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 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 FACTORS INFLUENCING MODERN CONTRACEPTIVE CHOICES AMONG WOMEN ATTENDING THE FAMILY PLANNING CLINIC UNIVERSITY COLLEGE HOSPITAL IBADAN(2015-06) MAKINDE, A.O.Choices about childbearing and contraceptive use are important health decisions. Restriction of choices and lack of information on methods is a constraint for contraceptive users to obtain a method that suits their needs, thereby resulting in lower levels of contraceptive uptake. Hence, this study was designed to assess the factors influencing modern contraceptive choices among women attending the family planning clinic of University College Hospital, Ibadan. A cross-sectional study using systematic random sampling technique to select 341 consenting women was conducted. A pre-tested interviewer-administered questionnaire which contained respondents' demographic characteristics, factors influencing the choice of modern contraceptives, factors responsible for continuation of chosen method of contraception, previous and current experiences relating to contraceptive use and level of satisfaction with modern contraceptive was adopted. Contraceptive continuation scores were categorised into unlikely (≤ 4), likely (5-6) and very likely (≥7). Satisfaction scores of ≤ 6 and ˃ 6 were categorized as low and high respectively. Data were analysed using descriptive statistics, Chi-square and multinomial logistic regression at 5% level of significance. Age of the respondents was 35.5 ± 6.4 years; 99.4% were married and 89.0% were in monogamous marriage. Forty-seven percent had tertiary education and 41.3% had senior secondary school certificate. Current method of contraception was influenced by perceived effectiveness (72.8%) and few side effects (56.1%). Implant was the commonest choice for women with secondary (48.2%) and tertiary education (42.9%) while IUCD (22.7%) and injectables (18.6%) was the least common respectively. Majority (78.5%) reported irregular menstruation, weight gain/loss (27.2%), breast tenderness (5.0%), stomach pain (4.1%) and frequent headache (1.7%). Of the 121 women that encountered problems, 85.0% were likely to continue, 6.1% likely to adopt traditional methods while 6.1% would rather opt out completely. However, among the 213 that had not encountered problems, 60.0% were likely to continue and 19.0% were very likely to continue their chosen methods even if they eventually encounter problem. A significant association was found between satisfaction with modern contraception and continuation. Factors influencing continuation of chosen method included availability (95.9%), easy discontinuation of method (90.3%) and husband support (88.3%). A major reason for being satisfied with chosen method was adequate information before choice (98.2%). A significant association was found between the chosen modern contraceptive and higher level of education. Husbands with secondary and higher education had significant influence on the kind of contraceptive chosen by their wives. Women whose choice of a particular method was not because it had worked for their mothers were twice (OR=0.54, 95%: 0.39-0.94) less likely to have chosen IUCD over implant than women who said yes. Women who had secondary education were (0R=0.44, 95% CI: 0.24-0.82) less likely to have chosen IUCD over implant than women who had tertiary education. Higher level of education and previous use of contraceptives by respondents’ mothers are factors influencing modern contraceptive choices. More emphasis should be geared towards public awareness and sensitization on the availability of various modern contraceptive methods. Advocacy on girl child education should be intensified.