Continuous Quality Improvement (CQI) is a process
where health teams systematically collect and regularly
reflect on local data to inform decisions and modify local
practices and so improve delivery of services. We implemented
a cluster randomized trial to examine the effects of CQI
interventions on Prevention of Mother-to-Child Transmission
(PMTCT) services. Here, we report our experiences and challenges
establishing CQI in 2 high HIV prevalence states in
northern Nigeria.

Nigeria’s widespread mixed epidemiology HIV program has achieved a 26% reduction in new infections since 2010. New HIV infections in Nigeria remain higher in key populations, adolescent girls and young women. Treatment as prevention was a relatively new concept in Nigeria in 2016,
Center for Integrated Health Programs with U=U adopted and launched in 2019 by the Federal Ministry of Health. This paper provides
justification on why a sustained focus on U=U campaigns in Nigeria will contribute to the successes of the Nigerian HIV program, improving the possibility of HIV epidemic control and attaining equitable health outcomes for all sub populations in Nigeria.

Retention in care is critical for improving HIVinfected
maternal outcomes and reducing vertical transmission. Health
systems’ interventions such as continuous quality improvement (CQI)
may support health services to address factors that affect the delivery
of HIV-related care and thereby influence rates of retention-in-care.

Definitions of retention-in-care in Prevention of Mother-to-Child Transmission of HIV (PMTCT) vary substantially
between studies and programmes. Some definitions are based on visits missed/made, others on a minimum total number
of visits, or attendance at a final clinic visit at a specific time. An agreed definition could contribute to developing evidencebased
interventions for improving retention-in-care. In this paper, we estimated retention-in-care rates according to different
definitions, and we quantified and visualized the degree of agreement between definitions.

Rates of retention in care of HIV-positive pregnant
women in care programs in Nigeria remain generally poor with rates
around 40% reported for specific programs. Poor quality of services
in health facilities and long waiting times are among the critical
factors militating against retention of these women in care. The aim
of the interventions in this study is to assess whether a continuous
quality improvement intervention using a Breakthrough Series
approach in local district hospitals and primary health care clinics
will lead to improved retention of HIV-positive women and mothers.

Mother to child transmission (MTCT) of HIV remains a significant public health problem globally and in Nigeria. MTCT (also known as vertical transmission) refers to the passage of HIV infection from the mother to the child during pregnancy, childbirth, or breastfeeding [1]. Globally in 2020, there were 37.7 million people living with HIV (PLHIV), with 680,000 AIDS-related deaths and 1.5 million new infections. Sub-Saharan Africa accounts for about 67% of the global burden of HIV with 25.4 million PLHIVs.

COVID-19 pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) was first discovered in December 2019 in Wuhan, China and later declared a pandemic on March 11, 2020 by the WHO. This study was conducted to assess the impact of COVID -19 pandemic and its attendant infection prevention of lockdown on ANC utilization and deliveries by skilled birth attendants in Kaduna State. It is a retrospective data review of 18 months data on ANC clinic visit and skill birth delivery from 1,722 health facilities. October 2019 to March 2021 data was extracted from the DHIS 2.

The maternal and child health situation in developing countries remains critical and
deeply concerning, These regions account for 99% of global maternal and under-five
deaths. In Nigeria, uptake of critical life-saving maternal, neonatal and child health
(MNCH) services, delivered through antenatal care (ANC), are sub-optimal, leading
to poor outcomes. Group antenatal care (G-ANC) is an evolving antenatal care delivery
model in low and medium-income countries.

Poor access to antenatal care (ANC), skilled birth attendance, and postnatal care services contribute to high
maternal and infant mortalities in Nigeria. Traditional ANC model has limitations especially in low resource settings. Group
antenatal care (G-ANC) offers an alternative, combining clinical assessments with group discussions, information sharing, selftesting
and peer support. This model has proven successful in various countries. This paper evaluated facilitators, barriers
and the sustainability of the G-ANC program in Kaduna State, Nigeria, through a qualitative assessment of its implementation
and outcomes.

Children still die from vaccine-preventable diseases. Nigeria contributes 30% of unimmunized children <5 years globally. This study was
conducted in 4 Local Government Areas (LGA) in Niger and Gombe States employing the positive deviance (PD) approach to increase vaccination
demand in low child immunization coverage settings.

The Positive Deviance Journey to improve childhood vaccination in Northern Nigeria

Pearl Project Compendium