Globally, immunization prevents an estimated 2-3 million deaths among under-5 children, yet in Nigeria, only 25% of children ages 12-23 months are fully immunized. There are also marked disparities in the uptake of immunizations, largely attributable to the context within which families live and seek health care. The authors assessed the individual and state determinants of child immunization in Nigeria and used multilevel logistic regression to estimate the odds of full immunization among 5,561 children aged 12-23 months, with their mothers clustered in the 36 states and the Federal Capital Territory (level 2). Findings indicate low immunization coverage rates overall: diphtheria, pertussis, and tetanus vaccine first dose (DPT1) = 49.8%, DPT3 = 38.2%, measles = 41.8%, and full immunization = 24.9%. There was also significant clustering of full immunization among states. The authors found that having a health card and receiving postnatal care within the first 2 months of life were positively associated with full immunization, as were maternal education, wealth, age, and ethnicity. At the state level, the proportion of employed mothers and those who received tetanus immunization before birth was positively associated with full immunization. The following barriers were negatively associated with full immunization: needing to obtaining permission, poor financial situation, and far distance to clinic. These findings call for state-specific targeting to address inequitable access to routine immunization in Nigeria.
Obstetric fistula is an abnormal opening between the vagina and rectum resulting from prolonged and obstructed labour that can cause substantial, long-term physical and psychological harm to the woman (Bangser, 2006; Wall, 2006). The most common cause of fistula in developing countries is due to the obstruction of labour and delayed delivery (Wall, 2006). The inability of a woman to deliver her baby through the birth canal is caused by a discrepancy in the available space in the pelvic region and the foetal size or when the foetus' head or body is too big to pass through the mother's pelvis opening (Abrams, 2012; Wall, 2006). The obstruction leads to a prolonged pressured contact of the foetal head in the birth canal area, causing a loss of blood flow to the soft tissues of the woman's bladder, vagina and rectum (Arrowsmith, Hamlin, & Wall, 1996; Wall, 2012). Consequently, ischaemic injury leads to massive tissue necrosis in the woman's pelvis, which results in the fistula being formed (Wall, 2006). Numerous studies have described women with obstetric fistula as within the age range of 9-65 years, with the mean age usu
The review provides insights into avenues of improving care provision and delivery by health professionals and policy makers. It also exposes areas that need further research for quality care provision.
Obstetric fistula is a condition that affects women and can lead to identity changes because of uncontrolled urinary and/or fecal incontinence symptom experiences. These symptoms along with different emerging identities lead to family and community displacement. Using narrative inquiry methodology that concentrates on the stories individuals tell about themselves; interviews were conducted for 15 fistula survivors to explore their perception of identities of living with obstetric fistula. Within a sociocultural context, these identities consist of the “leaking” identity, “masu yoyon fitsari” (leakers of urine) identity, and the “spoiled” identity, causing stigmatization and psychological trauma. The “masu yoyon fitsari” identity, however, built hope and resilience for a sustained search for a cure. Identity is a socially constructed phenomenon, and the findings reveal positive community involvement which reduces obstetric fistula stigmatization and improves women’s identity. Sexual and reproductive health issues remain of grave concern within a contextualized societal identity of women’s role.
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