Psychosocial influences on pregnancy and childbirth behaviours in north-western Nigeria: a cross-sectional analysis.

Antenatal care (ANC) and facility delivery are essential maternal health services, but uptake remains low in north-western Nigeria. This study aimed to assess the psychosocial influences on pregnancy and childbirth behaviours in Nigeria. Data were from a cross-sectional population-based survey of randomly sampled women with a child under 2 years conducted in Kebbi, Sokoto and Zamfara states of north-western Nigeria in September 2019. Women were asked about their maternal health behaviours during their last pregnancy. Psychosocial metrics were developed using the Ideation Model of Strategic Communication and Behaviour Change. Predicted probabilities for visiting ANC four or more times (ANC4+) and giving birth in a facility were derived using mixed-effects logistic regression models adjusted for ideational and socio-demographic variables. Among the 3039 sample women, 23.6% (95% CI: 18.0-30.3%) attended ANC4+ times and 15.5% (95% CI: 11.8-20.1%) gave birth in a facility. Among women who did not attend ANC4+ times or have a facility-based delivery during their last pregnancy, the most commonly cited reasons for non-use were lack of perceived need (42% and 67%, respectively) and spousal opposition (25% and 27%, respectively). Women who knew any ANC benefit or the recommended number of ANC visits were 3.2 and 2.1 times more likely to attend ANC4+ times, respectively. Women who held positive views about health facilities for childbirth had 1.2 and 2.6 times higher likelihood of attending ANC4+ times and having a facility delivery, respectively, while women who believed ANC was only for sickness or pregnancy complications had a 17% lower likelihood of attending ANC4+ times. Self-efficacy and supportive spousal influence were also significantly associated with both outcomes. To improve pregnancy and childbirth practices in north-western Nigeria, Social and Behavioural Change programmes could address a range of psychosocial factors across cognitive, emotional and social domains which have been found in this study to be significantly associated with pregnancy and childbirth behaviours: raising knowledge and dispelling myths, building women's confidence to access services, engaging spousal support in decision-making and improving perceived (and actual) maternal health services quality.

Understanding family planning outcomes in northwestern Nigeria: analysis and modeling of social and behavior change factors.

BACKGROUND: Northwestern Nigeria faces a situation of high fertility and low contraceptive use, driven in large part by high-fertility norms, pro-natal cultural and religious beliefs, misconceptions about contraceptive methods, and gender inequalities. Social and behavior change (SBC) programs often try to shift drivers of high fertility through multiple channels including mass and social media, as well as community-level group, and interpersonal activities. This study seeks to assist SBC programs to better tailor their efforts by assessing the effects of intermediate determinants of contraceptive use/uptake and by demonstrating their potential impacts on contraceptive use, interpersonal communication with partners, and contraceptive approval. METHODS: Data for this study come from a cross-sectional household survey, conducted in the states of Kebbi, Sokoto and Zamfara in northwestern Nigeria in September 2019, involving 3000 women aged 15 to 49 years with a child under 2 years. Using an ideational framework of behavior that highlights psychosocial influences, mixed effects logistic regression analyses assess associations between ideational factors and family planning outcomes, and post-estimation simulations with regression coefficients model the magnitude of effects for these intermediate determinants. RESULTS: Knowledge, approval of family planning, and social influences, particularly from husbands, were all associated with improved family planning outcomes. Approval of family planning was critical - women who personally approve of family planning were nearly three times more likely to be currently using modern contraception and nearly six times more likely to intend to start use in the next 6 m. Husband's influence was also critical. Women who had ever talked about family planning with their husbands were three times more likely both to be currently using modern contraception and to intend to start in the next 6 m. CONCLUSION: SBC programs interested in improving family planning outcomes could potentially achieve large gains in contraceptive use-even without large-scale changes in socio-economic and health services factors-by designing and implementing effective SBC interventions that improve knowledge, encourage spousal/partner communication, and work towards increasing personal approval of family planning. Uncertainty about the time-order of influencers and outcomes however precludes inferences about the existence of causal relationships and the potential for impact from interventions.

Factors associated with caregivers' consistency of use of bed nets in Nigeria: a multilevel multinomial analysis of survey data.

BACKGROUND: Malaria remains endemic in Nigeria despite programmes and policies put in place toward malaria elimination. Long-lasting insecticidal nets have been documented to offer protection from malaria by preventing mosquito bites. While many studies have examined the factors associated with the use of bed nets in Nigeria and across Africa, little information is available on the factors associated with consistency of use of bed nets. METHODS: The data for this study were derived from a household survey conducted in three states in Nigeria (Akwa Ibom, Kebbi and Nasarawa) between July and September 2015 by the Health Communication Capacity Collaborative, a 5-year cooperative agreement supported by the United States Agency for International Development and the US President's Malaria initiative and led by the Johns Hopkins Center for Communication Programs. The analysis was limited to a total of 3884 men and women selected from 2863 households with at least one bed net. Multilevel multinomial logistic regression was used to assess the factors associated with consistency of use of bed nets. RESULTS: The findings revealed 43.2% of the respondents use bed nets every night, while 38.4% use bed nets most nights. The factors associated with using a bed net every night rather than rarely or never using a bed net included sociodemographic and household variables (age, gender, religion, household size, net density, and household wealth), ideational variables (perceptions about severity, susceptibility, self-efficacy to use nets, and response-efficacy of bed net; awareness of place of purchase; willingness to pay for bed nets; attitudes towards net use; and descriptive norm about nets), and state of residence. The three study states differ significantly in terms of most of the independent variables included in the estimated model. CONCLUSIONS: The study recommends that efforts designed to promote consistent use of bed nets should be state-specific and include strategies targeting ideational variables. Furthermore, given the significance of unmeasured heterogeneity at the cluster level, strategies to engage and mobilize the community, such as community dialogue, home visits and engaging community leadership, are relevant.

Socio-demographic correlates of overweight and obesity among women of reproductive age in Nigeria.

The prevalence of excess adiposity is increasing in less developed countries. This study explored the associations of sociodemographic factors with increased BMI among Nigeria women aged 20-49 years using secondary data collected for the 2008 NDHS. Anthropometric and socio-demographic variables of interest were extracted from the data and analyzed with SPSS version 15.0. Chi(2) was used to compare categorical variables and multi-nominal logistic regression was used to examine for correlates. The prevalence of overweight (BMI 25 to 29.9kg/m(2)) and obesity (BMI 30kg/m(2) and above) in this population were 18.1% and 7.1% respectively. The prevalence of overweight/obesity was highest among Igbo women. Multivariable logistic regression revealed increased frequency of watching television, belonging to a particular ethnic group, having a tertiary education and increased parity as risk factors for increased BMI. This study confirms a high prevalence of overweight and obesity among Nigerian women and identifies high risk groups for excessive weight gain.

Public hospital costs of treatment of abortion complications in Nigeria.

Unsafe abortion is a significant contributor to maternal mortality in Nigeria, and treatment of postabortion complications drains public healthcare resources. Provider estimates of medications, supplies, and staff time spent in 17 public hospitals were used to estimate the per-case and annual costs of postabortion care (PAC) provision in Ogun and Lagos states and the Federal Capital Territory. PAC with treatment of moderate complications (US $112) cost 60% more per case than simple PAC (US $70). In cases needing simple PAC, treatment with dilation and curettage (D&C, US $80) cost 18% more per case than manual vacuum aspiration (US $68). Annually, all public hospitals in these 3 states spend US $807 442 on PAC. This cost could be reduced by shifting service provision to an outpatient basis, allowing service provision by midwives, and abandoning the use of D&C. Availability of safe, legal abortion would further decrease cost and reduce preventable deaths from unsafe abortion.

Introducing misoprostol for the treatment of incomplete abortion in Nigeria.

Despite legal restriction, induced abortions and resulting complications are common in Nigeria. Misoprostol administration for incomplete abortion was introduced in 3 Nigerian hospitals. The feasibility of the hospitals, patient and provider acceptability were assessed using questionnaire and interview guides administered to 205 women and 17 providers respectively. Amongst the women, 194 (95%) were satisfied and very satisfied with misoprostol, 176 (86%) would choose misoprostol again if another incomplete abortion occurred and 191 (93%) would recommend it to another woman in a similar situation. Providers were highly satisfied with misoprostol. The ease of use and ability to redirect surgical resources to more complicated issues were positive features cited by them. The providers agreed that integration of misoprostol was straightforward and required few resources. Therefore, misoprostol for incomplete abortion is safe, efficacious and acceptable to providers and patients. In remote areas of Nigeria with limited post-abortion care (PAC), misoprostol administration is an important potential PAC treatment modality. Features of misoprostol-low cost, room temperature stability, and ease of introduction-render it an important treatment option, particularly in low resource and rural settings.