Community mobilization to reduce postpartum hemorrhage in home births in northern Nigeria

The purpose of this study is to demonstrate the importance of community mobilization in the uptake of a health intervention, namely, community-based distribution of misoprostol to prevent postpartum hemorrhage. Community mobilization to increase access to misoprostol for postpartum hemorrhage prevention was implemented in northwestern Nigeria in 2009. Theories of community participation and the current near-epidemic maternal mortality conditions underpin an approach using modest levels of community involvement. The study was undertaken in five communities around Zaria, Nigeria. Community leaders and selected community members participated in a series of dialogs. Additionally, community education, information and dramas sessions were held. Twenty nine community oriented resource persons (CORPs), 27 drug keepers and 41 traditional birth attendants (TBAs) were involved in the intervention. Postpartum interviews were used to assess the impact of community mobilization efforts and to track use of misoprostol. Multiple logistic regression was used to examine the association between correct use and receiving information regarding misoprostol from TBAs or CORPs. A total of 1875 women were enrolled in the study in 2009. Most women delivered at home (95%) and skilled attendance at delivery was low (7%). Community mobilization efforts reached most women with information about postpartum hemorrhage and misoprostol (88%), resulting in high comprehension of intervention messages. Women identified TBAs and CORPs as the single most important source of information about misoprostol 41% and 31% of the time, respectively. Availability of misoprostol at the community level gave 79% of enrolled women some protection against postpartum hemorrhage which they otherwise would not have had. Although high level community participation in health care interventions is the ideal, this study suggests that even in circumstances where only modest levels of participation can realistically be achieved, community mobilization can have a significant impact on the successful distribution and uptake of a potentially life-saving health intervention, in turn helping promote policy change.     

Development of an Optimized Cassava Starch-Based Custard Powder

Custard powder is a dry-formulated food product primarily made from imported corn starch in developing countries. To reduce over-dependence on corn starch, this study investigated its replacement with yellow-fleshed cassava root starch (YfCRS) in custard powder formulation. Response surface methodology was used to develop an optimized cassava starch-based custard powder based on various combinations of YfCRS (90–98%) and whole egg powder (WEP) (2–10%). The result showed that the blends of YfCRS and WEP led to custard powder with wide functional, physicochemical, chemical, and micronutrient properties, with sensorily acceptable gruel. The second order response surface regression model accurately predicted most of these quality parameters (R2 > 0.90). The optimum formulation achieved to produce an acceptable custard was 90% YfCRS and 6.07% WEP. Therefore, this study showed that YfCRS might be a very good replacement for corn starch in the production of an acceptable custard.     

Nurse Competence: A Concept Analysis

PURPOSE: The purpose of this analysis was to explore the concept of nurse competence. DATA SOURCES: Data sources include EBSCOhost, Gale PowerSearch, ProQuest, PubMed Medline, Google Scholar, and Online Journal of Issues in Nursing. DATA SYNTHESIS: This paper utilizes Rodgers' evolutionary method to analyze the concept of nurse competence. CONCLUSION: Antecedents to nurse competence include personal and external motivations. Attributes include integrating knowledge into practice, experience, critical thinking, proficient skills, caring, communication, environment, motivation, and professionalism. Consequences include confidence, safe practice, and holistic care. Implications for nursing responsibility regarding defining nurse competence and ensuring nurse competence need to be identified. More research is needed to determine the best evaluation methods for the different facets of nurse competence.