Multi-level predictors of young people's attitudes towards gender biases concerning rape, sexual and domestic violence in intimate relationships among young people, Ebonyi State, Southeast Nigeria.

This study assessed multi-level factors that shape young people's attitudes towards gender biases about rape, sexual, and domestic violence in intimate relationships. This cross-sectional study was undertaken in three urban and three rural communities in Ebonyi State, southeast Nigeria. Data were collected from 1,020 young people using an interviewer-administered questionnaire. Descriptive and logistic regression analyses were performed using STATA. Findings revealed that most(64%) young people agree that when a girl doesn't physically fight back, you cannot really say it was rape. Many agreed that a girl who is raped is promiscuous or has a bad reputation (50%) and usually did something careless to put herself in that situation(45%). Young girls were approximately 2 times more likely to have positive attitudes towards sexual violence, rape, and domestic violence in intimate relationships than young boys (OR=1.5;P<0.01). Multi-level strategies to effectively address adverse gender norms and inequalities in intimate relationships are highly recommended.

Cette étude a évalué les facteurs à plusieurs niveaux qui façonnent les attitudes des jeunes à l'égard des préjugés sexistes concernant le viol, la violence sexuelle et domestique dans les relations intimes. Cette étude transversale a été entreprise dans trois communautés urbaines et trois communautés rurales de l'État d'Ebonyi, au sud-est du Nigeria. Les données ont été recueillies auprès de 1 020 jeunes à l'aide d'un questionnaire administré par un intervieweur. Des analyses de régression descriptive et logistique ont été effectuées à l'aide de STATA. Les résultats ont révélé que la plupart (64 %) des jeunes conviennent que lorsqu'une fille ne se défend pas physiquement, on ne peut pas vraiment dire qu'il s'agit d'un viol. Beaucoup conviennent qu'une fille violée est une promiscuité ou a une mauvaise réputation (50%) et a généralement fait quelque chose de négligent pour se mettre dans cette situation (45%). Les jeunes filles étaient environ 2 fois plus susceptibles d'avoir des attitudes positives à l'égard de la violence sexuelle, du viol et de la violence domestique dans les relations intimes que les jeunes garçons (OR=1,5 ; P<0,01). Des stratégies à plusieurs niveaux pour lutter efficacement contre les normes de genre défavorables et les inégalités dans les relations intimes sont fortement recommandées.

Can a school health club-based intervention significantly influence the drivers of gendered sexual norms and ideologies among in-school adolescents in southeast Nigeria?

Individual experiences, social policies, and environmental exposure shape beliefs, norms and ideologies about sexuality. The objective of this study was to determine the effectiveness of a school health club training programme in improving adolescents' knowledge and perceptions of gender norms and ideologies about sexuality. This was an intervention study among in-school adolescent boys and girls in 12 secondary schools in Ebonyi State, southeast Nigeria. The intervention was the establishment of school health clubs in six schools (intervention), while the six other schools served as controls that did not have school health clubs. Data was collected using a pre-tested interviewer-administered questionnaire. Bivariate and multivariate logistic regression analyses were used to analyse the data. More than half of the adolescents in the intervention (58.3%) and non-intervention (56.1%) schools believed that men need sex more than women. About 90% of adolescents in school (in both arms) agreed that both boys and girls should remain virgins until marriage. Majority of adolescents in both intervention and non-intervention schools disagreed with the notion that "it is justifiable for a boy to hit his girlfriend". Female gender (OR: 1.6; CI 1.1-2.4), senior secondary school level (OR: 1.6; CI 1.0-2.5), and urban residence (OR: 1.7; CI: 1.1-2.5) were associated with the perception that boys do not respect girls who agree to have sex with them. Working for pay decreases the likelihood of having the perception that girls should remain virgin until they marry (OR: 0.4; CI: 0.2-0.9), while living in the urban area increases the likelihood of having the perception that boys should remain virgins until marriage (OR: 2.1; 1.1-4.1). Female gender (OR: 0.7; CI: 0.5-1.0) and urban residence (OR: 0.6; 0.4-0.9) decrease the likelihood of having the perception that men need sex more frequently than women do. In the intervention arm, female gender was associated with perception that boys do not respect girls who agree to have sex with them (OR: 2.4; CI: 1.3-4.3) while older age was associated with the perception that men need sex more frequently than women in the intervention arm (OR:1.2; CI:1.0-1.4). No predictor was found in the non-intervention arm. Although both intervention and non-intervention arms had positive perceptions of gendered sexual norms and ideologies, a school health club-based intervention could influence the drivers of these norms.

Les expériences individuelles, les politiques sociales et l'exposition à l'environnement façonnent les croyances, les normes et les idéologies en matière de sexualité. L'objectif de cette étude était de déterminer l'efficacité d'un programme de formation d'un club de santé scolaire pour améliorer les connaissances et les perceptions des adolescents concernant les normes de genre et les idéologies en matière de sexualité. Il s'agissait d'une étude d'intervention auprès d'adolescents, garçons et filles, scolarisés dans 12 écoles secondaires de l'État d'Ebonyi, au sud-est du Nigeria. L'intervention consistait en la création de clubs de santé scolaire dans six écoles (intervention), tandis que les six autres écoles servaient de contrôles qui ne disposaient pas de clubs de santé scolaire. Les données ont été collectées à l'aide d'un questionnaire pré-testé administré par l'intervieweur. Des analyses de régression logistique bivariées et multivariées ont été utilisées pour analyser les données. Plus de la moitié des adolescents des écoles d'intervention (58,3 %) et de non-intervention (56,1 %) pensaient que les hommes avaient plus besoin de relations sexuelles que les femmes. Environ 90 % des adolescents scolarisés (dans les deux bras) étaient d'accord sur le fait que les garçons et les filles devraient rester vierges jusqu'au mariage. La majorité des adolescents des écoles d'intervention et des écoles non-interventionnelles étaient en désaccord avec l'idée selon laquelle « il est justifiable qu'un garçon frappe sa petite amie ¼. Le sexe féminin (OR : 1,6 ; IC 1,1-2,4), le niveau d'études secondaires de deuxième cycle (OR : 1,6 ; IC 1,0-2,5) et la résidence urbaine (OR : 1,7 ; IC : 1,1 2,5) étaient associés à la perception que les garçons font ne respecte pas les filles qui acceptent d'avoir des relations sexuelles avec elles. Travailler contre rémunération diminue la probabilité d'avoir l'impression que les filles devraient rester vierges jusqu'à leur mariage (OR : 0,4 ; IC : 0,2-0,9), tandis que vivre en zone urbaine augmente la probabilité d'avoir l'impression que les garçons devraient rester vierges jusqu'au mariage. (OU : 2.1 ; 1.1-4.1). Le sexe féminin (OR : 0,7 ; IC : 0,5-1,0) et la résidence urbaine (OR : 0,6 ; 0,4-0,9) diminuent la probabilité d'avoir la perception que les hommes ont besoin de relations sexuelles plus fréquemment que les femmes. Dans le groupe d'intervention, le sexe féminin était associé à la perception que les garçons ne respectent pas les filles qui acceptent d'avoir des relations sexuelles avec eux (OR : 2,4 ; IC : 1,3-4,3), tandis que l'âge plus avancé était associé à la perception que les hommes avaient besoin de relations sexuelles plus fréquemment que les hommes. femmes dans le bras d'intervention (OR : 1,2 ; IC : 1,0-1,4). Aucun prédicteur n'a été trouvé dans le bras sans intervention. Même si les groupes d'intervention et de non-intervention avaient des perceptions positives des normes et idéologies sexuelles sexistes, une intervention basée sur un club de santé scolaire pourrait influencer les moteurs de ces normes.

Determinants of peer education on sexual and reproductive health and rights among in-school adolescents in Ebonyi State, Nigeria.

BACKGROUND: Peer education has contributed to increased knowledge and preventive behaviors of adolescents toward reproductive health matters with the unique feature of maintaining peer-to-peer learning ability and sustaining intervention gains. This study examined the factors that predict the agency of in-school adolescents as peer educators on the sexual and reproductive health and rights (SRHR) of adolescents. MATERIALS AND METHODS: A cross-sectional study was conducted on 257 adolescent boys and girls, purposively selected from six public secondary schools that had received a package of interventions that aimed to improve peer-to-peer education on SRHR in Ebonyi State, Nigeria. Data were collected using a pretested structured interviewer-administered questionnaire. Univariate and multivariate analyses were performed. The level of statistical significance was determined at a P value < 0.05 and a 95% confidence limit. RESULTS: Almost all the students (98.05%) believed that adolescents need information on SRHR, which should be provided in the schools; however, 66.93% had ever shared information with their peers on the SRHR. The predictors of the practice of peer education on SRHR include being in senior secondary (adjusted odds ratios (AOR) =2.889, P = 0.026), participation in SRHR campaigns (AOR = 6.139, P = 0.005), receiving information, education and communication materials (AOR = 0.266, P = 0.042), and discussing SRH matter with adult family members (AOR = 2.567, P = 0.026). CONCLUSION: The practice of peer education among adolescents was determined by their level in school, availability of support structures such as parent-child communication, and program-related factors. Therefore, public health initiatives should prioritize these factors to strengthen adolescents' agency as peer educators on the SRHR of young people.

Understanding evidence ecosystems: What influences the production, translation, and use of modeled evidence in Burkina Faso, Nigeria, India, and Kenya?

Background: This study sought to document and understand facilitators and barriers to producing, translating, and using modeled evidence in decision-making in Burkina Faso, Nigeria, India, and Kenya. We explored researcher-decision-maker engagement mechanisms as key facilitators of evidence use, with a focus on knowledge brokers and boundary organizations. Methods: The study used sequential mixed methods drawing on data collected from surveys and key informant interviews, complemented by a rapid desk review to map modeling activities and actors. The survey was conducted online while the qualitative research entailed in-depth interviews with modelers, knowledge brokers, and decision-makers working in a representative variety of health fields, organizations, and levels of government. This study was approved by Health Media Lab IRB (Institutional Review Board) in the United States and a local IRB in each study country and conducted between September 2021 and June 2022. Results: Informants interviewed for this study described a range of factors that facilitate and inhibit the use of modeled evidence in public health decision-making at the individual, organizational, and environmental levels. Key themes included the capacity to produce, translate, and use modeled evidence; the timing and relevance of modeling outputs; the existence of communications channels between modelers and decision-makers; the strength of underlying data systems; the role of sustained funding; and the impact of global crises. Conclusion: This study highlights the importance of taking an ecosystem approach to supporting modeling activities, considering individual, organizational, and environmental factors and how different actors and interact to inform the production, translation, and use of modeled evidence. Structured interaction that promotes dialogue, debate, and joint sense making between the producers and users of evidence is critical to informing and influencing the use of evidence in decision-making.

Analysing key influences over actors' use of evidence in developing policies and strategies in Nigeria: a retrospective study of the Integrated Maternal Newborn and Child Health strategy.

BACKGROUND: Evidence-informed policymaking has been promoted as a means of ensuring better outcomes. However, what counts as evidence in policymaking lies within a spectrum of expert knowledge and scientifically generated information. Since not all forms of evidence share an equal validity or weighting for policymakers, it is important to understand the key factors that influence their preferences for different types of evidence in policy and strategy development. METHOD: A retrospective study was carried out at the national level in Nigeria using a case-study approach to examine the Nigerian Integrated Maternal Newborn and Child Health (IMNCH) strategy. Two frameworks were used for conceptualization and data analysis, namely (1) to analyse the role of evidence in policymaking and (2) the policy triangle. They were used to explore the key contextual and participatory influences on choice of evidence in developing the IMNCH strategy. Data was collected through review of relevant national documents and in-depth interviews of purposively selected key policy and strategic decision makers. Thematic analysis was applied to generate information from collected data. RESULTS: The breadth of evidence used was wide, ranging from expert opinions to systematic reviews. The choice of different types of evidence was found to overlap across actor categories. Key influences over actors' choice of evidence were: (1) perceived robustness of evidence - comprehensive, representative, recent, scientifically sound; (2) roles in evidence process, i.e. their degree and level of participation in evidence generation and dissemination, with regards to their role in the policy process; and (3) contextual factors such as global agenda and influence, timeline for strategy development, availability of resources for evidence generation, and lessons learnt from previous unsuccessful policies/plans. CONCLUSION: Actors' preferences for different types of evidence for policy are influenced not only by the characteristics of evidence itself, but on actors' roles in the evidence process, their power to influence the policy, and the context in which evidence is used.

How do health workers perceive and practice monitoring and evaluation of malaria control interventions in South-east Nigeria?

BACKGROUND: The Anambra state Malaria Control Booster Project (ANMCBP) depends on an effective monitoring and evaluation (M&E) system to continuously improve the implementation of the malaria control interventions. However, it is not clear how the health workers that are expected to be the fulcrum of the malaria M&E perceive and practise M&E. The study was carried out to determine the knowledge, perception, and practice of Malaria M&E among selected health staff, and to identify related socio-demographic factors, including cadre of staff. METHODS: A semi-structured questionnaire and an observation checklist were used to collect information from selected health workers in public primary health centres in all 21 local government areas of the State. Multistage sampling technique was used in selection of respondents. The questionnaire explored knowledge, perception and practice of malaria M&E from 213 health workers. The observation checklist was used to record the actual practice of malaria M&E as observed by trained supervisors. RESULTS: Over 80% of health workers interviewed were able to correctly identify the malaria M&E forms; 25.4% knew the basis for categorizing Artemisinin-based combination therapy (ACT) into ACT1 - ACT4; 97.6% of the respondents felt there was need to keep proper records to have information available and 7.5% of them kept records because they were asked to do so. Over 90% of respondents reported correct practice of M&E, but on verification of actual practice, 55.6% of the respondents had at least one wrongly filled form, and half of these had none of their forms properly filled; about 68.4% of respondents had met specified timeline for data transmission. Differences observed in knowledge, perception and practice of M&E across age categories and cadres were only significant in ability to identify malaria M&E forms; diagnosis of malaria based on blood film microscopy result; perception of how age should be recorded; and reported practice of keeping data till they are requested. Among lower cadre of staff, gaps still exist in knowledge, perception and practice of malaria M&E. CONCLUSIONS: Gaps still exist in health workers' understanding of malaria data management, perception of efficient data transmission and observed practice of malaria M&E.

Examining equity in access to long-lasting insecticide nets and artemisinin-based combination therapy in Anambra State, Nigeria.

BACKGROUND: In order to achieve universal health coverage, the government of Anambra State, southeast Nigeria has distributed free Long-lasting Insecticide treated Nets (LLINs) to the general population and delivered free Artemisinin-based Combination Therapy (ACT) to pregnant women and children less than 5 years. However, the levels of coverage with LLINS and ACTs is not clear, especially coverage of different socio-economic status (SES) population groups. This study was carried out to determine the level of coverage and access to LLINs and ACTs amongst different SES groups. METHODS: A questionnaire was used to collect data from randomly selected households in 19 local government areas of the State. Selected households had a pregnant woman and/or a child less than 5 years. The lot quality assurance sampling (LQAS) methodology was used in sampling. The questionnaire explored the availability and utilization of LLINs and ACTs from 2394 households. An asset-based SES index was used to examine the level of access of LLINS and ACTs to different SES quintiles. RESULTS: It was found that 80.5% of the households had an LLIN and 64.4% of the households stated that they actually used the nets the previous night. The findings showed that 42.3% of pregnant women who had fever within the past month received ACTs, while 37.5% of children<5 years old who had malaria in the past month had received ACTs. There was equity in ownership of nets for the range 1-5 nets per household. No significant SES difference was found in use of ACTs for treatment of malaria in children under five years old and in pregnant women. CONCLUSIONS: The free distribution of LLINs and ACTs increased household coverage of both malaria control interventions and bridged the equity gap in access to them among the most vulnerable groups.