Musibau A. Titiloye

Farm land size and onchocerciasis status of peasant farmers in south-western Nigeria

Summary Concern is being raised about the economic impact of the non‐blinding strain of onchocerciasis, since half of those affected with onchocerciasis in Africa live in the forest zones where the non‐blinding form is prevalent. WHOs TDR programme has embarked on multi‐country studies on the social and economic effects of onchocercal skin disease (OSD). Baseline data from one site, the Ibarapa Local Government Area of Oyo State, Nigeria, is presented here. Farmers were screened for signs and symptoms of onchocerciasis including palpable nodules, reactive skin lesions and self‐reported severe itching. Those having two or more of these conditions were classified as having severe OSD. A matching group of farmers without any of the signs or symptoms formed a control group. Women in the area either did not farm or held only one small plot. Land size comparisons were undertaken with 51 pairs of male farmers matched for age and location within 23 small hamlets bordering the Ogun River. Farmers with OSD had significantly less farmland under cultivation (9117 m2) than those with no OSD (13850 m2). The farmers with OSD did not appear to have alternative income strategies to compensate and, consequently, they had a lower value of personal wealth indicators (e.g. iron sheet roofing, motorcycle) than those without OSD. One can conclude that although the effect of forest strain onchocerciasis is less dramatic than of the blinding from, the disease poses an important economic threat in the region.

Willingness to seek HIV testing and counseling among pregnant women attending antenatal clinics in Ogun State, Nigeria.

HIV counseling and testing (CT) is slowly being introduced as one of several key components of the comprehensive package of HIV/AIDS prevention and care in Nigeria, particularly in the prevention of mother-to-child transmission of HIV (PMTCT). Across-sectional survey of 804 women attending antenatal clinics (ANC) in Ogun State, Nigeria was done using questionnaires to assess their willingness to seek and undergo CT and know the determinants. Focus group discussions were also held in the general community: 84.3% of respondents believed in AIDS reality, while 24.3% thought they were at risk of HIV infection. Only 27% knew about MTCT, while 69.7% of 723 who had heard of HIV/AIDS did not know about CT. Only 71 (8.8%) had thought about CT and 33 (4.5%) mentioned HIV testing as one of antenatal tests. After health education on CT, 89% of the women expressed willingness to be tested. Their willingness for CT was positively associated with education (p < 0.05), ranging from 77% (no education) to 93% (post-secondary). More of those with self-perceived risk expressed willingness to test for HIV (p < 0.05). Those willing to be tested had a higher knowledge score on how HIV spreads than those not willing. Multiple regressions identified four key factors that were associated with willingness for CT: increasing educational level; not fearing a blood test; perception that the clinic offered privacy; and perceptions of higher levels of social support from relatives and peers. Those unwilling or undecided about CT expressed strong fear of social stigma/rejection if tested positive. The results provided insights for planning promotional programs and showed that not only are IEC efforts needed to boost knowledge about HIV/AIDS, but that change in clinic setting and community are imperative in creating supportive environment to encourage uptake of CT services.

Mistreatment of women during childbirth in Abuja, Nigeria: a qualitative study on perceptions and experiences of women and healthcare providers

BackgroundGlobal efforts have increased facility-based childbirth, but substantial barriers remain in some settings. In Nigeria, women report that poor provider attitudes influence their use of maternal health services. Evidence also suggests that women in Nigeria may experience mistreatment during childbirth; however, there is limited understanding of how and why mistreatment this occurs. This study uses qualitative methods to explore women and providers’ experiences and perceptions of mistreatment during childbirth in two health facilities and catchment areas in Abuja, Nigeria.MethodsIn-depth interviews (IDIs) and focus group discussions (FGDs) were used with a purposive sample of women of reproductive age, midwives, doctors and facility administrators. Instruments were semi-structured discussion guides. Participants were asked about their experiences and perceptions of, and perceived factors influencing mistreatment during childbirth. Thematic analysis was used to synthesize findings into meaningful sub-themes, narrative text and illustrative quotations, which were interpreted within the context of this study and an existing typology of mistreatment during childbirth.ResultsWomen and providers reported experiencing or witnessing physical abuse including slapping, physical restraint to a delivery bed, and detainment in the hospital and verbal abuse, such as shouting and threatening women with physical abuse. Women sometimes overcame tremendous barriers to reach a hospital, only to give birth on the floor, unattended by a provider. Participants identified three main factors contributing to mistreatment: poor provider attitudes, women’s behavior, and health systems constraints.ConclusionsMoving forward, findings from this study must be communicated to key stakeholders at the study facilities. Measurement tools to assess how often mistreatment occurs and in what manner must be developed for monitoring and evaluation. Any intervention to prevent mistreatment will need to be multifaceted, and implementers should consider lessons learned from related interventions, such as increasing audit and feedback including from women, promoting labor companionship and encouraging stress-coping training for providers.

How women are treated during facility-based childbirth: development and validation of measurement tools in four countries – phase 1 formative research study protocol

BackgroundEvery woman has the right to dignified, respectful care during childbirth. Recent evidence has demonstrated that globally many women experience mistreatment during labour and childbirth in health facilities, which can pose a significant barrier to women attending facilities for delivery and can contribute to poor birth experiences and adverse outcomes for women and newborns. However there is no clear consensus on how mistreatment of women during childbirth in facilities is defined and measured. We propose using a two-phased, mixed-methods study design in four countries to address these research gaps. This protocol describes the Phase 1 qualitative research activities.Methods/DesignWe will employ qualitative research methodologies among women, healthcare providers and administrators in the facility catchment areas of two health facilities in each country: Ghana, Guinea, Myanmar and Nigeria. In-depth interviews (IDIs) and focus group discussions (FGDs) will be conducted among women of reproductive age (15–49 years) to explore their perceptions and experiences of facility-based childbirth care, focused on how they were treated by healthcare workers and perceived factors affecting how they were treated. IDIs will also be conducted with healthcare providers of different cadres (e.g.: nurses, midwives, medical officers, specialist obstetricians) and facility administrators working in the selected facilities to explore healthcare providers’ perceptions and experiences of facility-based childbirth care and how staff are treated, colleagues and supervisors. Audio recordings will be transcribed and translated to English. Textual data will be analysed using a thematic framework approach and will consist of two levels of analysis: (1) conduct of local analysis workshops with the research assistants in each country; and (2) line-by-line coding to develop a thematic framework and coding scheme.DiscussionThis study serves several roles. It will provide an in-depth understanding of how women are treated during childbirth in four countries and perceived factors associated with this mistreatment. It will also provide data on where and how an intervention could be developed to reduce mistreatment and promote respectful care. The findings from this study will contribute to the development of tools to measure the prevalence of mistreatment of women during facility-based childbirth.

By slapping their laps the patient will know that you truly care for her: A qualitative study on social norms and acceptability of the mistreatment of women during childbirth in Abuja Nigeria.

Background Many women experience mistreatment during childbirth in health facilities across the world. However, limited evidence exists on how social norms and attitudes of both women and providers influence mistreatment during childbirth. Contextually-specific evidence is needed to understand how normative factors affect how women are treated. This paper explores the acceptability of four scenarios of mistreatment during childbirth. Methods Two facilities were identified in Abuja, Nigeria. Qualitative methods (in-depth interviews (IDIs) and focus group discussions (FGDs)) were used with a purposive sample of women, midwives, doctors and administrators. Participants were presented with four scenarios of mistreatment during childbirth: slapping, verbal abuse, refusing to help the woman and physical restraint. Thematic analysis was used to synthesize findings, which were interpreted within the study context and an existing typology of mistreatment during childbirth. Results Eighty-four IDIs and 4 FGDs are included in this analysis. Participants reported witnessing and experiencing mistreatment during childbirth, including slapping, physical restraint to a delivery bed, shouting, intimidation, and threats of physical abuse or poor health outcomes. Some women and providers considered each of the four scenarios as mistreatment. Others viewed these scenarios as appropriate and acceptable measures to gain compliance from the woman and ensure a good outcome for the baby. Women and providers blamed a womans “disobedience” and “uncooperativeness” during labor for her experience of mistreatment. Conclusions Blaming women for mistreatment parallels the intimate partner violence literature, demonstrating how traditional practices and low status of women potentiate gender inequality. These findings can be used to facilitate dialogue in Nigeria by engaging stakeholders to discuss how to challenge these norms and hold providers accountable for their actions. Until women and their families are able to freely condemn poor quality care in facilities and providers are held accountable for their actions, there will be little incentive to foster change.

Statistical modelling of social risk factors for sexually transmitted diseases among female youths in Nigeria

INTRODUCTION Sexually Transmitted Diseases (STDs) are avertable, but the social risks factors connected to these infections are often unnoticed by many, particularly female youths. Previous studies on STDs among youths in Nigeria only focused on its risk factors but failed to model these risk factors as evidenced in this study. METHODOLOGY The study is retrospective cross-sectional in design which utilized Nigeria Demographic and Health Survey, 2008. It focused on female youths aged 15-24 (n=8093) who ever had sexual intercourse (vaginal, oral and anal). Data analysis was done using Chi-square and logistic regression models. The logistic regression on the data was performed at two stages. These stages generated three and eight different models respectively. RESULTS Data analyses revealed that the mean age of the respondents was 20.2 ± 2.5. Female youths who were aged between 20-24 years contacted STDs in the last 12 months (2.5%) than those between the ages of 15-19 months (1.4%). A year prevalence of STDs among female youths in Nigeria was 2.1%. Socio-demographic factors such as age, educational status, wealth index, marital status, toilet shared, place of residence, contraceptive use and total life-time number of sexual partners were found to be associated significant risk factors for contacting STDs (P<0.05). CONCLUSIONS The data confirmed the considerable impact of wealth index and contraceptive use as important predictors of STDs acquisition. Constant use of condoms, abstinence and having one uninfected sexual partner can help reduce the risk of STDs transmission.

The communication and emotional support needs to improve women's experience of childbirth care in health facilities in Southwest Nigeria: A qualitative study

To improve womens childbirth experiences in health facilities, their psychosocial and communication needs have to be met. However, what constitutes these specific needs is poorly understood, particularly in Sub‐Saharan Africa. This paper explores womens needs for communication and emotional support during facility‐based childbirth.

Healthcare providers’ perspectives on labor monitoring in Nigeria and Uganda: A qualitative study on challenges and opportunities

To explore current practices, challenges, and opportunities in relation to monitoring labor progression, from the perspectives of healthcare professionals in low‐resource settings.

Exclusive breastfeeding and related antecedent factors among lactating mothers in a rural community in Southwest Nigeria

This study explored the antecedent factors influencing the practice of exclusive breast feeding (EBF) among lactating mothers in Ayete, a rural community in Southwest Nigeria. A three-stage random sampling technique was used to select 410 mothers of newborns and infants less than six months from households. A pretested semi-structured questionnaire which included a 14-point knowledge scale was used for data collection. Data were analyzed using descriptive statistics, Chi-square test and analysis of variance (ANOVA). Mean age was 27.4±5.9 years and 67.1% respondents were aware that EBF should be initiated immediately after birth. Mean knowledge score on EBF was 8.2±2.9. Age, educational level and occupation were significantly associated with knowledge of EBF (p<0.05). Main perceived challenges associated with EBF were loss of essential nutrients by mothers (87.6%) and inducement of hunger (26.2%). Only 10.2% of respondents were practicing EBF as at the time of the study. Reasons for not practicing EBF included baby needs herbs for strength and vitality (31.3%), baby needed water to quench thirst (23.9%) and non-satisfaction with breast milk alone (20.8%). Practice of EBF was significantly more among respondents earning less than N5000.00 monthly (p<0.05). Continuous sensitization activities are needed to promote breast feeding among lactating mothers. Key words: Exclusive breastfeeding, lactating mothers, antecedent factors.

Defining quality of care during childbirth from the perspectives of Nigerian and Ugandan women: A qualitative study

To explore what “quality of care” means to childbearing women in Nigeria and Uganda, as a means of ensuring that womens voices and opinions are prioritized when developing interventions to improve quality in maternity care provision.