A narrative review of evidence to support increased domestic resource mobilization for family planning in Nigeria

BACKGROUND

Family planning (FP) is an important public health intervention that is proven to reduce unplanned pregnancies, unsafe abortions, and maternal mortality. Increasing investments in FP would ensure stability and better maternal health outcomes in Nigeria. However, evidence is needed to make a case for more domestic investment in family planning in Nigeria. We undertook a literature review to highlight the unmet needs for family planning and the situation of its funding landscape in Nigeria. A total of 30 documents were reviewed, including research papers, reports of national surveys, programme reports, and academic/research blogs. The search for documents was performed on Google Scholar and organizational websites using predetermined keywords. Data were objectively extracted using a uniform template. Descriptive analysis was performed for quantitative data, and qualitative data were summarized using narratives. Frequencies, proportions, line graphs and illustrative chart were used to present the quantitative data. Although total fertility rate declined over time from 6.0 children per woman in 1990 to 5.3 in 2018, the gap between wanted fertility and actual fertility increased from 0.2 in 1990 to 0.5 in 2018. This is because wanted fertility rate decreased from 5.8 children per woman in 1990 to 4.8 per woman in 2018. Similarly, modern contraceptive prevalence rate (mCPR) decreased by 0.6% from 2013 to 2018, and unmet need for family planning increased by 2.5% in the same period. Funding for family planning services in Nigeria comes from both external and internal sources in the form of cash or commodities. The nature of external assistance for family planning services depends on the preferences of funders, although there are some similarities across funders. Irrespective of the type of funder and the length of funding, donations/funds are renewed on annual basis. Procurement of commodities receives most attention for funding whereas, commodities distribution which is critical for service delivery receives poor attention.

CONCLUSION

Nigeria has made slow progress in achieving its family planning targets. The heavy reliance on external donors makes funding for family planning services to be unpredictable and imbalanced. Hence, the need for more domestic resource mobilization through government funding.

What are the Predictors of Burn out in Nigerian Bankers? A Case Study of Bankers in Enugu, Nigeria

BACKGROUND

In developing countries such as Nigeria, due to globalization and the deteriorating economy, workers are especially vulnerable to burnout. The pressure on bank employees from tight deadlines and unrealistic targets may predispose them to burnout. Burnout has been shown to occur in workers because of failure to cope with occupational stress, especially in the banking sector which requires intensive communication and interaction with service recipients.

OBJECTIVE

The aim of this study was to assess the prevalence and determinants of occupational burnout in bankers in Enugu Metropolis, Nigeria.

METHODS

A cross-sectional analytical study was carried out among 370 Bankers in Enugu state, Nigeria. The Copenhagen burnout inventory was used to assess personal, work and clientrelated burnout.

RESULTS

Majority of the bankers had all three components of burnout. Client related burnout was experienced more among female bankers (P=0.022), those that had spent five years or less on the job (P=0.021), bankers aged thirty-five years or less (P=0.013) and bankers who were married (P=0.018).Only bankers that had spent less than five years on the job (P=0.037) experienced personal burnout and no factor was found to be associated with work related burnout. Predictors of client-related burnout were age of 35 years or less, work experience of 5 years or less and being female.

CONCLUSION

Prevalence of burnout is very high among the bankers that were studied. The management of these banks should create measures aimed at reducing the risk of exposure to burnout.

Inequities in the use of sulphadoxine-pyrimethamine for malaria prophylaxis during pregnancy in Nigeria

Background

Intermittent presumptive treatment in pregnancy (IPTp) of malaria using sulfadoxine-pyrimethamine (SP) was introduced in Nigeria in 2005 to reduce the burden of malaria in pregnancy. By 2013, 23% of reproductive aged women surveyed received SP for malaria prevention in their last pregnancy of the past 5 years. This paper highlights geographic and socio-economic variations and inequities in accessing and using SP for malaria prophylaxis in pregnancy in Nigeria, as well as client-related and service delivery determinants.

Methods

Secondary data from 2013 Nigeria demographic and health survey (DHS) was used. Sample of 38,948 eligible women were selected for interview using stratified three-stage cluster design. Data obtained from the individual recode dataset was used for descriptive and logistic regression analysis of factors associated with SP use in pregnancy was performed. Independent variables were age, media exposure, region, place of residence, wealth index, place of antenatal care (ANC) attendance and number of visits.

Results

Women in the upper three wealth quintiles were 1.33 - 1.80 times more likely to receive SP than the poorest (CI: 1.15-1.56; 1.41-1.97; 1.49-2.17). Women who received ANC from public health facilities were twice as likely (inverse of OR 0.68) to use SP in pregnancy than those who used private facilities (CI: 0.60-0.76). Those who attended at least 4 ANC visits were 1.46 times more likely to get SP prophylaxis (CI: 1.31-1.63). Using the unadjusted odds ratio, women residing in rural areas were 0.86 times less likely to use SP compared to those in urban areas.

Conclusions

Inequities in access to and use of SP for malaria prophylaxis in pregnancy exist across sub-population groups in Nigeria. Targeted interventions on the least covered are needed to reduce existing inequities and scale-up IPTp of malaria.

Prevalence of malaria in HIV positive and HIV negative pregnant women attending antenatal clinics in south eastern Nigeria

Introduction

Globally, malaria in pregnancy is a public health challenge. Malaria and HIV are among the two most important diseases contributing to the global health burden of our time. HIV positive pregnant women are at increased risk of all the adverse outcomes of malaria in pregnancy.

Objective

The objective of this study was to compare malaria parasitaemia between HIV positive and HIV negative pregnant women attending antenatal clinics offering Preventing Maternal to Child Transmission (PMTCT) services in Enugu metropolis, south-eastern Nigeria.

Methods

A descriptive cross sectional study was conducted among 200 HIV positive and 200 HIV negative pregnant women attending antenatal clinics in Enugu. Two out of five hospitals that provide PMTCT services were selected through balloting. Finger pricked blood samples were collected and thick blood films were examined for malaria parasite using giemsa expert microscopy. A structured interviewer administered questionnaire was used for data collection. Data was analysed using SPSS version 22.

Results

The HIV positive pregnant women (152) (76%) and HIV negative women (137) (68.5%) studied were mostly in the age range of 25-34 years. Mean gestational age of HIV positive and HIV negative participants were 23.4±10.7 and 23.2±10.1 weeks respectively (P=0.001). The prevalence of malaria infection among HIV positive pregnant mothers was 81% (162/200) and 75% (150/200) among HIV negative pregnant women (P < 0.001). The HIV positive mothers had more moderate parasitaemia (86/200: 53.1%) compared to 43/200: 28.7% in HIV negative mothers (P<0.001). Even though more HIV positive mothers (54.5%) used insecticide treated nets ITNs during pregnancy compared to 41.5% in HIV negative mothers, moderate malaria parasitaemia was higher in HIV positive mothers. HIV positive nulliparous pregnant women had the highest rate of malaria parasitaemia (32/36: 88.9%).

Conclusion

Moderate malaria parasitaemia was higher among HIV positive pregnant women. All malaria preventive strategies should be intensified in pregnancy as ITNs provided little protection.

The Role of Health Education Intervention towards Improving Knowledge, Attitude and Practice of Onchocerciasis in Enugu State, Southern Nigeria

BACKGROUND: Onchocerciasis or river blindness constitutes a major burden to households especially in resource-poor settings, causing debilitation and reduction in household productivity. It is an endemic disease in Nigeria. The study aimed to determine the effect of health education on knowledge, attitudes and practices towards onchocerciasis.METHODS: This study was an intervention study carried out among 282 respondents. A multistage sampling technique was used to select the study sample. RESULTS: Both study and control groups had poor knowledge, 40.4% and 41.2% respectively pre-intervention. However, most of the respondents had good practices, but attitudes towards the disease is poor as most respondents do not see onchocerciasis as a serious problem. Knowledge of respondents improved significantly among the study group (X2=37.814, P=0.046) compared to control group (X2=1.756, P=0.416) post-intervention. Also, practices (X2=21.378, P=0.039) towards onchocerciasis improved significantly, but changes in attitudes was not statistically significant post-intervention among study group (X2=35.908, P=0.278).CONCLUSIONS: From our study, health education was shown to improve knowledge and practices on onchocerciasis in the study group compared to control group. Health promotion interventions such as health education campaigns should be scaled-up in onchocerciasis-endemic communities.