Decoding the impact of night/day shiftwork on well-being among healthcare workers

This study delved into the complex effects of work schedules on the well-being of healthcare professionals, spotlighting Nigeria's medical landscape. A diverse cohort of 387 participants, spanning doctors, nurses, pharmacists, and laboratory technicians or scientists, formed the research base, with the majority being women (67.7%), with a mean age of 34.67 years. Professionals self-reported their predominant schedules to gauge work patterns, classifying them as day or night shifts. The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) tool assessed the quality of life across the physical, psychological, social relationship, and environmental domains. Psychological distress was measured using the Depression, Anxiety, and Stress Scales (DASS), and perceived social support was evaluated via the Multidimensional Scale of Perceived Social Support (MSPSS). A cross-sectional design was adopted, and the study employed moderated mediation analysis using SmartPLS 4.0. The results underscored the significant ramifications of night shifts on environmental and physical well-being. Psychological health and social relationships were better among day shift than night shift workers. There was a pronounced correlation between night shifts and heightened levels of anxiety, stress, and depression. The mediating role of psychological distress and the moderating influence of social support in these relationships were evident. This study offers invaluable insights into the role of work schedules in shaping the well-being of healthcare professionals, emphasising the protective role of social support and the unique challenges faced by migrant health workers.

Paradox of life after work: A systematic review and meta-analysis on retirement anxiety and life satisfaction

Retirement is a pivotal life transition that often changes routines, identity, and objectives. With increasing life expectancies and evolving societal norms, examining the interplay between retirement anxiety and life satisfaction is vital. This study delves into this relationship, recognising the complexities of retirement. A systematic review and meta-analysis followed PRISMA guidelines. Research from 2003 to 2023 was sourced from databases like CINAHL, PubMed/Medline, PsycINFO, ERIC, and Google Scholar, focusing on diverse methodologies and outcomes related to retirement registered in Prospero database (CRD42023427949). The quality assessment used an eight-criterion risk of bias scale, and analyses included qualitative and quantitative approaches, such as random-effects meta-analysis and moderator analyses. After reviewing 19 studies with varied geographical and demographic scopes, a mixed relationship between retirement and life satisfaction emerged: 32% of studies reported a positive relationship, 47% were negative, and 21% found no significant correlation. Meta-analysis indicated high heterogeneity and non-significant mean effect size, suggesting no consistent impact of retirement on life satisfaction. Moderator analyses highlighted the influence of measurement tools on outcomes. The findings reveal a complex interplay between retirement anxiety and life satisfaction, stressing the need for holistic retirement policies that encompass mental health, social integration, and adaptability, focusing on cultural sensitivity. Challenges include potential biases in data sources, methodological diversity, the scarcity of longitudinal studies, and difficulties in addressing recent societal shifts, like the COVID-19 pandemic. Variability in measurement tools and possible publication bias may have also influenced results. This study contributes to understanding retirement, emphasising the relationship between retirement anxiety and life satisfaction. It advocates for ongoing, detailed, culturally informed research to grasp retirement's multifaceted aspects fully.

Psychological resilience mediates the relationship between diabetes distress and depression among persons with diabetes in a multi-group analysis

The aim to examine the link between diabetes distress and depression in individuals with diabetes, assess the mediating role of psychological resilience in this relationship, and analyses if these relationships differ between Type 1 and Type 2 diabetes. The study utilized a cross-sectional design. A total of 181 (age 33-72 years, mean = 54.76 years, and SD = 9.05 years) individuals diagnosed with diabetes who were receiving treatment from State Specialist Hospitals in Okitipupa were selected for the study using the convenient sampling technique. The data were analysed using Pearson Multiple correlation and multi-group mediation analysis. The analyses were carried out with Smartpls and IBM/SPSS Version 28.0. The results revealed a significant positive correlation between diabetes distress and depression (r = .80, p < .05), suggesting that higher levels of diabetes distress were associated with increased depression scores. Additionally, psychological resilience partially mediated the relationship between diabetes distress and depression (b = - 0.10, p < .05), signifying that resilience played a crucial role in mitigating the impact of diabetes distress on depression. Furthermore, a multi-group analysis was conducted to explore potential differences between Type 1 and Type 2 diabetes subgroups. The relationship between diabetes distress and depression was found to be more pronounced in the Type 1 subgroup (difference = 0.345, p < .05), while the relationship between psychological resilience and depression was negatively stronger in the Type 2 subgroup (difference = - 0.404, p < .05) compared to the Type 1 subgroup. There is an intricate linkage between diabetes distress, resilience, and depression, emphasizing the differential roles of resilience in Type 1 and Type 2 diabetes. The insights gleaned from this study underscore the importance of considering the type of diabetes when designing interventions and support mechanisms for individuals with diabetes who are also suffering from depression. By advancing our understanding of these dynamics, we can strive for more effective and personalized approaches to improve the overall well-being of those living with diabetes.

Prevalence and association of HIV and tuberculosis status in older adults in South Africa: an urgent need to escalate the scientific and political attention to aging and health

Objectives

This study examined the prevalence and sociodemographic factors among older adults with HIV and TB status in South Africa.

Methods

This data was cross-sectional and obtained from the 2019 General Household Surveys in South Africa. Adults 50 years and over with reported HIV and TB status were included (N = 9,180,047). We reported statistical analyses of the descriptive, Chi-square and Fisher's exact tests, and binary logistic regression.

Results

The study has found a prevalence rate of HIV to be 5.3% and TB to be 2.9% among older adults aged 50 years and above in South Africa. However, the study found HIV and TB to be highest among older adults residing in Gauteng, KwaZulu-Natal and Eastern Cape provinces. For HIV status, the female gender [AOR = 0.80*, CI 95% = 0.80-0.80] and secondary education [AOR = 0.57, CI 95% = 0.56-0.58] have lower odds of association among older adults with HIV. Regarding TB status, primary education [AOR = 1.08*, CI 95% = 1.06-1.10] and diabetes [AOR = 1.87*, CI 95% = 1.82-1.91] have lower likelihoods of associations among older adults with TB.

Conclusion

There is an urgent need to escalate scientific and political attention to address the HIV/TB burden in older adults and, public health policymakers need to take cognizance of the interdependence of inequality, mobility, and behavioural modification among this high-risk population.

"Health Outcomes of Grandparents Caring for Double Orphans in South Africa": What Are the Determinants?

In the 21st century, grandparenthood is a significant phenomenon in the fields of demography, gerontology, and sociology. It is mainly explored in the context of ageing, as it is poised to become one of the most significant demographic phenomena and social issues in contemporary South Africa. Therefore, this study examined the determinants associated with grandparents who are parenting as caregivers and the health challenges they are exposed to as caregivers. The National Income Dynamics Study (NIDS) Wave 5 dataset was utilised, and a total of 302,476 grandparents aged 25 years and older, who were reported to be primary caregivers of double orphans, were included in the analysis. Both bivariate and multivariate binary logistic regressions were performed to determine the predictors of the determinants of grandparents parenting as caregivers and their health challenges in South Africa. Estimated odds ratios (ORs) with 95% confidence intervals (CIs) were used, and the threshold for statistical significance was established at ρ < 0.05. A majority of the male and female grandparent caregivers were aged 24-34 years, were Black Africans (69.8%), had secondary education (46.9%), reported health challenges (HC) (59.7%), with 26.4% reporting headaches in the last 30 days. Logistic regression revealed that grandparent caregivers aged 55-64 years were 8.9 times more likely to report health challenges compared to those aged 25-34 years. Non-Black African grandparent caregivers were found to be 0.61 times less likely to report health challenges, compared to Black African grandparent caregivers. Those with perceived poor health status were 3.3 times more likely to report health challenges, compared to those with excellent perceived health status. Therefore, there is an urgent need to redesign health interventions to address these health burdens among grandparent caregivers and to take cognisance of providing economic and social support for these vulnerable populations.

Health services satisfaction and medical exclusion among migrant youths in Gauteng Province of South Africa: A cross-sectional analysis of the GCRO survey (2017-2018)

BACKGROUND

Medical xenophobia of migrant (either in-migrants or immigrants) youths is an ongoing problem in contemporary South African society. Medical mistreatment by healthcare workers and social phobia from migrant youths have been attributed to major obstacles to healthcare utilization as well as health services satisfaction. This study aimed to determine the prevalence and factors contributing to health services satisfaction and medical exclusion among migrant youths in Gauteng province in South Africa.

METHODS

The Round 5 Gauteng City-Region Observatory (GCRO) Quality of Life (QoL) survey was conducted in 2017‒2018, a nationally representative survey piloted every two years in South Africa, was utilized in this study. A 2-year cohort study of 24,889 respondents aged 18 to 29 and a baseline data consisted of 4,872 respondents, comprising non-migrants, in-migrants and immigrants, from where 2,162 in-migrants and immigrants were utilized as the sample size. The data was analysed using descriptive statistics, Chi-Square analysis and logistic regression.

RESULTS

A total of 2,162 migrants, comprising 35.4% in-migrants and 9.0% of immigrants, from the 4,872 respondents, were included in the analysis. The prevalence of medical exclusion of in-migrant and immigrant youths were 5.5% and 4.2%, and the majority of them reported the use of public health facilities (in-migrants ‒ 84.3% vs. immigrants ‒ 87.1%). At the bivariate level, demographic (age, sex, and population group), economic (employed and any income) and health-related (no medical aid and household member with mental health) factors were significantly associated with medical exclusion (ρ≤0.05). The adjusted odds ratio showed that only female gender (AOR: 1.07, 95% CI: 0.678, 1.705), no medical aid cover (AOR: 1.23, 95% CI: 0.450, 3.362), and neither (AOR: 1.59, 95% CI: 0.606, 4.174) or dissatisfied (AOR: 4.29, 95% CI: 2.528, 7.270) were independent predictors of medical exclusion.

CONCLUSION

Having no medical aid cover, being a female and dissatisfied, or neither satisfied nor dissatisfied with health services significantly increased the odds of medical exclusion among migrant youths. To increase healthcare utilization and ensuring adequate medical care of migrant youths, opting for medical aid insurance without increasing costs should be guaranteed. Therefore, there should be no consequences for lack of residence status or correct documentation papers when accessing healthcare services among migrant youths in South Africa.

Determinants of life satisfaction among migrants in South Africa: an analysis of the GCRO's quality of life survey (2009-2021)

BACKGROUND

Migrant populations in any country are a vulnerable group, and psycho-demographic research measuring life satisfaction has been used to assess migrants' well-being in developed and developing countries. However, South Africa, with its high influx of migrant populations, has investigated these topical concerns from the perspective of xenophobia, with mixed findings. However, no, or very few studies have examined life satisfaction among migrants in South Africa. This study, therefore, extends previous literature by examining the determinants of life satisfaction among South Africa's internal and international migrant populations.

METHODS

We conducted a cross-sectional study from the 2009 to 2021 Gauteng City-Region Observatory (GCRO) Quality of Life (QoL) surveys among migrant populations in two ways: a full sample and a gender-stratified sample. A sample of male and female migrants ranging from 15 to 49 years of age were recruited into this study. Cantril's Self-Anchoring Ladder Life Satisfaction scale captured their life satisfaction alongside relevant social demographic factors. Descriptive statistics were applied for the data analysis of the demographic factors. Bivariate and multivariate logistics regression analyses were conducted to assess the associations and the predictive factors of life satisfaction among migrants, both internal and international.

RESULTS

The key findings were the gender distribution of life satisfaction, showing that more international (male - 66.0% and female - 67.1%) migrants reported having a thriving life satisfaction than internal migrants (male - 61.7% and female - 61.5%). Findings from the Pearson correlation coefficient revealed a significant association between the individual, household, and community factors by migrant status (ρ < 0.05). However, the probit coefficients revealed that individual factors (age 48+: AOR = 2.18, 95% CI: 1.13, 3.23, and secondary/higher education: AOR = 1.1., 95% CI: 0.01, 1.19) and household factors (two persons living in households (H/H): AOR = 1.05, 95% CI: 0.50, 1.10), and community factors (international migrant status: AOR = 2.12, 95% CI: 0.08, 2.16) significantly increase the prediction of higher odds of life satisfaction by gender among migrants. The ordered logit coefficients also showed that individual factors (middle and high income and having health insurance) and household factors (receiving SASSA social grant) predicted the highest life satisfaction among migrants (internal and international).

CONCLUSION

We found substantial evidence that individual-, household-, and community-level factors were associated with life satisfaction among migrants. In particular, the pattern of life satisfaction varied slightly between male and female migrants, as well as with migrant status in South Africa. These findings collectively may provide helpful information for policymakers and practitioners to optimise interventions for migrant populations to improve their life satisfaction. Evidence from this study also calls on the government of South Africa to begin tracking the life satisfaction of its nationals, whether migrants or not.

Fraud within the Nigerian health system, a double threat for resilience of a health system and the response to the COVID-19 pandemic: a review

As Nigeria battles the COVID-19 pandemic, systemic fraud within the health system may undermine the efforts to halt the devastating effect of the disease and the fight against COVID-19. Fraud is a major concern worldwide, especially in developing countries such as Nigeria, where it is widespread within the health system. The vulnerability of the Nigerian health system despite several efforts from relevant stakeholders, has consistently been underscored before the pandemic arose, raising serious concerns. These concerns include fraud, embezzlement, and mismanagement of funds, exploitation, lack of transparency in policymaking, cutting corners in procurement processes, and taking advantage of the healthcare workforce for personal benefits. Also, other involvements in the vulnerability of the Nigerian health system that are worrisome include stakeholders using the pandemic to their advantage to increase their private benefits, a short supply of vital health resources, fraudulent recruitment of the health workforce, and ineffective crisis management. This study explores fraud within the Nigerian health system, its impact and implications for health-system resilience as well as its response to the COVID-19 pandemic. Guided by agency theory, causes and impacts of fraud in the health system and its implications on the response to COVID-19 were explained. Systematic review method was employed; out of 1462 articles identified and screened dated from 1991 to 2021, sixty articles were included in the analysis and interpretation. Specific fraud interventions should focus on a weak and vulnerable health system, service delivery, high-risk institutionalized health workforce, and addressing issues of fraud within and outside the health system in order to curb the dreaded COVID-19 and its variants in Nigeria.

Loneliness and happiness in the face of the COVID-19 lockdown: Examining the pathways through somatic symptoms and psychological distress

Studies show that loneliness was higher during the pandemic than in the pre-pandemic periods, with negative consequences on individual happiness. This study extends current knowledge by investigating the indirect effects of somatic symptoms and psychological distress in the loneliness-happiness relationship during the COVID-19 lockdown. The cross-sectional sample comprises 538 Nigerian adults (Meanage = 36.48 ± 12.03) with 43% females. Data were collected using structured self-report instruments and subjected to path analyses in SPSS AMOS. Results showed that loneliness and happiness were negatively related. Loneliness and happiness were indirectly related through the successive association between somatic symptoms and psychological distress. Specifically, greater loneliness was associated with increased somatic symptoms, which in turn were associated with greater psychological distress and reduced happiness levels. Clinicians can manage the decline in happiness from loneliness during the pandemic lockdown by administering treatments that mitigate somatic symptoms and psychological distress in concerned clients.

Retirement Planning and Financial Anxiety among Nigerian Civil Servants: Insights from Social Comparison Theory

The psychological implication of retirement is underemphasised. This study examined the relationship between proactive personality, social comparison, and retirement anxiety among Nigerian civil servants. The study is a cross-sectional design, using proactive personality, social comparison orientation, and Nigerian pre-retirement anxiety scales. Five hundred and eight staff members in government-owned tertiary institutions with five years or less to go until retirement, and at a mean age of 57.47 (SD = 3.02), were surveyed. The study established that a proactive personality negatively predicted retirement anxiety and that civil servants engage in diverse forms of intrapreneurship/entrepreneurship to augment their savings. The study also revealed that social comparison (opinion) mediated the relationship between proactive personality and retirement anxiety (financial preparedness and social alienation). In addition, the study found that social comparison (opinion and ability) mediated the relationship between proactive personality and retirement anxiety (financial preparedness) in a sequential order. The findings suggest that retirees in Nigeria face complex challenges, including financial unpreparedness, social alienation, and uncertainty. The study highlights the importance of understanding the relationship between personality traits, social comparison, and retirement anxiety in order to develop effective interventions and policies that support retirees in Nigeria.

Measuring the Impact of Social Media on Young People's Mental Health: Development and Validation of the Social Media-Induced Tendency Scale

Social media use has been linked to adverse health outcomes such as depression. To facilitate interventions, understanding the varied causes of depression is necessary. The authors developed a social media-induced depression tendency (SMIDT) scale for use with young people and aimed to validate it for young people in Nigeria. The study was conducted in three parts using an online survey (Google Forms) with purposive sampling targeting young people. Study 1 was an exploratory study that developed the SMIDT scale with 361 young people aged 16 to 26 years (mean age = 22.81). A concise measure of SMIDT was obtained. In study 2, confirmatory factor analysis was performed on the SMIDT with young people aged 17 to 25 years (mean age = 23.61). Construct, discriminant, and concurrent validities were established, and three factors were identified (sensitivity/attention seeking, worthlessness, and escapism/reality avoidance), which explained 55.87% of the variance. Study 3 tested the predictive validity of the scale. The results showed that the 15-item SMIDT scale had high internal consistency and satisfactory validity. The SMIDT scale can enable the assessment of factors associated with social media-induced depression tendency. The three factors identified in the scale provide insight into the factors contributing to depression associated with social media use. The SMIDT scale has the potential to help identify at-risk individuals and in-developing interventions to prevent or reduce social media-induced depression tendencies. However, this study only focused on young people in Nigeria. Additional studies using the SMIDT scale are required to assess its generalizability and applicability in evaluating other factors, such as quality of life among young people. Moreover, while social media use has been associated with adverse health outcomes, it is crucial to recognize that it can also positively affect mental health. Further research is necessary to explore the complex relationships between social media use and mental health outcomes.

Male Involvement in Family Planning Decisions in Malawi and Tanzania: What Are the Determinants?

The participation of males in joint spousal decisions is urgently needed in achieving the fundamental indicators of reproductive health. The low involvement of males in family planning (FP) decision-making is a major determining factor in low FP usage in Malawi and Tanzania. Despite this, there are inconsistent findings regarding the extent of male involvement and the determinants that aid male participation in FP decisions in these two countries. The objective of this study was to assess the prevalence of male involvement in FP decisions and its associated determinants within the household context in Malawi and Tanzania. We used data from the 2015-2016 Malawi and Tanzania Demographic and Health Surveys (DHSs) to examine the prevalence and the determinants inhibiting male involvement in FP decisions. The total sample size of 7478 from Malawi and 3514 males from Tanzania aged 15-54 years was employed in the analysis by STATA version 17. Descriptive (graphs, tables and means), bi-variate (chi-square) and logistic regression analyses (unadjusted (U) and adjusted odds ratio (AOR)) were performed to identify the determinants associated with male involvement in FP decisions. The mean age of respondents in Malawi was 32 years (±8 SD) and in Tanzania, 36 years (±6 SD), with the prevalence of male involvement in FP decisions being 53.0% in Malawi and 26.6% in Tanzania. Being aged 35-44 years [AOR = 1.81; 95% CI: 1.59-2.05] and 45-54 years [AOR = 1.43; 95% CI: 1.22-1.67], educated (secondary/higher) [AOR = 1.62; 95% CI: 1.31-1.99], having access to media information [AOR = 1.35; 95% CI: 1.21-1.51] and having a female head of household [AOR = 1.79; 95% CI: 1.70-1.90] were determinant factors of male involvement in FP decisions in Malawi. Primary education [AOR = 1.94; 95% CI: 1.39-2.72], having a middle wealth index ranking [AOR = 1.46; 95% CI: 1.17-1.81], being married [AOR = 1.62; 95% CI: 1.38-1.90] and working [AOR = 2.86; 95% CI: 2.10-3.88] were higher predictors of male involvement in FP decisions in Tanzania. Increasing the role of males in FP decisions and involvement in FP utilization may improve uptake and continuity of FP usage. Therefore, the findings from this cross-sectional study will support redesigning the ineffective strategic FP programs that accommodate socio-demographic determinants that may increase the likelihood of male involvement in FP decisions, especially in the grassroots settings in Malawi and Tanzania.

Transnational migrants' philanthropy: Its forms, operations, and implications from the perspectives of Ghanaian residents in Europe

INTRODUCTION

With the emergence of transnational migration studies in the 1990's, migration studies became involved in showing how migrants maintain transnational connections through money and non-monetary philanthropic contributions in their origin countries. However, there is little evidence about the interconnections between different forms of migrants' philanthropy and how they are developed and sustained over time across international borders.

METHODS

This work investigates individual and groups transnational philanthropy and shows how migrants become involved in these forms of philanthropy, highlighting some changes therein over time. We relied on fifty semistructured interviews and six focus group discussions conducted with Ghanaians in the Netherlands, Italy and Germany.

RESULTS AND DISCUSSION

Our thematic analyses confirm that transnational migrant philanthropy is about fulfilling certain "moral obligations," to derive a sense of belonging "here" (destinations) and "there" (origins). In performing the self, religious or culturally imposed sense of responsibility for human welfare and institutional development in the home country, Ghana, involved migrants overcome some challenges. For transnational migrant philanthropy to sustain itself, studied migrants think origin country governments must take necessary steps to remove structural obstacles like tedious procedures for clearing philanthropic goods at the ports and harbors. Involved migrants also suggested a need for a more organized platform to collect relevant information on potential beneficiary needs for their preparations to "give back" to their homeland.

Prevalence and knowledge of kidney disease risk factors among Nigerians resident in Lagos State Metropolitan District, South West Nigeria

Objective

The objective is to determine the prevalence of kidney disease (KD) risk factors and their knowledge among Nigerians aged 15-64 living in the Mainland and Island metropolitan districts of Lagos State, South West Nigeria.

Materials and Methods

A total of 1171 respondents between 15 and 64 years of age were recruited for the measurements of prevalence and knowledge of KD risk factors using a structured questionnaire. Descriptive, bivariate, and logistic regression statistical analyses were employed.

Results

The respondents' mean age was 33.83 ± 11.54, with a male-to-female ratio of 0.54:0.46. Respondents without KD have lower knowledge of KD risk factors (38.26; 37.27‒39.25) than those with KD (45.00; 38.84‒50.16) with an overall knowledge score of 38.39 (37.41‒39.36). The prevalent risk factors include indiscriminate use of analgesics and frequent use of traditional remedies (P < 0.05). Knowledge predictors of KD risk factors among respondents were older age (≥30 years) (with KD-Adjusted Odds Ratio (AOR) 1.06: 95% confidence interval [CI]: 0.82‒1.98; without KD-AOR 2.10: 95% CI: 1.52‒2.25) and chronic ailments (with KD-AOR 1.51: 95% CI: 0.28‒2.93; without KD-AOR 3.03: 95% CI: 0.04‒7.49).

Conclusion

The study revealed a lower knowledge of KD risk factors exists in respondents without KD, but the prevalence of risk factors was higher among both cohorts of respondents. Therefore, concerted efforts should be made to sensitize strategic public health programs to expand accurate and adequate awareness and understanding of KD risk factors and their implications for well-being, and to possibly avoid the risk of the disease later in life.

Psycho-social correlates of wellbeing among South Africans: An exploration of the 2017 South African Social Attitudes Survey (SASAS)

Wellbeing is a public health variable as it is an index of societal development. According to the most recent World Happiness Reports, South Africa ranks low in the self-reported wellbeing of its citizens. This study set out to understand the contributory factors to wellbeing of South Africans. This study explored the South African Social Attitudes Survey (SASAS) of 2017, a national survey of social attitudes in South Africa for variables that are related to the wellbeing of the citizens. Group identification, national identification, hopefulness for group's future, positive interracial contact, belief in sustaining memory of apartheid, attitude towards immigrants, frequency of group's discrimination experience, and life satisfaction were identified. Statistical analysis showed that these variables are significantly associated with wellbeing for the total sample. Also, analysis by population groups showed that these variables had differential significance for members of different groups. Life satisfaction emerged as the most important predictor of wellbeing for the total sample and Black Africans, Indian/Asians, and Colored groups. The findings of this study showed that different psycho-social factors are critical to the wellbeing of South Africans. It was suggested that the life experiences of the different population groups could influence how important a factor is in wellbeing and this should be considered in efforts to improve wellbeing of the citizens.

A Comparative Cross-Sectional Study of the Prevalence and Determinants of Health Insurance Coverage in Nigeria and South Africa: A Multi-Country Analysis of Demographic Health Surveys

Background: The core Universal Health Coverage (UHC) objectives are to ensure universal access to healthcare services by reducing all forms of inequalities. However, financial constraints are major barriers to accessing healthcare, especially in countries such as Nigeria and South Africa. The findings of this study may aid in informing and communicating health policy to increase financial access to healthcare and its utilization in South Africa and Nigeria. Nigeria-South Africa bilateral relations in terms of politics, economics and trade are demonstrated in the justification of the study setting selection. The objectives were to estimate the prevalence of health insurance coverage, and to explore the socio-demographic factors associated with health insurance in South Africa and Nigeria. Methods: This was a cross-sectional study using the 2018 Nigeria Demographic Health Survey and the 2016 South Africa Demographic Health Survey. The 2018 Nigeria Demographic Health Survey data on 55,132 individuals and the 2016 South Africa Demographic Health Survey on 12,142 individuals were used to investigate the prevalence of health insurance associated with socio-demographic factors. Percentages, frequencies, Chi-square and multivariate logistic regression were e mployed, with a significance level of p < 0.05. Results: About 2.8% of the Nigerian population and 13.3% of the South African population were insured (Nigeria: males-3.4%, females-2.7% vs. South Africa: males-13.9%, females-12.8%). The multivariate logistic regression analyses showed that higher education was significantly more likely to be associated with health insurance, independent of other socio-demographic factors in Nigeria (Model I: OR: 1.43; 95% CI: 0.34-1.54, p < 0.05; Model II: OR: 1.34; 95% CI: 0.28-1.42, p < 0.05) and in South Africa (Model I: OR: 1.33; 95% CI: 0.16-1.66, p < 0.05; Model II: OR: 1.76; 95% CI: 0.34-1.82, p < 0.05). Respondents with a higher wealth index and who were employed were independently associated with health insurance uptake in Nigeria and South Africa (p < 0.001). Females were more likely to be insured (p < 0.001) than males in both countries, and education had a significant impact on the likelihood of health insurance uptake in high wealth index households among both male and females in Nigeria and South Africa. Conclusion: Health insurance coverage was low in both countries and independently associated with socio-demographic factors such as education, wealth and employment. There is a need for continuous sensitization, educational health interventions and employment opportunities for citizens of both countries to participate in the uptake of wide health insurance coverage.

Multilevel Analysis of Urban-Rural Variations of Body Weights and Individual-Level Factors among Women of Childbearing Age in Nigeria and South Africa: A Cross-Sectional Survey

Background: An unhealthy body weight is an adverse effect of malnutrition associated with morbidity among women of childbearing age. While there is increasing attention being paid to the body weights of children and adolescents in Nigeria and South Africa, a major surge of unhealthy body weight in women has received less attention in both countries despite its predominance. The purpose of this study was to explore the prevalence of body weights (underweight, normal, overweight, and obese) and individual-level factors among women of childbearing age by urban-rural variations in Nigeria and South Africa. Methods: This study used the 2018 Nigeria Demographic Health Survey data (n = 41,821) and 2016 South Africa Demographic Health Survey (n = 8514). Bivariate, multilevel, and intracluster correlation coefficient analyses were used to determine individual-level factors associated with body weights across urban-rural variations. Results: The prevalence of being overweight or obese among women was 28.2% and 44.9%, respectively, in South Africa and 20.2% and 11.4% in Nigeria. A majority, 6.8%, of underweight women were rural residents in Nigeria compared to 0.8% in South Africa. The odds of being underweight were higher among women in Nigeria who were unemployed, with regional differences and according to breastfeeding status, while higher odds of being underweight were found among women from poorer households, with differences between provinces and according to cigarette smoking status in South Africa. On the other hand, significant odds of being overweight or obese among women in both Nigeria and South Africa were associated with increasing age, higher education, higher wealth index, weight above average, and traditional/modern contraceptive use. Unhealthy body weights were higher among women in clustering areas in Nigeria who were underweight (intracluster correlation coefficient (ICC = 0.0127), overweight (ICC = 0.0289), and obese (ICC = 0.1040). Similarly, women of childbearing age in clustering areas in South Africa had a lower risk of experiencing underweight (ICC = 0.0102), overweight (ICC = 0.0127), and obesity (ICC = 0.0819). Conclusions: These findings offer a deeper understanding of the close connection between body weights variations and individual factors. Addressing unhealthy body weights among women of childbearing age in Nigeria and South Africa is important in preventing disease burdens associated with body weights in promoting Sustainable Development Goal 3. Strategies for developing preventive sensitization interventions are imperative to extend the perspectives of the clustering effect of body weights on a country level when establishing social and behavioral modifications for body weight concerns in both countries.

Determinants and levels of cervical Cancer screening uptake among women of reproductive age in South Africa: evidence from South Africa Demographic and health survey data, 2016

BACKGROUND

Cervical cancer (CC) is the cancer with the most incidents and the leading cause of cancer mortality among women in South Africa. CC screening is one of the most cost-effective control approaches for the disease burden. This study assessed the determinants and individual-level indicators of cervical cancer screening uptake among women of reproductive age in South Africa.

METHODS

We analyzed data from the 2016 South Africa Demographic Health Survey. Our analysis focused on 5903 women (15-49 years). We conducted Chi-square test for bivariate analysis, and multivariate binary logistics regression was used to analyze independent association between individual-level factors and women who have had Pap smear testing. Statistical significance was set at p < 0.05.

RESULTS

The mean age at cervical cancer screening uptake among women in South Africa was 40.8 years (SD 18.6, range 15-95 years). A majority of the women (39.3%) were aged 45 years and above and 54.6% of them resides in urban settlements. About 35.4% of women (n = 2098) have had a Pap smear test, with 66.5% of them who had a Pap smear test resides in Western Cape province. The proportion of women who had a Pap smear test was significantly higher among those with higher educational attainment (68.7%, p = 0.000), in the rich wealth index (50.1%, p = 0.000), and those with health insurance cover (60.3%, p = 0.000). Pap smear testing was found to be more prevalent among women aged 45⁺ years, were in the white population group, had higher education, were divorced, and had health insurance cover. The predominance of Pap smear test was 14% higher among women who are working in the professional/formal sector (AOR; 1.38, 95% CI; 1.14-1.69). The uptake of Pap smear test was also higher among women aged 35-44 years.

CONCLUSIONS

The prevalence of cervical cancer uptake is substantially low among women aged 15-24 years in South Africa and shows a degree of between-provinces differences. Therefore, heath educational interventions aimed at increasing the uptake of cervical cancer screening services in South Africa are critically needed.

Prevalence and Socio-Demographic Correlates of Body Weight Categories Among South African Women of Reproductive Age: A Cross-Sectional Study

Background: The shift in disease patterns has been connected with increased body weight burden, becoming a major public health concern in South Africa, as previous studies have assessed overweight or obesity among certain populations. However, little is known about bodyweight burden (underweight, overweight, and obesity) among women aged 15-49 years. Therefore, this study was conducted to identify the prevalence and its associated socio-demographic correlates of bodyweight categories among women of reproductive age in South Africa. Methods: The present study used the South Africa Demographic Health Survey (2016 SADHS) data for 2016. A total of 3,263 women of reproductive age were included in the analysis. Both bivariable and multivariable logistics regressions were performed to determine the prevalence and socio-demographic correlates of bodyweight categories among women in South Africa. Thus, this study used the criteria of the WHO standard body mass index (BMI) cut-offs to classify bodyweight categories. The odds ratios (ORs) with 95% CIs were estimated for potential determinants included in the final model. Results: The overall prevalence of body weight burden was 66.5%, with 4.9% underweight, 27.1% overweight, and 34.5% obese (p < 0.05). The identified factors associated with underweight among women of reproductive age were those from "other" population group [adjusted odds ratio (AOR) 2.65: 95% CI 1.40-5.00], rural residence (AOR 1.23: 95% CI 0.75-2.02), and Northern Cape Province (AOR 1.58: 95% CI 0.65-3.87). For overweight/obese, the main factors were those aged 45-49 years (AOR 10.73: 95% CI 7.41-15.52), tertiary education (AOR 1.41: 95% CI 0.97-2.03), and residing in Eastern Cape (AOR 1.27: 95% CI 0.82-1.99) and KwaZulu-Natal Provinces (AOR 1.20: 95% CI 0.78-1.84). Conclusion: The findings presented in this study indicate the concurrence of underweight and overweight/obese among women aged 15-49 years in South Africa. Despite underweight prevalence being on the decline, yet overweight/obese is increasing over time. The health implication of body weight burden needs rapid and effective interventions, focusing on factors such as rural, education, population group, older age 45-49 years, and Provinces (Northern Cape, Eastern Cape, and KwaZulu-Natal) - the high-risk groups identified herein are of most importance to curb the growing burden among South African women of reproductive age.

The multidimensionality of inter-parental conflict on aggression and mental health among adolescents

The research sets out to reveal that multidimensionality of inter-parental conflict is a limitation in the direction of research which suggests that inter-parental conflict is a risk factor to poor mental health and aggression in adolescents. To validate the above assertion, 394 adolescents (227 males; mean age = 15.6, SD = 1.74) were purposively sampled for the study. Two hypotheses were formulated and tested and data were analyzed using the multiple regression analysis and Multivariate Analysis of Variance/Analysis of Variance (MANOVA/ANOVA) statistics. Results indicated that all dimensions of inter-parental conflict and its full scale had a significantly positive correlation with aggression while all dimensions of inter-parental conflict had a significant negative correlation with adolescents' mental health. Results further showed that all dimensions of inter-parental conflict jointly associated with aggression but only the dimensions of frequency and intensity independently related with aggression. All dimensions of inter-parental conflict jointly related with mental health while intensity, resolution, coping efficacy and self-blame dimensions independently associated with mental health of adolescents. Based on the above, the researchers recommended that the dimensionality of inter-parental conflict should be considered in further research and that intervention programs should aim at promoting positive family relationship, reducing family stress and promoting positive mental health as adolescents grow and develop in the course of time.

Hierarchical modelling of factors associated with the practice and perpetuation of female genital mutilation in the next generation of women in Africa

Despite a total prohibition on the practice of female genital mutilation (FGM), young girls continue to be victims in some African countries. There is a paucity of data on the effect of FGM practice in two generations in Africa. This study assessed the current practice of daughters' FGM among women living in 14 FGM-prone countries in Africa as a proxy to assess the future burden of FGM in the continent. We used Demographic and Health Surveys data collected between 2010 and 2018 from 14 African countries. We analyzed information on 93,063 women-daughter pair (Level 1) from 8,396 communities (Level 2) from the 14 countries (Level 3). We fitted hierarchical multivariable binomial logistic regression models using the MLWin 3.03 module in Stata version 16 at p<0.05. The overall prevalence of FGM among mothers and their daughters was 60.0% and 21.7%, respectively, corresponding to 63.8% reduction in the mother-daughter ratio of FGM. The prevalence of FGM among daughters in Togo and Tanzania were less than one per cent, 48.6% in Guinea, with the highest prevalence of 78.3% found in Mali. The percentage reduction in mother-daughter FGM ratio was highest in Tanzania (96.7%) and Togo (94.2%), compared with 10.0% in Niger, 15.0% in Nigeria and 15.9% in Mali. Prevalence of daughters' FGM among women with and without FGM was 34.0% and 3.1% respectively. The risk of mothers having FGM for their daughters was significantly associated with maternal age, educational status, religion, household wealth quintiles, place of residence, community unemployment and community poverty. The country and community where the women lived explained about 57% and 42% of the total variation in FGM procurement for daughters. Procurement of FGM for the daughters of the present generation of mothers in Africa is common, mainly, among those from low social, poorer, rural and less educated women. We advocate for more context-specific studies to fully assess the role of each of the identified risk factors and design sustainable intervention towards the elimination of FGM in Africa.

The extraversion-neuroticism and geriatric depression relations: do social engagements and social supports have roles to play?

Evidence on the social pathways by which personality traits associate with depressive feeling is lacking. This study assessed the mediating roles of social engagements and social supports on the associations of extraversion and neuroticism with depressive symptoms among 465 older adults (Meanage = 74.18 ± 9.42) recruited from the senatorial districts of Ekiti State, Nigeria. Major assumptions were tested in structural equation modelling frame-work. High extraversion influenced both high engagements in social activities and perceived social supports, and then low depressive symptoms. High neuroticism predicted both low social engagements and social supports, and then increased depressive symptoms. While a full mediation was established between extraversion and depression, a partial one was found between neuroticism and depression. The total effect of neuroticism on depression surpassed that of extraversion. Psychotherapeutic interventions targeting depression from high neuroticism may aim frequent social engagements and seeking family and non-family supports.

Menstrual attitude dimensions, Anxiety and Body Esteem in adolescent girls

One of the horrifying experiences that adolescent girls endure is menstruation. Understanding how some individual-related factors affect menstrual attitudes has substantial implications for coping with difficulties that come with it. We tested the direct and interactive effect of anxiety and body esteem dimensions (attribution, weight & appearance) on dimensions of menstrual attitudes (debilitating, bothersome, natural, prediction & denial) among adolescent girls in Ibadan, Nigeria. This is a cross- sectional survey of 276 secondary schools girls aged 12-19 years (M= 14.89, SD= 1.46). Multivariate Analysis of Variance results revealed adolescent girls with lower anxiety reported positive menstrual attitude by anticipating the onset of menstruation. Body esteem-appearance directly influenced both debilitating and bothersome dimensions of menstrual attitude; suggesting girls with higher body esteem for appearance positively accept menstrual experience as weakening and inconvenient. Interactively, anxiety and appearance dimension of body esteem influenced prediction dimension; likewise anxiety, weight and attribution dimensions of body esteem. It is concluded that body esteem and less anxiety are important for adolescent girls' positive menstrual attitudinal change. Thus, reduced apprehension and high self-respect for body appearance and weight are recommended for accepting menstruation as a normal bodily function occurrence during a woman's reproductive lifespan.

Modelling self-assessed vulnerability to HIV and its associated factors in a HIV-burdened country

BACKGROUND

Globally, individuals' self-assessment of vulnerability to HIV infection is important to maintain safer sexual behaviour and reduce risky behaviours. However, determinants of self-perceived risk of HIV infection are not well documented and differ. We assessed the level of self-perceived vulnerability to HIV infection in Nigeria and also identified its risk factors.

METHODS

We explored a recent nationally representative data with self-reported vulnerability ('high', 'low' and 'no risk at all') to HIV infection as the outcome of interest. Data were weighted and association between the outcomes and the risk factors determined. We used simple ordered logit regression to model relationship between the outcome variable and risk factors, and controlled for the significant variables in multiple ordered logistic regression at 5% significance level.

RESULTS

About 74% had good knowledge of HIV transmission and 6% had experienced STI recently. The likelihood of assessing oneself as having 'no risk at all' was 50% and for 'high chances' was 1.6%. Self-perceived high risk of HIV was higher among those who recently experienced STI (5.6%) than those who did not (1.7%), and also higher among those who recently engaged in transactional sex and had multiple sexual partners. The odds of good knowledge of HIV transmission on high self-perceived vulnerability to HIV was 19% higher than poor knowledge (OR = 1.19, 95% CI: 1.12-1.27). Also, respondents who recently had multiple sexual partners were 72% (OR = 1.72, 95% CI: 1.60-1.86) more likely to report self as having high risk. Younger respondents aged 14-19 years had higher odds of 41% (OR = 1.41, 95% CI: 1.29-1.55) to perceive self as having high vulnerability to HIV than older respondents.

CONCLUSION

High vulnerability to HIV infection was reported among younger respondents, those with history of STIS and those who engage in multiple sexual relations. Despite high level of risky sexual behaviour and good knowledge of HIV transmission and prevention found in this study, self-perceived vulnerability to HIV generally is low. For the low perception found in this study to translate to low chance of HIV infection, there is need for all stakeholders to embark on risk reduction initiatives through sexual education that would minimise risky sexual practices and ensuring availability and affordability of HIV prevention methods.

A Multicountry Perspective on Cultural Competence Among Baccalaureate Nursing Students

PURPOSE

To assess cultural competence among nursing students from nine countries to provide an international perspective on cultural competence.

DESIGN

A descriptive, cross-sectional design.

METHODS

A convenience sample of 2,163 nursing students from nine countries was surveyed using the Cultural Capacity Scale from April to November 2016.

RESULTS

The study found a moderate range of cultural competence among the students. The ability to teach and guide other nursing colleagues to display culturally appropriate behavior received the highest competence rating, while the ability to discuss differences between the client's health beliefs or behaviors and nursing knowledge with each client received the lowest competence rating. Differences in cultural competence were observed between students from different countries. Country of residence, gender, age, year of study, attendance at cultural-related training, the experience of taking care of patients from culturally diverse backgrounds and patients belonging to special population groups, and living in a multicultural environment were identified as factors affecting cultural competence.

CONCLUSIONS

The international perspective of cultural competence among nursing students provided by this study serves as a vital preview of where nursing education currently stands in terms of providing the necessary preparatory competence in the cultural aspect of care. The variation of cultural competence among nursing students from different nations should serve as a cue for designing a focused yet multimodal nursing education program in guiding them to be culturally sensitive, culturally adaptive, and culturally motivated.

CLINICAL RELEVANCE

The training of nursing students in providing competent culturally appropriate care should be ensured considering that adequate preparation of nursing students guarantees future competent nursing practice, which can positively impact the nursing profession in any part of the globe.

Trauma and PTSS of Zimbabwean refugees in South Africa: A summary of published studies

OBJECTIVE

This paper is a report of 4 published papers on posttraumatic stress symptoms (PTSS)/posttraumatic stress disorders (PTSD) and traumas experienced by homeless Zimbabwean refugees living in South Africa. The general purpose of the papers was to explore how pre- and postmigration difficulties predicts posttraumatic stress symptoms/disorder; to understand gender differences in PTSS/PTSD reports using quantitative and qualitative approaches; and finally, to understand the nature of abuses, perpetrators, and sex of perpetrators.

METHOD

Through focused group discussions (FGD)s, structured in-depth interviews, data were collected from 125 randomly selected homeless Zimbabwean refugees in Polokwane, Limpopo Province, South Africa. Age of participants ranged from 18 years to 48 years with a mean age of 28.3 years (SD = 6.27). Participants were assessed on demographic variables, Pre- and Post-Migration Difficulties Checklists, General Health Questionnaire 28 (GHQ-28), and PTSD Checklist (Civilian Version; PCL-C).

RESULTS

Results (Paper 1) indicated that a majority of the participants were significantly traumatized and pre- and postmigration traumas contributed to PTSS and PTSD. The qualitative study (Paper 2) overwhelmingly shared similar experiences that could be temporally framed into pre-, mid-, and postmigration. Many of the challenging sociocultural, structural, and institutional factors that they experienced were seen across all the migration stages. In Paper 3, results of a structural equation model (SEM) showed that none of the 3 paths (pre- and postmigration stress and poor mental health) on PTSD is significant for men whereas for women, the path from poor mental health to PTSD (β = .36, p = .013) is significant. Finally the fourth paper showed that rape and sexual harassment were common abuses. Perpetrators were mainly single male border and police officers.

CONCLUSION

The Zimbabwean refugees were found to constitute a particularly vulnerable group to have experienced cumulative traumas and therefore reported PTSS, PTSD, and poor mental health. These findings were discussed in line with practical implications for refugees in South Africa where xenophobic feelings are on the rise. (PsycINFO Database Record

Examining maternal age, breastfeeding self-efficacy and health locus of control in psychological wellbeing of mothers

We investigated the direct and interaction influence of maternal age, breastfeeding self-efficacy (BSE), health locus of control (HLOC) on six dimensions of psychological wellbeing of breastfeeding mothers in Lagos, Nigeria. Data were collected from a convenience sample of 291 mothers attending health facilities in two suburb local government areas. The survey included socio-demographics (maternal age, marital status, ethnicity, education level and position of the baby currently breastfeeding), breastfeeding self-efficacy, health locus of control and psychological wellbeing scales. Independent variables were tested against sense of autonomy, positive relations with others, purpose in life, self-acceptance, environmental mastery and personal growth using factorial Multivariate Analysis of Variance. Results showed direct influence of BSE, HLOC and maternal age on various dimensions of psychological wellbeing. Interaction influences indicate BSE and HLOC on environmental mastery; BSE and maternal age on self-acceptance and HLOC and maternal age on sense of autonomy, positive relationship with others and self-acceptance respectively. In conclusion, maternal age, breastfeeding self-efficacy and health locus of control are vital for mothers to enjoy plenty dimensions of psychological wellbeing. Breastfeeding mothers need to be confident in their abilities to breastfeed and have control over their health-related behaviour in order to enjoy sufficient dimensions of psychological wellbeing.

Wealth and antenatal care utilization in Nigeria: Policy implications

Antenatal care (ANC) utilization is lower in Nigeria than the African average. We investigated the relationship between wealth and utilization of ANC and also assessed other determinants associated with ANC utilization in Nigeria. Using data of the most recent births within 5 years prior to a 2012 nationally representative survey, we modeled predictors of ANC utilization. Respondents in the wealthiest quintile were over five times (aOR = 5.5 (95% CI: 4.2-7.2) more likely to adequately use ANC. The odds of ANC use were generally lower among the poor and the least educated women living in rural areas who need ANC the most.

Survival analysis and prognostic factors of timing of first childbirth among women in Nigeria

Background

First childbirth in a woman’s life is one of the most important events in her life. It marks a turnaround when she might have to drop roles of career building and education, for motherhood and parenthood. The timing of the commencement of these roles affects the child bearing behavior of women as they progress in their reproductive ages. Prevalent early first childbirth in Nigeria has been reported as the main cause of high population growth and high  fertility, mortality and morbidity among women, but little has been documented on the progression into first birth as well as factors affecting it in Nigeria. This paper modelled timing of first birth among women in Nigeria and determined socio-demographic and other factors affecting its timing.

Methods

We hypothesized that background characteristics of a woman will influence her progression into having first birth. We developed and fitted a survival analysis model to understand the timing of first birth among women in Nigeria using a national representative 2013 NDHS data. Women with no children were right censored as of the date of the survey. The Kaplan Meier survival function was used to estimate the probabilities of first birth not occurring until certain ages of women while Cox proportional hazard regression was used to model the timing of first births at 5 % significance level.

Results

About 75.7 % of the respondents had given birth in the Northern region of Nigerian compared with 63.8 % in the South. Half (50.1 %) of the first childbirth occurred within the 15–19 years age bracket and 38.1 % within 20–29 years. The overall median survival time to first birth was 20 years (North 19, South 22), 27 years among women with higher education and 18 years for those with no formal education. The adjusted hazard of first birth was higher in the Northern region of Nigeria than in the South (aHR = 1.24, 95 % CI: 1.20-1.27), and higher in rural areas than in urban areas (aHR = 1.15, 95 % CI: 1.12-1.19). Also, hazard of earlier first birth tripled among women with no education (aHR = 3.36, 95 % CI: 3.17-3.55) compared to women with higher education. The significant factors affecting age at first birth are education, place and zone of residence, age at first marriage, religion, ethnicity and use of contraceptives.

Conclusions

This study showed that progression into early first birth is most affected by the education standing of women as well as age at first marriage. Delay of first childbirths as a strategy for fertility reduction and maternal health improvement can be achieved if women are empowered early in life with quality education. Stakeholders should therefore, give adequate attention to educating the girl child. Adverse socio-cultural norms of betrothing and marrying young girls should be abrogated, while health education and promotion of need to delay child bearing must be intensified especially among rural dwellers and also in Northern Nigeria.

Assessment of quality of antenatal care services in Nigeria: evidence from a population-based survey

Background

The aim of the newly introduced “focused Antenatal Care (ANC)” is not only to achieve a minimum number of 4 visits, but also the timeliness of the commencement of the visits as well as the quality and relevance of services offered during the visits. This study is therefore designed to assess the quality of ANC services in Nigeria.

Methods

We used information supplied by the 13410 respondents who claimed to have used the ANC facilities at least once within five year preceding the 2013 Nigeria Demographic and Household Survey (NDHS). Ten components of ANC including: offer of HIV test, Tetanus Toxoid injection, receiving iron supplementation, intermittent preventive treatment (IPT), intestinal preventive drug (IPD), timely ANC enrollment and number of visits were assessed. Receipts of all the ten components were classified as desirable (good) quality of ANC services while receipt of eight critical components among the ten were assumed to be the minimum acceptable quality. Data was weighted and analyzed using descriptive statistics and logistic regression models at 5 % significance level.

Results

Measurement of blood pressure and receiving iron supplementation were the most commonly offered ANC component in Nigeria with 91.0 % each while IPD and IPT were given to only 20.7 % and 37.6 % respectively. Less than two thirds were taught on PMTCT while 41.7 % had HIV test and obtained results. Only 4.6 % (95 % CI: 4.2–5.1) of women received good quality of ANC while nearly 1.0 % did not receive any of the components. About 11.3 % (95 % CI: 10.6–11.9 %) of the attendees had minimum acceptable quality of ANC. Receipt of good quality ANC services was higher among users who initiated ANC early, had at least 4 ANC visits, attended to by skilled health workers, attended government and private hospitals and clinics. Higher odds of receiving good quality of ANC were found among users who lives in urban areas, having higher educational attainment, belonging to households in upper wealth quintiles and attended to by skilled ANC provider.

Conclusions

The levels of desirable and minimum acceptable quality of ANC services were poor in Nigeria thereby jeopardizing efforts to achieve the MDGs. There is need for intensified commitment by national and state governments in Nigeria as well as other stakeholders to ensure that main components of ANC are received by the users.

Barriers to antenatal care use in Nigeria: evidences from non-users and implications for maternal health programming

BACKGROUND

In Nigeria, over one third of pregnant women do not attend Antenatal Care (ANC) service during pregnancy. This study evaluated barriers to the use of ANC services in Nigeria from the perspective of non-users.

METHODS

Records of the 2199 (34.9%) respondents who did not use ANC among the 6299 women of childbearing age who had at least one child within five years preceding the 2012 National HIV/AIDS and Reproductive Health Survey (NARHS Plus II), were used for this analysis. The barriers reported for not visiting any ANC provider were assessed vis-à-vis respondents' social demographic characteristics, using multiple response data analysis techniques and Pearson chi-square test at 5% significance level.

RESULTS

Of the mothers who did not use ANC during five years preceding the survey, rural dwellers were the majority (82.5%) and 57.3% had no formal education. Most non-users (96.5%) were employed while 93.0% were currently married. North East with 51.5% was the geographical zone with highest number of non-users compared with 14.3% from the South East. Some respondents with higher education (2.0%) and also in the wealthiest quintiles (4.2%) did not use ANC. The reasons for non-use of ANC varied significantly with respondents' wealth status, educational attainment, residence, geographical locations, age and marital status. Over half (56.4%) of the non-users reported having a problem with getting money to use ANC services while 44.1% claimed they did not attend ANC due to unavailability of transport facilities. The three leading problems: "getting money to go", "Farness of ANC service providers" and "unavailability of transport" constituted 44.3% of all barriers. Elimination of these three problems could increase ANC coverage in Nigeria by over 15%.

CONCLUSION

Non-use of ANC was commonest among the poor, rural, currently married, less educated respondents from Northern Nigeria especially the North East zone. Affordability, availability and accessibility of ANC providers are the hurdles to ANC utilization in Nigeria. Addressing financial and other barriers to ANC use, quality improvement of ANC services to increase women's satisfaction and utilization and ensuring maximal contacts among women, society, and ANC providers are surest ways to increasing ANC coverage in Nigeria.

Personality and criminal outcomes of homeless youth in a Nigerian jail population: results of PDS and MAACL-H assessments

OBJECTIVE

The unprecedented incidence of armed robberies and the involvement of young people in these crimes necessitated - as part of a comprehensive study on homelessness and criminal behaviour in Nigeria - an assessmet and comparison of homeless youths incarcerated in prisons with a control group of non-prison and never-homeless youths from the general population using the Psychopathic Deviate Scale (PDS) and the Multiple Affect Adjective Checklist hostility subscale (MAACL-H).

METHOD

Through in-depth interviews using a questionnaire, data were collected from 100 randomly selected homeless inmates in three Nigerian medium-security prisons aged 15 to 26 (mean = 17.2), and another 100 non-prison and never-homeless youths from the general population aged 15 to 31 (mean = 25.2).

RESULTS

Hypothesis 1 showed a higher score on the PDS (mean = 29.3) and MAACL-H (mean = 21.7) among the homeless group than the non-prison and never homeless group (PDS mean = 21.2) and (MAACL-H = mean 12.5), (PDS (t = (98) = 6.62, p < .05) and MAACL-H (t = (98) = 21.7, p < .0001). The second hypothesis also showed a significant relationship between PDS and the type of crime committed by homeless inmates (F (2, 97) = 3.213; p < .05) and the direction of this relationship was higher for PDS and felony followed by misdemeanour offences (p < .05, LSD = 2.81). The MAACL-H did not reach an acceptable level of significance for type of crime.

CONCLUSION

These findings have significant practical and theoretical implications for personality and criminal outcomes for homeless youths in prisons when compared with non-prison and never-homeless youths. The study also suggests the need for more research in this direction and a review of antiquated penal policies for children, while the effective roles of governments and non-governmental organisations were also stressed.

Burnout among paramilitary personnel in Nigeria: a perspective from Conservation of Resources Theory

The job demands–resources model attributed burnout to incompatibility between job demands and job resources, and underplayed the role of personal resources in employees’ adaptation. Based on the Conservation of Resources Theory, this study proposes the inclusion of personal resources as predictors of burnout. A cross-sectional survey design was employed to gather data from 256 paramilitary personnel in Nigeria. Participants’ ages ranged from 19 to 65 years ( M = 35.03 years, standard deviation [ SD] = 8.55 years). Data were collected using measures of emotional intelligence, self-efficacy, organization-based self-esteem, optimism, and burnout. Results confirmed the joint influence of psychological resources on burnout. Emotional intelligence, self-efficacy, organization-based self-esteem, optimism, and tenure were found to have a significant influence on burnout. The findings suggest that organizations should be able to minimize burnout among their employees by increasing their adaptive capacities through appropriate training and development workshops.

Burnout and Fear of Contagion as Factors in Aggressive Tendency of Health-Care Workers Treating People with Aids

We investigated the roles of burnout and perceived fear of contagion with AIDS among 130 medical practitioners and 112 nurses (N = 242) working in AIDS care in Nigeria, in relation to the level of their aggressive tendency toward people living with AIDS (PLWAs). Participants completed scales concerning perceived AIDS anxiety, burnout, and aggressive tendency. Results showed that perceived fear of AIDS, burnout, and category of staff (medical practitioner or nurse), respectively, were associated with the tendency to perpetrate aggression against PLWAs. The implication of these findings is that stakeholders in the health-care system in Nigeria and elsewhere should address any aggressive tendency of health workers in public-health settings in order to prevent the occurrence of actual physical aggression against clients. We recommend that consideration should be given to the factors implicated in this study when intervention strategies are being developed.

Migration challenges among Zimbabwean refugees before, during and post arrival in South Africa

BACKGROUND

Zimbabweans are immigrating to South Africa with a commonly cited reason being economic opportunities. Prospects of finding employment may be a significant reason to leave behind family, friends, and community, sources that buffer and offer social support against life's challenges. Currently, there is a dearth of research examining the motivators for Zimbabweans immigrating and the experiences encountered along the way and after arrival in South Africa. Such research is essential as large numbers of Zimbabweans may be at risk for emotional and physical trauma during this process.

METHODS

Two gender specific focus group discussions, each lasting 90-minutes and consisting of homeless Zimbabwean refugees, were conducted in the Limpopo Province of South Africa. A semi-structured interview assessed for experiences in and reasons for leaving Zimbabwe, as well as experiences en-route and within South Africa. Discussions were audio-recorded, transcribed, and analyzed using consensual qualitative research and a constant comparison qualitative method.

RESULTS

Three temporal themes were identified and included challenges and trauma experienced in Zimbabwe (pre-migration), during the immigration journey (mid-migration), and upon arrival in South Africa (post-migration). While there were some experiential differences, Zimbabwean men and women shared numerous traumatic commonalities. In addition to the themes, three subthemes contributing to reasons for leaving Zimbabwe, two subthemes of negative and traumatic experiences incurred mid-migration, and two post-migration subthemes of challenges were identified.

CONCLUSIONS

Despite the difficulties encountered in their homeland, newly arrived Zimbabweans in South Africa may be exchanging old struggles for a new array of foreign and traumatic challenges. Reasons to immigrate and the psychological and physical toll of migration exacted at the individual and community levels are discussed. Recommendations advocating for culturally congruent mental health research, the training of culturally competent researchers and clinicians, and the development of policies that could influence the quality of life of Zimbabwean refugees are provided.

Self-concepts and demographic characteristics of battered women in Gauteng, South Africa

In South Africa, studies have shown that one in every four women are abused or battered. Put graphically, 25% of women in the Republic of South Africa (RSA) are assaulted by their boyfriend/partner or husband and a woman suffer battering on average of 39 times before she seeks outside help. Woman battering can leave women abused, distressed, create fear, limits behaviour, cause psychological damage and physical harms and very often breaks down self-esteem and leaves the individual self-incompetent. Hence the need to understand how women who have been abused rate their pre and post abuse self-concepts, how their demographic characteristics influence their self-concepts and also understand their attitude towards their abuser. Through in-depth interviews using a questionnaire, data were collected from 150 randomly selected abused women attending a respite centre located in Johannesburg. Age of women ranged from 16 years to 49 years with a mean age of 32.2 (SD = 8.27). Abuse or being battered in this study is defined as "women who have been emotionally abused or physically beaten by husband/boyfriend with blows, slapped, kicked and have experienced these over three times in a single relationship. The study was anchored on a three research questions. Results showed that before abuse, women rated themselves positively (X bar = 82.4) and negatively after abuse (X bar = 69.9). The study showed a huge drop in self-concept change (X bar = 23.9) after abuse. At a pre-abuse level, women generally rated themselves positively on almost all dimensions and negatively after abuse on almost all bi-polar items. The study also found that demographics of abused women such as marital status (C2 (1, N = 149) = 7.30, P < .01), educational level (C2 (1, N = 149) = 15.89, P < .001), duration of abuse (C2 (1, N = 149) = 12.71, P < .002), and nature of abuse (C2 (1, N = 149) = 4.502, P < .05) do influence self-concepts of abused women. Age of women was not significant. Finally, results also indicate that majority of the women have negative attitude towards their abuser (C2 (1, N = 149) = 4.051, P < .05). The abuser was described negatively as cold, slow, passive, weak, sick, tense, unpredictable, sad, dangerous, ignorant and bad. Surprisingly, the abuser was also described as rich, wise, clean and valuable. These findings have significant practical implications for intimate partner violence or Gender-based violence and the health and psychological outcomes for battered women. The study also suggests the need for more research in this direction and a need for culturally relevant programmes to help women in abusive relationships and in addition help the abusers deal with myths that have cultural relevance to factors maintaining battering.