Background Preconception care is a specialized care targeted at women of reproductive age before pregnancy to detect, treat or counsel them about pre-existing medical and social conditions that may militate against safe motherhood and positive pregnancy outcome. In spite of the known need for preconception care in Nigeria, routine preconception care services are not available in the country. This study explores existing preconception care practices in the country in order to encourage building on it and formalising it for inclusion in routine maternal and child health services in the country. Methods Forty-one in-depth interviews and 10 focus group discussions were conducted in this descriptive qualitative study to explore the existing preconception care services from the perspectives of community members (women and men in the reproductive age group), community and religious leaders, health care professionals as well as policy makers. Thematic analysis was carried out using MAXQDA 2018. Results Participants stated that there are no defined preconception care services in the health care system nor are there any structures or guidelines for preconception care in the country. Preconception care services are however provided when health workers perceive a need or when clients demand for it. The services provided include health information, education and counselling, treatment modification, medical check-up and screening. Outside of the health system, there are some traditional, religious and other practices with similar bearing to preconception care which the participants believed could be included as preconception care services. These include premarital counselling services by religious bodies, family life and HIV education within the secondary school system and some screening and outreach services provided by non-governmental and some governmental agencies. Conclusion There is a need to provide structure and guidelines for preconception care services in the country so that the services can be properly streamlined. This structure can also involve practices that are currently not within the health system.

Background Intimate partner violence (IPV) is an important public health problem with health and socioeconomic consequences and is endemic in Namibia. Studies assessing risk factors for IPV often use logistic and Poisson regression without geographical location information and spatial effects. We used a Bayesian spatial semi-parametric regression model to determine the risk factors for IPV in Namibia; assess the non-linear effects of age difference between partners and determine spatial effects in the different regions on IPV prevalence. Methods We used the couples’ dataset of the 2013–2014 Namibia Demographic and Health Survey (DHS) obtained on request from Measure DHS. The DHS domestic violence module included 2226 women. We generated a binary variable measuring IPV from the questions “ever experienced physical, sexual or emotional violence?” Covariates included respondent’s educational level, age, couples’ age difference, place of residence and partner’s educational level. All estimation was done with the full Bayesian approach using R version 3.5.2 implementing the R2BayesX package. Results IPV country prevalence was 33.3% (95% CI = 30.1–36.5%); Kavango had the highest [50.6% (95% CI = 41.2–60.1%)] and Oshana the lowest [11.5% (95% CI = 3.2–19.9%)] regional prevalence. IPV prevalence was highest among teenagers [60.8% (95% CI = 36.9–84.7%)]). The spatial semi-parametric model used for adjusted results controlled for regional spatial effects, respondent’s age, age difference, respondent’s years of education, residence, wealth, and education levels. Women with higher education were 50% less likely to experience IPV [aOR: 0.46, 95% CI = 0.23–0.87]. For non-linear effects, the risk of IPV was high for women ≥ 5 years older or ≥ 25 years younger than their partners. Younger and older women had higher risks of IPV than those between 25 and 45 years. For spatial variation of IPV prevalence, northern regions had low spatial effects while western regions had very high spatial effects. Conclusion The prevalence of IPV among Namibia women was high especially among teenagers, with higher educational levels being protective. The risk of IPV was lower in rural than urban areas and higher with wide partner age differences. Interventions and policies for IPV prevention in Namibia are needed for couples with wide age differences as well as for younger women, women with lower educational attainment and in urban and western regions.

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BackgroundFactors that predispose to poor maternal and child health outcomes in most low and middle income countries include the presence of pre-existing medical conditions that are amenable to preconception care (PCC). Nigeria has an increasing pool of women of reproductive age with pre-existing medical conditions but PCC services are not provided routinely in the maternal and child health framework. This study explores the pregnancy experiences of women with pre-existing medical conditions to make a case for PCC as a routine service.MethodsNine women purposively selected because they has pre-existing medical conditions participated in in-depth interviews (IDIs) in this qualitative study. The IDIs were held in the obstetric outpatient clinics and lying-in wards of two referral hospitals for maternal and child health services in Ibadan North LGA of Oyo State, southwest Nigeria. The interviews lasted an average of 30 minutes, were digitally recorded and transcribed verbatim. Thematic analysis using a hybrid of inductive and deductive coding was done using MAXQDA 2018.ResultsAmong the nine participants, seven were pregnant and two non-pregnant with pre-existing medical conditions including hypertension, diabetes mellitus, sickle cell disorder, chronic hepatitis, HIV, previous pregnancy loss of unknown cause and secondary infertility. None of the participants were aware of PCC and although they all desired their current pregnancy, there was no active preparation. None of the pregnant participants notified their health care providers about their desire for pregnancy and their medications were not adjusted or changed till after pregnancy. All except one of the participants believed they could have benefitted from PCC if they had been aware before pregnancy.ConclusionThe regular contact with the health system afforded by their pre-existing medical conditions is an opportunity for them to have been adequately prepared for pregnancy through counselling and adjustment or change in treatment regimen to prevent complications. This opportunity was missed among the study participants. Health care providers need to be proactive and ask women of reproductive age about their pregnancy desires during routine clinic visits in order to make adequate preparation.

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