Distribution of health facilities in Nigeria: Implications and options for Universal Health Coverage.

BACKGROUND: Nigeria is considering adopting Universal Health Coverage (UHC) as an official policy target to ensure access to quality health care services for her population without financial hardship. To facilitate discussion on the topic, the President of Nigeria convened a UHC summit in March 2014 to discuss Nigeria's options and strategies to achieve UHC. A strategy for achieving UHC requires analysis of the available infrastructure to deliver the services. We review the geographic and sectoral distribution of health facilities in Nigeria and discuss implications on the UHC strategy selected. METHODS: Secondary analysis of data from the Federal Ministry of Health's facility register was performed to assess the geographic and sectoral distribution of health facilities in Nigeria. Additionally, an extensive literature review was conducted to understand UHC strategies used by various countries and the associated health facility requirements. RESULTS: Primary health facilities make up 88% of health facilities in Nigeria while secondary and tertiary health facilities make up 12% and 0.25%, respectively. There are more government-owned health facilities than privately owned health facilities (67% vs 33%). Secondary health facilities are predominantly privately owned. The ratio of public to private health facilities is much higher in the northern part of the country than in the southern part. CONCLUSIONS: The distribution of health facilities across Nigeria is nonuniform. As such, a UHC strategy must be responsive to the variation in health facility distribution across the country. Additional investments are needed in some parts of the country to improve access to tertiary health facilities and leverage private sector capacity.

The Nigerian health information system policy review of 2014 : the need, content, expectations and progress.

BACKGROUND: Nigeria's national health information system (HIS) data sources are grouped into institutional and population based data that traverse many government institutions. Communication and collaboration between these institutions are limited, fraught with fragmentation and challenges national HIS functionality. OBJECTIVES: The objective of this paper was to share insights from and the implications of a recent review of Nigeria's HIS policy in 2014 that resulted in its substantial revision. We also highlight some subsequent enactments. REVIEW PROCESS AND OUTCOMES: In 2013, Nigeria's Federal Ministry of Health launched an inter-ministerial and multi-departmental review of the National Health Management Information System policy of 2006. The review was guided by World Health Organization's 'Framework and Standards for Country Health Information Systems'. The key finding was a lack of governance mechanisms in the execution of the policy, including an absent data management governance process. The review also found a multiplicity of duplicative, parallel reporting tools and platforms. CONCLUSION: Recommendations for HIS Policy revisions were proposed to and implemented by the Federal Government of Nigeria. The revised HIS policy now provides for a strong framework for the leadership and governance of the HIS with early results.

Baby factories taint surrogacy in Nigeria.

The practice of reproductive medicine in Nigeria is facing new challenges with the proliferation of 'baby factories'. Baby factories are buildings, hospitals or orphanages that have been converted into places for young girls and women to give birth to children for sale on the black market, often to infertile couples, or into trafficking rings. This practice illegally provides outcomes (children) similar to surrogacy. While surrogacy has not been well accepted in this environment, the proliferation of baby factories further threatens its acceptance. The involvement of medical and allied health workers in the operation of baby factories raises ethical concerns. The lack of a properly defined legal framework and code of practice for surrogacy makes it difficult to prosecute baby factory owners, especially when they are health workers claiming to be providing services to clients. In this environment, surrogacy and other assisted reproductive techniques urgently require regulation in order to define when ethico-legal lines have been crossed in providing surrogacy or surrogacy-like services.

Childhood exposure to armed conflict and nutritional health outcomes in Nigeria.

BACKGROUND: Armed conflicts are associated with an increased risk of food insecurity, the leading cause of malnutrition in low-and-middle-income countries. Multiple studies have uncovered significant influences of childhood malnutrition on children's overall health and development. As a result, it is increasingly important to understand how childhood experience of armed conflict intersects with childhood malnutrition in conflict-prone countries like Nigeria. This study examined the association between different measures of childhood experiences of armed conflicts and the nutritional health outcomes of children aged 36-59 months. METHODS: We used data from the Nigeria Demographic and Health Survey linked with Uppsala Conflict Data Program Geo-Referenced Events Dataset using geographic identifiers. Multilevel regression models were fitted on a sample of 4226 children aged 36-59 months. RESULTS: The prevalence of stunting, underweight and wasting was 35%, 20% and 3%, respectively. Armed conflicts were mostly recorded in the North-eastern states of Borno (222 episodes) and Adamawa (24 episodes). Exposure to armed conflicts ranged from 0 (no experience of armed conflict) to 3.75 conflicts per month since the child's birth. An increase in the frequency of armed conflicts is associated with increased odds of childhood stunting [AOR = 2.52, 95%CI: 1.96-3.25] and underweight [AOR = 2.33, 95%CI: 1.19-4.59] but not wasting. The intensity of armed conflict was only marginally associated with stunting and underweight but not wasting. Longer conflicts that occurred in the last year were also associated with the odds of stunting [AOR = 1.25, 95%CI: 1.17-1.33] and underweight [AOR = 1.19, 95%CI: 1.11-1.26] but not wasting. CONCLUSION: Childhood exposure to armed conflict is associated with long-term malnutrition in children aged 36-59 months in Nigeria. Strategies that aim to end childhood malnutrition could target children exposed to armed conflicts.

Geographical and time trends of measles incidence and measles vaccination coverage and their correlation in Nigeria.

Nigeria has one of the highest measles burdens in the world. While measles-containing vaccine is proven to be effective in reducing measles cases, empirical studies on the correlation between measles incidence and measles vaccine coverage in Nigeria has been limited. The aim of this study was to conduct a detailed analysis on measles incidence, measles vaccine coverage, and their correlation between 2012 and 2021. A retrospective observational study was conducted based on the Integrated Disease Surveillance and Response (IDSR) data for the measles incidence in each Nigerian state over time, District Health Information System, V.2 (DHIS2) and Nigeria Demographic and Health Survey (DHS) for the coverage of the first dose of measles containing vaccine (MCV1) over time (2012-2021). We observed the trend of measles incidence and measles vaccine coverage, as well as their correlation. Out of the study period from 2012 to 2021, we found that the majority of measles outbreaks occurred in the northeastern states in recent years after 2019, especially in Borno state, where Boko Haram insurgency has negatively impacted health service delivery, including routine vaccination. We observed a significant negative correlation between measles incidence and measles vaccine coverage across Nigerian states. However, there was no sudden drop in measles vaccine coverage before the recent outbreak in Borno state in 2019, which could be due to various factors other than the overall vaccine coverage.

Examining vulnerability and resilience in maternal, newborn and child health through a gender lens in low-income and middle-income countries: a scoping review.

INTRODUCTION: Gender lens application is pertinent in addressing inequities that underlie morbidity and mortality in vulnerable populations, including mothers and children. While gender inequities may result in greater vulnerabilities for mothers and children, synthesising evidence on the constraints and opportunities is a step in accelerating reduction in poor outcomes and building resilience in individuals and across communities and health systems. METHODS: We conducted a scoping review that examined vulnerability and resilience in maternal, newborn and child health (MNCH) through a gender lens to characterise gender roles, relationships and differences in maternal and child health. We conducted a comprehensive search of peer-reviewed and grey literature in popular scholarly databases, including PubMed, ScienceDirect, EBSCOhost and Google Scholar. We identified and analysed 17 published studies that met the inclusion criteria for key gendered themes in maternal and child health vulnerability and resilience in low-income and middle-income countries. RESULTS: Six key gendered dimensions of vulnerability and resilience emerged from our analysis: (1) restricted maternal access to financial and economic resources; (2) limited economic contribution of women as a result of motherhood; (3) social norms, ideologies, beliefs and perceptions inhibiting women's access to maternal healthcare services; (4) restricted maternal agency and contribution to reproductive decisions; (5) power dynamics and experience of intimate partner violence contributing to adverse health for women, children and their families; (6) partner emotional or affective support being crucial for maternal health and well-being prenatal and postnatal. CONCLUSION: This review highlights six domains that merit attention in addressing maternal and child health vulnerabilities. Recognising and understanding the gendered dynamics of vulnerability and resilience can help develop meaningful strategies that will guide the design and implementation of MNCH programmes in low-income and middle-income countries.

Vulnerability in maternal, new-born, and child health in low- and middle-income countries: Findings from a scoping review.

OBJECTIVES: To identify and synthesise prevailing definitions and indices of vulnerability in maternal, new-born and child health (MNCH) research and health programs in low- and middle-income countries. DESIGN AND SETTING: Scoping review using Arksey and O'Malley's framework and a Delphi survey for consensus building. PARTICIPANTS: Mothers, new-borns, and children living in low- and middle-income countries were selected as participants. OUTCOMES: Vulnerability as defined by the authors was deduced from the studies. RESULTS: A total of 61 studies were included in this scoping review. Of this, 22 were publications on vulnerability in the context of maternal health and 40 were on new-born and child health. Definitions used in included studies can be broadly categorised into three domains: biological, socioeconomic, and environmental. Eleven studies defined vulnerability in the context of maternal health, five reported on the scales used to measure vulnerability in maternal health and only one study used a validated scale. Of the 40 included studies on vulnerability in child health, 19 defined vulnerability in the context of new-born and/or child health, 15 reported on the scales used to measure vulnerability in child health and nine reported on childhood vulnerability indices. As it was difficult to synthesise the definitions, their keywords were extracted to generate new candidate definitions for vulnerability in MNCH. CONCLUSION: Included studies paid greater attention to new-born/ child vulnerability than maternal vulnerability, with authors defining the terms differently. A definition which helps in improving the description of vulnerability in MNCH across various programs and researchers was arrived at. This will further help in streamlining research and interventions which can influence the design of high impact MNCH programs. SCOPING REVIEW REGISTRATION: The protocol for this review was registered in the open science framework at the registered address (https://osf.io/jt6nr).

Risk assessment for COVID-19 transmission at household level in sub-Saharan Africa: evidence from DHS.

Household habitat conditions matter for diseases transmission and control, especially in the case of the novel coronavirus (COVID-19). These conditions include availability and adequacy of sanitation facilities, and number of persons per room. Despite this, little attention is being paid to these conditions as a pathway to understanding the transmission and prevention of COVID-19, especially in Africa, where household habitat conditions are largely suboptimal. This study assesses household sanitation and isolation capacities to understand the COVID-19 transmission risk at household level across Africa. We conducted a secondary analysis of the Demographic and Health Surveys of 16 African countries implemented between 2015 and 2018 to understand the status of households for prevention of COVID-19 transmission in home. We assessed handwashing capacity and self-isolation capacity using multiple parameters, and identified households with elderly persons, who are most at risk of the disease. We fitted two-level random intercept logit models to explore independent relationships among the three indicators, while controlling for the selected explanatory variables. Handwashing capacity was highest in Tanzania (48.2%), and lowest in Chad (4.2%), varying by household location (urban or rural), as well as household wealth. Isolation capacity was highest in South Africa (77.4%), and lowest in Ethiopia (30.9%). Senegal had the largest proportion of households with an elderly person (42.1%), while Angola (16.4%) had the lowest. There were strong, independent relationships between handwashing and isolation capacities in a majority of countries. Also, strong associations were found between isolation capacity and presence of older persons in households. Household capacity for COVID-19 prevention varied significantly across countries, with those having elderly household members not necessarily having the best handwashing or isolation capacity. In view of the age risk factors of COVID-19 transmission, and its dependence on handwashing and isolation capacities of households, each country needs to use the extant information on its risk status to shape communication and intervention strategies that will help limit the impact of the disease in its population across Africa. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s41118-021-00130-w.

Compliance with disease surveillance and notification by private health providers in South-West Nigeria.

INTRODUCTION: Private health facilities are important contributors to health service delivery across several low and middle income countries. In Nigeria, they make up 33% of the health facilities, account for more than 70% of healthcare spending and over 60% of healthcare contacts are estimated to take place within them However, their level of participation in the disease surveillance system has been questioned. METHODS: We conducted a cross-sectional survey of 507 private health facilities in South-West Nigeria to investigate the level of compliance with disease surveillance reporting and the factors that affect their participation. RESULTS: We found only 40% of the private health facilities to be complying with routine disease surveillance reporting which ranged from 17% to 60% across the six states in the region. Thirty-four percent of the private health facilities had the requisite data collection tools, 49% had designated professionals assigned to health records management and only 7% of the clinicians could properly identify the three data collection tools for disease surveillance. Some important factors such as awareness of a law on disease surveillance (OR=1.55 95% CI=1.08-2.24), availability of reporting tools (OR=13.69, 95% CI=8.85-21.62), availability of a designated health records officer (OR=3.9, 95% CI=2.68-5.73), and health records officers (OR=10.51, 95%CI=2.86-67.70) and clinicians (OR=2.49, 95% CI=1.22-5.25) with knowledge of disease surveillance system were important predictive factors to compliance with disease surveillance participation. CONCLUSION: Private health facilities are poorly compliant with disease surveillance in Nigeria resulting in missed opportunities for prompt identification and response to threats of infectious disease outbreaks.

Death registration in Nigeria: a systematic literature review of its performance and challenges.

BACKGROUND: Death registration provides an opportunity for the legal documentation of death of persons. Documentation of deaths has several implications including its use in the recovery of inheritance and insurance benefits. It is also an important input for construction of life tables which are crucial for national planning. However, the registration of deaths is poor in several countries including Nigeria. OBJECTIVE: This paper describes the performance of death registration in Nigeria and factors that may affect its performance. METHODS: We conducted a systematic literature review of death registration completeness in Nigeria to identify, characterize issues as well as challenges associated with realizing completeness in death registration. RESULTS: Only 13.5% of deaths in Nigeria were registered in 2007 which regressed to 10% in 2017. There was no data reported for Nigeria in the World Health Organization database between 2008 and 2017. The country scored less than 0.1 (out of a maximum of 1) on the Vital Statistics Performance Index. There are multiple institutions with parallel constitutional and legal responsibilities for death registration in Nigeria including the National Population Commission, National Identity Management Commission and Local Government Authorities, which may be contributing to its overall poor performance. CONCLUSIONS: We offer proposals to substantially improve death registration completeness in Nigeria including the streamlining and merger of the National Population Commission and the National Identity Management Commission into one commission, the revision of the legal mandate of the new agency to mainly coordination and establishment of standards. We recommend that Local Government authorities maintain the local registries given their proximity to households. This arrangement will be enhanced by increased utilization of information and communications technology in Civil Registration and Vital Statistics processes that ensure records are properly archived.

A qualitative inquiry on the status and adequacy of legal instruments establishing infectious disease surveillance in Nigeria.

INTRODUCTION: The threat of devastating disease outbreaks is on the rise with several outbreaks recorded across the world in the last five years. The intractable Ebola Virus Disease outbreak in West Africa which spread to Nigeria was a reawakening point. This study aims to review the status and adequacy of the legal framework for disease surveillance in Nigeria. Methods: a mixed methods approach comprising of document reviews and key informant interviews was used in data collection. METHODS: A mixed methods approach comprising of document reviews and key informant interviews was used in data collection. RESULTS: Fourteen key informants from the federal ministry of health (FMOH) and six States were interviewed. Five legal instruments were identified and reviewed. The Quarantine Act of 1926 remains the active National Law on disease surveillance in Nigeria. An Integrated Disease Surveillance and Response Policy (IDSR) was developed in 2005 as the means for achieving the International Health Regulations (IHR). All six states claimed to have adopted the national IDSR policy though none could present a domesticated version of the policy. Key informants were concerned that Nigeria does not yet have an adequate legal framework for disease surveillance. CONCLUSION: The legal instruments establishing disease surveillance in Nigeria require strengthening and possibly enactment as a National Law in order to address emerging disease threats.

Duplication of effort across Development Projects in Nigeria: An example using the Master Health Facility List.

OBJECTIVE: Duplication of effort across development projects is often the resultant effect of poor donor coordination in low- and middle- income countries which receive development assistance. This paper examines the persistence of duplication through a case study of health facility listing exercises in Nigeria. METHODS: Document reviews, key informant interviews, and a stakeholder's meeting were undertaken to identify similar health facility listing exercises between 2010 and 2016. RESULTS: As an outcome of this process, ten different health facility listing efforts were identified. DISCUSSIONS: Proper coordination and collaboration could have resulted in a single list grown over time, ensuring return on investments. This study provides evidence of the persistence of duplication, years after global commitment to harmonization, better coordination and efficient use of development assistance were agreed to. CONCLUSIONS: The paper concludes by making a proposal for strategic leadership in the health sector and the need to leverage information and communications technology through the development of an electronic Health Facility Registry that can archive the data on health facilities, create opportunity for continuous updates of the list, and provide for easy sharing of the data across different country stakeholders thereby eliminating duplication. KEYWORDS: Aid Effectiveness, Donor coordination; Health Facilities; Health Information System; Health Systems; International Cooperation; Master Facility List.

Baby Factories in Nigeria: Starting the Discussion Toward a National Prevention Policy.

Baby factories and baby harvesting are relatively new terms that involve breeding, trafficking, and abuse of infants and their biological mothers. Since it was first described in a United Nations Educational, Scientific and Cultural Organization report in Nigeria in 2006, several more baby factories have been discovered over the years. Infertile women are noted to be major patrons of these baby factories due to the stigmatization of childless couples in Southern Nigeria and issues around cultural acceptability of surrogacy and adoption. These practices have contributed to the growth in the industry which results in physical, psychological, and sexual violence to the victims. Tackling baby factories will involve a multifaceted approach that includes advocacy and enacting of legislation barring baby factories and infant trafficking and harsh consequences for their patrons. Also, programs to educate young girls on preventing unwanted pregnancies are needed. Methods of improving awareness and acceptability of adoption and surrogacy and reducing the administrative and legal bottlenecks associated with these options for infertile couples should be explored to diminish the importance of baby factories.

Community-based management versus traditional hospitalization in treatment of drug-resistant tuberculosis: a systematic review and meta-analysis.

BACKGROUND: Multidrug drug resistant Tuberculosis (MDR-TB) and extensively drug resistant Tuberculosis (XDR-TB) have emerged as significant public health threats worldwide. This systematic review and meta-analysis aimed to investigate the effects of community-based treatment to traditional hospitalization in improving treatment success rates among MDR-TB and XDR-TB patients in the 27 MDR-TB High burden countries (HBC). METHODS: We searched PubMed, Cochrane, Lancet, Web of Science, International Journal of Tuberculosis and Lung Disease, and Centre for Reviews and Dissemination (CRD) for studies on community-based treatment and traditional hospitalization and MDR-TB and XDR-TB from the 27 MDR-TB HBC. Data on treatment success and failure rates were extracted from retrospective and prospective cohort studies, and a case control study. Sensitivity analysis, subgroup analyses, and meta-regression analysis were used to explore bias and potential sources of heterogeneity. RESULTS: The final sample included 16 studies involving 3344 patients from nine countries; Bangladesh, China, Ethiopia, Kenya, India, South Africa, Philippines, Russia, and Uzbekistan. Based on a random-effects model, we observed a higher treatment success rate in community-based treatment (Point estimate = 0.68, 95 % CI: 0.59 to 0.76, p < 0.01) compared to traditional hospitalization (Point estimate = 0.57, 95 % CI: 0.44 to 0.69, p < 0.01). A lower treatment failure rate was observed in community-based treatment 7 % (Point estimate = 0.07, 95 % CI: 0.03 to 0.10; p < 0.01) compared to traditional hospitalization (Point estimate = 0.188, 95 % CI: 0.10 to 0.28; p < 0.01). In the subgroup analysis, studies without HIV co-infected patients, directly observed therapy short course-plus (DOTS-Plus) implemented throughout therapy, treatment duration > 18 months, and regimen with drugs >5 reported higher treatment success rate. In the meta-regression model, age of patients, adverse events, treatment duration, and lost to follow up explains some of the heterogeneity of treatment effects between studies. CONCLUSION: Community-based management improved treatment outcomes. A mix of interventions with DOTS-Plus throughout therapy and treatment duration > 18 months as well as strategies in place for lost to follow up and adverse events should be considered in MDR-TB and XDR-TB interventions, as they influenced positively, treatment success.

Potential use cases for the development of an electronic health facility registry in Nigeria: Key informant's perspectives.

BACKGROUND: Master facility lists (MFL) maintain an important standard (unique identifier) in country health information systems that will aid integration and interoperability of multiple health facility based data sources. However, this standard is not readily available in several low and middle income countries where reliable data is most needed for efficient planning. The World Health Organization in 2012 drew up guidelines for the creation of MFLs in countries but this guideline still requires domestication and process modeling for each country adopting it. Nigeria in 2013 published a paper-based MFL directory which it hopes to migrate to an electronic MFL registry for use across the country. OBJECTIVE: To identify the use cases of importance in the development of an electronic health facility registry to manage the MFL compiled in Nigeria. METHODS: Potential use cases for the health facility registry were identified through consultations with key informants at the Federal Ministry of Health. These will serve as input into an electronic MFL registry development effort. RESULTS: The use cases identified include: new health facility is created, update of status of health facility, close-out, relocation, new information available, delete and management of multi-branch health facility. CONCLUSION: Development of an application for the management of MFLs requires proper architectural analysis of the manifestations that can befall a health facility through its lifecycle. A MFL electronic registry will be invaluable to manage health facility data and will aid the integration and interoperability of health facility information systems.

The impact of medical tourism and the code of medical ethics on advertisement in Nigeria.

Advances in management of clinical conditions are being made in several resource poor countries including Nigeria. Yet, the code of medical ethics which bars physician and health practices from advertising the kind of services they render deters these practices. This is worsened by the incursion of medical tourism facilitators (MTF) who continue to market healthcare services across countries over the internet and social media thereby raising ethical questions. A significant review of the advertisement ban in the code of ethics is long overdue. Limited knowledge about advances in medical practice among physicians and the populace, the growing medical tourism industry and its attendant effects, and the possibility of driving brain gain provide evidence to repeal the code. Ethical issues, resistance to change and elitist ideas are mitigating factors working in the opposite direction. The repeal of the code of medical ethics against advertising will undoubtedly favor health facilities in the country that currently cannot advertise the kind of services they render. A repeal or review of this code of medical ethics is necessary with properly laid down guidelines on how advertisements can be and cannot be done.

Development of a master health facility list in Nigeria.

UNLABELLED: Abstract. INTRODUCTION: Routine Health Information Systems (RHIS) are increasingly transitioning to electronic platforms in several developing countries. Establishment of a Master Facility List (MFL) to standardize the allocation of unique identifiers for health facilities can overcome identification issues and support health facility management. The Nigerian Federal Ministry of Health (FMOH) recently developed a MFL, and we present the process and outcome. METHODS: The MFL was developed from the ground up, and includes a state code, a local government area (LGA) code, health facility ownership (public or private), the level of care, and an exclusive LGA level health facility serial number, as part of the unique identifier system in Nigeria. To develop the MFL, the LGAs sent the list of all health facilities in their jurisdiction to the state, which in turn collated for all LGAs under them before sending to the FMOH. At the FMOH, a group of RHIS experts verified the list and identifiers for each state. RESULTS: The national MFL consists of 34,423 health facilities uniquely identified. The list has been published and is available for worldwide access; it is currently used for planning and management of health services in Nigeria. DISCUSSION: Unique identifiers are a basic component of any information system. However, poor planning and execution of implementing this key standard can diminish the success of the RHIS. CONCLUSION: Development and adherence to standards is the hallmark for a national health information infrastructure. Explicit processes and multi-level stakeholder engagement is necessary to ensuring the success of the effort.