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Akwara E, Pinchoff J, Abularrage T, White C, Ngo TD. The Urban Environment and Disparities in Sexual and Reproductive Health Outcomes in the Global South: a Scoping Review. J Urban Health 2023:10.1007/s11524-023-00724-z. [PMID: 37052774 PMCID: PMC10100607 DOI: 10.1007/s11524-023-00724-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 04/14/2023]
Abstract
By 2050, the Global South will contain three-quarters of the world's urban inhabitants, yet no standardized categorizations of urban areas exist. This makes it challenging to compare sub-groups within cities. Sexual and reproductive health and rights (SRHR) are a critical component of ensuring that populations are healthy and productive, yet SRHR outcomes within and across urban settings vary significantly. A scoping review of the literature (2010-2022) was conducted to describe the current body of evidence on SRHR in urban settings in the Global South, understand disparities, and highlight promising approaches to improving urban SRHR outcomes. A total of 115 studies were identified, most from Kenya (30 articles; 26%), Nigeria (15; 13%), and India (16; 14%), focusing on family planning (56; 49%) and HIV/STIs (43; 37%). Findings suggest significant variation in access to services, and challenges such as gender inequality, safety, and precarious circumstances in employment and housing. Many of the studies (n = 84; 80%) focus on individual-level risks and do not consider how neighborhood environments, concentrated poverty, and social exclusion shape behaviors and norms related to SRHR. Research gaps in uniformly categorizing urban areas and key aspects of the urban environment make it challenging to understand the heterogeneity of urban environments, populations, and SRHR outcomes and compare across studies. Findings from this review may inform the development of holistic programs and policies targeting structural barriers to SRHR in urban environments to ensure services are inclusive, equitably available and accessible, and direct future research to fill identified gaps.
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Affiliation(s)
| | - Jessie Pinchoff
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA.
| | - Tara Abularrage
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA
| | - Corinne White
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA
| | - Thoai D Ngo
- Population Council, One Dag Hammarskjold Plaza, New York, NY, 10017, USA
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Baynes C, Steyn P, Soi C, Dinis A, Tembe S, Mehrtash H, Narasimhan M, Kiarie J, Sherr K. Use of implementation science to advance family planning programs in low- and middle-income countries: A systematic review. Front Glob Womens Health 2022; 3:1038297. [PMID: 36561275 PMCID: PMC9763469 DOI: 10.3389/fgwh.2022.1038297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
Objective As environmental and economic pressures converge with demands to achieve sustainability development goals, low- and middle-income countries (LMIC) increasingly require strategies to strengthen and scale-up evidence-based practices (EBP) related to family planning (FP). Implementation science (IS) can help these efforts. The purpose of this article is to elucidate patterns in the use of IS in FP research and identify ways to maximize the potential of IS to advance FP in LMIC. Design and methods We conducted a systematic review that describes how IS concepts and principles have been operationalized in LMIC FP research published from 2007-2021. We searched six databases for implementation studies of LMIC FP interventions. Our review synthesizes the characteristics of implementation strategies and research efforts used to enhance the performance of FP-related EBP in these settings, identifying gaps, strengths and lessons learned. Results Four-hundred and seventy-two studies were eligible for full-text review. Ninety-two percent of studies were carried out in one region only, whereas 8 percent were multi-country studies that took place across multiple regions. 37 percent of studies were conducted in East Africa, 21 percent in West and Central Africa, 19 percent in Southern Africa and South Asia, respectively, and fewer than 5 percent in other Asian countries, Latin America and Middle East and North Africa, respectively. Fifty-four percent were on strategies that promoted individuals' uptake of FP. Far fewer were on strategies to enhance the coverage, implementation, spread or sustainability of FP programs. Most studies used quantitative methods only and evaluated user-level outcomes over implementation outcomes. Thirty percent measured processes and outcomes of strategies, 15 percent measured changes in implementation outcomes, and 31 percent report on the effect of contextual factors. Eighteen percent reported that they were situated within decision-making processes to address locally identified implementation issues. Fourteen percent of studies described measures to involve stakeholders in the research process. Only 7 percent of studies reported that implementation was led by LMIC delivery systems or implementation partners. Conclusions IS has potential to further advance LMIC FP programs, although its impact will be limited unless its concepts and principles are incorporated more systematically. To support this, stakeholders must focus on strategies that address a wider range of implementation outcomes; adapt research designs and blend methods to evaluate outcomes and processes; and establish collaborative research efforts across implementation, policy, and research domains. Doing so will expand opportunities for learning and applying new knowledge in pragmatic research paradigms where research is embedded in usual implementation conditions and addresses critical issues such as scale up and sustainability of evidence-informed FP interventions.Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42020199353.
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Affiliation(s)
- Colin Baynes
- Department of Global Health, University of Washington, Seattle, WA, United States,Correspondence: Colin Baynes
| | - Petrus Steyn
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, Switzerland
| | - Caroline Soi
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Aneth Dinis
- Department of Global Health, University of Washington, Seattle, WA, United States,The National Directorate of Public Health, Ministry of Health of Mozambique, Maputo, Mozambique
| | - Stelio Tembe
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Hedieh Mehrtash
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Manjulaa Narasimhan
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, Switzerland
| | - James Kiarie
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Geneva, Switzerland
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, United States,Department of Epidemiology, University of Washington, Seattle, WA, United States,Department of Industrial and Systems Engineering, University of Washington, Seattle, WA, United States
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Mandal M, Calhoun LM, McGuire C, Speizer IS. Using structural equation modeling to examine the influence of family planning social norms on modern contraceptive use in Nigeria. FRONTIERS IN SOCIOLOGY 2022; 7:866254. [PMID: 36340618 PMCID: PMC9630911 DOI: 10.3389/fsoc.2022.866254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
Despite high knowledge of family planning (FP) among Nigerian women, use of modern contraceptives remains low. While FP investments in Nigeria have been ongoing for decades, relatively little emphasis on contextual and structural factors may have contributed to low demand for and use of contraception. From 2009 to 2014, the Bill & Melinda Gates Foundation (BMGF) supported the Nigerian Urban Reproductive Health Initiative (NURHI) with the aim of increasing voluntary use of contraceptives among women ages 15-49 years in six Nigerian cities. A subsequent phase of NURHI was implemented in three states for the next 3 to 5 years. Using cross-sectional survey data from three cities (two exposed to NURHI, one not exposed), this study examines whether social norms around FP were related to women's use of modern contraception, and whether the relationship differed by varying levels of exposure to the program (i.e., by city). We identified three distinct FP social norms through factor analysis: norms around delaying first pregnancy; spacing or limiting pregnancies; and using contraception when the husband disagrees. Using structural equation modeling, we found that FP social norms are related to use of modern contraceptive methods, and the relationship varies by city and norm type. The observed differences suggest that this relationship depends on numerous factors at the individual, interpersonal and societal level, and this may include malleable factors influenced by the NURHI program.
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Affiliation(s)
- Mahua Mandal
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lisa M. Calhoun
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Courtney McGuire
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Ilene S. Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Sustainability Assessment through Urban Accessibility Indicators and GIS in a Middle-Sized World Heritage City: The Case of Cáceres, Spain. BUILDINGS 2022. [DOI: 10.3390/buildings12060813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
The main objective of the research consists of quantifying the degree of sustainability of the city of Cáceres in terms of the inhabitant’s accessibility to public services through the use of GIS tools and urban indicators, taking into account two areas of study: The Historic Centre (PCH) and the city as a whole. The methodology applied is based on the criteria proposed by the Spanish Government derived from the Spanish Strategy for Urban and Local Sustainability (EESUL), which suggests suitable indicators for analysing urban environments. The degree of sustainability of the study areas, applied to the field of mobility and accessibility to public services, is evaluated through numerical calculations complementing the study with accessibility maps obtained using Geographic Information Systems (GIS) tools. The results show that the city of Cáceres is sustainable in terms of accessibility to bus stops, organic waste containers, household waste recycling centre, schools and education, health centres, and public administration. However, bike parking coverage and lanes, clothes and oil collection, and sports centres need to be further enhanced. In conclusion, there is little disparity in the results between the PCH and the city as a whole, not influenced by the fact that one of the areas is a consolidated historic area. This research has allowed some gaps in the topic to be addressed. However, the main limitation of this methodology consists in the need to have a considerable amount of initial starting data to be able to carry out the research. Finally, the sustainability analysis using urban indicators is considered a valuable source of information for the local manager, becoming a real planning tool in medium-sized cities.
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Duminy J, Cleland J, Harpham T, Montgomery MR, Parnell S, Speizer IS. Urban Family Planning in Low- and Middle-Income Countries: A Critical Scoping Review. Front Glob Womens Health 2021; 2:749636. [PMID: 34816250 PMCID: PMC8593933 DOI: 10.3389/fgwh.2021.749636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022] Open
Abstract
Health agendas for low- and middle-income countries (LMICs) should embrace and afford greater priority to urban family planning to help achieve a number of the global Sustainable Development Goals. The urgency of doing so is heightened by emerging evidence of urban fertility stalls and reversals in some sub-Saharan African contexts as well as the significance of natural increase over migration in driving rapid urban growth. Moreover, there is new evidence from evaluations of large programmatic interventions focused on urban family planning that suggest ways to inform future programmes and policies that are adapted to local contexts. We present the key dimensions and challenges of urban growth in LMICs, offer a critical scoping review of recent research findings on urban family planning and fertility dynamics, and highlight priorities for future research.
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Affiliation(s)
- James Duminy
- School of Geographical Sciences, University of Bristol, Bristol, United Kingdom
- African Centre for Cities, University of Cape Town, Cape Town, South Africa
| | - John Cleland
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Trudy Harpham
- School of Law and Social Sciences, London South Bank University, London, United Kingdom
| | - Mark R. Montgomery
- Department of Economics, Stony Brook University, Stony Brook, NY, United States
- Population Council, New York, NY, United States
| | - Susan Parnell
- School of Geographical Sciences, University of Bristol, Bristol, United Kingdom
- African Centre for Cities, University of Cape Town, Cape Town, South Africa
| | - Ilene S. Speizer
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States
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Hutchinson PL, Anaba U, Abegunde D, Okoh M, Hewett PC, Johansson EW. Understanding family planning outcomes in northwestern Nigeria: analysis and modeling of social and behavior change factors. BMC Public Health 2021; 21:1168. [PMID: 34140023 PMCID: PMC8212536 DOI: 10.1186/s12889-021-11211-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Northwestern Nigeria faces a situation of high fertility and low contraceptive use, driven in large part by high-fertility norms, pro-natal cultural and religious beliefs, misconceptions about contraceptive methods, and gender inequalities. Social and behavior change (SBC) programs often try to shift drivers of high fertility through multiple channels including mass and social media, as well as community-level group, and interpersonal activities. This study seeks to assist SBC programs to better tailor their efforts by assessing the effects of intermediate determinants of contraceptive use/uptake and by demonstrating their potential impacts on contraceptive use, interpersonal communication with partners, and contraceptive approval. METHODS Data for this study come from a cross-sectional household survey, conducted in the states of Kebbi, Sokoto and Zamfara in northwestern Nigeria in September 2019, involving 3000 women aged 15 to 49 years with a child under 2 years. Using an ideational framework of behavior that highlights psychosocial influences, mixed effects logistic regression analyses assess associations between ideational factors and family planning outcomes, and post-estimation simulations with regression coefficients model the magnitude of effects for these intermediate determinants. RESULTS Knowledge, approval of family planning, and social influences, particularly from husbands, were all associated with improved family planning outcomes. Approval of family planning was critical - women who personally approve of family planning were nearly three times more likely to be currently using modern contraception and nearly six times more likely to intend to start use in the next 6 m. Husband's influence was also critical. Women who had ever talked about family planning with their husbands were three times more likely both to be currently using modern contraception and to intend to start in the next 6 m. CONCLUSION SBC programs interested in improving family planning outcomes could potentially achieve large gains in contraceptive use-even without large-scale changes in socio-economic and health services factors-by designing and implementing effective SBC interventions that improve knowledge, encourage spousal/partner communication, and work towards increasing personal approval of family planning. Uncertainty about the time-order of influencers and outcomes however precludes inferences about the existence of causal relationships and the potential for impact from interventions.
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Affiliation(s)
- Paul L Hutchinson
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, 70112, USA.
| | - Udochisom Anaba
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, 70112, USA
| | | | - Mathew Okoh
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | | | - Emily White Johansson
- Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, 70112, USA
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Coulibaly A, Baguiya A, Garanet F, Tran NT, Millogo T, Yaméogo WME, Meda IB, Thieba B, Kouanda S. Yam Daabo interventions' effects on postpartum family planning use in Burkina Faso at 24 months after childbirth. BMC Public Health 2021; 21:946. [PMID: 34006237 PMCID: PMC8132432 DOI: 10.1186/s12889-021-10964-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/30/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction After testing the interventions for improving the prevalence of contraceptive use, very few studies have measured the long-term effects thereafter the end of the implementation. This study aimed to measure Yam Daabo interventions’ effects on contraceptive use in Burkina Faso at twelve months after completion of the intervention. Methods Yam Daabo was a two-group, multi-intervention, single-blind, cluster randomized controlled trial. Interventions comprised refresher training for the provider, a counseling tool, supportive supervision, availability of contraceptive services 7 days a week, client appointment cards, and invitation letters for partners. We used generalized linear mixed-effects models (log Poisson) to compare the modern contraceptive prevalence at 12 months post-intervention in the two groups. We collected data between September and November 2018. We conducted an intention-to-treat analysis and adjusted the prevalence ratios on cluster effects and unbalanced baseline characteristics. Results Twelve months after the completion of the Yam Daabo trial, we interviewed 87.4% (485 out of 555 women with available data at 12 months, that is, 247/276 in the intervention group (89.5%) and 238/279 in the control group (85.3%). No difference was observed in the use of hormonal contraceptive methods between the intervention and control groups (adjusted prevalence ratio = 1.21; 95% confidence interval [CI] = [0.91–1.61], p = 0.191). By contrast, women in the intervention group were more likely to use long-acting reversible contraceptives (LARC) than those in the control group (adjusted prevalence ratio = 1.35; 95% CI = [1.08–1.69], p = 0.008). Conclusion Twelve months after completion of the intervention, we found no significant difference in hormonal contraceptive use between women in the intervention and their control group counterparts. However, women in the intervention group were significantly more likely to use long-acting reversible contraceptives than those in the control group. Trial registration The trial registration number at the Pan African Clinical Trials Registry is PACTR201609001784334. The date of the first registration is 27/09/2016. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10964-w.
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Affiliation(s)
- Abou Coulibaly
- Unité de Surveillance Démographique et de Santé (Kaya-HDSS), Institut de Recherche en Sciences de la Santé (IRSS), 03 B.P. 7047, Ouagadougou, 03, Burkina Faso. .,Ecole doctorale Sciences de la Santé, Université Joseph KI-ZERBO, 03 B.P. 7021, Ouagadougou, 03, Burkina Faso.
| | - Adama Baguiya
- Unité de Surveillance Démographique et de Santé (Kaya-HDSS), Institut de Recherche en Sciences de la Santé (IRSS), 03 B.P. 7047, Ouagadougou, 03, Burkina Faso
| | - Franck Garanet
- Unité de Surveillance Démographique et de Santé (Kaya-HDSS), Institut de Recherche en Sciences de la Santé (IRSS), 03 B.P. 7047, Ouagadougou, 03, Burkina Faso
| | - Nguyen Toan Tran
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology, PO Box 123, Sydney, NSW, 2007, Australia
| | - Tieba Millogo
- Ecole doctorale Sciences de la Santé, Université Joseph KI-ZERBO, 03 B.P. 7021, Ouagadougou, 03, Burkina Faso.,Institut Africain de Santé Publique, 12 B.P, Ouagadougou, 199, Burkina Faso
| | | | - Ivlabèhirè Bertrand Meda
- Institut de Recherche en Sciences de la Santé (IRSS), 03 B.P. 7047, Ouagadougou, 03, Burkina Faso
| | - Blandine Thieba
- Unité de formation et de recherche en sciences de la santé, Université Joseph KI-ZERBO, 03 B.P. 7021, Ouagadougou, 03, Burkina Faso
| | - Séni Kouanda
- Institut Africain de Santé Publique, 12 B.P, Ouagadougou, 199, Burkina Faso.,Institut de Recherche en Sciences de la Santé (IRSS), 03 B.P. 7047, Ouagadougou, 03, Burkina Faso
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Speizer IS, Guilkey DK, Escamilla V, Lance PM, Calhoun LM, Ojogun OT, Fasiku D. On the sustainability of a family planning program in Nigeria when funding ends. PLoS One 2019; 14:e0222790. [PMID: 31557217 PMCID: PMC6762171 DOI: 10.1371/journal.pone.0222790] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 09/07/2019] [Indexed: 11/18/2022] Open
Abstract
Few studies have examined the sustainability of family planning program outcomes in the post-program period. This article presents the results of a natural experiment where the Nigerian Urban Reproductive Health Initiative Phase I programming ended in early 2015 and Phase II activities continued in a subset of cities. Using data collected in 2015 and 2017, we compare contraceptive ideation and modern family planning use in two cities: Ilorin where program activities concluded in 2015 and Kaduna where program activities continued. The results demonstrate that exposure to program activities decreased in Ilorin but for those individuals reporting continuing exposure, the effect size of exposure on modern family planning use remained the same and was not significantly different from Kaduna. Modern family planning use continued to increase in both cites but at a lower rate than during Phase I. The results are useful for designing family planning programs that sustain beyond the life of the program.
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Affiliation(s)
- Ilene S. Speizer
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - David K. Guilkey
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
- Department of Economics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Veronica Escamilla
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Peter M. Lance
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Lisa M. Calhoun
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | | | - David Fasiku
- Data Research and Mapping Corporation, Abuja, Nigeria
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