1. 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

2. OUTLINE
• Introduction / Background
• Objectives
• Methods
• Results
• Discussion
• Conclusion
• Recommendations
• References
tomowo, 2011

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]
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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%
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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%
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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]
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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].
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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.
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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.
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10. 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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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]
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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 Care
Fig. 6: In service training: Focused Ante Natal Care
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13. 35
31
30
25
20
20 19
Frequency
18
15 Yes
12
No
10 10
10
5
2
0
Benin Abai Abuja Ilorin
In service Tranning on Immunization
Fig.7: In service training: Integrated Mgt of
Childhood Illnesses
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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
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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 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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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]
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17. Tab. 4: pre & post training test for intervention
group
Edo State (n=25) Abia (n=27)
Knowledge Pre Post Pre Post
Score 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
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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.
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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.
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20. 35
30 28.6
25 22.7
Percentage
20
Pre Tranning
15 Post Traning
10
10 9
5
0
Abia Benin
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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21. Pre Tranning Post Traning
80 65 68
60
40 22
26
20
0
Abia
Benin
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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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].
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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
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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.
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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.
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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.
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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. Distinguished Ladies and
Gentlemen, Let’s get the
Health System Working
For Our Mothers and
Children through the
Community pharmacists
intervention.
thank you all.
help me, will u?
tomowo, 2011

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, 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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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.
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• 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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