Perceptions of and barriers to uptake of contraceptives in plantation farming communities of Cross River State, Nigeria: A qualitative inquiry.

The contraceptive use in Nigeria is relatively low, indicative of the non-adoption of contraceptives by people of reproductive age to curtail the increasing fertility rate with its attendant consequences on the family. The non-use is attributed to numerous factors, including perceptions of and attendant barriers to the uptake of contraceptives. This study was aimed at assessing the perception of and barriers to the uptake of contraceptives among residents of plantation farming communities in Cross River State, Nigeria. It was a multi-sited qualitative descriptive study conducted in three Local Government Areas (Ikom, Yakurr, and Akamkpa) in Cross River State, Nigeria between March and April 2022. Nine Focus Group Discussions (FGDs) and twelve key informant interviews (KIIs) were conducted with respondents from three plantation farming communities. The FGDs were conducted on sexually active unmarried girls, married women within the reproductive age, and married men with spouses of reproductive age. The KIIs were conducted on health care providers, village heads, youth leaders, and women leaders. The generated data were thematically analyzed using both deductive and inductive analytical approaches. Married women were deemed eligible to use contraceptives, which are viewed as a method for preventing pregnancy. The information supplied by healthcare professionals was deemed insufficient for women to make informed decisions. Fear of side effects, dysfunctional health facilities, frequent stock outs, and spousal opposition were the most significant barriers to contraceptive use. Family planning programs should be targeted more at residents of rural areas to increase awareness, dispel misconceptions, and promote contraceptive use.

L'utilisation de contraceptifs au Nigéria est relativement faible, ce qui indique que les personnes en âge de procréer ne les adoptent pas pour freiner l'augmentation du taux de fécondité et ses conséquences sur la famille. La non-utilisation est attribuée à de nombreux facteurs, notamment les perceptions et les obstacles à l'adoption des contraceptifs. Cette étude visait à évaluer la perception et les obstacles à l'adoption des contraceptifs parmi les résidents des communautés agricoles des plantations de l'État de Cross River, au Nigeria. Il s'agissait d'une étude descriptive qualitative multisites menée dans trois zones de gouvernement local (Ikom, Yakurr et Akamkpa) dans l'État de Cross River, au Nigeria, entre mars et avril 2022. Neuf discussions de groupe (FGD) et douze entretiens avec des informateurs clés (KII). ont été menées auprès de répondants de trois communautés agricoles de plantations. Les groupes de discussion ont été menés auprès de filles célibataires sexuellement actives, de femmes mariées en âge de procréer et d'hommes mariés ayant des épouses en âge de procréer. Les KII ont été menées auprès des prestataires de soins de santé, des chefs de village, des jeunes leaders et des femmes leaders. Les données générées ont été analysées thématiquement en utilisant des approches analytiques déductives et inductives. Les femmes mariées étaient considérées comme éligibles à l'utilisation de contraceptifs, considérés comme une méthode permettant de prévenir une grossesse. Les informations fournies par les professionnels de santé ont été jugées insuffisantes pour permettre aux femmes de prendre des décisions éclairées. La peur des effets secondaires, le dysfonctionnement des établissements de santé, les ruptures de stock fréquentes et l'opposition des conjoints étaient les obstacles les plus importants à l'utilisation des contraceptifs. Les programmes de planification familiale devraient cibler davantage les résidents des zones rurales afin de les sensibiliser, de dissiper les idées fausses et de promouvoir l'utilisation des contraceptifs.

The health inequity and socioeconomic inequality faced by adolescent girls and women on the move living with or at high risk of HIV infection, during the COVID-19 pandemic in Nigeria.

BACKGROUND: We assessed if women and girls on the move living with or at high risk of HIV faced increased health inequity and socioeconomic inequalities during the COVID-19 pandemic compared with other vulnerable women and girls. METHODS: We used data collected through a survey conducted in Nigeria between June and October 2021. Women and girls living with or at risk of HIV were recruited voluntarily, using a combination of venue-based and snowball sampling. We performed multivariable logistic regression models per mobility and HIV status to determine associations between health inequity, socioeconomic inequalities and macrosocial characteristics. FINDINGS: There were 3442 participants, of which 700 were on the move. We found no statistical difference between HIV-negative women and girls on the move and those not on the move. On the opposite, we found substantial differences in health inequity and socioeconomic inequalities between women and girls on the move living with HIV and those not on the move living with HIV. There are very strong associations between being a woman or girl on the move living with HIV and facing economic precarity (aOR 6.08, 95% CI 1.94 to 19.03), food insecurity (aOR 5.96, 95% CI 2.16 to 16.50) and experiencing more gender-based violence since COVID-19 started (aOR 5.61, 95% CI 3.01 to 10.47). INTERPRETATION: Being a woman or girl on the move and living with HIV compound increased health and socioeconomic vulnerabilities. The COVID-19 crisis seems to have exacerbated inequalities and gender-based violence. These findings call for more feminist interventions to protect women on the move living with HIV during health crises.

Factors influencing contraceptive use among women of reproductive age in plantation farming communities in South-South Nigeria.

The use of contraceptives by women of reproductive age remains one of the cost-effective ways of reducing maternal, infant, and child mortality and achieving a decline in the high fertility rate in the country. This was a descriptive cross-sectional study aimed to assess the association between the location of residence, occupation, and education level and the current use of contraceptives among women of reproductive age resident in plantation farming communities in South-south Nigeria. The test of associations between the dependent and independent variables and covariates was conducted using the Likelihood ratio Chi-square as appropriate. Multiple logistic regressions using the best-fit option of covariate selection were done with the use of contraceptives as the dependent variable. Of the 609 participants recruited, 189 (31.03%) were currently using a contraceptive. Women with secondary education were less likely to use contraceptives compared to the none educated [AOR=0.07; CL: 0.013-0.39]. Location and age were also significant predictors of the use of contraceptives by women in plantation farming communities in Nigeria. Deliberate and purposeful targeting of women and girls of reproductive age in plantation farming communities should be prioritized in the universal access to contraceptive use.

COVID-19 self-testing in Nigeria: Stakeholders' opinions and perspectives on its value for case detection.

BACKGROUND: COVID-19 testing coverage is limited in Nigeria. Access to rapid SARS-CoV-2 antigen-detection self-testing kits may help improve the detection of asymptomatic and mildly symptomatic cases and increase the country's low rate of SARS-CoV-2 testing. Before implementing self-testing in Nigeria, assessing the population's perceptions regarding this approach is imperative. In mid-2021, an exploratory cross-sectional qualitative research was conducted to investigate stakeholders' values and preferences for SARS-CoV-2 self-testing in Nigeria. METHODS: In-person and online semi-structured interviews and focus group discussions with healthcare workers, representatives of civil society, and potential implementors of self-testing delivery programs were used to explore values and perceptions around access to conventional provider-initiated COVID-19 testing. Topics included the public's values in relation to SARS-CoV-2 self-testing, the safe and effective use of SARS-CoV-2 self-testing, and likely actions upon receiving a positive SARS-CoV-2 self-test result. A thematic analysis approach was applied. RESULTS: The 58 informants (29 female) reported that Nigeria has limited availability of conventional provider-delivered SARS-CoV-2 testing. While just a few informants were familiar with SARS-CoV-2 self-testing, they generally supported using self-testing as an approach that they felt could assist with early case detection and improve access to testing. Concerns relating to the use of self-testing mainly related to the ability of low-literate individuals to use and interpret the self-tests, the affordability of self-tests, equity of access, and the availability of healthcare system support for those who self-test positive. CONCLUSION: Although the Nigerian public perceive multiple benefits associated with access to SARS-CoV-2 self-testing, the perceived inefficiency of the national health service delivery system may limit the access of users of the kits to psychosocial and clinical support. Nevertheless, in Nigeria, where COVID-19 vaccine coverage is low and the risk of further waves of COVID-19 is high, self-testing may assist in the prompt detection of cases and contribute to halting the spread of the virus.

People's willingness to use COVID-19 self-testing in Nigeria: a cross-sectional survey.

OBJECTIVES: Nigeria has been badly affected by the COVID-19 pandemic, and the poor testing coverage in the country may make controlling the spread of COVID-19 challenging. The aim of this study was to assess the general public's acceptability of SARS-CoV-2 self-testing as an approach which could help to address this gap. SETTING: A household-based survey was conducted in five urban and five rural local government areas in the states of Akwa Ibom, Anambra, Benue, Kaduna and Lagos, in mid-2021. PARTICIPANTS: 2126 respondents (969 were female) participated. A five-pronged, probabilistic sampling approach was used to recruit individuals older than 17 years and available to participate when randomly approached in their households by the surveyors. A 35-item questionnaire was used to collect data on their values towards SARS-CoV-2 self-testing. Primary outcomes were: likelihood to use a self-test; willingness to pay for a self-test; and likely actions following a reactive self-test result. RESULTS: Of the total 2126 respondents, 14 (0.66%) were aware of COVID-19 self-testing, 1738 (81.80%) agreed with the idea of people being able to self-test for COVID-19, 1786 (84.05%) were likely/very likely to use self-tests if available, 1931 (90.87%) would report a positive result and 1875 (88.28%) would isolate if they self-tested positive. Factors significantly associated with the use of a self-test were having a college education or higher (adjusted Odds Ratio (AOR): 1.55; 95% CI: 1.03 to 2.33), full-time employment (AOR: 1.67; 95% CI: 1.06 to 2.63), feeling at moderate/high risk of COVID-19 (AOR: 2.43; 95% CI: 1.70 to 3.47) and presence of individuals at risk of COVID-19 within the household (AOR: 1.38; 95% CI: 1.06 to 1.78). CONCLUSION: A majority of Nigerians agree with the concept of COVID-19 self-testing and would act to protect public health on self-testing positive. Self-test implementation research is necessary to frame how acceptability impacts uptake of preventive behaviours following a positive and a negative self-test result.

Using and improving the PHISICC paper-based tools in the health facility laboratories: Examples of Human Centered Design taking systems thinking into practice, in Côte d'Ivoire and Nigeria.

Background: Health workers in low- and middle-income countries are increasingly demanded to collect more and more data to report them to higher levels of the health information system (HIS), in detriment of useful data for clinical and public health decision-making, potentially compromising the quality of their health care provison. In order to support health workers' decision-making, we engaged with partners in Côte d'Ivoire, Mozambique and Nigeria in a research project to conceive, design, produce, implement and test paper-based health information tools: the PHISICC tools. Our aim was to understand the use of PHISICC tools by health workers and to improve them based on their feedback. Methods: The design Health Facility Laboratories (HF Labs) in Côte d'Ivoire and in Nigeria were set up after months of use of PHISICC tools. Activities were structured in three phases or 'sprints' of co-creative research. We used a transdisciplinary approach, including anthropology and Human Centered Design (HCD), observations, shadowing, structured interviews and co-creation. Results: Health workers appreciated the standardization of the tools across different health care areas, with a common visual language that optimized use. Several design issues were raised, in terms of formats and contents. They strongly appreciated how the PHISICC registers guided their clinical decision-making and how it facilitated tallying and counting for monthly reporting. However, adherence to new procedures was not universal. The co-creation sessions resulted in modifications to the PHISICC tools of out-patient care and postnatal care. Discussion: Although health systems and systemic thinking allowed the teams to embrace complexity, it was the HCD approach that actually produced a shift in researchers' mind-set: from HIS as data management tools to HIS as quality of care instruments. HCD allowed navigating the complexity of health systems interventions due to its capacity to operate change: it not only allowed us to understand how the PHISICC tools were used but also how to further improve them. In the absence of (or even with) an analytical health systems framework, HCD approaches can work in real-life situations for the ideation, testing and implementation of interventions to improve health systems and health status outcomes.

The effects of COVID-19 on food insecurity, financial vulnerability and housing insecurity among women and girls living with or at risk of HIV in Nigeria.

Aim: Women and girls living with or at high risk of acquiring HIV (WGL&RHIV) in Africa are economically vulnerable. This study aims to advance understanding of the economic impact of COVID-19 on WGL&RHIV and to identify the factors associated with this insecurity.Methods: Data were collected from a cross-sectional survey conducted among a convenience sample of WGL&RHIV in Nigeria between May and September 2021. Logistic regressions enabled the study of the role of HIV status, mental health and macrosocial characteristics (people with disability, transgender women, sex workers, persons engaged in transactional sex, substance users, and people on the move) on economic vulnerability, measured by food, financial and housing insecurity, since the COVID-19 pandemic began. The model accounted for the possible interactions between the macrosocial characteristics and controlled for confounders.Results: There were 3 313 (76.1%) of 4 355 respondents facing food insecurity, 3 664 (83.6%) of 4 385 with financial vulnerability and 1 282 (36.2%) of 3 544 with housing insecurity. Being a member of the key and vulnerable groups was strongly associated with food insecurity, financial vulnerability and housing insecurity, regardless of HIV serostatus. For example, WGL&RHIV engaging in transactional sex were more than four times more likely (aOR 4.42; 95% CI 2.57-7.59) to face housing insecurity and more than twice more likely to face food insecurity (aOR 2.47, 95% CI 1.35-4.52) and financial vulnerability (aOR 2.87, 95% CI 1.39-5.93). This economic vulnerability may reduce their negotiating power for safer sex or the use of HIV prevention methods, exposing them to increased risks of HIV infection. Poor mental health was also associated with the three forms of economic vulnerability.Conclusions: As the long-term impact of the COVID-19 crisis on African economies unfolds, HIV programmes at the country level must include economic vulnerability and mental unwellness mitigation activities for WGL&RHIV.

Factors associated with poor access to HIV and sexual and reproductive health services in Nigeria for women and girls living with HIV during the COVID-19 pandemic.

Aim: To determine the proportion of women and girls living with HIV (WGLHIV) who had poor access to HIV, tuberculosis and sexual and reproductive health (SRH) services in Nigeria during the COVID-19 pandemic and associated factors.Methods: This was a cross-sectional study that recruited WGLHIV with six categories of vulnerability (sex work, transactional sex, injecting or using illegal drugs, people on the move, transgender women and people with a disability) through an online survey conducted in ten Nigerian states between june and October 2021. The associations between the limited access to HIV, tuberculosis and SRH services due to COVID-19, the categories of vulnerability and the financial and non-financial barriers to these services were determined using multivariable logistics regression analysis.Results: Over 6 in 10, almost 2 in 10, and almost 4 in 10 WGLHIV had limited access to HIV, tuberculosis and SRH services respectively during the COVID-19 pandemic. Transgender women had 3.59 (95% CI 2.19-5.91) higher odds, women who engaged in sex work had 4.51 (95% CI 2.28-8.42) higher odds, and women who inject or use illegal drugs had 2.39 (95% CI 1.47-32.90) higher odds of facing limited access to sexual and reproductive health services when it was needed. In addition, the direct consequences of the COVID-19 crisis, such as the closure of HIV services and SRH service points, exacerbated pre-existing barriers significantly. Having no money, having to pay additional unofficial fees and the lack of security on the road to the health facility were the barriers with the greatest impact on access to health services.Conclusions: The COVID-19 pandemic had a negative impact on the access of WGLHIV to essential health services. This impact was disproportionately higher for marginalised groups. WGLHIV need non-discriminatory and affordable access to essential health services during the pandemic.