Obinna Onwujekwe

Verified

Obinna verified their affiliation via an institutional email.

Learn more

Verified

Obinna verified their affiliation via an institutional email.

Learn more

• MD, PhD
• Research Director at University of Nigeria

Background: Health policymaking is a complex process and analysing the role of evidence is still an evolving area in many low- and middle-income countries. Where evidence is used, it is greatly affected by cognitive and institutional features of the policy process. This paper examines the role of different types of evidence in health policy develo...

West African countries are ranked especially low in global corruption perception indexes. The health sector is often singled out for particular concern given the role of corruption in hampering access to, and utilization of health services, representing a major barrier to progress to universal health coverage and to achieving the health-related Sus...

Background: The need to build capacity for health policy and systems research (HPSR) in low- and middle-income countries has been underscored as this encompasses the processes of decision-making at all levels of the health system. This implementation research project was undertaken in Southeast Nigeria to evaluate whether the capacity-building int...

Absenteeism among primary health-care (PHC) workers in Nigeria is widespread and is a major obstacle to achieving Universal Health Coverage (UHC). There is increasing research on the forms it takes and what drives them, but limited evidence on how to address it. The dominant approach has involved government-led topdown solutions (vertical approach)...

Informal payments are widespread in many healthcare systems and can impede access to healthcare and thwart progress to achieving universal health coverage, a major element of the health-related Sustainable Development Goals. Gender may be an important driver in determining who pays informally for care, but few studies have examined this, particular...

Chronic care manages long-term, progressive conditions, while acute care addresses short-term conditions. Chronic conditions increasingly strain health systems, which are often unprepared for these demands. This study examines the burden of conditions requiring acute versus chronic care, including sequelae. Conditions and sequelae from the Global B...

Poor living conditions and poverty in urban slums mean that informal health providers (IHPs) often dominate health service provision in such settings. We explored the capacity of leaders within slums to contribute to linking IHPs to formal health providers (FHPs), for improved access to quality health services in slums. We purposively selected and...

Introduction This study assessed the effect of an intervention on adolescents’ attitudes towards condom use, contraceptive use, unsafe abortion, and intimate partner violence in urban and rural communities in Southeast Nigeria. Method A cross-sectional study was conducted in twelve (12) communities purposively selected from six (6) local governmen...

This study undertook an assessment of multigenerational attitudes towards gender norms related to intimate partner violence (IPV), sexuality, and reproductive health behaviours. A cross-sectional household survey was conducted among 1630 young people and adults, in six communities in Ebonyi state, southeast Nigeria. In data analysis, mean attitude...

Background: Communicating health information at the community level is a vital strategy in managing community health issues in Africa. This study examines the different practices of communicating health information towards improving community health in Nigeria, and how effective they have been. The social cognitive theory (SCT) provides the concep...

Objectives This study examines the economic burden and inequities in out-of-pocket expenditures (OOPEs) to access healthcare in urban slums in Nigeria. Methods The cross-sectional study was undertaken in eight urban slums in Enugu and Anambra, Nigeria. Participants (n = 1,025) responded to questions on health expenditures and access to healthcare....

Nigeria bears the highest global burden of malaria, accounting for 25% of cases and 19% of deaths worldwide. Development partners provide substantial support for malaria prevention and treatment in Nigeria. This study examines the financial burden of malaria on households and the benefit incidence of donor-supported bed net services in Enugu State,...

Background Despite the availability of effective interventions, malaria and diarrhea continue to be leading causes of disease burden in Nigeria. Informal healthcare providers (IHPs) account for a significant proportion of health service providers in urban slums and may pose a challenge to service quality if they are untrained and unregulated. This...

Background Hepatitis B immunoprophylaxis reduces the rate of mother-to-child transmission of hepatitis B virus infection and has effectively reduced the global burden of the hepatitis B virus infection. However, the cost of hepatitis B immunoglobulin could be prohibitive hampering adequate utilization in pregnancy and childbirth. Cost may affect pr...

Background Gender norms shape rights, privileges, and societal roles, impacting health and well-being. In low- and middle-income countries (LMICs), while young people may reject harmful gender discrimination, they often support other norms that perpetuate gender imbalances. This study examines factors influencing young people’s attitudes toward gen...

Background: Experiencing corruption when seeking health services remains a significant problem in Nigeria. An effective response requires knowledge of the individual characteristics of those impacted by corruption when seeking healthcare. This study examined the prevalence of corruption among those seeking health services in Nigeria’s public health...

Introduction Multisectoral plans and actions at the community level are one of the strategies that are deployed in the primary healthcare (PHC) system for improving the health and wellbeing of the people and also a means of addressing the social determinants of health. Multisectoral actions are also a means of implementing the Health in All Policie...

Background Collaboration among multiple stakeholders from different sectors requires a coherent coordination mechanism in implementing responses to public health emergencies such as coronavirus disease 2019 (COVID-19) to improve the effectiveness and efficiency of countermeasures against the pandemic. The paper describes multi-stakeholder roles and...

With most households in rapidly urbanizing cities in low- and medium-income countries using private and informal providers for basic healthcare, the need to establish linkages with the formal sector is paramount in the drive for universal health coverage. Successful and effective linkage of informal healthcare providers to the formal health system...

Background Lack of sexual and reproductive health (SRH) knowledge among adolescents can lead to risky sexual behaviors and poor SRH outcomes. This study aimed to assess the difference in SRH knowledge between adolescents in schools that received SRH interventions and those in non-intervention schools in Ebonyi State, Southeast, Nigeria. Methods Th...

Background There are massive gaps in communication between health researchers and policy-makers in Nigeria, which constrains the use of research evidence for policy-making. Mass media can help in bridging the gaps, especially since the media has the reach and a reputation for presenting information in ways that elicit actions from the public and po...

Introduction Attitudes of healthcare providers towards young people seeking sexual and reproductive health services (SRHS) are poorly described in research. Yet, this has implications for the promotion and operations of Youth Friendly Sexual and Reproductive Health Services (YFSRHS). This study seeks to identify and describe the overall treatments...

Cross-programmatic inefficiencies are duplications or misalignments that arise from undue fragmentation of health systems by vertical health programs. Identifying and addressing the root causes of cross-programmatic inefficiencies in a health system can ensure more efficient use of resources to make progress toward Universal Health Coverage. This p...

Despite global efforts encouraging institutional deliveries with skilled attendants, many pregnant women in developing countries such as Nigeria continue to rely on traditional birth attendants (TBAs) for child delivery. Attempts at weeding off TBAs have been firmly resisted by their clients who have developed confidence and trust in their services...

Background As set out in Sustainable Development Goal 3.3, the target date for ending the HIV epidemic as a public health threat is 2030. Therefore, there is a crucial need to evaluate current epidemiological trends and monitor global progress towards HIV incidence and mortality reduction goals. In this analysis, we assess the current burden of HIV...

Background To improve the efficient use of scarce resources, low- and middle-income countries and development partners are increasingly encouraged to deliver multiple vaccines and other interventions in a single integrated campaign. However, little is known regarding the cost of delivering vaccines through integrated campaigns, and the extent to wh...

Background This study sought to document and understand facilitators and barriers to producing, translating, and using modeled evidence in decision-making in Burkina Faso, Nigeria, India, and Kenya. We explored researcher-decision-maker engagement mechanisms as key facilitators of evidence use, with a focus on knowledge brokers and boundary organiz...

Background Community health system (CHS) exists through the actions and activities of different actors within and outside communities. However, these actors, their roles and their relationships with one another have not been properly explored to understand their dynamics in facilitating the effectiveness of CHS. This study identified the actors in...

Background: Adverse gender norms within the health care system are detrimental to the sexual and reproductive health of young people. This study assessed the attitudes of health workers toward adverse gender norms related to intimate partner relationships across three domains: intimate partner violence (IPV); sexuality; and reproductive health beh...

Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990–2021. We estimated incidence, prevalence, death, and disability-adjusted life-year (...

Objective: The study aimed to assess the equity of access to free maternal and child health services among reproductive-age women in Delta State, NigeriaDesign: the study adopted a descriptive cross-sectional survey designParticipants: The population for the study were 368 women of reproductive age (15-49 years) who had given birth between April 20...

Background: Up-to-date estimates of stroke burden and attributable risks and their trends at global, regional, and national levels are essential for evidence-based health care, prevention, and resource allocation planning. We aimed to provide such estimates for the period 1990–2021. Methods: We estimated incidence, prevalence, death, and disabilit...

Introduction Sub-optimal community health service delivery (CHSD) has been a challenge constraining community health systems (CHS) globally, especially in developing countries such as Nigeria. This paper examined the key factors that either enhance or constrain CHSD in Nigeria at the individual, community/facility and governmental levels while reco...

Individual experiences, social policies, and environmental exposure shape beliefs, norms and ideologies about sexuality. The objective of this study was to determine the effectiveness of a school health club training programme in improving adolescents’ knowledge and perceptions of gender norms and ideologies about sexuality. This was an interventio...

This study assessed multi-level factors that shape young people's attitudes towards gender biases about rape, sexual, and domestic violence in intimate relationships. This cross-sectional study was undertaken in three urban and three rural communities in Ebonyi State, southeast Nigeria. Data were collected from 1,020 young people using an interview...

This paper assessed gender differences and perceptions towards condom use among in-school adolescents in Ebonyi State, Nigeria. This was a cross-sectional study undertaken in six local government areas in Ebonyi State, Nigeria. Data were collected using a structured questionnaire and summarised using frequencies and proportions. Chi-square test and...

Introduction Gender-transformative approaches (GTAs) have been successfully carried out to address harmful gender norms and power imbalances to promote more gender equitability. However, to improve the health and wellbeing of young people, it is necessary to involve household heads by positively transforming their beliefs on gender equity and norms...

BACKGROUND: Uncorrected refractive error (URE) is a readily treatable cause of visual impairment (VI). This study provides updated estimates of global and regional vision loss due to URE, presenting temporal change for VISION 2020 METHODS: Data from population-based eye disease surveys from 1980-2018 were collected. Hierarchical models estimated pr...

Informal healthcare providers (IHPs) often serve as the first point of contact for healthcare services for non-communicable diseases in urban slums and their ability to identify risk factors and symptoms of the diseases is crucial for early detection and management. This paper assesses level of knowledge of hypertension and diabetes mellitus (DM) a...

BACKGROUND Peer education has contributed to increased knowledge and preventive behaviors of adolescents toward reproductive health matters with the unique feature of maintaining peer-to-peer learning ability and sustaining intervention gains. This study examined the factors that predict the agency of in-school adolescents as peer educators on the...

Background We aimed to update estimates of global vision loss due to age-related macular degeneration (AMD). Methods We did a systematic review and meta-analysis of population-based surveys of eye diseases from January, 1980, to October, 2018. We fitted hierarchical models to estimate the prevalence of moderate and severe vision impairment (MSVI;...

Background Significant gaps in scholarship on the cost-benefit analysis of haemodialysis exist in low-middle-income countries, including Nigeria. The study, therefore, assessed the cost-benefit of haemodialysis compared with comprehensive conservative care (CCC) to determine if haemodialysis is socially worthwhile and justifies public funding in Ni...

Context The burden of diabetes mellitus (DM) and hypertension (HTN) both singly and in comorbidity has gained increased attention, especially in developing countries and this has great socioeconomic consequences. In Nigeria, the prevalence of both diseases is known to be increasing, while government health expenditure (HE) is not. Aim The study ex...

Urban slums are human habitats with poor habitation qualities that are vulnerable to infectious diseases and public health crises. Low coverage from formal healthcare services providers created opportunity for informal providers to thrive in urban slums. This study examined the nature of relationship between informal and formal healthcare services...

The contributions of informal providers to the urban health system and their linkage to the formal health system require more evidence. This paper highlights the collaborations that exist between informal providers and the formal health system and examines how these collaborations have contributed to strengthening urban health systems in sub-Sahara...

Objectives Community involvement depends on the level of linked and targeted activities for health by community members. This study examines the collaborations employed within communities to ensure sustainable access and improved use of healthcare in the community. Methods This study was conducted in rural and urban local government areas in Anamb...

Objectives Assessed the level of awareness of hepatitis B virus infection and hepatitis B immunoglobulin, and determined the proportion of pregnant women that will accept hepatitis B immunoglobulin if needed for their babies and the factors that were associated with the choices made by pregnant women in the Enugu metropolis. Methods A cross-sectio...

Summary Background Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injur...

Introduction Sub-optimal community health service delivery (CHSD) has been a challenge constraining community health system (CHS) globally, especially in underdeveloped countries like Nigeria. This paper examined the key factors that either enhance or constrain CHSD in Nigeria at individual, community/facility and governmental levels while recommen...

Background School and Community-embedded reproductive health interventions have been implemented in developing countries, with evidence that they led to improved sexual and reproductive health among adolescents. However, this type of intervention is rarely evaluated for its potential adoption and use. This study evaluated the constraints and enable...

Background Accurate assessments of current and future fertility-including overall trends and changing population age structures across countries and regions-are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to i...

This appendix provides detailed information on the methods for the paper “Global fertility in 204 countries and territories, 1950–2021 with forecasts to 2100: a comprehensive demographic analysis for the Global Burden of Disease Study 2021”

Background Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensiv...

Summary Background Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injur...

Background Young people (aged 10 to 24 years) in sub-Saharan Africa bear a huge and disproportionate burden of poor sexual and reproductive health (SRH) outcomes due to inequalities and discrimination in accessing sexual and reproductive health services (SRHS). This study assessed the experiences and perceptions of discrimination among young people...

Background It is important to understand the sexual and reproductive health (SRH) needs of adolescents from the adolescents themselves to address their needs properly. Hence, this paper provides new knowledge on the information needs on SRH among adolescent boys and girls in selected secondary schools in Ebonyi state, southeast Nigeria. Method A c...

Background Detailed, comprehensive, and timely reporting on population health by underlying causes of disability and premature death is crucial to understanding and responding to complex patterns of disease and injury burden over time and across age groups, sexes, and locations. The availability of disease burden estimates can promote evidence-base...

Purpose Sexual and reproductive health (SRH) interventions demand diverse services, encompassing medical, social and psychological care to ensure the overall wellbeing of service users. In the absence of multidisciplinary response to SRH interventions, service users could be deprived of crucial SRH services, which could undermine their safety and w...

Background Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important follow...

This study determined the feasibility of investing revenues raised through Nigeria’s sugar-sweetened beverage (SSB) tax of 10 Naira/l to support the implementation of the National, Surgical, Obstetrics, Anaesthesia and Nursing Plan, which aims to strengthen access to surgical care in the country. We conducted a mixed-methods political economy analy...

Background Accurate assessments of current and future fertility-including overall trends and changing population age structures across countries and regions-are essential to help plan for the profound social, economic, environmental, and geopolitical challenges that these changes will bring. Estimates and projections of fertility are necessary to i...

Background Disorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditio...

Background Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of D...

Background Adolescents need both information about sexual behaviours and potential risks in order to make the right choices. This study compared adolescents’ level of awareness and predictors of knowledge of condoms and dual protection where a multi-component sexual and reproductive health (SRH) intervention was implemented and in communities where...

Background Health worker shortages are common in low-resource settings and this affects the range and quality of services delivered. Health facility try to adapt by utilizing volunteers to ensure modest service delivery. We deployed ethnographic observations and other qualitative approaches to understand the issues around volunteer recruitment and...

Background Primary Health Centers (PHCs) in Nigeria often have inconsistent and deficient supplies of resources (drugs, medical supplies and equipment), funds and staff, a situation which is underpinned by lack of investment, governance fragmentation and political inference. Rent-seeking remains a major, albeit unexplored, problem. This study explo...

Primary healthcare facilities are the bedrock for achieving universal health coverage (UHC) because of their closeness to the grassroots and provision of healthcare at low cost. Unfortunately, in Nigeria, the access and quality of health services in public primary healthcare centres (PHCs) are suboptimal, linked with persistent occurrence of absent...

Background Adolescents’ sexual and reproductive health (SRH) needs are largely unmet due to poor access to SRH information and services. A multicomponent community-embedded intervention, comprising advocacy to policymakers and community leaders, training of health workers on the provision of youth-friendly SRH services, and establishment of school...

Background: Volunteer health workers play an important, but poorly understood role in the Nigerian health system. We report a study of their lived experiences, enabling us to understand their motivations, the nature of their work, and their relationships with formally employed health workers in Primary Healthcare Centres (PHCs) in Nigeria, the role...

Background To improve the efficient use of scarce resources, low- and middle-income countries and development partners are increasingly encouraged to deliver multiple vaccines and other interventions in a single integrated campaign. However, little is known regarding the cost of delivering vaccines through integrated campaigns, and the extent to wh...

Background Family planning is fundamental to women’s reproductive health and is a basic human right. Global targets such as Sustainable Development Goal 3 (specifically, Target 3.7) have been established to promote universal access to sexual and reproductive healthcare services. Country-level estimates of contraceptive use and other family planning...

Background Evidence of willingness to pay for kidney replacement therapy is scarce in low-middle-income countries, including Nigeria’s Formal Sector Social Health Insurance Programme. The study, therefore, assessed the willingness to pay for haemodialysis among chronic kidney disease patients in Abuja, Nigeria. Methods The study adopted a cross-se...

Background. Modeled evidence is a proven useful tool for decision makers in making evidence-based policies and plans that will ensure the best possible health system outcomes. Thus, we sought to understand constraints to the use of models in making decisions in Nigeria’s health system and how such constraints can be addressed. Method. We adopted a...

Background Adolescents and their communities in Ebonyi State, Nigeria have poor attitudes and beliefs towards adolescent sexual and reproductive health (SRH). This paper reports on the effects of a community-embedded intervention that focused on creating positive changes in the attitudes and beliefs of adolescents and community members to enhance a...