Contraceptive Uptake among Women of Reproductive Age in a Semi Urban Area in Jos South Local Government Area of Plateau State, North Central Nigeria

Background Family planning reduces the number of unintended and unwanted pregnancies and thereby saving women from high risk pregnancies and unsafe abortions. Despite the persistent advocacy urging  the use of modern contraceptive methods for family planning, the fertility rates in most subSaharan African countries still remain unacceptably high mostly due to poor uptake of contraception because of cultural, economic and political barriers. Evidence from the recent Nigeria Demographic and Health Survey indicates that only about 15 percent of sexually active women currently practice effective  contraception. The objective of the study was to assess the knowledge of contraceptive and its uptake among women of reproductive age in Giring community in Jos South Local Government Area of Plateau  State.Methods A cross sectional study designed was used to assess knowledge and uptake of contraceptive among 400 respondents selected by multi stage sampling technique in Giring community using a semi structured interviewer administered questionnaire. Information about their knowledge, uptake, methods and factors  that determine uptake of contraceptives was obtained. Data was analysed using Epi Info statistical software and results were presented as tables. Chi square was used to test association between qualitative variables.ResultsMajority, 362 (90.5%) of the respondents were aware of contraceptives, 200 (55.2%) had used one form of contraceptive or the other. Two common methods of contraceptive used were pills, 184  (34.2%) and injectable (176 (32.8%). Determinants of uptake included; prevention of unintended pregnancies in 136 (53.1%) and to space timing of child birth in 78 (30.5%). Factors found to be  associated with contraceptive uptake among women included age, (p=O.OOO), education (p= 0.000)  and marital status (p= 0.000).Conclusion This study showed that despite high awareness about contraceptives, the uptake is relatively low compared to the rates in developed countries.  Factors like age, marital and educational status have statistically significant relationship with contraceptive uptake. There is a strong need to encourage continuing  female education to enhance awareness on contraceptives and their benefits in reproductive health.Keywords: Knowledge, Contraceptives, Uptake; Semi-Urban Women

Does inter-border conflict influence the views of task sharing among community health volunteers in Nigeria? A qualitative study

Background: Volunteer community health workers are increasingly being engaged in Nigeria, through the World Health Organization’s task sharing strategy. This strategy aims to address gaps in human resources for health, including inequitable distribution of health workers. Recent conflicts in rural and fragile border communities in northcentral Nigeria create challenges for volunteer community health workers to meet their community's increasing health needs. This study aimed to explore the perception of volunteers involved in task sharing to understand factors affecting performance and delivery in such contexts. Methods: This was a qualitative study conducted in fragile border communities in north central Nigeria. Eighteen audio recorded, semi-structured interviews with volunteers and supervisors were performed. Their perceptions on how task sharing and allocation of tasks affect performance and delivery were elucidated. The transactional social framework was applied during the thematic analysis process to generate an explanatory account of the research data, which was analysed using NVivo software. Results: Promotive and preventive tasks were shared among the predominantly agrarian respondents. There was a structured task allocation process that linked the community with the health system and mainly cordial relationships were in place. However, there were barriers related to ethnoreligious crises and current conflict, timing of task allocations, gender inequities in volunteerism, shortage of commodities, inadequate incentives, dwindling community support and negative attitudes of some volunteers. Conclusion: The perception of task sharing was mainly positive, despite the challenges, especially the current conflict. In this fragile context, reconsideration of non-seasonal task allocations within improved community-driven selection and security systems should be encouraged. Supportive supervision and providing adequate and timely renumeration will also be beneficial in this fragile setting

Assessment of the Knowledge and Practice of Universal Precaution for the Prevention of HIV Transmission by Health Workers in Mangu Local Government Area of Plateau State Nigeria

Background The increasing prevalence of HN increases the risk that health workers will be exposed to  patients infected with HN, especially when blood and bodyfluid precautions are not followed for all  patients. The objective of the study was to assess the knowledge of health workers on HN I AIDS as well as their practice of universal precaution with regards to HN I AIDS. Methodology This was a cross sectional study conducted among health workers in selected health  facilities in Mangu Local Government Area of Plateau state in north central Nigeria. A multistage sampling technique was used to select 104 health workers that are directly involved in patient care from 5 health facilities made up of a General Hospital and 4 Primary Health Centres. The data collection instrument was a structured interviewer administered questionnaire that obtained data on health workers' bio-data,  knowledge of transmission of HN, knowledge on universal precautions, practice of universal precautions, and the prevention of HN transmission by health workers.Result A total of 104 respondents were recruited for the study. The mean age of the health workers was 42.6 ± 7.9 years with 69 (66.3%) females and 35(33. 7%) males. All (1 00%) of the respondents were  aware of HNIAIDS and 78 (75.0%) knew that the disease has no cure. Modes of transmission that were recognized by the participants included sex [90(86.5%)] pregnancy [55(53.4%)], delivery [85(81. 7)].  Most of the respondents were able to identify components of UPs. Hand washing was identified by 85(81.  7%), use of PPE by 83(80.6%), safe collection and disposal of sharps by 99(95.2%) and prevention of  injury from sharps by 96(92.3%). Among the respondents 88 (84. 6%) practiced hand washing regularly when handling patients I carrying out procedures. General use of Personal Protective Equipment's (PPE)  was reported by 85 (81. 7%) though consistent use was reported by only 54(63.5%). PPE that are used by the respondents included gloves (93.1%), safety goggles (11.5%), apron (29.8%), boots (18.4%), facemask (25.3%) and gowns (21.8%). Also,  34(32. 7%) had experienced splashing of bodily fluids to the mouth, 28(26.9%) splashing to the eye, 38(36.5%) splashing to non-intact skin and 65(63. 7%) had sustained percutaneous injury. The devices commonly causing injury included hypodermic needles (52.2%), suture needle (26.1%) and intravenous stylet (14.5).ConclusionThis study conducted among 104 health workers showed good knowledge of various  aspects of HN I AIDS and UPs. Most were found to use PPE especially gloves, sharp boxes for disposal and regular hand washing. Up 64% had experienced exposures of various types of which less than half had been reported. Periodic re- training of the health workers would be of immense benefit in cultivating safe practices hence reducing the risk of injury and infection.Keywords: HN I AIDS; Universal Precaution; Personal Protective Equipmen

Optimising the performance of frontline implementers engaged in the NTD programme in Nigeria: lessons for strengthening community health systems for universal health coverage

Background: The control and elimination of Neglected Tropical Diseases (NTDs) is dependent on mass administration of medicines (MAM) in communities and schools by community drug distributers (CDDs) who are supported and supervised by health facility staff (FLHF) and teachers. Understanding how to motivate, retain and optimise their performance is essential to ensure communities accept medicines. This study aimed to capture and translate knowledge, problems and solutions, identified by implementers, to enhance NTD programme delivery at the community level in Nigeria. Methods: Qualitative data was collected through participatory stakeholder workshops organised around two themes: (i) identification of problems and (ii) finding solutions. Eighteen problem-focused workshops and 20 solution-focussed workshops were held with FLHF, CDDs and teachers in 12 purposively selected local government areas (LGA) across two states in Nigeria, Ogun and Kaduna States. Result: The problems and solutions identified by frontline implementers were organised into three broad themes: technical support, social support and incentives. Areas identified for technical support included training, supervision, human resource management and workload, equipment and resources and timing of MAM implementation. Social support needs were for more equitable drug distributor selection processes, effective community sensitisation mechanisms and being associated with the health system. Incentives identified were both non-financial and financial including receiving positive community feedback and recognition and monetary remuneration. The results led to the development of the ‘NTD frontline implementer’s framework’ which was adapted from the Community Health Worker (CHW) Generic Logic Model by Naimoli et al. (Hum Resour Health 12:56, 2014). Conclusion: Maximising performance of frontline implementers is key to successful attainment of NTD goals and other health interventions. As NTDs are viewed as a ‘litmus test’ for universal health coverage, the lessons shared here could cut across programmes aiming to achieve equitable coverage. It is critical to strengthen the collaboration between health systems and communities so that together they can jointly provide the necessary support for frontline implementers to deliver health for all. This research presents additional evidence that involving frontline implementers in the planning and implementation of health interventions through regular feedback before, during and after implementation has the potential to strengthen health outcomes. Keywords: Frontline implementers, NTD programme, Optimising performance, Challenges and solutions, Nigeria, Universal health coverage, Health equity, Participatory research method

Mass administration of medicines in changing contexts: Acceptability, adaptability and community directed approaches in Kaduna and Ogun States, Nigeria

Nigeria has the highest burden of NTDs in sub-Saharan Africa. Commitments to reach the control and elimination of many Neglected Tropical Diseases (NTDs), particularly those amenable to preventive chemotherapy (onchocerciasis, schistosomiasis, soil transmitted helminths, lymphatic filariasis and trachoma) by 2020 are detailed in the London declaration. Strategies to reach targets build on existing approaches, one of which is the use of community directed intervention (CDI) methods to deliver the mass administration of medicines (MAM). However, treatment using this approach has been inconsistent and there are questions about the acceptability and adaptability of these interventions during periods of programmatic, social, and political change. This paper explores the current strengths and weaknesses of CDI approaches in MAM delivery. We consider the acceptability and adaptability of existing MAM approaches to ensure equity in access to essential treatments. Using qualitative methods, we explore implementer perspectives of MAM delivery. We purposively selected programme implementers to ensure good programmatic knowledge and representation from the different levels of health governance in Nigeria. Data collection took place across two States (Kaduna and Ogun). Our results indicate that CDI approaches have underpinned many historic successes in NTD programme acceptance in Nigeria, specifically in Kaduna and Ogun State. However, our results also show that in some contexts, factors that underpin the success of CDI have become disrupted presenting new challenges for programme implementers. Capturing the tacit knowledge of health implementers at varying levels of the health system, we present the current and changing context of MAM delivery in Kaduna and Ogun States and consolidate a platform of evidence to guide future programme delivery and research studies. We situate our findings within the broader NTD literature, specifically, in identifying how our findings align to existing reviews focused on factors that shape individual acceptance of MAM

A mixed methods evaluation of an integrated training package for skin neglected tropical diseases in Kaduna and Ogun, Nigeria

Background: The overall burden of neglected tropical diseases (NTDs) affecting the skin is undetermined. Skin conditions are among the top 10 causes of disability worldwide. Affected persons seek treatment at advanced stages of the disease, resulting in morbidity and disability. We developed and evaluated an integrated training intervention for early case detection, referral and management of skin NTDs in two states in Nigeria. Methods: This was a mixed-methods study using participatory approaches to develop specific skin algorithms and training packages for community and primary level health workers. This supported the identification, referral and clinical diagnosis of suspected cases. We used Kirkpatrick's model to evaluate the training package. Results: Participants’ knowledge improved after the 2-months intervention. Across both states, knowledge retention appeared more robust for cadres at all levels: state, local government area and primary healthcare. All (100%) participants mentioned that the training assisted them in detecting, referring and managing skin NTDs. Training was understood by participants and training materials were easy to understand. Materials were also effective in educating community members about the symptoms of NTDs and supported referral to facilities for appropriate management. Conclusions: Community implementers can be trained and supervised to detect people affected by skin NTDs and support appropriate management within the existing patient care pathway

Guiding principles for quality, equity and sustainability in implementation research: Multicounty learnings from participatory action research to strengthen health systems

Global health gains can be achieved through strengthening health systems to identify and address implementation challenges in low- and middle-income countries. Participatory research, that promotes joint problem and solution finding between communities and different health systems actors, supports policy implementation analysis at all levels. Within the neglected tropical disease programmes in Liberia and Nigeria, we applied participatory action research (PAR) to address programmatic and health system bottlenecks with health systems strengthening embedded. This paper shares learning from 20 interviews with co-researchers, from national and sub-national levels and academic researchers who worked collaboratively to understand challenges, co-create solutions and advocate for policy change. Through analysis and reflections of existing PAR principles, we inductively identified five additional guiding principles for quality, ethical standards and ongoing learning within PAR projects that aim to strengthen health systems. (1) Recognize communities as units of identity and define stakeholder participation to ensure equitable engagement of all actors; (2) enable flexible action planning that builds on existing structures whilst providing opportunities for embedding change; (3) address health systems and research power differentials that can impede co-production of knowledge and solution development; (4) embed relational practices that lead to new political forms of participation and inquiry within health systems and (5) develop structures for ongoing learning at multiple levels of the health system. PAR can strengthen health systems by connecting and co-creating potentially sustainable solutions to implementation challenges. Additional research to explore how these five additional principles can support the attainment of quality and ethical standards within implementation research using a PAR framework for health systems strengthening is needed

Lessons from participatory community mapping to inform neglected tropical disease programmes in Nigeria

Background: Participatory research methods promote collaborations between researchers and communities to collectively overcome implementation challenges for sustainable social change. Programmes usually take a top-down approach to addressing such challenges. This study developed and piloted contextualised participatory methods to identify community structures that could improve the equity of medicine administration for neglected tropical diseases (NTDs) in northern and southern Nigeria. Methods: Participants and researchers conducted transect walks and social mapping to understand which community-based structures could be used to maximise accessibility and acceptability of medicines for NTDs. Results: Using visual participatory methods with a diverse set of stakeholders facilitated the identification of new structures within the community that could be used to improve the equity of medicine distribution and access. Available materials such as sticks, stones and leaves were appropriately used by respondents in the rural areas, which increased meaningful engagement irrespective of their literacy level. Structures identified included Qur'anic schools, football grounds, mechanics shops, shrines, village head's houses and worship centres. Challenges in using these structures for medicine distribution included resistance from school authorities and restrictions to women's access due to traditions and norms, particularly within palaces and mosques. Conclusions: This article highlights the importance of meaningful community engagement methods and engaging gatekeepers in visual participatory methods. It emphasizes the importance of including divergent views of various population groups in order to ensure that all communities are reached by NTDs programmes

‘You want to deal with power while riding on power’: global perspectives on power in participatory health research and co-production approaches

Introduction Power relations permeate research partnerships and compromise the ability of participatory research approaches to bring about transformational and sustainable change. This study aimed to explore how participatory health researchers engaged in co-production research perceive and experience ‘power’, and how it is discussed and addressed within the context of research partnerships. Methods Five online workshops were carried out with participatory health researchers working in different global contexts. Transcripts of the workshops were analysed thematically against the ‘Social Ecology of Power’ framework and mapped at the micro (individual), meso (interpersonal) or macro (structural) level. Results A total of 59 participants, with participatory experience in 24 different countries, attended the workshops. At the micro level, key findings included the rarity of explicit discussions on the meaning and impact of power, the use of reflexivity for examining assumptions and power differentials, and the perceived importance of strengthening co-researcher capacity to shift power. At the meso level, participants emphasised the need to manage co-researcher expectations, create spaces for trusted dialogue, and consider the potential risks faced by empowered community partners. Participants were divided over whether gatekeeper engagement aided the research process or acted to exclude marginalised groups from participating. At the macro level, colonial and ‘traditional’ research legacies were acknowledged to have generated and maintained power inequities within research partnerships. Conclusions The ‘Social Ecology of Power’ framework is a useful tool for engaging with power inequities that cut across the social ecology, highlighting how they can operate at the micro, meso and macro level. This study reiterates that power is pervasive, and that while many researchers are intentional about engaging with power, actions and available tools must be used more systematically to identify and address power imbalances in participatory research partnerships, in order to contribute to improved equity and social justice outcomes