Determinants of postnatal care non-utilization among women in Nigeria.

Although, there are several programs in place in Nigeria to ensure maternal and child health, maternal and neonatal mortality rates remain high with maternal mortality rates being 560/100,000 and neonatal mortality rates at 40/1,000 live births. While there are many studies on the utilization of maternal health services such as antenatal care and skilled delivery at birth, studies on postnatal care are rare. While efficient utilisation of postnatal care services has been proven to reduce morbidity and mortality among mothers and their newborns, the uptake of this service is low in Nigeria. Thus, identification of the factors that are associated with non-utilization of postnatal care services could shed light on what needs to be done to improve the uptake of the services in Nigeria and assist the country in achieving the MDG4 and MDG 5 targets of bringing down the levels of child and maternal mortality. Therefore, the aim of this study is to examine the factors associated with the non-utilization of postnatal care among mothers in Nigeria. Methods: Population-based cross-sectional data from 2008 Nigeria Demographic and Health Survey (NDHS) were used in this study. For analysis, the postnatal care uptake for 28,647 children born in the five years preceding the survey was considered. The dependent variable was a composite variable derived from a list of questions on postnatal care. Mothers who received postnatal care were coded as (0) while mothers who did not receive postnatal care were coded as (1). Child’s characteristics and mother's characteristics were used as the explanatory variables. Descriptive statistics were used to examine the patterns of postnatal care nonutilization by selected characteristics of mothers and children in the country. Binary logistic regression was used to identify factors associated with postnatal care non-utilization in Nigeria at bivariate and multivariate levels. Results: Results showed that 96% of the mothers of the 28,647 children did not utilize postnatal care services in the period examined. About 50% of the study population between 25-34 years did not utilize postnatal care and 46% of the women who did not utilize postnatal care had no education. Results from multivariate logistic regression show that accessibility, antenatal care use, birth size, education, place of delivery and region are significantly associated with the non-utilization of postnatal care services. Women who received antenatal care had lower odds (OR=0.23, 95% CI=1.09-1.87) of not utilizing postnatal care services. Also mothers of children who were smaller than average at birth had higher odds (OR=1.43, 95% CI=1.09- 1.87) of not utilizing postnatal care services. Conclusions: This study revealed the low uptake of postnatal care service in Nigeria. To increase mothers’ utilization of postnatal care services and improve maternal and child health in Nigeria, interventions should be targeted at mothers who deliver children that have low birth weight and great attention should be given to the women outside the South West region especially the Northern region of the country. In addition, it is crucial that steps should be taken on educating women. This would have a significant influence on their perceptions about the use of postnatal care services in Nigeria

Community structure and timing of sexual activity among adolescent girls in Nigeria

Studies have linked the timing of sexual debut to unplanned pregnancies and sexually transmissible infections, including HIV. Current understandings of sexual debut among Nigerian adolescents focused on the roles of individual and familial characteristics. We leveraged the 2018 Nigeria Demographic and Health Survey data to examine how community features like affluence, ethnic diversity, and women empowerment may be associated with the timing of sexual debut among adolescent girls. The sample comprised 7449 adolescent girls who were usual residents in 6,505 households and 1,352 clusters or communities. Statistical associations between community characteristics and the onset of sexual debut were assessed using a two-level mixed-effects parametric survival model with Weibull distribution

Gendered Conflict in the Human Family

Sexual conflict is a thriving area of animal behaviour research. Yet, parallel research in the evolutionary human sciences remains underdeveloped and has become mired by controversy. In this special collection, we aim to invigorate the study of fitness-relevant conflicts between women and men, advocating for three synergistic research priorities. First, we argue that a commitment to diversity is required to innovate the field, achieve ethical research practice, and foster fruitful dialogue with neighbouring social sciences. Accordingly, we have prioritized issues of diversity as editors, aiming to stimulate new connections and perspectives. Second, we call for greater recognition that human sex/gender roles and accompanying conflict behaviours are both subject to natural selection and culturally determined. This motivates our shift in terminology from sexual to gendered conflict when addressing human behaviour; countering stubborn tendencies to essentialize differences between women and men, and directing attention to the role of cultural practices, normative sanctions and social learning in structuring conflict battlegrounds. Finally, we draw attention to contemporary policy concerns, including the wellbeing consequences of marriage practices and the gendered implications of market integration. Focus on these themes, combined with attendance to the dangers of ethnocentrism, promises to inform culturally-sensitive interventions promoting gender equality worldwide

Resilience to depression: the role of benevolent childhood experiences in a South African sample

BackgroundStudies elsewhere show that benevolent childhood experiences (BCEs) have protective mental health value. However, this protective value has never been investigated in an African context. Given the need to better understand what might support mental health resilience among African young people, this study explores the relationship between BCEs and depressive symptoms among a South African sample of young adults living in a community dependent on the economically volatile oil and gas industry.MethodsA sample of young adults in an oil and gas community in South Africa (N = 313, mean age 20.3 years, SD = 1.83, range from 18 to 26; majority Black African) completed self-report questionnaires to assess BCEs and depressive symptoms (Beck Depression Inventory-II). The analysis controlled for socio-demographics and experience of family adversity. Multinomial logistic regressions were used to examine the association of BCEs with depressive symptoms using STATA 17.ResultsThe majority (86.4% of the sample) reported all 10 BCEs. Of the 10 BCEs, having at least one good friend was the most reported (94%) compared to 75% of the sample reporting having a predictable home routine, such as regular meals and a regular bedtime. The unadjusted multinomial logistic regression analysis indicated that having at least one good friend, comforting beliefs, and being comfortable with self were associated with lower odds of moderate depression. The adjusted results showed no association between BCEs and the depression of young adults in this sample.ConclusionIn this South African sample, our results do not show protective associations between BCEs and depression. This could be as a result of the homogeneity in our sample. It is also possible that the BCEs explored could not counteract the effect of chronic risk factors in the lives of the young people in this study context. Further research is needed to understand this complexity

Decade of research into the acceptability of interventions aimed at improving adolescent and youth health and social outcomes in Africa: a systematic review and evidence map

Objective Interventions aimed at improving adolescent health and social outcomes are more likely to be successful if the young people they target find them acceptable. However, no standard definitions or indicators exist to assess acceptability. Acceptability research with adolescents in low-and- middle- income countries (LMICs) is still limited and no known reviews systhesise the evidence from Africa. This paper maps and qualitatively synthesises the scope, characteristics and findings of these studies, including definitions of acceptability, methods used, the type and objectives of interventions assessed, and overall findings on adolescent acceptability. Design We conducted a systematic review of peer-reviewed studies assessing intervention acceptability with young adults (aged 10–24) in Africa, published between January 2010 and June 2020

Putting Children First: New Frontiers in the Fight Against Child Poverty in Africa

Despite important strides in the fight against poverty in the past two decades, child poverty remains widespread and persistent, particularly in Africa. Poverty in all its dimensions is detrimental for early childhood development and often results in unreversed damage to the lives of girls and boys, locking children and families into intergenerational poverty. This edited volume contributes to the policy initiatives aiming to reduce child poverty and academic understanding of child poverty and its solutions by bringing together applied research from across the continent. With the Sustainable Development Goals having opened up an important space for the fight against child poverty, not least by broadening its conceptualization to be multidimensional, this collection aims to push the frontiers by challenging existing narratives and exploring alternative understandings of the complexities and dynamics underpinning child poverty. Furthermore, it examines policy options that work to address this critical challenge.Comparative Research Programme on Poverty (CROP) at the University of Bergen.publishedVersio

Adolescent transport and unintentional injuries: a systematic analysis using the Global Burden of Disease Study 2019

Background: Globally, transport and unintentional injuries persist as leading preventable causes of mortality and morbidity for adolescents. We sought to report comprehensive trends in injury-related mortality and morbidity for adolescents aged 10–24 years during the past three decades. Methods: Using the Global Burden of Disease, Injuries, and Risk Factors 2019 Study, we analysed mortality and disability-adjusted life-years (DALYs) attributed to transport and unintentional injuries for adolescents in 204 countries. Burden is reported in absolute numbers and age-standardised rates per 100 000 population by sex, age group (10–14, 15–19, and 20–24 years), and sociodemographic index (SDI) with 95% uncertainty intervals (UIs). We report percentage changes in deaths and DALYs between 1990 and 2019. Findings: In 2019, 369 061 deaths (of which 214 337 [58%] were transport related) and 31·1 million DALYs (of which 16·2 million [52%] were transport related) among adolescents aged 10–24 years were caused by transport and unintentional injuries combined. If compared with other causes, transport and unintentional injuries combined accounted for 25% of deaths and 14% of DALYs in 2019, and showed little improvement from 1990 when such injuries accounted for 26% of adolescent deaths and 17% of adolescent DALYs. Throughout adolescence, transport and unintentional injury fatality rates increased by age group. The unintentional injury burden was higher among males than females for all injury types, except for injuries related to fire, heat, and hot substances, or to adverse effects of medical treatment. From 1990 to 2019, global mortality rates declined by 34·4% (from 17·5 to 11·5 per 100 000) for transport injuries, and by 47·7% (from 15·9 to 8·3 per 100 000) for unintentional injuries. However, in low-SDI nations the absolute number of deaths increased (by 80·5% to 42 774 for transport injuries and by 39·4% to 31 961 for unintentional injuries). In the high-SDI quintile in 2010–19, the rate per 100 000 of transport injury DALYs was reduced by 16·7%, from 838 in 2010 to 699 in 2019. This was a substantially slower pace of reduction compared with the 48·5% reduction between 1990 and 2010, from 1626 per 100 000 in 1990 to 838 per 100 000 in 2010. Between 2010 and 2019, the rate of unintentional injury DALYs per 100 000 also remained largely unchanged in high-SDI countries (555 in 2010 vs 554 in 2019; 0·2% reduction). The number and rate of adolescent deaths and DALYs owing to environmental heat and cold exposure increased for the high-SDI quintile during 2010–19. Interpretation: As other causes of mortality are addressed, inadequate progress in reducing transport and unintentional injury mortality as a proportion of adolescent deaths becomes apparent. The relative shift in the burden of injury from high-SDI countries to low and low–middle-SDI countries necessitates focused action, including global donor, government, and industry investment in injury prevention. The persisting burden of DALYs related to transport and unintentional injuries indicates a need to prioritise innovative measures for the primary prevention of adolescent injury. Funding: Bill & Melinda Gates Foundation

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens