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Introduction Adolescent pregnancy contributes significantly to the high maternal mortality in Nigeria. Research evidence from developing countries consistently underscores Antenatal Care (ANC) among childbearing adolescents as important to reducing high maternal mortality. However, more than half of pregnant adolescents in Nigeria do not attend ANC. A major gap in literature is on the influence of family context in pregnant adolescent patronage of ANC services. Methods The study utilized a cross-sectional survey with data collected among adolescent mothers in urban slums in three Nigerian states namely, Kaduna, Lagos, and Oyo. The survey used a multi-stage sampling design. The survey covered a sample of 1,015, 1,009 and 1,088 childbearing adolescents from each of Kaduna, Lagos, and Oyo states respectively. Data were analyzed at the three levels: univariate, bivariate and multivariate. Results Overall, about 70 percent of female adolescents in our sample compared with 75 percent in the Demographic and Health Survey (DHS) had any antenatal care (ANC) visit. About 62 percent in our sample compared with 70 percent in the DHS had at least 4 ANC visits, and, about 55 percent in our sample compared with 41 percent of the DHS that had 4 ANC visits in a health facility with skilled attendant (4ANC+). Those who have both parents alive and the mother with post-primary education have higher odds of attending 4ANC+ visits. The odds of attending 4ANC+ for those who have lost both parents is almost 60% less than those whose parents are alive, and, about 40% less than those whose mothers are alive. The influence of mother’s education on 4ANC+ attendance is more significant with large disparity when both parents are dead. Conclusion The study concludes that identifying the role of parents and community in expanding access to ANC services among adolescent mothers is important in improving maternal health in developing countries.

Inequalities in health care utilisation and outcomes vary significantly across geographies. Though available evidence suggests disparity in contraceptive uptake in favour of urban compared with rural geographies, there are unassessed nuances among women in urban communities. This study examines some of these disparities within the context of socioeconomic deprivations and family planning utilisation among urban women in West Africa. A secondary analysis of the most recent Demographic and Health Survey dataset of five selected West African countries was conducted, using pooled data of 21,641 women aged 15–49 years. Associations between family planning utilisation and women's deprivation status were investigated using a binary logistic regression model. The findings show that more than one-quarter of the women were severely deprived across the countries except Senegal (17.4%), and the severely deprived consistently have relatively low contraceptive prevalence rates (CPR) (16.0–24.3%) compared with women with no/low deprivation across the countries except Senegal (39.8%). The results for long-acting reversible contraceptives (LARC) were not consistent across the five countries: whereas, LARC utilisation was lower among severely deprived women in Nigeria (9.1%), Guinea (9.6%), and Mali (19.3%), utilisation was similar across the deprivation groups in Benin and Senegal. In the multivariable analyses, the log-odds of modern contraceptive utilisation decreases by 0.27 among the moderately deprived (ß = −0.27, SE = 0.05, p < 0.01) and by 0.75 among the severely deprived women (ß = −0.75, SE = 0.05, p < 0.01) compared with those with no/low deprivation, with variations across the countries. Similarly, the log-odds of LARC utilisation decreases by 0.44–0.72 among the severely deprived women compared with those with no/low deprivation across the countries except Senegal. This study concluded that family planning intervention programmes and policies need to underscore the deprivation context of urban geographies, particularly among women living in informal settlements.

Little is known about the link between health literacy and women's ability to safely and successfully use misoprostol to self‐induce an abortion. While abortion is only allowed to save a woman's life in Nigeria, misoprostol is widely available from drug sellers. We interviewed 394 women in 2018 in Lagos State, Nigeria, who induced abortion using misoprostol obtained from a drug seller to determine their sexual and reproductive health literacy (SRHL) and misoprostol knowledge levels; and how these were associated with ending the pregnancy successfully or seeking care for (perceived) complications. Our results show that women's misoprostol knowledge (measured both quantitatively and qualitatively) was low, but that almost all women were nevertheless able to use the drug effectively and safely. Higher SRHL was associated with being more likely to end the pregnancy successfully and also seeking postabortion health care. Our study is the first to examine this association and adds to the scarce literature examining the relationship between health literacy and self‐use of misoprostol to induce abortions in restrictive settings.

This study uses geospatial statistical tools and state-level admission data to examine gender inequalities in higher-education enrollment in Nigeria, and to investigate the key factors on enrollment. For gender inequality analysis, percentage female enrollments (PFE) are computed. Spatial clusters in PFE were assessed using global Moran’s I, while determinants of PFE were assessed with geographical weighted regression (GWR). Results indicated a general decrease in PFE from states in the south to states in the north throughout the study years: 2005–2015. All states except Anambra, Imo, Enugu and Abia had yearly PFE below 50% consistently, indicating gender inequality in favor of males in higher-education enrollment during the study period. High PFE rates tend to cluster in southern states and low PFE rates in northern states. The finding from GWR suggests that the persistent regional variations in female enrollment over time can be explained by the size and diversity of applicant pool. The study underpins the need for affirmative programmatic efforts to promote female enrollment in higher education in Nigeria.

Evidence suggests that despite high knowledge of family planning (FP), unwanted pregnancies and birth rates remain high among young Nigerians. There is a critical gap in understanding the nexus between exposure to FP information and contraception practices among this population. This study aimed to fill this gap and tested a pathway of the impact of media exposure to FP messages on modern contraceptive use. Data came from a 2018 cross-sectional baseline survey of young people aged 15-24 in three urban centers in Nigeria - Lagos, Kaduna, and Kano. This was part of an impact evaluation of a television-based drama designed to improve contraceptive use among young individuals. The study was limited to 777 young men and women who were sexually active. We found evidence of the mediation effect of media exposure to FP messages on partner discussion about FP, which in turn was associated with an increased likelihood of modern contraceptive use. Contraceptive self-efficacy also had positive associations with contraception. Our study elucidated a potential pathway through which media communication programs can significantly contribute to increased modern contraceptive use and underlined the importance of providing young people in Nigeria with opportunities to learn and practice obtaining and using contraception.

Introduction This paper examined the management of diarrhoea at sub-national levels with the aim of providing an analytic view towards linking diarrhoea management to sources of care within the Nigeria context. Methods We used the 2013 NDHS data. Based on the 2004 WHO/UNICEF guidelines, we classified the quality of diarrhoea management practice as good, fair or poor. Having ‘Good' diarrhoea management is our dependent variable. Descriptive statistics, Chi-square statistics, logistic regression models and life table techniques were used to analyse the data. All analyses were carried out using Stata version 13, weighted and adjusted for survey design and sampling errors at 5% significance level. Results The overall prevalence of diarrhoea was 9% with 6% among 0–6 months old children and 16% among those aged 7–23 months. Diarrhoea prevalence was highest in the North-East region of Nigeria (16%). Prevalence was 10% among children whose mothers had no education and 11% among children from the poorest households. Quality of diarrhoea management was significantly associated with child's age, mother's age, wealth quintile, place where treatments were taken, health care accessibility, parental education, having blood in stool, quality of water and open defecation. Children who had care from the hospital were over 8 times more likely to experience good diarrhoea management compared with other children who didn't receive care from hospitals (OR = 8.18, 95% CI: 5.73–11.69). Furthermore, children from urban areas (OR = 2.03, 95% CI: 1.58–2.60) or whose mother reported access to modern health care services (OR = 2.23, 95% CI: 1.72–2.88) were more likely to experience good diarrhoea management. Child survival increased with higher levels of good diarrhoea management. Conclusion In Nigeria, treatment of childhood diarrhoea at home and in the community is not as effective as that obtained from the health facility.

Background: Older persons’ living arrangements are currently major development discourses across Africa. With the increasing family nucleation, weakening traditional ties and support networks, what is the emerging pattern of living arrangements of the older persons within this changing social system in West Africa? Methods: The study utilized DHS household data on older persons aged 60 years and above in selected West African countries: Benin Republic, Cote d’Ivoire, Ghana, Niger, Nigeria, Senegal and Togo (n=31,695). Results: Results showed that West African older persons had an average of 5.0 household network members; proportion living alone were higher among women (21.6%) than men (10.4%), majorly widows (31.3%) or single/divorced (38.0%). Household network, headship and living arrangements varied significantly across countries by age, sex, education, marital status and wealth quintile (p

ObjectivesThis study aimed to assess the safety and effectiveness of self-managed misoprostol abortions obtained outside of the formal health system in Lagos State, Nigeria.DesignThis was a prospective cohort study among women using misoprostol-containing medications purchased from drug sellers. Three telephone-administered surveys were conducted over 1 month.SettingData were collected in 2018 in six local government areas in Lagos State.ParticipantsDrug sellers attempted to recruit all women who purchased misoprostol-containing medication. To remain in the study, participants had to be female and aged 18–49, and had to have purchased the medication for the purpose of abortion. Of 501 women initially recruited, 446 were eligible for the full study, and 394 completed all three surveys.Primary and secondary outcome measuresUsing self-reported measures, we assessed the quality of information provided by drug sellers; the prevalence of potential complications; and the proportion with completed abortions.ResultsAlthough drug sellers provided inadequate information about the pills, 94% of the sample reported a complete abortion without surgical intervention about 1 month after taking the medication. Assuming a conservative scenario where all individuals lost to follow-up had failed terminations, the completion rate dropped to 87%. While 86 women reported physical symptoms suggestive of complications, only six of them reported wanting or needing health facility care and four subsequently obtained care.ConclusionsDrug sellers are an important source of medical abortion in this setting. Despite the limitations of self-report, many women appear to have effectively self-administered misoprostol. Additional research is needed to expand the evidence on the safety and effectiveness of self-use of misoprostol for abortion in restrictive settings, and to inform approaches that support the health and well-being of people who use this method of abortion.

Background : Family planning expansion has been identified as an impetus to harnessing Nigeria’s demographic dividend. However, there is a need for data to address pockets of inequality and to better understand cultural and social factors affecting contraceptive use and health benefits. This paper contributes to addressing these needs by providing evidence on the trends and sub-national patterns of modern contraceptive prevalence in Nigeria and the association between contraceptive use and high-risk births in Nigeria. Design : The study utilised women’s data from the last three Demographic and Health Surveys (2003, 2008, and 2013) in Nigeria. The analysis involved descriptive, bivariate, and multivariate analyses. The multivariate analyses were performed to examine the relationship between high-risk births and contraceptive use. Associations were examined using Poisson regression. Results : Findings showed that respondents in avoidable high-risk birth categories were less likely to use contraceptives compared to those at no risk [rate ratio 0.82, confidence interval: 0.76–0.89, p

Background The epidemiology of stroke in sub-Saharan African populations and variation of subtypes between communities are not well understood. Our aim was to ascertain prospectively the incidence of first-ever stroke and ischemic stroke subtypes in an urban city population of Southwestern Nigeria. Methods A community-based stroke registry was set up to enroll hospitalized and nonhospitalized first-ever stroke cases at all health care facilities located in the assigned community. The study was conducted between November 1, 2010, and October 31, 2011, in Akure North and South Local Government Areas of Ondo State, Southwestern Nigeria. Results We identified 298 incidents of strokes in patients presenting for the first time ever. Pathologic diagnosis was confirmed in 75% of the cases. Adjusted age-standardized incidence rate was 60.67 per 100,000 per year after adjustment to the World Health Organization World Population. Incidence of cerebral infarction and intracerebral hemorrhage increased with age in both men and women. Conclusions The incidence of stroke in our population-based study ranks low compared with high-income countries. However, when incidence rates were compared by pathologic type, our rates for intracerebral hemorrhage and that of subarachnoid hemorrhage are comparable with those of high-income countries.

This article examined the personal and household characteristics influencing the quality of life (QoL) of grandparents caring for grandchildren in Skipped Generation Households in Nigeria with a sample of 2, 144 grandparents in Imo, Lagos and Kano. Chi square and multinomial logistic regression were employed to understand the relationship between the dependent variable (QoL) and independent variables (personal and household characteristics). The level of the QoL of the grandparents almost spread evenly among low (34.3%), average (34.3%) and high (31.4%). Five domains of QoL were examined including level of independence (LI), psychological well-being (PW), social relation (SR), physical health (PH), environment (ENV) and engagement in income generating activities (IGA). Personal characteristics including; state of residence was significantly associated with all the domains except LI and PW, age was associated with IGA, LI and ENV, sex was associated with SR and ENV and level of education was associated with all the domains except IGA and ENV while religious affiliation was associated with IGA. Household characteristics including; sex of household head was significantly associated with PH, SR and ENV, age of household head was associated with IGA and LI and wealth index was associated with all the domains while the number of household members was significantly associated with ENV. The regression analysis shows that only state of residence and wealth index significantly influence the QoL of the grandparents (P≤0.05). The state of residence and wealth index are therefore important in any policy intervention for this category of elderly persons in Nigeria.

Growing older in some communities in Africa is becoming more challenging and worrisome. The situation is compounded by an increase in neoliberal based reforms and the absence of state-funded pension schemes that could cushion the everyday challenges that comes with old age. By adopting an interactionist perspective, this chapter examines the consequences of neoliberal social policies by focusing on experiences of ageism and adoption of resilience among Older Yoruba People in a Semiurban Community, South West Nigeria. Using a purposive sampling approach, 37 elderly Yoruba men and women from two post-conflict communities participated in semi-structured face-to-face interviews. The findings revealed resilience as essential to surviving elderly abuse, marginalization and neglect in old age. Among this social category of older Yoruba people, resilience is functional to achieving healthy aging experiences. This is coming up within a cultural context devoid of formal social support in meeting aging needs and challenges. In confronting some of the daily challenges, the participants narrated their adoption of resilience in coping with different life situations. Ageism did not emerge as a major issue at a personal level but perceived as an increasing problem for other elderly in their communities. However, some of the narratives confirmed different dimensions of ageism as participants’ recounted abuse and dwindling quality in intergenerational relations. Hence, prompt identification and promotion of resilience across the diverse social categories of the elderly might be instrumental in negotiating aging experiences and coping with the inherent challenges of liberalization and chatting clear directions in later life within a social context.

Africa is characterized by highly varied sociocultural, ethnic, and economic configurations. Family systems, however, remain the major bedrock of social life. The African family system is dynamic and evolving, yet there are clear constellations of a basic, similar pattern as well as distinct characteristics in regional poles. Family's common features are entrenched in the culture of high fertility, patriarchy, kinship solidarity, and polygyny. High fertility is maintained by universal and early age at marriage and a low prevalence of contraceptives. These strong values have likely been a survival strategy in the face of a harsh environment, low-performance subsistence technologies, and vulnerability to external invasion. Modernization, especially increasing urbanization and female education, is modifying the African family, affecting traditional gender roles, values, and responsibilities and weakening the power of elders and the extended family. In this environment youth and women can begin to negotiate better roles for themselves within the family. Keywords: Africa; culture; family; kinship solidarity; patriarchy

Background: Aging issues are becoming a very serious concern in many developing countries, particularly the health care needs and challenges of the elderly. Crucial among these are the sexual, psychosocial and somatic challenges facing the elderly, and the factors that may influence these. The Aging Males’ Symptoms (AMS) scale was primarily designed for international comparability on measures of quality of life (QoL) among the elderly. The validity and reliability of this instrument have been tested in Nigeria and results confirm its comparability with results from other countries. It is pertinent to examine the influence of some socio-economic factors on the self-reported severity of sexual, psychosocial and somatic measures on the AMS. Methods: The AMS instrument was administered to 456 males aged 60 years and above in selected communities in Ijesaland, South-West Nigeria. The AMS has 17 items and scoring was done on a scale of 1–5 based on the level of severity. Three outcome variables for psy...

Despite widespread awareness of and access to modern contraception, high rates of unwanted pregnancies and abortions still persist in many parts of the world, even where abortion is legally restricted. This article explores perspectives on contraception and abortion, contraceptive decision-making within relationships, and the management of unplanned pregnancies. It presents findings from an exploratory qualitative study based on 17 in-depth interviews and 6 focus group discussions conducted in 2 locations in Nigeria in 2006. The results suggest that couples do not practice contraception consistently because of perceived side effects and partner objections. Abortion is usually resorted to because pregnancy was unwanted due to incomplete educational attainment, economic hardship, immaturity, close pregnancy interval, and social stigma. Males usually have greater influence in contraceptive-decision making than females. Though induced abortion is negatively viewed in the community, it is still common, and women usually patronise quacks to obtain such services. An abortion experience can change future views and decisions towards contraception. Family planning interventions should include access to and availability of adequate family planning information. Educational campaigns should target males since they play an important role in contraceptive decision-making.

Previous comparative international studies on wellbeing of older adults in Africa have presented figures based on indicators which tend to obscure the variations in terms of wellbeing among the older adults in a particular country. Even studies conducted in Nigeria are based on small accidental samples, focusing on limited geographical area. This paper presents a nationally representative bottom-up approach to data generation by looking at wellbeing of older adults as defined by them. Data for the paper was drawn from a national study on Vulnerability of older adults in Nigeria. A sample of 3,696 older adults (55.6% male; 44.4% females; mean age = 69.2, SD = 8.60) were selected through multi-stage systematic random sampling, using a national census enumeration area framework. Data was collected using structured interviews via Open Data Kit (ODK), and supplemented with Focus Group Discussions and In-Depth Interviews. Subjective Wellbeing was measured using the Flourishing Scale. Multi-linear regression analysis revealed resilience as the main predictor for older adults’ subjective wellbeing. Other significant predictors include attitudes towards old age, wealth index, ability to meet daily financial needs, and independence in handling Activities of Daily Living (ADL). The findings of the study make significant contribution to the existing literature on older adults’ wellbeing in Nigeria and provides material for future regional and international comparisons on the subject. It also provides data that can be utilized for policies and programme interventions that will be in alignment with the older adults’ perceived needs.

• Summary: The study examined the implications of the Nigerian Child Right Acts, 2003 on checking the proliferation of street children in Nigeria, focusing on such government institutions as the police and Social Welfare Department using a combination of quantitative and qualitative methods. • Findings: It is clear that the street children are the major targets by the government agencies but these children have no cordial relationship with the police. Their vision of the police is that of ‘punishment’ rather than ‘help’. Also, the government through the Social Welfare Department provides some assistance to street children, but their programmes were not attractive enough to the children, hence, the street children’s concept of approved schools is that of a typical ‘Nigerian prison yard‘. • Applications : It is argued that the global paradigm shift from eradication of street children to providing support for street children has a very weak root in Nigeria. Therefore, there is the need for proper implementation of the Nigeria Child Rights Act promulgated in the year 2003, which could improve the standard of practice presently obtainable in Social Welfare Department and in other government agencies such as the Police Department as a possible solution to this social menace.

The Aging Males' Symptoms scale (AMS) is an internationally used scale to analyse health related quality of life (HRQoL). The aim of this paper is to provide evidence that the Nigerian AMS scale measures HRQoL with similar accuracy as in other language versions. We also intended to show the severity of complaints of aging in males in advanced old age. More generally, we aim to demonstrate that the Nigerian AMS scale is an applicable, validated, sensitive instrument to measure HRQoL in Nigeria.We performed a representative survey in Nigeria to get data of the AMS scale in a group of males in old age. The survey was a household-based population sample conducted in March 2006. The Nigerian data were compared with existing data from other European countries. Only community-based data were used for this comparison.The internal structure of the AMS (factorial analysis) was sufficiently similar with the comparison group of other countries in Europe to conclude that the scale really measures the same phenomenon. The sub-scores and total score correlations were high (0.8-0.9) but lower among the sub-scales (0.4-0.8). This suggests that the domains are not fully independent. The reliability (consistency) was found to be good and almost identical with European countries. Mean scores of the Nigerian AMS did systematically differ from data of other European studies. There were much higher because of older age. The same applies for the population reference values obtained in Nigeria. It is the first time that population norm values are available for very old age.The Nigerian AMS scale is a standardized HRQoL scale that showed good psychometric characteristics (reliability, validity) similar to other international versions. We suggest that the results obtained with the Nigerian AMS scale should be used preliminarily as reference for 'norm values' for highest age, i.e. in absence of other data. Confirmation in future studies is needed.

Background : Evidence shows that family planning contributes to the decline in child mortality by decreasing the proportions of births that are considered high risk. The main objective of the present analysis was to examine the trends in use of modern contraceptives and their relationship with total fertility rate (TFR) and distribution of births by demographic risk factors as defined by mother’s age, birth interval, and birth order at the sub-national level in Ethiopia. Design : Analyses used data from three Demographic and Health Surveys in Ethiopia (2000, 2005, and 2011), which are nationally representative data collected through questionnaire-based interviews from women 15–49 using a stratified, two-stage cluster sampling. First, we examined the trends of and relationship between TFR (in the 3 years before each survey) and modern contraceptive use among currently married women in all administrative regions over the time period 2000–2011 using linear regression analysis. We also examined the relationship between birth risks and under-five mortality using the no-risk group as a reference. Finally, multiple logistic regression analysis was performed to estimate the relationship between the effect of being a resident in one of the regions and having an avoidable birth risk (which includes births to mothers younger than 18 and older than 34 years, birth interval of less than 24 months and birth order higher than third) after adjusting for select covariates including wealth, educational status, residence, religion and exposure to family planning information. Results : Sub-national-level regression analysis showed an inverse relationship between modern contraceptive use among married women and the TFR, with an average decrease of TFR by one child per woman associated with a 13 percentage point increase in modern contraceptive use between 2000 and 2011. A high percentage of births in Ethiopia (62%) fall in one of the risk categories (excluding first births), with wide regional variation from 55% in Gambela to 72% in the Somali region. The multivariate analysis showed women living in the Somali, Afar and Benishangul-Gumuz regions had significantly higher odds of having avoidable birth risk compared to those in Addis Ababa after controlling for observed covariates. The trend analysis showed there was a significant drop in the proportion of births from women above 34 years between 2000 and 2011. There was no significant decline in births to women less than 18 years between 2000 and 2011. Conclusions : A majority of births in Ethiopia fall in one of the risk categories, with substantial region-to-region variation in the percentage of births with avoidable risk factors, Somali and Afar having the highest burden. The analysis indicated that births in the three regions had significantly higher odds of having one of the avoidable risk factors compared to Addis Ababa, and we suggest family planning programmes need to identify differentials of modern contraceptive use at the sub-national level in order to better address coverage and equity issues. Keywords: Ethiopia; distribution of birth risks; modern contraceptive use; total fertility (Published: 9 November 2015) Responsible Editor: Peter Byass, Umea University, Sweden. To access the supplementary material for this article, please see Supplementary files in the column to the right (under ‘Article Tools’) Citation: Glob Health Action 2015, 8 : 29720 - http://dx.doi.org/10.3402/gha.v8.29720 This paper is part of the Special Issue: Countdown to 2015 for maternal, newborn and child survival . More papers from this issue can be found at http://www.globalhealthaction.net

Sexual behavior and contraceptive use dynamics within marital union presents a very complex and dyad interpretations. Among the complexities is the possibility of couples’ sexual fidelity to each other, infidelity of either of the partners or both partners. Secondly, are the couples’ approaches to other marital derivatives including fertility and contraceptive use. The analysis examined the determinants of concordance and discordance reporting of contraceptive use among couples in Nigeria with a view to understanding factors in concordance and discordance reporting of contraceptive use. The analysis utilized the 2008 NDHS couples recode dataset. The data were analyzed using Kappa Statistics and multinomial logistic regression. The results showed that age, education, wealth index, residence, fertility desire and fertility preference were significant factors predicting concordance reporting of contraceptive use (P

Background : In sub-Saharan Africa, few studies have stressed the importance of spatial heterogeneity analysis in modern contraceptive use and the relationships with high-risk births. Objective : This paper aims to analyse the association between modern contraceptive use, distribution of birth risk, and under-five child mortality at both national and regional levels in Burkina Faso. Design : The last three Demographic and Health Surveys – conducted in Burkina Faso in 1998, 2003, and 2010 – enabled descriptions of differentials, trends, and associations between modern contraceptive use, total fertility rates (TFR), and factors associated with high-risk births and under-five child mortality. Multivariate models, adjusted by covariates of cultural and socio-economic background and contact with health system, were used to investigate the relationship between birth risk factors and modern contraceptive prevalence rates (mCPR). Results : Overall, Burkina Faso’s modern contraception level remains low (15.4% in 2010), despite significant increases during the last decade. However, there are substantial variations in mCPR by region, and health facility contact was positively associated with mCPR increase. Women’s fertility history and cultural and socio-economic background were also significant factors in predicting use of modern contraception. Low modern contraceptive use is associated with higher birth risks and increased child mortality. This association is stronger in the Sahel, Est, and Sud-Ouest regions. Even though all factors in high-risk births were associated with under-five mortality, it should be stressed that short birth spacing ranked as the highest risk in relation to mortality of children. Conclusions : Programmes that target sub-national differentials and leverage women’s health system contacts to inform women about family planning opportunities may be effective in improving coverage, quality, and equity of modern contraceptive use. Improving the demand satisfied for modern contraception may result in a reduction in the percentage of women experiencing high-risk births and may also reduce child mortality. Keywords: modern contraceptive use; high-risk births; fertility; under-five child mortality; Burkina Faso (Published: 9 November 2015) Responsible Editor: Peter Byass, Umea University, Sweden. To access the supplementary material for this article, please see Supplementary files in the column to the right (under ‘Article Tools’) Citation: Glob Health Action 2015, 8 : 29736 - http://dx.doi.org/10.3402/gha.v8.29736 This paper is part of the Special Issue: Countdown to 2015 for maternal, newborn and child survival . More papers from this issue can be found at http://www.globalhealthaction.net

Andropause (also known as androgen decline in aging males) has implications for the reproductive health and quality of life of older males. Very few studies have, however, been reported among the Nigerian population on andropause-related issues. This study assesses the perspective and level of awareness of married men in Ile-Ife, South-west Nigeria, of andropause. We also assessed their experience of erectile dysfunction, using a questionnaire based on the review of the International Index of Erectile Dysfunction. The study involved 355 married men, aged between 30 and 70 years. Our result shows a high level of misconception about andropause among our respondents, with 38.9% indicating that it is a myth, and another 23.6% attributing it to various causes other than being a natural aging process. We recorded a prevalence of erectile dysfunction of 43.8% (8.0% severe dysfunction and 35.8% moderate dysfunction). The prevalence of erectile dysfunction increased significantly with age, varying from 38.5% for age 31-40 years to 63.9% for the older age group of 61-70 years. The trend in prevalence of erectile dysfunction with age was significant (p < 0.05). An odds ratio of 2.82 (95% confidence interval 1.19-6.76) was recorded for the prevalence of erectile dysfunction at age 61-70 years compared with age 31-40 years. Our findings indicate a need for health education about andropause in Nigeria, and increased attention to the reproductive health concerns of males, and the older population.

Background Nigeria is one of the countries where significant progress has not been recorded in contraceptive uptake despite decades of family planning programs while there are indications that slum dwellers may differ significantly from other urban dwellers in their sexual and reproductive behavior, including family planning uptake. This study therefore examined local notions regarding male partners’ involvement in family planning (FP) adoption by women in two selected urban slums areas in Nigeria – Ibadan (Southwest region) and Kaduna (Northwest region). Specifically, the study investigated women’s narratives about FP, perceived barriers from male partners regarding FP adoption by the women and how women negotiate male partners' cooperation for FP use. Methods Sixteen FGD sessions were conducted with selected groups of men and women, stratified by sex, age group, and FP experience using a vignette to generate discussions. Sessions were facilitated by experienced social scientists and audio-taped, with note-taker also present. The transcribed data were analyzed with Atlas.ti software version 7. Inductive approach was employed to analyze the data. Reasons given for FP attitudes and use are presented in a network format while critical discourse analysis was also used in generating relevant tables. Results The finding shows that women in the selected communities expressed desire for FP adoption. Three main reasons largely accounted for the desire to use FP: perceived need to space childbirth, family’s financial condition and the potential adverse effect of high fertility on the woman’s health. Male partners’ support for the use of FP by women was perceived to be low, which is due to misconceptions about FP and traditional pro-natalistic beliefs and tendencies. Mechanisms by which women negotiate their male-partner’s cooperation for FP adoption include seeking the support of the partner’s significant others and advice from older women. Conclusion To significantly improve family planning adoption rates among urban slum dwellers in Nigeria, there is the need to specifically and specially target men alongside their female partners as well as other stakeholders who have significant influences at family and community level. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-869) contains supplementary material, which is available to authorized users.

The study is focused on understanding the broad issues of care and support of the elderly with a view to explaining factors influencing the gaps in their expectations and experiences. This is an empirical attempt with a view to understanding and underscoring the importance and limitation of the domains of support from core family members (spouses and children) within the available support networks for the elderly. The study utilized primary dataset including quantitative and qualitative data collected in Ijesa communities in South-west, Nigeria. The findings showed that children and spouses ranked highest among sources of support networks rated by the elderly for five patterns of support identified. Logistic regression results showed that individual variables including age, education, family of orientation, and living in same town with children to a large extent determine level of unmet need for support. The study concluded that personal attributes rather than other social variables are important determinants of high level of unmet need for elderly.

The study examined the emerging network of supports available to street children in Nigeria, focusing on such institutions as the government, Non-Governmental Organizations (NGOs), Civil Society Organizations (CSOs), the Community and the street children themselves. The study employed both quantitative and qualitative research methods to collect and analyse the data. Study findings show that 'of' the street children are the major targets by the network of the support since children 'on' the street are still being supported by their families and the assistance received by these children of the street from their peers and homeless adults is preferred to assistance from other support providers. Hence, the children‘s ranking of the 'support providers' shows that the support provided by the homeless adults on the street is most preferred. This was followed by supports from community members while the Civil Society Organisations were ranked third and the NGOs were ranked fourth. The government agencies were least on this ranking scale. The study concluded that, despite the global shift from eradication of street children to providing support for them right on the streets, this paradigm shift has very weak roots in Nigeria as the homeless adults remain important role model for them on the street.

Background: The benefits of universal access to voluntary contraception have been widely documented in terms of maternal and newborn survival, women’s empowerment, and human capital. Given population dynamics, the choices and opportunities adolescents have in terms of access to sexual and reproductive health information and services could significantly affect the burden of diseases and nations’ human capital. Objectives: The objectives of this paper are to assess the patterns and trends of modern contraception use among sexually active adolescents by socio-economic characteristics and by birth spacing and parity; to explore predictors of use of modern contraception in relation to the health system; and to discuss implications of the findings for family planning policy and programmes. Design: Data are from the last three Demographic and Health Surveys of Ethiopia, Burkina Faso, and Nigeria. The descriptive analysis focused on sexually active adolescents (15- to 19-year age group), used modern contraception as the dependent variable, and a series of contact points with the health system (antenatal care, institutional delivery, postnatal care, immunisation) as covariates. The multivariate analysis used the same covariates, adjusting for socio-economic variables. Results: There are two different groups of sexually active adolescents: those married or in a union with very low use of modern contraception and lower socio-economic status, and those unmarried, among whom nearly 50% are using modern contraception. Younger adolescents have lower modern contraceptive prevalence. There are significant inequality issues in modern contraception use by education, residence, and wealth quintile. However, while there was no significant progress in Burkina Faso and Nigeria, the data in Ethiopia point to a significant and systematic reduction of inequalities. The narrowing of the equity gap was most notable for childbearing adolescents with no education or living in rural areas. In the three countries, after adjusting for socio-economic variables, the strongest factors affecting modern contraception use among childbearing adolescents were marriage and child immunisation. Conclusions: Addressing child marriage and adopting effective policies and strategies to reach married adolescents are critical for improving empowerment and human capital of adolescent girls. The reduction of the equity gap in coverage in Ethiopia warrants further studies and documentation. The results suggest a missed opportunity for maternal and newborn and family planning integration.

A descriptive study of the awareness, knowledge and attitude of health professionals toward andropause was conducted in Ile-Ife, Nigeria with the aim of assessing the influence of sociodemographic variables of the respondents on their perspectives of the subject matter. The study employed a structured questionnaire to assess respondents' level of awareness and knowledge, and Likert-type scales to rate respondents' attitudes. A total of 187 (45%) respondents indicated previous awareness of andropause, with younger people (aged below 40 years) displaying better awareness compared with the older ones (p = 0.05), and more doctors than 'other technical health professionals' displaying better awareness when compared with health administrators (p < 0.001). However, only 93 (23%) respondents demonstrated a good knowledge of andropause, with more females compared with males recording good knowledge scores (p = 0.01). While a slightly higher proportion of older respondents (aged 40 years and above) compared with younger ones demonstrated good knowledge of andropause, age and marital status were not significantly related to knowledge of the subject matter. While only 23 (5.4%) respondents displayed a positive attitude toward andropause, and respondents' knowledge was found to positively influence their attitude toward it, none of the sociodemographic variables of age, sex or marital status was significantly related to respondents' attitudes. The study concluded that there is still a low level of awareness and knowledge of andropause among health workers in Nigeria, unlike what obtains in more developed countries of the world, and called for active education of both health professionals and the general public on the subject matter of andropause and other related male reproductive health concerns in the country.

Nigeria is the most populous country in Africa and has a very high population momentum with an annual growth rate of 3.2 per cent per annum. This momentum can be a panacea for development and economic growth if well harnessed. The focus of the article is to provide an overview of population dynamics in Nigeria with a view to situating this within a broader context of contemporary population and development discourse. The article benefited immensely from secondary data sources and desk review of evidence.

The Nigeria ageing population is becoming increasingly visible with its attendant challenges. This article attempts to set the tone for a pragmatic discourse on “costly assumptions” being made on the issue in Nigeria and its attendant challenges. This is with a view of linking the ageing agenda to a broader developmental framework. The paper adopted a reflective theoretical viewpoint with desk review of evidence and secondary data. The paper identified critical areas of costly assumptions and challenges as it relates to the Nigerian ageing population including the changing family structure and roles for the elderly; the high burden on children; physical health-care and medical needs; poor finances and income; and the need for public intervention. The concluding remark reiterated the need to assess and recognize the reality of the social changes and the effect of these changes on the elderly, now and in the future.

Background Existing studies of delivery care in Nigeria have identified socioeconomic and cultural factors as the primary determinants of health facility delivery. However, no study has investigated the association between supply-side factors and health facility delivery. Our study analyzed the role of supply-side factors, particularly health facility readiness and management practices for provision of quality maternal health services. Methods Using linked data from the 2005 and 2009 health facility and household surveys in the five states in which the Community Participation for Action in the Social Sector (COMPASS) project was implemented, indices of health service readiness and management were developed based on World Health Organization guidelines. Multilevel logistic regression models were run to determine the association between these indices and health facility delivery among 2710 women aged 15–49 years whose last child was born within the five years preceding the surveys and who lived in 51 COMPASS LGAs. Results The health facility delivery rate increased from 25.4 % in 2005 to 44.1 % in 2009. Basic amenities for antenatal care provision, readiness to deliver basic emergency obstetric and newborn care, and management practices supportive of quality maternal health services were suboptimal in health facilities surveyed and did not change significantly between 2005 and 2009. The LGA mean index of basic amenities for antenatal care provision was more positively associated with the odds of health facility delivery in 2009 than in 2005, and in rural than in urban areas. The LGA mean index of management practices was associated with significantly lower odds of health facility delivery in rural than in urban areas. The LGA mean index of facility readiness to deliver basic emergency obstetric and neonatal care declined slightly from 5.16 in 2005 to 3.98 in 2009 and was unrelated to the odds of health facility delivery. Conclusion Supply-side factors appeared to play a role in health facility delivery after controlling for socio-demographic factors. Improving uptake of delivery care would require greater attention to rural–urban inequities and health facility management practices, and to increasing the number of health facilities with fundamental elements for delivery of basic emergency obstetric and neonatal care. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1097-3) contains supplementary material, which is available to authorized users.