Description of the design of a mixed-methods study to assess the burden and determinants of malaria transmission for tailoring of interventions (microstratification) in Ibadan and Kano metropolis.

BACKGROUND: Rapid urbanization in Nigerian cities may lead to localized variations in malaria transmission, particularly with a higher burden in informal settlements and slums. However, there is a lack of available data to quantify the variations in transmission risk at the city level and inform the selection of appropriate interventions. To bridge this gap, field studies will be undertaken in Ibadan and Kano, two major Nigerian cities. These studies will involve a blend of cross-sectional and longitudinal epidemiological research, coupled with longitudinal entomological studies. The primary objective is to gain insights into the variation of malaria risk at the smallest administrative units, known as wards, within these cities. METHODS/RESULTS: The findings will contribute to the tailoring of interventions as part of Nigeria's National Malaria Strategic Plan. The study design incorporates a combination of model-based clustering and on-site visits for ground-truthing, enabling the identification of environmental archetypes at the ward-level to establish the study's framework. Furthermore, community participatory approaches will be utilized to refine study instruments and sampling strategies. The data gathered through cross-sectional and longitudinal studies will contribute to an enhanced understanding of malaria risk in the metropolises of Kano and Ibadan. CONCLUSIONS: This paper outlines pioneering field study methods aimed at collecting data to inform the tailoring of malaria interventions in urban settings. The integration of multiple study types will provide valuable data for mapping malaria risk and comprehending the underlying determinants. Given the importance of location-specific data for microstratification, this study presents a systematic process and provides adaptable tools that can be employed in cities with limited data availability.

Prevalence, determinants and coercive strategies relating to marital rape among women in Oyo State, Nigeria.

Objectives: The study assessed the prevalence, determinants and coercive strategies relating to Marital Rape (MR) among women in Oyo State, Nigeria. Design: A cross-sectional survey. Setting: The study was conducted in 120 communities, 30 wards, 6 Local Government Areas in Oyo State. Participants: A total of 1200 ever-married women aged 18-60 years were recruited using a multi-stage sampling. Methods: The participants were interviewed using a semi-structured questionnaire which captured MR-related experiences and coercive strategies. Data were analysed using descriptive statistics, Chi-square, and logistic regression. Odds ratios (OR) and their corresponding 95% Confidence Interval (CI) were reported. Results: Respondents' mean age was 36.6±9.6 years, while husbands' mean age was 42.1±10.3 years. Most (n=1094, 91.2%) respondents had ever married once and 82.8% (n=993) were currently married. The prevalence of MR was 15.3%. Physical force (n=153, 25.9%), followed by threat (n=139, 23.5%) topped the list of coercive strategies involved in MR. Currently, married women were at a higher risk of MR (OR: 2.73, CI: 1.39-5.37, P = 0.04) relative to divorced women. Respondents whose husbands were aged <30 years were at lower risk of MR (OR:0.03, CI: 0.002-0.47, P=0.01). Women who take decisions on sex alone were more likely to suffer MR (OR:3.95, CI: 1.38 - 11.31, P=0.01). Conclusions: Marital rape existed among women with increased risk among those who were currently married, married to older partners or sole decision-makers on sex. Physical force was the commonest coercive strategy used to facilitate MR. Community-based MR -related interventions are recommended. Funding: None declared.

Community acceptance, satisfaction, and support for case management of malaria of various degrees in selected rural communities in Ibadan, Oyo-State.

Objectives: This study aimed to assess communities' perception and adoption of the evidenced-based malaria diagnosis and case management intervention targeted at under-five children. The effectiveness of trained Volunteer Community Health Workers (VCHWs) to diagnose malaria among under-five children using rapid diagnostic testing kit, provide treatment using Artemisinin Combination Therapy and rectal Artesunate were assessed. Design: A qualitative evaluation study was conducted in October 2015. Setting: Communities in the 6 rural wards in Ona-Ara Local Government Area, Oyo State Nigeria. Participants: Caregivers of under-five children, community-based frontline health workers, and community leaders selected using purposively sampling. Methods: Nine Focus Group Discussions and 15 Key Informant Interviews were conducted using a pre-tested guide. Data were subjected to thematic analysis. Results: It was disclosed that VCHWs promoted people's access to prompt and appropriate malaria treatment. The communities accepted the VCHWs; the reasons given for this included the following: effectiveness of VCHWs in case management of malaria; good inter-personal relationship with caregivers; and the positive health outcomes associated with services provided by them. In addition, community members expressed satisfaction with the VCHWs and provided them with all the support needed to function throughout the malaria case management intervention. The VCHWs considered the support as a great source of encouragement. Conclusions: The use of VCHWs to treat malaria was adjudged to be effective and considered acceptable to the communities. The adoption of the intervention and its integration into the primary health system by the government is advocated for in medically underserved rural communities. Funding: This work was supported by UNICEF/UNDP/World Bank/WHO Special Programme for Research & Training in Tropical Diseases, World Health Organization, Geneva, Switzerland (project ID: A80550 [Nigeria] through funds made available by the European Commission (FP7) for research to improve community access to health interventions in Africa.

Is the malaria short course for program managers, a priority for malaria control effort in Nigeria? Evidence from a qualitative study.

BACKGROUND: A Malaria Short Course (MSC) was conceptualized to build the capacity of program managers for malaria control due to the lack of a single comprehensive broad-based programmatic training in Nigeria. Prior to its implementation, a needs assessment was conducted based on the perspectives of stakeholders to plan and develop the curriculum. METHODS: This was an exploratory qualitative study. Fifty-six purposively selected stakeholders at local, state and national levels were interviewed. Opinions on the need for training, its perceived impact, priority focus, likelihood of participation, sustainability of and planned support for the MSC were explored using a pretested researcher-designed interview guide. Interviews were audiotape recorded, and the transcripts were subjected to thematic content analysis. RESULTS: Participants included Directors of Primary Health Care (50%), State Malaria Program Officers (8.9%), State Directors of Public Health Services (7.1%) and Roll Back Malaria Officers (5.4%). Participants' mean number of years of experience in their current positions was 6.2 (SD 4.7) years. The dominant view was "malaria remains a problem in Nigeria, exacerbated by poor funding, knowledge deficit, lack of training opportunities for program managers and prioritized training budget". A common viewpoint was "to achieve the malaria policy goals, MSC should focus on improving program managers' knowledge of the disease, novel interventions, data audit and use of data for decision making, supportive supervision as well as leadership and management skills. The prioritized thematic areas were malaria epidemiology, case management and data management. The consensus opinion was the MSC would have a positive impact on the performance of program managers. All managerial participants were willing to release their staff for the MSC and encouraged step-down training. However, most participants opined they could not guarantee that their institutions would provide financial support to the MSC attendees. CONCLUSIONS: Implementing the MSC for program managers was considered essential towards achieving malaria control. Moreover, there is need for prioritized funding and sustainability mechanisms to actualize the implementation of the course.

A Review of the Conceptual Issues, Social Epidemiology, Prevention and Control Efforts Relating to Rape in Nigeria.

Rape is an endemic criminal sexual behaviour in Nigeria and its perpetration not only violates survivors' dignity but also compromises their health and wellbeing. The rape-related data used in this traditional literature review are derived mainly from small-scale surveys conducted in Nigeria. The deviant behaviour could be perpetrated against both males and females of various socio-demographic characteristics; however, it is young females that are disproportionately more affected. The determinants of rape include factors that are associated with adverse social, cultural and economic conditions. In Nigeria the prevention and control of the practice involve stakeholders such as parents, Non-governmental Organisations, religious institutions, government ministries as well as government agencies that constitute the criminal justice system. The criminal justice system uses existing legal statutes on rape to arrest, prosecute, adjudicate, and punish offenders. The barriers to the control and prevention of rape in Nigeria include the following: inappropriate perception; social stigmatization; under-reporting; and cumbersome legal requirements needed to establish a case of rape. Strategies with potentials for curbing rape in the country include public enlightenment, multi-sectoral action, advocacy, amendment of rape-related laws; training targeted at personnel in health care and criminal justice systems and formulation of evidence-based policies.

Setting a Nigeria national malaria operational research agenda: the process.

BACKGROUND: Employing malaria operational research (MOR) findings in planning national malaria control programmes is gaining increased attention. The malaria control foci are diverse, resources are limited; therefore, agreeing on priority areas is critical. Hitherto, the process of prioritising MOR questions in Nigeria has been limited to few stakeholders. In support of the National Malaria Elimination Programme's (NMEP) effort at setting a MOR agenda, the Nigeria Field Epidemiology and Laboratory Training Programme (NFELTP) in collaboration with NMEP conducted preliminary exploratory study to identify key malaria research gaps and needs, and provide data to inform setting a robust national MOR agenda. The process of generating data is presented in this paper. METHODS: A twelve-member task-team comprising NFELTP, university researchers and NMEP officers was commissioned. Following an inaugural meeting the task-team developed a framework of activities and held five planning meetings, conducted five-week online and self-administered paper-based surveys, key informant interview (KII), two-day desk review workshop, seven-day qualitative data analysis, ten-day result and five-day report writing workshops. Paired group members conducted the interviews across six geopolitical zones of Nigeria. Abridged study report was used for a two-day MOR setting agenda stakeholders' workshop. RESULTS: A structured framework, study protocol and data collection instruments were developed and submitted for ethical approval. The instruments included survey questionnaire for detailed information on researchers and other stakeholders' experience with MOR, the gaps and needs in thematic MOR areas; KII and Delphi guides. After an initial scoping review, primary data were collected from purposively selected survey participants using mixed methods: - online survey (n = 100), self-administered paper-based survey (n = 85), KII (n = 40), desk review workshop (n = 22) and Delphi interviews (n = 8). Comprehensive lists of research gaps/bottlenecks and needs were generated for each thematic area in malaria control. These were used at a two-day national MOR setting stakeholder workshop (n = 54) to guide the development of national MOR agenda document. CONCLUSIONS: A systematic approach involving broad stakeholder engagement provided data and evidence-based information for development of a robust national MOR agenda. The processes involved are recommended for use in malaria endemic settings.

A qualitative exploration of malaria operational research situation in Nigeria.

BACKGROUND: Malaria, remains one of the leading causes of high morbidity and mortality in Nigeria despite implementation of several public health interventions for its control. Operational limitations and methodological gaps have been associated with malaria control interventions and research, and these have necessitated the need for a well-tailored Malaria Operational Research (MOR) agenda. However, there is paucity of evidence-based information on relevant stakeholders' experience, awareness, perceptions and use of MOR and suggestions on setting MOR agenda. As part of a larger study to provide data for national MOR agenda setting, we assessed the MOR research situation from the perspectives of key stakeholders in Nigeria and contribution of MOR to the malaria elimination agenda. METHODS: We conducted key informant interviews among 40 purposively selected stakeholders from the six geo-political zones in Nigeria. Data was collected using a pre-tested key informant interview guide which comprised issues related to experience, awareness, use of MOR and MOR needs, and suggestions for MOR. We conducted a detailed content analysis. RESULTS: Half of the participants had participated in MOR. Participants perceived MOR as important. Only few were aware of existing framework for MOR in Nigeria while above half expressed that MOR is yet to be used to inform policy in Nigeria. Participants identified several MOR needs such as development of improved diagnostic techniques, and interventions for promoting early diagnosis, prompt treatment and quality programmatic data. Participants opined the need for country-specific prioritised MOR agenda that cut across malaria thematic areas including malaria prevention and case management. Participants suggested the involvement of various stakeholders and multi-disciplinary approach in setting MOR. CONCLUSION: Although some stakeholders have been involved in MOR, it is still rarely used to inform policy and several needs exist across thematic areas. A broad-based stakeholder involvement, multi-disciplinary approach to agenda setting and its wide dissemination have been suggested.

A Qualitative Exploration of Date Rape Survivors' Physical and Psycho-Social Experiences in a Nigerian University.

Date rape (DR) is a serious but under-recognized public health problem that affects female university undergraduates. The burden of the problem in Nigerian universities is, however, yet to be fully investigated. The study was designed to explore the physical and psycho-social experiences of DR female survivors at the University of Ibadan. The study was qualitative in nature and involved eight consenting DR survivors. A pre-tested In-Depth Interview (IDI) guide that included questions relating to survivors' personal profile, context of DR experienced, factors that promoted survivors' vulnerability, reported adverse health consequences, help-seeking behaviors, and effects of the rape episode on dating relationship was used to facilitate the conduct of the narrative interview. The interviews were conducted in accordance to the protocol approved by the Joint University of Ibadan and University College Hospital Ethics Review Committee, and were taped-recorded and subjected to content analysis. Participants' mean age was 17.3 ± 2.3 years. All the participants were teenagers when they were first raped. Coercive and deceptive means were used to perpetrate the act of rape. Participants' use of verbal appeals, crying, and physical resistance to prevent being raped proved abortive. The experienced adverse physical health consequences included vaginal bleeding and injury. Major psycho-social effects of the experienced DR included self-blame, depression, hatred for men, and suicidal feelings. DR experiences occurred mainly in isolated settings, and most participants could not seek for medical help and other forms of care due to fear of being stigmatized. Some of the DR survivors continued their dating relationships when apologies were tendered by the perpetrators. DR is a traumatic experience, which is characterized by physical and psycho-social adverse effects. DR survivors, however, rarely seek for help as a result of the fear of being stigmatized. Multiple behavioral change interventions are needed to address the phenomenon.

Knowledge and perceptions of date rape among female undergraduates of a Nigerian university.

This paper focuses on knowledge and perceptions of Date Rape (DR) among female undergraduates of the University of Ibadan. The cross-sectional survey was conducted among 651 female undergraduates selected using a four-stage random sampling technique. A semi-structured questionnaire which included a 6-point knowledge scale and a 21-points perceptions scale was used to collect data. Knowledge scores of 0- 2, 3- 4 and 5- 6 were rated as poor, fair and good respectively. Perception scores of 0-10 and 11-21 were categorized as supportive and non-supportive perception of DR respectively. Data were analyzed using descriptive statistics and Chi-square at p < 0.05. Mean knowledge score was 2.3 +/- 2.1 and 50.0% participants had poor knowledge of DR. Knowledge of DR increased significantly by level of study. Participants' had a mean perception score of 9.1 +/- 2.8 and 66.9% had perceptions supportive of DR. Campus-based educational programme have potentials for addressing the phenomenon.