Missed opportunities for HIV counselling and testing service delivery among pregnant women in Nigeria: Evidence from the 2018 National nutrition and health survey.

According to UNAIDS, the 90-90-90 strategy calls for 90% of HIV-infected individuals to be diagnosed by 2020, 90% of whom will be on anti-retroviral therapy (ART) and 90% of whom will achieve sustained virologic suppression. HIV counselling and testing (HCT) is an important entry point for effective prevention of mother-to-child transmission of HIV. However, evidence abounds that HCT is often missed by pregnant women during antenatal care in Nigeria. We used secondary data from the 2018 Nigerian National Nutrition and Health Survey (NNHS) to determine the pattern of missed opportunities within the HCT algorithm and the factors associated with the missed opportunities. Of the 8,329 eligible women, 2,327 (27.9%) missed HCT because of lack of antenatal care; 1,493 (24.9%) missed HIV pre-test counselling; 180 (4.0%) missed HIV testing after participating in pre-test counselling, while 793 (18.2%) missed collection of HIV result and post-test counselling. Generally, most of the women that missed HCT were from the North West (43.3%) and had their antenatal care with traditional birth attendants. The odds of missing ANC were higher in women in the Northern and Southern regions. Concerning pre-test HIV counselling, the odds of missing it were higher among women in the Northwest and Southeast while the odds of missing post-test counselling of HIV test were higher among women in the Northeast and Southeast relative to other regions. Using TBA as a care provider was associated with higher odds of women missing pre-test and post-test counselling of HIV during ANC compared to those that used doctors or midwives or CHEWs. Missed opportunities are common in different stages of HIV counselling and testing pathway in Nigeria, particularly in the Northern regions. Future studies would need to identify the specific reasons for these missed opportunities, enabling the targeting of more specific policy reform and interventions.

Individual and ecological analyses of antenatal care: Prospects for delivery assistance and use of modern family planning in Nigeria.

Despite the availability of healthcare centres for the provision of antenatal care (ANC) services in Nigeria, the services are still underutilized by pregnant women. ANC services not only reduce maternal mortality and birth defects, but also have a strong link to many causes of maternal deaths. This study explored the individual and ecological relationships between antenatal care, skilled birth assistance during delivery, and family planning use across states in Nigeria. This study was a secondary analysis of data from the 2018 National Nutrition and Health Survey (NNHS) carried out among 24,985 women aged 15-49 years in the 36 states and the Federal Capital Territory (FCT) in Nigeria. Analysis was carried out at the level of individual women and at the ecological level. Only 68.3% visited a health professional (doctors, nurses, midwives, community health extension workers, and community health officers) for ANC in the most recent pregnancy before the survey. At delivery, 44.9% were assisted by delivery attendants with about half (50.1%) assisted by non-professional (traditional birth attendants, relatives and friends) during delivery. There was a significant variation in use of modern family planning (FP) across types of ANC provider. There was a strong positive correlation between ANC utilisation and skilled birth attendance (SBA) (r=0.706, p <0.001), and between SBA and FP (r=0.730, p <0.001). These results have implications for the design of appropriate interventions for strengthening the role of healthcare providers to enhance ANC patronage, utilization of safe delivery services and sustained use of reproductive health services.