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Degge HM, Laurenson M, Dumbili EW, Saxby H, Hayter M. Journey for a cure: Illness narratives of obstetric fistula survivors in North Central Nigeria. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:437-456. [PMID: 37786367 DOI: 10.1111/1467-9566.13715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 08/25/2023] [Indexed: 10/04/2023]
Abstract
Obstetric fistula is a life transforming event resulting in embodied biographical disruption. Survivors suffer myriad long-term physical and emotional consequences. This paper is an account of a narrative inquiry, conducted with 15 fistula survivors in North-central, Nigeria, who described how their identities had been transformed by their condition. A narrative therapeutic approach, using Frank's 'chaos, restitution and quest' typology, was used to map their recovery narratives. 'Chaos', described by Frank as the opposite of restitution, dominated, with women losing hope of recovery. Women's shift towards 'restitution' began with treatment, but inadequate health-care access often delayed this process. In their quest narratives, women's life and identify changes enabled them to derive meaning from their experience of obstetric fistula within the context of their own lives. The findings highlight socio-structural factors raising the risk of obstetric fistula, which in turn causes biographical disruption and hampers sufferers' treatment and recovery. Rehabilitation should include income-generating skills to bring succour to survivors, particularly those whose incontinence persists after repairs.
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Affiliation(s)
- Hannah M Degge
- Department of Health and Education, Coventry University, Scarborough, UK
| | - Mary Laurenson
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Emeka W Dumbili
- School of Sociology, University College Dublin, College of Social Sciences and Law, Dublin, Ireland
| | - Heidi Saxby
- Department of Health and Education, Coventry University, Scarborough, UK
| | - Mark Hayter
- Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK
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Igbokwe CC, Ihongo JT, Abugu LI, Iweama CN, Ugbelu JE. Influence of Cultural Beliefs on the Utilization of Integrated Maternal, Newborn, and Child Health Services in Benue State, Nigeria. Cureus 2024; 16:e52808. [PMID: 38389628 PMCID: PMC10883592 DOI: 10.7759/cureus.52808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
Background The maternal mortality ratio in Nigeria is high at 576 per 100,000 live births. The health policy is in favor of health advocacy programs that promote the utilization of integrated maternal newborn and child health (IMNCH) services in local primary health centers by childbearing mothers. Cultural factors, however, have been shown to limit the widespread adoption of these services. The purpose of this study was to investigate the influence of cultural beliefs on the utilization of IMNCH services by child-bearing mothers (CBMs) in Benue state. Methods A community-based correlational survey research was conducted on a random sample of 1,200 CBMs. A multistage sampling technique was used to select the study participants and a pretested, structured questionnaire was used to collect data through face-to-face interviews. Only 896 copies of the distributed Integrated Maternal Newborn and Child Health Services Utilization Questionnaire (IMNCHSUQ) had complete information and were used for analysis. The collected data were managed and analyzed using SPSS version 25 (IBM Corp., Armonk, NY). Mean, standard deviation, and point-biserial correlation were used to answer the research questions while linear regression was used to test the null hypotheses at a 0.05 level of significance. Results The majority of the CBMs were married (79.7%) and unemployed (66.0%) while the predominant age group was between 15 and 24 years (42.7%). CBMs had a high level of utilization of IMNCH services (X ®=3.30, SD=0.94); there was a positive moderate relationship between IMNCH utilization and cultural factors (rbp=.43, ρ= 0.000). Results also suggest that cultural factors were significant predictors of IMNCH services utilization in Benue State, Nigeria. Conclusion Any health education program for maternal and child health in Benue State should take cognizance of the cultural values, beliefs, and norms of the people to sustain positive ones while discouraging values and norms detrimental to the health and well-being of CBMs and their children.
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Affiliation(s)
- Chima C Igbokwe
- Department of Human Kinetics and Health Education, University of Nigeria, Nsukka, NGA
| | - James T Ihongo
- Department of Community Health, NKST College of Health Technology, Mkar, NGA
| | - Lawreta I Abugu
- Department of Human Kinetics and Health Education, University of Nigeria, Nsukka, NGA
| | - Cylia N Iweama
- Department of Human Kinetics and Health Education, University of Nigeria, Nsukka, NGA
| | - Jacinta E Ugbelu
- Department of Human Kinetics and Health Education, University of Nigeria, Nsukka, NGA
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Grunstra NDS, Betti L, Fischer B, Haeusler M, Pavlicev M, Stansfield E, Trevathan W, Webb NM, Wells JCK, Rosenberg KR, Mitteroecker P. There is an obstetrical dilemma: Misconceptions about the evolution of human childbirth and pelvic form. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023; 181:535-544. [PMID: 37353889 PMCID: PMC10952510 DOI: 10.1002/ajpa.24802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/27/2023] [Accepted: 06/11/2023] [Indexed: 06/25/2023]
Abstract
Compared to other primates, modern humans face high rates of maternal and neonatal morbidity and mortality during childbirth. Since the early 20th century, this "difficulty" of human parturition has prompted numerous evolutionary explanations, typically assuming antagonistic selective forces acting on maternal and fetal traits, which has been termed the "obstetrical dilemma." Recently, there has been a growing tendency among some anthropologists to question the difficulty of human childbirth and its evolutionary origin in an antagonistic selective regime. Partly, this stems from the motivation to combat increasing pathologization and overmedicalization of childbirth in industrialized countries. Some authors have argued that there is no obstetrical dilemma at all, and that the difficulty of childbirth mainly results from modern lifestyles and inappropriate and patriarchal obstetric practices. The failure of some studies to identify biomechanical and metabolic constraints on pelvic dimensions is sometimes interpreted as empirical support for discarding an obstetrical dilemma. Here we explain why these points are important but do not invalidate evolutionary explanations of human childbirth. We present robust empirical evidence and solid evolutionary theory supporting an obstetrical dilemma, yet one that is much more complex than originally conceived in the 20th century. We argue that evolutionary research does not hinder appropriate midwifery and obstetric care, nor does it promote negative views of female bodies. Understanding the evolutionary entanglement of biological and sociocultural factors underlying human childbirth can help us to understand individual variation in the risk factors of obstructed labor, and thus can contribute to more individualized maternal care.
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Affiliation(s)
- N. D. S. Grunstra
- Department of Evolutionary Biology, Unit for Theoretical BiologyUniversity of ViennaViennaAustria
- Mammal CollectionNatural History Museum ViennaViennaAustria
| | - L. Betti
- School of Life and Health SciencesUniversity of RoehamptonLondonUK
| | - B. Fischer
- Department of Evolutionary Biology, Unit for Theoretical BiologyUniversity of ViennaViennaAustria
| | - M. Haeusler
- Institute of Evolutionary MedicineUniversity of ZurichZurichSwitzerland
| | - M. Pavlicev
- Department of Evolutionary Biology, Unit for Theoretical BiologyUniversity of ViennaViennaAustria
| | - E. Stansfield
- Department of Evolutionary Biology, Unit for Theoretical BiologyUniversity of ViennaViennaAustria
| | - W. Trevathan
- School for Advanced ResearchSanta FeNew MexicoUSA
| | - N. M. Webb
- Institute of Evolutionary MedicineUniversity of ZurichZurichSwitzerland
- Institute of Archaeological Sciences, Senckenberg Centre for Human Evolution and PalaeoenvironmentEberhard‐Karls University of TübingenTübingenGermany
| | - J. C. K. Wells
- UCL Great Ormond Street Institute of Child Health, Population, Policy and Practice Research and Teaching ProgrammeChildhood Nutrition Research CentreLondonUK
| | - K. R. Rosenberg
- Department of AnthropologyUniversity of DelawareNewarkDelawareUSA
| | - P. Mitteroecker
- Department of Evolutionary Biology, Unit for Theoretical BiologyUniversity of ViennaViennaAustria
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Powis R, Bunkley EN. Handbooks and health interpreters: How men are assets for their pregnant partners in Senegal. Soc Sci Med 2023; 331:116074. [PMID: 37437426 DOI: 10.1016/j.socscimed.2023.116074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Global health researchers often approach fatherhood initiatives from a deficit-based perspective, assuming men need sensitization, education, or correction. Senegalese men, which some global health and development organizations have determined to be uninvolved, are part of a team of prenatal and postpartum support called the "entourage" and have a very specific role to play as ad hoc health interpreters. METHODS The findings of this article come from 12 months of ethnographic research in Dakar, Senegal in 2018. In addition to participant-observation in three maternity wards across the city, semi-structured interviews were conducted with 32 pregnant women, 27 expectant fathers, and numerous family members, midwives, physicians, and governmental and nongovernmental organization employees. Data were coded and evaluated using thematic analysis. RESULTS In Senegal, the Handbook of Mother and Child Health is distributed in state-funded maternity wards. The Handbook outlines what pregnant women should know about pregnancy and how to appropriately engage with clinical services. Male partners of pregnant women commonly read the book for and to their pregnant partners. Men are placed in the unique position of intermediary between pregnant women and the State and as such, they learn a lot about pregnancy and childbirth, as well as prenatal and postpartum care. CONCLUSIONS Our ethnographic insights challenge global health rhetoric that frames men as uninvolved in women and children's health and this study demonstrates that future interventions should take an asset-based approach to men's involvement. Senegalese men are uniquely positioned by gendered expectations to act as health interpreters for their pregnant partners. We conclude with specific, actionable recommendations for the Senegalese case.
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Affiliation(s)
- Richard Powis
- College of Public Health, University of South Florida, Tampa, FL, USA.
| | - Emma N Bunkley
- Department of Health & Behavioral Sciences, University of Colorado Denver, Colorado, USA
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Ajayi KV, Olowolaju S, Wada YH, Panjwani S, Ahinkorah B, Seidu AA, Adu C, Tunji-Adepoju O, Bolarinwa OA. A multi-level analysis of prevalence and factors associated with caesarean section in Nigeria. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000688. [PMID: 37363888 DOI: 10.1371/journal.pgph.0000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/02/2023] [Indexed: 06/28/2023]
Abstract
The choice of caesarean section (CS) plays a significant role in maternal and neonatal health. However, suboptimal CS uptake suggests unmet obstetric care leading to adverse maternal and neonatal health. Considering that maternal health problems in Nigeria remain a public health problem, this present study aims to assess the prevalence and multilevel factors associated with caesarean section among women of reproductive age in Nigeria. Data from the 2018 Nigeria Demographic and Health Survey were analysed. Our analyses included 19,964 women of reproductive age, with their last birth within five years preceding the survey. Multilevel logistic regression analysis was carried out to examine the predictors of the caesarean section in Nigeria. The prevalence of CS among women of reproductive age in Nigeria was 3.11%. Women from the Yoruba ethnic group [aOR = 0.52; 95%(CI = (0.32-0.84)], with two children [aOR = 0.67; 95%(CI = 0.52-0.88)], three children [aOR = 0.49; 95%(CI = 0.36-0.66)], four children and above [aOR = 0.34; 95%(CI = 0.26-0.46)], those who practised Islam [aOR = 0.74; 95%(CI = (0.56-0.99)], and those that had a normal weighted baby [aOR = 0.73; 95%(CI = 0.60-0.99)] were less likely to report having a CS in Nigeria compared to those from Hausa/Fulani ethnic group, those who had one child, those who practised Christianity, and those who had a high weighted baby. Also, women residing in rural areas [aOR = 0.79; 95% (CI = (0.63-0.99)] and the South-South [aOR = 0.65; 95%(CI = (0.46-0.92)] were less likely to have CS compared to those residing in urban areas and North Central. The study concluded that several individual and community-level factors, such as religious belief, number of children, ethnicity, place of residence, and region of residence, were associated with CS utilisation in Nigeria. Our study highlights the need for different regional, local, and cultural contexts for evidence-based policy and programmatic efforts to facilitate equitable access to a caesarean section in Nigeria.
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Affiliation(s)
- Kobi V Ajayi
- Educating Directing Empowerment & Nurturing (EDEN) Foundation, Abuja, Nigeria
- Department of Health Behaviour, School of Public Health, Texas A&M University, College Station, Texas, United States of America
| | - Samson Olowolaju
- Department of Demography, College for Health, Community and Policy, the University of Texas at San Antonio, San Antonio, Texas, United States of America
| | | | - Sonya Panjwani
- Department of Health Behaviour, School of Public Health, Texas A&M University, College Station, Texas, United States of America
| | - Bright Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Abdul-Aziz Seidu
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- Public Health & Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Collins Adu
- Public Health & Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Obasanjo Afolabi Bolarinwa
- Department of Public Health & Well-being, Faculty of Health, and Social Care, University of Chester, Chester, United Kingdom
- Institute for Advanced Studies in the Humanities, University of Edinburgh, Edinburgh, United Kingdom
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Latif D, Ahmed H. Distance and health facility choice: Evidence from a health micro insurance program in Punjab, Pakistan. Int J Health Plann Manage 2022; 37:3172-3191. [PMID: 35993512 DOI: 10.1002/hpm.3547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/15/2022] [Accepted: 07/11/2022] [Indexed: 11/08/2022] Open
Abstract
Health micro insurance offers a promising mechanism to protect the poor against risk and vulnerability arising from catastrophic healthcare expenditures. In light of this, we study the relationship between physical distance to hospitals and the choice of healthcare services in the context of a health micro insurance program in Punjab, Pakistan. We address three main research questions; first, how does physical distance affect choice of health facility? Second, is the burden of physical distance greater for women? Third, can the diffusion of information in social networks be a potential mechanism for reducing the burden of distance? We employ a Probit model with administrative data on hospitalisation claims made between 2014 and 2017. Our findings show that distance impedes individuals from making panel (cashless) claims and thus increases the likelihood of out-of-pocket expenditures at nearby non-panel hospitals. This adverse effect is more pronounced for women as compared to men. Dissemination of information in social networks increases the usage of panel facilities, especially by women. Hence, this can be an effective mechanism in reducing the role that distance plays in the choice of health facility.
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Affiliation(s)
- Dareen Latif
- Center for Research in Economics and Business (CREB), Lahore School of Economics, Lahore, Pakistan
| | - Hamna Ahmed
- Center for Research in Economics and Business (CREB), Lahore School of Economics, Lahore, Pakistan
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Adedini SA, Abatan SM, Ogunsakin AD, Alex-Ojei CA, Babalola BI, Shittu SB, Odusina EK, Ntoimo LFC. Comparing the timeliness and adequacy of antenatal care uptake between women who married as child brides and adult brides in 20 sub-Saharan African countries. PLoS One 2022; 17:e0262688. [PMID: 35025949 PMCID: PMC8758032 DOI: 10.1371/journal.pone.0262688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/02/2022] [Indexed: 11/18/2022] Open
Abstract
CONTEXT Considering the persistent poor maternal and child health outcomes in sub-Saharan Africa (SSA), this study undertook a comparative analysis of the timing and adequacy of antenatal care uptake between women (aged 20-24 years) who married before age 18 and those who married at age 18 or above. METHOD Data came from Demographic and Health Surveys of 20 SSA countries. We performed binary logistic regression analysis on pooled data of women aged 20-24 (n = 33,630). RESULTS Overall, the percentage of child brides in selected countries was 57.1%, with the lowest prevalence found in Rwanda (19.1%) and the highest rate in Chad (80.9%). Central and West African countries had the highest prevalence of child marriage compared to other sub-regions. Bivariate results indicate that a lower proportion of child brides (50.0%) had 4+ ANC visits compared to the adult brides (60.9%) and a lower percentage of them (34.0%) initiated ANC visits early compared to the adult brides (37.5%). After controlling for country of residence and selected socio-economic and demographic characteristics, multivariable results established significantly lower odds of having an adequate/prescribed number of ANC visits among women who married before age 15 (OR: 0.63, CI: 0.57-0.67, p<0.001), and women who married at ages 15-17 (OR: 0.81, CI: 0.75-0.84, p<0.001) compared to those who married at age 18+. Similar results were established between age at first marriage and timing of first ANC visit. Other interesting results emerged that young women who married earlier than age 18 and those who married at age 18+ differ significantly by several socio-economic and demographic characteristics. CONCLUSION Efforts to improve maternal and child health outcomes in SSA must give attention to address the underutilization and late start of antenatal care uptake among child brides.
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Affiliation(s)
- Sunday A. Adedini
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
- Programme in Demography and Population Studies, University of the Witwatersrand, Schools of Public Health and Social Sciences, Johannesburg, South Africa
- * E-mail:
| | - Sunday Matthew Abatan
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Adesoji Dunsin Ogunsakin
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Christiana Alake Alex-Ojei
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Blessing Iretioluwa Babalola
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Sarafa Babatunde Shittu
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Emmanuel Kolawole Odusina
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Lorretta Favour C. Ntoimo
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
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Social contexts of fertility desire among non-childbearing young men and women aged 15-24 years in Nigeria. Reprod Health 2021; 18:186. [PMID: 34544444 PMCID: PMC8454126 DOI: 10.1186/s12978-021-01237-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022] Open
Abstract
Background Reduction in ideal number of children has been suggested as a necessary precursor for fertility decline especially in high fertility countries of Western and Central Africa. In this study, we explored the social contexts of fertility desires by documenting the effects of individual, household as well as contextual characteristics among young men and women in Nigeria.
Methods Data source was the male and female recode file of 2018 Nigeria Demographic and Health Survey. Analytical sample comprised 2674 males and 9637 females aged 15–24 years. The main outcome variable was desire for large family size (DLFS) defined as ideal number of children greater than four. Analysis involved use of descriptive statistics and random-effect logit models fitted in four stages. Results DLFS was 71% among young men and 53% in women. Individual-level factors associated with DLFS among men includes Islam religion (OR = 3.95, CI 2.68–5.83), household size (OR = 1.05) and richer (OR = 0.47, CI 0.29–0.75) or richest wealth index (OR = 0.28, CI 0.16–0.75). Geo-political region and high level of negative attitude to family planning (OR = 1.72, CI 1.23–2.40) were the main contextual factors associated with DLFS. For women, individual-level correlates were education, religion, ethnicity, marital status, household size, and wealth index. Contextual factors include geo-political region, community education (OR = 0.68, CI 0.52–0.89), child mortality experience (OR = 1.29, CI 1.11–1.51) and negative attitude to family planning (OR = 1.36, CI 1.13–1.65). The influence of religion, household wealth and attitude to family planning differ between young men and women. Conclusion Active communication and programmatic interventions are needed so that desire for large family size by young men and women do not become a clog for fertility transition in Nigeria. Reduction in ideal number of children has been suggested as a necessary condition for fertility decline especially in high fertility countries of Western and Central Africa. In this study, we explored the effects of individual, household as well as community characteristics on fertility desires among young men and women aged 15–24 years in Nigeria. We analysed data for 2674 males and 9637 females aged 15–24 years extracted from the 2018 Nigeria Demographic and Health Survey. The outcome variable was desire for large family size (DLFS) defined as ideal number of children greater than four. Results showed that DLFS was 71% among men and 53% in women. Individual-level factors associated with DLFS among men include Islam religion, household size and wealth status. Geo-political region and high level of negative attitude to family planning were the main community-level factors associated with DLFS. For women, individual-level positively associated with DLFS were Islam religion, and being currently married. Compared to Yoruba, other ethnic groups were more likely to favour DLFS. The negative factors associated with DLFS among young women include higher education and wealth status. At the community-level, Northern geo-political regions, child mortality experience and negative attitude to family planning were positively associated with DLFS. The influence of religion, household wealth and attitude to family planning differ between young men and women. Multi-dimensional strategies with active communication and programmatic interventions are needed so that desire for large family size by young men and women do not slow down fertility transition in Nigeria.
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Amodu OC, Salami BO, Richter S, Okeke-Ihejirika P. Reproductive healthcare for women in IDP camps in Nigeria: An analysis of structural gaps. Glob Public Health 2021; 16:563-577. [PMID: 32960742 DOI: 10.1080/17441692.2020.1810296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Health and health service access for women displaced by terrorism from Northeast Nigeria is a serious problem. Existing government and humanitarian initiatives in Northeast Nigeria focus on food, security, housing, water and sanitation to the neglect of health access needs, especially access to reproductive health. With no policy in place and very little existing research, the systemic influences surrounding IDP women's health in Nigeria are not well understood. This study aimed to identify structural gaps influencing access to reproductive health care for women displaced by terrorism in Nigeria. The findings highlight important factors that undermine reproductive health access for internally displaced women: poor governance of the primary health care sector in Nigeria and insufficient co-ordination between the federal government and implementing agencies. Results have implications for policy and administrative restructuring in the primary health sector, as well as for improved funding allocation for the provision of reproductive health services. The Federal Government and all institutions managing healthcare funds should implement strategies to ensure strong leadership and accountability in health development assistance and practices. Specifically, a special taskforce should be established to co-ordinate and harmonise the development activities targeting improvements in the health and wellbeing of IDPs.
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Affiliation(s)
| | | | - Solina Richter
- Faculty of Nursing, University of Alberta, Edmonton, Canada
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Changes in contraceptive and sexual behaviours among unmarried young people in Nigeria: Evidence from nationally representative surveys. PLoS One 2021; 16:e0246309. [PMID: 33529246 PMCID: PMC7853509 DOI: 10.1371/journal.pone.0246309] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/15/2021] [Indexed: 11/19/2022] Open
Abstract
Context Nigeria is a high-burden country in terms of young people’s health. Understanding changes in young people’s sexual and reproductive health (SRH) behaviours and the associated factors is important for framing appropriate interventions. Objective This study assessed changes in SRH behaviours of unmarried young people aged 15–24 and associated factors over a ten-year period in Nigeria. Data and method We analysed datasets from Nigeria Demographic and Health Surveys of 2008, 2013 and 2018 to assess changes in inconsistent condom use, non-use of modern contraceptives; multiple sexual partnership; and early sexual debut. Using binary logistic regression, we assessed the association of selected variables with the SRH behaviours. Results Over four-fifths of unmarried young people (15–24) in Nigeria engaged in at least one risky sexual behaviour in each survey year. The pattern of changes in the four risky SRH behaviours was consistent over the 10-year period, with the highest rates of each behaviour occurring in 2018 while the lowest rates were in 2013, thus indicating an increase in the proportion of respondents engaging in risky sexual behaviours over the study period. Comprehensive HIV/AIDS knowledge, male gender, older age category (20–24), residence in south-west Nigeria, urban residence, higher socio-economic status, secondary/higher education were mostly protective against the four SRH variables analysed across the different data waves. Conclusion Addressing the high and increasing level of risky SRH behaviours among young people in Nigeria is imperative to improve overall national health status and to ensure progress towards achieving SDG target 3.7 focusing on SRH.
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Alex-Ojei CA, Odimegwu CO. Correlates of antenatal care usage among adolescent mothers in Nigeria: a pooled data analysis. Women Health 2020; 61:38-49. [PMID: 33153402 DOI: 10.1080/03630242.2020.1844359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study examined selected correlates of timing and frequency of antenatal care visits among adolescent mothers aged 15-19 in Nigeria. Data from the women's recode dataset of the Nigeria Demographic and Health Surveys between 2003 and 2018 were pooled, with a sample size of 4,775. Multivariate data analysis was carried out using binary logistic regression. It was found that being educated (aOR = 1.54; CI = 1.14-2.08; aOR = 1.64; CI = 1.11-2.42); higher wealth status (aOR = 1.88; CI = 1.45-2.43; aOR = 1.92; CI = 1.33-2.76); contributing to health decision-making (aOR = 1.44, CI = 1.15-1.81); having an educated partner (aOR = 1.73; CI = 1.31-2.30; aOR = 2.44; CI = 1.84-3.25); and living in the South West region (aOR = 3.68; CI = 1.72-7.87) were associated with higher complete antenatal care utilization. Having difficulty getting permission to go to the health facility (aOR = 0.75, CI = 0.57-0.99) and with the distance to the health facility (aOR = 0.61, CI = 0.49-0.75) were associated with lower likelihood of ANCU. Respondents with secondary and higher education were more likely to start ANC early (aOR = 1.57, CI = 1.05-2.34), but Muslim mothers (aOR = 0.61, CI = 0.40-0.32) and those living in the North West (aOR = 0.43, CI = 0.26-0.71), South-South (aOR = 0.30, CI = 0.17-0.53) and South West (aOR = 0.29, CI = 0.12-0.69) were less likely to begin ANC early. Therefore, interventions to increase antenatal care must be region-specific, and focus attention on lower status adolescent mothers with less autonomy.
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Affiliation(s)
- Christiana Alake Alex-Ojei
- Demography and Population Studies Programme, Schools of Public Health and the Social Sciences, University of the Witwatersrand , Johannesburg, South Africa.,Demography and Social Statistics Department, Faculty of Social Sciences, Federal University , Oye-Ekiti, Nigeria
| | - Clifford Obby Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and the Social Sciences, University of the Witwatersrand , Johannesburg, South Africa
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Trends in and determinants of neonatal and infant mortality in Nigeria based on Demographic and Health Survey data. J Biosoc Sci 2020; 53:924-934. [PMID: 33118890 DOI: 10.1017/s0021932020000619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study aimed to assess the changes in neonatal and infant mortality rates in Nigeria over the period 1990 to 2018 using Nigerian Demographic and Health Survey (NDHS) data, and assess their socio-demographic determinants using data from the most recent survey conducted in 2018. The infant mortality rate was 87 per 1000 live births in 1990, and this increased to 100 per 1000 live births in 2003 - an increase of around 15% over 13 years. Neonatal and infant mortality rates started to decline steadily thereafter and continued to do so until 2013. After 2013, neonatal morality rose slightly by the year 2018. Information for 27,465 infants under 1 year of age from the NDHS-2018 was analysed using bivariate and multivariate analysis and the Cox proportional hazard technique. In 2018, infant deaths decreased as wealth increased, and the incidence of infant deaths was greater among those of Islam religion than among those of other religions. A negative association was found between infant deaths and the size of a child at birth. Infant mortality was higher in rural than in urban areas, and was higher among male than female children. Both neonatal and infant death rates varied by region and were found to be highest in the North West region and lowest in the South region. An increasing trend was observed in neonatal mortality in the 5-year period from 2013 to 2018. Policy interventions should be focused on the poor classes, women with a birth interval of less than 2 years and those living in the North West region of the country.
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Mobolaji JW, Fatusi AO, Adedini SA. Ethnicity, religious affiliation and girl-child marriage: a cross-sectional study of nationally representative sample of female adolescents in Nigeria. BMC Public Health 2020; 20:583. [PMID: 32349733 PMCID: PMC7189516 DOI: 10.1186/s12889-020-08714-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The persistently high prevalence of girl-child marriage remains a public health and developmental concern in Nigeria. Despite global campaign against the practice and policy efforts by Nigerian government, the prevalence remains unabated. This study investigates the prevalence and the influence of ethnicity and religious affiliation on the girl-child marriage among female adolescents in Nigeria. METHODS Data of 7804 girls aged 15-19 years extracted from the 2013 Nigeria Demographic and Health Survey were used. Ethnic groups were classified into five: major Northern ethnic group (Hausa/Fulani); Northern ethnic minorities; two major Southern ethnic groups (Yoruba and Igbo), and Southern ethnic minorities. The prevalence of girl-child marriage was determined for the five ethnic groups and individually for each ethnic minority group. Relationships between ethnicity and religious affiliation on girl-child marriage were explored using Cox proportional hazard regression models, adjusting for residence, education and wealth quintile. RESULTS Child marriage was higher for the Northern majority ethnic group of Hausa/Fulani (54.8%) compared to the two major Southern ethnic groups (3.0-3.6%) and aggregated Northern ethnic minorities (25.7%) and Southern minorities (5.9%). However, overall, the less known Northern ethnic minority groups of Kambari (74.9%) and Fulfude (73.8%) recorded the highest prevalence. Compared to the major Southern ethnic group of Yoruba, the adjusted hazard ratio (AHR) of child marriage was significantly higher for Northern ethnic minorities (AHR = 2.50; 95% C.I. = 1.59-3.95) and Northern major ethnicity (AHR = 3.67, 95% C.I. = 2.33-5.77). No significant difference was recorded among Southern ethnic groups. Girls affiliated to other religions (Muslim and traditionalist) had higher child-marriage risks compared to Christians (AHR = 2.10; 95% C.I. = 1.54-2.86). CONCLUSION Ethnicity and religion have independent associations with girl-child marriage in Nigeria; interventions must address culturally-laden social norms that vary by ethnic groups as well as religious-related beliefs.
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Affiliation(s)
- Jacob Wale Mobolaji
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Adesegun O. Fatusi
- Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
- Academy for Health Development (AHEAD), Ile-Ife, Nigeria
| | - Sunday A. Adedini
- Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Programme in Demography and Population Studies, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Degge HM, Laurenson M, Dumbili EW, Hayter M. Reflections on Identity: Narratives of Obstetric Fistula Survivors in North Central Nigeria. QUALITATIVE HEALTH RESEARCH 2020; 30:366-379. [PMID: 31578929 DOI: 10.1177/1049732319877855] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Obstetric fistula is a condition that affects women and can lead to identity changes because of uncontrolled urinary and/or fecal incontinence symptom experiences. These symptoms along with different emerging identities lead to family and community displacement. Using narrative inquiry methodology that concentrates on the stories individuals tell about themselves; interviews were conducted for 15 fistula survivors to explore their perception of identities of living with obstetric fistula. Within a sociocultural context, these identities consist of the "leaking" identity, "masu yoyon fitsari" (leakers of urine) identity, and the "spoiled" identity, causing stigmatization and psychological trauma. The "masu yoyon fitsari" identity, however, built hope and resilience for a sustained search for a cure. Identity is a socially constructed phenomenon, and the findings reveal positive community involvement which reduces obstetric fistula stigmatization and improves women's identity. Sexual and reproductive health issues remain of grave concern within a contextualized societal identity of women's role.
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Farouk ZL, Slusher TM, Danzomo AA, Slusher IL. Factors Influencing Neonatal Practice in a Rural Community in Kano (Northern), Nigeria. J Trop Pediatr 2019; 65:569-575. [PMID: 30907422 DOI: 10.1093/tropej/fmz012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nigeria has the highest number of neonatal and under-five deaths in Africa. Socio-cultural determinants play an important role in disease burden in low-middle income countries. This study aimed to describe knowledge, attitudes and neonatal care practice among household caregivers in a rural community in Nigeria, specifically uvulectomy, female genital mutilation (FGM), failure to routinely immunize and unsafe cord care. Further, relationships between demographic characteristics and knowledge, attitudes and neonatal care practices among caregivers were analyzed. The study design was descriptive correlational and cross-sectional. Consented caregivers (N = 298) were enrolled and interviewed using a structured questionnaire. Data were collected on demographic characteristics of the study participants and practice of uvulectomy, FGM, immunization and cord care. Statistically significant correlations were found between the practice of uvulectomy, FGM and failure to immunize based on occupation (p = 0.0202, p = 0.0290, p = 0.0071) and educational level (p =< 0.0001, p =< 0.0001, p =< 0.0001), with variations by ethnicity. Intense, preventative health measures and maternal education to eliminate harmful care practices are essential to influence outcomes.
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Affiliation(s)
- Zubaida Ladan Farouk
- Department of Paediatrics, Bayero University & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Tina M Slusher
- Department of Pediatrics, Division of Global Health University of Minnesota & Hennepin Healthcare Minneapolis, MN, USA
| | | | - Ida L Slusher
- Department of Baccalaureate & Graduate Nursing, Eastern Kentucky University, Richmond, KY, USA
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Meh C, Thind A, Ryan B, Terry A. Levels and determinants of maternal mortality in northern and southern Nigeria. BMC Pregnancy Childbirth 2019; 19:417. [PMID: 31718572 PMCID: PMC6852989 DOI: 10.1186/s12884-019-2471-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/22/2019] [Indexed: 11/25/2022] Open
Abstract
Background Maternal mortality is still a major risk for women of childbearing age in Nigeria. In 2008, Nigeria bore 14% of the global burden of maternal mortality. The national maternal mortality ratio has remained elevated despite efforts to reduce maternal deaths. Though health disparities exist between the North and South of Nigeria, there is a dearth of evidence on the estimates and determinants of maternal mortality for these regions. Methods This study aimed to assess differences in the levels and determinants of maternal mortality in women of childbearing age (15–49 years) in the North and South of Nigeria. The Nigeria Demographic and Health Surveys (2008 and 2013) were used. The association between maternal mortality (outcome) and relevant sociocultural, economic and health factors was tested using multivariable logistic regression in a sample of 51,492 living or deceased women who had given birth. Results There were variations in the levels of maternal mortality between the two regions. Maternal mortality was more pronounced in the North and increased in 2013 compared to 2008. For the South, the levels slightly decreased. Media exposure and education were associated with maternal mortality in the North while contraceptive method, residence type and wealth index were associated with maternal death in the South. In both regions, age and community wealth were significantly associated with maternal mortality. Conclusions Differences in the levels and determinants of maternal mortality between the North and South of Nigeria stress the need for efforts to cut maternal deaths through new strategies that are relevant for each region. These should improve education of girls in the North and access to health information and services in the South. Overall, new policies to improve women’s socioeconomic status should be adopted.
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Affiliation(s)
- Catherine Meh
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada.
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada.,Department of Family Medicine, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada.,Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada
| | - Bridget Ryan
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada.,Department of Family Medicine, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada
| | - Amanda Terry
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada.,Department of Family Medicine, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada.,Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON, N6A 5C1, Canada
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Abstract
Physician anthropologists have contributed extensively to the anthropology of biomedicine, as well as to other aspects of medical anthropology. Their use of detailed clinical case narratives allows elucidation of what is at stake for individuals and communities in the course of any given illness. Biomedically informed observations of bodies illustrate the connections between microscopic harm and macrosocial arrangements, while observations of clinical spaces and medical knowledge production contribute to current debates over evidence, metrics, migration, and humanitarianism. In moving away from culturalist explanations for illness, physician anthropologists have drawn attention to the manifold workings of structural violence—and have often sacrificed the possibility of deep epistemological challenges to biomedicine. While raising a note of caution about the moral authority of physician anthropologists, I recognize that much of this scholarship has laid the intellectual groundwork for a movement toward equity that refuses to justify poor-quality health care for poor people.
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Affiliation(s)
- Claire L. Wendland
- Department of Anthropology and Department of Obstetrics and Gynecology, University of Wisconsin–Madison, Madison, Wisconsin 53706, USA
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18
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Adewuyi EO, Khanal V, Zhao Y, David L, Bamidele OD, Auta A. Home childbirth among young mothers aged 15-24 years in Nigeria: a national population-based cross-sectional study. BMJ Open 2019; 9:e025494. [PMID: 31537553 PMCID: PMC6756611 DOI: 10.1136/bmjopen-2018-025494] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To estimate the prevalence and identify factors associated with home childbirth (delivery) among young mothers aged 15-24 years in Nigeria. DESIGN A secondary analysis of cross-sectional data from the 2013 Nigeria Demographic and Health Survey (NDHS). SETTING Nigeria. PARTICIPANTS A total of 7543 young mothers aged 15-24 years. OUTCOME MEASURE Place of delivery. RESULTS The prevalence of home delivery among young mothers aged 15-24 years was 69.5% (95% CI 67.1% to 71.8%) in Nigeria-78.9% (95%CI 76.3% to 81.2%) in rural and 43.9% (95%CI 38.5% to 49.5%, p<0.001) in urban Nigeria. Using the Andersen's behavioural model, increased odds of home delivery were associated with the two environmental factors: rural residence (adjusted OR, AOR: 1.39, 95% CI 1.06 to 1.85) and regions of residence (North-East: AOR: 1.97, 95% CI 1.14 to 3.34; North-West: AOR: 2.94, 95% CI 1.80 to 4.83; and South-South: AOR: 3.81, 95% CI 2.38 to 6.06). Three of the enabling factors (lack of health insurance: AOR: 2.34, 95% CI 1.16 to 4.71; difficulty with distance to healthcare facilities: AOR: 1.48, 95% CI 1.15 to 1.88; and <4 times antenatal attendance: AOR: 3.80, 95% CI 3.00 to 4.85) similarly increased the odds of home delivery. Lastly, six predisposing factors-lack of maternal and husband's education, poor wealth index, Islamic religion, high parity and low frequency of listening to radio-were associated with increased odds of home delivery. CONCLUSIONS Young mothers aged 15-24 years had a higher prevalence of home delivery than the national average for all women of reproductive age in Nigeria. Priority attention is required for young mothers in poor households, rural areas, North-East, North-West and South-South regions. Faith-based interventions, a youth-oriented antenatal care package, education of girls and access to health insurance coverage are recommended to speed up the reduction of home delivery among young mothers in Nigeria.
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Affiliation(s)
- Emmanuel O Adewuyi
- Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Pharmacy Department, 2 Division Hospital, Ibadan, Nigeria
| | | | - Yun Zhao
- Department of Epidemiology and Biostatistics, Curtin University Bentley Campus, Perth, Western Australia, Australia
| | - Lungcit David
- Department of Nursing, College of Nursing and Midwifery Vom, Jos, Nigeria
| | | | - Asa Auta
- School of Pharmacy and Biomedical sciences, University of Central Lancashire, Preston, UK
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19
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Iacoella F, Tirivayi N. Determinants of maternal healthcare utilization among married adolescents: Evidence from 13 Sub-Saharan African countries. Public Health 2019; 177:1-9. [PMID: 31470265 DOI: 10.1016/j.puhe.2019.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 06/13/2019] [Accepted: 07/02/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Child and adolescent marriage are widely prevalent in some developing countries, and yet evidence on the maternal healthcare utilization of married adolescents is sparse. This study sought to identify the determinants of maternal healthcare utilization among married adolescents in 13 countries with the highest adolescent marriage rates in Sub-Saharan Africa. STUDY DESIGN This is a multicountry cross-sectional analysis. METHODS Demographic and Health Survey data on 4288 married adolescents were used. Multivariable logistic regressions were used to identify the individual- and household-level predictors of the utilization of antenatal care, safe delivery and postnatal care. RESULTS Wealth and access to media were positively associated with the utilization of all types of maternal healthcare services. Female education and partner education were positively associated with antenatal care. Predictors of safe delivery included urban residence (odds ratio [OR] = 1.87; 95% confidence interval [CI] = 1.15-3.03), female education (OR = 1.37; 95% CI = 1.16-1.60) and number of living children (OR = 1.25; 95% CI = 1.01,1.54), whereas positive correlates of postnatal care were urban residence (OR = 1.35; 95% CI = 1.00-1.82), partner education (OR = 1.32; 95% CI = 1.12-1.56) and employment (OR = 1.43; 95% CI = 1.07,1.89). Full antenatal care and safe delivery utilization were associated with increased postnatal care utilization. Second or third birth order and associated birth intervals were strong barriers to maternal healthcare utilization. Although autonomy in decision-making over financial spending and relationships were positively associated with full antenatal care (OR = 1.09; 95% CI = 1.03-1.14), the results suggest that autonomy over personal healthcare decisions had an opposite relationship (OR = 0.76; 95% CI = 0.58-1.01). CONCLUSIONS Living conditions and autonomy in decision-making over resources and relationships are facilitators of maternal healthcare utilization among married adolescents. Determinants observed in this multicountry study can help shape maternal healthcare interventions in context with high child and teenage marriage rates.
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Affiliation(s)
- F Iacoella
- Unu-Merit (United Nations University), Boschstraat 24, 6211 AX, Maastricht, the Netherlands.
| | - N Tirivayi
- Unu-Merit (United Nations University), Boschstraat 24, 6211 AX, Maastricht, the Netherlands
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Biradar R, Patel KK, Prasad JB. Effect of birth interval and wealth on under-5 child mortality in Nigeria. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2018.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Singh JP, Gupta SD, Khanna A, Sharma LS. Prevalence of Obstetric Fistula and Associated Factors in Rajasthan, India. JOURNAL OF HEALTH MANAGEMENT 2019. [DOI: 10.1177/0972063419835093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context: Obstetric fistula is a serious obstetric and social morbidity among women. Reliable data on incidence and prevalence of obstetric fistula are not available. Aims: The present study attempted to measure the prevalence of obstetric fistula and evaluate factors associated with it. Settings and design: Study was conducted in Rajasthan, India. The cross-sectional data were used for estimation of prevalence of obstetric fistula, while the case comparison design was used to identify the risk factors associated with obstetric fistula. Methods and material: A cross-sectional population-based district level survey covered 41,448 ever married women of age group 15–49 years in 40,052 randomly selected households. Statistical analysis used: To explore association between various identified demographic, social, economic, service delivery and utilization variables and obstetric fistula, simple and multivariate logistic regression was performed. Results: The estimated prevalence of obstetric fistula was 4 per 1,000 women. About 85 per cent of the women with fistula were married below 18 years of age, and 48 per cent gave birth to the first child before 20 years of age. The risk of developing obstetric fistula was more than twice among women who experienced obstructed labour, the adjusted odds ratio being 2.21 (95% Confidence Interval (CI) 1.12 −4.80). Conclusions: Obstructed labour was most prominent obstetric risk factor for obstetric fistula. The other risk factors were early marriage and early child birth. Ironically, obstetric fistula is preventable by improving quality of maternal care and effective emergency obstetric care. Education and communication can play an important role in postponement of early marriages and early child birth.
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Affiliation(s)
- J. P. Singh
- The Indian Institute of Health Management Research (IIHMR) University, Jaipur, Rajasthan, India
| | - S. D. Gupta
- The Indian Institute of Health Management Research (IIHMR) University, Jaipur, Rajasthan, India
| | - Anoop Khanna
- The Indian Institute of Health Management Research (IIHMR) University, Jaipur, Rajasthan, India
| | - Laxman Swaroop Sharma
- The Indian Institute of Health Management Research (IIHMR) University, Jaipur, Rajasthan, India
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22
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Adaji SE, Jimoh A, Bawa U, Ibrahim HI, Olorukooba AA, Adelaiye H, Garba C, Lukong A, Idris S, Shittu OS. Women's experience with group prenatal care in a rural community in northern Nigeria. Int J Gynaecol Obstet 2019; 145:164-169. [PMID: 30779108 DOI: 10.1002/ijgo.12788] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 09/10/2018] [Accepted: 02/13/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess women's experience of group prenatal care in a rural Nigerian community. METHODS In an observational study, consenting pregnant women were enrolled in a group prenatal care program based on the CenteringPregnancy model from July 1, 2010, to June 30, 2011, in Tsibiri, Nigeria. Women were interviewed before joining the group and postnatally. A predesigned pro forma was used to assess group behavior during sessions. Descriptive and inferential statistics were applied to data. RESULTS In total, 161 women enrolled, and 54 of 72 scheduled prenatal sessions took place. The average number of visits was three per woman, with good group interaction and cohesion. Mothers who could mention at least five out of eight danger signs of pregnancy increased from 1.4% (2) to 13.3% (14) (P<0.001, 95% CI 4.28-19.52), while mean knowledge score for danger signs increased from 31% to 47.8% (P<0.001, 95% CI 0.86-2.16). Commitment to birth preparedness plans was impressive. The mothers enjoyed the group sessions and shared the lessons they learned with others. CONCLUSION Group prenatal care was feasible and acceptable to women in the present study setting. Comparative trials would be helpful to demonstrate the benefits of the tested model in low-income settings.
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Affiliation(s)
- Sunday E Adaji
- Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Nigeria
| | - Adenike Jimoh
- College of Health Science, Bingham University, Jos, Nigeria
| | - Umma Bawa
- Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Nigeria
| | - Habiba I Ibrahim
- Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Nigeria
| | | | | | - Comfort Garba
- CBS Research Group, PRHI, Ahmadu Bello University, Zaria, Nigeria
| | - Anita Lukong
- Department of Nursing Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Suleiman Idris
- Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
| | - Oladapo S Shittu
- Department of Obstetrics and Gynaecology, Ahmadu Bello University, Zaria, Nigeria
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Shephard SN, Mamven OV, Lee E, Lengmang SJ. Marital disruption among women with genital fistula in Nigeria: who is at greatest risk? Int Urogynecol J 2019; 30:307-312. [PMID: 30069727 DOI: 10.1007/s00192-018-3729-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/18/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Marital disruption is a commonly identified sequela of genital fistula in developing countries. This study is aimed at identifying factors that correlate with marital outcomes. METHODS All new patients presenting to Evangel VVF Centre in Jos, Nigeria, between August 2015 and August 2017, were retrospectively reviewed with regard to demographics, medical history, and fistula details to identify variables correlating with marital status, particularly whether currently married or presently divorced, separated, or divorced and remarried (cumulatively the "divorce group"). RESULTS Among 581 new patients, 66% were married and 18% experienced marital disruption. Presence of living children in the home and having attended any level of formal education were found to be protective of marriage (p values <0.0001 and 0.0045 respectively). Patients in the divorce group were more likely to have delivered a baby before the age of 18, be of Muslim background, and have a longer time since fistula formation (p values all <0.0001), as were those married younger than 18 and those whose fistula followed a vaginal delivery (p values 0.0015 and 0.0017 respectively). CONCLUSION Several factors correlate with disruption of the marriage relationship. Patients at highest risk for marital disruption should be identified early and provided with interventions aimed at protecting their marriage and social support system.
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Affiliation(s)
- Steven N Shephard
- Evangel VVF Centre, Bingham University Teaching Hospital, Jos, Plateau State, Nigeria.
| | - Oluwatobi V Mamven
- Evangel VVF Centre, Bingham University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Eunjin Lee
- Evangel VVF Centre, Bingham University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Sunday J Lengmang
- Evangel VVF Centre, Bingham University Teaching Hospital, Jos, Plateau State, Nigeria
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El Ayadi AM, Barageine J, Korn A, Kakaire O, Turan J, Obore S, Byamugisha J, Lester F, Nalubwama H, Mwanje H, Tripathi V, Miller S. Trajectories of women's physical and psychosocial health following obstetric fistula repair in Uganda: a longitudinal study. Trop Med Int Health 2018; 24:53-64. [PMID: 30372572 PMCID: PMC6324987 DOI: 10.1111/tmi.13178] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To explore trajectories of physical and psychosocial health, and their interrelationship, among women completing fistula repair in Uganda for 1 year post-surgery. METHODS We recruited a 60-woman longitudinal cohort at surgical hospitalisation from Mulago Hospital in Kampala Uganda (Dec 2014-June 2015) and followed them for 1 year. We collected survey data on physical and psychosocial health at surgery and at 3, 6, 9 and 12 months via mobile phone. Fistula characteristics were abstracted from medical records. All participants provided written informed consent. We present univariate analysis and linear regression results. RESULTS Across post-surgical follow-up, most women reported improvements in physical and psychosocial health, largely within the first 6 months. By 12 months, urinary incontinence had declined from 98% to 33% and general weakness from 33% to 17%, while excellent to good general health rose from 0% to 60%. Reintegration, self-esteem and quality of life all increased through 6 months and remained stable thereafter. Reported stigma reduced, yet some negative self-perception remained at 12 months (mean 17.8). Psychosocial health was significantly impacted by the report of physical symptoms; at 12 months, physical symptoms were associated with a 21.9 lower mean reintegration score (95% CI -30.1, -12.4). CONCLUSIONS Our longitudinal cohort experienced dramatic improvements in physical and psychosocial health after surgery. Continuing fistula-related symptoms and the substantial differences in psychosocial health by physical symptoms support additional intervention to support women's recovery or more targeted psychosocial support and reintegration services to ensure that those coping with physical or psychosocial challenges are appropriately supported.
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Affiliation(s)
- Alison M El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
| | - Justus Barageine
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
| | - Othman Kakaire
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Janet Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Susan Obore
- Urogynaecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Felicia Lester
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Haruna Mwanje
- Urogynaecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | | | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA, USA
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The Experience of Women with Obstetric Fistula following Corrective Surgery: A Qualitative Study in Benadir and Mudug Regions, Somalia. Obstet Gynecol Int 2018; 2018:5250843. [PMID: 30363732 PMCID: PMC6180917 DOI: 10.1155/2018/5250843] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/09/2018] [Indexed: 11/18/2022] Open
Abstract
Obstetric fistula is a severe maternal morbidity which can have devastating consequences for a woman's life and is generally associated with poor obstetric services leading to prolonged obstructed labour. The predisposing factors and consequences of obstetric fistula differ from country to country and from community to community. The World Health Organization estimated that more than 2 million women in sub-Saharan Africa, Asia, the Arab region, Latin America, and the Caribbean are living with the fistula, and some 50,000 to 100,000 new cases develop annually with 30,000-90,000 new cases developing each year in Africa alone. This study aimed at describing and exploring the experiences of women living with obstetric fistulas following corrective surgery in Benadir and Mudug regions, Somalia. Women living with obstetric fistula who had surgical repairs at Daynile and GMC fistula centers and key informants were identified purposively. Twenty-one individual in-depth interviews among women with obstetric fistula and eight key informant interviews were conducted. Thematic analyses were used. Codes were identified, and those codes with similar connections were organized together as to form themes. Detailed reading and rereading of the transcribed interviews were employed in order to achieve and identify themes and categories. Themes, categories, and subcategories illustrating the experiences of women living with obstetric fistula emerged from the thematic analysis of individual in-depth and key informant interviews. These were challenges of living with OBF which include "wounds around genitalia, bad odour, incontinences of urine and feces, stigma, isolation, divorce, powerlessness, dependency, financial constraints, and loss of healthy years" and coping mechanisms which include "withdrawal from the community and improved personal hygiene." Women with obstetric fistula experience serious health and social consequences which prevents them fulfill social, family, and personal responsibilities. We recommend expansion of BEmONC services to underserved areas, capacity building for local OBF surgeons, and improved media campaign and birth preparedness at community levels.
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Adedini SA, Babalola S, Ibeawuchi C, Omotoso O, Akiode A, Odeku M. Role of Religious Leaders in Promoting Contraceptive Use in Nigeria: Evidence From the Nigerian Urban Reproductive Health Initiative. GLOBAL HEALTH: SCIENCE AND PRACTICE 2018; 6:500-514. [PMID: 30287529 PMCID: PMC6172128 DOI: 10.9745/ghsp-d-18-00135] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/17/2018] [Indexed: 11/23/2022]
Abstract
Exposure to family planning messages from religious leaders was significantly associated with higher modern contraceptive use, after accounting for background characteristics and other variables such as myths and misconceptions. Engaging religious leaders to support positive social norms is an important strategy to improving voluntary contraceptive use in Nigeria. Background: Despite the many supply- and demand-side interventions aimed at increasing contraceptive uptake, the modern contraceptive prevalence rate in Nigeria has remained very low (9.8%). Religion is an important part of the sociocultural fabric of many communities. As such, religious leaders have the power to inhibit or facilitate effective adoption of contraceptive methods to support family health. We assess the association of exposure to religious leaders' tailored scriptural family planning messages with contraceptive use in Nigeria. Methods: This cross-sectional study used data from a Measurement, Learning and Evaluation Project survey conducted in 2015 in 4 Nigerian states—Federal Capital Territory, Kaduna, Kwara, and Oyo. The final study sample was restricted to 9,725 non-pregnant women aged 15 to 49 years. Data analysis included descriptive statistics and binary logistic regression analysis to explore significant relationships between current use of a modern contraceptive method, exposure to family planning messages from religious leaders, and selected background characteristics. Results: About 2 in 5 women reported being exposed to family planning messages from religious leaders in the past year. Bivariate results revealed a higher uptake of modern contraceptives among women with high exposure to different NURHI interventions (35.5%) compared with respondents in the low or medium exposure categories (14.5% and 24.5%, respectively). The multivariable analysis revealed significantly higher contraceptive uptake among women who had exposure to family planning messages from religious leaders relative to those with no exposure (odds ratio=1.70; 95% confidence interval, 1.54 to 1.87; P<.001). This association remained significant after adjustment for background characteristics and other selected variables. Conclusion: Interventions that engage clerics of different faiths as change agents for shaping norms and informing behaviors about family planning and contraceptive use are crucial for increasing contraceptive uptake in Nigeria.
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Affiliation(s)
- Sunday A Adedini
- Demography and Social Statistics Department, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria; and Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Stella Babalola
- Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | | | | | - Akinsewa Akiode
- Nigerian Urban Reproductive Health Initiative, Abuja, Nigeria
| | - Mojisola Odeku
- Nigerian Urban Reproductive Health Initiative, Abuja, Nigeria
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Cockcroft A, Omer K, Gidado Y, Gamawa AI, Andersson N. Impact of universal home visits on maternal and infant outcomes in Bauchi state, Nigeria: protocol of a cluster randomized controlled trial. BMC Health Serv Res 2018; 18:510. [PMID: 29970071 PMCID: PMC6029180 DOI: 10.1186/s12913-018-3319-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal mortality in Nigeria is one of the highest in the world. Access to antenatal care is limited and the quality of services is poor in much of the country. Previous research in Bauchi State found associations between maternal morbidity and domestic violence, heavy work in pregnancy, lack of knowledge about danger signs, and lack of spousal communication about pregnancy and childbirth. This cluster randomized controlled stepped-wedge trial will test the impact of universal home visits to pregnant women and their partners, and the added value of video edutainment. METHODS The trial will take place in six wards of Toro Local Government Area in Bauchi State, Nigeria, randomly allocated into three waves of two wards each. Home visits will begin in wave 1 wards immediately; in wave 2 wards after one year; and in wave 3 wards after a further year. In each wave, one ward, randomly allocated, will receive video edutainment during the home visits. Female home visitors will contact all households in their catchment areas of about 300 households, register all pregnant women, and visit them every two months during pregnancy, after delivery and one year later. They will use android handsets to collect information on pregnancy progress, send this to a central server, and discuss with the women the evidence about household factors associated with higher maternal risks, using video clips in the edutainment wards. Male home visitors will contact the partners of the pregnant women and discuss with them the same evidence. We will compare outcomes between wave 1 and wave 2 wards at about one year, between wave 2 and wave 3 wards at about two years, and finally between wards with and without added edutainment. Primary outcomes will be complications in pregnancy and delivery, and child health at one year. Secondary outcomes include knowledge and attitudes, use of health services, knowledge of danger signs, and household care of pregnant women. DISCUSSION Demonstrating an impact of home visits and understanding potential mechanisms could have important implications for reducing maternal morbidity and mortality in other settings with poor access to quality antenatal care services. TRIAL REGISTRATION Registration number: ISRCTN82954580 . Registry: ISRCTN. Date of registration: 11 August 2017. Retrospectively registered.
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Affiliation(s)
- Anne Cockcroft
- CIET/PRAM, Department of Family Medicine, McGill University, 5858 Cote des Neiges, Montreal, Canada.
| | - Khalid Omer
- CIET in Nigeria, Federal Low Cost, Near Police Station, Bauchi, Bauchi State, Nigeria
| | - Yagana Gidado
- Federation of Muslim Women Association of Nigeria (FOMWAN), Bauchi Chapter, FOMWAN Nursery/Pri/Sec. Schools, AllahiruBatarwa Street, G.R.A., PO Box 2539, Bauchi, Bauchi State, Nigeria
| | - Adamu Ibrahim Gamawa
- Bauchi State Primary Health Care Development Agency, Ministry of Health, Bank Road, Bauchi, Bauchi State, Nigeria
| | - Neil Andersson
- CIET/PRAM, Department of Family Medicine, McGill University, 5858 Cote des Neiges, Montreal, Canada.,Centro de Investigaciones de Enfermedades Tropicales (CIET), Universidad Autonoma de Guerrero, Acapulco, Guerrero, Mexico
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Torloni MR, Riera R, Rogozińska E, Tunçalp Ö, Gülmezoglu AM, Widmer M. Systematic review of shorter versus longer duration of bladder catheterization after surgical repair of urinary obstetric fistula. Int J Gynaecol Obstet 2018; 142:15-22. [PMID: 29441572 DOI: 10.1002/ijgo.12462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/03/2017] [Accepted: 02/09/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Bladder catheterization duration after urinary obstetric fistula surgery varies widely. OBJECTIVE To assess the effect of bladder catheterization duration after urinary obstetric fistula surgery. SEARCH STRATEGY Medline, EMBASE, CINAHL, GIM, and POPLINE databases were searched, without language restrictions, using "obstetric urinary fistula" and "catheterization" from inception to September 30, 2017. SELECTION CRITERIA Randomized controlled trials comparing shorter versus longer (>10 days) bladder catheterization after urinary obstetric fistula repair were included. DATA COLLECTION AND ANALYSIS Data were extracted and meta-analyses were conducted. The GRADE system was used to assess evidence quality. MAIN RESULTS Two unblinded non-inferiority trials (684 patients combined) were included. There were no differences between shorter and longer bladder catheterization in the risk of fistula repair breakdown either before (relative risk [RR] 1.14; 95% confidence interval [CI] 0.49-2.64) or after (RR 1.64; 95% CI 0.81-3.31) hospital discharge. Similarly, urinary infection (RR 5.18; 95% CI 0.25-107.44); urinary incontinence before (RR 1.15; 95% CI 0.54-2.43) or after (RR 1.16; 95% CI 0.62-2.18) discharge; urinary retention (RR 1.34; 95% CI 0.79-2.27); or extended hospital stay (RR 9.33; 95% CI 0.51-172.41) were not associated with duration of catheterization. Evidence quality was low or moderate. CONCLUSIONS Shorter, compared to longer, bladder catheterization duration after urinary obstetric fistula surgery was not associated with significant outcome differences.
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Affiliation(s)
- M Regina Torloni
- Department of Medicine, Evidence Based Health Care Post-Graduate Program, São Paulo Federal University, São Paulo, Brazil
| | - Rachel Riera
- Department of Medicine, Evidence Based Health Care Post-Graduate Program, São Paulo Federal University, São Paulo, Brazil
| | - Ewelina Rogozińska
- Women's Health Research Unit, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,Multidisciplinary Evidence Synthesis Hub (MESH), Barts and the London School of Medicine, Queen Mary University London, London, UK
| | - Özge Tunçalp
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - A Metin Gülmezoglu
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Mariana Widmer
- Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
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Izugbara CO, Wekesah F. What does quality maternity care mean in a context of medical pluralism? Perspectives of women in Nigeria. Health Policy Plan 2018; 33:1-8. [PMID: 29036530 PMCID: PMC5886285 DOI: 10.1093/heapol/czx131] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 11/20/2022] Open
Abstract
User priorities regarding quality care in contexts of medical pluralism are poorly documented. Drawing on group and individual interviews with women, we interrogate ideas of quality maternity care in the context of Nigeria's medical pluralism. We found complex utilization patterns for conventional, complementary and alternative maternity care services as well as ideas of quality maternity care that stress effective coordination and integration of different typologies of maternity health services; socially sensitive and truthful providers; and socioeconomic, physical and parochial forms of safety. Informal providers were the commonly reported source of maternal health services in the study. Maternal health services in the country were also generally viewed as poor quality, characterized by pervasive abuse, quackery and lack of commitment to the needs and sensitivities of women. Convenience, availability and affordability of maternal health services, as well as sociocultural factors were major influences on women's use of services. Results demonstrate the embeddedness of women's quality of care notions in the vast socioeconomic inequities that typify Nigeria's particular form of poorly regulated medical pluralism, raising need for strategies to strengthen the delivery, coordination and supervision of maternal health services in the country.
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Affiliation(s)
- Chimaraoke O Izugbara
- African Population and Health Research Center, 2nd Floor, APHRC Campus, P.O. Box 10787- 00100, Nairobi, Kenya
| | - Frederick Wekesah
- African Population and Health Research Center, 2nd Floor, APHRC Campus, P.O. Box 10787- 00100, Nairobi, Kenya
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Ariyo O, Ozodiegwu ID, Doctor HV. The influence of the social and cultural environment on maternal mortality in Nigeria: Evidence from the 2013 demographic and health survey. PLoS One 2017; 12:e0190285. [PMID: 29287102 PMCID: PMC5747485 DOI: 10.1371/journal.pone.0190285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 12/09/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Reducing maternal mortality remains a priority for global health. One in five maternal deaths, globally, are from Nigeria. Objective This study aimed to assess the sociocultural correlates of maternal mortality in Nigeria. Methods We conducted a retrospective analysis of nationally representative data from the 2013 Nigeria Demographic and Health Survey. The analysis was based on responses from the core women’s questionnaire. Maternal mortality was categorized as ‘yes’ for any death while pregnant, during delivery or two months after delivery (as reported by the sibling), and ‘no’ for deaths of other or unknown causes. Multilevel logistic regression analysis was conducted to test for association between maternal mortality and predictor variables of sociocultural status (educational attainment, community women’s education, region, type of residence, religion, and women’s empowerment). Results Region, Religion, and the level of community women’s education were independently associated with maternal mortality. Women in the North West were more than twice as likely to report maternal mortality (OR: 2.14; 95% CI: 1.42–3.23) compared to those in the North Central region. Muslim women were 52% more likely to report maternal deaths (OR: 1.52; 95% CI: 1.10–2.11) compared to Christian women. Respondents living in communities where a significant proportion of women have at least secondary schooling were 33% less likely to report that their sisters died of pregnancy-related causes (OR: 0.67; 95% CI: 0.48–0.95). Conclusion Efforts to reduce maternal mortality should implement tailored programs that address barriers to health-seeking behavior influenced by cultural beliefs and attitudes, and low educational attainment. Strategies to improve women’s agency should be at the core of these programs; they are essential for reducing maternal mortality and achieving sustainable development goals towards gender equality. Future studies should develop empirically evaluated measures which assess, and further investigate the association between women’s empowerment and maternal health status and outcomes.
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Affiliation(s)
- Oluwatosin Ariyo
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, Tennessee, United States of America
| | - Ifeoma D Ozodiegwu
- Department of Epidemiology and Biostatistics, East Tennessee State University, Johnson City, Tennessee, United States of America
| | - Henry V Doctor
- Department of Information, Evidence and Research, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
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Haruna-Ogun OA. Geographical differentials in uptake of antenatal care services in Nigeria. Health Care Women Int 2017; 39:34-49. [PMID: 29053408 DOI: 10.1080/07399332.2017.1388804] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Uptake of antenatal care (ANC) is poor in Nigeria; however, there are geographical variations. We investigated the relationship between place of residence, region and ANC utilization in Nigeria. Using data of the most recent demographic and health survey, the geographic predictors of ANC were modeled. Women in the rural areas were 79% less likely to have the recommended four ANC visits. The odds of a woman in southern Nigeria having four ANC visit are 4.347 times the odds of a woman in northern Nigeria having the recommended ANC visit. We recommend increased coverage of maternal health services.
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Liese KL, Maeder AB. Safer Muslim motherhood: Social conditions and maternal mortality in the Muslim world. Glob Public Health 2017; 13:567-581. [PMID: 28929879 DOI: 10.1080/17441692.2017.1373837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The greatest variation in maternal mortality is among poor countries and wealthy countries that rely on emergency obstetric technology to save a woman's life during childbirth. However, substantial variation in maternal mortality ratios (MMRs) exists within and among poor countries with uneven access to advanced obstetric services. This article examines MMRs across the Muslim world and compares the impact of national wealth, female education, and skilled birth attendants on maternal mortality. Understanding how poor countries have lowered MMRs without access to expensive obstetric technologies suggests that certain social variables may act protectively to reduce the maternal risk for life-threatening obstetric complications that would require emergency obstetric care.
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Affiliation(s)
- Kylea Laina Liese
- a Department of Women, Children, and Family Health Science , University of Illinois Chicago , Chicago , IL , USA
| | - Angela B Maeder
- a Department of Women, Children, and Family Health Science , University of Illinois Chicago , Chicago , IL , USA
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El Ayadi A, Nalubwama H, Barageine J, Neilands TB, Obore S, Byamugisha J, Kakaire O, Mwanje H, Korn A, Lester F, Miller S. Development and preliminary validation of a post-fistula repair reintegration instrument among Ugandan women. Reprod Health 2017; 14:109. [PMID: 28865473 PMCID: PMC5581461 DOI: 10.1186/s12978-017-0372-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 08/23/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Obstetric fistula is a debilitating and traumatic birth injury affecting 2-3 million women globally, mostly in sub-Saharan Africa and Asia. Affected women suffer physically, psychologically and socioeconomically. International efforts have increased access to surgical treatment, yet attention to a holistic outcome of post-surgical rehabilitation is nascent. We sought to develop and pilot test a measurement instrument to assess post-surgical family and community reintegration. METHODS We conducted an exploratory sequential mixed-methods study, beginning with 16 in-depth interviews and four focus group discussions with 17 women who underwent fistula surgery within two previous years to inform measure development. The draft instrument was validated in a longitudinal cohort of 60 women recovering from fistula surgery. Qualitative data were analyzed through thematic analysis. Socio-demographic characteristics were described using one-way frequency tables. We used exploratory factor analysis to determine the latent structure of the scale, then tested the fit of a single higher-order latent factor. We evaluated internal consistency and temporal stability reliability through Raykov's ρ and Pearson's correlation coefficient, respectively. We estimated a series of linear regression models to explore associations between the standardized reintegration measure and validated scales representing theoretically related constructs. RESULTS Themes central to women's experiences following surgery included resuming mobility, increasing social interaction, improved self-esteem, reduction of internalized stigma, resuming work, meeting their own needs and the needs of dependents, meeting other expected and desired roles, and negotiating larger life issues. We expanded the Return to Normal Living Index to reflect these themes. Exploratory factor analysis suggested a four-factor structure, titled 'Mobility and social engagement', 'Meeting family needs', 'Comfort with relationships', and 'General life satisfaction', and goodness of fit statistics supported a higher-order latent variable of 'Reintegration.' Reintegration score correlated significantly with quality of life, depression, self-esteem, stigma, and social support in theoretically expected directions. CONCLUSION As more women undergo surgical treatment for obstetric fistula, attention to the post-repair period is imperative. This preliminary validation of a reintegration instrument represents a first step toward improving measurement of post-surgical reintegration and has important implications for the evidence base of post-surgical reintegration epidemiology and the development and evaluation of fistula programming.
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Affiliation(s)
- Alison El Ayadi
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Hadija Nalubwama
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Justus Barageine
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Torsten B. Neilands
- Center for AIDS Prevention Studies, Division of Prevention Sciences, Department of Medicine, University of California, San Francisco, USA
| | - Susan Obore
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Othman Kakaire
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Haruna Mwanje
- Urogynecology Division, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Abner Korn
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Felicia Lester
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - Suellen Miller
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
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Baker Z, Bellows B, Bach R, Warren C. Barriers to obstetric fistula treatment in low‐income countries: a systematic review. Trop Med Int Health 2017; 22:938-959. [DOI: 10.1111/tmi.12893] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Zoë Baker
- Department of Epidemiology UCLA Fielding School of Public Health Los Angeles CA USA
| | | | - Rachel Bach
- Department of Indigenous Studies University of Winnipeg Winnipeg Manitoba Canada
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Ouedraogo I, Payne C, Nardos R, Adelman AJ, Wall LL. Obstetric fistula in Niger: 6-month postoperative follow-up of 384 patients from the Danja Fistula Center. Int Urogynecol J 2017; 29:345-351. [PMID: 28600757 PMCID: PMC5847061 DOI: 10.1007/s00192-017-3375-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/28/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The impoverished West African country of Niger has high rates of obstetric fistula. We report a 6-month postoperative follow-up of 384 patients from the Danja Fistula Center and assess factors associated with operative success or failure. METHODS The medical records of 384 women who had completed a 6-month follow-up after fistula surgery were reviewed. Cases were categorized as "easy," "of intermediate complexity," or "difficult" based on a preoperative points system. Data were analyzed using simple chi-squared statistics and logistic regression. RESULTS The patients were predominantly of Hausa ethnicity (73%), married young (average 15.9 years), had teenage first pregnancies (average first delivery 16.9 years), and experienced prolonged labor (average 2.3 days) with poor outcomes (89% stillbirth rate). The average parity was four. Patients commonly developed their fistula during their first delivery (43.5%), but over half sustained a fistula during a subsequent delivery (56.5%). Prior fistula surgery elsewhere (average 1.75 operations) was common. The overall surgical success ("closed and dry") was 54%. When the 134 primary operations were analyzed separately, the overall success rate was 80%. Increasing success was seen with decreasing surgical difficulty: 92% success for "easy" cases, 68% for "intermediate" cases, and 57% success for "difficult" cases. Success decreased with increasing numbers of previous attempts at surgical repair. CONCLUSIONS These data provide further evidence that clinical outcomes are better when primary fistula repair is performed by expert surgeons in specialist centers with the support of trained fistula nurses.
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Affiliation(s)
- Itengre Ouedraogo
- The Danja Fistula Center, Danja, Niger
- The Worldwide Fistula Fund, Chicago, IL, USA
| | | | - Rahel Nardos
- The Worldwide Fistula Fund, Chicago, IL, USA
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
| | - Avril J Adelman
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - L Lewis Wall
- The Worldwide Fistula Fund, Chicago, IL, USA.
- Department of Anthropology, Washington University in St. Louis, Campus Box 1114, One Brookings Drive, St. Louis, MO, 63110, USA.
- Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO, USA.
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Obstetric fistula and sociocultural practices in Hausa community of Northern Nigeria. Women Birth 2017; 30:e258-e263. [PMID: 28283307 DOI: 10.1016/j.wombi.2017.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 02/09/2017] [Accepted: 02/11/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Obstetric Fistula is a childbirth injury that disproportionately affects women in sub-Saharan Africa. Although poverty plays an important role in perpetuating obstetric fistula, sociocultural practices has a significant influence on susceptibility to the condition. AIM This paper aims to explore narratives in the literature on obstetric fistula in the context of Hausa ethno-lingual community of Northern Nigeria and the potential role of nurses and midwives in addressing obstetric fistula. DISCUSSION Three major cultural practices predispose Hausa women to obstetric fistula: early marriages and early child bearing; unskilled birth attendance and female circumcision and sociocultural constraints to healthcare access for women during childbirth. There is a failure to implement the International rights of the girl child in Nigeria which makes early child marriage persist. The Hausa tradition constrains the decision making power of women for seeking health care during childbirth. In addition, there is a shortage of nurses and midwives to provide healthcare service to women during childbirth. CONCLUSION To improve health access for women, there is a need to increase political commitment and budget for health human resource distribution to underserved areas in the Hausa community. There is also a need to advance power and voice of women to resist oppressive traditions and to provide them with empowerment opportunities to improve their social status. The practice of traditional birth attendants can be regulated and the primary health care services strengthened.
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Mafo Degge H, Hayter M, Laurenson M. An integrative review on women living with obstetric fistula and after treatment experiences. J Clin Nurs 2017; 26:1445-1457. [PMID: 27680693 DOI: 10.1111/jocn.13590] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To review literature on the experiences of women with obstetric fistula, their lived experiences after treatment; and to provide evidence for future research. BACKGROUND Obstetric fistula is an injury most commonly resulting from a prolonged labour. Long eradicated in developed countries, obstetric fistula remains a public health issue in sub-Saharan Africa and Asia. This is a highly stigmatised health condition, and an understanding of the women's experience is required to inform holistic approaches for care and prevention. DESIGN A search of literature was conducted on databases of EBSCO host (Academic Search Premier, MEDLINE, PsychINFO, CINAHL), Web of Science; and websites of international organizations such as Women's Dignity Project and EngenderHealth. Keywords, Inclusion and exclusion criteria were defined and 25 articles published between 2004 to January 2015 were identified. METHODS An integrative review of 25 articles was carried out. RESULTS Three broad themes were identified: Challenges of living with fistula; treatment and care experiences; and reintegration experiences of women after fistula repair. CONCLUSIONS Living with a fistula presents multidimensional consequences affecting women, families and communities. Accessing treatment is difficult and there are no standardised treatment packages. Surgical repairs were variable in their success rate. Some authors claim women resume normal lives irrespective of their continence status, whilst others claim they face discrimination despite being continent thereby hindering reintegration. Quality of life is diminished for those remaining incontinent. Post repair psychosocial support services are beneficial for reintegration, but research on programme benefits is limited. Therefore further research is required to support its benefits; and for policy development to meet care provision for women with fistula. RELEVANCE TO CLINICAL PRACTICE The review provides insights into avenues of improving care provision and delivery by health professionals and policy makers. It also exposes areas that need further research for quality care provision.
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Affiliation(s)
| | - Mark Hayter
- Sexual and Reproductive Health, Faculty of Health and Social Care, University of Hull, Hull, UK
| | - Mary Laurenson
- Faculty of Health and Social Care, University of Hull, Hull, UK
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Heller A, Hannig A. Unsettling the fistula narrative: cultural pathology, biomedical redemption, and inequities of health access in Niger and Ethiopia. Anthropol Med 2017; 24:81-95. [DOI: 10.1080/13648470.2016.1249252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Alison Heller
- Department of Anthropology, University of Maryland at College Park, College Park, MD, USA
- School for Advanced Research, Santa Fe, NM, USA
| | - Anita Hannig
- Department of Anthropology, Health: Science, Society, Policy Program, Brandeis University, Waltham, MA, USA
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International Organizations and Their Approaches to Fostering Development. CHALLENGES IN HEALTH AND DEVELOPMENT 2017. [PMCID: PMC7114987 DOI: 10.1007/978-3-319-53204-2_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Multilateral agencies define and operationalized health and development in a variety of ways. The World Health Organization (WHO) and the World Bank are two dominant actors in health and development. Each espouses a different ideal of health as it relates to the process of development. The WHO defines health as a human right, and focuses on health outcomes as inputs to and the result of development. The World Bank’s approach to development focuses largely on macro-economic growth as input to human capabilities. The World Bank became a leading actor in international health policy in the 1990s when it operationalized health as an outcome of financial and health care systems. This chapter looks at programming efforts by the WHO and the World Bank to foster development via investment in health or through macro-economic adjustment. Results are mixed. Efforts to improve primary care were successful in improving health outcomes of children under five, but made little impact on maternal mortality. Structural adjustment programs achieved moderate success with medium- to long-term economic growth but increased health inequities. These mixed achievements resulted in an effort by the United Nations to foster a multi-sectoral approach to development espoused in the Millennium Development Goals and Sustainable Development Goals.
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Phillips BS, Ononokpono DN, Udofia NW. Complicating causality: patient and professional perspectives on obstetric fistula in Nigeria. CULTURE, HEALTH & SEXUALITY 2016; 18:996-1009. [PMID: 26958903 DOI: 10.1080/13691058.2016.1148198] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Obstetric fistula, a preventable maternal morbidity characterised by chronic bladder and/or bowel incontinence, is widespread in Nigeria. This qualitative, multi-site study examined the competing narratives on obstetric fistula causality in Nigeria. Research methods were participant observation and in-depth interviews with 86 fistula patients and 43 healthcare professionals. The study found that both patient and professional narratives identified limited access to medical facilities as a major factor leading to obstetric fistula. Patients and professionals beliefs regarding the access problem, however, differed significantly. The majority of fistula patients reported either delivering or attempting to deliver in medical facilities and most patients attributed fistula to a lack of trained medical staff and mismanagement at medical facilities. Conversely, a majority of health professionals believed that women developed obstetric fistula because they chose to deliver at home due to women's traditional beliefs about womanhood and childbirth. Both groups described financial constraints and inadequate transport to medical facilities during complicated labour as related to obstetric fistula onset. Programmatic insights derived from these findings should inform fistula prevention interventions both with healthcare professionals and with Nigerian women.
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Affiliation(s)
- Beth S Phillips
- a Department of Public Health , University of Calabar , Calabar , Nigeria
- b Department of Medicine , University of California-San Francisco , San Francisco , CA , USA
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Analyzing Spatial Distribution of Antenatal Care Utilization in West Africa Using a Geo-additive Zero-Inflated Count Model. SPATIAL DEMOGRAPHY 2016. [DOI: 10.1007/s40980-016-0027-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Doctor HV. Assessing Antenatal Care and Newborn Survival in Sub-Saharan Africa within the Context of Renewed Commitments to Save Newborn Lives. AIMS Public Health 2016; 3:432-447. [PMID: 29546174 PMCID: PMC5689808 DOI: 10.3934/publichealth.2016.3.432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 06/23/2016] [Indexed: 11/18/2022] Open
Abstract
Antenatal care (ANC) is one of the key interventions of the Every Newborn action plan to improve newborn health and prevent stillbirths by 2035. However, little is known about its relationship with neonatal mortality in sub-Saharan Africa since the 1990s. We use data from 54 Demographic and Health Survey (DHS) from 27 countries to make comparisons of neonatal mortality by ANC attendance. Each country had two surveys that were categorized as 'earliest surveys' (i.e. conducted since 1990 but before 2010) and 'latest surveys' (from 2010 to 2014). Multi-level logistic regression model and meta-analysis were applied on 1.1 million births that occurred among women in the 5 years preceding the surveys. Overall neonatal mortality rate (NMR) was 37.7 (95% CI, 37.4-38.1) deaths per 1000 live births; NMR in the earliest surveys were 46.0 (95% CI, 45.4-46.7) and 33.4 (95% CI, 33.0-33.8) deaths per 1000 live births in the latest surveys. The overall NMR was also 10% higher than expected NMR (37.7 vs 34.3 deaths per 1000 live births). NMR was 2.2 times higher among births of women with no ANC compared to those who had at least one ANC visit (42.5 vs 19.6 per 1000 live births). After adjusting for place of delivery, maternal age at birth, relative household wealth, residence, mother's education, marital status, birth order, sex of child, and period of survey, the overall odds ratio (OR) demonstrated that women with at least one ANC visit were 48% less likely to report neonatal deaths (OR: 0.52; 95% CI: 0.47-0.57) than women who did not receive ANC. NMR was 27% less likely to occur during the latest surveys than during the earliest surveys (OR: 0.73; 95% CI: 0.71-0.75). We discuss these results within the context of calls for continued efforts to deploy interventions aimed at improving the quality of maternal and newborn care.
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Affiliation(s)
- Henry V Doctor
- World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, 11371, Egypt
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Mwaniki MK, Baya EJ, Mwangi-Powell F, Sidebotham P. 'Tweaking' the model for understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries: "inserting new ideas into a timeless wine skin". BMC Pregnancy Childbirth 2016; 16:14. [PMID: 26809881 PMCID: PMC4727279 DOI: 10.1186/s12884-016-0803-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 01/07/2016] [Indexed: 11/30/2022] Open
Abstract
Background Maternal and neonatal morbidity and mortality in Low Income Countries, especially in sub-Saharan Africa involves numerous interrelated causes. The three-delay model/framework was advanced to better understand the causes and associated Contextual factors. It continues to inform many aspects of programming and research on combating maternal and child morbidity and mortality in the said countries. Although this model addresses some of the core areas that can be targeted to drastically reduce maternal and neonatal morbidity and mortality, it potentially omits other critical facets especially around primary prevention, and pre- and post-hospitalization continuum of care. Discussion The final causes of Maternal and Neonatal mortality and morbidity maybe limited to a few themes largely centering on infections, preterm births, and pregnancy and childbirth related complications. However, to effectively tackle these causes of morbidity and mortality, a broad based approach is required. Some of the core issues that need to be addressed include:-i) prevention of vertically transmitted infections, intra-partum related adverse events and broad primary prevention strategies, ii) overall health care seeking behavior and delays therein, iii) quality of care at point of service delivery, and iv) post-insult treatment follow up and rehabilitation. In this article we propose a five-pronged framework that takes all the above into consideration. This frameworks further builds on the three-delay model and offers a more comprehensive approach to understanding and preventing maternal and neonatal morbidity and mortality in Low Income Countries Conclusion In shaping the post 2015 agenda, the scope of engagement in maternal and newborn health need to be widened if further gains are to be realized and sustained. Our proposed five pronged approach incorporates the need for continued investment in tackling the recognized three delays, but broadens this to also address earlier aspects of primary prevention, and the need for tertiary prevention through ongoing follow up and rehabilitation. It takes into perspective the spectrum of new evidence and how it can be used to deepen overall understanding of prevention strategies for maternal and neonatal morbidity and mortality in LICS.
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Affiliation(s)
- Michael K Mwaniki
- University Research Co., LLC (URC) 7200 Wisconsin Avenue, Ste. 600, Bethesda, MD, 20814, USA. .,Afya Research Africa, P.O. Box 20880, 00202, Nairobi, Kenya.
| | - Evaline J Baya
- Afya Research Africa, P.O. Box 20880, 00202, Nairobi, Kenya.,Nairobi University, College of Health sciences, Kenyatta National Hospital, P. O. Box 19676-00202, Nairobi, Kenya
| | - Faith Mwangi-Powell
- University Research Co., LLC (URC) 7200 Wisconsin Avenue, Ste. 600, Bethesda, MD, 20814, USA
| | - Peter Sidebotham
- Mental Health & Wellbeing, University of Warwick, Medical school Building, Gibbet Hill Campus, Coventry, CV4 7AL, UK
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Byamugisha J, El Ayadi A, Obore S, Mwanje H, Kakaire O, Barageine J, Lester F, Butrick E, Korn A, Nalubwama H, Knight S, Miller S. Beyond repair - family and community reintegration after obstetric fistula surgery: study protocol. Reprod Health 2015; 12:115. [PMID: 26683687 PMCID: PMC4683951 DOI: 10.1186/s12978-015-0100-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 11/16/2015] [Indexed: 12/04/2022] Open
Abstract
Background Obstetric fistula is a debilitating birth injury that affects an estimated 2–3 million women globally, most in sub-Saharan Africa and Asia. The urinary and/or fecal incontinence associated with fistula affects women physically, psychologically and socioeconomically. Surgical management of fistula is available with clinical success rates ranging from 65–95 %. Previous research on fistula repair outcomes has focused primarily on clinical outcomes without considering the broader goal of successful reintegration into family and community. The objectives for this study are to understand the process of family and community reintegration post fistula surgery and develop a measurement tool to assess long-term success of post-surgical family and community reintegration. Methods This study is an exploratory sequential mixed-methods design including a preliminary qualitative component comprising in-depth interviews and focus group discussions to explore reintegration to family and community after fistula surgery. These results will be used to develop a reintegration tool, and the tool will be validated within a small longitudinal cohort (n = 60) that will follow women for 12 months after obstetric fistula surgery. Medical record abstraction will be conducted for patients managed within the fistula unit. Ethical approval for the study has been granted. Discussion This study will provide information regarding the success of family and community reintegration among women returning home after obstetric fistula surgery. The clinical and research community can utilize the standardized measurement tool in future studies of this patient population.
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Affiliation(s)
- Josaphat Byamugisha
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda. .,Mulago National Referral and Teaching Hospital, Kampala, Uganda.
| | - Alison El Ayadi
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, California, USA
| | - Susan Obore
- Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Haruna Mwanje
- Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Othman Kakaire
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Felicia Lester
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, California, USA
| | - Elizabeth Butrick
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, California, USA
| | - Abner Korn
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, California, USA
| | - Hadija Nalubwama
- Department of Obstetrics and Gynecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sharon Knight
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, California, USA
| | - Suellen Miller
- Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California San Francisco, California, USA
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Zafar S, Jean-Baptiste R, Rahman A, Neilson JP, van den Broek NR. Non-Life Threatening Maternal Morbidity: Cross Sectional Surveys from Malawi and Pakistan. PLoS One 2015; 10:e0138026. [PMID: 26390124 PMCID: PMC4577127 DOI: 10.1371/journal.pone.0138026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 08/24/2015] [Indexed: 12/02/2022] Open
Abstract
Background For more accurate estimation of the global burden of pregnancy associated disease, clarity is needed on definition and assessment of non-severe maternal morbidity. Our study aimed to define maternal morbidity with clear criteria for identification at primary care level and estimate the distribution of and evaluate associations between physical (infective and non-infective) and psychological morbidities in two different low-income countries. Methods Cross sectional study with assessment of morbidity in early pregnancy (34%), late pregnancy (35%) and the postnatal period (31%) among 3459 women from two rural communities in Pakistan (1727) and Malawi (1732). Trained health care providers at primary care level used semi-structured questionnaires documenting signs and symptoms, clinical examination and laboratory tests which were bundled to reflect infectious, non-infectious and psychological morbidity. Results One in 10 women in Malawi and 1 in 5 in Pakistan reported a previous pregnancy complication with 1 in 10 overall reporting a previous neonatal death or stillbirth. In the index pregnancy, 50.1% of women in Malawi and 53% in Pakistan were assessed to have at least one morbidity (infective or non-infective). Both infective (Pakistan) and non-infective morbidity (Pakistan and Malawi) was lower in the postnatal period than during pregnancy. Multiple morbidities were uncommon (<10%). There were marked differences in psychological morbidity: 26.9% of women in Pakistan 2.6% in Malawi had an Edinburgh Postnatal Depression Score (EPDS) > 9. Complications during a previous pregnancy, infective morbidity (p <0.001), intra or postpartum haemorrhage (p <0.02) were associated with psychological morbidity in both settings. Conclusions Our findings highlight the need to strengthen the availability and quality of antenatal and postnatal care packages. We propose to adapt and improve the framework and criteria used in this study, ensuring a basic set of diagnostic tests is available, to ensure more robust assessment of non-severe maternal morbidity.
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Affiliation(s)
| | | | - Atif Rahman
- Department of Mental Health and Well-Being, University of Liverpool, Liverpool, United Kingdom
| | - James P. Neilson
- Department of Women’s and Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Nynke R. van den Broek
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
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Munabi IG, Luboga SA, Mirembe F. A cross sectional study evaluating screening using maternal anthropometric measurements for outcomes of childbirth in Ugandan mothers at term. BMC Res Notes 2015; 8:205. [PMID: 26032185 PMCID: PMC4467626 DOI: 10.1186/s13104-015-1183-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 05/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Birth related newborn and maternal mortality/morbidity remains high in most of sub-Saharan Africa compared to the rest of the world. In this low income region there is a need for valid, low cost, easy to use mass screening tests. This study looked at the screening value of maternal: height, weight and pelvis height, for assessing the outcomes of parturition in Ugandan mothers at term. METHODS This was a multi site cross-sectional study on mothers with singleton pregnancies in labour at various hospitals in different parts of Uganda. A summary of the details of the pregnancy, maternal height, weight and the delivery record were captured and analysed to generate descriptive and inferential (multilevel logistic regression analysis) and diagnostic (Receiver Operator Curve analysis) statistics. RESULTS We recruited 1146 mothers from all the study sites during the study period of whom 987 (86.13%) had normal deliveries and healthy babies. Mothers with adverse outcomes included 107 mothers that had caesarean section and 52 mothers who had vaginal deliveries with foetal Apgar score of ≤7 at 5 min of whom 11 had fresh still births. Maternal height (Adj OR 0.97, 95% CI 0.94-1.00) and maternal pelvis height (Adj OR 0.73, 95% CI 0.61-0.86) were significantly associated with adverse pregnancy outcomes. The combination of maternal: height (<150 cm), weight (>55.7 kg) and pelvis height (>8.95 cm) had the best diagnostic value with a combined area under the curve of 0.60. CONCLUSIONS It was observed that an increase in either maternal pelvis height or maternal height was associated with a significant reduction in adverse pregnancy outcomes. The cut off values of all three evaluated maternal anthropometric measurements were of low test accuracy as screening tests even when used together. Further research is needed to develop low cost screening tools for use in low income settings.
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Affiliation(s)
- Ian G Munabi
- Department of Human Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences, New Mulago Hospital Complex, P. O. Box 7072, Kampala, Uganda.
| | - Samuel Abilemech Luboga
- Department of Human Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences, New Mulago Hospital Complex, P. O. Box 7072, Kampala, Uganda.
| | - Florence Mirembe
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, New Mulago Hospital Complex, Kampala, Uganda.
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Amoakoh-Coleman M, Ansah EK, Agyepong IA, Grobbee DE, Kayode GA, Klipstein-Grobusch K. Predictors of skilled attendance at delivery among antenatal clinic attendants in Ghana: a cross-sectional study of population data. BMJ Open 2015; 5:e007810. [PMID: 25991459 PMCID: PMC4442247 DOI: 10.1136/bmjopen-2015-007810] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/09/2015] [Accepted: 03/18/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify demographic, maternal and community predictors of skilled attendance at delivery among women who attend antenatal clinic at least once during their pregnancy in Ghana. DESIGN A cross-sectional study using the 2008 Ghana Demographic and Health Survey (DHS) data. We used frequencies for descriptive analysis, χ(2) test for associations and logistic regression to identify significant predictors. Predictive models were built with estimation of area under the receiver operating characteristic curves (AUC). SETTING Ghana. PARTICIPANTS A total of 2041 women who had a live birth in the 5 years preceding the survey, and attended an antenatal clinic having a skilled provider, at least once, during the pregnancy. OUTCOME Skilled attendance at delivery. RESULTS Overall, 60.5% (1235/2041) of women in our study sample reported skilled attendance at delivery. Significant positive associations existed between skilled attendance at delivery and the variables such as maternal educational level, wealth status class, ever use of contraception, previous pregnancy complications and health insurance coverage (p<0.001). Significant predictors of skilled attendance were wealth status class, residency, previous delivery complication, health insurance coverage and religion in a model with AUC (95% CI) of 0.85 (0.83 to 0.88). CONCLUSIONS Women less likely to have skilled attendance at delivery can be identified during antenatal care by using data on wealth status class, health insurance coverage, residence, history of previous birth complications and religion, and targeted with interventions to improve skilled attendance at delivery.
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Affiliation(s)
- Mary Amoakoh-Coleman
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
- School of Public Health, University of Ghana, Legon, Ghana
| | - Evelyn K Ansah
- Research and Development Division, Ghana Health Service, Accra, Ghana
| | - Irene Akua Agyepong
- Department of Health Policy Planning and Management, School of Public Health, University of Ghana, Legon, Ghana
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Gbenga A Kayode
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
- Faculty of Health Sciences, Division of Epidemiology & Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
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ADEDINI SUNDAYA, ODIMEGWU CLIFFORD, IMASIKU EUNICENS, ONONOKPONO DOROTHYN, IBISOMI LATIFAT. REGIONAL VARIATIONS IN INFANT AND CHILD MORTALITY IN NIGERIA: A MULTILEVEL ANALYSIS. J Biosoc Sci 2015; 47:165-87. [PMID: 24411023 PMCID: PMC4501304 DOI: 10.1017/s0021932013000734] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There are substantial regional disparities in under-five mortality in Nigeria, and evidence suggests that both individual- and community-level characteristics have an influence on health outcomes. Using 2008 Nigeria Demographic and Health Survey data, this study (1) examines the effects of individual- and community-level characteristics on infant/child mortality in Nigeria and (2) determines the extent to which characteristics at these levels influence regional variations in infant/child mortality in the country. Multilevel Cox proportional hazard analysis was performed on a nationally representative sample of 28,647 children nested within 18,028 mothers of reproductive age, who were also nested within 886 communities. The results indicate that community-level variables (such as region, place of residence, community infrastructure, community hospital delivery and community poverty level) and individual-level factors (including child's sex, birth order, birth interval, maternal education, maternal age and wealth index) are important determinants of infant/child mortality in Nigeria. For instance, the results show a lower risk of death in infancy for children of mothers residing in communities with a high proportion of hospital delivery (HR: 0.70, p < 0.05) and for children whose mothers had secondary or higher education (HR: 0.84, p < 0.05). Although community factors appear to influence the association between individual-level factors and death during infancy and childhood, the findings consistently indicate that community-level characteristics are more important in explaining regional variations in child mortality, while individual-level factors are more important for regional variations in infant mortality. The results of this study underscore the need to look beyond the influence of individual-level factors in addressing regional variations in infant and child mortality in Nigeria.
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Affiliation(s)
- SUNDAY A. ADEDINI
- Demography and Population Studies Programme, Schools
of Public Health and Social Sciences, University of the
Witwatersrand, Johannesburg, South
Africa
- Demography and Social Statistics
Department, Obafemi Awolowo University,
Ile-Ife, Nigeria
| | - CLIFFORD ODIMEGWU
- Demography and Population Studies Programme, Schools
of Public Health and Social Sciences, University of the
Witwatersrand, Johannesburg, South
Africa
| | - EUNICE N. S. IMASIKU
- Demography and Population Studies Programme, Schools
of Public Health and Social Sciences, University of the
Witwatersrand, Johannesburg, South
Africa
- Department of Geography,
University of Zambia, Lusaka,
Zambia
| | - DOROTHY N. ONONOKPONO
- Demography and Population Studies Programme, Schools
of Public Health and Social Sciences, University of the
Witwatersrand, Johannesburg, South
Africa
- Department of Sociology and
Anthropology, University of Uyo,
Nigeria
| | - LATIFAT IBISOMI
- Demography and Population Studies Programme, Schools
of Public Health and Social Sciences, University of the
Witwatersrand, Johannesburg, South
Africa
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Morphological Spectrum of Orbitoocular Diseases in a Tertiary Health Centre in Keffi, North Central Nigeria. Adv Med 2015; 2015:619414. [PMID: 26576453 PMCID: PMC4630344 DOI: 10.1155/2015/619414] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/01/2015] [Indexed: 11/17/2022] Open
Abstract
Aim. The aim of this study was to carry out a retrospective clinicopathological analysis of the ocular lesions requiring biopsy seen in the Department of Histopathology, Federal Medical Centre (FMC), Keffi, in North Central Nigeria. Materials and Method. A retrospective review of the clinicopathologic profile of orbitoocular lesions diagnosed at the FMC, Keffi, was done. Clinical and pathological data were obtained from the patients' clinical records and original biopsy reports, respectively. Results. Sixty-six cases of orbitoocular lesions were reviewed for this study. Of the 54 cases investigated, 28 were HIV negative while 26 were HIV positive (37.1% of all cases). There were 30 cases of Ocular Surface Squamous Neoplasia (OSSN) with a male-to-female ratio of 0.9 : 1. Squamous cell carcinoma (SCC) was the most frequent OSSN with 17 cases. The mean age of cases of SCC is 37.1 ± 7.6 SD (years). The mean age of carcinoma in situ is 35.8 ± 11.4 years. Conclusion. There was no significant difference in the sex distribution of patients with OSSN. It is probable that a diagnosis of squamous cell carcinoma may be encountered in about a year after diagnosis of a carcinoma in situ especially if the in situ carcinoma is left untreated or improperly treated.
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Adeoye IA, Ijarotimi OO, Fatusi AO. What are the factors that interplay from normal pregnancy to near miss maternal morbidity in a Nigerian tertiary health care facility? Health Care Women Int 2014; 36:70-87. [PMID: 25119488 PMCID: PMC4308809 DOI: 10.1080/07399332.2014.943839] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Researchers in Nigeria examined the epidemiological characteristics and factors associated with maternal outcomes using a mixed method approach: a prospective case control study design involving 375 pregnant women who received maternal care from a tertiary facility and in-depth interviews reporting the experience of near-miss survivors. A generalized ordered logit model was used to generate the estimates of partial proportional odds ratios (and 95% confidence intervals) across categories of the outcome variable. Factors strongly associated with maternal morbidity were late referral of women, presence of complications at booking antenatal visits, low birth weight, and severe birth asphyxia. The nearmiss women were further characterized, and a low proportion (25%) had organ dysfunction or failure. The challenge of such diagnoses in resource-constrained settings raises questions about the appropriateness of using organ dysfunction criteria in developing countries.
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Affiliation(s)
- Ikeola A Adeoye
- a Department of Epidemiology and Medical Statistics, College of Medicine , University of Ibadan , Ibadan , Nigeria
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