Nigerian Health Research Articles

Couples' social characteristics, family planning, and unwanted pregnancy risk: Evidence from two Nigerian Demographic and Health Surveys.

Increased cases of child abandonment, homeless and street children in developing countries are traceable to proportionate rates of unwanted pregnancies. Such pregnancies impose hardships on households and increased social vices in society. In Nigeria, baby factories are continually being discovered in almost every state, thereby raising concerns about the exposure of women to the dangers of unwanted pregnancies. In order to contribute to the government's efforts to control unwanted pregnancies in Nigeria, this study examined the effects of couples' social characteristics and family planning methods on unwanted pregnancies in Nigeria. We applied the Ordinary Least Squares (OLS) method of regression analysis because of its efficiency and unbiased property in statistical analysis. Survey data from the 2013 and 2018 Nigeria's Demographic and Health Surveys were used in the analysis. Results indicated that the more family planning methods are used in Nigeria, the fewer unwanted pregnancies will occur. Furthermore, the social characteristics of men are more important than those of women in predicting unwanted pregnancies. Based on other findings, literacy campaign in the Northern Nigeria where literacy rate is low, more counselling on the importance of modern family planning, and use of different strategies in population health awareness campaign across the different regions in Nigeria is encouraged.

Determinants of treatment seeking behaviour for sexually transmitted infections in Nigeria.

About 376 million new cases of sexually transmitted infections (STI) are reported annually across the globe. Also, untreated STI result in increased risks of complications including HIV, infertility and congenital infections. In Nigeria, enabling factors for STI transmission has increased in recent times. Thus, good treatment seeking behaviour is critical for the management of STI among people with sexually transmitted infections in Nigeria. Secondary data from the 2018 Nigeria Demographic and Health Survey dataset were used. The survey was conducted across Nigeria following a-2 stage stratified cluster sampling design from a sample of 4,997 women and 653 men aged 15 - 49 years who reported an STI history. Only 46.1% of the men and 55.7% of the women sought treatment for STI. Men who reported having genital ulcer were 3 times more likely to seek treatment, and women with genital ulcers were 2 times more likely to seek treatment than those who did not have genital ulcers. There is the need to reinforce HIV/STI messaging and health education campaigns in order to sensitize more people on transmission, symptoms and treatment of STI. Also, equitable mechanisms for financing STI treatment should be incorporated into the Nigerian health system in order to increase access for people of poorer economic status.

Progress in the face of cuts: a qualitative Nigerian case study of maintaining progress towards universal health coverage after losing donor assistance

In the coming years, about a dozen middle-income countries are excepted to transition out of development assistance for health (DAH) based on their economic growth. This anticipated loss of external funds at a time when there is a need for accelerated progress towards universal health coverage (UHC) is a source of concern. Evaluating country readiness for transition towards country ownership of health programmes is a crucial step in making progress towards UHC. We used in-depth interviews to explore: (1) the preparedness of the Nigerian health system to transition out of DAH, (2) transition policies and strategies that are in place in Nigeria, (3) the road map for the implementation of these policies and (4) challenges and recommendations for making progress on such policies. We applied Vogus and Graff’s expanded transition readiness framework within the Nigerian context to synthesize preparedness plans, gaps, challenges and stakeholders’ recommendations for sustaining the gains of donor-funded programmes and reaching UHC. Some steps have been taken to integrate and institutionalize service delivery processes toward sustainable immunization and responsive primary healthcare in line with UHC. There are ongoing discussions on integrating human immunodeficiency virus (HIV) services with other services and the possibility of covering HIV services under the National Health Insurance Scheme (NHIS). We identified more transition preparedness plans within immunization programme compared with HIV programme. However, we identified gaps in all the nine components of the framework that must be filled to be able to sustain gains and make significant progress towards country ownership and UHC. Nigeria needs to focus on building the overall health system by identifying systematic gaps instead of continuing to invest in parallel programmes. Programmes need to be consolidated within the overall health system, health financing priorities and policies. A comprehensive and functional structure will provide continuity even in the event of decreasing external funds or donor exits.

Preventable multiple high-risk birth behaviour and infant survival in Nigeria

BackgroundGlobally, infant mortality has declined considerably but has remained unacceptably high in sub-Saharan Africa, especially Nigeria where infant mortality rate is 67/1000 live births. To facilitate infant mortality reduction in Nigeria, an understanding of the synergistic effect of bio-demographic characteristics of mothers known as High Risk Birth Behaviours (HrBBs) is important. We therefore investigated the influence of HrBBs on infant survival in Nigeria.MethodsThis cross-sectional study design utilized data from the 2018 round of Nigerian Demographic Health Survey. The study participants were a representative sample of women of reproductive age (n = 21,350) who had given birth within the 5 years preceding the survey. HrBBs was measured through integration of information on maternal age at child’s birth, parity, and preceding birth interval with respect to the most recent child. The HrBBs was categorized as none, single and multiple. Data were analysed using descriptive statistics, Log-rank test and Cox proportional hazard model (α =0.05).ResultsThe mean age of the women was 29.7 ± 7.2 and 4.1% had experienced infant death. Infant mortality was highest among women with multiple HrBBs (5.1%). Being a male, having small size at birth, failure to receive tetanus injection, non-use of contraceptives and living in the core-north (North West and North East) predisposed children to higher risk of dying before 12 months of age. The hazard ratio of infant mortality was significantly higher among infants of mothers in multiple HrBBs category (aHR = 1.66; CI: 1.33–2.06) compared to their counterparts with no HrBBs.ConclusionMultiple HrBBs increase the chances of dying among infants in Nigeria. Screening women for HrBBs for special health attention during pregnancy, birth and postnatal period will alleviate infant death in Nigeria.

Readiness of Nigerian Health-Care Workers to Work During COVID-19 Pandemic

Introduction: Health-care professionals of all cadres are the utmost valuable resource during pandemics and maintaining an adequate workforce of health professionals during an emergency is critical to ensure uninterrupted provision of services that are essential for patient care. Aim: Examine readiness of health-care workers (HCWs) to provide service in the course of the COVID-19 pandemic and the factors influencing their decision. Methodology: This was a cross-sectional study of Nigerian health sector workers HCWs in the course of the COVID-19 pandemic. The respondents were recruited using HCWs focus groups on WhatsApp and Telegram social medial platforms. Results: A total of 481 HCWs were recruited, consisting of 288 females and 193 males (M: F, 1:1.5), mean age = 30.71 ± 5.9 years. Most HCWs (97.3%) showed a willingness to provide service during the pandemic; 73.3% of the HCWs were willing to work if supplied with adequate personal protective equipment (PPE) although 5.8% were less willing to work without proper PPE. Factors supporting unwillingness to work during the pandemic were: concerns about the lack of adequate testing for COVID-19 (48.9%), lack of disability insurance plan (40.1%), fear of being infected (47.2%), and the risk of infection in family members (24.5%). The readiness to work was related to the job cadres of the HCWs (P = 0.001), while the provision of additional incentives and a change in the working conditions would influence the readiness of the HCWs to work. Conclusion: HCWs were ready to provide service in the course of the COVID-19 pandemic if there was a safe work environment, although the availability of PPE and other personal factors would influence their willingness to work, while improvement in working conditions would motivate HCWs to work.

ARIMA Modelling and Forecasting of COVID-19 Daily Confirmed/Death Cases: A Case Study of Nigeria

Aims: The aim of this work is to develop suitable ARIMA models which can be sued to forecast daily confirmed/death cases of COVID-19 in Nigeria. This is subject to developing the model, checking them for suitability and carrying out eight months forecast, and making recommendations for the Nigerian Health sector.
 Study Design: The study used daily confirmed and death cases of COVID-19 in Nigeria.
 Methodology: This work covers times series data on the on the daily confirmed/death cases of COVID-19 in Nigeria, obtained from the Nigerian Centre for Disease Control (NDCD) from 21 March 2020 to 5 May 2020, covering a total of 51 data points. This work is geared towards developing a suitable Autoregressive Integrated Moving Average (ARIMA) models which can be used to forecast total daily confirmed/death cases of COVID-19 in Nigeria. Two adequate subset ARIMA (2, 2, 1) and AR (1) models for the confirmed/death cases, respectively, is fitted and discussed
 Results: A forecast of 239 days – from 6th May 2020 to 31 December 2020 was conducted using the fitted models and we observed that the COVID19 data has an upward trend and is best forecasted within a short period.
 Conclusion: Critical investigation into the rate of spread of COVID-19 pandemic has shown that, that the daily confirmed cases as well as death cases of the disease tends to follow an upward trend. This work aimed at developing a suitable ARIMA models which can be used to fit a most appropriate subsets to statistically forecast the actual number of confirmed cases as well as death cases of COVID-19 recorded in Nigeria for a period of 8 months.

Multivariate logistic regression analysis on the association between anthropometric indicators of under-five children in Nigeria: NDHS 2018

BackgroundChild malnutrition is a huge health problem having multifaceted consequences for child survival and long-term well-being. Although, several studies investigated stunting, underweight, and wasting in low- and middle-income countries, in Nigeria, the link between them received little attention. The aim of this study is, therefore, to assess the association between anthropometric indicators of under-five children such as stunting, underweight and wasting given that of other characteristics of children and households.MethodsThe data for this study was obtained from Nigerian Demographic and health survey (NDHS) in 2018. A total of 11,314 under-five children were involved. Multivariate logistic regression model was used to determine the association between stunting, underweight and wasting given that of the estimated effect of other determinants.ResultsFrom 11,314 under-five children the study considered 36.2, 21.4 and 6.7% of them suffered from stunting, underweight and wasting, respectively. About half (50.7%) of the children were male, 24.1% was obtained from North West region of Nigeria, and 37.8% of them were from households having unimproved drinking water. The pairwise dependency between stunting and underweight; underweight and wasting was measured using odds ratio (OR) of 15.796, and 16.750 respectively. The estimated odds of children from richest household to become stunted, underweight, and wasted was respectively 0.392, 0.540, 0.786 times that of the estimated odds of children from poorest households.ConclusionThe prevalence of under-five children with stunting, underweight and/or wasting in Nigeria was very high. The important determinants of stunting, underweight, and wasting for under five children were household wealth index, women body mass index, sex of the child, anemia, mothers’ age at first birth, and a diarrhea two weeks prior to the survey. Whereas, region, religion, multiple birth, women’s educational level significantly associated with both stunting and underweight. Both stunting and wasting significantly associated with underweight.

Barriers to PMTCT services uptake among pregnant women living with HIV: A qualitative study

Aim The uptake of the prevention of mother-to-child transmission of HIV (PMTCT) services is predictive of HIV transmission; however, many barriers limit pregnant women living with HIV from this uptake. This study, therefore, aimed to explore some barriers to PMTCT services uptake among pregnant women living with HIV. Methods A qualitative interview design was employed with pregnant women living with HIV, their husbands or relatives, and service providers in two Nigerian health facilities. Thirty-five participants were individually interviewed until data saturation occurred, and the data were thematically analyzed. Results Five barriers to PMTCT services uptake were found - “fear of stigmatization,” “poor support from family,” “conflict between attending to social role demands and PMTCT programs,” “financial and time cost to health facilities,” and “poor service provider-patient interaction.” Conclusion These data contribute to informing targeted interventions that strengthen the uptake of PMTCT services among HIV-positive pregnant women.

Analysis of 10 Cases of Orbital Infections Arising from Odontogenic Cervicofacial Infections

Orbital cellulitis, also called postseptal cellulitis, is an infection of contents of the orbit (periorbital fat, neurovascular bundle, and the extraocular muscles). It should be differentiated from preseptal (periorbital) cellulitis which is a lesion of the anterior portion of the eyelid. However, both preseptal and postseptal cellulitis could present in a similar way with eye pain, edema, and erythema. The aim of the study was to review patients with orbital cellulitis as a complication of odontogenic cervicofacial infections seen in a Nigerian tertiary care facility. A retrospective analysis of cases of odontogenic cervicofacial infections complicated by orbital infections that presented at a Nigerian tertiary health facility between January 2006 and September 2019 was conducted. A total of 10 patients with cervicofacial infections who presented with 11 orbital infections as a complication were retrieved for this study. They were six males and four females; male to female ratio was 1.5:1. Median age was 33.5 years (mean age was 34.3 years, range was 22-47 years). Based on clinical features and results of available imaging, orbital infections using the classification by Chandler et al., (1970), were one cases of type I (9.1%), seven cases (63.6%) of type II and two cases (18.2%) of type IV and one case (9.1%) of type V. There was no case of type III. Cervicofacial infections could arise from upper posterior teeth. These infections could spread into the orbit causing cellulitis especially type II.

Regional Variation of Family Planning Services in Nigerian Health Facilities

Background: Availability and accessibility of family planning (FP) services are the major factors affecting the fertility pattern and population growth rate in low-resource settings. This study aimed at assessing the availability of contraceptive methods in Nigeria health facilities offering FP services. Materials and Methods: This study compared survey data on FP services available from each of the six geopolitical zones in Nigeria. The study was a descriptive analysis of variations in the availability of FP services and contraceptive methods across the regions. Result: Out of the 767 facilities surveyed, 375 (48.9%) were located in rural areas and 392 (51.1%) in urban areas. The Northwest had the highest male condom availability of 96.2%. The emergency contraceptive method was being offered by 35.8% of the total 636 facilities reportedly offering the service. The proportion of the facilities offering the oral contraceptive method was higher in the Northeast (100.0%), Northwest (94.9%), and South-South (92.0%) than other regions (P = 0.002). While only 9.3% of facilities in the Northeast and 10.0% in the North-Central were offering sterilization for males, higher proportions, 17.7% of South-East and 32.7% of South-South facilities were offering it. The level of stockout of at least one FP method on the day of this survey was high across all regions, with the Northeast (60.8%) and North-Central (59.9%) having the highest proportion and the Northwest having the least stockouts (46.1%). Conclusion: This study found inconsistent FP services across all the six regions. Also, the proportion of facilities that had a stockout of at least one contraceptive method is unacceptably high and deserves improvement interventions.

Ensuring accountability in implementation of supplementary immunisation activities: A case study of the 2017/2018 measles vaccination campaign in Nigeria

IntroductionGlobally, there is a growing concern with accountability and health systems. This has been attributed majorly to discontent with health system performance. Within the Nigerian health system, weak accountability has been consistently singled out as a key challenge underpinning the poor performance of the immunisation programme. In preparation for the 2017/2018 Measles Vaccination Campaign in Nigeria, the National Measles Technical Coordinating Committee (NMTCC) was inaugurated with one of its key mandates being to ensure accountability in the conduct of the 2017/2018 MVC. This paper aims to share the innovative measures applied in the 2017/2018 Measles MVC to improve accountability and to highlight the contribution of the accountability framework to improving measles vaccination coverage. MethodsWe identified gaps in accountability from the post-campaign coverage reports and reviews of previous campaigns. We adapted an accountability framework developed by the Nigeria National Routine Immunization Strategic Plan (2013–2015),- which cuts across all levels. Selected indicators were used to monitor the implementation of the framework. Administrative actions such as sanctions and rewards were taken as necessary. FindingsWe found that the implementation of the accountability framework was highly instrumental in achieving a high level of coordination among all stakeholders and to improving efficient utilization of resources. We also found that the implementation of the accountability framework in the 2017/2018 MVC contributed to the improved performance of states in terms of measles vaccination coverage compared to the 2015/2016 campaign. ConclusionWe have demonstrated that the implementation of the accountability framework in the 2017/2018 MVC led to a considerable reduction in the misuse and abuse of resources and also contributed to remarkable improvement in the measles vaccination coverages across states compared to the 2015/2016 MVC.

Early Infant Diagnosis of HIV in Primary Health Care Centers

Background: Early diagnosis of HIV to identify infected children for early therapy is aimed at preventing high mortalities associated with child HIV infection. Early infant diagnosis (EID) intervention occurs across the three tiers of the Nigerian health care delivery system, including the primary health care centers (PHC). This study evaluates the implementation of early infant diagnosis of HIV in PHCs in a southern state of Nigeria. Methods: This was a cross-sectional descriptive study that took place between September and November 2019. Primary data were obtained from an interviewer-administered questionnaire on 120 health workers in six Local Government Areas (LGA) that were selected through a multi-stage, random sampling method. Secondary data were from the records of program implementation at the state headquarters of Ministry of Health and the PHCs. Results: A total of 116 (96.6%) health workers were interviewed; 17.2% were males, and 82.8% were females. More than two-thirds of respondents were aged between 41 and 60 years and 84.5% of them had worked in the PHC system for 11 years and above. Rural or urban location of the PHC, educational level of the health workers, and years of service in the PHC system did not have any significant effect on implementation of EID program in the health facilities. Implementation of EID program was ineffective in both rural and urban PHCs of Akwa Ibom state with the p-value of 0.337. In multiple regression analysis, access to EID program and provision of adequate supplies significantly affected implementation of the program with p = 0.001 and p = 0.000 respectively. Conclusion and Implication for Translation: The study indicates general ineffectiveness in the implementation of EID in a Southern State of Nigeria. There is need to improve access to EID services and provide needed supplies if the state, and by extension Nigeria, hopes to meet the target of joining the global community in ending HIV by 2030. Copyright © 2021 Markson. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Assessment of the Knowledge of Nigerian Health Technologists-In-Training on Sickle Cell Disease

Background: Community Health Workers (CHWs) have played a key role in the holistic care of sickle cell disease (SCD) in the developed world. However, in Nigeria and other African countries which harbour the largest burden of SCD globally, the poor involvement of CHWs in the care of individuals with the disease may be related to their knowledge about the disease. Objective: To assess the adequacy of knowledge or otherwise of CHWs-in-training (students of School of Health Technology) in SCD identification, screening and crises prevention. Methods: This cross-sectional study involved 600 students of the College of Health Technology, Ilesa, southwest Nigeria. A pre-tested self-administered forty-point questionnaire was used to assess information on what SCD is and how it is transmitted (6 questions); major clinical presentations (8 questions); ideal timing for diagnosis (7 questions); common methods of crisis prevention (7 questions); basic counselling of individuals with the disease (6 questions); and knowledge on the relevance of record keeping, home visit, immunisation and prompt referral in SCD care (6 questions). Results: Only 239 (39.8%) had good knowledge of SCD in the assessed domains. Knowledge on crisis prevention including roles of record keeping, home visits, immunisation and prompt referral in SCD care was particularly poor. Age group, gender and course of study were not significantly associated with the overall knowledge of the disease. Conclusion: The overall knowledge of Health Technologists-in-training in Nigeria on SCD is poor. Focused and comprehensive modules on SCD should be incorporated into the training curriculum of students in the Colleges of Health Technology in Nigeria.

Are Nigerian oral health workers overlooking opportunities to promote interventions for tobacco smoking cessation?

Are Nigerian oral health workers overlooking opportunities to promote interventions for tobacco smoking cessation?

Gender differences in electrocardiographic findings in the elderly; A Nigerian aging and health study.

Gender differences in electrocardiographic findings in the elderly; A Nigerian aging and health study.

Knowledge, attitude, and practices towards COVID-19: a cross-sectional study among nursing and midwifery students in Jalingo, Nigeria

Background: The coronavirus disease (COVID-19) infection rate and mortality among Nigerian health care workers appear to be on the increase. Aside from health workers, it has caused millions of infections and deaths worldwide. This study determined the level of knowledge, attitude, and practices of nursing and midwifery students towards COVID-19 in a North-Eastern Nigerian state.Methods: A total of 156 respondents were involved in this institutional-based cross-sectional study, conducted after the lockdown period. A total of 17 questions were used to assess the KAP with knowledge appraised with 12 questions, attitudes with 2 questions, and practices with 3 questions.Results: The majority of the students (53.80%) possessed a good level of knowledge regarding COVID-19, while 40.4% had fair knowledge regarding COVID-19 with only 5.80% having poor knowledge of COVID-19. The mean knowledge of COVID-19 in this study was 9.40±1.353 with an overall 78% correct answer rate. A vast majority of the respondent (82.7% and 98.1%) had strong confidence in Nigeria and believed that the pandemic will soon be over, respectively. Only a few avoided large gatherings of people (30.8%) with the vast majority reporting to have worn a mask when going out (84.6%) and washing their hands with running water and soap frequently as recommended (73.1%). In multiple logistic regression analyses, the COVID-19 knowledge score (OR: 0.39-0.40, 95%CI: 0.26 – 0.62, P<0.05) was significantly associated with a lower likelihood of negative preventive practices towards COVID-19.Conclusions: The participants in this study showed good knowledge, positive attitudes, and good practices toward COVID-19. There is still a need to strategize and implement periodic educational interventions and training on infection control practices among healthcare workers including students.

Working towards universal health coverage: a qualitative study to identify strategies for improving student enrolment for the pre-service training of nurses, midwives and community health workers in Nigerian health training institutions

BackgroundStudent enrolment processes and practices can affect the quality of pre-service training programmes. These processes and practices may have serious implications for the quality and quantity of students within health training institutions, the quality of education for prospective health workers and consequently health workforce performance. This study assessed current student enrolment processes and practices for nurses, midwives and community health workers within health training institutions in two Nigerian states, so as to identify strategies for improving student enrolment for these key cadres of frontline health workers.MethodsThis study was carried out in Bauchi and Cross-River States, which are the two Human Resources for Health (HRH) project focal states in Nigeria. Utilizing a qualitative research design, 55 in-depth interviews and 13 focus group discussions were conducted with key stakeholders including students and tutors from pre-service health training institutions as well as policy-makers and public sector decision-makers from Ministries of Health, Government Agencies and Regulatory Bodies. Study participants were purposively sampled and the qualitative data were audio-recorded, transcribed and then thematically analysed.ResultsStudy participants broadly described the application process to include the purchase, completion and submission of application forms by prospective students prior to participation in entrance examinations and oral interviews. The use of ‘weeding examinations’ during the student enrolment process, especially in Bauchi state, was identified as a useful quality assurance mechanism for the pre-service training programmes of frontline health workers. Other strategies identified by stakeholders to address challenges with student enrolment include sustained advocacy to counter-cultural norms and gender stereotypes vis-à-vis certain professions, provision of scholarships for trainee frontline health workers and ultimately the development as well as effective implementation of national and state-specific policy and implementation guidelines for the student enrolment of key frontline health workers.ConclusionWhile there are challenges which currently affect student enrolment for nurses, midwives and community health workers in Nigeria, this study has proposed key strategies which if carefully considered and implemented can substantially improve the status quo. These will probably have far-reaching implications for improving health workforce performance, population health outcomes and efforts to achieve universal health coverage.

Predictors of breastfeeding practices among mothers in a developing African country – A tertiary facility based study in Calabar, Nigeria

Introduction: Breastfeeding is essential for optimum childhood development. Although there is an increased awareness of the importance of breast milk, the Nigerian Demographic and Health Survey of 2018 showed that less than one-third (29%) of mothers in Nigeria practice exclusive breastfeeding. This may be attributed to several factors, hence the need for this study to assess the indicators and predictors of breastfeeding practices among mothers in a tertiary facility in Calabar, Cross River State. Methods: This cross-sectional study was conducted in the University of Calabar Teaching Hospital, Calabar, Nigeria. Consenting mothers of children aged six weeks to two years were sequentially recruited into the study using an interviewer-administered questionnaire. A test of association of categorical variables was done using Chi square test and pvalue was set at 0.05. Results: One hundred and twenty one children and their mothers were surveyed. Mean age of children was 6.2±3.8months and mothers was 28±25years. Exclusive breastfeeding rate for six months was 67.8%.Timely breastfeeding within one hour of life was 44.6%,ever breastfed rate was 86%. Practice of giving water alongside breast milk and use of breast milk substitute was 18.2% and 14.0% respectively. Mothers age was significantly associated with practice of exclusive breastfeeding (p=0.014) and giving water alongside breast milk (p=0.005) while birth order was associated with timely commencement of breastfeeding within one hour of life (p=0.022). Conclusion: The ever breastfed and exclusive breastfeeding rates were fairly high. However, the timely first suckling rate, increased use of breast milk substitute and giving of water alongside breast milk in the first six months of life were low. There is the need for continuous health education of mothers.

What happens after helping babies breathe training is complete? A prospective cohort study of Nigerian health care workers

Background: Neonatal mortality remains disturbingly high in Nigeria. Helping Babies Breathe (HBB) is an evidence- based neonatal resuscitation (NR) educational program designed to teach NR in resourcelimited areas. There is no information in Nigeria on what happens after health careworkers (HCWs) complete HBB training.Aim: To determine if HCWs who received HBB training utilized the acquired knowledge and skills (K&S) and engaged in any ongoing peer training. In addition, we studied HCW turnover one year after HBB training completion.Subjects and Methods: Seventy-two HCWs were trained in HBB, and surveyed 1 year later using a 10-item questionnaire. Data analysis used measures of central tendency and t testing.Results: Most HCWs reported the use of HBB daily. The commonest NR method used was suctioning (89.5 %), followed by drying and positioning (86%), however there was 0% reported use of bagmask- ventilation. Most HCWs (98%) reported sharing K&S with colleagues. Following training,100% HBB trainers remained at original employment but 53% HBB providers moved to new employment and did not utilize their HBB K&S at their new employment site.Conclusion: Frequent, brief, refresher practice sessions and implementation of a system for training new hires may improve HCW readiness for NR and their peer mentoring capabilities. Ensuring adequate equipment availability is critical for HCW to utilize acquired K&S. Significant HCW turnover occurred within a year of training. Trained HCW who left to new employment subsequently had limited impact at their new place of employment.

The Long-term Effects of Violent Conflict on Women’s Intra-Household Decision-Making Power

Does exposure to civil war during childhood affect women’s later-life intra-household decision-making power? This paper examines the long-term effects of early-life exposure to the Nigerian Civil War on women’s decision-making power within the household, using data from the 2008 Nigerian Demographic and Health Survey. To identify the effects, we adopt a difference-in-differences approach which exploits variation in exposure to the civil war by year of birth and ethnicity. The results show that early-life exposure to the war decreases the likelihood of women’s decision-making power within the household in adulthood. Likely mechanisms include different fertility and marriage choices as well as poorer education, health, and employment outcomes as a result of exposure to the war, which would place women in a more precarious position in the household relative to their partners.