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

BackgroundMost developed countries have made considerable progress in addressing maternal mortality, but it appears that countries with high maternal mortality burdens like Nigeria have made little progress in improving maternal health outcomes despite emphasis by the Millennium Development Goals (MDGs). Knowledge about safe motherhood practices could help reduce pregnancy related health risks. This study examines knowledge of safe motherhood among women in selected rural communities in northern Nigeria.MethodsThis was a cross-sectional study carried out in two states (Kaduna and Kano States) within northern Nigeria. Pretested, interviewer-administered questionnaires were applied by female data collectors to 540 randomly selected women who had recently delivered within the study site. Chi-square tests were used to determine possible association between variables during bivariate analysis. Variables significant in the bivariate analysis were subsequently entered into a multivariate logistic regression analysis. The degree of association was estimated by odds ratio (OR) and 95% confidence interval (CI) between knowledge of maternal danger signs and independent socio-demographic as well as obstetric history variables which indicated significance at p< 0.05.ResultsOver 90% of respondents in both states showed poor knowledge of the benefits of health facility delivery by a skilled birth attendant. More than 80% of respondents in both states displayed poor knowledge of the benefits of ANC visits. More than half of the respondents across both states had poor knowledge of maternal danger signs. According to multivariate regression analysis, ever attending school by a respondent increased the likelihood of knowing maternal danger signs by threefold (OR 2.63, 95% CI: 1.2-5.8) among respondents in Kaduna State. While attendance at ANC visits during most recent pregnancy increased the likelihood of knowing maternal danger signs by twofold among respondents in Kano State (OR 2.05, 95% CI: 1.1-3.9) and threefold among respondents in Kaduna State (OR 3.33, 95% CI: 1.6-7.2).ConclusionThis study found generally poor knowledge about safe motherhood practices among female respondents within selected rural communities in northern Nigeria. Knowledge of safe pregnancy practices among some women in rural communities is strongly associated with attendance at ANC visits, being employed or acquiring some level of education. Increasing knowledge about safe motherhood practices should translate into safer pregnancy outcomes and subsequently lead to lower maternal mortality across the developing world.

Introduction in this study, determinants of improved data consistency for routine immunization information at health facilities was measured to identify associated factors. Methods between June and August 2015, 1055 HFs were visited across 44 Local Government Areas in Kano state. We assessed data consistency, frequency of supportive supervision visits, availability of trained staff and attendance to monthly LGA RI review meetings. We compared RI monthly summary forms (MSF) versus national health management information system summary form (NHMIS) and vaccine management form 1a (VM1a) versus HF vaccine utilization summary monthly summary (HFVUM) for consistency. Data consistency at HF was determined at <+10% between number of children reportedly immunized, and doses of vaccine opened using 3 antigens (BCG, Penta and Measles). Levels of discrepancy <10% were considered as good data consistency. Bivariate and multivariate analysis used to determine association. Results data Consistency was observed in 195 (18.5%) HFs between (MSF vs NHMIS) and 90 (8.5%) HFs between (VM1a vs HFVUM). Consistency between MSF vs NHMIS was associated with receiving one or more SS visits in the previous month (p=0.001), data collection tools availability (p=0.001), recent attendance to monthly LGA RI review meeting and availability of trained staff. Data consistency between VM1a form and the HF VU summary was associated with a recent documented SS visit (p=0.05) and availability of trained staff (p=0.05). Conclusion low level of data consistency was observed in Kano. Enhanced SS visits and availability of trained staff are associated with improved data quality.

Background and objective Use of insecticide treated nets (ITN), one of the most cost-effective malaria interventions contributes to malaria cases averted and reduction in child mortality. We explored the use of ITN in children under five (CU5) and children of school age to understand factors contributing to ITN use. Methods A cross-sectional study analyzed 2018 Nigeria Demographic and Health Survey data. The outcome variable was CU5 or children of school age who slept under ITN the night before the survey. Independent variables include child sex, head of household’s sex, place of residence, state, household owning radio and television, number of household members, wealth quintile, years since ITN was obtained and level of malaria endemicity. Multi-level logistic regression model was used to access factors associated with ITN use among children. Results In total, 32,087 CU5 and 54,692 children of school age were examined with 74.3% of CU5 and 57.8% of children of school age using ITN the night before the survey. While seven states had more than 80% of CU5 who used ITN, only one state had over 80% of school children who used ITN. ITN use in CU5 is associated with living in rural area (aOR = 1.20, 95% CI 1.14 to 1.26) and residing in meso endemic area (aOR = 3.1, 95% CI 2.89 to 3.54). While In children of school age, use of ITN was associated with female headed households (aOR = 1.14, 95% CI 1.09 to 1.19), meso (aOR = 3.17, 95% CI 2.89 to 3.47) and hyper (aOR = 14.9, 95% CI 12.99 to 17.07) endemic areas. Children residing in larger households were less likely to use ITN. Conclusions This study demonstrated increased use of ITN in CU5 from poor households and children living in rural and malaria endemic areas. Findings provide some policy recommendations for increasing ITN use in school children.

Routine immunization (RI) delivery was declared a public health concern in Nigeria in 2017 because of persistently low immunization coverage rates reported in independent surveys. However, administrative coverage rates remain high, suggesting serious data quality issues. We posit that a shorter timespan between service provision and data reporting can improve the monitoring of RI data, and developed a short message system (SMS) text reporting strategy to generate daily RI data points from health facilities (HFs). The goal was to assess whether daily data collection produces complete, reliable and internally consistent data points. The SMS reporting platform was piloted between December 2017 and April 2018 in two Local Government Areas (LGAs, equivalent to districts) of Nasarawa state, Nigeria. The 145 healthcare workers from 55 HFs received one mobile phone and pre-configured SIM card, and were trained to send data through predefined codes. Healthcare workers compiled the data after each vaccination session and transmitted them via SMS. We analyzed completeness, number of weekly sessions, and supportive supervision conducted. During the pilot phase, we received data from 85% (n = 47) of the 55 HFs. We expected 66 fixed-post sessions and 30 outreach sessions per week, but received data for 33 fixed-post and 8 outreach weekly session on average. More HFs reported on Tuesdays compared to other days of the week. When assessing internal consistency, we observed that the reported number of children vaccinated was sometimes higher than the number of doses available from opening a given number of vaccine vials. When found, this discrepancy was noted for all antigens during fixed-post and outreach vaccination sessions. Despite these initial discrepancies, transmitting RI data sessions via texting is feasible and can provide real-time updates to the performance of the RI services at the HF level.

The dosage regimen for artemether-lumefantrine which is the standard of care for malaria in most of Sub-Saharan countries requires use of treatment guidelines and instructions to enhance caregivers' performance in the treatment of malaria. As part of a larger study evaluating its effectiveness in a rural local government area in southwestern Nigeria, 552 caregivers whose children had fever two weeks preceeding the survey were recruited. Information was collected with interviewer administered questionnaire. A multilevel logistic regression model was fitted using the gllamm approach in Stata to determine the factors associated with use of guideline. Age and educational background of caregiver were significantly associated with guideline use. Caregivers aged 26–30 years were 4 times more likely to use guideline than those aged >40 years. Caregivers with primary education were 4 times more likely to use guideline compared with caregivers with no formal education. Between-village variance was 0.00092 ± 0.3084. Guideline use reduced with increasing age and lower education.

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