Scholarly works in Health Promotion and Education
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Item Contextual factors influencing the roles of patent medicine vendors in the provision of injectable contraception services in Nigeria(Springer Nature, 2023) Adebayo, A. M.; Oluwasanu, M. M.; Okunade, F. T.; Ajayi, O. O.; Akindele, A. O.; Ajuwon, A. J.Background Patent medicine vendors (PMVs) play vital roles in the delivery of family planning services in Nigeria and other developing countries. There is a growing recognition of the need to integrate them into the formal health care system as a strategy to increase the contraceptive prevalence rate and achieve universal health coverage.Though promising, the success of this proposition is largely dependent on a critical analysis of the factors which influence their operations. This study was designed to identify the contextual factors influencing the provision of injectable contraceptive services by PMVs and the broader effects of their activities on the health system to inform similar interventions in Nigeria. Methods This was a qualitative study guided by the UK Medical Research Council’s Framework for Complex Interventions. Twenty-seven in-depth interviews were conducted among officials of the association of PMVs, health workers, government regulatory officers and programme implementers who participated in a phased 3-year (2015–2018) intervention designed to enhance the capacity of PMVs to deliver injectable contraceptive services. The data were transcribed and analyzed thematically using NVIVO software. Results The contextual factors which had implications on the roles of PMVs were socio-cultural and religious, the failing Nigerian health system coupled with government regulatory policies. Other factors were interprofessional tensions and rivalry between the PMVs and some categories of health care workers and increasing donors’ interest in exploring the potentials of PMVs for expanded healthcare service provision. According to the respondents, the PMVs bridged the Nigerian health system service delivery gaps serving as the first point of contact for injectable contraceptive services and this increased contraceptive uptake in the study sites. A negative effect of their operation is the tendency to exceed their service provision limits, which has spurred a planned tiered PMV accreditation system. Conclusions This study has highlighted the contextual factors which define the roles and scope of practice of PMVs involved in injectable contraceptive service provision. Strategies and interventions aimed at expanding the healthcare delivery roles of PMVs must be encompassing to address the broader contextual factors which underpin their capacities and functions.Item Temporal trends in overweight and obesity and chronic dease risks among adolescents and young adults: A ten-year review at a tertiary institution in Nigeria(Public Library of Science (PLoS), 2023) Oluwasanu, A. O.; Akinyemi. J. O.; Oluwasanu, M. M.; Oseghe, O. B.; Oladoyinbo, O. L.; Bello, J.; Ajuwon, A. J.; Jegede, A. S.; Danaei, G.; Akingbola, O.There is an increasing prevalence of obesity among college/university students in low- and middle-income countries, similar to the trend observed in high-income countries. This study aimed to describe the trend and burden of overweight/obesity and emerging associated chronic disease risks among students at the University of Ibadan (UI), Nigeria. This is a ten-year retrospective review of medical records of students (undergraduate and post-graduate) admitted between 2009 and 2018 at UI. Records of 60,168 participants were analysed. The Body Mass Index (BMI) categories were determined according to WHO standard definitions, and blood pressure was classified according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7). The mean age of the participants was 24.8, SD 8.4 years. The majority were ≤ 40 years (95.1%). There was a slight male preponderance (51.5%) with a male-to-female ratio of 1.1:1; undergraduate students constituted 51.9%. The prevalence of underweight, overweight, and obesity were 10.5%, 18.7% and 7.2%, respectively. We found a significant association between overweight/obesity and older age, being female and undergoing postgraduate study (p = 0.001). Furthermore, females had a higher burden of coexisting abnormal BMI characterised by underweight (11.7%), overweight (20.2%) and obese (10.4%). Hypertension was the most prevalent obesity-associated non-communicable disease in the study population, with a prevalence of 8.1%. Also, a third of the study population (35.1%) had prehypertension. Hypertension was significantly associated with older age, male sex, overweight/obesity and family history of hypertension (p = 0.001). This study identified a higher prevalence of overweight and obesity than underweight among the participants, a double burden of malnutrition and the emergence of non-communicable disease risks with potential lifelong implications on their health and the healthcare system. To address these issues, cost-effective interventions are urgently needed at secondary and tertiary-level educational institutions.Item Process evaluation of an intervention to improve access to injectable contraceptive services through patent medicine vendors in Nigeria: a mixed methods study(Springer Nature, 2021) Oluwasanu M. M.; Adebayo, A. M.; Okunade, F. T.; Ajayi, O.; Akindele, A. O.; Stanback, J.; Ajuwon, A. J.Background: The low utilisation of modern contraceptives in many low- and middle-income countries remains a challenge. Patent medicine vendors (PMVs) that operate in the informal health sector, have the potential to address this challenge. Between 2015 and 2018, the Population Council, in collaboration with the Federal and State Ministries of Health and the Pharmacy Council of Nigeria, trained PMVs in six states to deliver injectable contraceptive services. Outcome evaluation demonstrated increased client uptake of injectable contraceptive services; however, there is limited information on how and why the intervention influenced outcomes. This study was conducted to elucidate the processes and mechanism through which the previous intervention influenced women’s utilisation of injectable contraceptive services. Methods: The study utilised a mixed methods, convergent parallel design guided by the UK Medical Research Council framework. Quantitative data were obtained from 140 trained PMVs and 145 of their clients in three states and 27 in-depth interviews were conducted among relevant stakeholders. The quantitative data were analysed descriptively, while the qualitative data were analysed thematically. Results: The results revealed that even after the completion of the PMV study which had a time-bound government waiver for injectable contraceptive service provision by PMVs, they continued to stock and provide injectables in response to the needs of their clients contrary to the current legislation which prohibits this. The causal mechanism that influenced women’s utilisation of injectable contraceptives were the initial training that the PMV received; the favourable regulatory environment as demonstrated in the approval provided by government for PMVs to provide injectable contraceptives for the duration of the study; and the satisfaction and the confidence the female clients had developed in the ability of the PMVs to serve them. However, there were gaps with regards to the consistent supply of quality injectable contraceptive commodities and in PMVs use of job aids. Referral and linkages to government or private-owned facilities were also sub-optimal. Conclusion: PMVs continue to play important roles in family planning service provision; this underscores the need to formalize and scale-up this intervention to aid their integral roles coupled with multi-faceted initiatives to enhance the quality of their services.Item Emergency contraceptive pill knowledge, attitudes and dispensing practices of pharmacists in Ibadan and Lagos metropolis, Nigeria(2010-12) Omotoso, O.; Ajuwon, A. J.Use of Emergency Contraceptive Pills (ECP) is desirable in Nigeria where there is high rate of unwanted pregnancy. Pharmacists are expected to play important role in promoting use of ECP but few studies have assessed their knowledge, attitude and dispensing practice of this product in Nigeria. A total of 211 randomly selected pharmacists practicing in Ibadan and Lagos metropolis completed a questionnaire that assessed knowledge about ECP, attitude towards this contraceptive and actual dispensing practices. The results showed that the mean age of the respondents was 38.8 (±10.9) years. There were more male (57.3%) than female respondents (42.7%). The overall mean knowledge scores for the sample was 8.9 (SD: 2.6) out of 18. No significant difference was found in mean knowledge score of male (9.0) (± 2.6) and female respondents (8.9) (±2.8) (p>0.05). Respondents who had practiced for up to 30 years had significantly higher score (9.1) than those with less years of experience (7.7) (p< 0.05). Forty-three percent claimed they had religious or moral (46.9%) objection to dispensing ECP. The majority (79.1%) had ever dispensed ECP whereas 21.9% had never done so. Of the 167 respondents who had ever dispensed, 94.6% had a stock of ECP on the day of their interview. More respondents from Ibadan than Lagos had ever dispensed ECP (p<0.05). More community (80%) than hospital based (60%) pharmacists had dispensed ECP (p<0.05). Only 17.5% of those who had ever dispensed ECP had ever received a formal training on the mode of action of this drug. Although majority had dispensed ECP, their knowledge of the drug is limited. There is need for pharmacists to receive continue education on ECP to enable them serve better the clients who need this service.Item Community-directed interventions for priority health problems in Africa: results of a multicountry study(2010) Ajuwon, A. J.Objective: To deterrnine the extent to which the community-directed approach used in onchocerciasis control in Africa could effectively and efficiently provide integrated delivery of other health interventions. Methods: A three-year experirnental study was undertaken in 35 health districts from 2005 to 2007 in seven research sites in Carneroon, Nigeria and Uganda. Four trial districts and one comparison district were randomly selected in each site. All districts had established ivermectin treatment programmes, and in the trial districts four other established interventions - vitamin A supplementation, use of insecticide-treated nets, home management of malaria and short-course, directly-observed treatment for tuberculosis patients - were progressively incorporated into a community-directed intervention (CDI) process. At the end of each of the three study years, we performed quantitative evaluations of intervention coverage and provider costs, as well as qualitative assessments of the CDI process. Findings with the CDI strategy, significantly higher coverage was achieved than with other delivery approaches for all interventions except for Short-course, directly-observed treatment. The coverage of malaria interventions more than doubled. The district-level costs of delivering all five interventions were lower in the CDI districts, but no cost difference was found at the first-line health facility level. Process evaluation showed that: (i) participatory processes were important; (ii) recurrent problerns with the supply of intervention materials were a major constraint to implementation; (iii) the communities and community implementers were deeply committed to the CDI process; (iv) community implementers were more motivated by intangible incentives than by external financial incentives. Conclusion The CDI strategy, which builds upon the core principles of primary health care, is an effective and efficient model for integrated delivery of appropriate health interventions at the community level in Africa.