1
|
Ezeanolue EE, Pharr JR, Patel DV, Ezeanolue CO, Obiefune MC, Ogidi AG, Ehiri JE. Developing a Theoretical Framework for a Complex Maternal-Child Health Intervention: Health Beginning Initiative. Health Promot Pract 2018; 20:941-950. [PMID: 29938536 DOI: 10.1177/1524839918782929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A theoretical framework serves as a roadmap for the implementation and application of a complex, health promotion intervention; is used to test hypotheses; and guides analysis and evaluation of the intervention. The purpose of this article is to demonstrate how a theoretical framework was developed and used to guide the implementation of Healthy Beginning Initiative (HBI) to promote uptake of HIV services in a low-income country. We used the guide for developing a theoretical framework published in Health Promotion Practice. Developing the theoretical framework included seven steps: (1) identifying the essential elements of the intervention; (2) identifying the variables and the context; (3) listing the postulated mechanisms, mediating variables, and postulated outcomes; (4) identifying existing theoretical models supporting the theoretical framework underdevelopment; (5) scripting the theoretical framework into either a figure or sets of statements; (6) conducting content and face validation of the theoretical framework; and (7) revising the theoretical framework. The theoretical framework was developed and used to evaluate HBI's impact on HIV testing, linkage to care and retention in care for pregnant women, their male partners, and newborns. The theoretical framework will also be adapted for other screenings and other settings while remaining true to the essential elements of HBI.
Collapse
Affiliation(s)
| | | | | | | | | | - Amaka G Ogidi
- Prevention, Education, Treatment, Training and Research-Global Solutions, Enugu, Enugu State, Nigeria
| | | |
Collapse
|
2
|
Gunn JKL, Ehiri JE, Jacobs ET, Ernst KC, Pettygrove S, Center KE, Osuji A, Ogidi AG, Musei N, Obiefune MC, Ezeanolue CO, Ezeanolue EE. Prevalence of Caesarean sections in Enugu, southeast Nigeria: Analysis of data from the Healthy Beginning Initiative. PLoS One 2017; 12:e0174369. [PMID: 28355302 PMCID: PMC5371319 DOI: 10.1371/journal.pone.0174369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/07/2017] [Indexed: 11/29/2022] Open
Abstract
Background In order to meet the Sustainable Development Goal to decrease maternal mortality, increased access to obstetric interventions such as Caesarean sections (CS) is of critical importance. As a result of women’s limited access to routine and emergency obstetric services in Nigeria, the country is a major contributor to the global burden of maternal mortality. In this analysis, we aim to establish rates of CS and determine socioeconomic or medical risk factors associated with having a CS in Enugu, southeast Nigeria. Methods Data for this study originated from the Healthy Beginning Initiative study. Participant characteristics were obtained from 2300 women at baseline via a semi-structured questionnaire. Only women between the ages of 17–45 who had singleton deliveries were retained for this analysis. Post-delivery questionnaires were used to ascertain mode-of-delivery. Crude and adjusted logistic regressions with Caesarean as the main outcome are presented. Results In this sample, 7.22% women had a CS. Compared to women who lived in an urban setting, those who lived in a rural setting had a significant reduction in the odds of having a CS (aOR: 0.58; 0.38–0.89). Significantly higher odds of having a CS were seen among those with high peripheral malaria parasitemia compared to those with low parasitemia (aOR: 1.54; 1.04–2.28). Conclusion This study revealed that contrary to the increasing trend in use of CS in low-income countries, women in this region of Nigeria had limited access to this intervention. Increasing age and socioeconomic proxies for income and access to care (e.g., having a tertiary-level education, full-time employment, and urban residence) were shown to be key determinants of access to CS. Further research is needed to ascertain the obstetric conditions under which women in this region receive CS, and to further elucidate the role of socioeconomic factors in accessing CS.
Collapse
Affiliation(s)
- Jayleen K. L. Gunn
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
- * E-mail:
| | - John E. Ehiri
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
- University of Arizona Cancer Center, Tucson, Arizona, United States of America
| | - Kacey C. Ernst
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Sydney Pettygrove
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | | | - Alice Osuji
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Amaka G. Ogidi
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Nnabundo Musei
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Michael C. Obiefune
- Healthy Sunrise Foundation, Castle Ridge Avenue, Las Vegas, Nevada, United States of America
- Institute of Human Virology, University of Maryland, Baltimore, Maryland, United States of America
| | - Chinenye O. Ezeanolue
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Echezona E. Ezeanolue
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
- Healthy Sunrise Foundation, Castle Ridge Avenue, Las Vegas, Nevada, United States of America
- Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, Nevada, United States of America
| |
Collapse
|
3
|
Ehiri JE, Iwelunmor J, Iheanacho T, Blackstone S, Obiefune MC, Ogidi AG, Ahunanya FU, Nnadi D, Patel D, Hunt AT, Ezeanolue EE. Using a Cultural Framework to Understand Factors Influencing HIV Testing in Nigeria. Int Q Community Health Educ 2016; 37:33-42. [PMID: 28030987 PMCID: PMC5645216 DOI: 10.1177/0272684x16685258] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
With support from the U.S. President's Emergency Plan for AIDS Relief and the global fund for HIV, tuberculosis, and malaria, Nigeria offers free services for prevention of mother-to-child transmission of HIV. However, uptake of these services is low, and pediatric transmission of HIV remains a significant public health challenge. Using the PEN-3 cultural model as the theoretical framework, we examined social, cultural, and contextual factors that influenced uptake of HIV counseling and testing among pregnant women and their male partners. This was a qualitative study of participants in the Healthy Beginning Initiative (HBI), a congregation-based program to prevent mother-to-child transmission of HIV in Enugu, southeast Nigeria. We conducted eight focus group discussion sessions with 83 pregnant women and their male partners. Participants' perspectives on why they did or did not test for HIV were obtained. The most cited reasons for getting tested for HIV included the following: "the need to know one's status", "the role of prenatal testing" (positive perceptions); "the role of the church", "personal rapport with healthcare worker" (positive enablers); and the "influence of marriage" (positive nurturer). The most cited reason for not testing were: "fear of HIV test", "shame associated with HIV+ test results", "conspiratorial beliefs about HIV testing" (negative perceptions); "lack of confidentiality with HIV testing", (negative enabler); and "HIV-related stigma from family and community systems" (negative nurturer). Overall, numerous facilitators and barriers influence uptake of HIV testing in the study setting. Public health practitioners and policymakers need to consider how sociocultural and religious factors unique to specific local contexts may promote or hinder uptake of available HIV/AIDS prevention and care interventions.
Collapse
Affiliation(s)
- John E. Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Juliet Iwelunmor
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, IL, USA
| | - Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah Blackstone
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, IL, USA
| | - Michael C. Obiefune
- Prevention, Education, Treatment, Training and Research-Global Solutions, Enugu State, Nigeria
| | - Amaka G. Ogidi
- Prevention, Education, Treatment, Training and Research-Global Solutions, Enugu State, Nigeria
| | - Frances U. Ahunanya
- Prevention, Education, Treatment, Training and Research-Global Solutions, Enugu State, Nigeria
| | - Donatus Nnadi
- Prevention, Education, Treatment, Training and Research-Global Solutions, Enugu State, Nigeria
| | - Dina Patel
- Global Health and Implementation Research Initiatives, School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Aaron T. Hunt
- Global Health and Implementation Research Initiatives, School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Echezona E. Ezeanolue
- Global Health and Implementation Research Initiatives, School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| |
Collapse
|
4
|
Burnham-Marusich AR, Ezeanolue CO, Obiefune MC, Yang W, Osuji A, Ogidi AG, Hunt AT, Patel D, Ezeanolue EE. Prevalence of Sickle Cell Trait and Reliability of Self-Reported Status among Expectant Parents in Nigeria: Implications for Targeted Newborn Screening. Public Health Genomics 2016; 19:298-306. [PMID: 27614873 DOI: 10.1159/000448914] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 08/06/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Sickle cell disease (SCD) is a life-threatening, autosomal recessive blood disorder prevalent in sub-Saharan Africa. We identified the prevalence of sickle cell trait (SCT) among pregnant women and their male partners in Enugu State, Nigeria, and determined the accuracy of self-reported sickle cell status and its reliability for identifying high-risk newborns for targeted screening. METHODS We conducted a nested cohort study of expectant parents enrolled in the Healthy Beginning Initiative (HBI). The HBI is a cluster-randomized trial of a congregation-based approach designed to increase HIV testing. Participants completed a survey regarding self-awareness of their sickle cell genotype and consented to genotype screening by cellulose acetate electrophoresis. RESULTS SCT prevalence (HbAS) was 22% (746/3,371). Only 50% of participants provided an accurate self-report. Self-report accuracy was significantly different (p < 0.0001) between individuals who reported having SCT or SCD (61% accuracy) versus those who reported not having SCT or SCD (86% accuracy). Demographic variables including gender, age, household size, employment, education, and home location were significantly associated with providing an accurate self-report. CONCLUSIONS Low numbers of accurate parental self-reports, coupled with a high SCT prevalence in Nigeria, could limit the efficacy of targeted newborn screening. However, our data indicate that it is feasible to integrate sickle cell screening for pregnant women with existing, community-based health care programs developed by the President's Emergency Plan for AIDS Relief (PEPFAR), such as the HBI. Expanding screening programs could enable the development of targeted newborn screening based on maternal genotype that could identify all newborns with SCD in resource-limited settings.
Collapse
|
5
|
Ezeanolue EE, Obiefune MC, Ezeanolue CO, Ehiri JE, Osuji A, Ogidi AG, Hunt AT, Patel D, Yang W, Pharr J, Ogedegbe G. Effect of a congregation-based intervention on uptake of HIV testing and linkage to care in pregnant women in Nigeria (Baby Shower): a cluster randomised trial. Lancet Glob Health 2016; 3:e692-700. [PMID: 26475016 DOI: 10.1016/s2214-109x(15)00195-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 06/23/2015] [Accepted: 07/02/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Few effective community-based interventions exist to increase HIV testing and uptake of antiretroviral therapy (ART) in pregnant women in hard-to-reach resource-limited settings. We assessed whether delivery of an intervention through churches, the Healthy Beginning Initiative, would increase uptake of HIV testing in pregnant women compared with standard health facility referral. METHODS In this cluster randomised trial, we enrolled self-identified pregnant women aged 18 years and older who attended churches in southeast Nigeria. We randomised churches (clusters) to intervention or control groups, stratified by mean annual number of infant baptisms (<80 vs ≥80). The Healthy Beginning Initiative intervention included health education and on-site laboratory testing implemented during baby showers in intervention group churches, whereas participants in control group churches were referred to health facilities as standard. Participants and investigators were aware of church allocation. The primary outcome was confirmed HIV testing. This trial is registered with ClinicalTrials.gov, identifier number NCT 01795261. FINDINGS Between Jan 20, 2013, and Aug 31, 2014, we enrolled 3002 participants at 40 churches (20 per group). 1309 (79%) of 1647 women attended antenatal care in the intervention group compared with 1080 (80%) of 1355 in the control group. 1514 women (92%) in the intervention group had an HIV test compared with 740 (55%) controls (adjusted odds ratio 11·2, 95% CI 8·77-14·25; p<0·0001). INTERPRETATION Culturally adapted, community-based programmes such as the Healthy Beginning Initiative can be effective in increasing HIV screening in pregnant women in resource-limited settings. FUNDING US National Institutes of Health and US President's Emergency Plan for AIDS Relief.
Collapse
Affiliation(s)
| | - Michael C Obiefune
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | | | - John E Ehiri
- Department of Health Promotion Sciences/Global Health Institute, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Alice Osuji
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Amaka G Ogidi
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Aaron T Hunt
- Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV, USA
| | - Dina Patel
- Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, NV, USA
| | - Wei Yang
- School of Community Health Sciences, University of Nevada, Reno, NV, USA
| | - Jennifer Pharr
- School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Gbenga Ogedegbe
- New York University Langone Medical Center, and NYU College of Global Public Health, New York, NY, USA
| |
Collapse
|
6
|
Gunn JKL, Ehiri JE, Jacobs ET, Ernst KC, Pettygrove S, Kohler LN, Haenchen SD, Obiefune MC, Ezeanolue CO, Ogidi AG, Ezeanolue EE. Population-based prevalence of malaria among pregnant women in Enugu State, Nigeria: the Healthy Beginning Initiative. Malar J 2015; 14:438. [PMID: 26542777 PMCID: PMC4635587 DOI: 10.1186/s12936-015-0975-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Malaria adversely affects pregnant women and their fetuses or neonates. Estimates of the malaria burden in pregnant women based on health facilities often do not present a true picture of the problem due to the low proportion of women delivering at these facilities in malaria-endemic regions. METHODS Data for this study were obtained from the Healthy Beginning Initiative using community-based sampling. Self-identified pregnant women between the ages of 17-45 years were recruited from churches in Enugu State, Nigeria. Malaria parasitaemia was classified as high and low based on the malaria plus system. RESULTS Of the 2069 pregnant women for whom malaria parasitaemia levels were recorded, over 99 % tested positive for malaria parasitaemia, 62 % showed low parasitaemia and 38 % high parasitaemia. After controlling for confounding variables, odds for high parasitaemia were lower among those who had more people in the household (for every one person increase in a household, OR = 0.94, 95 % CI 0.89-0.99). CONCLUSION Results of this study are consistent with hospital-based estimates of malaria during pregnancy in southeastern Nigeria. Based on the high prevalence of malaria parasitaemia in this sample, education on best practices to prevent malaria during pregnancy, and resources in support of these practices are urgently needed.
Collapse
Affiliation(s)
- Jayleen K L Gunn
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave Drachman Hall, PO Box 245163, Tucson, AZ, 85724, USA.
| | - John E Ehiri
- Department of Health Promotion Sciences/Global Health Institute, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
| | - Elizabeth T Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave Drachman Hall, PO Box 245163, Tucson, AZ, 85724, USA. .,University of Arizona Cancer Center, Tucson, AZ, USA.
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave Drachman Hall, PO Box 245163, Tucson, AZ, 85724, USA.
| | - Sydney Pettygrove
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave Drachman Hall, PO Box 245163, Tucson, AZ, 85724, USA.
| | - Lindsay N Kohler
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave Drachman Hall, PO Box 245163, Tucson, AZ, 85724, USA.
| | - Steven D Haenchen
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave Drachman Hall, PO Box 245163, Tucson, AZ, 85724, USA.
| | - Michael C Obiefune
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria.
| | | | - Amaka G Ogidi
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria.
| | - Echezona E Ezeanolue
- Global Health and Implementation Science Initiative, School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA.
| |
Collapse
|
7
|
Ezeanolue EE, Iwelunmor J, Asaolu I, Obiefune MC, Ezeanolue CO, Osuji A, Ogidi AG, Hunt AT, Patel D, Yang W, Ehiri JE. Impact of male partner's awareness and support for contraceptives on female intent to use contraceptives in southeast Nigeria. BMC Public Health 2015; 15:879. [PMID: 26358642 PMCID: PMC4566290 DOI: 10.1186/s12889-015-2216-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 09/03/2015] [Indexed: 11/23/2022] Open
Abstract
Background Despite the growing body of evidence on use of modern contraceptives among women in sub-Saharan African countries, little is known about the broader context in which female decision-making concerning contraceptive use occurs, particularly the role of their male partners’ awareness and support of modern contraceptives. Methods We conducted a cross-sectional survey of 2468 pregnant women and their male partners enrolled in the Healthy Beginning Initiative (HBI), an intervention to increase HIV testing among pregnant women in Enugu, southeast Nigeria. The aims of this study were to determine: 1) male partners’ awareness of, and support for, female contraceptive methods, and 2) influence of male partners’ contraceptive awareness and support on pregnant women’s expressed desire to use contraception. We used logistic regression models to examine the association between male partners’ awareness and support of modern contraceptives on their spouses’ desire to use contraceptives. Results Men’s awareness of, and support for, use of modern contraceptives were significantly associated with their female partners’ desire to use contraception. A majority of the men who were aware of modern contraceptives (66.5 %) and those who supported their spouses’ use of contraception (72.5 %) had partners who expressed a desire to use contraception. Men who were aware of female contraception were 3 times more likely to have spouses who desired to use contraception (AOR = 3.17, 95 % C.I: 2.70–3.75). In addition, men who showed support for their spouses’ use of contraception were over 5 times more likely to have spouses who indicated a desire to use contraception (AOR = 5.76, 95 % C.I: 4.82–6.88). Living in a household of 5 or more people (AOR = 1.45, 95 % C.I: 1.23–1.72) and residing in an urban area (AOR = 0.81, 95 % C.I: 0.67–0.97) were also significantly associated with women’s expressed desire to use modern contraception. Conclusion Men’s awareness of, and support for, use of modern contraceptives were markedly associated with their spouses’ desire to use contraception. This underscores the need for men’s involvement in programs that seek to address women’s uptake of contraception in low and middle income countries.
Collapse
Affiliation(s)
- Echezona E Ezeanolue
- Global Health and Implementation Science Initiatives, School of Community Health Sciences, University of Nevada, 4505 S. Maryland Pkwy, Box 453064, Las Vegas, 89154, NV, USA.
| | - Juliet Iwelunmor
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, 123 Huff Hall, 1206S, Fourth St., Champaign, IL, 61820, USA.
| | - Ibitola Asaolu
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, Arizona, 85724, USA.
| | - Michael C Obiefune
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Plot 25 Liberty Estate, Independence Layout Enugu, 400001, Enugu State, Nigeria.
| | | | - Alice Osuji
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Plot 25 Liberty Estate, Independence Layout Enugu, 400001, Enugu State, Nigeria.
| | - Amaka G Ogidi
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Plot 25 Liberty Estate, Independence Layout Enugu, 400001, Enugu State, Nigeria.
| | - Aaron T Hunt
- Global Health and Implementation Science Initiatives, School of Community Health Sciences, University of Nevada, 4505 S. Maryland Pkwy, Box 453064, Las Vegas, 89154, NV, USA.
| | - Dina Patel
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Plot 25 Liberty Estate, Independence Layout Enugu, 400001, Enugu State, Nigeria.
| | - Wei Yang
- School of Community Health Sciences, University of Nevada, MS-274, RM212, Lombardi Recreation Center, Reno, NV, 89557, USA.
| | - John E Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, Arizona, 85724, USA.
| |
Collapse
|
8
|
Iwelunmor J, Ezeanolue EE, Airhihenbuwa CO, Obiefune MC, Ezeanolue CO, Ogedegbe GG. Socio-cultural factors influencing the prevention of mother-to-child transmission of HIV in Nigeria: a synthesis of the literature. BMC Public Health 2014; 14:771. [PMID: 25079673 PMCID: PMC4133635 DOI: 10.1186/1471-2458-14-771] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 07/17/2014] [Indexed: 12/15/2022] Open
Abstract
Background Currently, Nigeria alone accounts for 30% of the burden of mother-to-child transmission of HIV. This review explores the socio-cultural factors influencing prevention of mother-to-child transmission of HIV (PMTCT) service uptake in Nigeria. Methods Using the PEN-3 cultural model as a guide, we searched electronic databases and conducted a synthesis of empirical studies conducted from 2001 to 2013 that reported the perceptions people have towards PMTCT, the enablers/resources that influence PMTCT service uptake, and the role of nurturers/family or community in shaping actions and decisions towards PMTCT service uptake. Results A total of 42 articles meeting the search criteria were retained in this review. Thirty-six (36) were quantitative cross-sectional surveys; three were mixed methods, while three were qualitative studies. The findings highlight that there are perceptions, ranging from positive to negative that influence PMTCT service uptake in Nigeria. Furthermore, lack of available, accessible, acceptable, and affordable resources negatively influence decisions and actions towards PMTCT. Finally, family contexts matter with decisions and actions towards PMTCT service uptake in Nigeria particularly with disclosure and non-disclosure of sero-positive status, fertility intentions and infant feeding choices. Conclusion As ambitious goals are established and unprecedented resources deployed towards the elimination of mother-to-child transmission of HIV globally by 2015, there is clearly a need to develop effective family-oriented, culture-centered community-based PMTCT programs in Nigeria so as to improve the low uptake of PMTCT services.
Collapse
Affiliation(s)
- Juliet Iwelunmor
- Department of Kinesiology and Community Health, University of Illinois, Urbana-Champaign, 123 Huff Hall, 1206 S, Fourth St, Champaign, IL 61820, USA.
| | | | | | | | | | | |
Collapse
|
9
|
Ezeanolue EE, Obiefune MC, Yang W, Obaro SK, Ezeanolue CO, Ogedegbe GG. Comparative effectiveness of congregation- versus clinic-based approach to prevention of mother-to-child HIV transmission: study protocol for a cluster randomized controlled trial. Implement Sci 2013; 8:62. [PMID: 23758933 PMCID: PMC3700826 DOI: 10.1186/1748-5908-8-62] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 06/04/2013] [Indexed: 01/13/2023] Open
Abstract
Background A total of 22 priority countries have been identified by the WHO that account for 90% of pregnant women living with HIV. Nigeria is one of only 4 countries among the 22 with an HIV testing rate for pregnant women of less than 20%. Currently, most pregnant women must access a healthcare facility (HF) to be screened and receive available prevention of mother-to-child HIV transmission (PMTCT) interventions. Finding new approaches to increase HIV testing among pregnant women is necessary to realize the WHO/ President's Emergency Plan for AIDS Relief (PEPFAR) goal of eliminating new pediatric infections by 2015. Methods This cluster randomized trial tests the comparative effectiveness of a congregation-based Healthy Beginning Initiative (HBI) versus a clinic-based approach on the rates of HIV testing and PMTCT completion among a cohort of church attending pregnant women. Recruitment occurs at the level of the churches and participants (in that order), while randomization occurs only at the church level. The trial is unblinded, and the churches are informed of their randomization group. Eligible participants, pregnant women attending study churches, are recruited during prayer sessions. HBI is delivered by trained community health nurses and church-based health advisors and provides free, integrated on-site laboratory tests (HIV plus hemoglobin, malaria, hepatitis B, sickle cell gene, syphilis) during a church-organized ‘baby shower.’ The baby shower includes refreshments, gifts exchange, and an educational game show testing participants’ knowledge of healthy pregnancy habits in addition to HIV acquisition modes, and effective PMTCT interventions. Baby receptions provide a contact point for follow-up after delivery. This approach was designed to reduce barriers to screening including knowledge, access, cost and stigma. The primary aim is to evaluate the effect of HBI on the HIV testing rate among pregnant women. The secondary aims are to evaluate the effect of HBI on the rate of HIV testing among male partners of pregnant women and the rate of PMTCT completion among HIV-infected pregnant women. Discussion Results of this study will provide further understanding of the most effective strategies for increasing HIV testing among pregnant women in hard-to-reach communities. Trial Registration Clinicaltrials.gov, NCT01795261
Collapse
Affiliation(s)
- Echezona E Ezeanolue
- Department of Pediatrics, University of Nevada School of Medicine, 2040 West Charleston Boulevard, Las Vegas, NV, USA.
| | | | | | | | | | | |
Collapse
|