The study utilized a mixed-methods research study design. The combined use of quantitative and qualitative research methods mutually reinforce the strengths of each method and minimize their respective weaknesses [24]. It is expected that the triangulation afforded by this design will help secure a more thorough understanding of the potentially complex interplay of factors and issues related to MgSO4 use. The study utilized a descriptive cross-sectional design to survey service providers, perform in-depth interviews with facility managers, undertake structured analyses of facility documents, and conduct inventory analyses of drugs, equipment and supplies including facility guidelines and protocols for PE/E management. Combined, these methods are more likely to yield a more holistic picture of provider and health facility readiness to use MgSO4 in the management of PE/E in both Bauchi and Sokoto States.
A total of 80 health facilities were randomly sampled for the study. All primary and secondary (hospitals) health care facilities that were expected to diagnose, prevent, treat or facilitate cases of PE/E in Bauchi and Sokoto states were included in the sampling frame. The sampling frame included a total of 42 eligible hospitals (22 in Sokoto State and 20 in Bauchi State) and 800 primary health centers and maternal health centers (457 in Bauchi State and 343 in Sokoto States). Facilities that did not routinely provide delivery services to pregnant women were excluded from the sampling frame. The eligible hospitals were randomly selected from each of the three senatorial zones in each state. Ten of 22 hospitals were selected in Bauchi State, and ten of 20 were selected in Sokoto State. Primary health care facilities affiliated with the selected hospitals that supply maternal health-related referrals were retained in the sampling frame. The included PHC facilities were stratified into comprehensive PHCs and Maternal and Child Health (MCH) centers in Bauchi; in Sokoto State, delivery services were available only in PHCs and upgraded dispensaries with assigned PHC status, and so no further stratification was feasible. There were a total of 230 PHC facilities in Bauchi State and a total of 180 eligible facilities in Sokoto State. From this list, a total of 30 PHCs per state were randomly selected. Thus, we selected 10 PHCs and 20 MCHs in Bauchi and 30 PHCs in Sokoto state. For each facility, a complete list of service providers who rendered obstetric services was generated and using a table of random numbers, one service provider per health facility was randomly sampled for an interview. In addition, we purposively selected 30 health facility managers to further explore the mix of system factors that influenced the management of PE/E and the use of MgSO4 in these facilities (15 managers per state) in both states. Managers were purposively selected from a mix of urban and rural hospitals and PHC facilities.
Eight resident postgraduate medical doctors, were recruited as research assistants in each state, and were trained for three days on study methods and instruments. Data were collected in June and July 2013. The research assistants administered structured questionnaires to the 80 service providers; data were collected on service providers’ socio-demographic characteristics, training and experience in prevention and management of PE/E and factors influencing management of PE/E in their health facilities. Equipment and medical supplies including protocols and guidelines available for PE/E managements in sampled health facilities were similarly assessed using a checklist (Table 1). Epi Info™ version 7 (CDC, Atlanta, GA, USA) was utilized for data entry, univariate and bivariate analyses. Chi-square tests were used to perform tests of statistical significance.
การศึกษาใช้แบบศึกษาวิจัยวิธีผสม ใช้วิธีวิจัยเชิงปริมาณ และเชิงคุณภาพรวมกันเสริมสร้างจุดแข็งของแต่ละวิธี และลดจุดอ่อนของพวกเขาเกี่ยวข้อง [24] ที่คาดไว้ว่า สาม afforded โดยออกแบบนี้จะช่วยทำความเข้าใจอย่างละเอียดมากของล้ออาจซับซ้อนของปัจจัยและประเด็นที่เกี่ยวข้องกับการใช้ MgSO4 การศึกษาใช้แบบเหลวอธิบายการสำรวจบริการ ทำการสัมภาษณ์เชิงลึกกับผู้จัดการสินเชื่อ รับวิเคราะห์โครงสร้างของเอกสารที่สิ่งอำนวยความสะดวก และดำเนินการวิเคราะห์สินค้าคงคลังของยาเสพติด อุปกรณ์ และวัสดุรวมทั้งแนวทางอำนวยความสะดวกและโปรโตคอลสำหรับการจัดการ PE/E รวม วิธีการเหล่านี้มีแนวโน้มให้ผู้ให้บริการและสุขภาพพร้อมสิ่งอำนวยความสะดวกการใช้ MgSO4 ในจัดการ PE/อี ใน Bauchi และ Sokoto อเมริการูปแบบองค์รวมมากขึ้นA total of 80 health facilities were randomly sampled for the study. All primary and secondary (hospitals) health care facilities that were expected to diagnose, prevent, treat or facilitate cases of PE/E in Bauchi and Sokoto states were included in the sampling frame. The sampling frame included a total of 42 eligible hospitals (22 in Sokoto State and 20 in Bauchi State) and 800 primary health centers and maternal health centers (457 in Bauchi State and 343 in Sokoto States). Facilities that did not routinely provide delivery services to pregnant women were excluded from the sampling frame. The eligible hospitals were randomly selected from each of the three senatorial zones in each state. Ten of 22 hospitals were selected in Bauchi State, and ten of 20 were selected in Sokoto State. Primary health care facilities affiliated with the selected hospitals that supply maternal health-related referrals were retained in the sampling frame. The included PHC facilities were stratified into comprehensive PHCs and Maternal and Child Health (MCH) centers in Bauchi; in Sokoto State, delivery services were available only in PHCs and upgraded dispensaries with assigned PHC status, and so no further stratification was feasible. There were a total of 230 PHC facilities in Bauchi State and a total of 180 eligible facilities in Sokoto State. From this list, a total of 30 PHCs per state were randomly selected. Thus, we selected 10 PHCs and 20 MCHs in Bauchi and 30 PHCs in Sokoto state. For each facility, a complete list of service providers who rendered obstetric services was generated and using a table of random numbers, one service provider per health facility was randomly sampled for an interview. In addition, we purposively selected 30 health facility managers to further explore the mix of system factors that influenced the management of PE/E and the use of MgSO4 in these facilities (15 managers per state) in both states. Managers were purposively selected from a mix of urban and rural hospitals and PHC facilities.Eight resident postgraduate medical doctors, were recruited as research assistants in each state, and were trained for three days on study methods and instruments. Data were collected in June and July 2013. The research assistants administered structured questionnaires to the 80 service providers; data were collected on service providers’ socio-demographic characteristics, training and experience in prevention and management of PE/E and factors influencing management of PE/E in their health facilities. Equipment and medical supplies including protocols and guidelines available for PE/E managements in sampled health facilities were similarly assessed using a checklist (Table 1). Epi Info™ version 7 (CDC, Atlanta, GA, USA) was utilized for data entry, univariate and bivariate analyses. Chi-square tests were used to perform tests of statistical significance.
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