HIV-related risk perception among female sex workers in Nigeria

Augustine Ankomah1, Godpower Omoregie1, Zacch Akinyemi2, Jennifer Anyanti1, Olaronke Ladipo1, Samson Adebayo11Society for Family Health, Abuja, Nigeria; 2Population Services International, Kigali, RwandaBackground: Over one-third of sex workers in Nigeria are infected with human immunodeficiency virus (HIV), yet there is a lack of understanding of sex workers’ own perception of sexual risk-taking. Applying the theory of cognitive dissonance, this paper examined the personal HIV risk perception of brothel-based sex workers.Methods: The study is based on 24 focus group discussions held among brothel-based sex workers in four geographically and culturally dispersed cities in Nigeria.Results: It was found that sex workers underestimated their risk of infection and rationalized, defended, or justified their behaviors, a typical psychological response to worry, threat, and anxiety arising from the apparent discrepancies between beliefs and behaviors. To reduce dissonance, many sex workers had a strong belief in fatalism, predestination, and faith-based invulnerability to HIV infection. Many believed that one will not die of acquired immune deficiency syndrome if it is not ordained by God. The sex workers also had a high level of HIV-related stigma.Conclusion: From these findings, most sex workers considered risk reduction and in particular condom use as far beyond their control or even unnecessary, as a result of their strong beliefs in fatalism and predestination. Therefore, one critical area of intervention is the need to assist sex workers to develop accurate means of assessing their personal vulnerability and self-appraisal of HIV-related risk.Keywords: female sex workers, cognitive dissonance, risk perception, risky behavior, focus group discussions, Nigeri

Relationship between care-givers' misconceptions and non-use of ITNs by under-five Nigerian children

<p>Abstract</p> <p>Background</p> <p>Malaria has been a major public health problem in Nigeria and many other sub-Saharan African countries. Insecticide-treated nets have shown to be cost-effective in the prevention of malaria, but the number of people that actually use these nets has remained generally low. Studies that explore the determinants of use of ITN are desirable.</p> <p>Methods</p> <p>Structured questionnaires based on thematic areas were administered by trained interviewers to 7,223 care-givers of under-five children selected from all the six geo-political zones of Nigeria. Bivariate analysis and multinomial logit model were used to identify possible determinants of use of ITN.</p> <p>Results</p> <p>Bivariate analysis showed that under-five children whose care-givers had some misconceptions about causes and prevention of malaria were significantly less likely to use ITN even though the household may own a net (p < 0.0001). Education and correct knowledge about modes of prevention of malaria, knowing that malaria is dangerous and malaria can kill were also significantly associated with use of ITN (p < 0.0001). Knowledge of symptoms of malaria did not influence use of ITN. Association of non-use of ITN with misconceptions about prevention of malaria persisted with logistic regression (Odds ratio 0.847; 95% CI 0.747 to 0.960).</p> <p>Conclusions</p> <p>Misconceptions about causes and prevention of malaria by caregivers adversely influence the use ITN by under-five children. Appropriate communication strategies should correct these misconceptions.</p

Determinants of insecticide-treated net ownership and utilization among pregnant women in Nigeria

<p>Abstract</p> <p>Background</p> <p>Malaria during pregnancy is a major public health problem in Nigeria leading to increase in the risk of maternal mortality, low birth weight and infant mortality. This paper is aimed at highlighting key predictors of the ownership of insecticide treated nets (ITNs) and its use among pregnant women in Nigeria.</p> <p>Methods</p> <p>A total of 2348 pregnant women were selected by a multi-stage probability sampling technique. Structured interview schedule was used to elicit information on socio-demographic characteristics, ITN ownership, use, knowledge, behaviour and practices. Logistic regression was used to detect predictors of two indicators: ITN ownership, and ITN use in pregnancy among those who owned ITNs.</p> <p>Results</p> <p>ITN ownership was low; only 28.8% owned ITNs. Key predictors of ITN ownership included women who knew that ITNs prevent malaria (OR = 3.85; <it>p </it>< 0001); and registration at antenatal clinics (OR = 1.34; <it>p </it>= 0.003). The use of ITNs was equally low with only 7.5% of all pregnant women, and 25.7% of all pregnant women who owned ITNs sleeping under a net. The predictors of ITN use in pregnancy among women who owned ITNs (N = 677) identified by logistic regression were: urban residence (OR = 1.87; <it>p </it>= 0.001); knowledge that ITNs prevent malaria (OR = 2.93; <it>p </it>< 0001) and not holding misconceptions about malaria prevention (OR = 1.56; <it>p </it>= 0.036). Educational level was not significantly related to any of the two outcome variables. Although registration at ANC is significantly associated with ownership of a bednet (perhaps through free ITN distribution) this does not translate to significant use of ITNs.</p> <p>Conclusions</p> <p>ITN use lagged well behind ITN ownership. This seems to suggest that the current mass distribution of ITNs at antenatal facilities and community levels may not necessarily lead to use unless it is accompanied by behaviour change interventions that address the community level perceptions, misconceptions and positively position ITN as an effective prevention device to prevent malaria</p