BackgroundThe benefits of universal access to voluntary contraception have been widely documented in terms of maternal and newborn survival, women's empowerment, and human capital. Given population dynamics, the choices and opportunities adolescents have in terms of access to sexual and reproductive health information and services could significantly affect the burden of diseases and nations’ human capital.ObjectivesThe objectives of this paper are to assess the patterns and trends of modern contraception use among sexually active adolescents by socio-economic characteristics and by birth spacing and parity; to explore predictors of use of modern contraception in relation to the health system; and to discuss implications of the findings for family planning policy and programmes.DesignData are from the last three Demographic and Health Surveys of Ethiopia, Burkina Faso, and Nigeria. The descriptive analysis focused on sexually active adolescents (15- to 19-year age group), used modern contraception as the dependent variable, and a series of contact points with the health system (antenatal care, institutional delivery, postnatal care, immunisation) as covariates. The multivariate analysis used the same covariates, adjusting for socio-economic variables.ResultsThere are two different groups of sexually active adolescents: those married or in a union with very low use of modern contraception and lower socio-economic status, and those unmarried, among whom nearly 50% are using modern contraception. Younger adolescents have lower modern contraceptive prevalence. There are significant inequality issues in modern contraception use by education, residence, and wealth quintile. However, while there was no significant progress in Burkina Faso and Nigeria, the data in Ethiopia point to a significant and systematic reduction of inequalities. The narrowing of the equity gap was most notable for childbearing adolescents with no education or living in rural areas. In the three countries, after adjusting for socio-economic variables, the strongest factors affecting modern contraception use among childbearing adolescents were marriage and child immunisation.ConclusionsAddressing child marriage and adopting effective policies and strategies to reach married adolescents are critical for improving empowerment and human capital of adolescent girls. The reduction of the equity gap in coverage in Ethiopia warrants further studies and documentation. The results suggest a missed opportunity for maternal and newborn and family planning integration.

BackgroundDiarrhea remains a high burden disease, responsible for nine percent of deaths in children under five globally. We analyzed diarrhea management practices in young children and their association with the source of care.MethodsWe used Demographic and Health Survey data from 12 countries in sub-Saharan Africa with high burdens of childhood diarrhea. We classified the quality of diarrhea management practices as good, fair, or poor based on mothers’ reports for children with diarrhea, using WHO/UNICEF recommendations for appropriate treatment. We described the prevalence of diarrhea management by type and assessed the association between good management and source of care, adjusting for potential confounders.ResultsPrevalence of good diarrhea management is low in 11 of the 12 analyzed surveys, varying from 17 % in Cote d’Ivoire to 38 % in Niger. The exception is Sierra Leone, where prevalence of good practice is 67 %. Prevalence of good management was low even among children taken to health facilities [median 52 %, range: 34–64 %]. Diarrhea careseeking from health facilities or community providers was associated with higher odds of good management than care from traditional/informal sources or no care. Careseeking from facilities did not result systematically in a higher likelihood of good diarrhea management than care from community providers. The odds of good diarrhea management were similar for community versus facility providers in six countries, higher in community than facility providers in two countries, and higher in facility than in community providers in four countries.ConclusionMany children’s lives can be saved with correct management of childhood diarrhea. Too many children are not receiving adequate care for diarrhea in high-burden sub-Saharan African countries, even among those seen in health facilities. Redoubling efforts to increase careseeking and improve quality of care for childhood diarrhea in both health facilities and at community level is an urgent priority.

BackgroundNigeria is one of the countries where significant progress has not been recorded in contraceptive uptake despite decades of family planning programs while there are indications that slum dwellers may differ significantly from other urban dwellers in their sexual and reproductive behavior, including family planning uptake. This study therefore examined local notions regarding male partners’ involvement in family planning (FP) adoption by women in two selected urban slums areas in Nigeria – Ibadan (Southwest region) and Kaduna (Northwest region). Specifically, the study investigated women’s narratives about FP, perceived barriers from male partners regarding FP adoption by the women and how women negotiate male partners' cooperation for FP use.MethodsSixteen FGD sessions were conducted with selected groups of men and women, stratified by sex, age group, and FP experience using a vignette to generate discussions. Sessions were facilitated by experienced social scientists and audio-taped, with note-taker also present. The transcribed data were analyzed with Atlas.ti software version 7. Inductive approach was employed to analyze the data. Reasons given for FP attitudes and use are presented in a network format while critical discourse analysis was also used in generating relevant tables.ResultsThe finding shows that women in the selected communities expressed desire for FP adoption. Three main reasons largely accounted for the desire to use FP: perceived need to space childbirth, family’s financial condition and the potential adverse effect of high fertility on the woman’s health. Male partners’ support for the use of FP by women was perceived to be low, which is due to misconceptions about FP and traditional pro-natalistic beliefs and tendencies. Mechanisms by which women negotiate their male-partner’s cooperation for FP adoption include seeking the support of the partner’s significant others and advice from older women.ConclusionTo significantly improve family planning adoption rates among urban slum dwellers in Nigeria, there is the need to specifically and specially target men alongside their female partners as well as other stakeholders who have significant influences at family and community level.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2458-14-869) contains supplementary material, which is available to authorized users.

ObjectivesThis study aimed to assess the safety and effectiveness of self-managed misoprostol abortions obtained outside of the formal health system in Lagos State, Nigeria.DesignThis was a prospective cohort study among women using misoprostol-containing medications purchased from drug sellers. Three telephone-administered surveys were conducted over 1 month.SettingData were collected in 2018 in six local government areas in Lagos State.ParticipantsDrug sellers attempted to recruit all women who purchased misoprostol-containing medication. To remain in the study, participants had to be female and aged 18–49, and had to have purchased the medication for the purpose of abortion. Of 501 women initially recruited, 446 were eligible for the full study, and 394 completed all three surveys.Primary and secondary outcome measuresUsing self-reported measures, we assessed the quality of information provided by drug sellers; the prevalence of potential complications; and the proportion with completed abortions.ResultsAlthough drug sellers provided inadequate information about the pills, 94% of the sample reported a complete abortion without surgical intervention about 1 month after taking the medication. Assuming a conservative scenario where all individuals lost to follow-up had failed terminations, the completion rate dropped to 87%. While 86 women reported physical symptoms suggestive of complications, only six of them reported wanting or needing health facility care and four subsequently obtained care.ConclusionsDrug sellers are an important source of medical abortion in this setting. Despite the limitations of self-report, many women appear to have effectively self-administered misoprostol. Additional research is needed to expand the evidence on the safety and effectiveness of self-use of misoprostol for abortion in restrictive settings, and to inform approaches that support the health and well-being of people who use this method of abortion.