Association Between Urinary Parabens and Sperm Quality in Nigerian Men: A Case-Control Study.

Background: Parabens, which are chemicals used as preservatives in cosmetic and pharmaceutical products, have been reported to be associated with low sperm quality in animal and human models. Despite the high exposure of men to paraben-containing products in Nigeria, there are no known studies that investigate the association of parabens with sperm quality in the country. Objective: To determine the association of urinary levels of metabolites of parabens with sperm count and quality. Design/Setting: A multicenter case-control study among fertile and infertile men in five hospitals in southern Nigeria. A total of 136 men diagnosed with male infertility (cases) were compared with 154 controls with normal fertility. Urinary levels of parabens (ethyl-paraben, methylparaben, propylparaben, and butylparaben) were measured using liquid chromatography mass spectrometry, while semen analysis and hormone assays were carried out using World Health Organization standards and radioimmunoassay, respectively. Data were analyzed with non-parametric statistics and non-parametric linear regression. Results: The results showed high levels of parabens in both cases and controls. However, there was no statistically significant difference in urinary levels of ethyl-paraben, methylparaben, propylparaben, and butylparaben between cases and controls. In contrast, propylparaben had a decreasing association with total motility in both groups, but the effect was only statistically significant in the case of male infertility. The results of the regression analysis showed that a unit increase in propylparaben significantly decreased total motility in the cases (infertile men). Similarly, a unit increase in propylparaben decreased morphology significantly in the unadjusted model for infertile men. Only serum testosterone showed an insignificant correlation with urinary parabens. Conclusion: We conclude that urinary parabens are associated with features of poor sperm quality - motility, morphology, and volume. Measures to reduce exposure of men to agents containing parabens in Nigeria may reduce the prevalence of male infertility in the country.

Association of Urinary Mycotoxins with Sperm Quality: A Case-Control Study in Southern Nigeria.

The objective of this study was to determine the association between mycotoxins and the quality of spermatozoa in Nigeria. We designed a prospective case-control study involving 136 men diagnosed with reduced sperm count and quality in five infertility clinics in southwest Nigeria and 154 normal fertile controls. Sperm analysis was conducted in accordance with the recommendations of the World Health OrganizationWHO, while Liquid Chromatography-Mass Spectrometry was used to assay three metabolites of mycotoxins (zearalenone, ochratoxin A, and deoxyvinelol) in the urine samples of cases and controls. The data were analysed with descriptive statistics and non-parametric linear regression. The results showed no overall significant difference in levels of these metabolites between the cases and control groups. In contrast, higher levels of zearalenone and ochratoxin A significantly decreased sperm motility in the cases. Similarly, an increase in the level of ochratoxin A decreased sperm morphology in the unadjusted model in the cases. We conclude that exposure to mycotoxins reduces the quality of spermatozoa (motility and morphology) in Nigerian men but may have no effect on sperm count. Efforts to reduce the exposure of men to mycotoxins are important interventions to improve sperm quality and reduce the prevalence of male infertility in the country.

Outcome of interventions to improve the quality of intrapartum care in Nigeria's referral hospitals: a quasi-experimental research design.

BACKGROUND: Evidence indicates that Nigeria's high maternal mortality rate is attributable primarily to events that occur during the intrapartum period. This study determines the effectiveness of multifaceted interventions in improving the quality of intrapartum care in Nigeria's referral hospitals. METHODS: Data collected through an exit interview with 752 women who received intrapartum care in intervention and control hospitals were analyzed. The interventions were designed to improve the quality indicators in the WHO recommendations for positive childbirth and assessed using 12 quality indicators. Univariate, bivariate, Poisson, and logistic regression analyses were used to compare twelve quality indicators at intervention and control hospitals. RESULTS: The interventions showed a 6% increase in composite score of quality of care indicators at intervention compared with control hospitals. Five signal functions of intrapartum care assessed were significantly (< 0.001) better at intervention hospitals. Quality scores for segments of intervention periods compared to baseline were higher at intervention than in control hospitals. CONCLUSIONS: We conclude that multiple interventions that address various components of the quality of intrapartum care in Nigeria's referral hospitals have demonstrated effectiveness. The interventions improved five of ten quality indicators. We believe that this approach to developing interventions based on formative research is important, but a process of integrating the implementation activities with the normal maternal health delivery processes in the hospitals will enhance the effectiveness of this approach. TRIAL REGISTRATION: The study was registered at the Nigeria Clinical Trials Registry. Trial Registration Number NCTR No: 91,540,209 (14/04/2016) http://www.nctr.nhrec.net/ and retrospectively with the ISRCTN. Trial Registration Number 64 ISRCTN17985403 (14/08/2020) https://doi.org/10.1186/ISRCTN17985403 .

Clients' perspectives on the utilization of reproductive, maternal, neonatal, and child health services in primary health centers during COVID-19 pandemic in 10 States of Nigeria: A cross-sectional study.

BACKGROUND: Reports from various parts of the world suggest that the COVID-19 pandemic may have severe adverse effects on the delivery and uptake of reproductive health, maternal, neonatal, and child health (RMNCH) services. The objective of the study was to explore women's experiences with utilization of RMNCH services during the COVID-19 pandemic in Nigeria, and to elicit their perceptions on ways to sustain effective service delivery during the pandemic. METHODS: A cross-sectional survey of 2930 women using primary health care facilities for antenatal, delivery, postnatal, and child care services before and after the onset of the pandemic in 10 States of Nigeria were interviewed with a semi-structured questionnaire. Data were collected on women's socio-demographic characteristics and pregnancy histories, the services they sought before and after the pandemic, the challenges they faced in accessing the services, their use of alternative sources of health care, and their recommendations on ways to sustain RMNCH service delivery during the pandemic. The data were analyzed with descriptive statistics, and multivariable logistic regression using SPSS 20.0. All the statistical analyses were two-tailed with a 95% confidence interval, and the p-value was set at 0.05. RESULTS: The logistic regression results showed that women were at least 56% more likely to report that they used family planning, antenatal, and delivery services before the pandemic than after the pandemic started, but 38% less likely to report use of postnatal services. The experience of difficulty accessing RMNCH services was 23% more likely after the pandemic started than before the pandemic. Three categories of recommendations made by the respondents on measures to sustain RMNCH delivery during the pandemic included 1) facility improvement, and staff recruitment and re-training; 2) free and readily accessible PHC services, and 3) the provision of social safety nets including transportation and palliatives. CONCLUSION: We conclude that the COVID-19 pandemic limited women's access to antenatal, delivery, and childcare services offered in PHCs in Nigeria. Addressing the recommendations and the concerns raised by women will help to sustain the delivery of RMNCH services during the COVID-19 pandemic and future epidemics or health emergencies in Nigeria.

Outcomes of a multifaceted intervention to prevent eclampsia and eclampsia-related deaths in Nigerian referral facilities.

BACKGROUND: Eclampsia causes maternal mortality in Nigeria. This study presents the effectiveness of multifaceted interventions that addressed institutional barriers in reducing the incidence and case fatality rates associated with eclampsia. METHODS: The design was quasi-experimental and the activities implemented at intervention hospitals included a new strategic plan, retraining health providers on eclampsia management protocols, clinical reviews of delivery care and educating pregnant women and their partners. Prospective data were collected monthly on eclampsia and related indicators from study sites over 2 y. The results were analysed by univariate, bivariate and multivariable logistic regression. RESULTS: The results show a higher eclampsia rate (5.88% vs 2.45%) and a lower use of partograph and antenatal care (ANC; 17.99% vs 23.42%) in control compared with intervention hospitals, but similar case fatality rates of <1%. Overall, adjusted analysis shows a 63% decrease in the odds of eclampsia at intervention compared with control hospitals. Factors associated with eclampsia were ANC, referral for care from other facilities and older maternal age. CONCLUSION: We conclude that multifaceted interventions that address challenges associated with managing pre-eclampsia and eclampsia in health facilities can reduce eclampsia occurrence in referral facilities in Nigeria and potential eclampsia death in resource-poor African countries.

Causes and Risk Factors for Male Infertility: A Scoping Review of Published Studies.

Background: Despite the evidence of declining sperm counts worldwide and the increasing prevalence of male infertility, there has been limited documentation of the potential causes and risk factors for male infertility. With limited methods of primary treatment of male infertility, understanding the causes and risk factors will pinpoint specific lines of prevention. Objective: We reviewed published studies on causes and risk factors for male infertility and identify gaps in the literature enabling more focused research and innovations. Design/Setting: The study was a scoping review. The review included studies on the causes and risk factors of male infertility published in scientific/academic publications. It was not limited to any region or date. The following databases were searched: Cumulative Index to Nursing and Allied Health Literature, Wiley online, HINARI, Science Direct, PubMed/Medline, Google Scholar, African Journals Online, and the WHO Repository. In total, 1295 articles were identified. After removing 357 duplicates, 938 articles were screened, and 71 articles were identified for inclusion, while 60 articles met the inclusion criteria. Results: Four broad causes and risk factors of male infertility identified were 1) biological/physiological/genetic causes, 2) behavioral/lifestyle risk factors, 3) environmental factors, and 4) socio-demographic risk factors. However, no substantive results on actual causes under each category were identified, leaving gaps for further research and experimentation. Conclusion: The results indicate limited knowledge of the actual causes of male infertility in published studies. The gaps in knowledge that need to be bridged to enable a fuller understanding of the actual causes of male infertility were highlighted.

Effects of multifaceted interventions to prevent and manage primary postpartum haemorrhage in referral hospitals: a quasi-experimental study in Nigeria.

INTRODUCTION: Primary postpartum haemorrhage (PPH) is the leading cause of Nigeria's high maternal mortality rate. This study investigated the effectiveness of a set of multifaceted interventions to manage and reduce PPH in selected secondary referral health facilities in Nigeria. METHODS: This is a quasi-experimental study using an interrupted time-series design to assess a set of multifaceted interventions that address factors identified by stakeholders as associated with PPH. Interventions were implemented at two regional general hospitals, with a general hospital in the same region as the control. Intervention participants were women during antepartum and clinical and administrative staff. Cases of PPH were determined in women at delivery. The outcomes measured were the incidence of primary PPH and related deaths during the study period. Analyses included a comparative description of characteristics of the women, trend of time-series data at intervention and control hospitals, and multivariable analysis of factors associated with PPH occurrence. RESULTS: Monthly numbers of primary PPH were collected at participating hospitals over 21 months for 18 181 women. Intervention hospitals represent 54% vs 46% in control hospitals. Time-series analyses show a significant downward trend in intervention hospitals. The overall incidence of primary PPH was lower in the intervention hospitals than in the control hospitals. Multilevel regression adjusted for hospital-level effect showed a 68% reduction in odds of PPH cases at intervention compared with control hospitals. There were 12 PPH-related maternal deaths in one of the control hospitals, with no deaths in the intervention hospitals. CONCLUSION: We conclude that multiple interventions that address identified challenges in the prevention of primary PPH can potentially effectively reduce reported primary PPH in Nigerian referral hospitals. This approach is relevant for scaling the development of policies and programmes to prevent primary PPH and maternal mortality in Nigeria.

Effect of a multifaceted intervention on the utilisation of primary health for maternal and child health care in rural Nigeria: a quasi-experimental study.

OBJECTIVE: The objective of this study was to determine the effectiveness of a set of multifaceted interventions designed to increase the access of rural women to antenatal, intrapartum, postpartum and childhood immunisation services offered in primary healthcare facilities. DESIGN: The study was a separate sample pretest-post-test quasi-experimental research. SETTING: The research was conducted in 20 communities and primary health centres in Esan South East and Etsako East Local Government Areas in Edo State in southern Nigeria PARTICIPANTS: Randomly selected sample of ever married women aged 15-45 years. INTERVENTIONS: Seven community-led interventions implemented over 27 months, consisting of a community health fund, engagement of transport owners on emergency transport of pregnant women to primary health centres with the use of rapid short message service (SMS), drug revolving fund, community education, advocacy, retraining of health workers and provision of basic equipment. PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome measures included the number of women who used the primary health centres for skilled pregnancy care and immunisation of children aged 0-23 months. RESULTS: After adjusting for clustering and confounding variables, the odds of using the project primary healthcare centres for the four outcomes were significantly higher at endline compared with baseline: antenatal care (OR 3.87, CI 2.84 to 5.26 p<0.001), delivery care (OR 3.88, CI 2.86 to 5.26), postnatal care (OR 3.66, CI 2.58 to 5.18) and childhood immunisation (OR 2.87, CI 1.90 to 4.33). However, a few women still reported that the cost of services and gender-related issues were reasons for non-use after the intervention. CONCLUSION: We conclude that community-led interventions that address the specific concerns of women related to the bottlenecks they experience in accessing care in primary health centres are effective in increasing demand for skilled pregnancy and childcare in rural Nigeria.

Comparing the timeliness and adequacy of antenatal care uptake between women who married as child brides and adult brides in 20 sub-Saharan African countries.

CONTEXT: Considering the persistent poor maternal and child health outcomes in sub-Saharan Africa (SSA), this study undertook a comparative analysis of the timing and adequacy of antenatal care uptake between women (aged 20-24 years) who married before age 18 and those who married at age 18 or above. METHOD: Data came from Demographic and Health Surveys of 20 SSA countries. We performed binary logistic regression analysis on pooled data of women aged 20-24 (n = 33,630). RESULTS: Overall, the percentage of child brides in selected countries was 57.1%, with the lowest prevalence found in Rwanda (19.1%) and the highest rate in Chad (80.9%). Central and West African countries had the highest prevalence of child marriage compared to other sub-regions. Bivariate results indicate that a lower proportion of child brides (50.0%) had 4+ ANC visits compared to the adult brides (60.9%) and a lower percentage of them (34.0%) initiated ANC visits early compared to the adult brides (37.5%). After controlling for country of residence and selected socio-economic and demographic characteristics, multivariable results established significantly lower odds of having an adequate/prescribed number of ANC visits among women who married before age 15 (OR: 0.63, CI: 0.57-0.67, p<0.001), and women who married at ages 15-17 (OR: 0.81, CI: 0.75-0.84, p<0.001) compared to those who married at age 18+. Similar results were established between age at first marriage and timing of first ANC visit. Other interesting results emerged that young women who married earlier than age 18 and those who married at age 18+ differ significantly by several socio-economic and demographic characteristics. CONCLUSION: Efforts to improve maternal and child health outcomes in SSA must give attention to address the underutilization and late start of antenatal care uptake among child brides.

Influence of women's empowerment indices on the utilization of skilled maternity care: evidence from rural Nigeria.

There is increasing evidence that women with the ability to exercise control over their sexual and reproductive lives have greater access to prompt prevention and treatment of maternal health disorders, resulting in a concomitant reduction in maternal morbidity and mortality. This study assessed the association between indices of women's empowerment and utilization of skilled antenatal, intrapartum and postnatal maternity care in two rural Local Government Areas in Edo State, Nigeria. Data were taken from a household survey conducted in July and August 2017, and the study sample comprised 1245 ever-married women currently in a union who had given birth in the 5 years preceding the survey. A Gender Roles Framework guided the selection of independent women's empowerment variables. Using hierarchical logistic regression, the likelihood of receiving all three levels of skilled maternal health care service (antenatal, intrapartum and postnatal) by women's empowerment variables, grouped into resource, decision-making and influencer domains following the model of Anderson and Neuman, was assessed. Of the resource domain variables, respondent's education and respondent's participation in payment for their own health care positively predicted their use of all three levels of skilled maternal care, whereas their ownership of land negatively predicted this. Two decision-making domain variables were significantly associated with respondent's use of all three levels of service: those who made decisions alone about major household purchases were twice as likely to use all three levels of services than when decisions were made by their partners or others, while respondent making decisions alone about what food to cook each day was a negative predictor. Of the influencer variables, religion and a large spousal education gap were strong positive factors, whereas living in a consensual union rather than being legally married was a negative factor. Although health system factors are important, interventions geared towards changing gender norms that constrain women's empowerment are critical to achieving maternal health-related development goals in Nigeria. A composite strategy that targets all women's empowerment indices is recommended, as Nigeria strives towards achieving SDG-3.

Why women utilize traditional rather than skilled birth attendants for maternity care in rural Nigeria: Implications for policies and programs.

OBJECTIVE: Data from the Nigeria Demographic and Health Survey indicate that many pregnant women in rural Nigeria use traditional birth attendants (TBAs) rather than skilled birth attendants (SBAs) for maternal health care. This is one factor that accounts for the persistently high rate of maternal mortality in Nigeria. The objective of this study was to identify the pervading reasons that women use TBAs for pregnancy care in rural Nigeria and to make recommendations for policy and programmatic reform. DESIGN: Qualitative research design consisting of focus group discussions, key informant interviews, and community conversations, followed by inductive thematic analysis. SETTING: Twenty rural communities (villages) in Etsako East, and Esan South East Local Government Areas of Edo State, South-South, Nigeria. PARTICIPANTS: Twenty focus group discussions with men and women in a marital union; 15 key informant interviews with policymakers, senior health providers, and women leaders; and 10 community conversations with key community leaders. FINDINGS: Some reasons proffered for using TBAs included perceptions of higher efficacy of traditional medicines; age-long cultural practices; ease of access to TBAs as compared to SBAs; higher costs of services in health facilities; and friendly attitude of TBAs. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The continued use of TBA is a major challenge in efforts to achieve the Sustainable Development Goal 3 in Nigeria. We conclude that efforts to address the factors identified by community stakeholders as inhibiting the use of SBAs will promote skilled birth attendance and reduce maternal mortality in rural Nigeria.

Assessment of service readiness for maternity care in primary health centres in rural Nigeria: implications for service improvement.

INTRODUCTION: several scientific reports from studies across Nigeria revealed a higher incidence of maternal mortality in rural parts of the country as compared to the urban areas. Part of the reasons is the paucity of health care infrastructure and personnel. This study was designed as part of an intervention program with the goal to improve the access of pregnant women to skilled pregnancy care in rural Nigeria. The specific objective of the study was to determine the nature and readiness of Primary Health Centres (PHCs) in two Local Government Areas (LGAs) in rural parts of Edo State, Southern Nigeria to deliver effective maternal and child health services. METHODS: the study was conducted in 12 randomly selected PHCs in the two LGAs. Data were obtained with a semi-structured questionnaire administered on health workers and through direct observation and verification of the facilities in the PHCs. The results obtained were compared with the national standards established for PHCs in Nigeria by the National Primary Health Care Development Agency (NPHCDA). Descriptive statistics were used to analyze the data. RESULTS: the results showed severe deficits in buildings and premises, rooms, medical equipment, essential drugs, and personnel. Only 40% of items recommended by the NPHCDA were available for buildings; 41% of the PHCs had facilities available in the labour ward; while less than 30% had the recommended facilities in the antenatal care rooms. Only one PHC had a laboratory space, with only one item (a dipstick for urine analysis) identified in the laboratory. None of the PHCs had ambulances, mobile phones, internet or computers. There was no nurse/midwife in 4 PHCs; only one nurse/midwife each were available in 8 PHCs; while there was no Environmental/Medical Records Officer in any PHC. About 26% of the essential drugs were not available in the PHCs. CONCLUSION: we conclude that PHCs in Edo State, Nigeria have severe deficits in infrastructural facilities, equipment, essential drugs and personnel for the delivery of maternal and child health care. Efforts to improve these facilities will help increase the quality of delivery of maternal and child health, and therefore reduce maternal and child mortality in the country.

Outcomes of a multifaceted intervention to improve maternal satisfaction with care in secondary hospitals in Nigeria.

Background: Data in Nigeria suggests a high level of dissatisfaction among women attending maternity care in health facilities due to long wait times, disrespectful care, and poor attention by healthcare personnel. Objective: To examine the effectiveness of a multifaceted intervention in improving self-reported indicators of maternal healthcare satisfaction by women who use referral facilities in two regions of Nigeria. Method: The design was quasi-experimental and consisted of two intervention facilities and two control facilities. The interventions included strategic planning, staff re-training, a computerized appointment system, health education/feedback, maternal death reviews and surveillance, and advocacy. A random sample of 2262 women was selected (1205 in the intervention sites and 1057 in the two control sites) to respond to a 24-item questionnaire on service satisfaction as they exited the health facilities. Adjusted Poisson and binary regression analyses were used to assess and compare proportions of reported satisfaction by women between the intervention and control sites. Results: Women in the intervention sites were 54% more likely than those in control sites to report overall satisfaction with services. They were significantly less likely to report inadequate security arrangements in accessing the health facilities (p < .1); and three times more likely to agree that health workers were extremely thorough and careful in attending to them (p < .1). Conclusion: The interventions had positive effects on improving women's satisfaction with care. The findings from this study have implications for the design and implementation of interventions that address women's concerns relating to the provision of care and consequently improve service utilization.

Outcome of multifaceted interventions for improving the quality of antenatal care in Nigerian referral hospitals.

BACKGROUND: The study was designed as quasi-experimental research to investigate the effectiveness of multifaceted interventions for improving the quality of antenatal care in referral hospitals in Nigeria. Two referral hospitals (the Central Hospital in Benin City, South-South Nigeria, and the General Hospital in Minna) served as intervention sites, while two hospitals in comparable locations, (the Central Hospital Warri and the Suleja Hospital Abuja) were the control hospitals. METHODS: Intervention activities consisted of the introduction of a strategic plan with the shared vision of reducing maternal mortality by 50% in 1 year in the hospitals; staff training and re-training; the establishment of an automated appointment system; composite health education involving couples and providers; advocacy with policymakers; and the implementation of maternal death reviews and surveillance. These activities were implemented in the intervention hospitals over 21 months (October 2017 to June 2019). Exit interviews of pregnant women at intervention and control sites by trained interviewers were used to assess the quality of antenatal care after their visit, A total of 777 women were interviewed (427 in the intervention sites and 350 in the control sites). Data were analyzed with univariate and multivariate Poisson and logistic regression to determine the extent to which health providers in the clinics completed the 18 signal functions identified in the WHO assessment tool. RESULTS: The regression analyses showed the interventions were effective in improving six quality indicators (QIs) for counseling and information sharing. The difference between intervention and control sites on these QIs was significant at < 0.05. On the contrary, the interventions were less effective for maternal and fetal measurements; and disease testing and management QIs. CONCLUSION: The positive effects of the interventions are likely due to the effectiveness of the training and health education components. The lack of intervention impact observed for maternal and fetal measurements may be due to the high workload of care staff and inadequate clinic supplies, which we did not address. We conclude that interventions that address the quality of antenatal care in low-resource settings should focus on improving all elements of care, including adequate staffing and mobilization of material resources. TRIAL REGISTRATION: This study was registered in the ISRCTN on August 14th, 2020. TRIAL REGISTRATION NUMBER: SRCTN17985403 . Retrospective registration. The reason for the retrospective registration is the current non-recognition of the Nigeria Clinical Trials Registry (NCTR); which is currently not an ICMJE or WHO ICTRP approved registry. (This study was registered in the Nigeria Clinical Trials Registry on April 14th, 2016. Trial Registration Number NCTR No: 91540209 ).

Why rural women do not use primary health centres for pregnancy care: evidence from a qualitative study in Nigeria.

BACKGROUND: While Primary Health Care has been designed to provide universal access to skilled pregnancy care for the prevention of maternal deaths in Nigeria, available evidence suggests that pregnant women in rural communities often do not use Primary Health Care Centres for skilled care. The objective of this study was to investigate the reasons why women do not use PHC for skilled pregnancy care in rural Nigeria. METHODS: Qualitative data were obtained from twenty focus group discussions conducted with women and men in marital union to elicit their perceptions about utilisation of maternal and child health care services in PHC centres. Groups were constituted along the focus of sex and age. The group discussions were tape-recorded, transcribed verbatim and analyzed thematically. RESULTS: The four broad categories of reasons for non-use identified in the study were: 1) accessibility factors - poor roads, difficulty with transportation, long distances, and facility not always open; 2) perceptions relating to poor quality of care, including inadequate drugs and consumables, abusive care by health providers, providers not in sufficient numbers and not always available in the facilities, long waiting times, and inappropriate referrals; 3) high costs of services, which include the inability to pay for services even when costs are not excessive, and the introduction of informal payments by staff; and 4) Other comprising partner support and misinterpretation of signs of pregnancy complications. CONCLUSION: Addressing these factors through adequate budgetary provisions, programs to reduce out-of-pocket expenses for maternal health, adequate staffing and training, innovative methods of transportation and male involvement are critical in efforts to improve rural women's access to skilled pregnancy care in primary health care centres in the country.

Assessing the knowledge and skills on emergency obstetric care among health providers: Implications for health systems strengthening in Nigeria.

OBJECTIVE: To assess the existing knowledge and skills relating to Emergency Obstetrics Care (EMOC) among health providers in eight referral maternity hospitals in Nigeria. STUDY DESIGN: A cross-sectional study of skilled health providers (doctors, nurses and midwives) working in the hospitals during the period. SETTING: Six general hospitals (4 in the south and 2 in the north), and two teaching hospitals (both in the Northern part) of the country. POPULATION: All skilled providers offering EMOC services in the hospitals during the study. METHODS: A pre-tested self-administered questionnaire was used to obtain information relating to socio-demographic characteristics, the respondents' knowledge and skills in offering specific EMOC services (as compared to standard World Health Organization recommendations), and their confidence in transferring the skills to mid-level providers. Data were analyzed with univariate, bivariate, binary and multinomial logistic regression analyses. Main outcome measures: knowledge and skills in EMOC services by hospital and overall. RESULTS: A total of 341 health providers (148 doctors and 193 nurses/midwives) participated in the study. Averagely, the providers scored less than 46% in a composite EMOC knowledge score, with doctors scoring considerable higher than the nurses/midwives. Similarly, doctors scored higher than nurses/midwives in the self-reporting of confidence in carrying out specific EMOC functions. Health providers that scored higher in knowledge were significantly more likely to report confidence in performing specific EMOC functions as compared to those with lower scores. The self-reporting of confidence in transferring clinical skills was also higher in those with higher EMOC knowledge scores. CONCLUSION: The knowledge and reported skills on EMOC by health providers in referral facilities in Nigeria was lower than average. We conclude that the in-service training and re-training of health providers should be included in national policy and programs that address maternal mortality prevention in referral facilities in the country. TRIAL REGISTRATION: Nigeria Clinical Trials Registry 91540209.

Prevalence and determinants of stillbirth in Nigerian referral hospitals: a multicentre study.

BACKGROUND: In 2015, Nigeria's estimated 317,700 stillbirths accounted for 12.2% of the 2.6 million estimated global stillbirths. This suggests that Nigeria still makes substantial contribution to the global burden of stillbirths. This study was conducted to determine the prevalence and identify the causes and factors associated with stillbirth in eight referral hospitals in Nigeria. METHODS: This was a cross-sectional study of all deliveries over a period of 6 months in six general hospitals (4 in the south and 2 in the north), and two teaching hospitals (both in the north) in Nigeria. The study population was women delivering in the hospitals during the study period. A pre-tested study protocol was used to obtain clinical data on pregnancies, live births and stillbirths in the hospitals over a 6 months period. Data were analyzed centrally using univariate, bivariate and multivariate logistic regression analyses. The main outcome measure was stillbirth rate in the hospitals (individually and overall). RESULTS: There were 4416 single births and 175 stillbirths, and a mean stillbirth rate of 39.6 per 1000 births (range: 12.7 to 67.3/1000 births) in the hospitals. Antepartum (macerated) constituted 22.3% of the stillbirths; 47.4% were intrapartum (fresh stillbirths); while 30.3% was unclassified. Acute hypoxia accounted for 32.6% of the stillbirths. Other causes were maternal hypertensive disease (6.9%), and intrapartum unexplained (5.7%) among others. After adjusting for confounding variables, significant predictors of stillbirth were referral status, parity, past experience of stillbirth, birth weight, gestational age at delivery and mode of delivery. CONCLUSION: We conclude that the rate of stillbirth is high in Nigeria's referral hospitals largely because of patients' related factors and the high rates of pregnancy complications. Efforts to address these factors through improved patients' education and emergency obstetric care would reduce the rate of stillbirth in the country. TRIAL REGISTRATION: Trial Registration Number NCTR91540209. Nigeria Clinical Trials Registry. http://www.nctr.nhrec.net/ Registered April 14th 2016.

Examining the Role of Couples' Characteristics in Contraceptive use in Nigeria and Zambia.

Relationship-related characteristics influence diverse health and demographic outcomes. This study examined the role of couples' characteristics in contraceptive use. Data were obtained from 2013 Nigeria and 2013-14 Zambia Demographic and Health Surveys. The study population consisted of couples in monogamous union (married or living together) who had at least one live birth and the wife was not pregnant at the time of the survey. Prevalence of contraceptive use among couples in Nigeria was 27% and 63% in Zambia. Couples' educational attainment, religious affiliation, the frequency of listening to the radio, reported number of children, fertility preference, region of residence and household wealth index were significant predictors of contraceptive use among couples in Nigeria and Zambia. Given the significant role of couples' characteristics in the uptake of contraceptives, there is the need to encourage interventions that target couples, particularly those of poor socioeconomic status.