Combination prevention package of interventions for reducing vulnerability to HIV among adolescent girls and young women in Nigeria: An action research.

BACKGROUND: Adolescent girls and young women (AGYW) in Nigeria are especially at risk of HIV in Nigeria. Their vulnerability to HIV is linked to multiple concurrent sexual relationships, transgenerational sex, and transactional sex, amongst other factors. These factors have sociocultural contexts that vary across a multi-cultural country like Nigeria. The aim of this study was to use an innovative collaborative approach to develop a minimum HIV prevention package for AGYW which is responsive to sociocultural settings and based on combination HIV prevention. METHODS: We conducted action research to develop and implement actionable HIV prevention intervention models that address AGYW's vulnerabilities to HIV in three Nigerian States and the Federal Capital Territory (FCT) Abuja. The action research adopted the breakthrough series (BTS) collaborative, which accelerates improvement through mutual learning. The BTS implementation involved rapid Plan-Do-Study-Act (PDSA) cycles: an iterative process to plan and implement a basket of interventions. Problems or problematic situations, termed change topics, for which interventions could be carried out were identified in each study location. Using participatory approaches during a series of meetings called learning sessions, specific and innovative interventions, termed change ideas, were developed. These learning sessions were conducted with young women groups and other stakeholders. The change ideas were tested, studied, adapted, adopted, or discarded at each participating site. Exposure to and uptake of the implemented interventions was assessed in the study areas using a household survey with 4308 respondents, 53 focus group discussions, and 40 one-on-one interviews in intervention and control study sites. RESULTS: Five categories of interventions were collaboratively developed, namely: Parental communication; Peer to peer interventions; Facilitator-led interventions; Non-traditional outlets for condoms, and Social media-based interventions. A good reach of the interventions was demonstrated as 77.5% of respondents reported exposure to at least one type of intervention. Nearly half of the respondents reported being exposed to the parental communication interventions, while 45.1% reported being exposed to the youth facilitator-driven interventions. Social media interventions had the lowest penetration. Also, there was between 15 to 20 positive percentage point difference between intervention and control for the uptake of HIV testing, and between 5 to 9 positive percentage point difference for uptake of male condoms. These differences were statistically significant at p<0.001. CONCLUSIONS: Interventions developed through participatory approaches with young people and well-tailored to local realities can improve the acceptability and accessibility of programs that are able to reduce the risk of HIV infection among AGYW.

Differences in contraceptive prices between and within family planning outlets in urban and semiurban Nigeria: a prospective cohort study.

BACKGROUND: There is a lack of comprehensive evidence assessing variability and volatility in contraceptive prices. Improved understanding of contraceptive pricing, both between and within public and private service delivery points situated within complex, mixed health systems, may improve understanding of contraceptive access from the perspective of the consumer. OBJECTIVE: To describe variability and volatility in contraceptive method prices within localized urban and semiurban markets in Nigeria. STUDY DESIGN: We used product audit data from a complete census and longitudinal cohort of family planning vendors within 4 urban and semiurban study sites in Nigeria. Differences in outlet-level minimum prices by outlet type were assessed using generalized estimating equations. We presented descriptive summaries of within-outlet changes in minimum price over time. RESULTS: Among 672 family planning vendors, outlet-level minimum prices were significantly higher in private facilities/outlets than in public facilities. The outlet-level minimum price was $9.4 (95% confidence interval, $5.7-$13.2) higher for implants in private vs public facilities. We observed high availability of free contraceptive products in the public sector (79%-100%), moderate levels for specific contraceptive product types among community health workers and private facilities (28%-62% for male condoms), and low prevalence among private nonfacility outlets (0%-3%). Variability in contraceptive prices was high within private facilities and nonfacility outlets: standard deviations in the distribution of long-acting reversible contraceptive products ranged from $9.7 for implants to $13.1 for intrauterine devices in the private sector. Changes in minimum prices by contraceptive method type were common within the same outlets over time in the private sector. CONCLUSION: We observed high variability between and within contraceptive vendors in selected Nigerian family planning markets. Further research assessing the impact of price variability is critical for understanding contraceptive access and decision-making from the consumer's perspective.

Psychological distress and burden of care among family caregivers of patients with mental illness in a neuropsychiatric outpatient clinic in Nigeria.

BACKGROUND: The wellbeing of family caregivers of mentally ill persons has often been ignored, despite that family caregivers can be predisposed to psychiatric morbidities and burden in caring for their mentally ill family members. This study examined the levels of psychological distress and burden of care experienced by family caregivers who care for their mentally ill relatives in Edo State, Nigeria. METHODS: This study assessed psychological distress using the General Health Questionnaire (GHQ-12). Burden of care was measured using the 22-item Zarit Burden Interview (ZBI) questionnaire. Multiple linear regression was done to determine factors associated with burden of care and psychological distress, while factor analysis was used to determine the underlying forms of burden of care and psychological distress among participants. RESULTS: Caregivers studied were relatives of patients diagnosed for depression (25.1%), substance use disorder (22.2%), schizophrenia (20.2%) and bipolar affective disorder (11.1%). Approximately 15% experienced no-to-mild burden, 51.3% mild-to-moderate burden and 34.0% high-or-severe burden. Nearly halve (49.0%) of participants experienced psychological distress. Severe rate of psychological distress was observed among subjects caring for patients with schizophrenia (60.7%), epilepsy (60.0%), substance use disorder (52.2%) and depression (49.0%). High burden of care was more preponderant among caregivers of relatives with mental retardation and epilepsy (50% each) and schizophrenia (39.3%). Having a higher educational qualification and being self-employed was a predictor of psychological distress. Gender of caregiver and the diagnosis schizophrenia among relatives of caregivers predisposed to burden of care. Three factors including social and emotional dysfunction, psychological distress and cognitive dysfunction were identified as components of psychological health through factor analysis. On the burden scale, six factor components were identified as: personal strain, role strain, intolerance, patients' dependence, guilt and interference in personal life. CONCLUSION: There is a high prevalence of psychological morbidity and burden of care among family caregivers providing care for persons with mental illness.

Determinants of antenatal HIV testing in the opt-out approach in Nigeria: findings from the Nigerian Demographic and Health Survey.

Children in Nigeria are frequently born with HIV, despite available services to prevent mother-to-child transmission (MTCT). Not offering, or non-acceptance of, HIV testing during antenatal care (ANC) delays anti-retroviral commencement for infected women, thereby increasing the risk of MTCT. This study assessed the determinants of HIV testing during antenatal care in Nigeria using nationally representative data from the 2013 Nigerian Demographic Health Survey. This study included 13,352 women aged 15-49 years who reported having at least one antenatal visit. The outcome variables were HIV testing during ANC and during labour, while socio-demographic and maternal factors, including number of ANC visits, offer of HIV testing during ANC and labour, place of delivery and knowledge and counselling on MTCT, were among the independent variables. Multivariate regression analysis was used to predict HIV testing during ANC and labour. About half (53%) of the women were tested for HIV during antenatal care with 85% of those tested receiving their test results. Only 6% had HIV tests during labour. There was a 33% excess probability of urban women testing during ANC compared with rural women. Never having a previous pregnancy terminated was associated with lower odds of testing during ANC. No counselling on MTCT and no counselling to get tested were associated with a lower probability of testing during ANC. Counselling on the prevention of MTCT is crucial for women's willingness to be tested, and acceptance of testing. More effort is needed to ensure that providers in Nigeria offer these services to all women, educate women on the dangers of opting out and ensure the earliest commencement of ARV enrolment for those infected.

Examining inequalities in access to delivery by caesarean section in Nigeria.

BACKGROUND: Maternal deaths are far too common in Nigeria, and this is in part due to lack of access to lifesaving emergency obstetric care, especially among women in the poorest strata in Nigeria. Data on the extent of inequality in access to such lifesaving intervention could convince policymakers in developing an appropriate intervention. This study examines inequality in access to births by caesarean section in Nigeria. METHODS: Data for 20,468 women who gave birth in the five years preceding 2013 Nigerian Demographic and Health Survey (DHS) were used for this study. Inequality in caesarean delivery was assessed using the concentration curve and multiple logistic regression models. RESULTS: There was a high concentration in the utilisation of caesarean section among the women in the relatively high wealth quintile. Overall, delivery by caesarean section was 2.1%, but the rate was highest among women who had higher education and belonged to the richest wealth quintile (13.6%) and lowest among women without formal education and who belonged to the poorest wealth quintile (0.4%). Belonging to the poorest wealth quintile and having no formal education were associated with lower odds of having delivery by caesarean section. CONCLUSION: In conclusion, women in the richest households are within the WHO's recommended level of 10-15% for caesarean birth utilisation, but women in the poorest households are so far away from the recommended rate. Equity in healthcare is still a promise, its realisation will entail making care available to those in need not only those who can afford it.

Complementary feeding practices among mothers and nutritional status of infants in Akpabuyo Area, Cross River State Nigeria.

BACKGROUND: Malnutrition in infants during weaning has been attributed to inappropriate complementary feeding practices and it underlies more than one-third of child mortality in Nigeria. Thus, addressing the influence of complementary feeding practice on nutritional status may be an important approach to reducing the burden of child malnutrition. This cross-sectional study investigated the association between complementary feeding practices among mothers and nutritional status of their infants in Akpabuyo Local Government Area, Nigeria. The study enrolled 330 mother-child pairs from 10 randomly selected out of 32 Health Facilities in Akpabuyo. Socio-demographic information, child and maternal characteristics were obtained using an interviewer-administered questionnaire. Complementary feeding practices were assessed with World Health Organization infant and young child feeding indicators. Nutritional indicators wasting, underweight and stunting were determined. RESULTS: Prevalence of timely introduction of complementary feeding among infants aged 6-8 months was 85.4%, minimum dietary diversity rate was 31.5%, and minimum meal frequency 36.7%, the rate of minimum acceptable diet was 7.3%. One-third (33.3%) of the infants were underweight, 26.4%, wasted and 24.6%, stunted. Children who did not receive timely complementary foods had higher odds for wasting (OR 5.15; 95% CI 1.50-17.73). Children who did not receive the minimum dietary diversity had higher odds for underweight than children who received the minimum dietary diversity (OR 2.07; 95% CI 1.17-3.70). Children who did not receive the minimum feeding frequency were more likely to be stunted than their peers who received the minimum feeding frequency (OR 1.57; 95% CI 1.53-4.03). CONCLUSION: Sub-optimal complementary feeding predisposed to infant's malnutrition.

Psychosocial wellbeing of patients with multidrug resistant tuberculosis voluntarily confined to long-term hospitalisation in Nigeria.

BACKGROUND AND OBJECTIVE: Patient isolation, which is a widely successful treatment strategy for tuberculosis (TB), has been suspected to have effects on patient psychosocial wellbeing. We assessed the psychosocial wellbeing of multidrug resistant TB (MDR-TB) patients in voluntary and isolated long-term hospitalisation in Nigeria. METHODS: 98 accessible and consenting patients in four drug-resistant treatment centres (University College Hospital and Government Chest Hospital, Ibadan; Mainland Hospital, Lagos, and Lawrence Henshaw Memorial Hospital, Calabar) were enrolled in this study. Data were collected using an 18-item psychosocial wellbeing questionnaire including sociodemographic characteristics. We used descriptive statistics to present demographic characteristics; the χ2 test was used to assess associations between psychosocial wellbeing and independent variables and the relationship was modelled using logistic regression. RESULTS: The mean age of respondents was 36.1±11.9 years and 63% were males. Respondents had been in hospital an average of 4.5±1.9 months. Females had more psychosocial concerns compared with males. The most common concerns recorded among respondents were concern that people will get to know that the respondent had a bad type of TB (70%), discontent with being separated from and longing for the company of their marital partner (72%), concerns that they may have taken too many drugs (73%), and displeasure with being unable to continue to engage in their usual social and economic activities (75%). Respondents who were employed had eight times the odds of having more psychosocial concerns than the median number among respondents. Respondents who were supported by their own families during hospitalisation experienced a lower burden of psychosocial concerns compared with those who were supported by third parties. CONCLUSIONS: Prolonged hospitalisation resulted in significant psychosocial burden for the MDR-TB patients in our study centres. There is a need to consider alternative approaches that place less psychosocial burden on patients without compromising quality of care.