Background: Private entities play a major role in health globally. However, their contribution has not been fully optimized to strengthen delivery of public health services. The COVID-19 pandemic has overwhelmed health systems and precipitated coalitions between public and private sectors to address critical gaps in the response. We conducted a study to document the public and private sector partnerships and engagements to inform current and future responses to public health emergencies. Methods: This was a multi-country cross-sectional study conducted in the Democratic Republic of Congo, Nigeria, Senegal and Uganda between November 2020 and March 2021 to assess responses to the COVID-19 pandemic. We conducted a scoping literature review and key informant interviews (KIIs) with private and public health sector stakeholders. The literature reviewed included COVID-19 country guidelines and response plans, program reports and peer-reviewed and non-peer-reviewed publications. KIIs elicited information on country approaches and response strategies specifically the engagement of the private sector in any of the strategic response operations. Results: Across the 4 countries, private sector strengthened laboratory systems, COVID-19 case management, risk communication and health service continuity. In the DRC and Nigeria, private entities supported contact tracing and surveillance activities. Across the 4 countries, the private sector supported expansion of access to COVID-19 testing services through establishing partnerships with the public health sector albeit at unregulated fees. In Senegal and Uganda, governments established partnerships with private sector to manufacture COVID-19 rapid diagnostic tests. The private sector also contributed to treatment and management of COVID-19 cases. In addition, private entities provided personal protective equipment, conducted risk communication to promote adherence to safety procedures and health promotion for health service continuity. However, there were concerns related to reporting, quality and cost of services, calling for quality and price regulation in the provision of services. Conclusions: The private sector contributed to the COVID-19 response through engagement in COVID-19 surveillance and testing, management of COVID-19 cases, and health promotion to maintain health access. There is a need to develop regulatory frameworks for sustainable public–private engagements including regulation of pricing, quality assurance and alignment with national plans and priorities during response to epidemics.

Intimate partner violence (IPV) occurs in high proportions among young women, with long-lasting adverse health and social outcomes. Recent research findings suggest that experiencing economic vulnerability may influence the ways in which young women experience or are at risk for IPV, including economic abuse. Economic abuse, a form of IPV, involves a partner’s control over money and other economic resources or activities. This study explored economic vulnerability and IPV, including economic abuse, among young Nigerian women reporting a recent history of IPV. In-depth interviews (n = 25) were conducted with women aged 18–30 years who had experienced IPV in the past year. Women were recruited from community and health facilities in low-income neighborhoods of Ibadan, Nigeria. A semi-structured interview guide was used to gather data on women’s economic vulnerability (e.g., food security, living situation, employment/education opportunities, family financial support, economic independence) and experiences of IPV. An analysis was conducted using a thematic analysis approach. The coding scheme was based on interview protocols, adding open codes from emergent themes identified in the interviews. On average, participants were 21 years old, most had children (68%) and reported to be cohabitating with a male partner (56%), and 48% had less than a secondary level of education. Among the emergent themes, women reported economic vulnerability as being financially dependent on a male partner for basic needs. Among this sample, economic vulnerability was exacerbated by limited education, training, and work opportunities, and a disproportionate burden of household labor. Economic vulnerability precipitated all forms of IPV, including economic abuse, as well as sexual and pregnancy coercion. Economic abuse was reported to occur when male partners controlled household finances and denied women adequate allowance to purchase household food, including food for children. Findings from this qualitative study suggest that interventions promoting educational and employment opportunities may be critical to reducing financial reliance on male partners and young women’s vulnerability to economic abuse and other forms of IPV. More research and programmatic work are needed on food deprivation as a form of economic abuse affecting women and their children.

Background: Female genital cutting (FGC) inflicts life-long injuries on women and their female children. It constitutes a violation of women’s fundamental human rights and threats to bodily integrity. Though decreasing, the practice is high and widespread in Nigeria despite efforts towards its eradication. This study was conducted to perform cohort analysis of the state of FGC between the years 2009 and 2018 in Nigeria. Results: The study found that that FGC has reduced over the years from 56.3% among the 1959–1963 birth cohort to 25.5% among 1994–1998 cohorts but a rise in FGC between 1994–1998 cohorts and 1999–2003 cohorts (28.4%). The percentage of respondents who circumcised their daughters reduced from 40.1% among the oldest birth cohort to 3.6% among the younger cohort. Birth-cohort, religion, education, residence, region, and ethnicity were associated with FGC. Factors associated with the daughter’s circumcision were birth-cohort, religion, residence, region, ethnicity, wealth, marital status, FGC status of the respondent, and FGC required by religion. Similar factors were found for discontinuation intention. Conclusions: The practice of FGC is still high but decreasing among younger birth-cohorts in Nigeria. There is no significant change in the perception of the discontinuation of FGC. More awareness about the adverse effects of FGC, particularly among women with poor education in Nigeria will greatly reduce this cultural menace’s timely eradication.

The burden of hypertension and healthcare seeking behaviour can be driven by gender-related inequalities in access to care. Low hypertension awareness often originates in early adulthood, determining gender patterns in hypertension. The factors that contribute to these patterns in this life stage are critical for improving hypertension control and reducing cardiovascular disease risk. This study was conducted to assess the gender disparities in hypertension prevalence, awareness and healthcare seeking behaviour among young adults in three selected states in Nigeria. Using a cross-sectional design, we assessed gender differences in prevalence, awareness and healthcare seeking behaviour for hypertension among 924 young adults aged 18 – 40 years in three states of Nigeria (Abia, Oyo and Kano States). Pearson's Chi-square was used to test associations between variables. Predictors of gender disparities were assessed with binary logistic regression at 5% level of statistical significance. Of these, 416 (45.0%) were less than 30 years old while 508 (55.0%) of the respondents were ≥ 30 years of age with a mean age ± SD of 29.6 ± 6.8 and 29.8 ± 6.8 for male and female respondents respectively. Overall, the prevalence of hypertension among young adults in the three states was 169 (18.2%); higher among females 107 (19.2%) compared to males 61 (16.7%). Awareness of high blood pressure (BP) was higher among female respondents 333 (59.7%) compared to their male counterparts 192 (52.5%) and the difference was statistically significant (p = 0.03). Visits to a health care provider was higher among females (16.0%) than males (8.7%). Age, marital status, ethnicity, education and occupation were significantly associated (p < 0.005) with elevated BP among female hypertensives while age, marital status and ethnicity were significantly associated with elevated BP among male hypertensives. The study showed gender specific differences with regards to the burden, awareness and health seeking behaviour for hypertension among young adults in Nigeria. There is need for gender specific interventions to control the increasing burden of hypertension in Nigeria.

Background: Globally, infant mortality has declined considerably but has remained unacceptably high in sub-Saharan Africa, especially Nigeria where infant mortality rate is 67/1000 live births. To facilitate infant mortality reduction in Nigeria, an understanding of the synergistic effect of bio-demographic characteristics of mothers known as High Risk Birth Behaviours (HrBBs) is important. We therefore investigated the influence of HrBBs on infant survival in Nigeria.Methods: This cross-sectional study design utilized data from the 2018 round of Nigerian Demographic Health Survey. The study participants were a representative sample of women of reproductive age (n = 21,350) who had given birth within the 5 years preceding the survey. HrBBs was measured through integration of information on maternal age at child’s birth, parity, and preceding birth interval with respect to the most recent child. The HrBBs was categorized as none, single and multiple. Data were analysed using descriptive statistics, Log-rank test and Cox proportional hazard model (α =0.05).Results: The mean age of the women was 29.7 ± 7.2 and 4.1% had experienced infant death. Infant mortality was highest among women with multiple HrBBs (5.1%). Being a male, having small size at birth, failure to receive tetanus injection, non-use of contraceptives and living in the core-north (North West and North East) predisposed children to higher risk of dying before 12 months of age. The hazard ratio of infant mortality was significantly higher among infants of mothers in multiple HrBBs category (aHR = 1.66; CI: 1.33–2.06) compared to their counterparts with no HrBBs.Conclusion: Multiple HrBBs increase the chances of dying among infants in Nigeria. Screening women for HrBBs for special health attention during pregnancy, birth and postnatal period will alleviate infant death in Nigeria.