SFH Papers


Demand for women’s health services in northern Nigeria: a review of the literature. Sinai I, Anyanti J, Khan M, Daroda R, Oguntunde O. Demand for Women’s Health Services in Northern Nigeria: A Review of the Literature. Afr J Reprod Health. 2017;21(2):96-108.

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ABSTRACT : Demand for and utilization of women’s health services in northern Nigeria are consistently low and health indicators in the region are among the poorest in the world. This literature review focuses on social and cultural barriers to contraceptive use, antenatal care, and facility births in northern Nigeria, and influencers of young women’s health-seeking behavior. A thorough search of peer reviewed and grey literature yielded 41 publications that were synthesized and analyzed. The region’s population is predominantly Muslim, practicing Islam as a complete way of life. While northern Nigerian society is slowly changing, most women still lack formal education, with a significant proportion married in their teens, and the majority neither socially nor economically empowered. The husband largely makes most household decisions, including utilization of healthcare services by members of his household. These practices directly impact women’s health-seeking behaviors for themselves and for their children. Programs seeking to improve women’s health outcomes in northern Nigeria should involve women’s influencers to affect behavior change, including husbands, religious leaders, and others. More research is needed to identify pathways of information that can be utilized by programs designed to increase demand for health services.

When it just won’t go away: oral artemisinin monotherapy in Nigeria, threatening lives, threatening progress. ACTwatch Group, Ujuju C, Anyanti J, Newton PN, Ntadom G. When it just won’t go away:;16(1):489. Published 2017 Dec 15 oral artemisinin monotherapy in Nigeria, threatening lives, threatening progress. Malar J. 2017.

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ABSTRACT : Oral artemisinin monotherapy (AMT), an important contributor to multi-drug resistant malaria, has been banned in Nigeria. While oral AMT has scarcely been found for several years now in other malaria-endemic countries, availability has persisted in Nigeria’s private sector. In 2015, the ACTwatch project conducted a nationally representative outlet survey. Results from the outlet survey show the extent to which oral AMT prevails in Nigeria’s anti-malarial market, and provide key product information to guide strategies for removal.

Results: Between August 10th and October 3rd, 2015 a total of 13,480 outlets were screened for availability of anti-malarials and/or malaria blood testing services. Among the 3624 anti-malarial outlets, 33,539 anti-malarial products were audited, of which 1740 were oral AMT products, primarily artesunate (n = 1731). Oral AMT was imported from three different countries (Vietnam, China and India), representing six different manufacturers and 11 different brands. Availability of oral AMT was highest among pharmacies (84.0%) and Patent Propriety Medicine Vendors (drug stores, PPMVs) (38.7%), and rarely found in the public sector (2.0%). Oral AMT consisted of 2.5% of the national anti-malarial market share. Of all oral AMT sold or distributed, 52.3% of the market share comprised of a Vietnamese product, Artesunat®, manufactured by Mekophar Chemical Pharmaceutical Joint Stock Company. A further 35.1% of the market share were products from China, produced by three different manufacturers and 12.5% were from India by one manufacturer, Medrel Pharmaceuticals. Most of the oral AMT was distributed by PPMVs accounting for 82.2% of the oral AMT market share. The median price for a package of artesunate ($1.78) was slightly more expensive than the price of quality-assured (QA) artemether lumefantrine (AL) for an adult ($1.52). The median price for a package of artesunate suspension ($2.54) was three times more expensive than the price of a package of QA AL for a child ($0.76).

Conclusion: Oral AMT is commonly available in Nigeria’s private sector. Cessation of oral AMT registration and enforcement of the oral AMT ban for removal from the private sector are needed in Nigeria. Strategies to effectively halt production and export are needed in Vietnam, China and India.

Using brothel leadership to promote condom use among brothel-based female sex workers in Abuja, Nigeria: study protocol for a cluster randomized pilot trial. Pilot Feasibility Study. Okafor U, Crutzen R, Okekearu I, et al. Using brothel leadership to promote condom use among brothel-based female sex workers in Abuja, Nigeria: study protocol for a cluster randomized pilot trial. Pilot Feasibility Stud. 2017;3:10. Published 2017 Feb 20.

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ABSTRACT : The HIV prevalence among female populations involved in sex work in Nigeria has heightened interest in HIV prevention programming for this sub-population with brothel-based female sex workers (BB FSWs) having a prevalence of 27.4%, six times higher than the prevalence in the general population.

Methods/design: The clusters in the randomized pilot trial will be brothels and female sex workers (FSWs) residing in the brothels will be the participants of the study. The participants will receive free condom distribution as well as HIV prevention messages on condom use and negotiation skills to increase self-efficacy in handling social and gender power plays within their environment. Twelve brothels will be randomized into experimental and control conditions with a minimum total sample size of 200 participants. Recruitment of participants will be carried out from within the brothels. The control condition will receive a standard intervention consisting of a minimum of six interactive sessions with peer educators (PE) engaging their peers through group discussions and one on one interaction using pre-designed HIV prevention messages. The experimental condition will receive the standard intervention as well as interactive sessions with the brothel leadership (chairladies and brothel managers) to facilitate consistent condom use and appropriate condom use policies, conditions, and messaging. Both interventions will be delivered over a maximum period of 16 weeks, and male and female condoms will be distributed during the intervention. Quantitative assessments will be carried out at baseline and at 16 weeks follow-up, and the pilot findings will inform feasibility of and sample size estimation for a phase III trial. The primary outcomes measured are recruitment rate attrition rate and adherence to the intervention. Consistent condom use outcomes by FSWs within the brothel with all partner types and enhanced self-efficacy for condom negotiation with all partner types will be the primary outcomes for the main study, and the feasibility of their measurement will be determined in this pilot trial.

Discussion: The manuscript describes the protocol for a pilot study to determine the feasibility of a behavioral intervention to improve consistent condom use among BB FSWs. The results of this pilot will inform a larger intervention for HIV prevention for this target group in Nigeria.

Demand-related factors influencing caregivers’ awareness of malaria tests and health workers’ testing practices, in Makarfi. Nigeria. Ajumobi O, Sabitu K, Ajayi I, et al. Demand-related factors influencing caregivers’ awareness of malaria tests and health workers’ testing practices, in Makarfi, Nigeria. Malar J. 2017;16(1):487. Published 2017 Dec 12.

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ABSTRACT: Despite the World Health Organization’s recommendation of malaria test-treat strategy, which is the treatment of parasitological confirmed malaria cases with anti-malarials, presumptive diagnosis of malaria remains fairly common in Nigeria. The reasons for this have not been established in Makarfi, Nigeria, despite the high burden of malaria in the area. A study was conducted among caregivers of febrile children less than 5 years presenting for treatment to understand their awareness of malaria diagnostic testing and being offered testing by clinicians, the determinants of these outcomes, and caregivers’ perspectives of health workers’ testing practices.

HIV prevalence and high risk behaviour of young brothel and non-brothel based female sex workers in Nigeria. Okafor UO, Crutzen R, Ifeanyi O, Adebajo S, Van den Borne H. HIV prevalence and high-risk behaviour of young brothel and non-brothel based female sex workers in Nigeria. BMC Res Notes. 2017;10(1):380. Published 2017 Aug 10.

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ABSTRACT : Female sex workers (FSWs) have been identified as a core group in the transmission of HIV and other sexually transmitted infections (STIs). Young FSWs are particularly more vulnerable to HIV due to the combination of vulnerabilities associated with their youth and the sex work they engage in. This study aims to give more insight into HIV prevalence and sexual risk behaviour of young FSWs in Nigeria, by focusing on the differences between BB and NBB young FSWs.

Methods: Data was obtained from the Nigeria Integrated Biological and Behavioural Surveillance Survey (IBBSS) for high-risk groups conducted in 2010. IBBSS is a quantitative survey conducted amongst identified high-risk sub populations within Nigeria. HIV prevalence and risk behaviour data for young BB and NBB FSWs aged 15-24 years for nine states was extracted and analysed.

Results: A total of 1796 FSWs aged 15-24 years were interviewed during the survey, 746 (41.5%) were BB while 1050 (58.5%) were NBB. The HIV prevalence was higher among BB FSWs compared to the NBB FSWs (21.0% vs. 15.5%). BB FSWs reported less condom use with boyfriends and casual partners than NBB FSWs (26.3% vs. 45.5%) and (55.1% vs. 61.1%) respectively while risk of HIV infection due to injecting drug use was higher in NBB compared to BB FSWs (6.6% vs. 1.2%).

Conclusion: Existing and future interventions on HIV prevention should focus on empowering young FSWs with innovative and sustainable approaches aimed at improving their health and wellbeing.

Modelling of HIV transmission in Nassarawa State, Nigeria: An Analysisof distributuon of new infections. I Okekearu, IA Baku, A Salihu. (2017).

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ABSTRACT : The need to understand local HIV epidemics and linking the prevention and other interventions to evidences become very important for the success of HIV response. The objective of the study was to estimate the distribution of new HIV infections among adult population (15-49 yrs) and to identify the groups at highest risk of HIV infection in Nasarawa State Nigeria to inform HIV prevention programme planning and Implementation. The study was based on the Modes of HIV Transmission (MOT) incidence model recommended by the Joint United Nation’s Programme on AIDS (UNAIDS). Persons aged 15-49 years were divided into independent groups based on their risky behaviours. Demographic, epidemiological and behavioral data were obtained for each risk group from available survey reports/documents and inputed into the UNAID’s MOT Model spreadsheet.The model estimated that more than 45% of new infections would occur amongst persons who reported “low risk” sex. The Injecting Drug Users, Female Sex Workers (FSW) and Men having Sex with Men and their partners were estimated to contribute 20.7%. Persons reporting low risk sex practices, a sub-population that includes cohabiting or married sexual partners need to be targeted with appropriate HIV prevention interventions such as HIV Counselling and Testing, condom promotion, Interpersonal communications and other partner reduction strategies.

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