An appraisal of the prevention of mother-to-child transmission of hepatitis B virus health system in Nigeria

The study aimed to assess the strengths and weaknesses, opportunities and threats influencing the achievement of prevention of mother-to-child transmission of hepatitis B virus. It also sought to suggest recommendations to improve the current prevention of mother-to-child transmission of hepatitis B virus health system in Nigeria. A critical appraisal of the prevention of mother-to-child transmission of hepatitis B virus health system in Nigeria was conducted. The WHO health system framework was used to assess the prevention of mother-to-child transmission of hepatitis B virus system. Considering the recent call by the World Health Organization to eliminate hepatitis and the existence of a robust prevention of mother-to-child transmission of human immunodeficiency virus health system, the prevention of mother-to-child transmission of hepatitis B virus health system in Nigeria is riddled with numerous challenges. These range from a health worker crisis, poor leadership and governance, inadequate health information, medicines, vaccines and technologies and poor service delivery. Urgent action in the Nigerian prevention of mother-to-child transmission of hepatitis B virus health system is required if Nigeria is to achieve its goal of eliminating hepatitis by 2021

A qualitative study on stigma experienced by young adults living with Sickle Cell Disease in Accra, Ghana

Background Sickle cell disease (SCD) describes a group of multisystem, genetic and stigmatising blood conditions that are prevalent in sub-Saharan Africa. Health-related stigma is a negative experience or adverse social judgement about a group based on an enduring feature conferred by a particular health problem. Literature shows that stigmatisation is experienced by people with SCD with negative implications on their lives. This study investigated self-reported views and lived experiences of young adults in Accra, Ghana, regarding SCD-related stigma and its impact on their lives. Methods Data were collected from 19 males and females with SCD using semi-structured individual interviews and focus group discussions. Transcripts were analysed using Braun and Clark's framework for thematic analysis. Results Five themes were identified: exclusion; status loss; SCD misconceptions; internalised stigma; and stigma and health outcomes. Overall, interpersonal and institutional levels of stigma were evident throughout the data with a lack of public education, limited specialist care and religion acting as determinants of SCD-related stigma. Conclusions Stigma has detrimental consequences for young adults with SCD. Multilevel stigmatisation of SCD at interpersonal and institutional levels should be addressed through multipronged approaches including increased public education, investment in specialist healthcare and collaboration with socioreligious institutions. Further research is needed to investigate the experiences of young adults in rural Ghana

Qualitative exploration of local knowledge, attitudes and use of Moringa oleifera seeds for home-based water purification and diarrhoea prevention in Niger State, Nigeria

This qualitative study explored stakeholders' knowledge of diarrhoea; their attitude to and perceptions of the use of Moringa oleifera seeds for home-based water treatment (HWT) and diarrhoea prevention in a low resource setting. Data were collected using semi-structured interviews with 13 respondents comprising rural community dwellers, health implementers and policy makers, and analysed using thematic analysis. Most rural community members interviewed had no knowledge of specific causes of diarrhoea or of the link between unsafe water and diarrhoeal diseases. They also practised inadequate or no methods of HWT. Although respondents were unaware of the use of M. oleifera seeds for HWT, community members and policymakers were keen on adopting it after observing demonstrations of its use for this purpose. Reasons for this behaviour change included easy accessibility to and a familiarity with M. oleifera for other uses. These results highlight the importance of providing health education on diarrhoea and water safety to motivate and empower community members to adopt healthy HWT behaviours. The use of M. oleifera seeds for HWT should be taught and advocated because it is a cheap, efficient and acceptable method of water purification for stakeholders

Dietary assessment of type-2 diabetes in Africa: a systematic scoping review

Background The prevalence of type 2 diabetes (t2dm) in Africa is increasing due to increase in associated risks factors such as unhealthy eating, obesity and physical inactivity. Diet monitoring is an important component in the management of t2dm to aid and prevent progression and complications. Research on dietary assessment in Africa is currently gaining interests and this paper aims to review the dietary assessment methods used with people living with t2dm. Methods The Cochrane Library, MEDLINE, Global Health and Web of Science databases were searched using keywords to identify studies that assessed the diet of people living with type-2 diabetes in Africa. The keywords were those related to the concepts: t2dm, dietary assessment, Africa and nutrient intake. We excluded papers not written in English, studies without a quantitative dietary assessment and studying a specific food, studies done among Africans but in developed countries, studies done among children and studies that measured neither energy intake or body mass index. Result Search yielded 132 papers after duplicates were removed. This reduced to 41 after the title and abstract screening and further to 10 after the full text screening. The included papers were based in six African countries: Algeria, Morocco, Uganda, Ghana, Cameroon and South Africa. The 24-hour dietary recall was the most common dietary assessment method used in 8 studies and two studies used the estimated food diaries. Five studies did not use a country-specific food composition table. Eight used a researcher-entered online dietary analysis software for nutrient intake estimation, out of which 7 contained the food database of a different country. Two studies estimated nutrient intake using a statistical tool and paper-and-pen. None of the dietary assessment methods used in the studies was validated in this patient group. Conclusion Limited evidence was available on the measurement of diet in patients with t2dm in Africa. There is need to improve the dietary assessment methods in Africa to prevent the progression and complication of t2dm

Development of oral health policy in Nigeria: an analysis of the role of context, actors and policy process

Abstract Background: In Nigeria, there is a high burden of oral health diseases, poor coordination of health services and human resources for delivery of oral health services. Previous attempts to develop an Oral Health Policy (OHP) to decrease the oral disease burden failed. However, a policy was eventually developed in November 2012. This paper explores the role of contextual factors, actors and the policy process in the development of the OHP and possible reasons why the current approved OHP succeeded. Methods: The study was undertaken across Nigeria; information gathered through document reviews and in-depth interviews with five groups of purposively selected respondents. Analysis of the policy development process was guided by the policy triangle framework, examining context, policy process and actors involved in the policy development. Results: The foremost enabling factor was the yearning among policy actors for a policy, having had four failed attempts. Other factors were the presence of a democratically elected government, a framework for health sector reform instituted by the Federal Ministry of Health (FMOH). The approved OHP went through all stages required for policy development unlike the previous attempts. Three groups of actors played crucial roles in the process, namely academics/researchers, development partners and policy makers. They either had decision making powers or influenced policy through funding or technical ability to generate credible research evidence, all sharing a common interest in developing the OHP. Although evidence was used to inform the development of the policy, the complex interactions between the context and actors facilitated its approval. Conclusions: The OHP development succeeded through a complex inter-relationship of context, process and actors, clearly illustrating that none of these factors could have, in isolation, catalyzed the policy development. Availability of evidence is necessary but not sufficient for developing policies in this area. Wider socio-political contexts in which actors develop policy can facilitate and/or constrain actors’ roles and interests as well as policy process. These must be taken into consideration at stages of policy development in order to produce policies that will strengthen the health system, especially in low and middle-income countries, where policy processes and influences can be often less than transparent

Time to apply a social determinants of health lens to addressing sickle cell disorders in sub-Saharan Africa

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What makes advocacy work? Stakeholders’ voices and insights from prioritisation of maternal and child health programme in Nigeria

Background The Nigerian government introduced and implemented a health programme to improve maternal and child health (MCH) called Subsidy Reinvestment and Empowerment programme for MCH (SURE-P/MCH). It ran from 2012 and ended abruptly in 2015 and was followed by increased advocacy for sustaining the MCH (antenatal, delivery, postnatal and immunization) services as a policy priority. Advocacy is important in allowing social voice, facilitating prioritization, and bringing different forces/actors together. Therefore, the study set out to understand how advocacy works - through understanding what effective advocacy implementation processes comprise and what mechanisms are triggered by which contexts to produce the intended outcomes. Methods The study used a Realist Evaluation design through a mixed quantitative and qualitative methods case study approach. The programme theory (PT) was developed from three substantive social theories (power politics, media influence communication theory, and the three-streams theory of agenda-setting), data and programme design documentation, and subsequently tested. We report information from 22 key informant interviews including national and State policy and law makers, policy implementers, CSOs, Development partners, NGOs, health professional groups, and media practitioners and review of relevant documents on advocacy events post-SURE-P. Results Key advocacy organizations and individuals including health professional groups, the media, civil society organizations, powerful individuals, and policymakers were involved in advocacy activities. The nature of their engagement included organizing workshops, symposiums, town hall meetings, individual meetings, press conferences, demonstrations, and engagements with media. Effective advocacy mechanism involved alliance brokering to increase influence, the media supporting and engaging in advocacy, and the use of champions, influencers, and spouses (Leadership and Elite Gendered Power Dynamics). The key contextual influences which determined the effectiveness of advocacy measures for MCH included the political cycle, availability of evidence on the issue, networking with powerful and interested champions, and alliance building in advocacy. All these enhanced the entrenchment of MCH on the political and financial agenda at the State and Federal levels. Conclusions Our result suggest that advocacy can be a useful tool to bring together different forces by allowing expression of voices and ensuring accountability of different actors including policymakers. In the context of poor health outcomes, interest from policymakers and politicians in MCH, combined with advocacy from key policy actors armed with evidence, can improve prioritization and sustained implementation of MCH services

Changing stigmatisation of leprosy: an exploratory, qualitative life course study in Western Nigeria

Introduction: Renewed interest in health-related stigma has invigorated calls to understand factors and processes underlying stigma. However, few empirical studies explore the influences of structural discrimination and moral status on leprosy-related stigma. We investigated how sociocultural context and organisational policies and practices influenced the connotations of leprosy, sources of stigma and the changing social responses to leprosy in Western Nigeria. Methodology: Ethnographic research conducted between 2008 and 2012 combined documents review with life history interviews of 21 individuals affected by leprosy and semistructured interviews with 26 community members in Western Nigeria. Interviews were audiotaped, transcribed verbatim and coded. Theoretical frameworks used to deepen social understandings of leprosy and responses to stigma included Link’s and Phelan’s conceptualisation of stigma and the concepts of structural discrimination and moral status. Results: Findings showed that connotations of leprosy in Yorùbá culture included the following: (i) perception of leprosy as the most shameful and detested condition and (ii) symbolic association with filth and immoral behaviour that is dishonouring to Yorùbá identity. Secondary analysis of archival materials revealed four sources of stigma: cultural beliefs about leprosy, health promotion messages embedded in primary school books, religious teachings about leprosy and campaigns conducted by the leprosy service in 1950s. Contrary to the portrayal of Yorùbá attitudes to leprosy as entirely negative, we identified that people affected by leprosy were creating new life courses to counter existing cultural accounts of marginalisation. Emerging narratives of inclusion outlined five facilitators of acceptance namely, antileprosy treatment, good moral character, supportive family networks, livelihoods, and contribution to community survival. Conclusion: Gaps highlighted by this study suggest that the global target of zero stigma and discrimination of leprosy will remain unattainable without better understanding of cultural significance(s) of leprosy and the local sources and underlying drivers of stigma that are crucial for developing context-specific stigma reduction interventions