Community-Level Influences on Early Sexual Initiation in Nigeria

Using national survey data from Nigeria, this study examines individual and community-level determinants of early sexual initiation. Community-level factors exercise important effects on the early onset of sexual initiation. Consistent with the social capital hypothesis, young people living in communities that are more knowledgeable about HIV/AIDS transmission and prevention, communities that are open to receiving HIV/AIDS information, and communities that support condom use as well as family planning are more likely to delay sexual initiation than others. The disadvantages associated with living in a community that is less well informed, less supportive of condom use and less open to receiving information on HIV/AIDS are significantly higher for women. Women who live in communities where attitudes about reproductive health are not positive or where there is lack of social support for condom use are at a heightened risk of early sexual initiation

Myths, misinformation, and communication about family planning and contraceptive use in Nigeria

Background: This paper examines myths, misinformation, factual information, and communication about family planning and their effects on contraceptive use in Nigeria. Methods: A nationally representative sample of 20,171 respondents from two waves of a multiround survey (one in 2003 and the other in 2005), was analyzed at the bivariate level using Chi-square tests and at the multivariate level using logistic regression. Results: Key myths and misinformation about family planning having significant negative effects on contraceptive use included: “contraception makes women become promiscuous”, “it is expensive to practice family planning”, and “family planning causes cancer”. Factual information having significant positive effects on contraceptive use includes the messages that family planning methods are effective and not against religious teaching. The type of people with whom respondents discussed family planning had a significant effect on use of contraception. Respondents who discussed family planning with their spouse, friends, and health workers were more likely to use contraception than those who discussed it with religious leaders. Other significant predictors of contraceptive use were region of residence, gender, and socioeconomic status. Conclusion: Family planning programs should focus on eliminating myths and misinformation, while strengthening factual information. Contraception programs should factor in the role of significant others, particularly spouses and friends

Evaluating the inclusion of family planning within the National Health Insurance benefits package in Ghana

Contraceptive use in Ghana has remained low despite annual increases since 2012. Having a high unmet need for family planning (FP) suggests that there may be barriers to access and uptake. Over time, several policies, including Ghana’s Costed Implementation Plan from 2015–20, have suggested FP initiatives to improve contraceptive use yet they have not been entirely implemented. Further, although FP was included in the health insurance act passed in 2003, amended in 2008, and revised in 2012, which indicated that health-care benefits include FP, people continue to pay out of pocket for services at National Health Insurance Authority facilities because the policy is yet to be implemented. In some settings, evidence suggests an increase in contraceptive uptake with the removal of out-of-pocket costs for FP services, therefore embedding an FP package into Ghana’s national health insurance scheme may increase uptake of FP service and method mix and improve health outcomes. As noted in this report, this study assessed the impact of the FP pilot intervention, namely out-of-pocket cost removal for FP services, demand generation for FP, and provider training on long-acting reversible contraceptives service provision on FP service uptake

Issues for consideration in the scale-up of the inclusion of family planning in the National Health Insurance benefits package in Ghana

Ghana is working toward achieving universal health coverage (UHC). This is driven, in part, by the Sustainable Development Goals (SDGs), specifically SDG 3—Good Health and Well-Being, which seeks to ensure healthy lives and promote well-being for all at all ages. Achieving this feat will improve equity of access as people, especially the poor can access quality health services without financial hardships. Ensuring equitable access to family planning (FP) is essential to securing the well-being of women and supporting the health and development of communities. One pathway to ensuring equity is the inclusion of FP in affordable insurance. While the inclusion of FP in the National Health Insurance Scheme is critical to the equity of FP distribution, the issues identified in this brief would have to be addressed before or in the course of scale-up to achieve the desired results

Measuring adherence to ARVs among HIV-positive adolescents in Cameroon: a comparative assessment of self-report and medication possession ratio methods

Introduction: adherence to ARV medications has been shown to improve treatment outcomes in HIV positive patients. Given that ARV treatment is lifelong, adherence has become a critical issue as it may reduce over time. Measuring adherence is therefore imperative in programming. There are different methods of measuring adherence each with its advantages and disadvantages, depending on the context and the time. This study therefore compares two widely used adherence measurement scales in Cameroon, namely, the self-report and the medication possession ration (MPR) methods. Methods: the study was done in some selected health facilities of the North West and South West regions of Cameroon among adolescents on ARV. The study was designed as an analytical cross-sectional study with a record review component and systematic random sampling was used to select the participants. Adherence was measured through self-report and the medication possession ratio. Adolescents with adherence levels of at least 95% were considered adherent. Viral load suppression was considered as having the most recent viral load suppression results of less than 1000 copies per ml. The kappa statistics of inter-rate agreement was used to ascertain the difference between adherence as measured by self-report and MPR. The difference in adherence between the two scales was also compared using Fischer´s exact test and p-values were reported. Results: the study shows that adherence level using the self-report technique is 82.9% while that of MPR was 73.4%. When compared using the using Kappa statistics, there was substantial agreement between the two scales of 66% (p=0.54). The results of both self-report adherence and MPR were also compared with viral load suppression and the difference between viral load suppression and MPR was significant (p<0.01). The difference in adherence between viral load suppression and the self-report measure also showed to be significant (p<0.01). Conclusion: adherence from the self-report measure was higher than from MPR, but there was substantial agreement between the scales. Although there is no gold standard for adherence measurement, self-report or medication possession ratio could be used and complemented with laboratory markers like viral load counts

HIV-related risk perception among female sex workers in Nigeria

Augustine Ankomah1, Godpower Omoregie1, Zacch Akinyemi2, Jennifer Anyanti1, Olaronke Ladipo1, Samson Adebayo11Society for Family Health, Abuja, Nigeria; 2Population Services International, Kigali, RwandaBackground: Over one-third of sex workers in Nigeria are infected with human immunodeficiency virus (HIV), yet there is a lack of understanding of sex workers’ own perception of sexual risk-taking. Applying the theory of cognitive dissonance, this paper examined the personal HIV risk perception of brothel-based sex workers.Methods: The study is based on 24 focus group discussions held among brothel-based sex workers in four geographically and culturally dispersed cities in Nigeria.Results: It was found that sex workers underestimated their risk of infection and rationalized, defended, or justified their behaviors, a typical psychological response to worry, threat, and anxiety arising from the apparent discrepancies between beliefs and behaviors. To reduce dissonance, many sex workers had a strong belief in fatalism, predestination, and faith-based invulnerability to HIV infection. Many believed that one will not die of acquired immune deficiency syndrome if it is not ordained by God. The sex workers also had a high level of HIV-related stigma.Conclusion: From these findings, most sex workers considered risk reduction and in particular condom use as far beyond their control or even unnecessary, as a result of their strong beliefs in fatalism and predestination. Therefore, one critical area of intervention is the need to assist sex workers to develop accurate means of assessing their personal vulnerability and self-appraisal of HIV-related risk.Keywords: female sex workers, cognitive dissonance, risk perception, risky behavior, focus group discussions, Nigeri

Relationship between care-givers' misconceptions and non-use of ITNs by under-five Nigerian children

<p>Abstract</p> <p>Background</p> <p>Malaria has been a major public health problem in Nigeria and many other sub-Saharan African countries. Insecticide-treated nets have shown to be cost-effective in the prevention of malaria, but the number of people that actually use these nets has remained generally low. Studies that explore the determinants of use of ITN are desirable.</p> <p>Methods</p> <p>Structured questionnaires based on thematic areas were administered by trained interviewers to 7,223 care-givers of under-five children selected from all the six geo-political zones of Nigeria. Bivariate analysis and multinomial logit model were used to identify possible determinants of use of ITN.</p> <p>Results</p> <p>Bivariate analysis showed that under-five children whose care-givers had some misconceptions about causes and prevention of malaria were significantly less likely to use ITN even though the household may own a net (p < 0.0001). Education and correct knowledge about modes of prevention of malaria, knowing that malaria is dangerous and malaria can kill were also significantly associated with use of ITN (p < 0.0001). Knowledge of symptoms of malaria did not influence use of ITN. Association of non-use of ITN with misconceptions about prevention of malaria persisted with logistic regression (Odds ratio 0.847; 95% CI 0.747 to 0.960).</p> <p>Conclusions</p> <p>Misconceptions about causes and prevention of malaria by caregivers adversely influence the use ITN by under-five children. Appropriate communication strategies should correct these misconceptions.</p

Modeling the impact of inclusion of family planning services in Ghana\u27s National Health Insurance scheme

While access to and uptake of modern family planning (FP) in Ghana has steadily risen over the last decade, the modern Contraceptive Prevalence Rate (mCPR) among all women reached only 22% in 2019 with 30% of women still reporting unmet need. To increase FP uptake via mitigation of cost barriers among women with unmet need, the Government of Ghana is seeking to integrate claims-based FP services into the National Health Insurance Scheme benefits package. The impact of these activities has the potential to be significant with the proportion of women accessing modern FP shifting dramatically to public facilities over the past decade. The Ghana Ministry of Health, the National Health Insurance Authority, Marie Stopes International Ghana, and the Population Council launched a pilot in nine districts from 2018–20. This report uses data from pilot activity to model four scenarios involving implementation of cost removal, demand generation, and long-acting reversible contraceptives training to estimate impact on mCPR. These are input into the Health Policy Project’s ImpactNow tool to obtain estimates of health and economic benefits, intended to inform decisions regarding scale-up of these activities across the country