Neighbourhood characteristics and under-five mortality in Nigeria

Despite global decline in childhood mortality, under-5 mortality remains high in Nigeria. While many studies have reported individual level factors as important determinants of under-five mortality in Nigeria, similar studies on the effects of neighbourhood contexts have been minimal. Hence, this study examines the effects of neighbourhood contexts on under-5 mortality in Nigeria. Using 2003 and 2008 Nigeria Demographic and Health Survey (NDHS) data, multilevel Cox regression analysis was performed on a nationally representative sample of 6,028 children (2003 NDHS) and 28,647 children (2008 NDHS). Results indicated neighbourhood context as important factor for child survival.For instance, findings showed that being born or raised in poor neighbourhoods (HR:1.54,p<0.05), rural communities (HR:1.25,p<0.05), and North-eastern region of Nigeria (HR:1.56,p<0.05) was associated with elevated hazards of death before age 5. Findings of this study suggest that achieving improved neighbourhood contexts holds great potentials for acceleration of under-five mortality reduction in Nigeria

Do Family Structure and Poverty Affect Sexual Risk Behaviors of Undergraduate Students in Nigeria?

This study examined sexual practices in a Nigerian University community with a view to understanding the role of family structure and poverty on risky sexual behaviours. A representative sample of 1,301 undergraduate students was randomly selected from the various faculties that made up the University. Using a questionnaire instrument, information was obtained on sexual behaviours of interest such as sexual initiation, multi-partnered sexual activity and condom use. Findings showed a noticeable variation in the relationship between family structure and risky sexual behaviour. Contrary to expectations, students from single parent homes showed lower likelihood of having multiple sexual partners. Also poverty was found not to be a critical determinant of risky sexual behaviour. Given the unclear nature of the findings, future study should explore further understanding of the relationship between family characteristics, poverty rating and risky sexual behaviour among students. Keywords: Sexual risk behaviour, family structure, poverty, undergraduate students, Nigeria (Afr J Reprod Health 2013; 17[4]: 137-149

Linkages between autonomy, poverty and contraceptive use in two sub-Saharan African countries

The paper presents the interaction effect of poverty-wealth status and autonomy on modern contraceptive use in Nigeria and Namibia with a view to examining whether poor women with less autonomy are less likely to use modern contraception than other women. A weighted sample of 3,451 currently married women in 2006-07 Namibia Demographic and Health Survey (DHS) and 23,578 in 2008 Nigeria (DHS) are used in the analysis. In Nigeria, the odd of using modern contraception is nearly 15 times higher among rich women with more autonomy than their counterparts who are poor and are less autonomous and 5.5 times higher among Namibian women. The study concluded that contraceptive behaviors of currently married women of Namibia and Nigeria are not independent of the linkage between poverty and autonomy and thus recommended that more concerted efforts be made in addressing poverty and improving the autonomous status of women in sub-Sahara Africa

Assessing Africa’s child survival gains and prospects for attaining SDG target on child mortality

This study assessed Africa’s child survival gains and prospects for attaining Sustainable Development Goals (SDG) target 3.2. We analysed multiple country-level secondary datasets of 54 African countries and presented spatial analysis. Results showed that only 8 out of the 54 African countries have achieved substantial reductions in under-5 mortality with an under-five mortality rate (U5MR) of 25 deaths per 1,000 live births or less. Many countries are far from achieving this target. Results of the predictions using supervised machine learning on the Bayesian network reveal that the probability of achieving the SDG target 3.2 (i.e., having U5MR of 25 deaths per 1000 live births or less) increases (from 21.6% to 100%) when the contraceptive prevalence increases from 49.8% to 78.5%; and the use of skilled birth attendants increases from 44.8% to 86.3%; and percentage of secondary school completion of female increases from 42.5 to 74.0%. Our results from Local indicator of spatial autocorrelation (LISA) cluster maps show that 7 countries (mainly in West/Central Africa) formed the high-high clusters (hotspots for U5M) and may not achieve the SDG target 3.2 unless urgent and appropriate investments are deployed. As 2030 approaches, there is a need to address the problem of limited access to quality health care, female illiteracy, limited access to safe water, and poor access to quality family planning services, particularly across many sub-Saharan African countries

Assessing Community Acceptance of Maternal Immunisation in Rural KwaZulu-Natal, South Africa: A Qualitative Investigation.

Despite the significant benefits of maternal immunisation, uptake remains low in many parts of the world. In this qualitative study, we aimed to assess the factors that influence pregnant women's decision to engage with maternal immunisation in rural KwaZulu-Natal, South Africa. We conducted in-depth interviews with a total of 28 purposively sampled pregnant women and key informants using semi-structured topic guides. Data analysis was conducted using a modified Health Belief Model framework that included constructs of barriers to action, modifying factors of cue to action and perceived social norms. The findings show that traditional customs and institutional barriers such as low-quality health service delivery, long queues, and distance to the health facilities, immunisation vaccine stockouts and low levels of maternal knowledge influence the choice and decision to engage with maternal immunisation. Understanding health-related behaviours and addressing barriers to care is important in facilitating vaccination uptake. This study contributes to the understanding of maternal immunisation uptake in low-resource settings

Mortality Surveillance Methods to Identify and Characterize Deaths in Child Health and Mortality Prevention Surveillance Network Sites

Despite reductions over the past 2 decades, childhood mortality remains high in low- and middle-income countries in sub-Saharan Africa and South Asia. In these settings, children often die at home, without contact with the health system, and are neither accounted for, nor attributed with a cause of death. In addition, when cause of death determinations occur, they often use nonspecific methods. Consequently, findings from models currently utilized to build national and global estimates of causes of death are associated with substantial uncertainty. Higher-quality data would enable stakeholders to effectively target interventions for the leading causes of childhood mortality, a critical component to achieving the Sustainable Development Goals by eliminating preventable perinatal and childhood deaths. The Child Health and Mortality Prevention Surveillance (CHAMPS) Network tracks the causes of under-5 mortality and stillbirths at sites in sub-Saharan Africa and South Asia through comprehensive mortality surveillance, utilizing minimally invasive tissue sampling (MITS), postmortem laboratory and pathology testing, verbal autopsy, and clinical and demographic data. CHAMPS sites have established facility- and community-based mortality notification systems, which aim to report potentially eligible deaths, defined as under-5 deaths and stillbirths within a defined catchment area, within 24-36 hours so that MITS can be conducted quickly after death. Where MITS has been conducted, a final cause of death is determined by an expert review panel. Data on cause of death will be provided to local, national, and global stakeholders to inform strategies to reduce perinatal and childhood mortality in sub-Saharan Africa and South Asia

Comparing the reasons for contraceptive discontinuation between parenting adolescents and young women in sub-Saharan Africa: a multilevel analysis

Abstract Background Adolescent sexual and reproductive health remains a major public health and development issue of global importance. Given that adolescents and young people are heterogenous groups in terms of many characteristics, this study expands the literature by comparing the reasons for contraceptive discontinuation between parenting adolescents (aged 15–19) and parenting young women (aged 20–24) in sub-Saharan Africa (SSA). Methods Data for the study came from Demographic and Health Surveys of 22 SSA countries. The outcome variable was reasons for discontinuation. We performed multilevel binary logistic regression on analytic samples comprising 1485 parenting adolescents and 10,287 parenting young women across the selected SSA countries. Results Findings show that the proportion of respondents who used modern contraceptives was lower among parenting adolescents (35%) relative to their 20–24-year-old counterparts (43%). Higher percentages of parenting adolescents than young women discontinued contraceptives because of reasons such as pregnancy or method failure (i.e., 9.9% and 8.17% accordingly), husband disapproval, access or availability issues, wanting more effective methods, and inconvenience in using methods. The multilevel analysis further highlighted disparities between parenting adolescents and parenting young women who discontinued contraceptives. For instance, parenting young women had 30% lower odds of discontinuing contraceptives due to pregnancy or method failure than parenting adolescents. Conclusion The study established disparities in the reasons for contraceptive discontinuation between parenting adolescents and parenting young women, with adolescents demonstrating greater vulnerabilities and higher risks. Considerable attention must be given to parenting adolescents in the efforts to achieve equity goals such as the Sustainable Development Goals and universal health coverage in SSA

Is technical demography becoming less relevant? Two decade review of published articles in selected demography journals

Background: In this paper, we reviewed development in the field of technical demography and empirically demonstrate that there has been a decline in the proportion of technical demographic studies published in the last two decades.Methods: All original articles published in nine demographic journals from Africa, Europe, Australia, Canada and United States were reviewed. We derived yearly aggregate for total number of articles and number of technical demographic papers from 1994 to 2015. We illustrated the trends in the proportion of technical demographic studies in a graph and also estimated the annual rate of decline using least square regression techniques.Results: A total of 4091 studies were published in 465 issues of the selected journals between 1994 and 2015 of which 371 (9.0%) were related to technical demography. The proportion of technical demographic papers declined gradually at an annual rate of 0.42% (CI= 0.29-0.62) between 1994 (12.0%) and 2015 (10.0%).Conclusion: Technical demography need to be strengthened in order to provide the critical data and evidence required to objectively monitor the post-2015 development goals

Maternal health care utilization and neonatal mortality in Nigeria: looking beyond the micro-level pathway of influence

Neonatal mortality is a neglected but largely preventable public health challenge in Nigeria. The country contributes the largest number of neonatal deaths in Africa, and this is an important reason for the failure of the country to meet Millennium Development Goal (MDG4) of reducing child mortality. Maternal health services provide the platform for delivering cost-effective interventions that reduce maternal and child mortality. Thus, we examined the relationship between the utilization of maternal health services and neonatal mortality in Nigeria by carrying out a multilevel Cox proportional regression analysis of the most recent Nigeria Demographic and Health Survey (2013 NDHS) in order to decompose the micro and macro level factors on the pathway of influence for neonatal mortality.  Hazards of neonatal death were significantly lower for children whose mothers had 4 or more antenatal visits by skilled providers (HR: 0.78, CI: 0.61-0.98, p<0.05) and whose mothers received postnatal care from skilled provider (HR: 0.41, CI: 0.30-0.56, p<0.05) even after adjusting for other control variables. There was also a significantly elevated hazards of neonatal mortality for mothers in rural areas (HR: 1.44, CI: 1.09-1.90). Our findings highlight the importance of maternal health care services for neonatal mortality reduction especially in the rural areas

Multilevel analysis of male fertility behaviour in Nigeria

Context/Background: Fertility level in Nigeria remains high and currently, it stagnating at about six children per woman. Demographic literature had established the existence of preponderance of factors sustaining a high level of fertility in the country. Most previous studies on fertility had focused on women, and a few that examined male fertility behaviour focused mainly on individual-level factors, ignoring the influence of community contexts. This study, therefore, examined the influence of an individual, household and community level factors on male fertility behaviour in Nigeria.Data source and Methods: The study used male data from 2013 Nigeria Demographic and Health Survey (DHS).Results: Results showed that community variables like region, ethnic diversity, community family-size norm and community-level of education significantly influenced male fertility behaviour in Nigeria (p<0.05).Conclusion: The study thus established community contexts as an important factor influencing male fertility behaviour, and this factor must be taken into consideration in the efforts to reduce the fertility level in Nigeri