Solina Group (Nigeria)

Background and Objective: Nigeria accounts for about 28.5% of the global maternal death burden, with 22% of these deaths caused by postpartum hemorrhage (PPH). The high prevalence of poor-quality uterotonics, particularly oxytocin and misoprostol, results in more PPH cases. Heat-stable carbetocin (HSC), a thermo-stable analog of oxytocin, is a suitable uterotonic option for preventing PPH, particularly in regions like Nigeria where the quality of oxytocin, the “gold standard uterotonic, ” cannot be assured. Methods: This evaluation assesses the cost-effectiveness, budget, and health impacts of introducing HSC compared to current prophylactic standards for PPH prevention among women delivering in public healthcare facilities in Nigeria. Quantitative data on direct healthcare system costs of using oxytocin, misoprostol, oxytocin– misoprostol combination, and HSC to prevent PPH collected from one state in each of six geopolitical zones in Nigeria served as inputs into a hierarchical decision-tree model built to generate public healthcare system perspective outputs on related PPH deaths and disabilities (disability-adjusted life-years), budget impact, and cost-effectiveness. Results: In a cohort of 2,548,136 deliveries, HSC may avert 111,652 PPH events when compared against oxytocin. This includes 12,873 PPH cases, 31,442 severe morbidities (disability-adjusted life years), and 1,165 deaths. These are associated with a 6% reduction in total cost to the health system and cost per woman, respectively. The budget impact analysis revealed a possible total cumulative savings to the public healthcare system of ₦352,798,943 (USD $ 235,199) if HSC is scaled up over 5 years to a 17% market share of prophylactic uterotonics administered. Conclusion and Global Health Implications: Introducing HSC for PPH prevention may be a cost-effective public health intervention in Nigeria when compared to oxytocin, the current standard of care to prevent PPH. Health-economic modeling projects HSC to be associated with lower costs to the health system while conferring better maternal health outcomes when compared to oxytocin or oxytocin–misoprostol combination.

The core intent of the study is to: (i) compare the profitability of the land leasing market scheme participating and non-participating smallholder oil palm farmers in oil palm producing belt of Nigeria; and (ii) assess the effect of land leasing market scheme on their productivity. Multistage sample method was employed to select 240 smallholder oil palm farmers (120 land leasing market scheme participating smallholder oil palm farmers, and 120 land leasing market scheme non-participating smallholder oil palm farmers). From the result, the net profit margin ratio for the land leasing participating farmers was 46.41%, non-participating farmers was 42.27%. The study further shows that age,2, farm size, and knowledge of land leasing market scheme had negative value and the relationship was significant with land leasing market scheme participating status. The expected oil palm productivity from land leasing participating smallholder oil palm farmers was 2,946.4 kg/hectare compared with 2,042.0 kg/hectare from non-participating farmers. The study recommends that smallholder oil palm farmers should be sensitized by all stakeholders to participate in land leasing market scheme to increase their productivity.

ABSTRACT Climate change significantly impacts access to potable water, necessitating policy and practical reforms to achieve Sustainable Development Goal (SDG) 6. In Nigeria, population growth has outpaced access to piped water, leading to widespread water stress, with many Nigerians daily consuming a lesser quantity of water than the World Health Organization (WHO)'s minimum recommended threshold. This issue is exacerbated by weak institutions, corruption, and water governance instruments that lack specific climate change adaptation strategies, potentially hindering the achievement of SDG 6. This study, therefore, evaluates water provision and access in Nigeria to propose sustainable solutions. We conducted a systematic literature search across relevant databases and search engines, narratively synthesizing the retrieved data. Findings indicate that achieving SDG 6, given current institutional challenges, requires a re-evaluation of water governance policies and processes to embed adaptive capacity into existing structures and foster a climate-resilient water system. Through a comparative situational analysis of similar contexts, our results show that leveraging the existing national and local adaptive capacity frameworks can improve Nigeria's water system. Concrete and actionable recommendations that may serve as a roadmap for Nigeria and other developing countries facing similar challenges are provided.

SummaryBackgroundSub-Saharan Africa (SSA) alone contributed to 42% of global stillbirths in 2019, and the rate of stillbirth reduction has remained slow. There has been an increased uptake of community-based interventions to combat stillbirth in the region, but the effects of these interventions have been poorly assessed. Our objectives were to examine the effect of community-based interventions on stillbirth in SSA.MethodsIn this systematic review and meta-analysis, we searched eight databases (MEDLINE [OvidSP], Embase [OvidSP], Cochrane Central Register of Controlled Trials, Global Health, Science Citation Index and Social Science Citation index [Web of Science Core Collection], CINAHL [EBSCOhost] and Global Index Medicus) and four grey literature sources from January 1, 2000 to July 7, 2023 for relevant studies from SSA. Community-based interventions targeting stillbirths solely or as part of complex interventions, with or without hospital interventions were included, while hospital-only interventions, microcredit schemes and maternity waiting home interventions were excluded. Study quality was assessed using the Cochrane risk of bias and National Heart, Lung and Blood Institute's tools. The study outcome was odds of stillbirth in intervention versus control communities. Pooled odds ratios (ORs) were estimated using random-effects models, and subgroup analyses were performed by intervention type and strategies. Publication bias was evaluated by funnel plot and Egger’s test. This study is registered with PROSPERO, CRD42021296623.FindingsOf the 4223 records identified, seventeen studies from fifteen SSA countries were eligible for inclusion. One study had four arms (community only, hospital only, community and hospital, and control arms), so information was extracted from each arm. Analysis of 13 of the 17 studies which had community-only intervention showed that the odds of stillbirth did not vary significantly between community-based intervention and control groups (OR 0.96; 95% CI 0.78–1.17, I2 = 57%, p ≤ 0.01, n = 63,884). However, analysis of four (out of five) studies that included both community and health facility components found that in comparison with community only interventions, this combination strategy significantly reduced the odds of stillbirth by 17% (OR 0.83; 95% CI 0.79–0.87, I2 = 11%, p = 0.37, n = 244,868), after excluding a study with high risk of bias. The quality of the 17 studies were graded as poor (n = 2), fair (n = 9) and good (n = 6).InterpretationCommunity-based interventions alone, without strengthening the quality and capacity of health facilities, are unlikely to have a substantial effect on reducing stillbirths in SSA.FundingNuffield Department of Population Health, 10.13039/501100006558Balliol College, the 10.13039/501100014748Clarendon Fund, 10.13039/501100000265Medical Research Council.

PurposeThe COVID-19 pandemic has had a disruptive effect on the health system. Health facility leaders were at the forefront of maintaining service delivery and were exposed to varied stressors in the early phase of the pandemic. This study aims to explore the leadership experiences of health facility leaders during the early phase of the COVID-19 pandemic in Nigeria’s epicentre.Design/methodology/approachThis study conducted an exploratory descriptive qualitative study. To achieve this, 33 health facility leaders of different cadres across primary, secondary, and tertiary levels of the public health care system in Lagos, Nigeria, were remotely interviewed. The key informant interviews were transcribed verbatim and were analysed by using thematic analysis.FindingsThe health facility leaders experienced heightened levels of fear, anxiety and stressors during the early phase of the pandemic. They also had genuine concerns about exposing their family members to the virus and had to manage some health-care workers who were afraid for their lives and reluctant. Coping mechanisms included psychological and social support, innovative hygiene measures at health facility and at home, training and staff welfare in more ways than usual. They were motivated to continue rendering services during the crisis because of their passion, their calling, the Hippocratic oath and support from the State government.Originality/valueThe experiences of health facility leaders from different parts of the world have been documented. However, to the best of the authors’ knowledge, this is one of the first studies that specifically report multi-layer leadership experiences of health facility leaders during the early phase of the COVID-19 pandemic in sub-Saharan Africa.

OBJECTIVESWest Nile virus (WNV) is a re-emerging mosquito-borne viral infection. This study investigated the pooled prevalence pattern and risk factors of WNV infection among humans and animals in Nigeria.METHODSA systematic review was conducted of eligible studies published in PubMed, Scopus, Google Scholar, and Web of Science from January 1, 1950 to August 30, 2020. Peer-reviewed cross-sectional studies describing WNV infections in humans and animals were systematically reviewed. Heterogeneity was assessed using the Cochrane Q statistic.RESULTSEighteen out of 432 available search output were eligible and included for this study. Of which 13 and 5 were WNV studies on humans and animals, respectively. Although 61.5% of the human studies had a low risk of bias, they all had high heterogeneity. The South West geopolitical zone of Nigeria had the highest pooled prevalence of anti-WNV immunoglobulin M (IgM; 7.8% in humans). The pooled seroprevalence of anti-WNV IgM and immunoglobulin G (IgG) was 7.1% (95% confidence interval [CI], 5.9 to 8.3) and 76.5% (95% CI, 74.0 to 78.8), respectively. The WNV RNA prevalence was 1.9% (95% CI, 1.4 to 2.9), while 14.3% (95% CI, 12.9 to 15.8) had WNV-neutralizing antibodies. In animals, the pooled seroprevalence of anti-WNV IgM and IgG was 90.3% (95% CI, 84.3 to 94.6) and 3.5% (95% CI, 1.9 to 5.8), respectively, while 20.0% (95% CI, 12.9 to 21.4) had WNV-neutralizing antibodies. Age (odds ratio [OR], 3.73; 95% CI, 1.87 to 7.45; p<0.001) and level of education (no formal education: OR, 4.31; 95% CI, 1.08 to 17.2; p<0.05; primary: OR, 7.29; 95% CI, 1.80 to 29.6; p<0.01) were significant risk factors for WNV IgM seropositivity in humans.CONCLUSIONSThe findings of this study highlight the endemicity of WNV in animals and humans in Nigeria and underscore the need for the One Health prevention and control approach.