The distribution of health facilities across Nigeria is nonuniform. As such, a UHC strategy must be responsive to the variation in health facility distribution across the country. Additional investments are needed in some parts of the country to improve access to tertiary health facilities and leverage private sector capacity.

BACKGROUNDNigeria is a signatory to the Convention on the Rights of the Child, which identifies birth registration as a child's right. However, it is unclear how much progress has been made toward attaining universal birth registration in the country. METHODSThis paper reports findings from a secondary analysis of data from the 2007 and 2011 UNICEF Multiple Indicator Cluster Survey in Nigeria. Trends in birth registration completeness based on year of birth of children and age at survey were computed, tabulated, and graphed. RESULTSBirth registration completeness was 31.5% and 41.5% in 2007 and 2011 respectively. Children had better odds of registration across Nigeria in 2011 than in 2007 (OR 1.79, 95% CI 1.59-2.01), except in the North East geopolitical zone (OR 0.76, 95% CI 0.55-1.07). Likewise, older children had better odds of registration than those aged less than one year. Female children had worse chances of registration than their male counterparts (OR 0.92, 95% CI 0.85-0.99). CONCLUSIONBirth registration improved in 2011 over 2007 across Nigeria except in the North East region. However, much still needs to be done to achieve universal birth registration. Birth registration appears to still be influenced by the gender and age of the child. CONTRIBUTIONThis paper provides a rigorous assessment of the progress made toward universal birth registration, which has not been previously demonstrated.

Background: Death registration provides an opportunity for the legal documentation of death of persons. Documentation of deaths has several implications including its use in the recovery of inheritance and insurance benefits. It is also an important input for construction of life tables which are crucial for national planning. However, the registration of deaths is poor in several countries including Nigeria. Objective: This paper describes the performance of death registration in Nigeria and factors that may affect its performance. Methods: We conducted a systematic literature review of death registration completeness in Nigeria to identify, characterize issues as well as challenges associated with realizing completeness in death registration. Results: Only 13.5% of deaths in Nigeria were registered in 2007 which regressed to 10% in 2017. There was no data reported for Nigeria in the World Health Organization database between 2008 and 2017. The country scored less than 0.1 (out of a maximum of 1) on the Vital Statistics Performance Index. There are multiple institutions with parallel constitutional and legal responsibilities for death registration in Nigeria including the National Population Commission, National Identity Management Commission and Local Government Authorities, which may be contributing to its overall poor performance. Conclusions: We offer proposals to substantially improve death registration completeness in Nigeria including the streamlining and merger of the National Population Commission and the National Identity Management Commission into one commission, the revision of the legal mandate of the new agency to mainly coordination and establishment of standards. We recommend that Local Government authorities maintain the local registries given their proximity to households. This arrangement will be enhanced by increased utilization of information and communications technology in Civil Registration and Vital Statistics processes that ensure records are properly archived.

IntroductionRoutine Health Information Systems (RHIS) are increasingly transitioning to electronic platforms in several developing countries. Establishment of a Master Facility List (MFL) to standardize the allocation of unique identifiers for health facilities can overcome identification issues and support health facility management. The Nigerian Federal Ministry of Health (FMOH) recently developed a MFL, and we present the process and outcome.MethodsThe MFL was developed from the ground up, and includes a state code, a local government area (LGA) code, health facility ownership (public or private), the level of care, and an exclusive LGA level health facility serial number, as part of the unique identifier system in Nigeria. To develop the MFL, the LGAs sent the list of all health facilities in their jurisdiction to the state, which in turn collated for all LGAs under them before sending to the FMOH. At the FMOH, a group of RHIS experts verified the list and identifiers for each state.ResultsThe national MFL consists of 34,423 health facilities uniquely identified. The list has been published and is available for worldwide access; it is currently used for planning and management of health services in Nigeria.DiscussionUnique identifiers are a basic component of any information system. However, poor planning and execution of implementing this key standard can diminish the success of the RHIS.ConclusionDevelopment and adherence to standards is the hallmark for a national health information infrastructure. Explicit processes and multi-level stakeholder engagement is necessary to ensuring the success of the effort.

Baby factories are new systematic abuse structures that are promoting infant trafficking, neo-slavery and the exploitation of young women with unwanted pregnancies in Nigeria. Since this practice was first described in 2006, it has been growing rather than abating. This paper reviews the scientific literature, along with media reports, and critiques this phenomenon from a children's rights' perspective. Children born into baby factories are denied various civil rights. They also suffer abuse in the baby factories and as a consequence of being born in such places. This abuse can be classified into immediate and long term. Immediate abuse includes inadequate care and its repercussions, denial of birth registration, illegal adoption and murder. Long-term or delayed abuse that they may be exposed to includes health-related consequences, neglect, death, child labour, prostitution and other sexual abuse, organ trafficking and recruitment as child soldiers. Various factors are thought to drive the baby factory phenomenon which include poverty, high infertility rates and the profitability of local and inter-country adoptions. Programmes directed at addressing the root cause of the problem are needed in order to eliminate infant trafficking. Also, clear laws that delineate inter-country adoption and infant trafficking need to be enacted. Most importantly, baby factories need to be recognised as child trafficking routes.

Baby factories and baby harvesting are relatively new terms that involve breeding, trafficking, and abuse of infants and their biological mothers. Since it was first described in a United Nations Educational, Scientific and Cultural Organization report in Nigeria in 2006, several more baby factories have been discovered over the years. Infertile women are noted to be major patrons of these baby factories due to the stigmatization of childless couples in Southern Nigeria and issues around cultural acceptability of surrogacy and adoption. These practices have contributed to the growth in the industry which results in physical, psychological, and sexual violence to the victims. Tackling baby factories will involve a multifaceted approach that includes advocacy and enacting of legislation barring baby factories and infant trafficking and harsh consequences for their patrons. Also, programs to educate young girls on preventing unwanted pregnancies are needed. Methods of improving awareness and acceptability of adoption and surrogacy and reducing the administrative and legal bottlenecks associated with these options for infertile couples should be explored to diminish the importance of baby factories.

BackgroundMultidrug drug resistant Tuberculosis (MDR-TB) and extensively drug resistant Tuberculosis (XDR-TB) have emerged as significant public health threats worldwide. This systematic review and meta-analysis aimed to investigate the effects of community-based treatment to traditional hospitalization in improving treatment success rates among MDR-TB and XDR-TB patients in the 27 MDR-TB High burden countries (HBC).MethodsWe searched PubMed, Cochrane, Lancet, Web of Science, International Journal of Tuberculosis and Lung Disease, and Centre for Reviews and Dissemination (CRD) for studies on community-based treatment and traditional hospitalization and MDR-TB and XDR-TB from the 27 MDR-TB HBC. Data on treatment success and failure rates were extracted from retrospective and prospective cohort studies, and a case control study. Sensitivity analysis, subgroup analyses, and meta-regression analysis were used to explore bias and potential sources of heterogeneity.ResultsThe final sample included 16 studies involving 3344 patients from nine countries; Bangladesh, China, Ethiopia, Kenya, India, South Africa, Philippines, Russia, and Uzbekistan. Based on a random-effects model, we observed a higher treatment success rate in community-based treatment (Point estimate = 0.68, 95 % CI: 0.59 to 0.76, p < 0.01) compared to traditional hospitalization (Point estimate = 0.57, 95 % CI: 0.44 to 0.69, p < 0.01). A lower treatment failure rate was observed in community-based treatment 7 % (Point estimate = 0.07, 95 % CI: 0.03 to 0.10; p < 0.01) compared to traditional hospitalization (Point estimate = 0.188, 95 % CI: 0.10 to 0.28; p < 0.01). In the subgroup analysis, studies without HIV co-infected patients, directly observed therapy short course-plus (DOTS-Plus) implemented throughout therapy, treatment duration > 18 months, and regimen with drugs >5 reported higher treatment success rate. In the meta-regression model, age of patients, adverse events, treatment duration, and lost to follow up explains some of the heterogeneity of treatment effects between studies.ConclusionCommunity-based management improved treatment outcomes. A mix of interventions with DOTS-Plus throughout therapy and treatment duration > 18 months as well as strategies in place for lost to follow up and adverse events should be considered in MDR-TB and XDR-TB interventions, as they influenced positively, treatment success.

Incidents of violence perpetrated through digital technology platforms or facilitated by these means have been reported, often in high-income countries. Very little scholarly attention has been given to the nature of Technology-Facilitated violence and abuse (TFVA) across sub-Saharan Africa (SSA) despite an explosion in the use of various technologies. We conducted a literature review to identify and harmonize available data relating to the types of TFVA taking place in SSA. This was followed by an online survey of young adults through the SHYad.NET forum to understand the nature of TFVA among young adults in SSA. Our literature review revealed various types of TFVA to be happening across SSA, including cyberbullying, cyberstalking, trolling, dating abuse, image-based sexual violence, sextortion, and revenge porn. The results of our online survey revealed that both young men and women experience TFVA, with the most commonly reported TFVA being receiving unwanted sexually explicit images, comments, emails, or text messages. Female respondents more often reported repeated and/or unwanted sexual requests online via email or text message while male respondents more often reported experiencing violent threats. Respondents used various means to cope with TFVA including blocking the abuser or deleting the abused profile on social media.