Journal of Community Medicine and Primary Health Care

Improving maternal health outcomes in sub-Saharan Africa: The merits and demerits of person-centred maternity care

CE Omorogbe, OI. Adewale-Olalemi — Wed, 30 Apr 2025 00:00:00 +0000

Background: The traditional approach to maternity care, commonly practiced in developing countries such as sub-Saharan Africa (SSA), has been discovered to be primarily focused on the clinical health of the mother and the foetus. However, this has only had a minimal effect on maternal and infant mortality rates in SSA. Hence, there is a need for a holistic approach: Person-Centred Maternity Care (PCMC). PCMC is a novel approach that has recorded better maternal and infant health outcomes in developed countries due to its holistic focus on maternal health. Therefore, this article seeks to identify the merits and the demerits of PCMC over the traditional approach to maternity care.

Methodology: Using databases such as MEDLINE, EMBASE, and CINAHL, twenty-five articles were reviewed to identify the merits and demerits of the implementation of PCMC in countries within Sub-Saharan Africa, using Ethiopia, Rwanda, Uganda, Kenya, and Nigeria as case studies.

Results: Findings revealed benefits such as increased knowledge about pregnancy, improved relationship, birth preparedness, enhanced relationship with health team members and low incidence of complications. Inadequate resources, poor communication and non-proximity to health centres were identified as the barriers.

Conclusion: Maternity care must be person-centred, quality-based and outcome-focused. Considering the merits and barriers identified, its adoption in other developing countries where it is non-existent will be easier to achieve reduced maternal and infant morbidity and mortality rates.

The role of hydroxyurea and the clinical outcome of paediatric sickle cell disease patients in a tertiary hospital in North-western Nigeria

HA Muhammad, AG Suleiman, AA Umar, MB Sufiyan — Wed, 30 Apr 2025 00:00:00 +0000

Background: Sickle cell disease (SCD) is a common condition in Nigeria that is associated with high morbidity and mortality among children. The use of hydroxyurea (HU), a disease-modifying agent that induces the synthesis of foetal haemoglobin, is limited by efficacy and safety concerns. This study aimed to assess the relationship between the use of HU and the frequency of adverse clinical events among paediatric SCD patients at a tertiary hospital in Northwestern Nigeria.

Methods: Using a retrospective cohort study design, a pro forma was used to extract data from 192 medical records of patients on HU therapy, including sociodemographic characteristics, pattern of HU use and adverse clinical events before and after the initiation of HU. For each of these adverse clinical events, incidence rates (IRs) and incidence rate ratios (IRRs) were calculated and assessed for statistical significance.

Results: During the study period, patients on HU were 13 times less likely to experience vaso-occlusive crisis (IRR=0.07, 95%CI: 0.05–0.12) and six times less likely to require hospital admission (IRR=0.16, 95%CI: 0.11–0.22). The use of HU was associated with an increase in patients' mean packed cell volume (3.2%, t191=8.222, P<0.01). Starting HU was not associated with significant changes in the prevalence of therapy-related side effects (8.9% versus 12.5%, χ2=1.338, P=0.247).

Conclusion: Use of HU was associated with significant reductions in the incidence of all adverse clinical outcomes. There is a need for wider studies to further validate these findings, address the limitations of retrospective designs, and understand the factors limiting the wider use of HU.

Oral health-related quality of life among diabetic patients in a tertiary facility: A comparative study

Wed, 30 Apr 2025 00:00:00 +0000

Background: Diabetic patients display an increased risk of oral disorders and reduced oral health-related quality of life (OHRQoL). This study aimed to compare the OHRQoL among diabetic and non-diabetic patients attending a tertiary health facility in Lagos State.

Methods: A descriptive comparative study involving 110 participants, each recruited from the Diabetes and Outpatient clinics in a tertiary hospital, using simple random sampling. An interviewer-administered questionnaire was used for data collection, which included socio-demographic characteristics, oral complaints, glycaemic control, periodontal status and Oral Health Impact Profile (OHIP-14) to determine the OHRQoL. Logistic regression analysis was used to determine the predictors of OHRQoL, and p-value was set at ≤ 0.05 for significance.

Results: The most commonly reported oral complaint was bleeding gums (55.5% in Diabetics, 20.0% in Non-Diabetics), while the least reported was bad breath/mouth odour (12.7% in diabetics, 2.7% in non-diabetics). The mean OHRQoL of the diabetic participants was 9.9 ± 12.3, which is higher than the 6.2 ± 8.8 for non-diabetics. This trend was consistent across all OHIP-14 subscales, with non-diabetics showing significantly lower mean OHRQoL in psychological discomfort (p = 0.004), psychological disability (p = 0.009), social disability (p = 0.013), and handicap (p = 0.001). Diabetic respondents also showed a higher negative impact on OHRQoL in healthy periodontal status, gingivitis, and periodontitis.

Conclusion: A significantly increased OHRQoL was observed in diabetics compared to non-diabetics. Therefore, routine oral health screening is advocated for all diabetic patients to ensure improvement in their overall quality of life and glycaemic control.

A facility-based assessment on maternal experiences of disrespect and abuse during childbirth in Edo State, Nigeria

OC Egbuta, EO Ogboghodo, OI Otaigbe — Wed, 30 Apr 2025 00:00:00 +0000

Background: Disrespect and abuse during facility-based childbirth violate women’s rights to dignified and non-violent healthcare. Despite global efforts to promote respectful maternity care, disrespect and abuse remain a significant barrier to optimal maternal health outcomes, particularly in low- and middle-income countries. This study assessed women’s knowledge of and attitudes regarding disrespect and abuse during facility-based childbirth in Esan Central Local Government Area, Edo State, Nigeria.

Methods: A descriptive cross-sectional study utilizing a mixed-methods approach was conducted among 614 women who delivered in healthcare facilities in the preceding 18 months. Respondents were selected using multistage sampling. Data collection included semi-structured questionnaires and focus group discussions. Quantitative data were analysed using SPSS version 21.0, while thematic analysis was used for qualitative data. Logistic regression identified predictors of knowledge and attitudes, with statistical significance set at p<0.05.

Results: Respondents’ mean age was 30 ± 6 years, and 73.1% were married. Good knowledge of disrespect and abuse was observed in 57.8% of respondents, yet awareness of specific abusive practices, such as physical abuse (20.2%) and financial detention (26.9%), was low. While 71.8% strongly supported respectful care, 42.7% considered financial detention acceptable. Qualitative data highlighted the normalization of abusive behaviours, justified as necessary for safe delivery. Being married increased the likelihood of good knowledge, while formal education and good knowledge reduced the likelihood of accepting disrespect and abuse.

Conclusion: Significant gaps in knowledge and normalization of abusive practices underscore the need for targeted interventions, such as community education, healthcare provider training, and policy reforms, to eliminate disrespectful maternity care.

Factors influencing the nutritional status of adolescents in selected Public Secondary Schools of Abakaliki, Ebonyi State, Nigeria

Wed, 30 Apr 2025 00:00:00 +0000

Background: Adolescence is a critical time for nutritional intervention to support growth, yet understanding of adolescent nutritional status is limited. This study examines the patterns and determinants of nutritional status among adolescents in Abakaliki, Ebonyi State, Nigeria.

Method: A cross-sectional study was conducted among 1073 public secondary school attending adolescents aged 10-19 years in Abakaliki. Sociodemographic data were collected using self-completed questionnaires, while weight and height were measured to derive Height for Age (HAZ) scores and Body Mass Index (BMI)-Z scores based on the 2007 WHO growth reference chart. Data analysis included univariate, bivariate, and multivariate methods using SPSS version 26. The ethics committee at the Federal Teaching Hospital Abakaliki approved the research.

Results: Of the 1,073 participants, 64.4% were female. Slightly over half (51.6%) were middle-aged adolescents, with 3.4% underweight, 8.8% overweight, 8.7% stunted, and 1.6% tall for their age. The BMI-Z score was associated with sex, class, and fathers’ and mothers’ education (p = 0.001; 0.04; 0.01; 0.001). The HAZ score was associated with age group (p = 0.00). Multivariate analysis revealed that sex and both parents’ educational status strongly predicted BMI status, with females being about 16 times more likely (P = 0.00) to be overweight than males. Additionally, age, class, sex, and mother’s education was predictive of height Z score.

Conclusion: Underweight and stunting are associated with early adolescence, male gender, and low parental education. Regular nutritional assessments can identify at-risk individuals for targeted interventions to improve adolescent nutrition, including educational programs for students and parents.

Uptake of the Edo State Health Insurance Scheme by civil servants in Benin City, Nigeria

PS Mkpeme, OB Mbah, VO. Omuemu — Wed, 30 Apr 2025 00:00:00 +0000

Background: Financial constraints often limit the delivery of quality health services. Universal Health Coverage (UHC) ensures that all individuals can access essential health services without financial hardship. To achieve UHC for its citizens, the Edo State Government introduced the Edo State Health Insurance Scheme (EDOHIS) in 2019 and made it compulsory for state civil servants. This study assessed the uptake of EDOHIS among state civil servants in Benin City.

Methods: A descriptive cross-sectional study was conducted among 520 state civil servants in Benin City who were selected using a two-stage cluster sampling technique from 12 MDAs. Data was collected by a self-administered online questionnaire and analyzed with IBM SPSS 25.0. Ethical approval was obtained from the Ethics and Research Committee at the University of Benin Teaching Hospital.

Results: The mean age of respondents was 43.4±8.7 years, with 477 (91.9%) enrolled in EDOHIS. Non-enrollees cited reasons such as narrow policy options (47.6%) and infrequent illness (45.2%). Most enrollees (81.8%) had used the scheme, with 73.8% expressing satisfaction. Those who had not accessed care mentioned reasons like inadequate coverage (41.4%), distance to the allocated facility (34.5%), and not being sick (31.0%). The determinants of enrolment were being female (AOR=0.386, 95% CI=0.187–0.799, p=0.010); Christian (AOR=3.443, 95% CI=1.167–10.158, p=0.025) and married (AOR = 4.100, 95% CI=2.022–8.315, p=0.001).

Conclusion: There was a high uptake of EDOHIS among civil servants, with most enrollees satisfied with the services. More insurance policy options should be added to the scheme to increase its coverage.

A rural-urban comparative assessment about knowledge of pregnancy danger signs by women in a District of Ogun State

NO Adefala, AY Omotosho, AO Osinaike, NE Okoro, KJ. Sodeinde — Wed, 30 Apr 2025 00:00:00 +0000

Background: Danger signs in pregnancy are specific symptoms that signal serious complications requiring urgent medical attention to avert risks of maternal and foetal morbidity and mortality. This study compared knowledge of pregnancy danger signs among women in Ogun East Senatorial District.

Methods: This cross-sectional comparative study included 375 women from various communities, utilizing a multistage sampling method. An interviewer-administered, structured questionnaire was used for data collection and analysis using IBM SPSS version 22.0. Relevant descriptive and inferential statistics were calculated. The chi-square test was utilized to assess associations between categorical variables, while multivariate analysis identified factors independently associated with knowledge of these dangers signs. The significance level was set at a 95% confidence interval with a p-value ≤ 0.05.

Results: Urban respondents were older than rural respondents (mean age 31.07±6.115 and 30.69±6.312 years, respectively). Respondents identified at least three danger signs (rural 85.3%; urban 86.7%). Fever was the most known danger sign (rural 96.5%; urban 95.2%) while convulsions (rural 8.5%; urban 14.1%; p=0.016), dizziness (rural 24.0%; urban 17.3 %; p=0.024) and anaemia (rural 38.4%; urban 25.6%; p≤0.001) were the least known danger signs. ANC attendance (AOR=0.307, 95% CI: 0.129-0.730) and marital status (AOR=0.335, 95% CI: 0.142- 0.791) were significant predictors of knowledge of danger signs among urban and rural respondents, respectively.

Conclusion: Knowledge gaps regarding the danger signs of pregnancy indicate a need for tailored health education programs for pregnant women as well as a reinforcement of the importance of attending ANC.

Optimising informal medical outreach for universal health coverage and health system strengthening in low- and middle-income countries

A Oyeyemi, N Oyeyemi, W Sawyer, E Omu, B Angalabiri-Owei, I Chima, D. Ogoina — Wed, 30 Apr 2025 00:00:00 +0000

Background: Access to health services is limited in many parts of the world, particularly in low- and middle-income countries (LMICs), where the health system is weak and often excludes many people living in hard-to-reach areas. Medical outreach (MO) is a means of extending essential health services to such underserved populations. It is one of the tools used in the pursuit of universal health coverage (UHC), which envisions a world where all citizens have access to quality health services whenever they need them, regardless of where they live or their socioeconomic circumstances, without experiencing financial hardship in the process

Objective: This narrative review describes informal medical outreach (IMO), a type of MO, explains the nexus between IMO and the six building blocks of the World Health Organization’s health systems framework, and highlights how its optimal use can expedite the achievement of UHC and strengthen the weak health systems of LMICs.

Findings: IMO has been used for several years to provide essential health services to excluded populations. It is conducted by various organisations for different reasons. Despite its contribution to closing the healthcare coverage gap, its non-integration with the local or national health system has undermined its impact.

Conclusion: Informal medical outreach remains a useful strategy for delivering essential care to underserved populations. By addressing potential obstacles, its integration with the existing health system using a systems thinking approach can optimise its contribution to the achievement of UHC and a strengthened health system in many LMICs.

Assessing Postpartum depression in Bauchi State-Nigeria: A study on the prevalence and risk factors in primary healthcare settings

N Mohammed, M Alkali, A Adamu, A Mohammed, IM. Moi — Wed, 30 Apr 2025 00:00:00 +0000

Background: Postpartum depression (PPD) is a major public health issue that often goes undiagnosed, negatively impacting mothers, families, and infant development. Understanding its prevalence and associated risk factors is crucial for effective screening and intervention.

Objectives: This study assessed the prevalence of PPD and identified its risk factors among mothers attending immunization clinics in selected primary healthcare centres in Bauchi State, Nigeria.

Methods: A cross-sectional study was conducted from December 2023 to November 2024 among women of reproductive age. Participants were selected through a multistage sampling technique. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess PPD. Data was analysed using SPSS version 25.0. Ethical clearance was obtained for the study

Results: The study included 262 postpartum women aged 18-48 (mean age 30.9 ± 7.0 years). The majority (83.3%) had completed secondary and/or tertiary education. The prevalence of PPD was 43.4%. The strongest predictors were family conflict and lack of spousal and family support during pregnancy. Women experiencing family conflict had a six-fold increased risk of PPD (aOR = 6.5, 95% CI = 2.3–18.4). Lack of spousal support increased the risk by 2.3 times (aOR = 2.3, 95% CI = 1.0–4.8), while lack of family support tripled the risk (aOR = 3.5, 95% CI = 1.6–7.7).

Conclusion: The high PPD prevalence underscores the need for routine screening in postnatal care. Early identification of risk factors and targeted interventions can help prevent and manage PPD, improving maternal and child health outcomes.

Towards health for all in Nigeria: A sustainable primary health care pilot model in Ondo State, Nigeria

Wed, 07 May 2025 00:00:00 +0000

Background: The Nigerian experience of primary health care (PHC) implementation falls short of key principles related to the Alma-Ata Declaration, with consequent poor performance. The desire for an improved PHC system stimulated the conceptualization and piloting of a community-driven and sustainable PHC and health for all (SPHC-HFA) model. This paper describes the SPHC-HFA model in Ward 7 of Ile-Oluji/Okeigbo LGAs, Ondo State, Nigeria, detailing its features, establishment, and comparison with the traditional PHC (T-PHC) model.

Methodology: This is a review paper detailing the implementation process of the Okeigbo SPHC-HFA model project, from its conceptualization and community selection to the establishment of a functional, sustainable PHC model structure. Five primary care service delivery measures were adopted to compare the SPHC-HFA and T-PHC.

Implementation Processes: The community leadership of Okeigbo Kingdom took prominent roles in the establishment of the Ward 7 SPHC-HFA model, which entailed the selection of Ward 7; community nurse/midwife engagement and placement; enumeration area demarcation, de-jure census, and health survey; official launch of the program and take-off; development of at-risk-register; and routine home visits and commencement of clinic consultation. The SPHC-HFA model was rated higher than the T-PHC model regarding inclusiveness of care, active community engagement, and availability of population-based data for evidence-based PHC operations.

Conclusion/Implications: The Okeigbo Ward 7 SPHC-HFA model provides a practical demonstration of a community-driven PHC model with the potential for sustainability and presents the government and other stakeholders with a framework for possible adoption or adaptation of its best practices and lessons learnt.