IMPROVING MATERNAL AND CHILD

HEALTH IN NIGERIA

-the community pharmacists

participation

‘tomowo FADUYILE

FEDERAL MINISTRY OF HEALTH, ABUJA

detomowo@gmail.com

&

DR. C.A.OPARAH

CLINICAL PHARMACY

UNIVERSITY OF BENIN, EDO STATE

OUTLINE • Introduction / Background

• Objectives

• Methods

• Results

• Discussion

• Conclusion

• Recommendations

• References

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INTRODUCTION

• 1 in every 13 women will die from pregnancy

and child birth related complications, 2,300

children under five years die daily and 528

newborns die from most of the same

conditions that kill their mother in the first

week of life [IMNCH, 2008].

• MMR-545/100,000 live births [NDHS, 2008]

• U5MR-157/1,000 live births [NDHS, 2008]

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Malaria 24%

Pneumonia 20%

Diarrhoea 16%Measles 6%

HIV/AIDS 5%

Neonatal Causes

26%

Others 3%

Fig 1: Causes of Deaths in U5s in Nigeria, IMNCH, 2008

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Anemia 11%

Malaria 11%

Obstructed labour 11%

Unsafe abortion 11%

Toxemia/Eclampsia 11%

Infection 17%

Haemorhage 23%

Others 5%

Fig. 2: Causes of Maternal Death, IMNCH, 2008

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CONT’D: KEY ISSUES IN MATERNAL & CHILD SURVIVAL

Children bear the highest burden of disease in Nigeria today.

More than 60% of these children get ill and die at home with no contact with the health facility

90% of deaths in these vulnerable groups can be prevented or treated.

The health system is weak and cannot deliver high quality interventions in key areas along the continuum of care.

Mal-distribution of LIMITED available human resource for maternal and child health services [IMNCH, 2008]

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RATIONALE FOR COMM PHARM PARTICIPATION IN MNCH

• Pharmacists are repeatedly cited among most trusted and one

of most accessible health care professionals.

• Pharmacists can also offer useful bridge between patients and

physicians by identifying an individual patient’s needs and

facilitate referrals to health care providers when appropriate. [A

National Certificate program for Pharmacists on Pharmacy-Based Immunization, 2009]

Achieving optimal maternal and childhealth has become the responsibility of all health personnel in a task sharing approach at all levels of care [GPMNCH, 2010].

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OBJECTIVES

• assessed baseline status of Community Pharmacists’ participation in Maternal, Newborn and Child Health [MNCH]

• described a training intervention for community pharmacists on MNCH

• assessed its effect and possible impact on maternal and childhealth.

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METHODS

• Quasi - experimental design,[Erhun, 2009] using multi-stage stratified sampling method, conducted in Abuja, Kwara, Abia and Edo States [June - September, 2011].

• Used pre-tested questionnaires to generate data on baseline activities of pharmacists and endline clients’ assessment.

• Conducted additional training intervention and post-training endline assessment in two states [Abia & Edo].

• Over 80% of questionnaires sent were received, validated and analysed using Epi-Info Software.

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RESULTS

1. Situation analysis of Comm. Pharm. participation in MNCH services at the community level

2. Description of training intervention of community pharmacists in MNCH

3. Assessment of the effect of the described community pharmacists training intervention [client exit interview]

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1. situation analysis of Comm. Pharm.

involvement in MNCH services at the

community level

• Over 25% of community pharmacists see

between 5-10% women and 10-20% children daily.

• A gap in MNCH knowledge was observed.

• The client exit interview showed similar low MNCH counselling given by the CP in all 4 states, [pre training intervention]

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Fig. 6: In service training: Focused Ante Natal Care

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5 4 4 4

26

24

26

24

0

5

10

15

20

25

30

Benin Abia Abuja Ilorin

Fre

qu

en

cy

In service Tranning on Focus Ante Natal Care

Yes

No

Fig.7: In service training: Integrated Mgt of

Childhood Illnesses tomowo, 2011

12

2

10 10

19

31

20

18

0

5

10

15

20

25

30

35

Benin Abai Abuja Ilorin

Fre

qu

en

cy

In service Tranning on Immunization

Yes

No

Fig. 8: the % of respondents [clients] counselled on Ante Natal Care [pre training

assessment]

The pre training end line assessment indicated that only about 10% of the respondents

[clients who visited the pharmacies] across the states received counselling on Ante Natal

Care tomowo, 2011

0

2

4

6

8

10

Ante Natal care

7.9

10 10

9

Abuja Ilorin Abia Benin

Fig. 9: the % of respondents [clients] counselled on Immunization [pre training

assessment]

The pre training assessment on Immunization counselling showed 25% of the

respondents [clients who visited the pharmacies] from Ilorin 22% from Abia, 26%

from Abuja and 26% from Benin received counselling on the intervention,

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20

22

24

26

Immunization

26

25

22

26

Perc

en

tag

e

Pharmaceutical Care on Immunization

Abuja

Ilorin

Abia

Benin

2. Description of training intervention of

community pharmacists in MNCH

• Training intervention was described in two

states [Abia & Edo] while the remaining two

states [Abuja & Kwara] are used as the

control.

• The training intervention revealed improved

MNCH knowledge in the study states

[P<0.001]

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Tab. 4: pre & post training test for intervention

group

Edo State (n=25) Abia (n=27)

Knowledge

Score

Pre

Training test

Post

training test

Pre

Training test

Post

Training test

≤ 33 Poor 19(76.0) 3 ( 12.0) 23(85.2) 4(14.8)

34-66 Fair 5 (20.0) 7(28.0) 5(14.8) 6(22.2)

>66 Good 1(4.0) 15 (60.0) 0(0.0) 17(63.0)

X2 = 24.22 df =2 p<0.001 X2 = 30.45 df =2 p< 0.001

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3. Assessment of the effect of the described Comm.

Pharm training intervention [client exit interview]

• Post-training endline assessment showed a

40% average increase of mothers and under-

five caregivers counselled on key MNCH

interventions.

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MNCH counselling received by pregnant & child

bearing women who visited the pharmacies

• Key MNCH interventions [Counselling] on

Family Planning, Ante Natal Care, Birth Preparedness, Mgt of Childhood Illness & Immunization were among those assessed in the exit interview of the clients of all the pharmacies under study.

• This was repeated [pre & post training intervention assessment] in the study states [Abia & Benin] to assess the impact of the described training intervention.

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Fig. 10: the % of respondents counselled on Ante Natal Care [post training

assessment]

The post training assessment on Ante natal care indicated that more

respondents received counselling on Ante Natal Care. 28.6% from 10% in Abia

[P=0.0305] and 22.7% from 9% in Benin [P=0.1789]

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10 9

28.6

22.7

0

5

10

15

20

25

30

35

Abia Benin

Pe

rce

nta

ge

Pre Tranning

Post Traning

Fig. 12: the % of respondents counselled on Immunization

The post training assessment on Immunization indicated that more respondents

received counselling on the intervention. 65% from 22% in Abia [P=0.6951] and

68% from 26% in Benin [P=0.6919],

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0

20

40

60

80

Abia

Benin

22 26

65 68

Pre Tranning Post Traning

DISCUSSION • over 15% of the CP sees between 5 -10 pregnant

women and 10 – 20 children per day. This bring to fore the high load of pregnant and nursing mothers as well as U5 year old children that access the pharmacies on a regular basis. [missed opportunity ]

This agrees with a study implying that urban communities look to pharmacies as a source of medicines, advice, and information, for many types of health problems [Mookhetji et al, 1996], [Nabudere, 2010], [Nsimba, 2007].

• The study also showed knowledge gap of community pharmacists in MNCH and public health in general. This also tends to agree with several studies on need for improved knowledge for pharmacists for more effective service delivery in Public Health. [Ross-Degnan et al, 1996], [WATERS et al, 2011] , [Ross-Degnan et al, 1996].

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DISCUSSION -cont’d • The results of the training intervention of the community

pharmacists under study showed a significant knowledge

transfer [P< 0.001]. This was also demonstrated in studies

by Eades et al, 2011 and Goodman et al, 2007

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DISCUSSION cont’d

• The end line assessment showed a very clear

difference of possible patient outcome as more

respondents claimed counselled on MNCH

interventions during post training client assessment.

• Oparah and colleagues [2006] also agrees that effective

training intervention will yield enhanced capacity of CP

leading to improved pharmacists’ knowledge, attitudes and

self-efficacy.

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CONCLUSION • There is HIGH client load of pregnant and nursing mothers

with U5 children in contact with the Comm. Pharm daily. [MISSED OPPORTUNITY FOR MNCH SERVICES]

• There is a knowledge GAP for MNCH interventions in comm. pharmacists studied.

• The training intervention described showed a statistical significant knowledge transfer as depicted by the very high performances during the post training test.

• There was willingness of comm. pharm in Nigeria to participate in MNCH. With increased capacity building, confidence can be built to assume the rightful position in optimal MNCH Services at the community level.

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CONCLUSION . . . cont’d

• After the training intervention, the patients

outcome [counselling on key MNCH services]

was significantly improved in the study states.

• With improved capacity building, the

community pharmacists are well positioned

as PROMOTERS, FACILITATORS and

IMPLEMENTERS of maternal and child

health in Nigeria.

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RECOMMENDATIONS • Involvement of comm. Pharm in PH [esp MNCH]

is a great opportunity that should not be over

looked.

• Improved capacity of comm. Pharm is imperative

for relevance in the modern day PH.

• More studies should be commissioned on

community pharmacists’ participation in MNCH

for policy, planning and implementation

purposes.

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Distinguished Ladies and

Gentlemen, Let’s get the

Health System Working

For Our Mothers and

Children through the

Community pharmacists

intervention.

thank you all.

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help me, will u?

REFERENCES • A National Certificate program for Pharmacists on Pharmacy-Based Immunization Delivery by

American Pharmacists Association, [2009], [pg 14, 16].

• AZUKA C. OPARAH, EHIJIE F.O. ENATO, & ADEGO E. EFERAKEYA [2006]. Impact of an

educational intervention on the behavioural pharmaceutical care scale.. Pharmacy Education,

June 2006; 6(2): 97–106].

• Eades CE, Ferguson JS, O'Carroll RE [2011]. Public health in community pharmacy: A systematic

review of pharmacist and consumer views. Department of Psychology, University of Stirling,

Stirling, FK9 4LA, Scotland, UK claire.eades@nhs.net. BMC Public Health. 2011 Jul 21;11:582.

• Goodman C, Brieger W, Unwin A, Mills A, Meek S, Greer G. [2007]. Medicine sellers and malaria

treatment in sub- Saharan Africa: what do they do and how can their practice be improved? Am J

Trop Med Hyg. 2007 Dec; 77(6 Suppl):203

• Harriet Nabudere, MD, MPH et al. [2010]. An Evidence-Based Policy Brief Task shifting to

optimise the roles of health workers to improve the delivery of maternal and child healthcare Full

Report This policy brief was prepared by the Uganda country node of the Regional East African

Community Health (REACH) Policy Initiative.

• HUGH WATERS, LAUREL HATT AND DAVID PETERS [2011]. Working with the private sector

for child health. HEALTH POLICY AND PLANNING; 18(2): 127–137 Health, Policy and Planning

18(2), doi: 10.1093/heapol/czg017; Department of International Health, Johns Hopkins

Bloomberg School of Public Health, Baltimore, MD, USA Downloaded from

heapol.oxfordjournals.org by guest on July 2, 2011.

• National Demographic and Health Survey, Nigeria report, [2008].

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REFERENCES cont’d

• Nsimba SE [2007]. Assessing the impact of educational intervention for improving management of

malaria and other childhood illnesses In Kibaha District-Tanzania.. Department of Clinical

Pharmacology, Muhimbili University College of Health Sciences, Dar-es-Salaam, Tanzania.

snsimba@muchs.ac.tz] East Afr J Public Health. 4(1):5-11.

• Prof. W.O. Erhun. [2011]. Study guide. WAPCP Short course on PP Research.

• Ross-Degnan D, Soumerai SB, Goel PK, Bates J, Makhulo J, Dondi N, Sutoto, Adi D, Ferraz-Tabor L,

Hogan R. [1996]. The impact of face-to-face educational outreach on diarrhoea treatment in

pharmacies. Department of Ambulatory Care and Prevention, Harvard Medical School, Boston,

USA. Health Policy Plan. 1996 Sep; 11(3):308-18.

• Sangeeta Mookhetji Thomas Trudeau Kane Shams El Arifeen Abdullah Hel Baqui [1996]. The Role of

Pharmacies in Providing Family Planning and Health Services to Residents of Dhaka, Bangladesh.

CENTRE FOR HEALTH AND POPULATION RESEARCH, 1996 MCH-FP Extension Project (Urban)

Health and Population Extension Division (HPED) International Centre for Diarrhoeal Disease

Research, Bangladesh . GPO Box 128,Dhaka 1000, Bangladesh 1996 Working Paper No.2!

Telephone: 871751-871760 (10 lines) Fax: 880-2-871568 and 880-2-883116].

• The Integrated Maternal, Newborn and Child Health Strategy Document, [2007]. Federal Ministry of

Health, Nigeria.

• The Partnership for Maternal, Newborn and Child Health. [2011]. The Secretariat is hosted and

administered by the World Health Organization 20, Avenue Appia, 1211 Geneva 27, Switzerland Tel:

+41 22 791 2595 - Fax: +41 22 791 5854 – E-mail: pmnch@who.int – www.pmnch.org © World Health

Organization 2009].

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