Individual and Socioeconomic Factors Associated With Childhood Immunization Coverage in Nigeria

Immunization remains one of the most successful and cost-effective public health interventions worldwide. The purpose of this study was to examine the individual and socioeconomic factors that influence childhood immunization coverage in Nigeria. The health belief model and the social ecological model were used as the theoretical framework for the study, which examined the effects of individual, parental, and socioeconomic factors on complete immunization among Nigerian children. Univariate, bivariate, and multivariate tests were conducted within a secondary analysis of 2013 Nigerian National Demographic and Health Survey was done. Of 27,571 children aged 0 to 59 months, 22.1% had full vaccination and 29% never received any vaccination. Immunization coverage was significantly related to the socioeconomic status of the child\u27s parents, region, and marital status (p \u3c 0.00). Similarly, child birth order, delivery place, child number, and presence or absence of child health card in the family were significantly related to the level of immunization (p \u3c 0.00). Maternal age, geographical location, education, religion, literacy, wealth index, marital status, and occupation were significantly associated with immunization coverage. Respondent\u27s age, educational attainment, and wealth index remained significantly related to immunization coverage at 95% confidence interval in multivariate analysis. Implications for positive social change include evidence on hindrances to successful immunization programs and relevant information for a more effective, efficient, sustainable and acceptable immunization program for the stakeholders in Nigeria

Sustainable Health Development Goals (SHDG): breaking down the walls

The world's governments failed to achieve the Health for All 2000 goals from the Alma Ata Declaration of 1978. Although a lot of milestones have been covered since 2000, the world's governing authorities are unlikely to achieve the current Millennium Development Goals (MDGs) which expire by the end of this year. The inability to achieve these goals may be linked to the multiplicity of health-related directives and fragmentation of health systems in many countries. However, with the proposed 17 sustainability development goals, health has only one universal aim: to ensure healthy lives and promote wellbeing for all at all ages. Accomplishing this will require a focus on health systems (system-thinking), commonization of services and full integration of services with total dismantling of vertical programs across the world.Pan African Medical Journal 2015; 2

Premarital sex and condom use among trainee healthcare workers: an exploratory study of selected healthcare training institutions in Enugu State, Nigeria

Introduction: to assess the prevalence and causes of premarital sex and condom use among trainee healthcare workers in selected healthcare institutions in Enugu State, Nigeria; and to proffer solution to challenges identified. Methods: we used a mixed study approach with qualitative and quantitative components. Informed consent was obtained from participants and data collected using self-administered structured questionnaires. Epi info® was used for data analysis. Results: a total of 362 respondents (309 unmarried) from four healthcare training institutions participated in the study. Among unmarried respondents, 141(45.8%) were sexually active. Premarital sex was more common among Pentecostals and sexual activity increased with age (r=0.78; p <0.05). Premarital sexual activity was more common among males and trainee nurses (p <0.005). Although knowledge of condom use was high, actual use was poor (20.1%), with lowest rates among females, Catholics and age-group 30-35 years. Breakages, high failure rates and reduced sexual satisfaction were cited as major factors responsible for poor use. Use of non-specific terms such as "casual sex" and "casual or regular sex partners" hindered consistent, correct condom use. Conclusion: there is a significant gap between knowledge of and actual use of condoms, despite high premarital sexual activity amongst healthcare workers. Furthermore, non-specific terminologies hinders appropriate condom usage. We propose the term: Committed Spousal Partner (CSP) defined as "a sexual partner who commits to fidelity (one sexual partner per time) and whose current HIV status is known through medical testing and is properly documented" in place of all non-specific terminology

Commonization of HIV/AIDS services in Nigeria: the need, the processes and the prospects

Introduction: with the first case of Human Immunodeficiency Virus infection/Acquired Immunodeficiency Syndrome (HIV/AIDS) identified in 1986, the management of HIV/AIDS in Nigeria has evolved through the years. The emergency phase of the HIV/AIDS program, aimed at containing the HIV/AIDS epidemic within a short time frame, was carried out by international agencies that built structures separate from hospitals’ programs. It is imperative that Nigeria shifts from the previous paradigm to the concept of Commonization of HIV to achieve sustainability. Commonization ensures that HIV/AIDS is seen as a health condition like others. It involves making HIV services available at all levels of healthcare. Methods: Excellence & Friends Management Consult (EFMC) undertook this process by conducting HIV tests in people’s homes and work places, referring infected persons for treatment and follow up, establishing multiple HIV testing points and HIV services in private and public primary healthcare facilities. EFMC integrated HIV services within existing hospital care structures and trained all healthcare workers at all supported sites on HIV/AIDS prevention, care and treatment modalities. Results: commonization has improved the uptake of HIV testing and counseling and enrolment into HIV care as more people are aware that HIV services are available. It has integrated HIV services into general hospital services and minimized the cost of HIV programming as the existing structures and personnel in healthcare facilities are utilized for HIV services. Conclusion: commonization of HIV services i.e. integrating HIV care into the existing fabric of the healthcare system, is highly recommended for a sustainable and efficient healthcare system as it makes HIV services acceptable by all

Perceptions and opinions of Nigerians to the management and response to COVID-19 in Nigeria

Introduction: we present a qualitative analysis of opinions of the Nigerian public as to how successful healthcare strategies have been, in containing the COVID-19 outbreak. Methods: an online qualitative survey was conducted, consisting of 30 semi-structured questions. Results: four hundred and ninety-five (495) respondents participated, ranging in age from 18 to 59 years. Over 40% of all respondents were critical of public health information. Participants saw provision of social support measures (n = 83), lack of economic, financial and social support (n = 65), enforcement of restrictions on movement outside the home, availability of face-masks and social distancing (n = 53) and provision of COVID-19 testing (n = 48) as the major things that were handled poorly by the government and health authorities. Conclusion: we advocate coordinated forward planning for public safety until vaccines are widely available; while social distancing should continue. Policymakers need to be adaptable to changing conditions, given fluctuating case numbers and fatality rates

Evaluation of quality of TB control services by private health care providers in Plateau state, Nigeria; 2012

Introduction: Tuberculosis (TB) is public health concern in Nigeria. The country uses the Directly  Observed Treatment Short course (DOTS) strategy for its control. Plateau state started using the DOTS strategy in 2001 and had the Private health facilities (PHF) as an important stakeholder. We evaluated their contributions to case finding and quality of the services to identify gaps in monitoring and evaluation in the TB control services within the PHF to plan for intervention so as to meet the set target for TB control in the state. Methods: We used the logical framework approach to identify and analyze the  problem. We drew up an objective tree and from the objective tree developed a logical framework matrix including evaluation plan. We also conducted desk review to extract data on case findings, case  management and outcomes of the treatment. We interviewed TB focal persons and laboratory personnel using structured questionnaire. The data was analyzed using excel spread sheet. Results: Of the 127 health facilities with TB patients on treatment 27 (21.3%) were PHF. The PHF reported 54.6% (1494) of TB cases in 2011. The sputum conversion rates, cured rate, treatment success rate, and default rates were 85%, 73%, 81.4% and 6.6% respectively. The discordant rates were 3.1% and 1.2% for the state and private health facilities respectively. Conclusion: Log frame approach is a useful tool for evaluation of TB control services and helps provide evidence for decision making to improve quality of the TB services in the public and private health facilities in the state.Key words: Private facilities, Tuberculosis, monitoring and evaluation, Logframe approac

Public private partnership in in-service training of physicians: the millennium development goal 6-partnership for African clinical training (M-PACT) approach

Introduction: in-service training of healthcare workers is essential for improving healthcare services and outcome. Methods: The Millennium Development Goal (MDG) 6 Partnership for African Clinical Training (M-PACT) program was an innovative in-service training approach designed and implemented by the Royal College of Physicians (RCP) and West African College of Physicians (WACP) with funding from Eco Bank Foundation. The goal was to develop sustainable capacity to tackle MDG 6 targets in West Africa through better postgraduate medical education. Five training centres were establised: Nigeria (Abuja, Ibadan), Ghana (Accra), Senegal (Dakar) and Sierra Leone (Freetown) for training 681 physicians from across West Africa. A curriculum jointly designed by the RCP-WACP team was used to deliver biannual 5-day training courses over a 3-year period. Results: Of 602 trained in clinical medicine, 358 (59.5%) were males and 535 (88.9%) were from hosting countries. 472 (78.4%) of participants received travel bursaries to participate, while 318 (52.8%) were residents in Internal Medicine in the respective institutions. Accra had the highest number of participants (29.7%) followed by Ibadan, (28.7%), Dakar, (24.9%), Abuja, (11.0%) and Freetown, (5.6%). Pre-course clinical knowledge scores ranged from 35.1% in the Freetown Course to 63.8% in Accra Course 1; whereas post-course scores ranged from 50.5% in the Freetown course to 73.8% in Accra course 1. Conclusion: M-PACT made a positive impact to quality and outcome of healthcare services in the region and is a model for continued improvement for healthcare outcomes, e.g malaria, HIV and TB incidence and mortality in West Afric

Gaps and strategies in developing health research capacity: experience from the Nigeria Implementation Science Alliance

Abstract Background Despite being disproportionately burdened by preventable diseases than more advanced countries, low- and middle-income countries (LMICs) continue to trail behind other parts of the world in the number, quality and impact of scholarly activities by their health researchers. Our strategy at the Nigerian Implementation Science Alliance (NISA) is to utilise innovative platforms that catalyse collaboration, enhance communication between different stakeholders, and promote the uptake of evidence-based interventions in improving healthcare delivery. This article reports on findings from a structured group exercise conducted at the 2016 NISA Conference to identify (1) gaps in developing research capacity and (2) potential strategies to address these gaps. Methods A 1-hour structured group exercise was conducted with 15 groups of 2–9 individuals (n = 94) to brainstorm gaps for implementation, strategies to address gaps and to rank their top 3 in each category. Qualitative thematic analysis was used. First, duplicate responses were merged and analyses identified emerging themes. Each of the gaps and strategies identified were categorised as falling into the purview of policy-makers, researchers, implementing partners or multiple groups. Results Participating stakeholders identified 98 gaps and 91 strategies related to increasing research capacity in Nigeria. A total of 45 gaps and an equal number of strategies were ranked; 39 gaps and 43 strategies were then analysed, from which 8 recurring themes emerged for gaps (lack of sufficient funding, poor research focus in education, inadequate mentorship and training, inadequate research infrastructure, lack of collaboration between researchers, research-policy dissonance, lack of motivation for research, lack of leadership buy-in for research) and 7 themes emerged for strategies (increased funding for research, improved research education, improved mentorship and training, improved infrastructure for research, increased collaboration between academic/research institutions, greater engagement between researchers and policy-makers, greater leadership buy-in for research). Conclusions The gaps and strategies identified in this study represent pathways judged to be important in increasing research and implementation science capacity in Nigeria. The inclusion of perspectives and involvement of stakeholders who play different roles in policy, research and implementation activities makes these findings comprehensive, relevant and actionable, not only in Nigeria but in other similar LMICs