Role of community pharmacists in improving maternal and child health in Nigeria


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Role of community pharmacists in improving maternal and child health in Nigeria

  2. 2. OUTLINE• Introduction / Background• Objectives• Methods• Results• Discussion• Conclusion• Recommendations• References tomowo, 2011
  3. 3. 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] tomowo, 2011
  4. 4. Fig 1: Causes of Deaths in U5s in Nigeria, IMNCH, 2008 Others 3% Malaria 24% Neonatal Causes 26% Pneumonia 20%HIV/AIDS 5% Measles 6% Diarrhoea 16% tomowo, 2011
  5. 5. Fig. 2: Causes of Maternal Death, IMNCH, 2008 Others 5% Anemia 11% Malaria 11%Haemorhage 23% Infection 17% Obstructed labour 11% Unsafe abortion 11% Toxemia/Eclampsia 11% tomowo, 2011
  6. 6. 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] tomowo, 2011
  7. 7. 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]. tomowo, 2011
  8. 8. 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. tomowo, 2011
  9. 9. 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. tomowo, 2011
  10. 10. RESULTS1. Situation analysis of Comm. Pharm. participation in MNCH services at the community level2. Description of training intervention of community pharmacists in MNCH3. Assessment of the effect of the described community pharmacists training intervention [client exit interview] tomowo, 2011
  11. 11. 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] tomowo, 2011
  12. 12. 30 26 26 25 24 24 20 Frequency 15 Yes No 10 5 5 4 4 4 0 Benin Abia Abuja Ilorin In service Tranning on Focus Ante Natal CareFig. 6: In service training: Focused Ante Natal Care tomowo, 2011
  13. 13. 35 31 30 25 20 20 19Frequency 18 15 Yes 12 No 10 10 10 5 2 0 Benin Abai Abuja Ilorin In service Tranning on ImmunizationFig.7: In service training: Integrated Mgt of Childhood Illnesses tomowo, 2011
  14. 14. 10 10 10 7.9 9 8 6 4 2 0 Ante Natal care Abuja Ilorin Abia Benin 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
  15. 15. 26 26 26 25 Percentage 24 Abuja 22 Ilorin 22 Abia Benin 20 Immunization Pharmaceutical Care on Immunization Fig. 9: the % of respondents [clients] counselled on Immunization [pre training assessment] The pre training assessment on Immunization counselling showed 25% of therespondents [clients who visited the pharmacies] from Ilorin 22% from Abia, 26% from Abuja and 26% from Benin received counselling on the intervention, tomowo, 2011
  16. 16. 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] tomowo, 2011
  17. 17. Tab. 4: pre & post training test for intervention group Edo State (n=25) Abia (n=27)Knowledge Pre Post Pre PostScore Training test training test Training test 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 tomowo, 2011
  18. 18. 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. tomowo, 2011
  19. 19. 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. tomowo, 2011
  20. 20. 35 30 28.6 25 22.7 Percentage 20 Pre Tranning 15 Post Traning 10 10 9 5 0 Abia BeninFig. 10: the % of respondents counselled on Ante Natal Care [post training assessment]The post training assessment on Ante natal care indicated that morerespondents 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] tomowo, 2011
  21. 21. Pre Tranning Post Traning 80 65 68 60 40 22 26 20 0 Abia Benin Fig. 12: the % of respondents counselled on ImmunizationThe post training assessment on Immunization indicated that more respondentsreceived counselling on the intervention. 65% from 22% in Abia [P=0.6951] and 68% from 26% in Benin [P=0.6919], tomowo, 2011
  22. 22. 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]. tomowo, 2011
  23. 23. 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 tomowo, 2011
  24. 24. 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. tomowo, 2011
  25. 25. 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. tomowo, 2011
  26. 26. 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. tomowo, 2011
  27. 27. 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. tomowo, 2011
  28. 28. Distinguished Ladies and Gentlemen, Let’s get the Health System Working For Our Mothers and Children through the Community pharmacists intervention. thank you me, will u? tomowo, 2011
  29. 29. 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, OCarroll 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 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 by guest on July 2, 2011.• National Demographic and Health Survey, Nigeria report, [2008]. tomowo, 2011
  30. 30. 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.] 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: – © World Health Organization 2009]. tomowo, 2011