Factors associated with utilization of LLINs among women of child-bearing age in Igabi, Kaduna State, Nigeria.

BACKGROUND: The long-lasting insecticidal nets (LLIN) are effective against prevention of malaria and its utilization has been proven to save lives. Despite the mass distribution of LLIN, Nigeria remains the country with the highest malaria burden in Africa. The awareness of LLIN in Nigeria is high, but the utilization is low. The aim of this work is to describe factors associated with the utilization of LLIN among women of child-bearing age (WCBA) in Igabi, Kaduna, Nigeria. METHODS: A cross-sectional survey was conducted among 630 WCBA selected using a multi-stage sampling at 63 randomly selected villages in Igabi Local Government Area of Kaduna State. Trained female data collectors administered pre-tested structured questionnaires adapted from the Malaria Indicator Survey. Information collected were demographic profile, knowledge of LLIN as a preventive strategy for malaria, and LLIN ownership and utilization. LLIN utilization was assessed by identifying household members that slept under the hanged LLIN the night before the survey. Questions on the awareness of LLIN, ability to define what it is, use of LLIN, what differentiates LLIN from other bed nets, and duration of use before replacement, were scored and categorized as good, average and poor knowledge of LLIN. RESULTS: A total of 629 WCBA was sampled, their mean age (± SD) was 29.3 (± 6.2) years, 22.0% were pregnant, 40.5% had no formal education, 41.1% were employed, and 47.7% lived in rural communities. Awareness and good knowledge about LLINs for the prevention of malaria was 96.0% and 24.0%, respectively. The proportion of women who slept under a LLIN the night before the survey (utilization) was 70.0% and slightly higher (74.0%) among pregnant WCBA. Women who lived in rural communities were more likely to utilize LLINs compared to their urban counterparts (OR 3.4; 95% CI 2.3-4.9). Younger women (aged < 30 years) were less likely to utilize LLINs compared to the older women (OR 0.7; 95% CI 0.5-0.9). CONCLUSIONS: The knowledge of LLIN among WCBA was poor, but LLIN utilization was moderate. Living in rural communities and older WCBA were significant characteristics associated with LLIN utilization. Strategies that will improve the utilization of LLIN among the young and urban WCBA should be the focus of the Malaria Elimination Programme (MEP).

Costs and Patterns of Financing Maternal Health Care Services in Rural Communities in Northern Nigeria: Evidence for Designing National Fee Exemption Policy.

BACKGROUND: As population and access to information increases, so does the demand for health services. Unfortunately, many people who genuinely require these services do not usually have access to them. To increase access, various financing options have been used. Despite this, maternal morbidity and mortality rates remain high and spending is still largely out of pocket. This study assesses maternal health problems, preferred sources of care and the pattern of financing in a semi-rural community in North Western part of Nigeria. METHODOLOGY: A cross-sectional descriptive study design was used. The study population consisted of women within the reproductive age group who had experienced childbirth 12 months or less prior to the study. A sample size of 240 was drawn using cluster and random sampling techniques. Interviewer administered questionnaires were used and the results were analyzed using Statistical Package for Social Sciences (SPSS). RESULTS: The mean age of the respondents was 29 years and 49% had no personal income. Fever was the commonest problem. Although majority received antenatal care, those who lacked antenatal care mostly cited financial difficulties. Nearly half of the women delivered at home as opposed to a health facility. On average, women spent between Nigerian Naira (N) N1, 350-N14, 850 (USD$9-99) for a total package of maternal health services. Out of pocket spending by the husbands or household heads and the women themselves accounted for 73.3% of expenses. CONCLUSION AND PUBLIC HEALTH IMPLICATIONS: In Nigeria, women are still vulnerable to common and preventable causes of maternal morbidity and mortality due to lack of access to antenatal health care. Out of pocket spending is still a popular method of financing. Harmonization of fee exemption policies can improve access to maternal healthcare.

Stigmatization of people with mental illness among inhabitants of a rural community in northern Nigeria.

BACKGROUND: Despite the fact that mental illness is a common problem in society, people's perception of the mentally ill and community attitude towards them is still rather poor, making their rehabilitation and reintegration into society an uphill task. AIMS: To examine the stigmatization of people with mental illness within a rural community and identify the socio-demographic variables involved. METHOD: A cross-sectional descriptive study using a multi-stage random sampling technique to obtain data through an interviewer-administered questionnaire to 325 adult inhabitants of a rural community in Nigeria. RESULTS: The results showed widespread ignorance about causation, mode of transmission and remedies available for mental illness, with only 0.9% of respondents attributing mental illness to brain disease. The others attributed it to spiritual attack, punishment for evil doing and illicit psychoactive substance use, among other things. Negative views about the mentally ill were also widely expressed resulting in discriminatory practices. CONCLUSION: Stigmatization of people with mental illness is still rampant in our community. There is a need for adequate public education about the causes and mode of transmission of mental illness and the treatment options available in the community.