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There is no gainsaying the fact that many cultures in Africa are imbued with one form of prejudice or the other against women. Widowhood practices which encapsulate the rites performed for a woman after the death of her husband as enshrined in the different cultures of Africa are among the prevailing prejudices that have consistently impinged on the dignity and rights of womenfolk. Whereas the concept of widowhood essentially emphasizes the state of being a widow or widower, in most cultures in Africa, widowhood practices have become the exclusive preserve for widows, with associated elaborate and often gruesome guiding regulations, and not for widowers for whom little or no mourning rites are prescribed. This unfortunate trend does not only dehumanize and subjugate women to untold and unimaginable predicaments, but also institutionalizes their plights in our various cultures, thus marking them out as both socially and culturally endangered species. Through qualitative research approach and critical textual analysis, therefore, the study interrogates widowhood practices and the scapegoating of womenfolk in various Nigerian cultures, using Uche Ama-Abriel’s A Past Came Calling as Paradigm; and highlights the various dimensions of dehumanization and scapegoating to which women are subjected as a result of obnoxious widowhood practices. Hence, clutching tenaciously onto obnoxious widowhood practices which impede than facilitate meaningful rehabilitation of widows in our society and consistently portray us in a bad light is utterly unacceptable. The study is essentially envisioned as a timely clarion call for proper reorientation of the society’s psyche on the obnoxious widowhood practices, at a time when the commitment of all sundry is diligently employed in galvanizing and engendering not only ethical and political, but also socio-cultural transformation in the nation. This reorientation of psyche, if properly imbibed, will not only engender the auspicious wellbeing of widows in their rehabilitation as individual members of the society, but also the wellbeing of the society at large, and the advancing of its development.&nbsp

IntroductionRapid urbanization in Nigerian cities may likely result in small-scale variation in malaria transmission with a higher malaria burden in informal settlements and slums. However, data is unavailable to quantify city-level variations in transmission risk and to inform selection of appropriate interventions. We are conducting field studies to understand how malaria risk varies at the smallest administrative units (wards) in two major Nigerian cities – Ibadan and Kano – to inform tailoring of interventions for cities in Nigeria’s National Malaria Strategic Plan.Methods and AnalysisThis is a mixed-method research design involving qualitative and quantitative research methods. We will carry out formative qualitative studies to inform sampling strategies for formal settlements, informal settlements and slums and the design of survey questionnaires. Cross-sectional surveys will be conducted in the wet and dry seasons across wards in the study cities and within different settlement types at the household and health facility levels to map all-age and under-five malaria prevalence and evaluate related risk factors. A 12-month longitudinal study among children under the age of 10 years will provide information on malaria seasonality in the two cities and related factors. Entomological surveys will be used to undertaken for eight months (four months in each season) per city to assess local transmission risk in both cities. Descriptive and regression analysis will be applied to study data to assess malaria prevalence, seasonality and related factors. Mathematical models of malaria transmission for each study ward will be developed based on study data to inform assessment of the impact of various intervention scenarios specified by the NMEP on malaria transmission.Ethics and DisseminationThis protocol has been approved by Nigeria’s National Health Research Committee and relevant institutional Ethical Review Committees. Study results will be disseminated to key stakeholders and study communities.Strength and LimitationsStrengthsCross-sectional and longitudinal study sampling procedures and questionnaire design are enhanced by a strong formative research foundationStudy design and site selection are informed by modeling and local knowledgeThe combination of human and vector studies will provide detailed information on malaria transmission risk and associated driversLimitationsCross-sectional study may not be powered to measure all-age prevalence as sample size estimation is based on prevalence among children under the age of five yearsStudy findings may not adequately measure transmission burden and risk factors in unsampled wards

Nigeria adopted Seasonal Malaria Chemoprevention (SMC) for children under 5 years of age as part of national malaria control policies, in 2014. By 2021 the intervention was being implemented in 18 states, delivered over 4 months between June and October by 143,000 community drug distributors (CDDs) to a target population of 23.1million children. Further expansion of SMC is planned, extending to 21 states in 2022 with a target population of 27.1 million children, and an increased number of monthly cycles, from 4 to 5, may be needed in some states. In view of this massive scale-up of SMC, the National Malaria Elimination Programme conducted a qualitative research study shortly after the 2021 campaign to understand community attitudes to SMC, and to identify barriers to uptake and facilitating factors, in order to ensure that community perspectives inform future planning of SMC delivery in Nigeria. In each of five states (Kano, Kwara, Nasarawa, Yobe and Kebbi), Local Government Areas (LGAs) were ranked based on administrative coverage of SMC in 2021, and one LGA with high coverage and one with low coverage selected. In two wards (one urban and one rural) in each LGA, focus group discussions (FGDs) were held with caregivers, and in-depth interviews (IDIs) were conducted with community leaders and with community drug distributors. State-level and LGA malaria focal persons were also interviewed. At national level, key-informant interviews (KIIs) were held with the NMEP coordinator, and representatives of partners working on SMC in Nigeria. Interviews were recorded and transcribed, and those in local languages translated into English, and the transcripts were analysed using NVivo software. A total of 190 FGDs, KIIs and IDIs were undertaken. In all study areas malaria was seen as a major health concern and SMC was widely accepted as a key preventive measure, and community drug distributors (CDDs) were generally trusted. Caregivers preferred SMC delivered door-to-door to the fixed-point approach, because in addition to allowing them to continue daily tasks, door-to-door delivery allowed more time for the CDD to explain how to administer the treatments and advise about adverse reactions and to answer questions. Barriers identified included perceived side effects of SMC drugs, a lack of understanding of the purpose of SMC, mistrust and suspicions that medicines provided free may be unsafe or ineffective. Key informants and caregivers reported SMC distributions limited by drug shortages, supplies running out before all children in the community had been treated. Key findings from this study were shared with delivery teams during national and state level training in 2022 and through cascade training to all community drug distributors and others involved in SMC campaigns. Other steps to act on the findings will include updating the training curriculum to show SMC teams how to strengthen communication to caregivers on the importance, safety and effectiveness of SMC, during campaigns; more involvement of state and national level pharmacovigilance coordinators during implementation to improve completion and submission of individual case safety reports and investigation of suspected adverse drug reactions. To avoid local shortages of SMC drugs, NMEP will ensure stricter adherence to the planned medicine allocations for each facility based on microplanning estimates. Study findings were shared with donors and implementing partners, to reinforce the importance of retaining primarily door-to-door delivery of SMC in Nigeria.

Background Although Nigeria has made some progress in malaria control, there are variations across States. We investigated the factors associated with utilisation of long-lasting insecticide-treated net (LLIN) and parasitaemia among under-five children in 13 States with high malaria burden. Method Data from the 2015 Nigeria Malaria Indicator Survey and 2018 Demographic and Health Survey were obtained and analysed. The 2015 and 2018 data were compared to identify States with increase or reduction in parasitaemia. Analysis was done for all the 13 study States; four States with increased parasitaemia and nine States with reduction. Random-effects logit models were fitted to identify independent predictors of LLIN utilisation and parasitaemia. Results LLIN was used by 53.4% of 2844 children, while parasitaemia prevalence was 26.4% in 2018. Grandchildren (AOR = 5.35, CI: 1.09–26.19) were more likely to use LLIN while other relatives (AOR = 0.33, CI: 0.11–0.94) were less likely compared to children of household-heads. LLIN use was more common in children whose mother opined that only weak children could die from malaria (AOR = 1.83, CI: 1.10–3.10). Children whose mothers obtained net from antenatal or immunisation clinics (AOR = 5.30, CI: 2.32–12.14) and campaigns (AOR = 1.77, CI: 1.03–3.04) were also more likely to use LLIN. In contrast, LLIN utilisation was less likely among children in female-headed households (AOR = 0.51, CI: 0.27–0.99) and those in poor-quality houses (AOR = 0.25, CI: 0.09–0.72). Children aged 24–59 months compared to 0–11 months (AOR = 1.78, CI: 1.28–2.48), those in whom fever was reported (AOR = 1.31, CI: 1.06–1.63) and children of uneducated women (AOR = 1.89, CI: 1.32–2.70) were more likely to have parasitaemia. The likelihood of parasitaemia was higher among children from poor households compared to the rich (AOR = 2.06, CI: 1.24–3.42). The odds of parasitaemia were 98% higher among rural children (AOR = 1.98, CI: 1.37–2.87). Conclusion The key drivers of LLIN utilisation were source of net and socioeconomic characteristics. The latter was also a key factor associated with parasitaemia. These should be targeted as part of integrated malaria elimination efforts.

We sought to encourage health care providers to adhere to national malaria case management guidelines. This requires them to conduct malaria parasite tests for every patient presenting with a fever and provide malaria treatment only to those who test positive for malaria. Our goal was to make it easier for providers to follow guidelines by addressing drivers of nonadherence uncovered through facility observations and interviews with staff and clients.The case management interventions were piloted in 12 public health facilities in Akwa Ibom, Kebbi, and Nasarawa states in Nigeria between October and December 2019. Participating facilities included 1 hospital and 3 primary health centers in each state. Relevant changes included the following: (1) providers at each facility participated in facilitated discussions to correct misconceptions about the reliability of malaria test kits; (2) testing procedures were integrated into existing triage systems; (3) treatment algorithms were integrated into medical record forms; (4) providers were issued pictorial brochures outlining danger signs to share with clients, together with instructions for when to seek further care; and (5) a process was created for facilities to monitor their own adherence to guidelines.The lessons learned include: (1) disentangling the drivers of behavior allows for more targeted solutions, (2) solutions that streamline processes for overburdened providers allow them to redirect their attention and efforts where they can be most impactful, and (3) changing staff perceptions of workplace norms can support a holistic and sustained approach to behavior change.