ObjectivesTo identify the determinants of antenatal care (ANC) utilisation in sub-Saharan Africa.DesignSystematic review.Data sourcesDatabases searched were PubMed, OVID, EMBASE, CINAHL and Web of Science.Eligibility criteriaPrimary studies reporting on determinants of ANC utilisation following multivariate analysis, conducted in sub-Saharan Africa and published in English language between 2008 and 2018.Data extraction and synthesisA data extraction form was used to extract the following information: name of first author, year of publication, study location, study design, study subjects, sample size and determinants. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist for reporting a systematic review or meta-analysis protocol was used to guide the screening and eligibility of the studies. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the quality of the studies while the Andersen framework was used to report findings.Results74 studies that met the inclusion criteria were fully assessed. Most studies identified socioeconomic status, urban residence, older/increasing age, low parity, being educated and having an educated partner, being employed, being married and Christian religion as predictors of ANC attendance and timeliness. Awareness of danger signs, timing and adequate number of antenatal visits, exposure to mass media and good attitude towards ANC utilisation made attendance and initiation of ANC in first trimester more likely. Having an unplanned pregnancy, previous pregnancy complications, poor autonomy, lack of husband’s support, increased distance to health facility, not having health insurance and high cost of services negatively impacted the overall uptake, timing and frequency of antenatal visits.ConclusionA variety of predisposing, enabling and need factors affect ANC utilisation in sub-Saharan Africa. Intersectoral collaboration to promote female education and empowerment, improve geographical access and strengthened implementation of ANC policies with active community participation are recommended.

Introduction: Several studies on COVID-19 and pregnancy have been published recently, but few studies have evaluated the impact of this pandemic on maternal mental health particularly in low-resource setting. Aim: To determine the prevalence and predictors of COVID-19-related depression, anxiety and stress symptoms among pregnant women. Materials and methods: This was a questionnaire-based cross-sectional study conducted among 456 pregnant women attending prenatal care at Abakaliki, Nigeria during COVID-19-related lockdown. They were screened for psychological morbidities using DASS 21 (Depression, Anxiety and Stress Scale). Results: Severe and extremely severe depression were reported in 33 (7.2%) and 29 (6.4%) participants respectively. 15 (3.3%) and 35 (7.7%) women had severe and extremely severe anxiety respectively. 105 (23%) had severe anxiety whereas 76 (16.7%) reported extremely severe stress. Multiparity (2 - 4) and occupations such as trading and farming were predictors of depression whereas grandmultiparity, urban residence and trading were identified as predictors of anxiety and stress. Conclusion: Depression, anxiety and stress symptoms were relatively common among pregnant women during COVID-19-related lockdown in Abakaliki, Nigeria. There is a need to integrate screening for depression, anxiety and stress in existing antenatal care programs so as to identify and prevent long term adverse psychological outcome related to COVID-19 pandemic.

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the virus that causes it has spread to over 110 countries, including Nigeria. 1-3 Although the impact of COVID-19 on pregnant women is not yet clear, there are concerns over its potential effect on maternal and perinatal outcomes due to unique immunological suppression during pregnancy. 4,5 The World Health Organization (WHO) has recommended a series of preventive measures to halt the spread of the disease and its associated mortality. 3 In Nigeria, these preventive measures have been adopted, along with media campaigns to disseminate information on the measures to the general public. However, the level of knowledge and practice of these preventive measures against the spread of the virus among pregnant women, who constitute a vulnerable group, is yet to be evaluated.Between February 1 and March 31, 2020, we conducted a cross-sectional study to determine the knowledge and practice of preventive measures to protect against the virus causing COVID-19 among pregnant women attending prenatal care at Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. The study received ethical approval from the Research and Ethics Committee of the Alex Ekwueme Federal University Teaching Hospital, Abakaliki, and participants provided written informed consent. A pretested and validated self-administered questionnaire derived from the review of literature on WHO recommendations on preventive measures against COVID-19 was used to collect the data. 6 The variables assessed were age, parity, marital status, area of residence, occupation, participant's level of education, husband's level of education, and knowledge and practice of preventive measures. The measures assessed by the study questions were: (1) frequent hand washing with soap and water or using alcohol-based hand sanitizers; (2) maintaining at least 1 m distance from others; (3) avoiding touching eyes, nose, and mouth with hands; (4) covering mouth and nose when coughing or sneezing; (5) wearing a face mask in public; and (6) staying indoors.The questionnaire had a 12-item scale (six items for knowledge and six items for practice). The scoring system was 2 (for a correct answer) or 0 (for an incorrect answer). The minimum score was 0 whereas the maximum score was 12 for both the knowledge and practice components. Participants who scored 60% or more (score of 8-12) were classified as having adequate knowledge, whereas those who scored less than 60% (score up to 6) were classified as having inadequate knowledge. Women who scored 100% (score of 12) were classified as having good practice whereas those who scored less than 100% (score below 12) were classified as having poor practice.Statistical analysis was performed using SPSS version 22 (IBM Corp, Armonk, NY, USA). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated for variables of interest. P<0.05 was considered statistically significant.Of 284 pregnant participants, 173 (60.9%) had adequate knowledge of preventive measures. However, overall practice of these measures among pa...

Background Over the years, family planning uptake in Nigeria has remained low and this is as a result of the various challenges and barriers faced by women. The aim of this study was to systematically review studies on family planning services undertaken in Nigeria in order to understand the challenges to uptake of the services and the policy implications. Methods A PubMed search was performed in June 2020 and studies that investigated challenges of family planning uptake in Nigeria published in English between 2006 and 2020 were sought. A combination of the search terms family planning, contraceptives, challenges, barriers, Nigeria was used. Review articles, case reports, and case studies were excluded. Studies that did not report barriers or challenges to family planning or contraceptives were excluded. Result Twenty seven studies carried out in Nigeria which provided sufficient information were identified and used for this review. The Uptake of family planning recorded in the reviewed studies ranges from 10.3 to 66.8%. Challenges that are client related include education, desire for more children, uncertainty about its need, partner disapproval, previous side effects, religious beliefs, culture disapproval, age, marital status, and wealth index, residence, ignorance, embarrassment, domestic violence and sexual factor. Health service related factors identified include cost, difficulty accessing services, and procurement difficulties. Recommendations for family planning propram and policy include targeting of health service delivery for improvement, focus on gender issues and male involvement, involvement of religious leaders, targeting of younger women for better education and counseling, and continuous awareness creation and counseling among others. Conclusion The review has shown that uptake of family planning remains low in Nigeria and challenges abound. We recommend that strategies that are multi-sectoral should be applied to address the multi-pronged challenges facing uptake of family planning services.

Summary Background In the Nigerian context, preconditions for financial catastrophe are operational as there is high out‐of‐pocket spending (OOPS) on health with low capacity to pay, presence of user fees, and poor prepayment insurance coverage. We reviewed the incidence and determinants of catastrophic health expenditure (CHE) in Nigeria. Methods Databases including PubMed, OVID, EMBASE, CINAHL, and Web of Science were searched for primary research studies on the incidence and determinants of CHE in Nigeria published between 2003 and 2018. Search terms used include household, out‐of‐pocket expenditure, catastrophic health expenditure, and Nigeria. Results Twenty studies that met the inclusion criteria were included in the review. At 10% of total household and nonfood expenditure, the incidence of CHE was 8.2% to 50%, while 3.2% to 100% households incurred CHE at 40% of nonfood expenditure. The incidence of CHE was higher among inpatients and studies with lower threshold definitions. Outpatient CHE was highest for type 2 diabetes and tuberculosis while human immunodeficiency virus (HIV) care incurred the most CHE among inpatients. Determinants of CHE include wealth status, age, gender, place of residence/geographical location, household size/composition, educational status, health insurance status, illness, and health provider types. Conclusion There is a high incidence of CHE across various common health conditions in Nigeria. CHE was more among the poor, elderly, rural dwellers, private facility utilization, female gender, and noninsured among others. We recommend expansion of the National Health Insurance Scheme via informal social and financing networks platforms. Increased budgetary allocation to health and intersectoral collaboration will also play a significant role in CHE reduction.

Introduction Poor funding for Health Policy and Systems Research (HPSR) is a major constraint to the development, generation and uptake of HPSR evidence in Low and Middle-Income countries. The study assessed the status of HPSR domestic funding and advocacy strategies for improving HPSR funding in Nigeria. It equally explored the knowledge and perception of the domestic funding status of HPSR and the effect of capacity building on the knowledge of domestic funding for HPSR in Nigeria. Methods This was a sub-national study involving policymakers and researchers from Enugu and Ebonyi States in Southeast Nigeria who participated in the sub-national Health Systems Global convening for the African region. A before-after study design (workshop) was utilized. Data collection employed semi-structured questionnaires, group and panel discussions. The workshop facilitated knowledge of HPSR, funding processes, and advocacy strategies for increased domestic funding for HPSR. Pre and immediate post-workshop knowledge assessments were done. Data were analyzed using SPSS version 25 and thematic analysis. Results Twenty-six participants were involved in the study. Half were females (50.0%) and 46.2% were aged 35–44 years. Policymakers constituted 23.1% of the participants. Domestic funding for HPSR in Nigeria was adjudged to be grossly inadequate. Identified barriers to domestic funding of HPSR included bureaucratic bottlenecks, political and policy transitions, and corruption. Potential opportunities centered on existing policy documents and emerging private sector willingness to fund health research. Multi-stakeholder advocacy coalitions, continuous advocacy and researcher skill-building on advocacy with active private sector involvement were the strategies proffered by the participants. Pre-workshop, understanding of the meaning of HPSR had the highest mean ratings while knowledge of budgeting processes and use of legal action to enable opportunities for budget advocacy for HPSR funding had the lowest mean ratings. Following the capacity-building workshop, all knowledge and understanding parameters markedly improved (percentage increase of 12.5%–71.0%). Conclusion This study found that there was paucity of domestic funding for HPSR in Nigeria alongside poor knowledge of budgeting and advocacy strategies among both policymakers and researchers. We recommend the deployment of these identified strategies and wider national and regional stakeholder engagement towards prioritizing and improving domestic funding for HPSR.

Background: Family planning is a cost-effective strategy for achieving population development. Family planning uptake is low in sub-Saharan Africa, including Nigeria. We assessed the perception, pattern of use, partner support and determinants of uptake of family planning methods among married women of reproductive age in rural communities of Ebonyi state. Methods: This is part of a baseline report of a quasi-experimental study. A total of 484 married women of reproductive age were recruited using multistage sampling method. Four focus group discussions (men and women) and pretested semi-structured interviewer-administered questionnaires were used to collect information from the participants. Data were analysed using Statistical Package for Social Sciences (SPSS) version 20 software and thematic analysis. Chisquare test and logistic regression were carried out at 5% significance level. Results: Only 26.2% of respondents were currently using any method of family planning. The most commonly used method was the natural method (57%). Amongst those who reported using artificial methods, 32.7% used condoms, 27.3% used implant while 23.64 and 16.4% used injectables and pills respectively. Predictors of current use of any family planning method were: older age (AOR = 1.7, 95%CI = 1.01-3.00), having more than five children (AOR = 1.7, 95%CI = 1.05-2.83), minimum of secondary level of education for respondent (AOR = 3.3, CI = 1.60-6.96) and their husband/partner (AOR = 2.0, 95%CI = 1.05-3.92). Qualitative findings showed that only few families were using a method of family planning and those who did not practice family planning perceived it to interfere with God's plan for fruitfulness and to be counter-productive to household income due to decreased manpower for agricultural activities. Poor partner involvement and support for family planning was also cited as a deterrent by both male and female participants.