Basic Life Support Skills Training Among Healthcare Workers in Nigeria: A State-Wide Evaluation in The Niger-Delta Region

Abstract

Background: Healthcare systems are designed to efficiently minimize morbidity and mortality, especially through employment of diverse skills, including provision of Basic Life Support (BLS). Unfortunately, many healthcare workers (HCWs) lack BLS skills, which are essential for the reduction of preventable sudden deaths resulting from sudden cardiac arrest. Objective: A statewide assessment of the proportion of HCWs with BLS training, as well as the number available for such training in public primary and secondary healthcare facilities in Cross River State, Southern Nigeria, a low-middle income country (LMIC) setting. Methodology: By total enumeration, public primary and secondary healthcare facilities, in each of the 18 Local Government Areas (LGAs) in Cross River State, Southern Nigeria, were studied using descriptive cross-sectional design. Structured proforma was used to obtain data on number of doctors, nurses, Community health officers (CHOs) and Community Health Extension workers (CHEWs) as well as the number that have been trained on BLS/CPR in each facility. The Cross River State Research Ethics Committee approved the study, which was conducted for eight (8) weeks. The proportion of healthcare facilities with at least 1 doctor, nurse and staff trained on BLS/CPR were determined. Chi-square inferential statistic was used to compare these proportions between the three districts of the state. Also, Analysis of variance (ANOVA) was used to compare the mean number that had been trained on BLS per facility between these districts. P-value was set at 0.05. Results: Two hundred and five (205) healthcare facilities within the 18 L.G.A.s were surveyed. Sixteen (16) health facilities (7.8%) had staff that were trained on BLS. Seventy-five (75) staff had had training on BLS, yielding average of 0.37 trained staff per facility. Approximately one-tenth of facilities (10.2%) had a doctor, while one-third (34.1%) had a nurse. Less than one-tenth (9.3%) of health facilities had at least a doctor and nurse that may be available for BLS training. There were community health officers and community health extension workers in both rural and urban facilities but none was a trained BLS provider. There was also no staff trained on BLS in any health facility located in seven LGAs. A relatively higher proportion of facilities with staff trained on BLS was found in Odukpani (16.7%), Yakurr (20.0%) and Bekwarra (16.7%). In comparison with the southern and northern districts, there was a higher average number of staff trained on BLS per facility in the central district (p<0.00). Conclusion: There is gross lack of BLS trained HCWs in most healthcare facilities in Cross River State. Considering the high and increasing burden of cardio-metabolic diseases and sudden cardiac arrest events in Nigeria, this largely unmet need for BLS training warrants concerted efforts at institutionalization of the requisite skill acquisition among HCWs in the region