BackgroundThe Community Directed Interventions (CDI) strategy has proven effective in increasing access to health services in sedentary populations. It remains to be seen if CDI strategy is feasible among nomads given the dearth of demographic and medical data on the nomads. This study thus characterized the nomadic populations in Enugu State, Nigeria and outlined the potentials of implementing CDI among nomads.Study design and methodsThis exploratory study adopted qualitative methods. Forty focus group discussions (FGD) were held with members of 10 nomadic camps in 2 LGAs in Enugu State, as well as their host communities. Thirty in-depth interviews (IDIs) were held with leaders of nomadic camps and sedentary populations. Ten IDIs with traditional healers in the nomadic camps and 14 key informant interviews with health workers and programme officers were also conducted. Documents and maps were reviewed to ascertain the grazing routes of the nomads as well as existing health interventions in the area.ResultsLike sedentary populations, nomads have definable community structures with leaders and followers, which is amenable to implementation of CDI. Nomads move their cattle, in a definite pattern, in search of grass and water. In this movement, the old and vulnerable are left in the camps. The nomads suffer from immunization preventable health problems as their host communities. The priority health problems in relation to CDI include malaria, measles, anemia, and other vaccine preventable infections. However, unlike the sedentary populations, the nomads lack access to health interventions, due to the mutual avoidance between the nomads and the sedentary populations in terms of health services. The later consider the services as mainly theirs. The nomads, however, are desirous of the modern health services and often task themselves to access these modern health services in private for profit health facilities when the need arises.ConclusionGiven the definable organizational structure of the nomads in Enugu State and their desire for modern health intervention, it is feasible to test the CDI strategy for equitable healthcare delivery among nomads. They are willing and capable to participate actively in their own health programmes with minimal support from professional health workers.

BackgroundThe study investigated the factors associated with compliance to the recommended ≥90-day uptake of micronutrients for prevention of iron-deficiency anemia during pregnancy in Nigeria.MethodsA cross-sectional study of 1500 women who had babies within 6 months prior to the survey, drawn from six urban, peri-urban, and rural local government areas in Enugu and Imo States of Nigeria, was conducted, using a structured questionnaire. A focus group discussion was held with grandmothers and fathers of the new baby. In-depth interviews were held with health workers.ResultsThere were six demographic factors in the bivariate analysis: living in an urban center and close to health facility, and being wealthy, with post-secondary education as well as older and engaged in civil service showed significant association with compliance. The urban residents complied more than the peri-urban and rural residents (χ 2 = 12.749; p = 0.002). Those living close to the health facilities complied more than those living far away (χ 2 = 24.638; p < 0.001). Those in higher wealth quintile complied more (χ 2 = 13.216; p < 0.010). Utilization of antenatal clinics during pregnancy showed statistically significant association with compliance. Those who used the ANC services complied more than those that did not (χ 2 = 6.324; p = 0.010) and the more frequent the use of ANC services the more the compliance (χ 2 = 14.771; p < 0.001). These results were confirmed when the opinions expressed in the urban, peri-urban, and rural communities are compared. However, the multivariate binary logistic regression highlighted only urban residence, closeness to health facilities, and utilization of ANC services as positively associated with compliance.ConclusionThese findings could help in targeting health education program to increase compliance to the recommended uptake of micronutrients in prevention of anemia during pregnancy.

The factors associated with third dose of diphtheria, pertussis and tetanus (DPT3) uptake, a true indicator of compliance with required regimen of vaccines, in Anambra state, Nigeria, were investigated in a cross-sectional survey of 600 mothers (15-49). Being an older mother showed a positive association with compliance. Compliance was more among those who used the government health facilities for their health needs (χ(2 )= 12.286, p < .001). Satisfactory experiences with health service influenced compliance (χ(2 )= 8.542, p = .002). Those with good perception (30.1%) complied more (χ(2 )= 42.572, p < .001). Those who were aware that immunization protects the children against vaccine preventable diseases complied more (χ(2 )= 8.735, p = .002). In conclusion, the action-hesitancy model strengthens the Health Belief Model in explaining parents' attitude to childhood immunization, as experience and perception of the health service influenced uptake more. Health education and campaigns should be directed at factors that would encourage mothers to adopt required behaviours.

The factors associated with third dose of diphtheria, pertussis and tetanus (DPT3) uptake, a true indicator of compliance with required regimen of vaccines, in Anambra state, Nigeria, were investigated in a cross-sectional survey of 600 mothers (15–49). Being an older mother showed a positive association with compliance. Compliance was more among those who used the government health facilities for their health needs (χ2 = 12.286, p < .001). Satisfactory experiences with health service influenced compliance (χ2 = 8.542, p = .002). Those with good perception (30.1%) complied more (χ2 = 42.572, p < .001). Those who were aware that immunization protects the children against vaccine preventable diseases complied more (χ2 = 8.735, p = .002). In conclusion, the action-hesitancy model strengthens the Health Belief Model in explaining parents’ attitude to childhood immunization, as experience and perception of the health service influenced uptake more. Health education and campaigns should be directed at factors that would encourage mothers to adopt required behaviours.

This study aimed at ascertaining the connection between disease aetiology of the autochthonous psychiatric health system and the current mental health-seeking behaviors of the Nsukka people. Structured participant observation was the principal method of collecting data. In-depth interview sessions were also held with elders in the communities. It was found that although there has been social contact and change among the Nsukka, the personalistic elements in the aetiology of their traditional psychiatric system still largely determined their mental health-seeking behaviors. Thus, they were found to be more at home with traditional healers and syncretic churches than orthodox mental healthcare. To be successful, any mental healthcare program in Nsukka ought to consider how orthodox mental health practitioners, traditional healers, and those who run prayer houses could be incorporated in a comprehensive community mental healthcare program.