Factors Associated with Iron-Folic Acid Supplement Use among Pregnant Women in Karu, Nasarawa State, Nigeria - A Cross Sectional Study using Theory of Planned Behavior

Introduction: Iron-folic acid supplementation is one of the key interventions provided during antenatal care (ANC) services to reduce iron deficiency, maternal anemia, low birthweight and other pregnancy-related complications responsible for maternal and neonatal mortality. However, use of iron-folic acid supplements and adherence with recommended dosage in Nigeria is low. The purpose of this cross-sectional study was to examine factors associated with iron-folic acid supplements use among pregnant women in Karu local government area (LGA), Nasarawa, Nigeria. Methods: Questionnaires were administered in face-to-face interviews with 64 pregnant women (18 – 49 years old) and 19 healthcare providers in selected public primary health facilities across Karu LGA, Nasarawa State. Using the theory of planned behavior, pregnant women’s intention to use iron-folic acid supplements during pregnancy was predicted. In addition, factors associated with duration of use were also examined. Data was analyzed using STATA 15.0. Results: Subjective norm (p = 0.02) and perceived behavioral control (p = 0.04) significantly predicted the intention to use iron-folic acid supplements during pregnancy. However, attitude did not have a predictive influence on intention. A one unit increase in the number of antenatal care visits made, significantly increased the likelihood of taking iron-folic acid supplement for three months or more (p=0.000). Discussion: Perceived behavioral control was the strongest predictor of intention to use iron-folic acid supplements followed by subjective norm. Antenatal care attendance are very critical to the use of iron-folic acid supplements and should be promoted

Use of Mobile Health in Prenatal and Postnatal Care - A Systematic Review

Background: Pre- and post-natal care are essential to mother and child survival from pregnancy-related complications. The use of mobile technology as a health monitoring tool, and service provision tracking device to improve health, healthcare delivery, and health service outcomes, prevent disease, and manage chronic diseases has been well-documented. We conducted a systematic review to examine the use of mobile technology in promoting and educating mothers on prenatal and postnatal care, and the outcomes of these interventions. Methods: PubMed (Medline), CINAHL Complete, and PsycINFO were searched for primary articles on mobile technology interventions for prenatal and postnatal care published from 2000 to 2016. Key search terms included mobile technology, maternal health, pregnancy, prenatal and postnatal. Abstracts and full texts were reviewed by two reviewers using pre-determined inclusion and exclusion criteria. Eleven articles that met the inclusion criteria were assessed for quality and the content was analyzed. Results: All the 11 studies were intervention studies, four of which were randomized control trials. Four studies investigated the influence of mobile phone technologies on behaviors and attitudes among mothers during pregnancy and breastfeeding. Health outcomes attributed to mobile technology included improved breastfeeding practices, increased antenatal care attendance and coverage, and reduced perinatal mortality. Implication/Conclusion: Mobile technology interventions are very applicable in low-income settings where distance and cost of travel restrict access to maternal and newborn services. Thus, mobile phone interventions can facilitate health services by saving time, reduce the financial burden and other social costs for women

Striving to Meet Healthy People 2020 Objectives: Trend Analysis of Maternal Smoking

Objectives: We examined trends in prevalence rates of smoking and smoking cessation during pregnancy among women in the United States to assess achievement of Healthy People 2020 prevention targets. Methods: We assessed the smoking habits of 30 667 mothers whose children were born between 1985 and 2014 and who were sampled by the National Health and Nutrition Examination Survey, 1999-2014. Sampled participants were children aged 0-15 at the time of interview; however, an adult proxy—usually the biological mother—responded on the child’s behalf and reported information about maternal tobacco use during pregnancy. We calculated prevalence rates, adjusted odds ratios (aORs), and predicted annual increase or decrease of smoking and quitting smoking during pregnancy, adjusting for mother’s age at delivery and income level and child’s race/ethnicity and sex. Results: The average annual prevalence of smoking at any time during pregnancy decreased from 25.7% (95% confidence interval [CI], 15.3%-36.0%) in 1985 to 10.1% (95% CI, 7.1%-13.0%) in 2014 (P \u3c .001), and quitting smoking at any time during the index pregnancy increased from 36.6% (95% CI, 20.3%-52.9%) in 1985 to 54.9% (95% CI, 44.4%-65.4%) in 2008 (P = .002). The adjusted annual risk of smoking during pregnancy decreased significantly by 3% (aOR = 0.97; 95% CI, 0.95-0.98; P \u3c .001). The prevalence rate of smoking in the year 2020 extrapolated from the current trend would be 6.1%. Conclusions: Smoking during pregnancy in the United States is declining. However, renewed public health measures are needed to achieve the Healthy People 2020 objectives of preventing smoking among pregnant women in the United States

Breast Cancer Survivorship Resources in Bulloch and Surrounding Counties in Georgia

Presentation given at Georgia Southern University Research Symposium

Changes in clients\u27 perceptions of family planning quality of care in Kaduna and Lagos States, Nigeria: A mixed methods study

Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) are crucial to improving access to family planning (FP) services in Nigeria. Although the private sector is preferred for convenience, availability of commodity, privacy, and timeliness, less well known is the quality of care received by clients who obtain FP services from CPs and PPMVs. This paper seeks to explore the use of validated quality of care measures for programming in Kaduna and Lagos States and to assess how these measures worked in capturing changes in quality of care using client exit interviews implemented at two time points. Using validated measures of quality of care, 598 and 236 exit interviews in rounds 1 and 2 were conducted with FP clients aged 18–49 years old. The quality of care domains were assessed using 22 questions. A weighted additive quality score was created, and scores were grouped into three: low, medium, and high quality. Changes in quality of care received were examined using χ2 test. A subset of 53 clients were selected for in-depth interviews. Deductive and inductive approaches were used for coding, and data analysis was thematic. In Lagos, we observed increases in 16 out of 22 items while in Kaduna increases were only observed in 8 items. For instance, increases were observed in the proportion of women who experienced visual privacy between rounds 1 and 2 in Lagos (74%–89%) and Kaduna (66%–82%). The quality of care received by clients changed over time. Women who reported high quality care in Lagos increased from 42% to 63%, whereas women who reported high quality care in Kaduna decreased from 35% to 21%. In both states, in-depth interviews revealed that women felt they were treated respectfully, that their sessions with providers were visually private, that they could ask questions, and that they were asked about their preferred method. This study demonstrates that clients received high quality of care services from providers (CPs and PPMVs) especially in Lagos, and such services can be improved over time. Continuous support may be required to maintain and prevent reduction in quality of FP counseling and services, particularly in Kaduna

Can community pharmacists and patent proprietary medicine vendors retain family planning knowledge over time? Findings from the IntegratE Project in Kaduna and Lagos States, Nigeria

The IntegratE project is a proof-of-concept that Community Pharmacists (CPs) and Patent and Proprietary Medicine Vendors (PPMVs) have the capacity to provide a wider range of family planning (FP) and primary health care (PHC) services than they are currently authorized by law to provide. The project seeks to improve the quality of FP and PHC services provided by CPs and PPMVs and support the creation of an enabling environment that will sustain these services. The data set includes 559 CPs and PPMVs who completed a self-administered questionnaire in two groups (rounds 1 and 2) from February 2019–January 2021 in Kaduna and Lagos states, Nigeria on the IntegratE project. The focus of the study was the assessment of CPs and PPMVs\u27 knowledge as they relate to the provision of FP counseling, injectable and implant contraceptive services at three points in time: 1) before the training; 2) immediately after the training; and 3) 9-months after the training

Weight Misperception and Cigarette Smoking among Healthy Weight Adolescents in the U. S: NHANES 2005–2014

This study examined the relationship between cigarette smoking and body perception across measured body weight among adolescents aged 12–19 years, using 2005–2014 National Health and Nutrition Examination Survey data. Adjustment showed that normal weight girls who perceived themselves as overweight had a significantly higher smoking prevalence ratio of 2.03 (95% confidence interval (CI): 1.22–3.40). The prevalence of cigarette smoking and weight misperceptions among adolescent girls indicates a need for topics addressing body perception and body image among students to be included in smoking prevention programs in schools. In addition, factors that shape adolescent girls’ perception of body weight should be examined

Strengthening and monitoring health system's capacity to improve availability, utilization and quality of emergency obstetric care in northern Nigeria.

BACKGROUND:Quality improvement in emergency obstetric care (EmOC) is a critical and cost-effective suite of interventions for the reduction of maternal and newborn mortality and morbidity. This study was undertaken to evaluate the impact of quality improvement interventions following a baseline assessment in Bauchi state, Nigeria. METHODS:This was a prospective before and after study between June 2012, and April 2015 in Bauchi State, Nigeria. The surveys included 21 hospitals designated by Ministry of Health (MoH) as comprehensive EmOC centers and 38 primary healthcare centers (PHCs) designated as basic EmOC centers. Data on EmOC services was collected using structured established EmOC tools developed by the Averting Maternal Death and Disability (AMDD), and analyzed using univariate and bivariate statistical analyses. RESULTS:Facilities providing seven or nine signal EmOC functions increased from 6 (10.2%) in 2012 to 21 (35.6%) in 2015. Basic EmOC facilities increased from 1 (2.6%) to 7 (18.4%) and comprehensive EmOC facilities rose from 3 (14.3%) to 13 (61.9%). Facility birth increased from 3.6% to 8.0%. Cesarean birth rates increased from 3.8% in 2012 to 5.6% in 2015. Met need for EmOC more than doubled from 3.3% in 2012 to 9.9% in 2015. Direct obstetric case fatality rates increased from 3.1% in 2012 to 4.0% in 2015. Major direct obstetric complications as a percent of total maternal deaths was 70.9%, down from 80.1% in 2012. CONCLUSION:The rise in the percent of facility-based births and in met need for EmOC suggest that interventions recommended and implemented after the baseline study resulted in increased availability, access and utilization of EmOC. Higher patient load, late arrival and better record keeping may explain the associated increase in case fatality rates

The role of job aids in supporting task sharing family planning services to community pharmacists and patent proprietary medicine vendors in Kaduna and Lagos, Nigeria

Background: CPs and PPMVs are an important source of modern contraceptives in Nigeria, yet many lack the requisite knowledge and skills to capably provide these services. This skills gap might be addressed through targeted family planning (FP) training. This study measures family planning knowledge retention of CPs and PPMVs after receiving training in FP counseling and services in Kaduna and Lagos States, in Nigeria. Methods: In a quasi-experimental longitudinal design without a comparison group, 559 CPs and PPMVs who were enrolled in the IntegratE project between January and December 2019, completed a self-administered questionnaire to assess their knowledge related to the provision of FP counseling, and injectable and implant contraceptive services at three points in time: 1) before the training; 2) immediately after the training; and 3) 9-months after the training in Kaduna and Lagos states, Nigeria. Adjusted multivariate logistic regression analysis was used to assess the effect of provider characteristics and receipt of job aids on FP knowledge retention 9 months after the training. 95% confidence intervals and p-values were used to assess statistical significance. Results: Majority of study participants were females (60.3%) and between 30 and 49 years old (63.4%). The study revealed the importance of jobs aids as influence on knowledge retention. CPs and PPMVs who reported having the Balanced Counseling Strategy plus (BCS+) counseling cards, were more likely to retain knowledge (AOR: 2.92; 95% CI: 1.01-8.40, p-value = 0.05) at 9 months follow-up. Similarly, in terms of knowledge of injectable contraceptives, CPs and Tier 2 PPMVs who reported receiving the Medical Eligibility Criteria (MEC) Wheel were 2.1 times more likely to retain knowledge of injectable contraceptives 9-months later on (95% CI: 1.14-3.99, p-value = 0.02). Conclusion: Community Pharmacists and Proprietary Medicine Vendors had good retention of family planning knowledge, especially when combined with job aids. Training and providing them with job aids on FP will therefore support task shifting and task sharing on family planning services provision in Nigeria