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

Poverty and fever vulnerability in Nigeria: a multilevel analysis

<p>Abstract</p> <p>Background</p> <p>Malaria remains a major public health problem in Sub Saharan Africa, where widespread poverty also contribute to the burden of the disease. This study was designed to investigate the relationship between the prevalence of childhood fever and socioeconomic factors including poverty in Nigeria, and to examine these effects at the regional levels.</p> <p>Methods</p> <p>Determinants of fever in the last two weeks among children under five years were examined from the 25004 children records extracted from the Nigeria Demographic and Health Survey 2008 data set. A two-level random effects logistic model was fitted. </p> <p>Results</p> <p>About 16% of children reported having fever in the two weeks preceding the survey. The prevalence of fever was highest among children from the poorest households (17%), compared to 15.8% among the middle households and lowest among the wealthiest (13%) (p<0.0001). Of the 3,110 respondents who had bed nets in their households, 506(16.3%) children had fever, while 2,604(83.7%) did not. (p=0.082). In a multilevel model adjusting for demographic variables, fever was associated with rural place of residence (OR=1.27, p<0.0001, 95% CI: 1.16, 1.41), sex of child: female (OR=0.92, p=0.022, 95% CI: 0.859, 0.988) and all age categories (>6months), whereas the effect of wealth no longer reached statistical significance.</p> <p>Conclusion</p> <p>While, overall bednet possession was low, less fever was reported in households that possessed bednets. Malaria control strategies and interventions should be designed that will target the poor and make an impact on poverty. The mechanism through which wealth may affect malaria occurrence needs further investigation. </p

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Trends and drivers of skilled birth attendant use in Nigeria (1990-2013): policy implications for child and maternal health

ntroduction: While Nigeria accounts for only 2% of the world population, it regrettably shares 14% of global maternal death burden. Whether its reported increase in antenatal care utilization is accompanied by increased use of skilled birth attendants (SBAs) is not known. This study assessed trends in utilization of SBAs in Nigeria between 1990 and 2013 and identified its determinants. Methods: Data from four consecutive Nigerian Demographic and Health Survey reports between 1990 and 2013 were pooled. We used basic descriptive statistics, test of association, and logistic regression to assess the prevalence, relative change, and determinants of SBA use at 5% significance level. Sample weights were applied, and adjustment was made for survey design and sampling errors. Results: Nearly half (46.7%) of the respondents were aged 25-34 years, while half (50.3%) of the respondents had no formal education. The prevalence of SBA use increased only marginally across the years and characteristics studied, from 32.4% in 1990 to 38.5% in 2013, an insignificant 6% increase. Educated women used SBA more than women with no education (92.4% vs 13.1%), and their odds ratio of using SBA were thrice that of uneducated women (odds ratio =3.09, 95% confidence interval =2.17-4.38). Women involved in decisions regarding their use of health facility were 12% more likely to use SBAs than others who do not. Educational attainment, religion, tribe, rural/urban residence, and zone of residence were significant to the use of SBA. Conclusion: The use of SBA was very low throughout the study period, barely at one third usage with insignificant changes over the studied period. Women empowerment, including decision-making power and residence, were the strongest determinants of SBA use. To overturn poor child and maternal health outcomes in Nigeria through SBA use, efforts should be targeted at educating girls, sexual and reproductive health education, and accessible and improved health care facility services

Caregivers’ knowledge and utilization of long-lasting insecticidal nets among under-five children in Osun State, Southwest, Nigeria

Abstract Background Utilization of long-lasting insecticidal nets (LLIN) has been associated with reduction of malaria incidence, especially among children. The 2013 Nigeria Demographic and Health Survey revealed Osun State had the least proportion (5.7%) of under-five children (U5) who slept under LLIN the night before the survey. A study was conducted to assess caregivers’ knowledge about LLIN, utilization of LLIN and factors influencing LLIN use among U5 in Osun State, Nigeria. Methods A cross-sectional study was carried out among 1020 mothers/caregivers of U5 selected from six communities in Osun State using a multistage sampling technique. A pre-tested interviewer administered questionnaire was used to collect information on socio-demographic characteristics, mothers’ knowledge about LLIN, ownership and utilization of LLIN and factors influencing use of LLIN in U5. Questions on knowledge about LLIN were scored and categorized into good (scored ≥ 5) and poor (score < 5) knowledge out of a maximum obtainable score of seven. Utilization of LLIN was defined as the proportion of U5 who slept under net the night before the survey. Data were analysed using descriptive statistics, Chi square test and logistic regression at α < 0.05. Transcripts from focus group discussions (FGD) were analysed for emerging themes related to caregivers’ perspectives on utilization and factors affecting use of LLIN among U5. Results Majority of the respondents 588 (58.3%) fall between age 25–34 years, with a mean age of 30.0 ± 6.3 years. All were aware of LLIN but only 76.1% had good knowledge and 59.0% reported use of LLIN among their U5. Reported barriers to utilizing LLIN were; heat (96.4%), reactions to the chemical (75.5%) and unpleasant odour (41.3%). These were corroborated at FGD. Those with formal education [adjusted odds ratio (aOR) = 1.4; 95% CI 1.0–2.1] and those with good knowledge of LLIN (aOR = 1.8; 95% CI 1.4–2.5) were more likely to use LLIN than their counterparts without formal education and those with poor knowledge of LLIN respectively. Conclusions The level of knowledge of respondents about LLIN was high and the utilization of LLIN among U5 was above average, however, it is still far below the 80% target. Efforts should be made to further improve utilization of LLIN through intensified promotion and health education

Feasibility of Malaria Diagnosis and Management in Burkina Faso, Nigeria, and Uganda:A Community-Based Observational Study

Background. Malaria-endemic countries are encouraged to increase, expedite, and standardize care based on parasite diagnosis and treat confirmed malaria using oral artemisinin-based combination therapy (ACT) or rectal artesunate plus referral when patients are unable to take oral medication. Methods. In 172 villages in 3 African countries, trained community health workers (CHWs) assessed and diagnosed children aged between 6 months and 6 years using rapid histidine-rich protein 2 (HRP2)–based diagnostic tests (RDTs). Patients coming for care who could take oral medication were treated with ACTs, and those who could not were treated with rectal artesunate and referred to hospital. The full combined intervention package lasted 12 months. Changes in access and speed of care and clinical course were determined through 1746 random household interviews before and 3199 during the intervention. Results. A total of 15 932 children were assessed: 6394 in Burkina Faso, 2148 in Nigeria, and 7390 in Uganda. Most children assessed (97.3% [15 495/15 932]) were febrile and most febrile cases (82.1% [12 725/15 495]) tested were RDT positive. Almost half of afebrile episodes (47.6% [204/429]) were RDT positive. Children eligible for rectal artesunate contributed 1.1% of episodes. The odds of using CHWs as the first point of care doubled (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.9–2.4; P < .0001). RDT use changed from 3.2% to 72.9% (OR, 80.8; 95% CI, 51.2–127.3; P < .0001). The mean duration of uncomplicated episodes reduced from 3.69 ± 2.06 days to 3.47 ± 1.61 days, Degrees of freedom (df) = 2960, Student's t (t) = 3.2 (P = .0014), and mean duration of severe episodes reduced from 4.24 ± 2.26 days to 3.7 ± 1.57 days, df = 749, t = 3.8, P = .0001. There was a reduction in children with danger signs from 24.7% before to 18.1% during the intervention (OR, 0.68; 95% CI, .59–.78; P < .0001). Conclusions. Provision of diagnosis and treatment via trained CHWs increases access to diagnosis and treatment, shortens clinical episode duration, and reduces the number of severe cases. This approach, recommended by the World Health Organization, improves malaria case management. Clinical Trials Registration. ISRCTN13858170