When one door closes: a qualitative exploration of women's experiences of access to sexual and reproductive health services during the COVID-19 lockdown in Nigeria.

BACKGROUND: COVID-19 pandemic widely disrupted health services provision, especially during the lockdown period, with females disproportionately affected. Very little is known about alternative healthcare sources used by women when access to conventional health services became challenging. This study examined the experiences of women and adolescent girls regarding access to sexual and reproductive health (SRH) services during the COVID-19 lockdown in Nigeria and their choices of alternative healthcare sources. METHODS: The study sites were two northern states, two southern states, and the Federal Capital Territory. Qualitative data were obtained through 10 focus group discussion sessions held with married adolescents, unmarried adolescents, and older women of reproductive age. The data were transcribed verbatim and analysed using a thematic approach and with the aid of Atlas ti software. RESULTS: Women reported that access to family planning services was the most affected SRH services during the COVID-19 lockdown. Several barriers to accessing SRH services during COVID-19 lockdown were reported, including restriction of vehicular movement, harassment by law enforcement officers, fear of contracting COVID-19 from health facilities, and fear of undergoing compulsory COVID-19 tests when seeking care in health facilities. In the face of constrained access to SRH services in public sector facilities during the COVID-19 lockdown, women sought care from several alternative sources, mostly locally available and informal services, including medicine vendors, traditional birth attendants, and neighbours with some health experience. Women also widely engaged in self-medication, using both orthodox drugs and non-orthodox preparations like herbs. The lockdown negatively impacted on women's SRH, with increased incidence of sexual- and gender-based violence, unplanned pregnancy resulting from lack of access to contraceptives, and early marriage involving adolescents with unplanned pregnancies. CONCLUSION: COVID-19 negatively impacted access to SRH services and forced women to utilise mostly informal service outlets and home remedies as alternatives to conventional health services. There is a need to ensure the continuity of essential SRH services during future lockdowns occasioned by disease outbreaks. Also, community systems strengthening that ensures effective community-based health services, empowered community resource persons, and health-literate populations are imperative for overcoming barriers to healthcare access during future lockdowns.

Ethnicity, religious affiliation and girl-child marriage: a cross-sectional study of nationally representative sample of female adolescents in Nigeria.

BACKGROUND: The persistently high prevalence of girl-child marriage remains a public health and developmental concern in Nigeria. Despite global campaign against the practice and policy efforts by Nigerian government, the prevalence remains unabated. This study investigates the prevalence and the influence of ethnicity and religious affiliation on the girl-child marriage among female adolescents in Nigeria. METHODS: Data of 7804 girls aged 15-19 years extracted from the 2013 Nigeria Demographic and Health Survey were used. Ethnic groups were classified into five: major Northern ethnic group (Hausa/Fulani); Northern ethnic minorities; two major Southern ethnic groups (Yoruba and Igbo), and Southern ethnic minorities. The prevalence of girl-child marriage was determined for the five ethnic groups and individually for each ethnic minority group. Relationships between ethnicity and religious affiliation on girl-child marriage were explored using Cox proportional hazard regression models, adjusting for residence, education and wealth quintile. RESULTS: Child marriage was higher for the Northern majority ethnic group of Hausa/Fulani (54.8%) compared to the two major Southern ethnic groups (3.0-3.6%) and aggregated Northern ethnic minorities (25.7%) and Southern minorities (5.9%). However, overall, the less known Northern ethnic minority groups of Kambari (74.9%) and Fulfude (73.8%) recorded the highest prevalence. Compared to the major Southern ethnic group of Yoruba, the adjusted hazard ratio (AHR) of child marriage was significantly higher for Northern ethnic minorities (AHR = 2.50; 95% C.I. = 1.59-3.95) and Northern major ethnicity (AHR = 3.67, 95% C.I. = 2.33-5.77). No significant difference was recorded among Southern ethnic groups. Girls affiliated to other religions (Muslim and traditionalist) had higher child-marriage risks compared to Christians (AHR = 2.10; 95% C.I. = 1.54-2.86). CONCLUSION: Ethnicity and religion have independent associations with girl-child marriage in Nigeria; interventions must address culturally-laden social norms that vary by ethnic groups as well as religious-related beliefs.

Sexual practices, sexual behavior and HIV risk profile of key populations in Nigeria.

BACKGROUND: There is little evidence on the need for differentiated HIV prevention services for men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID in Nigeria. The aim of the study was to determine and compare the HIV sexual risk profiles of FSW, MSM and PWID resident in Nigeria; and identify factors associated with condom use among the groups. This will help identify if differentiated HIV prevention services are needed for MSM, FSW and PWID in Nigeria. METHODS: This is a cross-sectional study. Data on sexual practices (anal, vaginal and oral sex), history of alcohol and psychoactive substance use, and high risk sexual behaviors for HIV infection (inconsistent use of condom) was collected from study FSW, MSM and PWID resident in Enugu, Nassarawa, Benue, and Akwa-Ibom States of Nigeria between April and June, 2015. Association between sexual practices, alcohol and psychoactive substance use, and HIV sexual risk behaviors; and differences in sexual risk behaviors of MSM, FSW and PWID were determined using Pearson chi-square for categorical variables, and t-test for continuous variables. Determinants of condom use in the last 30 days were identified using logistic regression analysis. RESULTS: The study population consisted of 188 (38.5%) FSW, 145 (29.7%) MSM and 155 (31.8%) PWID. MSM (AOR: 0.17; 95%CI: 0.05-0.67; p = 0.01) and PWID (AOR: 0.07; 95%CI: 0.02-0.21; p < 0.001) were significantly less likely than FSW to have used condom in the last 30 days. A lower proportion of FSW and PWID used condom during anal sex in the last 12 months when compared with MSM (p < 0.001 respectively). The proportion of MSM (23.5%) and FSW (23.4%) who had ever used psychoactive drugs was high. Of those who had ever used psychoactive drugs, 25.0% of FSW and 29.4% of MSM had injected drugs in the last 30 days of the survey. Also, 39.3% of PWID shared needles and syringes. The use of psychoactive substances (AOR: 5.01; 95%CI: 2.59-9.68; p < 0.001) and the ability to negotiate condom use (AOR: 2.04; 95%CI: 1.06-3.93; p = 0.03) were factors associated with condom use in the last 30 days of the survey. CONCLUSION: HIV prevention programs designed for MSM, FSW and PWID need to address inconsistent condom use during sex by addressing condom negotation skills. This sexual risk behavior is common to the three groups.

Satisfaction with use of public health and peer-led facilities for HIV prevention services by key populations in Nigeria.

BACKGROUND: The aim of the study was to identify the proportion of female sex workers, men who have sex with men, and people who inject drugs who had accessed HIV prevention services at public health facilities and peer-led facilities, their level of satisfaction with these services, and perceived barriers and challenges to accessing HIV services from public and peer-led HIV prevention service providers. METHODS: A mixed-method approach was used to collect data from key populations in the four states in Nigeria. Quantitative data collected included level of satisfaction with and barriers to use of public and peer-led facilities. In-depth interviews and focus-group discussions were conducted to explore reasons for satisfaction with and barriers to use of services. Descriptive and bivariate analyses were was conducted for quantitative data. Qualitative data were summaried, emerging themes identified, described and quotes reflecting the themes corresponding to interview questions highlighted. RESULTS: Nine hundred sixty-seven persons responded to questions on the use of public health or/and peer-led facilities. Two hundred thirty-eight (49.4%) respondents had received HIV and sexual and reproductive health services through public health facilities, and 236 (48.7%) had received the services through peer-led facilities. Significantly more respondents were satisfied with the quality of services provided by peer-led organisations than with public health facilities with respect to service providers listening to respondent's problems and concerns (p = 0.007),privacy and confidentiality (p = 0.04) and respect of rights of service recipients (p = 0.04). Significantly more respondents using peer-led organisations than those using public health facilities identified no barriers to service access (p = 0.003). More respondents using public health facilities than peer-led facilities identified cost of services (p = 0.01), confidentiality (p = 0.002), waiting time (p < 0.01) and staff attitude (p = 0.001) as barriers to service access. Thee was no difference in the proportion of respondents willing to discontinue their use of either facilities (p = 0.08). Qualitative data revealed that concerns with access of services at the public health facility were due mainly to stigma and the effects of the same-sex prohibition law. CONCLUSION: Key populations were more satisfied receiving HIV prevention services at peer-led organisations than at public health facilities.

Quality of Spousal Relationship on Procurement of Abortion in Peri-Urban Nigeria.

The quality of spousal relationship may influence the acceptance of the status of pregnancies and the decision to procure abortion; however, this relationship has largely been unexplored. The objective of this paper is to assess the influence of specific dimensions of relationship quality on abortion procurement. Data from the 2010 Family Health and Wealth Survey site were used to assess the association between relationship quality and induced abortion among 763 ever-pregnant married or cohabiting women in Ipetumodu, South-west Nigeria. Abortion question though not directly related to current time, however, it provides a proxy for the analysis in such context where abortion is highly restrictive with high possibility of underestimation. The association between relationship quality and abortion risk was analyzed using bivariate and multivariate (logistic regression) methods. Only 7.9% of women 15-49 years reported ever having induced abortion. Communication was the only dimension of relationship quality that showed significant association with history of induced abortion (aOR = 0.42; 95% C.I. = 0.24-0.77). The paper concludes that spousal communication is a significant issue that deserves high consideration in efforts to improve maternal health in Nigeria.

What are the factors that interplay from normal pregnancy to near miss maternal morbidity in a Nigerian tertiary health care facility?

Researchers in Nigeria examined the epidemiological characteristics and factors associated with maternal outcomes using a mixed method approach: a prospective case control study design involving 375 pregnant women who received maternal care from a tertiary facility and in-depth interviews reporting the experience of near-miss survivors. A generalized ordered logit model was used to generate the estimates of partial proportional odds ratios (and 95% confidence intervals) across categories of the outcome variable. Factors strongly associated with maternal morbidity were late referral of women, presence of complications at booking antenatal visits, low birth weight, and severe birth asphyxia. The nearmiss women were further characterized, and a low proportion (25%) had organ dysfunction or failure. The challenge of such diagnoses in resource-constrained settings raises questions about the appropriateness of using organ dysfunction criteria in developing countries.

Sexual behavior of in-school adolescents in Osun State, Southwest Nigeria: a comparative study.

OBJECTIVES: The sexual and reproductive health of adolescents is of utmost importance in many nations (especially in developing countries). Sexual behavior varies from location to location and the outcome (when negative) creates great concerns mainly due to the consequential impact on health and development. This study aimed at comparing sexual behavior of in-school adolescents in rural and urban areas of Osun state. METHODS: A comparative cross sectional study was conducted. A total of 760 in-school adolescents were recruited using multistage sampling technique. Pre-tested questionnaires were administered after ethical considerations. Data were analysed and p-value was placed at 0.05. RESULTS: A total of 380 rural and 380 urban adolescents participated in this study with a mean age of 14.90 ± 2.44 and 14.34 ± 2.31 years, respectively. About one-fifth (20.1%) had experienced their first sex (66% of rural and 34% of urban). The mean age at first sex was 14.05 years ± 2.3 years (13.89 ± 2.3 years for rural and 14.37 ± 2.3 years for urban). Only 76 (49.7%) sexually experienced respondents had used condom in the past (45.5% of rural, 57.7% of urban). Half of the urban respondents used condom during their first sex while only a quarter of their rural counterparts had done so (p=0.003). CONCLUSION: Sexual behavior was commoner among the rural respondents than their urban counterpart. There is an urgent need for sexuality education especially among rural adolescents in the study area.

Performance needs assessment of maternal and newborn health service delivery in urban and rural areas of Osun State, South-West, Nigeria.

The study aimed to determine performance and compare gaps in maternal and newborn health (MNH) services in urban and rural areas of Osun State, Nigeria, to inform decisions for improved services. This study involved 14 urban and 10 rural-based randomly selected PHC facilities. Using a Performance Needs Assessment framework, desired performances were determined by key stakeholders and actual performances measured by conducting facility survey. Questionnaire interview of 143 health workers and 153 antenatal clients were done. Performance gaps were determined for the urban and rural areas and compared using Chi-square tests with SPSS version 17. PHC facilities and health workers in Osun State, Nigeria, were found to have significant gaps in MNH service performance and this was worse in the rural areas. Root cause of most of the performance gaps was poor political will of local government authorities. Improved government commitment to MNH is needful to address most of the gaps.

Incidence, determinants and perinatal outcomes of near miss maternal morbidity in Ile-Ife Nigeria: a prospective case control study.

BACKGROUND: Maternal mortality ratio in Nigeria is one of the highest in the world. Near misses occur in larger numbers than maternal deaths hence they allow for a more comprehensive analysis of risk factors and determinants as well as outcomes of life-threatening complications in pregnancy. The study determined the incidence, characteristics, determinants and perinatal outcomes of near misses in a tertiary hospital in South-west Nigeria. METHODS: A prospective case control study was conducted at the maternity units of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife Nigeria between July 2006 and July 2007. Near miss cases were defined based on validated disease-specific criteria which included severe haemorrhage, hypertensive disorders in pregnancy, prolonged obstructed labour, infection and severe anemia. Four unmatched controls of pregnant women were selected for every near miss case. Three categories of risk factors (background, proximate, clinical) which derived from a conceptual framework were examined. The perinatal outcomes were also assessed. Bi-variate logistic regressions were used for multivariate analysis of determinants and perinatal outcomes of near miss. RESULTS: The incidence of near miss was 12%. Severe haemorrhage (41.3%), hypertensive disorders in pregnancy (37.3%), prolonged obstructed labour (23%), septicaemia (18.6%) and severe anaemia (14.6%) were the direct causes of near miss. The significant risk factors with their odds ratio and 95% confidence intervals were: chronic hypertension [OR=6.85; 95% CI: (1.96 - 23.93)] having experienced a phase one delay [OR=2.07; 95% CI (1.03 - 4.17)], Emergency caesarian section [OR=3.72; 95% CI: (0.93 - 14.9)], assisted vaginal delivery [OR=2.55; 95% CI: (1.34 - 4.83)]. The protective factors included antenatal care attendance at tertiary facility [OR=0.19; 95% CI: (0.09 - 0.37)], knowledge of pregnancy complications [OR=0.47; 95% CI (0.24 - 0.94)]. Stillbirth [OR=5.4; 95% CI (2.17 - 13.4)] was the most significant adverse perinatal outcomes associated with near miss event. CONCLUSIONS: The analysis of near misses has evolved as a useful tool in the investigation of maternal health especially in life-threatening situations. The significant risk factors identified in this study are amenable to appropriate public health and medical interventions. Adverse perinatal outcomes are clearly attributable to near miss events. Therefore the findings should contribute to Nigeria's effort to achieving MDG 4 and 5.

Teachers' perspectives on sexual and reproductive health interventions for in-school adolescents in Nigeria.

High prevalence of early and unprotected sex, resulting in adverse reproductive health outcomes, has been reported among adolescents in Nigeria. While school-based sexual and reproductive health interventions for in-school adolescents is widely recognized, little is known on the kind of involvements desired by teachers and their perceptions of handling students' reproductive health concerns. In this study, the teachers favoured school-based reproductive health education (RHE), but have divers' opinions on what should be included in such RHE. Majority was not willing or comfortable in personal counseling of students but can teach RHE in classroom environment. They support the current approach of expelling pregnant school girls. The article advocates for gender-sensitive and developmental-oriented approaches that will ensure rehabilitation and re-integration of pregnant girls into the school system after their delivery, and recommend the need to build teachers skills and promote students-teachers dialogue in order to optimize school environment for addressing ASRH.

Adjunctive rectal misoprostol versus oxytocin infusion for prevention of postpartum hemorrhage in women at risk: a randomized controlled trial.

AIM: The aim of this study was to evaluate the efficacy of adjunctive rectal misoprostol compared to oxytocin infusion in the prevention of primary postpartum hemorrhage after routine active management of the third stage of labor in women with identifiable risk factors for uterine atony. MATERIAL AND METHODS: A double-blind randomized controlled trial was carried out at Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. A total of 264 parturients with known risk factors for postpartum hemorrhage were randomized to receive either rectal misoprostol (600 µg; n = 132) or oxytocin infusion (20 IU in 500 mL; n = 132) after routine active management of the third stage of labor. Intrapartum blood loss was measured using a combination of the BRASSS-V calibrated drapes and differential pad weighing. Hematocrit was measured intrapartum and 24 h postpartum. RESULTS: There was no significant difference (P = 0.07) in the mean intrapartum blood loss between the misoprostol (387.28 ± 203.09 mL) and oxytocin (386.73 ± 298.51 mL) groups. There was also no difference in the requirement for additional intervention for uterine atony (P = 0.74). Postpartum hematocrit drop and blood transfusion were, however, significantly less in the misoprostol group. CONCLUSION: Rectal misoprostol is as effective as oxytocin infusion as an adjunct for prevention of postpartum hemorrhage in women with risk factors for uterine atony and is associated with a lower hematocrit drop and blood transfusion postpartum. However, shivering, pyrexia and vomiting are more frequent with misoprostol, though usually self-limited.

Realist Evaluation of the "Abiye" Safe Motherhood Initiative in Nigeria: Unveiling the Black-Box of Program Implementation and Health System Strengthening.

Introduction: Realist evaluation studies have spanned different aspects of medicine, especially in the field of public health. However, very few of these studies explicitly detailed how program implementation triggered outcomes that could strengthen understanding of its effect on Health System Strengthening in specific settings. In low- and middle-income countries, like Nigeria, there is a paucity of realist evaluation studies, despite the implementation of multiple intervention programs and projects in these countries. This article is aimed at unveiling the black-box of program implementation and Health System Strengthening of the "Abiye" Safe Motherhood Program in Ondo State, Nigeria. Specifically, it identified the role of contextual factors in the "Abiye" program in Ondo State, determined the mechanisms that facilitated or constrained outcomes of the "Abiye" program, and developed a Context Mechanism Outcome (CMO) Configuration from which a Middle Range Theory (MRT) can be framed. Methodology: This was qualitative research structured along with the realist domains (Context, Mechanism, and Outcome). The Initial Program Theory was validated by the qualitative study, after which a new MRT was developed. The study population comprised key stakeholders, secondary stakeholders, and primary stakeholders in the Abiye safe motherhood program. Data was collected through 10 key informant interviews, 28 in-depth interviews, and six focus group discussions sessions. Thematic analysis was used to analyze all the qualitative data collected, and seven themes with 19 subthemes emerged in the study. Results: We identified 13 contextual factors under five principal areas, with most of the factors playing enabling roles, some playing inhibitory roles, while very few played both roles. We elicited eight mechanisms, and some of these facilitated the outcomes, while some constrained the outcomes of the program. Health system strengthening was a key feature of the outcome of the program. We developed a middle-range theory based on the 6 CMO configurations we elicited from the study. Conclusion and Policy Implications: Realist evaluation is an iterative process that looks beyond the surface to generate evidence. By applying the realist approach, we generated pieces of evidence that can be adapted for policymaking in public health interventions in LMIC.

Trends and correlates of girl-child marriage in 11 West African countries: evidence from recent Demographic and Health Surveys.

Background: West Africa historically has a high prevalence of girl-child marriage and requires substantial reduction to meet the United Nation's Sustainable Development Goals (SDG) target of ending child marriage by 2030, but current data on progress is sparce. We aimed to determine the trend in child marriage in West Africa and assess the influence of selected socio-demographic factors. Methods: We analysed data on women aged 18-24 years from the two most recent Demographic and Health Surveys (conducted between 2006 and 2014) for 11 West African countries to determine the prevalence and trend of girl-child marriage. Multivariable logistic regression analysis was used to assess the relationship between girl-child marriage and selected socio-demographic factors. Results: The prevalence of child marriage in West Africa is 41.5%. An overall decrease of 4.6% (annual rate of 0.01%) was recorded over a seven-year inter-survey period. Three countries (Cote d'Ivoire, Nigeria, and Niger) recorded increased prevalence while the rate was unchanged in Burkina Faso, and the other six countries had reduced prevalence between the last two surveys. Sierra Leone recorded the highest decrease in prevalence (22%) and an annual reduction rate of 0.04%; Cote d'Ivore had the highest increase (65.3%). In virtually all countries, rural residence, low education, poor household economic status and non-Christian religious affiliation were significantly associated with higher odds of girl-child marriage. Conclusions: The prevalence of girl-child marriage remains high in West Africa and the trend shows very slow progress. While substantial inter-country variations exist in overall rate and trend of child marriage, the rate of progress is inadequate across all countries.

Changes in contraceptive and sexual behaviours among unmarried young people in Nigeria: Evidence from nationally representative surveys.

CONTEXT: Nigeria is a high-burden country in terms of young people's health. Understanding changes in young people's sexual and reproductive health (SRH) behaviours and the associated factors is important for framing appropriate interventions. OBJECTIVE: This study assessed changes in SRH behaviours of unmarried young people aged 15-24 and associated factors over a ten-year period in Nigeria. DATA AND METHOD: We analysed datasets from Nigeria Demographic and Health Surveys of 2008, 2013 and 2018 to assess changes in inconsistent condom use, non-use of modern contraceptives; multiple sexual partnership; and early sexual debut. Using binary logistic regression, we assessed the association of selected variables with the SRH behaviours. RESULTS: Over four-fifths of unmarried young people (15-24) in Nigeria engaged in at least one risky sexual behaviour in each survey year. The pattern of changes in the four risky SRH behaviours was consistent over the 10-year period, with the highest rates of each behaviour occurring in 2018 while the lowest rates were in 2013, thus indicating an increase in the proportion of respondents engaging in risky sexual behaviours over the study period. Comprehensive HIV/AIDS knowledge, male gender, older age category (20-24), residence in south-west Nigeria, urban residence, higher socio-economic status, secondary/higher education were mostly protective against the four SRH variables analysed across the different data waves. CONCLUSION: Addressing the high and increasing level of risky SRH behaviours among young people in Nigeria is imperative to improve overall national health status and to ensure progress towards achieving SDG target 3.7 focusing on SRH.

Adolescents and youth in developing countries: Health and development issues in context.

Adolescence is a period of transition, marked by physical, psychological, and cognitive changes underpin by biological factors. Today's generation of young people - the largest in history - is approaching adulthood in a world vastly different from previous generations; AIDS, globalisation, urbanisation, electronic communication, migration, and economic challenges have radically transformed the landscape. Transition to productive and healthy adults is further shaped by societal context, including gender and socialisation process. With the evidence that young people are not as healthy as they seem, addressing the health and development issues of young people, more than ever before, need concerted and holistic approach. Such approach must take the entire lifecycle of the young person as well as the social environment into context. This is particularly critical in developing countries, where three major factors converge - comparatively higher proportion of young people in the population, disproportionately high burden of youth-related health problems, and greater resources challenge.

Women's self-reported experiences using misoprostol obtained from drug sellers: a prospective cohort study in Lagos State, Nigeria.

OBJECTIVES: This study aimed to assess the safety and effectiveness of self-managed misoprostol abortions obtained outside of the formal health system in Lagos State, Nigeria. DESIGN: This was a prospective cohort study among women using misoprostol-containing medications purchased from drug sellers. Three telephone-administered surveys were conducted over 1 month. SETTING: Data were collected in 2018 in six local government areas in Lagos State. PARTICIPANTS: Drug sellers attempted to recruit all women who purchased misoprostol-containing medication. To remain in the study, participants had to be female and aged 18-49, and had to have purchased the medication for the purpose of abortion. Of 501 women initially recruited, 446 were eligible for the full study, and 394 completed all three surveys. PRIMARY AND SECONDARY OUTCOME MEASURES: Using self-reported measures, we assessed the quality of information provided by drug sellers; the prevalence of potential complications; and the proportion with completed abortions. RESULTS: Although drug sellers provided inadequate information about the pills, 94% of the sample reported a complete abortion without surgical intervention about 1 month after taking the medication. Assuming a conservative scenario where all individuals lost to follow-up had failed terminations, the completion rate dropped to 87%. While 86 women reported physical symptoms suggestive of complications, only six of them reported wanting or needing health facility care and four subsequently obtained care. CONCLUSIONS: Drug sellers are an important source of medical abortion in this setting. Despite the limitations of self-report, many women appear to have effectively self-administered misoprostol. Additional research is needed to expand the evidence on the safety and effectiveness of self-use of misoprostol for abortion in restrictive settings, and to inform approaches that support the health and well-being of people who use this method of abortion.

Predictors of early sexual initiation among a nationally representative sample of Nigerian adolescents.

BACKGROUND: Early sexual debut among adolescents is associated with considerable negative heath and development outcomes. An understanding of the determinants or predictors of the timing of sexual debut is important for effective intervention, but very few studies to date have addressed this issue in the Nigerian context. The aim of the present study is to examine predictors of adolescent sexual initiation among a nationally representative sample of adolescents in Nigeria. METHODS: Interviewer-collected data of 2,070 never-married adolescents aged 15-19 years were analysed to determine association between age of sexual debut and demographic, psychosocial and community factors. Using Cox proportional hazards regression multivariate analysis was carried out with two different models - one with and the other without psychosocial factors. Hazard ratio (HR) and 95% confidence interval (CI) were calculated separately for males and females. RESULTS: A fifth of respondents (18% males; 22% females) were sexually experienced. In the South 24.3% males and 28.7% females had initiated sex compared to 12.1% of males and 13.1% females in the North (p < 0.001). In the first model, only region was significantly associated with adolescent sexual initiation among both males and females; however, educational attainment and age were also significant among males. In the second (psychosocial) model factors associated with adolescent sexual debut for both genders included more positive attitudes regarding condom efficacy (males: HR = 1.28, 95% CI = 1.07-1.53; females: HR = 1.24, 95% CI = 1.05-1.46) and more positive attitudes to family planning use (males: HR = 1.19, 95% CI = 1.09-1.31; females: HR = 1.18, 95% CI = 1.07-1.30). A greater perception of condom access (HR = 1.42, 95% CI = 1.14-1.76) and alcohol use (HR = 1.90, 95% CI = 1.38-2.62) among males and positive gender-related attitudes (HR = 1.13, 95% CI = 1.04-1.23) among females were also associated with increased likelihood of adolescent sexual initiation. Conversely, personal attitudes in favour of delayed sexual debut were associated with lower sexual debut among both males (males: HR = 0.36, 95% CI = 0.25-0.52) and females (HR = 0.38, 95% CI = 0.25-0.57). Higher level of religiosity was associated with lower sexual debut rates only among females (HR = 0.59, 95% CI = 0.37-0.94). CONCLUSION: Given the increased risk for a number of sexually transmitted health problems, understanding the factors that are associated with premarital sexual debut will assist programmes in developing more effective risk prevention interventions.

Sleep pattern, socioenvironmental factors, and use of electronic devices among Nigerian school-attending adolescents.

OBJECTIVES: To determine the sleep pattern among Nigerian school-attending adolescents and its association with socioenvironmental factors and the use of electronic devices. DESIGN: Descriptive cross-sectional survey. SETTING: Public and private secondary schools in Ile-Ife, Osun State, Nigeria. PARTICIPANTS: Multistage sampling technique was used to select 346 school-attending adolescents aged 10-19 years. MEASUREMENTS: A modified version of the Adolescent Sleep Habits Survey Questionnaire was administered to respondents in the school setting using the facilitated self-administration method. RESULTS: Participants' mean age was 13.5±2.29 years, and the male-female ratio was 1:1.1. The mean total sleep duration on weekends of 9 hours (h) 08 minutes (min) ± 113 min was significantly higher than that of weekdays (7 h 15 min ± 86 min) (P < .001). About half of the respondents (48.7 %) had access to a computer. Majority of the respondents (80.9%) use one or more electronic device at bedtime, although cell phone was used by more than half (52.3%) of the respondents at bedtime. The proportion of adolescents with short sleep duration was 44.4% for weekdays and 5.5% for weekends. Lower social class and non-use of computers in the night time were independent predictors of adequate sleep duration on weekdays, whereas female sex, age (early adolescence), and polygamous family setting were independent predictors of sufficient sleep on weekends. CONCLUSION: A high proportion of school-attending adolescents have insufficient sleep on weekdays and significantly sleep less during weekdays compared to weekends. There is a need to target adolescents, parents, and school authorities with education on sleep issues.

Factors associated with the desire for companionship during labor in a Nigerian community.

OBJECTIVE: To determine preferences for companionship during labor and to identify associated factors. METHODS: The present prospective cross-sectional survey was conducted at a university teaching hospital in Nigeria between September 1, 2011, and February 28, 2012. Participants included women who underwent the first stage of labor and delivery at the facility, male partners, and healthcare workers from the maternity unit. Data were collected using a pretested questionnaire. RESULTS: There were 226 parturients, 158 male partners, and 69 healthcare workers included in the final analysis; in all, 50 (22.1%) parturients and 37 (23.4%) male partners approved of companionship during labor, whereas 62 (90%) healthcare workers supported it. Among those who approved, a parturient's male partner was stated to be the preferred companion by 33 (66%) parturients, 32 (86%) male partners, and 58 (94%) healthcare workers. The perception of conduciveness of the labor ward for companionship was associated with approving of companionship among both the parturients (adjusted odds ratio [aOR] 2.74) and male partners (aOR 15.79). Previous home delivery (aOR 31.43) and companionship during a previous delivery (aOR 23.00) were also associated with approval. CONCLUSION: Most couples had negative attitudes toward companionship during labor. Intensive education programs and restructuring of facilities could enable Nigerian labor wards to improve the delivery experience for both parturients and their male partners.