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Introduction: While practice guidelines support clinical decision-making for optimal patient outcomes, there is often nonadherence to practice guidelines in implementing evidence-based interventions. Objectives: This article aimed to assess adherence to practice guidelines in emergency obstetric and newborn care (EmONC) and the outcome of pregnancy in cases of obstetric complications in referral hospitals. Method: The study employed a descriptive design. A purposive sampling technique was used to select the three tertiary hospitals and six out of nine state hospitals in Osun State. A data extraction form developed based on a fidelity framework was used to collect data on Adherence from 264 cases of obstetric complications. Descriptive statistics, such as frequency and percentage, and inferential statistics, such as chi-square, were done with the significance level set as p < .05. Results: Findings showed low adherence to practice guidelines in 70.8% of hemorrhage care, 52.0% of fetal distress care, 60.0% of prolonged obstructed labor care, and 44.4% of preeclampsia/eclampsia care. The study's findings also showed that 64.3% of cases of prolonged/obstructed labor, 54.9% of cases of fetal distress, and 46.7% of all cases of obstetric complications were referred out at the state hospitals. Neonatal mortality in state and tertiary hospitals was 3.7% and 21.7%, respectively, which was significantly different (p < .001). Conclusion: There was low adherence to practice guidelines for the implementation of EmONC in state and tertiary hospitals, and a significant number of cases of obstetric complications were referred out in the state hospitals. The low adherence to practice guidelines and numerous referrals truncate the successful implementation of EmONC and hinder women and newborns from receiving optimal care for obstetric complications. There is a need to develop strategies that promote adherence to practice guidelines in implementing EmONC.

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Objetivo: Evaluar la influencia de una intervención educativa sobre el conocimiento, la detección y el manejo de la violencia de pareja íntima (VPI) por parte de matronas. Método: Estudio quasi-experimental donde participaron 158 matronas procedentes de 2 distritos en el estado de Ekiti (Nigeria). La muestra se dividió en grupos: experimental y de control (79 matronas por grupo). Los datos se recogieron mediante un cuestionario y una lista de verificación de observación. Se realizó un programa de capacitación educativa adaptado sobre detección y manejo de la VPI en el grupo experimental. Se realizó una medición antes de la intervención, inmediatamente después y 6 semanas después. Los datos se analizaron utilizando estadística descriptivas e inferenciales (Chi-cuadrado y regresión logística binaria) con un nivel de significancia establecido en p<0,05. Resultados: El conocimiento previo respecto a la detección y el manejo de la VPI entre las matronas en ambos grupos fue deficiente, ya que tan solo el 16,5% del grupo experimental y el 17,7% del grupo control tenían un buen conocimiento en la fase previa a la intervención. El grupo experimental tuvo una mejora significativa en el conocimiento de la detección y el manejo de la VPI, con un 82,1% con buenos conocimientos inmediatamente después de la intervención y un 92,0% a las 6 semanas después de la intervención (p=0,001). La práctica observada de detección y manejo de la VPI obtuvo mejora significativa, pasando de un 21,9% de práctica satisfactoria antes de la intervención, a un 63,5% después de la intervención (p=0,001) en el grupo experimental, no detectándose una mejora apreciable en la práctica en el grupo control (21,9 versus 36,5%; p=0,682). Conclusión: El uso programa de capacitación educativa adaptado mejoró el conocimiento de las matronas y su práctica sobre la detección y el manejo de la violencia de pareja íntima.(AU)

Objective: To assess the influence of an educational intervention on midwives’ knowledge, detection and management of intimate partner violence (IPV). Methods: A quasi-experimental study involving 158 midwives from two districts in Ekiti State, Nigeria. The sample was divided into experimental and control groups (79 midwives per group). Data were collected using a questionnaire and an observation checklist. A customized educational training program on IPV detection and management was conducted in the experimental group. Measurement was performed before the intervention, immediately after and 6 weeks later. Data were analyzed using descriptive and inferential statistics (Chi-square and binary logistic regression) with a level of significance set at P<.05. Results: Prior knowledge regarding IPV detection and management among midwives in both groups was poor, with only 16.5% of the experimental group and 17.7% of the control group having good knowledge in the pre-intervention phase. The experimental group had a significant improvement in knowledge of IPV screening and management, with 82.1% having good knowledge immediately after the intervention and 92.0% at 6 weeks after the intervention (P=.001). Observed practice of IPV detection and management improved significantly from 21.9% satisfactory practice before the intervention to 63.5% after the intervention (P=.001) in the experimental group, with no appreciable improvement in practice detected in the control group (21.9 versus 36.5%; P=.682). Conclusion: The use of a customized educational training program improved midwives’ knowledge and practice in the detection and management of intimate partner violence.(AU)

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OBJECTIVE: To assess the influence of an educational intervention on midwives' knowledge, detection and management of intimate partner violence (IPV). METHODS: A quasi-experimental study involving 158 midwives from two districts in Ekiti State, Nigeria. The sample was divided into experimental and control groups (79 midwives per group). Data were collected using a questionnaire and an observation checklist. A customized educational training program on IPV detection and management was conducted in the experimental group. Measurement was performed before the intervention, immediately after and 6 weeks later. Data were analyzed using descriptive and inferential statistics (Chi-square and binary logistic regression) with a level of significance set at p < 0.05. RESULTS: Prior knowledge regarding IPV detection and management among midwives in both groups was poor, with only 16.5 % of the experimental group and 17.7 % of the control group having good knowledge in the pre-intervention phase. The experimental group had a significant improvement in knowledge of IPV screening and management, with 82.1 % having good knowledge immediately after the intervention and 92.0 % at 6 weeks after the intervention (p = 0.001). Observed practice of IPV detection and management improved significantly from 21.9 % satisfactory practice before the intervention to 63.5 % after the intervention (p = 0.001) in the experimental group, with no appreciable improvement in practice detected in the control group (21.9% versus 36.5%; p = 0.682). CONCLUSION: The use of a customized educational training program improved midwives' knowledge and practice in the detection and management of intimate partner violence.

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BACKGROUND: Successful implementation of Emergency Obstetric and Neonatal Care (EmONC) is likely to improve pregnancy outcomes and is essential for quality maternity care. Context in implementation is described as factors that enabled or disabled implementation of interventions. While the context of implementation is important for the effectiveness of evidence-based interventions, the context of EmONC implementation has not been widely studied in Nigeria. METHODS: The research design was cross-sectional descriptive. A mixed-methods approach was used to assess and explore the context of implementing EmONC in referral centres in Osun state. A purposive sampling technique was used to select the three tertiary health facilities in Osun State and six secondary health facilities from the six administrative zones in the State. A total of 186 healthcare providers in these referral centres participated in the quantitative part of the study, and eighteen in-depth interviews were conducted for its qualitative aspect. An adapted questionnaire from Context Assessment Index and an interview guide were used to collect data. Quantitative data were analysed using descriptive and inferential statistics at 0.05 significance level, while qualitative data were analysed using the thematic approach. RESULTS: The percentage mean score of context strength in EmONC implementation was 63% ± 10.46 in secondary and 68% ± 10.47 in tertiary health facilities. There was a significant difference in the leadership (F (1, 184) = 8.35, p < 0.01), evaluation (F (1, 184) = 5.35, p = 0.02) and overall context (F (1, 184) = 6.46, p = 0.01) of EmONC implementation in secondary and tertiary health facilities. Emerging themes in EmONC context were: Resources for EmONC implementation; Demand for EmONC; Efficiency of funding; Institutional leadership; and Performance evaluation. CONCLUSIONS: The context of EmONC implementation in the referral health facilities was generally weak. The secondary health facilities' weaknesses were worse compared to the tertiary health facilities. The five key contextual factors could inform strategies for improving EmONC implementation in health facilities to ensure improved access to care that will reduce deaths from obstetric complications in Nigeria.

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Introduction: The lack of continuous training of maternal and child healthcare providers has been identified as one of the factors contributing to the poor quality of maternal and child healthcare services in Nigeria. Objectives: The study aimed to evaluate the level of postnatal care-related knowledge among healthcare workers in Osun State and the impact of a structured training program on their learning. Method: A quasi-experimental research design using pre-test and post-test control groups was utilized in this study. One hundred and sixty-one healthcare workers were recruited from six Local Government Areas (LGA) and randomized into intervention and control groups. The healthcare workers in the intervention group (n = 82) were exposed to a 3-day structured training program. A structured questionnaire was used to collect data before, immediately, and 3-months after the training. Data were analyzed using descriptive statistics, multiple linear regression, t-test, and repeated measure analysis of variance (ANOVA) with posthoc pairwise comparison. Results: The mean ages of healthcare workers in the intervention and control groups are 40.96 ± 6.91 and 42.52 ± 7.58, respectively. At baseline, the mean knowledge score of the intervention and control groups were 60.0 ± 11.6 and 63.7 ± 10.4, respectively. There is a significant difference in the mean knowledge score of healthcare workers in the intervention group compared with those in the control group immediately after the training (t = 12.04, p < .001) and after 3-months of data collection training (t = 5.92, p < .001). A multivariate linear regression confirmed the positive effect of group membership (intervention vs. control) on the post-test knowledge among respondents (p < .001). Conclusion: An educational training significantly improved the knowledge of healthcare workers on the recommended postnatal care.

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The integration of emergency obstetric and newborn care (EmONC) into maternal and newborn care is essential for its effectiveness to avert preventable maternal and newborn deaths in healthcare facilities. This study used a theory-oriented quantitative approach to document the reported extent of EmONC integration, and its relationship with EmONC training, guidelines availability and level of healthcare facility. A descriptive cross-sectional study was conducted among five hundred and five (505) healthcare providers and facility managers across the three levels of healthcare delivery. An adapted questionnaire from NoMad instrument was used to collect data on the integration of EmONC from the study participants. Ethical approval was obtained and informed consents taken from the participants. Both descriptive (frequency, percentage, mean and median) and inferential analyses (Kruskal Wallis and Mann Whitney tests) were done with statistical significance level of p<0.05 using STATA 14. The mean age of respondents was 38.68±8.27. The results showed that the EmONC integration median score at the three levels of healthcare delivery was high (77 (IQR = 83-71)). The EmONC integration median score were 76 (IQR = 84-70), 76 (IQR = 80-68) and 78 (IQR = 84-74) in the primary, secondary and tertiary healthcare facilities respectively. Integration of EmONC was highest (83 (IQR = 87-78)) among healthcare providers who had EmONC training and also had EmONC guidelines made available to them. There were significant differences in EmONC integration at the three levels of healthcare delivery (p = 0.046), among healthcare providers who had EmONC training and those with EmONC guidelines available in their maternity units (p = 0.001). EmONC integration was reportedly high and significantly associated with EmONC training and availability of guidelines. However, the congruence of reported and actual extent of integration of EmONC at the three levels of healthcare delivery still need validation as such would account for the implementation success and maternal-neonatal outcomes.

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Abstractworldwide because of the link between education and development. What appears not to have been fully explored in the Nigerian context is the responsiveness of various professions, especially nursing, to the consistently changing educational system. Yet innovative advances in health care system in the twenty-first century demands that Nursing as a profession should prepare practitioners who are well equipped to meet the challenges of care within the context of a complex milieu. This paper, therefore, examines the Nigeria educational system, its reforms and current status of nursing education in Nigeria. Some of the challenges in the emergence of professional nursing in Nigeria and the progress made so far to advance professional as well as university education for nurses are articulated with propositions of possibilities and the gains for the Nigeria nation.

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