Findings from post-intervention analysis of pre-eclampsia/eclampsia in Ebonyi State

Maternal and newborn deaths due to pre-eclampsia and eclampsia (PE/E) are preventable, yet in Nigeria this is the most significant direct cause of maternal mortality. Following a landscape analysis to better understand the enormity of this problem across seven states in Nigeria, a cross-cutting intervention was implemented in Cross River, Ebonyi, and Kogi states. Researchers worked with primary healthcare (PHC) providers, policymakers, women’s groups, and community members to increase uptake of underutilized interventions and commodities for the prevention and treatment of PE/E in rural Nigeria. This brief presents study findings from Ebonyi State on post-intervention landscape changes in: programmatic and policy support for PE/E prevention and treatment; PHC facilities’ capacity to manage PE/E; provider knowledge and competence in preventing, detecting, and managing PE/E; and community awareness, beliefs, and experiences around PE/E

Strengthening the role of patent and proprietary medicine vendors in the provision of injectable contraception in Nigeria

In Nigeria, overall modern contraceptive use is very low, however 60 percent of modern contraceptive services are obtained from private providers, including Patent and Proprietary Medicine (PPM) shops, which provide more than half of these private-sector services. PPM shops are owned by Patent and Proprietary Medicine Vendors (PPMVs) licensed to sell patent or proprietary drugs. Current regulations do not permit PPMVs to sell or administer injectable contraceptives, though, because they are not regarded as sufficiently trained. Given this, it is an opportune time to generate evidence that can drive policy action to formally engage and train PPMVs in the provision of high-quality progestin-only injectable contraceptive services as a key strategy to increase women’s access to contraception. The Evidence Project, in collaboration with the Federal Ministry of Health, is conducting implementation research to: 1) demonstrate the feasibility of PPMVs administering all forms of progestin-only injectable contraceptives, such as Depo Provera and Sayana® Press; and 2) understand women’s experiences using progestin-only injectable contraceptives, including the quality of care they receive when accessing services from PPMVs

Delivering contraceptive vaginal rings—Task sharing policies and practices in the delivery of family planning services: Experiences from Nigeria

Despite tremendous progress over the past decades in family planning and fertility reduction, more than 220 million women have unmet need for contraception globally. The government of Nigeria pledged over $11 million to procure contraceptive commodities for distribution in the public sector from 2011–2015, to increase the contraceptive prevalence rate (CPR) that had stalled at 10 percent for almost two decades. The Population Council is facilitating the registration, introduction, and scale-up of the Progesterone Contraceptive Vaginal Ring (PCVR), designed particularly for breastfeeding women, in the sub-Saharan African countries of Kenya, Nigeria, and Senegal. In Nigeria, restrictive policies regarding matching health care cadres with maternal and child health interventions have previously hindered widespread availability of essential commodities to rural areas where providers’ skills were deemed marginal. With the adoption of the national task-sharing policy, which enables lower cadre and community-level providers to deliver essential reproductive health services in hard-to-reach terrains, this report weighs the feasibility of the PCVR to leverage the existing task-sharing platform to achieve large-scale rural uptake, expand the methods mix for postpartum contraception, and contribute to increasing the CPR in this country

Delivering contraceptive vaginal rings: Review of postpartum and postnatal care programs in Nigeria

Postpartum family planning is a major component of postpartum care services. The Population Council is working to introduce an additional method of contraception in Nigeria—the Progesterone Contraceptive Vaginal Ring (PCVR). The PCVR is administered vaginally but acts systemically to inhibit ovulation. The PCVR contains natural progesterone and is meant for breastfeeding women to augment lactational amenorrhea. As the Council conducts a series of activities as a prelude to eventual introduction of the PCVR in sub-Saharan Africa, including Nigeria, the detailed evaluation of the postpartum program environment is very important. Understanding the prevailing postpartum and postnatal care landscapes will be crucial in determining how best this relatively new contraceptive innovation would be placed within the existing framework. This report reviews the status of various postpartum and postnatal programs in Nigeria, the feasibility of leveraging the ongoing policy, and program opportunities to integrate the PCVR within Nigeria’s post-delivery care environment for the well-being of mothers and their infants

Country mapping: Nigeria

The Population Council conducted a three-year acceptability study of the progesterone vaginal ring (PVR) in three sub-Saharan African countries. This technical report presents results from Nigeria, laying out the country’s demographics and high fertility rates; describing the family planning program and policy context; and, finally, revealing the stakeholder support thus far with a discussion on how best to proceed with introduction activities. This country mapping confirms the likelihood that the PVR would be well received in Nigeria and fill a large need in family planning. The PVR is a safe, long-acting, user-controlled product that can be easily inserted and removed by the woman herself with minimal coaching. This is especially appropriate for women in the North who frequent healthcare facilities sparingly due to an aversion to male healthcare providers, need for permission from male partners to visit health facilities, poverty, and a lack of skilled health personnel. These and other characteristics make the PVR a highly desirable addition to the current contraceptive method mix in Nigeria

Findings from post-intervention analysis of pre-eclampsia/eclampsia in Kogi State

Maternal and newborn deaths due to pre-eclampsia and eclampsia (PE/E) are preventable, yet in Nigeria this is the most significant direct cause of maternal mortality. Following a landscape analysis to better understand the enormity of this problem across seven states in Nigeria, a cross-cutting intervention was implemented in Cross River, Ebonyi, and Kogi states. Researchers worked with primary healthcare (PHC) providers, policymakers, women’s groups, and community members to increase uptake of underutilized interventions and commodities for the prevention and treatment of PE/E in rural Nigeria. This brief presents study findings from Kogi state on post-intervention landscape changes in: programmatic and policy support for PE/E prevention and treatment; PHC facilities’ capacity to manage PE/E; provider knowledge and competence in preventing, detecting, and managing PE/E; and community awareness, beliefs, and experiences around PE/E

Findings from post-intervention analysis of pre-eclampsia/eclampsia in Cross River State

Maternal and newborn deaths due to pre-eclampsia and eclampsia (PE/E) are preventable, yet in Nigeria this is the most significant direct cause of maternal mortality. Following a landscape analysis to better understand the enormity of this problem across seven states in Nigeria, a cross-cutting intervention was implemented in Cross River, Ebonyi, and Kogi states. Researchers worked with primary healthcare (PHC) providers, policymakers, women’s groups, and community members to increase uptake of underutilized interventions and commodities for the prevention and treatment of PE/E in rural Nigeria. This brief presents study findings from Cross River State on post-intervention landscape changes in: programmatic and policy support for PE/E prevention and treatment; PHC facilities’ capacity to manage PE/E; provider knowledge and competence in preventing, detecting, and managing PE/E; and community awareness, beliefs, and experiences around PE/E

Assessing the feasibility and acceptability of community health extension workers to treat hypertension associated with pregnancy: An analysis of post-intervention findings

This brief reports on a study that tested the feasibility of tasking community health extension workers (CHEWs) with detecting and managing hypertension, and prescribing an oral antihypertensive drug at primary health care (PHC) facilities in Nigeria as part of a package of care for women with pre-eclampsia and eclampsia (PE/E). This evaluation measured improvements in knowledge retention and increases in early detection, prevention, and management of PE/E. Findings indicate that trained CHEWs working at intervention PHCs can correctly identify, differentiate, and manage normal, mild, moderate, and severe hypertension. These findings are important contributions to implementing Nigeria’s national task-shifting policy at the local level. Training and mentoring CHEWs to detect and manage PE/E at the local level will improve access to life-saving care for women, their families, and their communities, and will contribute to stronger health systems and improved maternal health outcomes in Nigeria

Engaging community women\u27s groups for improved uptake of antenatal care services in Cross River State, Nigeria: An analysis of post-intervention findings

The Ending Eclampsia project seeks to understand the potential of underutilized and promising interventions that increase access to services, particularly improving community referral systems. This brief reports on a study in Nigeria’s Cross River state that aimed to test the feasibility of women’s group leaders delivering health information for pre-eclampsia and eclampsia (PE/E), referral, and other antenatal care (ANC) services to their peers, to increasing access to quality maternal and newborn health services. Women’s group findings suggest that community engagement is a critical model for information sharing and is an adaptable, acceptable model for increasing PE/E prevention and danger-sign recognition across Nigeria. Following the implementation of women’s group activities, knowledge of hypertension and pregnancy complications increased alongside awareness of the importance of ANC attendance at health facilities. While symptoms of eclampsia (convulsions) are understood, gaps persist in the recognition of signs of hypertension/PE/E, as well as in prevention strategies

Contraceptive Use and Its Socio-economic Determinants among Women in North-East and North-West Regions of Nigeria: A Comparative Analysis

This study investigated the socio-economic factors associated with reported contraceptive use by women of reproductive age in northern Nigeria. Bivariate and logistic regression analysis was applied to successive Nigeria Demographic and Health Survey (NDHS: 1999-2013) data to examine the relationship between reported use of modern contraceptives (the dependent variable) and the socioeconomic status (age, rural-urban residence, education, religion, current work status, marital status, and number of living children) of these women in the north-east (NE) and north-west (NW) geo-political zones (GPZs). The results indicated that women’s socio-economic status were positively associated with use of modern contraceptives in the NW in 1999 (AOR=2.15; 95%CI=1.47, 3.14), 2003 (AOR=1.64; 95%CI=1.30, 2.08) and 2013 (AOR=1.30; 95%CI=1.12, 1.50) and also in the north-east in 2008 (AOR=0.74; 95%CI=0.64, 0.86). Contraceptive use could increase as FP programmes better respond to the socio-economic and cultural circumstances of women in northern Nigeria