Reproductive Maternal and Newborn Health Providers’ Assessment of Facility Preparedness and Its Determinants during the COVID-19 Pandemic in Lagos, Nigeria

  1. Charles Ameh
  2. Aduragbemi Banke-Thomas
  3. Mobolanle Balogun
  4. Christian Chigozie Makwe
  5. Bosede Bukola Afolabi

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Abstract

The global COVID-19 pandemic is predicted to compromise the achievement of global reproductive, maternal, and newborn health (RMNH) targets. The objective of this study was to determine the health facility (HF) preparedness for RMNH service delivery during the outbreak from the perspective of RMNH providers and to determine what factors significantly predict this. An anonymous cross-sectional online survey of RMNH providers was conducted from to July 1–21, 2020 in Lagos State, Nigeria. We conducted a descriptive and ordinal regression analysis, with RMNH worker perception of HF preparedness for RMNH service delivery during the outbreak as the dependent variable. In all, 256 RMNH workers participated, 35.2% reported that RMNH services were unavailable at some time since March 2020, 87.1% felt work-related burnout, 97.7% were concerned about the availability of personal protective equipment (PPE) and related guidelines, and only 11.7% were satisfied with the preparedness of their HFs. Our final model was a statistically significant predictor of RMNH worker perception of HF preparedness explaining 54.7% of the variation observed. The most significant contribution to the model was communication by HF management (likelihood ratio chi-square [LRCS]: 87.94, P < 0.001) and the availability of PPE and COVID-19 guidelines (LRCS: 15.43, P < 0.001). A one-unit increase in the level of concern about the availability of PPE and COVID-19 guidelines would increase the odds of observing a higher category of satisfaction with HF COVID-19 preparedness. Adequate support of RMNH providers, particularly provision of PPE and guidelines, and appropriate communications about COVID-19 should be prioritized as part of HF preparedness.

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  1. Version published to 10.4269/ajtmh.20-1324
  2. ScreenIT

    SciScore for 10.1101/2020.09.24.20201319: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Section 1 of the survey tool used contained study information and consent, and a question to confirm the provision of care in RMNH since March 2020.
    IRB: Ethics approval for the study was obtained from the Health Research and Ethics committee of College of Medicine University of Lagos (NHREC/19/08/2019B) and the Research and Ethics Committee of the Liverpool School of Tropical Medicine (20/052).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variable14 The total fertility rate in the state is between 3.4 and 4.2 (national average 5.3), 86.4% of women used a skilled health provider for antenatal care ANC (national average 67%) and between 61 and 77% of women have health facility birth (national average 39%).

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    IBM SPSS Statistics for Windows, Version 25.0.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and limitations: There are key strengths of note in our study, this was the first to go beyond just reporting levels of preparedness to understanding the determinants of health worker perception of HF preparedness and mechanisms that they use to cope during the COVID-19 pandemic. Compared to the earlier studies on preparedness to manage COVID-19 we explored the interaction between determinants of preparedness that included known risk factors of health worker stress and factors that can improve preparedness using ordinal regression analysis. Our study was conducted in a COVID- 19 safe way (online survey), most respondents were in management and clinical roles and were front line health workers, thus increasing the validity of the results. However, our study is not without limitations, Our sample was relatively small (256) for the size of the health workforce but was more than the minimum sample size of 240 required for ordinal regression analysis based on the recommendation of Hosmer, Lemeshow, and Sturdivant (2013) of a minimum sample for ordinal regression analysis of 10 observations per independent variable. 30 Also faith-based/private owned health facilities were under-represented (less than 10% all response) but over 85% of health facilities in Lagos are privately owned. 15 Other studies have reported a preference for privately owned health facilities for childbirth by about 50% of women irrespective of social class. 31,32 Therefore, our study may not be represe...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. ScreenIT

    SciScore for 10.1101/2020.09.24.20201319: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementSection 1 of the survey tool used contained study information and consent, and a question to confirm the provision of care in RMNH since March 2020.Randomizationnot detected.Blindingnot detected.Power Analysisnot detected.Sex as a biological variableDescriptive statistics Most respondents were female (72% or 184), aged 41-50 years (38% or 96), medical officers/registrars/house officers (40% or 101), from state Ministry of Health secondary facilities (52% or 133) and 63.7% (163) had a management role.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    IBM SPSS Statistics for Windows, Version 25.0.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

    Strengths and limitations There are key strengths of note in our study, this was the first to go beyond just reporting levels of preparedness to understanding the determinants of health worker perception of HF preparedness and mechanisms that they use to cope during the COVID-19 pandemic. Compared to the earlier studies on preparedness to manage COVID-19 we explored the interaction between determinants of preparedness that included known risk factors of health worker stress and factors that can improve preparedness using ordinal regression analysis. Our study was conducted in a COVID19 safe way (online survey), most respondents were in management and clinical roles and were front line health workers, thus increasing the validity of the results. However, our study is not without limitations, Our sample was relatively small (256) for the size of the health workforce but was more than the minimum sample size of 240 required for ordinal regression analysis based on the recommendation of Hosmer, Lemeshow, and Sturdivant (2013) of a minimum sample for ordinal regression analysis of 10 observations per independent variable. 30 Also faith-based/private owned health facilities were under-represented (less than 10% all response) but over 85% of health facilities in Lagos are privately owned. 15 Other studies have reported a preference for privately owned health facilities for childbirth by about 50% of women irrespective of social class. 31,32 Therefore, our study may not be representa...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2020.09.24.20201319v1 on medRxiv