Where, why and who delivers our babies? Examining the perspectives of women on utilization of antenatal and delivery services in a developing country.

BACKGROUND: The differences in maternal mortality between developed and developing countries is due to differences in use of antenatal and delivery services. The study was designed to determine the views of women on utilization of antenatal and delivery services in urban and rural communities of Ebonyi state, Nigeria. METHODS: Community based descriptive exploratory study design was employed. Qualitative data was collected through use of pre-tested focus group discussion (FGD) guide. Eight FGDs were conducted among women who were pregnant and others who have delivered babies one year prior to the study. Four FGDs each were conducted in urban and rural communities. QDA Miner Lite v2.0.6 was used in the analysis of the data. RESULTS: Most of the participants in urban and rural areas prefer the man and woman deciding on where to receive antenatal and deliver care. All the participants in urban and rural communities wish for the support of their husbands when pregnant. Perceived quality of care is the major reason the women choose a facility for antenatal and delivery services. Others reasons included cost of services and proximity to a facility. Participants in rural communities were of the opinion that traditional birth attendants deliver unique services including helping women to achieve conception. For participants in urban, traditional birth attendants are very friendly and perhaps on divine assignment. These reasons explain why women still patronize their services. The major criticism of services of traditional birth attendants is their inability to manage complications associated with pregnancy and delivery. The major reasons why women delivery at home included poverty and cultural beliefs. CONCLUSIONS: All efforts should be made to reduce the huge maternal death burden in Nigeria. This may necessitate the involvement of men and by extension communities in antenatal and delivery matters. There is need to train health workers in orthodox health facilities on delivery of quality healthcare. Public enlightenment on importance of health facility delivery will be of essence. Encouraging women to deliver in health facilities should be prioritized. This may entail the provision of free or subsidized delivery services. The deficiencies of primary health centers especially in rural communities should be addressed.

Factors associated with the practice of and intention to perform female genital mutilation on a female child among married women in Abakaliki Nigeria.

BACKGROUND: Female Genital Mutilation (FGM), also known as Female Genital Cutting or Female Circumcision is the harmful excision of the female genital organs for non-medical reasons. According to WHO, approximately 200 million girls and women have been genitally mutilated globally. Its recognition internationally as human rights violation has led to initiatives to stop FGM. This study investigated factors associated with the practice and intention to perform FGM among married women. METHODS: A cross-sectional study was conducted among 421 married women from communities in Abakaliki Nigeria. The participants were selected through multistage sampling. Data were collected through the interviewer's administration of a validated questionnaire. Data were analyzed using IBM-SPSS version 25. Chi-square and logistic regression tests were employed to determine factors associated with the practice and intention to perform FGM at a p-value of ≤ 0.05 and confidence level of 95%. RESULTS: The mean age of respondents is 40.5 ± 14.9 years. A majority, 96.7% were aware of FGM. On a scale of 15, their mean knowledge score was 8.1 ± 4.3 marks. Whereas 50.4% of the respondents were genitally mutilated, 20.2% have also genitally mutilated their daughters, and 7.4% have plan to genitally mutilate their future daughters. On a scale of 6, their mean practice score was 4.8 ± 1.2 marks. The top reasons for FGM are tradition (82.9%), a rite of passage into womanhood (64.4%), suppression of sexuality (64.4%), and promiscuity (62.5%). Women with at least secondary education are less likely to genitally mutilate their daughters (Adjusted Odds Ratio [AOR] = 0.248, 95% Confidence Interval [CI] = 0.094-0.652). Women who are genitally mutilated are more likely to genitally mutilate their daughters (AOR = 28.732, 95% CI = 6.171-133.768), and those who have previously genitally mutilated their daughters have greater intention to genitally mutilate future ones (AOR = 141.786; 95% CI = 9.584-209.592). CONCLUSIONS: Women who underwent FGM have a greater propensity to perpetuate the practice but attaining at least secondary education promotes its abandonment. Targeted intervention to dispel any harboured erroneous beliefs of the sexual, health, or socio-cultural benefits of FGM and improved public legislation with enforcement against FGM are recommended.

Physician emigration from Nigeria and the associated factors: the implications to safeguarding the Nigeria health system.

BACKGROUND: Adequate Human Resources for Health is indispensable to achieving Universal Health Coverage and physicians play a leading role. Nigeria with low physician-population ratio, is experiencing massive exodus of physicians. This study investigated emigration intention of physicians, the factors influencing it and discussed the implications to guide policy formulation and reforms, curtail the trend and safeguard the country's health system. METHODS: Through cross-sectional survey, 913 physicians from 37 States were interviewed with semi-structured questionnaire using Google form shared via WhatsApp and Telegram forums of Nigeria Medical Association. Data were analysed with IBM-SPSS version-25 and charts were created with Microsoft-Excel. Chi-square and multiple regression tests were done with p-value set at 0.05. RESULTS: The mean age of respondents is 37.6 ± 7.9 years; majority of them are males (63.2%), married (75.5%) with postgraduate qualifications (54.1%) and working in public health facilities (85.4%). Whereas 13% and 19.3% are, respectively, satisfied with their work and willing to continue practice in Nigeria, 43.9% want to emigrate and 36.8% are undecided about future location of their practice. The commonest reasons for emigration are poor remuneration (91.3%), rising insecurity (79.8%) and inadequate diagnostic facilities (61.8%). Physicians working in public health facilities are 2.5 times less satisfied than their counterparts in non-public sector (AOR = 0.4; 95% CI = 0.3-0.8). Physicians in their thirties, forties and fifties are 3.5 (95% CI = 1.5-8.0), 5.5 (95% CI = 2.1-14.5) and 13.8 (95% CI = 3.9-49.3) times, respectively, more willing to retain practice in Nigeria than those younger and those satisfied with their work are 4.7 (AOR = 4.7, 95% CI = 2.9-7.4) times more willing to practice in Nigeria than those not satisfied. CONCLUSION: Majority of Nigerian physicians want to emigrate for professional practice and top among the push factors are poor remuneration, rising insecurity and inadequate diagnostic facilities. The observed trend portends danger to the country's health system due to the foreseeable negative consequences of physician deficit to the system. We recommend upward review of physician remuneration, a root cause analysis of insecurity to determine workable preventive measures and increased funding of the health sector to improve the diagnostic infrastructure, retain physicians and save the health system from imminent collapse.

Improving TB Case Detection Through Active Case-Finding: Results of Multiple Intervention Strategies in Hard-to-Reach Riverine Areas of Southern Nigeria.

BACKGROUND: A major challenge to TB control globally is low case detection, largely due to routine health facility-based passive case-finding employed by national TB control programs. Active case-finding is a risk-population-based screening approach that has been established to be effective in TB control. This intervention aimed to increase TB case detection in hard-to-reach areas in southern Nigeria. METHODS: Using a descriptive cross-sectional design, we conducted implementation research in 15 hard-to-reach riverine local government areas with historically recognized low TB case notification rates. Individuals with TB symptoms were screened using multiple strategies. Data were collected quarterly over a 4-year period using reporting tools and checklists. Descriptive analysis was done with Microsoft Excel spreadsheet 2019. RESULTS: A total of 1,089,129 individuals were screened: 16,576 in 2017; 108,102 in 2018; 697,165 in 2019; and 267,286 in 2020. Of those screened, 24,802 (2.3%) were identified as presumptive TB, of which 88.8% were tested and 10% were diagnosed with TB (0.23% of those screened). TB notifications more than doubled, increasing by 183.3% and 137.5% in the initial implementation and scale-up, respectively. On average, 441 individuals needed to be screened to diagnose 1 TB case. The cases, predominantly males (56.1%) and aged 15 years and older (77.4%), comprised 71.9% bacteriologically confirmed drug-sensitive TB, 25.8% clinically diagnosed drug-sensitive TB, and 2.3% drug-resistant cases. Detection sources included community outreach (1,786), health facilities (505), people living with HIV (57), and household contacts of bacteriologically confirmed TB cases (123). Remarkably, 98.1% of diagnosed TB cases commenced treatment. CONCLUSIONS: We found a significant yield in TB case notifications, more than doubling the baseline figures. Given these successful results, we recommend prioritizing resources to support active case-finding strategies in national programs, especially in hard-to-reach areas with high-risk populations, to address TB more comprehensively.

Are rural pregnant women disadvantaged in accessing intermittent preventive treatment in pregnancy in Ebonyi State, Nigeria?

INTRODUCTION: Adequate intermittent preventive treatment (IPTp) uptake (≥3 doses) routinely delivered at antenatal clinics is effective in preventing malaria during pregnancy. Whereas, low IPTp uptake (24.0%) had been reported among pregnant women in Ebonyi State, there is paucity of studies comparing the uptake and its predictors in the urban and rural areas of Ebonyi State. We determined IPTp uptake and its predictors in the urban and rural areas of Ebonyi State. METHODS: We conducted a cross-sectional comparative study among 864 reproductive age women selected using multistage sampling. Using a structured interviewer-administered questionnaire, we collected data on respondent's socio-demographic characteristics and IPTp uptake. Uptake was adjudged adequate if ≥3 doses were taken, otherwise inadequate. We estimated the proportion of women with adequate IPTp uptake and determined the factors associated with adequate uptake in rural and urban areas using chi square and multiple logistic regression at 5% level of significance. RESULTS: The mean ages of respondents in the urban and rural areas were 28.5±4.6 and 27.4±5.0 years respectively. Adequate IPTp uptake was 82.5% and 60.8% in the urban and rural respectively (p<0.001). In the urban area, women whose husbands had attained ≥ secondary education (aOR:2.9; 95%CI:1.2-7.4; p = 0.02) and those who paid for sulfadoxine/pyrimethamime (aOR:0.2; 95%CI: 0.1-0.6; p = 0.01) were 2.9 times more likely and 5 times less likely to take adequate IPTp respectively compared to respondents whose husbands had attained ≤ primary education and those who had sulfadoxine/pyrimethamine free. In the rural area, women who had attended ANC <4 times (aOR:0.4; 95%CI: 0.3-0.7; p<0.001) were 2.5 times less likely to take adequate IPTp compared to women that had attended ANC ≥4 times. CONCLUSION: Uptake of IPTp was more in the urban than rural areas of Ebonyi State. Interventions that reinforce the importance of health professionals carrying out actions aimed at pregnant women and their partners (spousal) in order to guide them on preventive actions against malaria and other diseases are recommended in Ebonyi State.

Hygiene practices in abattoir and slaughter slab, determinants and assessment of abattoir and slaughter slab facilities in Abakaliki, Ebonyi State South-East Nigeria.

Background: Workers in slaughterhouses engaging in unhygienic practices create conducive environments for zoonoses and meat contamination. Knowledge of hygiene practices and their determinants provides evidence for the design of targeted interventions. Objectives: We investigated knowledge and determinants of hygiene practices among workers in slaughterhouses and assessed slaughterhouse facilities in Abakaliki. Methods: Workers in the Central Meat Market abattoir and Slaughter slab Abakaliki were interviewed in a cross-sectional quantitative study to ascertain their knowledge and hygiene practices while abattoir facilities were assessed using a checklist. Associations were analysed with Chi-square while predictors were determined using binary logistic model. Results: We interviewed 188 workers 75.5% and 85.6% of whom had good knowledge and good hygiene practices respectively. However, hand-washing before and after handling meat (44.1%), cleaning work surfaces with soap and water (45.2%) and sanitary disposal of waste (6.9%) were suboptimal. Knowledge of good hygiene practice was a predictor of good hygiene practice (AOR: 4.6, 95% CI: 2.0-11.3, p=0.001). Well water and borehole were present in both slaughterhouses and cold rooms were available in Central Meat market abattoir. Conclusions: The level of good knowledge was high and this was a determinant of good hygienic practices. Training on hygiene practices is recommended to prevent meat contamination and zoonoses.

Addressing constraints to informal providers' involvement in tuberculosis control: a qualitative study of patent medicine dealers and tuberculosis programme managers.

BACKGROUND: A major constraint to tuberculosis control is low case finding with under-reporting to national authorities. Evidence shows that Patent Medicine Dealers are first port of call for most people with symptoms of tuberculosis, yet there is poor referral of such clients to tuberculosis treatment facilities for further evaluation. This study investigated constraints to involvement of Patent Medicine Dealers in tuberculosis control. METHODS: This was a cross-sectional qualitative study among Patent Medicine Dealers and Tuberculosis Control Programme Managers in Ebonyi State Nigeria. Sixty-four Patent Medicine Dealers and five Tuberculosis Control Programme Managers were interviewed using Focus Group Discussion and In-Depth Interview respectively. Data was collected with electronic audio-recording device and analyzed using thematic approach. RESULTS: There are some knowledge gaps about tuberculosis signs, symptoms, free-treatment policy and mode of operation of care service among Patent Medicine Dealers. Patent Medicine Dealers and Tuberculosis Control Programme Managers are willing to collaborate in tuberculosis control effort but constant demand for incentives by Patent Medicine Dealers and inability of National Tuberculosis Control Programme to keep up with such demands are obvious constraints. CONCLUSIONS: Knowledge gaps in tuberculosis, its control, constant demand for incentives by Patent Medicine Dealers and inability of National Tuberculosis Control Programme to satisfy such demands are constraints to involvement of Patent Medicine Dealers in tuberculosis control. More robust engagement of Patent Medicine Dealers in tuberculosis control with clear job description through tuberculosis education and provision of incentives to support them are recommended policy approaches to improve linkage of clients to tuberculosis treatment facilities.

Practices toward presumptive tuberculosis clients among patent medicine vendors in Ebonyi State Nigeria.

Background: Tuberculosis (TB) is a major cause of ill-health and death globally but a serious challenge to its control is low case notification. In low- and middle-income countries, most patients with symptoms of the disease first seek care from patent medicine vendors (PMVs) who are not formerly trained to manage TB. The practices of PMVs toward presumptive TB are pivotal to control of TB. Aim: The aim of this study was to describe the pattern of practices toward presumptive TB and assess their determinants among PMVs. Method: The study was carried out in Ebonyi State Nigeria using descriptive cross-sectional design. Through a multistage sampling, 250 PMVs were selected and interviewed. Data were collected using pretested interviewer-administered questionnaire and analyzed with IBM SPSS Statistics for Windows, version 22 (IBM Corp., Armonk, N.Y., USA). Chi-square test and binary logistic regression were used to determine factors associated with practices toward presumptive TB with P value set at 0.05 for statistical significance. Results: Almost half (48.8%) of the respondents engaged in poor practices by inadequate referral of clients (45.2%), delayed referral (69.6%), and unstandardized treatment with antibiotics (56.4%). There was no statistically significant association between independent variables and practice and none of the variables significantly predicted practice. Conclusions: There were poor practices toward presumptive TB shown in inadequate referral, delayed referral, and unstandardized treatment of clients. We recommend that PMVs should be trained and regularly sensitized about TB to improve their practices and that regulatory authorities should enforce policies on antibiotics distribution and sale.

Point prevalence survey of antimicrobial prescription in a tertiary hospital in South East Nigeria: A call for improved antibiotic stewardship.

OBJECTIVES: Antimicrobial prescribing practices and use contribute to the growing threat of antimicrobial resistance (AMR) to global health. Information on antimicrobial prescribing and use are lacking in most developing countries, including Nigeria. This information is crucial for antimicrobial stewardship programmes, an effective tool in minimising AMR. This study was performed to gather baseline information on antimicrobial prescribing practices in Nigeria. METHODS: A cross-sectional survey was conducted on all inpatients of a tertiary hospital in South East Nigeria. All patients on admission on the day of the survey formed the study population. A standardised questionnaire, web-based data entry and validation process designed by the University of Antwerp, Belgium, were adopted. Information on basic patient demographics, antimicrobial agents used, indication for treatment, laboratory data prior to treatment and stop/review date was collected. RESULTS: Of 220 inpatients surveyed, 78.2% were receiving at least one antimicrobial agent. The highest prevalence of antimicrobial use was in the ICU (100%), adult surgical ward (82.9%) and paediatric medical ward (82.9%). Agents used were mainly third-generation cephalosporins (ceftriaxone 25.1%) and nitroimidazole (metronidazole 24.6%). Antimicrobial prescription was empirical (91.1% in medical wards, 96.8% in surgical wards and 100% in ICU). There was limited use of guidelines but clear documentation of stop/review dates and reasons for antimicrobial use. CONCLUSION: Although a majority of antimicrobial prescriptions were made with indications, they were mostly prescribed empirically and the majority of prescriptions were parenteral formulations. There is a need to develop antibiotic guidelines, to educate prescribers on antimicrobial stewardship and to encourage targeted prescription.

Appraisal of Healthcare-seeking Behavior and Prevalence of Workplace Injury among Artisans in Automobile Site in Abakaliki, Southeast Nigeria.

BACKGROUND: Healthcare-seeking behavior is a decision-making process governed by an individual's conduct, community norms, and expectations, as well as provider-related characteristics and manners. This study determined factors associated with healthcare seeking behavior of automobile artisans in Abakaliki. MATERIALS AND METHODS: A descriptive cross-sectional survey of 380 artisans was carried out. Respondents were selected using multi-stage sampling method and semi-structured interviewer administered pretested questionnaire was used to gather information. Data were analyzed using SPSS software, and the Chi-squared test was used to test for association at 5% level of significance. RESULTS: The mean age of the artisans was 31.3 ± 10.3 years, and the mean monthly income was N15277. Less than half of the respondents (47.7%) sought medical care in pharmacy/patent medicine stores. A significant association was found between distance to the facility for medical care and period of delay before seeking care (P = 0.01). Bruises (45.3%) and cuts (32.3%) were the most prevalent injuries sustained in the preceding 12 months. A significantly high proportion of those who had bruises and cuts traveled >6 km to seek care and less than half of the respondents (47.6%) who reside within 5 km radius to place of medical care patronized pharmacy/patent medicine shops. However, higher proportion of those with cuts (52.0%) and burns (62.5%) compared to other types of injury went to the hospitals no matter the distance. CONCLUSIONS: The artisans have poor health-seeking behavior and majority sought medical care in pharmacy/patent medicine shops rather than hospitals. However, a significant proportion of those with injuries used hospitals regardless of the distance. It is, therefore, imperative to establish healthcare facilities within 5 km radius from where they live and work.