When one door closes: a qualitative exploration of women's experiences of access to sexual and reproductive health services during the COVID-19 lockdown in Nigeria

BACKGROUND

COVID-19 pandemic widely disrupted health services provision, especially during the lockdown period, with females disproportionately affected. Very little is known about alternative healthcare sources used by women when access to conventional health services became challenging. This study examined the experiences of women and adolescent girls regarding access to sexual and reproductive health (SRH) services during the COVID-19 lockdown in Nigeria and their choices of alternative healthcare sources.

METHODS

The study sites were two northern states, two southern states, and the Federal Capital Territory. Qualitative data were obtained through 10 focus group discussion sessions held with married adolescents, unmarried adolescents, and older women of reproductive age. The data were transcribed verbatim and analysed using a thematic approach and with the aid of Atlas ti software.

RESULTS

Women reported that access to family planning services was the most affected SRH services during the COVID-19 lockdown. Several barriers to accessing SRH services during COVID-19 lockdown were reported, including restriction of vehicular movement, harassment by law enforcement officers, fear of contracting COVID-19 from health facilities, and fear of undergoing compulsory COVID-19 tests when seeking care in health facilities. In the face of constrained access to SRH services in public sector facilities during the COVID-19 lockdown, women sought care from several alternative sources, mostly locally available and informal services, including medicine vendors, traditional birth attendants, and neighbours with some health experience. Women also widely engaged in self-medication, using both orthodox drugs and non-orthodox preparations like herbs. The lockdown negatively impacted on women's SRH, with increased incidence of sexual- and gender-based violence, unplanned pregnancy resulting from lack of access to contraceptives, and early marriage involving adolescents with unplanned pregnancies.

CONCLUSION

COVID-19 negatively impacted access to SRH services and forced women to utilise mostly informal service outlets and home remedies as alternatives to conventional health services. There is a need to ensure the continuity of essential SRH services during future lockdowns occasioned by disease outbreaks. Also, community systems strengthening that ensures effective community-based health services, empowered community resource persons, and health-literate populations are imperative for overcoming barriers to healthcare access during future lockdowns.

Prevalence, Trends, and Factors Associated with Teen Motherhood in Nigeria: An Analysis of the 2008-2018 Nigeria Demographic and Health Surveys

Background: Teen pregnancy and childbearing are common in Nigeria, and understanding the complexities, such as sociodemographics and economic factors including sexual and reproductive health knowledge and awareness among adolescents over time can trigger innovative approaches and interventions. This study intends to capture the patterns and associated factors of teen motherhood among sexually active adolescents (15-19 years) between 2008 and 2018. Methods: The study data was extracted from 2008, 2013, and 2018 Nigeria Demographic and Health Surveys. Descriptive analysis was presented using frequencies and percentages; multivariable analysis was conducted using log-binomial logistic regression at a p-value <0.05. All analyses were performed using Stata 15.0, weighted and adjusted for the complex survey design and population size. Results: The prevalence of teen motherhood increased between the three successive survey waves (50.9% vs. 52.4% vs. 55.2%) from 2008, 2013, and 2018. Although, the pooled adjusted analysis revealed no significant change over the 10-year period. Knowledge of modern contraceptive methods, primary education, non-Catholic Christians, residing in the South-South region, and those currently or formerly married were associated with increased risk of teen motherhood. There was an inverse relationship between teen motherhood and wealth status; lower wealth status was associated with high adolescent pregnancy and childbearing. Conclusion: This study revealed an increase in the proportion of teen pregnancy and childbearing in Nigeria. Notably, there exist variations across age groups, geographic location, educational level, religious belief, marital and economic status. Interventions that ensure comprehensive sexuality education, girl child education, and economic empowerment especially for school dropouts are advocated to reduce teen motherhood.

Erythrocytic, Enzymatic, and Histological Markers of Oxidative Stress in Subacute and Chronic Stage Infections in Wistar Rats (Rattus norvegicus) Infected with Trypanosoma brucei brucei

Trypanosomiasis is a complex of diseases caused by a haemoprotozoan parasite of medical and veterinary importance. One of the leading factors that cause morbidity and death in trypanosomiasis is oxidative stress. The oxidative stress biomarkers in trypanosomiasis at the subacute and chronic stages of infection were investigated in this study. A total of twenty-four Wistar rats were used; the animals were placed in two groups: group A (subacute and chronic) and group B (control). The weight and body temperature of the experimental animals were determined using a digital weighing balance and thermometer. A hematology analyzer was used to determine the erythrocyte indices. Spectrophotometry was used to estimate enzyme (superoxide dismutase, catalase, and glutathione) activities in the serum, kidney, and liver of experimental animals. Liver, kidney, and spleen were harvested and analyzed for histological changes. The mean body weight of the infected decreased compared to the control (P < 0.05). The mean body temperature of infected individuals increased (35-37°C) compared to the control (P < 0.05). The erythrocyte indices of the infected and control groups indicate a significant decrease (P < 0.05). In erythrocyte indices, only MCHC indicated a nonsignificant decrease (P > 0.05). The SOD of serum shows a significant increase (P < 0.05), and no significant increase SOD (P > 0.05) in kidney and the liver SOD indicates a significant decrease (P < 0.05). The serum, kidney, and liver show a significant increase (P < 0.05) in CAT. The serum GSH from the findings indicates a nonsignificant increase (P > 0.05), and the kidney and liver GSH shows a significant increase (P < 0.05). The correlation analysis for SOD shows nonsignificant negative correlation for serum/kidney, and the serum/liver and kidney/liver show significant positive correlation. The result of CAT shows significant correlations for serum and kidney, serum and liver, and kidney/liver with a positive correlation. The GSH result shows no significant negative correlation for serum/kidney and no significant positive correlation for serum/liver and kidney/liver. The histological damage in the kidney, liver, and spleen was much higher in the chronic stage than in the subacute stage and no tissue damage in the control group. In conclusion, subacute and chronic stage trypanosome infection is associated with changes in hematological indices, antioxidants of the liver, spleen and kidney, and histological architecture.

Assessment and associated factors of comprehensive HIV knowledge in an at-risk population: a cross-sectional study from 19,286 young persons in Nigeria

Background:

The prevalence of HIV among young people aged 15–19 years in Nigeria is estimated as 3.5%, the highest among West and Central African countries. Comprehensive knowledge of HIV is associated with increased awareness of preventive interventions and a reduction in the spread of HIV. Therefore, this article seeks to assess and determine the associated factors of comprehensive HIV knowledge among youths in Nigeria.

Methods:

The study used the 2018 Nigerian Demographic Health Survey, a cross-sectional survey that employed a two-stage cluster sampling method. Comprehensive knowledge of HIV was assessed based on five questions. The data were analysed separately for men and women aged 15–24 years. A multivariable log-binomial regression model was used to determine factors associated with comprehensive HIV knowledge. All analysis was performed using Stata 15.0 and adjusted for weighting, clustering and stratification.

Results:

A total of 15,267 women and 4019 men aged 15–24 years were included in this study. The prevalence of comprehensive knowledge of HIV was higher among women than among men (42.6% versus 33.7%; p < 0.001) and lower among younger ages 15–17 years compared with other ages. The findings revealed that age, ethnicity, wealth, education and exposure to mass media were statistically significant factors associated with comprehensive knowledge of HIV. In addition, religion, place of residence, phone ownership, internet use, currently working and having initiated sex were significant factors among women and modern contraceptive use among men.

Conclusion:

Key findings from this study imply that public health programmes in Nigeria should focus on providing information on HIV/AIDS using different approaches, including comprehensive sex education as well as health promotion and education strategies in the formal and informal sectors. Because media exposure is a common and cost-effective way of public health promotion and education in modern times, emphasis could also be placed on using this channel to reach the target population.

Female genital mutilation and sexual behaviour by marital status among a nationally representative sample of Nigerian women

Background

Female Genital Mutilation (FGM) is believed to have a negative effect on sexual and reproductive health but the evidence from nationally representative sample in high-burdened countries like Nigeria is scarce. This study explored the association between FGM and sexual behaviour in a nationally representative sample of Nigerian women.

Methods

A secondary data analysis was conducted using the Nigeria Demographic Health Survey conducted in 2013 and 2018 among women aged 15–49 years. The descriptive summaries of respondent characteristics by marital status were presented using frequencies and percentages. The proportion and 95% Confidence Interval (CI) of circumcision by sexual behaviour characteristics were computed. A multivariable log-binomial logistic regression was used to determine the association between sexual behaviour and female circumcision while adjusting for other covariates. All analyses were performed using Stata 15.1 (StataCorp, College Station, TX, USA) at the 0.05 level of significance.

Results

The proportion of circumcised women was 38.6% among those who were ever-married and 32.4% among those unmarried. There were no statistically significant relationship between circumcision status and sexual behaviour among women who were unmarried. However, circumcised women who were ever married had 18% higher risk of having contracted sexually transmitted disease in the last 12 months preceeding the survey and 10% higher risk of engaging in pre-marital sex compared to ever married women who were uncircumcised after adjusting for other covariates. However, the risk of having multiple sexual partners in the last 12 month among uncircumcised ever married women was lower (aRR = 0.80; 95% CI: 0.66–0.97) in the adjusted model.

Conclusion

Circumcision is not associated with positive sexual behavioural outcomes including delay in sexual debut, virginity and marital fidelity, although there exists some perception behind increasing FGM in Nigeria including prevention of premarital sex and ensuring marital fidelity. While we strongly discourage FGM in all its form, we assert the need for alternative health promoting community measures to address these inherent sexual perceptions toward eliminating FGM and improving sexual and reproductive health across population groups.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-022-01379-w.

Female genital mutilation (FGM) recognized internationally as a violation of human right, refers to all procedures that involve partial or complete removal or other injury to the female genital organs for non-medical reasons. About 200 million girls and women in 30 countries mainly in Africa, Middle East and Asia have been subjected to FGM. Almost 22% of the estimated 68 million girls and women that are at the risk of being cut between 2015 and 2030 will be Nigerians.

FGM is deeply entrenched within socio-cultural beliefs around preserving a girl's purity, and controlling women's sexuality or chastity. It is also believed that FGM protects girl’s virginity, prevents marital infidelity and is necessary to ensure male partners and/or husbands get better sexual satisfaction. However, studies on the association between women sexual behaviour (sexual debut, pre-marital sex, multiple sexual partners, STDs, lifetime sexual partner, number of unions) and FGM is limited in countries where FGM is prevalent. This study utilized pooled datasets from the Nigerian Demographic Health Survey conducted in 2013 and 2018 to explore the association between FGM and sexual behaviour among women of reproductive age.

The findings revealed that there is no association between sexual behaviour and FGM among unmarried women. Circumcised ever-married women were more likely to contract sexually transmitted diseases and engage in pre-marital sex than those who were not circumcised. However, circumcised ever married women were less likely to have multiple sexual partner in the last 12 months preceding the survey. This study disproves the assertion that FGM could control women’s sexual behaviour.

Effect of COVID-19 pandemic on provision of sexual and reproductive health services in primary health facilities in Nigeria: a cross-sectional study

Background

Nigeria, like many other countries, has been severely affected by the COVID-19 pandemic. While efforts have been devoted to curtailing the disease, a major concern has been its potential effects on the delivery and utilization of reproductive health care services in the country. The objective of the study was to investigate the extent to which the COVID-19 pandemic and related lockdowns had affected the provision of essential reproductive, maternal, child, and adolescent health (RMCAH) services in primary health care facilities across the Nigerian States.

Methods

This was a cross-sectional study of 307 primary health centres (PHCs) in 30 Local Government Areas in 10 States, representing the six geopolitical regions of the country. A semi-structured interviewer-administered questionnaire was used to obtain data on issues relating to access and provision of RMCAH services before, during and after COVID-19 lockdowns from the head nurses/midwives in the facilities. The questionnaire was entered into Open Data Kit mounted on smartphones. Data were analysed using frequency and percentage, summary statistics, and Kruskal–Wallis test.

Results

Between 76 and 97% of the PHCS offered RMCAH services before the lockdown. Except in antenatal, delivery and adolescent care, there was a decline of between 2 and 6% in all the services during the lockdown and up to 10% decline after the lockdown with variation across and within States. During the lockdown. Full-service delivery was reported by 75.2% whereas 24.8% delivered partial services. There was a significant reduction in clients’ utilization of the services during the lockdown, and the difference between States before the pandemic, during, and after the lockdown. Reported difficulties during the lockdown included stock-out of drugs (25.7%), stock-out of contraceptives (25.1%), harassment by the law enforcement agents (76.9%), and transportation difficulties (55.8%). Only 2% of the PHCs reported the availability of gowns, 18% had gloves, 90.1% had hand sanitizers, and a temperature checker was available in 94.1%. Slightly above 10% identified clients with symptoms of COVID-19.

Conclusions

The large proportion of PHCs who provided RMCAH services despite the lockdown demonstrates resilience. Considering the several difficulties reported, and the limited provision of primary protective equipment more effort by the government and non-governmental agencies is recommended to strengthen delivery of sexual and reproductive health in primary health centres in Nigeria during the pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01217-5.

The onset of COVID-19 has raised concerns that it may compromise women’s access to sexual and reproductive health and rights. Although data are still emerging, some reports indicate reduced access to sexual and reproductive health services, largely due to disruptions in the demand and supply of contraceptive commodities, the diversion of staff and resources to other clinical services, and clinic closures. While these concerns have similarly been broached for Nigeria, there has been no systematic documentation of the extent of the disruptions of reproductive health services caused by COVID-19 and its effects on the provision and utilization of related services in the country This study was a cross-sectional facility-based survey conducted in 10 states, 30 Local Government Areas and 302 primary health centres in Nigeria. The objective of the study was to explore through key informant interviews with service providers in the health centres, the effects of the COVID-19 pandemic on demand and supply of sexual and reproductive health services. Field assistants administered a semi-structured interview guide to the heads of the health centres that elicited information on availability and use of the health centres before, during and after the lock-downs associated with the pandemic. The results indicate that a large proportion of the health centres opened for the provision of essential sexual and reproductive health services during the COVID-19 pandemic lockdown. However, fewer clients used the services due to difficulties in travel because of the lockdowns, stock-outs in the health centres, and the fear that they may contract the virus if they leave their houses to the health centres. Although the health centres reported some cases of COVID-19, there was limited provision for personal protective equipment to motivate the health workers to optimize services for clients. From this study, we conclude that efforts should be made to identify innovations for addressing these challenges to enable the continued provision of sexual and reproductive health services by health centres despite the COVID-19 pandemic in Nigeria’s health centres.

Processes of diversification and dispersion of rice yellow mottle virus inferred from large-scale and high-resolution phylogeographical studies

Phylogeography of Rice yellow mottle virus (RYMV) was reconstructed from the coat protein gene sequences of a selection of 173 isolates from the 14 countries of mainland Africa where the disease occurred and from the full sequences of 16 representative isolates. Genetic variation was linked to geographical distribution and not to host species as isolates from wild rice always clustered with isolates from cultivated rice of the same region. Genetic variation was not associated to agro-ecology, viral interference and insect vector species. Distinct RYMV lineages occurred in East, Central and West Africa, although the Central African lineage included isolates from Benin, Togo and Niger at the west, adjacent to countries of the West African lineage. Genetic subdivision at finer geographical scales was apparent within lineages of Central and West Africa, although less pronounced than in East Africa. Physical obstacles, but also habitat fragmentation, as exemplified by the small low-lying island of Pemba offshore Tanzania mainland, explained strain localization. Three new highly divergent strains were found in eastern Tanzania. By contrast, intensive surveys in Cote d'Ivoire and Guinea at the west of Africa did not reveal any new variant. Altogether, this supported the view that the Eastern Arc Mountains biodiversity hotspot was the centre of origin of RYMV and that the virus spread subsequently from east to west across Africa. In West Africa, specific strains occurred in the Inner Niger Delta and suggested it was a secondary centre of diversification. Processes for diversification and dispersion of RYMV are proposed.

Molecular epidemiology of the RNA satellite of Rice yellow mottle virus in Africa

Satellite RNA was sought in 51 isolates of Rice yellow mottle virus (RYMV) representative of the geographical, molecular and pathogenic variability of the virus in Africa. Three-quarters of the isolates from cultivated rice and wild gramineaceous hosts supported a satellite RNA. The prevalence of RYMV isolates that were associated with a satellite differed among regions, being c. 100% in West and Central Africa and c. 36% in East Africa. The RYMV satellite showed a low diversity as only seven of the 220 sequenced positions were variable. One insertion also occurred after serial host passages of the satellite. Two forms of the satellite differed by six substitutions forming three base pairs in one branch of the predicted RNA secondary structure. There was no evidence of intermediates between these two forms, but double-infection occurred. Each form had a specific geographical distribution: one occurred in Central Africa, the other elsewhere in Africa. There was no relation between the occurrence or the forms of the satellite and the phylogeny of the helper virus. The satellite was not involved in symptom modulation or ability to break host-plant resistances to the disease.

Wilt Pathogens of Solanaceae in Tanzania: Clavibacter michiganensis subsp. michiganensis, Pseudomonas corrugata, and Ralstonia solanacearum

Surveys of vegetables in the southern and northern growing regions of mainland Tanzania and Zanzibar during 1997 and 1998 indicated the presence of three wilt pathogens of tomato. Clavibacter michiganensis subsp. michiganensis (cause of bacterial canker) was isolated from wilting plants in the southern highlands and Lushoto District (Tanga Region, north) on selective King's medium B with polymyxin B (1). The identity of the isolates was confirmed by cultural, morphological, and biochemical characteristics and a plate-trapped antigen enzyme-linked immunosorbent assay (PTA-ELISA) kit (Pathoset 113-08, Adgen, Auchincruive, U.K.). Pathogenicity was confirmed by host inoculation. In addition, the bacterium was detected directly by the same methods in several sources of seed, including commercial farmers' saved seed and seed extracted from infected plants. Of 61 tomato seed lots tested, 18 samples were positive. Ralstonia solanacearum (cause of bacterial wilt) was isolated from tomato and potato by semiselective media and detected directly in stem and tuber tissues, respectively, by polymerase chain reaction and ELISA (4) in all vegetable-growing areas surveyed. In 1998, R. solanacearum was detected for the first time in Zanzibar on tomato and eggplant. Pathogenicity was confirmed by inoculation on and reisolation from tomato seedlings of cv. Money Maker. Only biovar 3 (2) occurred in tomato. Biovar 3 also was found in midaltitude potato. Biovar 2 has been found only in potato plants grown above 1,500 m. Pseudomonas corrugata (cause of pith necrosis) was isolated from tomato on semiselective media at only one location. From wilted tomato plants in the southern highlands, 38% of samples tested positive for C. michiganensis subsp. michiganensis and ≈ 10% for R. solanacearum. Of samples collected from the northern highlands, 43% tested positive for R. solanacearum. Wilt incidence of ≈35% was observed in tomato fields where the bacterial wilt pathogen was isolated in the northern highlands compared with gt;90% incidence and almost total crop loss in tomato fields of the southern highlands infected with bacterial canker. Although all three pathogens caused systemic wilt of plants, bacterial canker occasionally caused downward turning of lower leaves, unilateral wilting, and marginal necrosis of leaflets as well as fruit spotting. In general, wilts caused by C. michiganensis subsp. michiganensis, R. solanacearum, and P. corrugata were not readily differentiated in Tanzania prior to this research. Plants with pith browning had often been assumed to be infected by P. corrugata, until R. solanacearum was isolated (3) frequently from such plants. References: (1) Anonymous. OEPP/EPPO Bull. 22:219, 1992. (2) A. C. Hayward. J. Appl. Bacteriol. 27:265, 1964. (3) J. B. Jones et al., eds. 1991. Compendium of Tomato Diseases. The American Phytopathological Society, St. Paul, MN. (4) S. Seal and J. G. Elphinstone. Pages 35-57 in: Bacterial Wilt. The Disease and Its Causative Agent, Pseudomonas solanacearum. A. C. Hayward and G. L. Hartman, eds. CAB International, Wallingford, U.K. 1994.