Unravelling the effects of neighbourhood contextual influences on childhood mortality and morbidity in Nigeria

Background: The burden of childhood stunting and mortality remains huge in developing countries and in particular in the Sub-Saharan Africa region to which Nigeria is located. Despite the body of evidence supporting an association between neighbourhood contextual influences and health outcomes, few studies have examined the relationship between neighbourhood-level risk factors and childhood undernutrition (stunting) and mortality independent of the individual-level risk factors in a single analytical framework in Nigeria. Most studies to date have focused on individual-level factors overlooking the contribution of neighbourhood or area level factors. Beyond the effect of neighbourhood contextual influences, a child’s health will be influenced by the state, region and national policies and programs that in turn will affect the proximate determinants of his or her survival and health status. Aims: We described the variation that existed between the states in Nigeria using league table, control chart and spatial clustering of childhood stunting (Study I) and examined the contribution of community contextual factors at predicting childhood stunting beyond individual-level factors (Study II). We further identified and examined the predictors of childhood mortality in Nigeria (Study III) and developed prognostic model predicting differences in childhood mortality in Nigeria communities (Study IV). We also quantified the contribution of neighbourhood socioeconomic disadvantage alongside individual-level socioeconomic status to childhood mortality in Nigeria using multilevel analysis (Study V). Methods: We used the Nigeria Demographic and Health Survey (DHS) dataset which comprised of 28,647 and 31,482 under-five children nested within 888 and 896 communities for the 2008 and 2013 surveys respectively from 37 states including the Federal Capital Territory. We used league table, control chart and geospatial analysis to describe variations in childhood stunting that existed between the states in Nigeria (Study I). In study II, we applied multivariable multilevel logistic regression analysis to describe the independent contribution of community contextual influences (factors) alongside the individual level factors on childhood stunting in Nigeria. We applied multivariable logistic regression analysis that included Receiver Operating Characteristics (ROC) Curve to construct a model that examined the factors associated with childhood mortality (Study III). In study IV, we used mixed multivariable Poisson regression analysis to develop a prognostic model predicting differences in childhood mortality in Nigeria communities. In Study V, we applied multivariable multilevel logistic regression analysis and considered three measures of individual socioeconomic status i.e. maternal educational attainment, household wealth status, and employment status of the mothers. At the neighbourhood (level 2) and state (level 3), we included poverty rate, unemployment rate, and illiteracy rate. Results: There were statistically significant variations in the odds of childhood stunting and mortality across the neighbourhoods (Study II, IV & V) and states (I) in Nigeria. This confirmed the evidence of community and state level contextual phenomenon influencing childhood survival and stunting. Children residing in socioeconomically disadvantaged neighbourhoods had higher odds of childhood morbidity and mortality compared to their counterparts living in more socioeconomically advantageous neighbourhoods (Study II, IV & V). The odds of childhood morbidity and mortality were associated with neighbourhood and state socioecological conditions even after adjusting for individual’s household socioecological conditions (Study II, III, IV & V). There was moderate positive correlation between neighbourhood and individual variations in childhood mortality and morbidity (Study II & V). The odds of childhood stunting and mortality were higher in children residing in rural areas (Study II, III, IV & V) and in settings with poor sanitation (Study III & IV). Other factors that increased the odds of childhood mortality included low level of maternal health seeking behaviour, not breastfed for >18 months, being from a polygamous family setting, large family and high birth order, non-usage of contraceptive by mother, and mother having first marriage during their teenage years(Study III). Good household wealth status, adequate birth interval, being a female child and having normal birth weight, increasing maternal educational attainment were all associated with odds of not suffering from childhood stunting and surviving beyond five years of age (Study II & V). Conclusions: By adopting several modelling approaches including the multilevel modelling, we added to the growing body of evidence the effects of the neighbourhood contextual influences on childhood stunting and survival in Nigeria. Our study revealed that individual i.e. children and parental factors; neighbourhood and socioecological environment were associated with childhood stunting and mortality. Efforts at reducing the burden of childhood stunting and mortality should be directed at establishment of poverty alleviation programmes, effective publicly funded health care delivery, promotion of hygienic environmental practices and health education more importantly at the neighbourhood level. Lastly, given the importance of socioecological factors at influencing the lifestyles of neighbourhoods and individuals, interventions targeting structural make up of these two entities are vital in order to meet the MDGs 1 and 4 regarding childhood stunting and mortality in Nigeria and in particular developing countries in general

Predictors of differences in health services utilization for children in Nigerian communities

Health service utilization is an important component of child health promotion. Evidence shows that two-thirds of child deaths in low and middle income countries could be prevented if current interventions were adequately utilized. Aim of this study was to identify determinants of variation in health services utilization for children in communities in Nigeria. Multivariable negative binomial regression model attempting to explain observed variability in health services usage in Nigerian communities was applied to the 2013 Nigeria Demographic and Health Survey data. We included the index of maternal deprivation, gender of child, community environmental factor index, and maternal health seeking behavior, multiple childhood deprivation index and ethnicity diversity index as the independent variables. The outcome variable was under-fives’ hospital attendance rates for acute illness. Of the 7, 577 children from 896 communities in Nigeria that were sick 1, 936 (25.6%) were taken to the health care facilities for treatment. The final model revealed that both multiple childhood deprivation (incidence rate ratio [IRR] = 1.23, 95% confidence interval [CI] 1.12 to 1.35) and children living in communities with a high ethnic diversity were associated with higher rate of health service use. Maternal health seeking behaviour was associated with a significantly lower rate of health care service use. There are significant variations in health services utilization for sick children across Nigeria communities which appear to be more strongly determined by childhood deprivation factors and maternal health seeking behaviour than by health system functions

Contribution à l'analyse des paliers fluides et des joints d'étanchéité utilisés dans lesturbopompes spatiales

La conception des turbomachines à haute densité énergétique nécessite de plus en plus la maîtrise d'un plus grand nombre de paramètres fonctionnels. La moindre défaillance d'un composant conduit quasi immédiatement la machine à la rupture. C'est en particulier le cas pour le comportement des composants à films minces.L'appellation "film mince" correspond à tout espace de très faible épaisseur situé entre le rotor et le stator de la turbomachine. Leur but est soit de limiter les fuites de manière à optimiser les performances intrinsèques de la machine, soit alors à supporter et stabiliser le rotor. Ces derniers cas sont plus appelés communément "joints lisses ou annulaires" et "paliers fluides".Lorsqu'un fluide circule dans un espace de très faible épaisseur, typiquement quelques centièmes de millimètres sur une distance très longue, son champ de vitesses, donc de pression, dépend fortement des phénomènes visqueux aux parois dont l'une est mise en rotation et l'autre est immobile. Les efforts fluides sur ces parois peuvent être alors importants et doivent être pris en compte dans le dimensionnement de la machine.La connaissance précise de ces écoulements très complexes est indispensable pour déterminer les efforts statiques et dynamiques appliqués au rotor de manière à pouvoir dimensionner un fonctionnement calme.The design of high performance aerospace turbo pumps requires more control of an increasing number of functional parameters. Any component failure led almost immediately to a machine failure. This is particularly the case for the behavior of thin film lubricated components.The term "thin film" means any thin space between the rotor and the stator of the engine. Their goal is either to limit leakage to maximize the machine intrinsic performance, or to support and stabilize the rotor. These cases are more commonly called "smooth or annular seals" and "fluid film bearings".When a fluid flows in a space of very small thickness, typically a few hundredths of a millimeter, the velocity field, hence the pressure, are highly dependent on the walls viscous forces. Fluid forces on the walls (which one is rotated and the other is stationary) can then be important and should be taken into account in the design of the machine.The precise knowledge of these complex flows is essential to determine the static and dynamic forces applied to the rotor to ensure a quite functioning of the turbo pump.POITIERS-SCD-Bib. électronique (861949901) / SudocSudocFranceF

Integrating community pharmacy into community based anti-retroviral therapy program: A pilot implementation in Abuja, Nigeria

Background The landscape of Human Immunodeficiency Virus (HIV) epidemic control is shifting with the United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 benchmarks for epidemic control. Community-based Antiretroviral Therapy (CART) models have improved treatment uptake and demonstrated good clinical outcomes. We assessed the feasibility of integrating community pharmacy as a task shift structure for differentiated community ART in Abuja-Nigeria. Methods Stable patients on first line ART regimens from public health facilities were referred to community pharmacies in different locations within the Federal Capital Territory, Abuja for prescription refills and treatment maintenance. Bio-demographic and clinical data were collected from February 25, 2016 to May 31st, 2017 and descriptive statistics analysis applied. The outcomes of measure were prescription refill and patient retention in care at the community pharmacy. Results Almost 10% of stable patients on treatment were successfully devolved from eight health facilities to ten community pharmacies. Median age of the participants was 35 years [interquartile range (IQR); 30, 41] with married women in the majority. Prescription refill was 100% and almost all the participants (99.3%) were retained in care after they were devolved to the community pharmacies. Only one participant was lost-to-follow-up as a result of death. Conclusion Excellent prescription refill and high retention in care with very low loss-to-follow-up were associated with the community pharmacy model. The use of community pharmacy for community ART is feasible in Nigeria. We recommend the scale up of the model in all the 36 states of Nigeria

Exploring variations in childhood stunting in Nigeria using league table, control chart and spatial analysis

Background: Stunting, linear growth retardation is the best measure of child health inequalities as it captures multiple dimensions of children’s health, development and environment where they live. The developmental priorities and socially acceptable health norms and practices in various regions and states within Nigeria remains disaggregated and with this, comes the challenge of being able to ascertain which of the regions and states identifies with either high or low childhood stunting to further investigate the risk factors and make recommendations for action oriented policy decisions. Methods: We used data from the birth histories included in the 2008 Nigeria Demographic and Health Survey (DHS) to estimate childhood stunting. Stunting was defined as height for age below minus two standard deviations from the median height for age of the standard World Health Organization reference population. We plotted control charts of the proportion of childhood stunting for the 37 states (including federal capital, Abuja) in Nigeria. The Local Indicators of Spatial Association (LISA) were used as a measure of the overall clustering and is assessed by a test of a null hypothesis. Results: Childhood stunting is high in Nigeria with an average of about 39%. The percentage of children with stunting ranged from 11.5% in Anambra state to as high as 60% in Kebbi State. Ranking of states with respect to childhood stunting is as follows: Anambra and Lagos states had the least numbers with 11.5% and 16.8% respectively while Yobe, Zamfara, Katsina, Plateau and Kebbi had the highest (with more than 50% of their underfives having stunted growth). Conclusions: Childhood stunting is high in Nigeria and varied significantly across the states. The northern states have a higher proportion than the southern states. There is an urgent need for studies to explore factors that may be responsible for these special cause variations in childhood stunting in Nigeria

Association between antibiotic prescribing and deprivation in Wales: A multilevel analysis

Introduction The most recent Welsh Antimicrobial Resistance Programme (WARP) report on antibiotic use in primary care found significant variations between Health Boards and hospitals in gross antibiotic use in 2014. The aim of this study was to evaluate the association between socioeconomic deprivation and antibiotic prescribing volumes. Objectives and Approach Welsh General Practitioner (GP) antibiotic prescribing data for years 2013 to 2016 for patients’ resident in Wales were extracted from the Secure Anonymised Information Linkage GP tables. Deprivation was assessed by linking prescribing events to the Welsh Index of Multiple Deprivation (WIMD) score for the patient’s neighbourhood area. The association between deprivation area and antibiotic prescribed (items per 1000 persons per day) was stratified according to the patient’s age, sex, prescription year and antibiotic class. A three-level multilevel Poisson regression model of 1.58 million patients nested within 349 GP practices, nested with 67 GP clusters, was specified to assess the associations Results Just over 7.97 million antibiotic items were prescribed between 2013 and 2016. Patients in the most deprived WIMD quintile had an overall prescription rate that was 25.2% higher than those in the least deprived WIMD quintile. The final model revealed that residing in the most deprived WIMD quintile (incidence rate ratio [IRR] = 1.1769, 95% confidence interval [CI] 1.1768 to 1.1770, being female (IRR = 1,2699, 95% CI 1.2698 to 1.2700), being aged $\geq$90 (IRR = 2.0687, 95% CI 2.0683 to 2.0690), and prescription year being 2013 were associated with significantly higher rate of antibiotics prescription. There were significant primary cares clustering of antibiotics prescription in Wales. Conclusion/Implications This study provides evidence that patients in areas of higher socioeconomic deprivation are more likely to be prescribed antibiotics in primary care in Wales. Population health prevention strategies aimed at reducing high antibiotic prescription rates should consider targeting areas of high deprivation

Recurrence of cervical intraepithelial lesions after thermo-coagulation in HIV-positive and HIV-negative Nigerian women

Background: The burden of cervical cancer remains huge globally, more so in sub-Saharan Africa. Effectiveness of screening, rates of recurrence following treatment and factors driving these in Africans have not been sufficiently studied. The purpose of this study therefore was to investigate factors associated with recurrence of cervical intraepithelial lesions following thermo-coagulation in HIV-positive and HIV-negative Nigerian women using Visual Inspection with Acetic Acid (VIA) or Lugol’s Iodine (VILI) for diagnosis. Methods: A retrospective cohort study was conducted, recruiting participants from the cervical cancer “see and treat” program of IHVN. Data from 6 sites collected over a 4-year period was used. Inclusion criteria were: age ≥18 years, baseline HIV status known, VIA or VILI positive and thermo-coagulation done. Logistic regression was performed to examine the proportion of women with recurrence and to examine factors associated with recurrence. Results: Out of 177 women included in study, 67.8 % (120/177) were HIV-positive and 32.2 % (57/177) were HIV-negative. Recurrence occurred in 16.4 % (29/177) of participants; this was 18.3 % (22/120) in HIV-positive women compared to 12.3 % (7/57) in HIV-negative women but this difference was not statistically significant (p-value 0.31). Women aged ≥30 years were much less likely to develop recurrence, adjusted OR = 0.34 (95 % CI = 0.13, 0.92). Among HIV-positive women, CD4 count <200cells/mm3 was associated with recurrence, adjusted OR = 5.47 (95 % CI = 1.24, 24.18). Conclusion: Recurrence of VIA or VILI positive lesions after thermo-coagulation occurs in a significant proportion of women. HIV-positive women with low CD4 counts are at increased risk of recurrent lesions and may be related to immunosuppression

Electronic longitudinal alcohol study in communities (ELAStiC) Wales - protocol for platform development

Introduction: Excessive alcohol consumption has adverse effects on health and there is a recognised need for the longitudinal analysis of population data to improve our understanding of the patterns of alcohol use, harms to consumers and those in their immediate environment. The UK has a number of linkable, longitudinal databases that if assembled properly could support valuable research on this topic. Aims and Objectives This paper describes the development of a broad set of cross-linked cohorts, e-cohorts, surveys and linked electronic healthcare records (EHRs) to construct an alcohol-specific analytical platform in the United Kingdom using datasets on the population of Wales. The objective of this paper is to provide a description of existing key datasets integrated with existing, routinely collected electronic health data on a secure platform, and relevant derived variables to enable population-based research on alcohol-related harm in Wales. We illustrate our use of these data with some exemplar research questions that are currently under investigation. Methods: Record-linkage of routine and observational datasets. Routine data includes hospital admissions, general practice, and cohorts specific to children. Two observational studies were included. Routine socioeconomic descriptors and mortality data were also linked. Conclusion: We described a record-linked, population-based research protocol for alcohol related harm on a secure platform. As the datasets used here are available in many countries, ELAStiC provides a template for setting up similar initiatives in other countries. We have also defined a number of alcohol specific variables using routinely-collected available data that can be used in other epidemiological studies into alcohol related outcomes. With over 10 years of longitudinal data, it will help to understand alcohol-related disease and health trajectories across the lifespan

Prevalence of hypertension among patients aged 50 and older living with Human Immunodeficiency Virus

Background: Hypertension is one of the common medical conditions observed among patients aged 50 years and elder living with HIV (EPLWH) and to date no systematic review has estimated its global prevalence. Purpose: To conduct a systematic review to estimate the global prevalence of hypertension among EPLWH. Data Sources: PubMed/MEDLINE, Embase, the Cochrane Library, and Global Health databases for relevant publications up till May 25, 2018. Study Selection: Observational studies (cohort or cross-sectional studies) that estimated the prevalence of hypertension among EPLWH. Data Extraction: Required data were extracted independently by three reviewers and the main outcome was hypertension prevalence among EPLWH. Data Synthesis: The 24 (n = 29,987) eligible studies included were conducted in North America, Europe, Africa, and Asia. A low level bias threat to the estimated hypertension prevalence rates was observed. The global prevalence of hypertension among EPLWH was estimated at 42.0% (95% CI 29.6%–55.4%), I 2 = 100%. The subgroup analysis showed that North America has the highest prevalence of hypertension 50.2% (95% CI 29.2% –71.2%) followed by Europe 37.8% (95% CI 30.7%–45.7%) sub-Saharan Africa 31.9% (95% CI 18.5% –49.2%) and Asia 31.0% (95% CI 26.1%–36.3%). We found the mean age of the participants explaining a considerable part of variation in hypertension prevalence. Conclusion: This study demonstrated that two out of five EPLWH are hypertensive. North America appears to have the highest prevalence of hypertension followed by Europe, sub-Saharan Africa (SSA) and Asia respectively. Findings from this study can be utilized to integrate hypertension management to HIV management package. (Registration number: CRD42018103069

Addressing the under-reporting of adverse drug reactions in public health programs controlling HIV/AIDS, tuberculosis and malaria: A prospective cohort study

Background Adverse Drug Reactions (ADRs) are a major clinical and public health problem world-wide. The prompt reporting of suspected ADRs to regulatory authorities to activate drug safety surveillance and regulation appears to be the most pragmatic measure for addressing the problem. This paper evaluated a pharmacovigilance (PV) training model that was designed to improve the reporting of ADRs in public health programs treating the Human Immunodeficiency Virus (HIV), Tuberculosis (TB) and Malaria. Methods A Structured Pharmacovigilance and Training Initiative (SPHAR-TI) model based on the World Health Organization accredited Structured Operational Research and Training Initiative (SOR-IT) model was designed and implemented over a period of 12 months. A prospective cohort design was deployed to evaluate the outcomes of the model. The primary outcomes were knowledge gained and Individual Case Safety Reports (ICSR) (completed adverse drug reactions monitoring forms) submitted, while the secondary outcomes were facility based Pharmacovigilance Committees activated and health facility healthcare workers trained by the participants. Results Fifty-five (98%) participants were trained and followed up for 12 months. More than three quarter of the participants have never received training on pharmacovigilance prior to the course. Yet, a significant gain in knowledge was observed after the participants completed a comprehensive training for six days. In only seven months, 3000 ICSRs (with 100% completeness) were submitted, 2,937 facility based healthcare workers trained and 46 Pharmacovigilance Committees activated by the participants. Overall, a 273% increase in ICSRs submission to the National Agency for Food and Drug Administration and Control (NAFDAC) was observed. Conclusion Participants gained knowledge, which tended to increase the reporting of ADRs. The SPHAR-TI model could be an option for strengthening the continuous reporting of ADRs in public health programs in resource limited settings