National HIV Sero-Prevalence Sentinel Survey 2008
Eight round
Nigeria, 2008
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NGA-FMOH-ANC-2008-v1.1
National HIV Sero-Prevalence Sentinel Survey 2008
Eight round
SPA Service Provision Assessment 2008
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| Name | Country code |
|---|---|
| Nigeria | NGA |
Service Provision Assessment Survey
The World Health Organization (WHO) introduced the Antenatal Clinic (ANC) HIV sentinel seroprevalence survey to monitor the HIV and AIDS epidemic in countries of the world including the Federal Republic of Nigeria. The survey uses pregnant women attending antenatal clinics as proxy for the general population. Since inception in Nigeria in 1991, seven rounds of ANC HIV survey have been conducted with the 2008 wave making it the eight in the series.
The 2008 ANC survey was guided by a survey management committee constituted by the Federal Ministry of Health. The members of the committee were drawn from the Federal and State Ministries of Health, NACA, Development Partners, Research Institutions and private individuals among others.
This report highlights the findings from the 2008 HIV sentinel sero-prevalence survey among women 15-49 years attending antenatal clinics in Nigeria. The objectives of the survey were to determine HIV prevalence among pregnant women attending antenatal clinics, assess the trend in HIV prevalence and provide data for estimating and projecting the HIV epidemic in the general population. The survey was also designed to compare data obtained from PMTCT records with data obtained through ANC sentinel survey in the same sites. A Survey Management Committee (SMC) constituted by the Federal Ministry of Health under the chairmanship of the Director of Public Health coordinated the survey. Membership of this committee included the National Agency for the Control of AIDS (NACA), UN Agencies, bilateral agencies, academia and other stakeholders.
The data from the survey are used for advocacy, monitoring of the epidemic, programme planning and programme implementation. In addition to other data sources, the ANC survey has continued to contribute towards the realization of the second generation surveillance in Nigeria.
Goal
The goal of conducting this survey was to provide information about the current HIV prevalence and distribution in the country; it is aimed that the information would sensitize all stakeholders to take appropriate actions.
Specific Objectives
a. To determine the prevalence of HIV infection among women attending antenatal clinics in the 36 States and the Federal Capital erritory (FCT) in Nigeria.
b. To determine HIV prevalence by selected demographic characteristics and geographical locations.
c. To monitor trends of HIV prevalence among women attending antenatal clinics.
d. To provide general population estimates and projections of the HIV/AIDS epidemic and its impact in the country.
e. To determine the utility of PMTCT programme data for ANC HIV surveillance in Nigeria
Sample survey data [ssd]
The units of analysis are individuals, laboratories and facilities
Version
Version 1.0 (November 2011)
Version 1.1 (March 2012) Adding the literal question text and some missing label
2009-11-01
Version 1.0 Final clean and anonymized dataset
Version 1.1 (March 2012) Adding the literal question text and some missing label
Scope
Individuals-Age, Marital Status, PMTCT referal, Level of Education
Laboratories- HIV testing
Facility-Supervision, No. of women recruited, No. of women tested, ANC Doctor in charge present, ANC Nurse present,
| Topic | Vocabulary | URI |
|---|---|---|
| specific diseases and medical conditions [8.9] | CESSDA | http://www.nesstar.org/rdf/common |
| health policy [8.6] | CESSDA | http://www.nesstar.org/rdf/common |
Coverage
National
Local Government
HIV/AIDS service providers at facility
Producers and sponsors
| Name | Affiliation |
|---|---|
| Federal Ministry of Health | Federal Govenment of Nigeria |
| Name | Role |
|---|---|
| World Health Organization | Technical Assistance in Finance |
| Name | Abbreviation | Role |
|---|---|---|
| Center for Disease Conrtol | CDC | Technical and Financial Support |
| World Health Organization | WHO | Technical and Financial Support |
| National Agency for the Control of AIDS (NACA) | NACA | Technical and Financial Support |
| Name | Affiliation | Role |
|---|---|---|
| UNAIDS | Federal Govenment of Nigeria | Technical Support |
Sampling
The two rural sites in each State generated a minimum combined sample size of 300 (150 in each of the rural sites) such that the rural samples form a rural cluster with a total sample size large enough to be analyzed by State. This was used to estimate the rural prevalence in each State.
The response rate is very high
Facility
Survey instrument
Individuals-Age, Marital Status, PMTCT referal, Level of Education
Laboratories- HIV testing
Facility-Supervision, No. of women recruited, No. of women tested, ANC Doctor in charge present, ANC Nurse present,
The analysis focused on determining the prevalence of HIV infection by the relevant independentvariables such as age, site, State, zone, education and location. The median and the overall prevalence rates for States, zones and the entire country were determined. Exact 95% confidence intervals were determined for all the rates. The differences between the States and zones were evaluated and the trend analysis was carried out for some consistent sites and States. PMTCT and ANC
sentinel surveillance data were analyzed and compared for all the sites which provided PMTCTservices and participated in the ANC survey.
Data collection
| Start | End | Cycle |
|---|---|---|
| 2008-06-16 | 2008-09-08 | 12 weeks |
| Start date | End date | Cycle |
|---|---|---|
| 2008 | 2010 | 3yrs |
- Face-to-face [f2f]
Quality Assurance Measures
The following measures were adopted to ensure that the results were accurate, reliable and reproducible:
Engagement of highly qualified and experienced laboratory personnel at the State laboratories and QC laboratory.
Conducting central and zonal level trainings for all the personnel involved in the survey.
The central and zonal level trainings were conducted by a team of resource persons using a standardized three-day training package. This included two days of didactic lectures with group work and one day of laboratory practicals.
All the laboratory scientists who participated in the quality control aspect of the survey were adequately trained for the activity.
All the sites/States used the same test kits for syphilis and HIV.
All the test kits used were thoroughly evaluated and assessed for potency and shelve life before use, All kits were stored at 4-8C (refrigerator or vaccine cold room). Lot number, batch number and expiry date were noted and documented.
All the States were provided with positive and negative HIV Control panels (produced in Nigeria). Worksheets were provided to document the running of controls on a weekly basis. At the end of the survey, all the specimens and survey forms were retrieved.
All the consumables used for sample separation, storage and dispensing were sterile and disposable.
TWO supervisory visits were made to all the the survey sites by the national survey team to ensure compliance with the survey protocol by all field workers using the Checklist for site supervisory visit (Appendix IV).
A medical officer in the ANC clinic recruited for the survey supervised the sample and data collection procedures at the respective ANC clinic; while the State laboratory
scientist supervised sample processing and storage during the weekly visit to sites. The SAPC also carried out regular supervisory visits to the sites and State laboratory using the Checklist for site supervisory visit (Appendix IV).
Every State produced a detailed report on the conduct of the survey in the State.
Laboratory scientists selected for participation in the survey were currently performing routine syphilis and/or HIV screening on the bench at their respective centres.
A system was put in place to perform HIV test kit lot monitoring.
3.10 Data collection from PMTCT sites
Data on PMTCT were collected from ANC sentinel sites offering PMTCT services. Data collected from PMTCT sites three months preceding the survey and during the survey period included the following:
Number of new clients
Number of clients counselled for HIV
Number of clients tested for HIV
Number of clients positive for HIV
Individual level information from the Personal Data Forms of the ANC survey.
Blood and data collection
Government policy states that all public health facilities must screen all pregnant women for syphilis
in order to control and prevent congenital syphilis. As such, all women are routinely offered the
syphilis test during their first antenatal visit in Nigeria. If they accept, 5ml of blood is collected to
conduct the test. Women are then informed of the result of their syphilis screening during the next
visit and appropriately treated according to the country guidelines.
For this survey, an unlinked anonymous method was used. After the syphilis test, an anonymous and
unlinked serum sample was collected from the leftover blood and sent to the state central laboratory
for the HIV test.
3.6.1 Demographic data collection
All sites collected minimum demographic data from each eligible pregnant woman including age,
education, marital status, parity and gravidity using the Personal Data Form (Appendix I). The
participant's name was written on the personal data form and her survey ID sticker was also placed on
the same form.
3.6.2 Blood collection, processing and unlinking process
Pregnant women were sent to the laboratory staff or to the nurse responsible for blood collection.
Five (5) milliliters of blood were collected in a vacutainer labeled with the woman's name only and
sent to the local site laboratory for screening.
Data processing
At the survey site, data collection forms were completed, stored and later transported to the Statelevel. The State laboratory scientists collated all data forms at the State level and forwarded them to the Federal Ministry of Health for electronic entry by the data entry team. The team checked the data forms for completeness, obvious errors and inconsistencies in order to identify any possible data quality errors.
During the data entry process, the following specific measures were taken to ensure that the data were accurate:
CHECK codes were created to ensure that only legal entries and data in specified ranges were entered.
All entries on the computer were checked against the the data on paper, item by item.
Frequency tables were generated for all variables in order to further examine whether there were double or unusual entries.
Double entry of data (100%) was done to validate entered data using the VALIDATE option in EPIINFO menu.
Discrepant records were reviewed and corrected before data analysis commenced.
Data appraisal
The methods, tools and assumptions used to estimate the burden of HIV/AIDS in Nigeria are based on the recommendations made by the UNAIDS Reference Group in estimates, modelling and projections.
The UNAIDS Reference Group is a technical working group made up of experts in epidemiology, modelling and statistics, which advises UNAIDS on the best methods and tools to be used to estimate national figures for HIV and AIDS. These methods and tools are revised regularly and improvements have been made since 2003.
The Epidemic Projection Package (EPP 2007) was used to estimate and project adult HIV prevalence and the burden of infection in the country from the surveillance data obtained from ANC clients. The software uses inputs such as base population, sex ratio and urban - rural infection ratio. The resulting national estimated adult HIV prevalence was then transferred to a demographic package, Spectrum 3, modelling software for demographic projections to calculate the number of people infected and other parameters, such as AIDS cases, AIDS deaths and AIDS orphans.
The basic data used to estimate HIV prevalence at the national level was the data collected on pregnant women attending ANC clinics through regular surveys which have been conducted in Nigeria since 1991. In the recent past (since 1999), these surveys have been conducted every 2 years. One of the main factors affecting the results of this system is the level of attendance of pregnant women in the ANC clinics. In Nigeria, it has been estimated that ANC clinics cover about 60% of the pregnant women, and there are extreme variations in the different States and among social classes.
Table I Characteristics of the surveyed population 12
Table II HIV Prevalence by State, Site and Location, North Central Zone 17
Table III HIV Prevalence by State, Site and Location, North East Zone 19
Table IV HIV Prevalence by State, Site and Location, North West Zone 21
Table V HIV Prevalence by State, Site and Location, South East Zone 23
Table VI HIV Prevalence by State, Site and Location, South South Zone 25
Table VII HIV Prevalence by State, Site and Location, South West Zone 27
Table VIII HIV Prevalence by Marital Status 29
Table IX HIV Prevalence by Educational Status 30
Table X HIV Prevalence by Gravidity and Parity 30
Table XI HIV Prevalence Trends by States from 1991-2008 39
Table XII HIV Prevalence Trends in sites participating in the survey from 2001 to 2008 41
Table XIII HIV Estimates and Projections 43
Table XIV Camparisons of HIV Prevalence between ANC and PMTCT Programme 44
Data Access
| Name | Affiliation |
|---|---|
| Federal Ministry of Health | Federal Government of Nigeria |
| Is signing of a confidentiality declaration required? | Confidentiality declaration text |
|---|---|
| yes | Confidentiality of respondents is guaranteed by the National Statistics Act. Before being granted access to the dataset, all users have to formally agree: 1. To make no copies of any files or portions of files to which s/he is granted access except those authorized by the data depositor. 2. Not to use any technique in an attempt to learn the identity of any person, establishment, or sampling unit not identified on public use data files. 3. To hold in strictest confidence the identification of any establishment or individual that may be inadvertently revealed in any documents or discussion, or analysis. Such inadvertent identification revealed in her/his analysis will be immediately brought to the attention of the data depositor. |
- The data and other materials will not be redistributed or sold to other individuals, institutions, or organizations without the written agreement of the [National Data Archive].
- The data will be used for statistical and scientific research purposes only. They will be used solely for reporting of aggregated information, and not for investigation of specific individuals or organizations.
- No attempt will be made to re-identify respondents, and no use will be made of the identity of any person or establishment discovered inadvertently. Any such discovery would immediately be reported to the [National Data Archive].
- No attempt will be made to produce links among datasets provided by the [National Data Archive], or among data from the [National Data Archive] and other datasets that could identify individuals or organizations.
- Any books, articles, conference papers, theses, dissertations, reports, or other publications that employ data obtained from the [National Data Archive] will cite the source of data in accordance with the Citation Requirement provided with each dataset.
- An electronic copy of all reports and publications based on the requested data will be sent to the [National Health Data Archive].
"Federal Ministry of Health, Integrated Supportive Supervision Survey (ISSS 2011), Version 1.0 of the final data for public use dataset(2011), provided by the Federal Ministry of Health. www.fmoh.gov.ng"
Disclaimer and copyrights
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.
© 2012, Federal Ministry of Health
Contacts
| Name | Affiliation |
|---|---|
| Medical Officer | Federal Ministry of Health |
Metadata production
DDI-NGA-FMOH-ANC-2008-V1.1
| Name | Abbreviation | Affiliation | Role |
|---|---|---|---|
| Federal Ministry of Health | FMOH | Federal Government of Nigeria | Documentation of the Study |
2012-03-28
Metadata version
Version 1.0 (November 2011). This is the first version of the ANC 2008 documentation. Documented during the Microdata Management Toolkit Training 28th November - 2nd December 2011. Facilitated by FMOH, MEASURE Evaluation, WorldBank and OECD/PARIS 21.
Version 1.1 (March 2012) Adding the literal question text and some missing label