Background Intimate partner violence (IPV) is a global public health and human rights issue that affects millions of women and girls. While disaggregated national statistics are crucial to assess inequalities, little evidence exists on inequalities in exposure to violence against adolescents and young women (AYW). The aim of this study was to determine inequalities in physical or sexual IPV against AYW and beliefs about gender based violence (GBV) in sub-Saharan Africa (SSA). Methods We used data from the most recent Demographic and Health Surveys (DHS) conducted in 27 countries in SSA. Only data from surveys conducted after 2010 were included. Our analysis focused on married or cohabiting AYW aged 15–24 years and compared inequalities in physical or sexual IPV by place of residence, education and wealth. We also examined IPV variations by AYW’s beliefs about GBV and the association of country characteristics such as gender inequality with IPV prevalence. Results The proportion of AYW reporting IPV in the year before the survey ranged from 6.5% in Comoros to 43.3% in Gabon, with a median of 25.2%. Overall, reported IPV levels were higher in countries in the Central Africa region than other sub-regions. Although the prevalence of IPV varied by place of residence, education and wealth, there was no clear pattern of inequalities. In many countries with high prevalence of IPV, a higher proportion of AYW from rural areas, with lower education and from the poorest wealth quintile reported IPV. In almost all countries, a greater proportion of AYW who approved wife beating for any reason reported IPV compared to their counterparts who disapproved wife beating. Reporting of IPV was weakly correlated with the Gender Inequality Index and other societal level variables but was moderately positively correlated with adult alcohol consumption (r = 0.48) and negative attitudes towards GBV (r = 0.38). Conclusion IPV is pervasive among AYW, with substantial variation across and within countries reflecting the role of contextual and structural factors in shaping the vulnerability to IPV. The lack of consistent patterns of inequalities by the stratifiers within countries shows that IPV against women and girls cuts across socio-economic boundaries suggesting the need for comprehensive and multi-sectoral approaches to preventing and responding to IPV.

BackgroundThe continuing burden of maternal mortality, especially in developing countries has prompted a shift in paradigm from the traditional risk assessment approach to the provision of access to emergency obstetric care services for all women who are pregnant. This study assessed the knowledge of maternity unit operatives at the primary and secondary levels of care about the concept of emergency obstetric care (EmOC) and investigated the contents of antenatal care (ANC) counseling services they delivered to clients. It also described the operatives' preferred strategies and practices for promoting safe motherhood and averting maternal mortality in South-west Nigeria.MethodsThe study population included all the 152 health workers (doctors, midwives, nurses and community health extension workers) employed in the maternity units of all the public health facilities (n = 22) offering maternity care in five cities of 2 states. Data were collected with the aid of a self-administered, semi-structured questionnaire and non-participant observation checklist. Results were presented using descriptive statistics.ResultsNinety one percent of the maternity unit staff had poor knowledge concerning the concept of EmOC, with no difference in knowledge of respondents across age groups. While consistently more than 60% of staff reported the inclusion of specific client-centered messages such as birth preparedness and warning/danger signs of pregnancy and delivery in the (ANC) delivered to clients, structured observations revealed that less than a quarter of staff actually did this. Furthermore, only 40% of staff reported counseling clients on complication readiness, but structured observations revealed that no staff did. Only 9% of staff had ever been trained in lifesaving skills (LSS). Concerning strategies for averting maternal deaths, 70% of respondents still preferred the strengthening of routine ANC services in the health facilities to the provision of access to EmOC services for all pregnant women who need it.ConclusionWe concluded that maternity unit operatives at the primary and secondary care levels in South-west Nigeria were poorly knowledgeable about the concept of emergency obstetric care services and they still prioritized the strengthening of routine antenatal care services based on the risk approach over other interventions for promoting safe motherhood despite a global current shift in paradigm. There is an urgent need to reorientate/retrain the staff in line with global best practices.

The study concluded that wheat flour mill workers in Nigeria, like grain workers elsewhere, were at an increased risk of developing both pulmonary and non-pulmonary symptoms compared with control subjects. The result has implications for improved dust control measures in the grain industry in Nigeria.

BackgroundEliminating disrespect and abuse in health care facilities during childbirth could be a contributory factor in improving pregnancy outcomes and avoiding preventable illnesses and deaths. This study aims to provide evidence of disrespect and abuse in this community in order to create awareness about its occurrence.MethodsA cross-sectional survey was carried out on 384 recently delivered women who visited the postnatal and immunization clinics of a primary and tertiary health facility in Ile-Ife. Information was sought about awareness of disrespect and abuse, prevalence and forms of disrespect and abuse, and opinions on improvements which can be made in maternity services. Univariate analysis was used to summarise the data.ResultsAbout half of the respondents were in their fourth decade of life and had tertiary education. Overall, the majority (98.4%) of respondents agreed that it was their right to be treated with respect and dignity during childbirth while about one-fifth (19%) had ever experienced some form of disrespect and abuse. The commonly identified forms of disrespect and abuse were: non-dignified care (12.8%), discrimination (8.1%), a detention and abandonment (6%). However, the majority (81%) of the respondents did not have any suggestions for improvements in delivery services.ConclusionsAlthough most of the respondents knew it was their right to be treated with respect, some reported that they had experienced disrespect and abuse during childbirth in varying forms. The evidence from this survey draws attention to the need for interventions to address the health system factors hindering health service utilization.

Background Adolescent sexual and reproductive health (ASRH) is a major public health concern in sub-Saharan Africa (SSA). However, inequalities in ASRH have received less attention than many other public health priority areas, in part due to limited data. In this study, we examine inequalities in key ASRH indicators. Methods We analyzed national household surveys from 37 countries in SSA, conducted during 1990–2018, to examine trends and inequalities in adolescent behaviors related to early marriage, childbearing and sexual debut among adolescents using data from respondents 15–24 years. Survival analyses were conducted on each survey to obtain estimates for the ASRH indicators. Multilevel linear regression modelling was used to obtain estimates for 2000 and 2015 in four subregions of SSA for all indicators, disaggregated by sex, age, household wealth, urban–rural residence and educational status (primary or less versus secondary or higher education). Results In 2015, 28% of adolescent girls in SSA were married before age 18, declined at an average annual rate of 1.5% during 2000–2015, while 47% of girls gave birth before age 20, declining at 0.6% per year. Child marriage was rare for boys (2.5%). About 54% and 43% of girls and boys, respectively, had their sexual debut before 18. The declines were greater for the indicators of early adolescence (10–14 years). Large differences in marriage and childbearing were observed between adolescent girls from rural versus urban areas and the poorest versus richest households, with much greater inequalities observed in West and Central Africa where the prevalence was highest. The urban–rural and wealth-related inequalities remained stagnant or widened during 2000–2015, as the decline was relatively slower among rural and the poorest compared to urban and the richest girls. The prevalence of the ASRH indicators did not decline or increase in either education categories. Conclusion Early marriage, childbearing and sexual debut declined in SSA but the 2015 levels were still high, especially in Central and West Africa, and inequalities persisted or became larger. In particular, rural, less educated and poorest adolescent girls continued to face higher ASRH risks and vulnerabilities. Greater attention to disparities in ASRH is needed for better targeting of interventions and monitoring of progress.

College students exhibited an 'optimism bias' associating high rates of HIV risk indicators with low levels of perceived personal risk of infection. This has implications for HIV/AIDS control in Nigeria.

The SMS-based intervention has a positive effect on facility delivery, and mothers welcome its use in pregnancy.

BackgroundWorldwide heterosexual sex is the most common mode of HIV transmission, with the marital heterosexual route becoming a major contributor in sub-Sahara Africa. This study examined the role of inappropriate HIV status disclosure, after diagnosis, on marital sexual experiences of HIV positive women.MethodsThe study employed a descriptive cross-sectional design. An interviewer administered questionnaire that elicited information about HIV status disclosure to partners, sexual experiences, condom use and parity was administered to 122 married women living with HIV/AIDS. Participants were referred from peripheral health centres to receive comprehensive HIV care at the State Specialist Hospital, Osogbo, Nigeria.ResultsMean age (SD) of respondents was 33.8 (8.9) years. Only 23.8% of partners had HIV screening, with 3.3% being HIV positive. A majority (62%) of respondents reported experiencing marital sex deprivation since their partners became aware of their HIV status. There was a reported rejection (74.3%) of condom use by partners during sexual intercourse. Fear of becoming infected (85.7%) and blaming the women for their positive status (85.7%) were the main reasons the respondents gave for being sexually deprived by their partners.ConclusionInappropriate status disclosure due to poor HIV counseling and testing (HCT) practices resulted in sexual deprivation of married HIV positive women. Adequate training and retraining of health care workers on HCT and HIV status disclosure will reduce experience of sexual deprivation among married HIV positive women.