A qualitative investigation into pregnancy experiences and maternal healthcare utilisation among adolescent mothers in Nigeria.

BACKGROUND: Adolescent maternal healthcare utilisation is low in Nigeria, and little is understood about the pregnancy experiences and drivers of maternal healthcare utilisation among of adolescent girls. This study investigated the pregnancy experiences and maternal healthcare utilisation among adolescent mothers across Nigeria. METHODS: The study used the qualitative design. Urban and rural communities in Ondo, Imo and Katsina states were selected as research sites. Fifty-five in-depth interviews were conducted with adolescent girls who were currently pregnant or had given birth to a child recently, and nineteen in-depth interviews were conducted with older women who were either mothers or guardians of adolescent mothers. Additionally, key informant interviews were conducted with five female community leaders and six senior health workers. The interviews were transcribed, and resulting textual data were analysed via framework thematic analysis using a semantic and deductive approach, with the aid of NVivo software. RESULTS: The findings showed that the majority of unmarried participants had unintended pregnancies and stigma against pregnant adolescents was common. Social and financial support from family members, maternal support and influence, as well as healthcare preferences shaped by cultural and religious norms were the major drivers of maternal healthcare use among adolescent mothers, and the choice of their healthcare providers. CONCLUSIONS: Interventions to support adolescent mothers and increase maternal healthcare utilisation among them must focus on ensuring the provision of social and financial support for adolescent mothers, and should be culturally sensitive.

Exploring barriers and facilitators to integrated policy formulation and implementation of family planning and urban development programmes in Nigeria.

BACKGROUND: As more people now live in urban areas than in rural communities in Nigeria, urban development (UD) requires urgent policy and programmatic attention. Although the population factor has been identified as important to achieving national development goals, and evidence suggests that meeting the family planning (FP) and reproductive health (RH) needs of the vulnerable urban population can serve as an important recipe for achieving population growth rates consistent with building sustainable, habitable and prosperous urban settings, FP remains a neglected subject in UD initiatives in Nigeria. This study explored barriers and facilitators in achieving integrated policy formulation and implementation of FP and UD programmes in Nigeria. METHODS: We conducted key informant interviews (n = 37) with relevant FP/RH and UD stakeholders in Ibadan and Kaduna-two megacities that have undergone several UD and FP intervention programmes in the south and north of Nigeria. The sample size was determined by data saturation. Data were organized using ATLAS.ti and NVivo 12 software, and analysis was conducted using a thematic approach. RESULTS: We found that relevant government agencies largely work in silos. Other identified barriers to integrated policy formulation/implementation of FP and UD programmes in Nigeria include lack of knowledge about the FP-UD nexus between professionals, ineffective implementation and monitoring of existing guidelines, lack of policy documentation that clearly links FP and UD, and frequent transfer of government stakeholders. Notwithstanding the identified barriers, the study established ways of achieving synergy between FP and UD sectors, including stakeholder engagement, intersectoral collaborations, sensitization and publicity, roundtable discussion, interdisciplinary research, conferences and other interactive and knowledge-sharing fora. CONCLUSIONS: We conclude that addressing barriers to the intersectoral linkage between FP and UD is fundamental to achieving sustainable urbanization in Nigeria.

Characteristics of men who engage in cross-generational sexual behaviour in Nigeria.

Cross-generational sexual relationships are a major route of transmitting HIV and STI between older and younger generations. However, previous research has focused mainly on the young women in these relationships. This study examined the characteristics of men engaging in non-marital sexual relationships with girls aged 15-19 in Nigeria. The data were drawn from the 2013 Nigeria Demographic and Health Survey, and the analysis was restricted to a sub-sample of 7557 men aged 30-49 who were sexually active in the 12 months prior to the survey. Data analysis was carried out using frequency distributions, chi-squared tests of association and binary logistic regression. It was found that 9.5% of men aged 30-49 reported engaging in cross-generational sexual relationships. Also, being older (OR = 0.35), married (OR = 0.37), having secondary or higher education (OR = 0.70; 0.59) and having sexual debut between ages 18 and 30 (OR = 0.73) were associated with a lower likelihood of having cross-generational sexual relationships. However, Muslim men (OR = 2.10), men from Igbo (OR = 1.90), Hausa/Fulani (OR = 8.47) and Northern and Southern minority tribes (OR = 4.73; 2.49), men living in rural areas (OR = 1.34), men who were over the age of 30 at sexual debut (OR = 2.67) and those with 2-4 and 5 or more lifetime sexual partners (OR = 1.43; 1.58) were significantly more likely to engage in cross-generational sexual relationships. Addressing the challenges of cross-generational sexual relationships can be an effective strategy to reduce the menace of HIV and STI transmission. Men who have low education, those aged 30-34 years, those who initiated sex at an older age, rural dwellers and those who have had several lifetime sexual partners need to be targeted while designing and implementing programmes and policies to reduce cross-generational sexual relationships in Nigeria. These interventions must also take into account the religious and cultural attitudes towards cross-generational sexual relationships, and further investigations should identify men's motives for engaging in the practice.

Lived experiences of recovered COVID-19 persons in Nigeria: A phenomenological study.

BACKGROUND: Numerous publications have documented the mode of transmission and prevention of COVID-19 but little or no evidence exists on the experiences of people who survived the infection. OBJECTIVE: This study explored the specific experiences of persons who were infected with COVID-19, but have recovered completely. A secondary objective was to identify essential elements in the lived experiences of such persons, which would be useful in designing appropriate policies and programs for managing the virus in Nigeria. METHOD: The data were collected using in-depth interviews with 21 persons who were diagnosed with the virus and recovered. The data were transcribed and analyzed qualitatively using NVivo software. The experiences of the survivors of COVID-19 were examined under six themes: compliance with prevention measures before being infected, perceptions on how they contracted the virus, the symptoms they experienced, the management of the disease, their experiences with the healthcare system, their emotional experiences, and their recommendations on specific strategies to prevent and manage the virus based on their experiences. RESULTS: The commonly perceived means of contracting the virus were through colleagues, patients, and friends who were infected. The most commonly experienced symptoms were anosmia and fever. The health providers were described as courteous but some of the respondents observed avoidance and fear. Not all the interviewees knew the drugs they were treated with, but some, particularly the medical personnel, identified hydroxychloroquine, azithromycin, vitamin C, Augmentin, among others. Some of the participants used herbal remedies. While some respondents recounted good experiences in the isolation centre, others had unpleasant experiences. Direct and indirect encounters which were perceived as stigmatizing and discriminatory were reported by some respondents. CONCLUSION: We conclude that persons who recovered from COVID-19 in Nigeria had varied experiences relating to the mode of infection, the clinical features, methods of treatment, and psychosocial effects of the virus. These experiences would be useful for designing and implementing appropriate interventions, policies, and programs for managing the pandemic in the country.

Patterns of delivery assistance among adolescent mothers in Nigeria.

OBJECTIVE: This study examined the sociodemographic and sociocultural factors associated with the pattern of birth assistance used among adolescent mothers aged 15-19 in Nigeria. DESIGN: The study used a quantitative design, using secondary data from the Nigeria Demographic and Health Surveys conducted between 2003 and 2013. SETTING: The study was nationally representative and conducted across Nigeria. PARTICIPANTS: A weighted sample of 2,096 adolescent mothers aged 15-19. MEASUREMENTS AND FINDINGS: Data were analysed using frequencies, chi square tests and multinomial logistic regression respectively. It was discovered that mothers aged 18 and above had lower odds of using traditional and skilled birth attendants (aORs = 0.68 (0.51-0.92); 0.63 (0.44-0.92)); Igbo mothers had lower odds of using TBAs (aOR = 0.03 (0.002-0.53)); and mothers in female-headed households were less likely to use SBAs (aOR = 0.40 (0.20-0.82)). Rich mothers were more likely to use SBAs (aOR = 2.21 (1.23-3.94)). Mothers whose partners had at least primary education were more likely to use SBAs (aOR = 1.73 (1.09-2.73); 1.64 (1.03-2.59)). Adolescent mothers in the North East (aOR = 5.79 (2.91-11.51)), North West (aOR = 8.24 (4.01-16.93)), South East (aOR = 69.70 (13.96-348.05)) and South South (aOR = 27.84(7.80-99.30)) were more likely to use TBAs, while mothers in the North East (aOR = 0.46 (0.28-0.76)) and North West (aOR = 0.50 (0.29-0.84)) were less likely to use SBAs. Mothers who used partial ANC were more likely to use SBAs (aOR = 5.73 (3.43-9.56)), while those who used full ANC were more likely to use SBA (aOR = 7.33 (4.76-11.29)). KEY CONCLUSIONS: Higher socioeconomic status mothers were more likely to use skilled birth attendance. IMPLICATIONS FOR PRACTICE: Interventions to increase SBA use among adolescent mothers in Nigeria must consider the continued preference for traditional and unskilled birth attendants and unassisted births, and design culturally sensitive programmes.