Generating evidence for health policy in challenging settings: lessons learned from four prevention of mother-to-child transmission of HIV implementation research studies in Nigeria

Sam-Agudu, Nadia A.; Aliyu, Muktar H.; Adeyemi, Olusegun A.; Oronsaye, Frank; Oyeledun, Bolanle; Ogidi, Amaka G.; Ezeanolue, Echezona E.

doi:10.1186/s12961-018-0309-x

Cited by 4 publications

(3 citation statements)

References 29 publications

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“…Some study communities were either very hard to reach or had unpredictable periods of insecurity (24). Thus, questionnaires had to take a relatively short amount of time for completion and for staff to return to safety before nightfall.…”

Section: Instrument Adaptation Data Collection and Codingmentioning

confidence: 99%

Causes and Predictors of Mortality among HIV-Exposed Infants in Rural North-Central Nigeria: Results of a Simple Verbal Autopsy Survey

Ozigbu

Erekaha

Chinaeke

et al. 2020

Preprint

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Background HIV-exposed infants (HEI) who die before diagnosis or treatment initiation, or who die in spite of being HIV-free constitute missed opportunities for reducing infant mortality. Verbal autopsy (VA) has been successfully applied in the collection of data to determine symptoms and circumstances surrounding death among infants, children and adults among populations that lack vital registration systems. There is little available data on rates and causes of death among HIV-exposed infants (HEI) in Nigeria. We used VA to characterize attributable causes and predictors of mortality among HEI in rural North-Central Nigeria.Methods Pregnant women living with HIV and HEI were enrolled at rural primary healthcare facilities and followed-up for 12 months, post-delivery. A simple 21-item VA instrument was used to collect infant mortality information from mothers, other family members, mentor mothers, and/or healthcare workers. Attributable causes of death were determined by physician coding. Multivariate logistic regression was performed to determine independent predictors of mortality.Results Data from 455 HIV-exposed infected and uninfected fetus/infant-mother pairs were analyzed. All mothers received anti-retroviral therapy. Seventy-five (16.5%) fetuses/infants died during gestation and within 12 months post-delivery. Forty (53.3%) deaths occurred in utero . The 12-month infant mortality risk among HEI in our study was 88.7/1,000. Among the 35 live-born infants, birth asphyxia (6/17, 35.3%) and sepsis (7/18, 38.9%) were the most common causes of death in the neonatal and post-neonatal periods, respectively. Unadjusted estimates showed that a greater proportion of deceased infants had mothers who did not deliver at a health facility (53.3 vs 31.8%, p=0.003), and who were newly HIV-diagnosed during pregnancy (69.3 vs 50.8%, p=0.029). Infants receiving nevirapine prophylaxis within 72 hours were less likely to have died (aOR = 0.40, 95% CI: 0.2-0.9).Conclusions Early HIV diagnosis and treatment among women of child-bearing age, maternal access to facility delivery and timely infant antiretroviral prophylaxis should be programmatically strengthened to reduce HEI mortality. Additionally, robust monitoring and evaluation systems are needed to track and record deaths among HEI.

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Section: Instrument Adaptation Data Collection and Codingmentioning

confidence: 99%

Causes and Predictors of Mortality among HIV-Exposed Infants in Rural North-Central Nigeria: Results of a Simple Verbal Autopsy Survey

Ozigbu

Erekaha

Chinaeke

et al. 2020

Preprint

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“…Documentation with monitoring is the last component of public health programming and is critical to ensuring that the right things are done, the right results are obtained and the right structures are ultimately established 15. Documentation with monitoring should be a way of providing proof to the funders and to the world that the right investments were made and appropriate results, outcomes and benefits have been obtained 7.…”

Section: Documentation With Monitoringmentioning

confidence: 99%

<p>Revisiting public health programming in Nigeria: challenges and solutions</p>

Oleribe¹,

Nwanyanwu²,

Shen³

et al. 2019

IJGM

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Public health programming has three main components – capacity development, service provision and documentation with monitoring. However, most funders and programmers now focus on just documentation and monitoring. In this communication, the authors extensively discuss the need for the full complement of public health programming and why it is important to restructure supportive site visits to make them both empowering and impactful to the health care workers resulting in higher quality of public health services and documentation with monitoring. The authors are of the view that following problem identification, comprehensive capacity development of field workers will engender quality service provision and appropriate documentation and monitoring.

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“…Key challenges limiting research capacity-building in Nigeria and other LMICs are: a) few qualified researchers and trained support staff, including research assistants and research coordinators; b) poor research infrastructure, such as low access to computers, laboratories, and broadband internet access; c) lack of expertise in grant writing, manuscript preparation, and access to international published works; and d) disproportionately low funding priority for research by governments and institutions [17181920].…”

Section: Introductionmentioning

confidence: 99%

Challenges and Strategies for Improving Training of Mid-Level Research Personnel in Nigeria

Ezeanolue

Iheanacho

Patel

et al. 2019

Annals of Global Health

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Background: Contextual research evidence is needed to reduce morbidity and mortality due to chronic but preventable diseases in low- and middle-income countries. Nigeria, Africa’s most populous country, is particularly burdened by these diseases despite its academic and research infrastructure. A major impediment to developing robust evidence on sustainable disease prevention and treatment strategies is the lack of skilled research personnel. Objective: This study aimed to identify (1) training barriers for research assistants and coordinators and (2) potential strategies to counter these barriers using a Nominal Group Technique (NGT) exercise conducted at the 2017 conference of the Nigeria Implementation Science Alliance (NISA). Method: A one-hour NGT exercise was conducted with 26 groups of 2–9 persons each (N = 134) drawn from conference attendees. Group members were presented with questions related to the two objectives. Each member was asked to generate, list, discuss and vote on ideas that were eventually ranked by the group. Qualitative Thematic Analysis (QTA) was conducted for the collated responses. Findings: The QTA identified 166 training gaps and 147 potential solutions, out of which 104 were ranked. Themes that emerged for gaps included: 1) inadequate mentorship; 2) inadequate training/lack of organized curriculum; 3) limited access to opportunities for training and employment; 4) lack of government funding; 5) lack of interest, motivation; and 6) lack of research culture. Themes for potential strategies to address the gaps were: 1) trainings/curriculum development; 2) research modules implemented in secondary and tertiary institutions; 3) creating a sustainable forum for research-related questions and answers; and 4) advocating for and accessing more government funding for research training. Conclusion: This study identified actionable strategies that reflect practical realities in implementation research in Nigeria, which can guide government agencies, policy makers, research organizations, and local foundations as they work together to increase research capacity in Nigeria.

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Generating evidence for health policy in challenging settings: lessons learned from four prevention of mother-to-child transmission of HIV implementation research studies in Nigeria

Cited by 4 publications

References 29 publications

Causes and Predictors of Mortality among HIV-Exposed Infants in Rural North-Central Nigeria: Results of a Simple Verbal Autopsy Survey

Causes and Predictors of Mortality among HIV-Exposed Infants in Rural North-Central Nigeria: Results of a Simple Verbal Autopsy Survey

<p>Revisiting public health programming in Nigeria: challenges and solutions</p>

Challenges and Strategies for Improving Training of Mid-Level Research Personnel in Nigeria

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