Health research in Africa: Are we communicating our findings to relevant stakeholders?

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Adherence to infant-feeding choices by HIV-infected mothers at a Nigerian tertiary hospital: the pre-“rapid advice” experience

Objectives: The study examined adherence to infant-feeding choices made by human immunodeficiency virus (HIV)-infected mothers at a Nigerian tertiary hospital prior to implementation of the “rapid advice” guideline, i.e. the revised World Health Organisation principles and recommendations on infant feeding in the context of HIV.Design: This was a longitudinal descriptive study.Subjects and settings: The study was conducted on mother-infant pairs recruited from the prevention of mother-to-child transmission (PMTCT) of HIV programme of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. Final analyses included 142 mother-infant pairs.Outcome measures: Adherence to a prenatal infant-feeding choice and the infant’s HIV status at six months of age were determined.Results: On enrolment, 73% (n = 103) of the mothers chose exclusive formula feeding (EFF), and 28% (n = 39) exclusive breastfeeding (EBF) for the first six months of life. Of the mothers who chose EBF, the actual practice of EBF declined from 88% at two weeks to 21% at six months, while EFF with correctly reconstituted infant formula decreased from 55% to 8% over the same period. The proportion of mothers who switched over to early complementary feeding increased from 8% at six weeks to 80% at six months in the EBF group, and 2% at two weeks to 92% at six months in the EFF group. Major reasons for nonadherence to their initial choice were fear of the mother-to-child transmission (MTCT) of HIV (65%) and non-affordability of the formula (97%) in the EBF and EFF groups, respectively. Factors significantly associated with adherence to their initial choice included having individual prenatal infant-feeding counselling sessions, being married, having a small number of children, being of higher socio-economic status and the mother’s educational status. However, only socio-economic status remained significant after logistic regression analysis was applied. The total MTCT of HIV rate was 1% at six months.Conclusion: Adherence to either EFF or EBF in this study was low, owing to early breastfeeding cessation and the inability to sustain EFF.Keywords: HIV-infected mothers, infant-feeding choice, infant-feeding practices, PMTCT, adherenc

Experiences from polio supplementary immunization activities in Anambra State, Nigeria

Background: Routine immunization coverage is low in some States in Nigeria and contributes to the transmission of wild poliovirus. Anambra State has been polio‑free since 2004. However, the risk of importation of poliovirus from travelers and migrants is a public health concern due to the commercial nature of the State. This paper reported experiences and lessons from supplementary immunization activities (SIAs) conducted in the State that will be useful to other settings experiencing low uptake of routine immunization.Materials and Methods: The SIAs were conducted simultaneously in the 21 local government areas (LGAs) in Anambra State during January, March, and November 2010. Data were entered and analyzed in Excel spreadsheet and findings were summarized as frequencies and proportions.Results: A total of 1,187,866 children were vaccinated in January, 1,260,876 in March and 1,225,187 in November 2010. The State’s cumulative coverage exceeded the target coverage of >90% in the three SIAs. All LGAs met the >90% target in January and March, but one LGA achieved 79% coverage in November. The proportion of zero‑dose children decreased from 6% to 4.7%, and the vaccine wastage rate ranged from 6% to 6.6%. In that same year, the state did not achieve the target coverage of >80% for routine oral polio vaccine (OPV3) immunization in any of the months and only 29% of the LGAs exceeded the routine OPV3 target.Conclusion: The State achieved high polio vaccination coverage through the SIAs, but coverage through routine immunization was low. Adopting proper planning and supervision, financial and political support, community involvement, improved vaccine logistics, and other measures utilized during the SIAs could help to improve routine immunization.Key words: Community involvement/participation, polio eradication, supplemental immunization activities, vaccination coverag

Unintended pregnancy and termination of studies among students in Anambra state, Nigeria: Are secondary schools playing their part?

This study evaluated efforts of secondary schools to prevent unintended pregnancy among students and their reactions to pregnant students before and after delivery. A cross-sectional survey of 46 teachers in three public and two private schools in Anambra state, Nigeria was carried out. Information was collected using self-administered questionnaire. Of all the teachers in the study, 87% reported unintended pregnancies among students in the previous 3 years. Expulsion (43%) and suspension (28%) were the most common reactions. Private schools were more likely to expel pregnant students than public schools. Following the delivery of their babies, 43% discontinued their education in the same school, whereas 37% continued their education in a different school. Counselling was given before suspension or expulsion in 4% of public schools and 15% of private schools. Majority of the schools (61%) did not have sex education as part of their schools' curriculum. Students should be re-admitted in order to ensure continuity of their academic development, prevent unemployment and mitigate poverty-induced repeat pregnancy

Becoming pregnant during secondary school: findings from concurrent mixed methods research in Anambra State, Nigeria

Objectives: Pregnancies among teenagers and problems associated with premarital births have raised concerns in many countries. It is important to explore unintended pregnancy from the viewpoints of local stakeholders such as students, schools/teachers, and community members. This study assessed reported cases of unintended pregnancy among students and perceptions of these pregnancies by members of the community.Methods: This study took place in a rural community in Anambra state, southeastern Nigeria. A cross-sectional survey of 1,234 students and 46 teachers in five secondary schools was carried out using self-administered questionnaires. In addition, focus group discussions (FGD) involving 10 parents and in-depth interview (IDI) with a student who became pregnant were conducted.Results: Reports of pregnancy were more common during second and third years of junior secondary school than other school years or level. According to teachers, ignorance was the main reason given by students who became pregnant. Students who became pregnant were reported to have performed poorly academically and lived with both parents, who were either  subsistence farmers or petty traders. In the IDI, the ex-student opined that pregnant students faced shame, marital limitations and lack of respect from community members. Participants in the FGD suggested that  teenagers should be provided with sex education in schools and in  churches; parents should communicate with teenagers about sexual matters and make adequate financial provision; and the male partners should be held more accountable for the pregnancies.Conclusion: Poor sexual knowledge and poor socioeconomic conditions play important roles in teenage pregnancy. Male participation may enhance effectiveness of prevention programmes.Key words: Teenage pregnancy, Mixed methods research, Nigeria, Focus group discussion,In-depth intervie