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Abstract 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

Environmental issues resulting from production and application of wood charcoal can be addressed by using biomass briquettes as alternative. This research was undertaken to develop and evaluate briquette from jatropha, groundnut and melon seed residues. Samples of the briquette were formed from mixtures of 0.32-0.39 kg carbonised residues, 0.30-0.40 kg starch and 0.02- 0.04 kg water. Physical and mechanical properties of the briquette samples including calorific value, bulk density and breaking force were determined using standard methods. Box-Bekhen Design Methodology was used to determine the optimum briquette blend. The results showed that the optimal briquette blend gave values of 4711.87 kcal.kg–1 calorific value, 282.59 kg m–3 bulk density and 1.36 kN breaking force, with a desirability index of 61.5%. A comparative analysis of the properties of the optimal briquette with that of a wood charcoal indicates no significant difference (P

This research was conducted to study temperature variation in grain metal silo using Finite Element Method (FEM). A mathematical model was developed, based on conductive heat transfer expressed in Poisson and Laplace Differential models, by discretising the actual temperature variation at 8 hours storage interval for 153 days (May to September). The temperature variations were measured from specified radii (0, 3.25 m and 8.25 m) and at depth of 1.2 m from the base of the grain silo. The results of the simulation were compared with the ambient and measured values, and this agreed with each other. The pattern of temperature at the depth of 1.2 m from the radii of the metal silo did not differ from each other. This may imply that the silo will need aeration at an interval of 8 hours to curtail excessive heat build-up that may lead to deterioration of stored grains and possible structural failure.

Abstract Background The paucity of human resources for health buoyed by excessive workloads has been identified as being responsible for poor quality obstetric care, which leads to high maternal mortality in Nigeria. While there is anecdotal and qualitative research to support this observation, limited quantitative studies have been conducted to test the association between the number and density of human resources and risk of maternal mortality. This study aims to investigate the association between client-provider ratios for antenatal and delivery care and the risk of maternal mortality in 8 referral hospitals in Nigeria. Methods Client-provider ratios were calculated for antenatal and delivery care attendees during a 3-year period (2011–2013). The maternal mortality ratio (MMR) was calculated per 100,000 live births for the hospitals, while unadjusted Poisson regression analysis was used to examine the association between the number of maternal deaths and density of healthcare providers. Results A total of 334,425 antenatal care attendees and 26,479 births were recorded during this period. The client-provider ratio in the maternity department for antenatal care attendees was 1343:1 for doctors and 222:1 for midwives. The ratio of births to one doctor in the maternity department was 106:1 and 18:1 for midwives. On average, there were 441 births per specialist obstetrician. The results of the regression analysis showed a significant negative association between the number of maternal deaths and client-provider ratios in all categories. Conclusion We conclude that the maternal mortality ratios in Nigeria’s referral hospitals are worsened by high client-provider ratios, with few providers attending a large number of pregnant women. Efforts to improve the density and quality of maternal healthcare providers, especially at the first referral level, would be a critical intervention for reducing the currently high rate of maternal mortality in Nigeria. Trial registration Trial Registration Number: NCTR91540209. Nigeria Clinical Trials Registry. Registered 14 April 2016.

ObjectiveTo assess the existing knowledge and skills relating to Emergency Obstetrics Care (EMOC) among health providers in eight referral maternity hospitals in Nigeria.Study designA cross-sectional study of skilled health providers (doctors, nurses and midwives) working in the hospitals during the period.SettingSix general hospitals (4 in the south and 2 in the north), and two teaching hospitals (both in the Northern part) of the country.PopulationAll skilled providers offering EMOC services in the hospitals during the study.MethodsA pre-tested self-administered questionnaire was used to obtain information relating to socio-demographic characteristics, the respondents' knowledge and skills in offering specific EMOC services (as compared to standard World Health Organization recommendations), and their confidence in transferring the skills to mid-level providers. Data were analyzed with univariate, bivariate, binary and multinomial logistic regression analyses. Main outcome measures: knowledge and skills in EMOC services by hospital and overall.ResultsA total of 341 health providers (148 doctors and 193 nurses/midwives) participated in the study. Averagely, the providers scored less than 46% in a composite EMOC knowledge score, with doctors scoring considerable higher than the nurses/midwives. Similarly, doctors scored higher than nurses/midwives in the self-reporting of confidence in carrying out specific EMOC functions. Health providers that scored higher in knowledge were significantly more likely to report confidence in performing specific EMOC functions as compared to those with lower scores. The self-reporting of confidence in transferring clinical skills was also higher in those with higher EMOC knowledge scores.ConclusionThe knowledge and reported skills on EMOC by health providers in referral facilities in Nigeria was lower than average. We conclude that the in-service training and re-training of health providers should be included in national policy and programs that address maternal mortality prevention in referral facilities in the country.Trial registrationNigeria Clinical Trials Registry 91540209.

BACKGROUND:Late arrival in hospital by women experiencing pregnancy complications is an important background factor leading to maternal mortality in Nigeria. The use of effective and timely emergency obstetric care determines whether women survive or die, or become near-miss cases. Healthcare managers have the responsibility to deploy resources for implementing emergency obstetric care. OBJECTIVES:To determine the nature of institutional policies and frameworks for managing obstetric complications and reducing maternal deaths in Nigeria. METHODS:Thirty-six hospital managers, heads of obstetrics department and senior midwives were interviewed about hospital infrastructure, resources, policies and processes relating to emergency obstetric care, whilst allowing informants to discuss their thoughts and feelings. The interviews were audiotaped, transcribed and analyzed using Atlas ti 6.2software. RESULTS:Hospital managers are aware of the seriousness of maternal mortality and the steps to improve maternal healthcare. Many reported the lack of policies and specific action-plans for maternal mortality prevention, and many did not purposely disburse budgets or resources to address the problem. Although some reported that maternal/perinatal audit take place in their hospitals, there was no substantive evidence and no records of maternal/perinatal audits were made available. Respondents decried the lack of appropriate data collection system in the hospitals for accurate monitoring of maternal mortality and identification of appropriate remediating actions. CONCLUSION:Healthcare managers are handicapped to properly manage the healthcare system for maternal mortality prevention. Relevant training of healthcare managers would be crucial to enable the development of strategic implementation plans for the prevention of maternal mortality.