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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]

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]

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]

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]

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]