Multi-level predictors of young people's attitudes towards gender biases concerning rape, sexual and domestic violence in intimate relationships among young people, Ebonyi State, Southeast Nigeria.

This study assessed multi-level factors that shape young people's attitudes towards gender biases about rape, sexual, and domestic violence in intimate relationships. This cross-sectional study was undertaken in three urban and three rural communities in Ebonyi State, southeast Nigeria. Data were collected from 1,020 young people using an interviewer-administered questionnaire. Descriptive and logistic regression analyses were performed using STATA. Findings revealed that most(64%) young people agree that when a girl doesn't physically fight back, you cannot really say it was rape. Many agreed that a girl who is raped is promiscuous or has a bad reputation (50%) and usually did something careless to put herself in that situation(45%). Young girls were approximately 2 times more likely to have positive attitudes towards sexual violence, rape, and domestic violence in intimate relationships than young boys (OR=1.5;P<0.01). Multi-level strategies to effectively address adverse gender norms and inequalities in intimate relationships are highly recommended.

Cette étude a évalué les facteurs à plusieurs niveaux qui façonnent les attitudes des jeunes à l'égard des préjugés sexistes concernant le viol, la violence sexuelle et domestique dans les relations intimes. Cette étude transversale a été entreprise dans trois communautés urbaines et trois communautés rurales de l'État d'Ebonyi, au sud-est du Nigeria. Les données ont été recueillies auprès de 1 020 jeunes à l'aide d'un questionnaire administré par un intervieweur. Des analyses de régression descriptive et logistique ont été effectuées à l'aide de STATA. Les résultats ont révélé que la plupart (64 %) des jeunes conviennent que lorsqu'une fille ne se défend pas physiquement, on ne peut pas vraiment dire qu'il s'agit d'un viol. Beaucoup conviennent qu'une fille violée est une promiscuité ou a une mauvaise réputation (50%) et a généralement fait quelque chose de négligent pour se mettre dans cette situation (45%). Les jeunes filles étaient environ 2 fois plus susceptibles d'avoir des attitudes positives à l'égard de la violence sexuelle, du viol et de la violence domestique dans les relations intimes que les jeunes garçons (OR=1,5 ; P<0,01). Des stratégies à plusieurs niveaux pour lutter efficacement contre les normes de genre défavorables et les inégalités dans les relations intimes sont fortement recommandées.

Can a school health club-based intervention significantly influence the drivers of gendered sexual norms and ideologies among in-school adolescents in southeast Nigeria?

Individual experiences, social policies, and environmental exposure shape beliefs, norms and ideologies about sexuality. The objective of this study was to determine the effectiveness of a school health club training programme in improving adolescents' knowledge and perceptions of gender norms and ideologies about sexuality. This was an intervention study among in-school adolescent boys and girls in 12 secondary schools in Ebonyi State, southeast Nigeria. The intervention was the establishment of school health clubs in six schools (intervention), while the six other schools served as controls that did not have school health clubs. Data was collected using a pre-tested interviewer-administered questionnaire. Bivariate and multivariate logistic regression analyses were used to analyse the data. More than half of the adolescents in the intervention (58.3%) and non-intervention (56.1%) schools believed that men need sex more than women. About 90% of adolescents in school (in both arms) agreed that both boys and girls should remain virgins until marriage. Majority of adolescents in both intervention and non-intervention schools disagreed with the notion that "it is justifiable for a boy to hit his girlfriend". Female gender (OR: 1.6; CI 1.1-2.4), senior secondary school level (OR: 1.6; CI 1.0-2.5), and urban residence (OR: 1.7; CI: 1.1-2.5) were associated with the perception that boys do not respect girls who agree to have sex with them. Working for pay decreases the likelihood of having the perception that girls should remain virgin until they marry (OR: 0.4; CI: 0.2-0.9), while living in the urban area increases the likelihood of having the perception that boys should remain virgins until marriage (OR: 2.1; 1.1-4.1). Female gender (OR: 0.7; CI: 0.5-1.0) and urban residence (OR: 0.6; 0.4-0.9) decrease the likelihood of having the perception that men need sex more frequently than women do. In the intervention arm, female gender was associated with perception that boys do not respect girls who agree to have sex with them (OR: 2.4; CI: 1.3-4.3) while older age was associated with the perception that men need sex more frequently than women in the intervention arm (OR:1.2; CI:1.0-1.4). No predictor was found in the non-intervention arm. Although both intervention and non-intervention arms had positive perceptions of gendered sexual norms and ideologies, a school health club-based intervention could influence the drivers of these norms.

Les expériences individuelles, les politiques sociales et l'exposition à l'environnement façonnent les croyances, les normes et les idéologies en matière de sexualité. L'objectif de cette étude était de déterminer l'efficacité d'un programme de formation d'un club de santé scolaire pour améliorer les connaissances et les perceptions des adolescents concernant les normes de genre et les idéologies en matière de sexualité. Il s'agissait d'une étude d'intervention auprès d'adolescents, garçons et filles, scolarisés dans 12 écoles secondaires de l'État d'Ebonyi, au sud-est du Nigeria. L'intervention consistait en la création de clubs de santé scolaire dans six écoles (intervention), tandis que les six autres écoles servaient de contrôles qui ne disposaient pas de clubs de santé scolaire. Les données ont été collectées à l'aide d'un questionnaire pré-testé administré par l'intervieweur. Des analyses de régression logistique bivariées et multivariées ont été utilisées pour analyser les données. Plus de la moitié des adolescents des écoles d'intervention (58,3 %) et de non-intervention (56,1 %) pensaient que les hommes avaient plus besoin de relations sexuelles que les femmes. Environ 90 % des adolescents scolarisés (dans les deux bras) étaient d'accord sur le fait que les garçons et les filles devraient rester vierges jusqu'au mariage. La majorité des adolescents des écoles d'intervention et des écoles non-interventionnelles étaient en désaccord avec l'idée selon laquelle « il est justifiable qu'un garçon frappe sa petite amie ¼. Le sexe féminin (OR : 1,6 ; IC 1,1-2,4), le niveau d'études secondaires de deuxième cycle (OR : 1,6 ; IC 1,0-2,5) et la résidence urbaine (OR : 1,7 ; IC : 1,1 2,5) étaient associés à la perception que les garçons font ne respecte pas les filles qui acceptent d'avoir des relations sexuelles avec elles. Travailler contre rémunération diminue la probabilité d'avoir l'impression que les filles devraient rester vierges jusqu'à leur mariage (OR : 0,4 ; IC : 0,2-0,9), tandis que vivre en zone urbaine augmente la probabilité d'avoir l'impression que les garçons devraient rester vierges jusqu'au mariage. (OU : 2.1 ; 1.1-4.1). Le sexe féminin (OR : 0,7 ; IC : 0,5-1,0) et la résidence urbaine (OR : 0,6 ; 0,4-0,9) diminuent la probabilité d'avoir la perception que les hommes ont besoin de relations sexuelles plus fréquemment que les femmes. Dans le groupe d'intervention, le sexe féminin était associé à la perception que les garçons ne respectent pas les filles qui acceptent d'avoir des relations sexuelles avec eux (OR : 2,4 ; IC : 1,3-4,3), tandis que l'âge plus avancé était associé à la perception que les hommes avaient besoin de relations sexuelles plus fréquemment que les hommes. femmes dans le bras d'intervention (OR : 1,2 ; IC : 1,0-1,4). Aucun prédicteur n'a été trouvé dans le bras sans intervention. Même si les groupes d'intervention et de non-intervention avaient des perceptions positives des normes et idéologies sexuelles sexistes, une intervention basée sur un club de santé scolaire pourrait influencer les moteurs de ces normes.

Determinants of peer education on sexual and reproductive health and rights among in-school adolescents in Ebonyi State, Nigeria.

BACKGROUND: Peer education has contributed to increased knowledge and preventive behaviors of adolescents toward reproductive health matters with the unique feature of maintaining peer-to-peer learning ability and sustaining intervention gains. This study examined the factors that predict the agency of in-school adolescents as peer educators on the sexual and reproductive health and rights (SRHR) of adolescents. MATERIALS AND METHODS: A cross-sectional study was conducted on 257 adolescent boys and girls, purposively selected from six public secondary schools that had received a package of interventions that aimed to improve peer-to-peer education on SRHR in Ebonyi State, Nigeria. Data were collected using a pretested structured interviewer-administered questionnaire. Univariate and multivariate analyses were performed. The level of statistical significance was determined at a P value < 0.05 and a 95% confidence limit. RESULTS: Almost all the students (98.05%) believed that adolescents need information on SRHR, which should be provided in the schools; however, 66.93% had ever shared information with their peers on the SRHR. The predictors of the practice of peer education on SRHR include being in senior secondary (adjusted odds ratios (AOR) =2.889, P = 0.026), participation in SRHR campaigns (AOR = 6.139, P = 0.005), receiving information, education and communication materials (AOR = 0.266, P = 0.042), and discussing SRH matter with adult family members (AOR = 2.567, P = 0.026). CONCLUSION: The practice of peer education among adolescents was determined by their level in school, availability of support structures such as parent-child communication, and program-related factors. Therefore, public health initiatives should prioritize these factors to strengthen adolescents' agency as peer educators on the SRHR of young people.

An assessment of perceived prioritisation and resource allocation for health policy and systems research in West Africa.

OBJECTIVES: Globally, adequate funding is a strong underpinning to advance health policy and systems research (HPSR) and ensure its impact on strengthening health systems. This study examined the perceived prioritisation, and resource allocation for HPSR in West Africa. METHODS: A desk review was conducted of literature related to HPSR funding published between January 2010 and December 2019, sourced from various databases and government websites. This was followed by in-depth interviews with senior decision makers and HPSR and non-HPSR research leaders (n = 33) across nine West African countries: Benin, Burkina Faso, Côte d'Ivoire, Gambia, Ghana, Liberia, Nigeria, Senegal and Sierra Leone. RESULTS: The majority of the study participants were from ministries of health in their countries (66.7%). All countries except Sierra Leone had a program dedicated to health policy research and/or health planning/program research. There was no specific funding for health research nor HPSR in most countries and a mixed model (demand and supply led) was employed in most instances. HPSR was only considered a priority in two of the nine countries and specific funding for it was non-existent in all nine countries. In all countries, donor agencies played predominant roles in setting health research priorities and resource allocation decisions. Infectious disease and maternal/child health research were the research categories with the highest level of funding. There was limited capacity for HPSR, with a pronounced gap between researchers and policy makers. Stakeholder advocacy, basket funding for health research, multi-stakeholder institutional and individual HPSR capacity building were the major recommendations for improving the status and funding of HPSR. CONCLUSIONS: This study showed that both health research and HPSR were considered low priorities, with no designated funding (budget line) and inadequacy of funding disbursement in the surveyed countries in West Africa. Health research was largely conducted as prioritised and funded by the donor agencies. Given donor fatigue and the transitioning of donor funding, and the pivotal role of HPSR in strengthening health systems, there is an urgent need for West African states to commit to prioritising and funding HPSR and HPSR capacity development.

Demand for malaria rapid diagnostic test, health care-seeking behaviour, and drug use among rural community members with fever or malaria-like illness in Ebonyi state, Nigeria: a cross-sectional household survey.

BACKGROUND: A good understanding of the demand for malaria rapid diagnostic test (MRDT), malaria health care-seeking behavior, and drug use among community members is crucial to malaria control efforts. The aim of this study was to assess the demand (use and/or request) for MRDT, health care-seeking behavior, and drug use, as well as associated factors, among rural community members (both children and adults) with fever or malaria-like illness in Ebonyi state, Nigeria. METHODS: A cross-sectional household survey was conducted between October 1st and November 7th, 2018, in 18 rural geographical clusters. Data was collected using a structured interviewer-administered questionnaire. Descriptive analysis was done using summary statistics. Associated factors (socio-demographic, knowledge and opinion level) were assessed using bivariate and multivariate binomial logistic regressions while the overall effects of these factors were assessed using the "postestimation test" command in Stata. RESULTS: A total of 1310 children under 5 years of age and 2329 children ages 5 years and above and adults (excluding pregnant women) (3639 overall) participated in the study. Among the 1310 children under 5 years of age: 521 (39.8%) received MRDT of which the caregivers of 82 (15.7%) requested for the MRDT; 931 (71.1%) sought care with public/private sector providers (excluding traditional practitioners/drug hawkers) the same/next day; 495 (37.8%) sought care at government primary health centres, 744 (56.8%) sought care with the patent medicine vendors (PMVs); 136 (10.4%) sought care with traditional practitioners; 1020 (77.9%) took ACTs (=88.2%, 1020/1156 of those who took anti-malarial drugs). Generally, lower values were respectively recorded among the 2329 children ages 5 years and above and adults (excluding pregnant women). The most important overarching predictor of the demand for MRDT and care-seeking behaviour was the knowledge and opinion level of respondent female heads of households about malaria and malaria diagnosis. CONCLUSIONS: Among the rural community members with fever or malaria-like illness in Ebonyi state, Nigeria, while majority did not receive MRDT or diagnostic testing, and sought care with the PMVs, most took anti-malaria drugs, and mostly ACTs. Interventions are needed to improve the knowledge and opinion of the female heads of households about malaria and malaria diagnosis.

Social group and health-care provider interventions to increase the demand for malaria rapid diagnostic tests among community members in Ebonyi state, Nigeria: a cluster-randomised controlled trial.

BACKGROUND: The rate of diagnostic testing for malaria is still very low in Nigeria despite the scale-up of malaria rapid diagnostic test (MRDT) availability, following WHO's recommendation of universal diagnostic testing in 2010. We investigated whether a social group sensitisation and education intervention (social group intervention) and a social group intervention plus health-care provider training intervention would increase the demand (use or request, or both) for MRDTs among community members in Ebonyi state, Nigeria. METHODS: We did a three-arm, parallel, open-label, stratified cluster-randomised controlled trial in Ebonyi state, Nigeria, to evaluate the effects of two interventions compared with a control. We randomly assigned geographical clusters that were accessible (close to a road that was drivable even during the rainy seasons) and had at least one eligible public primary health facility and patent medicine vendor (those that offered MRDT services) in a 1:1:1 allocation to the control arm (receiving no intervention), social group arm (receiving sensitisation and education about MRDT), or social group plus provider arm (receiving the social group intervention plus provider training in health communication about MRDT). Investigators, participants (social groups, providers, respondents), and interviewers could not be masked to group assignments. The primary outcome was the proportion of children younger than 5 years with fever or malaria-like illness, in the 2 weeks preceding a household survey, who received an MRDT, and the coprimary outcome was the same outcome but among children aged 5 years and older (ie, up to and including 17 years) and adults (excluding pregnant women). The outcomes were measured at an individual level via household surveys before the interventions and 3 months after the end of the interventions. All analyses were done using a cluster-level method on an intention-to-treat basis. This trial is registered with ISRCTN, number ISRCTN14046444. FINDINGS: We carried out eligibility screening and recruitment of participants (clusters, social groups, and providers) between July 2 and Sept 27, 2018. 34 clusters met the eligibility criteria and 18 were randomly selected to participate and randomly assigned to arms (six clusters per arm). A mean proportion of 40·6% (SD 14·5) of eligible children younger than 5 years in the control arm received an MRDT, versus 66·7% (11·7) in the social group arm (adjusted risk difference [aRD] 28·8%, 95% CI 21·9-35·7, p<0·0001) and 71·7% (19·8) in the social group plus provider arm (aRD 32·7%, 24·9-40·5, p<0·0001), with no significant difference between the social group arm and the social group plus provider arm. A mean proportion of 36·3% (18·5) of eligible children aged 5 years and older in the control arm received an MRDT, versus 60·7% (14·0) in the social group arm (aRD 25·6%, 16·8-34·4, p=0·0004), and 59·5% (18·3) in the social group plus provider arm (aRD 28·0%, 19·5-36·5, p=0·0002), with no significant difference between the social group arm and the social group plus provider arm. INTERPRETATION: The sensitisation and education of social groups about MRDTs can significantly increase the demand for MRDTs. This intervention is pragmatic and could be applied within malaria control or elimination programmes, in Nigeria and in other high-burden countries, to enhance diagnostic testing for patients suspected of having malaria. FUNDING: There was no funding source for this study.