation in Nigeria needs to be carefully monitored by our health workers as there is a fear from increased number of human infections and deaths recording on daily basis. Till now, no COVID-19 cases have been confirmed in some states in Nigeria, however, in south western part of Nigeria, as at 26th of March, 2020, Lagos State has recorded 32 cases, while Ogun has recorded 3, Ekiti, Osunand Oyo (the case study for this research work) has recorded 1 case each. Thus, the concern over the possibility of an outbreak in Oyo State should not be taken lightly. The problem of COVID-19 pandemic becomes more complicated in absence of any prophylactic vaccines, curative treatment and lack of experience in control measures (Al-Ahdal et al., 2012). It is against this backdrop that the study sets to examine the attitude, knowledge and perception of health workers on transmission and prevention of COVID-19 by using health workers in the outpatient department of University College hospital Ibadan as a case study.

1.2  Statement of the Problem

Once again, the world is currently experiencing a global viral COVID-19 pandemic. As of March 26, 2020 confirmed cases of coronavirus disease (COVID-19) has been reported to be 478,446 and 21,524 deaths had been reported in more than 30 countries of the world. The majority of cases as at the time of writing have been from China which is closely followed by Italy, US, UK, Germany and Spain. Most countries in the world have made efforts to halt transmission through shutting down transport, quarantining entire cities, regular washing of the hand with soap and sanitizer and enforcing the use of face masks. International flights have been cancelled in Nigeria and other African nations have been following suites and affected cruise ships quarantined. This has been having effects on the economy of the world.

The effects of COVID-19 pandemic outbreak to the economy of the world will surely be discussed in its aftermath. The initial response in China to contain the virus has been applauded by WHO and considered much improved compared with its response to the 2003 SARS-CoV epidemic. Internationally, we have seen rapid generation and sharing of knowledge to the benefit of the outbreak response, but also counterproductive actions by some countries, including limiting trade and shutting of borders, to its detriment. With the increasing frequency of zoonotic spillovers leading to human infections and transmission, it is apparent that pandemic preparedness has become a priority for the global health agenda. It is on this claim that this study aims to examine the attitude, knowledge and perception of health workers on transmission and prevention of COVID-19 by using health workers in the outpatient department of University College hospital Ibadan as a case study.

1.3 Objectives of the Study

The objective of this study is to examine the attitude, knowledge and perception of health workers on transmission and prevention of COVID-19 by using health workers in the outpatient department of University College hospital Ibadan as a case study. However, the specific objectives are:

i) To understand the attitude, knowledge and perception of health workers to the general public towards the prevention of COVID-19  in Oyo State

ii) To determine the strategies used by health workers in the State to stop the general spread COVID-19

iii) To study the effects of COVID-19  on the economic status of the world

iv) To establish the symptoms of COVID-19 and the steps to take when these symptoms occur

1.4 Research Questions

The following questions were generated during the course of this study:

i)  What are the attitude, knowledge and perception of health workers to the general public towards the prevention of COVID-19 in Oyo State?

ii)What are the strategies used by health workers in the State to stop the general spread COVID-19?

iii) What are the effects of COVID-19 on the economic status of the world?

iv)What are the symptoms of COVID-19 and the steps to take when these symptoms occur?

1.5       Significance of the Study

Theoretically, this study stands to provide additional knowledge to the body of existing literature on the spread this pandemic disease to the world and of particular reference to Nigeria. The result of this study will serve as good base or guide for future reference and it will also encourage further research on the importance of staying healthy. Furthermore, this study will provide relevant information on the reasons for the spread of this disease from China to the rest of the world.

Practically, the findings of this study will reveal the reasons for regular health check up for the benefit of staying healthy at all times. The result from this research will also help health workers to design relevant, persuasive health messages that will help change the people’s attitude on the utilization of hospitals and create more awareness on the situation of health care services in the country. This study will be of great significant to the medical professionals who have defaulted in carrying out their duties to their patients

1.6       Scope of the Study

This study focuses mainly on the attitude, knowledge and perception of health workers on transmission and prevention of COVID-19 of health workers in the outpatient department of University College hospital Ibadan. It will therefore, be carried out among the students and health workers in the outpatient department of University College hospital Ibadan.

1.7       Limitations of the Study

            The time frame was not enough for the researcher to delve into the issue as comprehensively as would have been desired. This also informed the decision to focus on one department so the time would be invested in identifying and evaluating all possible aspects of the subject matter so as to make the study as comprehensive as possible. The use of a case study arguably has many limitations, however it allows for a level of research that was commensurate with the nature of results expected

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Dec 18

ATTITUDE OF NURSES AND MIDWIVES TOWARDS DOCUMENTATION AND QUALITY RECORD KEEPING

Attitude Of Nurses And Midwives Towards Documentation And Quality Record Keeping

CHAPTER ONE

INTRODUCTION

 

This chapter presents the background of the study related to the context of Nigeria and Nigeria’s health system, and the quality of patient record-keeping. It outlines the problem statement related to the quality of patient record-keeping, and the aim and objectives of the study. It also describes the significance of the study and gives operational definitions of terms. Lastly, an outline of the thesis is presented.

 

Background to the study

 

    

Keeping patient records accurately provides a correct account of the treatment and care given to patients; this allows for good communication between nurses and midwives  as a team in their daily activities (Stevens & Pickering, 2010). Patients’ daily records, including the nursing records, are considered legal documents and must accurately and honestly reflect nursing actions carried out for the patients (Maharaj, 2015). Poor documentation potentially negatively affects patient care, professional accountability, and organisational risk (Blair & Smith, 2012). In addition, future improvement of nursing care depends on precise nursing information in the patient’s records; it is thus essential that nursing records be completed comprehensively and accurately. However, many countries across the world are experiencing problems in decision making, planning processes, and performance evaluation of healthcare programmes due to the poor quality of health data recording (Corrao et al., 2009).

 

 

The United States Department of Health and Human Services in 2006 reported that the ratio for missing medical records was 1:7 in health services institutions, which means that for every 7 patients one medical file is missing, due to the lack of quality patient record-keeping (Marutha,

2011). Problems of poor-quality health data, a low level of health information use and poor management of health information systems have also been reported in a systematic review of health data quality management and best practices at community and district levels in low- and middle-income countries (LMIC) (Ndabarora, Chipps & Uys, 2014).

 

 

 

 

Keeping a clear and accurate nursing record for each patient is one of a nurse’s day-to-day duties, as this is only one method to support a nurse to remember everything that has been done during a shift, in order to facilitate a clear and complete handover of patient information to the next team of nurses and midwives  (Stevens & Pickering, 2010).

 

 

According to the law in many countries, if care or treatment given to a patient is not accurately recorded, it can be taken that it has not been done (Stevens & Pickering, 2010). Records provide for accountability by offering a basis for continuity of care, evidence of changes in the patient’s condition and proof that care has occurred (McIntosh, 2008).

 

 

The South African Nursing Council (SANC) states that “the quality of nursing practice is founded on timely, accurate and complete recording of the care provided to patient” (McIntosh, 2008, 3 ). Furthermore, the South African Nursing Council Act 33 of 2005 indicates that a nurse may be disciplined if found negligent for not recording details of his or her nursing care (Mtsha, 2009).

 

 

Evidence in the literature has shown that poor record-keeping leads to failure of the healthcare system to deliver an efficient service (Marutha, 2011). Similarly, a study by Ngoepe (2012) revealed that poor record-keeping is one of the major factors contributing to negative audit reports.

In South Africa studies by Marutha (2011) and Chinyemba (2011) identified that many institutions in public health sectors in Limpopo Province and some other provinces are experiencing the same problems of poor quality of patient record-keeping.

 

 

 

 

According to Jefferies et al (2010: 113) study, state that traditionally nurses and midwives  communicate information more verbally about their patients, more so than confirming it in writing. In Tanzania a study conducted by Mamseri (2012, 107) on ‘The nursing process as a means of improving patient care’ revealed that nurses and midwives  often use verbal communication rather than written communication while reporting their patients’ care and conditions. The study identified that among 120 respondents, 31 (26%) agreed that they always use verbal communication, 59 (49%) indicated that nurses and midwives  sometimes use written communication, 18 (15%) reported that they rarely take care about written communication, and 12 (10%) were not at all if they always use verbal communication or sometimes use written communication.

 

 

In a study by Olivier (2010), revealed that there is an evidence correlation between the length of time following completion of training and reluctance to keep records. It means that with the more time lapsed, the least likely nurses and midwives  are to keep adequate records, and this should be the result of the lack of the current knowledge regarding nurse’s attitude related to terminology and record- keeping.

According to Saranto and Kinunen (2009: 465) study, standardised terminology is a pre-requisite for consistent communication, therefore certain skills and knowledge are essential to achieve this effective communication among health care providers. The action of record-keeping requires skills and knowledge as information is recorded in line with the steps of the nursing process of

assessment, planning, implementation and evaluation (Mamseri, 2012).

 

However in Maharaj (2015) study, conducted in three hospitals in the Umgungudlovu District of KwaZulu-Natal, South Africa, confirmed that a shortage of nurses and midwives , non-use of support staff per nursing unit, bed occupancy rate and type of unit, including type of hospital, are the greatest barriers hindering the quality of patient information recording and processing. Other major factors are lack of awareness about the proper filing systems, lack of training and of knowledge, and practical skills of nursing staff in patient information record-keeping (Marutha, 2011)

 

Nigeria is experiencing nurses and midwives ’ complaints about workload (Carlsson et al., 2014) and has a continuously decreasing investment in education and research activities (Klopper & Gasanganwa, 2015). There is limited information regarding the quality of patient information recording in clinical settings in Nigeria.

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Jun 26

knowledge and utilization of partograph in the management of labour among the obstetrics care givers

BACKGROUND TO THE STUDY

The partograph is an instrument that can be used for a variety of purposes, including the monitoring of labor (Ogwang, Karyabakabo & Rutebemberwa, 2009:27). The utilization of the partograph is a well-known best practice for quality monitoring of labor and, as a result, the prevention of obstructed and prolonged labor, according to Yisma et al. (2013:13), who carried out a cross-sectional quantitative study in Ethiopia. Their findings were published in the journal Obstetrics and Gynecology. Despite this, there are still some cases of obstructed labor that occur in healthcare facilities due to the inadequate quality of the intrapartum care that is provided to the patients. The researcher suggested that pre-service and on-the-job training for obstetric care givers on how to use partographs should be prioritized for effective monitoring of pregnant mothers while they are in labor. This would allow for more accurate tracking of the progress of labor. Training on how to make use of partographs would fall under this category.

In 2014, research was carried out by the World Health Organization (WHO) that led to the discovery of a result based on a test that was carried out on 35,484 women hailing from Southeast Asian countries. It was concluded that a partograph was an essential tool for the efficient management of labor, and it was also recommended that it should be universally adopted for use in all medical facilities in order to reduce the rates of maternal mortality and infant morbidity. These recommendations were adopted. The findings of the study were presented in a paper that was published in The Lancet. The findings of the research indicate that there has been a sizeable reduction in the number of cases that call for prolonged augmentation, as well as emergency cesarean sections and stillbirths, to name a few of the aforementioned occurrences. Because of the stringent regulations that must be followed when using partographs, medical facilities in developing countries have been forced to place severe restrictions on their use.

 

As a consequence of this, in reference to the partograph published by the World Health Organization in 2014, it can be seen that many developing countries designed their partograph to cater to the immediate medical problems that they were facing. This, in turn, led to the rebirth of a variety of different methods of partograph. In conclusion, the partograph that is used by the World Health Organization underwent revision in the year 2014. Another thing that was noticed was that when these methods were used, the ending point of a partograph became an exception rather than the standards that were based on the client’s record. In previous research that was conducted at specific general hospitals in Kenya, Gichangi, Ndavi, and Wamwana (2010) came to the conclusion that partograph was utilized in 11% of cases. This was determined based on their findings. In addition to this, Delvaux(2011) came to the conclusion that in only nine percent of cases in urban maternity wards in Côte d’Ivoire, a partograph was completed, and contractions were monitored. This is in contrast to the ninety-one percent of cases that were observed in rural maternity wards. These two sets of numbers are derived from studies that were carried out in the country of Côte d’Ivoire. In excess of sixty percent of all deliveries were recorded on partographs that were completed after delivery at two of the fields that were utilized in the study. According to the guidelines that governed its application, it was intended to be used solely as a tool for record-keeping and not as a tool for monitoring.

 

Njoroge (2013) found that fifty percent of health practitioners in rural Kenya have little to no knowledge on the use of partographs, and their capability on the usage of the parameters of partograph indecision was below expectation. This is a problem because partographs are used to help diagnose and treat diseases. Sixty percent of health practitioners were unable to use the findings that were derived from the utilization of partographs in the decision-making process regarding the active management of labor. Delvaux (2011) found that providers did an inaccurate job of assessing the conditions of women when they were admitted; vital signs and the progression of labor were not properly monitored in the maternity ward; neither was correctly measured in the majority of cases; and the provider’s assessment of the women’s conditions was inaccurate. In addition, Delvaux (2011) found that providers did an inaccurate job of assessing the conditions of women when they were admitted. The authors also took issue with the common method of determining whether or not there is a problem with maternal health by counting the number of births that were witnessed by a trained medical professional. They argued that this is an insufficient measure. They also brought up the point that having a skilled attendant does not automatically equate to having skilled and appropriate care provided for you. In forty-nine developing countries, maternal and neonatal services were evaluated by Bulatao and Ross (2009) as part of a research project. When attempting to refer cases of obstructed labor to specialized facilities in these countries, the results of their research led them to the conclusion that health facilities in these countries did not make use of partographs and had limited access to transportation.

Partograph is an instrument that can be used appropriately in settings where there is basic training in obstetric skills to enable effective performance in normal delivery, vaginal examinations, and assessment of cervical dilations with reference to the availability of partograph. As a result of this, partograph is an instrument that can be used appropriately in settings where there is basic training in obstetric skills. In addition to a comprehensive training program that covers supervision and quality assurance, as well as detailed training that covers the mechanics of using a partograph, there should be an evaluation of the level of understanding and skills possessed by the health care staff. This evaluation should take place in conjunction with the implementation of a training program. In addition to this, it is necessary to carry out a successful supply and introduction at the same time as this evaluation.

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