Prevalence of and risk factors for iron deficiency among pregnant women with moderate or severe anaemia in Nigeria: a cross-sectional study.

BACKGROUND: Anaemia during pregnancy causes adverse outcomes to the woman and the foetus, including anaemic heart failure, prematurity, and intrauterine growth restriction. Iron deficiency anaemia (IDA) is the leading cause of anaemia and oral iron supplementation during pregnancy is widely recommended. However, little focus is directed to dietary intake. This study estimates the contribution of IDA among pregnant women and examines its risk factors (including dietary) in those with moderate or severe IDA in Lagos and Kano states, Nigeria. METHODS: In this cross-sectional study, 11,582 women were screened for anaemia at 20-32 weeks gestation. The 872 who had moderate or severe anaemia (haemoglobin concentration < 10 g/dL) were included in this study. Iron deficiency was defined as serum ferritin level < 30 ng/mL. We described the sociodemographic and obstetric characteristics of the sample and their self-report of consumption of common food items. We conducted bivariate and multivariable logistic regression analysis to identify risk factors associated with IDA. RESULTS: Iron deficiency was observed among 41% (95%CI: 38 - 45) of women with moderate or severe anaemia and the prevalence increased with gestational age. The odds for IDA reduces from aOR: 0.36 (95%CI: 0.13 - 0.98) among pregnant women who consume green leafy vegetables every 2-3 weeks, to 0.26 (95%CI: 0.09 - 0.73) among daily consumers, compared to those who do not eat it. Daily consumption of edible kaolin clay was associated with increased odds of having IDA compared to non-consumption, aOR 9.13 (95%CI: 3.27 - 25.48). Consumption of soybeans three to four times a week was associated with higher odds of IDA compared to non-consumption, aOR: 1.78 (95%CI: 1.12 - 2.82). CONCLUSION: About 4 in 10 women with moderate or severe anaemia during pregnancy had IDA. Our study provides evidence for the protective effect of green leafy vegetables against IDA while self-reported consumption of edible kaolin clay and soybeans appeared to increase the odds of having IDA during pregnancy. Health education on diet during pregnancy needs to be strengthened since this could potentially increase awareness and change behaviours that could reduce IDA among pregnant women with moderate or severe anaemia in Nigeria and other countries.

Determinants of health facility delivery among young mothers aged 15 - 24 years in Nigeria: a multilevel analysis of the 2018 Nigeria demographic and health survey.

BACKGROUND: Young mothers aged 15 to 24 years are particularly at higher risk of adverse health outcomes during childbirth. Delivery in health facilities by skilled birth attendants can help reduce this risk and lower maternal and perinatal morbidity and mortality. This study assessed the determinants of health facility delivery among young Nigerian women. METHODS: A nationally representative population data extracted from the 2018 Nigeria Demographic and Health Survey of 5,399 young women aged 15-24 years who had had their last birth in the five years before the survey was analysed. Data was described using frequencies and proportions. Bivariate and multivariate analyses were carried out using Chi-Square test and multilevel mixed effect binary logistic regression. All the analysis were carried out using STATA software, version 16.0 SE (Stata Corporation, TX, USA).. RESULTS: Of the total sampled women in the 2018 NDHS, 5,399 (12.91%) formed our study population of young women 15 -24 years who had their last birth in the preceding five years of the survey. Only 33.72% of the young mothers utilized health facility for delivery. Women educated beyond the secondary school level had 4.4 times higher odds of delivering at a health facility compared with women with no education (AOR 4.42 95%, CI 1.83 - 10.68). Having fewer children and attending more antenatal visits increased the odds of health facility delivery. With increasing household wealth index, women were more likely to deliver in a health facility. The odds of health facility delivery were higher among women whose partners had higher than secondary level of education. Women who lived in communities with higher levels of female education, skilled prenatal support, and higher levels of transportation support were more likely to deliver their babies in a health facility. CONCLUSION: Strategies to promote institutional delivery among young mothers should include promoting girl child education, reducing financial barriers in access to healthcare, promoting antenatal care, and improving skilled birth attendants and transportation support in disadvantaged communities.

Effect of social marketing on the knowledge, attitude, and uptake of pap smear among women residing in an urban slum in Lagos, Nigeria.

INTRODUCTION: Nigeria has a low uptake of cervical cancer screening and is one of the five countries that represent over half of the global burden of deaths from cervical cancer. Social marketing principles can be used to design and implement interventions to increase uptake of cervical cancer screening. This study assessed the effect of a social marketing intervention on the knowledge, attitude, and uptake of pap smear among women residing in an urban slum in Lagos State, Nigeria. MATERIALS AND METHODS: This was a quasi-experimental study. The intervention arm consisted of 140 women recruited from Ago-Egun Bariga community and the control arm consisted of 175 women recruited from Oto-Ilogbo extension community. Social marketing intervention was instituted in the intervention group. Data analysis was done using IBM SPSS Statistics version 20 and Stata version 16.0. Between groups comparisons and within groups comparisons were done using bivariate analysis with Chisquare, Students t test and Paired t test as appropriate. RESULTS: In both the intervention and control groups, the mean knowledge score of cervical cancer was low at baseline (0.0 ± 0.3 and 0.1 ± 0.9 respectively). In the intervention group, there was a significant increase in mean knowledge score to 15.1 ± 3.7, post-intervention (p < 0.001). In both groups, the mean attitude score of cervical cancer was low at baseline (27.1 ± 0.8 in the intervention group and 27.2 ± 1.4 in the control group). In the intervention group, there was a significant increase in mean attitude score to 36.5 ± 4.8, post-intervention (p < 0.001). In both the intervention and control groups, uptake of pap smear was low at baseline (0.0% and 0.6%, respectively). In the intervention group, there was a significant increase in uptake of pap smear to 84.3%, post-intervention (p < 0.001). There was no statistically significant change in knowledge, attitude or uptake of pap smear in the control group, post-intervention. CONCLUSION: This study demonstrated that social marketing intervention can be successful in improving knowledge, attitude, and also the uptake of pap smear, even in settings where these are abysmally low. It is recommended that social marketing intervention be employed as a strategy for improving cervical cancer screening among women residing in slums.

Barriers and recommendations for a cervical cancer screening program among women in low-resource settings in Lagos Nigeria: a qualitative study.

BACKGROUND: Cervical cancer is the fourth most common cancer in women globally despite being a largely treatable and preventable malignancy. Developing countries account for over 80% of all new cases. Women residing in low-resource settings such as those residing in slums have a higher risk of cervical cancer, and lower uptake of cervical cancer screening. Diverse barriers influence the uptake of cervical cancer screening among women in low-resource settings. OBJECTIVES: This qualitative study was done prior to the introduction of a cervical cancer screening program in two slum areas in Lagos Nigeria and explored women's knowledge about cervical cancer, and their perceived barriers and recommendations for the program. METHOD: Four focus group discussions(FGD) were conducted among 35 women between the ages of 21-65 years residing in two urban slums in Lagos, Nigeria from February to April 2019. Each FGD was limited to 8-10 participants of women of similar ages. Voice recordings were transcribed verbatim and thematic analysis was done. RESULTS: Most of the women were not aware of cervical cancer and none knew the symptoms or risk factors of cervical cancer. The participants felt that the cervical cancer screening program would be well accepted in the community, however, expressed concerns about the cost of the screening test and the sex of the person performing the test. The recommendations proffered for a successful cervical cancer screening program include; reducing the cost of the test or providing the test free of charge, having people that speak the local language as part of the team, using female health care providers, using a private location within the community or nearby primary health center, and publicizing the program with the use of SMS, phone calls, town crier, and health talks. It was recommended that organizing health education sessions would help improve women's poorly perceived susceptibility to cervical cancer. CONCLUSION: Interventions to increase uptake of cervical cancer screening among women in low resource settings need to improve knowledge of cervical cancer and address barriers to cervical cancer screening such as cost, distance, and as much as possible, sex of the healthcare provider should be considered.

Utilisation and preferences of family planning services among women in Ikosi-Isheri, Kosofe Local Government area, Lagos, Nigeria.

BACKGROUND: Despite women's adequate knowledge and the obvious unmet need for family planning (FP), contraceptive prevalence in Nigeria is low. A greater understanding of the barriers to FP that informs service utilisation and preferences is needed to improve service delivery. AIM: This study was aimed at assessing the use and preferences of FP services among women. SUBJECTS AND METHODS: A community-based, descriptive, cross-sectional survey was carried out among 367 women (15-49 years of age) residing in Ikosi-Isheri, Kosofe local government area, who were selected by multistage sampling method. Data were collected using a pre-tested, semi-structured, interviewer-administered questionnaire and were analysed using SPSS software version 20. Frequency distributions and cross tabulations were generated. The Chi-square and Fisher's exact tests were used to determine associations, and the level of significance was set at P ≤ 0.05. RESULTS: Although 64.0% were aware of FP, only 26.4% had ever used FP services. The contraceptive prevalence was 17.9%. Traditional or religious restrictions were given as the reasons for not using FP (40.9%). The preferred FP services were those offered at primary healthcare centres (45.2%) and teaching hospitals (33.9%) because of proximity (38.7%), privacy (14.5%) and health workers being female (22.6%). Age, level of education and marital status were associated with the utilisation of FP services (P < 0.001, P = 0.020 and P < 0.001, respectively). CONCLUSION: Although awareness was high, uptake was low. Government health facilities were preferred. Primary healthcare should be strengthened, and FP services should be scaled up to make FP more accessible. Services should be closer to where people live while providing the privacy they desire.

Nigerian parents can harbour harmful views about the causes and treatment of childhood enuresis that result in child abuse.

AIM: The aim of this study was to determine Nigerian parents' views about the causes and treatment of childhood enuresis. METHODS: Parents of children aged 5-17 years were individually interviewed in an urban community in Nigeria using a pretested questionnaire. Their responses about the causes and treatment of enuresis were grouped under common themes. RESULTS: We included 448 respondents in the study: 75.5% were mothers, 44.2% had at least one child with enuresis and only 1.3% had spoken to a doctor about it. Enuresis was thought to be due to playing too much and drinking too much fluid at night by 69.7% and 21.2% of the respondents, respectively. The two most common treatment methods that parents were aware of for enuresis were waking to void (23.7%) and urinating on hot charcoal (20.8%). The most common methods that parents actually employed included waking to void (49.0%), punishing the child (36.9%) and doing nothing (28.8%). CONCLUSION: Most of the respondents believed that playing too much and drinking or eating too much were responsible for childhood enuresis. Parents rarely discussed childhood enuresis with their doctors and some of the self-help measures that were employed may be harmful and could constitute child abuse.

Harmful traditional practices among market women in ojuwoye market mushin, South West, Nigeria.

Traditions are the long-established patterns of actions or behaviors, often handed down within a community over many generations. Harmful traditional practices (HTPs) are customs that are known to have deleterious effects on people's health and obstruct the goals of equality, political, and social rights. They include female genital mutilation, intimate partner violence, male preference, child marriage, and food taboos. This study was carried out to assess the knowledge, attitude, and practice of HTPs among market women in Mushin Local Government Area (LGA) of Lagos, Nigeria. This cross-sectional, descriptive study was carried out among 235 market women in Ojuwoye market, Mushin LGA, Lagos. Respondents were selected using the systematic sampling method, and the data were collected using pretested interviewer-administered questionnaires. Data were analyzed using Epi info version 7. Proportions, mean, and standard deviation were generated and Chi-square test was used to explore the associations. Binary logistic regression was used to determine the predictors of HTP. Majority (66.8%) of the respondents had fair knowledge of HTPs. Overall attitude was generally good as 86% had an opposing attitude toward HTPs. About one-third of respondents (35.3%) practiced at least one form of HTP. Supportive attitude toward HTP was a predictor of HTP. Respondents with supportive attitude toward HTPs were 15.5 times more likely to practice HTPs than respondents with opposing attitude (adjusted odds ratio 15.51 confidence interval 4.22-57.07). Behavioral change programs should be geared toward improving the attitude of women against HTP and reducing the practice of HTP.

Résumé Les traditions sont des modèles d'actions ou de comportements établis de longue date, souvent transmis au sein d'une communauté sur plusieurs générations. Nuisible les pratiques traditionnelles sont des coutumes connues pour avoir des effets délétères sur la santé des personnes et entraver les objectifs d'égalité, politiques, et les droits sociaux. Ils comprennent les mutilations génitales féminines, la violence entre partenaires intimes, la préférence masculine, le mariage des enfants et les tabous alimentaires. Cette étude a été menée pour évaluer la connaissance, l'attitude et la pratique des pratiques traditionnelles parmi les femmes du marché dans la zone de gouvernement local de Mushin de Lagos, Nigéria. Cette étude descriptive transversale a été menée auprès de 235 marchandes du marché d'Ojuwoye, zone de gouvernement local de Mushin, Lagos. Les répondants ont été sélectionnés à l'aide de la méthode d'échantillonnage systématique, et les données ont été recueillies à l'aide d'intervieweurs prétestés administrés questionnaires. Les données ont été analysées à l'aide d'Epi info version 7. Les proportions, la moyenne et l'écart type ont été générés et le chi carré test a été utilisé pour explorer les associations. Une régression logistique binaire a été utilisée pour déterminer les prédicteurs de pratiques traditionnelles. La majorité (66,8 %) des les répondants avaient une bonne connaissance des pratiques traditionnelles. L'attitude globale était généralement bonne puisque 86% avaient une attitude opposée à l'égard pratiques traditionnelles. Environ un tiers des répondants (35,3 %) pratiquaient au moins une forme de pratiques traditionnelles. Attitude de soutien envers les nuisibles les pratiques traditionnelles étaient un prédicteur de pratiques traditionnelles. Les répondants avec attitude de soutien envers les nuisibles les pratiques traditionnelles étaient 15,5 fois plus susceptibles de pratiquer des pratiques nuisibles pratiques traditionnelles que les répondants ayant une attitude opposée (rapport de cotes ajusté intervalle de confiance de 15,51 4,22 à 57,07). Les programmes de changement de comportement devraient viser à améliorer l'attitude des femmes contre les pratiques traditionnelles et réduire la pratique des pratiques traditionnelles. Mots-clés: les mutilations génitales féminines, la violence entre partenaires intimes, la préférence masculine, le mariage des enfants, les tabous alimentaires, Les pratiques traditionnelles néfastes, Nigeria.

Knowledge and utilization of family planning among rural postpartum women in Southwest Nigeria.

BACKGROUND: In Nigeria, contraceptive use has remained low, 12% for any modern method, despite the huge resources committed to family planning programs by stakeholders. This study was carried out to assess the knowledge and utilization of family planning and determine predictors of utilization of family planning among postpartum women attending primary health care centers (PHCs) in a selected rural area of Lagos State, southwest Nigeria. METHODS: This was a descriptive cross-sectional study conducted among 325 postpartum women attending PHCs in Ibeju-Lekki local government area of Lagos State selected using a multi-stage sampling technique. A pretested, interviewer-administered questionnaire was used to collate data which was analyzed using the IBM SPSS Statistics version 23. RESULT: The mean age was 29.94 ± 5.14 years. All the respondents (100%) had heard of contraceptive methods, however only 38 (11.7%) had good knowledge of family planning. About 38.5% of the respondents used modern family planning methods during the postpartum period. The most commonly used methods were male condoms (26.3%) and implants (17.0%). The significant predictors of postpartum family planning (PPFP) were non-intention to have more children [AOR = 1.88 (95% CI: 1.14-3.11)], and good knowledge of family [AOR = 2.31 (95% CI: 1.11-4.81)]. CONCLUSION: It is recommended that interventions be designed to educate and advocate for the use of family planning methods not only to stop childbearing but also to space pregnancies. Education about family planning should also be intensified to improve knowledge of family planning, and thus practice.

Awareness and practice of family planning among women residing in two rural communities in Ogun State, South West Nigeria.

Background: Family planning helps individuals and couples to avoid unwanted pregnancies, regulate interval between pregnancies, and determine the number of children in the family. Family planning is an effective intervention for promoting maternal health, but its acceptability and utilization are impeded by many factors. Aim: This study was conducted to assess the rural women's awareness and practice of family planning in two communities in Ogun State. Materials and Methods: This was a cross-sectional study conducted among 561 women of reproductive age. Data collection was done using interviewer administered questionnaire. Data were analyzed using IBM SPSS version 20. Frequencies were generated and Chi-square test was used to explore associations. Binary logistic regression was used to determine predictors of ever-used family planning. Results: Majority were aware of family planning (410, 73.1%). The method most commonly known was male condom (348, 84.9%), pills (276, 67.3%), and injectables (231, 56.3%). Respondents who had ever-used family planning were (265, 47.2%). The methods commonly used were injectables (104, 39.2%) and pills (85, 32.1%). Reasons for not using family planning include the desire for more children (78, 26.3%), lack of spousal support (56, 18.9%), and fear of undesirable effects (44, 14.9%). Determinants of ever-used family planning after logistic regression were age and occupation. Women between 31 and 40 years of age were two times more likely than women <20 years to have used family planning (adjusted odds ratio [AOR] 2.17, 95% confidence interval [CI] 2.17-1.23). Farmers were 53% less likely than traders to have ever-used family planning (AOR: 0.47, 95% CI: 0.29-0.78). Conclusion: Although the awareness of family planning was high in this study, it did not correspond to practice. Campaigns promoting the use of family planning for child spacing, male involvement in family planning and dispelling of fears is recommended to improve practice of family planning.

RésuméContexte: La planification familiale aide les individus et les couples à éviter les grossesses non désirées, à réguler l'intervalle entre les grossesses et à déterminer le nombre d'enfants dans la famille. La planification familiale est une intervention efficace pour promouvoir la santé maternelle, mais son acceptabilité et son utilisation sont entravée par de nombreux facteurs. Objectif: Cette étude a été menée pour évaluer la sensibilisation et la pratique des femmes rurales en matière de planification familiale dans deux communautés dans l'État d'Ogun. Matériel et Méthodes: Il s'agit d'une étude transversale menée auprès de 561 femmes en âge de procréer. La collecte des données a été effectuée en utilisant un questionnaire administré par l'intervieweur. Les données ont été analysées à l'aide d'IBM SPSS version 20. Des fréquences ont été générées et le test du chi carré a été utilisé pour explorer les associations. La régression logistique binaire a été utilisée pour déterminer les prédicteurs de la planification familiale jamais utilisée. Résultats: La majorité était au courant planification familiale (410, 73,1%). La méthode la plus connue était le préservatif masculin (348, 84,9%), les pilules (276, 67,3%) et les injectables (231, 56,3%). Les répondants qui avaient déjà utilisé la planification familiale étaient (265, 47,2%). Les méthodes couramment utilisées étaient les injectables (104, 39,2%) et les pilules (85, 32,1%). Les raisons de ne pas recourir à la planification familiale comprennent le désir d'avoir plus d'enfants (78, 26,3%), le manque de soutien conjugal (56, 18,9%) et la peur des indésirables effets (44, 14,9%). Les déterminants de la planification familiale jamais utilisée après la régression logistique étaient l'âge et la profession. Femmes entre 31 et 40 ans l'âge était deux fois plus susceptible que les femmes de moins de 20 ans d'avoir utilisé la planification familiale (odds ratio ajusté [AOR] 2,17, intervalle de confiance à 95% [IC] 2.17­1.23). Les agriculteurs étaient 53% moins susceptibles que les commerçants d'avoir déjà utilisé la planification familiale (AOR: 0,47, IC à 95%: 0,29 à 0,78). Conclusion: bien la prise de conscience de la planification familiale était élevée dans cette étude, elle ne correspondait pas à la pratique. Campagnes encourageant l'utilisation de la planification familiale pour l'enfant l'espacement, la participation des hommes à la planification familiale et la dissipation des peurs sont recommandés pour améliorer la pratique de la planification familiale.

Knowledge, attitude and practice of cervical cancer prevention, among women residing in an urban slum in Lagos, South West, Nigeria.

INTRODUCTION: cervical cancer is the most common genital tract malignancy among women in Nigeria. Cancer of the cervix is preceded by a curable premalignant stage which can be detected by screening. The disease can also be prevented by Human papillomavirus (HPV) immunization. Women living in slums usually have poor reproductive health knowledge and poor health behaviours. Mostly of low socioeconomic status, these women are at higher risk of cervical cancer. This study assessed the knowledge, attitude and preventive practices towards cervical cancer among women living in an urban slum in Lagos, Nigeria. METHODS: this descriptive cross-sectional study was carried out among 305 women of reproductive age in Idi-Araba, Lagos, Nigeria. Multistage sampling method was used to select respondents. Data was collected using interviewer administered questionnaires. Analysis was done with SPSS 20 software. RESULTS: only 39 (12.8%) had heard about cervical cancer. Knowledge of cervical cancer, screening and Human papilloma virus (HPV) immunization was poor. Most respondents (64.3%) did not consider themselves at risk for cervical cancer. However, majority (88.9%) were willing to undergo screening and 93.8% were willing to take HPV immunization or recommend the vaccine to a friend/relative. Only 2(0.7%) had done a cervical cancer screening test and none had taken HPV vaccine or immunized their eligible daughters. CONCLUSION: there is thus the need for increased awareness creation and health education programs on cervical cancer prevention among such population of women.

Predictors of tuberculosis knowledge, attitudes and practices in urban slums in Nigeria: a cross-sectional study.

INTRODUCTION: Nigeria is among six countries responsible for the majority of tuberculosis (TB) cases in the world. The Nigerian government has emphasized community-based case finding to increase detection of TB. This process requires efforts to improve knowledge, attitudes and practices (KAP) of TB, particularly in the poorest of communities. This study presents data from a KAP survey administered in two underserved Nigerian communities. METHODS: a structured survey was administered by trained interviewers among adult residents in two slum communities in Lagos, Nigeria. Participants were selected through multistage random sampling. KAP scores were computed and the predictors of higher scores were assessed. RESULTS: a total of 504 respondents were surveyed. The mean KAP scores were relatively low: 9.8 ± 7.1 for knowledge (out of a maximum 34), 5.3 ± 3.4 for attitude (maximum = 10), and 5.2 ± 1.5 for practice (maximum = 7). The predictors of good knowledge were increasing age, post secondary education and professional occupation. The predictors of positive attitude were post secondary education and good TB knowledge. Good knowledge was a predictor of good practice. CONCLUSION: our findings underscore the need to improve the education about TB in underserved communities. Improving KAP scores will ultimately lead to higher rates of TB detection and treatment.