A population-based estimation of maternal mortality in Lagos State, Nigeria using the indirect sisterhood method.

BACKGROUND: Pregnancy and delivery deaths represent a risk to women, particularly those living in low- and middle-income countries (LMICs). This population-based survey was conducted to provide estimates of the maternal mortality ratio (MMR) in Lagos Nigeria. METHODS: A community-based, cross-sectional study was conducted in mapped Wards and Enumeration Areas (EA) of all Local Government Areas (LGAs) in Lagos, among 9,986 women of reproductive age (15-49 years) from April to August 2022 using a 2-stage cluster sampling technique. A semi-structured, pre-tested questionnaire adapted from nationally representative surveys was administered using REDCap by trained field assistants for data collection on socio-demographics, reproductive health, fertility, and maternal mortality. Data were analysed using SPSS and MMR was estimated using the indirect sisterhood method. Ethical approval was obtained from the Lagos State University Teaching Hospital Health Research and Ethics Committee. RESULTS: Most of the respondents (28.7%) were aged 25-29 years. Out of 546 deceased sisters reported, 120 (22%) died from maternal causes. Sisters of the deceased aged 20-24 reported almost half of the deaths (46.7%) as due to maternal causes, while those aged 45-49 reported the highest number of deceased sisters who died from other causes (90.2%). The total fertility rate (TFR) was calculated as 3.807, the Lifetime Risk (LTR) of maternal death was 0.0196 or 1-in-51, and the MMR was 430 per 100,000 [95% CI: 360-510]. CONCLUSION: Our findings show that the maternal mortality rate for Lagos remains unacceptable and has not changed significantly over time in actual terms. There is need to develop and intensify community-based intervention strategies, programs for private hospitals, monitor MMR trends, identify and contextually address barriers at all levels of maternal care.

Contraceptive use and fertility control in rural and urban communities of Lagos Nigeria.

Background: It is predicted that the population of sub-Saharan Africa will be thrice its size by the end of the 21st century. Our study compared patterns, incentives and disincentives for the uptake of contraceptives in rural and urban communities of Lagos, Nigeria. Materials and Methods: This is a population-based cross-sectional study on 1445 women of reproductive ages 15-49 years using a cluster sampling technique and a pre-tested, interviewer-administered electronic questionnaire in 2020. Data were analysed using the Statistical Package for the Social Sciences (SPSS) software version 26.0 and ethical approval was obtained for the study. Results: About 32.4% of the respondents were rural dwellers and 67.6% were urban residents. The overall mean age was 31.7 ± 7.8 years. In terms of pattern, slightly over half (53.3%) of all respondents had ever used family planning (FP), including modern contraceptives and slightly less than a third (30.8%) currently use FP methods in both rural and urban communities, respectively. Predominant disincentives for non-use of FP include a desire to retain fertility, lack of further need, unbearable side effects and lack of spousal support. The odds of being an urban dweller currently using a method of contraceptive method is 4.169 times higher for earners above ₦60,000, which is twice the minimum wage compared to those without income (adjusted odd's ratio: 4.169, 95% confidence interval: 1.395-12.462). Conclusion: Sustained effort is required to improve contraceptive uptake, FP service delivery and demand satisfaction for modern contraceptives to enable the achievement of demographic dividends and gains.

Maternal and child health service readiness among primary health care facilities in Ekiti, Nigeria.

BACKGROUND:  The availability of adequate infrastructure, diagnostic medical equipment, medicines and commodities and well-trained medical personnel are essential for the effective delivery of health care services. AIM:  This study assessed maternal and child health (MCH) services' specific readiness by type and location of the health facility and compared the readiness between urban and rural primary health care (PHC) facilities in Ekiti State, Nigeria. SETTING:  The study was conducted amongst the heads (officers in charge) of PHC facilities in Ekiti State, Nigeria between August 2020 and October 2020. METHODS:  A descriptive cross-sectional study in which all PHC facilities were conducted and data were collected with the aid of the Service Availability and Readiness Assessment (SARA) tool using the KoboCollect app. Data were cleaned and coded on Microsoft Excel 2016 and exported to Stata SE 12 for analysis. The level of significance was set at p  0.05. RESULTS:  Overall, the MCH readiness score amongst PHC facilities was 47% (0.47 ± 0.18). About half (52%) of the facilities had necessary and relevant equipment. Health facilities located in urban areas had more medicines and commodities compared with those of rural areas (0.51 ± 0.16 vs 0.45 ± 0.17, p  0.05). Primary health care facilities in Ekiti North I had an overall higher service readiness score (0.63 ± 0.19) compared with other federal constituencies (p  0.001). CONCLUSION:  The overall MCH-specific service readiness in Ekiti State was relatively low. Strategies to address the identified gaps for a smooth journey towards the achievement of Universal Health Coverage (UHC) are recommended.

Use of modern contraceptives in Lagos Nigeria during the COVID-19 pandemic.

We estimated modern contraceptive prevalence rate (mCPR) and examined predictors of modern contraceptives utilization amongst 1,445 sampled reproductive age women in Lagos (Nigeria's epicenter) during the devastating COVID-19 pandemic. Estimated mCPR was 30.8%. Women aged 20-29 years were 50% (95%CI:0.37-0.71) less likely to use modern contraceptives during the pandemic than those 30-39 years. Married and divorced women were about three (95%CI:1.37-5.25) and over three (95%CI:1.32-7.79) times more likely to use modern contraceptives compared to single women. Though mCPR has not reduced, sustained contraceptive needs assessment of sometimes obscure sub-populations is required, especially if outbreaks like COVID-19 become our 'new normal'.

Predictors of Client Satisfaction Among Recent Users of Health Services in Lagos, Nigeria.

Client satisfaction is an important measure of quality of care as it provides information on how well health service providers meet clients' values and expectations. The study was cross-sectional and analytical in nature. Data were obtained with the use of an interviewer-administered questionnaire. Respondents (n = 994) were a subset of a larger group of community members recruited for a study on quality of health care who had used a health facility for care within 3 months prior to data collection. A total of 94% of clients were satisfied with services received although client satisfaction rates were higher with private than public health facilities. Waiting time of less than 20 minutes (adjusted odds ratio [AOR] = 9.35, 95% confidence interval [CI] = 2.08-41.67), cheap cost of all services received (AOR = 7.58, 95% CI = 1.95-29.41), and the ability of the health care provider to offer explanations clearly to clients (AOR = 6.21, 95% CI = 1.90-20.41) were predictors of client satisfaction. However, the use of a government-owned hospital (AOR = 0.23, 95% CI = 0.08-0.63) was predictive of client dissatisfaction. Only service characteristics were predictive of client satisfaction. Improvement in service delivery is recommended.

Nuances of reproductive decisions by women in a rural community of Lagos, Nigeria.

INTRODUCTION: inadequate utilization of maternal health services due to limited reproductive decision-making capacity could be contributory to high maternal mortality in developing countries. This study sought to assess nuances of reproductive decisions by women in a rural community of Lagos, Nigeria. METHODS: this descriptive, cross-sectional house to house survey was part of a study conducted in April 2015 on females selected from 298 households chosen based on geographical clusters by simple random sampling. The study instrument was adapted from a USAID-funded project and was interviewer-administered. Data entry and analysis were performed with the aid of Epi-info™ 7.0.8.3 statistical software and ethical approval was obtained for the study. RESULTS: spousal age difference was less than 10 years for about half (51.3%) of the respondents. The majority (91.6%) of the respondents had received antenatal care during pregnancy and jointly decided with their spouses on place of care. The most commonly used contraceptives were the pills (23.5%), injectables (16.8%) and condoms (13.8%). Spousal disapproval regarding the use of family planning was almost nil at 1%. Employment status as a socio-economic factor did not significantly affect respondents´ involvement in decision-making. However, there were statistically significant associations between spousal age differences and some indicators of autonomy such as respondents´ involvement in health care decisions and the determinant on choice of antenatal care provider. CONCLUSION: women´s reproductive independence and involvement in health decisions could result in reduction of maternal ill-health and mortality whilst promoting higher male involvement and better maternal health.

Hand hygiene practices in the context of Ebola virus disease: A cross-sectional survey of Lagos residents.

BACKGROUND: The Ebola virus disease outbreak that ravaged parts of West Africa has been described as the most severe acute public health emergency seen in modern times. Hand washing was promoted among other measures for infection prevention. OBJECTIVE: This study assessed the awareness of Ebola virus disease and hand-washing practices among Lagos residents, southwest Nigeria. METHODS: A descriptive cross-sectional study was used. A total of 1982 respondents aged 18 ⩾ years were selected using a multi stage sampling technique. An interviewer-administered, pre-tested questionnaire was used for data collection between August and November 2015. Data were analysed using the Statistical Package for Social Sciences (SPSS) version 22, with level of significance set at 0.05. RESULTS: Almost all (97.3%) respondents were aware of Ebola virus disease, with over half of respondents having heard about it from television. A majority of 1890 (95.4%) respondents were aware of the importance of hand washing in disease prevention. Similarly, high proportions of respondents were aware they should wash their hands after an outing, toilet use, touching pets, before and after meals, while 1628 (82.1%) of respondents knew to wash their hands after a hand shake. However, less than half of respondents (38.8%) always washed their hands after handshakes. DISCUSSION: A majority of respondents surveyed were aware of Ebola virus disease and hand washing, but the practice of hand washing, which is key in prevention of infection, lagged behind the knowledge of the respondents.

How does the public perceive healthcare workers in Lagos? A comparison of health workers in public and private health facilities.

BACKGROUND: The perception of healthcare workers (HCWs) by community members is dependent on the quality of services rendered by HCWs and contributes to utilisation. The objective of the study was to assess the perception of health workers in both public and private facilities by residents of Lagos State. MATERIALS AND METHODS: A descriptive cross-sectional study was conducted using mixed-methods approach. Respondents (n = 2000) were selected using a multistaged sampling technique from four local government areas. An interviewer-administered, pre-tested questionnaire developed for the study was used for data collection and focus group discussions were held. Domains assessed included competence, work attitudes, interpersonal skills and unethical behaviour. A perception index was generated. Data were analysed using the Statistical Package for the Social Sciences version 22, with level of significance set at 0.05 for quantitative data and ATLAS.ti software (Scientific Software, Berlin; version 7) for qualitative data. RESULTS: At least seven out of ten participants (>71%) perceived the HCWs highly in the areas of professional competence, attitude to work, responsiveness and interpersonal skills. Out of a maximum of 12, doctors had the highest mean perception index (10.6 ± 1.9), laboratory scientists had 10.1 ± 2.1, pharmacists had 10.0 ± 2.3 and nurses had 9.6 ± 2.7. A larger proportion of respondents had a significantly better perception of workers in private facilities more than those in government facilities. CONCLUSION: Perception of health workers was high and was better in privately owned facilities. Periodic retraining of health workers and regular assessments of health facilities are recommended.

Breastfeeding Knowledge and Practices among Mothers of Children under 2 Years of Age Living in a Military Barrack in Southwest Nigeria.

BACKGROUND: Human milk is uniquely superior as a source of nutrition for infants, and breastfeeding has many benefits. This study determined the breastfeeding knowledge and practices of women who have children aged 0-2 years living in a Naval Barracks. METHODS: This descriptive cross sectional study was carried out among 220 women in a Naval Barracks selected using systematic random sampling method. Pre tested questionnaires were administered by trained interviewers, and data was analyzed using Epi info 2000 and Statistical Package for Social Sciences version 19. RESULTS: There was generally fair knowledge about breastfeeding among the women. Most of the respondents (97.3%) had ever breastfed their babies, 56.5% of them initiated breastfeeding within an hour of delivery, 24.1% admitted that they gave pre lacteal feeds, 74.1% practiced exclusive breastfeeding for a mean period of 4.98 months and 30.7% engaged in bottle-feeding. Several factors were significantly associated with breastfeeding practices. CONCLUSIONS: Breastfeeding practices varied among the respondents despite the fair knowledge. GLOBAL HEALTH IMPLICATIONS: This study reveals the need to educate women and communities worldwide particularly in low-income countries about good breastfeeding practices. Targeting these women will help to improve maternal and child health.

Modifying sexual behaviour of patients attending human immunodeficiency virus treatment centres in lagos.

AIMS AND OBJECTIVES: This study was carried out among patients attending human immunodeficiency virus (HIV) treatment centres in Lagos to assess their sexual behaviour, conduct a health education intervention on safe sexual behaviour among the patients in the study group and re-assessing the sexual behaviour in both control and study groups. SUBJECTS AND METHODS: A multi-stage sampling method was used to recruit 253 control and 256 intervention patients. The study sites selected were HIV treatment centres in Lagos State University Teaching Hospital (control), and Ifako-Ijaiye and Isolo General Hospitals (intervention). A pre-tested interviewer-administered questionnaire was used for data collection. The study site intervention consisted of health education seminars. Post-intervention data were collected after 3 and 6 months. Total study duration was about 10 months. RESULTS: At baseline, there was no statistically significant difference in the sexual behaviour of respondents in both groups. Post-intervention, the notable effects of this intervention on the sexual behaviour of the study group were a 37.7% rise in condom use at last sexual exposure, a 74.3% increase in consistent condom use in the last 3 months, a 74.3% rise in consistent condom use with regular partners and a 39.0% rise in consistent condom use with casual partners. CONCLUSION: The modification of sexual behaviour of respondents achieved in this study has shown that dedicated interventions to increase the practice of safer sex can be effective. More of such interventions are required to stem the spread of HIV in Nigeria.