Key informants' perspectives on policy- and service-level challenges and opportunities for delivering adolescent and youth-friendly health services in public health facilities in a Nigerian setting

BACKGROUND

Integrating the care of adolescents and young people into existing public health facilities requires deliberate efforts to address challenges related to policy and service provision. This study assessed key informants' perspectives on policy- and service-level challenges, and opportunities, for implementing a strategic framework for adolescent and youth-friendly health services (AYFHS) in public health facilities in a Nigerian setting.

METHODS

Seventeen key informants were interviewed including members of the Adolescent sexual and reproductive health (ASRH) Technical Working Group (TWG), program managers of non-governmental organizations (NGO), State and local level health officials, and youth representatives, in Ogun State, Southwest Nigeria.

RESULT

Findings from this study indicate that some health workers continue to have a negative attitude toward young people's sexual and reproductive health. There was some level of inclusion of adolescents and young people living with disabilities in ASRH programming which is welcome and extremely important. Some of the challenges in ASRH service provision included insufficient coordination of activities of donors/partners working in the adolescent health space. Also found was the missed opportunity to strengthen policy implementation with research, and the need for increased focus on mental health, substance use, and other aspects of adolescent and young people's health. There was noted the opportunity to explore the Basic Health Care Provisions Funds (BHCPF) as a new source of funding for health services for AYP in Nigeria.

CONCLUSION

This study provided the context of the implementation of a strategic framework for adolescent reproductive health in a Nigerian setting from the perspectives of policy and service-level stakeholders. Opportunities for improving program delivery identified include ensuring research-based policy implementation and seeking program sustainability through tapping into new sources of funding.

Knowledge and Attitude of Fathers towards Childhood Vaccination in Ogun State, Nigeria: A Comparative Study

ACKGROUND/OBJECTIVES

Vaccine-preventable diseases (VPDs) have been shown to account for one-fifth of deaths among under-fives. Father's knowledge and attitude greatly influence the approval and uptake of childhood vaccination in patriarchal communities. This study aimed to assess and compare fathers' knowledge and attitude to childhood vaccination in urban and rural communities of Ogun State, Nigeria.

METHODS

Four hundred and forty men each were interviewed in rural and urban areas. An interviewer-administered questionnaire was used to elicit data which were analyzed with IBM SPSS version 20. Mean ages of respondents were compared using T-test while chisquare was used in testing association between categorical variables. Results were presented in tables and P < 0.05 was considered statistically significant.

RESULTS

There was no statistically significant difference in the mean ages of residents in the urban and rural areas (t = -1.82, p= 0.07). A greater proportion of rural participants (51.4%) had an overall good knowledge of childhood vaccination as against 45.2% of urban men but this difference was not statistically significant with p = 0.069. A greater percentage of participants in the urban area (58.0%) had an overall positive attitude to male participation in childhood vaccination compared to 54.1% of rural men. However, this difference was not statistically significant (p= 0.204).

CONCLUSION/RECOMMENDATION

There was better knowledge of childhood vaccination among rural participants. In contrast, attitude towards childhood vaccination was better among urban residents. There is a need for educational interventions that may positively influence the attitude of men towards childhood vaccinations, particularly in rural areas to be conducted by the government, health workers, and other stakeholders through various communication media and adopting diverse health education methods.

Causes and contributory factors of maternal mortality: evidence from maternal and perinatal death surveillance and response in Ogun state, Southwest Nigeria

BACKGROUND

Nigeria still ranks second globally in the number of maternal deaths. Most maternal death reviews in Nigeria are isolated research based reports from a single health facility. This study determined causes and contributory factors of maternal mortality in Ogun statefollowing a periodic State-widematernal and perinatal deaths surveillance and response (MPDSR) review.

METHODS

We carried out a retrospective analysis of cases of maternal deaths notified (n = 77) and reviewed (n = 45) in health facilities in Ogun State from 2015 to 2016selected using total sampling method. Using the national MPDSR structured and validated data collection tools or questionnaire, collected data was extracted from existing MPDSR data base, andanalyzed using the Statistical Package for Social Sciences (SPSS) software 20.0. We obtained approval from the State Ministry of Health for this study.

RESULTS

Average age at maternal death was 30.8 ± 5.7 years. Haemorrhageand pre-eclampsia or eclampsia account for 43.4 and 36.9% of causes respectively. Leading contributory factors ofmaternal deaths include inadequate human resource for health, delay in seeking care, inadequate equipment, lack of ambulance transportation, and delay in referrals services. 51.1%of the women had antenatal care while a significant proportion of the women were referred from Traditional Births Attendants (TBAs) and mission houses.

CONCLUSION

We concluded that many of the contributory factors of maternal mortality could be avoided if preventive measures were taken and adequate care available. MPDSR provides a platform for critical evidence of where the main problems lie, and can provide valuable information on strategies which maternal mortality prevention programs should focus on. The implementation and institutionalization of MPDSR programme is on course in Ogun State. MPDSR is feasible and should be institutionalized in all states of Nigeria. A commitment to act upon the findings of MPDSR is a key prerequisite for success.