Knowledge, Accessibility and Utilization of the National Health Insurance Scheme (NHIS) Among Registered Employees of Federal Government Institutions in Ebonyi State: Lessons for Medical Social Workers.

Like most low-and-middle-income countries, Nigeria has been finding it difficult to meet the basic needs of her populace including their health needs. Nigerians are dying of preventable diseases because of poverty and the lack of a functional healthcare system. As a result, the Nigerian government introduced the National Health Insurance Scheme (NHIS) to cater to the health needs of its population. This study assessed the knowledge, accessibility and utilization of the NHIS among registered employees of federal government institutions in Ebonyi state. The study used Focus Group Discussions (FGDs) and in-depth interviews (IDIs) to collect data from 43 participants. The collected data was analyzed using thematic analysis. Findings revealed that most of the participants have accessed and utilized the scheme and saw it as a good healthcare system. They also reported a lack of most of the prescribed drugs and inadequate personnel at the NHIS clinics which is impacting the effectiveness of the scheme. The paper recommends that NHIS should create more awareness about the scheme, and cover more dependents, drugs, tests, and treatment bills to make it more effective in healthcare delivery.

A Focused Group Perspective of Risk Factors for Hypertension Among Middle-Aged Adults in Rural Areas of Anambra State, Nigeria.

PURPOSE: Recent records by the World Health Organization show that hypertension is more prevalent in Africa than in other parts of the world, and remains the foremost common risk factor for cardiovascular-related diseases, stroke, renal diseases, and death. However, little is known about the risk factors for hypertension by people from rural areas, especially among middle-aged adults. Therefore, the study examined the knowledge of the risk factors for hypertension among middle-aged adults in rural areas of Anambra state, Nigeria. MATERIALS, AND METHOD: Focus group discussions were used to collect data from 40 middle-aged adults (20 males and 20 females). Two key themes stood out from the data collection guides. These are "awareness of hypertension and its' symptoms" and "knowledge of risk factors of hypertension". RESULTS: The findings showed that the participants were aware of hypertension but lacked in-depth knowledge of the risk factors for the disease. Most participants did not believe that intake of certain foods like starchy foods and excess alcohol consumption could lead to one being hypertensive. DISCUSSION AND CONCLUSION: There is a need for social workers to sensitize and enlighten the middle-aged adults in the study area on the risk factors for the disease.

An Exploratory Study of the Situation of Persons with Disabilities in Nigeria: Practice Consideration for Social Workers.

PURPOSE: Disability is one of the various challenges that people face around the world. People with disabilities are confronted with a lot of challenges, and they experience depression, social marginalization, and isolation. The study aims to explore the situation of persons with disabilities in Nigeria. METHOD: To conduct this study, focus group discussions and key informant interviews were used to collect data from 45 purposively selected study participants (40 persons living with disabilities, and 5 chairpersons of a joint association of persons living with disabilities). RESULTS: Findings showed that some of the challenges facing persons living with disabilities in Nigeria include environmental, educational, and socio-economic challenges. DISCUSSION AND CONCLUSION: In conclusion, to overcome some of these challenges social workers should advocate for inclusive strategies and one way this can be realized is by the domestication and implementation of the Discrimination against Persons with Disabilities (Prohibition) Act, 2018.

Incarcerated individuals and education programmes in Nigeria: A task for social workers.

Much is not known about education programmes for Nigerian incarcerated individuals. Consequently, different correctional institutions worldwide have different forms of correctional education offered to incarcerated individuals. Nigerian incarcerated individuals perceive that there are implementations of education programmes offered to them. However, little or nothing is known about how incarcerated individuals perceive these education programmes. To this end, this study ascertains the incarcerated individuals' perception of education programmes as well as the expectations of social work profession in ensuring that incarcerated individuals in correctional institutions are provided with quality education. In-depth interviews involving 20 convicted incarcerated individuals from Owerri correctional centre were conducted. Thematic analysis was used in analyzing data generated for the study. Findings show that education programmes are available and essential, but the quality of the programme does not go down well with the incarcerated individuals. It also revealed that incarcerated individuals were not allowed to decide on the type of education programme to be involved in. To this end, their participation in the programme is jeopardized. The findings further revealed that little or nothing is known about social workers in prison education. Therefore, the inclusion of correctional social workers as an integral part of education programmes that aim to reform, rehabilitate and reintegrate incarcerated individuals becomes necessary.

Aging in rural Nigeria: gendered exclusion of rural older adults and its impact on their perceived life satisfaction in South-East Nigeria.

Globally, there is an immense increase in the number of older adults. This can be attributed to an increase in life expectancy brought about by advances in general living standards as well as medicine and healthcare. However, exclusion which is linked to discrimination and access restrictions in areas such as education, employment, housing, and medical care has been identified as one of the challenges facing this increasing demographic. This study explored the exclusion of older rural women in southeast Nigeria and its impact on their life satisfaction. The study used a qualitative method of research to obtain data from a sample of 32 older adults aged 65 years and above through focus group discussions in Nru community in Nsukka Local Government Area of Enugu State. The obtained data were thematically analyzed and the findings showed that many older rural women in the study area are socially excluded at home, churches, and the larger society, with poverty and stereotyping of older rural women as less intelligent identified as the leading factor predisposing them to social exclusion in Nigeria. Results also showed that social exclusion brings about sadness and depression which have severe negative implications on their life satisfaction. Finally, implications of the findings for gerontological social workers through advocacy geared toward changes in social policy and structures that promote ageism were discussed.

Is filial care for older adults in Nigeria threatened? Examining concerns from adult offspring providing care.

Filial care for older adults is a normative family practice in Nigeria, heralded by offspring. However, as families continuously evolve away from the extended structure to more nuclear setups, with women contesting traditional domestic roles, strong concerns about filial care are emerging. Our qualitative study investigated filial care using data elicited from 32 adult offspring in Enugu, Nigeria. Narratives reveal that filial care remains the most culturally acceptable and 'feasible' care option for older adults in Nigeria. Notwithstanding challenges constraining the efficiency of filial care, such as changing gender roles, an increase in the ages of adult offspring, uncooperative older adults, deplorable economic conditions, and living arrangements, filial care for older adults abound. Although contested, the paid care option within filial setup was reasonably considered by the participants as an important measure to address the challenges of filial care. In all, participants were unsure about the future of government assistance, hence there is a need to improve filial care by strategically adopting policy and programme directions, with social workers playing potentially pivotal roles.

"They will only remember us during elections": The culture of government support to Nigerian older adults and policy implications.

Governments are obliged to ensure the healthy living, well-being, and life satisfaction of every citizen. This, however, has not been achieved in Nigeria, especially with regard to older adults. Despite the notable shift in the country's demographic stance, few studies have investigated the government's roles in addressing the support to Nigerian older adults given that inadequate support is a risk factor for general poor health conditions and high mortality rates. This study, therefore, sought to investigate views on available government support to older adults in Nnewi, South-East Nigeria. Focus Group Discussion and In-depth interviews were adopted to collect data from older adults. The generated data were subjected to a thematic method of analysis. Findings show that Nigerian older adults are usually remembered during political activities, such as electioneering and election. However, the support is not all-inclusive but reserved for those who could actively participate in these political activities. To achieve the African Union and the 2030 global agenda's commitment to "leave no one behind," the study recommends social policies that address all-inclusive support and care for Nigeria older adults. Social workers' intervention will also be crucial to facilitate the formulation and implementation of welfare policies and programmes for the support and well-being of older adults.

Social work undergraduates students and COVID-19 experiences in Nigeria.

Following the highly contagious nature of the coronavirus disease and the increase in confirmed cases, the Nigerian government, imposed lockdowns, quarantines, and various social distancing measures to curb the rate of infection. Schools were closed, and examinations were postponed indefinitely. Students of private schools were able to resume academic activities online. However, most public schools could not do so, due to lack of infrastructure. This study aimed to qualitatively investigate the impacts of the novel coronavirus on final-year students of social work, at the University of Nigeria. Data was collected from 20 undergraduates using in-depth interviews. Findings showed that the pandemic had negative effects on different aspects of the students' lives. It was also revealed that some of the students were resilient and were able to use various coping strategies to avoid being overwhelmed by the situation. A policy implication of this study is the need for revitalization of Nigerian public universities, as the continued lockdown of schools shows how public universities are poorly managed in the country. This poor management of public schools has made it impossible for a switch to virtual learning.

Aging in Nigeria: A Growing Population of Older Adults Requires the Implementation of National Aging Policies.

While the continent of Africa currently has the lowest share of adults aged 60 and older in its population among all world regions, the total number of older Africans is projected to triple between 2020 and 2050. Nigeria-Africa's leading economy and most populated country-has the highest number of older people in the continent and the 19th highest across the globe, with the population of Nigerians aged 65 and older projected to nearly triple by 2050. However, the increase in older Nigerians is occurring against the backdrop of extreme poverty, unsolved development problems, socioeconomic inequality, the HIV/AIDS epidemic, and a decline in the traditional care and support of older adults. Additionally, the absence of an operational national aging policy or safety net services and programs poses a unique challenge to older Nigerians and their families. In this article, we examined social statistics and the current literature to describe aging in the Nigerian context. Our findings highlight the importance of establishing effective governmental policy interventions for the adequate care and support of older Nigerians and the training of gerontological professionals. This article will describe the demography of aging in Nigeria, significant areas of research, key scholars and publicly available data sets, public policy issues, and emerging issues affecting the health and well-being of older Nigerians.

Gender differences in family support to older adults and implications for social work in south-east Nigeria.

The increase in the number of older adults in Nigeria is a significant demographic trend, requiring adequate and sustainable attention. Usually, these older adults depend on family members for support due to increasing frailty and/or disengagement from the civil service or other income-earning pursuits. Studies that depict differences in gender vis a vis access to social support from family networks are limited. This study will attempt to contribute to filling this gap. Four focus group discussions and 16 in-depth interviews were conducted on a sample of (N = 56) older adults aged 70 years and above and their 23 to 46 year old family carers. The generated data were analysed in themes. Findings revealed no differences in access to health support by gender; however, females received more financial, emotional as well as material support, and were more involved in social activities than their male counterparts. This study will facilitate a better understanding of gender differences in social support for older adults in Nigeria. This could, in turn, inform inclusive social policies guided by social workers which have greater focus on the needs of older adults.

Exploring the Impact of COVID-19 Pandemic on Economic Activities and Well-being of Older Adults in South-eastern Nigeria: Lessons for Gerontological Social Workers.

The novel COVID-19 pandemic and its containment measures such as lockdown and physical distancing are remarkedly affecting older adults' economic activities and well-being in ways deserving of urgent attention. To strengthen caregiving and promote targeted care for older adults during and after the pandemic, this paper investigates the impact of the coronavirus on the economic activities and well-being of older adults in Enugu and Anambra states, Nigeria. Hermeneutic phenomenology was adopted and 16 older adults aged between 60 and 81 years, with a majority of them still working as farmers and traders were phone-interviewed. Findings highlighted four key lessons for gerontological social workers including 1) the fear that impact of the containment measures could kill the older adults faster than the virus; 2) the measures generate a feeling of neglect and marginalization of healthcare needs among older adults; 3) altered positive health-seeking behavior among the older adults; 4) and concern about the absence of functional policy and plan to address the welfare of older adults. Therefore, the central focus of the gerontological social workers and Nigerian polity should not be on how to reduce the spread of the disease alone, but on an application of caution in instituting and implementing the measures.

Mortality Experiences for Women in Riverine Areas of the Niger Delta and Utilization of Maternal Health Services.

Developing countries grapple with poor maternal health outcomes, and the Niger Delta is no exception. Discourses in the Niger Delta have been dominated by oil resource, with suboptimal attention paid to health outcomes in the region. This study investigated barriers to utilization of maternal health care services in the Okrika local government area of Rivers State, Nigeria. Data were sourced through focus group discussions organized for 21 health care professionals and 24 mothers residing in the area. Analysis was done thematically, relying on relevant qualitative analytical tools. Poor income, ignorance, absence of social support, religion and culture, and health care system inefficiencies were the barriers associated with utilization of maternal health care services. It was clear that maternal health outcomes and the state of health care generally in the Niger Delta do not reflect the enormous resources generated from oil that is plentiful in the region. Results point to an evident need for social work expertise to mitigate these barriers in view of improving health outcomes in the region.

Challenges with Institutional Support Services for Undergraduate Students with Visual Impairment in University of Nigeria Nsukka.

PURPOSE: The purpose of this article was to discover available institutional support services for undergraduate students with visual impairment within the University of Nigeria, Nsukka. The study also examined challenges with institutional support services and the urgent need for sustainable social work services for undergraduate students with visual impairment. METHOD: The study reports the result of a qualitative study using focus group discussion with 17 undergraduate students with visual impairment. RESULT: Findings revealed discontent by the majority of study participants over institutional support services. Social work services were reported by study participants as invisible. DISCUSSION: Based on the findings of our study, there is a need to develop sustainable social work services and also engage relevant stakeholders to improve on available support services for undergraduate students with visual impairment.

When Primary Healthcare Facilities are Available but Mothers Look the Other Way: Maternal Mortality in Northern Nigeria.

Poor maternal health outcomes are reported commonplace in Northern Nigeria in spite of a relatively efficient distribution of primary healthcare centers (PHCs) across the grassroot. There is need to understand why such availability of PHCs is yet to translate into improved maternal health for the region in line with global health goals. Thus, this article investigates factors that affect utilization of PHCs by maternal-aged women in Niger-east senatorial zone in Niger State, Nigeria. Data were sourced from 48 respondents comprising pregnant women, nursing mothers and health workers. Data were analyzed thematically. From our findings, occurrences of maternal mortality abound in the study area as a result of the disparity between availability and utilization of maternal health services offered by PHCs in the location. Influential factors include culture, support networks, policy and equipment gaps, economic challenges, and attitude of health workers. We recommend the engagement of social workers to galvanize a blend of upstream, midstream and downstream public health interventions in order to address these influential factors and achieve positive maternal health outcomes for Nigeria in future.

Coping strategies of families of persons with learning disability in Imo state of Nigeria.

BACKGROUND: Coping with a relative with a learning disability could be a stressful experience for family members. The present study is aimed at exploring the coping strategies adopted by families in trying to make meaning of their situation. METHOD: A qualitative study design using focus group discussions (FGDs) was adopted. Ten FGD sessions were held with family members of persons with a learning disability. RESULTS: Findings revealed patterns of family coping to include problem-focused, emotion-focused, and spiritual/religious-focused. Also, coping responses to a learning disability varied based on the level of information available to families about the condition of their relative. In some cases, interspousal relationship was strained due to stress. CONCLUSION: It was recommended that families of persons with a learning disability need social support and professional help from social workers to facilitate the adoption of more positive-oriented coping strategies by family members.

Factors affecting the utilization of prevention of mother-to-child transmission of HIV services in Anambra South, Nigeria

Background: In spite huge leaps in combating the spread and transmission of HIV globally, Nigeria still ranks high in the incidence of HIV among children. The study investigates the factors affecting the utilization of prevention of mother-to-child transmission (PMTCT) of HIV services in Anambra South. Data source and Method: Data from 515 HIV positive women of child bearing age were collected using a structured questionnaire. The data sets were subjected to chi square and binary logistic regression analysis. Result: The results show that 86% of the respondents were aware of the PMTCT strategies while marital status (69.8%), age (70.7%) and place of residence (52.1%) were found to affect the uptake and utilization of PMTCT services. Conclusion: Evidence from the study drew attention to the need for government, social workers and healthcare providers to rise to their responsibilities in encouraging HIV women of reproductive age to utilize PMTCT services in order to achieve African Union Agenda 3

Compliance with regimens of existing vaccines in Orumba North local government area of Anambra state, Nigeria.

The factors associated with third dose of diphtheria, pertussis and tetanus (DPT3) uptake, a true indicator of compliance with required regimen of vaccines, in Anambra state, Nigeria, were investigated in a cross-sectional survey of 600 mothers (15-49). Being an older mother showed a positive association with compliance. Compliance was more among those who used the government health facilities for their health needs (χ(2 )= 12.286, p < .001). Satisfactory experiences with health service influenced compliance (χ(2 )= 8.542, p = .002). Those with good perception (30.1%) complied more (χ(2 )= 42.572, p < .001). Those who were aware that immunization protects the children against vaccine preventable diseases complied more (χ(2 )= 8.735, p = .002). In conclusion, the action-hesitancy model strengthens the Health Belief Model in explaining parents' attitude to childhood immunization, as experience and perception of the health service influenced uptake more. Health education and campaigns should be directed at factors that would encourage mothers to adopt required behaviours.

Knowledge of nutritional and health needs of children among rural residents of Enugu north senatorial zone in Enugu State, Nigeria.

The article assessed knowledge of the nutritional and health needs of children among rural dwellers in Nigeria. Focus group discussions were conducted with all male and female groups in four purposively chosen rural communities in Nsukka Senatorial zone of Enugu State. These generated data on participants' knowledge on the nutritional and health needs of the children as well as their socio-demographic characteristics. All the participants were married with mean age of 41 and 36 years for males and females, respectively. The participants had six and four children on the average for male and female participants, respectively. Findings show that participants demonstrate knowledge of basic dietary needs of children; however, actual practice is lacking. Men believe women have the sole responsibility for children's nutrition. Exclusive breastfeeding is not adhered to by participants. Some reservation still exists about immunization. Sustained health education on exclusive breastfeeding and child immunization targeting both sexes is still needed.

Knowledge of causes of VVF and discrimination suffered by patients in Ebonyi State, Nigeria: a qualitative study.

Vesico-vaginal fistula (VVF) is a major public health issue in Nigeria. This study focused on VVF patients seeking treatment. Hospital records were used to sample 30 respondents. Three focus group discussions were conducted and analyzed in themes. Results reveal that most of the respondents did not know what brought about their condition, whereas some felt it was a curse from the gods. Respondents reported discrimination and stigmatization by relatives. Findings suggest the need to have trained social workers working in all fistula centers in the country. They will help in the counseling, rehabilitation, and reintegration of these women.

Living with vesico-vaginal fistula: experiences of women awaiting repairs in Ebonyi State, Nigeria.

Vesico-vaginal fistula (VVF) is one of maternal health problems confronting public health workers in Nigeria today. Information on how women suffering from this condition cope is important in that it can inform the design and delivery of programmes and interventions to address the challenges that face victims of VVF. The objective of this study was to highlight how women living with VVF cope with the health problem in Ebonyi state, Nigeria. In-depth interviews were conducted with ten women awaiting repairs at the National Fistula Centre at Abakaliki in Nigeria. Six of the women have lived with the health problem for more than ten years. Findings show that nearly all the women attributed their health problem to supernatural causes. The women stated that they go through a lot of physical and emotional problems. Some of the ways they have devised of physically coping with the problem include bathing regularly and use of strips of old wrappers as pads. Many of them cope emotionally and financially by attending religious gatherings and having some form of income yielding business. The study recommends the need for repairs to go hand in hand with vocational training so that they will have some income yielding business after repairs.