Using Verbal Autopsy to Measure Causes of Death: the Comparative Performance of Existing Methods.

Monitoring progress with disease and injury reduction in many populations will require widespread use of verbal autopsy (VA). Multiple methods have been developed for assigning cause of death from a VA but their application is restricted by uncertainty about their reliability. We investigated the validity of five automated VA methods for assigning cause of death: InterVA-4, Random Forest (RF), Simplified Symptom Pattern (SSP), Tariff method (Tariff), and King-Lu (KL), in addition to physician review of VA forms (PCVA), based on 12,535 cases from diverse populations for which the true cause of death had been reliably established. For adults, children, neonates and stillbirths, performance was assessed separately for individuals using sensitivity, specificity, Kappa, and chance-corrected concordance (CCC) and for populations using cause specific mortality fraction (CSMF) accuracy, with and without additional diagnostic information from prior contact with health services. A total of 500 train-test splits were used to ensure that results are robust to variation in the underlying cause of death distribution. Three automated diagnostic methods, Tariff, SSP, and RF, but not InterVA-4, performed better than physician review in all age groups, study sites, and for the majority of causes of death studied. For adults, CSMF accuracy ranged from 0.764 to 0.770, compared with 0.680 for PCVA and 0.625 for InterVA; CCC varied from 49.2% to 54.1%, compared with 42.2% for PCVA, and 23.8% for InterVA. For children, CSMF accuracy was 0.783 for Tariff, 0.678 for PCVA, and 0.520 for InterVA; CCC was 52.5% for Tariff, 44.5% for PCVA, and 30.3% for InterVA. For neonates, CSMF accuracy was 0.817 for Tariff, 0.719 for PCVA, and 0.629 for InterVA; CCC varied from 47.3% to 50.3% for the three automated methods, 29.3% for PCVA, and 19.4% for InterVA. The method with the highest sensitivity for a specific cause varied by cause. Physician review of verbal autopsy questionnaires is less accurate than automated methods in determining both individual and population causes of death. Overall, Tariff performs as well or better than other methods and should be widely applied in routine mortality surveillance systems with poor cause of death certification practices

Utilisation of a community-based health facility in a low-income urban community in Ibadan, Nigeria

Background: Primary healthcare is established to ensure that people have access to health services through facilities located in their community. However, utilisation of health facilities in Nigeria remains low in many communities. Aim: To assess the utilisation of community-based health facility (CBHF) amongst adults in Ibadan, Nigeria. Settings: A low-income community in Ibadan North West Local Government Area of Oyo State.Methods:A cross-sectional survey was conducted using a simple random sampling technique to select one adult per household in all 586 houses in the community. A semi-structured interviewer-administered questionnaire was used to collect information on respondents’ sociodemographic characteristics, knowledge and utilisation of the CBHF. Data analysis included descriptive statistics and association testing using the Chi-square test at p = 0.05. Results: The mean age of the respondents was 46.5 ± 16.0 years; 46.0% were men and 81.0% married; 26% had no formal education and 38.0% had secondary-level education and above; traders constituted 52.0% of the sample; and 85.2% were of low socioeconomic standing; 90%had patronised the CBHF. The main reasons for non-utilisation were preference for general hospitals (13.8%) and self-medication (12.1%). Respondents who had secondary education and above, were in a higher socioeconomic class, who had good knowledge of the facility and were satisfied with care, utilised the CBHF three months significantly more than their counterparts prior to the study (p < 0.05). However, only satisfaction with care was found to be a significant predictor of utilisation of the CBHF. Conclusion: The utilisation of the CBHF amongst adults in the study setting is high, driven mostly by satisfaction with the care received previously. Self-medication, promoted by uncontrolled access to drugs through pharmacies and patent medicine stores, threatens this high utilisation

Experience of intimate partner violence among rural women in Southwest, Nigeria

Intimate partner violence (IPV) is a significant public health issue that affects 1 in 3 women globally. Women’s experiences of IPV in rural southwest Nigeria was examined in this study, conducted between July and August, 2019. A total of 677 women participated in this survey which employed a mobile phone application. Results revealed that the prevalence of experience of IPV was 39.4%. Experience of IPV was significantly higher among women who had been married longer (AOR = 2.09, 95% CI: 1.23, 2.93), completed secondary school (AOR = 1.81, 95% CI: 1.07, 3.05), were in the middle or richer wealth tertiles (AOR (95% CI= 1.59, 1.02, 2.51 and 1.84, 1.19, 2.84 respectively), and who justified IPV (AOR = 1.44, 95% CI: 1.00, 2.06). The prevalence of IPV among women in southwest Nigeria is high and determining factors are multi-faceted, hence the need for community sensitization interventions designed to address social norms that justify partner violence. (Afr J Reprod Health 2021; 25[5]: 113-124)

Determinants of wasting among schoolchildren in a Southwestern state of Nigeria: Implications to strengthen the nutritional component of primary health-care model

Background: Wasting is linked to about one-third of mortality among school-age children. More studies have centered on stunting among under-five children, with few documented studies exploring comparability and determinants of wasting among school pupils in southwestern Nigeria. This study aimed to investigate the comparability and determinants of wasting among schoolchildren in rural and urban communities of Obafemi-Owode local government area, Ogun State, Nigeria. Methods: A cross-sectional study utilizing a quantitative approach was carried out among children both in rural and urban primary schools. Data were collected through interviewer-administered questionnaires. EPI-INFO version 6.03 was used, children were classified as wasted if weight-for-height Z-scores were <2 standard deviations below the National Center for Health Statistics/World Health Organization median. Associations were tested using t-tests and Chi-square test, while predictors were examined with logistic regression at 95% level of significance. Results: Male gender was predominant (54.6%). Significantly more pupils from rural areas lived with grandparents and other guardians (60.3%) compared to their urban counterparts (39.7% P = 0.005). Pupils from rural schools were four times more likely to be wasted compared to those located in urban regions (odds ratio [OR]: 4.2; 95 confidence interval [CI] = 2.24–7.69). Male pupils were twice likely to be wasted compared to the female pupils (OR: 2.08; 95 CI = 1.22–3.55). Conclusion: Conclusively, the study revealed that the prevalence of wasting was higher among children from rural schools than in urban schools. There is an urgent need to implement viable interventions and policies that address nutritional deficiencies in primary school pupils, particularly in rural areas

Pattern of intimate partner violence disclosure among pregnant women attending ante-natal clinic in Oyo East Local Government, Nigeria

Background: Intimate partner violence (IPV) is a significant public health problem. Despite being a phenomenon that occurs globally, few studies have reviewed the issue of intimate partner violence among pregnant women as it relates to disclosure of abuse. This study sets out to determine the prevalence and pattern of disclosure of intimate partner violence among pregnant women attending antenatal clinic in Oyo East Local Government of Oyo State. Methods: A descriptive cross-sectional study among pregnant women aged 18–49 years. A total of 350 pregnant women in the sole secondary health care facility and 3 out of the 18 primary health care facilities randomly selected by balloting were consecutively recruited. A pre-tested semi-structured questionnaire adapted from the WHO Multi-Country Study on Women’s Health and Domestic Violence was used to collect data. Data were analysed with SPSS® version 16. Results: Of 252 (72.0%) women who had been exposed to violence by their partner in pregnancy, 72 (28.6%) disclosed their IPV experience. The experience was disclosed to relatives, friends and religious leaders. Of the 72 that disclosed their IPV experience, 31 (43.1%) reported for the purpose of seeking redress through religious or local leaders, healthcare professionals and law enforcement agencies. Conclusion: Intimate partner violence is common among pregnant women, but a culture of silence still persists, making identification of the exposed difficult. These data may encourage healthcare providers to include screening for IPV in the curriculum of the antenatal care. (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp) S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.127224

A rural-urban comparison of client-provider interactions in patent medicine shops in South west Nigeria.

The increasing prominence of patent medicine vendors (PMVs) in healthcare provision makes information about how they operate of interest. This study assessed consumers\u27 behavior and PMVs\u27 performance in the treatment of childhood illnesses in rural and urban communities in South West Nigeria. Non-participatory observations were carried out in 163 licensed patent medicine stores in Oyo State, Nigeria. Many PMV shops (70.6% rural and 61.9% urban; p = 0.141); stocked non proprietary drugs. Clients often requested for drugs by name (75.4% urban versus 62.2% rural; p = 0.002) and PMVs mostly sold drugs as requested without questions (65.3% urban 57.8% rural; p = 0.07). Inappropriate treatment practices and invasive procedures were observed more often in urban PMVs shops (p \u3c 0.001). PMVs functioned mostly as sales persons supplying clients\u27 drug requests. Strategies to improve PMV treatment practices should include caregiver education to be effective

Survey of Knowledge, Attitudes and Sexual Practices Relating to HIV Infection/AIDS among Nigerian Secondary School Students

The research was carried out to study the AIDS-related knowledge, attitudes and sexual behaviour of 540 students selected by the multistage sampling technique from four Nigerian secondary schools. Eighty-three per cent of the students knew AIDS was transmitted sexually, but the percentage of those aware of other modes of transmission' was much lower. Attitudes were poor, as 372 (82.7%) students would dislike having someone with AIDS near them. First sexual experience occurred at 15.8 years for males and 16.3 in females. Of the 450 students studied, 159 (35.3%) had experienced sexual intercourse before. Of the 120 students (26.7%) who became sexually active a month before the survey, 34 (28.3%) had multiple sexual partners. Constituent condom use was reported in only 22 (19.8%) of the sexually active students. The use of unreliable methods for the prevention of sexually transmitted diseases was common. There is an urgent need to intensify ongoing AIDS campaign especially school-based AIDS education programmes to secondary school students before their behaviour become fixed. (Afr J Reprod Health 1999; 3[2]: 15-24) Key Words: HIV, AIDS, students, knowledge, attitude, practic

HIV/AIDS-related knowledge and misconceptions among women attending government-owned antenatal clinics in Gwagwalada Area Council of Abuja, Nigeria

This study assessed the level of knowledge and misconceptions about HIV/AIDS transmission and prevention among women. Using a semi-structured pretested questionnaire we obtained relevant data from 420 respondents in five randomly selected antenatal clinics (ANCs) in Gwagwalada Area Council (GAC) of Abuja, Nigeria. Knowledge about the existence of HIV/AIDS was high (92.8%). Only 52.1% knew the cause of AIDS and 58.6% were aware that AIDS had no cure. About twenty percent of respondents believed that breast-milk could not transmit HIV and 27.9% were unaware that condom protects against HIV. Only 33.3% were aware that HIV infected persons may look and feel healthy. Mothers with at least secondary level education had significantly higher knowledge scores on HIV/AIDS transmission (X2 = 14.8, p = 0.01) than less educated mothers and less educated mothers were more likely to relate HIV infection to past misdeeds (X2 = 13.6, p = 0.01). Significant misconception concerning HIV transmission existed in the study population. More community outreach programmes to intensify HIV education and counseling in GAC is required.Cette étude a fait une évaluation du niveau de connaissances et d&apos;idées fausses sur la transmission du VIH / sida et sa prévention chez les femmes. A l’aide d&apos;un questionnaire semi-structuré et pré-contrôlé, nous avons obtenu des données pertinentes parmi les 420 interviewées choisies au hasard dans cinq consultations prénatales (CPN) auprès du Conseil Local de Gwagwalada (CLG), Abuja, au Nigéria. La connaissance de l&apos;existence du VIH / sida était élevée (92,8%). Seulement 52,1% connaissaient la cause du sida et 58,6% étaient au courant que le sida n’avait pas de remède. Environ vingt pour cent des interviewées croyaient que le lait maternel ne pouvait pas transmettre le VIH et 27,9% ne savaient pas que le préservatif protège contre le VIH. Seulement 33,3% étaient au courant que les personnes infectées par le VIH peuvent avoir l’air d’être en bonne santé. Les mères qui ont au moins une éducation secondaire ont obtenu des notes significativement plus élevées de connaissances de la transmission du VIH / sida (X2 = 14,8, p = 0,01) que les mères moins instruites et les mères moins instruites étaient plus susceptibles d’attribuer l’infection du VIH aux méfaits du passé (X2 = 13,6, p = 0,01). Un malentendu significatif concernant la transmission du VIH existe dans la population étudiée. Il faut davantage de programmes communautaires pour intensifier le renseignement sur le VIH et de conseil dans le CA

Social network as a determinant of pathway to mental health service utilization among psychotic patients in a Nigerian hospital

Objective: The main objectives of the study were to determine the relationship between social network and pathway to service utilization among psychotic patients. Materials and Methods: This descriptive study was carried out in a psychiatric unit in a general hospital in South West Nigeria. Using structured questionnaires, primary data were collected from 652 psychotic patients on their social network, health behaviors and pathway to current service use. Logistic regression analysis was used to assess the effect of social network on patients\u2032 use of services, controlling for sociodemographics, health and functional status. Results: Mean age of the respondents was 29.0 \ub1 7.5 years, range 14-58 years, males constituted 52.6%. Regarding pathway to services, alternative sources of care such as priests, spiritualists, natural therapists, herbalists, was the first port of call for 78.9% of respondents. Family dominated the social network in 51.1% of patients. The presence of some social network and social support structures were significantly associated with the use of general medical and specialty psychiatric services for patients with schizophrenia (P = 0.03), schizoaffective disorder (P = 0.02), bipolar I disorder (P = 0.01), but not with major depression and symptoms of psychological distress. Conclusions: Findings indicate that social support and social network enhanced utilization of mental health services for psychiatric patients except for those with psychotic depression or those with symptoms of psychological distress. In addition, alternative sources of care are still relevant in mental health service delivery in South West Nigeria