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Background Nigeria, like many other countries, has been severely affected by the COVID-19 pandemic. While efforts have been devoted to curtailing the disease, a major concern has been its potential effects on the delivery and utilization of reproductive health care services in the country. The objective of the study was to investigate the extent to which the COVID-19 pandemic and related lockdowns had affected the provision of essential reproductive, maternal, child, and adolescent health (RMCAH) services in primary health care facilities across the Nigerian States. Methods This was a cross-sectional study of 307 primary health centres (PHCs) in 30 Local Government Areas in 10 States, representing the six geopolitical regions of the country. A semi-structured interviewer-administered questionnaire was used to obtain data on issues relating to access and provision of RMCAH services before, during and after COVID-19 lockdowns from the head nurses/midwives in the facilities. The questionnaire was entered into Open Data Kit mounted on smartphones. Data were analysed using frequency and percentage, summary statistics, and Kruskal–Wallis test. Results Between 76 and 97% of the PHCS offered RMCAH services before the lockdown. Except in antenatal, delivery and adolescent care, there was a decline of between 2 and 6% in all the services during the lockdown and up to 10% decline after the lockdown with variation across and within States. During the lockdown. Full-service delivery was reported by 75.2% whereas 24.8% delivered partial services. There was a significant reduction in clients’ utilization of the services during the lockdown, and the difference between States before the pandemic, during, and after the lockdown. Reported difficulties during the lockdown included stock-out of drugs (25.7%), stock-out of contraceptives (25.1%), harassment by the law enforcement agents (76.9%), and transportation difficulties (55.8%). Only 2% of the PHCs reported the availability of gowns, 18% had gloves, 90.1% had hand sanitizers, and a temperature checker was available in 94.1%. Slightly above 10% identified clients with symptoms of COVID-19. Conclusions The large proportion of PHCs who provided RMCAH services despite the lockdown demonstrates resilience. Considering the several difficulties reported, and the limited provision of primary protective equipment more effort by the government and non-governmental agencies is recommended to strengthen delivery of sexual and reproductive health in primary health centres in Nigeria during the pandemic. Plain language summary The onset of COVID-19 has raised concerns that it may compromise women’s access to sexual and reproductive health and rights. Although data are still emerging, some reports indicate reduced access to sexual and reproductive health services, largely due to disruptions in the demand and supply of contraceptive commodities, the diversion of staff and resources to other clinical services, and clinic closures. While these concerns have similarly been broached for Nigeria, there has been no systematic documentation of the extent of the disruptions of reproductive health services caused by COVID-19 and its effects on the provision and utilization of related services in the country This study was a cross-sectional facility-based survey conducted in 10 states, 30 Local Government Areas and 302 primary health centres in Nigeria. The objective of the study was to explore through key informant interviews with service providers in the health centres, the effects of the COVID-19 pandemic on demand and supply of sexual and reproductive health services. Field assistants administered a semi-structured interview guide to the heads of the health centres that elicited information on availability and use of the health centres before, during and after the lock-downs associated with the pandemic. The results indicate that a large proportion of the health centres opened for the provision of essential sexual and reproductive health services during the COVID-19 pandemic lockdown. However, fewer clients used the services due to difficulties in travel because of the lockdowns, stock-outs in the health centres, and the fear that they may contract the virus if they leave their houses to the health centres. Although the health centres reported some cases of COVID-19, there was limited provision for personal protective equipment to motivate the health workers to optimize services for clients. From this study, we conclude that efforts should be made to identify innovations for addressing these challenges to enable the continued provision of sexual and reproductive health services by health centres despite the COVID-19 pandemic in Nigeria’s health centres.

While antiretroviral therapy (ART) coverage for pregnant women has undergone steady scale-up, Nigeria's final mother- to-child transmission of HIV (MTCT) rate remains unacceptably high at 10%. This study aimed to determine final outcomes (MTCT rates) and their correlates among HIV-exposed infants (HEI) in nine states and the Federal Capital Territory, Nigeria. This retrospective, cross-sectional study was conducted at 96 primary, secondary and tertiary health facilities supported by the Institute of Human Virology Nigeria. Data was abstracted for a birth cohort of HEI born between October 30, 2014 and April 30, 2015 whose 18-24 month final outcome was assessed by October 30, 2016. Only infants with a six-week first DNA PCR result, and a rapid HIV antibody test result at age 18 to 24 months were included. Multivariate logistic regression (adjusted odds ratios [aORs]) evaluated for predictors of HIV positivity at ≥18 months. After testing at ≥18 months, 68 (2.8%) of the 2,405 exposed infants in the birth cohort were HIV-positive. After a minimum of 18 months of follow-up, 51 (75%) HIV-positive infants were alive on ART; 7 (10%) had died, 5 (7.3%) were lost to follow-up and 5 (7.3%) were transferred out. Rural maternal residence, lack of maternal ART/ARV prophylaxis, mixed infant feeding and infant birth weight less than 2.5 kg correlated with an HIV-positive status for infant final outcomes. The final HIV positivity rate of 2.8% is encouraging, but is not population-based. Nevertheless, supported by our findings, we recommend continued programmatic focus on early access to quality prenatal care and maternal ART for pregnant women, especially for women living with HIV in rural areas. Furthermore, implementation of nationwide sensitization and education on six-months' exclusive infant breastfeeding with concurrent maternal ART should be strengthened and sustained to reduce MTCT rates.

Background COVID-19 pandemic widely disrupted health services provision, especially during the lockdown period, with females disproportionately affected. Very little is known about alternative healthcare sources used by women when access to conventional health services became challenging. This study examined the experiences of women and adolescent girls regarding access to sexual and reproductive health (SRH) services during the COVID-19 lockdown in Nigeria and their choices of alternative healthcare sources. Methods The study sites were two northern states, two southern states, and the Federal Capital Territory. Qualitative data were obtained through 10 focus group discussion sessions held with married adolescents, unmarried adolescents, and older women of reproductive age. The data were transcribed verbatim and analysed using a thematic approach and with the aid of Atlas ti software. Results Women reported that access to family planning services was the most affected SRH services during the COVID-19 lockdown. Several barriers to accessing SRH services during COVID-19 lockdown were reported, including restriction of vehicular movement, harassment by law enforcement officers, fear of contracting COVID-19 from health facilities, and fear of undergoing compulsory COVID-19 tests when seeking care in health facilities. In the face of constrained access to SRH services in public sector facilities during the COVID-19 lockdown, women sought care from several alternative sources, mostly locally available and informal services, including medicine vendors, traditional birth attendants, and neighbours with some health experience. Women also widely engaged in self-medication, using both orthodox drugs and non-orthodox preparations like herbs. The lockdown negatively impacted on women’s SRH, with increased incidence of sexual- and gender-based violence, unplanned pregnancy resulting from lack of access to contraceptives, and early marriage involving adolescents with unplanned pregnancies. Conclusion COVID-19 negatively impacted access to SRH services and forced women to utilise mostly informal service outlets and home remedies as alternatives to conventional health services. There is a need to ensure the continuity of essential SRH services during future lockdowns occasioned by disease outbreaks. Also, community systems strengthening that ensures effective community-based health services, empowered community resource persons, and health-literate populations are imperative for overcoming barriers to healthcare access during future lockdowns.

Background: The prevalence of HIV among young people aged 15–19 years in Nigeria is estimated as 3.5%, the highest among West and Central African countries. Comprehensive knowledge of HIV is associated with increased awareness of preventive interventions and a reduction in the spread of HIV. Therefore, this article seeks to assess and determine the associated factors of comprehensive HIV knowledge among youths in Nigeria. Methods: The study used the 2018 Nigerian Demographic Health Survey, a cross-sectional survey that employed a two-stage cluster sampling method. Comprehensive knowledge of HIV was assessed based on five questions. The data were analysed separately for men and women aged 15–24 years. A multivariable log-binomial regression model was used to determine factors associated with comprehensive HIV knowledge. All analysis was performed using Stata 15.0 and adjusted for weighting, clustering and stratification. Results: A total of 15,267 women and 4019 men aged 15–24 years were included in this study. The prevalence of comprehensive knowledge of HIV was higher among women than among men (42.6% versus 33.7%; p < 0.001) and lower among younger ages 15–17 years compared with other ages. The findings revealed that age, ethnicity, wealth, education and exposure to mass media were statistically significant factors associated with comprehensive knowledge of HIV. In addition, religion, place of residence, phone ownership, internet use, currently working and having initiated sex were significant factors among women and modern contraceptive use among men. Conclusion: Key findings from this study imply that public health programmes in Nigeria should focus on providing information on HIV/AIDS using different approaches, including comprehensive sex education as well as health promotion and education strategies in the formal and informal sectors. Because media exposure is a common and cost-effective way of public health promotion and education in modern times, emphasis could also be placed on using this channel to reach the target population.

Background Little is known about the oral health profile of forcibly displaced persons (internally displaced persons (IDPs), and refugees), and migrants in Nigeria, despite being one of the largest communities of people with humanitarian service needs in the world. This study assessed the associations between dental caries prevention knowledge, self-care dental caries preventive practices, and dental caries prevention knowledge among IDPs, refugees, and migrants in Nigeria. Methods This was a secondary analysis of the data of a cross-sectional study conducted in five states in Nigeria—Borno, Taraba, Yobe, Cross River, and Benue— with large populations of refugees, IDPs, and migrants in December 2024. The data of 1554 women (IDPs: 690; migrants: 281; and refugees: 583) who had children in their care were extracted for this study. The data extracted were the dependent variables (knowledge of dental caries prevention, daily use of fluoridated toothpaste, daily tooth brushing frequency, and daily frequency of consumption of refined carbohydrates between meals), the confounding variables (educational level, current marital status, and age at last birthday), and the independent variables (IDPs, refugees, and migrants’ status). Multivariable logistic regression models were used to determine the associations between the dependent and independent variables after adjusting for the confounders. Results Both IDPs (AOR: 3.68, p  < 0.001) and migrants (AOR: 3.89, p  < 0.001) had significantly higher odds of good dental caries prevention knowledge compared to refugees. On the other hand, IDPs (AOR = 0.22, p  < 0.001) and migrants (AOR: 0.56, p  < 0.001) were less likely to brush twice daily than refugees. of daily use of fluoride-containing toothpaste every time or almost every time than refugees, but the difference was not statistically significant. On the converse, both IDPs and migrants had lower odds of consumption of refined carbohydrates in-between-meals daily, but the difference was not statistically significant. Conclusion Although IDPs and migrants demonstrated better knowledge of dental caries prevention compared to refugees, they seemed less likely than refugees to brush twice daily. This highlights a disconnect between knowledge and practices in displacement settings. Studies are needed to explore contextual drivers of dental caries preventive knowledge and practices among IDPs, migrants, and refugees.

Reports from various parts of the world suggest that the COVID-19 pandemic may have severe adverse effects on the delivery and uptake of reproductive health, maternal, neonatal, and child health (RMNCH) services. The objective of the study was to explore women's experiences with utilization of RMNCH services during the COVID-19 pandemic in Nigeria, and to elicit their perceptions on ways to sustain effective service delivery during the pandemic. A cross-sectional survey of 2930 women using primary health care facilities for antenatal, delivery, postnatal, and child care services before and after the onset of the pandemic in 10 States of Nigeria were interviewed with a semi-structured questionnaire. Data were collected on women's socio-demographic characteristics and pregnancy histories, the services they sought before and after the pandemic, the challenges they faced in accessing the services, their use of alternative sources of health care, and their recommendations on ways to sustain RMNCH service delivery during the pandemic. The data were analyzed with descriptive statistics, and multivariable logistic regression using SPSS 20.0. All the statistical analyses were two-tailed with a 95% confidence interval, and the p-value was set at 0.05. The logistic regression results showed that women were at least 56% more likely to report that they used family planning, antenatal, and delivery services before the pandemic than after the pandemic started, but 38% less likely to report use of postnatal services. The experience of difficulty accessing RMNCH services was 23% more likely after the pandemic started than before the pandemic. Three categories of recommendations made by the respondents on measures to sustain RMNCH delivery during the pandemic included 1) facility improvement, and staff recruitment and re-training; 2) free and readily accessible PHC services, and 3) the provision of social safety nets including transportation and palliatives. We conclude that the COVID-19 pandemic limited women's access to antenatal, delivery, and childcare services offered in PHCs in Nigeria. Addressing the recommendations and the concerns raised by women will help to sustain the delivery of RMNCH services during the COVID-19 pandemic and future epidemics or health emergencies in Nigeria.

ObjectivesTo examine family planning through the community’s perception, belief system and cultural impact; in addition to identifying the determining factors for family planning uptake.DesignA descriptive exploratory study.SettingThree communities were selected from three local government areas, each in the three senatorial districts in Ekiti State.ParticipantsThe study was conducted among young unmarried women in the reproductive age group who were sexually active as well as married men and women in the reproductive age group who are currently living with their partners and were sexually active.Main outcome measuresEight focus group discussions were conducted in the community in 2019 with 28 male and 50 female participants. The audio recordings were transcribed, triangulated with notes and analysed using QSR NVivo V.8 software. Community perception, beliefs and perceptions of the utility of family planning, as well as cultural, religious and other factors determining family planning uptake were analysed.ResultsThe majority of the participants had the perception that family planning helps married couple only. There were diverse beliefs about family planning and mixed reactions with respect to the impact of culture and religion on family planning uptake. Furthermore, a number of factors were identified in determining family planning uptake—intrapersonal, interpersonal and health system factors.ConclusionThe study concluded that there are varied reactions to family planning uptake due to varied perception, cultural and religious beliefs and determining factors. It was recommended that more targeted male partner engagement in campaign would boost family planning uptake.

This study assesses the sexual and reproductive health (SRH) needs and barriers faced by youth living with HIV/AIDS in Lagos State, Nigeria. Conducted between September and December 2022, the cross-sectional survey involved 117 participants from HIV support groups, with a mean age of 18.6±2.6 years. Most participants were female (57.3%), and 47% had lost one or both parents. While 78.6% were aware of male condoms, only 33.3% reported being sexually active, and just 41% demonstrated good SRH knowledge. Key SRH needs included access to youth-friendly services, comprehensive education, diverse contraceptive options, support for HIV status confidentiality, as well as transportation assistance. Barriers to service utilisation were fear of HIV disclosure (66.7%) and transportation costs (59.8%). Sexual activity was significantly associated with contraceptive use (p=0.001) and being in a relationship (p<0.001). Regression analysis revealed that contraceptive use increased the odds of sexual activity 3.3 times (aOR 3.32, 95% CI 1.134-9.744, p=0.029), while being in a relationship raised it by 5.9 times (aOR 5.96, 95% CI 2.126-16.747, p=0.001). The findings underscore the need for targeted policies and programs to enhance access to SRH services and address the unique needs of youth living with HIV/AIDS in Lagos State.

This study assesses the sexual and reproductive health (SRH) needs and barriers faced by youth living with HIV/AIDS in Lagos State, Nigeria. Conducted between September and December 2022, the cross-sectional survey involved 117 participants from HIV support groups, with a mean age of 18.6±2.6 years. Most participants were female (57.3%), and 47% had lost one or both parents. While 78.6% were aware of male condoms, only 33.3% reported being sexually active, and just 41% demonstrated good SRH knowledge. Key SRH needs included access to youth-friendly services, comprehensive education, diverse contraceptive options, support for HIV status confidentiality, as well as transportation assistance. Barriers to service utilisation were fear of HIV disclosure (66.7%) and transportation costs (59.8%). Sexual activity was significantly associated with contraceptive use (p=0.001) and being in a relationship (p<0.001). Regression analysis revealed that contraceptive use increased the odds of sexual activity 3.3 times (aOR 3.32, 95% CI 1.134–9.744, p=0.029), while being in a relationship raised it by 5.9 times (aOR 5.96, 95% CI 2.126–16.747, p=0.001). The findings underscore the need for targeted policies and programs to enhance access to SRH services and address the unique needs of youth living with HIV/AIDS in Lagos State.

Background Forcibly displaced populations, refugees, and internally displaced persons (IDPs), and migrants face distinct challenges, increasing vulnerability to HIV infection and substance use disorders. This study assessed the associations between psychological distress, alcohol consumption, substance use, and HIV risk behaviour among these populations in Nigeria. Methods This was a secondary analysis of the data of a cross-sectional study, collected in five states in Nigeria (Benue, Borno, Cross Rivers, Taraba, and Yobe), in December 2024. Data collected included the dependent variable (HIV risk behavior), independent variables (psychological distress level, substance use, and alcohol consumption), and confounding variables (age, sex at birth, sexual orientation, educational level, marital status, employment/occupational status, and religious status). A stepwise approach was used in the building of four models. Model 1 presented the unadjusted bivariate analysis. Model 2 was the adjusted multivariate logistic regression. Model 3 assessed the interaction effect of psychological distress level, alcohol consumption, substance use, and being IDP on HIV risk behaviour, and Model 4 assessed the same interaction for refugees. Results The sample of 3,211 participants included 1237 (38.5%) migrants, 1497 (46.6%) IDPs, and 477 (14.9%) refugees. Among participants, moderate (AOR: 1.46; 95% CI: 1.38–1.56; p  < 0.001) and high (AOR: 1.70; 95% CI: 1.57–1.85; p  = 0.01) psychological distress significantly increased the odds of high-risk sexual behaviour. IDPs had the highest odds of engaging in risky behaviour compared to migrants (AOR: 1.59; 95% CI: 1.32–1.92; p  = 0.02). Substance use further amplified risk, particularly for IDPs (OR: 3.17; 95% CI: 2.11–3.72; p  < 0.001) and refugees (OR: 2.09; 95% CI: 2.02–2.37; p  < 0.001) compared to migrants. No significant association was found between alcohol consumption and HIV risk behaviour. Conclusion This study highlights the compounded vulnerability of IDPs and refugees, driven by psychological distress and substance use. Findings underscore the urgent need for integrated interventions addressing mental health, substance use, and HIV prevention tailored to forcibly displaced populations in Nigeria.