Qualitative Exploration of factors affecting Uptake and Demand for Contraception and other Family Planning Services in North-West Nigeria

In spite of the improvements in knowledge about family planning (FP), the contraceptive prevalence rate and unmet need for FP remain poor in most parts of Northern Nigeria. This study sought to explore specific factors that influence contraceptive uptake and demand in North-West Nigeria. Key Informant and In-depth Interviews were conducted using guides among stakeholders in two selected states in North-West Nigeria, Kebbi and Sokoto States. Interviewees were selected purposively to include Reproductive  Health Focal Persons at the local government level, service providers,  Women of Reproductive Age (WRA) and FP coordinators. Factors inhibiting contraceptive uptake included lack of health education, religion, fear of spousal rejection and side effects. Poor government funding and  inadequate number of health workers were also identified as systemic factors. Suggested methods of overcoming identified challenges include; task-shifting, increased stakeholder participation and political will.Keywords: Contraceptive demand, North-West Nigeria, factors affecting FP demandMalgré l'amélioration des connaissances sur la planification familiale (PF), le taux de la prévalence contraceptive et les besoins non satisfaits en PF restent pauvres dans la plupart des régions du nord du Nigéria. Cette étude a cherché à explorer des facteurs spécifiques qui influencent l'adoption et la demande des contraceptifs dans le nord-ouest du Nigéria. Des entretiens avec des informateurs clés et approfondis ont été menés à l'aide de guides parmi les parties prenantes de deux États sélectionnés du nordouest du Nigéria, les États de Kebbi et de Sokoto. Les personnes interrogées ont été choisies à dessein pour inclure les personnes focales en santé de la reproduction au niveau du gouvernement local, les prestataires de services, les femmes en âge de procréer (FAP) et les  coordinateurs de PF. Les facteurs inhibant l'adoption des contraceptifs comprenaient le manque d'éducation  sanitaire, la religion, la peur du rejet du conjoint et les effets secondaires. Le financement insuffisant du  gouvernement et le nombre insuffisant d'agents de santé ont également été identifiés comme des facteurs  systémiques. Les méthodes suggérées pour surmonter les défis identifiés comprennent: le transfert de tâches, la participation accrue des parties prenantes et la volonté politique.Mots-clés: Demande des contraceptifs, nord-ouest du Nigéria, facteurs affectant la demande de P

Mammalian and reptilian species expected and observed in roadside wildlife markets of southwest Nigeria and the implications for conservation

Wildlife provides both consumptive and non-consumptive utilities to human beings around the world. Under wild animal utilization as food and medicine, some wildlife species have been overharvested. Coupled with environmental degradation affecting wildlife species in their habitats, the need to evaluate wildlife populations in Southwest Nigeria is therefore essential. Twenty-three wildlife markets along five highways in Southwest Nigeria were surveyed for two years to determine the pattern of mammalian and reptilian species occurrence; wild animal species assessed were freshly dead and roasted ones. The species named by literatures were tagged Expected while those found in the sales points were referred to as Observed. The names of species found were matched with literatures that established them. Indirect method of species of identification was questionnaire use among stakeholders of wildlife marketing (hunters, traders and farmers) selected through Systematic Random Sampling (Odd Method). This approach firstly identified the wildlife species being sold in the markets and their vernacular (Yoruba) names. These names were linked with literatures that confirmed their scientific names. Results revealed that twelve mammalian and three reptilian species were absent in all road markets. Implication of results is that mammals and reptiles which were absent in all market Roads are those whose populations have reduced in the wild. Recommendations for Government sensitisation on animals absent in the Sales Points about hunting pressure reduction through print and electronic media were first made. Conservation education among forest exploitation professionals, campaign against forest degradation and establishment of more forest reserves and National parks by Nigerian Government were made too

Impacts of Dietary Chrysophyllum albidum Fruit Pulp on Brain Cholinesterase Function in High-Fat Diet/Streptozotocin-Induced Diabetic Rats

Epidemiologic studies have shown strong correlations between Alzheimer’s disease and diabetes mellitus. The exact mechanism through which this happens remains unclear. However, the dependence on glucose for brain function has been proposed as one possible mechanism. Hence, this study investigated the neuroprotective potential of Chrysophyllum albidum fruit pulp (CAPP) with hypoglycaemic properties in diabetic rats induced with high-fat diet/streptozotocin (STZ). The animals were grouped into seven units as follows: control, STZ-induced, STZ + metformin (positive control), STZ + 5% CAPP, STZ + 10% CAPP, control + 5% CAPP and control + 10% CAPP and each group was made up of six rats. The animals were first placed on normal diet (non-diabetic groups) and high fat diet (diabetic groups) for a fortnight, respectively before induction with STZ and were treated with diets containing 5 and 10% CAPP for 14 days. After the experiment, the rat brain cholinesterase and antioxidant activities were determined. The results revealed that acetylcholinesterase (AChE), butylcholinesterase (BuChE), arginase, adenosine deaminase (ADA) and antioxidant activities were altered in STZ-diabetic group in comparison to the control. However, a significant decrease at p < 0.05 was found in the activities of AChE, BuChE, arginase and ADA. In addition, there was a concomitant rise in the levels of antioxidant in all the groups administered supplemented diets and the group treated with metformin in comparison to the STZ-diabetic group. Conclusively, we can suggest that the fruit pulp prevents neurological damage in diabetic rats via anticholinesterase activity and improvement of brain antioxidant status

Socio-economic status and hunger among orphans and vulnerable children households in Lagos State, Nigeria

Background: HIV/AIDS has contributed to increasing orphans and vulnerable children in Nigeria. A measure of vulnerability is household hunger. Objective: To assess level of household hunger and associated factors among OVC households in Lagos State. Methods: A cross-sectional survey of 1300 OVC households in 5 selected Local Government Areas. The LGAs were selected using the Household Vulnerability Assessment index. Data collection was by personal interview of households\u2019 heads/ caregivers using a structured questionnaire capturing socio-demographic, household economic profile and food-related variables. A multivariate logit model was fitted to identify independent predictors of household hunger after adjusting for confounding variables. Results: The population density was 5.1 and 52.8% were females. A larger proportion of females (84.6%) than males (78.3%) reported that they had no food to eat in the last four weeks prior the survey. Poor household economic status (OR=1.41, CI: 1.03-1.92), age and marital status of caregiver were independent predictors of household hunger. The odds of hunger increased with caregiver\u2019s age; higher in households headed by never married (OR=3.99, CI: 1.15-13.89) and divorced/separated caregivers (OR=2.39, CI: 1.11-5.12). Conclusion: OVC households experienced severe hunger. Household economic strengthening would be useful strategy to mitigate the nutrition challenges of OVC in Lagos state

Blood pressure control and left ventricular hypertrophy in hypertensive Nigerians

Background : Hypertension is a disease characterized by end-organ complications, leading to high morbidity and mortality in many cases. People with untreated or uncontrolled hypertension often run the risk of developing complications directly associated with the disease. Left ventricular hypertrophy (LVH) has been shown to be a significant risk factor for adverse outcomes both in patients with hypertension and in the general population. We investigated the prevalence and pattern of LVH in a treated hypertensive population at the University College Hospital, Ibadan, Nigeria, using non-hypertensive subjects as control. Design and Setting : A prospective observational study performed at the University College Hospital, Ibadan, Nigeria. Methods : Patients had 6 visits, when at least one blood pressure measurement was recorded for each hypertensive subject and average calculated for systolic blood pressure (SBP) and diastolic blood pressure (DBP) separately. The values obtained were used for stratification of the subjects into controlled and uncontrolled hypertension. Subjects also had echocardiograms to determine their left ventricular mass. Results : LVH was found in 14 (18.2%) of the normotensive group, 40 (20.8%) of the uncontrolled hypertensive group and 14 (24.1%) of the controlled hypertensive group when left ventricular mass (LVM) was indexed to body surface area (BSA). When LVM was indexed to height, left ventricular hypertrophy was found in none of the subjects of the normotensive group, while it was found present in 43 (22.4%) and 14 (24.1%) subjects of the uncontrolled and controlled hypertensive groups, respectively. Significant difference in the prevalence of LVH was detected only when LVM was indexed to height alone. Conclusion : Clinic blood pressure is an ineffective way of assessing BP control. Thus in apparently controlled hypertensive subjects, based on office blood pressure, cardiac structural changes do remain despite antihypertensive therapy. This population is still at risk of cardiovascular events.arri\ue8re-plan: l\u2019hypertension est une maladie caract\ue9ris\ue9e par l\u2019orgue de fi n complications menant \ue0 \ue9lev\ue9 de morbidit\ue9 et mortalit\ue9 dans de nombreux cas. Personnes avec l\u2019hypertension non trait\ue9e ou non contr\uf4l\ue9e souvent risquent de d\ue9velopper complications directement associ\ue9es \ue0 la maladie. Laiss\ue9 ventriculaire hypertrophie (LVH) a \ue9t\ue9 d\ue9montr\ue9 un facteur de risque signifi catif pour les effets n\ue9gatifs r\ue9sultats tant chez les patients atteints de l\u2019hypertension et de la population g\ue9n\ue9rale. Nous avons a enqu\ueat\ue9 sur la pr\ue9valence et le mod\ue8le de LVH dans un trait\ue9 hypertendues population au University College Hospital, \ue0 l\u2019aide Ibadan, Nigeria non-hypertendues des sujets comme contr\uf4le. conception et la confi guration: A \ue9ventuel \ue9tude d\u2019observation effectu\ue9e \ue0 la University College Hospital, Ibadan, Nigeria. m\ue9thodes: Patients avaient six visites o\uf9 au moins un sang mesure de pression a \ue9t\ue9 enregistr\ue9e pour chaque sujet hypertendues et moyenne calcul\ue9s s\ue9par\ue9ment pour SBP et DBP. Les valeurs obtenues ont \ue9t\ue9 utilis\ue9es pour stratifi cation des sujets dans l\u2019hypertension contr\uf4l\ue9e et incontr\uf4l\ue9e. Sujets ont \ue9galement echocardiograms pour d\ue9terminer leur masse ventriculaire gauche. r\ue9sultats: LVH a \ue9t\ue9 trouv\ue9 en 14(18.2%) de la groupe normotensive, 40(20.8%) de groupe de hypertendues non contr\uf4l\ue9es et 14(24.1%) de hypertendues contr\uf4l\ue9e groupe lorsque quitt\ue9 masse ventriculaire (LVM) a \ue9t\ue9 index\ue9e \ue0 corps surface (BSA). Lorsque LVM a \ue9t\ue9 index\ue9 \ue0 hauteur, laiss\ue9 ventriculaire hypertrophie a \ue9t\ue9 trouv\ue9 dans aucun du groupe normotensive, bien qu\u2019il a \ue9t\ue9 constat\ue9 pr\ue9sents dans les 43(22.4%) et 14(24.1%) de hypertendues non ma\ueetris\ue9e et contr\uf4l\ue9e groupes respectivement. \uc9tait de diff\ue9rence signifi cative dans la pr\ue9valence de la LVH d\ue9tect\ue9s uniquement lorsque LVM a \ue9t\ue9 index\ue9 \ue0 hauteur alone. conclusion: clinique art\ue9rielle est un moyen ineffi cace de mesurer le contr\uf4le de BP. Ainsi en sujet hypertendues apparemment contr\uf4l\ue9e bas\ue9e sur la pression art\ue9rielle de bureau, des changements structurels cardiaques restent malgr\ue9 th\ue9rapie antihypertensive. Cette population est toujours \ue0 risque de maladies cardiovasculaires \ue9v\ue9nements

Screening of crude extracts of six medicinal plants used in South-West Nigerian unorthodox medicine for anti-methicillin resistant Staphylococcus aureus activity

BACKGROUND: Six Nigerian medicinal plants Terminalia avicennioides, Phylantus discoideus, Bridella ferruginea, Ageratum conyzoides, Ocimum gratissimum and Acalypha wilkesiana used by traditional medical practitioners for the treatment of several ailments of microbial and non-microbial origins were investigated for in vitro anti-methicillin Resistant Staphylococcus aureus (MRSA) activity. METHODS: Fresh plant materials were collected from the users. Water and ethanol extracts of the shredded plants were obtained by standard methods. The Bacterial cultures used were strains of MRSA isolated from patients. MRSA was determined by the reference broth microdilution methods using the established National Committee for Clinical Laboratory Standards break points. Staphylococcus aureus NCIB 8588 was used as a standard strain. Susceptibility testing and phytochemical screening of the plant extracts were performed by standard procedures. Controls were maintained for each test batch. RESULTS: Both water and ethanol extracts of T. avicennioides, P. discoideus, O. gratissimum, and A. wilkesiana were effective on MRSA. The Minimum Inhibition Concentration (MIC) and Minimum Bactericidal Concentration (MBC) of the ethanol extracts of these plants range from 18.2 to 24.0 mcg/ml and 30.4 to 37.0 mcg/ml respectively. In contrast, MIC range of 30.6 to 43.0 mcg/ml and 55.4 to 71.0 mcg/ml were recorded for ethanol and water extracts of B. ferruginea, and A. conyzoides respectively. Higher MBC values were obtained for the two plants. These concentrations were too high to be considered active in this study. All the four active plants contained at least trace amount of anthraquinones. CONCLUSION: Our results offer a scientific basis for the traditional use of water and ethanol extracts of A. wilkesiana, O. gratissimum, T. avicennioides and P. discoideus against MRSA-associated diseases. However, B. ferruginea and A. conyzoides were ineffective in vitro in this study; we therefore suggest the immediate stoppage of their traditional use against MRSA-associated diseases in Lagos, Nigeria

Echocardiographic partition values and prevalence of left ventricular hypertrophy in hypertensive Nigerians

BACKGROUND: Left ventricular hypertrophy (LVH) is a well known independent risk factor for cardiovascular events. It has been shown that combination of left ventricular mass (LVM) and relative wall thickness (RWT) can be used to identify different forms of left ventricular (LV) geometry. Prospective studies have shown that LV geometric patterns have prognostic implications, with the worst prognosis associated with concentric hypertrophy. The methods for the normalization or indexation of LVM have also recently been shown to confer some prognostic value especially in obese population. We sought to determine the prevalence of echocardiographic lLVH using eight different and published cut-off or threshold values in hypertensive subjects seen in a developing country's tertiary centre. METHODS: Echocardiography was performed in four hundred and eighty consecutive hypertensive subjects attending the cardiology clinic of the University college Hospital Ibadan, Nigeria over a two-year period. RESULTS: Complete data was obtained in 457 (95.2%) of the 480 subjects (48.6% women). The prevalence of LVH ranged between 30.9–56.0%. The highest prevalence was when LVM was indexed to the power of 2.7 with a partition value of 49.2 g/ht(2.7 )in men and 46.7 g/ht(2.7 )in women. The lowest prevalence was observed when LVM was indexed to body surface area (BSA) and a partition value of 125 g/m(2 )was used for both sexes. Abnormal LV geometry was present in 61.1%–74.0% of our subjects and commoner in women. CONCLUSION: The prevalence of LVH hypertensive patients is strongly dependent on the cut-off value used to define it. Large-scale prospective study will be needed to determine the prognostic implications of the different LV geometry in native Africans

Characterisation of heart failure with normal ejection fraction in a tertiary hospital in Nigeria

<p>Abstract</p> <p>Background</p> <p>The study aimed to determine the frequency and characteristics of heart failure with normal EF in a native African population with heart failure.</p> <p>Methods</p> <p>It was a hospital cohort study. Subjects were 177 consecutive individuals with heart failure and ninety apparently normal control subjects. All the subjects underwent transthoracic echocardiography. The group with heart failure was further subdivided into heart failure with normal EF (EF ≥ 50) (HFNEF) and heart failure with low EF(EF <50)(HFLEF).</p> <p>Results</p> <p>The subjects with heart failure have a mean age of 52.3 ± 16.64 years vs 52.1 ± 11.84 years in the control subjects; p = 0.914. Other baseline characteristics except blood pressure parameters and height were comparable between the group with heart failure and the control subjects. The frequency of HFNEF was 39.5%. Compared with the HFLEF group, the HFNEF group have a smaller left ventricular diameter (in diastole and systole): (5.2 ± 1.22 cm vs 6.2 ± 1.39 cm; p < 0.0001 and 3.6 ± 1.24 cm vs 5.4 ± 1.35 cm;p < 0.0001) respectively, a higher relative wall thickness and deceleration time of the early mitral inflow velocity: (0.4 ± 0.12 vs 0.3 ± 0.14 p < 0.0001 and 149.6 ± 72.35 vs 110.9 ± 63.40 p = 0.001) respectively.</p> <p>The two groups with heart failure differed significantly from the control subjects in virtually all echocardiographic measurements except aortic root diameter, LV posterior wall thickness(HFLEF), and late mitral inflow velocity(HFNEF). HFNEF accounted for 70(39.5%) of cases of heart failure in this study.</p> <p>Hypertension is the underlying cardiovascular disease in 134(75.7%) of the combined heart failure population, 58 (82.9%) of the subjects with HFNEF group and 76(71%) of the HFLEF group. Females accounted for 44 (62.9%) of the subjects with HFNEF against 42(39.3%) in the HFLEF group (p = 0.002).</p> <p>Conclusion</p> <p>The frequency of heart failure with normal EF in this native African cohort with heart failure is comparable with the frequency in other populations. These groups of patients are more likely female, hypertensive with concentric pattern of left ventricular hypertrophy.</p

Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018

Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030

Global, regional, and national progress towards Sustainable Development Goal 3.2 for neonatal and child health: all-cause and cause-specific mortality findings from the Global Burden of Disease Study 2019

Background Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. Methods We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (USMR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. Findings Global U5MR decreased from 71.2 deaths per 1000 livebirths (95% uncertainty interval WI] 68.3-74-0) in 2000 to 37.1 (33.2-41.7) in 2019 while global NMR correspondingly declined more slowly from 28.0 deaths per 1000 live births (26.8-29-5) in 2000 to 17.9 (16.3-19-8) in 2019. In 2019,136 (67%) of 204 countries had a USMR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030,154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9.65 million (95% UI 9.05-10.30) in 2000 and 5.05 million (4.27-6.02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3.76 million 95% UI 3.53-4.021) in 2000 to 48% (2.42 million; 2.06-2.86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0.80 (95% UI 0.71-0.86) deaths per 1000 livebirths and U5MR to 1.44 (95% UI 1-27-1.58) deaths per 1000 livebirths, and in 2019, there were as many as 1.87 million (95% UI 1-35-2.58; 37% 95% UI 32-43]) of 5.05 million more deaths of children younger than 5 years than the survival potential frontier. Interpretation Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve USMR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd