Skilled Birth Attendance in Nigeria: A Function of Frequency and Content of Antenatal Care

The utilization rate of maternal services remains low in sub-Saharan Africa and may be contributing to the region’s high maternal mortality rate. This study examines the influence of antenatal care (ANC) on skilled birth attendance (SBA) in Nigeria. The data used were collected from a nationally representative sample of women (aged 15-49) in 2011. The sample is restricted to women who were within two years postpartum (weighted n=9879). Multivariate logistic regression was used to assess the association between ANC (number of visits attended and services received during last pregnancy) and SBA. Despite 70% of the women receiving any ANC, only 49% had SBA during their last childbirth. The number of ANC services received, rather than the number of ANC visits attended, was positively associated with having SBA during last childbirth after controlling for relevant covariates (p<0.05). The focus, therefore, should be on increasing the number of services received during ANC. Keywords: Antenatal care, skilled birth attendance, pregnancy, Nigeri

Risk Factors for Transactional Sex among Young Females in Post-Conflict Liberia

This study aimed to examine the risk factors for engaging in transactional sex among young females in Montserrado County, Liberia. Data from an HIV behavioral survey conducted among young people aged 14 – 25 years were used. The analytical sample included 493 sexually-experienced females. Bivariate and multivariate analyses were conducted. We found that 72% of our sample had ever engaged in transactional sex. Engagement in transactional sex was associated with education (OR: 0.5); reporting no earned income (OR: 1.9); longer duration of sexual activity (OR: 3.5); early sexual debut (OR: 2.5); history of sexual violence (OR: 2.1) and multiple sexual partnerships (OR: 4.0). Respondents' age, residence, and drug/alcohol use were not associated with engagement in transactional sex. HIV interventions should incorporate educational strategies to reduce the prevalence of transactional sex among young people. These strategies should include economic opportunities to offset financial need as well as efforts to eradicate sexual violence. (Afr J Reprod Health 2014; 18[3]: 133-141)Keywords: Transactional sex, Young women, HIV risk behaviors, Post-conflict, Liberia

Factors Associated with Unmet Need for Modern Contraception in Post-Conflict Liberia

We examined the association between intimate partner violence and  unmet need for modern contraception in post-conflict Liberia. This is a secondary analysis of data collected using the Priorities for Local AIDS Control Efforts (PLACE) method. Data from 499 sexually experienced young women (aged 14-25) in Montserrado County, Liberia were examined.  Intimate partner violence (55.7%), unintended pregnancy (83.2%), and abortion (45.3%) were pervasive in the study population. An estimated 35.9% of respondents had an unmet need for modern contraception.  However, multivariate logistic regression results did not reveal an  association between intimate partner violence and unmet need (OR 1.11; 95% CI 0.70-1.75). Among covariates examined, only contraceptive use at sexual debut (26.1%) was significantly associated with unmet need (OR 0.27; 95% CI 0.14-0.52). Liberian youth need information about and access to modern contraceptive methods besides condoms. Interventions to identify and treat victims of violence are also needed. Afr J Reprod Health 2014; 18[2]: 58-67).Key words: Intimate partner violence, unintended pregnancy, abortion, unmet need for contraception, adolescents, Liberi

Biopsychosocial risk factors and knowledge of cervical cancer among young women: A case study from Kenya to inform HPV prevention in Sub-Saharan Africa

Background: Cervical cancer is the second most common female reproductive cancer after breast cancer with 84% of the cases in developing countries. A high uptake of human papilloma virus (HPV) vaccination and screening, and early diagnosis leads to a reduction of incidence and mortality rates. Yet uptake of screening is low in Sub-Saharan Africa and there is an increasing number of women presenting for treatment with advanced disease. Nine women in their twenties die from cervical cancer in Kenya every day. This paper presents the biopsychosocial risk factors that impact on cervical cancer knowledge among Kenyan women aged 15 to 24 years. The findings will highlight opportunities for early interventions to prevent the worrying prediction of an exponential increase by 50% of cervical cancer incidences in the younger age group by 2034. Methods: Data from the 2014 Kenya Demographic and Health Survey (KDHS) was analysed using complex sample logistic regression to assess biopsychosocial risk factors of knowledge of cervical cancer among young women aged 15 to 24 years (n = 5398). Findings: Close to one third of the participants were unaware of cervical cancer with no difference between participants aged 15–19 years (n = 2716) and those aged 20–24 years (n = 2691) (OR = 1; CI = 0.69–1.45). Social predisposing factors, such as lack of education; poverty; living further from a health facility; or never having taken a human immunodeficiency virus (HIV) test, were significantly associated with lack of awareness of cervical cancer (p<0.001). Young women who did not know where to obtain condoms had an OR of 2.12 (CI 1.72–2.61) for being unaware of cervical cancer. Psychological risk factors, such as low self-efficacy about seeking medical help, and an inability to refuse unsafe sex with husband or partner, perpetuated the low level of awareness about cervical cancer (p<0.001). Conclusions: A considerable proportion of young women in Kenya are unaware of cervical cancer which is associated with a variety of social and psychological factors. We argue that the high prevalence of cervical cancer and poor screening rates will continue to prevail among older women if issues that affect young women’s awareness of cervical cancer are not addressed. Given that the Kenyan youth are exposed to HPV due to early sexual encounters and a high prevalence of HIV, targeted interventions are urgently needed to increase the uptake of HPV vaccination and screening

Unmet Need for Contraception among Clients of FP/HIV Integrated Services in Nigeria: The Role of Partner Opposition

While women are aware of family planning (FP) methods in Nigeria, the unmet need for modern contraception remains high. We assessed the association between male partner opposition to FP and unmet need for modern contraception among women seeking anti-retroviral therapy (ART), HIV counseling and testing (HCT) and prevention-of-mother-to-child-transmission of HIV (PMTCT) services in Cross-River State, Nigeria. This secondary analysis used data from a facility-based FP/HIV integration study. Logistic regression was used to model the association of interest. Unmet need for modern contraception was high among all clients . ART (49%), HCT (75%), and PMTCT (32%). Perceived partner opposition to FP was widespread (.70%); however, multivariate analysis showed no significant association with unmet need for modern contraception. Significant covariates were womanfs age, marital status, parity, and previous use of modern contraception. Efforts to improve modern contraceptive use among women at risk of HIV infection in Nigeria should contemplate involving their male partners. Afr J Reprod Health 2014; 18[2]: 134-143).Keywords: Partner opposition, contraceptive use, HIV/FP service integration, NigeriaMalgre la bonne connaissance des methodes de la planification familiale (PF) au Nigeria, le besoin non satisfait de la contraception moderne reste eleve. Nous avons evalue l'association entre lfopposition du partenaire masculin a la PF et le besoin non satisfait de la contraception moderne chez les femmes qui recherchent un traitement anti- retroviral ( TAR), le conseil et le depistage du VIH CDV) et des services de la prevention de la transmission du VIH de la mere a lfenfant (PTME) dans lfetat de Cross River, Nigeria. Cette analyse secondaire a utilise des donnees provenant d'une etude d'integration PF / VIH basee sur un etablissement. La regression logistique a ete utilisee pour modeliser l'association d'interet. Le besoin non satisfait de la contraception moderne etait eleve parmi tous les clients - TAR (49 %), CDV (75 %) et la PTME (32 %). La perception de l'opposition du partenaire a la PF etait generalisee (. 70 %) ; cependant, l'analyse multivariee nfa montre aucune association significative avec le besoin non satisfait de la contraception moderne. Les covariables significatives etaient l'age de la femme, l'etat civil, la parite et l'utilisation anterieure de la contraception moderne. Les initiatives destinees a ameliorer l'utilisation de la contraception moderne chez les femmes a risque d'infection du VIH au Nigeria devraient envisager a mobiliser leurs partenaires masculins. Afr J Reprod Health 2014; 18[2]: 134-143).Mots-cles: Lfopposition de la part du partenaire, utilisation des  contraceptifs, integration des services du VIH / FP, Nigeria