Differences in Population Dynamics and Uptake of Reproductive Health Services in the Urban and Rural Cohorts of Cross River Health and Demographic Surveillance System of Southern Nigeria

Background: Health and demographic surveillance systems (HDSSs) generate essential health and demographic data from longitudinal surveillance of populations resident in distinctly demarcated enumeration areas. The Cross River HDSS (CRHDSS) located in southern Nigeria includes distinct urban and rural cohorts. Concurrent surveillance of adjacent urban and rural communities provides an opportunity to identify differences in population characteristics and access or utilization of health services. In this paper, we report the result of comparative analysis of rural and urban cohorts of the CRHDSS from November 2012 to December 2018. Methodology: Data was collected through house-to-house interviews performed in 6-monthly cycles through the years. Information obtained included demographic characteristics, pregnancies, child birth, health-seeking behaviour, migration and deaths. Trained field workers collected data from all households in the demographic surveillance area with mobile Android devices (running the ODKCollect). Collected data were transferred electronically to a remote server running on ODKAggregate and further processed by MirthConnect on OpenHDS web application with a MySQL backend database. Data was exported, cleaned and analyzed with the R Statistical Computing Software. Results: Total population undergoing longitudinal health and demographic surveillance was 37,808 persons in 9,452 households with 18,414 males and 19,394 females. The rural cohort made up 47.4% of the population while the urban cohort was 52.6%. Population structure showed that while the rural cohort has a relative depletion of young adults, the urban cohort has preponderance of this population segment indicating the high rate of rural to urban migration. There is also a striking difference in pattern of utilization of reproductive health services by pregnant women. While 68.6% of childbirth in the rural cohort occurred outside the formal health service (at TBAs and at home), 79.1% of childbirth in the urban area occurred in formal health facilities. Both the crude fertility rate, infant mortality and under-five mortality rates were higher in rural than the urban cohorts.Conclusion: Surveillance data showed relative depletion of young adults from rural population cohort, suggesting high rate of rural to urban migration. Majority of childbirths in rural areas still occur outside formal health facilities, which may partly contribute to higher infant mortality rate in the rural cohort. This calls for more efforts to enhance reproductive health services and employment opportunities in rural areas. Keywords: Population, Health characteristics, births, deaths, health and demographic surveillance systems DOI: 10.7176/DCS/9-5-08 Publication date:May 31st 201

Childbirth Practices in the Akpabuyo Rural Health and Demographic Surveillance System

Maternal and neonatal mortality remain high in Nigeria. The State and Federal governments have adopted several strategies to prevent maternal and infant deaths such as the Cross River State Free Health Services to pregnant women and infants, and the National Midwives’ Service Scheme. This study assessed pregnancy and childbirth practices of Nigerian women in rural communities located in Akpabuyo in the Niger Delta region of Nigeria. Women who were pregnant or had recently given birth in a population of 5,668 people under surveillance in some rural communities of Akpabuyo were interviewed to obtain information on pregnancy and childbirth practices. Validated semi-structured questionnaires were administered by well-trained field workers. Completed questionnaires were entered into electronic data forms in OpenHDS software and exported to STATA for analysis. Results showed that, 39.5% of women reported that they had sought prenatal care from a traditional birth attendant (TBA). 84.6% of all births occurred outside the formal health system with the majority attended by TBAs. Only 15.4% of births occurred in hospitals or health centres. The implements used to cut the umbilical cord were knives (46.2%), new razor blades, old razor blades, sharp stone and scissors. The materials used for treating the umbilical cord were mostly methylated spirit (63.1%); other treatment materials were“western medicine”, “black powder” and others including herbs and earth. The study concluded that, childbirth practices that pose significant risk to maternal and newborn health remain common in these rural communities. Majority of births were attended by TBAs despite free delivery services available at the formal health facilities. TBAs should be assisted to enhance their role in health care delivery. Effort should be made to increase public awareness and interest in facility-based services. Keywords: Maternal health, neonatal infection, longitudinal data, pregnancy

Optimum hardware, software and personnel requirements for a paperless health and demographic surveillance system: a case study of Cross River HDSS, Nigeria

Health and Demographic Surveillance Systems (HDSS) are a robust and rigorous data collection, validation, storage, analysis and reporting platforms for community-based data on vital events. These processes make high demands on paper and man-hours with attendant implications on running costs and environmental impact. However, with the rapid development of ICT and increasing affordability of computing devices, some of the manual processes can be replaced with ICT tools. This paper presents a case study of the Cross River HDSS in Akpabuyo Southern Nigeria with a view to highlighting the essential personnel, hardware and software requirements for running an IT-based paperless HDSS in low income settings. The DSA comprised of 22 contiguous EAs of 1370 households. The case study entailed four update rounds, each of which involved field workers visiting households and obtaining information on vital events. The first update round was purely paper-based involving the use of large collections of paper forms for interviews. The last three rounds were IT-based, devoid of paper questionnaires and ran on web-based open source software. Hardware was a set of high-end servers, desktops, tablet PCs and android phones for data collection.   The case study demonstrated the feasibility of running a paperless IT-based HDSS in a resource-poor setting using free and open source software, such as the web-based OpenHDS, MySQL, ODK, MirthConnect, etc. This overcomes the limitations of the popular HRS2 in terms of costs, complexities, and lack of compatibility with changing hardware and system software configurations. However, running IT-based paperless HDSS threw up some challenges, such as cases of poor internet connectivity, absence of GSM network connectivity using mobile devices, and having the right mix of staff with sufficient IT skills. This paper recommended solution strategies for overcoming these challenges. The need for the development of new set of protocols for data quality in a paperless HDSS is also discussed.   Keywords: Health, demographic surveillance system, information technology, paper, environment, enumeration area

A comparison of all-cause and cause-specific mortality by household socioeconomic status across seven INDEPTH network health and demographic surveillance systems in sub-Saharan Africa

Background: Understanding socioeconomic disparities in all-cause and cause-specific mortality can help inform prevention and treatment strategies. Objectives: To quantify cause-specific mortality rates by socioeconomic status across seven health and demographic surveillance systems (HDSS) in five countries (Ethiopia, Kenya, Malawi, Mozambique, and Nigeria) in the INDEPTH Network in sub-Saharan Africa. Methods: We linked demographic residence data with household survey data containing living standards and education information we used to create a poverty index. Person-years lived and deaths between 2003 and 2016 (periods varied by HDSS) were stratified in each HDSS by age, sex, year, and number of deprivations on the poverty index (0–8). Causes of death were assigned to each death using the InterVA-4 model based on responses to verbal autopsy questionnaires. We estimated rate ratios between socioeconomic groups (2–4 and 5–8 deprivations on our poverty index compared to 0–2 deprivations) for specific causes of death and calculated life expectancy for the deprivation groups. Results: Our pooled data contained almost 3.5 million person-years of observation and 25,038 deaths. All-cause mortality rates were higher among people in households with 5–8 deprivations on our poverty index compared to 0–2 deprivations, controlling for age, sex, and year (rate ratios ranged 1.42 to 2.06 across HDSS sites). The poorest group had consistently higher death rates in communicable, maternal, neonatal, and nutritional conditions (rate ratios ranged 1.34–4.05) and for non-communicable diseases in several sites (1.14–1.93). The disparities in mortality between 5–8 deprivation groups and 0–2 deprivation groups led to lower life expectancy in the higher-deprivation groups by six years in all sites and more than 10 years in five sites. Conclusions: We show large disparities in mortality on the basis of socioeconomic status across seven HDSS in sub-Saharan Africa due to disparities in communicable disease mortality and from non-communicable diseases in some sites. Life expectancy gaps between socioeconomic groups within sites were similar to the gaps between high-income and lower-middle-income countries. Prevention and treatment efforts can benefit from understanding subpopulations facing higher mortality from specific conditions

Bridging the Digital Divide:Leveraging Early Strides in NigeriaThe Nigerian Universities’ Experience

This paper outlines the current state, opportunities and potentials in the use of ICT for education, R&amp;D, and governance in Nigeria. It presents several ICT initiatives and the roles of some ICT bodies capable of bridging the digital divide between Nigeria and the developed world. Challenges facing the continuing development of ICT in the country are identified, and solution strategies to harness the full potential of ICT as an indispensable vehicle for socio-economic development in Nigeria are also discussed.</jats:p

Web Service Composition, Optimization and the Implications for Developing Economies

The emergence of the Service Oriented computing paradigm with its implicit inclusion of web services has caused a precipitous revolution in software engineering, e-service compositions, and optimization of e-services. Web service composition requests are usually combined with end-to-end Quality of Service (QoS) requirements, which are specified in terms of non-functional properties e.g. response time, throughput, and price. This chapter describes what web services are; not just to the web but to the end users. The state of the art approaches for composing web services are briefly described and a novel game theoretic approach using genetic programming for composing web services in order to optimize service performance, bearing in mind the Quality of Service (QoS) of these web services, is presented. The implication of this approach to cloud computing and economic development of developing economies is discussed.</jats:p

Antioxidant activity of the inflorescents of Vernonia calvoana growing in Yakurr Local Government Area of Cross River State, Nigeria

Vernonia calvoana is an indigenous green leafy vegetable that grows around the Cameroons and the southern part of Nigeria. This study was designed to evaluate the phytochemical and antioxidant activity of V. calvoana inflorescents using the following methods: 1, 1 – diphenyl-2-picrylhydrazyl radical (DPPH), Ferric reducing/antioxidant power (FRAP), 2, 2–azobis-3-ethyl benzothiolin-6-sulphonic acid (ABTS), anti-lipid, superoxide, phosphomolybdate and ascorbic acid assay. The result showed significantly high saponins, alkaloids and polyphenols at (p&lt;0.05). Oxalates, cyanates, phytates, tannins, terpenoids, steroids, anthraquinones, flavonoids and sesquiterpene lactones were found in trace amounts. The assay indicated strong free radical scavenging activity, including ABTS, anti-lipid, superoxide, phosphomolybdate activities of the inflorescents. However, the percentage antioxidant capacity was low in the inflorescents using FRAP, whereas the antioxidant capacity increased with increase in concentration compared to the ascorbic acid standard. Moreover, the inflorescents were found to show stronger antioxidant activity (137.0+6.86) compared to ascorbic acid (79.44%).We therefore conclude that V. calvoana inflorescents could serve as source strong diatary antioxidants.Running Title: Vernonia calvoana inflorescents in CalabarKeywords: Vernonia calvoana, antioxidant activity and nutraceutical

Evaluation of the therapeutic potentials of extract fractions of Vernonia calvoana on streptozotocin-induced diabetic rats: approach through in silico, in vitro and in vivo studies

Abstract Background Diabetes is a serious metabolic disorder and many medicinal plants are used in traditional medicine to manage it. This study aimed to evaluate the therapeutic effects of Vernonia calvoana (V. calvoana) extract fractions on streptozotocin-induced diabetic rat models. In this study, we first investigated the binding affinity of ligands from extracts of V. calvoana crystal structure proteins using a molecular docking approach. Furthermore, the in silico predictions were validated by in vitro and in vivo biochemical evaluations to ascertain the efficacy of these extract fractions. The in vitro antioxidant activity of the fractions was evaluated using DPPH, FRAP, SOD, and LPx scavenging. For biological activity, extract fractions of V. calvoana and metformin (400 mg and 500 mg/kg body weight, respectively) were administered to diabetic rats for 21 days after induction and confirmation of diabetes. Results The radical scavenger activities of the fractions showed a good dose-dependent reaction activity. A significant reduction in hyperglycemia, hyperlipidemia, nephrotoxicity, and hepatotoxicity was observed in all experimental treated groups. Improved hematological and histopathological changes were also observed. Conclusion The In silico analyses revealed that all the compounds from extract fractions of V. calvoana have varying binding affinity for PFK and lipoprotein lipase, with some showing higher affinity than the standard drug, further validating the biological activity of the plant. The results of this study indicated that V. calvoana extracts might have potential value in treating complications arising from diabetes mellitus

Prevalence of molecular markers of resistance to sulfadoxine–pyrimethamine before and after community delivery of intermittent preventive treatment of malaria in pregnancy in sub-Saharan Africa: a multi-country evaluation

International audienceBackground Intermittent preventive treatment of malaria in pregnancy (IPTp) with sulfadoxine–pyrimethamine isrecommended at each antenatal care clinic visit in high-moderate transmission areas. However, its coverage remainsunacceptably low in many countries. Community health workers can effectively deliver malaria preventive interventions.The aim of this study was to assess the effect of community delivery of IPTp (C-IPTp) on antenatal care and IPTpcoverage.Methods A community-based IPTp administration approach was implemented in four sub-Saharan countries: theDemocratic Republic of the Congo (DR Congo), Madagascar, Mozambique, and Nigeria. A quasi-experimental beforeand after evaluation by cluster sampling was designed where C-IPTp was implemented in selected country areas indifferent phases. Baseline (before C-IPTp implementation), midline, and endline household surveys were carried outto assess IPTp intake in pregnant women in 2018, 2019, and 2021. Eligible participants of the household survey werewomen of reproductive age (13–50 years old, depending on the country) that had a pregnancy that ended (anypregnancy regardless of pregnancy outcome) in the 6 months before the interview. For the first baseline surveys, thetarget population was women who had a pregnancy that ended in the 12 months before the interview. The primaryoutcome from the household surveys was the proportion of women who reported having received at least three dosesof IPTp during pregnancy. The trial is registered at ClinicalTrials.gov, NCT03600844.Findings A total of 32 household surveys were conducted between March 15, and Oct 30, 2018, and data from18 215 interviewed women were analysed. The coverage of at least three doses of IPTp (IPTp3+) increased after thefirst year of C-IPTp implementation in all project areas in DR Congo (from 22∙5% [170/755] to 31∙8% [507/1596]),Madagascar (from 17∙7% [101/572] to 40∙8% [573/1404]), and Nigeria (from 12∙7% [130/1027] to 35∙2% [423/1203]),with increases between 145∙6% (Madagascar) and 506∙6% (Nigeria). IPTp3+ coverage increased between baselineand endline in all districts, except for Murrupula (Mozambique) and ranged between 9∙6% and 533∙6%. This patternwas similar in DR Congo, Madagascar, and Nigeria, and in Mozambique, the increase was lower than the othercountries. Antenatal care attendance did not change or increased lightly in all study countries.Interpretation C-IPTp was associated with an increase in IPTp uptake without reducing antenatal care attendance.The strategy might be considered for malaria control in pregnancy