Impact of a capacity-building intervention on views and perceptions of healthcare providers towards the provision of adolescent sexual and reproductive health services in southeast Nigeria: a cross-sectional qualitative study

Agu, Ifunanya Clara; Agu, Chibuike; Mbachu, Chinyere; Onwujekwe, Obinna

doi:10.1136/bmjopen-2023-073586

Cited by 4 publications

(4 citation statements)

References 25 publications

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“…Thus, the observed challenges in DTG access in adolescent and young females also reflects the fear of health care providers to address this concern and their inability to offer contraceptive use in this population. Indeed, contraceptive uptake among adolescent girls and young women in Sub-Saharan Africa is low [20,21] and healthcare providers lack education or face bias in addressing these questions [22,23]. The gap between males and females in terms of DTG initiation tended to close towards the end of the follow-up period.…”

Section: Discussionmentioning

confidence: 99%

Disparities in access to Dolutegravir in West African children, adolescents and young adults aged 0-24 years living with HIV. A IeDEA Pediatric West African cohort analysis

Desmonde,

Dame,

Malateste

et al. 2024

Preprint

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Introduction: We describe the incidence of Dolutegravir (DTG)-containing antiretroviral treatment (ART) initiation since its introduction in 2019 in pediatric West African IeDEA cohorts. Methods: We included all patients aged 0-24 years on ART, from nine clinics in Cote d\'Ivoire (n=4), Ghana, Nigeria, Mali, Benin, and Burkina Faso. Baseline varied by site and was defined as date of first DTG prescription; patients were followed-up until database closure/death/loss to follow-up (LTFU, no visit ≥7 months), whichever came first. We computed the cumulative incidence function for DTG initiation; associated factors were explored in a shared frailty model, accounting for clinic heterogeneity. Results: Since 2019, 3,350 patients were included; 49% were female;79% had been on ART ≥12 months. Median baseline age was 12.9 years (IQR: 9-17). Median follow-up was 14 months (IQR: 7-22). Overall, 1496 (48%) initiated DTG. The overall cumulative incidence of DTG initiation reached 23.6% (95% CI: 21.6-25.6) and 41.3% (95% CI: 39.0-43.6) at 6 and 12 months respectively. Adjusted ART line and available viral load (VL) at baseline, among patients >5 years, DTG-initiation was associated with being male (aHR among 5-9 years: 1.39, 95% CI: 1.06-1.84; among 10-14 years: 1.78, 95% CI: 1.52-2.01; among ≥15 years: 2.46, 95% CI: 2.08-2.91). After 12 months of DTG-implementation, those with detectable VL were less likely to initiate DTG compared to those in viral suppression (aHR: 0.86, 95% CI: 0.76-0.97) and those on NNRTIs were three times more likely to initiate DTG compared to those on PIs (aHR: 3.30, 95% CI: 1.91-5.69). Conclusion: Children and adolescent males ≥5 years, on NNRTIs, with access to VL were the most likely to switch to DTG. As DTG access scales up, updated documentation of treatment practices is required to better ensure universal and equal access.

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Section: Discussionmentioning

confidence: 99%

Disparities in access to Dolutegravir in West African children, adolescents and young adults aged 0-24 years living with HIV. A IeDEA Pediatric West African cohort analysis

Desmonde,

Dame,

Malateste

et al. 2024

Preprint

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“…In total, 80 voluntary CHWs, and 80 PMVs were trained. More details about the training formats can be found here [ 26 ].…”

Section: Methodsmentioning

confidence: 99%

Factors influencing adoption of sexual and reproductive health intervention for adolescents in Ebonyi, Nigeria

Odii,

Akamike,

Mbachu

et al. 2024

BMC Health Serv Res

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Background School and Community-embedded reproductive health interventions have been implemented in developing countries, with evidence that they led to improved sexual and reproductive health among adolescents. However, this type of intervention is rarely evaluated for its potential adoption and use. This study evaluated the constraints and enablers of the adoption of a school and community-embedded intervention that used community engagement, capacity building, partnerships and collaborations to deliver sexual and reproductive health services to adolescents. Methods The intervention was implemented between 2019 and 2021 in six local government areas in Ebonyi State. The results on adoption presented here were collected four months into the mid-phase of the project, targeting adolescents, parents, adult family members, healthcare providers, local authorities, and community members. Sixteen in-depth interviews were conducted with policymakers, 14 with health service providers and 18 Focus Group Discussions (FGDs) with parents, community leaders and adolescents who were part of the implementation process. The coding reliability approach, a type of thematic data analysis was used, that involves early theme development and the identification of evidence for the themes. Results The adoption of school and community-embedded reproductive health intervention was strong among stakeholders at the early stages of the implementation process. Multi-stakeholder involvement and its multi-component approach made the intervention appealing, thereby enabling its adoption. However, at the later stage, the adoption was constrained by beliefs and norms about sexual and reproductive health (SRH) and the non-incentivisation of stakeholders who acted as advocates at the community level. The sustainability of the intervention may be threatened by the non-incentivisation of stakeholders and the irregular supply of materials and tools to facilitate SRH advocacy at the community level. Conclusions The inclusive community-embedded reproductive health intervention was adopted by stakeholders because of the enablers which include timely stakeholder engagement. However, for it to be sustainable, implementers must address the non-incentivising of community-level advocates which serve as constraints.

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“…The school-based interventions were co-designed and implemented by a team of researchers from University of Nigeria, and school health focal officers from State Ministry of Health, State Ministry of Education and State Ministry of Information, Ebonyi State [ 22 ]. The study was registered (retrospectively) with ISRCTN registry, with study registration number ISRCTN29711792.…”

Section: Methodsmentioning

confidence: 99%

Sexual and reproductive health information needs; an inquiry from the lens of in-school adolescents in Ebonyi State, Southeast Nigeria

Agu,

Eigbiremolen

et al. 2024

BMC Public Health

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Background It is important to understand the sexual and reproductive health (SRH) needs of adolescents from the adolescents themselves to address their needs properly. Hence, this paper provides new knowledge on the information needs on SRH among adolescent boys and girls in selected secondary schools in Ebonyi state, southeast Nigeria. Method A comparative assessment was conducted among adolescent boys and girls in public secondary schools that received a specific school-based SRH intervention (group A) and those that did not receive the intervention (group B). These schools were spread across six urban and rural local government areas in Ebonyi state, southeast Nigeria. A structured interviewer-administered questionnaire was used to collect data from 514 adolescents aged 13 to 18 on their stated needs for SRH information and services. Categorical variables were compared using the Chi-square test, and predictors were determined using logistic regression analysis. The statistical significance was determined at p < 0.05. Result Majority of the adolescents (82% of intervention group and 92% of non-intervention group) identified puberty and pubertal changes as perceived SRH information need for adolescents (χ2 = 7.94; p-value = 0.01). Adolescents who received SRH intervention have 3.13 (p < 0.001) times the odds of perceiving the need for adolescents to be provided with SRH information than adolescents who did not receive SRH intervention. The odds of perceiving the need for adolescents to be provided with SRH information for adolescents who reside in urban communities are 0.31 (p < 0.001) times the odds for adolescents who resides in rural communities. That is, the perception odds are higher adolescents who reside in rural communities. Multivariate regression of specific SRH information showed the location of residence as a strong predictor of adolescents’ perceived need for information on ‘puberty and pubertal changes’ (OR = 0.30; p = 0.001), ‘safe sex and sexual relations’ (OR = 0.33; p < 0.001) and ‘prevention of pregnancy and use of contraceptives’ (OR = 0.28; p < 0.001). Adolescents in senior secondary school have 2.21 (p = 0.002) times the odds of perceiving the need for adolescents to be provided with specific SRH information than adolescents who are in junior secondary school. Conclusion Adolescents’ age, location of residence, and study group were found to be strong predictors of SRH information needs. This suggests the need for in-school adolescents to be provided with substantial and continuous SRH information for healthy living and making informed SRH choices. In developing SRH interventions that will achieve optimal effectiveness in the lives of adolescents in school, different demographic factors should be considered for context-specific and appropriate strategies.

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Impact of a capacity-building intervention on views and perceptions of healthcare providers towards the provision of adolescent sexual and reproductive health services in southeast Nigeria: a cross-sectional qualitative study

Cited by 4 publications

References 25 publications

Disparities in access to Dolutegravir in West African children, adolescents and young adults aged 0-24 years living with HIV. A IeDEA Pediatric West African cohort analysis

Disparities in access to Dolutegravir in West African children, adolescents and young adults aged 0-24 years living with HIV. A IeDEA Pediatric West African cohort analysis

Factors influencing adoption of sexual and reproductive health intervention for adolescents in Ebonyi, Nigeria

Sexual and reproductive health information needs; an inquiry from the lens of in-school adolescents in Ebonyi State, Southeast Nigeria

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