Papers by Godwin Afenyadu
Journal of community medicine & health education, 2016
Background: Community Health Workers (CHWs) can facilitate access to primary health care services... more Background: Community Health Workers (CHWs) can facilitate access to primary health care services among isolated rural communities. This study examines how Nigeria's Subsidy Reinvestment and Empowerment Program on Maternal and Child Health (SURE-P MCH) Village Health Worker (VHW) programme provides a model for the Nigerian Road Map for VHWs. We used pre-post with comparison model design, comparing two successive VHW cohorts, recruited in 2013 (n=109) and in 2014 (n=147) in Jigawa, Katsina and Zamfara states, northern Nigeria. We collected performance statistics and conducted interviews with the VHWs, and focus group discussions with the VHWs, their CHEW mentors, the in-charges at the facilities, and the village health/ ward development committees overseeing the recruitment and support of the VHWs. Significant differences between the 2013 and 2014 cohort were assessed using bi-variate statistics. Results: All VHWs were female. The VHWs worked 20.8 hours/week, and averaged 34.3 home visits/month. After their training, 90% were comfortable with their primary tasks of encouraging antenatal care (ANC) visits and teaching about a healthy pregnancy. They identified 11.7 newly pregnant women per month, of whom 9.0 went to ANC. The pictorial guides were the most useful tools for encouraging ANC and facility deliveries. Compared to before the VHWs began work, clinics recorded 84.8% more women making 4+ ANC visits and 119.9% more skilled birth deliveries. Clinical consultations at the PHC referral sites for the VHWs increased significantly after the introduction of the VHWs and again from 2013 to 2014 (p < 0.010). Qualitative feedback identified the following factors supporting their effectiveness: linkage to support systems within and in the peripheral health facility, pictorial materials and a thank-you stipend for services. The SURE-P MCH VHWs were associated with significant increases in maternal health service uptake at the rural PHCs to which they were affiliated. The factors associated with their effectiveness should be incorporated into the Nigerian Road Map for VHWs: training in coaching health promotion topics, pictorial guides to assist in coaching, mentoring and support from the CHEWs and the community, and a nominal stipend.
African Journal of Reproductive Health, Nov 9, 2017
Access to quality reproductive health and family planning services remain poor in Nigeria. We pre... more Access to quality reproductive health and family planning services remain poor in Nigeria. We present results on family planning awareness and use from a survey of 3,080 women (age 15-49 years) in Jigawa, Katsina, Yobe, and Zamfara States. About 43.0% had heard of any method of contraception whereas 36.6% had heard of any modern method. Overall, 7.0% of all currently married women reported ever using a method of contraception; 4.4% used a modern method and 2.9% used a traditional method. Only 1.3% of women in union (currently married or cohabiting) used modern contraception methods at the time of the survey; 1.3% of women in union used traditional methods. Unmet need for family planning was 10.3%. Low family planning use in the presence of low awareness and low felt need suggests, among other things, a need to increase awareness and uptake and make family planning commodities available.
Additional file 4. Desk Review Guide. The desk review guide is an observational interview guide t... more Additional file 4. Desk Review Guide. The desk review guide is an observational interview guide that was used to guide the review of documented evidence all three levels of the district health system during the study.
Additional file 5. In-depth Interview Guide. The in-depth interview guide is a qualitative interv... more Additional file 5. In-depth Interview Guide. The in-depth interview guide is a qualitative interview guide that was used to collect qualitative data for the purpose of the study. This file is in PDF format
Additional file 1. District Assessment Form. The district assessment form is quantitative intervi... more Additional file 1. District Assessment Form. The district assessment form is quantitative interview guide used to collect data from participants who were selected from the district health management team.
Global Journal of Health Science, 2013
Reported maternal and child health (MCH) outcomes in Nigeria are amongst the worst in the world, ... more Reported maternal and child health (MCH) outcomes in Nigeria are amongst the worst in the world, with Nigeria second only to India in the number of maternal deaths. At the national level, maternal mortality ratios (MMRs) are estimated at 630 deaths per 100,000 live births (LBs) but vary from as low as 370 deaths per 100,000 LBs in the southern states to over 1,000 deaths per 100,000 LBs in the northern states. We report findings from a performance based financing (PBF) pilot study in Yobe State, northern Nigeria aimed at improving MCH outcomes as part of efforts to find strategies aimed at accelerating attainment of Millennium Development Goals for MCH. Results show that the demand-side PBF led to increased utilization of key MCH services (antenatal care and skilled delivery) but had no significant effect on completion of child immunization using measles as a proxy indicator. We discuss these results within the context of PBF schemes and the need for a careful consideration of all the critical processes and risks associated with demand-side PBF schemes in improving MCH outcomes in the study area and similar settings.
Additional file 2. Facility Assessment Form. The facility assessment form is a quantitative inter... more Additional file 2. Facility Assessment Form. The facility assessment form is a quantitative interview guide used to collect data from participants who were selected from health facilities at the district, sub-district and community levels.
A quasi-experimental study of mother's preferences for the advanced distribution of misoprost... more A quasi-experimental study of mother's preferences for the advanced distribution of misoprostol to prevent postpartum hemorrhage (PPH) and chlorhexidine gel to prevent newborn umbilical cord sepsis at 34-36 weeks' gestation <i>vesus</i> distribution on demand at onset of labor. Data were collected from 1,160 pregnant mothers and their newborns in three communities (Ward A, Ward B, and Ward C) in Nahuche area of Zamfara State, Nigeria. Data collection protocol was approved by the Zamfara State Ministry of Health Research Ethics Committee hosted in Zamfara Ministry of Health, Gusau, Nigeria. Zamfara Health Ethics is nationally registered in Nigeria with registration number NHREC/10/11/2011b. The permit number of this study is ZSHREC/01/11/2013.
Additional file 3. Behavioral Assessment Form. The behavioral assessment form is a quantitative i... more Additional file 3. Behavioral Assessment Form. The behavioral assessment form is a quantitative interview guide used to collect data from all selected participants during the study.
Maternal mortality is one of the major challenges to health systems in sub Saharan Africa. This p... more Maternal mortality is one of the major challenges to health systems in sub Saharan Africa. This paper estimates the lifetime risk of maternal death and maternal mortality ratio (MMR) in four states of Northern Nigeria. Data from a household survey conducted in 2011 were utilized by applying the “sisterhood method” for estimating maternal mortality. Female respondents (15–49 years) were interviewed thereby creating a retrospective cohort of their sisters who reached the reproductive age of 15 years. A total of 3,080 respondents reported 7,731 maternal sisters of which 593 were reported dead and 298 of those dead were maternal-related deaths. This corresponded to a lifetime risk of maternal death of 9% (referring to a period about 10.5 years prior to the survey) and an MMR of 1,271 maternal deaths per 100,000 live births; 95% CI was 1,152–1,445 maternal deaths per 100,000 live births. The study calls for improvement of the health system focusing on strategies that will accelerate redu...
Journal of Community Medicine & Health Education
Background: Community Health Workers (CHWs) can facilitate access to primary health care services... more Background: Community Health Workers (CHWs) can facilitate access to primary health care services among isolated rural communities. This study examines how Nigeria’s Subsidy Reinvestment and Empowerment Program on Maternal and Child Health (SURE-P MCH) Village Health Worker (VHW) programme provides a model for the Nigerian Road Map for VHWs. Methods: We used pre-post with comparison model design, comparing two successive VHW cohorts, recruited in 2013 (n=109) and in 2014 (n=147) in Jigawa, Katsina and Zamfara states, northern Nigeria. We collected performance statistics and conducted interviews with the VHWs, and focus group discussions with the VHWs, their CHEW mentors, the in-charges at the facilities, and the village health/ ward development committees overseeing the recruitment and support of the VHWs. Significant differences between the 2013 and 2014 cohort were assessed using bi-variate statistics. Results: All VHWs were female. The VHWs worked 20.8 hours/week, and averaged 34.3 home visits/month. After their training, 90% were comfortable with their primary tasks of encouraging antenatal care (ANC) visits and teaching about a healthy pregnancy. They identified 11.7 newly pregnant women per month, of whom 9.0 went to ANC. The pictorial guides were the most useful tools for encouraging ANC and facility deliveries. Compared to before the VHWs began work, clinics recorded 84.8% more women making 4+ ANC visits and 119.9% more skilled birth deliveries. Clinical consultations at the PHC referral sites for the VHWs increased significantly after the introduction of the VHWs and again from 2013 to 2014 (p < 0.010). Qualitative feedback identified the following factors supporting their effectiveness: linkage to support systems within and in the peripheral health facility, pictorial materials and a thank-you stipend for services. Conclusion: The SURE-P MCH VHWs were associated with significant increases in maternal health service uptake at the rural PHCs to which they were affiliated. The factors associated with their effectiveness should be incorporated into the Nigerian Road Map for VHWs: training in coaching health promotion topics, pictorial guides to assist in coaching, mentoring and support from the CHEWs and the community, and a nominal stipend.
Archives of International Surgery, 2016
Background: The provision of safe anesthesia in developing countries is often challenging due to ... more Background: The provision of safe anesthesia in developing countries is often challenging due to multiple health systems and infrastructural challenges. We explored the suitability and reliability of the Universal Anaesthesia Machine (UAM) in Northern Nigeria. Patients and Methods: Over an 18-month period from 1st June 2012 to 30th November 2013, Nurse anesthetists and biomedical technicians were trained on the use, maintenance, and installation of the UAM in the study facilities. Patients requiring general anesthesia (GA) were then randomly assigned to the UAM or other forms of GA. Availability, ease of ues ans safety were monitored. Results: A total of 1562 patients had anesthesia administered with 54.8% using UAM. Cesarean section due to obstructed labor was the most common indication. There was no malfunctioning of the UAM and its use was preferred over other forms of GA. Complications were less than with other form of GA provided by the same staff. Conclusion: The UAM is suitable for health facilities with limited equipment and manpower. It has the potential to improve access to surgery and emergency obstetric care as it can be safely used by non-physician anesthetists.
Rural Health [Working Title]
Inadequate number of health workers in rural areas is a major concern in many countries. It cause... more Inadequate number of health workers in rural areas is a major concern in many countries. It causes underutilization, prevents equitable access of health services, and is a barrier to universal health coverage. To increase the number and improve retention of health workers in rural areas, the World Health Organization (WHO) issued global recommendations to improve the rural retention of the health workforce. This paper presents the experiences of adopting and implementing the WHO recommendations in four states in Northern Nigeria. It highlights the results, challenges and lessons learnt with the implementation. We used an implementation research approach and evaluated the implementation at three stages: the pilot; full implementation; and immediate post exit. A total of 477 midwives were recruited and deployed to rural health facilities over a period of four years. Of these, 196 (41%) were in Jigawa, 126 (26.4%) in Yobe, 78 (16.4%) in Zamfara and 77 (16.1%) in Katsina. Midwives’ rete...
BMC Health Services Research
Background There is growing interest in the use of reliable evidence for health decision-making a... more Background There is growing interest in the use of reliable evidence for health decision-making among low-and middle-income countries. Ghana has deployed DHIMS2 to replace the previously existing manual data harmonization processes. Methods This cross-sectional study was conducted in 12 districts comprising 12 district directorates, 10 district hospitals, 29 sub-district health centers, and 38 community health facilities in the Brong-Ahafo Region. Data collection tools were developed based on the Measure Evaluate assessment tools designed for evaluating the performance of routine information systems management tools. Utilization was assessed based on documented evidence and data was analyzed using STATA version 14. Results Although 93% of the health facilities studied submitted data unto the DHIMS2 platform, evidence suggested low use of this data in decision-making, particularly at the community level facilities where only 26% of the facilities used data from DHIMS2 to inform annua...
Journal of Health Care for the Poor and Underserved
Nigeria is one of 57 countries with critical shortage of health workers (HWs). Strategies to incr... more Nigeria is one of 57 countries with critical shortage of health workers (HWs). Strategies to increase and equitably distribute HWs are critical to the achievement of Health Millennium/Sustainable Development Goals. We describe how three Northern Nigeria states adapted World Health Organisation (WHO)-recommended incentives to attract, recruit, and retain midwives. Secondary analysis of data from two surveys assessing midwife motivation, retention, and attrition in Northern Nigeria; and expert consultations. Midwives highlighted financial and non-financial incentives as key factors in their decisions to renew their contracts. Their perspectives informed the consensus positions of health managers, policymakers and heads of institutions, and led to the adaptation of the WHO recommendations into appropriate state-specific incentive packages. The feedback from midwives combined with an expert consultation approach allowed stakeholders to consider and use available evidence to select appropriate incentive packages that offer the greatest potential for helping to address inadequate numbers of rural midwives.
African Population Studies, 2016
Health Policy and Planning, 2013
Introduction Topographical, cultural, socioeconomic and developmental factors combine to create s... more Introduction Topographical, cultural, socioeconomic and developmental factors combine to create significant barriers to health services delivery in areas of Northern Nigeria, resulting in poor health outcomes in states such as Katsina. The Katsina State Ministry of Health has introduced a mobile clinic service to provide primary health care to particularly inaccessible communities. This study reports early evidence of beneficiary and provider perceptions of the service, and indicators of initial coverage. Methods Key informant interviews were held with community leaders and service providers from communities receiving mobile clinic services from across six local government areas (LGAs), selected to represent diversity of conditions across the state. Exit interviews were conducted with 455 service users across three sites. Data on utilization were collated from routine service records and from a survey of a representative sample of households across the six LGAs. Results Beneficiaries reported high levels of satisfaction with respect to most aspects of the mobile clinic service. However, there was significant variation in ratings of service quality. Concerns for beneficiaries included the lack of privacy provided, waiting times and lack of guidance on follow-up care. Providers of the service reported high levels of satisfaction with the work, highlighting the reach of services and the teamwork involved. Antenatal care (ANC) coverage of 30% of pregnant women-well above the average for the northern states-was achieved in one LGA, though much lower rates were secured elsewhere. Discussion Data indicate that while services are generally well-received there are clear opportunities for strengthening quality of service provision. Improved service supervision and monitoring-potentially linked to performance-based financing mechanisms-promise to raise general quality of care to that demonstrated as attainable in the best performing LGAs. Provider reports suggesting high levels of motivation are notable in a general healthcare work environment with high rates of absenteeism.
Global Health Action, 2014
Background: The present time reflects a period of intense effort to get the most out of public he... more Background: The present time reflects a period of intense effort to get the most out of public health interventions, with an emphasis on health systems reform and implementation research. Population health approaches to determine which combinations are better at achieving the goals of improved health and well-being are needed to provide a ready response to the need for timely and real-world piloting of promising interventions. Objective: This paper describes the steps needed to establish a population health surveillance site in order to share the lessons learned from our experience launching the Nahuche Health and Demographic Surveillance System (HDSS) in a relatively isolated, rural district in Zamfara, northern Nigeria, where strict Muslim observance of gender separation and seclusion of women must be respected by any survey operation. Discussion: Key to the successful launch of the Nahuche HDSS was the leadership's determination, stakeholder participation, support from state and local government areas authorities, technical support from the INDEPTH Network, and international academic partners. Solid funding from our partner health systems development programme during the launch period was also essential, and provided a base from which to secure long-term sustainable funding. Perhaps the most difficult challenges were the adaptations needed in order to conduct the requisite routine population surveillance in the communities, where strict Muslim observance of gender separation and seclusion of women, especially young women, required recruitment of female interviewers, which was in turn difficult due to low female literacy levels. Local community leaders were key in overcoming the population's apprehension of the fieldwork and modern medicine, in general. Continuous engagement and sensitisation of all stakeholders was a critical step in ensuring sustainability. While the experiences of setting up a new HDSS site may vary globally, the experiences in northern Nigeria offer some strategies that may be replicated in other settings with similar challenges.
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Papers by Godwin Afenyadu