Barriers and facilitators to hepatitis B birth dose vaccination: Perspectives from healthcare providers and pregnant women accessing antenatal care in Nigeria.

Nigeria is estimated to have the largest number of children worldwide, living with chronic hepatitis B virus (HBV) infection, the leading cause of liver cancer. Up to 90% of children infected at birth develop chronic HBV infection. A birth dose of the hepatitis B vaccine (HepB-BD) followed by at least two additional vaccine doses is recommended for prevention. This study assessed barriers and facilitators of HepB-BD administration and uptake, using structured interviews with healthcare providers and pregnant women in Adamawa and Enugu States, Nigeria. The Consolidated Framework for Implementation Sciences Research (CFIR) guided data collection and analysis. We interviewed 87 key informants (40 healthcare providers and 47 pregnant women) and created a codebook for data analysis. Codes were developed by reviewing the literature and reading a subsample of queries line-by-line. The overarching themes identified as barriers among healthcare providers were: the lack of hepatitis B knowledge, limited availability of HepB-BD to vaccination days only, misconceptions about HepB-BD vaccination, challenges in health facility staffing capacity, costs associated with vaccine transportation, and concerns related to vaccine wastage. Facilitators of timely HepB-BD vaccination included: vaccine availability, storage, and hospital births occurring during immunization days. Overarching themes identified as barriers among pregnant women were lack of hepatitis B knowledge, limited understanding of HepB-BD importance, and limited access to vaccines for births occurring outside of a health facility. Facilitators were high vaccine acceptance and willingness for their infants to receive HepB-BD if recommended by providers. Findings indicate the need for enhanced HepB-BD vaccination training for HCWs, educating pregnant women on HBV and the importance of timely HepB-BD, updating policies to enable HepB-BD administration within 24 hours of birth, expanding HepB-BD availability in public and private hospital maternity wards for all facility births, and outreach activities to reach home births.

Determinants of primary healthcare services utilisation in an under-resourced rural community in Enugu State, Nigeria: a cross-sectional study.

Introduction: primary health care (PHC) is essential towards achieving universal health coverage. Improving PHC services require understanding context-specific factors influencing utilisation. We assessed the factors influencing utilisation of PHC services in a rural community in Enugu, Nigeria. Methods: we conducted a cross-sectional community-based survey between May and June, 2017. Information on socio-demographic characteristics, utilisation of PHC services, community- and PHC facility-related factors associated with utilisation of PHC services was obtained from 335 adult residents aged ≥ 18 years using a pre-tested semi-structured interviewer-administered questionnaire. Data were analysed using descriptive and inferential statistics at 5% level of significance. Results: of the 335 respondents, 155 (46.2%) reported utilisation of PHC services the last time they were sick. Of 178 respondents who did not utilise PHC services, 51 (28.7%) reported poor quality health services, 41 (23.0%) unavailability of medical doctors, 31 (17.4%) long patient waiting time and 25 (14.0%) unavailability of drugs as reasons for non-utilisation. Being a female (AOR = 2.3 (95% CI 1.3 - 4.0)), affordability of health services (AOR = 2.4 (95% CI 1.3 - 4.6)), inadequacy of healthcare staff (AOR = 0.3 (95% CI 0.1 - 0.5)), shorter hospital waiting time (AOR = 2.2 (95% CI 1.2 - 4.3)) and satisfaction with PHC services during previous visit (AOR = 2.6 (95% CI 1.1 - 6.3)) influenced utilisation of PHC services. Conclusion: PHC services utilisation was low. Improving utilisation would require addressing cost of health services, adequacy of healthcare staff, patient waiting time and ensuring patient satisfaction with PHC services.

Determinants of perinatal mortality in public secondary health facilities, Abuja Municipal Area Council, Federal Capital Territory, Abuja, Nigeria.

INTRODUCTION: in Nigeria, perinatal mortality rate remains high among births at the health facility. Births occur majorly at the secondary healthcare level in Abuja Municipal Area Council (AMAC) of the Federal Capital Territory (FCT). Identifying factors influencing perinatal deaths in this setting would inform interventions on perinatal deaths reduction. We assessed perinatal mortality and its determinants in public secondary health facilities in AMAC. METHODS: delivery and neonatal data from two selected public secondary health facilities between 2013 and 2016 were reviewed and we extracted maternal socio-demographics, obstetrics and neonatal data from hospital delivery, newborns´ admissions and discharge registers. Data were analyzed using descriptive statistics and Cox proportional hazard models (α = 5%). RESULTS: perinatal mortality rate was 129.5 per 1000 births. Asphyxia 475 (34.0%), neonatal infection 279 (20.0%) and prematurity 242 (17.3%) accounted for majority of the 1,398 perinatal deaths. Unbooked status [aHR = 1.8 (95% CI 1.4 - 2.2)], antepartum haemorrhage [aHR = 2.8 (95% CI 1.2 - 6.7)], previous perinatal death [aHR = 2.3 (95% CI 1.7 - 3.1)] and maternal age ≥ 35 years [aHR= 1.4 (95% CI 1.0 - 1.8)] were associated with increased risk of perinatal death. CONCLUSION: perinatal mortality in the studied hospitals was high. Determinants of perinatal death were unbooked antenatal care (ANC) status, antepartum haemorrhage, previous perinatal death and high maternal age. Reducing perinatal deaths would require improving antenatal care attendance with healthcare staff identifying and targeting women at risk of pregnancy complications.

Water, sanitation and hygiene risk factors associated with diarrhoea morbidity in a rural community of Enugu, South East Nigeria.

INTRODUCTION: diarrhoea remains a public health problem globally with majority of diarrhoea morbidity and mortality occurring in low resource settings. This study assessed the prevalence of diarrhoea and factors associated with diarrhoea in a rural community in Enugu, South East Nigeria. METHODS: a community-based cross-sectional survey was conducted between May and June, 2017. Information on socio-demographic characteristics, water, sanitation, hand washing practices and diarrhoea history was obtained from 534 community residents using a structured interviewer administered questionnaire. Data were analyzed using descriptive statistics, Chi-square and logistic regression tests at 5% level of significance. RESULTS: prevalence of diarrhoea in the two weeks preceding the study was 7.47% and 10.77% among all ages and children younger than five years respectively. Of 469 residents aged five years and above, 206 (43.92%) accessed source of drinking water within 30 minutes round trip walking distance from their households, 275 (58.64%) practiced open defecation while 456 (97.23%) and 455 (97.01%) reported washing hands with soap or ash and water before eating and after using the toilet respectively. Two or more households sharing a toilet facility [AOR = 4.78 (95% CI 2.03-11.24)] was a risk factor for diarrhoea while washing hands with soap or ash and water before eating [AOR = 0.23 (95% CI 0.06-0.90)] and after using the toilet [0.16 (95% CI 0.04-0.55)] protected against diarrhoea. CONCLUSION: increasing access to improved sanitary sewage disposal methods and promoting hand washing with soap and water at critical moments would improve diarrhoeal disease control.

Snakebite outbreak and associated risk factors in Donga, Taraba State, Nigeria, June, 2016.

Snakebite envenoming is a public health problem among rural communities in Nigeria. In June, 2016, an outbreak of snakebites in Donga Local Government Area, Taraba State, north-east Nigeria, was reported. We investigated the outbreak to identify risk factors for snakebites and to institute appropriate control measures. We conducted an unmatched case control study to identify risk factors for snakebite in the communities involved. We conducted key informant interviews and Focus Group Discussions with stakeholders in the communities to obtain information on the community´s perspective of the outbreak. There were Sixty-one (61) snakebite cases with Fifteen (15) deaths [CFR 24.6%]. Majority of the mortalities [37(60.3%)] were males. Median age was 27 years (Range: 5-58). Kadarko ward had the highest [26 (42.6%)] number of cases. Most snakebites 12 (44.4%) occurred in the farm, 27 (96.4%) vipers Echis spp were responsible for most of the bite and most [26 (92.9%)] victims sought care from traditional healers. Residing in Kadarko ward and having a history of snakebite in the past were risk factors [Odds ratio of 2.9 (95% CI 1.1-7.4) and 5.9 (95% CI 1.1-32.5)] respectively. Abandonment of homes for two years due to communal clashes has been thought to have allowed snake populations to grow. The snakebite outbreak in Donga, Taraba State affected predominantly male farmers in the rural wards. Residing in Kadarko ward and having a previous history of snakebite were risk factors.