Women In Rural Nigeria Research Articles

A Postcolonial Feminist Perspective on Traditional Birth Attendants and Management of Pregnancy Complications Among Indigenous Women in Rural Nigeria

The work of Traditional Birth Attendants (TBAs) in the Global South continues to be pivotal to the operations of rural healthcare services, especially as formal healthcare services often malfunction in rural communities, as in rural Nigeria, where TBAs preponderantly conduct deliveries among Indigenous women. This study examines TBAs’ management of delivery complications in rural Nigeria among Indigenous women using a sample of TBAs and TBAs’ service users. The study adopts a qualitative methodology involving focus groups of TBAs’ service users and interviews of TBAs to determine TBAs’ effectiveness in managing obstetric complications, considering their differentiation in terms of service competence. The study apprehends the phenomenon through a postcolonial feminist theoretical lens. The results show that TBAs have differential capabilities in the management of cases and their perception and interpretation of problems determined whether physical or metaphysical strategies were employed in their work. While some TBAs competently managed the presented cases, others invited either TBA colleagues or traditional resource persons to assist in such dire moments. Even though the TBAs—victims of patriarchy and colonial subjugation—continue to be marginalized and subjugated by male-dominated colonial and neocolonial power structures, they have significantly transformed their values to create a model for rural social work that provides social and emotional support to Indigenous women in rural spaces. The study therefore identifies a social policy and social work imperative for ideas sharing between different forms of Westernized healthcare practitioners and TBAs to engender the best health outcomes for rural Indigenous women.

Incidence, intensity and drivers of multidimensional poverty among rural women in Nigeria

Rural women are important agents of development and they are the backbone of achieving sustainable development in any society. However, rural women in Nigeria, like in most developing countries, disproportionately bear the burden of poverty due to poor access to productive resources, information and services. There is growing evidence that prioritizing measures for ending poverty among rural women represents an important gateway to the achievement of other global goals. This study therefore seeks to determine the extent of multidimensional poverty among rural women in Nigeria and to also identify its critical risk factors. Using secondary data obtained from 2018/2019 Harmonized Nigeria Living Standard Survey (HNLSS), findings from the study reveal that more than three-quarters of the rural women in Nigeria are multidimensionally poor and they experience multiple deprivations in the weighted indicators across the poverty dimensions. The living standard dimension accounted for the largest share of deprivation suffered by rural women while health dimension contributed the least. However, further analysis across the sub-indicators of poverty dimensions revealed security shocks, unemployment and time to health care services as the biggest contributors to multidimensional poverty of rural women in Nigeria. Results also show that age, household size, years of education, household expenditure, ownership of cropland, credit access and access to safety nets are the main determinants of multidimensional poverty among rural women. The study recommends the need to focus on policy options that provide more primary health care services, increase employment opportunities and strengthen shock-preventive or shock-responsive social protection systems of rural women.

Household Poverty-Wealth and Decision-Making Autonomy as Predictors of Reproductive and Maternal Health Services Utilization among Rural Women in Nigeria: Evidence from a National Survey.

Adequate reproductive and maternal healthcare services utilization are significant in reducing maternal deaths, however, the prevalence rate of contraceptive use remains low, with inadequate maternal health services utilization among rural women in Nigeria. This study examined the influence of household poverty-wealth and decision-making autonomy on reproductive and maternal health services utilization among rural women in Nigeria. The study analyzed data from a weighted sample of 13,151 currently married and cohabiting rural women. Descriptive and analytical statistics including multivariate binary logistic regression were conducted using Stata software. An overwhelming majority of rural women (90.8%) have not used modern contraceptive methods, with poor utilization of maternal health services. About 25% who delivered at home received skilled postnatal checks during the first 2 days after childbirth. Household poverty-wealth significantly reduced the likelihood of using modern contraceptives (aOR: 0.66, 95% CI: 0.52-0.84), having at least four ANC visits (aOR: 0.43, 95% CI: 0.36-0.51), delivering in a health facility (aOR: 0.35, 95% CI: 0.29-0.42) and receiving a skilled postnatal check (aOR: 0.36, 95% CI: 0.15-0.88). Women's decision-making autonomy regarding their healthcare significantly increased the use of modern contraceptives and the number of ANC visits, while women's autonomy on how their earnings are spent positively influenced the use of maternal healthcare services. In conclusion, the use of reproductive and maternal health services among rural women was associated with household poverty-wealth and decision-making autonomy. Government should formulate more pragmatic policies that will create awareness and promote universal access to reproductive and maternal healthcare services.

Exploring underutilization of skilled maternal healthcare in rural Edo, Nigeria: A qualitative study.

IntroductionExisting studies have acknowledged the underutilization of skilled maternal healthcare services among women in rural Nigeria. Consequently, women in rural areas face a disproportionate risk of poor health outcomes including maternal morbidity and mortality. Addressing the challenge of non-use of skilled maternal healthcare in rural areas necessitates the involvement of multi-stakeholders across different sectors who have vital roles to play in improving maternal health. This study explores the factors contributing to the non-use of maternal healthcare services in rural areas of Edo, Nigeria from the perspectives of community elders and policymakers.MethodsIn this qualitative study, data were collected through 10 community conversations (group discussions) with community elders each consisting of 12 to 21 participants, and six key informant interviews with policymakers in rural areas of Edo State, Nigeria. Participants were purposefully selected. Conversations and interviews occurred in English, Pidgin English and the local language; lasted for an average of 9 minutes; were audio-recorded and transcribed to English. Data were manually coded, and data analysis followed the analytical strategies for qualitative description including an iterative process of inductive and deductive approaches.ResultsPolicymakers and community elders attributed the non-use of maternal health services to poor quality of care. Notions of poor quality of care included shortages in skilled healthcare workers, apathy and abusive behaviours from healthcare providers, lack of life-saving equipment, and lack of safe skilled pregnancy care. Non-use was also attributed to women’s complex utilization patterns which involved a combination of different types of healthcare services, including traditional care. Participants also identified affordability and accessibility factors as deterrents to women’s use of skilled maternal healthcare.ConclusionThe emerging findings on pregnant women’s combined use of different types of care highlight the need to improve the quality, availability, accessibility, and affordability of skilled maternal care for rural women in Nigeria.

PROFITABILITY AND EFFICIENCY OF TOMATO PRODUCTION AMONG FEMALE FARMERS IN IBADAN NORTH LOCAL GOVERNMENT AREA, IBADAN, OYO STATE, NIGERIA

Women farmers in Nigeria particularly in rural areas have always worked and their labour contributes a key role in the survival of millions of Nigeria families. Most rural women in Nigeria are the invisible farmers and they form the backbone of rural development, however more than half of Nigeria’s food is produced by female farmers. These studies analyze the profitability and efficiency of tomato production among female farmers in Ibadan North Local Government Area of Oyo State. The study specifically described the socioeconomic characteristics of the respondents, determines the technical efficiency and factors affecting technical efficiency and lastly estimated the profitability of tomato production in the study area. The study revealed that the female tomato farmers were adult and active, most of the farmers were literate, majority had 5 household sizes and less and most of the female tomato farmers had little experience in tomato production. The study also revealed that farm size, capital and labour were the factors that significantly affected tomato production of the respondents while the variables representing household size and number years spent in school affected the Inefficiency of farmers in the study area. The mean technical efficiency was found to be 0.97 (or 97%) which implied that, on the average, the farmers were 97% technically efficient; hence their observed output was about 3% less than the maximum frontier output.

Providing reproductive health information to rural women: The potentials of public libraries.

Access to reproductive health information is an integral part of the sustainable development goal3 of good health and well-being. The World Health Organization (WHO) recommends a gender-based approach to public health that should holistically address the physical, mental and emotional well-being of women. However, women in urban areas seem to be benefiting more from various laudable reproductive health programmes than those in rural areas. This scenario negates the concept of sexual and reproductive health and rights, which have fundamental bearing for sound economic development and poverty alleviation. It is against this background that this paper examined the provision of reproductive health information to rural women in Nigeria. It identified the reproductive health information needs of rural women, including information on fertility, management of unplanned pregnancies, sexually transmitted diseases, prenatal and postnatal care. It further discussed the problems hindering rural women from accessing reproductive health information. To alleviate these problems, the paper discussed various roles public libraries can play in helping rural women gain access to reproductive health information. It recommended adequate funding, community engagements, and collaboration with relevant agencies for public libraries to take their place in the dissemination of reproductive health information to rural women.

Effect of access to innovations on assets acquisition and development capacity of women in rural Nigeria

This study investigates the attribution effect of access to innovation on assets acquisition and development among rural women. The study analyzed gender differences in access to innovations and its consequence on assets ownership among rural males and females. Primary data for the study were sourced through a structured questionnaire. The data was fitted to a propensity score matching model in order to isolate the effect of access to innovation on gender differences in an asset acquisition. The findings showed that rural development drive requires innovative intervention in the rural areas and its effect could be more favorable to males than females in terms of productive asset acquisition and development. But, no significant difference (5% level) was established for non-productive asset acquisition across gender. There is a need for gender-inclusive strategies for rural development.

Informal Saving Group: A Pathway to Financial Inclusion among Rural Women in Nigeria

Financial inclusion is a key to economic development and has continually gained increased attention across countries, particularly in developing countries where there is relatively high rate of financial exclusion. In Nigeria, despite several measures taken to promote financial inclusion, there is still high rate of financial exclusion among rural women, as rural people and women are generally more financially excluded. This article provides an overview of financial inclusion, analysis of the patterns and dynamics of financial inclusion in Nigeria and the pathway for promoting financial inclusion among rural women is discussed. The article posits informal savings groups as a potential pathway to financial inclusion among rural women, by reviewing journal articles and grey literatures. The review shows that most rural women are participating in informal saving groups, but these saving groups are however faced with some challenges, such as limited income base, inability to receive remittance and vulnerability to theft. The pathway to financial inclusion among rural women discussed include, sensitizing these rural women through financial literacy, thereafter fostering informal saving groups which most rural women are already aware of their operations and thirdly, linking these groups to formal financial institutions. We conclude that informal saving groups have great potentials of accelerating financial inclusion among rural women, therefore Government should carry out financial literacy campaigns among rural women and policies that promote financial inclusion should be designed building on informal saving groups.

Socioeconomic Dynamics in Women's Access and Utilization of Health Technologies in Rural Nigeria.

Technology has become a powerful tool for resolving women's health problems hence women's access and use of healthcare technologies have become an important aspect of the Sustainable Development Goals. Though health technologies have improved the lives of women worldwide, in Nigeria, especially in rural settings, use of health technologies remains low. The objective of this study was to examine the socioeconomic dynamics that influence the use of health technologies by women in rural Nigeria. A cross sectional survey using qualitative methods to collect data from 147 purposively selected women (15-65 years) was conducted in three rural Local Government Areas in Enugu State. Focus Group Discussion (FGD) and In-depth interview guides were used to collect information from 147 purposively selected women and healthcare workers on access and use of health technologies among women in rural communities. Thematic analytic method was used to analyze the data. The data gathered revealed that there was unavailability of health technologies in some communities studied while many had skeletal provision of health technologies. Bad road networks, cost of transportation and unavailability of health technologies impacted on access. Low socioeconomic status of rural women influenced their use of health technologies. Health technologies especially diagnostic technologies are not available in rural communities. Women cannot access what is not available. The study recommends need for the provision of these lifesaving technologies at little or no cost.

Effectiveness of Melon Shelling Technology and Preference by Rural Women in Nigeria

Few years ago National Centre for Agricultural Mechanization (NCAM) launched melon sheller to reduce burden of obtaining melon oil and cake, and to enhance rural women’s productivity. This study looked at the productivity of promoted melon shelling technology and preference by rural women in Nigeria. Data were gathered from the NCAM workshop and survey of melon processors in Niger State. In the workshop, it was found that time allowed for soaking melon and covering with piece of clothes contributed to the productivity of the sheller. Results from survey revealed that 95.1% of the respondents’ preferred Internal Combustion technology and 90.2% liked electric-driven melon shellers over the manual one. Also, 69.5% obtained the shellers from local fabricators rather than NCAM. The technology led to increased turnout of melon (378kg/hr) and reduced wastages to 1.26kg out of 75.6kg. The study concluded that the promoted melon sheller is efficient and have positive implication on the rural women’s productivity and revenue. The study recommends that the rural women should put the melon sheller into its maximum capacity use. The NCAM should extend training to the local fabricators so that they can improve on the technology most especially in the areas of winnowing and washing of melon kernels.

Unlocking community capabilities for addressing social norms/practices: behavioural change intervention study to improve birth preparedness and complication readiness among pregnant women in rural Nigeria

BackgroundMaternal mortality is attributed to combination of contextual factors that cause delay in seeking care, leading to poor utilization of skilled health services. Community participation is one of the acknowledged strategies to improve health services utilization amongst the poor and rural communities. The study aimed at assessing the potentials of improving birth preparedness and complication readiness (BP/CR) using community-driven behavioural change intervention among pregnant women in rural Nigeria.MethodsA pre-post intervention study was conducted from June 2018 to October 2019 on 158 pregnant women selected through multi-stage sampling technique from 10 villages. Data on knowledge and practices of birth preparedness and utilization of facility health services were collected through interviewer-administered pre-tested structured questionnaire. Behavioural change intervention comprising of stakeholders’ engagement, health education, facilitation of emergency transport and fund saving system, and distribution of educational leaflets/posters were delivered by twenty trained volunteer community health workers. The intervention activities focused on sensitization on danger signs of pregnancy, birth preparedness and complication readiness practices and emergency response. Means, standard deviations, and percentages were calculated for descriptive statistics; and T-test and Chi square statistical tests were carried out to determine associations between variables. Statistical significance was set at p-value < 0.05.ResultsThe result showed that after the intervention, mean knowledge score of danger signs of pregnancy increased by 0.37 from baseline value of 3.94 (p < 0.001), and BP/CR elements increased by 0.27 from baseline value of 4.00 (p < 0.001). Mean score for BP/CR practices increased significantly by 0.22 for saving money. The proportion that had antenatal care (76.6%) and had facility delivery (60.0%) increased significantly by 8.2 and 8.3% respectively. Participation in Community-related BP/CR activities increased by 11.6% (p = 0.012).ConclusionWith the improvements recorded in the community-participatory intervention, birth preparedness and complication readiness should be promoted through community, household and male-partner inclusive strategies. Further evaluation will be required to ascertain the sustainability and impact of the programme.

Education for inclusion: numeracy intervention in second chance education of market women in rural Nigeria

Background: A second chance education intervention was initiated for market women in rural Nigeria, who previously missed opportunity for formal education in their younger ages, with the aim of acquiring and improving basic numeracy skills for inclusion of the women. Data source and methods: Thirty (30) questionnaires on hands-on activity were administered on 30 women purposively selected from the membership list of the association of market women, while 15 other women were similarly sampled to form the control group, giving a total of 45 questionnaires. In-depth interviews, and two focus group discussions (FGDs) comprising 12 volunteer women each were also conducted. The qualitative data were content analysed while mean, standard deviation, Chi-square and Analysis of covariance (ANCOVA) were used to analyse the quantitative data. Results: Participants have similar socio-demographic characteristics. Over 70% of the respondents were aged less than 40 years while over 50% of the respondents attained primary education. Similarly, 64.4% of the rural women had no opportunity for formal education as adults. Results showed that there were significant effects of hands-on activities on mean ability of rural women in giving balance and stock taking. Conclusions: The second chance education initiative provided an avenue for peer learning and more inclusive and equitable numerical skill development of market women, thus enhancing the prospect of contributing to AU Agenda 2063 and the 4th goal of the post-2015 development agenda.

NTFP Utilization and Its Impact on Poverty Reduction among Rural Women in Ondo State, Nigeria

Poverty among rural women in Nigeria is high and widespread. Exploitation of NTFPs possesses great potentials in reducing poverty among rural women in Nigeria. This is because NTFPs provide income that is significant to the income of rural women. This paper therefore examines the impact of NTFP utilization on poverty reduction among rural women in Ondo State, Nigeria. Five local government areas (LGAs) out of 18 LGAs in the study area were purposively selected. Four rural communities were randomly selected from each sampled LGA making a total of 20 villages in the study area. 15 rural women were randomly selected in each sampled community to make a total of 300 respondents. Semi-structured questionnaire were used to get information on the income realized from NTFPs. The results showed that rural women utilize NTFPs for household consumption and to generate income. The results also showed that 22.3% of the respondents earned more than USD278 per annum from the exploitation of NTFPs. Chi- square tests (p&lt; 0.05) shows that age of rural women has a significant association with the income earned from the exploitation of NTFPs. The results further showed that 73% of the respondents earned more than 50% of their income from the exploitation of NTFPs. Rural women are however faced with some problems in the utilization of NTFPs in the study area. These include insect attack, bad weather and poor roads. These problems can be solved through repair of rural roads, improved forestry extension and provision of boots to rural women.

Malaria Parasitaemia and Some Iron Parameters of Pregnant Women in Rural Nigeria

Malaria Parasitaemia and Some Iron Parameters of Pregnant Women in Rural Nigeria

Asset Ownership and Welfare Deprivation of Women in Rural Nigeria: A Bi-Causal Relationship

Women are an important segment of the human population and appropriate investment in their welfare would be of great benefit to the individual, household, and community levels. There has been an increasing incidence of welfare deprivation among women in rural Nigeria. However, information on the link between asset ownership and welfare deprivation of women in rural Nigeria is scanty. Thus, the relationship between the level of asset ownership and welfare deprivation of women in rural Nigeria was investigated. Data on 18,869 women living in rural Nigeria were sourced from Nigeria Demographic and Health Survey 2013. Data analysis was done using descriptive statistics, composite score analysis, fuzzy analysis and Instrumental Variable(IV) Tobit Regression at α0.05. A higher proportion of the rural women-owned physical assets such as mobile phone (68.7%) and radio (63.5%), while only 5.9% owned natural asset (land). Women in low-LAO, intermediate-LAO and high-LAO were 20.3%, 63.8% and 15.9%, respectively. Level of asset ownership (β=-0.31), age (β=-0.01), being a widow (β=0.04), being a female household head (β=-0.08), and Geo-Political Zone (North-East, β=0.04; South-East, β=-0.05; South-West, β=-0.07) explained welfare deprivation of women. A unit increase in the level of asset ownership led to 30.8% decrease in welfare deprivation. An increase in the level of asset ownership decreased welfare deprivation. Asset ownership had a positive influence on women’s welfare deprivation.

Correlates of reported modern contraceptive use among postpartum HIV-positive women in rural Nigeria: an analysis from the MoMent prospective cohort study

BackgroundNigeria has an annual population of ~ 200,000 women who are both pregnant and HIV-positive. High unmet need for family planning in this population could lead to unintended pregnancies, along with the increased risk of mother-to-child transmission of HIV (MTCT). To identify modifiable barriers and facilitators in effective family planning, we examined correlates of modern contraceptive use among HIV-positive women enrolled in the MoMent prevention of MTCT (PMTCT) implementation research study in rural North-Central Nigeria.MethodsIn this prospective cohort study, HIV-positive pregnant women were enrolled at 20 Primary Healthcare Centers and followed up to 12 months postpartum. Baseline socio-demographic, clinical and obstetric data were collected at enrollment. Participants were to receive routine family planning counselling from healthcare workers during postnatal visits. Analysis utilized baseline data linked to available family planning information collected from each woman at the first postpartum visit. Multivariate logistic regression was performed to determine factors associated with modern contraceptive use.ResultsOut of 497 women enrolled, family planning data was available for 399 (80.3%) women, of whom 349 (87.5%) received family planning counselling, and 321 (80.5%) were 30 years old or less. Two-thirds (268, 67.2%) of the cohort analyzed had 1–2 children at baseline; 24.8% (n = 99) had 3–4 children, and 8.0% (n = 32) had > 4 children. Approximately half (199, 49.9%) of the women reported no modern contraceptive use in the postpartum period. Male condoms (116, 29.1%) were the most reported method of contraception; other methods reported included oral hormones (71, 17.8%) and intrauterine devices (13, 3.2%). Only disclosure of HIV status to male partner or relative (aOR = 2.0, 95% CI: 1.2–3.3; p = 0.01) and receipt of family planning counselling (aOR = 2.3, 95% CI: 1.1–4.8; p = 0.03) were positively associated with reported modern contraceptive use. Age, marital or educational status, religious affiliation, employment status, gravidity and parity were non-correlates.ConclusionsFamily planning counselling and disclosure of HIV status are modifiable positive predictors of contraceptive use among our cohort of postpartum HIV-positive women in rural Nigeria. Rates of unintended pregnancy and concomitant risk of MTCT could be significantly reduced through strategies that facilitate these correlates.Clinical trials registrationClinicaltrials.gov registration number: NCT 01936753; registered September 3, 2013.

The Women Who Fear the Unknown: Potential Drivers of the Cervical Cancer Epidemic in Rural Nigeria

Background: Visual inspection of the cervix under acetic acid is the most cost-effective method for the control of cervical cancer in sub-Saharan Africa. The region bears about 90% of the global burden of the disease accounting for about 85% of new disease and more than 90% of the mortality. The WHO piloted a largely successful community-based cervical screening in six African countries including Nigeria between 2009 and 2012. Community-based cervical screening was subsequently adopted in Nigeria as a major strategy for preventing cervical cancer. An evaluation of the community-based cervical screening in two rural local government areas in Ogun state, Nigeria, however, revealed that more than 95% of sexually active women had never had cervical screening done despite availability of the services. A substantial number of these women would not want to have cervical screening done because of the fear of a positive cervical screening result. Aim: The current study explored the characteristics of women who are unwilling to have cervical screening because of the fear of a negative result in two rural local government areas in Nigeria. Methods: A post hoc analysis of data collected for the evaluation of community-based cervical screening in two rural LGAs in Nigeria. The analysis described the characteristics of 700 sexually active women aged 25 to 64 years who declined to have cervical screening. The socio-demographic characteristics, perception (0 to 6) and knowledge scores (0 to 36) of the participants were fitted into a multivariate logistic regression model to predict the fear of an unfavorable cervical screening result. Results: About 81% (567) of the women were unwilling to get a cervical screening due to the fear of a negative result. Age, gravidity, knowledge, and perception about cervical cancer and screening were associated with the women declining cervical screening due to the fear of a negative result. On multivariate logistic regression analysis age (OR: 0.968, P = 0.007) and knowledge score (OR: 0.914, P &lt; 0.001) were found to predict the fear of a negative result. The adjusted outcome variable model showed fair discrimination (AUC = 0.67) and good calibration ( P = 0.416). Conclusion: Many women in rural Nigeria decline to have cervical screening mainly because of the fear of a negative result which is in turn predicted by younger age and poorer knowledge scores about cervical cancer and screening. There is a need for further qualitative research to explore the dimensions of fear as it relates to refusal to have cervical screening among rural women in Nigeria.

Psychic vs. Economic Barriers to Vaccine Take-Up: Evidence from a Field Experiment in Nigeria

Abstract This paper experimentally evaluates the relative importance of psychic costs of tetanus vaccination compared to monetary costs among women in rural Nigeria. We compare vaccine take-up between two conditions to receive cash incentives: clinic attendance vs. vaccine take-up. Because the only difference between these two conditions is whether a woman was required to receive a vaccine upon arrival at the clinic, the difference in clinic attendance between these two groups captures the psychic costs of vaccination. Contrary to conventional wisdom, we find no evidence for significant psychic costs. Priming about disease severity increases the perceived severity of disease, but not vaccine take-up. Monetary costs strongly affect vaccination decisions.

P-E2 The Impact of structured mentor mother support on retention during the first 12 months postpartum among HIV positive women in rural Nigeria

Introduction: With the advent of lifelong therapy, interventions that sustain long-term engagement with PMTCT services are needed. We evaluated the impact of a structured peer support program on postpartum PMTCT retention among rural Nigerian women. Methods: This prospective cohort study enrolled HIV+ pregnant women from 20 primary healthcare centers (PHCs). Ten PHCs with structured mentor mother (MM) support (training, supervision, client tracking, standard documentation and performance evaluation) were pair-matched with 10 routine unstructured peer support (PS) PHCs. Participants received viral load at 6 months and were followed up to 12 months postpartum. Viral suppression was defined as &lt;20 copies/mL. Retention assessment was based on monthly and bi-monthly clinic visits in the first and second 6 month postpartum periods respectively. Participants with ≥5 of 9 expected visits were considered retained. A logistic regression model with generalized estimating equation was used to evaluate the effect of PS and other factors on retention. Results: Of 497 women enrolled, 260 and 237 were exposed to MM and routine PS respectively. Women with MM support (aOR = 6.6, 95% CI 3.4 to 13.1) and viral suppression at 6 months (aOR = 3.1, 95% CI 1.8 to 5.6) had higher odds of retention during the 12 month postpartum period. Age, distance from PHC, religion, gravidity, disclosure &amp; time of diagnosis had no effect on retention. Discussion: Structure in peer support programs improved retention. Also, viral suppression had an independent effect on retention, indicating a strong link between adherence and sustained engagement; both being essential for PMTCT. Conclusion: Built-in structure can significantly enhance the impact of PS interventions on PMTCT outcomes.

P-E4 The MoMent Study: Correlates of viral suppression at 6 months postpartum among HIV-positive women in rural Nigeria

Introduction: The risk of mother-to-child transmission of HIV (MTCT) reduces with sustained pre &amp; postpartum administration of suppressive maternal ARVs. The MoMent study evaluated for maternal viral suppression &amp; its correlates among HIV+ Nigerian women. Methods: This prospective cohort study compared structured Mentor Mother (MM) vs unstructured peer support (PS) for PMTCT outcomes. Pregnant women were recruited at 20 matched Primary Healthcare Centers in rural North-Central Nigeria. Structured PS included daily MM supervision, standardized documentation, client tracking, &amp; MM performance evaluations. Maternal viral load (VL) was performed at 6 months postpartum; women lost to followup were tracked back for VL tests. Viral suppression was defined as VL &lt;20 copies/mL. All participants were on ART for ≥6 months. Multivariate logistic regression with generalized estimating equations was used to account for clusters and for adjusting confounders. Results: Among 497 enrolees, 296 (59.6%) presented for VL; 273/296 (92.2%) had samples collected. Of the 238/273 (87.2%) with available results, 138 (58%) were suppressed. Correlates of suppression were structured MM support (aOR 4.9, CI 2.6 to 9.2); age &gt;30 years (aOR 2.3, CI 1.0 to 4.9); ≥secondary education (aOR 2.0, CI 1.2 to 3.3); Christian religion (aOR 1.4, CI 1.1 to 2.1); PI-based ART (aOR 4.6, CI 1.3 to 16.0), and retention (aOR 3.7, CI 2.5 to 5.5). Marital/disclosure status &amp; distance from facility were not significant. Discussion: Organized PS, older age, education, potent ARVs &amp; retention supported viral suppression in our study. The role of religion is unclear &amp; should be further explored. Conclusion: Structured PS should be targeted to young &amp; lesser educated women to reduce MTCT risk.