Assessment of diagnostic accuracy and adherence to maternal and child health guidelines as a measure of clinical competence of frontline healthcare workers in Nigeria

O Obisesan, J O Akinyemi, I O Morhason-Bello, O B Yusuf, R O Eyelade, T Ilori, A A Aderinto, I Kana, O Solanke, J Suleiman, D Okara, A Adebiyi, A M Abdullahi, I F Adewole

Abstract

Clinical competence of primary healthcare (PHC) workers is important in the delivery of maternal and child health care and services. In this cross-sectional study, we investigated the diagnostic accuracy and adherence to clinical guidelines for the management of some clinical conditions such as malaria, diarrhea, pneumonia, neonatal asphyxia and postpartum hemorrhage, as a proxy to measure the clinical competence of frontline health workers in PHCs in selected states in Nigeria. Ninety PHC facilities were randomly selected in each State and the FCT. Of the 3330 health workers, only 36.0% were able to correctly diagnose the five selected medical conditions. There was a significant difference in the diagnostic accuracy of the health workers with the doctors having highest diagnostic accuracy (65.5%) compared to other health workers (p<0.001).  Adherence to the management guidelines was generally poor across all cadres of health workers and this pattern appear similar across the geopolitical regions in the country. The highest adherence to guidelines was observed among medical doctors (38.2%). The diagnostic accuracy and adherence to national guidelines for managing patients was poor among health workers, particularly, among other cadres except doctors. PHC workers in Nigeria need continuous training to enhance their clinical competence to improve quality of maternal and child health care.

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References

The WHO U, UNICEF, ICM, ICN, FIGO and IPA. Defining competent maternal and newborn health professionals. Geneva: World Health Organization, Licence: CC BY-NC-SA 30 IGO 2018.

Harvey SA, Blandón YC, McCaw-Binns A, Sandino I, Urbina L, Rodríguez C, Gómez I, Ayabaca P and Djibrina S. Are skilled birth attendants really skilled? A measurement method, some disturbing results and a potential way forward. Bull World Health Organ 2007; 85(10): 783-90.

Chotchoungchatchai S, Marshall AI, Witthayapipopsakul W, Panichkriangkrai W, Patcharanarumol W and Tangcharoensathien V. Primary health care and sustainable development goals. Bull World Health Organ 2020; 98(11): 792-800.

Tilley-Gyado R, Filani O, Morhason-Bello I and Adewole IF. Strengthening the Primary Care Delivery System: A Catalytic Investment Toward Achieving Universal Health Coverage in Nigeria. Health Systems & Reform 2016; 2(4): 277-84.

Abubakar I, Dalglish SL, Angell B, Sanuade O, Abimbola S, Adamu AL, Adetifa IMO, Colbourn T, Ogunlesi AO, Onwujekwe O, Owoaje ET, Okeke IN, Adeyemo A , Aliyu G, Aliyu MH, Aliyu SH, Ameh EA, Archibong B, Ezeh A, Gadanya MA, Ihekweazu C, Ihekweazu V, Iliyasu Z, Chiroma AK, Mabayoje DA, Sambo MN, Obaro S, Adesola Yinka-Ogunleye AY, Okonofua F, Oni T, Onyimadu O, Ali Pate MA, Salako BL, Shuaib F, Tsiga-Ahmed F and Zanna FH. The Lancet Nigeria Commission: investing in health and the future of the nation. Lancet 2022; 399(10330): 1155-200.

Onyenwenyi AOC and McHunu GG. Primary health care workers’ understanding and skills related to cervical cancer prevention in Sango PHC centre in south-western Nigeria: a qualitative study. Primary Health Care Research & Development 2019; 20: e93.

Meh C, Thind A, Ryan B and Terry A. Levels and determinants of maternal mortality in northern and southern Nigeria. BMC Pregnancy and Childbirth 2019; 19(1): 417.

Saving One Million Lives. “Our objective is to increase the utilization and quality of high impact reproductive,children health and nutrition interventions" Available from https://somlpforr.org.ng (10/01/2022). 2021.

Federal Ministry of Health. National Health Facility Survey 2016. Available from: https://ngfrepository.org.ng:8443/bitstream/123456789/3147/1/NHFS-Final-Report-for-Printing_VI.pdf (2 July 2022). 2017.

Briggs DC, Eneh AU and Alikor EAD. Basic neonatal resuscitation: retention of knowledge and skills of primary health care workers in Port Harcourt, Rivers State, Southern Nigeria. Pan Afr Med J 2021; 38: 75.

Adewole AO, Fawole O, Ajayi I, Yusuf B, Oladimeji A, Waziri E, Nguku P and Ajumobi O. Determinants of intermittent preventive treatment of malaria among women attending antenatal clinics in primary health care centers in Ogbomoso, Oyo State, Nigeria. Pan Afr Med J 2019; 33: 101.

Esan O, Fatusi A and Ojo T. The knowledge versus self-rated confidence of facility birth attendants with respect to maternal and newborn health skills: the experience of Nigerian primary healthcare facilities. Malawi Med J 2019; 31(3): 212-20.

Oladapo OT, Daniel OJ and Olatunji AO. Knowledge and use of the partograph among healthcare personnel at the peripheral maternity centres in Nigeria. J Obstet Gynaecol 2006; 26(6): 538-41.

Fawole AO, Hunyinbo KI and Adekanle DA. Knowledge and utilization of the partograph among obstetric care givers in south west Nigeria. Afr J Reprod Health 2008; 12(1): 22-9.

Adefolarin AO, Gershim A, Sola AO and Oye G. The effect of training and supervision on primary health care workers' competence to deliver maternal depression inclusive health education in Ibadan, Nigeria: a quasi-experimental study. BMC Health Serv Res 2021; 21(1): 1286.

Brown N, Dratler S, Pate M, Raube K and Mitchell W. Improving the Management Skills of Primary Healthcare Leaders: The “Mid-Level Management Training” Program in Nigeria. Health Management Policy and Innovation 2017; 2(2): 1-15.

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