Sexual autonomy and the use of modern contraceptives in Nigeria: Evidence from the 2018 demographic and health survey.

Objective: The objective of the study was to determine the prevalence and relationship between sexual autonomy and modern contraceptive use among Nigerian women. Methods: Secondary data analysis of the 2018 Nigerian Demographic and Health Survey was conducted among Nigerian women aged 15-49 years who were married or had a partner. Analysis was conducted using descriptive analysis and univariate and multivariate logistic regression. P < 0.05 was considered statistically significant. Results: Participants that had never heard or seen a family planning awareness message were 59.6%, whereas 55.9% were capable of deciding whether to refuse their husband/partner's sex or not. The prevalence of modern contraceptive use was 12%, and the likelihood of using modern contraceptives increased with the level of education, wealth status, and the number of living children. Sexual autonomy was also a significant predictor of modern contraceptive use (odds ratio = 1.35, 95% confidence interval: 1.25-1.46). Conclusion: There is a very low prevalence of modern contraceptive use among women in Nigeria. Sexual autonomy, poverty, education, and the number of living children play a major role. Thus, women empowerment and girl-child education are critical interventions needed for the best outcomes on contraceptive use in Africa. Male involvement in sexual autonomy is also key since they are major decisionmakers regarding women's issues.

Résumé Objectif: L'objectif de l'étude était de déterminer la prévalence et la relation entre l'autonomie sexuelle et l'utilisation de méthodes contraceptives modernes chez les femmes nigériennes. Méthodes: L'analyse des données secondaires de l'enquête démographique et sanitaire nigérienne de l'année 2018 a été menée auprès de femmes nigérienne âgées de 15 à 49 ans mariées ou en couple. L'analyse a été effectuée à l'aide d'une analyse descriptive et d'une régression logistique univariée et multivariée. P < 0,05 était considéré comme statistiquement significatif. Résultats: Les participants qui n'avaient jamais entendu ou vu un message de sensibilisation à la planification familiale étaient 59,6 %, tandis que 55,9 % étaient capables de décider ou refuser les rapports sexuelles avec leur mari/partenaire. La prévalence de l'utilisation de méthodes contraceptives modernes était de 12 % et la probabilité d'utiliser des contraceptifs modernes augmentait avec le niveau d'éducation, la richesse et le nombre d'enfants. L'autonomie sexuelle était également un prédicteur significatif de l'utilisation de méthode contraceptives modernes (rapport des chances = 1,35, intervalle de confiance à 95 % : 1,25-1,46). Conclusion: Il y a une très faible prévalence de l'utilisation de méthodes contraceptives modernes chez les femmes nigériennes. L'autonomie sexuelle, la pauvreté, l'éducation et le nombre d'enfants jouent un rôle majeur. Ainsi, l'autonomisation des femmes et l'éducation des filles sont des interventions essentielles nécessaires pour obtenir les meilleurs résultats en matière d'utilisation des méthodes contraception en Afrique. L'implication des hommes dans l'autonomie sexuelle est également essentielle car ils jouent un rôle important dans les décisions concernant la vie de couple. Mots-clés: Utilization méthodes contraceptives, Enquête démographique et sanitaire, planification familiale, autonomie sexuelle, autonomisation des femmes.

Psychiatric morbidity among pregnant and non pregnant women in Ibadan, Nigeria.

A comparative cross-sectional study was conducted among 991 pregnant and 674 non-pregnant women of reproductive age attending healthcare facilities in Ibadan, Nigeria using the General Health Questionnaire-12 (GHQ), and WHO self-reporting questionnaire (SRQ). Logistic regression analysis was conducted to identify predictors of psychiatric morbidity at p < 0.05. A significantly higher proportion of pregnant women experienced psychological distress on the GHQ (51.8%) and psychiatric morbidity on SRQ (33.3%) compared with 28.6% and 18.2% of non-pregnant women, respectively. Predictors of psychiatric morbidity among pregnant women were the type of facility, poor satisfaction and communication with partners, the experience of violence in the home, previous abortions, and previous history of depression. Psychiatric morbidity among non-pregnant women was predicted by younger age, previous history of depression, poor satisfaction and communication with partners. There is a need for early identification of psychiatric morbidity among women of reproductive age, to ensure early interventions and prevent long-term disability.Impact statementWhat is already known on this subject? Psychiatric morbidity has immense effects on a woman's quality of life, social functioning, obstetric outcome, and economic productivity.What do the results of this study add? Psychiatric morbidity among women of reproductive age is high. Pregnant women when compared to non-pregnant women had significantly higher rates of psychiatric morbidity. This high prevalence of psychiatric morbidity in both groups was predicted by poor satisfaction and communication with partners, and a previous history of depression.What are the implications of these findings for clinical practice and/or further research? Simple screening for women of reproductive age attending healthcare facilities may help with the early identification of psychiatric morbidity leading to prompt interventions, and preventing long-term disability.

Diarrhoeal pathogens in the stools of children living with HIV in Ibadan, Nigeria.

Introduction: Diarrhoea can be debilitating in young children. Few aetiological investigations in Africans living with human immunodeficiency virus (HIV) have been performed since antiretrovirals became widely available. Methods: Stool specimens from children with diarrhoea living with HIV, and HIV-uninfected controls, recruited at two hospitals in Ibadan, Nigeria, were screened for parasites and occult blood, and cultured for bacteria. Following biochemical identification of at least five colonies per specimen, diarrhoeagenic Escherichia coli and Salmonella were confirmed by PCR. Data were line-listed and comparisons were made using Fisher's Exact test. Results: Only 10 children living with HIV could be enrolled during the 25-month study period and 55 HIV-uninfected children with diarrhoea were included for comparison. The most common pathogens overall were enteroaggregative E. coli (18/65, 27.7%), enteroinvasive E. coli (10/65, 15.4%), Cryptosporidium parvum (8/65, 12.3%) and Cyclospora cayetanensis (7/65, 10.8%). At least one pathogen was detected from seven of ten children living with HIV and 27 (49.1%) HIV-uninfected children. Parasite detection was associated with HIV positive status (p=0.03) with C. parvum specifically recovered more commonly from children living with HIV (p=0.01). Bacterial-parasite pathogen combinations were detected in specimens from four of ten children living with HIV but only 3(5.5%) HIV-uninfected children (p=0.009). Stools from five of ten children living with HIV and 7(12.7%) HIV-negative children (p = 0.014) contained occult blood. Discussion: Even though children living with HIV present infrequently to Ibadan health facilities with diarrhoea, their greater propensity for mixed and potentially invasive infections justifies prioritizing laboratory diagnosis of their stools.

Evaluation of physicians' knowledge of deprescribing, deprescribing tools and assessment of factors affecting deprescribing process.

BACKGROUND : Polypharmacy is a common global health concern in the older population. Deprescribing has been acknowledged as an important aspect of medication use review that helps to reduce polypharmacy, inappropriate medication uses and medication adverse events, thus ensuring medication optimization and improving health-related quality of life. As physicians are primarily responsible for prescribing and monitoring of drug therapy, their perception of deprescribing and knowledge of available deprescribing tools is highly important. This study aimed to explore physicians' knowledge of deprescribing, deprescribing tools and factors that may affect the deprescribing process. METHODS: This was a cross-sectional survey carried out among 70 physicians in selected units of a teaching hospital in Nigeria between May and June 2022. Social-demographic information, knowledge of deprescribing and deprescribing tools were obtained using a self-administered, semi-structured questionnaire, while barriers and enablers of medication deprescribing were assessed with modified Revised Patients' Attitudes Towards Deprescribing (rPATD) Questionnaire. Descriptive and bivariate analyses were carried out using SPSS and α was set at p < 0.05. RESULTS: Most of the physicians (56; 80.0%) were aware of the term "deprescribing" and had good knowledge (53; 75.7%) of the steps to deprescribing. However, (16; 22.9%) respondents knew of the deprescribing tools, of this, (5; 31.3%) were aware of Beers criteria and STOPP/START criteria. Awareness of the term "deprescribing" was significantly associated with knowledge of deprescribing steps (p = 0.012), while knowledge of deprescribing tools was significantly associated with; awareness of the term "deprescribing" (p = 0.029), and daily encounters with older multimorbid patients (p = 0.031). Very important factor affecting physicians deprescribing decisions include benefit of the medication. The most common barrier is lack of information for a full clinical picture of the patient. CONCLUSION: The physicians had good knowledge of the term "deprescribing" and the steps to deprescribing. Specific measures to target the barriers faced by the physicians in deprescribing medications and policies to implement physicians use of existing guidelines to facilitate their deprescribing decisions are essential.

Sexual autonomy and the use of modern contraceptives in Nigeria evidence from the 2018 demographic and health survey

Objective: The objective of the study was to determine the prevalence and relationship between sexual autonomy and modern contraceptive use among Nigerian women. Methods: Secondary data analysis of the 2018 Nigerian Demographic and Health Survey was conducted among Nigerian women aged 15-49 years who were married or had a partner. Analysis was conducted using descriptive analysis and univariate and multivariate logistic regression. P < 0.05 was considered statistically significant. Results: Participants that had never heard or seen a family planning awareness message were 59.6%, whereas 55.9% were capable of deciding whether to refuse their husband/partner's sex or not. The prevalence of modern contraceptive use was 12%, and the likelihood of using modern contraceptives increased with the level of education, wealth status, and the number of living children. Sexual autonomy was also a significant predictor of modern contraceptive use (odds ratio = 1.35, 95% confidence interval: 1.25-1.46). Conclusion: There is a very low prevalence of modern contraceptive use among women in Nigeria. Sexual autonomy, poverty, education, and the number of living children play a major role. Thus, women empowerment and girl-child education are critical interventions needed for the best outcomes on contraceptive use in Africa. Male involvement in sexual autonomy is also key since they are major decisionmakers regarding women's issues.

Prevalence and pattern of intimate partner violence among men and women in Edo State, Southern Nigeria.

BACKGROUND:  Intimate partner violence (IPV) is a growing concern in Nigeria and globally. Although women are at greater risk of IPV, men are also affected, but this is less reported. AIM:  This study sought to determine the prevalence and pattern of IPV among the respondents and to compare the pattern of IPV among the male and female respondents. SETTING:  The study was conducted in six towns (local government headquarters) across the three senatorial districts in Edo State, Southern Nigeria. METHODS:  The study was a descriptive, cross-sectional, community-based study. A multistage sampling technique was used in selecting 1227 respondents from Edo State, Southern Nigeria. A semistructured, interviewer-administered questionnaire and the Extended Hurt, Insult, Threaten, Scream (E-HITS) tool were used to collect data, which were analysed with Epi Info version 7.1.2.0. RESULTS:  The study found an IPV prevalence of 37.7% among the respondents (confidence interval [CI]: 95%, odds ratio [OR]: 0.169-0.294). The mean age was 38 ± 12 and respondents were mostly female (725, 59.1%), married (770, 62.8%) and unemployed (406, S33.1%), with a tertiary level of education (766, 62.4%). Intimate partner violence was significantly higher among women compared with men (95% CI: 4.474, OR: 3.425-5.846). The pattern of IPV showed a lower OR between sexual and physical IPV (95% CI: 0.276, OR: 0.157-0.485). There was a higher likelihood of IPV among married women (95% CI: 1.737, OR: 1.279-2.358). CONCLUSION:  There is a need to improve the socio-economic status of the Nigerian populace, especially women. Healthy, nonviolent and safe relationships should be promoted in communities by signalling what is socially unacceptable and strengthening sanctions against perpetrators.

Nutrition-related knowledge, practice, and weight status of patients with chronic diseases attending a district hospital in Nigeria.

Background: Africa is experiencing an epidemic of non-communicable diseases (NCDs), and the projected mortality from NCDs by 2030 will overtake the combined mortality from communicable diseases. Nutrition is a key modality for preventing and treating NCDs, and optimal nutrition knowledge is essential for self-care. Aim: This study assessed the nutritional-related knowledge, dietary practice, and weight status of patients with non-communicable diseases attending State Specialist Hospital, Ring Road, Ibadan, Nigeria. Methods: This hospital-based descriptive cross-sectional study was conducted among 302 adult patients with chronic diseases attending a district hospital in Ibadan, Nigeria. Data were obtained using a semi-structured interviewer's administered questionnaire on sociodemographic, diet-related knowledge and dietary practices, sources of dietary information and body mass index. The knowledge and practice score was calculated, and Chi-squared test was used to evaluate associations between socio-demographics, nutrition-related knowledge and practices; statistical significance was set at P < 0.05. Results: The mean age of respondents was 61.94 ± 10.60, and 74.4% were women. Overall, 61.3% of the respondents had good nutrition knowledge, with a higher proportion among women (61.8%) than men (59.5%). However, more women were overweight (33.2%) or obese (21.7%). There was a significant difference in the knowledge of respondents based on income (P < 0.034), duration of illness (P < 0.012), as well as nutrition practice (P < 0.000). Conclusion: There was a high prevalence of overweight and obesity among the participants despite the overall satisfactory nutritional knowledge. Hence, primary care physicians as frontline doctors coordinating care need to advocate for holistic weight reduction strategies in managing chronic diseases.

Socio-economic factors associated with antenatal care in Nigeria.

There is a dearth of knowledge on how much financial autonomy interacts with affordability and consequently access to ante-natal health care in Nigeria. This study evaluated the relationship between women's financial autonomy and utilization of antenatal care (ANC) services. ANC attendance during pregnancy and the financial autonomy of women aged 15-49 in 42,000 selected households across all 36 states and the FCT, was assessed using data from the 2018 NDHS. Descriptive statistics and bivariate and multivariate logistic regression analyses were carried out and significant predictors were tested at a 95% significance level. The proportion of women considered to have no financial, partial and full autonomies were 63.1%, 32.0% and 4.9% respectively. Living in an urban region was a statistically significant predictor of financial autonomy among women and the odds of financial autonomy increased with the level of education and wealth index. Type of residence and occupation type were also significant predictors of ANC utilization. Full financial autonomy to make financial decisions did not significantly improve the odds of antenatal health care services during pregnancy (OR = 1.03; 95% CI: 0.87 - 1.22). Other factors such as education, employment and wealth index of the women were more significantly associated with antenatal care attendance. A call for improved educational facilities and wealth creation schemes at national and sub-national levels of government is necessary to improve ante-natal care utilization in health care facilities.

The contribution of family physicians to primary health care: Experiences from southwest Nigeria.

Although an emerging speciality in Africa, family medicine contributes significantly to African health systems. Leadership from family physicians can enable the delivery of high-quality primary health care that is accessible, comprehensive, coordinated, continuous and person-centred. This short report chronicles how family physicians from a university teaching hospital in Ibadan, Nigeria, adopted a health post located in a home for persons with mild physical and mental disabilities and changed it into a hub of comprehensive, holistic and person-centred care for residents and staff of the home, as well as individuals and families in the neighbouring communities and its environs. The Department of Family Medicine of the University College Hospital, Ibadan, with the aid of a benefactor, reorganised a modest health facility to include the services of family medicine senior registrars (undergoing training-related rotations) with supervision by consultant family physicians. Family physicians led the primary health care team that provided both facility-based care and community outreach services. This report demonstrates how family physicians can improve the quality of primary health care and outcomes such as health equity in the community served.

Development of a video-observation method for examining doctors' clinical and interpersonal skills in a hospital outpatient clinic in Ibadan, Oyo State, Nigeria.

BACKGROUND: Improving the quality of primary healthcare provision is a key goal in low-and middle-income countries (LMICs). However, to develop effective quality improvement interventions, we first need to be able to accurately measure the quality of care. The methods most commonly used to measure the technical quality of care all have some key limitations in LMICs settings. Video-observation is appealing but has not yet been used in this context. We examine preliminary feasibility and acceptability of video-observation for assessing physician quality in a hospital outpatients' department in Nigeria. We also develop measurement procedures and examine measurement characteristics. METHODS: Cross-sectional study at a large tertiary care hospital in Ibadan, Nigeria. Consecutive physician-patient consultations with adults and children under five seeking outpatient care were video-recorded. We also conducted brief interviews with participating physicians to gain feedback on our approach. Video-recordings were double-coded by two medically trained researchers, independent of the study team and each other, using an explicit checklist of key processes of care that we developed, from which we derived a process quality score. We also elicited a global quality rating from reviewers. RESULTS: We analysed 142 physician-patient consultations. The median process score given by both coders was 100 %. The modal overall rating category was 'above standard' (or 4 on a scale of 1-5). Coders agreed on which rating to assign only 44 % of the time (weighted Cohen's kappa = 0.26). We found in three-level hierarchical modelling that the majority of variance in process scores was explained by coder disagreement. A very high correlation of 0.90 was found between the global quality rating and process quality score across all encounters. Participating physicians liked our approach, despite initial reservations about being observed. CONCLUSIONS: Video-observation is feasible and acceptable in this setting, and the quality of consultations was high. However, we found that rater agreement is low but comparable to other modalities that involve expert clinician judgements about quality of care including in-person direct observation and case note review. We suggest ways to improve scoring consistency including careful rater selection and improved design of the measurement procedure for the process score.

Enrollees' Knowledge and Satisfaction with National Health Insurance Scheme Service Delivery in a Tertiary Hospital, South West Nigeria.

BACKGROUND: Social health insurance scheme provides a platform for mobilizing revenue for health and enhances universal health-care coverage. In addition, knowledge about patients' satisfaction with health care under the scheme will help in identifying gaps and provides evidence toward strengthening the scheme. This study assessed enrollees' knowledge about the National Health Insurance Scheme (NHIS) and satisfaction with health services provided under the scheme. MATERIALS AND METHODS: The study was a descriptive cross-sectional survey conducted among the NHIS enrollees accessing health-care services in the University College Hospital, Ibadan. A total of 373 individuals were consecutively recruited for the study, and a semi-structured, pretested interviewer-administered questionnaire was used to obtain information from respondents. Descriptive statistics was used to present results, and Chi-square test was used to test for the association between categorical variables. The level of significance was set at P < 005. RESULTS: The mean age was 42.5 ± 10.0 years. Of the respondents, 209 (56.0%) were male and 359 (96.2%) were married. About two-thirds, 227 (60.9%), had good knowledge about the NHIS. Majority of the respondents 303 (81.2%) reported paying for some of the costs of service (drugs, laboratory tests, consultation fees, and X-ray) through out-of-pocket and of these, 218 (71.9%) reported that such payments were occasional. Overall, slightly more than half, 197 (52.8%), of the respondents were satisfied with service delivery under the scheme. Female respondents were significantly more satisfied with health-care services (χ2 = 3.894,P = 0.048). CONCLUSION: There was good knowledge of NHIS, but the level of satisfaction with service delivery was not outstandingly appreciable. There is an urgent need to improve on all areas of quality of service to improve satisfaction with care among enrollees in the scheme.

Targeting women with free cervical cancer screening: challenges and lessons learnt from Osun state, southwest Nigeria.

INTRODUCTION: The study was conducted to determine the challenges and suggest solutions to conducting free cervical cancer screening among Nigerian women. METHODS: Awareness was created among women groups and mass media in Osun State for women to undergo free cervical cancer screening programme. Consenting women had their socio-demographic characteristics, awareness and uptake of HPV vaccine documented and papanicolaou smear procedure done with adequate referral for treatment given where necessary. RESULTS: A total of 287 women had cervical cancer screening. Mean (SD) age was 51.6 (14.3) years. Most participants were urban based (87.1%), married (63.1%), had secondary education (39%) and were traders (79.1%). None of the women were aware of the preventive HPV vaccine or had been vaccinated against HPV. About 6% were pre-invasive while 0.7% had invasive cervical cancer. The highest proportions of respondents affected were young, married and had lower education. Challenges identified included poor attendance, low risk perception and logistic issues. CONCLUSION: Most participants were urban based. There is need to decentralize cancer of cervix screening through mobile clinics and establishment of screening centres in the rural areas. Neighbour to neighbour sensitization is essential. Also, HPV vaccine should be available and affordable to all girls before sexual maturity.