The right to health for the Lesbian, Gay, Bisexual and Transgender (LGBT) population in Nigeria? – an exploration of access to, and delivery of healthcare services

Lesbian, Gay, Bisexual or Transgender (LGBT) individuals experience challenges in accessing culturally and clinically appropriate healthcare services. The aim of this research was to generate scientific evidence on barriers and facilitators influencing access to healthcare services for LGBT people living in Nigeria. Three empirical studies and a systematic review were carried out. The first study, a cross-sectional survey among undergraduate students in Lagos examined the existence and severity of homophobia against men who have sex with men. Findings showed that for heterosexual individuals, the criminalization of same-sex relationships provided justification for denial of rights including access to healthcare services. This study was followed by semi-structured qualitative interviews among LGBT people living in two cosmopolitan cities in Nigeria, exploring their experiences of accessing healthcare services. Analysis of the data generated a framework for social determinants of LGBT health in Nigeria and an adapted three-level intersectionality wheel displaying the factors responsible. These studies provided evidence on barriers to healthcare services. A systematic review to synthesise evidence of the effectiveness of educational training programs on LGBT health for healthcare students and professionals showed that such training programs have the potential to improve the knowledge, attitudes and practices of professionals. Finally, a mixed-method case study of a college of medicine showed deficiencies in the current state of teaching and learning about LGBT health and service provision. The findings above were used to modify the WHO social determinants of health framework to address LGBT health within the Nigerian context

Tobacco and Alcohol Use among a Sample of Men who have Sex with Men in Lagos state, Nigeria

Background: Research in other parts of the world has shows that men who have sex with men (MSM) may have higher rates of alcohol and tobacco use than the general population of men. Little is known about the pattern of tobacco and alcohol use among MSM in Nigeria. Aim: This study set out to assess the pattern of tobacco and alcohol use and to determine the factors associated with their use among a sample of MSM. Subjects and Methods: This cross-sectional descriptive study was carried out among 320 MSM. For the purpose of this study, we collaborated with an MSM-led registered Non-governmental organization (NGO) that works closely with the state and developmental partners to provide health programs exclusively for MSM in Lagos State. Data were collected using a pretested interviewer administered survey. MSM were recruited using a non-probability sampling technique (Snow ball sampling). Data analysis was carried out using Epi info version 3.5.3 and SPSS 17.0. Results: Up to 22.2% (71/320) were ever-smokers with 15.4% (49/320) remaining as current smokers. Among current smokers more than half of the men smoked daily and 36.7% (27/49) were heavy smokers (smoked more than 10 sticks per day). About one in three, 34.1% (109/320) currently drank alcohol with majority having their most recent drink less than a week before the study. Using the CAGE assessment for alcohol dependence, almost half of the current drinkers had a drinking problem. Respondents who used marijuana and those whose partners smoked were more likely to be current smokers. Current smokers, marijuana users and those whose partners consumed alcohol were more likely to have a drinking problem. Conclusion: Both tobacco and alcohol use is common among this sample of MSM. Efforts to address these issues should be given priority when planning health care programs targeted at MSM.Keywords: Men who have sex with men, Alcohol, Tobacc

Parents’ knowledge of car safety and practices amongst school children in an urban community of Lagos, Nigeria

No fewer than 1.2 million deaths globally are attributed to road traffic crashes yearly, with low- and middleincome countries contributing disproportionately to these deaths. Children are a vulnerable road user group, and riding unrestrained is a significant risk factor for death and injury among child car passengers. This studyaimed to determine child car safety knowledge and practices among parents of children attending a private school in an urban setting in Lagos, Nigeria. A descriptive study, using observations of child car safety practices, and a survey of parental knowledge and attitudes of child car safety, were conducted simultaneously amongst children 0-10 years riding in cars to school. Data was analysed using Epi Info Version 3.5.1. A total of 127 cars were observed as children were being dropped off at school. The proportion of child passengers aged 0 - 10 years restrained by any device was 6.3%, with only 2.4% of these children being appropriately restrained for age; 19.7% of observed child passengers rode in the front seat. Awareness of car safety seats among parents was high at 85%. However, less than 40% of respondents knew the correct age to commence use of child restraints, seat belts, or front seating. The reason most cited for non-use of child restraints was unavailability (24.1%). Despite the high level of awareness about car safety seats, parental knowledge of specific child passenger safety issues and practices were poor. Targeted interventions are needed to bridge the gap between awareness, knowledge and practice in this population.Keywords: child, motor vehicle passenger, car restraints, adults, knowledge and attitude, road safet

Gender disparities in the socio-economic burden of HIV/AIDS among patients receiving care in an HIV clinic in Lagos, Nigeria

Background: In sub-Saharan Africa, women are bearing a heavier burden than men in terms of rate of infection and socio-economic impact of HIV/AIDS. This study was aimed at assessing gender disparities in the socio-economic burden of HIV/AIDS. Methods: This descriptive cross-sectional study was conducted among 422 HIV-positive adult patients attending an HIV clinic in Lagos, Nigeria, selected by multi-stage sampling and interviewed using a pretested, semi-structured questionnaire. Bivariate analysis was used to assess how the socioeconomic constructs differed by gender. Results: This study revealed that females suffered more of the socio-economic consequences of having HIV/AIDS than males; cruelty and isolation were significantly higher among the females (p<0.0001), more females (50.0%) were discriminated against at the workplace compared to males (32.1%) (p=0.005), physical abuse (p=0.002) and extortion (p=0.029) were experienced by more of the females than the males. Also, the cost of care outside of antiretroviral therapy was significantly higher among the females (p= 0.002). Conclusion: Quantifying the social and economic disparities between HIV-infected men and women has shown that the burden is by far higher among women than men. Focused interventions are therefore needed to control the spread of the disease and improve the quality of life of HIV-infected women. Keywords: HIV/AIDS; gender disparities; women; Lagos; Nigeria

Leading in a time of crisis: exploring early experiences of health facility leaders during the COVID-19 pandemic in Nigeria's epicentre.

PURPOSE: The COVID-19 pandemic has had a disruptive effect on the health system. Health facility leaders were at the forefront of maintaining service delivery and were exposed to varied stressors in the early phase of the pandemic. This study aims to explore the leadership experiences of health facility leaders during the early phase of the COVID-19 pandemic in Nigeria's epicentre. DESIGN/METHODOLOGY/APPROACH: This study conducted an exploratory descriptive qualitative study. To achieve this, 33 health facility leaders of different cadres across primary, secondary, and tertiary levels of the public health care system in Lagos, Nigeria, were remotely interviewed. The key informant interviews were transcribed verbatim and were analysed by using thematic analysis. FINDINGS: The health facility leaders experienced heightened levels of fear, anxiety and stressors during the early phase of the pandemic. They also had genuine concerns about exposing their family members to the virus and had to manage some health-care workers who were afraid for their lives and reluctant. Coping mechanisms included psychological and social support, innovative hygiene measures at health facility and at home, training and staff welfare in more ways than usual. They were motivated to continue rendering services during the crisis because of their passion, their calling, the Hippocratic oath and support from the State government. ORIGINALITY/VALUE: The experiences of health facility leaders from different parts of the world have been documented. However, to the best of the authors' knowledge, this is one of the first studies that specifically report multi-layer leadership experiences of health facility leaders during the early phase of the COVID-19 pandemic in sub-Saharan Africa

Challenges in access and satisfaction with reproductive, maternal, newborn and child health services in Nigeria during the COVID-19 pandemic: A cross-sectional survey.

BACKGROUND: The presence of COVID-19 has led to the disruption of health systems globally, including essential reproductive, maternal, newborn and child health (RMNCH) services. This study aimed to assess the challenges faced by women who used RMNCH services in Nigeria's epicentre, their satisfaction with care received during the COVID-19 pandemic and the factors associated with their satisfaction. METHODS: This cross-sectional survey was conducted in Lagos, southwest Nigeria among 1,241 women of reproductive age who had just received RMNCH services at one of twenty-two health facilities across the primary, secondary and tertiary tiers of health care. The respondents were selected via multi-stage sampling and face to face exit interviews were conducted by trained interviewers. Client satisfaction was assessed across four sub-scales: health care delivery, health facility, interpersonal aspects of care and access to services. Bivariate and multivariate analyses were used to assess the relationship between personal characteristics and client satisfaction. RESULTS: About 43.51% of respondents had at least one challenge in accessing RMNCH services since the COVID-19 outbreak. Close to a third (31.91%) could not access service because they could not leave their houses during the lockdown and 18.13% could not access service because there was no transportation. The mean clients' satisfaction score among the respondents was 43.25 (SD: 6.28) out of a possible score of 57. Satisfaction scores for the interpersonal aspects of care were statistically significantly lower in the PHCs and general hospitals compared to teaching hospitals. Being over 30 years of age was significantly associated with an increased clients' satisfaction score (ß = 1.80, 95%CI: 1.10-2.50). CONCLUSION: The COVID-19 lockdown posed challenges to accessing RMNCH services for a significant proportion of women surveyed. Although overall satisfaction with care was fairly high, there is a need to provide tailored COVID-19 sensitive inter-personal care to clients at all levels of care

Challenges in access and satisfaction with reproductive, maternal, newborn and child health services in Nigeria during the COVID-19 pandemic: a cross-sectional survey

Background The presence of COVID-19 has led to the disruption of health systems globally, including essential reproductive, maternal, newborn and child health (RMNCH) services. This study aimed to assess the challenges faced by women who used RMNCH services in Nigeria’s epicentre, their satisfaction with care received during the COVID-19 pandemic and the factors associated with their satisfaction. Methods This cross-sectional survey was conducted in Lagos, southwest Nigeria among 1,241 women of reproductive age who had just received RMNCH services at one of twenty-two health facilities across the primary, secondary and tertiary tiers of health care. The respondents were selected via multi-stage sampling and face to face exit interviews were conducted by trained interviewers. Client satisfaction was assessed across four sub-scales: health care delivery, health facility, interpersonal aspects of care and access to services. Bivariate and multivariate analyses were used to assess the relationship between personal characteristics and client satisfaction. Results About 43.51% of respondents had at least one challenge in accessing RMNCH services since the COVID-19 outbreak. Close to a third (31.91%) could not access service because they could not leave their houses during the lockdown and 18.13% could not access service because there was no transportation. The mean clients’ satisfaction score among the respondents was 43.25 (SD: 6.28) out of a possible score of 57. Satisfaction scores for the interpersonal aspects of care were statistically significantly lower in the PHCs and general hospitals compared to teaching hospitals. Being over 30 years of age was significantly associated with an increased clients’ satisfaction score (ß = 1.80, 95%CI: 1.10–2.50). Conclusion The COVID-19 lockdown posed challenges to accessing RMNCH services for a significant proportion of women surveyed. Although overall satisfaction with care was fairly high, there is a need to provide tailored COVID-19 sensitive inter-personal care to clients at all levels of care

The effects of educational curricula and training on LGBT specific health issues for healthcare students and professionals: a mixed-methods systematic review

Introduction: Poor access of lesbian, gay, bisexual and transgender (LGBT) people to healthcare providers with clinical and cultural competency contributes to health inequalities between heterosexual/cisgender and LGBT people. This systematic review assesses the effect of educational curricula and training for healthcare students and professionals on LGBT healthcare issues. Methods: Systematic review; the search terms, strategy and process as well as eligibility criteria were predefined and registered prospectively on PROSPERO. A systematic search of electronic databases was undertaken. Screening for eligible studies and data extraction were done in duplicate. All the eligible studies were assessed for risk of bias. The outcome of interest was a change in participants’ knowledge, attitude and or practice. Results: Out of 1171 papers identified, 16 publications reporting 15 studies were included in the review. Three were non-randomized controlled studies and 12 had a pre/post-design; two had qualitative components. Bias was reported in the selection of participants and confounding. Risk reported was moderate/mild. Most studies were from the USA, the topics revolved around key terms and terminology, stigma and discrimination, sexuality and sexual dysfunction, sexual history taking, LGBT-specific health and health disparities. Time allotted for training ranged from 1 to 42 hours, the involvement of LGBT people was minimal. The only intervention in sub-Saharan Africa focused exclusively on men who have sex with men. All the studies reported statistically significant improvement in knowledge, attitude and/or practice post-training. Two main themes were identified from the qualitative studies: the process of changing values and attitudes to be more LGBT inclusive, and the constraints to the application of new values in practice.Conclusions: Training of healthcare providers will provide information and improve skills of healthcare providers which may lead to improved quality of healthcare for LGBT people. This review reports short-term improvement in knowledge, attitudes and practice of healthcare students and professionals with regards to sexual and LGBT-specific healthcare. However, a unified conceptual model for training in-terms of duration, content and training methodology was lacking

Training a Continent: A Process Evaluation of Virtual Training on Infection Prevention and Control in Africa During COVID-19.

BACKGROUND: Strengthening infection prevention and control (IPC) capacity was identified as a key intervention to prepare African Union member states to curb the COVID-19 pandemic. As part of the Africa Taskforce for Coronavirus, which helped implement the Africa Joint Continental Strategy for COVID-19 Outbreak response, the IPC Technical Working Group (IPC TWG) was convened to coordinate the development of IPC core components for preparedness, response, and recovery from COVID-19. As part of the IPC TWG's work, the Africa Centres for Disease Control and Prevention, in collaboration with the Infection Control Africa Network, delivered virtual IPC training sessions targeted to African Union member states. We aimed to undertake a process evaluation of this training to inform and improve both ongoing and future programming. METHODS: The scope of the evaluation was agreed upon through discussion with the training organizers and advisory members and a design workshop. A mixed-methods approach was used; data collection was partly prospective and partly retrospective due to the rapid start of some of the training activities. Existing available data included: usage analytics, the content of questions posed during the webinar and community of practice, and participant feedback survey results. In addition, in-depth qualitative interviews were conducted with a sample of webinar participants. RESULTS: The rapid development of this training was efficient and responsive. The training reached more than 3,000 participants across the 2 rounds, but the numbers varied substantially by location. Participants engaged well during the question period during each webinar, but the asynchronous community of practice was less utilized during the evaluation time frame. Many participants appreciated the African focus of the webinars and gave positive feedback on the practical and context-specific content. CONCLUSIONS: The move toward online training provides an important opportunity to improve IPC across the African continent