The survey results revealed a predominant concentration of individuals aged 35–44 years (37.3%), with significant proportions of women aged 25–34 years (25.1%) and 45–54 years (24.0%). The youngest [18,19,20,21,22,23,24] and oldest (65+) categories are few at 5.3% and 1.1%, respectively. The North Central region has the highest representation (26.5%), and a significant proportion holds a secondary school certificate (29.3%). Traders constitute the largest occupation category (32.8%), Christianity is the dominant religion (66.9%), and urban residences are more common (65.9%). The majority (23.1%) earn ≤ 25,000 naira (≤ 19.16 USD), and most (87.5%) have 0–5 children. Close to half (46.4%) make health decisions independently, and most are at Stage 1 of their disease (82.9%). Table 1 provides a comprehensive overview of the sociodemographic characteristics of the respondents.

Table 1 Demographic characteristics of the respondentsGaps in Palliative Care among WLWH assessing care at NISA-MIRCs sitesKnowledge of Palliative Care

Overall, the study results revealed that there was a greater proportion of respondents in South West Nigeria (31.2%) indicating knowledge about palliative care than in other zones. In Southern Nigeria, the proportion of respondents with knowledge of palliative care was notably greater (59.9%) than that in Northern Nigeria (9.1%). Specifically, 4.5% and 4.6% of the respondents in North West and North Central Nigeria, respectively, indicated knowledge of palliative care. Furthermore, 31.2%, 15.4%, and 13.3% of respondents in South West Nigeria, South Nigeria, and South East Nigeria, respectively, had knowledge of palliative care. However, there was no record of knowledge of palliative care among those in North East Nigeria. Figure 1 below illustrates the distribution of respondents’ knowledge regarding palliative care across different geopolitical zones.

Fig. 1

Knowledge of palliative care across the six regions in Nigeria

Awareness of Palliative Care services in their facilities.

Figure 2 illustrates respondents’ awareness of palliative care services in their healthcare facilities across different geopolitical zones. Most respondents in all zones reported not being aware of such services, with percentages ranging from 90.4% in North East Nigeria to 98.7% in South Nigeria. Conversely, the proportion of respondents who were aware of palliative care services in their facility was low, ranging from 1.3% in North West China to 9.6% in North Central Nigeria. Overall, the majority of respondents across all zones reported a lack of awareness of palliative care services in their facility, with only a few indicating awareness.

Fig. 2

Awareness of Palliative Care services in NISA-MIRCs facilities across the six regions in Nigeria

Attitude towards Palliative Care

The examination of attitudes toward palliative care across different geopolitical zones revealed diverse attitudes, as shown in Fig. 3. Notably, the respondents expressed fear of referral to palliative care, with proportions varying from 9.6% in South Nigeria to 35.5% in South West Nigeria. Similarly, respondents indicated feelings of anxiety triggered by the term “palliative care,” varying from 1.9% in South Nigeria to 16.7% in South West Nigeria. With respect to beliefs about palliative care, the majority of respondents across all zones perceived it as offering hope (ranging from 42.0% in South West Nigeria to 84.6% in South Nigeria) and as potentially improving quality of life (ranging from 41.3% in South West Nigeria to 90.0% in North East Nigeria). Additionally, some believed that palliative care could alleviate pain when sick, with proportions varying from 32.6% in South West Nigeria to 71.2% in South Nigeria. Similarly, divergent attitudes were observed regarding the perception that palliative care signifies imminent death (ranging from 18.8% in North West Nigeria to 55.0% in North East Nigeria) or implies that medical professionals can no longer provide needed care (ranging from 26.6% in South East Nigeria to 84.6% in South Nigeria). These perceptions were more nuanced and varied across different regions. More information on attitudes toward palliative care across the six regions in Nigeria is presented in Fig. 3.

Fig. 3

Attitudes toward Palliative Care across the six regions in Nigeria

Table 2 Predictors of knowledge of Palliative CareSociodemographic predictors of knowledge of Palliative Care

Table 2 provides a comprehensive overview of the predictors of palliative care knowledge. A chi-square (χ2) test of independence was used to ascertain the predictors of knowledge of palliative care among women who were sampled across various sociodemographic and other health-associated variables. Specifically, respondents’ educational level, occupation, religion, number of children, place of residence, type of residence and income all reached statistical significance in terms of their knowledge of palliative care (p < .05). Knowledge of palliative care varied by education, with higher rates among those with HND/Degree (26%) and postgraduate (30%) than among those with OND/Diploma (14%), JSC/SSCE (9%), and FSLC (5%). Those without formal education had the lowest level of knowledge. Chi-square analysis revealed significant variation (p = .000). Occupation also showed significant variation (p = .000), with civil servants (23%), teachers (19%), and traders (12%) having more knowledge than do housewives (3%) and farmers (4%). Religion was significant (p = .023), with Christians (13%) having more knowledge than Muslims (10%). Women with fewer children (0–5) had more knowledge (13%) than those with 6 or more children (4%), with significant variation (p = .010). Urban residents (15%) had more knowledge than did rural residents (5%) (p = .000). The type of residence was also significant (p = .000), with those in duplexes (53%) and bungalows (26%) showing more knowledge than those sharing spaces (4%).

Income levels significantly predicted knowledge (p = .000); higher earners had more knowledge, with 22% of those earning above $76.65 (N100,000) having knowledge compared with 1% of those earning ≤$19.16 (N25,000). On the other hand, the geopolitical zone, age, and health decision autonomy variables did not show statistically significant associations with knowledge of palliative care, as indicated by the nonsignificant p values (p > .05). Specifically, the p-value for geopolitical zones is 0.052, suggesting that there are no significant regional differences in palliative care knowledge. With p values of 0.113 and 0.086, respectively, the respondents’ age and autonomy over health decisions do not exhibit any significant relationships. In summary, the findings revealed that socioeconomic variables play a crucial role in the knowledge of palliative care among the women included in the study.

Barriers and facilitators influencing the integration of Palliative Care into routine HIV care in PHC Willingness of participants to access PCs in PHCs

Figure 4 depicts the ‘willingness’ of respondents to access or use palliative care services provided by primary healthcare centers (PHCs) near them. The South South region has the highest inclination, with 88.5% of respondents expressing willingness, followed by the North Central region (68.8%). On the other hand, the South West region has a lower proportion (39.9%) reporting willingness. These data indicate considerable regional differences in palliative care acceptance and utilization.

Fig. 4

Willingness to access or utilize palliative care in nearby PHC

Perceived high cost

Across all likely barriers within regions, some crucial distributions were observed. As shown in Fig. 5, a high cost of palliative care topped the list of possible barriers, with respondents in the North Central (82.7%), North West (71.8%) and South South (73.1%) zones indicating it as a concern. The South East and South West zones report similar proportions (approximately 57.8% and 59.4%, respectively), whereas the North East Zone indicates a lower, but still notable, concern at 55.0%.

Stigma

The respondents highlighted that stigma could influence access to palliative care, as those (69.8%) in the North West Zone mentioned it as a barrier. The North Central and North East Zones also reported stigma as a possible concern, at 64.2% and 60.0%, respectively. Moreover, the South West zone has the lowest value of 39.1%.

Negative attitudes of health workers

The issue of negative attitudes from healthcare workers is most pronounced in the South South Zone, with 76.9% of respondents identifying it as a barrier. The North Central and North West zones also have high proportions, at 64.2% each. The South East zone shows a slightly lower proportion at 51.6%, whereas the South West and North East zones report the lowest levels of negative attitudes, at 30.4% and 50.0%, respectively. This indicates regional variation in healthcare workers’ attitudes toward palliative care patients, reflecting potential differences in training, awareness, and cultural attitudes toward palliative care across zones.

Unavailability of trained health workers

Similarly, the majority of respondents in the South South (69.2%), North West (64.4%) and North Central (63.1%) zones highlighted the unavailability of trained healthcare staff as a likely barrier. However, few of those in South East Nigeria (43.8%) and South West Nigeria (29.0%) perceived the unavailability of trained healthcare staff as a problem. The large distance between health facilities and homes emerged as a likely barrier for a moderate proportion of respondents in the North Central (51.9%) and North West (43.6%) zones. However, fewer respondents identified the same barrier in South West Nigeria (23.3%) and South East Nigeria (32.0%).

Decision autonomy

Decision autonomy has lower proportions across all zones, indicating that it is less of a barrier than other factors. The South South and South West zones have the lowest percentages, at 7.7% and 13.8%, respectively. In contrast, non-recommendation from doctors is a substantial barrier in the North East (70.0%) and North West (50.5%) zones, indicating possible gaps in physician advocacy for palliative care. Finally, personal opinions concerning palliative care are a less prevalent obstacle overall, with South East Nigeria reporting the largest share (25.8%), followed by North Central Nigeria (17.7%). This implies that while beliefs influence palliative care uptake, other systemic constraints, such as cost, stigma, and personnel availability, are more important across geographical zones.

Fig. 5

Distribution of selected barriers to Palliative Care across geopolitical zones

Facilitators of integrating Palliative CareLow cost of Palliative Care services

Figure 6 presents the distribution of facilitators of palliative care across six geopolitical zones in Nigeria. As shown in the figure below, a great majority of respondents in North East China (90.0%), South South Nigeria (88.5%), North Central Nigeria (85.8%), and North West Nigeria (80.7%) highlighted low-cost or no-cost palliative care as a likely facilitator of integration.

Positive attitudes of healthcare workers

Another facilitator mentioned by most of the respondents in North East Nigeria (80.0%), South South Nigeria (76.9%), North Central Nigeria (74.2%) and North West Nigeria (67.8%) was positive attitudes of health workers. However, fewer than half of the respondents in South West Nigeria identified the positive attitudes of health workers as facilitators.

Recommendation by physicians and the subjective other

Physician recommendations were regarded as critical facilitators, with South South Nigeria (88.5%), North East Nigeria (85.0%), North Central Nigeria (74.6%), South East Nigeria (73.4%), and other zones having the highest proportions. Palliative care is perceived as necessary for well-being in the North East (80.0%), North Central (80.0%), North West (68.8%), and South South (55.8%) zones, indicating strong recognition of its importance, whereas the South West (38.4%) and South East (46.9%) zones report lower proportions. Recommendations by subjective others are highest in the North East (45.0%) and North Central (34.2%) zones, indicating strong community support, whereas the South West (10.1%) and South East (14.8%) zones indicate lower approval rates.

The perception that palliative care lessens the burden on family caregivers was identified as a facilitator in the North East (65.0%) and North Central (63.1%) zones. Comparatively, South West Nigeria (15.2%) and South East Nigeria (27.3%) presented smaller proportions, suggesting a need for increased awareness of this benefit. Finally, belonging to a support group, which can enhance the support system for palliative care patients, was the most common facilitator in the South East (21.1%) and North Central (16.9%) zones. South West Nigeria (4.3%) and South South Nigeria (1.9%) reported the lowest proportions.

Fig. 6

Facilitators of integration of Palliative Care