Understanding barriers to clinical management of rape (CMR) services among survivors of rape in crisis settings in Borno state

Sexual and gender-based violence (SGBV) is a global public health concern disproportionately affecting women, with negative consequences for their health, well-being, human rights, and equality. SGBV includes any act perpetrated against an individual that is against that person’s will and is predicated upon gender norms and unequal power relationships. SGBV occurs in crisis settings where vulnerability is increased, and social and legal sanctions are reduced. Internally Displaced Persons are vulnerable to SGBV during times of conflict as well as in post-conflict settings due to resultant losses of socioeconomic opportunities in addition to housing, security, lack of institutional protection, and familial separation. More than two million people in Nigeria’s North East region have been displaced due to armed attacks in the past decade. This research brief presents findings from a study that documents barriers to access to medical and psycho-social support services for SGBV survivors in Borno state, Nigeria. The study provides recommendations for the development of interventions to address prevention needs among groups vulnerable to SGBV

Cannabis use among young people in Nigeria: Exploring the context of use and associated factors

Background: Cannabis is the most widely used illicit substance in Nigeria and is the first illicit substance young people are likely to use. There is evidence to show that cannabis use causes health and social problems that are more severe among young people. Cannabis use is criminalised in Nigeria and the context of use relating to motivation, risk factors and situations in which it is used is poorly understood. Aim: This research aimed to explore the context and factors that are associated with cannabis initiation and continued use among young people in Nigeria with a view to making evidence based recommendations for health promotion. Methods: Two studies were conducted in Lagos state among young people aged 16-21 years utilising the Theory of Triadic Influence as a framework. A quantitative study entailed the use of questionnaires to evaluate risk factors for the initiation and use of cannabis among 909 secondary school students in Lagos state. Binary logistic regression and multinomial logistic regression utilising latent class models were the analytical strategies used. A qualitative study utilising interviews and focus groups among 39 young people explored motivations, meanings and the context of cannabis use. Interviews were analysed using thematic analysis. Results: Findings showed that initiation was influenced by subcultural issues and individual factors influenced continued use. There was a tendency for continuation after initiation that was possibly linked to its use as a coping strategy for social inequalities, failed aspirations, family conflicts and the criminal identity. Cannabis users were more likely to be older, higher sensation seekers and were associated with family members or peers who used cannabis. Recommendation: These findings suggest that a non-judgemental participatory approach is needed to understand how the current cannabis policy affects young people. It is important to contextualise the needs of young people in programme planning

A diagnostic assessment of the health system\u27s response to FGM/C management and prevention in Nigeria

In Africa, it is estimated that 27 million, 24 million, and 20 million girls and women have undergone FGM/C in Egypt, Ethiopia, and Nigeria, respectively, making them the countries with the highest absolute numbers of women and girls living with FGM/C in the continent. Despite the existence of laws, policies, and plans of action that should drive the health system’s response, the practice persists at a substantial level in Nigeria. The goal of the study, detailed in this working paper, was to contribute to a reduction in the prevalence and ultimately the abandonment of FGM/C through a diagnostic assessment of the health sector’s response to FGM/C management and prevention in Nigeria and the identification of possible solutions for strengthening the existing response. The study explored how the health system implements the national policy and plan of action for FGM/C, and how the health-care sector supports the prevention and management of FGM/C-related complications to identify possible solutions for system strengthening. Findings suggest that improving the health system response in the prevention and management of FGM/C complications requires government ownership at all tiers

A diagnostic assessment of the health system\u27s response to FGM/C management and prevention in Nigeria—Brief

Globally, over 200 million women have been cut and are living with FGM/C-related consequences. In Africa, an estimated 27 million, 24 million, and 20 million girls/women have undergone FGM/C in Egypt, Ethiopia, and Nigeria respectively, the countries with the highest prevalence of FGM/C on the continent. In Nigeria, although the practice is considered widespread, national surveys suggest a gradual decline of FGM/C prevalence among women aged 15–49 years from 30 percent in 2008 to 20 percent in 2018. While these statistics suggest progress, the prevalence is still as high as 67 percent in some states. Nigeria’s National Strategic Health Development Plan Framework highlighted the need to strengthen the health system to cater to an increasing population served by scarce skilled health professionals. Findings from this study show that the level of readiness of the health facilities to handle FGM/C-related complications is low as evidenced by poor infrastructure, lack of equipment, and limited human capacity. Improving the health system response in the prevention and management of FGM/C complications requires focused funding, political leadership, and better stakeholder coordination

An assessment of human resources for health hiring, deployment and retention, procedures and practices in Cross river and Bauchi states, Nigeria

Primary health care (PHC) is the first contact in a healthcare system and, at its core, includes access to basic interventions that address health needs at the community level. These basic interventions are provided by key frontline health workers—nurses, midwives, and community health extension workers—critical for facilitating immediate access to maternal, newborn, and child health services at PHC facilities. Despite the critical roles of these healthworker cadres, their distribution is uneven and skewed—geographic and within levels of care and governments, in addition to poor distribution of skills—compounded by high attrition due to poor human resources for health (HRH) management and development. The aim of this study is to examine the HRH hiring, deployment, and retention procedures and practices in Cross River and Bauchi states in Nigeria, to generate evidence to support the development of improved and gender-sensitive hiring and deployment guidelines. The study also provides recommendations for improved HRH planning and management for better service delivery

Exploring the regulatory context for HIV self-testing and PrEP market authorisation and use in Nigeria

Funded by the World Health Organization, this study aimed to assess HIVST/PrEP availability and market authorisation; determine the facilitators and barriers to access; and identify existing systems that support the availability, appropriate use, affordability, and accessibility in the private sector in Nigeria

Women\u27s groups and COVID-19: An evidence review on savings groups in Africa

This paper presents emerging evidence from studies in diverse contexts in sub-Saharan Africa —with a deep dive into Nigeria and Uganda—on how COVID-19 has affected women’s groups and how these groups have helped mitigate the gendered effects of the pandemic’s and the associated policy responses’ consequences up until April 2021. The synthesis presents evidence that savings groups found ways to continue operating, provided leadership opportunities for women during the pandemic, and mitigated some of the negative economic consequences of COVID-19 on individual savings group members. Savings, credit, and group support from other members all likely contributed to the ability of groups to positively affect women’s group member’s resilience during COVID-19. However, savings groups themselves often faced financial challenges because of decreased savings, which sometimes resulted in the depletion of group assets. These findings are consistent with a recent evidence synthesis on how past covariate shocks affected women’s groups and their members. We conclude the paper by presenting various policy recommendations to enable savings groups to achieve improvements in women’s empowerment and economic outcomes and research recommendations to address some of the current evidence-gaps on how COVID-19 is affecting women’s groups and their members

Understanding medicalisation of female genital mutilation/cutting (FGM/C): A qualitative study of parents and health workers in Nigeria

This community-based, cross-sectional qualitative study was conducted in four communities in Nigeria’s Delta, and was conceptualized to address gaps in our understanding of medicalization of female genital mutilation/cutting (FGM/C) and to provide critical evidence needed to effectively design abandonment interventions. The study findings reveal that the social norms driving FGM/C practice remain entrenched despite a shift to medicalization. They also reflect the tendency of parents and health workers to view FGM/C, whether traditional or medicalized, as a minor procedure with few complications and significant benefits that would positively impact a daughter’s future status as a wife and mother. Findings reveal that there is a need for aggressive, consistent, and specific FGM/C abandonment interventions targeting families and key influencers including health workers, traditional cutters, traditional birth attendants, and community leaders in the study communities. Such interventions should explicitly discourage medicalization along with other forms of FGM/C practice and must involve men who are often removed from the mechanics of FGM/C but are key decisionmakers. Interventions focused on health workers must view them not only within their professional capacities but also as community members functioning within FGM/C friendly socio-cultural milieus who may share community social norms

I think this is the only challenge… the stigma” Stakeholder perceptions about barriers to antenatal care (ANC) and prevention of mother-to-child transmission (PMTCT) uptake in Kano state, Nigeria

Background: Despite the progress made so far in reducing mother-to-child transmission (MTCT), Nigeria still contributes significantly to the global burden of new pediatric HIV infections. The elimination target for MTCT has not been reached and the decline in new infections among all Global Plan countries from 2009 to 2015 was lowest in Nigeria. This qualitative study explores the barriers to uptake of prevention of mother-to-child transmission (PMTCT) intervention in Kano, the second most populous state in Nigeria. Methods: Key informant interviews (KIIs) were conducted among twelve stakeholders who were purposively selected based on their knowledge and involvement in PMTCT program activities in the state. The KII guide explored the status and challenges of PMTCT uptake in Kano state. Qualitative data analysis was managed using NVIVO 11 software and themes were analyzed using thematic analysis. Results: We found that the key barriers to uptake of PMTCT identified by stakeholders cut across the domains of the socio-ecological model. These include—fear of stigma associated with being seen accessing HIV related services, low male partner involvement, socio-cultural beliefs about the dangers of hospital-based delivery, poor attitude of health workers, distance/cost to facilities, issues with availability of HIV test kits and poor organization of health services. Conclusion: The implementation of effective PMTCT programs would require innovative strategies that leverage improvement of Antenatal care (ANC) uptake as an entry point for PMTCT. In addition, sustaining engagement in care requires creating a supportive stigma-free environment in the community as well as spousal support to ensure women can navigate the socio-cultural barriers that limit access to health services