What is the link between malaria prevention in pregnancy and neonatal survival in Nigeria?

Neonatal mortality has been recognized as a global public health challenge and Nigeria has the highest prevalence in Africa. Malaria during pregnancy jeopardizes neonatal survival through placental parasitaemia, maternal anaemia, and low birth weight. This study investigated association between the malaria prevention in pregnancy and neonatal survival using a nationally representative data - Nigeria Demographic Health Survey 2013. Child recode data was used and the outcome variable was neonatal death. The main independent variables were the use of at least 2 doses of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPT-SP) and proportion of pregnant women who reported Insecticide Treated Net (ITN) use the night before the survey. Data were analyzed using Pearson Chi-square (x 2 ) test of association and survival analysis techniques. Total neonatal mortality rate was 38 per1000 live births. Cox proportional hazard model showed that low birth weight (HR 1.49, 95% CI (1.15 – 1.93 p=0.003) and adequate number of ANC visits (≥ 4 visits) (HR 0.68, 95% CI (0.53 – 0.93) were associated with neonatal survival. The use of at least 2 doses of IPT-SP was not an independent factor for neonatal survival (HR 0.72, 95% CI (0.53 – 1.15). Malaria prevention in pregnancy is crucial for neonatal survival through the prevention of low birth weight. Keywords: Malaria Prevention, Pregnancy, Intermittent Preventive Treatment in pregnancy with Sulfadoxine-Pyrimethamine, Insecticide Treated Net, Neonatal Mortality, Nigeria La mortalité néonatale a été reconnue comme un problème de santé publique mondial et le Nigéria connait la prévalence la plus élevée d'Afrique. Le paludisme pendant la grossesse compromet la survie néonatale par la parasitémie placentaire, l'anémie maternelle et l'insuffisance pondérale à la naissance. Cette étude a examiné l'association entre la prévention du paludisme pendant la grossesse et la survie néonatale à l'aide de données représentatives au niveau national - Enquête démographique sur la santé au Nigéria de 2013. Les données de recodage des enfants ont été utilisées. Les principales variables indépendantes étaient l'utilisation d'au moins 2 doses de traitement préventif intermittent pendant la grossesse par la sulfadoxine-pyriméthamine (IPTSP) et la proportion de femmes enceintes qui avaient déclaré avoir utilisé une moustiquaire imprégnée d'insecticide (MII) la nuit précédant l'enquête. Les données ont été analysées à l'aide du test de Pearson sur le chi carré (x2 ) des techniques d'analyse d'association et de survie. Le taux de mortalité néonatale total était de 38 pour 1 000 naissances vivantes. Le modèle de risque proportionnel de Cox a montré qu'un faible poids à la naissance (HR 1,49, IC à 95% (1,15 - 1,93 p = 0,003) et un nombre adéquat de visites ANC (≥ 4 visites) (HR 0,68, IC à 95% (0,53 - 0,93) étaient associés `a la survie néonatale. L‘utilisation d‘au moins deux doses d‘IPT-SP n‘est pas un facteur indépendant de la survie néonatale (HR 0,72, IC à 95% (0,53 - 1,15). La prévention du paludisme pendant la grossesse est cruciale pour la survie néonatale à travers la prévention du faible poids à la naissance.Mots-clés: Prévention du paludisme, grossesse, traitement préventif intermittent par la sulfadoxine-pyriméthamine pendant la grossesse, moustiquaire imprégnée d'insecticide, mortalité néonatale, Nigéria

Self-efficacy and antiretroviral therapy adherence among HIV positive pregnant women in South-West Nigeria: a mixed methods study

Background: In Nigeria, an estimated 60,000 paediatric HIV infections occur annually mainly through mother-to-child transmission.  Adherence to antiretroviral therapy (ART) in pregnancy is crucial in preventing new paediatric HIV infections. We investigated HIV-treatment adherence self-efficacy and ART adherence among HIV-positive pregnant women in South-West Nigeria.Methods: A mixed method approach was employed using a sequential explanatory strategy in which HIV-positive pregnant women were recruited from three facilities providing Prevention of Mother-to-Child Transmission (PMTCT) services. Self-efficacy and adherence were assessed using the HIV-Treatment Adherence Self-efficacy Scale and the Centre for Adherence Support Evaluation Index Tool, respectively. A focus group discussion and key informant interviews were used to explore barriers and motivating factors to ART adherence in pregnancy. Quantitative data were analysed using descriptive statistics and logistic regression at 5% significance level, while thematic content analysis was used to analyse qualitative data. Results: A total of 126 women participated in the study. The mean age and mean gestational age of respondents were 32.7 ± 4.58 years and 24.4 ± 7.41 weeks, respectively. The prevalence of good adherence and HIV-treatment adherence self-efficacy were 70.6% and 26.2%, respectively. Low self-efficacy (OR=0.2, 95%CI=0.05– 0.53, p<0.05) was statistically associated with poor adherence. Planned pregnancy (OR=3.1, 95%CI=1.23-7.72, P<0.05) increased the likelihood for ART adherence. Looking healthier and protecting unborn babies were motivators to adherence while stigmatization and negative spousal influences were barriers to adherence.Conclusion: Low HIV-treatment adherence self-efficacy was related to poor adherence in pregnancy. Interventions aimed at improving adherence in pregnancy should also focus on HIV-treatment adherence self-efficacy

Contraceptive use among Nigerian women with no fertility intention: interaction amid potential causative factors

High fertility (HF) remains a public health problem and intention to reduce fertility is a global phenomenon. The health hazards and economic burden of HF on women are enormous. Contraceptive is widely known as a fertility reduction method. Achieving desirable MDGs and PoA of 1994 ICPD will be an illusion if research on the relationship between fertility intention and contraceptive use is neglected. The study which focused on 2,257 women of childbearing age who do not have any intention to bear more children utilized Nigeria Demographic Health Survey, 2008 dataset. Data was analysed using Chi-square, binary and multinomial logistic regression (=5.0%). Mean age of the women and children ever born were 40.91±5.73 years and 6.28±2.62 respectfully. The prevalence of Current Use of Any Contraceptive Method (CUACM) was 37.6% with 12.4% and 25.2% currently using natural and modern family planning methods respectively. About 7.0% of women in poorest wealth quintile are CUACM compared to 61.8% of those in richest wealth quintile. Current use of modern contraceptive prevalence rate was strikingly higher among Yorubas (41.8%) than the Hausas (3.6%). Multivariate analysis identified age, region, residence, education, ethnicity and family planning media exposure as significant predictors of CUACM. In addition; religion and decision on how to spend family income were identified as predictors of current use of modern contraceptive method (p<0.05). The use of contraceptive is not adequately practiced in Nigeria. The identified predictors of contraceptive use in this study should be considered while designing strategies to improve contraceptive prevalent rate in Nigeria

Factors Associated with Treatment Success among Pulmonary Tuberculosis and HIV Co-infected Patients in Oyo State, South West-Nigeria

Background The co-existence of Tuberculosis (TB) and Human immunodeficiency Virus (HIV) is  known to increase morbidity and mortality in patients. The determinants of treatment success in TBHIV co-infection are not yet well studied. Such information can help optimise treatment and reduce morbidity and mortality.Objective To determine factors associated with antitubercular treatment success among TB I HIV coinfected patients.Methods A cross sectional study was carried out in fifty  three DOT clinics and treatment centres  using tuberculosis patient's records from January 2009 to December 2010 in Oyo state, Nigeria. The study population consisted of 7905 tuberculosis patients. Information on variables of interest were obtained with the use of data extraction forms. Chi-square and logistic regression were used to test the relationship between TB I HIV coinfection and socio-demographic variables, clinical characteristics and treatment success.Results Prevalence ofTB I HIV co-infection was found to be 14.2%. Patients with TB-HIV co-infection  were younger and more likely to be females. There were statistically significant association between treatment success and gender, marital status and patient point of care. After adjusting for other variables, it was found that patients receiving treatment in private facilities were independently less likely to be successfully treated compared with those receiving care in Public facilities. Female patients were also independently more likely to have better treatment outcome than male.Conclusion In addition to patients' point of care, gender of the patients can adversely impact on their treatment success. Efforts from the government to strengthening the private public mix, health education and media awareness on adherence to treatment to improve treatment success should be intensified in the country.Keywords: Tube rc ulosis; Human immunodeficiency virus, Directly observe therapy short-course;  Treatment success, Coinfection

Prevalence, risk factors and outcome of congenital anomalies among neonatal admissions in OGBOMOSO, Nigeria

Abstract Background Congenital anomalies (CA) are a major cause of neonatal morbidity and mortality, especially in developing countries. Data on these anomalies are still poorly collated in developing countries. We aimed to assess the prevalence, pattern, risk factors and outcome of congenital anomalies among neonatal admissions in Ogbomoso Town, Nigeria. Methods A cross-sectional retrospective study in which a review of the records of all neonates admitted in the neonatal unit of the Bowen University Teaching Hospital, Ogbomoso over a five-year period (January 2012–December 2016) was undertaken. The occurrence rate and pattern of anomalies were determined, while factors associated with the occurrence and outcome of anomalies were calculated with the odds ratio and 95% confidence interval. Data entry and analysis were performed using SPSS version 21. Results CA were found in 67 of the 1057 neonatal admissions, giving a prevalence rate of 6.3%. Anomalies of the cardiovascular and digestive systems were the most common. A higher proportion of babies referred from other facilities had CA, and this was found statistically significant. There was no significant association between CA and low birth weight, sex, maternal age or parity. The mortality rate among neonates with CA was 10.4%. Although, CA was associated with reduced risk of neonatal mortality compared to those with other acute conditions, this was not statistically significantly. Conclusion CA is a major indication for neonatal admissions in Ogbomoso. There is the need to establish a surveillance system for CA and efforts should be made to raise awareness of the occurrence and risk factors of CA in developing countries

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

Incidence, determinants and perinatal outcomes of near miss maternal morbidity in Ile-Ife Nigeria: a prospective case control study

BACKGROUND: Maternal mortality ratio in Nigeria is one of the highest in the world. Near misses occur in larger numbers than maternal deaths hence they allow for a more comprehensive analysis of risk factors and determinants as well as outcomes of life-threatening complications in pregnancy. The study determined the incidence, characteristics, determinants and perinatal outcomes of near misses in a tertiary hospital in South-west Nigeria. METHODS: A prospective case control study was conducted at the maternity units of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife Nigeria between July 2006 and July 2007. Near miss cases were defined based on validated disease-specific criteria which included severe haemorrhage, hypertensive disorders in pregnancy, prolonged obstructed labour, infection and severe anemia. Four unmatched controls of pregnant women were selected for every near miss case. Three categories of risk factors (background, proximate, clinical) which derived from a conceptual framework were examined. The perinatal outcomes were also assessed. Bi-variate logistic regressions were used for multivariate analysis of determinants and perinatal outcomes of near miss. RESULTS: The incidence of near miss was 12%. Severe haemorrhage (41.3%), hypertensive disorders in pregnancy (37.3%), prolonged obstructed labour (23%), septicaemia (18.6%) and severe anaemia (14.6%) were the direct causes of near miss. The significant risk factors with their odds ratio and 95% confidence intervals were: chronic hypertension [OR=6.85; 95% CI: (1.96 – 23.93)] having experienced a phase one delay [OR=2.07; 95% CI (1.03 – 4.17)], Emergency caesarian section [OR=3.72; 95% CI: (0.93 – 14.9)], assisted vaginal delivery [OR=2.55; 95% CI: (1.34 – 4.83)]. The protective factors included antenatal care attendance at tertiary facility [OR=0.19; 95% CI: (0.09 – 0.37)], knowledge of pregnancy complications [OR=0.47; 95% CI (0.24 – 0.94)]. Stillbirth [OR=5.4; 95% CI (2.17 – 13.4)] was the most significant adverse perinatal outcomes associated with near miss event. CONCLUSIONS: The analysis of near misses has evolved as a useful tool in the investigation of maternal health especially in life-threatening situations. The significant risk factors identified in this study are amenable to appropriate public health and medical interventions. Adverse perinatal outcomes are clearly attributable to near miss events. Therefore the findings should contribute to Nigeria’s effort to achieving MDG 4 and 5

"I was raped by the broker on the first day of my arrival in the town." Exploring reasons for risky sexual behavior among sexually-active unmarried young female internal migrants in Ethiopia: A qualitative study.

BackgroundStudies revealed that internal migrants are one of the most vulnerable groups for poor sexual and reproductive health (SRH) information and services. Risky sexual behavior (RSB) is a threat to public health and might lead to serious health problems such as unintended pregnancy, abortion, and sexually transmitted infections (STIs) including HIV/AIDS. The reported prevalence of RSB among young female internal migrants in Ethiopia was as high as 70.3%. This requires in-depth understanding of the underlying cause. So, this study aimed at exploring reasons for RSB among sexually-active unmarried young female migrants in Ethiopia.MethodsA descriptive qualitative study was conducted using focus group discussions among sexually-active young female migrants working Burayu town. The focus group discussions were done in the local languages of participants (Afaan Oromo and Amharic). The recorded data were transcribed verbatim and translated into English for analysis and presentation in the study. The data were coded and Atlas.ti 7.5 software packages were used for data analyses. Then, the findings were thematically organized and analyzed using content analysis.ResultsThis study revealed that poor socio-economic status, social media indulgence, rape, substance use, poor knowledge of condom use, unfavorable attitude toward condom use, misconceptions about emergency pills, and the nature of the new environment and work place were responsible for RSB among internal migrants. The participants described that the migrants' economic conditions and workplace sexual violence are pushing them toward engaging in unprotected sex, being sexually abused, commercial sex, and transactional sex.ConclusionsInternal migrants' sexual behavior is a complex process influenced by multiple interrelating systems. We have explored a set of factors namely poverty, pressure and sexual abuse from brokers, sexual exploitation and abuses against domestic workers by their bosses, indulgence in social media, sexting, inadequate knowledge, and unfavorable attitude toward condom use that led young female internal migrants to risky sexual practices. An intervention to promote safe sex targeted to this population is urgently needed with a focus on an intervention to eliminate misconceptions about condoms, increase proper condom use, and end sexual violence. Moreover, a relevant policy is needed to safeguard internal migrants from sexual exploitation and abuses at their work place

Risky sexual behavior and associated factors among sexually-active unmarried young female internal migrants working in Burayu Town, Ethiopia.

BackgroundYoung female internal migrants are highly vulnerable to risky sexual behaviors (RSB) which may result in serious health problems such as unintended pregnancy, abortion and sexually transmitted infections including HIV. RSB includes early sexual debut (before 18 years), having multiple sexual partners, sex without a condom or inconsistent use of condom and sex under the influence of substance use. This study aimed to assess the magnitude and the factors associated with RSB among sexually-active unmarried young female internal migrants in Burayu Town, Ethiopia.MethodsA cross sectional study design was used for the study. A total of 267 respondents was recruited into the study using a simple random sampling technique. A semi-structured interviews-administered questionnaire was used to obtain information from the study participants. The collected data were cleaned, coded and entered into Epi data version 3.1 and then exported to SPSS Ver.21 for analysis. Multiple logistic regression models were used to indicate the association between dependent and independent variables.The resultsAbout 35% of the young female internal migrants had sexual debut before the age of 18 years; 64.4% had sex without condom or inconsistently used condom; nearly one quarter of the participants had multiple sexual partners, and 29.6% had sex under the influence of substance uses. The magnitude of RSB among the study participants was (79.1%). Sexting [AOR 3.47(95%; CI;1.10-11.94)], frequent engagement in social media [AOR 10.9(95%;CI;2.31-51.89)], feeling of embarrassment to buy condom [AOR 8.28(95%; CI; 2.10-32.62)], unfavorable attitude toward using condom for steady and loving relationship [AOR 5.72(95%; CI; 1.47-22.24)] were related with RSB while self-efficacy [AOR 0.15(95%: CI; 0.04-0.57)] to use condom and perceived risks of getting pregnant [AOR 0.05(95%; CI; 0.01-0.23)] were found to be protective factors.ConclusionThe study found high levels of RSB among sexually-active unmarried young female internal migrants. This finding suggests an urgent need of intervention to promote safe sex among this group. Special attention and prompt interventions are needed to promote the use of condoms