Menu
Menu
Menu
Menu
Introduction. Uptake of antenatal services is low in Nigeria; however, indicators in the Christian-dominated South have been better than in the Muslim-dominated North. This study evaluated religious influences on utilization of general and HIV-related maternal health services among women in rural and periurban North-Central Nigeria. Materials and Methods. Targeted participants were HIV-positive, pregnant, or of reproductive age in the Federal Capital Territory and Nasarawa. Themes explored were utilization of facility-based services, provider gender preferences, and Mentor Mother acceptability. Thematic and content approaches were applied to manual data analysis. Results. Sixty-eight (68) women were recruited, 72% Christian and 28% Muslim. There were no significant religious influences identified among barriers to maternal service uptake. All participants stated preference for facility-based services. Uptake limitations were mainly distance from clinic and socioeconomic dependence on male partners rather than religious restrictions. Neither Muslim nor Christian women had provider gender preferences; competence and positive attitude were more important. All women found Mentor Mothers highly acceptable. Conclusion. Barriers to uptake of maternal health services appear to be minimally influenced by religion. ANC/PMTCT uptake interventions should target male partner buy-in and support, healthcare provider training to improve attitudes, and Mentor Mother program strengthening and impact assessment.
The venues for this qualitative study were one urban community and 6 periurban and rural Primary Healthcare Centers (PHCs) located in the Federal Capital Territory (FCT) and Nasarawa State in North-Central Nigeria. The 6 sites were selected from a list of 26 study-eligible PHCs assessed for a large implementation research study conducted in rural and hard-to-reach areas of the aforementioned states (see Section 2.2). The 2006 National Census survey reported populations for FCT and Nasarawa at 1,406,239 and 1,869,377, respectively [23]. As of 2013, the population of Nasarawa comprised 56.7% Christians and 41.1% Muslims [8], while FCT comprised 68.0% Christians and 27.4% Muslims [7]. General population HIV prevalence in Nasarawa and FCT is 8.1% and 7.5%, respectively [7]. The most recent antenatal HIV seroprevalence survey reported 7.5% for Nasarawa and 8.6% for FCT, against a national antenatal seroprevalence of 4.1% [24]. Study population included pregnant ANC attendees, HIV-positive women, and young women of childbearing age. Focus Group Discussions (FGDs) were conducted as part of the MoMent Nigeria study, a Canadian government-funded and World Health Organization-supported PMTCT implementation research project under the 6-study, 3-country INSPIRE initiative [25]. MoMent Nigeria investigates the impact of trained peer HIV-positive counselors (Mentor Mothers) on PMTCT outcomes for HIV-positive women and HIV-exposed infants [26]. MoMent’s formative aspect explored barriers to PMTCT access and uptake, and acceptability of Mentor Mothers as a viable intervention [26]. Participants from the PHCs were first approached as they attended clinic or were contacted by phone by PHC healthcare workers and briefly informed of the study. Young females were recruited from the National Youth Service Corps; they were providing 12 months of community service in FCT and in Nasarawa. Given the staff profiles of the study PHCs and other healthcare facilities in the surrounding study communities, all study participants had been exposed to both male and female Sexual and Reproductive Health or maternal service providers. Women 18 years of age and over were recruited on a rolling basis according to the target focus group, for example, ANC attendees or HIV-positive women; no other specifications were applied for recruitment. Recruitment was stopped once a target of 10 women had been reached for each FGD. Interested participants showed up for the FGD on the appointed date. The study was fully explained and consent sought by study staff. Written participant consent was obtained prior to initiation of all the FGDs. Participants received refreshments and reimbursements commiserate with transport costs applicable to the day of the FGD only. The qualitative study time period was December 2012 to April 2013. Ethical approval was granted by the Institutional Review Boards of the Institute of Human Virology Nigeria and the University of Maryland, Baltimore. Two FGDs were conducted among Mentor Mothers, 2 among pregnant ANC clinic attendees, 2 among mother-to-mother (M2M) HIV support group members, and 1 with young women, totaling 7 FGDs. An interviewer-administered form was used to capture participants’ sociodemographic information such as religious affiliation, age, place of residence, marital status, and parity. Religious affiliation data was collected only after consent was provided and as such the focus groups were a mixture of both Muslim and Christian women. The FGDs were guided by semistructured questionnaires organized thematically as follows: barriers to uptake of ANC services (cost, distance, quality of ANC service, and attitude of healthcare providers), women’s views and experiences as members of M2M groups, and/or being Mentor Mothers, use of unconventional healthcare services or remedies, stigma related to HIV+ status, gender preference for a healthcare provider, and acceptability of Mentor Mother services. FGD facilitators comprised two Social Science professors as well as health professionals (doctors, nurses) and graduate students trained to conduct FGDs. A moderator and comoderator facilitated all FGDs along with at least one observer documenting synergistic group effects and nonverbal cues. Sessions were conducted in English and/or Hausa (the dominant language of the study communities). Bilingual (English and Hausa) facilitators were involved in the conduct, transcription, and analysis of all the FGDs. To maintain anonymity and establish a conducive atmosphere for discussion, participants used self-chosen aliases for each FGD. Each FGD was audio-recorded and lasted approximately 60–90 minutes. Audio recordings were transcribed verbatim; Hausa sessions were transcribed into English by bilingual study staff. FGD transcripts were assigned to 4 groups of 2 coders each. Coders were the same trained individuals who facilitated and transcribed the FGDs. Each group member independently hand-coded their assigned transcript by reviewing each line, phrase, and paragraph to identify the initial key themes. Subsequently, each coding group met separately and then with all other groups, for review and merging of independently analyzed and coded transcripts into a final document. This stage was succeeded with a joint review of each of the 5 groups’ finalized transcripts by the entire team (a panel of 10 researchers from the 4 groups, facilitated by two Social Science professors). In this validation process, codes and themes were examined for content within the context of the document and thematically in relation to the overall interview guide. The resultant data were combined into one matrix to develop visual charts of the words and phrases that represented the themes discovered during analysis. In order to protect the privacy of the respondents and organizations, names of persons and institutions were deleted in the final report.
N/A
