Ue Asibong

An Evaluation of the Knowledge and Utilization of the Partogragh in Primary, Secondary, and Tertiary Care Settings in Calabar, South-South Nigeria

The challenge to maternal well-being with associated maternal wastages especially in labor has remained unsurmountable across the three tiers of health care delivery in Nigeria. This study aimed to determine and compare the factors that influence utilization of the partograph in primary, secondary, and tertiary health care delivery levels in Calabar, Nigeria. This was a descriptive study, using a self-administered semistructured questionnaire on 290 consenting nonphysician obstetric care workers, purposively recruited. The mean age of the respondents was 40.25 ± 8.68 with a preponderance of females (92.4%). Knowledge of the partograph and previous partograph training had statistically significant relationship with its utilization among respondents from the tertiary and general hospitals. The level of knowledge was higher among workers in the general hospital than those working in the university teaching hospital. Nurses/midwives in the three levels of care were significantly more knowledgeable in partograph use than other nonphysician obstetric care workers. Lack of detailed knowledge of the partograph, its nonavailability and poor staff strength in the study centers were factors militating against its ease of utilization. The authors recommend periodic in-service training and provision of partograph in labor rooms in all maternity wards in our environment.

The use of the partograph in labor monitoring: a cross-sectional study among obstetric caregivers in General Hospital, Calabar, Cross River State, Nigeria

Background Prolonged and obstructed labor is a significant cause of maternal morbidity and mortality in Nigeria, one of the six countries contributing significantly to the global maternal mortality crisis. The use of the partograph would engender a remarkable reduction in the number of these deaths since abnormal markers in the progress of labor would be identified early on. Objective This study aimed to evaluate the non-physician obstetric caregivers’ (OCGs) knowledge of partograph use, assess the extent of its use, determine the factors that impede its usage, and unravel the relationship between years of experience and partograph use among the respondents (OCGs) in General Hospital, Calabar, Nigeria. Methodology Using a self-administered semi-structured questionnaire, a cross-sectional descriptive study was conducted among 130 purposely selected and consenting OCGs working in the General Hospital, Calabar, Nigeria. Results The majority of the respondents (70.8%) had good general knowledge of the partograph but lacked detailed and in-depth knowledge of the component parts of the partograph. Knowledge of partograph (χ2=12.05, P=0.0001) and partograph availability (χ2=56.5, P=0.0001) had a significant relationship with its utilization. Previous training (χ2=9.43, P=0.002) was significantly related to knowledge of partograph. Factors affecting utilization were: little or no knowledge of the partograph (85.4%), nonavailability (70%), shortage of staff (61.5%), and the fact that it is time-consuming to use (30%). Conclusion Lack of detailed knowledge of the partograph, nonavailability of the partograph, poor staff numbers, and inadequate training are factors that work against the effective utilization of the partograph in the study facility. Usage of this tool for labor monitoring can be enhanced by periodic training, making partographs available in labor wards, provision of reasonable staff numbers, and mandatory institutional policy.

Assessment of the Knowledge and Utilization of the Partograph among Non-physician Obstetric Care Givers in the University of Calabar Teaching Hospital, Calabar, Nigeria

Thomas U. Agan, Ubong Akpan, Ita B. Okokon, Afiong O. Oku, Udeme E. Asibong, Margaret M. Opiah, Ekere J. Essien and Emmanuel Monjok Department of Obstetrics and Gynaecology, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria. Department of Family Medicine, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria. Department of Community Medicine, University of Calabar and University of Calabar Teaching Hospital, Calabar, Nigeria. Department of Maternal and Child Health Nursing, Faculty of Nursing, College of Health Sciences, Niger Delta University, Bayelsa State, Nigeria. University of Houston, Institute of Community Health, Texas Medical Center, Houston Texas, USA.

Work-Related Traumatic Injury in the Paper-Producing Industry in Nigeria: ACase Study of the Nigerian Newsprint Manufacturing Company Limited, Oku-Iboku, Akwa Ibom State

Introduction: This research aimed to determine the characteristics of work-related traumatic injuries in a paper-producing company over a 12-month period, as a case study of the traumatic injury picture in the industry in Nigeria. Materials and Methods: This was a longitudinal descriptive study using a structured questionnaire to collect information from permanent employees of the Nigerian Newsprint Manufacturing Company Limited, upon presentation to the Company Medical Service. The identification number of each affected employee was noted. All traumatic injuries sustained by employees while on duty were examined, classified and coded following the World Health Organisation’s guidelines. Data gathered were analysed using tables and percentages. The chi-square test was employed in the comparison of the burden of injury in the two major divisions of the Company with the level of statistical significance set at 0.05. Results: Affected workers were all males with a mean age of 32.14±3.23 years. The Crude Incidence rate of severe injury for the whole Company was 50.7 injuries per 1000 employees, and the Specific Incidence rate for the producing divisions of the Company was 71.7 injuries per 1000 employees. The majority of cases were superficial traumatic injuries (65.1%) requiring only first-aid care and the leading cause of severe injury in forest work was “struck by falling object” (22.86%), while “contact with powered hand tool”, the chainsaw (15.50%) was commonest equipment in causation of severe traumatic injury. The burden of Injury in the Forestry division was statistically significant over that in Operations division of the Company (p< 0.05). Conclusion: This study recommends the opening of a National work-related Injury register in Nigeria, for the ease of tracking such injuries in workplaces in the country. Family Physicians are enjoined to work together with the few occupational health physicians to strengthen industrial safety in the emerging factories nationally.

Comparison of cold water sponging and acetaminophen in control of fever among children attending a tertiary hospital in South Nigeria

Background: A wide range of childhood illnesses are accompanied by fever, leading to varied attempts at treatment by caregivers at home before coming to a hospital. Common modalities of treatment include use of antipyretics and physical methods such as cold water sponging, fanning and removal of clothing. These treatment modalities have been received with varied attitudes among physicians and the scientific community. This study was to assess the efficacy of both modalities in first-line management of fever in our area. Objectives: The main aim of the study is to compare the effectiveness of cold water sponging with that of oral paracetamol in the treatment of fever in children attending the University of Calabar Teaching Hospital, Calabar. Subjects and Methods: This is a randomized clinical trial. Eighty-eight children aged 12-120 months who presented to the Children Outpatient Clinic (CHOP) and the Children Emergency Room (CHER) of University of Calabar Teaching Hospital, Calabar, with acute febrile illness and axillary temperatures spanning ≥ 38.0-40.0°C. All children within the age limit whose caregivers gave consent were recruited into the study and were randomized to receive either cold water sponging or oral paracetamol. Axillary temperature, pulse rate, respiratory rate and assessment of discomforts (crying, shivering, goose pimples and convulsions) were recorded every 30 min for 2 h. The results were analyzed using the SPSS statistical software and have been presented in the tables. Results: Cold water sponging was very effective in temperature reduction within the first 30 min, with 29 (70.73%) having their temperature reduced to within normal limits. This declined to 12 (29.26%) at 60 min and 4 (10.53%) at 120 min, with the mean temperature differences from the baseline value following the same trends (1.63°C by 30 min, 0.91°C by 60 min and 0.39°C by 120 min). When compared with paracetamol, cold water sponging was more effective in temperature reduction within the first 30 min (P = 0.000), with the difference in effect at 60 min less significant between these two groups (P = 0.229). Paracetamol demonstrated a gradual and sustained reduction in temperature with the proportions of afebrile children in this group increasing from 7 (16.27%) at 30 min to 33 (78.57%) at 120 min. The mean temperature differences from the baseline value also showed the same trend. Children who received cold water sponging had more discomforts compared with those who received only oral paracetamol. Conclusions: It is concluded that cold water sponging, although producing rapid reduction in temperature compared with paracetamol, has effects that last only for a short time. Paracetamol on the other hand produces a gradual but sustained effect. The discomforts experienced should not be a limiting factor to the use of cold water sponging in reducing the body temperature of febrile children. Cold water sponging is safe and its use by mothers and primary caregivers should be encouraged while preparing to take the child to the nearest health facility for definitive treatment of the underlying cause of the fever.

Antenatal Deworming and Materno-Perinatal Outcomes in Calabar, Nigeria

BACKGROUND: Studies have shown that administration of anthelmintic drugs in pregnancy can reduce the incidence of maternal anaemia; however, data on other maternal and perinatal outcomes are limited. AIM: This study was therefore conducted to evaluate the direct impact of mass deworming on delivery and perinatal outcome. MATERIAL AND METHODS: A total of 560 healthy pregnant women in their second trimester were randomised to receive a single dose of oral mebendazole (500 mg) and placebo. Each participant received the standard dose of iron supplement and malaria prophylaxis. They were followed up to delivery and immediate postpartum period to document the possible impact on maternal and perinatal outcomes. RESULTS: The prevalence of anaemia at term, 37 weeks gestation and above, among the treatment arm was 12.6% compared with 29.9% in the placebo arm (p < 0.001). Caesarean section rates was higher in the treated group and the placebo (p = 0.047). There were no statistically significant differences in incidences of postpartum haemorrhage (p = 0.119), Puerperal, pyrexia (p = 0.943), low birth weight (p = 0.556) asphyxia (p = 0.706) and perinatal death (p = 0.621). CONCLUSION: Presumptive deworming during the antenatal period can significantly reduce the incidence of peripartum anaemia. However, more studies may be needed to prove any positive perinatal outcome.

Correlates and Predictors of Low Back Pain Disability and its Impact on Health- Related Quality of Life in a Family Practice Clinic in Calabar, South- South Nigeria

Background: Non-specific low back pain is a common health problem incurring immense health and social costs with concomitant disability, which has assumed significant public health importance in our setting. The impact from this condition is multi-factorial, and includes pain, activity limitations and impairment of quality of life. This study therefore aimed to examine the level of low back pain disability, its correlates and predictors, and the impact on selfperceived quality of life. It also sought to determine the predictors of health-related quality of life among low back pain patients in a Family Practice setting in Calabar, Nigeria. Method: This was a cross-sectional analytical study involving 350 consecutively selected patients with nonspecific low back pain. Standardized questionnaires were used including: the Oswestry Disability Index (ODI) questionnaire, the 12-item General Health Questionnaire (GHQ-12), the Short-form 36 (SF-36) questionnaire and the Visual Analogue Pain Scale. These were used to assess low back pain disability, psychological distress, healthrelated quality of life and pain intensity respectively. Result: The mean age of the respondents was 36.16 ± 9.93 years. Majority (70.6%) were females and had chronic pain lasting more than three months. Most of the respondents (88.9%) characterized their pain as severe. The mean health-related quality of life score was 45.82 ± 4.3. Factors associated with severe disability were: psychological distress and pain intensity. Significant correlations were observed between disability, pain intensity and psychological distress using Pearson’s correlation analysis. Independent risk factors for disability were psychological distress and those with chronic pain lasting more than 3 months. Overweight and obese subjects were more likely to have poor health-related quality of life when compared with those with normal body mass index (X2=8.81, P<0.05). The significant predictors of poor health-related quality of life using logistic regression were overweight/obesity and those with severe disability. Conclusion: This study identified significant correlations between low back pain disability, pain intensity and psychological distress. These correlations could be informative and should guide family physicians in the management of the index problem in our environment. The perception of quality of life in individuals with low back pain should also raise awareness of issues connected to the problem and encourage more research into this area.