What is needed to improve quality of implant removal services in Nigeria? results of a landscape assessment.

Introduction: Stunning recent increases in subdermal contraceptive implant use, especially in sub-Saharan Africa, necessitate availability of quality implant removal services. In Nigeria, service delivery capacity and coverage for removal are lacking, despite strong government commitment and rapid uptake; there is a dearth of knowledge about barriers to quality implant removals in Nigeria. Methods: To determine access to and quality of contraceptive implant removal services, a landscape assessment was conducted in two states in Nigeria, focusing on four conditions for quality delineated in the Global Implant Removals Task Force framework. This mixed-methods approach integrated results from a desk review, a survey of health facilities and family planning managers, review of implant service statistics, and key informant interviews with providers and diverse stakeholders. Results: Seventy percent of providers (N = 21 of 30) had experienced problems performing implant removal, usually due to deeply inserted implants and equipment shortages. Providers had low confidence in performing removal and poor knowledge of implant removal steps. No facilities assessed had comprehensive equipment required for implant removal. Few facilities maintained systems or referral pathways to support difficult removals; difficult removals are absent from training manuals, and no formal trainings have been conducted. While most facilities collect data on removals, family planning dashboards do not capture it; few facilities use data for quality improvement. Conclusion: This study identified numerous challenges to quality implant removal, including poorly trained providers, inadequate supplies, underutilization of data on removals, and inability to manage difficult removals. As demand for implant removals skyrockets, providers need improved training in implant removal, appropriate job aids, supportive supervision, and effective procurement systems to ensure availability of supplies and equipment for removal. Tracking removals and reasons for removal in information systems and the Family Planning dashboard could sensitize providers to need for implant removals and improve data for decision-making in facilities and health systems.

Prevalence and risk factors associated with malaria infection among pregnant women in a semi-urban community of north-western Nigeria.

BACKGROUND: Malaria during pregnancy remains a serious public health problem, with substantial risks for the mother, her foetus and the newborn. The aim of this study was to determine the prevalence of malaria and possible risk factors for malaria infection among pregnant women in a semi-urban area in north-western Nigeria. Pregnant women are among the most susceptible to malaria infection. Knowledge of their malaria infection status is an important yardstick to measure the effectiveness of any malaria control programme. METHODS: We conducted a cross sectional study in the semi-urban area of Argungu, Kebbi State Nigeria. Two hundred and fifty five pregnant women were included in the study after informed verbal consent was obtained. For each participant, the socio-demographic profile, stage of pregnancy and attitude to the use of insecticide- treated nets (ITNs) were investigated using a questionnaire. Peripheral blood samples were collected and thick blood smears were prepared and stained with Giemsa stains to check for malaria parasitaemia. The associations between age, education level and use of ITNs with occurrence of malaria infection during pregnancy were analysed using the chi-square test. RESULTS: One hundred and six (41.6%) out of 255 pregnant women were infected with malaria parasites, with a mean parasite density of 800 parasitesµl(-1). It was found that prevalence and parasite density decreased as age increased. The chi-square test indicated that a lack of education and non-usage of ITNs were significantly associated with malaria infection. CONCLUSION: Malaria is still a major public health issue among pregnant women mainly due to illiteracy and non -compliance to using ITNs. Increasing awareness about malaria preventive measures and early attendance of antenatal care services will help to reduce malaria and, consequently, its associated morbidities and mortalities.