Predictors of utilization of facility-based ante-natal care and delivery services in a Nigerian Rural Community.

Background: With maternal mortality ratio of 2,000/100,000 live births and perinatal mortality rate of 40/1,000 total births, Cross River State is one of the states with the highest maternal and perinatal deaths in Nigeria. One of the causes of these poor health indices is low utilization of facility-based maternal and child healthcare services during pregnancy and childbirth. The objective of this study was to assess the predictors of utilization of antenatal care and delivery services in Akpabuyo, a rural community in Cross River State of Nigeria. Method: This was an analytical cross-sectional survey. Data were collected from 370 pregnant women between June and July, 2013 and analyzed using SPSS version 25. Results: Binary logistic regression showed that compared with women with tertiary education, women with non-formal education were less likely to attend antenatal clinic (AOR=0.510, 95% CI=0.219-1.188) although the difference was not statistically significant. Also, compared with farmers, full-time housewives were less likely to deliver in a health facility (AOR=0.650, 95% CI=0.305-1.389) while civil servants were nearly five times more likely to deliver in the health facility (AOR=4.750, 95%CI=1.616-13.962). Conclusion: The predictors of antenatal care and facility delivery services utilization identified by the study were educational status and occupation. This raises the need for policies and programmes to ensure girl child education and the economic empowerment of women.

Comparative study of sexual health knowledge and practices among sexually active adolescent girls in co-educational and girls-only secondary school in Calabar, Nigeria.

Introduction: there is little or no progress towards the attainment of sexual and reproductive health (SRH) targets of the Sustainable Development Goals (SDGs) in many developing country settings. Key SRH gap in these settings includes suboptimal knowledge-based safe sexual practices, especially among adolescent girls as a vulnerable subpopulation. Unique features of school environmental settings including gender segregation have not been harnessed for cost-effective sexual health education, perhaps due to the current paucity of literature. This study was aimed at comparing sexual health knowledge and practices, between sexually active adolescent girls in co-educational and girl-only secondary schools in Calabar, Nigeria. Methods: cross-sectional comparative study design was used. Sexually active adolescent girls were randomly recruited from co-educational and girl-only secondary schools in Calabar, Nigeria. Validated questionnaire developed by the United Nations Educational Scientific and Cultural Organization (UNESCO), was used to assess sexual health knowledge and behavioral practice. Factors associated with a satisfactory level of knowledge were assessed using the Chi-square test. Data analysis was done using SPSS version 24.0, with the p-value set at 0.05. Ethical approval was obtained before data collection. Results: one hundred and twenty respondents were studied, comprising an equal proportion of sixty (60) in co-educational and girl-only schools. Mean age and age at sexual debut were 16.4 ± 1.8 and 14.3 ± 2.2 years, respectively. Compared with group 1 (co-education), respondents in group 2 (girl-only) had significantly higher mean knowledge scores (26.1 vs. 30.4, p<0.05). Fifty respondents (41.7%) had a satisfactory level of knowledge of sexual health. There was no significant difference in mean practice scores comparing groups 1 and 2 (20.4 vs. 21.5, p>0.05). Internet use, unmarried parental status, and not living with both parents, were associated with unsatisfactory levels of knowledge on sexual health. Conclusion: compared with co-educational schools, girl-only schools have better sexual health knowledge, but a similar level of behavioral practices. There is a need for improvement in sexual health education efforts among adolescent girls, perhaps with more focus on coed schools, within the context of potential inherent disadvantage in the school environmental setting.

Assessing baseline knowledge and practices of injection safety among primary health care workers in Cross River State, Nigeria: a cross-sectional urban-rural comparative study.

INTRODUCTION: unsafe injection practices are commonplace in low-income countries, and place health care workers at risk of blood-borne infections. A safe injection strategy requires a synchronized approach to deal with change in behavior of users and service providers towards safer practice. There is general lack of data on injection safety practices in Cross River State. This was a baseline study to compare the knowledge and practice of safe injection practices among primary health care (PHC) workers in urban and rural health facilities in Cross River State, Nigeria. METHODS: this was a cross-sectional comparative study among PHC workers in randomly selected rural and urban Local Government Areas (LGAs). Using multistage sampling technique, a total of 320 respondents: 160 from the urban LGAs and 160 from the rural LGAs were interviewed. Semi-structured interviewer administered questionnaires were used to obtain data. Data analysis was done using STATATM version 14.0. Associations were tested using Chi square, and multivariate logistic regression analysis. RESULTS: in this study, there was no difference in the baseline knowledge (58.8% vs. 55.0%, P=0.499) and practice (33.1% vs. 34.4%, P=0.813) of injection safety between PHC workers in the urban and rural locations. In the multivariate logistic regression model, the senior health workers had a two-fold increased odds of practicing safe injection compared to their junior counterparts [OR=2.21 (95% CI: 1.28,3.84)]. CONCLUSION: in both the urban and rural locations, there was good knowledge but poor practice of injection safety among respondents in the LGAs; hence, the need to organize periodic injection safety training and retraining of PHC workers targeting junior workers to improve on the practices of injection safety.

Predictors of Poor Pregnancy Outcomes Among Antenatal Care Attendees in Primary Health Care Facilities in Cross River State, Nigeria: A Multilevel Model.

Objectives Pregnancy carries a high risk for millions of women and varies by urban-rural location in Nigeria, a country with the second highest maternal deaths in the world. Addressing multilevel predictors of poor pregnancy outcomes among antenatal care (ANC) attendees in primary health care (PHC) facilities could reduce the high maternal mortality rate in Nigeria. This study utilised the "Risk Approach" strategy to (1) compare the risks of poor pregnancy outcomes among ANC attendees by urban-rural location; and (2) determine predictors of poor pregnancy outcomes among ANC attendees in urban-rural PHC facilities in Cross River State, Nigeria. Methods A cross-sectional survey was conducted in 2011 among 400 ANC attendees aged 15-49 years recruited through multistage sampling. Data on risk factors of poor pregnancy outcomes were collected using interviewer-administered questionnaires and clinic records. Respondents were categorised into low, medium or high risk of poor pregnancy outcomes, based on their overall risk scores. Predictors of poor pregnancy outcomes were determined by multilevel ordinal logistic regression. Results A greater proportion of the women in the rural areas were below the middle socio-economic quintile (75 vs. 4 %, p < 0.001), had no education (12 vs. 2 %, p < 0.001), and were in the 15-24 age group (58 vs. 35 %, p < 0.001) whereas women in the urban areas were older than 35 years (10 vs. 5 %, p < 0.001). The women attending antenatal care in the urban PHC facilities had a low overall risk of poor pregnancy outcomes than those in the rural facilities (64 vs. 50 %, p = 0.034). Pregnant women in the urban areas had decreased odds of being at high risk of poor pregnancy outcomes versus the combined medium and low risks compared with those in the rural areas (OR 0.55, 95 % CI 0.09-0.65). Conclusions for Practice Pregnant women attending antenatal care in rural PHC facilities are more at risk of poor pregnancy outcomes than those receiving care in the urban facilities. Health programmes that promote safe pregnancy should target pregnant women in rural settings.