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BackgroundThe maternal, newborn and child health care continuum require that mother/child pair should receive the full package of antenatal, intrapartum and postnatal care in order to derive maximum benefits. Continuity of care is a challenge in sub-Saharan Africa. In this study, we investigate the patterns and factors associated with dropout in the continuum of maternity (antenatal, delivery and postnatal) care in Nigeria.MethodUsing women recode file from the 2013 Nigeria Demographic and Health Survey, we analysed data on 20,467 women with an index birth within 5 years prior to data collection. Background characteristics and pattern of dropouts were summarised using descriptive statistics. The outcome variable was dropout which we explored in three stages: antenatal, antenatal-delivery, delivery-6 weeks postnatal visit. Multilevel logistic regression models were fitted to identify independent predictors of dropout at each stage. Measure of effect was expressed as Odds Ratio (OR) with 95 % confidence interval (CI).ResultsOverall, 12,392 (60.6 %) of all women received antenatal care among whom 38.1 % dropout and never got skilled delivery assistance. Of those who received skilled delivery care, 50.8 % did not attend postnatal visit. The predictors of dropout between antenatal care and delivery include problem with getting money for treatment (OR = 1.18, CI: 1.04–1.34), distance to health facility (OR = 1.31, CI: 1.13–1.52), lack of formal education, being in poor wealth quintile (OR = 2.22, CI: 1.85–2.67), residing in rural areas (OR = 1.98, CI: 1.63–2.41). Regional differences between North East, North West and South West were significant. Between delivery and postnatal visit, the same factors were also associated with dropout.ConclusionThe rate of dropout from maternity care continuum is high in Nigeria and driven by low or lack of formal education, poverty and healthcare access problems (distance to facility and difficulty with getting money for treatment). Unexpectedly, dropouts are high in South east and South south as well as in the Northern regions. Intervention programs focusing on community outreach about the benefits of continuum of maternal healthcare package should be introduced especially for women in rural areas and lower socio-economic strata.

It is not clear whether the 16% unmet need for contraceptives in Nigeria indicates a success story. This study assessed the contraceptive prevalence rate (CPR), total contraceptive demand, and unmet needs and determined the distribution, determinants, and barriers to contraceptive demands and unmet needs in Nigeria. The fertility, breastfeeding, and contraceptive use information provided by 27,829 women who were either currently married or in a sexual union in the 2013 Nigeria Demographic and Health Survey (NDHS) were extracted. Associations between having unmet needs and the demographic, socioeconomic, and reproductive profiles of the respondents were assessed using bivariate and multiple logistic regression at 5% significance level. Multiple response data analysis techniques were used to assess barriers to nonuse of contraceptives. Data were weighted to reflect differentials in the population of in-union women in each geographical state. The modern CPR was 9.8% while total demand for contraception was 31.2%, consisting of unmet need at 16.1% and met needs at 15.1%. Unmet need for family planning was higher among rural women compared with urban women (16.8% vs. 14.9%); younger women (adjusted odds ratio [aOR] = 4.29; confidence interval [CI] = [3. 03, 6.07]), women belonging to poorer economic status (aOR = 2.27, CI = [1.92, 2.68]), and women with no education (aOR = 3.23, CI = [2.60, 4.02]) had higher odds of unmet needs. The low unmet need should not be mistaken for a good progress in family planning programming in Nigeria; the success is better measured using the level of total demand for contraceptives and CPR. Interventions to improve the socioeconomic status of women, increase the knowledge of modern contraceptives, and improve women's decision-making power should be prioritized.

Background Delays in diagnosis and treatment of pulmonary tuberculosis are a major set-back to global tuberculosis control. There is currently no global evidence on the average delays thus, the most important contributor to total delay is unknown. We aimed to estimate average delay measures and to investigate sources for heterogeneity among studies assessing delay measures. Methods Systematic review of studies reporting mean (± standard deviation) or median (interquartile range, IQR) of patient, doctor, diagnostic, treatment, health system and/or total delays in journal articles indexed in PubMed. We pooled mean delays using random-effects inverse variance meta-analysis, investigated for variations in pooled estimates in subgroup analyses and explored for sources of heterogeneity using pre-specified explanatory variables. Results The systematic review included 198 studies (831,724 patients) from 78 countries. The median number of patients per study was 243 (IQR; 160–458) patients. Overall, the pooled mean total delay was 87.6 (95% CI: 81.4–93.9) days. The most important and largest contributor to total delay was patient delay with a pooled mean delay of 81 (95% CI: 70–92) days followed by doctor’s delay and treatment delay with pooled mean delays of 29.5 (95% CI: 25.9–33.0) and 7.9 (95% CI: 6.9–8.9) days respectively. There was considerable heterogeneity in all pooled analyses (I 2 > 95%). In the meta-regression models of mean delays, studies excluding extra-pulmonary tuberculosis patients reported increased mean doctor’s delay by 45 days on average, non-use of chest x-ray and conducting studies in high income countries decreased mean treatment delay by 20 and 22 days on average, respectively. Conclusion Strategies to address patients’ delay could have important implications for the success of the global tuberculosis control programmes.

Background Nigeria, a patriarchal society, is one of the more impoverished countries of the world and while its fertility and population growth rates are high, its modern contraceptive (MC) prevalence rate is low. The wealth status and decisionmaking power of a woman have implications on their use of MC. Studies that examined the relationship between women's empowerment, wealth index and MC use in Nigeria are scarce. Methods A national representative cross-sectional data on women of reproductive age (n = 5,098) was used. Data were analysed using Chi-square and interactive logistic regression models (α = 0.05). Results Mean age of the women was 32.9(σ = 8.0) and 23.8 % were currently using MC. Current use of MC was found to be higher among the following: Yoruba (48.5 %) than Igbo (27.3 %) and Hausa women (2.9 %); highly (36.9 %) than poorly empowered women (12.1 %); upper class (35.0 %) than lower class (5.9 %); and Christians (35.5 %) than Muslims (12.6 %; p < 0.001). Injectables and condoms were the most reported MC method currently used. In the interactive model, being in lower class and poorly empowered inhibits current use of MC. The predictors of current use of MC when wealth index and women empowerment were used either jointly or interactively in the controlled regression equation were wealth index, region, education, religion, ethnicity, family planning information access on media, receiving family planning information at health facility and living children sex composition. Conclusion Modern contraceptive prevalence rate among Nigerian women was low particularly among the lower class and poorly empowered. Strategies to improve the use of MC should target women in the lower class in Nigeria.