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Background: Abortion stigma as reported globally has been inadequately documented empirically in Nigeria, Africa's most populous country with a restrictive abortion law and a high rate of unsafe abortions., Objective: The objectives of this study were to investigate the ways in which abortion stigma is experienced by Nigerian health professionals and how such experiences influence health professionals' practice of safe abortion and post-abortion care., Methods: The study utilized qualitative research consisting of in-depth interviews with 10 abortion providers. We elicited information with an open-ended interview guide that investigated the understanding of participants' experiences of abortion stigma in Nigeria. The data were analysed qualitatively and thematically using Atlas.ti., Results: The themes centred on perceptions and experiences of stigma among the providers interviewed. Participants' experiences of abortion stigma included the following: being treated differently to other health professionals; experiencing disapproval and disrespect; name-calling and societal judgement; tagging and profiling of clinics by anti-abortionists; and social isolation. Participants attributed stigma to cultural and religious beliefs, the restrictive national abortion law, and pointed to hypocrisy. Some reported effects of stigma on providers included a feeling of insecurity, social exclusion, secrecy, and insincerity in clinical practice, discouragement, and guilt feelings. Despite the negative impacts, many respondents reported a sense of satisfaction stemming from their views that they were saving lives., Conclusion: Systematic efforts to address these adverse factors could reduce the level of stigma experienced by providers, with a potential follow-through effect of improving women's access to safe abortion care in Nigeria.

This paper documents the results of an intervention conducted in Nigeria to test the effectiveness of a mobile phone technology, text4life , in enabling women to self-report gender-based violence (GBV). Women experiencing GBV and other challenges related to sexual and reproductive health and rights were requested to use their mobile phones to text a code to a central server. In turn, the server relayed the messages to trained nearby health providers and civil society organization (CSO) officials who reached out to provide health care and social management services to the callers. Interviews were conducted with some callers, health care providers, and CSO staff to explore their experiences with the device. The interviews and data from the server were analyzed qualitatively and quantitatively. The results indicate that over a 27-month period, 3,403 reports were received by the server, 34.9% of which were reporting GBV. While interviewees perceived that a large proportion of the women were satisfied with the use of text4life , and many received medical treatment and psychological care, the consensus opinion was that many women reporting GBV did not wish to pursue police or legal action. This was due to women's perceptions that there would be negative cultural and social backlash should they pursue civil punishments for their partners. We conclude that a mobile phone device can be used effectively to report GBV in low-resource settings. However, the device would be more useful if it contributes to equitable primary prevention of GBV, rather than secondary prevention measures.

The African Journal of Reproductive Health is pleased to publish these compendia of articles that originated from an international symposium on public health which took place in Surabaya, Indonesia in 2023 (ISoPH 2023). Indonesia, the world's fourth largest country, with a population of 280 million people, has a robust healthcare system that comprises a mix of public and private providers' financing. Of interest, is Indonesia's approach to health promotion through the digitization of its health services resulting in the development of multiple health applications by the central government, regional governments, and the private sector. The uniqueness of the ISoPH symposium is its strategic focus on providing an understanding of the ways that various communities in Indonesia have been engaged and are involved in using digital technologies to promote health outcomes. This being one of the first such descriptions globally, it remains an essential approach that will help to draw similar innovations from other parts of the world., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

Mycotoxins in drinking water are neglected pollutants that have serious health implications when ingested. Common mycotoxins with health concerns include deoxynivalenol (DON), ochratoxin A (OTA), and zearalenone (ZEN). This study considers the distribution and apparent health risks of these mycotoxins in drinking water sources (groundwater, surface water, bottled water, sachet water) in three Southwest Nigeria States: Osun, Oyo, and Lagos States, using the UHPLC-ESI-QTOF. ZEN and DON were found in all 95 water samples across all three states. ZEN in sachet water samples has the highest mean concentrations, with those from Osun, Oyo, and Lagos States having concentrations of 14.96 ± 4.46, 8.59 ± 3.86, and 10.56 ± 2.84 μg L -1 , respectively. In contrast, the mean concentrations of all three mycotoxins (± Standard Error of Mean) in bottled water samples are the lowest across the three States. The mean concentrations of OTA in sachet water samples (2.93 ± 0.79, 1.24 ± 0.40, and 3.01 ± 1.50 μg L -1 ) are slightly higher than those in bottled water (1.47 ± 0.28, 1.53 ± 0.31, and 0.75 ± 0.31 μg L -1 ) for Osun, Oyo, and Lagos States, respectively. Groundwater samples across the three States had the lowest average pH values, below the WHO's lowest limit of 6.5. Principal Component Analysis studies indicate that all three mycotoxins in water samples are closely associated by source. Possible human exposure values for ZEN suggest some health concerns, especially with the use of sachet water type based on the estrogenicity of this mycotoxin. However, OTA values for all water samples analyzed, are much lower than the tolerable daily intake (TDI) of 4.73 μg kg -1 bw per day provided by European Food Safety Auhtority (EFSA). The levels of DON in all water sample types were of no serious health concern. However, human exposure levels to all three mycotoxins in bottled water fall within safe limits of health-based guidance values (HBGV) indicating that this drinking water type is better treated, unlike sachet water. Nevertheless, stakeholders need to re-examine water quality with respect to these mycotoxins and adopt stringent guidelines and new water treatment strategies to provide consumers with safe drinking water in line with the UN SDG #6., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

The African Journal of Reproductive Health is pleased to publish these compendiums of original research in this special edition that document new findings in adolescent sexual and reproductive health and rights from the West and Central African region (WCA). While sub-Saharan Africa has some of the worst indicators of sexual and reproductive health and rights (SRHR) in the world, the indicators are more daunting in the WCA region. To date, the WCA is recognized to have the highest rates of unwanted pregnancy, unsafe abortion, and human immunodeficiency virus (HIV) and other sexually transmissible infections, as well as the lowest contraceptive prevalence rates among adolescents worldwide.1 Despite the high rate of adverse adolescent reproductive health outcomes in WCA, there has been limited documentations of the socio-cultural and economic circumstances that perpetuate these adverse consequences. There have also been no purposefully designed interventions that provide strong scientific evidence for developing strategies to reverse the trend., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

The prospect of a Biden-Trump rematch had raised concerns. The argument of Trump on the older age of Biden led to a boomerang effect when the latter was replaced by the much younger Kamala Harris whose mixed African and Asian ancestry should lead to her support on international issues. Swing voters might be attracted by her potential as the first female president. Assertive on the politically controversial issue of abortion, Kamala Harris already spent a substantial part of her vice-presidency on women issues. Her promotion of sexual and reproductive rights during the presidential campaign augurs well for restoring those priorities on the American political agenda., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

Constituting a valuable resource, youth deserve more attention regarding their rights through increased access to sexual and reproductive health services. Limitations in health service delivery for youth should be overcome, whether pertaining to restrictive legislation and policies or technical approaches. Clear clinical guidelines will improve quality of care thereby complying with national commitments to international legal instruments. It is apt for both decision-makers and service providers to celebrate International Youth Day on Monday 12 August, by paying special consideration to innovative approaches for the delivery of youth-friendly sexual and reproductive health services that are adaptable to local circumstances., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

The COVID-19 pandemic challenged health systems globally. Reverse transcription polymerase chain reaction (RT-PCR) is the gold standard for detecting the presence of SARS-CoV-2 in clinical samples. Rapid diagnostic test (RDT) kits for COVID-19 have been widely used in Nigeria. This has greatly improved test turnover rates and significantly decreased the high technical demands of RT-PCR. However, there is currently no nationally representative evaluation of the performance characteristics and reliability of these kits. This study assessed the sensitivity, specificity, and predictive values of ten RDT kits used for COVID-19 testing in Nigeria. This large multi-centred cross-sectional study was conducted across the 6 geo-political zones of Nigeria over four months. Ten antigen (Ag) and antibody (Ab) RDT kits were evaluated, and the results were compared with RT-PCR. One thousand, three hundred and ten (1,310) consenting adults comprising 767 (58.5%) males and 543 (41.5%) females participated in the study. The highest proportion, 757 (57.7%), were in the 20-39 years' age group. In terms of diagnostic performance, Lumira Dx (61.4, 95% CI: 52.4-69.9) had the highest sensitivity while MP SARS and Panbio (98.5, 95% CI: 96.6-99.5) had the highest specificity. For predictive values, Panbio (90.7, 95% CI: 79.7-96.9) and Lumira Dx (81.2, 95% CI: 75.9-85.7) recorded the highest PPV and NPV respectively. Ag-RDTs had better performance characteristics compared with Ab-RDTs; however, the sensitivities of all RDTs in this study were generally low. The relatively high specificity of Ag-RDTs makes them useful for the diagnosis of infection in COVID-19 suspected cases where positive RDT may not require confirmation by molecular testing. There is therefore the need to develop RDTs in-country that will take into consideration the unique environmental factors, interactions with other infectious agents, and strains of the virus circulating locally. This may enhance the precision of rapid and accurate diagnosis of COVID-19 in Nigeria., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Omonkhua et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

It is opportune for the Journal to contribute to Self-Care Month and Self-Care Day, as proclaimed by the World Health Organization (WHO) in its efforts to promote self-care which is increasingly prominent in discourses in resource-limited settings for attaining universal health coverage. With sexual and reproductive health and rights facing hindrances, such as cultural barriers, self-care should facilitate access to services whilst maintaining privacy. Largely limited to pregnancy beforehand, self-care can now be promoted for the self-management of medical abortion, self-administration of injectable contraceptives and gender-affirming hormones besides self-collection of samples for infection testing., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

Diabetes mellitus is a chronic metabolic disorder that affects glucose, lipid, and protein metabolism. Targeting these metabolic derangements can optimize the therapeutic strategies for this disease. Utilizing in vitro and in silico models, this study investigated the ability of aqueous and ethanol extracts of Irvingia gabonensis to inhibit α-amylase, α-glucosidase, pancreatic lipase, and protein glycation. High-performance liquid chromatography (HPLC) was used to identify the compounds found in the stem bark of I. gabonensis . In silico analysis determined the binding mode and mechanism of interactions between the enzymes and phytochemicals. With an IC 50 value of 11.47 µg/ml, the aqueous extract demonstrated higher inhibitory efficacy against α-amylase compared to the ethanol extract (IC 50 19.88 µg/ml). However, the ethanol extract had stronger inhibitory activities against α-glucosidase, pancreatic lipase, and protein glycation compared to the aqueous extract (IC 50 values of 3.05, 32.85, 0.0014 versus 25.72, 332.42, 0.018 µg/ml respectively). Quercetin ranked highest in binding energy with α-amylase (-6.6 kcal/mol), α-glucosidase (-6.6 kcal/mol), and pancreatic lipase (-5.6 kcal/mol). This was followed by rhamnetin (6.5, 6.5, and 6.1 kcal/mol respectively). Hydrogen bonding, hydrophobic interactions, and pi-pi stacking are forces responsible for the binding of quercetin and rhamnetin to these enzymes. Molecular dynamics simulation showed that the lead phytochemicals formed stable and energetically stabilized complexes with the target proteins. This study showed that the extracts of I. gabonensis stem bark had significant in vitro anti-diabetic, anti-pancreatic lipase, and anti-protein glycation activities. The strong binding affinities of some of the identified compounds could be responsible for the inhibitory potential of the extracts. I. gabonensis stem bark could be further explored as a natural remedy for the treatment of diabetes mellitus and its complications., Competing Interests: Competing interestsThe authors declare no competing interests.Conflict of interestAll authors declare that there is no conflict of interest., (© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

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., (© The Author(s) 2023. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

This month, April 2024, the University of Benin, a federally-funded university in Southern Nigeria announced the first endowed professorial chair in sexual and reproductive health and rights (SRHR) in sub-Saharan Africa, and possibly the first such chair globally. This professorship is named in honour of Friday Okonofua1, the irrepressible champion who is a trailblazer in women's health, social advocate for women's social advancement, lead founder of the University's African Centre of Excellence in Reproductive Health, and founder of Nigeria's leading non-governmental organization, the Women's Health and Action Research Centre and the African Journal of Reproductive Health. The new professorship will be crucial in deepening and scaling up reproductive health curricula at the University of Benin, by drawing upon the principles and models of transparency, excellence, and accountability that Friday Okonofua has championed over several years. The University's Registrar alluded to this approach by explaining that the endowment "will strengthen the leadership of the University of Benin in Nigeria in this area of public health and educational delivery., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

In September 1994, the International Conference on Population and Development (ICPD), that gave birth to the doctrine of sexual and reproductive health and rights (SRHR), was held in Cairo, Egypt1. This year is the 30th year following the conference. Given that a total of 179 governments attended the ICPD and agreed to the Platform for Action for promoting and improving sexual and reproductive health and rights, it is appropriate to take stock of changes, expectations, and commitments that have occurred as a result of actions taken by governments. The 57th session of the Commission on Population and Development will be held in April 2024 and will be dedicated to assessing the status of sexual and reproductive health and rights 30 years after Cairo. Additional post-30years events will take place in Geneva, Switzerland in October 19-20, 2024 which are intended to enable the global community to take a look backwards identify ways in which the ICPD processes have influenced global development., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

With advances in clinical knowledge and changing norms for health services delivery, lifelong learning is essential for practitioners of sexual and reproductive health. Clinical topics should be complemented by various items, such as communications and management, to optimise the provision of care. Aiming to update knowledge, improve skills and enhance competence, professional development can take the form of diverse modalities ranging from the reading of professional journals through attendance at meetings to formal participation in schemes organised by licensing authorities. Already mandatory in numerous countries in Africa, continuing professional development is assuming more importance for medical, nursing, and midwifery practitioners., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

Climate change has featured repeatedly in the most recent discourses on global development1. Several global conferences have been held in recent times to discuss and reach consensus on ways to ameliorate the causes and address the consequences of climate change worldwide. These conferences, now called "Conference of the Parties (COP) to the United Nations Framework on Climate change" have taken place in many countries over the last couple of years. The most recent conferences included COP26 and COP27 which took place in Glasgow, UK 2021 and Sham El Sheikh, Egypt in 2022 respectively. The COP28, which took place in Dubai, UAE in 2023 focused on the theme "unite, act, deliver", and was attended by over 85,000 participants., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2024.)

A systematic literature review was conducted to examine all recent academic, peer-reviewed studies of menstrual hygiene management (MHM) across adolescent girls in Anglophone West Africa. The objective was to assess the status of the scholarship surrounding the knowledge, attitudes, and practices of MHM across English-speaking West African countries and identify gaps in the literature for further research. The authors searched the epidemiological literatures indexed in PubMed and cross-referenced bibliographies for studies published between 2010-2022. Of 59 abstracts and articles screened, 35 met the final inclusion criteria. Despite differences in study design, setting, and data sources, the study results concurred on an average age of menarche between 12-15 years old among adolescent girls. The knowledge of MHM came from multiple sources, most commonly mothers, female siblings, and teachers and higher knowledge was associated with age, source, wealth, religion, and education level. Less than half of the adolescent girls knew about menstruation before menarche. Many studies showed that girls were shocked by their first period and fearful of staining. Menstruation was associated with dysmenorrhea, fear/embarrassment, and missing school. The existing studies suggest that more implementation and evaluation of menstrual hygiene management materials, education, and facilities are needed to address the educational, physical, and social disparities that exist among girls in West African countries., Competing Interests: African Journal of Reproductive Health © 2024, (The Authors declared no conflict of interest.)

Cervical cancer remains a critical challenge in reproductive health worldwide, with especially high burden in Africa. A recent publication in the Lancet reported 604,127 cases of cervical cancer worldwide in 20201, of which 117,316 cases (19.4%) were in the five African regions. East Africa had the highest incidence rate followed by West Africa, while north and South Africa had the lowest rates. Similarly, the highest cervical cancer mortality rate worldwide, 28.6 deaths per 100,000 women years, was reported from East Africa, and was followed by South Africa., Competing Interests: The Authors declared no conflict of interest, (African Journal of Reproductive Health © 2023.)

Background: Evidence indicates that Nigeria's high maternal mortality rate is attributable primarily to events that occur during the intrapartum period. This study determines the effectiveness of multifaceted interventions in improving the quality of intrapartum care in Nigeria's referral hospitals., Methods: Data collected through an exit interview with 752 women who received intrapartum care in intervention and control hospitals were analyzed. The interventions were designed to improve the quality indicators in the WHO recommendations for positive childbirth and assessed using 12 quality indicators. Univariate, bivariate, Poisson, and logistic regression analyses were used to compare twelve quality indicators at intervention and control hospitals., Results: The interventions showed a 6% increase in composite score of quality of care indicators at intervention compared with control hospitals. Five signal functions of intrapartum care assessed were significantly (< 0.001) better at intervention hospitals. Quality scores for segments of intervention periods compared to baseline were higher at intervention than in control hospitals., Conclusions: We conclude that multiple interventions that address various components of the quality of intrapartum care in Nigeria's referral hospitals have demonstrated effectiveness. The interventions improved five of ten quality indicators. We believe that this approach to developing interventions based on formative research is important, but a process of integrating the implementation activities with the normal maternal health delivery processes in the hospitals will enhance the effectiveness of this approach., Trial Registration: The study was registered at the Nigeria Clinical Trials Registry. Trial Registration Number NCTR No: 91,540,209 (14/04/2016) http://www.nctr.nhrec.net/ and retrospectively with the ISRCTN. Trial Registration Number 64 ISRCTN17985403 (14/08/2020) https://doi.org/10.1186/ISRCTN17985403 ., (© 2023. BioMed Central Ltd., part of Springer Nature.)

The authors call for urgent action to ensure that COP27, the 5th Conference of the Parties (COP) finally delivers climate justice for Africa and vulnerable countries. Topics covered include the needs for wealthy nations to step up support for Africa and vulnerable countries in addressing past, present and future impacts of climate change, the impact of the climate crisis on the environmental and social determinants of health across Africa, and how global inaction has caused the climate crisis.

Lassa fever (LF) remains endemic in Nigeria with the country reporting the highest incidence and mortality globally. Recent national data suggests increasing incidence and expanding geographic spread. Predictors of LF case positivity in Nigeria have been sparsely studied. We thus sought to determine the sociodemographic and clinical determinants of LF positivity amongst suspected cases presenting to health facilities from 2018 to 2021. A secondary analysis of the national LF surveillance data between January 2018 and December 2021. Socio-demographic and clinical data of 20,027 suspected LF cases were analysed using frequencies and Chi-square statistics with significant p-value set at p < 0.05. The outcome variable was LF case status (positive or negative). Predictors of LF case positivity were assessed using multiple logistic regression models with 95% confidence intervals (CI). Case positivity rate (CPR) for the four years was 15.8% with higher odds of positivity among age group 40-49 years (aOR = 1.40; 95% CI 1.21-1.62), males (aOR = 1.11; 95% CI 1.03-1.20), those with formal education (aOR = 1.33; 95% CI 1.13-1.56), artisans (aOR = 1.70; 95% CI 1.28-2.27), religious leaders (aOR = 1.62; 95% CI 1.04-2.52), farmers (aOR = 1.48; 95% CI 1.21-1.81), and symptomatic individuals (aOR = 2.36; 95% CI 2.09-2.68). Being a health worker (aOR = 0.69; 95% CI 0.53-0.91), a teacher (aOR = 0.69; 95% CI 0.53-0.89) and cases reporting in the 3rd quarter (aOR = 0.79; 95% CI 0.69-0.92) had lower odds. In a sex-disaggregated analysis, female farmers had higher odds of positivity (aOR = 2.43; 95% CI 1.76-3.38; p < 0.001) than male farmers (aOR = 1.52; 95% CI 1.19-1.96; p < 0.01). Fever (aOR = 2.39; 95% CI 2.00-2.84) and gastrointestinal (GI) symptoms (aOR = 2.15; 95% CI 1.94-2.37) had the highest odds among symptoms. Combination of fever and GI symptoms (aOR = 2.15; 95% CI 1.50-3.10), fever and neurological symptoms (aOR = 6.37; 95% CI 1.49-27.16), fever and musculo-skeletal symptoms (aOR = 2.95; 95% CI 1.37-6.33), fever and cardiopulmonary symptoms (aOR = 1.81; 95% CI 1.24-2.64), and cardiopulmonary and general symptoms (aOR = 1.50; 95% CI 1.19-1.89) were also predictive. Cumulative LF CPR appears high with clearly identified predictors. Targeted interventions with heightened index of suspicion for sociodemographic categories predictive of LF in suspected cases are recommended. Ethnographic and further epidemiological studies could aid better understanding of these associations., (© 2023. The Author(s).)

Background: Difficulty in transportation to access skilled providers has been cited repeatedly as a major barrier to utilization of emergency obstetric care in Nigeria., Objective: The objective of this paper is to describe the design, implementation, and outcomes of a mobile phone technology aimed at rapidly reaching rural Nigerian women who experience pregnancy complications with emergency transportation and access to providers., Method: The project was implemented in 20 communities in two predominantly rural Local Government Areas (LGAs) of Edo State, in southern Nigeria, as part of a larger implementation project aimed at improving the access of rural women to skilled pregnancy care. The digital health innovation named Text4Life, allowed women to send a brief message from their mobile phone to a server linked to Primary Health Care (PHC) facilities and to access pre-registered transport owners. Pregnant women were registered and taught to text short messages to a server from their mobile phones or those of a friend or relative when they experience complications., Results: Over 18 months, 56 women out of 1620 registered women (3.5%) texted the server requesting emergency transportation. Of this number, 51 were successfully transported to the PHC facilities, 46 were successfully treated at the PHC, and five were referred to higher-level care facilities. No maternal deaths occurred during the period, while four perinatal deaths were recorded., Conclusion: We conclude that a rapid short message sent from a mobile phone to a central server and connected to transport providers and health facility managers is effective in increasing the access of pregnant women to skilled emergency obstetric services in rural Nigeria., (© 2023. The Author(s).)

Background: Involving men and boys as both users and supporters of Family Planning (FP) is now considered essential for optimising maternal and child health outcomes. Evidence on how to engage men and boys to meet FP needs is therefore important., Objectives: The main objective of this review was to assess the strength of evidence in the area and uncover the effective components and critical process- and system-level characteristics of successful interventions., Search Methods: We searched nine electronic databases, seven grey literature databases, organisational websites, and the reference lists of systematic reviews relating to FP. To identify process evaluations and qualitative papers associated with the included experimental studies, we used Connected Papers and hand searches of reference lists., Selection Criteria: Experimental and quasi-experimental studies of behavioural and service-level interventions involving males aged 10 years or over in low- and middle-income countries to increase uptake of FP methods were included in this review., Data Collection and Analysis: Methodology was a causal chain analysis involving the development and testing of a logic model of intervention components based on stakeholder consultation and prior research. Qualitative and quantitative data relating to the evaluation studies and interventions were extracted based on the principles of 'effectiveness-plus' reviews. Quantitative analysis was undertaken using r with robust variance estimation (RVE), meta-analysis and meta-regression. Qualitative analysis involved 'best fit' framework synthesis., Results: We identified 8885 potentially relevant records and included 127 in the review. Fifty-nine (46%) of these were randomised trials, the remainder were quasi-experimental studies with a comparison group. Fifty-four percent of the included studies were assessed as having a high risk of bias. A meta-analysis of 72 studies ( k  = 265) showed that the included group of interventions had statistically significantly higher odds of improving contraceptive use when compared to comparison groups (odds ratio = 1.38, confidence interval = 1.21 to 1.57, prediction interval = 0.36 to 5.31, p  < 0.0001), but there were substantial variations in the effect sizes of the studies ( Q  = 40,647, df = 264, p  < 0.0001; I 2  = 98%) and 73% was within cluster/study. Multi-variate meta-regression revealed several significant intervention delivery characteristics that moderate contraceptive use. These included community-based educational FP interventions, interventions delivered to women as well as men and interventions delivered by trained facilitators, professionals, or peers in community, home and community, or school settings. None of the eight identified intervention components or 33 combinations of components were significant moderators of effects on contraceptive use. Qualitative analysis highlighted some of the barriers and facilitators of effective models of FP that should be considered in future practice and research., Authors' Conclusions: FP interventions that involve men and boys alongside women and girls are effective in improving uptake and use of contraceptives. The evidence suggests that policy should continue to promote the involvement of men and boys in FP in ways that also promote gender equality. Recommendations for research include the need for evaluations during conflict and disease outbreaks, and evaluation of gender transformative interventions which engage men and boys as contraceptive users and supporters in helping to achieve desired family size, fertility promotion, safe conception, as well as promoting equitable family planning decision-making for women and girls., (© 2023 The Authors. Campbell Systematic Reviews published by John Wiley & Sons Ltd on behalf of The Campbell Collaboration.)

Background: Lassa fever is a viral haemorrhagic fever endemic in Nigeria. Improved surveillance and testing capacity have revealed in an increased number of reported cases and apparent geographic spread of Lassa fever in Nigeria. We described the recent four-year trend of Lassa fever in Nigeria to improve understanding of its epidemiology and inform the design of appropriate interventions., Methods: We analysed the national surveillance data on Lassa fever maintained by the Nigeria Centre for Diseases Control (NCDC) and described trends, sociodemographic, geographic distribution, and clinical outcomes. We compared cases, positivity, and clinical outcomes in the period January 2018 to December 2021., Results: We found Lassa fever to be reported throughout the year with more than half the cases reported within the first quarter of the year, a recent increase in numbers and geographic spread of the virus, and male and adult (>18 years) preponderance. Case fatality rates were worse in males, the under-five and elderly, during off-peak periods, and among low reporting states., Conclusion: Lassa fever is endemic in Nigeria with a recent increase in numbers and geographical distribution. Sustaining improved surveillance, enhanced laboratory diagnosis and improved case management capacity during off-peak periods should remain a priority. Attention should be paid to the very young and elderly during outbreaks. Further research efforts should identify and address specific factors that determine poor clinical outcomes., Competing Interests: The authors declared no competing interests., (Copyright: © 2022 Dalhat et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)