Process evaluation of the 'Lafiyan Yara' project on enhancing access to HIV testing services using existing community structures in Nigeria.

BACKGROUND: The Lafiyan Yara Project aimed to increase demand for HIV counselling, testing, treatment, and prevention services among pregnant women and children in Taraba State, Nigeria. Implemented from 2019 to 2021, the project utilized existing community structures, including traditional birth attendants, village health workers, and patent and proprietary medicine vendors, for mobilization. This study assessed the project's activities, contributors, relevance, effectiveness, and efficiency. METHODS: The process evaluation was conducted using focus group discussions and key informant interviews with beneficiaries, community leaders, project staff, health facility personnel, and government officials. Data analysis employed framework analysis. RESULTS: The Lafiyan Yara project was reported to have achieved notable successes, including increased HIV testing rates among children and pregnant women, improved linkage to care services, reduced mother-to-child transmission of HIV, increased HIV/AIDS awareness and knowledge, and enhanced community engagement and support. Challenges identified included insufficient funding for community mobilizers, training needs for health workers, and inadequate availability of test kits at health facilities. Confidentiality and stigma issues arose during community mobilizations. A key lesson learned was the importance of a comprehensive HIV care approach, emphasizing testing and ensuring support for individuals testing positive. CONCLUSIONS: The project's approach of leveraging community structures to create demand for HIV services among women and children proved effective, provided proper linkage to care for those testing positive. Addressing stigma and involving husbands/fathers in the community approach are crucial for improving outcomes. TRIAL REGISTRATION: IPHOAU/12/1384.

Leveraging Responsive Feedback to Redesign a Demand Generation Strategy: Experience From the IntegratE Project in Lagos State, Nigeria.

Use of modern contraceptives in Nigeria is low (12%) despite very high knowledge of modern methods (92%). Knowledge of modern methods of contraception in Lagos and Kaduna is high at nearly 100% and 94%, respectively, yet contraceptive use in Lagos and Kaduna remains low at 29% and 14%, respectively. Demand generation was a key strategy in increasing contraceptive uptake through the involvement of providers in the private sector (community pharmacists and patent and proprietary medicine vendors) in family planning service delivery.We describe how an interpersonal communication strategy was modified using a responsive feedback approach and detail the insights gained in implementing an individual compared with a group interpersonal communication strategy during the implementation of the IntegratE Project in Lagos State, Nigeria. We conducted monthly pause-and-reflect sessions for interpersonal communication agents to pause and reflect on lessons learned and address challenges. Using the responsive feedback approach helped to improve contraceptive uptake by adopting a group strategy. Also, the monthly pause-and-reflect sessions have helped interpersonal communication agents see program implementation as a collective responsibility.

Operationalizing strategies for expanding UHC for the vulnerable population in Nigeria.

People living in vulnerable conditions have often been neglected or have a low coverage in health insurance which exacerbate poverty, vulnerability and social exclusion. This necessitates building and implementing insurance coverage that fully integrates social protection systems and community-based social care that prioritise the needs of the most vulnerable. To that end, we propose a decentralized system of sustainable financing and management of the vulnerable group fund that is performance driven with multi-stakeholder accountability systems premised on integrated data management. Integrating these elements will ensure that some of the existing gaps in the basic healthcare provision fund implementation in Nigeria are addressed with the following fundamental building blocks for the vulnerable group fund. These recommendations will help governments, resource partners and relevant stakeholders to consider in formulating strategies for operationalizing the vulnerable group funds and decreasing health inequalities among the population. In addition to implementation of this to accelerate universal health coverage and social protection, this will help to mitigate the currents challenges that exacerbate the inequality gaps, and build more resilient health and social protection systems, including the systems within humanitarian crises settings.

Use of Objective Structured Clinical Examination (OSCE) in a hybrid digital / in-person training for hormonal IUD in Nigeria: findings and applications of the approach.

Background: The hormonal intrauterine device, a long-acting reversible contraceptive method, is being introduced to pilot sites in the private and public sector in Nigeria by the Nigerian Federal Ministry of Health since 2019. To inform training of health care providers, a study was conducted on a hybrid digital and in-person training which utilized Objective Structured Clinical Examination (OSCE) to assess competency of provider trainees. This study represents one of few documented experiences using OSCE to assess the effectiveness of a digital training. Methods: From September - October 2021, in Enugu, Kano and Oyo states of Nigeria, 62 health care providers from public and private sector health facilities were trained in hormonal IUD service provision using a hybrid digital / in-person training approach. Providers, who were skilled in provision of copper IUD, underwent a didactic component using digital modules, followed by an in-person practicum, and finally supervised service provision in the provider trainee's workplace. Skills were assessed using OSCE during the one-day practicum. Results: Use of the OSCE to assess skills provided valuable information to study team. The performance of provider trainees was high (average 94% correct completion of steps in the OSCE). Conclusions: OSCE was used as a research methodology as part of this pilot study; to date, OSCE has not been integrated into the training approach to be scaled up by FMOH. Uniformly high performance of provider trainees was seen on the OSCE, unsurprising since provider trainees were experienced in providing copper IUD. If and when training is rolled out to providers inexperienced with copper IUD, OSCE may have a more important role to assess skills before service provision. The role of OSCE in design of hybrid digital / in-person training approaches should be further explored in rollout of hormonal IUD and other contraceptive technologies.

Effectiveness of community mobilisation models in improving HIV testing services uptake among women and children in Nigeria: A quasi-experimental study.

Nigeria carries a high burden of HIV infections, with Taraba State having a prevalence of 2.49%. This quasi-experimental study evaluated the impact of the Lafiyan Yara project, which utilised various community-based mobilisation models, on the enhancement of HTS uptake among women during pregnancy, and children. The intervention involved the implementation of mobilisation by Traditional Birth Attendants (TBA), Village Health Workers (VHW), Patent and Proprietary Medicine Vendors (PPMVs), and a combination of the three in four study local government areas (LGA) in Taraba State. Baseline and end-line surveys were conducted focused on women aged 15-49 years who delivered a child in the past 1 year, and children in their households, in the study and a control LGA. A difference-in-difference (DID) approach was applied by using a probit regression model with interaction terms for treatment status (intervention vs. control) and survey timing to compute the DID estimates of uptake of HTS. The TBA model showed the highest impact in the referral of women to HTS, while the combined model demonstrated the greatest impact in referrals for children. Scaling up and strengthening these community mobilisation efforts can improve access to HIV testing and contribute to HIV/AIDS prevention and control in the region.

Use of a hybrid digital training approach for hormonal IUD providers in Nigeria: results from a mixed method study.

BACKGROUND: In Nigeria, in-service trainings for new family planning (FP) methods have typically been conducted using a combination of classroom-based learning, skills labs, and supervised practicums. This mixed-methods study evaluated the feasibility, acceptability, provider competency, and costs associated with a hybrid digital and in-person training model for the hormonal intrauterine device (IUD). METHODS: The study was conducted in Enugu, Kano, and Oyo states, Nigeria, and enrolled FP providers previously trained on non-hormonal IUDs. Participants completed a digital didactic training, an in-person model-based practicum with an Objective Structured Clinical Examination (OSCE), followed by supervised provision of service to clients. Provider knowledge gains and clinical competency were assessed and described descriptively. Data on the feasibility, acceptability, and scalability of the approach were gathered from participating providers, clinical supervisors, and key stakeholders. Training costs were captured using an activity-based approach and used to calculate a cost per provider trained. All analyses were descriptive. RESULTS: Sixty-two providers took the hybrid digital training, of whom 60 (91%) were included in the study (n = 36 from public sector, n = 15 from private sector, and n = 9 both public/private). The average knowledge score increased from 62 to 86% pre- and post-training. Clinical competency was overall very high (mean: 94%), and all providers achieved certification. Providers liked that the digital training could be done at the time/place of their choosing (84%), was self-paced (79%), and reduced risk of COVID-19 exposure (75%). Clinical supervisors and Ministry of Health stakeholders also had positive impressions of the training and its scalability. The hybrid training package cost $316 per provider trained. CONCLUSIONS: We found that a hybrid digital training approach to hormonal IUD service provision in Nigeria was acceptable and feasible. Providers demonstrated increases in knowledge following the training and achieved high levels of clinical competency. Both providers and clinical supervisors felt that the digital training content was of high quality and an acceptable (sometimes preferable) alternative to classroom-based, in-person training. This study provided insights into a hybrid digital training model for a long-acting contraceptive, relevant to scale-up in Nigeria and similar settings.

Enablers and barriers to effective HIV self-testing in the private sector among sexually active youths in Nigeria: A qualitative study using journey map methodology.

BACKGROUND: HIV is a public health burden in Nigeria. HIV self-testing is one of the approaches to testing, which is the first of the 95:95:95 cascade of a coherent response to the epidemic. The ability to self-test HIV is influenced by various factors that can either serve as enablers or barriers. Exploring these enablers and barriers to the uptake of HIVST will help achieve optimal HIV self-testing and provide a deeper understanding of the HIVST kits users' journey. OBJECTIVE: The purpose of the study was to identify enablers and barriers to the uptake of HIV self-testing among sexually active youth in Nigeria using journey map methodology. METHODS: We conducted a qualitative exploratory study between January 2021 to October 2021 to understand the journey map for taking up and using HIVST in the private health delivery systems which include the pharmacies and PPMVs. 80 youths in Lagos, Anambra and Kano states were interviewed using IDIs and in-person FGDs. Their responses were audio-recorded, transcribed and analyzed using a qualitative software package (Nvivo software). RESULTS: A journey map for taking up and effectively using HIVST using the private sector among sexually active youths using key enablers and barriers at the attract, purchase, use, confirmation, linkage, and reporting stage was developed. The major enablers among participants were privacy and confidentiality, bundling purchases with other health products, easy-to-use instructions, and past experience with other self-testing kits. The major barriers were fear of discrimination, big packaging, high price, lack of confidence from user error and fear of status disclosure. CONCLUSIONS: Sexually active young people's perspectives enhance our understanding of the barriers and enablers of using HIVST through the private sector. Optimizing the enablers such as improved confidentiality that may be seen in e-pharmacy, reducing barriers and factoring sexually young people's perspectives will enhance the market and the uptake of HIVST towards ensuring sustainability and accelerating progress towards the 95-95-95 targets.

Stakeholders' perception of a total market approach to HIV self-testing (HIVST) for the private sector in Nigeria.

BACKGROUND: The continuous supply of affordable and quality HIV self-test (HIVST) is a key pillar toward achieving the global HIV 95-95-95 target in Nigeria. This was a descriptive qualitative study that explored private sector stakeholders' perceptions of the enablers and barriers of the HIVST market in Nigeria. METHODS: A total of 29 In-depth interviews (IDIs) were conducted with HIVST supply chain stakeholders and private sector providers (PPMVs and Community Pharmacies). Responses were analyzed using Nvivo software and we systematically developed a total market approach analysis for supply chain stakeholders and archetypes for community Pharmacies and PPMVs based on insights gathered from their journey map. RESULTS: Challenges to the supply side dynamics include forecasting, point of care service delivery, the availability of free and subsidized HIVST kits in the market, neglect of private sector providers (Community Pharmacists and PPMVs) in the healthcare delivery system, limited demand for HIVST, and regulatory bottlenecks influences the overall market dynamics. High cost of the HIVST kit, which triggers low availability, accessibility and affordability from the demand side, depicts the need to understand the market dynamics. Addressing the barriers and optimizing the enablers of the three-model pharmacist and PPMV's will change the market dynamic and service delivery to generate demand. CONCLUSION: To address challenges which already exist, the government need to revise the process guidelines for introducing new HIVST products in the Nigerian market, developing contingency plans to ensure the supply of HIVST remains sufficient when experiencing economic shocks, and create a sustainable roadmap toward optimizing the market for HIVST kits.

Public health implications of endocrine disrupting chemicals in drinking water and aquatic food resources in Nigeria: A state-of-the-science review.

This state-of-the-science review is aimed at identifying the sources, occurrence, and concentrations of EDCs, including potential public health risks associated with drinking water and aquatic food resources from Nigerian inland waters. A total of 6024 articles from scientific databases (PubMed, Scopus, Web of science, ScienceDirect, Google Scholar, and African Journals Online) were identified, out of which, 103 eligible articles were selected for this study. Eleven (11) classes of EDCs (OCPs, PCBs, PBDEs, PAHs, BPA, OTs, PEs, PCs, PPCPs, sterols and n-alkanes) were identified from drinking waters, river sediments and aquatic food species from Nigerian rivers, showing that OCPs were the most studied and reported EDCs. Analytical methods used were HPLC, LC-MS/MS, GC-FID, GC-ECD and GC-MS with all EDCs identified to originate from anthropogenic sources. Carcinogenic, mutagenic, and teratogenic effects were the highest (54.4 %) toxicological effects identified, while reproductive/endocrine disruptive effects (15.2 %) and obesogenic effects (4.3 %) were the least identified toxicological effects. The targeted hazard quotient (THQ) and cancer risk (CR) were generally highest in children, compared to the adult populations, indicating age-specific toxicity. PEs produced the highest THQ (330.3) and CR (1.2) for all the EDCs in drinking water for the children population, suggesting enhanced vulnerability of this population group, compared to the adult population. Due to associated public health, wildlife and environmental risk of EDCs and their increasing concentrations in drinking water and food fish species from Nigerian inland waters, there is an urgent need for focused and strategic interventions, sensitization and policy formulation/implementation towards public health and aquatic food safety in Nigeria.

How valid are women's reports of the antenatal health services they receive from Community Health Workers in Gombe State north-eastern Nigeria?

BACKGROUND: Community health workers (CHWs) in low- and middle-income countries are key to increasing coverage of maternal and newborn interventions through home visits to counsel families about healthy behaviours. Household surveys enable tracking the progress of CHW programmes but recent evidence questions the accuracy of maternal reports. We measured the validity of women's responses about the content of care they received during CHW home visits and examined whether the accuracy of women's responses was affected by CHW counselling skills. METHODS: We conducted a criterion validity study in 2019, in Gombe State-Nigeria, and collected data from 362 pregnant women. During accompanied CHW home visits the content of CHW care and the presence or absence of 18 positive counselling skills were observed and documented by a researcher. In a follow-up interview three months later, the same women were asked about the care received during the CHW home visit. Women's reports were compared with observation data and the sensitivity, specificity, and area under receiver curve (AUC) calculated. We performed a covariate validity analysis that adjusted for a counselling skill score to assess the variation in accuracy of women's reports with CHW counselling skills. RESULTS: Ten indicators were included in the validity analysis. Women consistently overestimated the content of care CHWs provided and no indicator met the condition for individual-level accuracy set at AUC ≥ 0.6. The CHW counselling skill score ranged from 9-18 points from a possible 18, with a mean of 14.3; checking on client history or concerns were the most frequently missed item. There was evidence that unmarried women and the relatively most poor women received less skilled counselling than other women (mean counselling scores of 13.2 and 13.7 respectively). There was no consistent evidence of an association between higher counselling skill scores and better accuracy of women's reports. CONCLUSIONS: The validity of women's responses about CHW care content was poor and consistently overestimated coverage. We discuss several challenges in applying criterion validity study methods to examine measures of community-based care and make only cautious interpretation of the findings that may be relevant to other researchers interested in developing similar studies.

The role of job aids in supporting task sharing family planning services to community pharmacists and patent proprietary medicine vendors in Kaduna and Lagos, Nigeria.

BACKGROUND: CPs and PPMVs are an important source of modern contraceptives in Nigeria, yet many lack the requisite knowledge and skills to capably provide these services. This skills gap might be addressed through targeted family planning (FP) training. This study measures family planning knowledge retention of CPs and PPMVs after receiving training in FP counseling and services in Kaduna and Lagos States, in Nigeria. METHODS: In a quasi-experimental longitudinal design without a comparison group, 559 CPs and PPMVs who were enrolled in the IntegratE project between January and December 2019, completed a self-administered questionnaire to assess their knowledge related to the provision of FP counseling, and injectable and implant contraceptive services at three points in time: 1) before the training; 2) immediately after the training; and 3) 9-months after the training in Kaduna and Lagos states, Nigeria. Adjusted multivariate logistic regression analysis was used to assess the effect of provider characteristics and receipt of job aids on FP knowledge retention 9 months after the training. 95% confidence intervals and p-values were used to assess statistical significance. RESULTS: Majority of study participants were females (60.3%) and between 30 and 49 years old (63.4%). The study revealed the importance of jobs aids as influence on knowledge retention. CPs and PPMVs who reported having the Balanced Counseling Strategy plus (BCS+) counseling cards, were more likely to retain knowledge (AOR: 2.92; 95% CI: 1.01-8.40, p-value = 0.05) at 9 months follow-up. Similarly, in terms of knowledge of injectable contraceptives, CPs and Tier 2 PPMVs who reported receiving the Medical Eligibility Criteria (MEC) Wheel were 2.1 times more likely to retain knowledge of injectable contraceptives 9-months later on (95% CI: 1.14-3.99, p-value = 0.02). CONCLUSION: Community Pharmacists and Proprietary Medicine Vendors had good retention of family planning knowledge, especially when combined with job aids. Training and providing them with job aids on FP will therefore support task shifting and task sharing on family planning services provision in Nigeria.

Effects of behaviour change communication on hypertension and diabetes related knowledge, attitude and practices in Imo and Kaduna States: a quasi-experimental study.

BACKGROUND: Behaviour change communication is a proven health communication strategy among used in promoting changes in knowledge, attitudes, beliefs, and behaviours', especially for communicable diseases. Few studies have been conducted on its effectiveness for non-communicable diseases prevention and control. This study was conducted as an evaluation assessment for a non-communicable disease focused intervention implemented in Imo and Kaduna States, Nigeria. METHODS: A twelve-month long strategic behaviour change communication intervention on hypertension and diabetes was implemented in selected communities across Imo and Kaduna States, Nigeria. This study adopted a quasi-experimental design approach among adult residents aged at least 35 years to assess the effectiveness of the intervention. Data was collected at baseline (prior to implementation of the interventions) and at the endline; among study and control groups. A uniform study tool was used to collect information on awareness & lifestyle related factors for Hypertension & Diabetes. RESULTS: The awareness of hypertension was 98.9% among the respondents in the study group compared to 94.4% among the baseline respondents (χ2 = 20.276, p < 0.001). The history of blood pressure check was recorded among 86.8% of the study group compared to 79.0% of the baseline group (χ2 = 20.27, p < 0.001). In the last 6 months prior to the study, 71.9% of the study group compared to 30.6% of the baseline group (χ2 = 243.34, p = 0.002) had blood glucose check at least once. Daily alcohol consumers make up 36.8% of the baseline respondents, compared to 22.6% in the study group (χ2 = 33.84, p < 0.001) and 30.6% of those in the control group compared to the 22.6% of the study group (χ2 = 9.23, p = 0.002). The mean (± SD) knowledge score on hypertension and diabetes was 18.12 (± 8.36) among the study group compared to 11.84 (± 6.90) among the baseline group (t = 15.29, p < 0.001), and compared to 10.97 (± 8.79) among the control group (t = 13.08, p < 0.001). CONCLUSION: Significant changes in lifestyle practices, knowledge of hypertension and diabetes and risk perception was observed following the implementation of community-based behaviour change communication interventions. There is a need to increased access to health education and promotion interventions for non-communicable diseases.

Common childhood illnesses: a cross-sectional study of commodity stocking patterns and management knowledge among patent and proprietary medicine vendors in Nigeria.

BACKGROUND: The trio of commonest illnesses and causes mortality among children under five (Malaria, Pneumonia and Diarrhea) are easily treatable through timely exposure to cost effective interventions at the community level. Patent and proprietary medicine vendors (PPMVs) are a leading source of care for illnesses among under-five children in Nigeria. This study was designed to explore child health services offering, particularly commodity stocking patterns and case management knowledge for common childhood illnesses among PPMVs in Ebonyi and Kaduna States. METHODS: A descriptive cross-sectional study was conducted among PPMVs in four local government areas across Ebonyi and Kaduna States. Data was collected using semi-structured interviewer-administered questionnaires. Information was obtained on medicine and supplies, knowledge of common childhood illnesses management and referral practices. RESULTS: A total of 374 PPMVs were interviewed; the mean age was 33.7 ± 9.8 years. Among the 132 health trained respondents, 59.0% offer treatment services for sick children while 83.5% of the non-health trained respondents offer the same service. At least, 88.0% of the respondents keep stock ACTs, Amoxycilin DT, ORS and Zinc. About 38.5% reported stock-out of ACTs in the month preceding the study, 55.1% reported stock out lasting only 0 to 6 days. Only 83 (22.2%) of respondents knew the correct diagnosis of fast breathing among children aged 2 to less than 12 months old. Education and health training background were associated with a good knowledge of common childhood illnesses management (X2 = 44.88, p < 0.001; X2 = 27.14, p < 0.001). CONCLUSION: The relative constant availability of medicines and commodities for managing childhood illnesses positions PPMVs as a preferred source of care for these illnesses. There is a need to complement steady stock availability with provision of quality services by exposing PPMVs to trainings on integrated community case management of childhood illnesses and implementation of robust supervision mechanism to monitor them.

Improving maternal and newborn health services in Northeast Nigeria through a government-led partnership of stakeholders: a quasi-experimental study.

OBJECTIVES: This study aimed to quantify change in the coverage, quality and equity of essential maternal and newborn healthcare interventions in Gombe state, Northeast Nigeria, following a four year, government-led, maternal and newborn health intervention. DESIGN: Quasi-experimental plausibility study. Repeat cross-sectional household and linked health facility surveys were implemented in intervention and comparison areas. SETTING: Gombe state, Northeast Nigeria. PARTICIPANTS: Each household survey included a sample of 1000 women aged 13-49 years with a live birth in the previous 12 months. Health facility surveys comprised a readiness assessment and birth attendant interview. INTERVENTIONS: Between 2016-2019 a complex package of evidence-based interventions was implemented to increase access, use and quality of maternal and newborn healthcare, spanning the six WHO health system building blocks. OUTCOME MEASURES: Eighteen indicators of maternal and newborn healthcare. RESULTS: Between 2016 and 2019, the coverage of all indicators improved in intervention areas, with the exception of postnatal and postpartum contacts, which remained below 15%. Greater improvements were observed in intervention than comparison areas for eight indicators, including coverage of at least one antenatal visit (71% (95% CI 62 to 68) to 88% (95% CI 82 to 93)), at least four antenatal visits (46% (95% CI 39 to 53) to 69% (95% CI 60 to 75)), facility birth (48% (95% CI 37 to 59) to 64% (95% CI 54 to 73)), administration of uterotonics (44% (95% CI 34 to 54) to 59% (95% CI 50 to 67)), delayed newborn bathing (44% (95% CI 36 to 52) to 62% (95% CI 52 to 71)) and clean cord care (42% (95% CI 34 to 49) to 73% (95% CI 66 to 79)). Wide-spread inequities persisted however; only at least one antenatal visit saw pro-poor improvement. CONCLUSIONS: This intervention achieved improvements in life-saving behaviours for mothers and newborns, demonstrating that multipartner action, coordinated through government leadership, can shift the needle in the right direction, even in resource-constrained settings.

Impact of peer education on sexual health knowledge among adolescents and young persons in two North Western states of Nigeria.

BACKGROUND: Generally, social development among young people is largely influenced by their peers. Peer education is a proven and effective approach for promoting reproductive health among young people, especially HIV/AIDS education. This study was conducted to assess the effectiveness of a peer-led education intervention in addressing sexual and reproductive health related knowledge and concerns among young people in Kaduna and Kano States, northwest Nigeria. METHODS: A pre and post-test study was conducted among 8930 young people aged 15-24 years who participated in the MTV Shuga Peer Education intervention selected from communities in Kaduna and Kano States. A baseline pre-test was conducted before the education program, and it was followed up with a post-test at the end of the five-day long peer education sessions. RESULTS: Majority of the respondents, 7846 (87.9%) were adolescents aged 15-19 years while the rest 1084 (12.1%) were young adults aged 20-24 years. A total of 6099 (68.3%) of the respondents correctly stated that condoms prevent pregnancy during the pre-test compared to 6429 (72.0%) peers during the post test. Lower abdominal pain was correctly indicated as a symptom of STI by 6282 (70.3%) and 6984 (78.2%) of the respondents at pre-test and post-test respectively. More males (58.5%) had good knowledge about condom use compared to the females, 51.9% (χ2 = 24.62, p < 0.001). while more females (79.6%) compared to 74.7% males opined that going for HIV test with their sexual partner is important to them during the pre-test (χ2 = 19.44, p≤ 0.001).However, no significant difference was observed on knowledge of condom use and opinion on going for HIV testing with sexual partner among either gender at post-test. CONCLUSION: Significant positive changes in knowledge, views and opinions regarding STIs and HIV, HIV anti-stigma and the use of condoms were observed following exposure to the peer sessions of the MTV Shuga peer education intervention. Sustained exposure and access to informative and enlightening peer education sessions over time have the potential to comprehensively improve SRH knowledge, influence positive opinion change and in turn adoption of positive behaviours among young people.

Peer education is an approach to health promotion, in which community members are supported to promote health-enhancing change among their peers. This approach is being adopted to improve access to comprehensive sexual and reproductive health information among young people. Society for Family Health implemented a peer education intervention (MTV Shuga Naija Peer Education Project) among young people aged 15­24 years in Kaduna and Kano States, Nigeria. This study presents findings on the effectiveness of peer-education in addressing myths, misconceptions and improving knowledge on sexual and reproductive health issues.The knowledge and opinion of the project beneficiaries were assessed before and after exposure to the project's interventions (the MTV Shuga drama series and peer education). Findings from both assessments were compared and the results were presented in this article. In total, 8930 persons between the age of 15­24 years were assessed. We observed that more proportion of the respondents after exposure to the project's intervention correctly identified that condom use can prevent pregnancy and that lower abdominal pain is a sign of sexually transmitted illnesses, when compared to before the intervention. Significant improvement was observed for most of other questions that the respondents were asked about.We generally observed that the peer education strategy used in this study resulted in the knowledge of HIV/AIDS, sexually transmitted illnesses, contraception, and other reproductive health issues among young people. The use of peer-to-peer education should be encouraged and consistently adopted to improve knowledge of pertinent health issues among young people.

'A seamless transition': how to sustain a community health worker scheme within the health system of Gombe state, northeast Nigeria.

Health interventions introduced as part of donor-funded projects need careful planning if they are to survive when donor funding ends. In northeast Nigeria, the Gombe State Primary Health Care Development Agency and implementing partners recognized this when introducing a Village Health Worker (VHW) Scheme in 2016. VHWs are a new cadre of community health worker, providing maternal, newborn and child health-related messages, basic healthcare and making referrals to health facilities. This paper presents a qualitative study focussing on the VHW Scheme's sustainability and, hence, contributes to the body of literature on sustaining donor-funded interventions as well as presenting lessons aimed at decision-makers seeking to introduce similar schemes in other Nigerian states and in other low- and middle-income settings. In 2017 and 2018, we conducted 37 semi-structured interviews and 23 focus group discussions with intervention stakeholders and community members. Based on respondents' accounts, six key actions emerged as essential in promoting the VHW Scheme's sustainability: government ownership and transition of responsibilities, adapting the scheme for sustainability, motivating VHWs, institutionalizing the scheme within the health system, managing financial uncertainties and fostering community ownership and acceptance. Our study suggests that for a community health worker intervention to be sustainable, reflection and adaption, government and community ownership and a phased transition of responsibilities are crucial.

Assessment of the level of knowledge, awareness and management of hypertension and diabetes among adults in Imo and Kaduna states, Nigeria: a cross-sectional study.

OBJECTIVES: This study was designed to assess levels of awareness, knowledge, attitude and practices relating to hypertension and diabetes among adults aged 35 years resident in selected communities in Imo and Kaduna states, Nigeria. DESIGN: A descriptive cross-sectional study. SETTING: Selected communities across 14 local government areas in Imo and Kaduna states were included. PARTICIPANTS: In total, 824 adults, aged 35 years or older and resident in selected communities where the Access-N project was being implemented in Imo and Kaduna states participated in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: The study assessed the level of hypertension and diabetes knowledge among the participants. Regular blood pressure (BP) and glucose screening practices were also examined as outcome measures. RESULTS: The mean age of the respondents was 48.32 years. In total, 778 (94.4%) and 746 (90.5%) of the respondents were aware of hypertension and diabetes, respectively. The mean hypertension and diabetes knowledge scores (±SD) were 4.99 (±1.99) and 8.02 (±2.61), respectively. A total of 326 (41.9%) respondents aware of hypertension had a good knowledge of hypertension while 477 (63.9%) of those aware of diabetes had a good knowledge of diabetes. Levels of hypertension and diabetes knowledge were found to be associated with physical activity and the level of education of the respondents. About two-thirds (62.6%) and less than half (41.5%) of the respondents, respectively check their BP and blood glucose (BG) levels regularly (at least once yearly). Statistically significant associations were observed between age and regular BP and BG level checks. CONCLUSIONS: Despite the high awareness rate of hypertension and diabetes observed in this study and a relatively good knowledge about the two conditions, unhealthy lifestyle practices and non-regular routine screening abounds among the respondents. Thus, there is a need to improve access to quality information about hypertension and diabetes aimed at motivating adoption of healthy behaviours.

Characterization and distribution of medicine vendors in 2 states in Nigeria: implications for scaling health workforce and family planning services.

BACKGROUND: In 2014, Nigeria issued the task-shifting/sharing policy for essential health services, which aimed to fill the human resource gap and improve the delivery of health services across the country. This study focuses on the characteristics, spread, and family planning (FP) stocking practices of medicine vendors in Lagos and Kaduna, assessing the influence of medical training on the provision and stocking of FP services and commodities by vendors. METHODS: We conducted a census of all Patent Medicines stores (PMS) followed up with a facility assessment among 10% of the mapped shops, utilizing an interviewer-administered questionnaire. Bivariate analysis was conducted using the Chi-square test, and multiple logistic regression was used to estimate the adjusted odds ratio (OR) and confidence intervals (CI) for the test of significance in the study. RESULTS: A total of 8318 medicine shops were enumerated (76.2% urban). There were 39 shops per 100,000 population in both states on average. About half (50.9%) were manned by a medicine vendor without assistance, 25.7% claimed to provide FP services to > 2 clients per week, and 11.4% were not registered with the regulatory body or any professional association. Also, 28.2% of vendors reported formal medical training, with 56.3% of these medically trained vendors relatively new in the business, opening within the last 5 years. Vendors utilized open drug markets as the major source of supply for FP products. Medical training significantly increased the stocking of FP products and inhibited utilization of open drug markets. CONCLUSION: Patent and Proprietary Medicines Vendor (PPMVs) have continued to grow progressively in the last 5 years, becoming the most proximal health facility for potential clients for different health services (especially FP services) across both Northern and Southern Nigeria, now comprising a considerable mass of medically trained personnel, able to deliver high-quality health services and complement existing healthcare infrastructure, if trained. However, restrictions on services within the PPMV premise and lack of access to quality drugs and commodities have resulted in poor practices among PPMVs. There is therefore a need to identify, train, and provide innovative means of improving access to quality-assured products for this group of health workers.