A Rapid Assessment of the Availability and Use of Obstetric Care in Nigerian Healthcare Facilities

Background: As part of efforts to reduce maternal deaths in Nigeria, pregnant women are being encouraged to give birth in healthcare facilities. However, little is known about whether or not available healthcare facilities can cope with an increasing demand for obstetric care. We thus carried out this survey as a rapid and tactical assessment of facility quality. We visited 121 healthcare facilities, and used the opportunity to interview over 700 women seeking care at these facilities. Findings Most of the primary healthcare facilities we visited were unable to provide all basic Emergency Obstetric Care (bEmOC) services. In general, they lack clinical staff needed to dispense maternal and neonatal care services, ambulances and uninterrupted electricity supply whenever there were obstetric emergencies. Secondary healthcare facilities fared better, but, like their primary counterparts, lack neonatal care infrastructure. Among patients, most lived within 30 minutes of the visited facilities and still reported some difficulty getting there. Of those who had had two or more childbirths, the conditional probability of a delivery occurring in a healthcare facility was 0.91 if the previous delivery occurred in a healthcare facility, and 0.24 if it occurred at home. The crude risk of an adverse neonatal outcome did not significantly vary by delivery site or birth attendant, and the occurrence of such an outcome during an in-facility delivery may influence the mother to have her next delivery outside. Such an outcome during a home delivery may not prompt a subsequent in-facility delivery. Conclusions: In conclusion, reducing maternal deaths in Nigeria will require attention to both increasing the number of facilities with high-quality EmOC capability and also assuring Nigerian women have access to these facilities regardless of where they live

Changing housing policies and housing provision in Jos, Nigeria

Nigeria's housing problems have persisted regardless of changes in policy, strategies, actions and instruments. This study examines housing policy changes and factors that influence housing supply outcomes at the local level. The study reviews the state of housing provision in the national context. The focus is then turned to the city of Jos in north-central Nigeria, where institutional arrangements for the provision of housing are critically examined. Primary data was obtained through interviews with industry role players (government officers and house builders) and the views of people were sampled through a questionnaire survey. This data was then combined with secondary source material to examine financial mechanisms, subsidy provision and local-level organisational frameworks for partnership. The findings suggest that a shift from a state-led to an enabling approach for housing did stimulate the activities of private house-builders and primary mortgage institutions. However, their activities are not spread across the regions of Nigeria. The issue of equitable allocation of public housing across the regions of Nigeria by the federal agencies has not been addressed by the enabling policy framework. Further, the idea of decentralisation of housing provision was introduced but did not result in the formulation of strategies by the local authorities in Jos. The national housing policy itself appears to be ambiguous and difficult to implement by the authorities in Jos. The ambiguities arose because there is a lack of policy enforcement mechanism, political commitment, and a poor local organisation and coordination framework. These failures create uncertainties and risks for private house builders that partnered the government to access finance and subsidies for the provision of low-income housing in Jos. Also, there is limited participation of households due to lack of awareness on public policies. On the basis of the study's findings, some policy recommendations are made

National food consumption and micronutrient survey 2021: preliminary report

The last National Food Consumption and Micronutrient Survey (NFCMS) was undertaken about 20 years ago in 2001 (Maziya-Dixon, et al., 2004; Nigeria Food Consumption and Nutrition Survey 2001-2003, IITA, https://hdl.handle.net/10568/100010). The findings of that study likely no longer represent the current micronutrient status or dietary consumption patterns of the Nigerian population. This lack of recent and reliable information presents several challenges, both in terms of reviewing ongoing programmes and in informing the development of new guidance and policies. Updated information on the population’s micronutrient status and dietary intakes is required for informed, evidenced-based decisions about current and future food, nutrition, and agriculture programming and policy making in Nigeria. During a high-level national nutrition data stakeholder workshop in Abuja in July 2017, stakeholders agreed that a national survey to collect information on dietary intake and micronutrient status was needed. Subsequently, in January 2018, a NFCMS methodology workshop was held in Abuja, during which agreements were reached on the scope and level of representativeness for the survey, and key decisions pertaining to the survey governance structure. In this light, UNICEF was nominated as the fund management agency for the survey, and lITA as the lead implementing agency

A dataset for the flood vulnerability assessment of the upper Cross River basin using morphometric analysis

The on-site collection of data is not only time consuming, but expensive and perhaps near impossible in restive communities within the upper Cross River basin (UCRB). Therefore, the importance of this data cannot be overemphasized. This article presents a Digital Elevation Model (DEM), land use and land cover (LULC) map, soil map, geology map and climatic datasets which enhance the understanding of the physical characteristics of the upper Cross River basin using morphometric analysis. The use of the LULC map, soil map and the DEM in conjunction with the climatic data enhance the creation of the Hydrologic Response Units (HRUs) and the water balance modelling. The simulation of the water balance at the HRU level enables the routing of the runoff to the reaches of the sub-basins and then to the channels. The geology map provides confirmatory information to the morphometric analysis. The compound factor computed from all the derived morphometric parameters enhance the determination of the overall flood potential of the congruent sub-basins

Cost-effectiveness analysis of rapid diagnostic test, microscopy and syndromic approach in the diagnosis of malaria in Nigeria: implications for scaling-up deployment of ACT

BACKGROUND: The diagnosis and treatment of malaria is often based on syndromic presentation (presumptive treatment) and microscopic examination of blood films. Treatment based on syndromic approach has been found to be costly, and contributes to the development of drug resistance, while microscopic diagnosis of malaria is time-consuming and labour-intensive. Also, there is lack of trained microscopists and reliable equipment especially in rural areas of Nigeria. However, although rapid diagnostic tests (RDTs) have improved the ease of appropriate diagnosis of malaria diagnosis, the cost-effectiveness of RDTs in case management of malaria has not been evaluated in Nigeria. The study hence compares the cost-effectiveness of RDT versus syndromic diagnosis and microscopy. METHODS: A total of 638 patients with fever, clinically diagnosed as malaria (presumptive malaria) by health workers, were selected for examination with both RDT and microscopy. Patients positive on RDT received artemisinin-based combination therapy (ACT) and febrile patients negative on RDT received an antibiotic treatment. Using a decision tree model for a hypothetical cohort of 100,000 patients, the diagnostic alternatives considered were presumptive treatment (base strategy), RDT and microscopy. Costs were based on a consumer and provider perspective while the outcome measure was deaths averted. Information on costs and malaria epidemiology were locally generated, and along with available data on effectiveness of diagnostic tests, adherence level to drugs for treatment, and drug efficacy levels, cost-effectiveness estimates were computed using TreeAge programme. Results were reported based on costs and effects per strategy, and incremental cost-effectiveness ratios. RESULTS: The cost-effectiveness analysis at 43.1% prevalence level showed an incremental cost effectiveness ratio (ICER) of 221 per deaths averted between RDT and presumptive treatment, while microscopy is dominated at that level. There was also a lesser cost of RDT ($0.34 million) compared to presumptive treatment ($0.37 million) and microscopy ($0.39 million), with effectiveness values of 99,862, 99,735 and 99,851 for RDT, presumptive treatment and microscopy, respectively. Cost-effectiveness was affected by malaria prevalence level, ACT adherence level, cost of ACT, proportion of non-malaria febrile illness cases that were bacterial, and microscopy and RDT sensitivity. CONCLUSION: RDT is cost-effective when compared to other diagnostic strategies for malaria treatment at malaria prevalence of 43.1% and, therefore, a very good strategy for diagnosis of malaria in Nigeria. There is opportunity for cost savings if rapid diagnostic tests are introduced in health facilities in Nigeria for case management of malaria

A media framing analysis of urban flooding in Nigeria: current narratives and implications for policy

© 2017, The Author(s). A critical element of current flood management is the importance of engaging key policy actors when policy decisions are to be made. However, there is still only limited understanding of how narratives of flood management actors may influence flood management policies, even though there is a suggestion that actors can strategically use their narratives to influence policy directions. In a developing country like Nigeria, there are still questions around lessons that can be learnt from understanding the narratives of policy actors, to unravel the complex nature of strategies and policy directions in managing urban floods. To help fill these gaps, this paper uses quantitative content analysis to explore the frame of five policy actor groups (government, local communities, business, multilateral organisations and non-governmental organisations (NGOs)) as expressed in local and national newspapers between 2012 and 2016 to understand their narratives of causes and strategies to solve the problem of urban flooding in Nigeria. The narratives of government, local communities and businesses align with the premise that flooding can and should be prevented whilst that of multilateral and business actors champion adaptation strategies on the basis that flooding is inevitable and hence more energy should be directed at ‘living with water’—emergency response, damage reduction and the aftermath. The study also identified areas of potential consensus and conflict between direct actors such as government and local communities on the one hand and funders on the other. Better discussion among actors aiding understanding of contemporary thinking and local realities will aid policy-making and policy implementation in the Nigerian context. An important step will be in the collaborative design of an urgently needed ‘Nigerian policy on flooding’ which currently does not exist

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic