Search

Despite the wide spread awareness regarding the need to improve maternal health, maternal mortality remains a great concern in Nigeria. Consequently, the importance of medical attention required in the care of pregnant women cannot be over emphasised. This study investigates the influence of barriers to attending antenatal care among pregnant women in Ibadan. Using a survey method, a total of 114 pregnant women were purposively selected from Akinyele Local Government Area of Ibadan.Data were analyzed using descriptive statistics, t- test and one way analysis of variance at 0.05 level of significance. Three hypotheses were tested. Results revealed that pregnant women who had more barriers (N = 54, mean = 4.5) were less likely to attend antenatal care than women who had fewer barriers (N = 60, mean = 5.6). Pregnant women who had no children (nulliparous) attended antenatal care more than pregnant women who have had at least one child (multiparous) (t (112) = 1.2 p< 0.05).Thus, barriers should be reduced by making antenatal care mobile and health care givers should be re- trained to develop more positive attitude towards better service delivery especially to pregnant women during antenatal period.

Investigated taboos and beliefs about the nutritional value of foods among pregnant women from Nigeria's Hausa and Yoruba tribes. Found that Hausa women had greater nutritional anemia than Yoruba women; their babies had greater incidence of low birth weights and smaller chest and head measurements. Hausa women learned food-related beliefs from their mothers, Yoruba women, from their mothers-in-law. (JPB)

Background: Oral health care behaviors during pregnancy affects maternal and child health outcomes. This scoping review sought to map the existing literature on the oral healthcare behaviors of pregnant women in Nigeria. Methods: PubMed, Science Direct, Web of Science, EBSCOHOST, Sabinet, African Index Medicus, and Scopus data based were searched in August 2023. Articles with reports on the oral health behavior of pregnant women in Nigeria, published in English in peer review were included in the review. Articles whose full lengths could not be accessed, and commentaries on studies, and letters to the editor were also excluded. Data on authors and year of publication of the study, study location, study objective, study design, methodological approach for data collection, and study outcomes were extracted and descriptively synthesized. Results: The search yielded a total of 595 articles of which 573 were unique. Only 21 articles were left after titles and abstracts screening and only 18 articles met the eligibility criteria. The proportion of pregnant women had utilized dental services ranged from 4 to 62.9%, the use of toothbrush and toothpaste ranged from 59.6 to 99.3%, twice daily tooth brushing ranged from 5.2 to 66.9%, and the use of toothbrush among pregnant women in the studies varies from 70.9 to 100%. Chewing stick was used by 0.1–27.7% of study participants. Dental problems such as caries, pain, swollen gums, and excessive salivation were reasons for seeking dental care. We identified individual, structural, and behavioral factors, including myths as barriers for dental service utilization. Conclusion: This scoping review shows that dental service utilization by pregnant women in Nigeria is poor and mainly due to curative than preventive needs. Oral health behaviours also need to be improved through tailored oral health education accessible to pregnant women in Nigeria. [ABSTRACT FROM AUTHOR]

Objective: To describe the incidence, and sociodemographic and clinical factors associated with preterm birth and perinatal mortality in Nigeria. Design: Secondary analysis of data collected through the Maternal Perinatal Database for Quality, Equity and Dignity (MPD‐4‐QED) Programme. Setting: Data from births in 54 referral‐level hospitals across Nigeria between 1 September 2019 and 31 August 2020. Population: A total of 69 698 births. Methods: Multilevel modelling was used to determine the factors associated with preterm birth and perinatal mortality. Outcome measures: Preterm birth and preterm perinatal mortality. Results: Of 62 383 live births, 9547 were preterm (153 per 1000 live births). Maternal age (<20 years – adjusted odds ratio [aOR] 1.52, 95% CI 1.36–1.71; >35 years – aOR 1.23, 95% CI 1.16–1.30), no formal education (aOR 1.68, 95% CI 1.54–1.84), partner not gainfully employed (aOR 1.94, 95% CI 1.61–2.34) and no antenatal care (aOR 2.62, 95% CI 2.42–2.84) were associated with preterm births. Early neonatal mortality for preterm neonates was 47.2 per 1000 preterm live births (451/9547). Father's occupation (manual labour aOR 1.52, 95% CI 1.20–1.93), hypertensive disorders of pregnancy (aOR 1.37, 95% CI 1.02–1.83), no antenatal care (aOR 2.74, 95% CI 2.04–3.67), earlier gestation (28 to <32 weeks – aOR 2.94, 95% CI 2.15–4.10; 32 to <34 weeks – aOR 1.80, 95% CI 1.3–2.44) and birthweight <1000 g (aOR 21.35, 95% CI 12.54–36.33) were associated with preterm perinatal mortality. Conclusions: Preterm birth and perinatal mortality in Nigeria are high. Efforts should be made to enhance access to quality health care during pregnancy, delivery and the neonatal period, and improve the parental socio‐economic status. [ABSTRACT FROM AUTHOR]

Introduction: Antenatal care (ANC) is crucial for positive pregnancy outcomes, but it is underutilised in Nigeria, suggesting unmet needs, and potentially contributing to the country's high burden of maternal and neonatal mortalities. This study comprehensively assesses ANC utilisation and receipt of its components in Nigeria, focusing on disparities between rural and urban areas. Methods: We used the data disaggregation approach to analyse the Nigeria Demographic and Health Survey 2018. We estimated ANC utilisation, assessed the receipt of ANC components, and identified factors associated with eight or more (≥ 8) ANC contacts nationally and across rural and urban residences. Results: Nationwide, only 20.3% of women had ≥ 8 ANC contacts, with a significant disparity (P < 0.001) between urban (35.5%) and rural (10.4%) areas in Nigeria. The North-East region had the lowest ANC utilisation nationally (3.7%) and in urban areas (3.0%), while the North-West had the lowest in rural areas (2.7%). Nationally, 69% of mothers received iron supplements, 70% had tetanus injections, and 16% received medicines for intestinal parasites, with urban residents having higher proportions across all ANC components. Maternal and husband education, health insurance, and maternal autonomy were associated with increased ANC odds at the national, rural, and urban residences. However, differences exist, with all ethnicities having higher ANC odds than the Hausa/Fulanis in urban areas and the Yorubas demonstrating greater odds than other ethnicities in rural settings. Internet use was significant only in the national context, watching television only in urban settings, while maternal working status, wealth, birth type, religion, and radio listenership were significant in rural areas. Conclusion: Our study reveals significant disparities in ANC utilisation and components across Nigeria, with rural residents, particularly in northern regions, as well as socioeconomically disadvantaged and teenage mothers facing notable challenges. A multifaceted approach prioritising the interplay of intersectional factors like geography, socioeconomic status, education, religion, ethnicity, and gender dynamics is essential. Key strategies should include targeted interventions to promote educational opportunities, expand health insurance coverage, leverage internet and context-specific media, and foster socioeconomic empowerment, with priority for underserved populations. [ABSTRACT FROM AUTHOR]

Background: Gestational diabetes mellitus (GDM) is a serious threat to first-time pregnancy. Objective: To determine the knowledge, attitude, and practice (KAP) regarding gestational diabetes mellitus (GDM) among pregnant women on antenatal appointment in government approved healthcare facilities in Nigeria and also to establish the significant correlation and association within sociodemographic variables. Methods: It was a facility-based cross-sectional study, conducted in government-approved healthcare facilities in Nigeria, from January to March, 2023. A total of 1750 pregnant women were sampled and surveyed using convenient sampling technique. Data were collected using an adapted questionnaire "Gestational Diabetes Mellitus Knowledge, Attitude and Practice Questionnaire" with 0.87 reliability index. Statistical analysis was completed using IBM SPSS version 22. Frequency, percentage, odds ratio statistics, and chi-square test were applied for data analysis. All computations were deemed statistically significant at p value ≤ 0.05. Results: Out of 1750 eligible participants, 1488 (88.4%) valid responses were analyzed. The study showed that 69% knew about GDM, 65% had positive attitude, and 79% had desirable GDM practice. Statistically, there were strong correlation between KAP regarding GDM and age, marital status, education level, and parity status (odds ratio ≥ 1). Furthermore, the KAP regarding GDM was significantly associated with alcohol consumption, education, parity status, and resident (p value < 0.05), respectively. Conclusion: Approximately three-quarter of the pregnant women knew about GDM, had positive attitude, and had desirable GDM practice. The KAP regarding GDM was strongly correlated and significantly associated with sociodemographic variables. Facility-based interventions on KAP regarding GDM are paramount to be incorporated in the national health programs to improve knowledge and enhance attitude and GDM practices. [ABSTRACT FROM AUTHOR]

Background: Unskilled delivery, particularly the use of traditional birth attendants, is a major threat to reducing maternal mortality in Africa. Despite the associated risks, there is insufficient evidence on the major reasons why pregnant women in Nigeria continue to use traditional birth attendant (TBA) services, especially in rural areas. This study, therefore, assessed the perception, reasons for use, and utilization of only TBA services in current pregnancy among rural-dwelling pregnant women in Lagos, Nigeria. Methods: A descriptive cross-sectional study was conducted among 347 pregnant women recruited from traditional birth attendant facilities at Ikorodu Local Government Area, Lagos. Data were collected with an interviewer-administered questionnaire and analyzed using SPSS version 25. Bivariate and multivariate analyses were conducted with a significance level set at p<0.05. The outcome measures included perception, utilization of only TBA services in current pregnancy, and reasons for use. Positive perception refers to positive thought, belief, or opinionheld by the participants towards the TBA. Results: All the respondents had a positive perception of TBAs, majority (70.3%) utilized TBA only while 29.7% combined TBA and healthcare facilities services in the current pregnancy. Recommendations from previous users (81.6%), welcoming and hospitable staff (77.2%), perceived spiritual protection (75.2%), and past use (68.6%), were some of the reasons cited by the respondents for utilizing only TBA services. Predictors of utilizing only TBA services were respondents' level of education, those with secondary (aOR = 0.261; 95% CI; 0.108–0.629) and tertiary (aOR = 0.352; 95% CI; 0.162–0.769) had lower utilization while the lack of health insurance coverage (aOR = 3.017; 95% CI; 1.476–6.166) were associated with higher utilization of TBAs. Conclusion: Respondents in this study had a positive perception of TBA services. Continuous training and an effective monitoring system of TBAs by the government and other healthcare stakeholders to improve women's birthing experiences is recommended. [ABSTRACT FROM AUTHOR]

Background: Maternal deaths are concentrated in low and middle-income countries, and Africa accounts for over 50% of the deaths. Women from socioeconomically disadvantaged households have higher morbidity and mortality rates and lower access to maternal health services. Understanding and addressing these inequalities is crucial for achieving the Sustainable Development Goals and improving maternal health outcomes. This study examines the demographic and economic disparities in the utilization of antenatal care (ANC) in four countries with high maternal mortality rates in Africa, namely Nigeria, Chad, Liberia, and Sierra Leone. Method: The study utilised data from Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) from Nigeria, Chad, Liberia, and Sierra Leone. The data was obtained from the Health Equity Assessment Toolkit (HEAT) database. The study examined ANC service utilisation inequality in four dimensions such as economic status, education, place of residence, and subnational region across different subgroups by using four summary measures (Difference (D), Absolute Concentration Index (ACI), Population Attributable Risk (PAR), and Population Attributable Factor (PAF)). Result: A varying level of inequality in ANC coverage across multiple survey years was observed in Nigeria, Chad, Liberia, and Sierra Leone. Different regions and countries exhibit varying levels of inequality. Disparities were prominent based on educational attainment and place of residence. Higher level of inequality was generally observed among individuals with higher education and those residing in urban areas. Inequality in ANC coverage was also observed by economic status, subnational region, and other factors in Nigeria, Chad, Liberia, and Sierra Leone. ANC coverage is generally higher among the richest quintile subgroup, indicating inequality. Nigeria and Chad show the highest levels of inequality in ANC coverage across multiple measures. Sierra Leone displays some variation with higher coverage among the poorest quintile subgroup. Conclusion and recommendation: Inequalities in ANC coverage exist across age groups and survey years in Nigeria, Chad, Liberia, and Sierra Leone. Disparities are prominent based on education, residence, and economic status. Efforts should focus on improving access for vulnerable groups, enhancing education and awareness, strengthening healthcare infrastructure, and addressing economic disparities. [ABSTRACT FROM AUTHOR]

Background Eclampsia causes maternal mortality in Nigeria. This study presents the effectiveness of multifaceted interventions that addressed institutional barriers in reducing the incidence and case fatality rates associated with eclampsia. Methods The design was quasi-experimental and the activities implemented at intervention hospitals included a new strategic plan, retraining health providers on eclampsia management protocols, clinical reviews of delivery care and educating pregnant women and their partners. Prospective data were collected monthly on eclampsia and related indicators from study sites over 2 y. The results were analysed by univariate, bivariate and multivariable logistic regression. Results The results show a higher eclampsia rate (5.88% vs 2.45%) and a lower use of partograph and antenatal care (ANC; 17.99% vs 23.42%) in control compared with intervention hospitals, but similar case fatality rates of <1%. Overall, adjusted analysis shows a 63% decrease in the odds of eclampsia at intervention compared with control hospitals. Factors associated with eclampsia were ANC, referral for care from other facilities and older maternal age. Conclusion We conclude that multifaceted interventions that address challenges associated with managing pre-eclampsia and eclampsia in health facilities can reduce eclampsia occurrence in referral facilities in Nigeria and potential eclampsia death in resource-poor African countries. [ABSTRACT FROM AUTHOR]

Background: Pregnancy serves as a physiological stress test for the thyroid which often leads to dysfunction in women with limited thyroid reserves. The occurrence of gestational thyroid dysfunction is linked to unfavourable obstetric and foetal outcomes. Globally, iodine deficiency is a prominent causative factor for thyroid dysfunction. The study aimed to determine the prevalence and pattern of thyroid dysfunction among pregnant women in Enugu, South-east Nigeria. Methodology: This hospital-based descriptive cross-sectional and observational study was conducted over six months on selected participants from pregnant women attending antenatal clinics at the study sites. Maternal clinical and demographic risk factors for thyroid dysfunction were evaluated in a cohort of 318 pregnant women. An analysis of variance (ANOVA) was performed to compare participants' thyroid status across different trimesters of pregnancy, and different thyroid and nutritional iodine states. Result: The prevalence of thyroid dysfunction in the study population is 6.6%. Hypothyroidism was detected in 5.3% of the participants, consisting of 3.8% sub-clinical hypothyroidism and 1.6% overt hypothyroidism. Subclinical hyperthyroidism accounted for 1.3% of all participants; no overt hyperthyroidism was detected in this study. Conclusion: There is a relatively high prevalence of gestational thyroid dysfunction in the study population with hypothyroidism being the predominant disorder. This highlights the need for region-specific considerations in antenatal care to facilitate early detection and effective management of gestational thyroid dysfunction, thereby mitigating potential adverse maternal and foetal outcomes. [ABSTRACT FROM AUTHOR]

Malaria presents a huge threat to pregnant women, their foetus, and children below five years. This study is aimed at assessing malaria prevalence, associated clinical symptoms, and urine abnormalities among pregnant women in Aba metropolis, Abia State, Nigeria. A cross-sectional study involving 450 pregnant women purposively selected from nine health care centres was conducted. Data were analysed using SPSS version 26. The overall malaria prevalence rate was 68.4% (n = 308). Age group of 21-25 years had the highest prevalence rate of 20.4% (n = 92) while the least was recorded among the age group of 41-45 years (17 (3.8%)). Pregnant women in their first trimester had the greatest prevalence rate of 28.6% (n = 129), and the least prevalence was recorded among those in their third trimester (7 (15.6%)). The primigravidae were mostly infected at the rate of 27.7% (n = 125) whereas the multigravidae recorded the least prevalence of 85 (18.9%). Participants with secondary education were the most susceptible at the rate of 38.6% (n = 174). The infected participants exhibited significantly higher frequencies of reported fever (p > 0.001 , OR 12.881, 95% CI 3.977-41.725) and headaches (p < 0.001 , OR 4.688, 95% CI 1.819-12.083). However, cold, cough, body pains, poor appetite, and catarrh showed no significant association with malaria infection at p > 0.05. Participants using long-lasting insecticidal nets (LLINs) showed significantly lower prevalence rate of malaria infection (p < 0.001 , OR 2.485, 95% CI 1.619-3.814). Malaria-infected participants showed statistically significant frequencies of proteinuria (p < 0.001 , OR 274.14, 95% CI 16.91-4444.0), bilirubinuria (p < 0.001 , OR 49.29, 95% CI 11.01-186.34), and urobilinogenuria (p < 0.001 , OR 65.16, 95% CI 4.00-1062.40) than those not infected. Ascorbic acid, nitrate, and ketone showed no significant associations with malaria infection at p > 0.005. Infected participants had statistically significant amber and clear urine colour whereas there was no statistically significant difference between the pH levels of urine of the malaria-infected and malaria-noninfected pregnant women. [ABSTRACT FROM AUTHOR]

Despite the vast advantages of making antenatal care visits, the service utilization among pregnant women in Nigeria is suboptimal. A five-year monitoring estimate indicated that about 24% of the women who had live births made no visit. The non-utilization induced excessive zeroes in the outcome of interest. Thus, this study adopted a zero-inflated negative binomial model within a Bayesian framework to identify the spatial pattern and the key factors hindering antenatal care utilization in Nigeria. We overcome the intractability associated with posterior inference by adopting a Pólya-Gamma data-augmentation technique to facilitate inference. The Gibbs sampling algorithm was used to draw samples from the joint posterior distribution. Results revealed that type of place of residence, maternal level of education, access to mass media, household work index, and woman's working status have significant effects on the use of antenatal care services. Findings identified substantial state-level spatial disparity in antenatal care utilization across the country. Cost-effective techniques to achieve an acceptable frequency of utilization include the creation of a community-specific awareness to emphasize the importance and benefits of the appropriate utilization. Special consideration should be given to older pregnant women, women in poor antenatal utilization states, and women residing in poor road network regions. [ABSTRACT FROM AUTHOR]

Background: Platelets are pivotal players in the pathophysiology of pre-eclampsia, with observed lower counts in affected individuals compared to normotensive counterparts. Despite advancements, the elusive cause of pre-eclampsia persists, motivating intense global efforts to identify reliable predictors. The currently recommended predictors of pre-eclampsia are not readily available in many resource-limited regions like Nigeria. This cohort study explores the potential of mean platelet volume (MPV) and platelet distribution width (PDW) as predictive markers of early-onset pre-eclampsia. Both platelet indices are components of the full blood count, a widely available routine test in pregnancy. Methods: In this prospective cohort study, 648 healthy pregnant women attending antenatal care at Lagos State University Teaching Hospital and General Hospital Ifako-Ijaiye, Lagos, were recruited between 14-18weeks gestational age. Platelet count (PC), MPV and PDW were measured from their venous blood at recruitment. Participants were monitored until 34weeks of gestation, focusing on the occurrence of early-onset preeclampsia as the outcome of interest. Individuals with chronic medical conditions were excluded from the study. Data analysis involved t-test, Chi-Square and Mann–Whitney U tests, with statistical significance set at a confidence level of 95% and p < 0.05. Sensitivity, specificity, and predictive values were determined using receiver operating characteristics (ROC) curves. Results: The incidence of early-onset pre-eclampsia in the study was 5.9%. Women who later developed pre-eclampsia had higher median MPV and PDW at 14-18weeks (10.8 fl. and 24.8 fl.) compared to normotensive women (8.1 fl. and 13.3 fl.)(p < 0.001). The median PC was lower in pre-eclamptics (190 × 103/µl) compared to normotensives(264 × 103/µl)(p < 0.001). Using Youden's test, cut-off values identified: PC < 211.5 × 103/µl, MPV > 9.4 fl., and PDW > 21.3 fl., predicted early-onset pre-eclampsia with 96.6% sensitivity and 65.6% specificity for PC; 79.3% sensitivity and 97.7% specificity for PDW; and 82.8% sensitivity and 96.1% specificity for MPV. Cut-offs of PC < 185 × 103/µl, MPV > 10.7 fl., and PDW > 28.3 fl., predicted severe early-onset pre-eclampsia with 100.0% sensitivity and 90.9% specificity for PC, 100.0% sensitivity and 99.4% specificity for MPV, and 100.0% sensitivity and 99.8% specificity for PDW, with corresponding area under the ROC curves of 0.983, 0.996, and 0.998, respectively. Conclusion: The evaluation of MPV and PDW between 14 and 18 weeks of gestation appears to be a reliable predictor of severe early-onset pre-eclampsia. [ABSTRACT FROM AUTHOR]

Objective: COVID-19 disrupted health service delivery and weakened global and national health systems. The objective of this study was to describe the changes in health service utilization in three local government areas (LGAs) in Nigeria and examine factors involved. Methods: A cross-sectional mixed-methods approach was used. A total of 315 pregnant women seen for antenatal care in 80 health facilities in three LGAs between October 1 and November 30, 2020, participated in exit interviews; 93 women participated in focus group discussions (FGDs). Descriptive analyses and a multivariable logistic analysis were conducted to examine associations between characteristics and decreased service utilization. Content analysis was used to identify the emerging themes related to health service utilization during the pandemic. Results: One quarter of women reported that they reduced or ceased health service. The biggest reported changes were in immunization (47 to 30%, p < 0.001) and a small but statistically significant decline in antenatal care (98.7 to 93.8%, p < 0.001) was observed. Qualitative findings show that lockdowns, transportation issues, increased costs and fear of contracting COVID-19 or being labeled as COVID-positive were the most common reasons for not seeking care during this period of the pandemic. Conclusions: The pandemic negatively impacted health service utilization amongst pregnant women in Nigeria. A better understanding of differences in state response could help inform future actions. The findings highlight the need for health systems to consider how to facilitate service utilization during a pandemic, such as providing safe transport or increasing outreach, and to minimize stigma for those seeking care. Significance: What is already known on this subject? The COVID-19 pandemic has disrupted health systems worldwide and service utilization decreased as a result, including the utilization of maternal and child health services. What this study adds? This study shows that there were significant declines in service utilization and provides insight into why pregnant woman did or did not alter their care-seeking for antenatal care and immunizations services. The qualitative results indicate that pregnant women responded to or interpreted State and facility-level responses differently, which resulted in increased or decreased utilization. These insights can inform future emergency responses and policies to build more resilient health systems and communities. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The International Diabetes Federation has identified the emergence of gestational diabetes mellitus (DM) (GDM) as an underappreciated threat to maternal and child health. Adequate knowledge, a positive attitude towards prevention, and a positive perception of its danger could motivate pregnant women to take preventive measures. However, there is a dearth of literature on these among women attending antenatal clinics at UCH. This study, therefore aimed to assess pregnant women's knowledge about GDM, report their attitudes and determine their perception towards GDM. Methods: A cross-sectional study assessed the knowledge, attitude and perception towards GDM. A total of 300 pregnant women registered with and attending the antenatal clinic in University College Hospital (UCH), were selected using a random sampling technique. A self-structured questionnaire using a GDM Knowledge Questionnaire and previous research questions on Perception and Attitude was used to collect data from participants. Data were analysed using Statistical Package for Social Sciences 20.0 and hypotheses were tested using chi-square at 0.05 level of significance. Results: The mean age of the pregnant women was 30.60 ± 5.88 years. A little over one-fifth of the participants were knowledgeable about GDM. Three-quarters of the participants demonstrated a positive attitude while just a little over half had a positive perception of GDM. A significant association exists between participants' knowledge about GDM and belief about screening for diabetes during pregnancy (p =.006). There was a significant association between participants' attitude and their perception of GDM (p =.000). A direct significant association was also found between participants' knowledge and their perceived risk of developing GDM (p =.000). Discussion: While most of the pregnant women had poor knowledge about GDM, more than half of the pregnant women had positive attitudes towards GDM. A little over average possesses a positive perception towards GDM. Healthcare providers should intensify efforts in formulating appropriate methods to increase awareness with emphasis on the risks associated with GDM. [ABSTRACT FROM AUTHOR]

Malaria parasite (MP) and human immunodeficiency virus (HIV) infections exist concomitantly in Nigeria. This study determined the prevalence of MP and HIV as they co-existed together using the data of pregnant women who came for antenatal visits at Ekiti State University Teaching Hospital, Ado-Ekiti between 2015 and 2016. The records of the pregnant women were obtained from the records of the hospital. The prevalence of MP among the pregnant women was 0.74% in 2015 and 0.51% in 2016 (P = 0.28) while that of HIV was 0.63% in 2015 and 1.84% in 2016 (P = 0.019). Since MP and HIV were observed in some of the patients indicate that MP and HIV exist among some pregnant women in Ekiti. Efforts to control these diseases should be intensified. [ABSTRACT FROM AUTHOR]

Background: In countries with high child mortality rates, such as Nigeria, early intervention for common childhood illnesses (e.g., pneumonia and malaria) is essential for improving clinical outcomes. The timely reporting and treatment of fever is therefore critical in making a differential diagnosis and choosing an appropriate course of treatment. The present study aimed to investigate the prevalence and major risk factors associated with delays in seeking treatment for fever in children under five years of age in Nigeria. Methods: This study used a total weighted sample of 7,466 children under five years of age from the 2018 National Nigerian Demographic and Health Survey. Multivariable binary logistic regression modelling was used to investigate the association between predisposing, enabling, need, health service and community level factors, and delay in treatment-seeking for fever. Results: We report the delays in seeking treatment for childhood fever that was reported by mothers in the last two weeks prior to the national survey. The prevalence for delayed treatment was 62.1% (95% confidence interval [CI]: 60.1%, 64.1%). Our findings showed that there were fewer delays in seeking treatment in children aged 24–59 months (adjusted odds ratio [aOR] = 0.79, 95% CI: 0.68, 0.93), among mothers who were formally employed (aOR = 0.84; 95% CI: 0.73, 0.96), regularly attended antenatal services (aOR = 0.76, 95%CI: 0.66, 0.88), and for those who resided in wealthier households (aOR = 0.71; 95% CI: 0.56, 0.89). Children whose mothers resided in the North-West geopolitical zone of Nigeria were less likely to delay seeking treatment for fever (aOR = 0.55; 95% CI: 0.42, 0.73). However, mothers who had an unwanted pregnancy had a higher odds of delaying treatment for childhood fever (aOR = 1.58; 95% CI: 1.05, 2.39). Conclusion: There were significant delays in seeking treatment for childhood fever in poorer homes found in geopolitically unstable zones of Nigeria. Mothers who were poor, unemployed, and with younger children (<12 months) often delayed seeking treatment for their febrile child. Future health promotion strategies and microenterprise schemes should target both rural and urban mothers residing in poor households. Children under 12 months of age should be a priority. [ABSTRACT FROM AUTHOR]

Across several African countries, birth preparedness and complication readiness (BPACR) among pregnant women is poor. The practice of BPACR, though improving in recent years, is not commensurate with the knowledge available to pregnant women. Maternal health indices remain sub-optimal. This study evaluates the determinants of this "know-do' gap among women receiving antenatal care at a secondary health facility in Benin City, Nigeria. A cross-sectional study involving 427 pregnant women was conducted between October and December 2020 using a structured interviewer-administered questionnaire. The prevalence of knowledge and practice were described, and the determinants of BPACR practice evaluated using bivariable (chi-square) analysis and multivariable ordinal logistic regression with post-estimation predictive margins analysis. About 77% of respondents had good birth preparedness practice. Multivariable regression revealed that respondents with poor knowledge and moderate knowledge of components of BPACR had statistically significant lower odds (OR:0.05 (95% CI: 0.02-0.13) and 0.10 (95% CI: 0.03-0.30) times, respectively) for greater practice of BPACR when compared to those with good knowledge. Respondents with poor knowledge of danger signs had statistically significant lower odds (OR: 0.08 (95% CI: 0.03-0.26) for greater practice of BPACR when compared to those with good knowledge. But predictive margins analyses demonstrates that knowledge, though critical to practice, is insufficient to optimize practice. The optimum number of danger signs women need to know to improve practice may be between eight to ten. Beyond this number, practice may not change significantly. Other predictors of BPACR practice include income level, parity, gravidity, and residential settings. The number of antenatal clinic visits had no statistically significant correlation with BPACR practice. Interventions to facilitate practice at the community level may be helpful to improve outcomes and bridge the know-do gap with respect to BPACR within the study context. [ABSTRACT FROM AUTHOR]

Background: Persistent inequalities in coverage of maternal health services in sub-Saharan Africa (SSA), a region home to two-thirds of global maternal deaths in 2017, poses a challenge for countries to achieve the Sustainable Development Goal (SDG) targets. This study assesses wealth-based inequalities in coverage of maternal continuum of care in 16 SSA countries with the objective of informing targeted policies to ensure maternal health equity in the region. Methods: We conducted a secondary analysis of Demographic and Health Survey (DHS) data from 16 SSA countries (Angola, Benin, Burundi, Cameroon, Ethiopia, Gambia, Guinea, Liberia, Malawi, Mali, Nigeria, Sierra Leone, South Africa, Tanzania, Uganda, and Zambia). A total of 133,709 women aged 15-49 years who reported a live birth in the five years preceding the survey were included. We defined and measured completion of maternal continuum of care as having had at least one antenatal care (ANC) visit, birth in a health facility, and postnatal care (PNC) by a skilled provider within two days of birth. We used concentration index analysis to measure wealth-based inequality in maternal continuum of care and conducted decomposition analysis to estimate the contributions of sociodemographic and obstetric factors to the observed inequality. Results: The percentage of women who had 1) at least one ANC visit was lowest in Ethiopia (62.3%) and highest in Burundi (99.2%), 2) birth in a health facility was less than 50% in Ethiopia and Nigeria, and 3) PNC within two days was less than 50% in eight countries (Angola, Burundi, Ethiopia, Gambia, Guinea, Malawi, Nigeria, and Tanzania). Completion of maternal continuum of care was highest in South Africa (81.4%) and below 50% in nine of the 16 countries (Angola, Burundi, Ethiopia, Guinea, Malawi, Mali, Nigeria, Tanzania, and Uganda), the lowest being in Ethiopia (12.5%). There was pro-rich wealth-based inequality in maternal continuum of care in all 16 countries, the lowest in South Africa and Liberia (concentration index = 0.04) and the highest in Nigeria (concentration index = 0.34). Our decomposition analysis showed that in 15 of the 16 countries, wealth index was the largest contributor to inequality in primary maternal continuum of care. In Malawi, geographical region was the largest contributor. Conclusions: Addressing the coverage gap in maternal continuum of care in SSA using multidimensional and people-centred approaches remains a key strategy needed to realise the SDG3. The pro-rich wealth-based inequalities observed show that bespoke pro-poor or population-wide approaches are needed. [ABSTRACT FROM AUTHOR]

The authors assessed the knowledge of obstetric danger signs and its determinants among 405 pregnant women in their 3rd trimester receiving antenatal care. The study was cross-sectional. Those knowledgeable of danger signs during pregnancy were 24.9%, labor 29.9%, postpartum 15.6% and in the new-born 36.0%. There were associations between age, higher level of education, gestational age and social class and knowledge of obstetric danger signs. Our findings suggest the need to increase the awareness of obstetric danger signs through provision of information, education, and empower the family. [ABSTRACT FROM AUTHOR]

Women have distinct nutritional requirements, especially before, during pregnancy and while breastfeeding. Avoiding certain foods during pregnancy for any reasons devoid of scientific proofs adversely affects maternal nutritional needs. This study explored foods avoidance in pregnancy and related reasons among pregnant women in Ebonyi state. The study adopted a descriptive survey research design. Population was made up of pregnant mothers attending antenatal clinics in the health care facilities in Ebonyi state. Questionnaire was used for data collection. Data were analyzed using percentages, rank order, means and standard deviation. Results include 25 avoided foods by pregnant women in Ebonyi state. Those with the high avoidance percentage scores are squirrels (59.1%), bird gizzard (59.1%), snails (55.50%), frogs (55.2) and others. Other findings are four strongest reasons for avoiding foods, namely, snails in pregnancy because my baby would be sluggish and spit too much saliva (X̅ =2.53), bird gizzard (eke-okuko)/ meat liver (mejiu – anu) during pregnancy because it is against my culture and can prolong labour and delivery difficulties (X̅ = 3.06), okra soup in pregnancy because my baby spit too much saliva after birth (X̅ = 3.01), and snails were avoided in pregnancy becauset it is against my culture (X̅ =3.12). There are also six weak reasons for avoidance of food. These are egg during pregnancy because it will make my baby a thief (X̅ =2.13), male organ of an animal during pregnancy because it is a taboo in my community (X̅ =2.02), vegetables like cabbage and avocado during pregnancy to avoid fatty baby which is difficult to deliver (X̅ =1.67) and others. The study recommended the need for nutritional education programme and sensitization campaign by the relevant stakeholders/health educators to address foods avoidance in pregnancy and its reasons, especially during antenatal care services. [ABSTRACT FROM AUTHOR]

Background: Gestational weight gain (GWG) is a risk factor for adverse pregnancy outcomes, future obesity and chronic diseases among women. However, has not received much attention in many low and middle-income countries such as Nigeria. We investigated the pattern, associated factors and pregnancy outcomes of GWG in Ibadan, Nigeria, using the Ibadan Pregnancy Cohort Study (IbPCS). Methodology: The IbPCS is a multicentre prospective cohort study conducted among 1745 pregnant women recruited from four health facilities in Ibadan, Nigeria. GWG, the primary outcome, was categorised according to the Institute of Medicine's classification into insufficient, adequate and excessive weight gain. Pregnancy outcomes were the secondary outcome variables. Logistic regression analysis (Adjusted odds ratios and 95% confidence interval CI) was used to examine associations, and Poisson regression analyses were used to investigate associations with outcomes. Results: Only 16.9% of women had optimal GWG, 56.8% had excessive GWG, and 26.9% had insufficient GWG. Excessive GWG was associated with high income '> #20,000-' (AOR: 1.64, 95% CI: 1.25–2.17), being overweight (AOR: 2.12, 95% CI: 1.52–2.95) and obese (AOR: 1.47, 95% CI: 1.02–2.13) after adjusting for confounders. In contrast, increased odds of insufficient GWG have associated women with depression (AOR: 1.70, 95% CI 1.17–2.47). There was no significant association between inappropriate GWG and pregnancy outcomes However, there was an increased odds for postpartum haemorrhage (AOR: 2.44, 95% CI 1.14–5.22) among women with obesity and excessive GWG. Conclusions: Excessive GWG was the most typical form of GWG among our study participants and was associated with high maternal income, and being overweight or obese. GWG needs to be monitored during antenatal care, and interventions that promote appropriate GWG should be implemented among pregnant women in Nigeria. [ABSTRACT FROM AUTHOR]

Background: The most recent WHO guideline on antenatal care (ANC) utilization reaffirmed the necessary and compulsory care and services a pregnant woman should receive to maximize the importance and gains of ANC. While most studies focused on the time of initiation and number of ANC contacts, emphasis was rarely placed on the components of ANC offered to women. This study assessed how complete the components of ANC received by pregnant women are as a proxy for the quality of ANC services offered in Nigeria. We also assessed the clustering of the components and state-level differentials and inequalities in the components of ANC received in Nigeria. Methods: We used nationally representative cross-sectional data from the 2018 Nigeria Demographic Health Survey. We analysed the data of 11,867 women who had at least one ANC contact during the most recent pregnancy within five years preceding the survey. The assessed components were tetanus injection, blood pressure, urine test, blood test, iron supplement, malaria intermittent preventive treatment in pregnancy (IPTp), and told about danger signs. Others are intestinal parasite drugs (IPD)intermittent and HIV/PMTCT counsel. Descriptive statistics, bivariable and multivariable multilevel Bayesian Monte Carlo Poisson models were used. Results: In all, 94% had blood pressure measured, 91% received tetanus injection, had iron supplement-89%, blood test-87%, urine test-86%, IPTp-24%, danger signs-80%, HIV/PMTC-82% and IPD-22%. The overall prevalence of receiving all 9 components was 5% and highest in Ogun (24%) and lowest in Kebbi state (0.1%). The earlier the initiation of ANC, the higher the number of contacts, and the higher the quality of ANC received. Respondents with higher education have a 4% (adjusted incidence risk ratio (aIRR): 1.04, 95% credible interval (CrI): 1.01–1.09) higher risk of receiving more components of ANC relative to those with no education. The risk of receiving more ANC components was 5% (aIRRR: 1.05, 95% CI: 1.01–1.10) higher among pregnant women aged 40 to 49 years than those aged 15 to 19 years. Women who decide their healthcare utilization alone had a 2% higher risk of getting more components than those whose spouses are the only decision taker of healthcare use. Other significant factors were household wealth status, spouse education, ethnicity, place of ANC, and skill of ANC provider. Pregnant women who had their blood pressure measured were very likely to have blood and urine tests, tetanus injections, iron supplements, and HIV talks. Conclusions: Only one in every 20 pregnant women received all the 9 ANC components with wide disparities and inequalities across the background characteristics and the States of residence in Nigeria. There is a need to ensure that all pregnant women receive adequate components. Stakeholders should increase supplies, train, and create awareness among ANC providers and pregnant women in particular. [ABSTRACT FROM AUTHOR]

Background: Access to health services during pregnancy, childbirth and the period after birth provides a substantial opportunity to limit cases of maternal mortality. In sub-Saharan Africa, the proportions of women who utilize health services remain below 70%. This study examined the factors associated with partial and adequate maternal health services utilization in Nigeria. Methods: This paper used data from 2018 Nigeria Demographic and Health Survey (DHS) comprising 21,792 women aged 15–49 years who had given births within five years of the survey. The study focused on antenatal care attendance, place of birth and postnatal care using a combined model. Multinomial logistic regression was applied in the analysis. Results: About 74% of the women attended antenatal care, 41% gave birth in health facilities and 21% attended postnatal care. While 68% of the women partially utilized health services, 11% adequately utilized the services. The odds of partially and adequately utilizing health services increased for ever married women, women with secondary or higher education, from richest households, living in urban area, having no problem either getting permission to visit health facility or reaching health facility. Conclusions: This study has revealed the factors associated with partial and adequate utilization of maternal health services in Nigeria. Such factors include education, household wealth, marital status, employment status, residence, region, media exposure, getting permission to use health service, unwillingness to visit health facility without being accompanied and distance to health facility. Efforts aimed at improving maternal health services utilization should place emphasis on these factors. [ABSTRACT FROM AUTHOR]

Background: Recent reports of artemisinin partial resistance from Rwanda and Uganda are worrisome and suggest a future policy change to adopt new anti-malarials. This is a case study on the evolution, adoption, and implementation of new anti-malarial treatment policies in Nigeria. The main objective is to provide perspectives to enhance the future uptake of new anti-malarials, with an emphasis on stakeholder engagement strategies. Methods: This case study is based on an analysis of policy documents and stakeholders' perspectives drawn from an empirical study conducted in Nigeria, 2019–2020. A mixed methods approach was adopted, including historical accounts, review of programme and policy documents, and 33 qualitative in-depth interviews and 6 focus group discussions. Results: Based on policy documents reviewed, the adoption of artemisinin-based combination therapy (ACT) in Nigeria was swift due to political will, funding and support from global developmental partners. However, the implementation of ACT was met with resistance from suppliers, distributors, prescribers, and end-users, attributed to market dynamics, costs and inadequate stakeholder engagement. Deployment of ACT in Nigeria witnessed increased developmental partner support, robust data generation, ACT case-management strengthening and evidence on anti-malarial use in severe malaria and antenatal care management. A framework for effective stakeholder engagement for the future adoption of new anti-malarial treatment strategies was proposed. The framework covers the pathway from generating evidence on drug efficacy, safety and uptake; to making treatment accessible and affordable to end-users. It addresses which stakeholders to engage with and the content of engagement strategies with key stakeholders at different levels of the transition process. Conclusion: Early and staged engagement of stakeholders from global bodies to community level end-users is critical to the successful adoption and uptake of new anti-malarial treatment policies. A framework for these engagements was proposed as a contribution to enhancing the uptake of future anti-malarial strategies. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Studies in Nigeria and elsewhere in sub-Saharan Africa (sSA) have explored factors influencing usage of intermittent preventive treatment of malaria in pregnancy (IPTp). Most studies, however, are not model or theory-based, which provides less satisfactory guidance to malaria control programming. This study fills the knowledge gap by adapting Andersen's behavioral model of health care use to IPTp usage in Nigeria. Methods: This study adopted a cross-sectional design that utilized secondary data extracted from the 2018 Nigeria Demographic and Health Survey (NDHS). A weighted sample of 4,772 women who had given birth in the past year preceding the survey, was analyzed. Outcome variable was usage of IPTp, dichotomized into optimal or otherwise. Explanatory variables cut across individual and community levels and were divided into predisposing, enabling and need factors in line with the theoretical constructs of the Andersen model. Two multilevel mixed-effects logistic regression models were fitted to identify factors which influenced optimal usage of IPTp. Analyses were performed using STATA 14. Statistical significance was set at 5%. Results: Realised level of optimal IPTp usage was 21.8%. Factors that either predispose or enable pregnant women to take optimal doses of IPTp were maternal education, being employed, being autonomous in their own healthcare, health insurance enrolment, partner education, receiving antenatal care in public health facilities, rural residence, being resident in northern geo-political zones, community literacy level and community perception of the consequences of malaria. Two significant need factors affecting optimal usage of IPTp were timing of the first antenatal care visit and sleeping under mosquito bed nets. Conclusion: Optimal usage of IPTp is low among pregnant women in Nigeria. There is a need to devise additional public health educational programs promoting IPTp usage through the formation of Advocacy, Communication and Social Mobilisation (ACSM) in every ward in all local government areas, particularly in the rural and northern parts of the country. In addition, health planners should adopt the Andersen model for assessing key determinants of IPTp usage among childbearing women in Nigeria. [ABSTRACT FROM AUTHOR]

Background: Facility delivery remains an important public health issue in Nigeria. Studies have confirmed that antenatal care may improve the uptake of facility delivery. However, information is rarely available in Nigeria on the extent to which antenatal care in public health facilities is associated with delivery in public health facilities. The objective of the study was thus to examine the extent of the association between antenatal care in public health facilities and delivery in public health facilities in Nigeria. The study was guided by the Andersen behavioral model of health services use. Methods: The cross-sectional design was adopted. Data were extracted from the most recent Nigeria Demographic and Health Survey (NDHS). A sample of 9,015 women was analyzed. The outcome variable was the facility for delivery. The main explanatory variable was the antenatal care facility. The predisposing factors were maternal age, age at first birth, parity, exposure to mass media, and, religion. The enabling factors were household wealth, work status, partners' education, women's autonomy, health insurance, and, perception of distance to the health facility. The need factors were pregnancy wantedness, the number of antenatal care visits, and the timing of the first antenatal care. Statistical analyses were performed with the aid of Stata version 14. Two binary logistic regression models were fitted. Results: Findings showed that 69.6% of the women received antenatal care in public health facilities, while 91.6% of them subsequently utilized public health facilities for deliveries. The significant predisposing factors were age at first birth, parity, maternal education, and religion, while household wealth, work status, women's autonomy, and partners' education were the significant enabling factors. The timing of the first antenatal contact, pregnancy wantedness, and the number of antenatal care visits were the important need factors. Conclusion: To a significant extent, antenatal care in public health facilities is associated with deliveries in public health facilities in Nigeria. It is imperative for governments in the country to take more steps to ensure the expanded availability of public health facilities in all parts of the country since their use for antenatal care is well-associated with their use for delivery care. [ABSTRACT FROM AUTHOR]

Introduction: High maternal death is attributable to developing countries' health systems and sociocultural factors This study assessed the effect of participatory-action research on males' perception and practice towards maternity care and safe motherhood in rural southeast Nigeria. Methods: A pre-post-intervention study design was employed to study 396 male partners of pregnant women selected through cluster sampling in rural communities in southeast Nigeria. Males' perceptions and practices towards maternity care and safe motherhood were assessed using an interviewer-administered five-point Likert scale questionnaire. A community-participatory intervention was implemented comprising advocacy, and training of community volunteers, who then educated male partners of pregnant women on safe motherhood and facilitated emergency saving and transport schemes. A post-intervention assessment was conducted six months later, using the same questionnaire. Good perception and good practices were determined by mean scores >3.0. Continuous variables were summarised using mean and standard deviation, and categorical variables using frequencies and proportions. A comparison of the mean scores pre- and post-intervention mean scores were compared, and the mean difference was determined using paired T-test. Statistical significance was set at a p-value <0.05. Results: The perception that male partners should accompany pregnant women for antenatal care had the least mean score at the pre-intervention stage, 1.92 (0.83). However, the mean score increased for most variables after the intervention (p<0.05). The mean score for maternity care practices increased post-intervention for accompanying pregnant women to antenatal care, facility delivery, and helping with household chores (p<0.001), with a composite mean difference of 0.36 (p<0.001). Birth preparedness/complication readiness practices–saving money, identifying transport, skilled providers, health facilities, blood donors and preparing birth kits, were good, with a composite mean score that increased from 3.68(0.99) at pre-intervention to 4.47(0.82) at post-intervention (p<0.001). Conclusions: Males' perceptions and practices towards safe motherhood improved after the intervention. This highlights that a community-participatory strategy can enhance males' involvement in maternal health and should be explored. Male partners accompanying pregnant women to clinics should be advocated for inclusion in maternal health policy. Government should integrate community health influencers/promoters into the healthcare systems to help in the provision of health services. [ABSTRACT FROM AUTHOR]

Background: Poor maternal, newborn and child health outcomes remain a major public health challenge in Nigeria. Mobile health (mHealth) interventions such as patient-held smart cards have been proposed as effective solutions to improve maternal health outcomes. Our objectives were to assess the acceptability and experiences of pregnant women with the use of a patient-held smartcard for antenatal services in Nigeria. Methods: Using focus group discussions, qualitative data were obtained from 35 pregnant women attending antenatal services in four Local Government Areas (LGAs) in Benue State, Nigeria. The audio-recorded data were transcribed and analyzed using framework analysis techniques such as the PEN-3 cultural model as a guide. Results: The participants were 18–44 years of age (median age: 24 years), all were married and the majority were farmers. Most of the participants had accepted and used the smartcards for antenatal services. The most common positive perceptions about the smartcards were their ability to be used across multiple health facilities, the preference for storage of the women's medical information on the smartcards compared to the usual paper-based system, and shorter waiting times at the clinics. Notable facilitators to using the smartcards were its provision at the "Baby showers" which were already acceptable to the women, access to free medical screenings, and ease of storage and retrieval of health records from the cards. Costs associated with health services was reported as a major barrier to using the smartcards. Support from health workers, program staff and family members, particularly spouses, encouraged the participants to use the smartcards. Conclusion: These findings revealed that patient-held smart card for maternal health care services is acceptable by women utilizing antenatal services in Nigeria. Understanding perceptions, barriers, facilitators, and supportive systems that enhance the use of these smart cards may facilitate the development of lifesaving mobile health platforms that have the potential to achieve antenatal, delivery, and postnatal targets in a resource-limited setting. [ABSTRACT FROM AUTHOR]

There are missed opportunities for the prevention of mother-to-child transmission of HIV (PMTCT) in Nigeria. However, little is known about the geographic variation. We examined the geographic pattern in the missed opportunities for HIV testing among antenatal care (ANC) attendees and initiation t on antiretroviral therapy (ART) in Nigeria. This study was an analysis of aggregated state-level data on 2,875,370 ANC attendees from the 2019 national HIV/AIDS health sector data. We performed descriptive statistics and explanatory spatial data analysis. Overall, the missed opportunity for HIV testing was 9.3%, ranging from 1.8% in the South South to 14.5% in the North West. The missed opportunity for HIV testing ranged from 0.2% in Imo State to 25.2% in Kaduna State. The local indicator of spatial association cluster map showed a concentration of cold spots in the South and hot spots in the North. The overall missed opportunity for ART was 9.5%, ranging from 7.4% in the South West to 11.1% in the NorthCentral. It was lowest in Adamawa State (0%), while Enugu State had the highest (32.2%). Missed opportunities for PMTCT among women attending ANC in Nigeria occur at varying degrees across the states, with higher levels in the northern region. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Midwifery Research & Practice is the property of Canadian Association of Midwives and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Unprescribed and herbal medicines use among pregnant women is a public health concern in low and middle-income countries because of the potential teratogenic effects, insufficient safety and weak drug regulatory systems. Unprescribed and herbal medicines are common among pregnant women in Nigeria, and only a few researchers have documented the prevalence and the risk factors. However, evidence on the associated pregnancy outcomes is still lacking. We assessed the prevalence, predictors and pregnancy outcomes of unprescribed and herbal medicines use among pregnant women in Ibadan, Nigeria. Methods: This study was a component of the Ibadan Pregnancy Cohort Study, a prospective cohort study, among pregnant women in Ibadan, Nigeria, who were enrolled at ≤ 20 weeks gestation at their first antenatal visit and followed up till delivery. In all, 571 women participated in the maternal drug use assessment during the third trimester using a pretested interviewer-administered questionnaire. The primary outcomes were unprescribed and herbal medicines use and pregnancy outcomes, secondary outcomes, were abstracted from medical records. The predictors assessed included sociodemographic, obstetric, antenatal care utilization, and lifestyle characteristics. Bi-variate logistic and Poisson regression analyses were used to evaluate the predictors and relative risk for the pregnancy outcomes of unprescribed and herbal medicines at 5% significance. Results: The prevalence of unprescribed and herbal medicine use was 31.9% and 21.7%, respectively. On bivariate analysis, the significant predictors of unprescribed medicine (which were protective) were tertiary education, increasing income, adequate antenatal care (≥ 4 visits), and at least two doses of sulfadoxine-pyrimethamine. However, high parity and having an antenatal admission increased the risk. However, after adjusting for confounders, the significant factors associated with unprescribed medicines were; tertiary education (AOR) = 0.23; 95% CI: (0.06 – 0.95); p-value: 0.043] and obtaining at least two doses of sulfadoxine-pyrimethamine [AOR = 0.33; 95% CI: (0.29 – 3.60); p-value: 0.048]. For herbal medicines, the predictors were similar to unprescribed drugs. However, after adjusting for confounders, none was significant for herbal medicines. Unprescribed and herbal medicines were not significantly associated with pregnancy outcomes. Conclusions: Unprescribed and herbal medicines use were common among pregnant women in Ibadan, Nigeria, particularly among women with low economic status and those with poor utilization of antenatal care services. These significant predictors can be targeted for public health intervention. Specifically, health education that discourages the use of unprescribed and herbal medications to pregnant women during antenatal care. [ABSTRACT FROM AUTHOR]

Background: The differences in maternal mortality between developed and developing countries is due to differences in use of antenatal and delivery services. The study was designed to determine the views of women on utilization of antenatal and delivery services in urban and rural communities of Ebonyi state, Nigeria. Methods: Community based descriptive exploratory study design was employed. Qualitative data was collected through use of pre-tested focus group discussion (FGD) guide. Eight FGDs were conducted among women who were pregnant and others who have delivered babies one year prior to the study. Four FGDs each were conducted in urban and rural communities. QDA Miner Lite v2.0.6 was used in the analysis of the data. Results: Most of the participants in urban and rural areas prefer the man and woman deciding on where to receive antenatal and deliver care. All the participants in urban and rural communities wish for the support of their husbands when pregnant. Perceived quality of care is the major reason the women choose a facility for antenatal and delivery services. Others reasons included cost of services and proximity to a facility. Participants in rural communities were of the opinion that traditional birth attendants deliver unique services including helping women to achieve conception. For participants in urban, traditional birth attendants are very friendly and perhaps on divine assignment. These reasons explain why women still patronize their services. The major criticism of services of traditional birth attendants is their inability to manage complications associated with pregnancy and delivery. The major reasons why women delivery at home included poverty and cultural beliefs. Conclusions: All efforts should be made to reduce the huge maternal death burden in Nigeria. This may necessitate the involvement of men and by extension communities in antenatal and delivery matters. There is need to train health workers in orthodox health facilities on delivery of quality healthcare. Public enlightenment on importance of health facility delivery will be of essence. Encouraging women to deliver in health facilities should be prioritized. This may entail the provision of free or subsidized delivery services. The deficiencies of primary health centers especially in rural communities should be addressed. [ABSTRACT FROM AUTHOR]

This study determines the prevalence and antimicrobial susceptibility pattern of Klebsiella pneumoniae and Pseudomonas aeruginosa among women with urinary tract infections attending antenatal care in Barau Dikko Teaching Hospital Kaduna, Nigeria. A total of 230 mid-stream urine samples were collected and the organisms were identified using cultural (MacConkey agar and Cetrimide agar respectively) and biochemical methods. Antibiotics susceptibility test was performed using commercial disc. The overall UTIs prevalence was 22.17% (51/230) among which 14.78% (34/230) were Klebsiella pneumonia and 7.39% (17/230) were Pseudomonas aeruginosa. Klebsiella pneumonia was most sensitive to Augmentin, Ciprofloxacin (100% susceptible to the isolates respectively), and Amoxicillin (88.24%). It was moderately sensitive to chloramphenicol (67.65%), Trimethoprim/Sulfamethoxazole (44.17%), Gentamycin (38.24%) and Pefloxacin (29.24%), while being least sensitive to Sparfloxacin (26.41%), Streptomycin (26.41%) and Ofloxacin (Tarivid) (11.76%). The highest susceptibility of Pseudomonas aeruginosa was observed in Amoxicillin (94.12%) followed by Ciprofloxacin (84.35%) and then Augmentin (76.47%), while being least susceptible to Chloramphenicol (41.18%), Sparfloxacin (35.29%), Pefloxacin (23.53%) and Tarivid (14.23%). On the other hand, isolates of Pseudomonas aeruginosa obtained from the urine cultures exhibited intermediate susceptibility to Streptomycin (70.59%), Septrin (64.71%), and Gentamycin (58.82%). In conclusion the uropathogens examined were 100% susceptible to Augmentin and Ciprofloxacin for Klebsiella pneumonia and Amoxicillin was more sensitive to Pseudomonas aeruginosa. Health education among women, especially pregnant mothers, on the risk, transmission and prevention of infection with uropathogens should be embarked upon by relevant authorities. Furthermore, health care personnel should be proactive in taking steps to prevent nosocomial transmission of these pathogens during antenatal visits of expectant mothers. [ABSTRACT FROM AUTHOR]

Background: In light of the rising global effort to lower maternal mortality rates, it is crucial for low- and middle-income countries with poor maternal indices to investigate the problem of maternal satisfaction and the key elements that affect it. To this effect, this study explored the experiences of postnatal women in relation to labour services and investigated the factors that contribute to their overall satisfaction. Aim: The study set out to explore factors influencing maternal satisfaction with labour care services in Ogbomoso, Oyo State, Nigeria. This study ultimately seeks to advance our understanding of this phenomenon to impact labour care and policy. Setting: The study was conducted among multiparous women who had their antenatal care and delivery in Ogbomoso, Oyo State, Nigeria. Methods: A qualitative study was performed using in-depth interviews among postnatal women. Results: The results revealed a number of variables that could affect the women's satisfaction with labour care, including the choice of health facility, healthcare providers, environment of the facility, assurance of privacy, treating patients with dignity, provision of needed amenities and having a well-planned postnatal care assessment. Conclusion: The study revealed that the costs of care, the skill of the caregiver, the provision of confidential and dignified care, and the availability of supplies all have an impact on maternal satisfaction. Hospital administration should address these issues to enhance the experience of women and labour care services. Contribution: The study's findings provide insights that will inform strategies to improve the quality of care being provided to parturients in Nigeria. [ABSTRACT FROM AUTHOR]

Tetanus is an infection caused by the Clostridium tetani; a ubiquitous Gram-positive, motile, spore-forming, and toxin-producing anaerobe. It is the only vaccine-preventable infection that is not communicable and which is still causing regrettable morbidity and mortality in newborns in Nigeria. The objective of this study was to review the pattern of neonatal tetanus infection and to document its outcome in a secondary health care level in South-west Nigeria. This was a hospital-based prospective study. Questionnaires were also administered to collect information from the parents. Out of a total of 4,277 out-born babies, 23 had Neonatal Tetanus (NNT). The mean incubation period was 6.62±2.2 days; the period of onset was less than 24 hours in 9 (39.1%) of the babies and greater than 24 hours in 14 (60.9%) babies. Four babies (17.4%) died, 4 (17.4%) left against medical advice, and the mean age at death was 11.7±3.5 days. Other clinical records showed that 56.5% of mothers did not receive antenatal care or tetanus toxoid, 65.2% had non-hospital deliveries, cord care was sub-optimal in the majority of cases, and the case fatality ratio was 17.4%. The study reveals that NNT still contributes to morbidities and mortalities among Nigerian neonates. The incidence per year, though, waxes and wanes with no particular pattern; the disease still has the tendency to dip the neonatal indices. [ABSTRACT FROM AUTHOR]

Background: Although studies in Nigeria showed the efficacy of intermittent preventive treatment using sulfadoxine-pyrimethamine (IPT-SP) in preventing malaria in pregnancy among Nigerian women there is still poor implementation of the intervention in Nigeria. Methods: A mixed method study was conducted in Bwari Area Council, Nigeria in 2018. The quantitative part of the study is presented and discussed in this paper. Pregnant women were interviewed using a validated interviewer-administered questionnaire and observations of current practice were performed. Results: A total of 422 pregnant women were recruited into the study (mean age, 26 years) with the majority being married women (90.3%). Most respondents (68.5%) did not know who could take IPT-SP and 58.5% of respondents did not know when and how many times IPT-SP should be taken during pregnancy. Nearly all participants (99.5%) did not take SP at the facility under direct observation of the health worker. None of the facilities had free SP and all respondents paid for SP through the Drug Revolving Fund. The knowledge of the use of SP was significantly influenced by respondents' parity, ward of residence, antenatal clinic (ANC) attendance history and education. Respondents who had tertiary and secondary education were 8.3 (95% CI: 1.01–68.27) times more likely to use IPT-SP than those without formal education. Conclusion: Most women who attend ANC in Bwari Area council did not receive IPT-SP as per the national guidelines. The unavailability of logistics (SP, Water and Cup) on a regular basis, the cost of the SP, poor knowledge of the importance of IPT in malaria prevention, and the non-implementation of the administration of SP under direct observation were factors influencing the use of IPT-SP. Outcomes could be enhanced through the provision of measures to address identified gaps by this study. [ABSTRACT FROM AUTHOR]

Background: Community health workers (CHWs) in low- and middle-income countries are key to increasing coverage of maternal and newborn interventions through home visits to counsel families about healthy behaviours. Household surveys enable tracking the progress of CHW programmes but recent evidence questions the accuracy of maternal reports. We measured the validity of women's responses about the content of care they received during CHW home visits and examined whether the accuracy of women's responses was affected by CHW counselling skills.Methods: We conducted a criterion validity study in 2019, in Gombe State-Nigeria, and collected data from 362 pregnant women. During accompanied CHW home visits the content of CHW care and the presence or absence of 18 positive counselling skills were observed and documented by a researcher. In a follow-up interview three months later, the same women were asked about the care received during the CHW home visit. Women's reports were compared with observation data and the sensitivity, specificity, and area under receiver curve (AUC) calculated. We performed a covariate validity analysis that adjusted for a counselling skill score to assess the variation in accuracy of women's reports with CHW counselling skills.Results: Ten indicators were included in the validity analysis. Women consistently overestimated the content of care CHWs provided and no indicator met the condition for individual-level accuracy set at AUC ≥ 0.6. The CHW counselling skill score ranged from 9-18 points from a possible 18, with a mean of 14.3; checking on client history or concerns were the most frequently missed item. There was evidence that unmarried women and the relatively most poor women received less skilled counselling than other women (mean counselling scores of 13.2 and 13.7 respectively). There was no consistent evidence of an association between higher counselling skill scores and better accuracy of women's reports.Conclusions: The validity of women's responses about CHW care content was poor and consistently overestimated coverage. We discuss several challenges in applying criterion validity study methods to examine measures of community-based care and make only cautious interpretation of the findings that may be relevant to other researchers interested in developing similar studies. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: This study aims to explore the role of consultation and relational empathy (CARE) and sociodemographic profile as predictors of patients' satisfaction among pregnant women attending antenatal care (ANC) in selected public primary health facilities in rural sub-districts of Saki, Oyo State, Nigeria. Methods: This cross-sectional study recruited a total of 582 pregnant women in four primary health centers. Expectant mothers responded to a questionnaire covering demographic characteristics, clinic visitation, CARE, and patients' satisfaction. All data was analyzed using descriptive, univariate and multivariate statistical tools. P < 0.05 level was considered statistically significance. Results: Findings revealed that the participants had a mean age of 23.15 ± 5.23 years. The pattern of patients' satisfaction revealed that 13.40% (78/582) were highly satisfied with the health care received compared to 86.60% (504/582) with moderate to low satisfaction ratings with ANC. Highly satisfied patients placed higher value on technical quality, interpersonal relation, communication, financial aspects, time spent and accessibility convenience (P = 0.001). Multiple linear regression model indicated that relational empathy (β = 0.28, P < 0.001), 2nd trimester of pregnancy (β = 0.13, P = 0.01), age categories of 30-< 40 years (β = - 0.12, P = 0.02), and 40 -< 50 years (β = - 0.11, P = 0.04), religious affiliation (β = 0.10, P = 0.03) predicted satisfaction with ANC. Conclusion: Low patients' satisfaction with antenatal healthcare services resulting from hostile attitudes from health workers has implication for the delivery and acceptability of services offered to eradicate maternal mortality globally. Thus, regular training and re-training of health care personnel in frequent contact and interaction with patients will go a long way in reducing untoward work attitude and maternal mortality in rural ANC centers globally. [ABSTRACT FROM AUTHOR]

The low uptake of maternal healthcare services (MHS) in Nigeria is implicated in the country's poor maternal health outcomes. In northern Nigeria where these outcomes are poorest, not much is known about the contribution of violence within unions on married women's uptake of MHS. Using data on antenatal care (ANC) utilisation and place of delivery, and their sociodemographic confounders from the Nigerian Demographic and Health Survey, this study investigates this relationship. Results of univariate, bivariate and multivariate analyses show that 46.4% and 22.1% of the women had at least four ANC sessions and had health facility delivery respectively. At the subregional level however, the North-Central zone had the highest utilisation rates while the North-West zone had the lowest. The prevalence of intimate partner violence (IPV) ranged from 8.2% (sexual violence) to 16.7% (physical violence) and 35.8% (emotional violence). Subregional analysis of IPV shows that the North-West zone had the lowest prevalence rates. Contrary to some literature evidence, women who experienced IPV in the study area had higher odds of utilising MHS (P < 0.001). When the sociodemographic characteristics of the women were adjusted for, the relationship became statistically insignificant however. The association between the women's socioeconomic characteristics and their MHS uptake suggests that attention be paid to the wealth and educational status of the population because of their propensity for sustaining the higher uptake recorded. The role of religion in the outcomes further suggests that it be used as a tool to promote the uptake of MHS in the region. [ABSTRACT FROM AUTHOR]

Background: Antenatal care (ANC) is a recognized factor for favorable pregnancy outcomes. Despite the benefits associated with early initiation of antenatal care, late booking still predominates in sub-Saharan Africa including Nigeria. Objective: This study aimed to assess the factors, including family dynamics, associated with the booking gestational age among women attending ANC clinics in a Local Government Area of Osun State, Nigeria. Methods: A descriptive cross-sectional study was conducted among 255 pregnant women attending ANC at the Primary Health Centres in Osun State, who were selected by stratified random sampling technique. Data were obtained with aid of a semi-structured questionnaire and subjected to descriptive and inferential analyses. Results: The mean age of respondents was 27.3 ± 5.1 years. Their mean booking gestational age was 23.0 ± 6.6 weeks, while the majority (85.3%) booked late for ANC. Most (122, 54.2%) of the respondents booked in the second trimester. The opinion of the husband influenced most women (54.2%) in the decision regarding the time of ANC booking. There was no association between the booking gestational age and each of respondents' age, education, parity, perceived family support, level of family functioning, and other sociodemographic characteristics. The booking GA was however significantly related to the previous booking GA at the last pregnancy (p =.004). Conclusion: Late initiation of antenatal care was high among pregnant women attending PHCs in the study area and it was not associated with measures of family dynamics. The predominant influence of husbands' opinion on time of booking suggests the need for strategic outreach to males through relevant reproductive health educational campaigns. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Delayed first antenatal care contact refers to first antenatal care contact occurring above twelfth weeks of gestation. Studies in Nigeria and in other countries have examined the prevalence and predictors of delayed first antenatal care contact. Nevertheless, existing studies have rarely examined the predictors among primiparous women. In addition, the evidence of higher health risks associated with primigravida emphasizes the need to focus on primiparous women. This study, therefore, examined the predictors of delayed first antenatal care contact among primiparous women in Nigeria.Methods: The study was a descriptive cross-sectional design that analyzed data extracted from the 2018 Nigeria Demographic and Health Survey. The study analyzed a weighted sample of 3,523 primiparous women. The outcome variable was delayed first antenatal care contact. explanatory variables were grouped into predisposing, enabling, and need factors. The predisposing factors were maternal age, education, media exposure, religion, household size, The knowledge of the fertile period, and women's autonomy. The enabling factors were household wealth, employment status, health insurance, partner's education, financial inclusion, and barriers to accessing healthcare. The need factors were pregnancy wantedness and spousal violence during pregnancy. Data were analyzed using Stata 14. Two multivariable logistic regression models were fitted. Statistical significance was set at p < 0.05.Results: Nearly two-thirds (65.0%) of primiparous women delayed first antenatal care contact. Maternal age, maternal education, media exposure, religion, household membership, and knowledge of the fertile period were predisposing factors that significantly influenced the likelihood of delayed first antenatal care contact. Also, household wealth, employment status, health insurance, partner's education, perception of distance to the health facility, and financial inclusion were enabling factors that had significant effects on delayed first antenatal care contact. Pregnancy wantedness was the only need factor that significantly influenced the likelihood of delayed first antenatal care contact.Conclusion: The majority of primiparous women in Nigeria delayed first antenatal care contact and the delay was predicted by varied predisposing, enabling, and need factors. Therefore, a public health education program that targets women of reproductive age especially primiparous women is needed to enhance early antenatal care contact in the country. [ABSTRACT FROM AUTHOR]