BackgroundAlthough Primary Health Care (PHC) was designed to provide universal access to skilled pregnancy care for the prevention of maternal deaths, very little is known of the factors that predict the use of PHC for skilled maternity care in rural parts of Nigeria - where its use is likely to have a greater positive impact on maternal health care. The objective of this study was to identify the factors that lead pregnant women to use or not use existing primary health care facilities for antenatal and delivery care.MethodsThe study was a cross-sectional community-based study conducted in Esan South East and Etsako East LGAs of Edo State, Nigeria. A total of 1408 randomly selected women of reproductive age were interviewed in their households using a pre-tested structured questionnaire. The data were analyzed with descriptive and multivariate statistical methods.ResultsThe results showed antenatal care attendance rate by currently pregnant women of 62.1%, and a skilled delivery of 46.6% by recently delivered women at PHCs, while 25% of women delivered at home or with traditional birth attendants. Reasons for use and non-use of PHCs for antenatal and delivery care given by women were related to perceptions about long distances to PHCs, high costs of services and poor quality of PHC service delivery. Chi-square test of association revealed that level of education and marital status were significantly related to use of PHCs for antenatal care. The results of logistic regression for delivery care showed that women with primary (OR 3.10, CI 1.16–8.28) and secondary (OR 2.37, CI 1.19–4.71) levels education were more likely to receive delivery care in PHCs than the highly educated. Being a Muslim (OR 1.56, CI 1.00–2.42), having a partner who is employed in Estako East (OR 2.78, CI 1.04–7.44) and having more than five children in Esan South East (OR 2.00, CI 1.19–3.35) significantly increased the odds of delivery in PHCs. The likelihood of using a PHC facility was less for women who had more autonomy (OR 0.75, CI 0.57–0.99) as compared to women with higher autonomy.ConclusionWe conclude that efforts devoted to addressing the limiting factors (distance, costs and quality of care) using creative and innovative approaches will increase the utilization of skilled pregnancy care in PHCs and reduce maternal mortality in rural Nigeria.

No abstract

Background Human dietary exposure to chemicals can result in a wide range of adverse health effects. Some substances might cause non-communicable diseases, including cancer and coronary heart diseases, and could be nephrotoxic. Food is the main human exposure route for many chemicals. We aimed to assess human dietary exposure to a wide range of food chemicals. MethodsWe did a total diet study in Benin, Cameroon, Mali, and Nigeria. We assessed 4020 representative samples of foods, prepared as consumed, which covered more than 90% of the diet of 7291 households from eight study centres. By combining representative dietary surveys of countries with findings for concentrations of 872 chemicals in foods, we characterised human dietary exposure. FindingsExposure to lead could result in increases in adult blood pressure up to 2•0 mm Hg, whereas children might lose 8•8-13•3 IQ points (95th percentile in Kano, Nigeria). Morbidity factors caused by coexposure to aflatoxin B1 and hepatitis B virus, and sterigmatocystin and fumonisins, suggest several thousands of additional liver cancer cases per year, and a substantial contribution to the burden of chronic malnutrition in childhood. Exposure to 13 polycyclic aromatic hydrocarbons from consumption of smoked fish and edible oils exceeded levels associated with possible carcinogenicity and genotoxicity health concerns in all study centres. Exposure to aluminium, ochratoxin A, and citrinin indicated a public health concern about nephropathies. From 470 pesticides tested across the four countries, only high concentrations of chlorpyrifos in smoked fish (unauthorised practice identified in Mali) could pose a human health risk. Interpretation Risks characterised by this total diet study underscore specific priorities in terms of food safety management in sub-Saharan Africa. Similar investigations specifically targeting children are crucially needed. Funding Standards and Trade Development Facility.

Maternal mortality ratio in Nigeria is estimated to be 512 deaths per 100,000 live births. As with other low-income countries, a higher proportion of these deaths occur among women living in rural areas and in poor communities where access to maternal health care is limited by several barriers including quality of care in health facilities. The objective of this study was to assess the quality of antenatal and postnatal care in Primary Health Centres (PHCs) in two rural Local Government Areas of Edo State in Southern Nigeria. The data were obtained from exit interviews with 177 women after completion of antenatal and postnatal care in eight randomly selected PHCs. The interview questionnaire was adapted from the 2017 results-based financing exit interviews conducted by the World Bank in collaboration with the Federal Ministry of Health and the National Bureau of Statistics. It consisted of questions on the treatment received by women. The data were analysed with descriptive statistics and logistic regression. The results showed the self-reporting by women of sub-optimal offerings of 20 signal antenatal treatments and 8 signal postnatal care treatments. Close to half (45.6%) of the respondents for antenatal care reported receiving sub-optimal antenatal treatments compared to about a third of postnatal care attendees. The predictors of sub-optimal offerings of standard PHC care included local government area, marital status and previous childbirths. We conclude that concerted actions by health providers and policymakers in the PHCs to develop policies and interventions will improve the quality of delivery of antenatal and postnatal services in rural PHCs in Nigeria.

No abstract