Intimate partner violence against adolescents and young women in sub-Saharan Africa: who is most vulnerable?

BACKGROUND: Intimate partner violence (IPV) is a global public health and human rights issue that affects millions of women and girls. While disaggregated national statistics are crucial to assess inequalities, little evidence exists on inequalities in exposure to violence against adolescents and young women (AYW). The aim of this study was to determine inequalities in physical or sexual IPV against AYW and beliefs about gender based violence (GBV) in sub-Saharan Africa (SSA). METHODS: We used data from the most recent Demographic and Health Surveys (DHS) conducted in 27 countries in SSA. Only data from surveys conducted after 2010 were included. Our analysis focused on married or cohabiting AYW aged 15-24 years and compared inequalities in physical or sexual IPV by place of residence, education and wealth. We also examined IPV variations by AYW's beliefs about GBV and the association of country characteristics such as gender inequality with IPV prevalence. RESULTS: The proportion of AYW reporting IPV in the year before the survey ranged from 6.5% in Comoros to 43.3% in Gabon, with a median of 25.2%. Overall, reported IPV levels were higher in countries in the Central Africa region than other sub-regions. Although the prevalence of IPV varied by place of residence, education and wealth, there was no clear pattern of inequalities. In many countries with high prevalence of IPV, a higher proportion of AYW from rural areas, with lower education and from the poorest wealth quintile reported IPV. In almost all countries, a greater proportion of AYW who approved wife beating for any reason reported IPV compared to their counterparts who disapproved wife beating. Reporting of IPV was weakly correlated with the Gender Inequality Index and other societal level variables but was moderately positively correlated with adult alcohol consumption (r = 0.48) and negative attitudes towards GBV (r = 0.38). CONCLUSION: IPV is pervasive among AYW, with substantial variation across and within countries reflecting the role of contextual and structural factors in shaping the vulnerability to IPV. The lack of consistent patterns of inequalities by the stratifiers within countries shows that IPV against women and girls cuts across socio-economic boundaries suggesting the need for comprehensive and multi-sectoral approaches to preventing and responding to IPV.

Inequalities in early marriage, childbearing and sexual debut among adolescents in sub-Saharan Africa.

BACKGROUND: Adolescent sexual and reproductive health (ASRH) is a major public health concern in sub-Saharan Africa (SSA). However, inequalities in ASRH have received less attention than many other public health priority areas, in part due to limited data. In this study, we examine inequalities in key ASRH indicators. METHODS: We analyzed national household surveys from 37 countries in SSA, conducted during 1990-2018, to examine trends and inequalities in adolescent behaviors related to early marriage, childbearing and sexual debut among adolescents using data from respondents 15-24 years. Survival analyses were conducted on each survey to obtain estimates for the ASRH indicators. Multilevel linear regression modelling was used to obtain estimates for 2000 and 2015 in four subregions of SSA for all indicators, disaggregated by sex, age, household wealth, urban-rural residence and educational status (primary or less versus secondary or higher education). RESULTS: In 2015, 28% of adolescent girls in SSA were married before age 18, declined at an average annual rate of 1.5% during 2000-2015, while 47% of girls gave birth before age 20, declining at 0.6% per year. Child marriage was rare for boys (2.5%). About 54% and 43% of girls and boys, respectively, had their sexual debut before 18. The declines were greater for the indicators of early adolescence (10-14 years). Large differences in marriage and childbearing were observed between adolescent girls from rural versus urban areas and the poorest versus richest households, with much greater inequalities observed in West and Central Africa where the prevalence was highest. The urban-rural and wealth-related inequalities remained stagnant or widened during 2000-2015, as the decline was relatively slower among rural and the poorest compared to urban and the richest girls. The prevalence of the ASRH indicators did not decline or increase in either education categories. CONCLUSION: Early marriage, childbearing and sexual debut declined in SSA but the 2015 levels were still high, especially in Central and West Africa, and inequalities persisted or became larger. In particular, rural, less educated and poorest adolescent girls continued to face higher ASRH risks and vulnerabilities. Greater attention to disparities in ASRH is needed for better targeting of interventions and monitoring of progress.

Reproductive health challenges of male and female street beggars and use of reproductive health services by female street beggars in Ife-Ijesa, Nigeria.

OBJECTIVES: The aims of the study were to investigate the reproductive health challenges in Nigeria of male and female street beggars and the use of reproductive health services by female street beggars. METHODS: The study had a cross-sectional descriptive design. An interviewer-administered questionnaire, designed by the authors, was used to elicit information from 100 male and female street beggars recruited over a 4 week period in Ife-Ijesa zone, south-western Nigeria. Information was obtained about male and female participants' reproductive health challenges (symptoms and issues) and female participants' use of reproductive health services. RESULTS: More than a third of participants were aged ≥60 years (37%), 57% were men, 82% were from the Hausa tribe and 92% were Muslims. The main reasons given for street begging were poverty (30%) and physical handicap (66%). Although most of the street beggars were aware of the availability of reproductive health services (81%) and where to access them (89%), only a small proportion of female street beggars had given birth in hospital (9.3%) and family planning services (32.6%). CONCLUSION: Street beggars are a poor and vulnerable group with reproductive health challenges. They have difficulty accessing reproductive health services because of physical disabilities and related low socioeconomic status.

Burden of family caregivers of ophthalmic patients in a university teaching hospital in south-west Nigeria.

Background: The family provides support in the care of their ill members and suffers some burden during caregiving. This study assessed the burden of family caregivers and associated factors in an ophthalmic clinic situated in a university teaching hospital in southwest Nigeria. Methods: This was a descriptive cross-sectional study where consenting family caregivers of ophthalmic patients completed a semi-structured questionnaire containing information on their socio-demographic characteristics and caregiving burden using the Zarit burden interview. Descriptive and inferential statistics analyses were done. Results: A total of 273 caregivers completed the study. The caregivers were parents (23.5%), spouses (20.1%), siblings (3.3%), children (35.9%) and other relatives (14.2%) with mean age (SD) of 38.9 (14.9) years (range 8-79 years). Majority (81.2%) experienced caregiver burden with prayer (89%) as a coping strategy. Financial support (56%) was a major caregiver need with majority (59.3%) satisfied with their relatives' hospital care. Neither the patients nor their caregivers were on health insurance scheme. Statistical significant factors associated with caregivers' burden included young age (AOR=4.63, 95%CI=1.55-13.90; p=0.01), higher education (AOR=5.51, 95%CI=2.30-13.2, p=0.01), being employed (AOR=1.72, 95CI=1.30-4.76, p=0.04), longer caregiving (AOR=3.37, 95%CI=1.27-7.02, p=0.02), and having patient on hospital admission (AOR=1.90, 95%CI=1.26-3.09, p=0.02). Conclusion: Family caregivers of ophthalmic patients experienced significant burden. Hence, they need more assistance from the health care institutions and community, including policy makers, so that they can cope with their caregiving activities. Enrollment in the social health insurance scheme will reduce out of pocket payment of hospital bills.

Lifting the veil on disrespect and abuse in facility-based child birth care: findings from South West Nigeria.

BACKGROUND: Eliminating disrespect and abuse in health care facilities during childbirth could be a contributory factor in improving pregnancy outcomes and avoiding preventable illnesses and deaths. This study aims to provide evidence of disrespect and abuse in this community in order to create awareness about its occurrence. METHODS: A cross-sectional survey was carried out on 384 recently delivered women who visited the postnatal and immunization clinics of a primary and tertiary health facility in Ile-Ife. Information was sought about awareness of disrespect and abuse, prevalence and forms of disrespect and abuse, and opinions on improvements which can be made in maternity services. Univariate analysis was used to summarise the data. RESULTS: About half of the respondents were in their fourth decade of life and had tertiary education. Overall, the majority (98.4%) of respondents agreed that it was their right to be treated with respect and dignity during childbirth while about one-fifth (19%) had ever experienced some form of disrespect and abuse. The commonly identified forms of disrespect and abuse were: non-dignified care (12.8%), discrimination (8.1%), a detention and abandonment (6%). However, the majority (81%) of the respondents did not have any suggestions for improvements in delivery services. CONCLUSIONS: Although most of the respondents knew it was their right to be treated with respect, some reported that they had experienced disrespect and abuse during childbirth in varying forms. The evidence from this survey draws attention to the need for interventions to address the health system factors hindering health service utilization.

Engendering a conducive environment for university students with physical disabilities: assessing availability of assistive facilities in Nigeria.

PURPOSE: This study assessed awareness and availability of assistive facilities in a Nigerian public university. METHODS: Study was conducted in Obafemi Awolowo University (OAU), Ile Ife Nigeria using a mixed methods approach. Fifty two students with disability (SWD) were interviewed with a semistructured, self-administered questionnaire. A checklist was used to assess assistive facilities on campus while in-depth interviews (IDI) were conducted with university officials, to assess their perspectives about the availability and use of assistive facilities in the university. RESULTS: Almost three-thirds (57.7%) of SWD were male while more than two-thirds were aged between 21 and 30 years. About seven in 10 (71.1%) respondents, had mobility impairment, while two-fifth had visual impairment (40.8%) and a few had hearing impairment. Only the university's administrative building had a functioning elevator. Slightly more than half (54.5%) of the lecture theatres have public address systems, while only two have special entrances and exits with ramps for SWD. Almost all respondents were unaware of facilities that aid learning (96.2%) and facilities for library use (90.4%). University officials were aware of assistive facilities for SWD but do not know the actual number of SWD. CONCLUSION: Assistive facilities for SWD on campus are limited. More assistive facilities need to be provided alongside increased awareness about these facilities and a disability register should be open for students on campus. Assistive facilities to aid learning and make SWD more comfortable are required. Implications for Rehabilitation Universities should have an official policy on students with disabilities and implement it, such a policy should address special considerations for disabled students, such as having an updated register for students with disability, having examination questions in large fonts for students with visual disabilities, giving them extra time for examinations and providing special counselling services for students with disabilities. Awareness about assistive facilities in tertiary institutions for students with disability should be increased so that they can utilize the ones available and demand for such if non-existent. The design of buildings on university campus should be made disability friendly. A disability register should be open for SWD on campus.

The effect of mobile phone short message service on maternal health in south-west Nigeria.

BACKGROUND: The maternal mortality ratio in Nigeria is estimated to be about 814 per 100,000 live births, and deliveries taken outside a health facility have been implicated as a major factor for this high number. Mobile phones interventions are continually being explored in the health field but its usefulness in maternal health in Nigeria has not been widely explored. OBJECTIVE: To determine the impact of SMS (text messages) on maternal health behaviour in Ife-Ijesa zone of Osun State, Nigeria. METHODS: We conducted an experimental study involving 2 groups of pregnant women and sent text messages to both groups. The control group was sent general health messages while the intervention group was sent specific pregnancy related messages and both groups were followed up till 6 weeks after delivery. RESULTS: An increase in facility delivery rates among both groups, between the index pregnancy and their last pregnancies, were recorded for both groups with a higher percentage increase recorded in the intervention group (29%) compared with the control group 13%. Crude and adjusted linear regression coefficients were done to estimate the effect of the intervention on the change in proportion of deliveries in health facilities. After adjusting for other variables, the difference obtained was a significant value of 14% (regression coefficient = 0.14, 95% CI = 0.08-0.20, P value = .005). Most participants in the intervention group (96.6%) expressed support for the use of text message for maternal health promotion. CONCLUSION: The SMS-based intervention has a positive effect on facility delivery, and mothers welcome its use in pregnancy.

Street hawking among in-school adolescents in a south-western town in Nigeria: pattern, determinants and effects on school performance.

Street hawking is the commonest form of child labor in Nigeria. Although street hawking is very pervasive, there is the increasing need to fully understand its pattern and effects on those involved in hawking particularly adolescents who combine schooling with hawking. In Nigeria, data on the effects of street hawking on in-school adolescents are generally scanty. Therefore, the present study was undertaken in Ife Central Local Government Area (LGA) of Osun State, Nigeria to assess the pattern, determinants of street hawking among in-school adolescents and its effect on school performance. A cross-sectional study of 435 adolescents (aged 10-19) attending public secondary schools was done. Data were collected using facilitated self-administered questionnaires alongside a review of class records. Appropriate statistical analysis including multiple regression was done. Results showed mean age of respondents to be 14.6±2.1 years with prevalence of street hawking at 37.2%. Early adolescents (10-13 years) were more likely to engage in street hawking compared to their counterparts in late adolescence (aged 17-19). Female adolescents and students of trading mothers were significantly more likely to engage in street hawking. Respondents engaged in street hawking were significantly more likely to have failed the last academic term examination. The findings from this study will be useful for stakeholders as they develop policies and programmes to address the challenge of street hawking among adolescent school goers.

New paradigm old thinking: The case for emergency obstetric care in the prevention of maternal mortality in Nigeria.

BACKGROUND: The continuing burden of maternal mortality, especially in developing countries has prompted a shift in paradigm from the traditional risk assessment approach to the provision of access to emergency obstetric care services for all women who are pregnant. This study assessed the knowledge of maternity unit operatives at the primary and secondary levels of care about the concept of emergency obstetric care (EmOC) and investigated the contents of antenatal care (ANC) counseling services they delivered to clients. It also described the operatives' preferred strategies and practices for promoting safe motherhood and averting maternal mortality in South-west Nigeria. METHODS: The study population included all the 152 health workers (doctors, midwives, nurses and community health extension workers) employed in the maternity units of all the public health facilities (n = 22) offering maternity care in five cities of 2 states. Data were collected with the aid of a self-administered, semi-structured questionnaire and non-participant observation checklist. Results were presented using descriptive statistics. RESULTS: Ninety one percent of the maternity unit staff had poor knowledge concerning the concept of EmOC, with no difference in knowledge of respondents across age groups. While consistently more than 60% of staff reported the inclusion of specific client-centered messages such as birth preparedness and warning/danger signs of pregnancy and delivery in the (ANC) delivered to clients, structured observations revealed that less than a quarter of staff actually did this. Furthermore, only 40% of staff reported counseling clients on complication readiness, but structured observations revealed that no staff did. Only 9% of staff had ever been trained in lifesaving skills (LSS). Concerning strategies for averting maternal deaths, 70% of respondents still preferred the strengthening of routine ANC services in the health facilities to the provision of access to EmOC services for all pregnant women who need it. CONCLUSION: We concluded that maternity unit operatives at the primary and secondary care levels in South-west Nigeria were poorly knowledgeable about the concept of emergency obstetric care services and they still prioritized the strengthening of routine antenatal care services based on the risk approach over other interventions for promoting safe motherhood despite a global current shift in paradigm. There is an urgent need to reorientate/retrain the staff in line with global best practices.

Male involvement in family planning decision making in Ile-Ife, Osun State, Nigeria.

This study assessed men's awareness, attitude, and practice of modern contraceptive methods, determined the level of spousal communication, and investigated the correlates of men's opinion in family planning decision making in Ile-Ife, Nigeria. Quantitative methodology was employed in this cross-sectional descriptive design using a structured household questionnaire to collect information from 402 male study participants. A multistage sampling procedure was employed. Eighty-nine percent of men approved of the use of family planning while only about 11 percent disapproved of it. Eighty percent of men had ever used contraception while 56 percent of them were current users. Spousal communication about family planning and other family reproductive goals was quite poor. The socio-demographic correlates of men's opinions included religion, marriage type, educational attainment, and occupation (p < 0.05). The study concluded that male involvement in family planning decision making was poor and their patronage of family planning services was low.

Male involvement in family planning decision making in Ile-Ife, Osun State, Nigeria

This study assessed men's awareness, attitude, and practice of modern contraceptive methods, determined the level of spousal communication, and investigated the correlates of men's opinion in family planning decision making in Ile-Ife, Nigeria. Quantitative methodology was employed in this cross-sectional descriptive design using a structured household questionnaire to collect information from 402 male study participants. A multistage sampling procedure was employed. Eighty-nine percent of men approved of the use of family planning while only about 11 percent disapproved of it. Eighty percent of men had ever used contraception while 56 percent of them were current users. Spousal communication about family planning and other family reproductive goals was quite poor. The socio-demographic correlates of men's opinions included religion, marriage type, educational attainment, and occupation (p<0.05). The study concluded that male involvement in family planning decision making was poor and their patronage of family planning services was low (Afr J Reprod Health 2010; 14[4]: 45-52)

College students in Nigeria underestimate their risk of contracting HIV/AIDS infection.

OBJECTIVES: To assess the perceptions of personal risk of acquiring HIV/AIDS infection among students of selected tertiary institutions in Osun State, Nigeria and to determine the correlates of perceptions of personal risk of infection. METHODS: The study employed a cross-sectional descriptive design. An interviewer-administered questionnaire was applied to the 405 study participants and correlates of perceptions of personal risk of HIV infection were evaluated using multiple logistic regression analysis, confidence intervals and odd ratios. RESULTS: Only 15% of the students perceived themselves to be at moderate-to-high risk of acquiring HIV infection compared with 85% who perceived themselves to be at little or no risk. Investigators' assessment of risk status of the participants revealed that 77% of the participants were actually at high risk of infection and only 23% at low risk. The sensitivity, specificity and negative predictive value of the students' self-perception of personal risk compared with their assessed risk were 7, 58 and 16%, respectively, with a Kappa statistic of 0.178. The only significant correlate of self-perception of personal risk was a recent symptom of sexually transmitted infections. CONCLUSIONS: College students exhibited an 'optimism bias' associating high rates of HIV risk indicators with low levels of perceived personal risk of infection. This has implications for HIV/AIDS control in Nigeria.

Correlates of physicians' attitudes toward communication with HIV/AIDS patients in Ile-Ife, Nigeria.

OBJECTIVES: The study assessed physicians' perceptions of HIV/AIDS patients and identified the determinants of physicians' attitudes toward communication with HIV/AIDS patients in Ile-Ife, Nigeria. METHODS: A semi-structured questionnaire was used to elicit information from 110 physicians in a cross-sectional survey, while in-depth interviews were conducted with 10 people living with HIV/AIDS (PLWHA) who had been previously admitted under the care of the physicians. Univariate, bivariate and multivariate analyzes were conducted. RESULTS: Although most physicians perceived PLWHA positively and 58% of them displayed a positive attitude toward communication with PLWHA under their care, the expectations of the patients concerning HIV/AIDS communication were not being met. Only 43% of physicians expressed any degree of comfort engaging PLWHA in lengthy discussions or communicating the diagnosis of HIV to patients. The strongest correlates of physicians' positive attitude were previous exposure to HIV/AIDS counseling, the number of HIV/AIDS patients treated per month, the number of years spent in the care of PLWHA, and the gender of the physicians (p < 0.05). CONCLUSIONS: Physicians in Ile-Ife, Nigeria are not adequately equipped by way of training to effectively meet the expectations of their patients concerning HIV/AIDS communication. The large number of PLWHA in the country calls for urgent attention to address this important aspect of care.