ObjectivesThe subcutaneous depot medroxyprogesterone acetate (DMPA-SC) injectable contraceptive was introduced in South West Nigeria in 2015 through private sector channels. The introduction included community-based distribution and was supported by a social marketing approach. From program monitoring and evaluation, aimed at understanding performance, market reach and other process measures, we identify lessons learned to inform future scale-up efforts.MethodsWe synthesized the findings from a core set of key performance indicators collected through different methods: (1) implementer performance indicators, (2) phone survey of DMPA-SC users (n=541) with a follow-up after 3 months (n=342) and (3) in-depth interviews with 57 providers and 42 users of DMPA-SC.ResultsDistribution of DMPA-SC to private providers was concentrated in states with large urban populations. A shift toward focusing on high-volume family planning facilities coincided with a rapid increase in distribution in late 2016. Users reached in the phone survey were generally older and married with children; few were under age 25. Users and providers reported favorable opinions of DMPA-SC. Many users reported choosing DMPA-SC due to recommendations from providers and friends, and the hope of experiencing reduced side effects compared to other methods. While users reported positive experiences interacting with community-based distributors, the delivery model encountered a number of challenges — high turnover, low motivation, lack of an appropriate compensation package and logistical costs — and was ultimately disbanded.ConclusionsIn the DMPA-SC introductory program in Nigeria, distribution was amplified when focused on high-volume contraceptive providers. Although community-based distribution can be one effective service delivery model for reaching underserved populations, more consideration for balancing cost recovery and public health goals through private sector approaches are needed in the context of South West Nigeria. Additional communications and outreach efforts are needed to reach younger, unmarried users with contraceptive services.

Aim of the studyThe study sought to assess the fear of COVID-19 among the general population and suggested ways to reduce anxiety levels.Subject or material and methodsA web-based cross-sectional survey was designed using Google forms to collect data. Participants were recruited using a convenience snowballing technique. The questionnaire contained 3 sections on Socio-demographic data, the Fear of COVID-9 scale, and an open-ended question on suggested ways to mitigate anxiety towards COVID-19. For the open-ended question, scores were grouped based on the similarity of thematic content. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 21.0.ResultsA total of 1011 respondents completed the survey. The Mean Sum Fear of Corona was 18.28±5.909 out of a possible maximum score of 35. More than half (53.6%, n = 542) of the respondents had ‘Low fear’ of COVID-19. There was an increasing fear of COVID-19 with increasing educational qualification, however, this was not statistically significant. Respondents with health-related occupations had less anxiety towards COVID-19 compared to people in non-health related occupations (17.83±5.85 Vs. 18.54±5.91).DiscussionWhen respondents were asked to suggest ways anxiety towards COVID-19 could be reduced, one-third of them (34%, n =344) responded that public enlightenment programs with accurate information on the virus should be embarked on.ConclusionsOverall, there was a low fear of COVID-19 among the general Nigerian population surveyed in this study. Public enlightenment and limited consumption of news on COVID-19 were the most suggested ways to abate fear of the virus.

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Background: Beginning in 2015, subcutaneous depot medroxyprogesterone acetate (DMPA-SC) was added to the contraceptive method mix in Nigeria, primarily through social marketing in the private sector and community-based distribution in the public sector. We compare user experiences in acquiring DMPA-SC across sectors during this national scale-up. Methods: From October 2017 to February 2018, 459 women (Npublic=235; Nprivate=224) completed a phone survey from a convenience sample of 1,444 women (Npublic=912; Nprivate=532) who obtained DMPA-SC from participating providers and agreed to be contacted. We examined the sociodemographic predictors of attending a public vs. private provider and analyzed differences in care-seeking across sectors (becoming aware of DMPA-SC, choosing a provider, choosing DMPA-SC, quality of care). Results: Respondents obtaining DMPA-SC from public providers were younger and less educated than those attending private providers. Both program respondents were comprised of similar percentages of new users of modern contraception (58.7-60.3%), although most respondents became aware of DMPA-SC through a friend/family member (43.1%) or a provider (41.5%). Relatively more public sector respondents also heard about DMPA-SC through community outreaches whereas relatively more private sector respondents became aware through media. Convenience was the most common reason for choosing a provider—43.8% among all respondents (higher among public sector respondents). Private sector respondents were also more likely to choose a past or usual provider. Having overall higher quality interactions were more likely among clients who attended private providers than public providers, but responses to individual quality item measures show specific areas of poor quality for providers in each sector. Conclusions: Training emphasizing technical thoroughness, sensitivity toward younger women, and client choice may help improve women’s experiences with obtaining DMPA-SC, ultimately contributing to accelerating demand for and uptake of DMPA-SC specifically and contraception in general.

The coronavirus pandemic may have harmful effects on use of family planning services. Lockdown regulations make it more difficult for people to visit health providers to obtain information about family planning, to discuss side-effects or problems they are experiencing with their current method, and go out to obtain new family planning supplies (e.g., to renew their contraceptive injection). The inability to earn income during the lockdown may also make family planning products and services unaffordable. As a result, efforts to curb the pandemic may cause unintended interruptions in contraceptive use and may prevent non-users from adopting a contraceptive method. Given these rapidly changing circumstances, it is important that family planning implementers make program adjustments without delay. When a timely programmatic response is of the essence, program implementers need simple behavior change models that can be used to inform programmatic decisions. This paper presents a case study of how DKT/Nigeria applied a behavior change model from persuasive design - the Fogg Behavior Model – to make timely adjustments to their contraceptive social marketing program during the course of the COVID-19 lockdown. Other public health programs, including programs that target health areas other than family planning, may be able to use similar approaches to guide the design of timely and responsive program adjustments.