Does where mothers live matter? Regional variations in factors influencing place of child delivery in Nigeria.

Utilization of health care facilities for child delivery is associated with improved maternal and neonatal outcomes, but less than half of mothers use these for child delivery in Nigeria. This study investigated the factors associated with facility delivery in Nigeria, and their variation between the Northern and Southern parts of the country - two regions with distinct socio-cultural make-ups. The study included 33,924 mothers aged 15-49 who had given birth in the last 5 years preceding the 2018 Nigeria Demographic and Health Survey. Overall, higher age, being educated, being a Christian, being an urban resident, being exposed to mass media, making joint decisions with partner on health care, beginning antenatal visits in the first trimester and attending antenatal clinics frequently were found to be associated with improved use of a health care facility for child delivery. An average mother in Northern Nigeria had a 38% chance of having a facility-based delivery, whereas the likelihood in the South was 76%. When other factors were adjusted for, age and listening to the radio were significant predictors of facility-based delivery in the South but not in the North. In the North, Christians were more likely than Muslims to have a facility-based delivery, but the reverse was true in the South. Rural women in the South had a 16% greater chance of having a facility-based delivery than urban women in the North. The study results suggest that there is inequality in access to health care facilities in Nigeria, and the differences in the socio-cultural make-up of the two regions suggest that uniform intervention programmes may not yield similar results across the regions. The findings give credence to, and expand on, the Cosmopolitan-Success and Conservative-Failure Hypothesis.

Determinants of antiretroviral treatment adherence among patients attending secondary health care facilities in north-east and south-west Nigeria: a comparative study.

BACKGROUND: Four decades after its discovery, HIV continues to be a major global public health issue, even with antiretroviral therapy (ART). Strict adherence to ART remains a challenge, with attendant implications for treatment success. This study aimed at comparing ART adherence between north-east and south-west Nigeria. METHODS: A comparative cross-sectional study was conducted in two regions in Nigeria among 400 HIV/AIDS patients on ART. Data were collected using a pre-tested, semi-structured interviewer-administered questionnaire. Multivariable analysis was performed to determine predictors of ART adherence in the regions. The level of significance was set at 0.05. RESULTS: The majority of respondents from both the north-east (87.5%) and south-west (92.5%) of Nigeria had good knowledge about ART. The self-reported adherence level was 90.0% in the north-east and 87.5% in the south-west. Predictors of ART adherence in the north-east were knowledge about ART (AOR 9.949; 95% CI 2.009-49.284) and transport costs to the clinic (AOR 0.177; 95% CI 0.047-0.661). In the south-west, education (AOR 0.198; 95% CI 0.047-0.832) and knowledge of ART (AOR 8.945; 95% CI 1.749-45.751) were identified as predictors of ART adherence. CONCLUSION: In both regions, knowledge about ART was appreciable, but adherence was sub-optimal. Strategies to support adherence should be tailored to specific predictors in each region.

Social and Bio-Medical Predictors of Exclusive Breastfeeding Among Nursing Mothers in Lagos and Taraba States, Nigeria.

PURPOSE: Although exclusive breastfeeding (EBF) is known to have positive consequences for mothers and infants, EBF rate in Nigeria is <25%. This study investigated if social factors were stronger predictors of EBF than bio-medical factors in the metropolitan areas of Lagos and Taraba States. Social factors included mother's education, infant sex, place of birth, and nature of mother's employment, while bio-medical factors included nature of birth (whether vaginal or caesarean section), problems with breast/nipple, breast milk insufficiency, and mother's age. DESIGN AND METHODS: The study adopted a cross-sectional survey design and mixed method of data collection. From the two states, 500 mothers with babies between 7 and 12 months of age completed a structured questionnaire. Twenty respondents from each state were interviewed using an in-depth interview guide. RESULTS: Education (ß = 1.743; p < 0.001), infant sex (ß = -0.454; p < 0.05), and place of delivery (ß = -1.552; p < 0.001) were significant social predictors. Breast milk insufficiency (ß = -1.851; p < 0.001) and mother's age (ß = 0.064; p < 0.001) were significant bio-medical predictors. When all the eight factors were considered, only two of the three social factors, namely, education and infants' sex, remained significant, while three bio-medical factors, namely, breast milk insufficiency, mother's age, and nature of delivery, were significant. CONCLUSIONS: Social and bio-medical factors co-determine the practice of EBF and must not be considered dichotomous. PRACTICAL IMPLICATIONS: Interventions to encourage EBF among Nigerian mothers must focus on education regarding its benefits and correction of misconceptions that breast milk alone is insufficient as an infant's diet.

Factors Associated with Choice of Non-Facility Delivery among Women Attending Antenatal Care in Bali Local Government Area of Taraba State, North-Eastern Nigeria.

One intervention that is widely believed to reduce the high maternal mortality in resource-poor countries including Nigeria is delivery in health facilities under skilled birth attendance. However, the practice of non-facility delivery is still common in these countries. Curiously, women who attend ANC in health facilities are also among those who choose to deliver in a non-facility. This was a descriptive cross-sectional study conducted in Bali LGA of Taraba State, Nigeria. Multi-stage sampling technique was used to select 320 women of childbearing age who attended ANC and had had a recent delivery. The objective was to determine the factors associated with choice of non-facility delivery among women attending ANC in the area. Data analysis was done using EPI info computer software version 7.2.1.0 Most of the women (73.1%) delivered in a non-facility. Ethnicity and place of ANC were the predictors of non-facility delivery. The most common reason for non-facility delivery was that labour came without complications (58.8%). Prevalence of non-facility delivery in the area was disturbingly high. Strategies to discourage the practice should include providing adequate skilled personnel and equipment at all levels of healthcare. There should also be active engagement of the traditional and religious institutions in the area.

Tuberculosis preventive practices among treatment supporters in Lagos, Nigeria.

Context: Tuberculosis (TB) treatment support is one of the recommended strategies to enhance treatment adherence and outcomes. Treatment supporters are at risk of contracting TB and adequate knowledge of TB and good preventive practices are required for their protection. Aims: This study aimed at assessing the knowledge and preventive practices of TB treatment supporters at Directly Observed Treatment Short-course (DOTS) centers in Lagos Mainland Local Government Area of Lagos state, Nigeria. Settings and Design: This cross-sectional study was conducted among 196 TB treatment supporters selected from five DOTS centers in Lagos. Methods: Data were obtained using an adapted pretested questionnaire. Statistical Analysis Used: Bivariate and multivariate analyses were performed to determine the factors associated with self-protection practices. A P < 0.05 was considered statistically significant. Results: The mean age of the participants was 37.3 ± 12.1 years. More than half of the respondents were females (59.2%) and immediate family members (61.3%). Overall, 22.5% had good knowledge of TB, while 53.0% had positive attitudes toward TB. Only 26.0% adequately protected themselves from infection. The caregiver's level of education (P = 0.001) and their relationship to the patient (P = 0.001) were significantly associated with good preventive practices in bivariate analysis. Not being related to the patient was a predictor of adequate TB prevention practices (adjusted odds ratio = 2.852; P = 0.006; 95% confidence interval = 1.360-5.984). Conclusions: This study revealed low levels of TB knowledge and fair preventive practices, especially among caregivers who are relatives. There is, therefore, a need to improve population literacy about TB and its prevention and a more focused orientation of relatives who volunteer as treatment supporters, through health education, with periodic monitoring during clinic visits, of how they prevent TB.

Résumé Contexte: Le soutien au traitement de la tuberculose (TB) est l'une des stratégies recommandées pour améliorer l'observance du traitement et les résultats. Traitement les supporters courent le risque de contracter la tuberculose et une connaissance adéquate de la tuberculose et de bonnes pratiques préventives sont nécessaires pour leur protection. Objectifs: Cette étude visait à évaluer les connaissances et les pratiques préventives des accompagnants du traitement de la tuberculose au traitement directement observé Centres de formation courte (DOTS) dans la zone de gouvernement local de Lagos Mainland, dans l'État de Lagos, au Nigéria. Réglages et conception : Cette section transversale L'étude a été menée auprès de 196 agents de soutien au traitement de la tuberculose sélectionnés dans cinq centres DOTS à Lagos. Méthodes: Les données ont été obtenues à l'aide de un questionnaire prétesté adapté. Analyse statistique utilisée : Des analyses bivariées et multivariées ont été effectuées pour déterminer les facteurs associés aux pratiques d'autoprotection. Un P < 0.05 était considéré comme statistiquement significatif. Résultats: L'âge moyen des participants était 37.3 ± 12.1 ans. Plus de la moitié des répondants étaient des femmes (59.2 %) et des membres de la famille immédiate (61.3 %). Dans l'ensemble, 22.5 % avaient bonne connaissance de la tuberculose, tandis que 53.0 % avaient des attitudes positives à l'égard de la tuberculose. Seuls 26.0% se sont protégés de manière adéquate contre l'infection. Les le niveau d'instruction de l'aidant (P = 0.001) et sa relation avec le patient (P = 0.001) étaient significativement associés à une bonne prévention. pratiques en analyse bivariée. Ne pas être apparenté au patient était un facteur prédictif de pratiques adéquates de prévention de la tuberculose (rapport de cotes ajusté = 2.852 ; P = 0.006 ; Intervalle de confiance à 95 % = 1.360­5.984). Conclusions: Cette étude a révélé de faibles niveaux de connaissances sur la tuberculose et des pratiques préventives équitables, surtout chez les soignants qui sont des proches. Il est donc nécessaire d'améliorer les connaissances de la population sur la tuberculose et sa prévention et de une orientation plus ciblée des proches qui se portent volontaires pour soutenir le traitement, par le biais d'une éducation à la santé, avec un suivi périodique pendant la cliniquevisites, de la façon dont ils préviennent la tuberculose. Mots-clés: Lagos, Nigéria, soutien au traitement, tuberculose.

Menstrual hygiene management among adolescent school girls in Taraba State, Nigeria.

BACKGROUND: The onset of menstruation denotes a landmark event in pubertal development of the adolescent girl. Lack of adequate knowledge and good menstrual hygiene management can have far reaching consequences on the girl's wellbeing, dignity and reproductive health. OBJECTIVES: This study assessed the menstrual knowledge and hygiene practices of adolescent school girls in Taraba State, Nigeria. METHODS: A descriptive cross sectional study conducted among 297 adolescent school girls. Participants were selected using multistage sampling technique. A self-administered, structured questionnaire was used for data collection. The Statistical Package for Social Sciences (SPSS) version 22.0 was used for the analysis of data. RESULTS: The mean age at menarche was 13.7 years (± 6.7). Over three-quarter (76.1%) of the girls knew about menstruation before experiencing it. Mothers (48.1%) were the leading source of information about menstruation to the students. The study found that 207 (69.7%) of respondents had good knowledge about menstruation while 171 (57.58%) had good menstrual hygiene management. Knowledge was significantly associated with good menstrual hygiene management (p<0.001). CONCLUSION: Knowledge of menstruation and hygienic practices during menstruation among the participants in the study was encouraging. Every adolescent girl should be equipped with the right knowledge and support for good menstrual hygiene management.

Tuberculosis preventive practices among treatment supporters in Lagos, Nigeria

Context: Tuberculosis (TB) treatment support is one of the recommended strategies to enhance treatment adherence and outcomes. Treatment supporters are at risk of contracting TB and adequate knowledge of TB and good preventive practices are required for their protection. Aims: This study aimed at assessing the knowledge and preventive practices of TB treatment supporters at Directly Observed Treatment Short-course (DOTS) centers in Lagos Mainland Local Government Area of Lagos state, Nigeria. Settings and design: This cross-sectional study was conducted among 196 TB treatment supporters selected from five DOTS centers in Lagos. Methods: Data were obtained using an adapted pretested questionnaire. Statistical analysis used: Bivariate and multivariate analyses were performed to determine the factors associated with self-protection practices. A P < 0.05 was considered statistically significant. Results: The mean age of the participants was 37.3 ± 12.1 years. More than half of the respondents were females (59.2%) and immediate family members (61.3%). Overall, 22.5% had good knowledge of TB, while 53.0% had positive attitudes toward TB. Only 26.0% adequately protected themselves from infection. The caregiver's level of education (P = 0.001) and their relationship to the patient (P = 0.001) were significantly associated with good preventive practices in bivariate analysis. Not being related to the patient was a predictor of adequate TB prevention practices (adjusted odds ratio = 2.852; P = 0.006; 95% confidence interval = 1.360-5.984). Conclusions: This study revealed low levels of TB knowledge and fair preventive practices, especially among caregivers who are relatives. There is, therefore, a need to improve population literacy about TB and its prevention and a more focused orientation of relatives who volunteer as treatment supporters, through health education, with periodic monitoring during clinic visits, of how they prevent TB.