48 research outputs found
Accelerating and improving survey implementation with mobile technology: Lessons from PMA2020 implementation in Lagos, Nigeria
Large-scale nationally representative surveys have traditionally been implemented using paper surveys, necessitating secondary steps of data entry and management after data collection. Errors occurring during data collection or entry may not be rapidly identified. The Performance Monitoring and Accountability (PMA2020) project implementation in Lagos, Nigeria demonstrates four advantages to integrating mobile technology into survey implementation. First is the rapidity of data collection; data collection lasted six weeks from mapping/listing to final collection – and, since completed surveys are uploaded to a cloud-based server, identification of errors can occur in near real-time. Second, time-stamping and GPS marking allow for improved quality assurance. Third, the inclusion of GPS coordinates creates new opportunities to analyze relationships of distance with use of health services. Fourth, PMA2014/Lagos utilized a 10% resample of households to validate data collection allowing for rapid identification of questionable data and quality control
Determinants of women’s preferred and actual abortion provision locations in Nigeri
Background: Unsafe abortion remains a leading cause of maternal mortality globally. Many factors can infuence
women’s decisions around where to seek abortion care; however, little research has been done on abortion care decisions at a population-level in low-resource settings, particularly where abortion is legally restricted.
Methods: This analysis uses data from a 2019–2020 follow-up survey of 1144 women in six Nigerian states who
reported an abortion experience in a 2018 cross-sectional survey. We describe women’s preferred and actual primary abortion care provider/location by distinguishing clinical, pharmacy/chemist, or other non-clinical providers or
locations. We also examine factors that infuence women’s decisions about where to terminate their pregnancy and
identify factors hindering women’s ability to operationalize their preferences. We then examine the characteristics of
women who were not able to use their preferred provider/location.
Results: Non-clinical providers (55.0%) were more often used than clinical providers (45.0%); however, clinical providers were preferred by most women (55.6%). The largest discrepancies in actual versus preferred abortion provider/
location were private hospitals (7.6% actual versus 37.2% preferred), government hospitals (4.3% versus 22.6%),
chemists (26.5% versus 5.9%) and pharmacies (14.9% versus 6.6%). “Privacy/confdentiality” was the most common
main reason driving women’s abortion provider/location choice (20.7%), followed by “convenience” (16.9%) and
“recommended” by someone (12.3%), most often a friend (60.8%), although top reasons difered by type of provider/
location. Cost and distance were the two most common reasons that women did not use their preferred provider/
location (46.1% and 21.9%, respectively). There were no statistically signifcant diferences in the sociodemographic
characteristics between women who were able to use their preferred provider/location and those who were not able
to implement their preferred choice, with the exception of state of residence.
Conclusions: These fndings provide insights on barriers to abortion care in Nigeria, suggesting discretion is key to
many women’s choice of abortion location, while cost and distance prevent many from seeking their preferred care
provider/location. Results also highlight the diversity of women’s abortion care preferences in a legally restrictive
environment
School and work absenteeism due to menstruation in three West African countries: findings from PMA2020 surveys
Reports of school and work absences due to unmet menstrual needs have prompted increased
attention to menstruation in policy and practice. However, there appear to be few quantitative studies
reported in published literature capturing the prevalence of this hypothesised absenteeism. This study
undertook secondary analysis of nationally representative Performance Monitoring and Accountability 2020
(PMA2020) data from Burkina Faso and Nigeria, and city-representative data from Niamey, Niger to
determine the extent of women’s and girls’ self-reported absence from school and work due to menstruation.
Among women and adolescent girls aged 15–49 years who had worked outside the household in the past
month in Burkina Faso (n = 998), Niger (n = 212) and Nigeria (n = 3638), 19%, 11% and 17%, respectively,
reported missing work due to menstruation. Among those aged 15–24 years who attended school in the past
year in Burkina Faso (n = 461), Niger (n = 213) and Nigeria (n = 1574), 17%, 15% and 23% reported missing
school in the past year due to menstruation. Findings support the assertion that menstruation is a source of
absenteeism in West Africa and indicate that greater attention from research, practice, and policy is needed.
In presenting this data we also reflect critically on the performance of questions regarding menstrual-related
absenteeism in national monitoring surveys
The relationship between client dissatisfaction and contraceptive discontinuation among urban family planning clients in three sub-Saharan African countries
Although researchers and practitioners have suggested that the quality of family planning
services impacts contraceptive discontinuation, establishing a causal relationship has been
challenging, primarily due to data limitations and a lack of agreement on how to measure
quality. This longitudinal study estimated the relationship of the dissatisfaction with family
planning services on contraceptive discontinuation for a sample of 797 female clients who
sought family planning services at urban facilities across Kenya, Nigeria, and Burkina Faso.
Clients who sought family planning services were first interviewed in person at private and
public health facilities and received a follow-up phone interview four to six months later
A mixed-methods study exploring women’s perceptions of terminology surrounding fertility and menstrual regulation in Côte d’Ivoire and Nigeria
Women use various terms when discussing the management of their fertility and menstrual irregularities and may interpret the experience of ending a possible pregnancy in nuanced ways, especially when their pregnancy status is ambiguous. Our study aims to understand the terminology used to refer to abortion-like experiences
(specifcally menstrual regulation and pregnancy removal), and the specifc scenarios that these practices encompass
among women who reported doing something to bring back a late period or ending a pregnancy in Nigeria and
Côte d’Ivoire.Our analysis draws upon surveys with women in Nigeria (n=1114) and Cote d’Ivoire (n=352). We also
draw upon qualitative in-depth interviews with a subset of survey respondents in Anambra and Kaduna States
in Nigeria, and Abidjan, Cote d’Ivoire (n=30 in both countries). We examine survey and interview questions that
explored women’s knowledge of terminology pertaining to ending a pregnancy or bringing back a late period. Survey
data were analyzed descriptively and weighted, and interview data were analyzed using inductive thematic analysis
The role of packaged water in meeting global targets on improved water access
Packaged water (as either refill, bottled, or sachet water) has become an important element of water
security in many low- and middle-income countries, owing to poor reliability and lack of piped water
infrastructure. However, over time and across countries, the Demographic and Health Surveys
monitoring program has inconsistently classified packaged water components as either improved or
unimproved. Using data collected as part of the Performance Monitoring and Accountability 2020
(PMA2020) surveys on water options in nine study geographies across eight countries, we identified
five geographies where packaged water constituted one of several options for 5% or more of users.
In this study, four scenarios were designed in which packaged water components were variously
classified as either improved or unimproved. Unimproved water use was highest in scenarios where
sachet or refill water was classified as an unimproved source. Across the four scenarios, the
difference in the use of unimproved water as the main option was highest (65%) in Nigeria (Lagos).
That difference increased to 78% when considering all regular options. The development of these
scenarios highlights the importance of classifying a source as improved or unimproved in the overall
metric that indicates progress at national and international levels.IS
Contraceptive use following spontaneous and induced abortion and its association with family planning services in primary health care: results from a Brazilian longitudinal study
Abstract\ud
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Background\ud
Although it is well known that post-abortion contraceptive use is high when family planning services are provided following spontaneous or induced abortions, this relationship remains unclear in Brazil and similar settings with restrictive abortion laws. Our study aims to assess whether contraceptive use is associated with access to family planning services in the six-month period post-abortion, in a setting where laws towards abortion are highly restrictive.\ud
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Methods\ud
This prospective cohort study recruited 147 women hospitalized for emergency treatment following spontaneous or induced abortion in Brazil. These women were then followed up for six months (761 observations). Women responded to monthly telephone interviews about contraceptive use and the utilization of family planning services (measured by the utilization of medical consultation and receipt of contraceptive counseling). Generalized Estimating Equations were used to analyze the effect of family planning services and other covariates on contraceptive use over the six-month period post-abortion.\ud
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Results\ud
Women who reported utilization of both medical consultation and contraceptive counseling in the same month had higher odds of reporting contraceptive use during the six-month period post-abortion, when compared with those who did not use these family planning services [adjusted aOR = 1.93, 95 % Confidence Interval: 1.13–3.30]. Accessing either service alone did not contribute to contraceptive use. Age (25–34 vs. 15–24 years) was also statistically associated with contraceptive use. Pregnancy planning status, desire to have more children and education did not contribute to contraceptive use.\ud
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Conclusions\ud
In restrictive abortion settings, family planning services offered in the six-month post-abortion period contribute to contraceptive use, if not restricted to simple counseling. Medical consultation, in the absence of contraceptive counseling, makes no difference. Immediate initiation of a contraceptive that suits women’s pregnancy intention following an abortion is recommended, as well as a wide range of contraceptive methods, including long-acting reversible methods, even in restrictive abortion laws contexts.This work was supported by São Paulo Research Foundation (FAPESP), grants 2010/15297-0 and 2012/15482-8
The relationship between household sanitation and women’s experience of menstrual hygiene: Findings from a cross-sectional survey in Kaduna State, Nigeria
Global efforts to improve sanitation have emphasized the needs of women and girls.
Managing menstruation is one such need, yet there is scarce research capturing current practices.
This study investigated the relationships between household sanitation and women’s experience of
menstrual management. Secondary analyses were undertaken on data from 1994 women and girls
collected through the Performance Monitoring and Accountability 2020 survey in Kaduna, Nigeria.
In multivariable models, women had higher odds of using the main household sanitation facility
for menstrual management when they had access to a basic (OR = 1.76 95%CI 1.26–2.46) or limited
(OR = 1.63 95%CI 1.08–2.48) sanitation facility, compared to an unimproved facility. Women with
no household sanitation facility had higher odds of using their sleeping area (OR = 3.56 95%CI
2.50–5.06) or having no facility for menstrual management (OR = 9.86 95%CI 5.76–16.87) than women
with an unimproved sanitation facility. Menstrual management locations were associated with
ratings of their characteristics. Safely managed or basic sanitation facilities were not rated more
favorably than unimproved facilities in privacy (OR = 1.02 95%CI 0.70–1.48), safety (OR = 1.45
95%CI 0.98–2.15), access to a lock (OR = 0.93 95%CI 0.62–1.37), or soap and water (OR = 1.04 95%CI
0.70–1.56). Women using their sleeping area had more favorable perceptions of their environment.
Findings suggest household sanitation influences women’s choices for menstrual management,
but that existing indicators for improvement are not sensitive to menstrual needs.SCOPU
Use of Objective Structured Clinical Examination (OSCE) in a hybrid digital / in-person training for hormonal IUD in Nigeria: findings and applications of the approach [version 1; peer review: 2 approved]
Background: The hormonal intrauterine device, a long-acting reversible contraceptive method, is being introduced to pilot sites in the private and public sector in Nigeria by the Nigerian Federal Ministry of Health since 2019. To inform training of health care providers, a study was conducted on a hybrid digital and in-person training which utilized Objective Structured Clinical Examination (OSCE) to assess competency of provider trainees. This study represents one of few documented experiences using OSCE to assess the effectiveness of a digital training. Methods: From September – October 2021, in Enugu, Kano and Oyo states of Nigeria, 62 health care providers from public and private sector health facilities were trained in hormonal IUD service provision using a hybrid digital / in-person training approach. Providers, who were skilled in provision of copper IUD, underwent a didactic component using digital modules, followed by an in-person practicum, and finally supervised service provision in the provider trainee’s workplace. Skills were assessed using OSCE during the one-day practicum. Results: Use of the OSCE to assess skills provided valuable information to study team. The performance of provider trainees was high (average 94% correct completion of steps in the OSCE). Conclusions: OSCE was used as a research methodology as part of this pilot study; to date, OSCE has not been integrated into the training approach to be scaled up by FMOH. Uniformly high performance of provider trainees was seen on the OSCE, unsurprising since provider trainees were experienced in providing copper IUD. If and when training is rolled out to providers inexperienced with copper IUD, OSCE may have a more important role to assess skills before service provision. The role of OSCE in design of hybrid digital / in-person training approaches should be further explored in rollout of hormonal IUD and other contraceptive technologies