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ObjectivesThis study aimed to quantify change in the coverage, quality and equity of essential maternal and newborn healthcare interventions in Gombe state, Northeast Nigeria, following a four year, government-led, maternal and newborn health intervention.DesignQuasi-experimental plausibility study. Repeat cross-sectional household and linked health facility surveys were implemented in intervention and comparison areas.SettingGombe state, Northeast Nigeria.ParticipantsEach household survey included a sample of 1000 women aged 13–49 years with a live birth in the previous 12 months. Health facility surveys comprised a readiness assessment and birth attendant interview.InterventionsBetween 2016–2019 a complex package of evidence-based interventions was implemented to increase access, use and quality of maternal and newborn healthcare, spanning the six WHO health system building blocks.Outcome measuresEighteen indicators of maternal and newborn healthcare.ResultsBetween 2016 and 2019, the coverage of all indicators improved in intervention areas, with the exception of postnatal and postpartum contacts, which remained below 15%. Greater improvements were observed in intervention than comparison areas for eight indicators, including coverage of at least one antenatal visit (71% (95% CI 62 to 68) to 88% (95% CI 82 to 93)), at least four antenatal visits (46% (95% CI 39 to 53) to 69% (95% CI 60 to 75)), facility birth (48% (95% CI 37 to 59) to 64% (95% CI 54 to 73)), administration of uterotonics (44% (95% CI 34 to 54) to 59% (95% CI 50 to 67)), delayed newborn bathing (44% (95% CI 36 to 52) to 62% (95% CI 52 to 71)) and clean cord care (42% (95% CI 34 to 49) to 73% (95% CI 66 to 79)). Wide-spread inequities persisted however; only at least one antenatal visit saw pro-poor improvement.ConclusionsThis intervention achieved improvements in life-saving behaviours for mothers and newborns, demonstrating that multipartner action, coordinated through government leadership, can shift the needle in the right direction, even in resource-constrained settings.

A response surface methodology (RSM) has been utilized for investigating the effects of the speed of shelling, melon seed moisture content and the number of beaters of a developed mechanized centrifugal melon shelling and cleaning machine. The machine shells the melon and then cleans the shelled seed from the shells and other impurities. The experiment was based on a central composite rotatable design (CCRD). The results of the experiments revealed that the highest shelling efficiency of 88.5% was obtained from a combination of a speed of 2300 rpm, moisture content of 15% (w.b) and 20 beaters, while the least efficiency of 25.11% was obtained from an interaction between a speed of 959 rpm, moisture content of 20% (w.b) and 18 beaters. Numerical optimization carried out with the goal of maximizing the shelling efficiency revealed optimum values of speed of 2200 rpm, moisture content of 12% (w.b) and 19 beaters for shelling efficiency of 88.80%. The result of this study provided standard input parameters capable of yielding high cleaning and recovery efficiency.

African locust bean is a leguminous plant that is rich in nutrients and is used as food condiment. The traditional method of processing this food condiment is mostly unhygienic; consume a lot of fire wood, human energy and time. Using traditional methods for boiling 33.7Kg of locust bean would take about 12 hours. This study attempts to mechanize the existing traditional methods of boiling locust bean by designing, constructing, and evaluating electrically powered locust bean boiler. The boiler consists of three composite drums, each with a cylindrical upper part and conical lower part. The boiling chamber is made of 304 austenitic stainless steel which contains the heating elements. Fibre glass is lodged between the steel materials as an insulator. As power is supplied to the boiler, the elements convert the electrical energy to heat energy attaining the temperature of 200.7°C in 5 minutes. The machine has the capacity of boiling 33.7Kg of locust bean in 1 hour at 90°C. The cost of producing a unit is ₦20,207.5.

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

Planting of turmeric has been a challenge to the farmers in Nigeria due to the absence of planting machine. The farmers are left to the traditional method of planting with hoes and cutlasses. This method is time consuming, labour intensive, associated with human drudgery and a high demand for human energy. As a result, a mechanical planter was designed and fabricated. The main objective of the study is to develop and evaluate the performance of a tractor- drawn turmeric planter. The planter was designed, fabricated and tested in the Agricultural and Bioresources Department of The Federal University of Technology, Minna. It consists of a ground drive wheel, hopper, metering system furrow opener, residue cutting edge, furrow closing device press wheel and power transmission mechanism. The performance tests of the fabricated machine were carried out using three levels of turmeric rhizome lengths (30 mm, 45 mm and 60 mm) at three levels of operational speeds (8km/h 10km/h and 12km/h). The results revealed that there was no steady pattern in the increase or decrease of miss index with increase in turmeric rhizome length and machine operational speed. The highest percentage turmeric rhizome miss index of 35% was recorded for turmeric rhizome length of 30cm at machine operational speed of 10km/h whereas the lowest percentage turmeric rhizome miss index of 15% was obtained for turmeric rhizome length of 60cm at the machine operational speed of 12km/h. The machine operational speed and size of the turmeric rhizomes affect the field capacity of the machine. The highest capacity of 0.96ha/h was recorded at the highest operational speed of 12km/h. The lowest field capacity of 0.63ha/h was recorded at the lowest machine speed of 8km/h. The developed machine could reduce drudgery involved in manual turmeric planting and save about substantial amount of labour and operating time.

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 Conclusion The positive effects of the interventions are likely due to the effectiveness of the training and health education components. The lack of intervention impact observed for maternal and fetal measurements may be due to the high workload of care staff and inadequate clinic supplies, which we did not address. We conclude that interventions that address the quality of antenatal care in low-resource settings should focus on improving all elements of care, including adequate staffing and mobilization of material resources. Trial registration This study was registered in the ISRCTN on August 14th, 2020. Trial Registration Number. SRCTN17985403. Retrospective registration. The reason for the retrospective registration is the current non-recognition of the Nigeria Clinical Trials Registry (NCTR); which is currently not an ICMJE or WHO ICTRP approved registry. (This study was registered in the Nigeria Clinical Trials Registry on April 14th, 2016. Trial Registration Number NCTR No: 91540209).

Characterization of nanocomposite film requires a high level of instrumentation and accuracy in measurements. It is normally arduous to achieve correct measurement of a system under different conditions using the same instrument without allowing for errors. For this reason, model representation of a system is usually encouraged. In this research, empirical model equations were developed for predicting some physical attributes of cassava starch–zinc nanocomposite film for food-packaging applications. Samples of the films, with thickness ranging between 15 and 17 µm, were developed by blending 24 g of cassava starch, 0–2% zinc nanoparticles, and 45–55% glycerol. The permeability of the films, which helps in maintaining the quality of packaged food, was determined due to oxygen and water vapour at a temperature of 27 °C and 65% RH. Elastic modulus and hardness were determined using nano-indentation techniques. Empirical model equations were developed using Box–Behnken design from 60% of the total data and the remainder were predicted. Results showed that the models developed are fit, and there were no significant differences between the 40% remaining data and model predicted data (

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.

A breaker plate of a screw mixer is an efficient mixing device for use in homogenizing nanocomposites. This research was undertaken to investigate the effects of glycerol and diameter of holes in a breaker plate on performance of a screw mixer for nanocomposites. Samples of the nanocomposites were formulated by blending 1000 g cassava starch, 45-55% glycerol and 2% magnetite nanoparticles; and used to evaluate the performance of a locally developed screw mixer at 5 mm and 7 mm diameters of holes in its breaker plate. The effects of glycerol and diameter of holes in the breaker plate on mixing index, amount of unmixed nanocomposites and output/1000g were evaluated as performance indices for 1 hour. Empirical models were determined for predicting the performance of the mixer within the designed criteria. The results showed that the output/1000g and the mixing index increased with higher glycerol and diameter of holes in the breaker plate. However, the amount of unmixed nanocomposites decreases with a higher diameter of holes in the breaker plate (p2=0.89, p

Size reduction of agricultural products is an essential requirement for their processing and transportation. This research designed and fabricated a manually operated and motorised cassava chipping machine, which is adaptable to the local farmers at the cottage level. The design was carried out by empirically computing the threshold force required for cutting the cassava tubers, with a prior knowledge of the length (350 mm) and thickness (1.5 mm) of the cutting blades as influencing indexes. Also, the capacity of the machine was evaluated using six different cutting forces above and below the cutting threshold force (68.99 N). The results show that the cutting force increased exponentially with the length and diameter of the tuber. Also, less force was required to chip cassava tuber with longer length and shorter diameter probably due to the presence of inner and central crack defects, which is capable of forming easy crack initiation points with the slightest blade effort . The size of the electric motor required was a single phase 1 hp (4500 rpm), which is capable of powering the machine to an approximate capacity of 225 kg/h and comparable to the required human effort. The machine was also found effective in chipping cassava tuber to average size of 30 mm.

DOI: 10.19072/ijet.329078, Destoning is a processing technique for removing stones and broken grains from a batch of milled rice. This research was carried out to modify an existing rice destoner for the purpose of increasing its capacity and efficiency. The modification introduced addressed challenges associated with the existing machine, such as lower stone removal efficiency and lower air flow channel, which affects the aerodynamic lifting of the rice grains. The performance was evaluated for 3 kg of locally milled rice samples based on the design capacity of the machine, cleaning efficiency and degree of grain flow. The result showed that the design capacity (1800 kg/h) of the modified destoner was higher than that of the existing (864 kg/h). Also, the machine has 40.8% destoning efficiency which is relatively higher than the existing machine.

The research work was conducted to develop an automated grain drinks processing machine capable of integrating several operations (blending of soaked grains, mixing the slurry, extracting the aqueous liquid and discharging of the paste out of the machine) together and finished in one go. Fundamental design analysis and calculations were carried out in order to determine and select materials of appropriate strength and sizes for the machine component parts. The major machine parts include hopper, delivery tube, blending chamber, blade, conical centrifugal basket, electric motors and control system. The results of testing of the machine using soya beans revealed that blending efficiency of 85.52% was obtained from combination of 3 blades assembly, basket with half angle of 30° and speed of 1400 rpm. The optimisation of the machine parameters using response surface methodology produced optimum paste expelling efficiency of 94.89% with desirability of 94.3% from combination of 3-blades assembly, basket of half angle of 50° and speed of 1400 rpm. The speed of rotation and basket angle has positive significant effects on the paste expelling efficiency while blade number has insignificant effect. Paste expelling efficiency increase with both increased in speed of rotation and basket angle. The machine capacity and cost of production are 100 L per hour and $ 1670 respectively.

Background\ud Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage.\ud \ud Methods\ud In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283.\ud \ud Findings\ud Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group.\ud \ud Interpretation\ud Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset.\ud \ud Funding\ud London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation.

The research work was carried out to develop an indented cylinder metering device for a tractor drawn manure spreader capable of transporting, metering and uniform spreading of the manure in the farm. Materials of right strength and sizes for the equipment parts were determined and selected based on the design analysis and calculations carried out. Hopper, manure metering system, floor wheels, energy transfer system, machine frame and gear system are the main components of the machine. The equipment was tested using three factors; number of grooves, speed and the manure moisture contents while the response is spreading efficiency. The metering system used are 1, 2, 3 and 4 grooves, and the speed was varied at four levels of 8 km/hr, 13 km/hr, 18 km/hr, and 23 km/hr. The manure moisture content was varied at 8%, 12%, 16% and 20% (d.b). The test outcomes of the equipment using cow dung, the largest manure delivery efficiency of 82% was achieved from a velocity of 23 km/h using a metering cylinder with four grooves, whereas a minimum efficiency of 48% was achieved from a velocity of 8 km/h using a single groove metering cylinder. Also highest manure delivery efficiency of 85% was obtained from manure with 8% moisture content (db) while least efficiency of 63% moisture content was obtained from manure with 20% moisture content (db). The efficiency of manure delivery improved with both tractor speed and amount of metering groove but reduced with enhanced humidity content of manure. The three parameters therefore have important impacts on the efficiency of manure delivery. The throughput capacity of the equipment is 11 hectares per day. It is anticipated that the development of this equipment will decrease human drudgery, reduce accumulation of manure in the soil and improve application uniformity and enhance the productivity of the farmer.

Application of Dynamic Control Systems (DCS) in detecting and diagnosing car engine Starter Cranks is continuously being implemented to serve different cases of real life problems such as Control of MEMS-based scanning-probe data-storage devices, track-follow control for tape storage, probe-based ultrahigh-density storage technology, a review of feed forward control approaches in nanopositioning for high-speed SPM and so on. Car engine Starter Cranks faults can be detected by sequence of diagnostic processes which brings about the deployment of an Expert System. An Expert System is one of the leading Artificial Intelligence techniques that have been adopted to handle such task. This paper presents the imperatives for an Expert System in developing Dynamic Control Systems for detecting and diagnosing car engine Starter Crank faults through input and output requirements of constructing successful Knowledge-Based Systems. Furthermore, diagnosis of car engine Starter Cranks faults requires high technical skills and experience. thus, DCS provides input and output equations in form of Matrix/Vector State Space Representation (MSSR) which is useful in assisting mechanics for car engine Starter Cranks fault detection and diagnosis via DCS and mathematical Differential Equations (DE’s).

This study focused on investigations of effects of mechanical parameters (peeling speed, cutter length) and handling parameter (cassava tuber length) of a cassava peeling machines on the machine output (peeling and recovery efficiencies) with the view of optimizing the parameters. The serious issues of existing techniques of peeling cassava are moderately low peeling and recovery efficiencies because of the irregular shape and size of cassava tubers. The results of the trial of the machine utilizing the cassava tubers revealed that all the parameters have significant effects on the peeling and recovery efficiencies of the machine. The cutter length had a more significant impact on the peeling and recovery efficiencies. Maximum values of 83.5 % and 97.2% for peeling and recovery efficiencies respectively, with an attractive quality of 0.864 were achieved from peeling cassava tuber of 50 mm length with cutter length of 2 mm at a speed of 328 rpm. The investigation’s discoveries give the standard machine input parameters which are equipped for improving quality, peeling and recovery efficiencies of a mechanical cassava peeling system.

Knowledge of physical and mechanical properties of seeds is an important factor for designing agricultural machines and equipment. A fluted pumpkin is a very important vegetable crop as well known for its high nutritional, medicinal and economic values, but the data on its physical and mechanical properties is still lacking. The aim of this study is to determine the effect of moisture content on the physical (basic dimensions, porosity, bulk and true densities, coefficient of friction, repose angle and sphericity) and mechanical properties of fluted pumpkin seed. These properties were evaluated as a function of moisture content at 45, 50, 55 and 60%. The results revealed that length, width and thickness increased with increasing moisture content. Similarly, an average mass of the seed, volume, surface area, sphericity, angle of repose all increased with increasing moisture content. Bulk density decreased as the moisture content increases. The parameters obtained from this study could be used as a reference data for the design of fluted pumpkin seed handling and processing equipment.

Background: Coronavirus disease 2019 (COVID-19) infection has announced by the World Health Organization (WHO) as a pandemic disease in 2020. Identification and analysis of COVID-19 presentation are important for quick isolation and diagnosis. Respiratory symptoms are typically present in COVID-19 patients. Objectives: The objectives of this study were to identify of gastrointestinal (GI) symptoms and laboratory results in the initial presentation of COVID-19 patients. Materials and Methods: Our study is a retrospective study of 379 COVID-19 patients’ assessments. They were admitted into government hospitals in Kingdom of Saudi Arabia’s South and East regions through April month 2020. Results: About 14% of the patients were presented initially with GI symptoms only, in which Nausea and anorexia are the most common complain. The mean C-reactive protein, alanine aminotransferase , and aspartate aminotransferase levels were significantly elevated. Conclusion: It is crucial for physicians to be aware that COVID-19 infection could present initially with GI-related symptoms and keep appropriate attention and suspicion.

Water contamination is an issue requiring continuous remedy on daily basis because of the high demand for clean quality water. Scientists have proffered numerous ways of making this possible but the techniques involved is often difficult to replicate at small scale. For this reason, easier and cheaper techniques for contaminated water treatment are often sought after. One way of actualizing this is via nanotechnology, which involves the use of smaller particles ( Lass Than 100 nm in size) to coagulate suspended substances and inhibit microbial growth in the targeted water. The mechanisms involved have been presented for zinc and magnetite nanoparticles in this write-up. This technology provides way of getting clean quality water for domestic, agricultural and industrial applications.

Objectives : The objective of the study was to identify where delays occur when women present for antenatal care in four Nigerian referral hospitals, and to make recommendations on ways to reduce delays in the course of provision of antenatal care in the hospitals. Design : Prospective observational study Setting : Four Nigerian (1 tertiary and 3 secondary) Hospitals Participants : Women who presented for antenatal care. Interventions : A process mapping. The National Health Service (NHS) Institute Quality and Service Improvement Tool was used for the assessment. Main outcome measures: The time women spent in waiting and receiving antenatal care in various departments of the hospitals. Results : Waiting and total times spent varied significantly within and between the hospitals surveyed. Mean waiting and total times spent were longest in the outpatients’ departments and shortest in the Pharmacy Departments. Total time spent was an average of 237.6 minutes. χ2= 21.074; p= 0.0001 Conclusion : There was substantial delay in time spent to receive care by women seeking routine antenatal health services in the four secondary and tertiary care hospitals. We recommend managers in health facilities include the reduction of waiting times in the strategic plans for improving the quality of antenatal care in the hospitals. This should include the use of innovative payment systems that excludes payment at time of service delivery, adoption of a fast-track system such as pre-packing of frequently used commodities and the use of new tech informational materials for the provision of health education. Funding : The Alliance for Health Policy and Systems Research, World Health Organization, Geneva; Protocol IDA65869. Keywords : Delays; Waiting time; antenatal; Hospitals; Women; Maternity care; Process mapping; Nigeria.

Lorretta F Ntoimo,1,2 Friday E Okonofua,1,3,4 Rosemary N Ogu,1,3,5 Hadiza S Galadanci,6 Mohammed Gana,7 Ola N Okike,8 Kingsley N Agholor,9 Rukiyat A Abdus-Salam,10 Adetoye Durodola,11 Eghe Abe,12 Abdullahi J Randawa13 On behalf of the WHARC WHO FMOH MNCH Implementation Research Study Team 1WHO Implementation Research Group, The Women’s Health and Action Research Centre, Benin City, Edo State, 2Department of Demography and Social Statistics, Federal University Oye-Ekiti, Ekiti State, 3Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Edo State, 4Vice Chancellors Office, University of Medical Sciences, Ondo City, Ondo State, 5Department of Obstetrics and Gynaecology, University of Port Harcourt, Port Harcourt, Rivers State, 6Aminu Kano Teaching Hospital, Kano, Kano State, 7General Hospital, Minna, Niger State, 8Karshi General Hospital, Federal Capital Territory, Abuja, 9Central Hospital, Warri, Delta State, 10Adeoyo Maternity Hospital, Ibadan, Oyo State, 11General Hospital, Ijaye, Abeokuta, Ogun State, 12Central Hospital, Benin City, Edo State, 13Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Kaduna State, Nigeria Introduction: While reports from individual hospitals have helped to provide insights into the causes of maternal mortality in low-income countries, they are often limited for policymaking at national and subnational levels. This multisite study was designed to determine maternal mortality ratios (MMRs) and identify the risk factors for maternal deaths in referral health facilities in Nigeria.Methods: A pretested study protocol was used over a 6-month period (January1–June 30, 2014) to obtain clinical data on pregnancies, births, and maternal deaths in eight referral hospitals across eight states and four geopolitical zones of Nigeria. Data were analyzed centrally using univariate, bivariate, and multivariate statistics.Results: The results show an MMR of 2,085 per 100,000 live births in the hospitals (range: 877–4,210 per 100,000 births). Several covariates were identified as increasing the odds for maternal mortality; however, after adjustment for confounding, five factors remained significant in the logistic regression model. These include delivery in a secondary health facility as opposed to delivery in a tertiary hospital, non-booking for antenatal and delivery care, referral as obstetric emergency from nonhospital sources of care, previous experience by women of early pregnancy complications, and grandmultiparity.Conclusion: MMR remains high in referral health facilities in Nigeria due to institutional and patient-related factors. Efforts to reduce MMR in these health facilities should include the improvement of emergency obstetric care, public health education so that women can seek appropriate and immediate evidence-based pregnancy care, the socioeconomic empowerment of women, and the strengthening of the health care system. Keywords: maternal death, maternal mortality ratio, emergency obstetric care, pregnancy care, tertiary hospital

The research work focus on design and construction of automatic system for integrated plant for grain beverages processing. A grain beverage processing plant is a complex system that integrates several operations (blending of soaked grains, mixing the slurry, extracting the aqueous liquid and discharging of the paste out of the machine) together and finished in one go. Incorporating an automatic system into the integrated system simplify its mode of operation. Essential design consideration, analysis and calculations were carried out in order to determine and select materials of appropriate strength and sizes for various part of the automatic system. The major parts of the automatic system includes power supply unit, transformer, filter capacitor, voltage regulator, power indicator, pre-set buttons, time controller, eprom, display unit, controllers, limiting sensor, solenoid valve and electro-mechanical switch. The system was designed to have two controllers, one interfaced with the button network and the other organized the operational time (blending, sieving and paste expelling) in minute. Results of the testing revealed that the highest machine output of 90.24 L/h was obtained from speed of 1650 rpm using the integrated machine with automated system, low value of output of 52.64 L/h was obtained from the same speed using the integrated machine with semi-automatic system. The least machine output of 32.59 L/h was obtained from the same speed using the integrated machine without the automated system. The machine output was found to be influenced by both the automatic system and machine speed. The automatic system allows efficient work flow, reduces human labor, ensure safety and hygiene product production by eliminating human interference. Also it increased the machine output by 67%, reduce operational time by 65% and completely eliminating human interference with the product.

Food wastage resulting from lack of facilities for drying and the unhygienic methods of processing are major causes of food shortage in supply chain. Thus, to address these issues, an existing electric dryer was modified for drying high moisture vegetables. The machine was evaluated for drying tomatoes with an initial moisture content of 63% (wb). A heating element was attached below the fan of the dryer to allow a through air circulation instead of the cross air flow pattern of the previous design. Four trays, with each having a capacity of 0.092m 3 , were loaded with 30.4kg of slice tomatoes at a rate of 7.6kg per tray and dried for 5h. Thermostat was used to regulate temperature and relative humidity in the drying compartment at 42 o C and 11% RH. Control experiment was set up to determine the quality loss upon drying under sun for 5 h. Nutritional quality parameters of the dried products were determined using standard known methods. The results showed that actual volume of heated air delivered to the drying chambers, thickness of polyurethane used as lagging and power requirement for heating were 8.96m 3 , 38mm and 3000W, respectively. The nutritional quality loss in the sun dried samples was lower than the corresponding loss in the dryer. The modified dryer has 73% drying efficiency, which higher than the efficiency of the existing dryer.

Available evidence suggests that the low use of antenatal, delivery, and post-natal services by Nigerian women may be due to their perceptions of low quality of care in health facilities. This study investigated the perceptions of women regarding their satisfaction with the maternity services offered in secondary and tertiary hospitals in Nigeria. Five focus group discussions (FGDs) were held with women in eight secondary and tertiary hospitals in four of the six geo-political zones of the country. In all, 40 FGDs were held with women attending antenatal and post-natal clinics in the hospitals. The questions assessed women’s level of satisfaction with the care they received in the hospitals, their views on what needed to be done to improve patients’ satisfaction, and the overall quality of maternity services in the hospitals. The discussions were audio-taped, transcribed, and analyzed by themes using Atlas ti computer software. Few of the participants expressed satisfaction with the quality of care they received during antenatal, intrapartum, and postnatal care. Many had areas of dissatisfaction, or were not satisfied at all with the quality of care. Reasons for dissatisfaction included poor staff attitude, long waiting time, poor attention to women in labour, high cost of services, and sub-standard facilities. These sources of dissatisfaction were given as the reasons why women often preferred traditional rather than modern facility based maternity care. The recommendations they made for improving maternity care were also consistent with their perceptions of the gaps and inadequacies. These included the improvement of hospital facilities, re-organization of services to eliminate delays, the training and re-training of health workers, and feedback/counseling and education of women. A women-friendly approach to delivery of maternal health care based on adequate response to women’s concerns and experiences of health care will be critical to curbing women’s dissatisfaction with modern facility based health care, improving access to maternal health, and reducing maternal morbidity and mortality in Nigeria. Trial Registration Number NCTR No: 91540209. Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/ . Registered April 14th 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.

Epithelioid hemangioendothelioma (EHE), is a rare vascular tumor, described for the first time in 1975 by Dail and Liebow as an aggressive bronchoalveolar-cell carcinoma. The aetiology is still a dilemma to this day. Studies about suggestive hypothesis are ongoing. Most of the times, it affects lung, liver, and bones, but can arise from any part of the body. It has a very low prevalence of one in one million. Because of its heterogeneous presentation and rarity - represents