Providers\u27 and key opinion leaders\u27 attitudes, beliefs, and practices regarding emergency contraception in Nigeria: Key findings

This brief reports on a study in Nigeria to document provider attitudes, beliefs, and practices regarding emergency contraception (ECP), and to identify key opinion leaders’ opinions and insights pertaining to policy and programmatic issues in that country. Findings reveal that ECP is well known in urban Nigeria. Its provision is controlled mainly by the largely unregulated and unmonitored private sector. Government plays a distant role, thereby leaving family planning and ECP supply almost entirely in the hands of donor agencies. For wider availability and affordability of ECP products in both the private and public sectors, official policy action is required, along with increased education of potential users and providers

Providers\u27 and key opinion leaders\u27 attitudes, beliefs, and practices regarding emergency contraception in Nigeria

Despite significant progress in product development, procurement, and distribution in the past few decades, emergency contraception’s (EC) capacity to benefit many women in countries such as Nigeria is hampered by a number of potential barriers, that are not well understood. The Population Council, with support from the International Consortium for Emergency Contraception, documented EC-related knowledge, attitudes, and practices among providers in Nigeria as well as perceptions of key opinion leaders who help shape the policy environment for EC and family planning in general. Findings suggest significant gaps in Nigeria, potentially necessitating continuous training and re-training to help dispel misperceptions and negative attitudes. In Nigeria, where much of the health infrastructure, facilities, and human resources are controlled by the government, the public sector must play a greater role in providing EC-supportive policies and practices, and in monitoring their implementation

Providers\u27 and key opinion leaders\u27 attitudes, beliefs, and practices concerning emergency contraception: A multicountry study in India, Nigeria, and Senegal

The Population Council conducted a cross-sectional, descriptive, multicountry study in India, Nigeria, and Senegal aimed at understanding the attitudes, beliefs, and practices of providers and key opinion leaders (KOLs) regarding the provision and use of emergency contraception (ECP). The overarching goal of this study was to investigate and document providers’ attitudes, beliefs, and practices regarding ECP, and to capture the opinions and insights of providers and KOLs on a range of policy and program issues. Findings indicate that many provider-related barriers can be overcome through implementation of targeted interventions such as training and values clarification, whereas other barriers will require a broader strategy to address contextual and health systems-level factors that hinder women’s access to ECP. The brief includes a number of interventions that might prove useful in addressing these barriers

HIV/AIDS vulnerabilities, discrimination, and service accessibility among Africa\u27s youth: Insights from a multi-country study

This report contains information from a study implemented between August 2011 and July 2012 that sought to provide a comprehensive, evidence-based picture of the HIV-related issues facing young people across Africa, and the prevailing legal, policy, and programmatic responses. The study was designed to establish a basis for a sharper focus on youth within the response to HIV on the continent. Researchers conducted country-specific analytical reviews of the relevant literature on factors associated with HIV risk-taking and health-seeking behaviors among young people aged 15–24 in six countries across Africa—Egypt, Kenya, Nigeria, Senegal, South Africa, and Uganda. In addition, qualitative and quantitative analyses enabled an evaluation of the similarities and differences among countries regarding factors associated with young people’s sexual risk behavior, HIV-related health-seeking behavior, and the extent of policy and programmatic involvement

Trends and determinants of comprehensive knowledge of HIV among adolescents and young adults in Nigeria: 2003–2013

This study examined comprehensive knowledge of HIV (CKH) and its determinants among young people aged 15–24 years in Nigeria between 2003 and 2013. Secondary analysis was conducted on three rounds of NDHS 2003, 2008 and 2013 data. CKH increased significantly between 2003 and 2013, but the level reached in 2013 fell short of the global expectation for young people. Its significant determinants included gender, age, educational attainment, place and region of residence, household wealth status and uptake of HIV test. There is need to sustain all on-going effective youth-focused interventions and programmes to meet the comprehensive knowledge needs for all young people in Nigeria

Attrition from care after the critical phase of severe pre-eclampsia and eclampsia: Insights from an intervention with magnesium sulphate in a primary care setting in northern Nigeria

Background: Evidence has shown that Magnesium Sulphate (MgSo_4) is the gold standard for treating severe pre-eclampsia and eclampsia (SPE/E), and calls for its widespread use at all levels of health service delivery, including the primary care level. Objective: To determine if administering loading dose of MgSo_4 on pregnant women with severe preeclampsia and eclampsia at primary care level would improve maternal and fetal outcomes. Method: Two sets of Primary Health Care (PHC) facilities were identified; one served as experimental one and the other as control. The community health extension workers (CHEWs) and the community health officers (CHOs) at the experimental PHCs were trained to administer the loading dose of MgSo_4 for patients with SPE/E, in addition to other supportive treatments, before making a referral while the control PHCs did not give MgSo_4, and neither administered diazepam as an alternative or no anti-convulsant at all, before making a referral to higher centers. Patients from the experimental and control facilities were prospectively monitored for fetal and maternal outcomes, namely maternal and fetal deaths, and for toxic effects of MgSo_4 in the experimental arm. Results: Of the 150 patients recruited, 82 (55%) were in the experimental group and 68 (45%) were in the control group. 90% of the patients in the experimental group defaulted after receiving the loading dose of MgSo_4 while the remaining 10% completed the referral process. 44% of those in the control group completed the referral process. There were 3 maternal and 3 perinatal deaths, all in the control group. No adverse outcome (maternal or fetal death) or toxic effect was recorded among the recipients of MgSo_4. Conclusion: This study suggests that lower-cadre health care professionals at PHCs can administer the loading dose of MgSo_4 to SPE/E patients to improve maternal and fetal survival in critical states, without significant risk of adverse effects. However, the lack of compliance with referral processes remains a huge challenge

Attitudinal and behavioral factors associated with extramarital sex among Nigerian men: Findings from a national survey

Using couple data from a national survey, this article examines couple\u27s characteristics associated with extramarital sex among Nigerian men. We found 15.4% of married men had extramarital sex in the past 12 months. Extramarital sex was significantly associated with men\u27s attitude toward extramarital sex (OR = 1.7 [1.4-3.0]), early sexual debut (OR = 1.9 [1.6-2.3]), alcohol use (OR = 1.7 [1.4-2.1]), and intimate partner violence against wife (IPV) (OR = 1.4 [1.2-1.7]). Increased wife\u27s education was associated with decreased husband\u27s extramarital sex. Men living in rural areas and in the Central and Southern regions were also more likely to have extramarital sex. The findings suggest useful implications for HIV prevention programs in Nigeria. Interventions should focus on influencing social norms around protective behaviors for men to avoid risks associated with extramarital sex and IPV, helping men to change attitudes toward extramarital sex and IPV, and promoting delay in age at first sex among young men

Prevalence of internalized homophobia and HIV associated risks among men who have sex with men in Nigeria

This study assessed the level of internalized homophobia and associated factors among men who have sex with men (MSM) in Nigeria. Using respondent driven sampling, MSM were recruited in Lagos and Ibadan between July and September, 2006. Internalized homophobia was assessed as a negative composite score using an 11-item scale. A total of 1,125 MSM were interviewed. About 44.4% self-identified as homosexual or gay while 55% regarded themselves as bisexual. About a third of the respondents reported internalized homophobia. With homosexual/gay men as reference, respondents who self-identified as bisexual were two times more likely [AOR 2.1; 95 CI: 1.6 - 2.9, p \u3c 0.001] to report internalized homophobia. Those who were HIV positive were also twice as likely to report internalized homophobia compared to those who were HIV negative [AOR 1.8; 95% CI: 1.2 - 2.7, p = 0.004]. As internalized homophobia impedes acceptance of HIV prevention programming, identifying MSM who experience internalized homophobia is integral to the success of HIV prevention programming in Nigeria

Benefits of using magnesium sulphate (MgSO_4) for eclampsia management and maternal mortality reduction: Lessons from Kano State in northern Nigeria

Background: Despite clear emphasis through the Millennium Development Goals, the problem of high maternal mortality persists especially within low and middle income countries. Various studies report remarkably high maternal mortality rates in northern Nigeria, where maternal mortality rates exceed 1,000 deaths per 100,000 live births and eclampsia contributes approximately 40% of maternal deaths. Across Nigeria, diazepam is routinely used for the management of eclampsia. Prior to February 2008, diazepam was widely used for the management of eclampsia in Kano State (within northern Nigeria) with case fatality rate being over 20%. While magnesium sulphate (MgSO_4) is recognized as the most effective drug for the management of eclampsia; this study aims to compare MgSO_4 therapy with diazepam therapy in terms of case fatality rates and costs. Findings: This retrospective study, including 1,045 patients with eclampsia and pre-eclampsia during the years 2008 and 2009, reports a drop in case fatality rates from 20.9% (95% CI: 18.7, 23.2) to 2.3% (95% CI: 1.4, 3.2) among eclampsia patients following the MgSO_4 intervention. The study observed no significant difference in the cost of using MgSO_4 therapy compared to diazepam therapy. Conclusions: The study found a remarkable reduction in case fatality rate due to eclampsia in those who received MgSO_4 therapy with minimal increase in costs when compared to diazepam therapy. Concerted efforts should be focused on properly introducing MgSO_4 into emergency obstetric protocols especially within developing countries to reduce maternal mortality and also impact on health system performance

Evaluating the impact of three HIV counselling and testing strategies on male most-at-risk population in Nigeria: A segmented regression analysis

Background: Alternative HIV counselling and testing (HCT) delivery models, such as mobile HTC, have been shown to increase access to and uptake of HCT. We evaluated the effects of three strategies in increasing uptake of HCT among male most-at-risk population (M-MARPS). Methods: Three HCT strategies implemented between July, 2009, and July, 2012, among men who have sex with men and injecting drug users in three states in Nigeria were evaluated in a longitudinal analysis. The first strategy (S1) was facility based with a community mobilisation component using key opinion leaders (KOLs). The second strategy (S2) involved KOLs referring M-MARPS to nearby mobile HCT teams, while the third (S3) involved mobile M-MARPS peers conducting the HCT. Segmented linear regression was used to assess the effect of different strategies on uptake of HCT among M-MARPS. Findings: A total of 1988, 14 726, and 14 895 M-MARPS received HCT through S1, S2, and S3 methods, respectively. Overall, S3 (12·7%; 1853 of 14 622) identified the highest proportion of HIV-positive M-MARPS compared with S1 (9·0%; 177 of 1956) and S2 (3·3%; 480 of 14 671; p \u3c 0·0001). Also S3 (13·2%; 1729 of 13 074) identified the highest proportion of new HIV diagnosis compared with S1 (8·2%; 132 of 1618) and S2 (2·9%; 355 of 12 034), respectively (p \u3c 0·0001). For the total number of M-MARPS reached by each strategy, there was no immediate (271; p=0·539) or long-term change (53; p=0·334) in the total number of clients reached by S2 compared with S1. Compared with S2, S3 showed a significant immediate decrease (3068; p=0·029) but a sustained long-term increase (822; p=0·007) in the total number of M-MARPS reached with HCT. Interpretation: Peer-mediated HCT (S3) had the highest impact on the total number of M-MARPS reached, identifying HIV-positive M-MARPS and new testers. Since HCT is a key intervention strategy for effective HIV/AIDS control, training M-MARPS peers to provide HCT is a high-impact approach in delivering HCT to M-MARPS