Pneumonia‐related ideations, care‐seeking, and treatment behaviors among children under 2 years with pneumonia symptoms in northwestern Nigeria

This analysis was published in Pediatric Pulmonology in a special journal issue on “Pediatric Pneumonia in Nigeria.” Pneumonia remains the leading infectious cause of child mortality worldwide despite declines in pneumonia-related child mortality rates since 2000 globally. In Nigeria, approximately 134,000 deaths among children under 5 years were due to pneumonia in 2017. Prompt treatment of pediatric pneumonia symptoms is a cornerstone of child survival programs but remains a challenge in Nigeria. Psychosocial influences, or ideations, directly influence pathways to care but have not been previously measured nor examined for pediatric pneumonia. Kincaid’s Ideation Model of Strategic Communication and Behavior Change theorizes that psychosocial influences, or ideations, are intermediate determinants that help catalyze a person\u27s decision to engage in a specific action such as care-seeking or treatment for pneumonia symptoms. This model guided development of ideational metrics for pediatric pneumonia care-seeking and treatment behaviors. In this analysis, we aimed to develop a set of pneumonia-related ideational factors and to examine the extent of their associations with care-seeking from formal medical sources and antibiotic use for children under 2 years with pneumonia symptoms in northwestern Nigeria

Feasibility and acceptability of community health extension workers to identify and treat hypertension associated with pregnancy: Implementation research report

Hypertensive disorders in pregnancy, experienced by 10 percent of women globally, are major contributors to maternal and newborn mortality, morbidity, and disability. Task shifting essential health services to mitigate insufficient human resources is recommended to strengthen and expand the health workforce and rapidly increase access to quality services. Nigeria’s task-shifting policy recommends that community health extension workers administer a loading dose of magnesium sulphate for severe pre-eclampsia or eclampsia prior to referral to a higher-level facility. This study tested the feasibility and acceptability of community health extension workers at primary health care facilities in Ebonyi state in detecting and managing pregnancy-associated hypertension using alpha methyldopa and magnesium sulphate, where appropriate, and referring for follow-up. Although challenges remain in ensuring that sufficient commodities and supplies are continuously available, this endline report details how ministries of health might use these missed opportunities to detect pre-eclampsia and prevent deterioration by providing anti-hypertensives and magnesium sulphate to stabilize and refer women

Behavioral sentinel surveillance survey in Nigeria: Endline technical report

This technical report presents results from the Behavioral Sentinel Surveillance (BSS) endline survey undertaken by Breakthrough RESEARCH/Nigeria in Kebbi, Sokoto, and Zamfara states between October 1 and November 10, 2022. BSS surveys are intended to assess changes in indicators targeted by the integrated social and behavior change (SBC) activities of the USAID-funded Breakthrough ACTION/Nigeria project. The Breakthrough ACTION/Nigeria project, which began in 2019 and is slated to run until 2025, focuses on the health areas of malaria; family planning; and maternal, newborn, and child health plus nutrition (MNCH+N) in Kebbi and Sokoto states, as well as malaria-only SBC activities in Zamfara State. The project uses three primary SBC approaches: advocacy outreach to opinion leaders and community influencers at the state and local government area (LGA) levels, direct engagement of community members through community dialogues and group meetings, and SBC messaging campaigns through mass media and digital media. The primary objective of this study is to compare the effectiveness of integrated SBC programming, as implemented by Breakthrough ACTION/Nigeria in Kebbi and Sokoto states, with single-focused vertical SBC programming, used by Breakthrough ACTION/Nigeria to target malaria outcomes in Zamfara state

Behavioral sentinel surveillance survey in Nigeria: Endline technical report for couples

This technical report presents information from married couples on health norms, attitudes, and beliefs as part of the Behavioral Sentinel Surveillance (BSS) endline survey undertaken by Breakthrough RESEARCH/Nigeria in Kebbi, Sokoto and Zamfara States between October 1 and November 10, 2022. BSS surveys assess changes in indicators targeted by the integrated social and behavior change (SBC) activities of the USAID-funded Breakthrough ACTION/Nigeria’s project. Breakthrough ACTION/Nigeria, which is slated to run from 2019 to 2025, utilizes SBC focused on the health areas of malaria; family planning (FP); and maternal, newborn, and child health plus nutrition (MNCH+N) in Kebbi and Sokoto states, as well as malaria-only SBC activities in Zamfara State. The project uses three primary SBC approaches: advocacy outreach to opinion leaders and community influencers at the state and local government area (LGA) levels, direct engagement of community members through community dialogues, group meetings and household visits, and SBC messaging campaigns through mass media and digital media

Post-intervention analysis of pre-eclampsia and eclampsia in three Nigerian states

In the last three decades, global maternal mortality has decreased by almost 45 percent, but approximately 830 women still die daily from largely preventable pregnancy complications. Since 2015, the Ending Eclampsia project, with support from USAID, has been working to expand proven, underutilized interventions and commodities for pre-eclampsia/eclampsia (PE/E) prevention, early detection, and treatment, and to strengthen global partnerships for care of hypertensive disorders in pregnancy (HDP), of which PE/E are the severest forms. A systematic review of the literature identifies a number of articles reporting PE/E burdens within set populations, common risk factors, adverse outcomes, and mortality rates, but few discuss implementation research (IR) to improve PE/E prevention, detection, and timely management. Following the literature review and subsequent analysis of antenatal care and PE/E in seven Nigerian states in 2015, the project intensified its activities and IR in Cross River, Ebonyi, and Kogi states, emphasizing task sharing with primary health-care providers for the detection and management of HDP. This endline report describes the IR approach of the Population Council in Nigeria from 2016 to 2018 and its results

Behavioral Sentinel Surveillance Survey in Nigeria

This technical report presents results of the baseline Behavioral Sentinel Surveillance survey by Breakthrough RESEARCH in Nigeria in September and October 2019. From 2019 to 2021, baseline, midline, and endline surveys will assess the effectiveness of Breakthrough ACTION integrated social and behavior change activities for malaria, family planning, and maternal, newborn and child health plus nutrition in Kebbi and Sokoto in comparison to Breakthrough ACTION\u27s exclusively malaria activities in Zamfara state. Malaria activities were initiated in Zamfara in October 2019. This technical report presents detailed baseline results, including comparisons of results for the Breakthrough ACTION integrated and malaria-exclusive program areas. This report also presents findings about contextual factors influencing health behavior and service utilization outcomes, as these results have important and direct implications for Breakthrough ACTION program adaption and expansion

Pneumonia‐related ideations, care‐seeking, and treatment behaviors among children under 2 years with pneumonia symptoms in northwestern Nigeria

Background: Prompt treatment of pediatric pneumonia symptoms is a cornerstone of child survival programs but remains a challenge in Nigeria. Psychosocial influences, or ideations, directly influence pathways to care but have not been previously measured or examined for pediatric pneumonia. Methods: A two‐stage cluster‐sample cross‐sectional population‐based survey was conducted in Kebbi, Sokoto, and Zamfara States in September 2019. Across 108 enumeration areas, all households were enumerated to census pregnant women and randomly sample women with children under 2 years (“under‐twos”) for inclusion. Respondents were asked about pediatric pneumonia and other health‐related behaviors and ideations developed using the Ideation Model of Strategic Communication and Behavior Change. Prevalence ratios for predictors of care‐seeking from formal medical sources and antibiotic treatment for pneumonia symptoms among under‐twos were calculated using mixed‐effects Poisson regression models with robust error variance. Results: Among 350 under‐twos with pneumonia symptoms, 33.8% were taken to formal medical care and 38.0% used antibiotics. Women who positively viewed treatment efficacy and those who positively viewed health services quality had 1.35 (95% CI: 1.00‐1.82; P = .050) and 2.13 (95% CI: 1.35‐3.35; P = .001) times higher likelihood of attending formal medical sources, while women viewing peers as mostly attending drug shops had 29% lower likelihood. Perceived treatment efficacy and illness susceptibility were also significant predictors for antibiotic use. Conclusions: Program interventions focusing on increasing pneumonia knowledge alone may not be sufficient to improve care‐seeking and treatment rates and should expand to address perceived and actual poor‐quality health services and maternal beliefs about treatment efficacy, social norms, illness severity, and susceptibility

Pneumonia-related ideations, care-seeking, and treatment behaviors among children under 2 years with pneumonia symptoms in northwestern Nigeria

Background: Prompt treatment of pediatric pneumonia symptoms is a cornerstone of child survival programs but remains a challenge in Nigeria. Psychosocial influences, or ideations, directly influence pathways to care but have not been previously measured or examined for pediatric pneumonia. Methods: A two‐stage cluster‐sample cross‐sectional population‐based survey was conducted in Kebbi, Sokoto, and Zamfara States in September 2019. Across 108 enumeration areas, all households were enumerated to census pregnant women and randomly sample women with children under 2 years (“under‐twos”) for inclusion. Respondents were asked about pediatric pneumonia and other health‐related behaviors and ideations developed using the Ideation Model of Strategic Communication and Behavior Change. Prevalence ratios for predictors of care‐seeking from formal medical sources and antibiotic treatment for pneumonia symptoms among under‐twos were calculated using mixed‐effects Poisson regression models with robust error variance. Results: Among 350 under‐twos with pneumonia symptoms, 33.8% were taken to formal medical care and 38.0% used antibiotics. Women who positively viewed treatment efficacy and those who positively viewed health services quality had 1.35 (95% CI: 1.00‐1.82; P = .050) and 2.13 (95% CI: 1.35‐3.35; P = .001) times higher likelihood of attending formal medical sources, while women viewing peers as mostly attending drug shops had 29% lower likelihood. Perceived treatment efficacy and illness susceptibility were also significant predictors for antibiotic use. Conclusions: Program interventions focusing on increasing pneumonia knowledge alone may not be sufficient to improve care‐seeking and treatment rates and should expand to address perceived and actual poor‐quality health services and maternal beliefs about treatment efficacy, social norms, illness severity, and susceptibility

Gender-Based Violence Narratives in Internet-Based Conversations in Nigeria: Social Listening Study

BackgroundOvercoming gender inequities is a global priority recognized as essential for improved health and human development. Gender-based violence (GBV) is an extreme manifestation of gender inequities enacted in real-world and internet-based environments. In Nigeria, GBV has come to the forefront of attention since 2020, when a state of emergency was declared due to increased reporting of sexual violence. Understanding GBV-related social narratives is important to design public health interventions. ObjectiveWe explore how gender-related internet-based conversations in Nigeria specifically related to sexual consent (actively agreeing to sexual behavior), lack of consent, and slut-shaming (stigmatization in the form of insults based on actual or perceived sexuality and behaviors) manifest themselves and whether they changed between 2017 and 2022. Additionally, we explore what role events or social movements have in shaping gender-related narratives in Nigeria. MethodsSocial listening was carried out on 12,031 social media posts (Twitter, Facebook, forums, and blogs) and almost 2 million public searches (Google and Yahoo search engines) between April 2017 and May 2022. The data were analyzed using natural language processing to determine the most salient conversation thematic clusters, qualitatively analyze time trends in discourse, and compare data against selected key events. ResultsBetween 2017 and 2022, internet-based conversation about sexual consent increased 72,633%, from an average 3 to 2182 posts per month, while slut-shaming conversation (perpetrating or condemning) shrunk by 9%, from an average 3560 to 3253 posts per month. Thematic analysis shows conversation revolves around the objectification of women, poor comprehension of elements of sexual consent, and advocacy for public education about sexual consent. Additionally, posters created space for sexual empowerment and expressions of sex positivity, pushing back against others who weaponize posts in support of slut-shaming narrative. Time trend analysis shows a greater sense of empowerment in advocating for education around the legal age of consent for sexual activity, calling out double standards, and rejecting slut-shaming. However, analysis of emotions in social media posts shows anger was most prominent in sexual consent (n=1213, 73%) and slut-shaming (n=226, 64%) posts. Organic social movements and key events (#ArewaMeToo and #ChurchToo, the #SexforGrades scandal, and the #BBNaija television program) played a notable role in sparking discourse related to sexual consent and slut-shaming. ConclusionsSocial media narratives are significantly impacted by popular culture events, mass media programs, social movements, and micro influencers speaking out against GBV. Hashtags, media clips, and other content can be leveraged effectively to spread awareness and spark conversation around evolving gender norms. Public health practitioners and other stakeholders including policymakers, researchers, and social advocates should be prepared to capitalize on social media events and discourse to help shape the conversation in support of a normative environment that rejects GBV in all its forms