Trend Analysis of Teenage Pregnancy in Nigeria (1961-2013): How Effective is the Contraceptive Use Campaign

Teenage pregnancy (TP) is a recurrent global and public health problem. It poses both social and health challenges. Considering the massive campaign on the use of modern contraceptives to prevent TP in recent decades, we assessed trends in TP in Nigeria between 1961 and 2013. Pregnancy and contraception history of 70,811 women who were at least 20 years old when the Nigerian DHS was conducted in 1990, 2003, 2008, and 2013 respectively were used for the study, and descriptive statistics, time analysis techniques and multiple logistic regression were used to analyze the data at 5% significance level. The overall prevalence of TP between 1961 and 2013 was 49.5% which fluctuated insignificantly during the studied period. The TP prevalence among women who entered adulthood in 1961 was 39.2%; it peaked in 1978 at 58.9% before its unsteady decline to 39.6% in 2012, and then rose sharply to 55.6% in 2013. We predicted TP prevalence as 49.0%, 49.9% and 51.0% in 2014, 2015 and 2016 respectively. The odds of TP were over 4 times higher in the North East and 5 times higher in the North West than in the South West. Teenagers with no education had higher odds of TP and it was higher among teenagers from the poorest households (OR=5.64, 95% CI: 5.36-5.94). Rather than reducing with the worldwide acknowledged increase in contraceptive campaigns, TP increased over the years studied. As far as TP is concerned in Nigeria, the impact of the campaign on MC use is far from being effective. To achieve the objective of fewer TPs, fewer resources should be spent on access to contraception and instead diverted to areas more likely to achieve results such as improvements in educational achievement amongst girls

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

Approximation of the Cox survival regression model by MCMC Bayesian hierarchical Poisson modelling of factors associated with childhood mortality in Nigeria

The need for more pragmatic approaches to achieve sustainable development goal on childhood mortality reduction necessitated this study. Simultaneous study of the influence of where the children live and the censoring nature of children survival data is scarce. We identified the compositional and contextual factors associated with under-five (U5M) and infant (INM) mortality in Nigeria from 5 MCMC Bayesian hierarchical Poisson regression models as approximations of the Cox survival regression model. The 2018 DHS data of 33,924 under-five children were used. Life table techniques and the Mlwin 3.05 module for the analysis of hierarchical data were implemented in Stata Version 16. The overall INM rate (INMR) was 70 per 1000 livebirths compared with U5M rate (U5MR) of 131 per 1000 livebirth. The INMR was lowest in Ogun (17 per 1000 live births) and highest in Kaduna (106), Gombe (112) and Kebbi (116) while the lowest U5MR was found in Ogun (29) and highest in Jigawa (212) and Kebbi (248). The risks of INM and U5M were highest among children with none/low maternal education, multiple births, low birthweight, short birth interval, poorer households, when spouses decide on healthcare access, having a big problem getting to a healthcare facility, high community illiteracy level, and from states with a high proportion of the rural population in the fully adjusted model. Compared with the null model, 81% vs 13% and 59% vs 35% of the total variation in INM and U5M were explained by the state- and neighbourhood-level factors respectively. Infant- and under-five mortality in Nigeria is influenced by compositional and contextual factors. The Bayesian hierarchical Poisson regression model used in estimating the factors associated with childhood deaths in Nigeria fitted the survival data.Publisher PDFPeer reviewe

Gender variation in self-reported likelihood of HIV infection in comparison with HIV test results in rural and urban Nigeria

<p>Abstract</p> <p>Background</p> <p>Behaviour change which is highly influenced by risk perception is a major challenge that HIV prevention efforts need to confront. In this study, we examined the validity of self-reported likelihood of HIV infection among rural and urban reproductive age group Nigerians.</p> <p>Methods</p> <p>This is a cross-sectional study of a nationally representative sample of Nigerians. We investigated the concordance between self-reported likelihood of HIV and actual results of HIV test. Multivariate logistic regression analysis was used to assess whether selected respondents' characteristics affect the validity of self-reports.</p> <p>Results</p> <p>The HIV prevalence in the urban population was 3.8% (3.1% among males and 4.6% among females) and 3.5% in the rural areas (3.4% among males and 3.7% among females). Almost all the respondents who claimed they have high chances of being infected with HIV actually tested negative (91.6% in urban and 97.9% in rural areas). In contrast, only 8.5% in urban areas and 2.1% in rural areas, of those who claimed high chances of been HIV infected were actually HIV positive. About 2.9% and 4.3% from urban and rural areas respectively tested positive although they claimed very low chances of HIV infection. Age, gender, education and residence are factors associated with validity of respondents' self-perceived risk of HIV infection.</p> <p>Conclusion</p> <p>Self-perceived HIV risk is poorly sensitive and moderately specific in the prediction of HIV status. There are differences in the validity of self-perceived risk of HIV across rural and urban populations.</p

Shifts in age pattern, timing of childbearing and trend in fertility level across six regions of Nigeria: Nigeria Demographic and Health Surveys from 2003-2018.

Nigeria's population is projected to increase from 200 million in 2019 to 450 million in 2050 if the fertility level remains at the current level. Thus, we examined the shifts in the age pattern of fertility, timing of childbearing and trend in fertility levels from 2003 and 2018 across six regions of Nigeria. This study utilised the 2003, 2008, 2013, and 2018 Nigeria Demographic and Health Survey datasets. Each survey was a cross-sectional population-based design, and a two-stage cluster sampling technique was used to select women aged 15-49 years. The changes in the timing of childbearing were examined by calculating the corresponding mean ages at the birth of different birth orders for each birth order separately to adjust the Quantum effect for births. The Gompertz Relational Model was used to examine the age pattern of fertility and refined fertility level. In Nigeria, it was observed that there was a minimal decline in mean children ever born (CEB) between 2003 and 2018 across all maternal age groups except aged 20-24 years. The pattern of mean CEB by the age of mothers was the same across the Nigeria regions except in North West. Nigeria's mean number of CEB to women aged 40-49 in 2003, 2008, 2013 and 2018 surveys was 6.7, 6.6, 6.3 and 6.1, respectively. The mean age (years) at first birth marginally increased from 21.3 in 2003 to 22.5 in 2018. In 2003, the mean age at first birth was highest in South East (24.3) and lowest in North East (19.4); while South West had the highest (24.4) and both North East and North West had the lowest (20.2) in 2018. Similar age patterns of fertility existed between 2003 and 2018 across the regions. Nigeria's estimated total fertility level for 2003, 2008, 2013 and 2018 was 6.1, 6.1, 5.9 and 5.7, respectively. The findings showed a reducing but slow fertility declines in Nigeria. The decline varied substantially across the regions. For a downward change in the level of fertility, policies that will constrict the spread of fertility distribution across the region in Nigeria must urgently be put in place. [Abstract copyright: Copyright: © 2023 Olowolafe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Demystifying the factors associated with rural–urban gaps in severe acute malnutrition among under-five children in low- and middle-income countries: a decomposition analysis

What explains the underlying causes of rural–urban differentials in severe acute malnutrition (SAM) among under-five children is poorly exploited, operationalized, studied and understood in low- and middle-income countries (LMIC). We decomposed the rural–urban inequalities in the associated factors of SAM while controlling for individual, household, and neighbourhood factors using datasets from successive demographic and health survey conducted between 2010 and 2018 in 51 LMIC. The data consisted of 532,680 under-five children nested within 55,823 neighbourhoods across the 51 countries. We applied the Blinder–Oaxaca decomposition technique to quantify the contribution of various associated factors to the observed rural–urban disparities in SAM. In all, 69% of the children lived in rural areas, ranging from 16% in Gabon to 81% in Chad. The overall prevalence of SAM among rural children was 4.8% compared with 4.2% among urban children. SAM prevalence in rural areas was highest in Timor-Leste (11.1%) while the highest urban prevalence was in Honduras (8.5%). Nine countries had statistically significant pro-rural (significantly higher odds of SAM in rural areas) inequality while only Tajikistan and Malawi showed statistically significant pro-urban inequality (p < 0.05). Overall, neighbourhood socioeconomic status, wealth index, toilet types and sources of drinking water were the most significant contributors to pro-rural inequalities. Other contributors to the pro-rural inequalities are birth weight, maternal age and maternal education. Pro-urban inequalities were mostly affected by neighbourhood socioeconomic status and wealth index. Having SAM among under-five children was explained by the individual-, household- and neighbourhood-level factors. However, we found variations in the contributions of these factors. The rural–urban dichotomy in the prevalence of SAM was generally significant with higher odds found in the rural areas. Our findings suggest the need for urgent intervention on child nutrition in the rural areas of most LMIC

SARS-CoV-2 viral shedding and transmission dynamics : implications of WHO COVID-19 discharge guidelines

This work was supported through the Alliance for Accelerating Excellence in Science in Africa (AESA), a funding, agenda-setting, programme management initiative of the African Academy of Sciences (AAS), the African- Union Development Agency (AUDA-NEPAD), founding and funding global partners and through a resolution of the summit of African Union Heads of Governments.The evolving nature of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has necessitated periodic revisions of COVID-19 patient treatment and discharge guidelines. Since the identification of the first COVID-19 cases in November 2019, the World Health Organization (WHO) has played a crucial role in tackling the country-level pandemic preparedness and patient management protocols. Among others, the WHO provided a guideline on the clinical management of COVID-19 patients according to which patients can be released from isolation centers on the 10th day following clinical symptom manifestation, with a minimum of 72 additional hours following the resolution of symptoms. However, emerging direct evidence indicating the possibility of viral shedding 14 days after the onset of symptoms called for evaluation of the current WHO discharge recommendations. In this review article, we carried out comprehensive literature analysis of viral shedding with specific focus on the duration of viral shedding and infectivity in asymptomatic and symptomatic (mild, moderate, and severe forms) COVID-19 patients. Our literature search indicates that even though, there are specific instances where the current protocols may not be applicable ( such as in immune-compromised patients there is no strong evidence to contradict the current WHO discharge criteria.Publisher PDFPeer reviewe

Shifts in age pattern, timing of childbearing and trend in fertility level across six regions of Nigeria: Nigeria Demographic and Health Surveys from 2003–2018

Background Nigeria’s population is projected to increase from 200 million in 2019 to 450 million in 2050 if the fertility level remains at the current level. Thus, we examined the shifts in the age pattern of fertility, timing of childbearing and trend in fertility levels from 2003 and 2018 across six regions of Nigeria. Method This study utilised the 2003, 2008, 2013, and 2018 Nigeria Demographic and Health Survey datasets. Each survey was a cross-sectional population-based design, and a two-stage cluster sampling technique was used to select women aged 15–49 years. The changes in the timing of childbearing were examined by calculating the corresponding mean ages at the birth of different birth orders for each birth order separately to adjust the Quantum effect for births. The Gompertz Relational Model was used to examine the age pattern of fertility and refined fertility level. Result In Nigeria, it was observed that there was a minimal decline in mean children ever born (CEB) between 2003 and 2018 across all maternal age groups except aged 20–24 years. The pattern of mean CEB by the age of mothers was the same across the Nigeria regions except in North West. Nigeria’s mean number of CEB to women aged 40–49 in 2003, 2008, 2013 and 2018 surveys was 6.7, 6.6, 6.3 and 6.1, respectively. The mean age (years) at first birth marginally increased from 21.3 in 2003 to 22.5 in 2018. In 2003, the mean age at first birth was highest in South East (24.3) and lowest in North East (19.4); while South West had the highest (24.4) and both North East and North West had the lowest (20.2) in 2018. Similar age patterns of fertility existed between 2003 and 2018 across the regions. Nigeria’s estimated total fertility level for 2003, 2008, 2013 and 2018 was 6.1, 6.1, 5.9 and 5.7, respectively. Conclusion The findings showed a reducing but slow fertility declines in Nigeria. The decline varied substantially across the regions. For a downward change in the level of fertility, policies that will constrict the spread of fertility distribution across the region in Nigeria must urgently be put in place