Police violence targeting LGBTIQ+ people in Nigeria: Advancing solutions for a 21st century challenge

The Government of Nigeria passed the Same-Sex Marriage Prohibition Act (SSMPA) in 2014, emboldening the human rights violations of LGBT Nigerians by state and nonstate actors. Nigerian police enforce morality laws that criminalize same-sex relations, but their role as perpetrators of violence has not been well studied. Using six-year (2014 to 2019) administrative data, this article investigates the severity, prevalence, and typology of police violence and abuse of LGBT Nigerians. Since SSMPA, violence against LGBT Nigerians has risen by 214 percent. Survivors frequently report arbitrary arrest and unlawful detention, invasion of privacy, physical assault and battery, and blackmail/extortion. This study is the first to present serial, cross-sectional findings of LGBT Nigerians’ experience with the police. Available administrative reports and data were synthesized to produce a general picture of the situation on the ground. Findings point to actionable social and policy recommendations that can be taken to promote police accountability and improve police-LGBT community relations

Prevalence of surgically correctable conditions among children in a mixed urban-rural community in Nigeria using the SOSAS survey tool:Implications for paediatric surgical capacity-building

BackgroundIn many low- and middle-income countries, data on the prevalence of surgical diseases have been derived primarily from hospital-based studies, which may lead to an underestimation of disease burden within the community. Community-based prevalence studies may provide better estimates of surgical need to enable proper resource allocation and prioritization of needs. This study aims to assess the prevalence of common surgical conditions among children in a diverse rural and urban population in Nigeria.MethodsDescriptive cross-sectional, community-based study to determine the prevalence of congenital and acquired surgical conditions among children in a diverse rural-urban area of Nigeria was conducted. Households, defined as one or more persons 'who eat from the same pot' or slept under the same roof the night before the interview, were randomized for inclusion in the study. Data was collected using an adapted and modified version of the interviewer-administered questionnaire-Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey tool and analysed using the REDCap web-based analytic application.Main resultsEight-hundred-and-fifty-six households were surveyed, comprising 1,883 children. Eighty-one conditions were identified, the most common being umbilical hernias (20), inguinal hernias (13), and wound injuries to the extremities (9). The prevalence per 10,000 children was 85 for umbilical hernias (95% CI: 47, 123), and 61 for inguinal hernias (95% CI: 34, 88). The prevalence of hydroceles and undescended testes was comparable at 22 and 26 per 10,000 children, respectively. Children with surgical conditions had similar sociodemographic characteristics to healthy children in the study population.ConclusionThe most common congenital surgical conditions in our setting were umbilical hernias, while injuries were the most common acquired conditions. From our study, it is estimated that there will be about 2.9 million children with surgically correctable conditions in the nation. This suggests an acute need for training more paediatric surgeons

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

On being gay in Nigeria: discrimination, mental health distress, and coping

Higher rates of mental health problems are reported among men who have sex with men (MSM) compared to heterosexual men, and this has been partly attributed to the discriminatory experiences they face. This study aimed to explore factors associated with poor mental health in MSM resident in Nigeria. Twenty MSM were recruited through a non-governmental organization working with the MSM community in Nigeria. In-depth interviews were conducted using a guide developed for the study. Interviews were recorded, transcribed, and analyzed using grounded theory. Sources of stress for Nigerian MSM include concerns about security and discrimination, needing to conceal their sexual orientation, and homophobia among health care providers. MSM in Nigeria face stress that has implications for their mental health. There is a need to provide mental health care accessible by community members, and to mitigate factors that also cause stress for MSM in Nigeria. Recommended interventions include educating health care providers about the harmful effects of homophobia and training peer counsellors to provide basic psychological support

Community Members' Concern about Research Ethics

HIV prevention is a critical health issue in Nigeria; a country that has one of the worst HIV epidemic profiles in the world. With 270,000 new infections in 2012, Nigeria is a prime site for HIV prevention research. One effect of the HIV epidemic has been to revolutionalise ethical norms for the conduct of research: it is now considered unethical to design and implement HIV related studies without community engagement. Unfortunately, there is very little commensurate effort in building the capacity of local persons to engage actively with researchers, and there is no existing platform to facilitate dialogue between researchers and communities engaged in research in Nigeria. In an effort to address this gap, we undertook a series of three community dialogues (Phase One) and two community-researcher interface meetings (Phase Two) in Nigeria. This paper aims to give an empirical account of the dialogue from these community engagement processes and provide a resulting critique of the implementation of research ethics practices in Nigeria. It is anticipated that the outputs will: (i) support researchers in designing community-based research protocols; (ii) inform ethics committees of key considerations during research protocol reviews from a community perspective; and (iii) inform policy makers and research sponsors about issues of primary concern to communities with respect to HIV research

Determining the Impact of the COVID-19 Pandemic on Availability, Use, and Readiness of Family Planning and Contraceptive Services at Selected Primary Health Care Facilities in Africa and Asia: Protocol for a Mixed Methods Study

BackgroundThe COVID-19 pandemic and the associated social restrictions may have disrupted the provision of essential services, including family planning (FP) and contraceptive services. This protocol is adapted from a generic study protocol titled “Health systems analysis and evaluations of the barriers to availability and readiness of sexual and reproductive health services in COVID-19 affected areas,” conducted by the World Health Organization (WHO) Department of Reproductive Health and Research. ObjectiveThis study aims to assess the availability and use of FP and contraceptive services in primary health facilities during and after the COVID-19 pandemic; assess the risk perceptions of COVID-19 stigma, barriers to access, and quality of services from clients’ and providers’ perspectives in the COVID-19–affected areas; and assess the postpandemic recovery of the facilities in the provision of FP and contraceptive services. MethodsIn-depth interviews will be conducted with clients—women in the reproductive age group and their male partners who visit the selected health facilities for FP and contraceptive services—and health providers (the most knowledgeable person on FP and contraceptive service provision) at the selected health facilities. Focus group discussions will be conducted with clients at the selected health facilities and in the community. The in-depth interviews and focus group discussions will help to understand clients’ and health service providers’ perspectives of FP and contraceptive service availability and readiness in COVID-19–affected areas. A cross-sectional health facility assessment will be conducted in all the selected health facilities to determine the health facility infrastructure’s ability and readiness to provide FP and contraceptive services and to capture the trends in FP and contraceptive services available during the COVID-19 pandemic. Scientific approval for this study is obtained from the WHO Research Project Review Panel, and the WHO Ethics Review Committee has given ethical approval in the 3 countries. ResultsUsing a standardized research protocol will ensure that the results from this study can be compared across regions and countries. The study was funded in March 2021. It received ethics approval from the WHO Ethics Review Committee in February 2022. We completed data collection in September 2022. We plan to complete the data analysis by March 2023. We plan to publish the study results by Summer 2023. ConclusionsThe findings from this study will provide a better understanding of the impact of the COVID-19 pandemic on FP and contraceptive services at the facility level, which will help policy makers and health managers develop and strengthen FP policies and services in health facilities to be more responsive to community needs. International Registered Report Identifier (IRRID)DERR1-10.2196/4332

Time to change the paradigm: Limited condom and lubricant use among Nigerian men who have sex with men and transgender women despite availability and counseling

Purpose: This study characterized availability and uptake of condoms and condom-compatible lubricants (CCLs) at community-engaged condom education and distribution programs serving cisgender men who have sex with men (MSM) and transgender women (TGW) in Abuja and Lagos, Nigeria. Methods: Condoms and water-based CCLs were freely available to participants in the TRUST/RV368 cohort. Factors associated with their consistent use were assessed using Poisson regression with robust error variance to estimate relative risks (RRs) and 95% confidence intervals (CIs). Results: From March 2013-November 2017, 2090 MSM and TGW enrolled with HIV prevalence 40.4% and incidence 12.8 cases per 100 person-years. Fifteen months after enrollment, the proportion who reported consistent condom and CCL use increased during receptive anal sex (21.7% to 67.1%, p \u3c 0.001) and insertive anal sex (25.4% to 67.8%, p \u3c 0.001). Multivariable analyses demonstrated independent impact of 15 months in care on uptake during both receptive (RR 2.62 [95% CI 2.29-3.00]) and insertive (RR 2.27 [95% CI 2.01-2.57]) sex. Conclusions: Engagement in care improved condom and CCL uptake over time, but inconsistent use remained common. Novel approaches to further increase uptake must be pursued alongside complementary strategies, such as sustained access to ART for those living with HIV and provision of pre- and post-exposure prophylaxis for those at risk

Adaptation of the Wound Healing Questionnaire universal-reporter outcome measure for use in global surgery trials (TALON-1 study): mixed-methods study and Rasch analysis

BackgroundThe Bluebelle Wound Healing Questionnaire (WHQ) is a universal-reporter outcome measure developed in the UK for remote detection of surgical-site infection after abdominal surgery. This study aimed to explore cross-cultural equivalence, acceptability, and content validity of the WHQ for use across low- and middle-income countries, and to make recommendations for its adaptation.MethodsThis was a mixed-methods study within a trial (SWAT) embedded in an international randomized trial, conducted according to best practice guidelines, and co-produced with community and patient partners (TALON-1). Structured interviews and focus groups were used to gather data regarding cross-cultural, cross-contextual equivalence of the individual items and scale, and conduct a translatability assessment. Translation was completed into five languages in accordance with Mapi recommendations. Next, data from a prospective cohort (SWAT) were interpreted using Rasch analysis to explore scaling and measurement properties of the WHQ. Finally, qualitative and quantitative data were triangulated using a modified, exploratory, instrumental design model.ResultsIn the qualitative phase, 10 structured interviews and six focus groups took place with a total of 47 investigators across six countries. Themes related to comprehension, response mapping, retrieval, and judgement were identified with rich cross-cultural insights. In the quantitative phase, an exploratory Rasch model was fitted to data from 537 patients (369 excluding extremes). Owing to the number of extreme (floor) values, the overall level of power was low. The single WHQ scale satisfied tests of unidimensionality, indicating validity of the ordinal total WHQ score. There was significant overall model misfit of five items (5, 9, 14, 15, 16) and local dependency in 11 item pairs. The person separation index was estimated as 0.48 suggesting weak discrimination between classes, whereas Cronbach's α was high at 0.86. Triangulation of qualitative data with the Rasch analysis supported recommendations for cross-cultural adaptation of the WHQ items 1 (redness), 3 (clear fluid), 7 (deep wound opening), 10 (pain), 11 (fever), 15 (antibiotics), 16 (debridement), 18 (drainage), and 19 (reoperation). Changes to three item response categories (1, not at all; 2, a little; 3, a lot) were adopted for symptom items 1 to 10, and two categories (0, no; 1, yes) for item 11 (fever).ConclusionThis study made recommendations for cross-cultural adaptation of the WHQ for use in global surgical research and practice, using co-produced mixed-methods data from three continents. Translations are now available for implementation into remote wound assessment pathways