Table of Contents - Issue
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Effect of Transport Cash Incentives on Routine Immunization Uptake Among Caregivers in Rural Communities. A Case Study of Gwiwa LGA, Jigawa State, NigeriaAuthor: Sani H, AbubakarDOI: 10.21522./TAJMHR.2016.06.01.Art001
Effect of Transport Cash Incentives on Routine Immunization Uptake Among Caregivers in Rural Communities. A Case Study of Gwiwa LGA, Jigawa State, Nigeria
Abstract:
Routine immunization remains a critical public health strategy for reducing child morbidity and mortality, yet coverage in many developing regions continues to face significant challenges. This study examined the socio-demographic characteristics of caregivers, the effect of cash incentives, and barriers to attending immunization sessions. A total of 107 respondents participated in the survey, and data were analyzed using descriptive statistics. The results revealed that most caregivers were women within the reproductive age group, with low levels of formal education and limited income, factors that significantly influenced their health-seeking behavior. Despite the provision of cash incentives, distance to health facilities (74.8%) and lack of transport or money (45.8%) remained major barriers to attendance. However, the majority of respondents strongly agreed (69.2%) or agreed (24.3%) that financial incentives positively influenced their decision to attend immunization sessions. Other barriers, such as busy schedules, health concerns, and fear of side effects, were reported but had a less significant impact. The findings suggest that while financial incentives play a crucial role in improving uptake, structural and socioeconomic barriers persist in hindering access. The study concludes that a multifaceted approach—addressing transportation, accessibility, health education, and community awareness in addition to financial support—is necessary to achieve sustainable improvements in immunization coverage and child health outcomes.
Effect of Transport Cash Incentives on Routine Immunization Uptake Among Caregivers in Rural Communities. A Case Study of Gwiwa LGA, Jigawa State, Nigeria
References:
[1]. WHO, 2020, Routine immunization as one the most effective global public health strategies for reducing child morbidity and mortality: Vaccines protect against life-threatening diseases such as measles, tuberculosis, polio, and diphtheria, saving millions of lives annually.
[2]. Oleribe, et al., 2019, Immunization coverage in many low- and middle-income countries, including Nigeria, Immunization in Nigeria remains inadequate due to limited health-seeking behavior, chronic underfunding of health systems, and socioeconomic challenges that hinder access to services.
[3]. NPC & ICF, 2019, Survey (NDHS) revealed that only 31% of children aged 12–23 months were fully immunized in Jigawa state Nigeria.
[4]. Oleribe, et al., 2017, Immunization challenges in Nigeria Rural communities. Rural communities in Nigeria including those in Jigawa State, face additional challenges such as long distances to health facilities, poor road conditions, and financial constraints that limit access to vaccination services.
[5]. Ozawa, et al., 2012, Effect of financial incentives on health seeking behavior in Northern Nigeria: Evidence from behavioral economics suggests that even small financial incentives can significantly influence health-seeking behavior, especially among low-income households.
[6]. Fagbamigbe & Kandala, 2021, Conditional and unconditional cash transfers can improve uptake of maternal and child health services, including antenatal care, facility-based delivery, and immunization.
[7]. Yakubu, et al., 2019, Gwiwa Local Government Area (LGA) of Jigawa State is a predominantly rural region where socioeconomic constraints and limited infrastructure pose challenges to healthcare delivery and utilization.
[8]. WHO & UNICEF, 2019, Broader equity-driven efforts aimed at ensuring that no child is left behind due to financial or geographic barriers to immunization.
[9]. WHO & Gavi, 2020, Routine immunization remains one of the most cost-effective public health interventions globally, helping to prevent childhood morbidity and mortality from vaccine-preventable diseases.
[10]. NPC & ICF, 2019, UNICEF, 2021, National health surveys consistently show that routine immunization coverage often falls below recommended levels, exposing children under two to preventable health risks.
[11]. Lakew, et al., 2015, Fagbamigbe & Kandala, 2021, transportation costs pose a significant obstacle, as many caregivers in rural communities cannot afford travel to distant health facilities.
[12]. Odusanya, et al., 2008, Adedokun, et al., 2017, Yakubu, et al., 2019, In Jigawa State Nigeria, low immunization uptake has been linked to several barriers, including poor access to health facilities, limited awareness among caregivers, cultural beliefs, and financial constraints.
[13]. UNICEF, 2021, NPC & ICF, 2019, MICS, 2021, Nigeria national surveys and zero-dose landscape analyses show lower coverage in many northern states (including the North-West) and highlight distance, transport cost, and socioeconomic constraints as major demand-side barriers
[14]. Barham, T., & Maluccio, J. A., 2009, Eradicating diseases: The effect of conditional cash transfers on vaccination coverage in rural Nicaragua. Journal of Health Economics, 28(3), 611–621.
[15]. Ozawa, et al., 2012, Systematic and scoping reviews from LMICs, over the past decade conclude that monetary incentives can raise vaccine uptake, though effect sizes vary based on context, transfer size, and program design.
[16]. NPC & ICF, 2019, UNICEF, 2021, Oleribe, et al., 2017, Nigeria national surveys, The NDHS and MICS show lower coverage in many northern states, including the North-West, and highlight distance, transport cost, and socioeconomic constraints as major demand-side barriers.
[17]. Adepoju, P., 2021, Nigeria’s immunization coverage: Progress, challenges, and future directions. The Lancet Global Health, 9(3), e247–e248. https://doi.org/10.1016/S2214-109X(21)00043-6
[18]. Barham & Maluccio, 2009, Ozawa et al., 2012, Earlier economic and public health evidence also demonstrates that conditional cash transfers improve vaccination outcomes in similar low-resource contexts.
[19]. Adedokun, S. T., & Yaya, S., 2020, Correlates of childhood immunization in Nigeria: Evidence from the Demographic and Health Survey. BMC Public Health, 20(1), 1–10.
[20]. Ajzen, 1991, The Theory of Planned Behavior (TPB), explains that human behavior is influenced by three main factors: attitudes toward the behavior, subjective norms, and perceived behavioral control.
[21]. Rosenstock, et al., 1988, The health belief model (HBM), posits that individuals’ willingness to act depends on their perceived susceptibility to illness, perceived severity of the illness, perceived benefits of taking action, and perceived barriers to action.
[22]. Skinner, 1953, The Incentive Theory of Motivation (ITM) suggests that human behavior is often driven by external rewards or incentives.
[23]. Yakubu, et al., 2019, Oleribe, et al., 2017, Caregivers utilizing immunization services in northern Nigeria. Studies in northern Nigeria have shown that, caregivers utilizing immunization services are predominantly married women.
[24]. NPC & ICF, 2019, Nigeria national surveys, demonstrating that caregivers of young children in northern Nigeria are predominantly women aged 25–39 years.
[25]. uptake Odusanya et al., 2008, Adedokun & Yaya, 2020, Literacy level among gender in Northern Nigeria. Northern Nigeria has lower female educational attainment, a factor strongly associated with reduced health-seeking behavior and suboptimal immunization.
[26]. Fagbamigbe & Kandala, 2021, Occupational pattern among caregivers in rural Northern Nigeria. Occupational patterns have been observed in rural immunization studies, where most caregivers are unemployed or engaged in low-income work.
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Missed Opportunities for Vaccination: A Descriptive Study of Primary and Secondary Health Facilities in Bayelsa State, NigeriaAuthor: Joshua IyeneomiDOI: 10.21522./TAJMHR.2016.06.01.Art002
Missed Opportunities for Vaccination: A Descriptive Study of Primary and Secondary Health Facilities in Bayelsa State, Nigeria
Abstract:
Immunization is one of the most effective public health interventions aimed at reducing child morbidity and mortality yet missed opportunities for vaccination (MOV) and systemic barriers continue to undermine immunization efforts in Nigeria and Bayelsa state in particular. This study assessed the prevalence, determinants, and systemic challenges associated with routine immunization uptake in Bayelsa State. A descriptive cross-sectional design was employed, involving 354 caregivers of children under five and 50 health workers across selected facilities. Data was collected using structured questionnaires, facility checklists, and interviews. Quantitative data were analyzed using SPSS version 26 with descriptive statistics, Chi-square tests, and logistic regression. Qualitative responses were thematically analyzed. Findings revealed that 34.5% of children experienced MOV, with measles (44.3%) and oral polio vaccine (30.3%) being the most frequently missed. Systemic challenges included vaccine stockouts (54%), cold chain failures (36%), and poor service integration (58%). Logistic regression showed that stockouts (AOR = 0.42, p < 0.001), cold chain breakdown (AOR = 0.58, p = 0.030), caregiver knowledge of immunization schedules (AOR = 2.11, p = 0.005), and service integration (AOR = 1.89, p = 0.022) significantly influenced adherence. This study concludes that systemic factors outweigh caregiver-level determinants in explaining missed opportunities. Addressing supply chain gaps, strengthening cold chain infrastructure, and services’ integration are crucial steps toward reducing missed opportunities and improving vaccination coverage in Nigeria.
Missed Opportunities for Vaccination: A Descriptive Study of Primary and Secondary Health Facilities in Bayelsa State, Nigeria
References:
[1]. World Health Organization, 2023, Immunization coverage: Key facts. WHO Report, https://www.who.int/news-room/fact-sheets/detail/immunization-coverage, (Accessed 27 June 2025).
[2]. World Health Organization, 2020, Global Vaccine Action Plan 2011–2020: Review and lessons learned. WHO Publication, https://www.who.int/teams/immunization-vaccines-and-biologicals/strategies/global-vaccine-action-plan, (Accessed 03 June 2025).
[3]. WHO/UNICEF, 2023, Progress and challenges with global immunization: 2023 data update. WHO/UNICEF Joint Report, https://www.who.int, (Accessed 10 July 2025).
[4]. United Nations Children’s Fund (UNICEF), 2022, Immunization overview: Challenges in low- and middle-income countries. UNICEF Policy Brief, https://www.unicef.org, (Accessed 05 July 2025).
[5]. United Nations Children’s Fund (UNICEF), 2021, State of the World’s Children 2021: On my mind – Promoting, protecting and caring for children’s mental health. UNICEF Publication, https://www.unicef.org/reports/state-worlds-children-2021, (Accessed 05 July 2025).
[6]. National Population Commission (NPC) [Nigeria] and ICF, 2019, Nigeria Demographic and Health Survey 2018. NPC and ICF Report, https://dhsprogram.com/pubs/pdf/FR359/FR359.pdf, (Accessed 28 July 2025).
[7]. Ophori, E. A., Tula, M. Y., Azih, A. V., Okojie, R., Ikpo, P. E., 2014, Current trends of immunization in Nigeria: Prospects and challenges. Tropical Medicine and Health, 42(2):67–75, Doi: 10.2149/tmh.2014-13.
[8]. Adedire, E. B., Ajayi, I. O., Fawole, O. I., et al., 2022, Immunization coverage and factors influencing it in southwestern Nigeria. Vaccine, 40(12):1807–1814, Doi: 10.1016/j.vaccine.2022.01.045.
[9]. Oladokun, R. E., Lawoyin, T. O., Adediran, I. A., 2010, Immunization status and its determinants among children of female traders in Ibadan, South-Western Nigeria. African Journal of Medicine and Medical Sciences, 39(1):19–27.
[10]. Akande, T. M., Owoyemi, J. O., 2009, Missed opportunities for immunization in children under 5 years attending primary health care facilities in Ilorin, Nigeria. Nigerian Journal of Paediatrics, 36(3):82–88.
[11]. Olorunsaiye, C. Z., Degge, H. M., 2020, Variations in childhood immunization uptake in Nigeria: Socioeconomic and community factors. BMC Public Health, 20:1238, Doi: 10.1186/s12889-020-09396-3.
[12]. World Health Organization, 2017, Missed Opportunities for Vaccination: WHO methodology and field guide. WHO Report, https://www.who.int/immunization/research/missed_opportunities, (Accessed 29 June 2025).
[13]. Donadel, M., Merten, S., Preziosi, M. P., Dumolard, L., 2017, Missed opportunities for vaccination: A standardized methodology for field surveys. Vaccine, 35(42):5592–5597, Doi: 10.1016/j.vaccine.2017.07.066.
[14]. Babirye, J. N., Engebretsen, I. M. S., Makumbi, F., et al., 2012, Timeliness of childhood vaccinations in Kampala, Uganda: A community-based cross-sectional study. PLoS One, 7(4): e35432, Doi: 10.1371/journal.pone.0035432.
[15]. Eze, P., Agu, U. J., Aniebo, C. L., Agu, S. A., Lawani, L. O., & Acharya, Y., 2021, Factors, associated with incomplete immunization in children aged 12–23 months at subnational level, Nigeria: a cross-sectional study. BMJ open, 11(6), e047445
[16]. Nnaji, C. A., Okoro, C. E., Umar, A. S., 2023, Barriers to routine immunization uptake in South–South Nigeria: A mixed-methods analysis. BMC Public Health, 23(1):1120, doi: 10.1186/s12889-023-15718-0.
[17]. Cochran, W. G., 1977, Sampling Techniques (3rd ed.). John Wiley & Sons, New York, pp.75–78.
[18]. Adedokun, S. T., Uthman, O. A., Adekanmbi, V. T., Wiysonge, C. S., 2017, Incomplete childhood immunization in Nigeria: A multilevel analysis of individual and contextual factors. Pan African Medical Journal, 27:6, Doi: 10.11604/pamj.2017.27.6.11371.
[19]. Salako, J., Bakare, D., Uchendu, O. C., Bakare, A. A., Graham, H., Falade, A. G., 2024, Factors associated with immunization status among children aged 12–59 months in Lagelu Local Government Area, Ibadan: A cross-sectional study. Pan African Medical Journal, 47:35, Doi: 10.11604/pamj.2024.47.35.37013.
[20]. Abadura, S. A., Lerebo, W. T., Kulkarni, U., Mekonnen, Z. A., 2015, Individual and community-level determinants of childhood full immunization in Ethiopia: A multilevel analysis. BMC Public Health, 15:972, Doi: 10.1186/s12889-015-2315-z.
[21]. Akwataghibe, N. N., Ogunsola, E. A., Broerse, J. E., Popoola, O. A., Agbo, A. I., Dieleman, M. A., 2019, Exploring factors influencing immunization utilization in Nigeria: A mixed-methods study. BMC Public Health, 19:1009, Doi: 10.1186/s12889-019-7350-z.
[22]. World Health Organization, 2017, Planning guide to reduce missed opportunities for vaccination (MOV). WHO, Geneva, https://iris.who.int/handle/10665/259202, (Accessed 08 June 2025).
[23]. Ibraheem, R. M., Bello, A. O., Adeboye, M. A., Adeyeba, D. T., Mohammed, M. J., 2016, Missed vaccination opportunities at a secondary health facility in Ilorin, Nigeria. Journal of Community Medicine and Primary Health Care, 28(1):31–37.
[24]. Abdulraheem, I. S., Onajole, A. T., Jimoh, A. A. G., Oladipo, A. R., 2011, Reasons for incomplete vaccination and factors for missed opportunities among rural Nigerian children. Journal of Public Health and Epidemiology, 3(4):194–203.
[25]. Nnaji, C. A., Ndwandwe, D., Lesosky, M., Mahomed, H., Wiysonge, C. S., 2021, Tackling missed opportunities for vaccination in a new era of immunisation. The Lancet, 397(10275):1324, Doi: 10.1016/S0140-6736(21)00777-3.
[26]. Pertet, A. M., Kaseje, D., Odawa, C. O., Ochieng, J., Wanjala, C., Jaoko, M., Odindo, D., 2018, Completion, timeliness and under-vaccination of childhood vaccinations in a nomadic pastoralist community of Kenya. International Journal of Contemporary Pediatrics, 5(3):998–1007, Doi: 10.18203/2349-3291.ijcp20182530.
[27]. World Health Organization, 2020, Immunization Agenda 2030: A global strategy to leave no one behind. WHO Report, https://www.who.int/teams/immunization-vaccines-and-biologicals/strategies/ia2030, (Accessed 02 June 2025).
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Do Vendors’ Knowledge and Attitudes Reflect their Practices? Food Safety Insights from Seikwa Community, GhanaAuthor: Christian Ankamah AbabioDOI: 10.21522./TAJMHR.2016.06.01.Art003
Do Vendors’ Knowledge and Attitudes Reflect their Practices? Food Safety Insights from Seikwa Community, Ghana
Abstract:
Food safety is a major public health concern, especially in communities where food vending is a primary economic activity. In Seikwa, Ghana, food vendors are central to daily meal provision, making safe food handling essential to prevent foodborne illnesses. This study assessed food safety knowledge, attitudes, and practices (KAP) among food vendors in the Seikwa community. A descriptive cross-sectional design with a quantitative approach was employed. Respondents were selected through simple random sampling, and data were collected using a predesigned questionnaire adapted from the WHO’s Five Keys to Food Safety. The instrument included a self-administered section for knowledge and attitudes and an observational checklist for practices. A total of 94 food vendors participated. Results showed that 52 (55.3%) had good knowledge of food safety, 52.3% exhibited positive attitudes, and 66.4% demonstrated good practices. Gaps in knowledge and practices were more pronounced among younger vendors (22-27 years) and those with higher education levels. Vendors operating in regulated environments, such as school premises and market squares, showed more positive attitudes. These findings indicate the need for targeted training and regular monitoring to enhance food safety standards among food vendors in the Seikwa community.
Do Vendors’ Knowledge and Attitudes Reflect their Practices? Food Safety Insights from Seikwa Community, Ghana
References:
[1]. Yakubu, M., Gaa, P. K., Kalog, G. L. S., Mogre, V., 2023, The competence of street food vendors to provide nutritious and safe food to consumers: A cross-sectional survey among street food vendors in Northern Ghana. Journal of Nutritional Science, 12(3), 1-8.
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[5]. Odonkor, S. T., Odonkor, C. J. A., 2020, An assessment of food safety knowledge and practices in the Ghanaian hospitality industry. Journal of Food Quality, 2020.
[6]. Onyeaka, H., Ekwebelem, O. C., Eze, U. A., Onwuka, Q. I., Aleke, J., Nwaiwu, O., et al., 2021, Improving food safety culture in Nigeria: A review of practical issues. Foods, 10(8), 1-11.
[7]. Tuglo, L. S., Agordoh, P. D., Tekpor, D., Pan, Z., Agbanyo, G., Chu, M., 2021, Food safety knowledge, attitude, and hygiene practices of street-cooked food handlers in North Day District, Ghana. Environmental Health and Preventive Medicine, 26(1), 1-13.
[8]. World Health Organization (WHO), 2021, Food safety is everyone’s business in street food vending. WHO Publication, 2-3. Available at: https://www.who.int/publications/i/item/WHO-HEP-NFS-AFS-2022.4
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[12]. Lawal, M., 2021, Prioritizing food safety in Ghana. Science E-Magazine, April, 1-5. Available at: https://scientect.com/prioritizing-food-safety-in-ghana
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[14]. Amoako, G. K., Neequaye, E. K., Kutu-Adu, S. G., Caesar, L. D., Ofori, K. S., 2019, Relationship marketing and customer satisfaction in the Ghanaian hospitality industry: An empirical examination of trust and commitment. Journal of Hospitality and Tourism Insights, 2(4), 326-340.
[15]. Tuglo, L. S., Mishra, S., Mohapatra, R. K., Kortei, N. K., Nsor-Atindana, J., Mulugeta, H., et al., 2023, A systematic review and meta-analysis of food handling practices in Ghana vis-à-vis the associated factors among food handlers during 2009 and 2022. Scientific Reports, 13(1), 1-12. Available at: https://doi.org/10.1038/s41598-023-46150-8
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Risk Behaviors During Pesticide Application: An Observational Study Among Cotton Farmers in Côte d’IvoireAuthor: Adama CoulibalyDOI: 10.21522./TAJMHR.2016.06.01.Art004
Risk Behaviors During Pesticide Application: An Observational Study Among Cotton Farmers in Côte d’Ivoire
Abstract:
Risk behaviors during pesticide application remain insufficiently documented through direct observation in African cotton-farming settings. In the sub-prefecture of Toumoukoro (northern Côte d’Ivoire), cotton production involves 19,562 registered producers who routinely handle organophosphates and pyrethroids. Most available studies rely on self-reported data, which introduces a social desirability bias that overestimates protective behaviors and underestimates actual risk practices. This study aimed to describe and quantify risk behaviors observed during pesticide application, to test their association with three individual determinants — received training, educational level, and duration of exposure — and to compare observed results with self-reported data to document the declarative-behavioral gap. A non-participant observational study was conducted with a purposive sub-sample of 68 cotton producers (22% of a quantitative survey of N = 315) across 13 villages. Each session covered the full application cycle (3 to 5 hours), coded in real time on a standardized eight-section grid. Fisher’s exact tests, relative risks (RR), and phi coefficients were used, triangulated with questionnaire data. Results showed that 73.5% of producers mixed pesticides with bare hands, 100% did not wash after application, and 0% wore boots or full-body protective clothing. Training received by 87% of producers produced no measurable behavioral effect (p = 1.000 for each PPE item; RR = 0.92 to 1.00). The only statistically significant determinant was exposure duration: 100% of producers exposed for ≥ 4 hours wore no gloves (RR = 1.78, p < 0.001). Risk behaviors are near-universal, homogeneous, and driven by structural determinants — economic barriers to PPE access and community norms of indifference — which training alone cannot correct. Simultaneous interventions targeting PPE economic accessibility and community-level normative change are essential.
Risk Behaviors During Pesticide Application: An Observational Study Among Cotton Farmers in Côte d’Ivoire
References:
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Functionality and Effect of Mother-to-Mother Support Groups in Improving Child Health and Nutrition in Northern GhanaAuthor: Micah A. OladDOI: 10.21522./TAJMHR.2016.06.01.Art005
Functionality and Effect of Mother-to-Mother Support Groups in Improving Child Health and Nutrition in Northern Ghana
Abstract:
Maternal and child health have gain significant attentional globally, especially in sub-Sahara Africa where illness among newborns, complications in pregnancy, malnutrition, and maternal and neonatal deaths are higher comparable to countries in the global north. In light of this, the study explored the effect of mother support groups on primary health care and nutrition outcomes among children under five years. The mixed method research approach supported by pragmatic philosophy was to conduct a cross-sectional survey that gathered data from 484 mothers of children under five years. The study combined questionnaires, interviews and focused group discussions to gather data. The study showed that MTMSG translates into positive impact on nutritional practices among children under five years. Although some level of variabilities existed, yet the study demonstrated that, high consumption of grains meat and fish, fruits and vegetables, dairy and nuts/legumes were significantly influenced by MTMSG. Again, it was shown that, MTMSG translates into high maternal knowledge on child health issues which improves timely treatment of respiratory illnesses, malaria, diarrhea by a margin of 80%. Most importantly, the study showed that, nearly 70% of the issues discussed within MTMSG were centered on hygiene followed by nutrition within discussion rate of 32%. Discussions on both family planning and malaria were least with each scoring 21% and 14% discussion rates. In general, the study showed that, 65% of the respondents had received support suggesting that MTMSG provide progressive assistants to its members which enhance the tracking of health progress among children under five years.
Functionality and Effect of Mother-to-Mother Support Groups in Improving Child Health and Nutrition in Northern Ghana
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[19]. Tripathy, P., Nair, N., Sinha, R., Rath, S., Gope, R. K., Rath, S., Roy, S. S., Bajpai, A., Singh, V., Nath, V., and Ali, S., 2016, Effect of participatory women's groups facilitated by Accredited Social Health Activists on birth outcomes in rural eastern India: a cluster-randomised controlled trial. The Lancet Global Health, 4(2), pp. e119-e128. https://doi.org/10.1016/S2214-109X(15)00287-9
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Assessment of Willingness to Enrol in Health Insurance After National Youth Service Among Corps Members in Rivers State, NigeriaAuthor: Daramola O. EDOI: 10.21522./TAJMHR.2016.06.01.Art006
Assessment of Willingness to Enrol in Health Insurance After National Youth Service Among Corps Members in Rivers State, Nigeria
Abstract:
The expansion of health insurance depends not only on new enrolment but also on reenrolment and retention of subscribers. Individuals’ decision to enrol in a health insurance scheme may be influenced by their perception of service quality among other factors. The NYSC members constitute a distinct population of young Nigerians, serving their nation in various locations in the country and are covered under a national health insurance programme during their service year. This study assessed willingness to enrol in health insurance after the service year and the factors influencing enrolment intentions among corps members in Rivers State, Nigeria. A cross-sectional study was conducted among 697 corps members in Rivers State, South-South Nigeria, using a self-administered online questionnaire. Data were analysed using IBM SPSS version 23. Descriptive and inferential statistics were used in the data analysis. A majority of the respondents, 619 (88.8%), expressed willingness to enrol in health insurance after their service year. Among those unwilling, the main reasons included dissatisfaction with the programme (38.5%), financial constraints (38.5%) and poor service quality (33.3%). Perception and satisfaction were significant predictors. Respondents with low satisfaction had significantly lower odds of willingness (OR = 0.24; 95% CI: 0.11 ̶ 0.53; p < 0.001). Similarly, poor perception was associated with significantly lower willingness (OR = 0.16; 95% CI: 0.07–0.51; p < 0.001). Most corps members expressed willingness to enrol in health insurance after their service year. However, gaps in service quality and user experience may undermine sustained participation. There is therefore a need to prioritise improvements in service quality to strengthen positive perceptions and encourage enrolment beyond the service year, thereby contributing to Nigeria’s progress towards universal health coverage.
Assessment of Willingness to Enrol in Health Insurance After National Youth Service Among Corps Members in Rivers State, Nigeria
References:
[1]. Federal Republic of Nigeria, 2022, National Health Insurance Authority Act, Federal Republic of Nigeria.
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[7]. Abdulmalik, U., and Anka, N., 2024, Analysing smartphone usage among students of tertiary institutions in North-West Nigeria, International Journal of Research Findings in Engineering, Science and Technology, 6(1),1-16. https://doi.org/10.48028/iiprds/ijrfest.v6.i1.01.
[8]. Akinyede, M. B., and Busayo, I. O., 2020, The use of mobile phones by third year undergraduate students of the Federal University, Oye-Ekiti, Nigeria, Library and Information Perspectives and Research, 2(2), 55-64.
[9]. Omole, G. D., Olokoba, L. B., Tairu, S. K., Ojeniran, T. P., Ayinde, V. O., Afolabi, A. A., et al., 2023, Acceptance of health insurance scheme among civil servants in Ilorin West Local Government Area, Kwara State, Nigeria, Nigerian Health Journal, 23(4), 943-951. https://doi.org/10.60787/tnhj-751.
[10]. Adeneye, A., Musa, A., Afocha, E., Adewale, B., Ezeugwu, S., Yisau, J., et al., 2021, Perception of community-based health insurance scheme in Ogun State, Nigeria, Global Journal of Infectious Diseases and Clinical Research, 1-12. https://doi.org/10.17352/2455-5363.000039.
[11]. Adewale, B., Adeneye, A. K., Ezeugwu, S. S. C., Afocha, E. E., Musa, A. Z., Enwuru, C. A., et al., 2016, A preliminary study on enrollees’ perception and experiences of National Health Insurance Scheme in Lagos State, Nigeria, International Journal of Tropical Disease and Health, 18(3), 1-14. https://doi.org/10.9734/IJTDH/2016/27309.
[12]. Michael, G. C., Grema, B. A., Aliyu, I., Tanimu, S. T., Suleiman, A. K., Shuaibu, A., et al., 2020, Awareness, knowledge, and perception of the National Health Insurance Scheme among National Youth Service Corps members in Kano, Nigeria, Nigerian Medical Journal, 61(4), 201-205. https://doi.org/10.4103/nmj.NMJ_140_19.
[13]. Hussien, M., and Azage, M., 2021, Barriers and facilitators of community-based health insurance policy renewal in low- and middle-income countries: a systematic review, ClinicoEconomics and Outcomes Research, 13, 359-375. https://doi.org/10.2147/CEOR.S306855.
[14]. Daramola, O. E., Maduka, W. E., Adeniran, A., and Akande, T. M., 2017, Evaluation of patients’ satisfaction with services accessed under the National Health Insurance Scheme at a tertiary health facility in North Central Nigeria, Journal of Community Medicine and Primary Health Care, 29(1), 1-17.
[15]. Batbaatar, E., Dorjdagva, J., Luvsannyam, A., Savino, M. M., and Amenta, P., 2017, Determinants of patient satisfaction: a systematic review, Perspectives in Public Health, 137(2), 89-101. https://doi.org/10.1177/1757913916634136.
[16]. Akinyinka, M. R., Oluwole, E. O., Odusanya, O. O., Goodman, O. O., and Odugbemi, B. A., 2019, Client satisfaction with the quality of primary health care services in Lagos State, Nigeria, Journal of Community Medicine and Primary Health Care, 31(2), 1-16.
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[18]. Effiong, F. B., Dine, R. D., Hassan, I. A., Olawuyi, D. A., Isong, I. K., and Adewole, D. A., 2025, Coverage and predictors of enrollment in the state-supported health insurance schemes in Nigeria: a quantitative multi-site study, BMC Public Health, 25(1), 2125. https://doi.org/10.1186/s12889-025-23329-4.
[19]. Erinoso, O., Oyapero, A., Familoye, O., Omosun, A., Adeniran, A., and Kuyinu, Y., 2023, Predictors of health insurance uptake among residents of Lagos, Nigeria, Population Medicine, 5. https://doi.org/10.18332/popmed/169666.
[20]. Daramola, O. E., Agede, O. A., Joseph, A. I., and Awunor, N. S., 2025, Strengthening healthcare access in Nigerian tertiary institutions: a review of the Tertiary Institution Social Health Insurance Programme, Delta Oghara Medical Journal, 1(1), 1-4.
[21]. Uguru, N. P., Uguru, C. C., Ogu, U. U., Agwu, P. C., Okeke, C. C., Onyejaka, N., et al., 2022, Tertiary institutions’ social health insurance program, International Journal of Medicine and Health Development, 27(4), pp.337-343. https://doi.org/10.4103/ijmh.ijmh_20_22.
[22]. Tyavyar, J. A., Otokpa, E., Adeoye, P. A., Mang, C., Longpoe, S., Dabang, F. T., et al., 2023, Satisfaction of stakeholders with the implementation of the Tertiary Institutions Social Health Insurance Programme in Jos: a qualitative study, Jos Journal of Medicine, 17(2), 112-116.
[23]. Adeniran, A., Wright, K., Aderibigbe, A., Akinyemi, O., Fagbemi, T., Ayodeji, O., et al., 2024, Determinants of health insurance adoption among residents of Lagos, Nigeria: a cross-sectional survey, Open Health, 5(1), 20230043. https://doi.org/10.1515/ohe-2023-0043.
[24]. Acharya, D., Thapa, K. B., Sharma, B., and Rana, M. S., 2023, Causes of dropout from health insurance program: an experience from Lumbini Province, Nepal, Dialogues in Health, 3, 100150. https://doi.org/10.1016/j.dialog.2023.100150.
[25]. Nayak, R. S., 2025, Exploring the factors affecting retention in health and life insurance: systematic literature review (SLR), Cuestiones de Fisioterapia, 54(2), 2802-2821. https://doi.org/10.48047/pfrtg940.
[26]. Fadlallah, R., El-Jardali, F., Hemadi, N., Morsi, R. Z., Abou Samra, C. A., Ahmad, A., et al., 2018, Barriers and facilitators to implementation, uptake and sustainability of community-based health insurance schemes in low- and middle-income countries: a systematic review, International Journal for Equity in Health, 17(1), 13. https://doi.org/10.1186/s12939-018-0731-3.
[27]. Fenny, A. P., Kusi, A., Arhinful, D. K., and Asante, F. A., 2016, Factors contributing to low uptake and renewal of health insurance: a qualitative study in Ghana, Global Health Research and Policy, 1, 18. https://doi.org/10.1186/s41256-016-0018-3.
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Perceived Effects of Common Technical Document Adoption on Dossier Quality and Regulatory Review Processes in Nigeria: A Mixed-Methods StudyAuthor: Ake, Paul AyodeleDOI: 10.21522./TAJMHR.2016.06.01.Art007
Perceived Effects of Common Technical Document Adoption on Dossier Quality and Regulatory Review Processes in Nigeria: A Mixed-Methods Study
Abstract:
The Common Technical Document (CTD) has been widely adopted as a regulatory harmonisation tool intended to improve medicines dossier quality and regulatory review processes, yet evidence on its operational effects in low- and middle-income countries remains limited. This study examined the perceived impact of CTD adoption on dossier quality and regulatory review processes in Nigeria using a mixed-methods design. Quantitative data were collected through a structured questionnaire administered to 380 regulatory stakeholders, while qualitative insights were obtained from semi-structured interviews with 12 regulatory assessors and industry professionals. Quantitative data were analysed descriptively using SPSS and qualitative data were analysed thematically. Survey results indicated that 65.3% of respondents agreed or strongly agreed that CTD adoption improved overall dossier quality, while 68.9% reported that CTD modules were clearly structured and easier to navigate. In addition, 58.7% agreed or strongly agreed that regulatory queries became clearer and more consistent under the CTD framework. However, perceptions of review speed were mixed, with 46.9% reporting improvements and 30.0% reporting no improvement or slower feedback. A large majority (71.6%) indicated that ongoing CTD-related training is necessary to improve compliance and dossier quality. Qualitative findings supported these results, showing that although CTD improved dossier structure and communication clarity, substantive content deficiencies and repeated review cycles persisted due to capacity and training gaps. Overall, CTD adoption improved dossier structure and regulatory communication but produced uneven gains in substantive dossier quality and review efficiency.
Perceived Effects of Common Technical Document Adoption on Dossier Quality and Regulatory Review Processes in Nigeria: A Mixed-Methods Study
References:
[1]. International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, 2004, Organisation of the Common Technical Document for the registration of pharmaceuticals for human use (ICH M4), ICH, https://www.ich.org/page/ctd
[2]. International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use, 2016, The Common Technical Document (CTD), ICH, https://www.ich.org/page/common-technical-document.
[3]. World Health Organization, 2022, Global benchmarking tool (GBT) for evaluation of national regulatory systems, WHO, https://www.who.int/publications/i/item/9789240046884
[4]. Rägo, L., Santoso, B., & Bonanno, M., 2017, Regulatory reliance: Concept and practice. WHO Drug Information, 31(2), 201–210.
[5]. Eichler, H. G., et al., 2019, From adaptive licensing to adaptive pathways: Delivering a flexible life-span approach to bring new drugs to patients, Clinical Pharmacology & Therapeutics, 105(4), 745–752, https://doi.org/10.1002/cpt.1284
[6]. Kaplan, W. A., Ritz, L. S., Vitello, M., & Wirtz, V. J., 2017, Policies to promote use of generic medicines in low and middle income countries, Health Policy and Planning, 31(5), 658–670, https://doi.org/10.1093/heapol/czv085
[7]. Lumpkin, M. M., et al., 2020, Regulatory harmonization: A key enabler of access to safe and effective medicines, Clinical Pharmacology & Therapeutics, 108(5), 840–846, https://doi.org/10.1002/cpt.1913
[8]. McAuslane, N., et al., 2018, Transparency in medicines regulation: A global perspective, Therapeutic Innovation & Regulatory Science, 52(5), 589–600, https://doi.org/10.1177/2168479018756494
[9]. Walker, S., & Lumley, T., 2019, Improving regulatory decision making through standardised submissions, Regulatory Affairs Journal, 30(6), 312–320.
[10]. Ndomondo-Sigonda, M., et al., 2020, Medicines regulation in Africa: Current state and opportunities, Pharmaceutical Medicine, 34(6), 383–397, https://doi.org/10.1007/s40290-020-00340-5
[11]. African Union Development Agency–NEPAD, 2021, African Medicines Regulatory Harmonization (AMRH): Progress and impact, AUDA-NEPAD, https://www.nepad.org
[12]. World Health Organization, 2021, WHO guideline on good reliance practices in regulatory decision-making, WHO, https://www.who.int/publications/i/item/9789240029870
[13]. Vamathevan, J., et al., 2019, Applications of machine learning in drug discovery and development, Nature Reviews Drug Discovery, 18(6), 463–477, https://doi.org/10.1038/s41573-019-0024-5
[14]. Rotolo, D., Hicks, D., & Martin, B. R., 2015, What is an emerging technology? Research Policy, 44(10), 1827–1843, https://doi.org/10.1016/j.respol.2015.06.006
[15]. Nwokike, J., & Eghan, K., 2018, Strengthening regulatory systems in developing countries, Journal of Pharmaceutical Policy and Practice, 11(8), 1–9, https://doi.org/10.1186/s40545-018-0139-1
[16]. Kaplan, W. A., et al., 2016, Balancing expedited regulatory pathways and evidence generation, BMJ Global Health, 1(3), e000060, https://doi.org/10.1136/bmjgh-2016-000060
[17]. Creswell, J. W., & Plano Clark, V. L., 2018, Designing and conducting mixed methods research (3rd ed.), SAGE Publications.
[18]. Braun, V., & Clarke, V., 2006, Using thematic analysis in psychology, Qualitative Research in Psychology, 3(2), 77–101, https://doi.org/10.1191/1478088706qp063oa
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[21]. Duguet, A., et al., 2021, Digitalisation of regulatory submissions: Challenges and opportunities, Regulatory Rapporteur, 18(4), 16–23.
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Assessing Socio-Technical Transitions Shaping Wash Sustainability in Lower Omo Valley, EthiopiaAuthor: Getachew Asmare BelayDOI: 10.21522./TAJMHR.2016.06.01.Art008
Assessing Socio-Technical Transitions Shaping Wash Sustainability in Lower Omo Valley, Ethiopia
Abstract:
The sustainability of water, sanitation, and hygiene (WASH) services in pastoralist regions remains a complex challenge, exacerbated by environmental variability and large-scale infrastructural transitions. This study examines the socio-technical determinants of WASH functionality in Dassenech Woreda, South Omo Zone, Ethiopia, focusing on the systemic impact of the Upper Omo River highlands and the effectiveness of 2023 integrated interventions. Using a convergent mixed-methods design, the research integrates quantitative data from 430 household surveys with qualitative ethnographic insights into the Dassenech age-set system, clan structures, and the Dimi ceremony. Findings indicate that WASH systems embedded within strong socio-technical arrangements—characterized by community ownership and appropriate technology—demonstrate significantly higher functionality rates. The study also reveals that the Upper Omo River highlands has disrupted traditional flood-recession agriculture, forcing a transition toward sedentary livelihoods and fishing, which increases vulnerability to waterborne diseases. However, the 2023 integrated WASH response, which coupled physical rehabilitation of 28 water schemes with hygiene promotion based on the Health Belief Model, contributed to the successful containment of cholera and acute watery diarrhoea. The report concludes that long-term resilience requires aligning technological solutions with the egalitarian social structures and mobility patterns of pastoralist communities.
Assessing Socio-Technical Transitions Shaping Wash Sustainability in Lower Omo Valley, Ethiopia
References:
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The Role of Community Health Workers in Bridging the Primary Health Care Gap: A Case of Tiko Health District, CameroonAuthor: Smith AfanjiDOI: 10.21522./TAJMHR.2016.06.01.Art009
The Role of Community Health Workers in Bridging the Primary Health Care Gap: A Case of Tiko Health District, Cameroon
Abstract:
Community Health Workers (CHWs) play a central role in improving access to primary health care (PHC), particularly in low- and middle-income settings where shortages of trained personnel persist. In Cameroon, the Community-Directed Intervention (CDI) approach has been adopted to support community-based service delivery. However, evidence on the extent of CHWs’ contribution to bridging gaps in PHC remains limited. This study assessed the role of CHWs in the Tiko Health District. A convergent mixed-methods cross-sectional study was conducted among 464 participants, including household heads, CHWs, and key stakeholders. Quantitative data were analyzed using IBM SPSS version 27, while qualitative data from key informant interviews were analyzed thematically. Statistical significance was set at p < 0.05. Awareness of CHWs was high (96.9%), and 78.1% of respondents reported having received CHW services, while 97.6% indicated that CHWs were accessible when needed. Overall satisfaction was reported by 81.4% of participants. There was a significant positive correlation between awareness and utilization of CHW services (r = 0.315, p < 0.001). CHWs contributed mainly to immunization mobilization (30.4%), referrals (28.9%), and health education (27.9%), whereas their involvement in maternal and child health (9.9%) and disease surveillance (8.9%) was lower. Although most CHWs reported receiving supervision, training, and incentives, important gaps were identified in transport support, availability of essential medicines, and reporting tools. Support factors were significantly associated with service utilization (p < 0.001). CHWs contribute meaningfully to improving access to PHC in the Tiko Health District. Addressing gaps in logistics, supervision, and system support is essential to strengthening their effectiveness and long-term sustainability.
The Role of Community Health Workers in Bridging the Primary Health Care Gap: A Case of Tiko Health District, Cameroon
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[2]. Perry, H. B., 2018, An extension of the Alma-Ata vision for primary health care in light of twenty-first-century evidence and realities. Gates Open Research 2(70), https://doi.org/10.12688/gatesopenres.12848.1
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[7]. Perry, H. B., & Rohde, J., 2019, The Jamkhed Comprehensive Rural Health Project and the Alma-Ata vision of primary health care. American Journal of Public Health, 109(5), 699–704. https://doi.org/10.2105/AJPH.2019.304968
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Barriers to Routine Immunization: A Descriptive Study of Secondary and Primary Health Facilities in Bayelsa state, NigeriaAuthor: Joshua IyeneomiDOI: 10.21522./TAJMHR.2016.06.01.Art010
Barriers to Routine Immunization: A Descriptive Study of Secondary and Primary Health Facilities in Bayelsa state, Nigeria
Abstract:
Immunization has remained a cost effective and critical public health intervention aimed at reducing child morbidity and mortality, yet it has continued to face logistics and systemic barriers that undermines its efforts in Nigeria and Bayelsa state in particular. This study assessed the systemic challenges associated with routine immunization uptake in Bayelsa State. A descriptive cross-sectional design was employed, involving 354 caregivers of children under five and 50 health workers across selected facilities. Structured questionnaires, facility checklists, and interviews was used in collecting data. Quantitative data were analyzed using SPSS version 26 with descriptive statistics, Chi-square tests, and logistic regression. Qualitative responses were thematically analyzed. Findings revealed that. systemic challenges included vaccine stockouts (54%), cold chain failures (36%), and poor service integration (58%). Logistic regression showed that stockouts (AOR = 0.42, p < 0.001), cold chain breakdown (AOR = 0.58, p = 0.030), caregiver knowledge of immunization schedules (AOR = 2.11, p = 0.005), and service integration (AOR = 1.89, p = 0.022) significantly influenced adherence. This study concludes that systemic factors outweigh caregiver-level barriers to immunization. Addressing supply chain gaps, strengthening cold chain infrastructure, and services’ integration are crucial steps toward reducing immunization barriers and improving vaccination coverage in Nigeria.
Barriers to Routine Immunization: A Descriptive Study of Secondary and Primary Health Facilities in Bayelsa state, Nigeria
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[3]. United Nations Children’s Fund (UNICEF). State of the World’s Children 2021, On My Mind – Promoting, protecting and caring for children’s mental health. New York: UNICEF; 2021, Available from: https://www.unicef.org/reports/state-worlds-children-2021 (Accessed 05 July 2025).
[4]. National Population Commission (NPC) [Nigeria] and ICF. Nigeria Demographic and Health Survey 2018, Abuja, Nigeria, and Rockville, Maryland, USA: NPC and ICF; 2019. Available from: https://dhsprogram.com/pubs/pdf/FR359/FR359.pdf (Accessed 28 July 2025).
[5]. Ophori, E. A., Tula, M. Y., Azih, A. V., Okojie, R., Ikpo, P. E., 2014, Current trends of immunization in Nigeria: Prospect and challenges. Trop Med Health. 42(2):67–75. p. 67–75.
[6]. Mohammed, Y., Reynolds, H. W., Waziri, H., Attahiru, A., Olowo-okere, A., Kamateeka, M., & Nguku, P., 2024, Exploring the landscape of routine immunization in Nigeria: A scoping review of barriers and facilitators. Vaccine: X, 20, 100563.
[7]. Oladokun, R. E., Lawoyin, T. O., Adediran, I. A., 2010, Immunization status and its determinants among children of female traders in Ibadan, South-Western Nigeria. Afr J Med Med Sci. 39(1):19–27. p. 19–27.
[8]. Adedokun, S. T., Uthman, O. A., 2019, Women who have not utilized health service for delivery in Nigeria: Who are they and where do they live? BMC Pregnancy Childbirth. 19(1):93.
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[10]. Abisola, O., Chinwoke I., Saheed A., Olubunmi, A., Belinda, Ifie, M. H., 2022, Barriers, facilitators, and recommendations for childhood immunisation in Nigeria: perspectives from caregivers, community leaders, and healthcare workers. Pan African Medical Journal. 43:97. [Doi: 10.11604/pamj.2022.43.97.35797]
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Community Perceptions of Non-Municipal Drinking Water Safety in the Blue and John Crow Mountains, Jamaica: Policy Gaps and Implications for Sustainable DevelopmentAuthor: Karlene AtkinsonDOI: 10.21522./TAJMHR.2016.06.01.Art011
Community Perceptions of Non-Municipal Drinking Water Safety in the Blue and John Crow Mountains, Jamaica: Policy Gaps and Implications for Sustainable Development
Abstract:
This research explored community perceptions of non-municipal drinking water safety and quality in the Blue and John Crow Mountains, Jamaica, and examined policy gaps in water quality management. A census survey was conducted among fifty-six households in Bottom Dublin Castle and Pear Tree two rural localities that relies exclusively on entombed springs and tributaries domestic water use. The study aimed to assess residents’ perceptions of the safety of these sources and to identify implications for public health and sustainable development. A total of 56 household interviews were included, targeting heads of households as respondents, data were collected using interviews with participants then rresponses were recorded on structured questionnaires and analysed quantitatively using descriptive statistics. The mains findings are widespread reliance on untreated water, with households expressing concerns about contamination, inconsistent supply, and inadequate government support. Although most households attempted disinfection, primarily through chlorine bleach, incorrect dosing and reliance on visual cues limited effectiveness. Reported illnesses, including gastrointestinal and dermatological conditions, highlighted epidemiological risks associated with unsafe practices. Perceptions of safety were mixed, with half of respondents believing their water was safe despite evidence of contamination risks. Policy awareness was low, with only 18% of respondents familiar with national water frameworks, underscoring governance gaps. Despite Jamaica’s Water Resource Act 1995 and Water Sector Policy 2002, rural non-municipal supplies remain excluded from surveillance and regulation. According to the results the study provides baseline data for policymakers and stakeholders like emphasizing the need for intersectoral policies, improved monitoring, and community education, sstrengthening rural water governance is essential to reduce health risks, ensure equity in access, and align Jamaica’s water management strategies with Sustainable Development Goal 6, which calls for universal access to safe and affordable drinking water by 2030.
Community Perceptions of Non-Municipal Drinking Water Safety in the Blue and John Crow Mountains, Jamaica: Policy Gaps and Implications for Sustainable Development
References:
[1]. United Nations Educational, Scientific and Cultural Organization (UNESCO), 2021, World Water Development Report. Paris: UNESCO.
[2]. World Health Organization (WHO), 2017, Water and sanitation in Latin America and the Caribbean. Geneva: WHO.
[3]. Blue and John Crow Mountains Authority, (n.d.,), Hydrological description and community water use. Kingston: BJCM Authority.
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Tobacco Control Laws in the Gambia: Scope and Alignment with the World Health Organisation’s Framework Convention on Tobacco ControlAuthor: Dawda SOWEDOI: 10.21522./TAJMHR.2016.06.01.Art012
Tobacco Control Laws in the Gambia: Scope and Alignment with the World Health Organisation’s Framework Convention on Tobacco Control
Abstract:
Realising the harmful effects of tobacco use, the World Health Organization through World Health Assembly Resolution 56.1 passed the Framework Convention on Tobacco Control (FCTC), a landmark international legal instrument aimed at addressing tobacco use and protecting the public. To support the implementation of the FCTC, the World Health Organisation in 2008 adopted a comprehensive policy package MPOWER, for tobacco control. This package consists of six evidence-based tobacco control measures of Monitoring tobacco use, protecting people from tobacco smoke, offering help to quit tobacco, Warning people about the dangers of tobacco, enforcing bans on tobacco advertising, promotion and sponsorship, and Raising taxes on tobacco. The Gambia a signatory to the FCTC, have undertaken legislations with the aim of reducing the impact of tobacco use. A needs assessment conducted in 2012 reviewed the progress made in tobacco control implementation. This resulted in the enactment of the Tobacco Control Act 2016 with the accompanying Tobacco Control Regulations 2019. The Act and Regulations encompass ambitious policies, including regulations on tobacco packaging design, restrictions on advertising and tobacco promotion, prohibition of tobacco sale to minors, national smoking ban in workplaces and public settings. Key provisions in the act include the formation of a National Tobacco Control Committee with diverse membership, prohibition of smoking in public places, total ban on tobacco advertisement, promotion and sponsorship, prohibition of sale of tobacco products to minors, which aligns greatly with the FCTC. One of the shortfalls within the act is the exclusion of a provision to support tobacco cessation, which is a key component of the MPOWER.
Tobacco Control Laws in the Gambia: Scope and Alignment with the World Health Organisation’s Framework Convention on Tobacco Control
References:
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Determinants of Pesticide Exposure Among Cotton Farmers in Côte d'Ivoire: A Mixed-Methods Cross-Sectional Study in Toumoukoro Sub-PrefectureAuthor: Adama CoulibalyDOI: 10.21522./TAJMHR.2016.06.01.Art013
Determinants of Pesticide Exposure Among Cotton Farmers in Côte d'Ivoire: A Mixed-Methods Cross-Sectional Study in Toumoukoro Sub-Prefecture
Abstract:
Cotton farmers in sub-Saharan Africa face considerable pesticide exposure risks, yet behavioural determinants remain insufficiently documented through approaches combining self-reported and directly observed data. This study identified structural determinants of pesticide exposure among cotton farmers in Toumoukoro sub-prefecture, northern Côte d’Ivoire, and measured the gap between declared and observed behaviours. A cross-sectional mixed-methods design integrated a quantitative phase (structured questionnaire, N = 315, stratified random sampling from 19,562 producers across 13 villages) and a qualitative phase (direct non-participant observation, N = 68). Statistical analyses included odds ratios (OR), relative risks (RR), numbers needed to treat (NNT), Fisher’s exact test, and 95 % confidence intervals. All producers used pesticides (100 %), and 95.9 % reported at least one symptom after application (OR absence of PPE vs symptoms = 35.9; NNT = 10.3). Access to personal protective equipment (PPE) was limited for 89.2 % of producers, with cost as the dominant barrier (OR cost/unavailability = 100.4). Training was associated with higher self-reported PPE use (OR = 1.96) but produced no measurable behavioural effect in direct observation (Fisher p = 1.000 for all PPE items). Risk underestimation was reported by 64.8 % of producers, and 87.6 % perceived pesticide use as socially normalized in their community. Pesticide exposure results from four interdependent structural determinants: economic barriers to PPE access, social normalization of risk, behavioral ineffectiveness of current training, and productivist pressure toward overdosing. Simultaneous action across all four axes is required to durably reduce exposure and associated morbidity.
Determinants of Pesticide Exposure Among Cotton Farmers in Côte d'Ivoire: A Mixed-Methods Cross-Sectional Study in Toumoukoro Sub-Prefecture
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[15]. FAO, 2020, Pesticide use statistics and safe handling guidelines. Food and Agriculture Organization of the United Nations, Rome, Italy.
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[20]. Devegappanavar, G., 2020, Occupational health: farmers knowledge on pesticide usage and its harmful effects on human health in rural areas of South India. Journal of Ecophysiology and Occupational Health, 108–113. https://doi.org/10.18311/jeoh/2020/25130
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Epidemiology and Divergent Transmission Dynamics of Cholera and Diphtheria in Kaduna State, Nigeria, 2023–2024: A Retrospective Surveillance StudyAuthor: Idowu Makinde OlapemiDOI: 10.21522./TAJMHR.2016.06.01.Art014
Epidemiology and Divergent Transmission Dynamics of Cholera and Diphtheria in Kaduna State, Nigeria, 2023–2024: A Retrospective Surveillance Study
Abstract:
Nigeria continues to experience recurrent cholera and diphtheria outbreaks, driven by distinct yet overlapping structural vulnerabilities. While cholera transmission is environmentally mediated and amplified by flooding and inadequate water, sanitation, and hygiene (WASH) systems, diphtheria resurgence reflects immunity gaps in under-vaccinated populations. This retrospective analytical study examined cholera and diphtheria cases reported in Kaduna State between January 2023 and December 2024 using Integrated Disease Surveillance and Response (IDSR) data and standard Nigeria Centre for Disease Control case definitions. Descriptive statistics, incidence rates per 100,000 population, cumulative attack rates, and chi-square tests were used. A total of 1,161 suspected cases were reported (323 diphtheria and 838 cholera). Diphtheria declined significantly between 2023 and 2024 (χ² = 57.07; p < 0.001), with incidence decreasing from 2.47 to 1.33 per 100,000 population. In contrast, cholera incidence increased approximately 81-fold, from 0.12 to 9.74 per 100,000 (χ² = 1593.05; p < 0.001). The cumulative attack rates were 0.0038% for diphtheria and 0.0099% for cholera. Both diseases peaked in October, corresponding to the late rainy season. No deaths were recorded in the surveillance dataset; however, incomplete documentation of outcomes cannot be excluded. These findings demonstrate divergent transmission ecologies operating within a shared structural context. Effective epidemic control requires integrated yet disease-specific strategies that simultaneously strengthen immunization systems and invest in climate-resilient WASH infrastructure.
Epidemiology and Divergent Transmission Dynamics of Cholera and Diphtheria in Kaduna State, Nigeria, 2023–2024: A Retrospective Surveillance Study
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[1]. World Health Organization, 2023, Cholera fact sheet. World Health Organization, https://www.who.int/news-room/fact-sheets/detail/cholera
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[20]. Musa, E. O., Bamidele, J. O., Adebimpe, W. O., 2020, Assessment of IDSR implementation in Nigeria. Nigerian Medical Journal, 61(3), 150–156.
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Determinants of Caregiver Acceptance and Uptake of Newly Introduced Vaccines in Uganda: Insights from the Health Belief and Diffusion of Innovation FrameworksAuthor: Alex W. BarasaDOI: 10.21522./TAJMHR.2016.06.01.Art015
Determinants of Caregiver Acceptance and Uptake of Newly Introduced Vaccines in Uganda: Insights from the Health Belief and Diffusion of Innovation Frameworks
Abstract:
Uganda introduced new vaccines (Measles-Rubella second dose [MR2], Inactivated Polio Vaccine second dose [IPV2], Hepatitis B Birth Dose [HepB-BD], and Yellow Fever [YF]), to strengthen routine immunization. However, caregiver acceptance and uptake remain uneven across cities and districts. Understanding behavioural determinants is critical for improving demand. We examined factors influencing uptake of newly introduced vaccines using the Health Belief Model (HBM) and the Diffusion of Innovation (DoI) theory. A mixed-methods study was conducted using Post-Introduction Evaluation (PIE) caretaker surveys (n = 85) from Six cities and 11 districts, 24 key informant interviews and eight focus group discussions. Quantitative data were analyzed using descriptive statistics and multivariate logistic regression to identify predictors of vaccine uptake. Qualitative data were thematically analyzed and integrated using the HBM and DoI frameworks. High acceptance was associated with caregiver vaccine benefits knowledge (OR 2.16, 95% CI 1.32–3.55), trust in health workers (OR 1.88, 95% CI 1.11–3.17), and perceived susceptibility to disease. Barriers included misconceptions, side effects fear, long waiting times, and inconsistent communication. Early adopters of new vaccines were influenced by strong health worker engagement and timely information flow, whereas late adopters by social norms, peer reassurance, and community mobilizers. Qualitative insights highlighted trust, social influence, and perceived vaccine usefulness as key determinants. Caregiver acceptance of newly introduced vaccines in Uganda is shaped by health beliefs, perceived benefits, social influence, and communication pathways. Strengthening behavioural communication strategies, addressing misconceptions, and enhancing health worker engagement will improve uptake and reduce inequities in future vaccine introductions.
Determinants of Caregiver Acceptance and Uptake of Newly Introduced Vaccines in Uganda: Insights from the Health Belief and Diffusion of Innovation Frameworks
References:
[1]. World Health Organization, 2013, Global Vaccine Action Plan 2011–2020. Geneva: WHO.
[2]. World Health Organization, 2020, Immunization Agenda 2030: A Global Strategy to Leave No One Behind. Geneva: WHO.
[3]. Gavi, The Vaccine Alliance, 2022, New Vaccine Introduction and Implementation Guidelines. Geneva: Gavi.
[4]. UNICEF, 2023, State of the World’s Children 2023: Vaccines and the Future of Immunization. New York: UNICEF.
[5]. Ministry of Health Uganda, 2021, UNEPI Comprehensive Multi-Year Plan for Immunization 2021–2025. Kampala: MoH.
[6]. Ministry of Health Uganda, 2024, National Post-Introduction Evaluation (PIE) for MR2, IPV2 and HepB-BD. Kampala: UNEPI.
[7]. National Medical Stores, 2023, Vaccine Logistics and Cold Chain Performance Report. Kampala: NMS.
[8]. Uganda Bureau of Statistics and ICF, 2023, Uganda Demographic and Health Survey 2022. Kampala: UBOS.
[9]. World Health Organization and UNICEF, 2023, Estimates of National Immunization Coverage (WUENIC). Geneva: WHO.
[10]. PATH, 2022, Improving Vaccine Logistics and Cold Chain Efficiency in LMICs. Seattle: PATH.
[11]. Rosenstock, I. M., 1974, Historical origins of the Health Belief Model. Health Education Monographs, 2(4), 328–335.
[12]. Rogers, E. M., 2003, Diffusion of Innovations, 5th ed. New York: Free Press.
[13]. World Health Organization, 2022, Behavioural and Social Drivers of Vaccination (BeSD) Framework. Geneva: WHO.
[14]. UNICEF, 2023, Interpersonal Communication for Immunization: Global Guidelines. New York: UNICEF.
[15]. Larson, H. J., et al., 2022, Understanding vaccine demand and hesitancy. Lancet, 400, 381–398.
[16]. Brewer, N. T., Chapman, G. B., et al., 2017, Increasing vaccination uptake: Psychological determinants. Psychological Science in the Public Interest, 18(3), 149–207.
[17]. Machingaidze, S., Wiysonge, C. S., 2021, Vaccine hesitancy in Africa: An overview. Vaccine, 39, 489–500.
[18]. Betsch, C., et al., 2019, Self-efficacy and vaccination decisions. Health Psychology, 38(11), 1050–1062.
[19]. Bednarczyk, R. A., 2018, Barriers to vaccine uptake in LMICs. BMC Public Health, 18, 1317.
[20]. Mboera, E., et al., 2021, Misconceptions driving vaccine hesitancy in East Africa. BMJ Global Health, 6, e006000.
[21]. Akwiri, A., et al., 2023, Adoption patterns of MR2 vaccine in Kenya. East African Health Journal, 5(2), 45–56.
[22]. Mphuru, A., et al., 2021, Challenges in Hepatitis B birth-dose introduction in Tanzania. Vaccine, 39(52), 7452–7458.
[23]. Okello, A., et al., 2022, Determinants of immunization service uptake in Northern Uganda. BMC Health Services Research, 22, 954.
[24]. Abubakar, A., et al., 2020, Role of community health workers in vaccine uptake in Nigeria. Journal of Global Health, 10, 020402.
[25]. Tadesse, E., et al., 2022, Behavioural predictors of routine immunization in Ethiopia. Pan African Medical Journal, 41, 220.
[26]. Bosch-Capblanch, X., et al., 2017, Service experience and its impact on immunization uptake. Tropical Medicine & International Health, 22(3), 342–355.
[27]. Humphreys, G., et al., 2021, Strengthening vaccine cold chain in Africa. Bulletin of the World Health Organization, 99, 240–247.
[28]. Chukwu, E. E., et al., 2020, Health worker communication and immunization uptake. African Journal of Reproductive Health, 24(4), 112–123.
[29]. Oyo-Ita, A., et al., 2021, Interventions for improving vaccination timeliness in LMICs. Cochrane Database of Systematic Reviews, 3, CD006093.
[30]. Nsubuga, F., et al., 2022, Determinants of uptake of birth-dose vaccines in Uganda. Plos ONE, 17(9), e0275024.
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[32]. Kata, A., 2012, Misinformation and anti-vaccine rhetoric in LMICs. Vaccine, 30, 3778–3789.
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[35]. World Health Organization and UNICEF, 2020, Guidelines for Post-Introduction Evaluation of Vaccines. Geneva: WHO.
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[37]. Gavi Secretariat, 2021, Operational Lessons from New Vaccine Introductions in Africa. Geneva: Gavi.
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Compliance with Baby Friendly Hospital Initiative (BFHI); A Case Study of the Sagnarigu Municipal Health Directorate of Northern GhanaAuthor: Micah A. OladDOI: 10.21522./TAJMHR.2016.06.01.Art016
Compliance with Baby Friendly Hospital Initiative (BFHI); A Case Study of the Sagnarigu Municipal Health Directorate of Northern Ghana
Abstract:
It has been estimated that the deaths of 823,000 children each year could be averted by increasing Breastfeeding has been established in literature as one of the practices. In fact, it has been established that nearly 900,000 infant deaths can be prevented globally through progressive breastfeeding. Imperatively, Baby-Friendly Hospital Initiative has been demonstrated in literature as one of the pathways through which breastfeeding can be initiated right after birth. Other studies have also demonstrated positive association between BFHI and exclusive breastfeeding. While the global narrative has been established, not much is known on compliance levels with healthcare facilities in Ghana. The study adopted mixed method research to investigate compliance with BFHI, using Sagnarigu Municipal Health Directorate of Northern Ghana as the case study. Data for the study were gathered through field survey and in-depth interview and analysed through descriptive statistics and thematic analysis. Findings showed higher compliance level to exclusive breastfeeding, on-demand feeding and breastfeeding education with each of them scoring above 90% compliance level. On the contrary, the qualitative findings demonstrate that none of the healthcare facilities demonstrated comprehensive understanding of the ten steps involved in BFHI. Thus, health workers were not adequately trained to fully implement the breastfeeding policy actions with BFHI. The study showed that, none of the sample healthcare facilities met the criteria for steps one and two of the BFHI. Key barriers that undermine compliance to BFHI included; lack of in-service training, inadequate national and regional support for the program and high-client to staff ratio.
Compliance with Baby Friendly Hospital Initiative (BFHI); A Case Study of the Sagnarigu Municipal Health Directorate of Northern Ghana
References:
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Community Participation and WASH Service Sustainability in Pastoralist Areas of Ethiopia: A Mixed-Methods StudyAuthor: Getachew Asmare BelayDOI: 10.21522./TAJMHR.2016.06.01.Art017
Community Participation and WASH Service Sustainability in Pastoralist Areas of Ethiopia: A Mixed-Methods Study
Abstract:
Community participation is widely recognized as a cornerstone of sustainable water, sanitation, and hygiene (WASH) service delivery, particularly in pastoralist areas characterized by mobility, resource scarcity, and institutional fragility. This study examines the relationship between community participation and WASH service sustainability in the Dassenech Woreda of the South Omo Zone, South Ethiopia Regional State. Grounded in Social Practice Theory and the Health Belief Model, the research utilizes a convergent mixed-methods design, integrating quantitative household survey data (n = 435) with qualitative insights from 23 key informant interviews and 7 focus group discussions. Findings reveal that higher levels of participation—measured through decision-making, financial contribution, and maintenance engagement—are significantly associated with improved WASH system functionality (β=0.53, p<0.01). Socio-cultural analysis highlights how traditional institutions, such as the eight-clan structure and the Dimi ceremony, influence collective action. Despite the challenges posed by the Upper Omo River Highlands and unseasonal flooding, integrated interventions in 2023 demonstrated that combining continuous treated water access with culturally embedded hygiene promotion can eliminate reported cholera cases. However, barriers including the marginalized "Die" social class and the normalization of human-livestock proximity constrain long-term outcomes. The study contributes empirical evidence on sustaining WASH systems in mobile and climate-stressed environments, emphasizing the need for governance models that align with indigenous ecological knowledge and egalitarian social structures.
Community Participation and WASH Service Sustainability in Pastoralist Areas of Ethiopia: A Mixed-Methods Study
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A Mixed-Method Study on Barriers and Facilitators of Mental Health Well-Being Among Postnatal Mothers: A Preliminary StudyAuthor: Simone Roberts KentDOI: 10.21522./TAJMHR.2016.06.01.Art018
A Mixed-Method Study on Barriers and Facilitators of Mental Health Well-Being Among Postnatal Mothers: A Preliminary Study
Abstract:
Perinatal mental health disorders affect approximately 10–20% of women globally, yet research in Caribbean Small Island Developing States remains limited. Understanding context-specific barriers and facilitators to mental health care among postnatal mothers is essential for developing appropriate interventions. A mixed method, cross-sectional design was adopted. Ten postnatal mothers were selected by purposive sampling and completed a self-administered questionnaire comprising socio-demographic proforma, the Depression Anxiety and Stress Scale (DASS-21), and the 36-Item Short Form Survey (SF-36) were used. Four postnatal mothers and two healthcare workers were interviewed. Descriptive statistics and thematic analysis were employed. The study findings revealed that in the DASS Scale, 50% of participants reported depressive symptoms above the normal range, 100% for anxiety, and 20% for stress. The SF-36 revealed that the lowest scores were in role limitations due to emotional problems (mean 45.8) and energy/fatigue (mean 52.5), while physical functioning (mean 77.6) was higher than mental health (mean 67.6). Cross-tabulation revealed that younger mothers (18–24 years) had the lowest mean mental health score (61.0) compared to mothers aged 25–34 years (72.0) and 35–44 years (72.0). The majority of participants (40%) were in the early postpartum period (1–4 weeks). Qualitative findings identified barriers including cultural expectations of strength, stigma, lack of partner support, financial constraints, inconsistent screening practices, unclear referral pathways, and inadequate training among healthcare workers. Facilitators included emotional safety, supportive partners and family, trust in healthcare providers, and willingness among healthcare workers to receive training. This study finding reported that postnatal mothers had anxiety symptoms above the normal range warrants urgent attention and highlights the critical need for integrated perinatal mental health services in St. Vincent and the Grenadines.
A Mixed-Method Study on Barriers and Facilitators of Mental Health Well-Being Among Postnatal Mothers: A Preliminary Study
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From Interoperability to Impact: Evaluating the Effect of Digital Health on Population Reach and Service Utilization in ZambiaAuthor: Andrew KashokaDOI: 10.21522./TAJMHR.2016.06.01.Art019
From Interoperability to Impact: Evaluating the Effect of Digital Health on Population Reach and Service Utilization in Zambia
Abstract:
Digital health systems are increasingly recognized as strategic enablers of health system strengthening and Universal Health Coverage (UHC) in low- and middle-income countries. However, limited empirical evidence exists regarding whether digital health transformation initiatives produce measurable population-level health system outcomes. This study evaluates Zambia’s national digital health transformation by examining the effect of interoperability, governance, and integrated electronic health record systems on population reach, demographic utilization, and health service delivery outcomes. An implementation science case study approach was employed using a national SmartCare Pro dataset comprising more than 12.5 million client records. Additional data sources included interoperability reports, Ministry of Health strategic frameworks, governance instruments, and digital health policy documents. Descriptive statistical analysis was conducted across population reach, demographic distribution, healthcare utilization, and system-level operational outcomes. Findings demonstrate that SmartCare Pro achieved substantial national digital health coverage across all provinces in Zambia. Female utilization accounted for 58.8% of registered clients, while Lusaka, Southern, and Copperbelt provinces collectively accounted for more than 53% of all registrations. Interoperability between SmartCare Pro and logistics management systems improved prescription-to-dispensing linkage, medicine stock visibility, supply chain forecasting, continuity of care, and evidence-based planning. The study demonstrates that governance-driven interoperable digital health ecosystems can generate measurable health system outcomes beyond technical implementation indicators. Zambia’s digital health transformation provides an important implementation model for low- and middle-income countries seeking to strengthen healthcare systems through integrated digital ecosystems capable of supporting healthcare delivery, national health intelligence, and population-level decision-making.
From Interoperability to Impact: Evaluating the Effect of Digital Health on Population Reach and Service Utilization in Zambia
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[19]. Jembi Health Systems., 2021, OpenHIE architecture and interoperability implementation guide. Jembi Health Systems, South Africa.
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Evaluation of Routine Immunization Coverage using Lot Quality Assurances Sampling (LQAs) of Jalingo LGA, Taraba State, NigeriaAuthor: Sani H, AbubakarDOI: 10.21522./TAJMHR.2016.06.01.Art020
Evaluation of Routine Immunization Coverage using Lot Quality Assurances Sampling (LQAs) of Jalingo LGA, Taraba State, Nigeria
Abstract:
Routine immunization remains an effective public health intervention in controlling morbidity and mortality among children. However, most areas in Nigeria have continued to perform below optimal levels, and thus it becomes essential to investigate its effectiveness using Lot Quality Assurance Sampling in Jalingo Local Government Area, Taraba State, Nigeria, and also address issues concerning non-vaccinated children who are supposed to be immunized. This study is a cross-sectional quantitative survey research on caregivers of children between 0 and 23 months of age. A total of 360 caregivers were surveyed for this category of children across six different wards within the study area using multistage sampling techniques. The study survey involved a questionnaire administered through a survey method. From the study, it is evident that 76% of children were adequately immunized for their respective ages, 14% were partially immunized, and 10% were unimmunized against diseases for which immunization is required. Although this is an improvement from previous survey estimates on the level of improvement required for RI performances within the LGA, only one ward out of six met the decision threshold using Lot Quality Assurance Sampling. The most cited reasons for non-vaccination and incomplete immunization among children were "not given, reason unknown/others" 38.63%, unavailability of immunization vaccines in most health facilities 24.64%, distance to health facilities in most cases 13.98%, lack of time in most instances 10.66%, and cultural reasons in most instances 7.11%. In light of this, it becomes essential, based on this study, that for the areas that are performing badly to be covered, and also for areas that are doing well to be maintained, vaccine supplies should be strengthened, and community mobilization should be enhanced.
Evaluation of Routine Immunization Coverage using Lot Quality Assurances Sampling (LQAs) of Jalingo LGA, Taraba State, Nigeria
References:
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Barriers, Facilitators, and Lived Experiences Influencing Mothers’ Uptake of Postnatal Care at Primary Health Care Facilities in Ondo State, NigeriaAuthor: Adeyinka W. OdejimiDOI: 10.21522./TAJMHR.2016.06.01.Art021
Barriers, Facilitators, and Lived Experiences Influencing Mothers’ Uptake of Postnatal Care at Primary Health Care Facilities in Ondo State, Nigeria
Abstract:
Postnatal care (PNC) is critical for improving maternal and child health outcomes, yet uptake remains suboptimal in many developing countries including Nigeria. This study explored barriers and facilitators influencing mothers’ utilization of PNC services in Nigeria, as well as their knowledge and experiences of care. A qualitative exploratory study design was employed from February 6, 2026 to February 26, 2026 using semi-structured interviews with Postnatal and ANC clients as well as users of under-five services in primary health facilities in Ondo State. Participants were purposively selected to gain rich insight into the PNC utilization in the setting. All interviews were audio-recorded, transcribed verbatim, and analysed thematically. Thematic analysis identified financial constraints, transportation challenges, cultural beliefs, preference for alternative care providers, and health system factors such as long waiting times and negative provider attitudes as major barriers. Enablers included positive health-seeking behaviour, availability of free or subsidised services, supportive provider attitudes, and mothers’ perceived need for care. Mothers demonstrated moderate PNC knowledge and reported predominantly positive care experiences. Despite positive experiences with PNC, structural, socio-cultural, and individual barriers continue to hinder optimal service uptake. Strengthening health systems, improving geographic access, and implementing culturally sensitive interventions are essential to promote maternal and child health outcomes.
Barriers, Facilitators, and Lived Experiences Influencing Mothers’ Uptake of Postnatal Care at Primary Health Care Facilities in Ondo State, Nigeria
References:
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Harnessing Artificial Intelligence for Maternal and Child Digital Health in India: A Narrative ReviewAuthor: Pavani DiviDOI: 10.21522./TAJMHR.2016.06.01.Art022
Harnessing Artificial Intelligence for Maternal and Child Digital Health in India: A Narrative Review
Abstract:
Artificial Intelligence (AI) and digital health systems are transforming maternal and child healthcare through the application of predictive analytics, risk stratification, remote monitoring, and clinical decision support systems(CDSS) for better health outcomes. This narrative review examines the integration of AI-enabled digital health interventions in India’s Maternal and Child Health (MCH) systems, and synthesizes the existing evidence and their impact on key areas of its application. It also examines the structural, socio-behavioral, and ethical factors influencing their implementation, informed by global, low- to middle-income countries (LMIC), and India-specific evidence. Literature was obtained from PubMed, Google Scholar, and Scopus (2015–2026) and supplemented by reports from governmental and multilateral organizations. In India, digital health platforms such as mMitra, SMART health pregnancy system, and telemedicine (eSanjeevani) have demonstrated feasibility and acceptability in rural settings. Whereas AI-enabled platform eSanjeevani CDSS have enhanced the quality of teleconsultations and improved diagnostic accuracy for gestational diabetes mellitus and pregnancy-induced hypertension at the primary healthcare level. Ayushman Bharat Digital Mission (ABDM), supported by over 863 million Ayushman Bharat Health Accounts (ABHA), establishes the interoperability infrastructure necessary for the integration of AI. For the responsible use of AI in Healthcare, two initiatives have been launched by the Government of India: the Strategy for Artificial Intelligence in Healthcare (SAHI) and Benchmarking Open Data Platform for Health (BODH) in February 2026. Review concludes that responsible AI deployment, grounded in ethical governance, equity, and context-sensitive adaptation, is essential to achieve Sustainable Development Goal 3 (SDG 3) and universal quality MCH care in India.
Harnessing Artificial Intelligence for Maternal and Child Digital Health in India: A Narrative Review
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Effect of Community Health Worker Interventions on Antenatal Care Utilization and Facility-Based Delivery in East Africa: A Systematic Review and Meta-AnalysisAuthor: Mosses Simon BoniphaceDOI: 10.21522./TAJMHR.2016.06.01.Art023
Effect of Community Health Worker Interventions on Antenatal Care Utilization and Facility-Based Delivery in East Africa: A Systematic Review and Meta-Analysis
Abstract:
Local health workers are often used in low- and middle-income settings to boost maternal health care, especially in remote settings. But evidence on their effectiveness in enhancing service use is mixed. This study sought to assess the effect of community-based approaches on antenatal service utilization and institutional birth in Kenya, Tanzania, and Uganda. This study used the methodology of systematic reviews and meta-analysis in line with PRISMA 2020 guidelines. Articles published between 2015 and 2025 were found via searching PubMed, Scopus, Web of Science, and Google Scholar, complemented by grey literature. Studies reviewed assessed the effect of community-based programs on uptake of antenatal care or giving birth in health facilities. Random-effects models were used to calculate effect sizes, and the I² statistic was calculated to assess heterogeneity. Fourteen studies fitted the inclusion criteria (including randomized or quasi-experimental studies and cohorts). In general, the interventions exhibited a modest increase in the uptake of antenatal care services, but not to a statistically significant extent (OR 1.16, 95% CI 0.86 – 1.56; I² = 58.8%). A similar non-substantial positive trend was observed for facility-based childbirth (OR 1.56, 95% CI 0.55 – 4.46; I² = 91.7%). The diversity of study results was likely due to differences in the design and implementation. The results suggest that community-based strategies likely increase maternal health service use, especially during pregnancy. But improvements in facility-based delivery seem to rely on the health system factors. This suggests that a combination of strategies to improve community-based approaches with better service accessibility and quality may result in better outcomes in East Africa.
Effect of Community Health Worker Interventions on Antenatal Care Utilization and Facility-Based Delivery in East Africa: A Systematic Review and Meta-Analysis
References:
[1]. Asiki, G., Newton, R., Kibirige, L., Kamali, A., Marions, L., Smedman, L., 2018, Feasibility of using smartphones by village health workers for pregnancy registration and effectiveness of mobile phone text messages on reduction of home births in rural Uganda. PLoS ONE, 13(6), e0198653, https://doi.org/10.1371/journal.pone.0198653
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[6]. Geldsetzer, P., Mboggo, E., Larson, E., Lema, I. A., Magesa, L., Machumi, L., et al., 2019, Community health workers to improve uptake of maternal healthcare services: A cluster-randomized pragmatic trial in Dar es Salaam, Tanzania. PLoS Medicine, 16(3), e1002768, https://doi.org/10.1371/journal.pmed.1002768
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[8]. Lee, S., Kasibante, S., Eminai, A., Wani, S., Opii, D. J., Levine, L. D., et al., 2025, Effectiveness of a community health worker-led education intervention on knowledge, attitude, and antenatal care attendance among pregnant women in Eastern Uganda. Journal of Health, Population and Nutrition, 44(1), 232, https://doi.org/10.1186/s41043-025-00876-5
[9]. Maldonado, L. Y., Bone, J., Scanlon, M. L., Anusu, G., Chelagat, S., Jumah, A., et al., 2020, Improving maternal, newborn and child health outcomes through a community-based women’s health education program: A cluster randomised controlled trial in western Kenya. BMJ Global Health, 5(12), e003370, https://doi.org/10.1136/bmjgh-2020-003370
[10]. Maldonado, L. Y., Songok, J. J., Snelgrove, J. W., Ochieng, C. B., Chelagat, S., Ikemeri, J. E., et al., 2020, Promoting positive maternal, newborn, and child health behaviors through a group-based health education and microfinance program: A prospective matched cohort study in western Kenya. BMC Pregnancy and Childbirth, 20(1), 288, https://doi.org/10.1186/s12884-020-02978-w
[11]. Mangwi Ayiasi, R., Kolsteren, P., Batwala, V., Criel, B., Orach, C. G., 2016, Effect of village health team home visits and mobile phone consultations on maternal and newborn care practices in Masindi and Kiryandongo, Uganda: A community intervention trial. PLoS ONE, 11(4), e0153051, https://doi.org/10.1371/journal.pone.0153051
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[15]. Ssetaala, A., Ssempiira, J., Wambuzi, M., Nanyonjo, G., Okech, B., Chinyenze, K., et al., 2022, Improving access to maternal health services among rural hard-to-reach fishing communities in Uganda: The role of community health workers. Women’s Health, 18, https://doi.org/10.1177/17455057221103993
[16]. Wafula, S. T., Kananura, R. M., Pande, G., Kizito, F., Namutamba, S., Kyobe, B., et al., 2024, Effect of community–facility linked interventions on maternal health service utilization and newborn care in rural low-resource settings in Eastern Uganda. BMC Pregnancy and Childbirth, 24(1), 692, https://doi.org/10.1186/s12884-024-06883-4
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What Factors Impact on the Integration of Lifestyle Modification in Chronic Disease Management in Low and Middle-Income CountriesAuthor: Kegomoditswe MatshedisoDOI: 10.21522./TAJMHR.2016.06.01.Art024
What Factors Impact on the Integration of Lifestyle Modification in Chronic Disease Management in Low and Middle-Income Countries
Abstract:
As Non-Communicable Chronic Diseases (NCDs) grow in Low- and Middle-Income Countries (LMICs), the need for effective sustainable strategies in prevention and management of these conditions becomes critical. Lifestyle change (e.g., healthier eating, physical activity, stress management, and less tobacco use) are now considered the primary and sustainable approaches in addressing NCDs. While lifestyle, changing lifestyle proven clinically to be a cost effective in managing NCDs, it is an approach that is highly dependent on a variety of factors that affect a person’s behaviour and their ability to achieve and sustain it. The purpose of this review was to identify these factors that impact the adoption and successful integration of lifestyle modification in management of NCDs in LMICs. A qualitative literature review and narrative synthesis were employed in this study. Published peer reviewed, randomised controlled trials searched from global data base such as PubMed, Google Scholar etc were retrieved and analysed. The search was restricted to the period from 2018 to 2025. A comparative matrix was used to evaluate data from selected studies to evaluate the population, type of intervention, and as well as the outcomes. Thematic analysis was applied to highlight what is deemed to be the barriers as well what is deemed as facilitators for successful integration of lifestyle modification in management of NCDs. The narrative synthesis indicated that though lifestyle modification interventions positively impact the management of NCDs, full integration is hindered by unsupportive healthcare infrastructure, low health literacy, financial constrains, as well as rigid cultural norms and practices. However, there is evidence that community led programs, application of digital health technologies, and adoption of models that integrate lifestyle modification into primary health care may have a positive impact on successful integration of lifestyle modification in managing NCDs in LMICs. The study is concluded with implications for context-driven strategies, sustainable policy, and multisector collaboration to foster sustainable and attainable lifestyle change within resource-limited contexts.
What Factors Impact on the Integration of Lifestyle Modification in Chronic Disease Management in Low and Middle-Income Countries
References:
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[9]. Sagastume, D., Siero, I., Mertens, E., Cottam, J., Colizzi, C., & Peñalvo, J. L., 2022, The effectiveness of lifestyle interventions on type 2 diabetes and gestational diabetes incidence and cardiometabolic outcomes: A systematic review and meta-analysis of evidence from low- and middle-income countries. EClinicalMedicine, 53, 101650.
[10]. Bytyçi-Katanolli, A., Obas, K. A., Ramadani, Q., Fota, N., Jerliu, N., Merten, S., Gerold, J., Zahorka, M., Kwiatkowski, M., & Probst-Hensch, N., 2023, Effectiveness of behavioural change interventions on physical activity, diet and body mass index of public primary healthcare users in Kosovo: the KOSCO cohort. BMJ Open, 13(10), e071100.
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[12]. Hilmarsdóttir, E., Sigurðardóttir, Á. K., & Arnardóttir, R. H., 2021, A Digital Lifestyle Program in Outpatient Treatment of Type 2 Diabetes: A Randomized Controlled Study. Journal of Diabetes Science and Technology, 15(5), 1134–1141.
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[18]. Kumah, E., & Kwawuvi, D. K., 2025, Bridging the diabetes care gap: cost-effective impact of self-management education and support. Academia Medicine, 2(2). https://doi.org/10.20935/AcadMed7742
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Self-Medication Prevalence, Knowledge, Perceptions, and Preventive Practices for Cervical Cancer Among Women of Reproductive Age: Lessons from Uganda — A Scoping ReviewAuthor: Elizabeth Situma NagudiDOI: 10.21522./TAJMHR.2016.06.01.Art025
Self-Medication Prevalence, Knowledge, Perceptions, and Preventive Practices for Cervical Cancer Among Women of Reproductive Age: Lessons from Uganda — A Scoping Review
Abstract:
The approximate number of women who were diagnosed with cervical cancer worldwide by 2022 was 660,000 and out of these 350,000 were registered deaths from the disease. It is noted that 94% of the registered deaths were from low and middle income countries. The scoping review focused on effect of health education on self-medication prevalence, knowledge, perceptions and practices related to prevention of cervical cancer among women of reproductive age in Uganda. Prior definition of the question and scope was effectively done. Papers which were published in English over the last 10 years on the mentioned topic were included in the review. Incorporated in this scoping review were primary studies from researchers and reviews. It was identified from the review that research related to the title, effect of health education intervention on self-medication prevalence, knowledge, perceptions and preventive practices for cervical cancer was limited. Self-medication is largely practiced but under documented, despite it being an ineffective approach to preventing or treating cervical cancer. The risks of self-medication include delayed diagnosis and treatment. It was further identified that self-medication allows disease to progress to advanced stage due to inadequate treatment. This in turn interferes with appropriately prescribed treatments thus increasing the risk of side effects. Uganda is one of the countries where self-medication is common and noted as a leading course to delayed diagnosis for cervical cancer. Among women of reproductive age in sub-Saharan Africa, health education interventions have been proved to be effective in improving knowledge, perceptions and preventive practices for cervical cancer. It is therefore noted that, the intended research focusing on the effect of health education intervention on self-medication practices for cervical cancer should be done further. In order to reduce the burden of cervical cancer in low resource settings like Uganda, health education interventions could be effective.
Self-Medication Prevalence, Knowledge, Perceptions, and Preventive Practices for Cervical Cancer Among Women of Reproductive Age: Lessons from Uganda — A Scoping Review
References:
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[13]. Ebu, N. I., Amissah Essel, S., Asiedu, C., Akaba, S., & Pereko, K. A., 2019, Impact of health education intervention on knowledge and perception of cervical cancer and screening for women in the Komenda, Edina, Eguafo Abirem (K.E.E.A.) District in the Central Region of Ghana. BMC Public Health, 19, Article 1505. https://doi.org/10.1186/s12889-019-7867
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