Applications of First Order Equations
4.3 ELEMENTARY MECHANICS
METHODOLOGY
• •
The stt1dy area was L olcoia L J oca 1 G overr
: ment Area (LGA) of Kogi State which is located i11 the North Central 1. .
geopo 1t1ca zone of Nigeria at tl1e intersection of the 1 col1ntry's two most i1nportant and defi . 1n1ng rivers, na1nely River Niger and River .
Ber,ue. Tl1e state shares boundaries witl1 ten other states and the Federal Capital Territory· To the north, it is bottnded by 1l1e Federal Capital Territory, Abuja, Niger
and Nasarawa States. To the west it sl1arr:s boundaries with J(wara Elciti and Ondo ' states. On tl1e t;ast, it is bou11ded by Benue, A11a111bra, Edo and Enugt1 �.tates .
•
•
Tl1e people engage i11 t1sl1ing, farming an<l trading, while a few are in public service .
According to tl1e National Population Conn1ission, Lokoja LOA has a population of 195,261 with a fen1ale population of 9c., 688. It is the state capital and seat of administration It is strategically located along a Federal highway that links the southern states of Nigeria witl1 Abuja and 11orthern Nigeria .
•
The state incltiding Lokoja has a hot and humid tropical cli1nate and vegetation. The rainy season commences in April, rea)hes its peak in September and almost disappears in December. It has an average maximum temperature of 34.5 ° C and an average minirr um te1nperatur e of 22.8 °C. The arable and habitabl e land in Lokoja is travers e d v.1ith tributaries and riv u lets which perennially fill g utters and drainages,
making th e en ,ironment suitable for reproduction of mosquitoes.
The health seeking behavio r of resid e nts of Lokoja is typical of that in other Nig erian
·t· ·rhc re ,dents access trcatrnent for illnesses inclt1ding 1nnlnrin tl1roug l1
commun1 1es. · ·
government o·Nned health f ac11it1es, r.rivatcly owned health f1tcili1ie�. pilll'lll
)6
I
UNIVERSITY OF
IBADAN LIBRARY
AFRICAN DIGITAL HEALTH REPOSITORY PROJECT
- - - --
---I
medicine vendors and through tr a 1 tonal healthcare providers. Traditional treatment d·t·
for malaria involves use of roots h b , er s and concoct1ons. The health facilities in Lokoja are categorized as prima ry, second,iry or tertiary health facilities. The primary .
health facilities are the priman., h Ith ·J ea centers (PHCs), tI1e secondary health facilities is tl1e State Specialist Hos ·t I (SSH) IJl a wh�le the tertiary health facilit; is the Federal . Medical Cente.r (FMC). At the PI-ICs, malaria is treated by junior community health extension workers senior co , mmun1 1ea ' ty } I· . h extension worl<ers and com1nun1ty healtl1 ·
officers. At tl1
(!SSH and FMC, malaria is treated by doctors, nurses and phar1nacists.
At· the patent n1edicine sl1ops, 1nala.ria is tr(!ated by the patent 1nedicine vendors.
The supply cr1ain and logistic systetn fo ·· ACTs and RDTs in Lol<<)ja is relatively sirnple. ACTs and RDTs are procured b)' Jol1n Snow International (a supply chain organization) throt1gl1 USAID-DELIVER l)roject. The commodities are kept at central medical store n Loi oja. From central medical store, the commoditie� are supplied to health facilities in tl1e LGA based on reqt1est. At review meetings, qttantities of the corn1nodities to be re-supplied to health 11cilities are determined. P1equalified third party logistic c)rganizations get distribution awards from USAID- DELIVER project.
These third party organizations undertake last mile distribution (every two months) of the commodities to health facilities.
At the healtl l facilities, commodities Nere l<ept at optimum storage facilities (· pharmagradc · stores) under ambient ternperattire, away from sunligl1t, tf1e floor, dust, \\'ater. At PJ--f C the ACTs and RDTs are l<ept under care of comm unit)' health extension ,-.·orkers and nurses. At gene1 al hospitals, they are kep\ in ct1stod) of
pharmacists \vhiJc at cottage hospitals, they are under care of pl1arrnacy tccl1nic1n11�
•
UNIVERSITY OF
IBADAN LIBRARY
AFRICAN DIGITAL HEALTH REPOSITORY PROJECT
rnalaria commodity 1 logistic ma nagement system 1s a monitoring system that ensures there is no stock out or over-stocking of antimalarials and RDTs.
The National l\1alaria Elimination Program (NMEP) issues guidelines for operation of tl 1 e inalaria si 1 pply and logistics management system. The program also plays
oversight role:.; and offers supportive supervision to Kogi State Malaria Control Program to e11sure s1nooth operation of the system.
Patent medicit e vendors get tl1eir supplie� of RDTs and ACTs throt1gh open marl<et, tl 1 ot1gh so1ne of the patent n1edicine ve ndc•rs also get their cotnmodities frorn Society
for Family Health at st1bsidized prizes. The system is faced wit�1 challenges of inadequate storage facilities, inadeqt1ate capacity personnel at the PHC level.
3.2 Study :Desig11
It was a cross-sectio11al survey of healthcare providers.
3.3 Study ·population:
Healthcare providers including doctors, pharmacists, nurses, cor:1.munity health officers, co,nrriunity health extension workers and patent rnedicine vendors.
3.3.1. Inclusion Crit�ria
'd who prescribed or sold orthodox anti·malarials in Lokoja LGA Healthcare prov1 ers
t t he time of datz collection who gave conse11t · for interview.
for one or more years as a 3.3.2. Exclusion Criteria
'd ho prescribed or sold orthodox antimalarials in Lokoja LGA Healthcare prc)VI ers w
t the time of data collection but who did 11ot give consent for for one or mo1 e year as a
• 1ntcrv1ew.
•
•
I
UNIVERSITY OF
IBADAN LIBRARY
AFRICAN DIGITAL HEALTH REPOSITORY PROJECT
•
3.4. Sample Size estimation
San1ple size was calculated usi11g the form Jla:
n = (Z1-afl) 2 x p(1-p)/d . 2 (L wanga and Lemesho"v, 1991)
Where; n = sample size ' t-a/2 z = 1 9 · 6 Cstand�rd nor1nal deviate) at a.=0.05 d- = square of· the desired precision level Jf 5%
P==proportion vf healthcare providers \Vho was found to adhere to the treat1nent guidelines in past studies = 38.5<.fo (ie 0.385) (Igboeli et al, 2010)
Assu111ing a nc,n-response rate (NR) of 1 og1a, St1bstitt1ting in 1/1- R, 1/1-0.1 o =l. l l
Multiplying b)
1the 1100-response rate, 1.96xl .96x0.385(1-0.385)x 1.11
0.05x0.05
Minimt1m sa1nple size n=404 3.4.1. Sampling Method
malaria
•
Stratified 1nul :i stage sampling techniqt1e was ttsed. First, healthcare providers were stratified into commttnity-based healthcare providers and facility -t .ase d healthcare providers. Second the healthcare provider� were further stratified into different cadres.
For example community-based healthcare providers were further stratified into patent medicine vendors, community health extension workers and co1nmunity health officers· cadr-!s. The facility -based prc,viders were further stratit:ed into doctors (ph) sicians) nurses and pharmacists.
·rhen sampJe ,ize "'as proportionately aJI Jcated to the different cadres of healtl1 care providers. A last of each cadre of healthcare providers \Vas obtained fro111 tl1c rclc, 1 n11t autt 1 orities. f=or cxa,nplc list of doctors, pharrnacists n11d ntrrscs \V}10 \vork ir, I rdcrnl
39
•
I
UNIVERSITY OF
IBADAN LIBRARY
AFRICAN DIGITAL HEALTH REPOSITORY PROJECT
s TO,
1 2 3 4
- )
6
-Medical Centre Lokoja and I<ogi State Specialist Hospital were obtain�d from offices of t he Chi e f Medic , a l Directors in t he tv,o h 't I L' osp1 a s. 1s t s of community health officers (CHOs) and community health e>:tension workers (CHEWs) were obtained from the office of the Head of Department (Health) Lokoja LGA \\-hile the list of p atent m e dicin•! vendors w a s ob t ained fron1 the s e cre ta ry of t he Associa t ion of Pate n t a n d Propri et ary. Medici ne V e ndors (PMV s).
Tl1e t o t al numb e r of healthc a re providers was 914. TJ 1 e proportion of eacl1 cadre in the sampl e frame was de
•t er111ined (by prob2 bility proportional to size,. Then, each
•propor t io n w a s mt1l t iplied by th e s a mple size to deter11 1 in e the actL1al 11t1mber to select fro111 each cadi'e. Tl 1 ereafter, tl1e sa1npling interval, le =N/n was calculated wl1ere N was the 11t1mb,�r of l1ealtl 1 care providers n eacl1 cadre while n was tl1e proportion sa1npled per c2.dre. Tl 1 e first healthcare pr<>vider was selected randomly using a t able of rando111 nun1bers. Tl1en every n th healtltcare provider was selected. A table on the calct1lation is shown below.
Table 3.1 ProJJOrtional allocation of sample size to cadres of healtl1care providers Cadre
Doctors
Phar1nacists Nurses
Commu n ity Health Officers
Community Health Extension \\' orkers Patent Medic;inc
Vendors J otal
•
In document
Elementary Differential Equations with Boundary Value Problems
(Page 160-171)