Ensuring lifelong protection against tetanus infection is a global concern, and Nigeria is among the 10 countries that have not yet achieved full maternal and neonatal tetanus elimination (MNTE). With pregnant women in tetanus-prone regions commonly taking neonatal protective doses of 1-2 tetanus-toxoid-containing vaccine (TTCV) during each pregnancy or not using it at all, women of childbearing age are unlikely to gain lifetime immunity. Understanding why pregnant women disregard or rarely complete the recommended five doses of TTCV after delivery can help vaccine policymakers and all stakeholders who are working towards local and global elimination of tetanus-related cases tailor their strategies. The objective of this study is to review and synthesize findings from published literature on various factors that influence initiation to complete use of the recommended five doses of TTCV from the start of pregnancy to post-delivery in Nigeria. We carried out a structured narrative search of literature and synthesis to identify factors that inform Nigerian women's non- and repetitive use of the protective doses of TTCV during pregnancy and hinder the complete use of the recommended doses after delivery. An electronic database search was carried out in Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, Global Health, MEDLINE Plus, PubMed, Google Scholar, and the Edinburgh Research Archive to retrieve relevant articles published in English from 2000 to 2025. Seven articles and one published thesismet the criteria for inclusion in the narrative review. The factors that informed the trend of non- and repetitive 1-2 doses of TTCV were reported to be largely associated with misconceptions, geographical location, religious beliefs, parity, spousal approval, women's parents, missed appointments, competing priorities, lack of knowledge of vaccine, doses, and dose intervals. The factors that hinder pregnant women from completing the recommended five doses of TTCV after delivery included forgetfulness, loss of interest, and the assumption that TTCV is not necessary after the baby has been born. Most pregnant Nigerian women who claimed to have had up to five doses of TTCV did so either out of personal determination or by repeating 1-2 doses in subsequent pregnancies. Our findings strengthen the knowledge that the factors that influence pregnant Nigerian women's initiation or complete use of TTCV are complex and multifactorial. National vaccine policy and vaccine recommendations should be informed by studies that provide balanced perspectives and knowledge of the reasons pregnant Nigerian women disregard or rarely complete the recommended doses of TTCV. The findings also emphasize the need for a reorientation of vaccine recommenders and users to the use of TTCV beyond the period of pregnancy.

The aetiological pattern of infertility in most African countries appeared to differ from that in developed countries. The aim of this study was to identify significant causes of infertility among infertile women attending the gynaecological clinics of the University of Ilorin Teaching Hospital. It was a hospital-based retrospective cross-sectional study of infertility cases managed at the gynaecology clinics of the hospital between 2016 and 2018. A total of 797 infertile women were recruited for the study. Aetiologic factors and patterns of infertility data were extracted from the participants' case files. Chi-square test of association and logistic regression analyses were done to assess the significant association between studied aetiological factors and the pattern of infertility among them. The mean age of the participants was 32.9 ± 6 years. About a third of the participants had at least one form of menstrual disorder (35%), and fewer of them had PID (20.8%), obesity (14.2%), and hypertension (3.6%). More than half of them were with male partners with abnormal seminal fluid analysis results (55%). Regression analysis revealed that the most significant aetiological factor for the type of infertility among the patients studied was history of having had dilatation and curettage procedure (P < 0.001). The predominant aetiologic factor in the study was male factor infertility with more than half of the women married to men with abnormal seminal fluid parameters. This finding underscores the growing significance of male factor in the aetiology of infertility among Nigerian women.

Cervical cancer poses a major global health challenge, particularly impacting women.Although largely preventable through regular screening, uptake remains suboptimal in Nigeria due to multiple access barriers. Guided by Andersen’s Behavioural Model of Health Services Use – which posits that health service utilisation is influenced by predisposing, enabling, and need factors – this study assessed the prevalence and determinants of cervical cancer screening among women aged 30–49 years in Nigeria. We analysed secondary data from the 2023–24 Nigeria Demographic and Health Survey, including a weighted sample of 17,649 women aged 30–49 years. Analyses accounted for the complex survey design and were conducted using Stata version 18. Multivariable logistic regression was used to identify determinants of cervical cancer screening, with statistical significance set at p < 0.05. Cervical cancer screening among women aged 30–49 years in Nigeria was 5% (95% CI = 4.6, 5.5), ranging from 3.3% in the North East and 10.8% in the South West. Consistent with Andersen’s model, predisposing factors such as older age and higher education (AOR = 2.37; 95% CI: 1.58–3.57) were associated with increased screening. Enabling factors – including higher wealth quintile (AOR = 1.47; 95% CI: 1.03–2.14), health insurance coverage, recent health facility visit, prior breast cancer examination (AOR = 4.22; 95% CI: 2.70–5.91) and regular mass media exposure – significantly improved uptake. The Need factors – HIV-positive status (AOR = 4.34; 95% CI: 2.34–8.05) was a strong predictor. Conversely, higher parity (≥3 children) and residence in certain regions (North Central and South East) were associated with lower odds of screening. Cervical cancer screening prevalence among Nigerian women remains very low. Findings, highlight the critical role of socioeconomic access, health system contact, and perceived need in shaping screening behaviour. Interventions should prioritise reducing financial and geographical barriers, strengthening routine health system touchpoints, and enhancing risk perception through targeted health education to improve equitable screening uptake.

Mammography still remains the gold standard for breast cancer screening, considering its impact on breast cancer mortality. However, it has a relatively low utilization rate in Nigeria. Although the National Strategic Cancer Control Plan (NSCCP) has a goal of making screening services and early detection of cancer available for all Nigerians, there is currently no national breast cancer screening program implemented in Nigeria. The modelling study aimed to evaluate the cost-effectiveness of mammography screening from the healthcare provider’s perspective and to determine the appropriate screening interval for Nigerian women, aiming to enhance the efficiency and effectiveness of breast cancer detection programs. A state-transition Markov model was adapted to simulate annual and biennial mammography, breast cancer diagnosis, and treatment in a cohort of cancer-free Nigerian women aged 40 years and followed them for a lifetime. The study was conducted from the healthcare provider’s perspective. Disability-adjusted life year (DALY) averted, representing the health outcomes, was used to estimate the incremental cost-effectiveness ratio (ICER). Costs and outcomes were discounted at an annual rate of 5%. Annual mammography screening costs US$238.60, averted a DALY of 1.060, and was the most cost-effective intervention with an ICER of US$207.24 (95% CI US$213.31 – US$216.88)/DALY averted, which was below the willingness-to-pay threshold of $1074. Mammography screening strategies were estimated to be cost-effective from the healthcare payer’s perspective under the model assumptions. Annual screening showed the most favorable cost-effectiveness profile among the strategies evaluated, but this finding is model-dependent and should be interpreted as comparative economic evidence rather than a definitive screening recommendation. These results can inform future research, policy discussions, and consideration of sustainable financing for breast cancer screening in Nigeria.

BackgroundHuman immunodeficiency virus (HIV) disproportionately affects young Nigerian women, yet testing uptake remains suboptimal. This study identified individual- and community-level determinants of HIV testing among this demographic to guide targeted healthcare interventions.MethodsA secondary analysis of the 2024 Nigeria Demographic and Health Survey (NDHS) was conducted (N = 14,634, ages 15-24). Multilevel logistic regression models were applied to account for the hierarchical data structure, with Model III (the full model containing both individual and community-level covariates) demonstrating the best fit based on Akaike information criterion and Bayesian information criterion.ResultsThe prevalence of HIV testing among young women in Nigeria was 21.3%. The multilevel logistic regression analysis revealed that key individual-level factors significantly associated with higher odds of HIV testing included advanced age category, higher educational status, higher wealth index, high individual media exposure, comprehensive HIV knowledge, and a history of sexually transmitted infections. Additionally, marital status was a strong predictor, with married and formerly married women exhibiting significantly higher odds of testing compared to their never-married peers. At the community level, living in communities with high community-level HIV knowledge and high community wealth significantly boosted testing practice. The intraclass correlation coefficient in the null model indicated that 19.0% of the total variance in HIV testing practice was attributable to community-level factors, confirming a notable neighborhood effect.ConclusionHIV testing practices among young Nigerian women are multidimensionally shaped by a prominent “neighborhood effect” alongside individual socioeconomic and marital status. To bridge the current implementation gap in Nigeria, clinical and public health interventions must transition toward decentralized, community-based testing models that intentionally reach out to younger, never-married, and socioeconomically disadvantaged women.

Untargeted 1H NMR metabolomics offers a noninvasive means to identify biomarkers in breast cancer (BC) patients; however, metabolic signatures specific to Nigerian women remain poorly understood. This study aimed to identify plasma metabolomic and lipidomic biomarkers associated with BC in Nigerian patients, evaluate their diagnostic performance using machine learning (ML), and identify dysregulated metabolic pathways. This case-control study recruited 100 BC patients and 100 healthy controls from 4 Nigerian teaching hospitals. Plasma metabolites and lipids were profiled using 1H NMR spectroscopy and the Liposcale test. Multivariate and ML analyses revealed a clear distinction between BC and controls (PLS-DA accuracy: 92.4-94.4%). Twenty-four metabolites were significantly altered (FDR < 0.05), with decreased glycine and glutamine, and increased GlycA, GlycB, glucose, and ketone bodies. Lipoprotein profiling showed reduced small HDL, LDL, and large VLDL particles, alongside with increased HDL diameter. The random forest model achieved the best classification performance (AUC = 0.985) and identified 23 key biomarkers. Pathway analysis revealed 29 enriched metabolic pathways, including glyoxylate and dicarboxylate metabolism. Overall, these findings highlight distinct metabolic alterations in Nigerian BC patients and demonstrate the potential of combining NMR-based metabolomics with ML for population-specific, noninvasive BC diagnostics.

Lumefantrine is a key partner drug in artemether-lumefantrine therapy, yet data describing its pharmacokinetics among women with efavirenz-based antiretroviral therapy remains limited. This study aimed to characterise the population pharmacokinetics of lumefantrine in pregnant and non-pregnant Nigerians living with HIV, evaluate the influence of pregnancy and CYP3A5 genotype, and assess the adequacy of current and alternative dosing regimens with respect to day-7 plasma concentration targets. Plasma lumefantrine concentrations were analysed using nonlinear mixed-effects modelling in Pumas. Structural models comprising one to three compartments, along with alternative absorption models, were evaluated. Pregnancy status and CYP3A5 expressor status, among other candidate covariates, were tested using a stepwise covariate modelling procedure. Model robustness was assessed using nonparametric bootstrap resampling and simulation-based diagnostics. Monte Carlo simulations were then performed to compare the probability of achieving a day-7 lumefantrine concentration of at least 0.2µg/mL under current versus alternative dosing regimens. Lumefantrine pharmacokinetics were adequately described by a two-compartment model with transit absorption. Pregnancy status and functionally relevant CYP3A5 genotype were not identified as significant covariates on lumefantrine pharmacokinetic parameters among the study population. At the currently recommended twice-daily dosing for 3 days, approximately 65% of simulated patients achieved the day-7 concentration target. Extending dosing to twice daily for 5 days increased target attainment to approximately 96%, while alternative intensified regimens also improved exposure. No statistically significant effect of pregnancy on lumefantrine pharmacokinetics was identified in this EFV-treated population. However, the standard 3-day dosing regimen may result in suboptimal exposure in a substantial proportion of patients. Simulation results suggest that extended dosing regimens could markedly improve day-7 target attainment, supporting further evaluation of alternative dosing strategies to optimise the efficacy of artemether-lumefantrine among people with concurrent EFV-based ART.

Cumulative lifetime endogenous estrogen exposure (CLEEE) is an established breast cancer (BC) risk factor, yet Nigeria faces increasing BC incidence and mortality despite reproductive patterns typically associated with lower estrogen exposure. We evaluated the association of endogenous estrogen exposure and BC risk in this population. We analyzed 609 Nigerian BC cases and 609 controls from the MEND case-control study to examine associations between CLEEE and BC risk by molecular subtype. CLEEE was defined as time from menarche to menopause (or enrollment), minus pregnancy duration; a breastfeeding-adjusted measure (CLEEE-b) subtracted breastfeeding duration. Most cases were grade 2 (67.2%) or grade 3 (27.9%), with 42.8% triple-negative breast cancer (TNBC), 33.7% luminal A, 12.6% HER2-enriched, and 10.9% luminal B. Compared with controls(medians), cases had lower BMI (25.4 vs. 26.7, p < 0.001), earlier menarche (mean:14.9 vs. 15.2 years, p < 0.001), and higher CLEEE (330 vs. 321 months, p < 0.018) and CLEEE-b (273 vs. 264 months, p = 0.043). In multivariable models adjusting for BMI and menopausal status, each standard deviation increase in CLEEE was associated with 33% higher BC odds (aOR 1.33, 95% CI 1.13-1.57), with stronger association for postmenopausal women (aOR: 1.62, 95% CI: 1.22-2.19), women with BMI ≥ 3025 (aOR: 1.52, 95% CI: 1.07-2.20), and for TNBC (highest vs. low CLEEE tertile: aOR 1.90, 95% CI 1.12-3.26). Associations for CLEEE-b remained significant but modestly attenuated. Higher CLEEE was associated with increased BC odds, particularly for TNBC. Larger studies among African women are needed to confirm these associations to inform prevention strategies.

Breast cancer is the leading cause of death in Nigerian women. Clinical trials are required to provide evidence for treatment. We aimed to generate efficacy data to support the shift in local practice of neoadjuvant therapy for breast cancer. A one-stage, phase II feasibility, single-arm study design was used. Treatment-naïve patients with clinically nonmetastatic human epidermal growth factor receptor 2 (HER2)-positive breast cancer received four cycles of neoadjuvant docetaxel with subcutaneous trastuzumab (T + scH). Patients with complete clinical response underwent surgery. Patients with stable disease/partial response received three further cycles of 5-fluorouracil, epirubicin, and cyclophosphamide + scH before surgery. Responders completed 18 scH cycles. The primary end point was pathologic complete response (pCR). The secondary end points were toxicity and invasive disease-free survival. A total of 53 female patients age 18-70 years were enrolled. The median age of the 47 evaluable female patients was 50 years. pCR was achieved in 25 of 47 patients (53% [95% CI, 38.1 to 67.9]; P < .001). Forty-two percent of patients were estrogen receptor+ and 40% were progesterone receptor+ (95% CI, 20.3 to 66.5 and 21.5 to 69.2, respectively). All were HER2+, with 40% stage II and 60% stage III disease. Three patients (6.4%) experienced grade 3 myelosuppression, one (2.1%) experienced grade 3 diarrhea, two (4.3%) had a grade 4 adverse event, and two developed hepatitis while on the study medications. The reporting of disease-free and overall survival awaits future analysis. This phase II study showed that neoadjuvant chemotherapy with T + scH resulted in pCR of 53%, surpassing the planned cutoff for success of 40%. This is comparable with the rates and other efficacy end points that follow data from phase II international trials. This regimen may be useful in the absence of pertuzumab and warrants further investigation.

To explore Nigerian women's lived experiences of menopause and identify sociocultural, structural, and health-system factors shaping symptom recognition, care-seeking, and wellbeing, using in-depth qualitative inquiry. Qualitative interview study. Urban, peri-urban, and rural communities across Nigeria. Post-menopausal women aged 40-66 years experiencing natural, surgical, or medical menopause. As part of the Nigerian arm of the MARIE project, semi-structured qualitative interviews were conducted with purposively sampled post-menopausal women to capture diverse menopausal stages, socioeconomic positions, and geographic contexts. Interviews were analysed using thematic analysis informed by an equity-centred, intersectional framework. Multiple researchers independently coded transcripts, with iterative discussion and triangulation to enhance analytic rigour and validity. Three interrelated themes characterised menopausal experiences in Nigeria. First, structural health-system inequalities were evident, including limited anticipatory information, inadequate clinician training, fragmented care pathways, and restricted access to hormone replacement therapy and non-hormonal treatments. Second, sociocultural and gendered norms shaped symptom interpretation and disclosure, with menopause often framed as a natural or inevitable life stage requiring endurance rather than care, compounded by stigma and silencing within families and communities. Third, women demonstrated adaptive coping and resilience, relying on peer networks, faith-based practices, and self-management strategies in the absence of formal support. Urban participants reported comparatively better access to information and services, while rural women described pronounced neglect and dependence on informal care. This qualitative study provides the first in-depth, context-specific account of menopausal experiences among Nigerian women, revealing substantial inequities driven by sociocultural beliefs, economic constraints, and systemic gaps in healthcare provision. The findings underline the urgent need for culturally sensitive, equity-oriented menopause care in Nigeria, including integration into primary healthcare, improved professional training, affordable access to evidence-based treatments, and public health education to reduce stigma and unmet need.

Arboviral burden among pregnant women with HIV coinfection in sub-Saharan Africa remains inadequately characterised. To assess arboviral seroprevalence using IgG and IgM antibodies to distinguish historical exposure from relatively recent infection among Nigerian women. We conducted a cross-sectional serosurvey (December 2020-November 2023) across three Nigerian regions representing distinct ecological zones, recruiting 619 women: HIV-positive pregnant (n = 207), HIV-negative pregnant (n = 207), and HIV-positive non-pregnant (n = 205). Arboviral IgG and IgM antibodies against chikungunya virus (CHIKV), dengue virus (DENV), Zika virus (ZIKV), and other flaviviruses were detected using immunoblot assays, with plaque reduction neutralisation testing (PRNT) performed on a subset of 150 samples to support virus-specific interpretation. IgG seropositivity was highest for CHIKV (42.2%), followed by DENV (27.1%) and ZIKV (13.6%). IgM seropositivity, indicating relatively recent infection, was observed for CHIKV (14.1%), DENV (9.0%), and ZIKV (4.5%). All IgM-positive individuals were also IgG-positive; overall seroprevalence patterns suggest both endemic transmission and infections occurring at different time points within a previously exposed population. Northern regions showed significantly higher odds of CHIKV IgM (aOR 2.13, 95% CI: 1.18-3.87) and ZIKV IgM (aOR 4.71, 95% CI: 1.53-14.49) seropositivity. Among pregnant women, CHIKV IgM seropositivity was associated with higher odds of preterm birth, while other birth outcome associations should be interpreted cautiously given limited power and the cross-sectional design. PRNT identified samples with predominant virus-specific neutralising patterns, while others showed evidence consistent with multiple flavivirus exposures. Substantial arboviral exposure exists across Nigerian populations, with evidence consistent with ongoing endemic transmission. Dual serology supported by PRNT helped distinguish remote exposure from relatively recent infection, but does not precisely date infection timing. These findings support enhanced surveillance and prospective pregnancy studies incorporating molecular diagnostics (e.g., RT-PCR) to better define the impact of arboviral infection on pregnancy and birth outcomes.

Analysis of MED-12 mutations in uterine leiomyomas of Nigerian women.

Self-sampling for HPV testing is increasingly adopted for cervical cancer screening globally, including in Sub-Saharan Africa. However, concerns remain regarding women's willingness and ability to collect samples and the effectiveness of educational interventions. Although prior studies in Africa and Nigeria have examined acceptability and barriers, there is limited evidence on whether structured educational interventions can modify women's attitudes toward HPV self-sampling in routine screening contexts. We evaluated the effect of a structured educational intervention on women's attitudes toward self-sampling and, secondarily, explored baseline correlates of willingness to self-sample among Nigerian women. We conducted a single-group pre-post quasi-experimental study nested within the African Collaborative Center for Microbiome and Genomics (ACCME) prospective cohort study in central Nigeria. A total of 220 eligible women undergoing cervical cancer screening were enrolled. Baseline measurements were obtained prior to the intervention. The standardized educational intervention, delivered by trained research staff, included brochures, leaflets, an instructional video, verbal instructions, and hands-on familiarization with the Evalyn® self-sampling brush. Participants subsequently performed self-sampling privately at participating screening facilities. Post-intervention measurements were collected immediately after the educational session and procedure. Samples were analyzed using DEIA/LIPA HPV assays. Most participants were married (63.2%), belonged to the middle socioeconomic group (69.5%), had prior knowledge of cervical cancer (61.8%), and had never undergone screening (89.5%). At baseline, 91.8% were willing to self-sample. The intervention significantly improved mean attitude scores from 42.6 (SD 8.3) to 50.8 (SD 9.8) (p<0.001). Among women unwilling to self-sample, 50.0% (9/18) were in the lower SES group compared with 12.9% (26/202) among willing participants (p<0.001). In exploratory analyses, younger age (OR 0.95, 95% CI 0.90-1.00), cervical cancer knowledge (OR 1.42, 95% CI 1.00-1.99), middle SES (OR 3.69, 95% CI 1.07-12.66), and pre-intervention attitude (OR 0.89, 95% CI 0.81-0.99) were associated with willingness. A structured educational intervention significantly improved attitudes toward HPV self-sampling. Baseline willingness was high, and exploratory analysis indicate that younger age, better knowledge, and middle SES are associated with willingness. These findings support context-specific educational strategies to optimize HPV self-sampling uptake in Nigeria and similar low-resource settings.

Miscarriage is a common complication of pregnancy. Several pregnancy biomarkers have been used to predict spontaneous miscarriage, but these have shown conflicting results. A biomarker such as pregnancy-associated plasma protein A (PAPP-A) may likely prognosticate the clinical progress of pregnancy in early pregnancy assessment. It was a prospective cohort study involving 98 pregnant women with threatened miscarriage and 98 pregnant women with normal ongoing pregnancy, recruited between 6 and 20 weeks of gestation. Blood samples were collected at enrollment from the participants to assay PAPP-A serum levels, and they were followed up till 28 weeks of gestation to document the outcome (failed or continued pregnancy). Statistical analysis was performed using the Stata version 16 (STATA Corp., USA). Multiple of the median (MoM) of serum PAPP-A levels was lower among the threatened miscarriage group compared to the women with normal ongoing pregnancy (0.98 MoM vs. 1.06 MoM, P < 0.0001). Furthermore, median plasma PAPP-A MoM was significantly lower among women with threatened miscarriage who had spontaneous miscarriage compared with those with ongoing pregnancy (0.35 [0.15-0.60] vs. 1.02 [0.89-1.29]; P < 0.0001). At the optimal cutoff of ≤0.63 MoM, serum PAPP-A level significantly predicted the occurrence of failed pregnancy with sensitivity and specificity of 77.3% and 93.4%, respectively. A low maternal serum PAPP-A level was significantly associated with the occurrence of threatened miscarriage and failed pregnancy among pregnant Nigerian women. Serum PAPP-A level of <0.63 MoM significantly predicted the occurrence of failed pregnancy with sensitivity and specificity of 77.3% and 93.4%, respectively. Larger prospective multicenter studies are needed to further investigate the clinical usefulness of maternal serum PAPP-A level in evaluating women with threatened miscarriage in our environment.

Breast cancer is a major global health concern, significantly contributing to morbidity and mortality among women. Early detection is essential for reducing breast cancer-related deaths, and breast self-examination (BSE) represents a simple and cost-effective preventive strategy. However, the practice of BSE among specific migrant populations remains insufficiently studied. This study evaluates the knowledge and practice of BSE among adult Nigerian women residing in Sunderland, United Kingdom. A cross-sectional study was conducted using a structured questionnaire distributed to 126 Nigerian women aged 18 years and above residing in Sunderland, UK. The questionnaire evaluated participants' knowledge of BSE, frequency of practice, perceived barriers, and factors influencing adherence. Descriptive statistics, including percentages, and inferential analysis using chi-square tests were applied for data analysis. A substantial majority (88.10%) of respondents reported awareness of BSE, with health workers identified as the primary source of information. Participants also demonstrated a high level of BSE practice, with 40.48% performing it weekly. Additionally, a statistically significant association was found between knowledge and practice of BSE in breast cancer prevention among the study population (p &lt; 0.05). The findings highlight the necessity of ongoing education regarding breast cancer prevention strategies. Healthcare professionals are encouraged to intensify awareness initiatives by providing Nigerian women with information on the optimal timing and techniques for performing BSE, thereby improving adherence and early detection outcomes.

Social determinants of subjective well-being among Nigerian women

ABSTRACT Status mismatches between partners can generate marital conflict that may escalate into intimate partner violence (IPV). Household decision-making dynamics further shape the distribution of power, as women’s predominance or exclusion in decision-making informs their experiences of IPV. However, the impact of status compatibility and decision-making on IPV remains underexplored in African countries. This study employs the 2018 Nigerian Demographic Health Survey (NDHS) to examine the relationship between status compatibility, decision-making, and IPV among Nigerian women. Guided by the status compatibility framework, backlash perspective, and marital dependency theory, multinomial, logistic, and negative binomial regression models were estimated. The study revealed that unemployed women with employed husbands face a higher risk of emotional abuse than dual-employed partners. Women with more education than their husbands face a higher risk of coercive control and severe violence, while equitable decision-making is linked to the lowest risk of controlling behaviors. The study highlights the need for enlightenment programs to address IPV in Nigeria.

BACKGROUND: Despite its life-saving benefits, there is reluctance among Nigerian women and their husbands to have a caesarean section (CS) when indicated. This study assessed attitude and associated subjective norms involved in resolving whether to accept CS delivery among married men and women in Lagos, Nigeria. METHODS: This was a cross-sectional survey. A validated questionnaire was used to collect data from 422 consenting respondents who were selected through a systematic sampling technique. Attitudinal disposition was measured on15-point rating scale; subjective norms influence was on a 27 point-rating scale and intention to accept CS was measured on 10-point-rating scale. Data were transformed from response items into weighted-aggregate scores for moderating variables. Descriptive and Multiple regression analysis was conducted. All tests were conducted at p ≤ 0.05 level of significance. RESULTS: The mean age of the respondents for males and females were 38.7 ± 11.6 years and 37.4 ± 9.8 years respectively. The male and female respondents had a mean score of 7.78 ± 2.82; 8.56 ± 3.08; 15.41 ± 6.97 and 13.66 ± 7.10 computed for attitudinal disposition and subjective norms respectively. About 30% of male respondents and 20% female respondents were likely to accept CS if the need arose. Fear of being mocked by friends (male: 42.0%; female: 42.9%) and risk/complications of the method (male: 30.3%; female: 23.7%) were barriers the respondents reported. There was a significant association between the subjective norm considerations of both the male (β = 0.19; p = 0.007) and female (β = 0.29; p = 0.001) respondents regarding their intention to accept CS. Male and female respondents with a master’s degree showed higher intention to accept CS compared with those with primary education (β = 0.27, p = 0.026; β = 0.23, p = 0.044). CONCLUSION: The respondents had positive attitude toward CS, with moderate subjective norm considerations in accepting CS. Education, Spouse, family, friends, and cultural beliefs played a major role in decision-making, reinforcing societal expectations regarding childbirth delivery options. These factors, in turn, contributed to intention to accept CS delivery among the respondents in the study. Integrating CS education into antenatal care, while ensuring that partners are also engaged, may enhance overall acceptance of caesarean section.

Spirituality is deeply embedded in childbirth experiences among Nigerian women; yet, its integration into maternity care remains limited, especially at the primary health care (PHC) level. This study explored the barriers and facilitators to integrating spirituality in childbirth among PHC workers in Ogbomoso, Nigeria. An exploratory qualitative research design was used, involving semi-structured interviews with ten purposively selected female PHC workers from selected health centers. Participants were mostly aged 41-50years, predominantly Christian, and had 11-20years of professional experience. Thematic analysis generated six themes as barriers to integrating spirituality: safety concerns related to harmful or unsterile spiritual items; concerns about disturbance from loud prayers disrupting the ward environment; heavy workload limiting attention to non-clinical needs; lack of training on spiritual care beyond prayer; time constraints, particularly during emergencies; and personal beliefs of health workers which sometimes conflicted with patients' spiritual preferences. Facilitators to integrating spirituality generate four themes: strong rapport between patients and caregivers, a calm and organized clinical environment, allowing access to personal spiritual items like scriptures or prayer beads, and supportive management policies that enabled flexibility without compromising care. The findings suggest that while spirituality is valued, systemic, institutional, and individual-level factors influence its implementation. Integrating spiritual care into PHC will require targeted training, staffing improvements, clear policies, and culturally sensitive guidelines to ensure holistic and respectful maternal care.

Cervical cancer is the third most common cancer in Nigeria, with 13,676 new cases and 7093 deaths in 2022 (according to GLOBOCAN estimates). Cervical cancer survival is poor in Sub-Saharan Africa, with nearly half of diagnosed women dying within 3 years. Most cases occur in women aged 15-44 years, resulting in significant social, economic, and psychological consequences. Despite this disease being preventable and curable when detected early, many Nigerian women present at advanced stages due to low awareness, misconceptions, and limited screening. Previous studies have been largely hospital-based or limited in scope. This study assessed knowledge, attitude, and screening uptake of cervical cancer among rural women in North Central Nigeria and identified significant predictors of these outcomes. A community-based cross-sectional study was conducted in Omala local government area, Kogi State, Nigeria between September and October 2023. Using multistage sampling, 416 women aged 15 years and above were recruited from four rural communities to ensure representativeness. Data were collected by trained interviewers through a semi-structured, pretested questionnaire administered by face-to-face interviews or self-completed depending on literacy levels. The instrument included sociodemographic variables, four domains of knowledge (general, risk factors, signs/symptoms, screening), attitude assessed on a five-point Likert scale, and uptake of cervical cancer screening. Consolidated knowledge scores were calculated and categorized as poor or fair/good. Willingness to undergo screening was categorized as 'yes', 'no' and 'not sure'. Logistic regression models were fitted to identify independent predictors of knowledge, attitude, and uptake, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs). Ethics approval was obtained from the National Open University of Nigeria, and informed consent was secured. Most participants were 40 years or less (71.7%) and married (58.2%). Overall, 41.7% had fair/good consolidated knowledge of cervical cancer, with substantial variation across domains: general knowledge (59.2%), knowledge of risk factors (15.5%), knowledge of signs and symptoms (26.8%), and knowledge of screening (45.2%). Only 42.3% recognized HPV infection as a risk factor, while fewer than one-third recognized intermenstrual or postcoital bleeding as symptoms. Mass media (36.7%) and hospitals (26.6%) were the most common sources of information. The median attitude score was 3.3, with positive attitude expressed toward the curability of cervical cancer if detected early and to the effectiveness of Pap smears and vaccination. Nonetheless, only 12.2% of women reported ever undergoing screening although 36% expressed willingness to undergo a screening test. Reported barriers included lack of knowledge about the test (23.3%), absence of symptoms (22.4%), and low perceived susceptibility (11.1%). Multivariable analysis showed that higher education (p (trend)=0.001), increasing age (OR=1.07, 95%CI 1.03-1.11), later commencement of sexual intercourse (OR=1.04, 95%CI 1.00-1.08), smaller family size (OR=2.62, 95%CI 1.34-5.11), and family history of cervical cancer (OR=3.72, 95%CI 1.18-11.68) were associated with good knowledge. Positive attitude was predicted by higher education (p=0.037), nulliparity (OR=2.61, 95%CI 1.04-6.54), and smaller family size (OR=2.16, 95%CI 1.14-4.10). Screening uptake was significantly associated with positive attitude (p=0.006), being married (OR=3.50, 95%CI 1.08-11.39) or divorced/separated (OR=6.03, 95%CI 1.21-30.02), and knowledge of screening (OR=2.54, 95%CI 1.00-6.69). Knowledge of cervical cancer and its risk factors among rural women in North Central Nigeria remains poor, and uptake of screening services was profoundly low. Positive attitude, marital status, and good knowledge were key drivers of screening uptake. These findings highlight the need for context-specific health promotion programs, improved access to screening, and targeted education strategies in rural settings. Lessons from this study have broader implications for rural health systems globally, particularly in low-resource contexts where similar barriers persist.