Why rural women do not use primary health centres for pregnancy care : evidence from a qualitative study in Nigeria

Pregnant women in rural communities in Nigeria often do not use Primary Health Care Centres. Through focus group discussions, the study found four broad categories of reasons underlying non-use: 1) accessibility factors – poor roads and transportation, long distances, and facility not always open; 2) perceptions relating to poor quality of care, inadequate drugs, abusive care by health providers, long wait times, and inappropriate referrals; 3) costs of services, including inability to pay for services even when costs are not excessive; the introduction of informal payments by staff; and 4) partner support (or lack thereof), and misinterpretation of signs of pregnancy complications.Global Affairs Canada (GAC)Canadian Institutes of Health Research (CIHR

Assessment of the quality of antenatal and postnatal care services in primary health centres in rural Nigeria

Study findings show predictors of sub-optimal offerings of standard Primary Health Care (PHC) that include: local government area, marital status and previous childbirths. A higher proportion of maternal deaths in Nigeria occur among women living in rural areas, where barriers to maternal health include quality of care in health facilities. There is evidence of continuing under-utilization of primary care by pregnant women in poor and rural communities. Due to the small number of women who use PHC, and the non-availability of accurate records of women who use the facilities for maternal care, a sample size could not be determined beforehand.Global Affairs Canada (GAC)Canadian Institute for Health research (CIHR

Influence of women’s empowerment indices on the utilization of skilled maternity care : evidence from rural Nigeria

This study assessed the association between indices of women’s empowerment and utilization of skilled antenatal, intrapartum and postnatal maternity care in two rural Local Government Areas in Edo State, Nigeria. Findings indicate that female education is a strong predisposing factor for utilization of maternal health services in the study area. Survey respondents’ education and participation in payment for their own health care positively predicted use of all three levels of skilled maternal care. Women who made decisions alone about major household purchases were twice as likely to use all three levels of services than when decisions were made by their partners or others.Global Affairs Canada (GAC)Canadian Institute for Health Research (CIHR

Examining the Role of Couples’ Characteristics in Contraceptive use in Nigeria and Zambia

Relationship-related characteristics influence diverse health and demographic outcomes. This study examined the role of couples‘ characteristics in contraceptive use. Data were obtained from 2013 Nigeria and 2013-14 Zambia Demographic and Health Surveys. The study population consisted of couples in monogamous union (married or living together) who had at least one live birth and the wife was not pregnant at the time of the survey. Prevalence of contraceptive use among couples in Nigeria was 27% and 63% in Zambia. Couples‘ educational attainment, religious affiliation, the frequency of listening to the radio, reported number of children, fertility preference, region of residence and household wealth index were significant predictors of contraceptive use among couples in Nigeria and Zambia. Given the significant role of couples‘ characteristics in the uptake of contraceptives, there is the need to encourage interventions that target couples, particularly those of poor socioeconomic status. Keywords: Contraceptive, relationship-related characteristics, monogamous union, couples, Nigeria, Zambi

Outcomes of a multifaceted intervention to improve maternal satisfaction with care in secondary hospitals in Nigeria

Background: Data in Nigeria suggests a high level of dissatisfaction among women attending maternity care in health facilities due to long wait times, disrespectful care, and poor attention by healthcare personnel. Objective: To examine the effectiveness of a multifaceted intervention in improving self-reported indicators of maternal healthcare satisfaction by women who use referral facilities in two regions of Nigeria. Method: The design was quasi-experimental and consisted of two intervention facilities and two control facilities. The interventions included strategic planning, staff re-training, a computerized appointment system, health education/feedback, maternal death reviews and surveillance, and advocacy. A random sample of 2262 women was selected (1205 in the intervention sites and 1057 in the two control sites) to respond to a 24-item questionnaire on service satisfaction as they exited the health facilities. Adjusted Poisson and binary regression analyses were used to assess and compare proportions of reported satisfaction by women between the intervention and control sites. Results: Women in the intervention sites were 54% more likely than those in control sites to report overall satisfaction with services. They were significantly less likely to report inadequate security arrangements in accessing the health facilities (p < .1); and three times more likely to agree that health workers were extremely thorough and careful in attending to them (p < .1). Conclusion: The interventions had positive effects on improving women’s satisfaction with care. The findings from this study have implications for the design and implementation of interventions that address women’s concerns relating to the provision of care and consequently improve service utilization

Clients' perspectives on the utilization of reproductive, maternal, neonatal, and child health services in primary health centers during COVID-19 pandemic in 10 States of Nigeria: A cross-sectional study.

BackgroundReports from various parts of the world suggest that the COVID-19 pandemic may have severe adverse effects on the delivery and uptake of reproductive health, maternal, neonatal, and child health (RMNCH) services. The objective of the study was to explore women's experiences with utilization of RMNCH services during the COVID-19 pandemic in Nigeria, and to elicit their perceptions on ways to sustain effective service delivery during the pandemic.MethodsA cross-sectional survey of 2930 women using primary health care facilities for antenatal, delivery, postnatal, and child care services before and after the onset of the pandemic in 10 States of Nigeria were interviewed with a semi-structured questionnaire. Data were collected on women's socio-demographic characteristics and pregnancy histories, the services they sought before and after the pandemic, the challenges they faced in accessing the services, their use of alternative sources of health care, and their recommendations on ways to sustain RMNCH service delivery during the pandemic. The data were analyzed with descriptive statistics, and multivariable logistic regression using SPSS 20.0. All the statistical analyses were two-tailed with a 95% confidence interval, and the p-value was set at 0.05.ResultsThe logistic regression results showed that women were at least 56% more likely to report that they used family planning, antenatal, and delivery services before the pandemic than after the pandemic started, but 38% less likely to report use of postnatal services. The experience of difficulty accessing RMNCH services was 23% more likely after the pandemic started than before the pandemic. Three categories of recommendations made by the respondents on measures to sustain RMNCH delivery during the pandemic included 1) facility improvement, and staff recruitment and re-training; 2) free and readily accessible PHC services, and 3) the provision of social safety nets including transportation and palliatives.ConclusionWe conclude that the COVID-19 pandemic limited women's access to antenatal, delivery, and childcare services offered in PHCs in Nigeria. Addressing the recommendations and the concerns raised by women will help to sustain the delivery of RMNCH services during the COVID-19 pandemic and future epidemics or health emergencies in Nigeria

Recommendations from respondents.

BackgroundReports from various parts of the world suggest that the COVID-19 pandemic may have severe adverse effects on the delivery and uptake of reproductive health, maternal, neonatal, and child health (RMNCH) services. The objective of the study was to explore women’s experiences with utilization of RMNCH services during the COVID-19 pandemic in Nigeria, and to elicit their perceptions on ways to sustain effective service delivery during the pandemic.MethodsA cross-sectional survey of 2930 women using primary health care facilities for antenatal, delivery, postnatal, and child care services before and after the onset of the pandemic in 10 States of Nigeria were interviewed with a semi-structured questionnaire. Data were collected on women’s socio-demographic characteristics and pregnancy histories, the services they sought before and after the pandemic, the challenges they faced in accessing the services, their use of alternative sources of health care, and their recommendations on ways to sustain RMNCH service delivery during the pandemic. The data were analyzed with descriptive statistics, and multivariable logistic regression using SPSS 20.0. All the statistical analyses were two-tailed with a 95% confidence interval, and the p-value was set at 0.05.ResultsThe logistic regression results showed that women were at least 56% more likely to report that they used family planning, antenatal, and delivery services before the pandemic than after the pandemic started, but 38% less likely to report use of postnatal services. The experience of difficulty accessing RMNCH services was 23% more likely after the pandemic started than before the pandemic. Three categories of recommendations made by the respondents on measures to sustain RMNCH delivery during the pandemic included 1) facility improvement, and staff recruitment and re-training; 2) free and readily accessible PHC services, and 3) the provision of social safety nets including transportation and palliatives.ConclusionWe conclude that the COVID-19 pandemic limited women’s access to antenatal, delivery, and childcare services offered in PHCs in Nigeria. Addressing the recommendations and the concerns raised by women will help to sustain the delivery of RMNCH services during the COVID-19 pandemic and future epidemics or health emergencies in Nigeria.</div

Distribution of experience of difficulties by the respondents’ characteristics and State.

Distribution of experience of difficulties by the respondents’ characteristics and State.</p

The odds of utilizing RMNCH services before the pandemic versus after the pandemic started.

The odds of utilizing RMNCH services before the pandemic versus after the pandemic started.</p