Inequitable childhood immunization uptake in Nigeria: a multilevel analysis of individual and contextual determinants

Background: Immunization coverage in many parts of Nigeria is far from optimal, and far from equitable. Nigeria accounts for half of the deaths from Measles in Africa, the highest prevalence of circulating wild poliovirus in the world, and the country is among the ten countries in the world with vaccine coverage below 50 percent. Studies focusing on community-level determinants therefore have serious policy implications Methods: Multilevel multivariable regression analysis was used on a nationally-representative sample of women aged 15-49 years from the 2003 Nigeria Demographic and Health Survey. Multilevel regression analysis was performed with children (level 1) nested within mothers (level 2), who were in turn nested within communities (level 3). Results: Results show that the pattern of full immunization clusters within families and communities, and that socio-economic characteristics are important in explaining the differentials in full immunization among the children in the study. At the individual level, ethnicity, mothers' occupation, and mothers' household wealth were characteristics of the mothers associated with full immunization of the children. At the community level, the proportion of mothers that had hospital delivery was a determinant of full immunization status. Conclusion: Significant community-level variation remaining after having controlled for child- and mother-level characteristics is indicative of a need for further research on community-levels factors, which would enable extensive tailoring of community-level interventions aimed at improving full immunization and other child health outcomes

Regional inequalities in under-5 mortality in Nigeria: a population-based analysis of individual- and community-level determinants

<p>Abstract</p> <p>Background</p> <p>Regions with geographically diverse ecology and socioeconomic circumstances may have different disease exposures and child health outcomes. This study assessed variations in the risks of death in children under age 5 across regions of Nigeria and determined characteristics at the individual and community levels that explain possible variations among regions.</p> <p>Methods</p> <p>Multilevel Cox proportional hazards analysis was performed using a nationally representative sample of 6,029 children from 2,735 mothers aged 15-49 years and nested within 365 communities from the 2003 Nigeria Demographic and Health Survey. Hazard ratios (HR) with 95% confidence intervals (CI) were used to express measures of association among the characteristics. Variance partition coefficients and Wald statistic were used to express measures of variation.</p> <p>Results</p> <p>Patterns of under-5 mortality cluster within families and communities. The risks of under-5 deaths were significantly higher for children of mothers residing in the South South (Niger Delta) region (HR: 1.30; 95% CI: 1.76-2.20) and children of mothers residing in communities with a low proportion of mothers attending prenatal care by a doctor (HR: 1.36; 95% CI: 1.15-1.86). In addition, the cross-level interaction between mothers' education and community prenatal care by a doctor was associated with a more than 40% higher risk of dying (HR: 1.41; 95% CI: 1.21-1.78).</p> <p>Conclusion</p> <p>The findings suggest the need to differentially focus on community-level interventions aimed at increasing maternal and child health care utilization and improving the socioeconomic position of mothers, especially in disadvantaged regions such as the South South (Niger Delta) region. Further studies on community-levels determinants of under-5 mortality are needed.</p

Entrance channel effects in fission of (TI)-T-197

The pre- and post-scission neutron multiplicities are measured for (16)O+(181)Ta and (19)F+(178)Hf systems where the same compound nucleus (197)Tl is formed at the same excitation energies (E(*)=72, 76, and 81 MeV). The measured pre-scission neutron multiplicities are found to be different for the two reactions and this difference in neutron yield increases with the excitation energy of the compound nucleus. The experimental pre-scission neutron yield is compared with predictions from the statistical model of compound nuclear decay containing the strength of nuclear viscosity as a free parameter. The magnitude of nuclear viscosity required to fit the experimental yield is found to be different for the two reactions. Because the two systems under consideration lie on the two sides of the Businaro-Gallone point, this observation indicates that the entrance channel mass asymmetry plays an important role in determining the number of neutrons emitted prior to scission in fusion-fission reactions

Role of nuclear dissipation and entrance channel mass asymmetry in pre-scission neutron multiplicity enhancement in fusion-fission reactions

Pre-scission neutron multiplicities are measured for (12)C + (204)Pb and (19)F + (197)Au reactions at laboratory energies of 75-95 MeV for the (12)C beam and 98-118 MeV for the (19)F beam. The chosen projectile-target combinations in the present study lie on either side of the Businaro-Gallone mass asymmetry (alpha(BG)) and populate the (216)Ra compound nucleus. The dissipation strength is deduced after comparing the experimentally measured neutron yield with the statistical model predictions which contains the nuclear viscosity as a free parameter. Present results demonstrate the combined effects of entrance channel mass asymmetry and the dissipative property of nuclear matter on the pre-scission neutron multiplicity in fusion-fission reactions

Measurement of neutron multiplicity from fission of U-228 and nuclear dissipation

Pre- and post-scission neutron multiplicities are measured at different excitation energies of the compound nucleus (228)U populated using the (19)F+(209)Bi reaction. The measured yield of pre-scission and total neutrons are compared with the statistical model calculation for the decay of a compound nucleus. The statistical model calculations are performed using the Bohr-Wheeler transition state fission width as well as the dissipative dynamical fission width due to Kramers. Comparison between the measured and the calculated values shows that, while the Bohr-Wheeler fission width grossly underestimates the pre-scission neutron yield, a large amount of dissipation is required in the Kramers width to fit the experimental pre-scission multiplicities. Various factors contributing to the large excitation energy dependence of the fitted values of the dissipation coefficient are discussed

Institutional delivery service utilization in Munisa Woreda, South East Ethiopia: a community based cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Reducing maternal morbidity and mortality is a global priority which is particularly relevant to developing countries like Ethiopia. One of the key strategies for reducing maternal morbidity and mortality is increasing institutional delivery service utilization of mothers under the care of skilled birth attendants. The aim of this study was to determine the level of institutional delivery service utilization and associated factors.</p> <p>Methods</p> <p>A community-based cross-sectional survey was conducted from April 1–20, 2011, among mothers who gave birth 12 months before the study began in Munesa Woreda, Arsi Zone, Oromia Region, Southeast Ethiopia. A stratified cluster sampling was used to select a sample of 855 participants.</p> <p>Results</p> <p>Out of all deliveries, only 12.3% took place at health facilities. Women who were urban residents (AOR = 2.27, 95%CI: 1.17, 4.40), women of age at interview less than 20 years (AOR = 6.06, 95%CI: 1.54, 23.78), women with first pregnancy (AOR = 2.41, 95%CI: 1.17, 4.97) and, women who had ANC visit during the last pregnancy (AOR = 4.18, 95%CI: 2.54, 6.89) were more likely to deliver at health institutions. Secondary and above level of mother`s and husband`s education had also a significant effect on health institution delivery with AOR = 4.31 (95%CI: 1.62, 11.46) and AOR = 2.77 (95%CI: 1.07, 7.19) respectively.</p> <p>Conclusion</p> <p>Institutional delivery service utilization was found to be low in the study area. Secondary and above level of mother`s and husband`s education, urban residence and ANC visit were amongst the main factors that had an influence on health institution delivery. Increasing the awareness of mothers and their partners about the benefits of institutional delivery services are recommended.</p