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Background: Adolescent girls face numerous challenges which hinder their ability to manage menstruation in a healthy and dignified manner. Objectives: To examine the menstrual hygiene practices of adolescent girls schooling in rural Anambra communities. Study design: Cross-sectional descriptive study. Method: Participants were selected using multistage stratified random sampling technique and interviewed using self-administered semi-structured questionnaire. Data were analysed using Statistical Package for Social Sciences version 22.0. Results: Mean age of all, pre-menarche and post-menarche girls were 14.7 ± 1.84, 12.8 ± 1.09 and 15.1 ± 1.73 years, respectively. About 46% of the pre-menarche girls had not received any information on menstruation. Common sources of initial menstruation information were mother (87.3%), school (52.2%) and peers (20.0%). Among the 1091 (85.0% (1091/1283)) post-menarche girls, last menstrual period, last menstrual period duration and cycle length could not be recalled by 53.9%, 34.4% and 39.3%, respectively. Majority (98.3%) who could recall last menstrual period had a cycle length of ⩽30 days and the mean duration of menses was 4.4 ± 0.84 days. Disposable sanitary pad was mostly (60%) cited as recommended product, but cloth/rags (40.6%) or tissue paper (32. 3%) were predominantly used. Majority (88.6%) took their bath ⩾twice/day, 50.9% changed sanitary product ⩽twice/day while 72.5% exhibited poor hand washing. Sanitary products were mostly discarded by burning (45.4%). Fifty-one percent could not change in school predominantly due to lack of functional toilets/changing rooms (84.2%) while 72.5% of those who changed did so in bushes or unused spaces. Challenges faced during menstruation include restriction from holy places (38.9%), waist pain (74.9%), blood stains (36.1%) and lack of money to buy pad (27.0%). Factors significantly associated with using commercial pads were age (p = 0.047), class (p = 0.006), mother's educational status (p < 0.001), social class (p < 0.001), ability to recall last menstrual period date (p = 0.029) or duration (p = 0.001). Conclusion: Menstrual hygiene management was unsatisfactory among studied adolescents. Continuous education of adolescent girls on menstrual hygiene management and advocacy for adequate menstrual hygiene management support are imperative. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to critically examine the multinational oil companies' (MOCs) corporate social responsibility (CSR) initiatives in Nigeria. Its special focus is to investigate the impact of the global memorandum of understanding (GMoU) on gender difference in nutrition and health in the Niger Delta region of Nigeria. Design/methodology/approach: This paper adopts a survey research technique, aimed at gathering information from a representative sample of the population, as it is essentially cross-sectional, describing and interpreting the current situation. A total of 800 women respondents were sampled across the rural areas of the Niger Delta region. Findings: The results from the use of a combined propensity score matching and logit model indicate that CSR of the MOCs using GMoU model has made significant success in closing the gender difference in nutrition and health in agricultural household in the Niger Delta region. The findings also show that mainstreaming gender in nutrition within the field of agriculture is a critical aspect of strengthening gender and nutrition/health linkages, in recognition of women's substantial contribution to agriculture production and their central role in household food collection, preservation/processing and preparation. Practical implications: This suggests that mainstreaming gender in nutrition offers opportunities to integrate agriculture and health approaches in GMoU projects, which will require increased collaboration and coordination between the MOCs' and CBD clusters in the field of gender and nutrition to exploit existing complementary and comparative advantages, and to apply a holistic approach in host communities. Social implications: This implies that gender and nutrition/health have multiple dimensions and are highly context-specific; and the pathway towards improved food and nutrition security for all should be a gender-equitable process incorporated in CSR programmes and projects in sub-Saharan Africa. Originality/value: This research contributes to the gender debate in agriculture from a CSR perspective in developing countries and rationale for demands for social project by host communities. It concludes that business has an obligation to help in solving problems of public concern. [ABSTRACT FROM AUTHOR]

This paper examines the various labels ascribed to males in the heterosexual discourse among female undergraduates in Nigeria. Insights from Community of Practice and Sexual Script Theory were used to demonstrate the use of situated linguistic choices to establish the differentials in male sexual behaviours. Data for the study were generated through participant observation and unstructured interviews with the aid of audiotape recordings and field notes. The study involves a representative sample of 22 female undergraduates who served as participants and research assistants. The findings reveal that situated language practices stimulate heterosexual discourses where female undergraduates creatively ascribe labels to the different males' sexual scripts. The labels include those related to male sexual performance, body size and size of sex organs, financial and marital status, familial and gatekeeping roles, and other routine sexual behaviours shown by men in sexual phases such as advances, arousal and intercourse. The scripts are also combined to re-enact the peculiar sexual narratives by the female students that show emerging sexual orientations. It is believed that the categorisation of such males' sexual behaviours in the University social contexts, would provide a basis for comparison with the sexual practices of other young adults' social groups across the globe. The paper discusses the various strands of sexual scripts shown by men in their heterosexual relationships with female undergraduates in a Nigerian University. The students ascribed labels based on the sexual performance, economic and marital status, and other routine behaviours that have an impact on the male sexual lifestyle. [ABSTRACT FROM AUTHOR]

Background: Adolescents and their communities in Ebonyi State, Nigeria have poor attitudes and beliefs towards adolescent sexual and reproductive health (SRH). This paper reports on the effects of a community-embedded intervention that focused on creating positive changes in the attitudes and beliefs of adolescents and community members to enhance adolescents' access to SRH information and services. Methods: This study adopted the Qualitative Impact Assessment approach to evaluate the changes in attitudes and beliefs about the SRH of adolescents from the perspectives of the beneficiaries of a community-embedded intervention namely, adolescents, parents, school teachers, and community leaders. The intervention was implemented in six local government areas in Ebonyi State, southeast Nigeria and the evaluation was undertaken four months after the implementation of the interventions commenced. Eighteen (18) interviews were conducted with 82 intervention beneficiaries including: (i) six in-depth interviews with school teachers; (ii) two sex-disaggregated FGDs with parents; (iii) two sex-disaggregated FGDs with community leaders; and (iv) eight sex-disaggregated FGDs with in school and out of school adolescents. A thematic analysis of data was performed with the aid of NVivo software, version 12. Results: The community-embedded intervention led to changes in individual attitudes and beliefs, as well as changes in community norms and values concerning adolescent SRH. Adolescents reported that following the community-embedded SRH intervention, they have become more comfortable discussing openly SRH issues with their peers, and they could more easily approach their parents and initiate SRH discussions. The parents of adolescents reported that following the intervention, they have become more willing to discuss sensitive SRH issues with adolescents, and frequently make out time to do so. It was also reported that parents no longer use euphemisms to describe sexual body parts, and community leaders now believe that it is all right to discuss SRH with adolescents. Hence, initiating or having SRH discussions with adolescents is no longer misconceived as encouraging sex, and menstruation in unmarried adolescents is no longer viewed as a sign of promiscuity. Respondents also highlighted changes in community norms of, (i) gendered parental communication of SRH matters, as both mothers and fathers have started discussing SRH issues with their adolescent boys and girls; and (ii) public shaming and discipline of pregnant teenage girls are on the decline. Conclusion: The community-based intervention had a positive impact on individual attitudes and beliefs, as well as community and societal values and norms about adolescent SRH. Interventions that take into account community norms and values regarding adolescent SRH should be prioritized to enable the achievement of the SRH-related target of SDG 3. Plain language summary: Adolescents face significant sexual and reproductive health (SRH) challenges which makes it difficult for them to access and utilize SRH services as a result of negative community norms and values. These norms discourage discussions relating to sex and sexuality in Nigeria because sexuality matters are regarded as taboo for young people, and sex is regarded as sacred and the exclusive reserve of the married. This qualitative study explored the views of adolescents, parents, and community leaders on the impact of a community-based intervention on their attitudes and beliefs concerning SRH issues. Using focus group discussions, the community members described the impact of the intervention on the beliefs and attitudes of adolescents, parents/guardians, and the community. Following the SRH intervention, parents started to make out time to discuss SRH issues with adolescents. They became more approachable and willing to discuss sensitive SRH issues with adolescents. Both mothers and fathers started to take up the role of communicating SRH matter with their adolescent boys and girls. Adolescents also started initiating SRH discussions with parents and could openly discuss SRH issues with their peers. In the community, adolescent girls were no longer publicly shamed for engaging in pre-marital sex. There were changes in community leaders' attitudes to teenage pregnancy and they no longer misconceive adolescent SRH issues. Considering the positive changes in individual attitudes, social values, and norms, there is a need for the community-embedded SRH intervention to be sustained and scaled up to other parts of the state by program managers. [ABSTRACT FROM AUTHOR]

Inadequate on-campus student accommodation in Sub-Saharan higher educational institutions triggered the need for private sector intervention in the off-campus student private housing (SPH) delivery within university communities. This paper examines students' experiences of off-campus accommodation in terms of satisfaction indicators and driving factors in a vulnerable university's communities in South-southern Nigeria. The paper drew upon a sequential exploratory mixed method, comprising semi-structured interviews and a questionnaire survey. The paper explored interconnectivity of satisfaction indicators and factors within the threshold of building's physical attributes, community-related attributes, contract-related covenants, academic and social environment capability, through CAQDAS; Atlas.ti. The paper found disproportionate students' satisfaction level within the filtered elements and scored the overall satisfaction low. Methodologically, a convergence of results pointing to the factors for improving physical, locational, landlord commitment to tenancy agreement on services and management, and flexible regulation of students' social activities, from the two approaches, was observed. Variation surfaces from the individual rating of each indicator and the driving factors. Five distinct recommendations emerged; policy on planning, environment, and building regulations compliance, reform on SPH governance, stakeholders democracy, parent' involvement in off-campus governance, and a committee on private housing accreditation in the university communities. [ABSTRACT FROM AUTHOR]

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In Nigeria, adolescents in urban slums are increasingly at risk of adverse sexual and reproductive health (SRH) outcomes. However, little is known about how individual factors predict parent-adolescent communication on SRH issues in a resource-poor urban setting in Ibadan. Thus, this study investigated individual factors associated with parent-adolescent communication on SRH issues in urban slums of Ibadan, southwest, Nigeria. This study is part of a larger project that explores the socio-ecological factors influencing parent-adolescent communication on SRH issues in selected slums in Ibadan, Nigeria. Within this broader framework, this paper relies on the quantitative data obtained in 10 selected slums. Interviewer-administered structured questionnaire [scripted on open data kits (ODK)] was utilized to collect data from a sample of 796 parent-adolescent dyads. Six SRH topics were investigated to describe the issues discussed. Analytical techniques utilized include; frequency counts, chi-square, and multinomial logistic regression. Parent-adolescent communication regarding SRH issues is not uncommon in urban slums of Ibadan but characterized by indirect communication, threat and warning. Parents and adolescents' age, gender, marital/relationship status, educational attainments and religion played influential role in parent-adolescent communication regarding SRH issues. These factors were identified to be significantly associated with the pattern of parent-adolescent discussion of SRH issues. Age-specific SRH education should be available to adolescents and parents need to be educated on appropriate SRH information and the best way to engage their adolescents on SRH issues. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed at exploring support for older people in protracted displacement in Nigeria, emphasising the available support and the gap in the support provided to them. Design/methodology/approach: Qualitative interviews were used to collect data from ten displaced older people in New-Kuchingoro internally displaced persons (IDP) camp Abuja, Nigeria. The collected data were analysed thematically with NVivo 12. Findings: Results show that older people received material, emotional and psychological supports from their families, neighbours, friends, religious organisations and non-governmental organisations. Several gaps were identified in the support provided to displaced older people. For example, their special nutritional or medical needs were neglected, and their support was primarily material, sporadic and spontaneous, as there is no existing framework guiding the care and support of older people in displacement. Research limitations/implications: This study provides a foundation for further research on older people in displacement, an area that has received minimal scholarly attention. Practical implications: The paper recommends that researchers and displaced persons' care providers should pay more attention to the peculiar support needs of this less visible vulnerable group and adopt the internal displacement policy for the long-term protection of older people in displacement. Originality/value: Older people in displacement remain less visible as humanitarian aid programmes and research focus more on women and children. This lack of attention may put older people in displacement at more risk as their peculiar needs may not be met. To the best of the authors' knowledge, this study is the first to examine the gap in support for older people in displacement in Nigeria. [ABSTRACT FROM AUTHOR]

Background: Studies have shown that motivation to avoid pregnancy is associated with contraceptive use and continuation. These motivations can change, however, even within a short period of time. This paper uses longitudinal data to look at women's motivation to avoid pregnancy at two time points, and how changes in motivation influence contraceptive continuation. Methods: Data for this analysis came from an evaluation of the IntegratE project which seeks to expand access to family planning (FP) in Nigeria through community pharmacies and drug shops. 491 women were interviewed within 10 days after receiving a FP service from these sources and again approximately 9 months later. The dependent variable was contraceptive continuation at the follow-up interview. A categorical independent variable was used to represent changes in motivation to avoid pregnancy from enrollment to the follow-up interview. Univariate and multivariate logistic regression models were used to assess the association between changes in motivation and contraceptive continuation. Results: 89% of women continued using contraception approximately 9 months after the enrollment interview. Women who remained highly motivated to avoid pregnancy were significantly more likely to continue using contraception compared to women who became more motivated (AOR 2.5; 95% CI 1.0–6.0). Women who became less motivated were 64% less likely to continue using contraception compared to who became more motivated (AOR 0.36 95% CI 0.1–0.9). Conclusion: FP providers, including private sector pharmacists and drug shop owners, should continuously check-in with women about their motivations around pregnancy to support continuation among those who wish to avoid pregnancy. Plain language summary: Previous research has found women's motivations to avoid pregnancy- how important it is to avoid pregnancy now- is associated with their contraception use. Yet women's motivations to avoid pregnancy often change, even within a short period of time. This paper looks at whether changes in motivation to avoid pregnancy are associated with continued use of contraception in Nigeria. We used data from a larger evaluation of the IntegratE project which seeks to expand access to family planning (FP) in Nigeria through community pharmacies and drug shops. 491 women were interviewed within 10 days after receiving a FP service (counseling, referral or FP method) from these sources and again 9 months later. We then used logistic regression models to assess whether changes in motivation to avoid pregnancy between receiving a FP service to 9 months later is associated with continued use of FP. We found that many women (89%) continued using contraception approximately 9 months after the enrollment interview. Women who remained highly motivated (reported it was very important to avoid pregnancy at both interviews) were more likely to continue using contraception compared to women who became more motivated between the two interviews. Women who became less motivated were 64% less likely to continue using contraception compared to who became more motivated. Our results suggest that FP providers, including private sector pharmacists and drug shop owners, should continuously check in with women about their motivations around pregnancy to support continuation contraceptive use among those who wish to avoid pregnancy. [ABSTRACT FROM AUTHOR]

Purpose: Reintegration programs have emerged as part of the regimes of care for survivors of human trafficking. However, empirical analysis of the reintegration outcomes for survivors remains limited in the African context. Hence, this paper aims to examine the challenges and opportunities of reintegration assistance programs for survivors of human trafficking in Nigeria. Design/methodology/approach: Drawing on qualitative methods of data collection and analysis, this study conducted semi-structured interviews with repatriated women who have accessed reintegration assistance in Nigeria, and data was analyzed using thematic analysis. Findings: The findings suggest that while the reintegration programs might address the procedural aspect of reintegration, the achievement of substantive reintegration remains incomplete. This is because of the structural conditions of the context within which reintegration is supposed to occur. Practical implications: There is a need to take seriously the distinction between the reintegration of survivors into a new community or a former community in the design of a regime of care for survivors of human trafficking in Africa. Crucially, the focus on procedural reintegration should not also divert attention away from the structural conditions and reforms needed to ensure survivors achieve substantive reintegration. Originality/value: This paper contributes to the limited literature on life after trafficking and demonstrates the strengths and limitations of reintegration programs as a regime of care for survivors of human trafficking. In addition, this study empirically grounded the theoretical distinction between different aspects of the process of reintegration. [ABSTRACT FROM AUTHOR]

Gestational Diabetes Mellitus (GDM) is a major public health issue and a threat to the well-being of a mother and her offspring. As a growing concern in sub-Saharan Africa, this paper explores the knowledge, attitude, and practices of healthy expectant mothers towards GDM, and the content of GDM information delivered by prenatal nurses during Antenatal Clinic (ANC) in Warri, Delta State, Nigeria. Semi-structured telephone interviews were employed with 22 participants comprising 20 pregnant women and 2 antenatal nurses. The results reveal that majority of the pregnant women were unaware of GDM as a particular health condition during pregnancy that poses a risk to both maternal and infant health and could lead to a long-term risk of developing the chronic condition of Type 2 Diabetes Mellitus (T2DM). This low level of awareness was attributed to a lack of adequate information during prenatal clinic sessions. The findings from this study emphasize the need to enhance the quality of public health education offered to pregnant women during pre and antenatal clinical services emphasizing GDM as part of the overall global agenda on promoting maternal and infant health. [ABSTRACT FROM AUTHOR]

BACKGROUND: People with intellectual disability are likely to face long-standing employment barriers in finding and keeping jobs, for a variety of reasons. This study, therefore, investigated barriers to employment of people with intellectual disability. The participants in this study were made up of sixty-five stakeholders who were recruited from six different categories. OBJECTIVE: The objective of the study was to determine barriers to employment of people with intellectual disability. METHODS: A qualitative and quantitative research design was used in the study. The qualitative method was used to systematically identify barriers to employment for people with intellectual disability while the quantitative method was used to rank the barriers. RESULTS: Findings indicate that barriers to employment for people with developmental disabilities are discrimination, stigma, employers' attitude, and management style, feeling unappreciated, and working environment such as culture to accommodation, understanding and strengths. Moreover, results shows that discrimination was ranked the highest while feeling unappreciated was ranked the least of the barriers to employment of people with intellectual disability. CONCLUSION: The paper provides information about barriers to employment of people with intellectual disability in Nigeria that is required to initiate change in policy development. [ABSTRACT FROM AUTHOR]

The paper documents environmental health conditions and healthcare access challenges faced by internally displaced people (IDPs) from Borno State living in informal settlements in Lagos, Nigeria, in 2020, during the early stages of the COVID-19 pandemic. This qualitative study with 32 IDPs suggests a high vulnerability to COVID-19. Their accommodation often lacked basic sanitation including water and toilet facilities; overcrowding and high population density restricted ability to adhere to social distancing; and IDPs experienced serious consequences from lockdown, as the majority depended on daily wages, and did not receive food packages or other support from the State. Finally, there were obstacles to accessing healthcare. We highlight the importance of an integrated approach, consolidating the efforts of communities, non-governmental organisations, environmental and public health, and international organisations to address the health and well-being issues of IDPs in urban informal settlements. [ABSTRACT FROM AUTHOR]

A small proportion of women are found in the prison population worldwide and consequently they have been ignored in prison studies and policy engagements designed to mitigate their "pains of imprisonment." Despite the growing literature on prison science, only a few data-based studies have investigated the negative experiences of women prisoners in Nigeria. This research, therefore, sets out to empirically examine the gender-specific problems facing female inmates. A thematic analysis of the in-depth oral interview data generated from 25 inmates purposively selected from the women population revealed that their dietary, medical, personal hygienic and motherhood needs were grossly insufficient and dehumanizing. The situation is so debilitating that they have no option but to reuse such personal hygienic requirements as sanitary/menstrual pads and sometimes, use toilet papers and pieces of cloths in its stead. Other needs were occasionally met by their family members, churches, charity organizations, and individual donors. Confining women in correctional facilities established and equipped for men rather intensified their plight. The study calls for continuous determined efforts by governments, civil liberty organizations, faith-based institutions, and the academia to obtain – through policy, research, and practice – empirical evidence that is capable of providing practical solution to the problem. The intervention is both multi-sectoral and cross-disciplinary based, demonstrating a new drive and potential for harm reduction, as well as strengthening the growing advocacy on the treatment of (women) prisoners for better results. The call for further studies was also discussed to justify any perceived limitations. [ABSTRACT FROM AUTHOR]

Young mothers often encounter stigma and discrimination, affecting their lives and that of their children. This paper explores stigma management strategies and their effectiveness for young mothers in rural Nigeria. Ten key informants and 24 young mothers were recruited from Ife-East in South-Western Nigeria. Data from semi-structured interviews showed that societal disapproval of pregnant teenagers and young mothers were common experiences. Women used a range of strategies to actively cope with stigma including: belief in predestination, avoidance, concealment, and cohabitation. These strategies could be seen as tools to mitigate negative stereotypes and discrimination. However, they also had the unintended consequences of compounding many young women’s difficult circumstances and exposing them to adverse outcomes, including gender-based violence, repeat pregnancies, poor mental health, and low uptake of services. The results show the need for policy frameworks to actively combat stigma by addressing the negative framing of early pregnancy and motherhood and promoting supportive environments for young mothers. Health professionals need to be trained to offer de-stigmatising services to encourage young mothers to seek help and reduce pre-existing inequities in access to services, and policies need to include measures that address the rights of young mothers and protect them from violence and abuse. [ABSTRACT FROM AUTHOR]

Internally displaced youth and adolescents may continue to suffer from displacement-associated trauma and stress many years after initial displacement. Hence, our study initially aimed to qualitatively explore how displaced youth and adolescents in Nigeria are coping with the trauma and stress associated with protracted displacement. However, through serendipity, results from the thematic analysis of semi-structured interviews from 22 displaced youths and nine professionals in Abuja revealed that in addition to some positive coping mechanisms, some displaced young males turn to drugs, while some young women turn to transactional sex and multiple sexual partners to deal with the impact of protracted displacement. This may lead to increased crime, morbidity, and mortality, thus requiring immediate intervention. This paper concluded by recommending that social workers help displaced youth and adolescents deal with their current stressors by advocating for the improvement of their living situation while also working with other professionals to intervene on the issue of drug misuse and unhealthy sexual behaviours through continuous education. [ABSTRACT FROM AUTHOR]

Suicide is one of the leading causes of death among young people aged 15 to 29 years of age. Ideation or suicidal thoughts, which precedes suicide is sometimes normalized and excused thereby missing avertable deaths within a given context. Understanding suicide ideation and the associated social correlates within contexts can provide cues on how to mitigate suicide. This paper examines the potential social factors that are shaping suicidal ideation among young people in two universities in Nigeria. Based on a mixed-method design, a survey was conducted among a proportionate sample of 500 young people (18–25years that are undergraduates). Four Focus Group Discussion sessions were also held among the same group and six semi-structured interviews with social workers at both universities. Quantitative evidence associated irregular financial support (OR = 0.60; p < 0.05) and broken intimate relationship (OR = 1.57; P < 0.05) with suicide ideation. Findings from the qualitative component also considered undergraduates that have academic challenges, engage in substance abuse, and have parents with marital problems to be prone to suicidal ideation. Suicidal ideation among these young people is embedded in their network of relationships, which can be mitigated when the quality of support systems is responsive and adequately accessed. [ABSTRACT FROM AUTHOR]

Aging is a natural occurrence often associated with decline in body functioning and common health conditions. With the emergency of new diseases, vulnerable groups like older adults are prone and more possibly to be infected. In the era of COVID-19 pandemic and beyond, health management of older adults becomes demanding with increasing ill-health, morbidity and mortality. This paper aims to investigate caregivers' lived experiences in health care management of older adults amid and post COVID-19 pandemic for quality of life and wellbeing in Nigeria. With the phenomenological approach in qualitative research, we sourced our data using focus group discussions (FGDs) and in-depth interviews (IDI) from 21 caregivers purposively selected from three health institutions based on their ownership in Nsukka. Data were analyzed thematically. Results revealed that though care-giving is perceived to be filial, it is no longer effectively provided owing to financial and health status of the care recipient. Other findings indicated that factors predicting responds to preventive measures in older adults' health care include disregard of information, inadequate geriatric knowledge and noncompliance of health information. Suggestions to ease challenges in health care demand of older adults were brought to fore. Recommendations were on aligning geriatric professionals in health institutions and health care financing for all older adults in Nigeria. [ABSTRACT FROM AUTHOR]

Purpose: Institutionalized older adults in care homes and long-care facilities have been identified as being at greater risk of COVID-19 related morbidity and mortality. Thus, this paper aims to explore the impact of COVID-19 on care homes in south-east Nigeria given the recent increasing popularity of care homes in Nigeria. Design/methodology/approach: The study adopted qualitative research method, and data was collected from 10 older residents and 5 caregivers using interviews from two care homes, while ensuring the safety of the researcher and participants. The collected data was analyzed using thematic analysis. Findings: Findings revealed that the physical health impact of the COVID-19 pandemic is not a major problem in the homes. However, fear and anxiety, social disconnection and economic hardship were the major problems identified by the older residents and caregivers in the homes. Originality/value: The popularity of care homes in Nigeria is growing as family structures continue to change. However, previous studies which have revealed devastating effect of COVID-19 on institutionalized older adults have been from the global north. This is the first study designed to bridge the gap in literature and contribute to knowledge on this topic from Nigeria and Sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

The novel COVID-19 pandemic and its containment measures such as lockdown and physical distancing are remarkedly affecting older adults' economic activities and well-being in ways deserving of urgent attention. To strengthen caregiving and promote targeted care for older adults during and after the pandemic, this paper investigates the impact of the coronavirus on the economic activities and well-being of older adults in Enugu and Anambra states, Nigeria. Hermeneutic phenomenology was adopted and 16 older adults aged between 60 and 81 years, with a majority of them still working as farmers and traders were phone-interviewed. Findings highlighted four key lessons for gerontological social workers including 1) the fear that impact of the containment measures could kill the older adults faster than the virus; 2) the measures generate a feeling of neglect and marginalization of healthcare needs among older adults; 3) altered positive health-seeking behavior among the older adults; 4) and concern about the absence of functional policy and plan to address the welfare of older adults. Therefore, the central focus of the gerontological social workers and Nigerian polity should not be on how to reduce the spread of the disease alone, but on an application of caution in instituting and implementing the measures. [ABSTRACT FROM AUTHOR]

While studies in social media and disability are growing globally, there is paucity in such studies in Nigeria. This study addresses this apparent gap by exploring the experiences and perceptions of Nigerian adults living with physical disability regarding social media, using an interpretive approach. A total of nine adults with physical disability between the ages of 20 and 34, living in urban areas, were interviewed in this study. Findings show that participants experienced diminished social contact and smaller social networks due to their disability. However, participants who used social media experienced increased social contact, developed social relationships, and had larger social networks. Participants also acknowledged social media as a useful platform for disability advocacy and awareness. Results support a call for continued efforts to support adults with physical disability experiencing diminished social contact to use social media to increase their social wellbeing. Implications for future research and practice are discussed. The paper examines the perceptions and experience of social media use among adults with physical disability in Nigeria. Analyses show that adults with physical disability in Nigeria experience some form of diminished social contact and smaller social networks due to their disability. Nigerian adults with physical disability who use social media experience increased social contact, establish and maintain social relationships, and have a larger social networks. Adults with physical disability in Nigeria acknowledge social media as a useful platform for disability awareness and advocacy. This research recommends that Nigerian adults with physical disability experiencing diminished social contact should use social media to increase their social wellbeing. [ABSTRACT FROM AUTHOR]

Studies on medicinal ethnobotany in rural areas and communities are important for documentation and generation of indigenous knowledge on the medicinal use of plants, as well as identification of new botanicals of pharmacological significance. This paper presents, for the first time, the quantitative ethnobotanical uses of medicinal plants in Ile-Ife, Osun State, Nigeria. The ethnobotanical survey was carried out by conducting semistructured interviews with 70 informants/collaborators. Data were analyzed using various quantitative indices, namely, Ethnobotanical Knowledge Index (EKI), Species Popularity Index (SPI), Relative Frequency of Citation (RFC), Cultural Importance Index (CII), Informant Consensus Factor (FIC), Fidelity Level (FL), and Species Therapeutic Index (STI). A total of 87 plant species belonging to 43 families were documented along with their medicinal uses. Euphorbiaceae is the most implicated family (9%) of the plants documented, and herbs (36%) were the prevalent life form while leaf (46%) was the most used plant part. Fevers are the most common diseases treated with the medicinal plants with 1012 use-reports, followed by skin diseases with 314 use-reports while the most common mode of preparation is decoction (37%). Telfaria occidentalis has the highest SPI and RFC (0.99, 0.99) while Khaya grandifoliola has the highest CII of 1.91. The community has EKI of 0.57 indicating a good knowledge of medicinal plants around them. Species such as Citrus aurantifolia, Khaya grandifoliola, and Ocimum gratissimum have high quantitative indices suggesting that they are effective in the treatment of various diseases in the community and therefore should be considered for pharmacological studies to validate their folkloric usages. [ABSTRACT FROM AUTHOR]

Purpose: The novel coronavirus disease (COVID-19) pandemic has further intensified the vulnerability of older persons in displacement and rendered them more unseen. This study aims at exploring the impact of COVID-19 on older people in displacement. Design/methodology/approach: Data were obtained using semi-structured interviews from 12 older persons at Durumi IDP camp Abuja, while observing strict infection control measures. The data were inductively coded with Nvivo and analysed thematically. Findings: Findings revealed that the economic and psychosocial fallout of the COVID-19 pandemic has increased older persons in displacement poverty, psychological stress and placed them at risk of ageism, social isolation and may subsequently lead to secondary displacement, thereby losing all progress, development and resilience built after initial displacement. Social implications: This paper concluded by encouraging the need for all stakeholders to pay more attention to this invisible yet vulnerable group to ensure no one is left behind as people fight through this pandemic and its social implications. Originality/value: To the best of the authors' knowledge, this study is the first to explore the impact of COVID-19 on older people in displacement in Nigeria. This is because they have been relatively invisible to research endeavours. [ABSTRACT FROM AUTHOR]

Background Absenteeism in the health sector is increasingly seen as a form of harmful rule-breaking, with health workers receiving a salary although they are not present to provide care. It is a barrier to achieving universal health coverage yet remains widespread in primary health centres (PHCs) in Nigeria and many other low-resource settings. Traditional approaches to combatting absenteeism have relied on anti-corruption measures such as promoting accountability and transparency. However, more needs to be understood about the social and cultural realities, including perceptions and norms enabling or constraining the application of such measures in Nigeria and in similar contexts. Methods We conducted 34 in-depth interviews (IDIs) with frontline health workers and their managers/supervisors and two focus group discussions (FDGs) with service users (n=22) in Enugu State, South Eastern Nigeria. We discussed their experiences and views about absenteeism, allowing the respondents' framings to emerge. We adopted a mixed approach of narrative analysis and phenomenology to examine respondents' narratives - identifying the concepts and social constructs within the narratives that manifested through the language used. Results Stakeholders acknowledged the problem of absenteeism but had differing perspectives on its dynamics. Health workers distinguished two forms of absenteeism: one as a mundane, everyday response to the poorly funded health system; and the other, brazen and often politically enabled absenteeism, where health workers whom powerful politicians protect are absent without facing consequences. There is a general feeling of powerlessness among both health service providers and service users confronted by politically backed absentees as the power dynamics in the health sector resonate with experiences in other spheres of life in Nigeria. Health workers rationalised mundane, technical absenteeism, adjusted to it and felt it should be accommodated in the health system. Service users are often unsure about who is absent and why, but when they notice absenteeism, they often ascribe it to wider system malpractices that characterise public services. Conclusion Interventions to tackle absenteeism and other forms of health sector corruption should be sensitive to socio-cultural and political contexts that shape everyday lives in specific contexts. Challenging narratives/beliefs that normalise absenteeism should be part of reform plans. [ABSTRACT FROM AUTHOR]

Background The obstetric transition model suggests that, as countries economically develop, the primary causes of maternal mortality change. Countries are assigned to one of five stages based on their maternal mortality ratio to identify priorities for reducing maternal deaths based on predominant determinants of mortality at each stage. We aim to validate the obstetric transition model using data from six diverse low- and middle-income countries representing self-identified priorities for improving maternal health and measurement compiled in a multi-stakeholder process. Methods We used multiple data sources from Bangladesh, Cote d'Ivoire, India, Mexico, Nigeria, and Pakistan, which included secondary data on country context and primary data derived from two sources: the content of multi-stakeholder meetings, called National Dialogues, which were organised around the 11 key themes identified in the World Health Organization's "Strategies toward ending preventable maternal mortality" (EPMM) and follow-up key informant interviews conducted in five of the seven countries. We conducted the analysis in four phases examining, the country's contextual profile, mapping the key themes and indicators to the model, exploring stakeholder prioritisation, and examining reasons for divergence from the model. Results Our results suggest that the stages of the obstetric transition generally align with the social, epidemiological, and health systems characteristics that the model predicts to be associated with countries at each stage, with some deviation related to health system deficiencies and barriers to access. Stakeholder priorities in maternal health generally align with those predicted by the model. Equity and women's rights emerged as a priority throughout all stages, not only within countries that are more advanced in the transition, as predicted by the model. Deviations between the model's predictions and country-level prioritisation were often explained by context-specific challenges. Conclusions This study is one of the first to validate the obstetric transition model using real data. Our findings support the validity of the obstetric transition model as a useful guide to aid decisionmakers in prioritising attention towards addressing maternal mortality. Country context, including equity, remains important to further inform priority-setting. [ABSTRACT FROM AUTHOR]

Refugees and asylum seekers bring with them a plurality of cultures, traditions, and values that could prove crucial in influencing perceived health needs, requests for intervention, or willingness to undergo specific health treatments. Although studies have focused on the health consequences of forced migration, in recent years, there has been a lack of information on how refugees and asylum seekers represent their experiences of perceived health needs and elements that influence well-being, in a community context. This study aims to explore the experience of refugees and asylum seekers in an Italian multicultural community about perceived health needs. A qualitative phenomenological study was conducted with an interpretive approach. The data were collected using a semi-structured face-to-face interview. The interviews were transcribed, read thoroughly, and analyzed. Nineteen refugees and asylum seekers were interviewed. Three main themes were extracted: (1) the centrality of the family to feel healthy; (2) feeling part of a community; and (3) stability and security. The results confirm that health needs, experiences, and different cultural representations of health and illness should be read and addressed with a culturally competent vision. This study was not registered. [ABSTRACT FROM AUTHOR]

Background: Community health workers play an important role in linking communities with formal health service providers, thereby improving access to and utilization of health care. A novel cadre of community health workers known as village health workers (VHWs) were recruited to create demand for maternal health services in the Nigerian Subsidy Reinvestment Programme (SURE-P/MCH). In this study, we investigated the role of contextual factors and underlying mechanisms motivating VHWs. Methods: We used realist evaluation to understand the impact of a multi-intervention maternal and child health programme on VHW motivation using Anambra State as a case study. Initial working theories and logic maps were developed through literature review and stakeholder engagement; programme theories were developed and tested using focus group discussions and in-depth interviews with various stakeholder groups. Interview transcripts were analysed through an integrated approach of Context, Mechanism and Outcomes (CMO) categorisation and connecting, and matching of patterns of CMO configurations. Motivation theories were used to explain factors that influence VHW motivation. Explanatory configurations are reported in line with RAMESES reporting standards. Results: The performance of VHWs in the SURE-P maternal and child health programme was linked to four main mechanisms of motivation: feelings of confidence, sense of identity or feeling of acceptance, feeling of happiness and hopefulness/expectation of valued outcome. These mechanisms were triggered by interactions of programme-specific contexts and resources such as training and supervision of VHWs by skilled health workers, provision of first aid kits and uniforms, and payments of a monthly stipend. The monthly payment was considered to be the most important motivational factor by VHWs. VHWs used a combination of innovative approaches to create demand for maternity services among pregnant women, and their performance was influenced by health system factors such as organisational capacity and culture, and societal factors such as relationship with the community and community support. Conclusion: This paper highlights important contextual factors and mechanisms for VHW motivation that can be applied to other interventions that seek to strengthen community engagement and demand creation in primary health care. Future research on how to sustain VHW motivation is also required. [ABSTRACT FROM AUTHOR]

Blind people have been consistently underemployed in Nigeria. There have been recent policy initiatives, and programmes especially by the federal government and the Lagos state government, aimed at improving the unemployment situation of people with disabilities, but not much success has been recorded. This study explored the views of blind individuals about their (un)employment experiences to understand their challenges and proffer solutions. The study employed a qualitative approach, conducting one-to-one unstructured qualitative interviews with 22 blind and visually impaired adults aged between 18 and 55 years. Verbatim transcripts of the interviews were analysed using the thematic analysis approach. Four major themes emerged: describing participants' views on discrimination and lack of inclusive processes in recruitment; perceived gaps with policy enforcement; inadequate support systems for vocational skills training and entrepreneurship; as well as general views on life, society, and hopes for future employment opportunities. The most common barrier to employment mentioned by participants was the misconception by employers that being blind meant being unable to work. There was a general lack of confidence and trust in recent policies seeking to address structural barriers to visually impaired people's employment goals. Real solutions and specific policy changes were desired. [ABSTRACT FROM AUTHOR]

Background: Multidrug‑resistant bacterial infections are still a global challenge and successful antimicrobial stewardship (AMS) requires multidisciplinary collaborative partnership. Studies have highlighted the knowledge and perceptions of pharmacists, but there is a paucity of data about practices of pharmacists in teaching hospitals in Nigeria. We set out to determine the knowledge and practices of pharmacists in a major tertiary health facility (THF) in Lagos, Nigeria, before starting an AMS intervention program. Methods: This cross‑sectional survey used electronic forms to find out the knowledge and practices of pharmacists employed in a large tertiary health facility. Data were collected during a Commonwealth Partnerships for AMS program to support low‑ and middle‑income countries to produce antimicrobial consumption surveillance data, quality improvement initiatives, and infection prevention and control (IPC) processes. Results: Two‑thirds of respondents knew that antibiotics were effective against bacteria, and 48.6% knew the causes of antimicrobial resistance. Almost all (97.1%) agreed that AMS must be done, IPC is important, and they were confident to point out inappropriate prescribing. Three‑quarters had advised colleagues or been involved in AMS activities; however, 62.9% had fully or mostly changed their practices based on information received, and 26.5% had participated in World Antibiotic Awareness Week. Conclusion: There are still gaps in knowledge and practices, which underscore the need to entrench regular training on the job. However, there is overall awareness of AMS and a desire for it to be carried out at all levels. Pharmacists are useful for choosing appropriate antibiotics and can play a vital role in AMS. [ABSTRACT FROM AUTHOR]

Objective: This study was carried out to document the medicinal values and therapeutic applications of different parts of A. cordifolia in Ekebedi Oboro ancient Kingdom of Abia State, Nigeria, and profile its bioactive constituents. Material-Method: The ethno-botanical survey involved questionnaires and oral interviews of 81 randomly selected traditional medicine doctors and natives on medicinal values of A. cordifolia. GC-MS fingerprinting was adopted to elucidate the bioactive constituents of the methanol leaf extract of the plant. Results: The survey showed that A. cordifolia is prescribed in different treatment regimens for coughs, bronchitis, postpartum bleeding, lacerations, wounds, vaginitis, diarrhea, sickle cell anemia, and venereal diseases, including gonorrhea, syphilis, and prostatitis. Phytochemical fingerprinting revealed the presence of several bioactive compounds as the major active ingredients of the plant. A total of 27 fatty acids and volatile hydrocarbons were detected in the leaf extract of the plant with 9, 12-Octadecadienoic acid (Z, Z)- methyl ester (18.42%), 9-Octadecenoic acid methyl ester (19.93%), Dodecanoic acid 1,2,3-propanetrieyl (15.87%) as most abundant ingredients. Conclusion: A. cordifolia is used to treat various diseases such as sickle cell anemia, diabetes, post-partum bleeding, and HIV infections amongst others. The fatty acids identified in A. cordifolia possibly underscored these antimicrobial and therapeutic actions of the plant in traditional medicine. [ABSTRACT FROM AUTHOR]

An estimated 6 million children under the age of five in Nigeria (out of nearly 31 million) risk not reaching their full developmental potential. The dearth of context-relevant measures poses a challenge to the planning and implementation of effective interventions. This study assesses the utility of the Early Childhood Development Index (ECDI) in Nigeria. We used the Multiple Indicator Cluster Surveys to track progress among 3- to 4-year-old children (n = 11,073); 3-year-old, 51%; female, 49%. Using random calibration samples, the results from psychometric tests indicate that while over half of the children were on track in their development based on the ECDI, the instrument had low to average internal consistency and weak face validity, suggesting an inadequacy in capturing ECD information of value. At the outset of the launch of the new ECDI2030, the results of this study point to the need for continued discourse and advocacy for the use of culturally appropriate measures of child development, and a child-centered community engagement approach. This is essential in ensuring accountability and responsive interventions for the children served and their families. [ABSTRACT FROM AUTHOR]

The report that persons over 65 years of age are the fastest-growing age group and the projected potential effect of the growth rate on older adults' support ratio has raised concerns globally, resulting in interventions targeted at promoting and establishing alternative care options, including residential facilities. Promoting alternative care options became more necessary with the reduction of traditional informal care, a significant source of care in many developing countries. However, while studies in developed countries documented the views of older adults regarding alternative care options, those in Nigerian settings majorly reported opinions of caregivers of older adults. This underscores the relevance of exploring the perception of living in residential care facilities from the standpoint of older adults who are the primary residents of the care facilities. A qualitative descriptive design was adopted in interviewing 20 older adults categorised as non-residents, residents in care facilities and adult day-care recipients. The participants were drawn from Enugu-East and Enugu-West senatorial zones in Enugu State. The data was coded with the use of NVivo 12 and analysed thematically. The results revealed that the non-residents majorly perceived care provided to the ageing population in residential care facilities as abandonment by selfish and irresponsible children. This perception was highly influenced by the people's culture, which favoured the filial care option. Also, the people stigmatized-shamed those who accept alternative care options. With these, the study recommends culture reorientation through education and sensitisation to ensure the ageing population is knowledgeable about other care options as filial care continues to decline. [ABSTRACT FROM AUTHOR]

Background: Anaemia in pregnancy causes a significant burden of maternal morbidity and mortality in sub-Saharan Africa, with prevalence ranging from 25 to 45% in Nigeria. The main treatment, daily oral iron, is associated with suboptimal adherence and effectiveness. Among pregnant women with iron deficiency, which is a leading cause of anaemia (IDA), intravenous (IV) iron is an alternative treatment in moderate or severe cases. This qualitative study explored the acceptability of IV iron in the states of Kano and Lagos in Nigeria. Methods: We purposively sampled various stakeholders, including pregnant women, domestic decision-makers, and healthcare providers (HCPs) during the pre-intervention phase of a hybrid clinical trial (IVON trial) in 10 healthcare facilities across three levels of the health system. Semi-structured topic guides guided 12 focus group discussions (140 participants) and 29 key informant interviews. We used the theoretical framework of acceptability to conduct qualitative content analysis. Results: We identified three main themes and eight sub-themes that reflected the prospective acceptability of IV iron therapy. Generally, all stakeholders had a positive affective attitude towards IV iron based on its comparative advantages to oral iron. The HCPs noted the effectiveness of IV iron in its ability to evoke an immediate response and capacity to reduce anaemia-related complications. It was perceived as a suitable alternative to blood transfusion for specific individuals based on ethicality. However, to pregnant women and the HCPs, IV iron could present a higher opportunity cost than oral iron for the users and providers as it necessitates additional time to receive and administer it. To all stakeholder groups, leveraging the existing infrastructure to facilitate IV iron treatment will stimulate coherence and self-efficacy while strengthening the existing trust between pregnant women and HCPs can avert misconceptions. Finally, even though high out-of-pocket costs might make IV iron out of reach for poor women, the HCPs felt it can potentially prevent higher treatment fees from complications of IDA. Conclusions: IV iron has a potential to become the preferred treatment for iron-deficiency anaemia in pregnancy in Nigeria if proven effective. HCP training, optimisation of information and clinical care delivery during antenatal visits, uninterrupted supply of IV iron, and subsidies to offset higher costs need to be considered to improve its acceptability. Trial registration ISRCTN registry ISRCT N6348 4804. Registered on 10 December 2020 Clinicaltrials.gov NCT04976179. Registered on 26 July 2021 Plain language summary: Low blood level in pregnancy is of public health importance and with common occurrence worldwide, but with a higher rate in low resource settings where its burden greatly affects both the mother and her baby. This low blood level is usually caused by poor intake of an iron-rich diet. It could lead to fatigue, decreased work capacity, and dizziness if not detected. Without treatment, this condition could affect the baby, possibly leading to its sudden demise in the womb, immediately after birth, or even the woman's death. The use of oral iron has been the primary treatment; however, it is associated with significant side effects, which have led to poor compliance. Fortunately, an alternative therapy in the form of a drip has been shown to overcome these challenges. However, it is not routinely used in countries like Nigeria. Moreover, being effective is different from being utilised. Therefore, this study was conducted to understand the factors that will make this treatment widely accepted. We interviewed pregnant women, family support and health care providers in 10 health facilities in Lagos and Kano States, Nigeria. Our findings revealed good attitudes to iron drip. However, its inclusion into routine antenatal health talk, training of health care providers, availability of space, drugs and health workers who will provide this care, and ensuring this drug is of low cost are some of the efforts needed for this treatment to be accepted. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: Sexual and reproductive health (SRH) interventions demand diverse services, encompassing medical, social and psychological care to ensure the overall wellbeing of service users. In the absence of multidisciplinary response to SRH interventions, service users could be deprived of crucial SRH services, which could undermine their safety and wellbeing. Based on this knowledge, our study was designed to map the interprofessional space in primary healthcare (PHC) facilities in Ebonyi State, Nigeria that deliver SRH services. Design/methodology/approach: Interviews with 20 health workers and group discussions with 72 young people aged 15–24 years provided the data for the study. We analyzed data deductively, focusing on the assessments of the presence or absence of specific professionals that are typically expected to provide different aspects of SRH services. Findings: We found conspicuous absence of laboratory diagnostic, social care, psycho-cognitive and some medical services expected of primary care. These absences necessitated unnecessary referrals, encouraged breaches in confidentiality, undermined social care and justice, increased cost of care and discouraged young clients from utilizing SRH services provided in PHCs. Our study, therefore, emphasizes the need for integrated care in the delivery of SRH services, which would involve relevant diverse professionals contributing their expertise toward comprehensive care for SRH service users. Originality/value: The study provides human resource insights toward strengthening primary healthcare in Nigeria vis-à-vis efficient delivery of SRH services to guarantee the health security of service users. [ABSTRACT FROM AUTHOR]

Children are considered as social and economic safety nets for their elderly parents in many developing countries, including Nigeria. This perception is driven by the fact that state-sponsored welfare systems are almost non-existent thereby placing parents as the sole care providers for their young children, and grown children as the sole care providers for their older parents. What this may mean for older people without children is that they are left with inadequate material support which could affect their well-being and life satisfaction. This study examines the adequacy of material support systems for childless older adults in southeast Nigeria with the aim to inform policy and social work interventions to ensure adequate support for the older adults. Twelve childless older adults aged 75 and older partook in the in-depth interview. The collected data was analyzed thematically. Except for the government support system, childless older adults receive material support from the networks of family, community, and churches. However, the support available from these networks seems to be inadequate and irregular. The study recommends for the political will by government to ensure that the newly approved national policy on ageing benefits older adults. Social workers are highly needed to ensure that other necessary programmes are established, and also strengthen the systems that support older adults. [ABSTRACT FROM AUTHOR]

Background: HIV seroprevalence in Nigeria is increasing among men who have sex with men (MSM) from 14% to 2007 to 23% in 2014, threatening progress towards ending the epidemic in the country. Expanding access to HIV testing and linkage to care for key populations, like young MSM (YMSM), is critical to end the HIV epidemic in Nigeria. The Intensive Combination Approach to Roll Back the Epidemic in Nigerian Adolescents (iCARE Nigeria) pilot intervention successfully implemented a combination of evidence-based interventions utilizing peer navigators and popular social media apps and platforms to reach young men at risk for HIV exposure, including YMSM. We conducted sequential mixed methods explanatory implementation research to expand on the previously reported effectiveness and implementation outcomes and to explore the determinants and strategies which contributed to primary study results. Methods: We conducted key informant interviews and focus group discussions with 2 peer navigators and 3 study staff at the end of the pilot. We used directed content analysis to understand the quantitative results from the pilot. Using the Implementation Research Logic Model, we were able to identify and map strategies through mechanisms of action from barriers addressed to the reported implementation outcomes including feasibility, acceptability fidelity and adoption. Results: We found that iCARE Nigeria's pilot intervention implementers reported high feasibility, acceptability fidelity and adoption were associated with implementation of strategies which addressed many challenging contextual factors, including social stigma, online social networking, legal barriers surrounding MSM behavior, and the COVID-19 pandemic. These strategies included integration of stakeholders' interests, selection of experienced peer navigators including from the targeted population, training and supportive supervision using an implementation guide, ensuring safety (COVID and legal) and identification of clinics serving the targeted population. Conclusion: Mixed methods using implementation research frameworks provided insights into the strategies and barriers and facilitators they addressed which may explain the success of the pilot. These results can inform strategies needed to scale-up the intervention to youth including YMSM in other areas in Nigeria and the region. Trial registration ISRCTN: ISRCTN94590823, https://doi.org/10.1186/ISRCTN94590823 [ABSTRACT FROM AUTHOR]

Background: Hepatitis B virus (HBV) screening is an important component of antenatal care for pregnant women in Nigeria. However, the screening rates remain low, particularly at primary healthcare centers (PHCs). The objective of this study was to identify the barriers affecting antenatal HBV screening in PHCs in Nigeria from the perspective of health workers. Methods: We conducted a survey among 30 health workers from 30 PHCs (one per PHC) across three states (Akwa Ibom, Anambra, and Kaduna) in Nigeria. An open-ended questionnaire was used to obtain written responses on the perceived barriers limiting antenatal HBV screening in PHCs and their recommended solutions to the identified barriers. The data were analyzed using an inductive thematic approach. Results: The perceived barriers exist at patient, provider and health system levels. They included: lack of test kits, unaffordability of HBV test, shortage of trained personnel, poor awareness among pregnant women, knowledge of HBV among health workers, high cost of antiviral treatment, and unavailability of HBV vaccine. The recommended solutions to the identified barriers were: making test kits and vaccines available and free, creating awareness about HBV, and capacity-building interventions for health workers. Conclusions: HBV screening of pregnant women attending PHCs in Nigeria appears to be affected by multilevel barriers. As the country continues to work towards eliminating HBV, these highlighted barriers at the patient, provider and health system levels must be addressed through effective and sustainable interventions. [ABSTRACT FROM AUTHOR]

Aim: To explore the experiences of Nigerian nurses in research and scholarly endeavours. Design: Descriptive phenomenological qualitative study design. Method: In‐depth interviews were conducted among 30 nurses until data saturation was reached. Data were analysed using the thematic analysis method, and consolidated criteria for reporting qualitative research guidelines (COREQ) were adhered to in reporting this study. Results: Three themes emerged: (1) challenges of nurses with research; (2) the state of nursing research in Lagos state; (3) strategies to improve the state of nursing research in Lagos state. Some challenges nurses in Lagos State encounter with research include heavy workload and nursing shortage due to brain drain, faulty research foundation, lack of continuing education in research and the stressful nature of conducting research in Lagos. Conclusion: As research is essential in addressing healthcare challenges, policymakers are encouraged to employ more nurses to reduce the workload and provide time for research activities. Training and continuing education in research can be incorporated into professional development programmes. Lagos State will benefit from nursing research units in the hospitals, and a coordinating centre for the units should be provided with adequate funding. Support could be obtained from the Institute of Nursing Research Nigeria in establishing these structures. Hospital management should embrace and welcome research output from nurses and ensure such results are implemented to improve patients' care. Nurses who excel in research might be recognised with awards and other incentives to inspire their peers. [ABSTRACT FROM AUTHOR]

Objective: To adapt and validate the original English version of the World Health Organization Quality of Life Questionnaire-version for older adults (WHOQOL-OLD) in Igbo language, culture, and environment. Participants: Community-dwelling older adults (≥65 years) from Nnewi community in Nigeria. Methods: This was a cross-cultural adaptation and validation study. The original English version of the WHOQOL-OLD was translated into Igbo language, synthesized, backward translated into the English language, subjected to expert panel review, and pretested. The Igbo and English versions of the WHOQOL-OLD were then used to assess the quality of life among consecutively recruited 109 older adults through interviewer-administration. Findings: The structure of the Igbo version of the WHOQOL-OLD differed from that of the original WHOQOL-OLD. The Igbo version of the WHOQOL-OLD displayed acceptable internal consistency (0.63–0.95), known-group validity (0.60–0.99), convergent validity, and ceiling and floor effects. Conclusion: The I-WHOQOL-OLD is a reliable and valid tool and thus can be used as an outcome measure among Igbo-speaking older adults. [ABSTRACT FROM AUTHOR]

Background: Folk medicine is crucial to healthcare delivery in the underdeveloped countries. It is frequently used as a primary treatment option or as a complementary therapy for malaria. Malaria is a deadly disease which greatly threatens global public health, claiming incredible number of lives yearly. The study was aimed at documenting the medicinal plants used for malaria treatment in folk medicine in Kwara State, Nigeria. Methods: Ethnobotanical information was collected from selected consenting registered traditional medicine practitioners (TMPs) through oral face-to-face interviews using in-depth, semi-structured interview guide. The ethnobotanical data were analysed, and descriptive statistical methods were used to compile them. Results: Sixty-two indigenous medicinal plants, including 13 new plants, used for malaria treatment were identified in this study. The TMPs preferred decoction in aqueous solvent (34%) and steeping in decaffeinated soft drink (19%) for herbal preparations. Oral administration (74%) was the main route of administration, while leaves (40%) and stem barks (32%) were the most dominant plant parts used in herbal preparations. The most cited families were Fabaceae (15%) and Rutaceae (6%), while Mangifera indica (77.14%), Enantia chlorantha (65.71%), Alstonia boonei (57.14%) followed by Cymbopogon citratus (54.29%) were the most used plants. Besides, the antimalarial activities of many of the plants recorded and their isolated phytocompounds have been demonstrated. Furthermore, the conservation status of 4 identified plants were Vulnerable. Conclusion: The study showed strong ethnobotanical knowledge shared by the TMPs in the State and provides preliminary information that could be explored for the discovery of more potent antimalarial compounds. [ABSTRACT FROM AUTHOR]

Background: Patent medicine vendors (PMVs) play vital roles in the delivery of family planning services in Nigeria and other developing countries. There is a growing recognition of the need to integrate them into the formal health care system as a strategy to increase the contraceptive prevalence rate and achieve universal health coverage. Though promising, the success of this proposition is largely dependent on a critical analysis of the factors which influence their operations. This study was designed to identify the contextual factors influencing the provision of injectable contraceptive services by PMVs and the broader effects of their activities on the health system to inform similar interventions in Nigeria. Methods: This was a qualitative study guided by the UK Medical Research Council's Framework for Complex Interventions. Twenty-seven in-depth interviews were conducted among officials of the association of PMVs, health workers, government regulatory officers and programme implementers who participated in a phased 3-year (2015–2018) intervention designed to enhance the capacity of PMVs to deliver injectable contraceptive services. The data were transcribed and analyzed thematically using NVIVO software. Results: The contextual factors which had implications on the roles of PMVs were socio-cultural and religious, the failing Nigerian health system coupled with government regulatory policies. Other factors were interprofessional tensions and rivalry between the PMVs and some categories of health care workers and increasing donors' interest in exploring the potentials of PMVs for expanded healthcare service provision. According to the respondents, the PMVs bridged the Nigerian health system service delivery gaps serving as the first point of contact for injectable contraceptive services and this increased contraceptive uptake in the study sites. A negative effect of their operation is the tendency to exceed their service provision limits, which has spurred a planned tiered PMV accreditation system. Conclusions: This study has highlighted the contextual factors which define the roles and scope of practice of PMVs involved in injectable contraceptive service provision. Strategies and interventions aimed at expanding the healthcare delivery roles of PMVs must be encompassing to address the broader contextual factors which underpin their capacities and functions. [ABSTRACT FROM AUTHOR]

Introduction: The "second victim" phenomenon refers to the distress and other negative consequences that physicians experience when they commit medical error. There has been increasing awareness about this phenomenon and efforts are being made to address it. However, there is dearth of information about it in developing countries. This study explored the experiences of surgical resident doctors of the University College Hospital in Ibadan, Nigeria about the "second victim" phenomenon and the support they had following medical errors. Methods: This is a phenomenology study in which qualitative data were obtained from interviews with 31 resident doctors across 10 surgical units/departments. Interviews were transcribed verbatim, and data were coded inductively. Data were analyzed using content analysis method. Themes and subthemes were generated using axial coding. The themes were then integrated using selective coding. Results: There were 31 participants and 10(32.3%) were females. All had witnessed other physicians encountering medical errors while 28(90.3%) had been directly involved in medical errors. Most of the errors were at the inter-operative stage. Prolonged work hours with inadequate sleep were identified as major causes of most medical errors. The feelings following medical errors were all negative and was described as 'stressful'. Most of the residents got support from their colleagues, mostly contemporaries following medical errors, and many viewed medical errors as a learning point to improve their practice. However, there was a general belief that the systemic support following medical errors was inadequate. Conclusion: The "second victim" phenomenon was common among the study group with consequent negative effects. Normalizing discussions about medical errors, reduction of work hours and meticulous intraoperative guidance may reduce medical errors and its consequences on the surgical residents. Steps should be taken within the system to address this issue effectively. [ABSTRACT FROM AUTHOR]

Background: Maternal and child health is a priority for most governments, especially those in low and middle-income countries (LMICs), due to high mortality rates. The combination of individual and social actions designed to gain political commitment, policy support and social acceptance for health goals are influenced by the interplay between the advocates and the strategies they deploy in planning and advocating for maternal and child health issue. This study aims to deepen our understanding of how advocacy has influenced maternal and child health priority setting in Nigeria. Methods: This is a mixed method study that involved 24 key informant interviews, document review, policy tracking and mapping of advocacy events that contributed to the repositioning of maternal and child health on the political agenda was done. Respondents were deliberately selected according to their roles and positions. Analysis was based on Shiffman and Smith's policy analysis framework of agenda setting. Results: Our findings suggest that use of various strategies for advocacy such as influencers, media, generated different outcomes and the use of a combination of strategies was found to be more effective. The role of advocacy in issue emergence was prominent and the presence of powerful actors, favorable policy window helped achieve desired outcomes. The power of the advocates and the strength of the individuals involved played a key role. Conclusion: This study finds it possible to understand the role of advocacy in policy agenda setting through the application of agenda setting framework. To achieve the health SDG goals, advocacy barriers need to be addressed at multiple levels. [ABSTRACT FROM AUTHOR]

Introduction: This study explored the perspectives of traditional health care practitioners (THPs) practicing in the areas of herbalism, bone setting, and traditional birth attendance, from Akwa Ibom state, Nigeria, on the possibility and implications of applying informed consent (IC) during African traditional medicine (ATM) practice. Methods: Semistructured interviews were conducted with 11 THPs, consisting of 5 herbalists, 3 traditional bone setters (TBS), and 3 traditional birth attendants (TBAs), who represented the diverse groups that the study intended to cover. In-depth interviews were conducted using a semistructured guide and were recorded, transcribed, and analyzed using thematic analysis with the assistance of NVivo® qualitative analysis software. Results: Participants were seven males (64%) and four females (36%), 35–67 years of age, with 5–25 years of experience as THPs. Forty-six percent of participants were herbalists (27%), TBS, and TBAs (27%). Most participants (82%) were Annang, and (18%) were Ibibio first-language speakers. Three major themes emerged from the data analysis: (i) Existing ethical framework related to IC, (ii) knowledge of consent, and (iii) application of IC during traditional medical practice. These themes and relevant subthemes were explored. All (100%) THPs agreed that it was essential to communicate risks and benefits while allowing patients to ask questions before treatment. All participants (100%) stated that risk communication is essential in ATM, whereas 36% said they communicated all therapy benefits to their patients. Respondents believed patients could make an informed choice if they had complete information disclosure. However, THPs in this study had limited knowledge of formal IC rules and regulations. Conclusions: This study revealed that THPs in this setting disclose a diagnosis, risks, some benefits, and treatment options to patients. Consent/agreement was obtained verbally and voluntarily during ATM practice, consistent with IC doctrine. THPs had limited knowledge of the critical elements of IC. However, they suggested that a form of IC that does not conflict with traditional African norms could be applicable in ATM. IC could facilitate documentation and help reduce risks in ATM practice. [ABSTRACT FROM AUTHOR]

Background: Adolescent maternal healthcare utilisation is low in Nigeria, and little is understood about the pregnancy experiences and drivers of maternal healthcare utilisation among of adolescent girls. This study investigated the pregnancy experiences and maternal healthcare utilisation among adolescent mothers across Nigeria. Methods: The study used the qualitative design. Urban and rural communities in Ondo, Imo and Katsina states were selected as research sites. Fifty-five in-depth interviews were conducted with adolescent girls who were currently pregnant or had given birth to a child recently, and nineteen in-depth interviews were conducted with older women who were either mothers or guardians of adolescent mothers. Additionally, key informant interviews were conducted with five female community leaders and six senior health workers. The interviews were transcribed, and resulting textual data were analysed via framework thematic analysis using a semantic and deductive approach, with the aid of NVivo software. Results: The findings showed that the majority of unmarried participants had unintended pregnancies and stigma against pregnant adolescents was common. Social and financial support from family members, maternal support and influence, as well as healthcare preferences shaped by cultural and religious norms were the major drivers of maternal healthcare use among adolescent mothers, and the choice of their healthcare providers. Conclusions: Interventions to support adolescent mothers and increase maternal healthcare utilisation among them must focus on ensuring the provision of social and financial support for adolescent mothers, and should be culturally sensitive. [ABSTRACT FROM AUTHOR]

Purpose: The ways family members engage and communicate with each other has significant impacts on well-being and coping strategies in the face of adversity, but there is a dearth of studies examining family functioning programming in humanitarian settings, particularly programs that incorporate a gender lens and engage multiple family members and genders. This study evaluates the Sibling Support for Adolescent Girls in Emergencies (SSAGE) intervention to understand the impact of gender transformative family programming on family functioning. Methods: The 12-week SSAGE program engaged adolescent girls, their adolescent brothers, and their caregivers in Northeast Nigeria in synchronous sessions stratified by gender and age, with curricula exploring topics including gender-based violence, healthy relationships, and positive parenting. The two-week, post-intervention qualitative evaluation consisted of key informant and paired interviews, participatory research activities, focus group discussions, and in-depth interviews with 90 program participants and 12 program staff/mentors to understand the intervention's impact on attitudes and behaviors around family gender roles. Results: Findings revealed improved communication within families, bolstered by mentors' encouragement to discuss program topics within households, and caregivers' and siblings' shift toward the use of healthier, non-corporal behavior control methods. Families described how the intervention promoted conversations around gendered issues including early marriage, education, employment, and puberty. Results: This study builds the evidence base for gender transformative family functioning programming in humanitarian contexts. Practitioners should work to ensure safety of women and girls in future programming, particularly by focusing on communication skills and promoting gender norms change both within households and the community. [ABSTRACT FROM AUTHOR]

The increasing phenomenon of street children aiding visually challenged beggars and the risk factors involved in such activity is of much concern to social workers in Nigeria. With low investment in social protection for vulnerable children, a large number of children are constantly involved in income‐generating activities on the street. This study through in‐depth interviews explored the experiences of children who aid visually challenged beggars in a semi‐urban city in Nigeria. Findings based on lived experiences are thematically discussed in this study. Well‐coordinated social protection measures can keep vulnerable children off the street and within the safety net of their family. [ABSTRACT FROM AUTHOR]

Patient-centered healthcare is a goal for all health systems. However, given the inherent complexities of the health system as one with many nonlinear and dynamic components, the safety of patients could be affected. Therefore, there is the need to study these complexities to manage them toward optimal service delivery. The present study is a qualitative inquiry into the complexities of primary healthcare (PHC) in Nigeria and effects on patients' safety across four PHC facilities in Enugu state in southeast Nigeria. It utilizes a framework that draws on the components of interprofessional collaboration, inclusive of health financing and health workforce satisfaction, to understand the complex PHC system and patient safety. The study findings show that the PHC system in the study area performs suboptimally on the three counts, which implies poor management of the complexities of the system such that patients are highly susceptible to harm. Making a commitment to addressing the shortcomings present in each of the three components will help to decomplexify PHC in line with the World Health Organization agenda of achieving resilient and strong health systems. Importantly, optimizing the psychosocial space in Nigeria's PHC by employing qualified social workers and other psychosocial professionals is crucial for patient safety and a range of psychosocial activities that can enhance job satisfaction of health workers. [ABSTRACT FROM AUTHOR]

Adequate intake of high‐quality nutritious foods during infancy and early childhood is critical to achieving optimal growth, cognitive and behavioural development, and economic productivity later in life. Integrating high‐quality and nutrient‐dense animal source foods (ASFs), a major source of protein and micronutrients, into children's diets is increasingly considered essential to reducing the global burden of malnutrition in low‐ and middle‐income countries. While eggs are an ASF that shows promise for mitigating child undernutrition, interventions promoting egg consumption among children have had mixed results in improving egg intake and child growth outcomes. As part of an evaluation of a demand creation campaign promoting egg consumption, qualitative research was carried out in September 2019 to assess sociocultural and household factors affecting egg intake among young children living in Kaduna State, Nigeria, where a thriving egg industry and childhood stunting rates of 50% exist. Methods included freelisting exercises (11), key informant interviews (11), in‐depth interviews (25) and FGDs (4). Results illuminated cultural rules that restrict egg consumption among children living in low‐income households. These rules and norms reflect social and economic valuations that foster male dominance in household decision‐making and guide food purchasing and intrahousehold food allocation that allow men to consume eggs more regularly. Study results highlight sociocultural considerations when selecting food interventions to address child malnutrition in low‐income contexts. Interventions encouraging increased consumption of ASFs, and specifically eggs in young children, should be informed by formative research to understand sociocultural norms and beliefs guiding egg consumption. Key messages: In food classification systems, eggs are considered a light, non‐filling food associated with enjoyment, status and wealth, and in low‐income households widespread consumption of eggs is reserved for special occasions.Cultural rules devised to regulate egg consumption according to age and gender in low‐income households reflect differential social and economic valuations that favour men and discourage egg consumption in young children.Interventions encouraging increased egg intake in young children must consider economic constraints and related sociocultural norms and beliefs guiding egg consumption and identify contextually appropriate strategies to buffer the effects of gender and age bias. [ABSTRACT FROM AUTHOR]