Evaluation of Injection Safety and Health Care Waste Management in Nigeria
Nigeria, 2005 - 2008
Identification
NGA_2008_MMIS_v01_M
Evaluation of Injection Safety and Health Care Waste Management in Nigeria
Making Medical Injections Safer Project
| Name | Country code |
|---|---|
| Nigeria | NGA |
Service Provision Assessments [hh/spa]
Baseline and final evaluation surveys were carried out through interviews, observations, and an inventory of materials in a sample of health facilities in six states. Data were collected in September 2005 for the baseline and in October 2008 for a final evaluation in the project expansion states of Anambra, Cross Rivers, Edo, Kano, FCT, and Lagos.
One of the objectives of the Federal Ministry of Health (FMOH) is to improve the quality of care provided on all levels of the health care pyramid. Previous studies revealed that the problem of injection safety and the health care waste management (HCWM) is acute. Through PEPFAR, Nigeria received technical and financial support to promote injection safety and HCWM through the support of USAID. This injection safety and HCWM project has resulted in the activities of the Making Medical Injections Safer (MMIS) project. With the goal of conducting a broad assessment to measure the impact of project activities the FMOH and MMIS organized a comprehensive evaluation of injection safety and HCWM at project's intervention sites. The final evaluation on the status of injection safety and health care waste management took place in Nigeria, during the month of October 2008 in six states.The injection safety intervention continued through September 30, 2009.
This evaluation of the status of injection safety and HCWM is a descriptive follow-up study (data were collected in September 2005 for the baseline and in October 2008 for a final evaluation/follow-up). It includes interviews, observations, and stock assessments in a sample of health facilities in the project's five expansion states, namely, Anambra, Cross Rivers, Edo, Kano, Lagos as well as the Federal Capital Territory (FCT).
The overall objective is to evaluate the general status of injection safety and HCWM in the health facilities of the six project expansion states. The specific objectives are as follows:
- Evaluate the availability of the injection equipment/materials/products and stock management methods,
- Evaluate the availability of the collection equipment/materials, transportation, and removal of waste, as well as the HCWM practices,
- Describe the conditions and steps for administering injections in the treatment rooms,
- Evaluate the existence of reference documents (national policy, norms, guidelines) with the health care staff and managers of health facilities,
- Evaluate the adequacy of the quantities of injectable products ordered (vaccines, medications), injection equipment (syringes/needles), and HCWM equipment,
- Describe the experiences related to injections in the health facilities and community of patients (or parents/families of patients) who received injections on the day of the survey.
Sample survey data [ssd]
Health Facilities
Scope
The evaluation covers the following:
- Availability of the injection equipment/materials/products and stock management methods,
- Availability of the collection equipment/materials, transportation, and removal of waste, as well as the HCWM practices,
- Conditions and steps for administering injections in the treatment rooms,
- Existence of reference documents (national policy, norms, guidelines) with the health care staff and managers of health facilities,
- Adequacy of the quantities of injectable products ordered (vaccines, medications), injection equipment (syringes/needles), and HCWM equipment,
- Experiences related to injections in the health facilities and community of patients (or parents/families of patients) who received injections on the day of the survey.
Coverage
The survey covered five states - Anambra, Cross Rivers, Edo, Kano, Lagos as well as the Federal Capital Territory (FCT).
The survey units and target populations of the injection safety and HCWM evaluation are the general medicine, pediatrics, gynecology-obstetrics, and surgery wards as well as central stores, immunization, and laboratories. This survey obtained a sample of health facilities to evaluate through a mix of purposeful and random selection. In each state evaluated, the survey used purposeful selection to sample hospitals, and random selection for other types of health care facilities. The target populations which were planned for this survey, were the stockrooms (for equipment/ medications/vaccines, etc.), injection providers, supervisors of the staff responsible for administering injections, waste handlers and health care recipients (patients who had just received an injection[s] in the study facilities).
Producers and sponsors
| Name |
|---|
| Federal Ministry of Health |
| Making Medical Injections Safer Project |
| Name | Role |
|---|---|
| President's Emergency Plan for AIDS Relief | Financial and Technical Support |
| United States Agency for International Development | Financial and Technical Support |
Sampling
The survey units and target populations of the injection safety and HCWM evaluation are the general medicine, pediatrics, gynecology-obstetrics, and surgery wards as well as central stores, immunization, and laboratories. This survey obtained a sample of health facilities to evaluate through a mix of purposeful and random selection. In each state evaluated, the survey used purposeful selection to sample hospitals, and random selection for other types of health care facilities.
The target populations, which were planned for this survey, were the stockrooms (for equipment/ medications/vaccines, etc.), injection providers, supervisors of the staff responsible for administering injections, waste handlers, health care recipients (patients who had just received an injection[s] in the study facilities) according to the following distribution:
-
One central stockroom in each health facility, or 216 stockrooms total, visited at baseline and follow-up (114 baseline, 102 follow-up).
-
Providers administering the largest number of injections in the health care units or 521 injection providers total (237 at baseline, 284 at follow-up).
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A total 484 supervisors of the staff responsible for administering injections (199 baseline, 285 follow-up).
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A total 198 waste handlers with one participant per health facility (97 baseline, 101 follow-up).
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1,316 total recipients of health care services coming for an injection(s) procedure in the evaluation centers (514 baseline; 781 follow-up), with 4 clients per hospital and 4 per health care center.
-
In addition to the people interviewed, data collectors observed 1,601 total injection procedures (557 baseline, 1,044 follow-up). Data collectors observed up to 4 procedures by ward in each hospital and in each lower-level health center or private facility.
Injection procedures observed included the following types: Vaccinations, curative injections, diagnostic injections including phlebotomy and FP.*See Table 1 in the Final Report (Under External Resources) for a summary of the sampling of target population by section of the survey.
Survey instrument
Data were collected in the field with the aid of an MMIS questionnaire adapted to the context of the health care system in Nigeria (See Appendix 1 of the Final Report under External Resorces). The MMIS questionnaire includes seven components or sections related to the specific intervention areas of injection safety and medical waste management. These sections apply to the different stakeholders, which are:
- Stockrooms (equipment/medications/vaccines, etc.): "Section 1."
- Observations on the structure of care and the waste in each health facility: "Section 2."
- Observations on the practices of the injection providers: "Section 3."
- Interviews with injection providers: "Section 4."
- Supervisors of the staff responsible for administering injections: "Section 5."
- Waste handlers: "Section 6."
- Recipients of health care services who had just received one or more injections at the health care facilities surveyed: "Section 7 ".
Data collection
| Start | End | Cycle |
|---|---|---|
| 2005-09 | 2005-09 | Baseline |
| 2008-10 | 2008-10 | Follow-up |
At baseline, a total of 12 data collectors and 5 supervisors were identified and trained to participate in the collection of data in the health facilities. Training for the data collectors and supervisors lasted 4 days and was conducted from August 9 through 12, 2005. Following the training, 5 teams were formed with 2 data collectors and a supervisor on each team.
At follow up a total of 23 data collectors and 7 supervisors were identified and trained to participate in the collection of data for the follow-up survey. Training for the data collectors and supervisors lasted 3 days including 1 day for a pretest. Following the training, 6 teams of 3 to 4 persons each were formed. One supervisor was assigned to each team except for the Lagos team, which had two supervisors.
Baseline data were collected from August 15 through September 3, 2005, in the expansion states of Kano, Lagos, Edo, Anambra, and Cross River and the FCT. A total of 12 data collectors and 5 supervisors were identified and trained to participate in the collection of data in the health facilities. Training for the data collectors and supervisors lasted 4 days and was conducted from August 9 through 12, 2005. Following the training, 5 teams were formed with 2 data collectors and a supervisor on each team. Data collectors worked in the field over a 15-day period. MMIS project staff coordinated activities.
Mirroring the process carried out at baseline, follow-up data were collected from November 10 through 19, 2008, in the same geographic expansion areas. A total of 23 data collectors and 7 supervisors were identified and trained to participate in the collection of data for the follow-up survey. Training for the data collectors and supervisors lasted 3 days including 1 day for a pretest. Following the training, 6 teams of 3 to 4 persons each were formed. One supervisor was assigned to each team except for the Lagos team, which had two supervisors.
Prior to the fieldwork, the forms were reviewed and validated through a pretest conducted in 2 health facilities with the same characteristics as those surveyed. In 2005, the field testing took place in Niger state and in 2008 in Nasarawa state. These health facilities were not included in the survey proper or the results presented it this report.
Each supervisor was placed in charge of a team to ensure the proper implementation of the survey. In all the health facilities surveyed, the informed consent of the staff facilitated the collection of data.
Data processing
Organization and Coordination of the Data Entry and Analysis : The data were analyzed using SPSS software. This required the contribution of data entry operators with prior training on the use of the data entry program . Each completed questionnaire was reviewed and validated with the team supervisors before being entered into the SPSS software and analyzed.
Data appraisal
Limitations with data collection were:
- Some facilities had incorrect addresses, making them difficult to identify quickly. In some cases, the facilities had changed their names.
- In some cases, listed facilities were closed or could not be found and as such were not assessed.
- Health facility staffs were sometimes hesitant to allow data collectors to observe injection administration and in other cases were sometimes reluctant to participate in the study. This caused some delays and, in some cases, restricted the study sample.
- A byproduct of the promotion of oral medications is that the number of injection observations was difficult to obtain because there were fewer injections to observe.
- Patients were often ready to leave after their visit and did not want to spend a lot of time providing interview responses.
Data Access
Use of the dataset must be acknowledged using a citation which would include:
- the Identification of the Primary Investigator
- the title of the survey (including country, acronym and year of implementation)
- the survey reference number
- the source and date of download
Disclaimer and copyrights
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.
Metadata production
DDI_NGA_2008_MMIS_v01_M_WB
| Name | Affiliation | Role |
|---|---|---|
| Development Economics Data Group | The World Bank | Documentation of the DDI |
2013-07-16
Metadata version
Version 01 (July 2013)