Background: Utilization of maternal health services is associated with improved maternal and neonatal health outcomes. Considering global and national interests in the Millennium Development Goal and Nigeria's high level of maternal mortality, understanding the factors affecting maternal health use is crucial. Studies on the use of maternal care services have largely overlooked community and other contextual factors. This study examined the determinants of maternal services utilization in Nigeria, with a focus on individual, household, community and state-level factors.

BackgroundThe use of insecticide-treated bed nets (ITNs) is crucial to the prevention, control, and elimination of malaria. Using household surveys conducted in 2014–2015 by the Health Communication Capacity Collaborative project in Madagascar, Mali, and Nigeria, we compared a model of psychosocial influence, called Ideation, to examine how malaria-related variables influence individual and household bed net use in each of these countries. Evaluations of non-malaria programs have confirmed the value of the ideational approach, but it is infrequently used to guide malaria interventions. The study objective was to examine how well this model could identify potentially effective malaria prevention approaches in different contexts.MethodsSampling and survey designs were similar across countries. A multi-stage random sampling process selected female caregivers with at least one child under 5 years of age for interviews. Additional data were collected from household heads about bed net use and other characteristics of household members. The caregiver survey measured psychosocial variables that were subjected to bivariate and multivariate analysis to identify significant ideational variables related to bed net use.ResultsIn all three countries, children and adolescents over five were less likely to sleep under a net compared to children under five (OR = 0.441 in Madagascar, 0.332 in Mali, 0.502 in Nigeria). Adults were less likely to sleep under a net compared to children under five in Mali (OR = 0.374) and Nigeria (OR = 0.448), but not Madagascar. In all countries, the odds of bed net use were lower in larger compared to smaller households (OR = 0.452 in Madagascar and OR = 0.529 in Nigeria for households with 5 or 6 members compared to those with less than 5; and OR = 0.831 in Mali for larger compared to smaller households). Of 14 common ideational variables examined in this study, six were significant predictors in Madagascar (all positive), three in Mali (all positive), and two in Nigeria (both negative).ConclusionThis research suggests that the systematic use of this model to identify relevant ideational variables in a particular setting can guide the development of communication strategies and messaging, thereby improving the effectiveness of malaria prevention and control.

Exposure to family planning messages from religious leaders was significantly associated with higher modern contraceptive use, after accounting for background characteristics and other variables such as myths and misconceptions. Engaging religious leaders to support positive social norms is an important strategy to improving voluntary contraceptive use in Nigeria.

Greater exposure to a comprehensive family planning program in urban Nigeria that emphasized demand generation and communication theory was associated with improved ideation among women (their beliefs, ideas, and feelings about family planning), and more positive ideation was associated with greater contraceptive use, especially among the poor. Improving providers' knowledge, attitudes, and skills was also key. By the end of the observation period, outreach through mobile service delivery contributed nearly one-half of the project clinics' family planning services.

Côte d'Ivoire is the country worst affected by the HIV epidemic in West Africa, and young people in this country are a particularly vulnerable group. This study examined the relation between parental factors and sexual risk-taking among young people using logistic regression and survival analysis methods. Three parental factors (living in the same household as the father during childhood, perceived parental disapproval of early and premarital pregnancy, and parent-child communication about sexual abstinence) were positively associated with primary sexual abstinence (defined as yet to experience sexual debut), secondary sexual abstinence (defined as sexual abstinence subsequent to sexual debut) and reduced number of sex partners. The findings suggest that parental monitoring and control are important predictors of youth sexual behaviours and underscore the need to target parents and guardians in efforts to promote responsible sexual behaviours among adolescents. It is important to promote parent-child communication about sexual issues and empower parents and guardians to communicate effectively with their children and wards about sexual issues. RÉSUMÉFacteurs parentaux et la prise de risque sexuel chez les jeunes gens en Côte-d'lvoire. La Côte-d'lvoire est le pays le plus atteint par l'épidémie du VIH en Afrique de l'ouest et les jeunes gens de ce pays constituent un groupe surtout vulnérable. Cette étude a examiné le rapport entre les facteurs parentaux et la prise de risque sexuel chez les jeunes gens à l'aide de la regression logistique et la méthode de l'analyse de survie. Trois facteurs parentaux (le fait d'habiter dans la mème maison que le père pendant l'enfance, la désapprobation parentale perçue de la grossesse précoce et la grossesse prémaritale et la communication parent-enfant concernant l'abstinence sexuelle primaire (définie comme n'ayant pas encore eu l'expérience sexuelle), l'abstinence sexuelle secondarie (définie comme une abstinence sexuelle postérieure à l'expérience sexuelle initiale) et le nombre réduit de partenaires sexuels. Les résultats démontrent que la surveillance et l'autorité des parents sont des facteurs importants qui soulignent le besoin de viser les parents et les tuteurs dans les tentatives de promouvoir des comportements sexuels responsables chez les adolescents. Il est important de promouvoir la communication parent-enfant par rapport aux questions sexuelles et de capabiliser les parents et les tuteurs afin qu'ils puissent communiquer de manière effetive avec leurs enfants et leurs pupilles quant aux questions sexuelles. (Rev Afr Santé Reprod 2005; 9[1]: 49-65)

This study examined the predictors of readiness for HIV testing among young people in northern Nigeria, paying special attention to the role of stigma. Stigma is measured at two levels: individual and community (social norm). There are commonalities and differences in the correlates of readiness among men and women. For men and women, knowledge about HIV prevention, knowledge about a source for VCT, discussion about condom use for HIV prevention and perceived risk are strong predictors. Knowledge that an apparently healthy person can be HIV-infected is only significant for women. Perceived stigma is a significant predictor for both men and women although the specific dimension of note differs between the sexes. Social norm is strongly and directly associated with readiness among men but has no apparent influence among women. For both sexes, social norm appears to have strong mediating influence on the relationship between personal perceived stigma and readiness. The results strongly suggest that to eliminate HIV-related stigma, it is not enough to target individual cognitive processes; strategic efforts should target social structures in order to change negative social norms.

Efforts to promote the uptake of immunisation need to address both demand- and supply-side factors. Increasing knowledge about immunisation, changing negative attitudes about immunisation, debunking myths and rumours about immunisation, and addressing religious, ethnic and political bases for resistance to immunisation are necessary to encourage parents to initiate child immunisation. To promote timely completion of immunisation schedule, programmes will need to improve vaccine supply, strengthen provider's capacity for quality service and increase community knowledge about immunisation.

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