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Background: As part of implementation quality standards, community distributors are expected to ensure that only age-eligible children (aged 3–59 months) receive seasonal malaria chemoprevention (SMC) medicines during monthly campaigns. There is uncertainty about the extent to which SMC medicines are administered to ineligible children. This study aimed to assess the magnitude of this occurrence, while exploring the factors associated with it across nine states where SMC was delivered in Nigeria during the 2022 round. Methods: This analysis was based on data from representative end-of-round SMC household surveys conducted in nine SMC-implementing states in Nigeria. Data of 3299 age-ineligible children aged > 5 years and their caregivers were extracted from the survey dataset. Prevalence of receipt of SMC medicines by ineligible children was described by child-, caregiver- and SMC-related factors. Mixed-effects multivariable logistic regression models were fitted to explore the factors associated with ineligible receipt of SMC medicines. Results: 30.30% (95% CI 27.80–32.90) of ineligible children sampled received at least one dose of SMC medicines in 2022, the majority (60.60%) of whom were aged 5–6 years while the rest were aged 7–10 years. There were lower odds of an age-ineligible child receiving SMC among caregivers who had knowledge of SMC age eligibility (OR: 0.53, 95% CI 0.37–0.77, p < 0.001), compared with those who were knowledgeable of age eligibility. Higher odds of receipt of SMC were found among age-ineligible children whose caregivers had higher confidence in the protective effect of SMC against malaria (OR: 2.01, 95% CI 1.07–3.72, p = 0.030), compared with those whose caregivers were less confident. Compared with ineligible children of younger caregivers (aged < 20 years), those whose caregivers were older had lower odds of receiving SMC than those whose caregivers were younger; with lower odds among children of caregivers aged 20–39 years (OR: 0.50, 95% CI 0.30–0.82, p = 0.006). Conclusions: This study contributes important evidence on the magnitude of the receipt of SMC medicines by age-ineligible children, while identifying individual and contextual factors associated with it. The findings provide potentially useful insights that can help inform and guide context-specific SMC implementation quality improvement efforts. [ABSTRACT FROM AUTHOR]

Background: Attainment of universal health coverage (UHC) requires optimal utilization of health services. Poor coverage and inequitable access to healthcare could hinder improvement in service delivery towards UHC. The study analyzed the progress in service delivery coverage and equity in access to care within the Nigerian health systems based on the tracer indicators of the WHO framework for monitoring UHC. Methods: We searched the literature in databases: PubMed, Scopus, Directory of Open Access Journals, Google Scholar, Science Direct and websites of relevant health Ministries, Agencies, and Organizations between March to December 2022. Search terms were identified in four broader themes: Service delivery coverage, equity, UHC and Nigeria. Data were collected through a review of 37 published articles (19 peer-reviewed articles and 8 grey documents). We synthesized the findings in thematic areas using the WHO framework for monitoring UHC. Results: The findings show a slow improvement in service delivery coverage across the UHC tracer indicators; reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases and service capacity and access. With regards to equity in access to care across the tracer indicators, there has been a great disparity in the utilization of healthcare services among rural dwellers, lower educational level individuals and those with poor socio-economic status over 20 years. However, there was remarkable progress in the ownership and use of long-lasting insecticide-treated nets among rural and lowest-wealth quantile households than their urban counterpart. Conclusion: There is poor coverage and persistent inequitable access to care among the tracer indicators for monitoring progress in service delivery. Attaining UHC requires concerted efforts and investment of more resources in service delivery to address inequitable access to care and sustainable service coverage for improved health outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Adherence to full vaccination is important in preventing childhood diseases. The aim of this study was to evaluate the level of compliance to full vaccination and identify the socio-cultural factors associated with full vaccination compliance in children. Methodology: The socioeconomic variables associated with each of the four binary dependent variables of whether or not a child is fully vaccinated against tetanus, BCG, measles, and pentavalent were determined using logistic regression. Results: While compliance to full tetanus and BCG vaccinations was > 60% at the national level, less than 50% and 10% full vaccination compliance were recorded for pentavalent and measles vaccinations, respectively. The South East region of Nigeria recorded the overall highest full vaccination compliance while the least performing region was the North West zone. The mother or guardian literacy level, employment status, antenatal care attendance, and internet usage were strong predictors of full vaccination compliance (p < 0.05). Conclusions: The socio-cultural factors associated with achieving full vaccination coverage in Nigeria in this study should drive the implementation of policies that will be best suited to each geopolitical zone of Nigeria. [ABSTRACT FROM AUTHOR]

This study explored how the different media in Nigeria report banditry currently ravaging some parts of the country. We sampled two newspapers and two television stations to articulate the study. The result showed, among others, that both TV and newspapers did not adequately set the agenda on the problem of banditry in Nigeria. Comparatively, newspapers did better than TV stations. We discussed these findings in the light of agenda-setting and made suggestions for further studies. [ABSTRACT FROM AUTHOR]

All WHO regions have set measles elimination objective for 2020. To address the specific needs of achieving measles elimination, Nigeria is using a strategy focusing on improving vaccination coverage with the first routine dose of (monovalent) measles (MCV1) at 9 months, providing measles vaccine through supplemental immunization activities (children 9–59 months), and intensified measles case-based surveillance system. We reviewed measles immunization coverage from population-based surveys conducted in 2010, 2013 and 2017–18. Additionally, we analyzed measles case-based surveillance reports from 2008–2018 to determine annual, regional and age-specific incidence rates. Survey results indicated low MCV1 coverage (54.0% in 2018); with lower coverage in the North (mean 45.5%). Of the 153,097 confirmed cases reported over the studied period, 85.5% (130,871) were from the North. Moreover, 70.8% (108,310) of the confirmed cases were unvaccinated. Annual measles incidence varied from a high of 320.39 per 1,000,000 population in 2013 to a low of 9.80 per 1,000,000 in 2009. The incidence rate is higher among the 9–11 months (524.0 per million) and 12–59 months (376.0 per million). Between 2008 and 2018, the incidence rate had showed geographical variation, with higher incidence in the North (70.6 per million) compare to the South (17.8 per million). The aim of this study was to provide a descriptive analysis of measles vaccine coverage and incidence in Nigeria from 2008 to 2018 to assess country progress towards measles elimination. Although the total numbers of confirmed measles cases had decreased over the time period, measles routine coverage remains sub-optimal, and the incidence rates are critically high. The high burden of measles in the North highlight the need for region-specific interventions. The measles program relies heavily on polio resources. As the polio program winds down, strong commitments will be required to achieve elimination goals. [ABSTRACT FROM AUTHOR]

Background: Civil society organizations (CSOs) are important in health care delivery. They have the potential to play significant roles in immunization-related services, such as advocacy, health education, demand creation and resource mobilization. Their roles are often indispensable, diverse and beneficial in reducing infant morbidity and mortality due to vaccine-preventable diseases. This study explored the potential barriers to and facilitators of CSO engagement in increasing immunization coverage in Odukpani Local Government Area of Cross River State, Nigeria.Methods: The study adopted qualitative data collection methods. Twenty-two focus group discussion (FGD) sessions, three in-depth interviews (IDIs) and 26 key informant interviews (KIIs) were conducted. Appropriate guides (FGD guide, IDI guide and KII guide) were used to conduct face-to-face interviews and the discussions. The FGDs, KIIs and IDIs were audio-recorded and transcribed. A framework analysis approach involving five key stages of analysis (familiarization with data, identification of thematic framework, indexing, charting, mapping/interpretation) was used for data analyses and presentation.Results: CSOs encounter barriers in the course of their immunization advocacy, communication and social mobilization due to male child preference, leading to shielding of male children and not allowing them to be given immunization, as well as patriarchy, safety concerns, religious concerns, anti-vaccine misinformation and rumours, low perception of effectiveness and efficacy of vaccines, inaccessibility of localities, low health literacy and superstitious beliefs. Various community structures, such as the institution of the village head, elders' council and town crier (announcer), and the existence of change agents, act as facilitators of immunization advocacy and uptake. Factors such as traditional control mechanisms including masquerades and religion act as either barriers or facilitators depending on the community and the mode of deployment. CSO members are willing to overcome these barriers and leverage the facilitators.Conclusions: For successful engagement in immunization-related services, there are barriers in the study area that CSOs should overcome, such as male child preference and geographic inaccessibility, as well as facilitators that they should leverage such as traditional information dissemination systems and enforcement of compliance by the chiefs and elders' council. [ABSTRACT FROM AUTHOR]

Background: From January to May 2019, large measles outbreaks affected Nigeria. Borno state was the most affected, recording 15,237 suspected cases with the state capital of Maiduguri having 1125 cases investigated and line-listed by March 2019. In Borno state, 22 of the 27 Local Government Areas (LGAs or Districts), including 37 internally displaced persons (IDPs) camps were affected. In response to the situation, an outbreak response immunization (ORI) campaign was conducted in the 13 most affected LGAs. In addition to conventional vaccination teams, special teams were deployed in security compromised areas, areas with migrants, and for nomadic and IDPs. Here we describe the outbreak and the ORI campaign. We also assess the measles-containing vaccine (MCV) coverage and vaccine effectiveness (VE) in order to quantify the population-level impact.Methods: We reviewed the ORI activities, and conducted an analysis of the surveillance and the outbreak investigation reports. We assessed VE of MCV by applying the screening-method. Sensitivity analyses were also conducted to assess the effect of final classification of cases on the VE of MCV. The MCV coverage was assessed by a post-campaign coverage survey after completion of the ORI through a quantitative survey in the 12 LGAs that were accessible.Results: Of the total 15,237 reported measles cases, 2002 cases were line-listed and investigated, and 737 were confirmed for measles by week 9 of 2019. Of the investigated cases 67.3% (n = 1348) were between 9 and 59 months of age. Among the 737 confirmed cases, only 9% (n = 64) stated being vaccinated with at least 1 dose of MCV. The overall VE for MCV was 98.4% (95%CI: 97.8-98.8). No significant differences were observed in the VE estimates of lab-confirmed and epi-linked cases when compared to the original estimates. The aggregated weighted vaccination coverage was 85.7% (95% CI: 79.6-90.1).Conclusion: The experience in Borno demonstrates that adequate VE can be obtained in conflict-affected areas. In complex emergencies affected by measles outbreaks, health authorities may consider integration with other health strategies and the engagement of security personnel as part of the ORI activities. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of measles has spiked in recent times despite the efforts to its eradication using a highly effective measles vaccine. Vaccine coverage and underreporting of cases are the major challenges to this effort. Aim: This study was designed to assess the parental knowledge of measles, attitude to measles vaccine and practice of case notification in a rural area in Enugu Nigeria. Materials and Methods: A descriptive cross-sectional study carried out during a house to house campaign on measles in Ogwuagor (a rural area in Enugu, with frequent cases of measles like symptoms) between June to November 2019. A pre-tested self/interviewer’s administered questionnaire was used to assess the knowledge of measles while Parental Attitude on Childhood Vaccine (PACV) questions were adopted and used to assess the attitude of parents to the measles vaccine. The participants were parents of at least one child of above 12 months of age. The findings and scores were analysed using IBM SPSS Statistic software for windows (SPSS statistical software V.21 (IBM Corp. 2019). The age of the respondents was grouped, and the simple mean obtained. The associations of variables; number of children, level of education and last antenatal care with respect to knowledge and attitude were analysed using chi-square and p<0.05 was regarded as statistically significant. Results: Out of 652 households in the area, 213 were assessed. One hundred and ninety three (90.6%) expressed knowledge above average about measles and measles vaccine. The score was higher among mothers who had at least three children in their household (p=0.518), tertiary education (p=0.706) and their last antenatal care in a hospital (p=0.774). Majority of the participants have good knowledge about symptoms, transmission and prevention of measles. Only about half, 114 (53.5%) knew the complication of measles. All the respondents had a positive attitude to the measles vaccine. Forty seven (22.1%) of the respondents delayed having their child get a measles shot while 31 (14.6) had concern on the efficacy of the vaccine. Forty-eight 22.5% were concerned about the side-effects of the measles vaccine. The delays having their child get a measles shot, concern on the efficacy of the vaccine, and concern about the side-effects of the measles vaccine observed were significant (p=0.0001, 0.0001, 0.0001, respectively) among parents of more than two children. Conclusion: There was adequate knowledge on measles symptoms, transmission and prevention but poor knowledge of the complication. Their attitudes on the measles vaccine were generally good however, the expression of delays having their child get a measles shot, concern on the efficacy of the vaccine, and concern about the side-effects of the measles vaccine were significant among parents of more than two children. Also, few measles cases were treated in hospital. There is a need to educate parents on the complication of measles and the importance of early hospital presentation of suspected cases for confirmation and prompt management. This will help to prevent complications and community transmission. [ABSTRACT FROM AUTHOR]

The conflict between farmers and herdsmen in Nigeria has been going on for many years, resulting in huge loss of lives and resources, and the media have expectedly been covering the conflict. This study investigated how Nigerian newspapers covered the conflict with a view to finding out if there is ethnic othering in the reportage. A total of three Nigerian newspapers (The Punch, The Sun and Leadership) were purposively selected and studied for a period of seven months (1 January 2018–31 July 2018). About 598 online copies of newspaper articles were content-analysed, with the code sheet as the instrument for data collection. The result was analysed quantitatively, using tables and percentages and supplemented with qualitative analysis using verbal quotes. Findings showed that the newspapers gave adequate coverage of the issue with the straight news format as the most used, while the dominant voices heard in the news reports were those of the Government and victims/residents. The results also showed that there is ethnic othering in the newspapers as reports indicated that the terms "herdsmen" and "Fulani herdsmen" were used interchangeably, with labels like "Fulani terrorists", 'Rampaging/marauding Fulani herdsmen", "killer Fulani herdsmen", among others. [ABSTRACT FROM AUTHOR]

The escalating population growth in Nigeria calls for urgent attention to malaria control and the provision of accessible public health care for treatment of the disease (appropriate malaria treatment and intervention can, in turn, bring a reduction in the sickle cell disease (SCD) crisis). Malaria is a major cause of visits to healthcare facilities, which is amplified by the malaria interaction with SCD. Access to treatment is a basic need of the population in a country; however, in Nigeria, access to health care is generally poor. Healthcare facilities are sparsely distributed and services inadequate to take care of the health needs of the whole population. This article discusses malaria and SCD prevalence in Nigeria and analyses the spatial distribution of primary healthcare facilities in the Ikorodu Local Government Area of Lagos State, Nigeria, using Geographic Information System (GIS). Analysis is based on existing facility locations in relation to 15 and 30 minutes' walking time in a 1-km and 2-km catchment radius, respectively. The results show primary health center (PHC) facilities' coverage of 48 percent for 2-km catchment radius and 15 percent for 1-km catchment. Based on this analysis, this article argues that there is a need to increase the number of facilities for treatment that are optimally located to take care of travel distance and expand facility coverage. This will reduce mortality and morbidity rates due to the diseases. [ABSTRACT FROM AUTHOR]

Background: Coverage is an important indicator to assess both the performance and effectiveness of public health programs. Recommended methods for coverage estimation for the treatment of severe acute malnutrition (SAM) can involve active and adaptive case finding (AACF), an informant-driven sampling procedure, for the identification of cases. However, as this procedure can yield a non-representative sample, exhaustive or near exhaustive case identification is needed for valid coverage estimation with AACF. Important uncertainty remains as to whether an adequate level of exhaustivity for valid coverage estimation can be ensured by AACF.Methods: We assessed the sensitivity of AACF and a census method using a capture-recapture design in northwestern Nigeria. Program coverage was estimated for each case finding procedure.Results: The sensitivity of AACF was 69.5% (95% CI: 59.8, 79.2) and 91.9% (95% CI: 85.1, 98.8) with census case finding. Program coverage was estimated to be 40.3% (95% CI 28.6, 52.0) using AACF, compared to 34.9% (95% CI 24.7, 45.2) using the census. Depending on the distribution of coverage among missed cases, AACF sensitivity of at least ≥70% was generally required for coverage estimation to remain within ±10% of the census estimate.Conclusion: Given the impact incomplete case finding and low sensitivity can have on coverage estimation in potentially non-representative samples, adequate attention and resources should be committed to ensure exhaustive or near exhaustive case finding.Trial Registration: ClinicalTrials.gov ID NCT03140904. Registered on May 3, 2017. [ABSTRACT FROM AUTHOR]

Introduction: indoor residual spraying (IRS) is among the major vector control strategies recommended for endemic populations by the World Health Organization (WHO). The success of IRS requires high coverage which is dependent on its acceptability. In Nigeria, IRS pilots have been ongoing and rejection has been a major setback to its coverage. We assessed coverage of IRS and determined factors associated with its acceptability in Nasarawa Eggon district, Nasarawa state, Nigeria. Methods: a cross-sectional survey involving 409 households selected using multi-stage sampling was carried out. Trained data collectors administered pre-tested structured questionnaire to collect data on socio-demographic characteristics of household heads or their representatives, their perceptions on IRS and factors associated with IRS acceptability. Descriptive, bivariate and multivariate analyses were done at 5% level of significance. Results: majority of respondents were male (79.7%) and married (82.6%), and their mean age was 36.4 ± 13.3 years. Coverage of IRS was 99.3%. However, only 82.6% of those who previously accepted IRS were willing to accept it in again. Factors independently associated with acceptability were perceived effectiveness of IRS (aOR = 21.8; 95%CI = 6.9-68.8) and lower household cost of malaria prevention after IRS (aOR = 5.0; 95%CI = 1.1-21.8). Conclusion: IRS coverage in the communities studied met WHO minimum standard of 85%. However, for similar results to be achieved in future, acceptability must be promoted by providing information on its effectiveness and its ability to reduce household cost of malaria prevention. [ABSTRACT FROM AUTHOR]

Objective: To determine the feasibility of distributing micronutrient powders (MNP) for home fortification during biannual Maternal, Neonatal and Child Health Week (MNCHW) events, as a strategy to improve young child nutrition.Design: We evaluated the coverage, delivery, use and adherence of MNP, and associated behaviour change communication (BCC) materials and social mobilization, through cross-sectional surveys of caregivers attending health-service distribution events and health workers involved in MNP distribution, facility-based observations of MNP distribution activities and a repeated survey of caregivers in their homes who received MNP for their child.Setting: Four Local Government Areas in Benue State, Nigeria.Subjects: Caregivers of children 6-59 months of age attending health-service distribution events.Results: The 8 million MNP delivered in this pilot during three distribution events were estimated to reach about one-third of eligible children in the area at each event. Programme fidelity was limited by shortages of MNP, BCC materials and inadequate social mobilization, with some limitations in health worker training and engagement. MNP use was consistent with the recommended two or three sachets per week among 51-69 % of caregivers surveyed at home.Conclusions: MNP coverage was low, but consistent with that typically achieved with other services delivered through MNCHW in Benue. Among caregivers who received MNP, acceptance and use among targeted children was high. While some weaknesses in knowledge and delivery of MNP by health workers were observed, health system strengthening and more extensive social mobilization would be key to achieving higher coverage with MNP and other health services provided through MNCHW. [ABSTRACT FROM AUTHOR]

Background: Developing countries are devising strategies and mechanisms to expand coverage and benefit-package access for their citizens through national health insurance schemes (NHIS). In Nigeria, the scheme aims to provide affordable healthcare services to insured-persons and their dependants. However, inclusion of dependants is restricted to four biological children and a spouse per user. This study assesses the progress of implementation of the NHIS in Nigeria, relating to coverage and benefit-package access, and examines individual factors associated with the implementation, according to users' perspectives.Methods: A retrospective, cross-sectional survey was done between October 2010 and March 2011 in Kaduna state and 796 users were randomly interviewed. Questions regarding coverage of immediate-family members and access to benefit-package for treatment were analysed. Indicators of coverage and benefit-package access were each further aggregated and assessed by unit-weighted composite. The additive-ordinary least square regression model was used to identify user factors that may influence coverage and benefit-package access.Results: With respect to coverage, immediate-dependants were included for 62.3% of the users, and 49.6 rated this inclusion 'good' (49.6%). In contrast, 60.2% supported the abolishment of the policy restriction for non-inclusion of enrolees' additional children and spouses. With respect to benefit-package access, 82.7% of users had received full treatments, and 77.6% of them rated this as 'good'. Also, 14.4% of users had been refused treatments because they could not afford them. The coverage of immediate-dependants was associated with age, sex, educational status, children and enrolment duration. The benefit-package access was associated with types of providers, marital status and duration of enrolment.Conclusion: This study revealed that coverage of family members was relatively poor, while benefit-package access was more adequate. Non-inclusion of family members could hinder effective coverage by the scheme. Potential policy implications towards effective coverage and benefit-package access are discussed. [ABSTRACT FROM AUTHOR]

Background: The world is closer than ever to a polio-free Africa. In this end-stage, it is important to ensure high levels of population immunity to prevent polio outbreaks. Here, we introduce a new method of assessing vaccination campaign effectiveness and estimating immunity at the district-level. We demonstrate how this approach can be used to plan the vaccination campaigns prospectively to better manage population immunity in Northern Nigeria.Methods: Using Nigerian acute flaccid paralysis surveillance data from 2004-2014, we developed a Bayesian hierarchical model of campaign effectiveness and compared it to lot-quality assurance sampling data. We then used reconstructed sero-specific population immunity based on campaign history and compared district estimates of immunity to the occurrence of confirmed poliovirus cases.Results: Estimated campaign effectiveness has improved across northern Nigeria since 2004, with Kano state experiencing an increase of 40 % (95 % CI, 26-54 %) in effectiveness from 2013 to 2014. Immunity to type 1 poliovirus has increased steadily. On the other hand, type 2 immunity was low and variable until the recent use of trivalent oral polio vaccine. We find that immunity estimates are related to the occurrence of both wild and vaccine-derived poliovirus cases and that campaign effectiveness correlates with direct measurements using lot-quality assurance sampling. Future campaign schedules highlight the trade-offs involved with using different vaccine types.Conclusions: The model in this study provides a novel method for assessing vaccination campaign performance and epidemiologically-relevant estimates of population immunity. Small-area estimates of campaign effectiveness can then be used to evaluate prospective campaign plans. This modeling approach could be applied to other countries as well as other vaccine preventable diseases. [ABSTRACT FROM AUTHOR]

Background: Nigeria has made notable gains in improving childhood survival but the country still accounts for a large portion of the world's overall disease burden, particularly among women and children. To date, no systematic analyses have comprehensively assessed trends for health outcomes and interventions across states in Nigeria. Methods: We extracted data from 19 surveys to generate estimates for 20 key maternal and child health (MCH) interventions and outcomes for 36 states and the Federal Capital Territory from 2000 to 2013. Source-specific estimates were generated for each indicator, after which a two-step statistical model was applied using a mixed-effects model followed by Gaussian process regression to produce state-level trends. National estimates were calculated by population-weighting state values. Results: Under-5 mortality decreased in all states from 2000 to 2013, but a large gap remained across them. Malaria intervention coverage stayed low despite increases between 2009 and 2013, largely driven by rising rates of insecticide-treated net ownership. Overall, vaccination coverage improved, with notable increases in the coverage of three-dose oral polio vaccine. Nevertheless, immunization coverage remained low for most vaccines, including measles. Coverage of other MCH interventions, such as antenatal care and skilled birth attendance, generally stagnated and even declined in many states, and the range between the lowest- and highest-performing states remained wide in 2013. Countrywide, a measure of overall intervention coverage increased from 33% in 2000 to 47% in 2013 with considerable variation across states, ranging from 21% in Sokoto to 66% in Ekiti. Conclusions: We found that Nigeria made notable gains for a subset of MCH indicators between 2000 and 2013, but also experienced stalled progress and even declines for others. Despite progress for a subset of indicators, Nigeria's absolute levels of intervention coverage remained quite low. As Nigeria rolls out its National Health Bill and seeks to strengthen its delivery of health services, continued monitoring of local health trends will help policymakers track successes and promptly address challenges as they arise. Subnational benchmarking ought to occur regularly in Nigeria and throughout sub-Saharan Africa to inform local decision-making and bolster health system performance. [ABSTRACT FROM AUTHOR]

Background: Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. Methods: PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period. Results: We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies. Conclusions: The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence. [ABSTRACT FROM AUTHOR]

Background: Enrollment in sub-national social health insurance schemes (SSHIS) can be challenging in developing countries like Nigeria, particularly among people in the informal sector. This could be due to a lack of knowledge on its mode of operation and benefits, distrust in government, inimical religious and traditional beliefs, as well as constraining economic factors. A complementary and innovative financing strategy such as the philanthropist adoption model (ADM) could be beneficial in improving SSHIS coverage and financial resources among persons in the informal sector. The study provides new evidence on how ADM influenced health insurance coverage and resources within SSHIS among informal settings in Nigeria. It also highlights contextual factors influencing the implementation of ADM., Methods: This study employed a mixed-methods case-study approach undertaken in Anambra State, Southeast Nigeria. Data were collected through in-depth interviews ( n = 14), document review ( n = 12), and quantitative (enrollment data) methods. The respondents were purposively selected based on their involvement with the implementation of the SSHIS. Data analysis for qualitative data was done using the manual thematic framework approach while descriptive analysis was performed for the quantitative data., Results: The implementation of ADM was a valuable and effective strategy for improving knowledge, coverage, and resource mobilization (annual premium pool) within the SSHIS in the informal sector. The main enablers of the implementation of ADM include strong political will and commitment, wider stakeholders' consultation and collaboration, numerous public-spirited philanthropists, and legal institutionalization of health insurance. Other enablers include organizational factors like good teamwork among Anambra State Health Insurance Agency (ASHIA) staff, enabling work environment (incentives, supervision, office space), and experienced marketers in the agency. However, ADM had several barriers that affected its implementation-acceptability issues due to distrust for government and the health system, health systems barriers including substandard health facilities and equipment, and inimical cultural and religious beliefs about health insurance., Conclusion: The study demonstrates a case for the implementation of innovative ADM as a strategy for enhancing SSHIS financial sustainability and coverage of persons in the informal sector. Hence, the strategy should be adopted in settings where philanthropy abounds for increasing access to quality healthcare delivery to poor beneficiaries toward achieving universal health coverage in developing countries., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer PA declared a shared affiliation with the author URE to the handling editor at the time of the review., (Copyright © 2022 Onyemaechi and Ezenwaka.)

Purpose: The purpose was to estimate the prevalence of blindness due to cataract, assess visual outcomes of cataract surgery, and determine the cataract surgical coverage rate and barriers to uptake of services among individuals aged 50 years or older in Plateau State, Nigeria. Materials and Methods: A population-based, cross-sectional survey of 4200 adults 50 years or older was performed. Multistage stratified random sampling, with probability proportional to size was used to select a representative sample. The Rapid Assessment of Cataract Surgical Services protocol was used. Statistical significance was indicated by (P < 0.05). Results: The cohort comprised 4115 subjects (coverage: 98%). The prevalence of bilateral blindness due to cataract was 2.1%, [95% confidence intervals (CI): 1.7-2.5%] in the entire cohort, 2.4% in females (95% CI: 1.8-3.8%); and 1.8% in males (95% CI: 1.2-2.4%) (X2-0.85,P> 0.05). The prevalence of monocular blindness due to cataract was 5.9% (95% CI: 5.2-6.6%). The cataract surgical coverage for subjects with visual acuity (VA) less 3/60 was 53.8% in the entire cohort; 60.5% for males and 48% for females (X2 = 2.49, P > 0.05). The couching coverage for subjects who were blind was 12%. A total of 180 eyes underwent surgical intervention (surgery or couching) for cataract, of which, 48 (26.7%) eyes underwent couching. The prevalence of bilateral (pseudo) aphakia was 1.5%, (95% CI: 1.2-1.9%) and 2.7% (95% CI: 2.2-3.2%) for unilateral (pseudo) aphakia. Visual outcomes of the 180 eyes that underwent surgical intervention were good (VA ⩾ 6/18) in 46 (25.6%) eyes and poor (VA < 6/60) in 105 (58.3%) eyes. Uncorrected aphakia was the most common cause of poor outcome (65.1%). Most subjects who underwent cataract surgery were not using spectacles 74 (71.2%). Cost and lack of awareness were the main barriers to uptake of cataract surgery services. Conclusion: Couching remains a significant challenge in Nigeria. The outcomes of cataract surgery are poor with the lack of aphakic correction being the main cause of the poor outcomes. [ABSTRACT FROM AUTHOR]

Community-directed distribution with ivermectin (CDTI) has been adopted by the African Programme for Onchocerciasis Control (APOC) as its main strategy for achieving sustained high coverage in endemic communities. This article describes the coverage results achieved when CDTI was introduced in four local government areas of Oyo State, Nigeria. Using a household survey after the second distribution, researchers documented that 68.6% of the community overall received the drug, and as did 85.0% of those who were eligible (not pregnant, not sick and at least 5 years of age). Six factors were associated with having received ivermectin. Four were personal characteristics: being male, being at least 35 years of age, belonging to the Fulani ethnic minority, having taken the drug at a previous distribution. Two village characteristics were smaller size, as measured by number of houses, and use of the central place mode of distribution as opposed to house-to-house. In-depth interviews with village leaders and volunteer community-directed distributors (CDDs) and focus group discussions among villagers provided qualitative data to help interpret the findings. Women in many villages felt excluded from decision making. The concerns of migrant farm workers living in Yoruba farm settlements were not well understood by health staff or the majority population. The main factor associated with receiving the ivermectin was having received it before, and qualitative comments about side-effects and beliefs about orthodox drugs indicated that issues of personal preferences, not addressed in a household coverage survey, need to be explored further. The findings can provide guidance in re-orienting health workers to the importance of fostering participation and cohesion among all segments of the community, especially the inclusion of women and minority groups. [ABSTRACT FROM AUTHOR]

There is a global shift in discource on issues related to COVID-19 with greater attention paid to the vaccine. COVID-19. Despite this, the literature on media coverage of COVID-19 is yet to be extended to media coverage of issues related to medical progress on a vaccine for the virus. The objective of the current study was to fill this gap by examining how Nigerian media report COVID-19 vaccine development In doing so, attention was paid to the frequency of coverage, sources of stories as well as story type used. Two newspapers and TV stations were sampled for the current study. The current study made use of content analysis with a code sheet as the instrument for data collection. The result of the current study revealed that only 23% of the media stories on COVID-19 were related to vaccine development. Additionally, most of the stories made use of official sources as well as straight news. Comparatively, newspapers covered more in vaccine development than TV. The implications of these results on medical communication and theory are discussed.