A Longitudinal Multilevel Analysis of the Effects of Contraceptive Failures on Unintended Pregnancies among Women in Urban Nigeria

Unintended pregnancy is a global public health concern. However, the effect of contraceptive failure on unintended pregnancy remains unclear in Nigeria. We undertook a longitudinal analysis to examine the effect of contraceptive failure on unintended pregnancy among urban women in Nigeria. We used panel data from the Nigerian Urban Reproductive Health Initiative. The Measurement, Learning and Evaluation program conducted the surveys among a cohort of women aged 15-49 who were first interviewed at baseline in 2010/2011 and followed up at endline in 2014/2015. Analytic sample was 4140 women aged 15-49 who ever used contraceptives. We fitted three-level multilevel binary logistic regression models estimated with GLLAMM. The study established evidence that there is a significant effect of contraceptive failure on unintended pregnancy among urban women in Nigeria. The positive effect of between-person contraceptive failure indicates that respondents who experienced more contraceptive failure than the average in the sample had 5.26 times higher odds of unintended pregnancy (OR = 5.26; p-value < 0.001). Results also established a significant effect of within-person contraceptive failures among the respondents. Findings suggest there is evidence of a significant longitudinal effect of contraceptive failure on unintended pregnancy in urban Nigeria. Efforts to reduce unintended pregnancy must include interventions to address the problem of contraceptive failure among urban women in Nigeria.

Comparing the reasons for contraceptive discontinuation between parenting adolescents and young women in sub-Saharan Africa: a multilevel analysis

BACKGROUND

Adolescent sexual and reproductive health remains a major public health and development issue of global importance. Given that adolescents and young people are heterogenous groups in terms of many characteristics, this study expands the literature by comparing the reasons for contraceptive discontinuation between parenting adolescents (aged 15-19) and parenting young women (aged 20-24) in sub-Saharan Africa (SSA).

METHODS

Data for the study came from Demographic and Health Surveys of 22 SSA countries. The outcome variable was reasons for discontinuation. We performed multilevel binary logistic regression on analytic samples comprising 1485 parenting adolescents and 10,287 parenting young women across the selected SSA countries.

RESULTS

Findings show that the proportion of respondents who used modern contraceptives was lower among parenting adolescents (35%) relative to their 20-24-year-old counterparts (43%). Higher percentages of parenting adolescents than young women discontinued contraceptives because of reasons such as pregnancy or method failure (i.e., 9.9% and 8.17% accordingly), husband disapproval, access or availability issues, wanting more effective methods, and inconvenience in using methods. The multilevel analysis further highlighted disparities between parenting adolescents and parenting young women who discontinued contraceptives. For instance, parenting young women had 30% lower odds of discontinuing contraceptives due to pregnancy or method failure than parenting adolescents.

CONCLUSION

The study established disparities in the reasons for contraceptive discontinuation between parenting adolescents and parenting young women, with adolescents demonstrating greater vulnerabilities and higher risks. Considerable attention must be given to parenting adolescents in the efforts to achieve equity goals such as the Sustainable Development Goals and universal health coverage in SSA.

The Relationship between Childcare-Giving Arrangements and Children's Malnutrition Status in South Africa

Multiple caregiving arrangements have become common for childcare globally, and South Africa is no exception. Previous childcare studies mainly focused on the caregiver and household characteristics. Evidence on the influence of childcare on malnutrition is sparse. This study aimed to examine the relationship between exposure to secondary and multiple forms of care and child malnutrition, with a particular focus on child stunting and overweight among children. A cross-sectional study of a sample of 2966 dyads of mothers and children under five were analysed from the 2017 National Income Dynamics Study (NIDS) Wave 5. Descriptive and inferential statistics were used to analyse the data. The results indicated that 22.16% of the children were stunted and that 16.40% were overweight. Most children were mainly cared for at home (67.16%) during the day. Some results of the obtained multivariable analyses show that lack of being cared for in a crèche or school during the day was significantly associated with stunting (odds ratio (OR) 2; confidence interval (CI) 1.10-3.62, p < 0.05) and overweight (OR) 3.82; (CI) 1.60-9.08, p < 0.05). Furthermore, in this study, 69.88% of children who were cared for at home by the primary caregiver had no other forms of multiple care arrangements. The results showing high stunting and overweight rates among children cared for at home suggest that the government needs to look into supporting caregiver parenting. The high unemployment rates in the country highlight the importance of socioeconomic status in childcare and its implication for children's nutritional outcomes. The study's findings suggest the need for innovative strategies to address the challenges associated with multi-caregiving which negatively affects children's nutritional outcomes.

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

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.

Influence of child marriage on institutional delivery and high-risk births among young women in 31 sub-Saharan African countries

While child marriage persists in sub-Saharan Africa (SSA), little is known about its influence on institutional delivery/high-risk births (IDHRB). We analyzed pooled data on young women aged 15-24 (N = 113,588) from the most recent Demographic and Health Surveys of 31 SSA countries to examine the influence of child marriage on IDHRB. Binary logistic regression analysis was done to explore statistically significant relationships. Findings showed that unskilled delivery was significantly higher among women who married before age 15 (67.2%) and at ages 16-17 (48.2%) compared to those who married at age 18+ (30.2%). The prevalence of high-risk birth was higher among women who married before age 15 (97.2%) and at ages 16-17 (80.8%) compared to those who married at 18+ (48.4%). Inferential analysis showed that respondents who married before age 15 and at ages 16-17, respectively, had five-fold and two-fold higher odds of experiencing unskilled delivery compared to those who married at age 18 +. Odds of having high-risk births were significantly higher among child-brides compared to those who had first marriage as adults. This study concludes that policies/programs that would successfully delay first marriage among women must be pursued to reduce high-risk births and unskilled delivery in SSA.

Community perspectives and caregivers' healthcare practices and responses to the four major childhood killer diseases in Nigeria

Two-thirds of Nigeria's childhood deaths is attributable to four preventable/curable diseases-diarrhoea, malaria, meningitis and pneumonia (DMMP). Community perspectives and caregivers' practices about these child-killer diseases are poorly documented. Drawing on individual and group interviews (n=259), we explored community members' perspectives, and caregivers' practices/responses regarding DMMP among children across Nigeria's three major ethnic groups. Using deductive reasoning and data analysis in Atlas.ti, results from the narratives formed four thematic issues-respondents' perception and knowledge about the causes of the diseases; perception and knowledge about prevention; perception and knowledge of symptoms and fatality of the diseases; and caregivers' practices regarding the prevention and management of the diseases. Results demonstrate significant misconception about the aetiology of pneumonia and meningitis. We found ostensible disconnection between knowledge and practice. Interventions including health education programmes/sensitizations on the causes, prevention/management of DMMP are necessary to achieve reduction in the burden of childhood mortality in Nigeria.

Community-level influences on women’s experience of intimate partner violence and modern contraceptive use in Nigeria: a multilevel analysis of nationally representative survey

Background: Modern contraceptives (MC) are important strategies for reducing unwanted pregnancies, unsafe abortion and maternal mortality, but MC remains low at 18% in Nigeria. Similarly, while there is increasing prevalence of intimate partner violence (IPV) in Nigeria, its effects on contraceptive use remain unclear. This study examined the influence of IPV on MC use, while adjusting for individual- and community-level confounders. Methods : The study utilized 2018 Nigeria Demographic and Health Survey data. We performed multilevel binary logistic regression analysis on 24,973 married women aged 15-49 49 (nested within 1,400 communities), who were sexually active and were not pregnant at the time of the survey. Results : Findings show that use of MC was higher among married women who reported experience of IPV than those without IPV exposure. After adjusting for individual-level and contextual factors, the odds of using MC was significantly higher among women who experienced any form of IPV (OR: 1.61, 95% CI: 1.17-2.21, p<0.005) compared to those who reported no IPV experience. Around one-quarter of the total variance in contraceptive use with respect to the different types of IPV could be explained at the community level. Conclusion : The study provides empirical evidence that there is significant community effect on IPV exposure and women’s contraceptive uptake. Attention must therefore be given to the context-specific social and gender norms that affect women’s sexual and reproductive health in Nigeria.

Trends and correlates of girl-child marriage in 11 West African countries: evidence from recent Demographic and Health Surveys

Background: West Africa historically has a high prevalence of girl-child marriage and requires substantial reduction to meet the United Nation’s Sustainable Development Goals (SDG) target of ending child marriage by 2030, but current data on progress is sparce. We aimed to determine the trend in child marriage in West Africa and assess the influence of selected socio-demographic factors.

Methods: We analysed data on women aged 18-24 years from the two most recent Demographic and Health Surveys (conducted between 2006 and 2014) for 11 West African countries to determine the prevalence and trend of girl-child marriage. Multivariable logistic regression analysis was used to assess the relationship between girl-child marriage and selected socio-demographic factors.

Results: The prevalence of child marriage in West Africa is 41.5%. An overall decrease of 4.6% (annual rate of 0.01%) was recorded over a seven-year inter-survey period. Three countries (Cote d’Ivoire, Nigeria, and Niger) recorded increased prevalence while the rate was unchanged in Burkina Faso, and the other six countries had reduced prevalence between the last two surveys. Sierra Leone recorded the highest decrease in prevalence (22%) and an annual reduction rate of 0.04%; Cote d’Ivore had the highest increase (65.3%). In virtually all countries, rural residence, low education, poor household economic status and non-Christian religious affiliation were significantly associated with higher odds of girl-child marriage.

Conclusions: The prevalence of girl-child marriage remains high in West Africa and the trend shows very slow progress. While substantial inter-country variations exist in overall rate and trend of child marriage, the rate of progress is inadequate across all countries.

Community-level influences on women’s experience of intimate partner violence and modern contraceptive use in Nigeria: a multilevel analysis of nationally representative survey

Background: Modern contraceptives (MC) are important strategies for reducing unwanted pregnancies, unsafe abortion and maternal mortality, but MC remains low at 18% in Nigeria. Similarly, while there is increasing prevalence of intimate partner violence (IPV) in Nigeria, its effects on contraceptive use remain unclear. This study examined the influence of IPV on MC use, while adjusting for individual- and community-level confounders. Methods: The study utilized 2018 Nigeria Demographic and Health Survey data. We performed multilevel binary logistic regression analysis on 24,973 married women aged 15-49, who were sexually active and were not pregnant at the time of the survey. Results: Findings show that use of MC was higher among married women who reported experience of IPV than those without IPV exposure. After adjusting for individual-level and contextual factors, the odds of using MC was significantly higher among women who experienced any form of IPV (OR: 1.61, 95% CI: 1.17-2.21, p<0.005) compared to those who reported no IPV experience. Around one-quarter of the total variance in contraceptive use with respect to the different types of IPV could be explained at the community level. Conclusion: The study provides empirical evidence that there is significant community effect on IPV exposure and women’s contraceptive uptake. Attention must therefore be given to the context-specific social and gender norms that affect women’s sexual and reproductive health in Nigeria.

Disparities in pregnancy-related deaths: spatial and Bayesian network analyses of maternal mortality ratio in 54 African countries

BACKGROUND

Maternal mortality remains a public health problem despite several global efforts. Globally, about 830 women die of pregnancy-related death per day, with more than two-third of these cases occurring in Africa. We examined the spatial distribution of maternal mortality in Africa and explored the influence of SDoH on the spatial distribution.

METHODS

We used country-level secondary data of 54 African countries collected between 2006 and 2018 from three databases namely, World Development Indicator, WHO's Global Health Observatory Data and Human Development Report. We performed descriptive analyses, presented in tables and maps. The spatial analysis involved local indicator of spatial autocorrelation maps and spatial regression. Finally, we built Bayesian networks to determine and show the strength of social determinants associated with maternal mortality.

RESULTS

We found that the average prevalence of maternal mortality ratio (MMR) in Africa was 415 per 100 000 live births. Findings from the spatial analyses showed clusters (hotspots) of MMR with seven countries (Guinea-Bissau, Guinea, Sierra Leone, Cote d'Ivoire, Chad and Cameroon, Mauritania), all within the Middle and West Africa. On the other hand, the cold spot clusters were formed by two countries; South Africa and Namibia; eight countries (Algeria, Tunisia, Libya, Ghana, Gabon and Congo, Equatorial Guinea and Cape Verde) formed low-high clusters; thus, indicating that these countries have significantly low MMR but within the neighbourhood of countries with significantly high MMR. The findings from the regression and Bayesian network analysis showed that gender inequities and the proportion of skilled birth attendant are strongest social determinants that drive the variations in maternal mortality across Africa.

CONCLUSION

Maternal mortality is very high in Africa especially in countries in the middle and western African subregions. To achieve the target 3.1 of the sustainable development goal on maternal health, there is a need to design effective strategies that will address gender inequalities and the shortage of health professionals.

Trends and correlates of girl-child marriage in 11 West African countries: evidence from recent Demographic and Health Surveys

Background: West Africa historically has a high prevalence of girl-child marriage and requires substantial reduction to meet the United Nation’s Sustainable Development Goals (SDG) target of ending child marriage by 2030, but current data on progress is sparce. We aimed to determine the trend in child marriage in West Africa and assess the influence of selected socio-demographic factors. Methods: We analysed data on women aged 18-24 years from the two most recent Demographic and Health Surveys (conducted between 2006 and 2014) for 11 West African countries to determine the prevalence and trend of girl-child marriage. Multivariable logistic regression analysis was used to assess the relationship between girl-child marriage and selected socio-demographic factors. Results: The prevalence of child marriage in West Africa is 41.5%. An overall decrease of 4.6% (annual rate of 0.01%) was recorded over a seven-year inter-survey period. Three countries (Cote d’Ivoire, Nigeria, and Niger) recorded increased prevalence while the rate was unchanged in Burkina Faso, and the other six countries had reduced prevalence between the last two surveys. Sierra Leone recorded the highest decrease in prevalence (22%) and an annual reduction rate of 0.04%; Cote d’Ivore had the highest increase (65.3%). In virtually all countries, rural residence, low education, poor household economic status and non-Christian religious affiliation were significantly associated with higher odds of girl-child marriage. Conclusions: The prevalence of girl-child marriage remains high in West Africa and the trend shows very slow progress. While substantial inter-country variations exist in overall rate and trend of child marriage, the rate of progress is inadequate across all countries.

Approaches, achievements, challenges, and lessons learned in setting up an urban-based Health and Demographic Surveillance System in South Africa

Reliable civil registration and vital statistics (CRVSs) are essential for estimating mortality rates and population changes, and are critical for public health and socio-economic planning. CRVSs are largely incomplete in Africa, thus Health and Demographic Surveillance Systems (HDSSs) fill gaps in CRVSs, albeit existing HDSSs in South Africa are in rural areas. This limits the generalisability of such data in a country such as South Africa where over 60% live in urban areas, and where there are limitations to access health and social services. We describe the approaches, achievements, challenges and lessons learned in setting up a HDSS site in Soweto and Thembelihle (SaT-HDSS), Johannesburg; which is the first urban-based HDSS in Southern Africa. We also highlight a number of studies being implemented in the HDSS. In 2017–2020, the HDSS has enrolled 124,169 individuals and followed up 95% of this population through 3 rounds of data collection. Several challenges were encountered during the initiation of the HDSS, including difficulties in community mobilisation and entry, stakeholders’ engagement and participation, inaccessibility problems and concerns about safety of fieldworkers, and difficulty in getting/recruiting technical staff with requisite experience. Nevertheless, the SaT-HDSS was successfully established through application of several strategies, including continuous community engagement and stakeholders’ mobilisation; in-depth training and retraining of all study staff; technical support from well-established HDSS sites across Africa, and international academic collaborations. Despite the challenges of undertaking routine surveillance of a hard-to-reach and highly mobile population, the SaT-HDSS was successfully established with a high-retention rate. The HDSS offers an important lens on morbidity and mortality and serves as a platform for pilots of interventions and programmes aimed at improving health and well-being of an urban population.

Death registration in Nigeria: a systematic literature review of its performance and challenges

Background

Death registration provides an opportunity for the legal documentation of death of persons. Documentation of deaths has several implications including its use in the recovery of inheritance and insurance benefits. It is also an important input for construction of life tables which are crucial for national planning. However, the registration of deaths is poor in several countries including Nigeria.

Objective

This paper describes the performance of death registration in Nigeria and factors that may affect its performance.

Methods

We conducted a systematic literature review of death registration completeness in Nigeria to identify, characterize issues as well as challenges associated with realizing completeness in death registration.

Results

Only 13.5% of deaths in Nigeria were registered in 2007 which regressed to 10% in 2017. There was no data reported for Nigeria in the World Health Organization database between 2008 and 2017. The country scored less than 0.1 (out of a maximum of 1) on the Vital Statistics Performance Index. There are multiple institutions with parallel constitutional and legal responsibilities for death registration in Nigeria including the National Population Commission, National Identity Management Commission and Local Government Authorities, which may be contributing to its overall poor performance.

Conclusions

We offer proposals to substantially improve death registration completeness in Nigeria including the streamlining and merger of the National Population Commission and the National Identity Management Commission into one commission, the revision of the legal mandate of the new agency to mainly coordination and establishment of standards. We recommend that Local Government authorities maintain the local registries given their proximity to households. This arrangement will be enhanced by increased utilization of information and communications technology in Civil Registration and Vital Statistics processes that ensure records are properly archived.

Knowledge and attitudes towards maternal immunization: perspectives from pregnant and non-pregnant mothers, their partners, mothers, healthcare providers, community and leaders in a selected urban setting in South Africa

BACKGROUND

Maternal immunization has prevented millions of child deaths globally; nevertheless, incomplete vaccination remains a public health concern in South Africa, where almost half of child deaths occur during neonatal period. This study explored the knowledge and attitudes inhibiting vaccine acceptancy during pregnancy.

METHODS

Key informant and semi-structured interviews were conducted with pregnant women receiving antenatal care at community clinics, antenatal care staff, women enrolled in maternal immunization trials, community leaders and non-pregnant women residing in Soweto. Focus Group Discussions were also held with the mothers and husbands/partners of the pregnant women (n = 55).

RESULTS

The study established good knowledge, a positive attitude and high acceptability of maternal immunization among pregnant women, non-pregnant women, antenatal staff as well as church and community leaders. Men were the least positive about maternal immunization. Aside from antenatal staff, there was poor knowledge regarding the types of vaccinations administered and the health benefits of immunization across all the study groups. Reasons adduced for poor knowledge about the types of vaccinations include lack of communication on maternal immunization during antenatal sessions or clinic visits and power dynamics that tend to exist between healthcare workers and patients.

CONCLUSION

Ensuring that healthcare workers provide useful information on immunization during antenatal visits as well as include men in education sessions regarding the benefit of vaccination may increase patients' confidence and immunization uptake.

Health and Demographic Surveillance Systems Within the Child Health and Mortality Prevention Surveillance Network

Health and demographic surveillance systems (HDSSs) provide a foundation for characterizing and defining priorities and strategies for improving population health. The Child Health and Mortality Prevention Surveillance (CHAMPS) project aims to inform policy to prevent child deaths through generating causes of death from surveillance data combined with innovative diagnostic and laboratory methods. Six of the 7 sites that constitute the CHAMPS network have active HDSSs: Mozambique, Mali, Ethiopia, Kenya, Bangladesh, and South Africa; the seventh, in Sierra Leone, is in the early planning stages. This article describes the network of CHAMPS HDSSs and their role in the CHAMPS project. To generate actionable health and demographic data to prevent child deaths, the network depends on reliable demographic surveillance, and the HDSSs play this crucial role.

Ethnicity, religious affiliation and girl-child marriage: a cross-sectional study of nationally representative sample of female adolescents in Nigeria

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.

Child's Risk Attributes at Birth and Infant Mortality Disparities in Nigeria

Births in avoidable high-risk contexts defined by the interplay of sub-optimal childbearing age, short spacing, and first and high birth order incur elevated risks of childhood death. However, the extent of disparities in risks of dying in infancy vis-à-vis the continuum of non-high-risk and (un)avoidable high-risk attributes at birth as determined by mother's age at childbirth, child spacing, and birth order characteristics is yet to be adequately explored in Nigeria as elsewhere. To fill this gap, chi-square association test and Cox's proportional hazards regression were used to analyze data of 31,260 nationally representative children aged 0-59 months drawn from 2013 Nigeria Demographic and Health Survey. Disparities in infant mortality risks were mainly examined across the spectrum of birth-related risk attributes at birth broadly categorized as no extra high-risk, unavoidable first- order risk and combined avoidable high-risk. The risks of dying in infancy differed significantly by risk attributes to the extent dictated by other confounders. Also, infant mortality risks varied significantly by all moderating factors excluding religion, water source, toilet type and place of delivery. Interventions targeted at reducing avoidable high-risk fertility rate and strengthening health system to provide life-saving care to most-at-risk children would engender rapid improvement in infant survival.

Regional variations in the use of postnatal care in Nigeria: a spatial analysis

Maternal health outcomes vary considerably in Nigeria, with maternal mortality ratio ranging from 165 per 100,000 live births in the South-west to 1549 per 100,000 live births in the North-east. One important maternal health indicator is an adequate use of postnatal care (PNC); however, the evidence is sparse on its spatial distribution across regions in Nigeria. This paper thus examined the spatial distribution of uptake of postnatal care in Nigeria using data from the 2013 Nigeria Demographic and Health Survey, with a sample of 12,127 women aged 15-49 years. The Bayesian-structured additive regression of the logit model was used to examine the spatial relationships. The results revealed a north-south divide in the use of postnatal care, with higher PNC uptake established in the latter. Interestingly, results showed significant intra-region residual spatial variations with higher PNC use in Yobe and Bauchi in North-east Nigeria compared to other states within the region. The findings indicate the need for policymakers to develop state- and region-specific health policy and intervention programs to address the inequity in postnatal care coverage and usage across regions in Nigeria.

Trends, patterns and determinants of long-acting reversible methods of contraception among women in sub-Saharan Africa

BACKGROUND

Method-specific contraceptive prevalence varies widely globally, as huge variations exist in the use of different types of contraception, with short-term methods being the most common methods in sub-Saharan Africa (SSA). Evidence is scanty on the trends, patterns and determinants of long-acting reversible contraceptive (LARC) methods in SSA. This study aimed to address this knowledge gap.

METHODS

Using a pseudo longitudinal research design and descriptive and inferential statistics, we analysed Demographic and Health Survey data of eight countries selected on the basis of contraceptive prevalence rates across SSA. Multinomial logistic regression modelling was used to tease out the predictors of the uptake of LARC methods in the selected countries.

RESULTS

Findings exhibit a steady but slow upward trend in LARC methods across selected countries, as a marginal increase was recorded in LARC uptake over a 10-year period in many of the selected countries. Results established significant predictors of LARC methods uptake, including fertility-related characteristics, age, level of education, work status, wealth index and exposure to mass media. This study underscored the need to address various barriers to the uptake of LARC methods in SSA. It is recommended that governments at different levels undertake to cover the costs of LARC methods in order to increase access and uptake.

Role of Religious Leaders in Promoting Contraceptive Use in Nigeria: Evidence From the Nigerian Urban Reproductive Health Initiative

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.

Independent and combined effects of maternal smoking and solid fuel on infant and child mortality in sub-Saharan Africa

OBJECTIVE

To estimate the independent and combined risks of infant and child mortality associated with maternal smoking and use of solid fuel in sub-Saharan Africa.

METHODS

Pooled weighted data on 143 602 under-five children in the most recent demographic and health surveys for 15 sub-Saharan African countries were analysed. The synthetic cohort life table technique and Cox proportional hazard models were employed to investigate the effect of maternal smoking and solid cooking fuel on infant (age 0-11 months) and child (age 12-59 months) mortality. Socio-economic and other confounding variables were included as controls.

RESULTS

The distribution of the main explanatory variable in households was as follows: smoking + solid fuel - 4.6%; smoking + non-solid fuel - 0.22%; no smoking + solid fuel - 86.9%; and no smoking + non-solid fuel - 8.2%. The highest infant mortality rate was recorded among children exposed to maternal smoking + solid fuel (72 per 1000 live births); the child mortality rate was estimated to be 54 per 1000 for this group. In full multivariate models, the risk of infant death was 71% higher among those exposed to maternal smoking + solid fuel (HR = 1.71, CI: 1.29-2.28). For ages 12 to 59 months, the risk of death was 99% higher (HR = 1.99, CI: 1.28-3.08).

CONCLUSIONS

Combined exposures to cigarette smoke and solid fuel increase the risks of infant and child mortality. Mothers of under-five children need to be educated about the danger of smoking while innovative approaches are needed to reduce the mortality risks associated with solid cooking fuel.

Barriers to accessing health care in Nigeria: implications for child survival

BACKGROUND

Existing studies indicate that about one in every six children dies before age five in Nigeria. While evidence suggests that improved access to adequate health care holds great potential for improved child survival, previous studies indicate that there are substantial barriers to accessing health care in Nigeria. There has not been a systematic attempt to examine the effects of barriers to health care on under-five mortality in Nigeria. This study is designed to address this knowledge gap.

DATA AND METHOD

Data came from a nationally representative sample of 18,028 women (aged 15-49) who had a total of 28,647 live births within the 5 years preceding the 2008 Nigeria Demographic and Health Survey. The risk of death in children below age five was estimated using Cox proportional hazard models and results are presented as hazards ratios (HR) with 95% confidence intervals (CI).

RESULTS

Results indicate higher under-five mortality risks for children whose mothers had cultural barriers and children whose mothers had resource-related barriers to health care (HR: 1.44, CI: 1.32-1.57, p<0.001), and those whose mothers had physical barriers (HR: 1.13, CI: 1.04-1.24, p<0.001), relative to children whose mothers reported no barriers. Barriers to health care remained an important predictor of child survival even after adjusting for the effects of possible confounders.

CONCLUSION

Findings of this study stressed the need for improved access to adequate health care in Nigeria through the elimination of barriers to access. This would enable the country to achieve a significant reduction in childhood mortality.

Differential effect of wealth quintile on modern contraceptive use and fertility: evidence from Malawian women

BACKGROUND

High fertility and wide inequality in wealth distribution are phenomenal problems in sub-Saharan Africa. Modern Contraceptives (MC) are useful for limiting fertility, but are not always easily accessible in Malawi. This study examines the gap in MC use and fertility between women in the richest and poorest Wealth Quintile (WQ).

METHODS

The study was cross-sectional in design and utilized Malawi DHS dataset, 2010. It focused on women of reproductive age. The dependent variables are ever and current use of MC. Chi-square and multinomial logistic regression were used for the analysis.

RESULTS

Mean children ever born by women in the poorest and richest WQs were 3.94 ± 2.7 and 2.82 ± 2.3 respectively (p < 0.001). The adjusted total fertility rate (Adj.TFR) was higher among women in the poorest (Adj.TFR = 7.60) WQ than the richest (Adj.TFR = 4.45). The prevalence of ever use of MC was higher among women in the richest WQ (82.4%) than the poorest (66.8%) (p < 0.001). Similar pattern exists for current use of MC; 58.5% and 45.9% for women in the richest and poorest WQs respectively (p < 0.001). Women in the richest WQ were more likely to ever use (OR = 2.36; C.I = 2.07-2.69, p < 0.001) and currently using (OR = 1.66; C.I = 1.40-1.97, p < 0.001) MC than their counterparts in the poorest WQ. Slight reduction in odd-ratio of MC use among women in richest WQ resulted when socio-demographic variables were used as control.

CONCLUSION

Fertility was higher and the use of MC was lower among women in the poorest than their counterparts in the richest WQ. Ensuring availability of MC at little or no cost may bridge the gap in contraceptive use between women in the poorest and richest WQ in Malawi.

Ethnic differentials in under-five mortality in Nigeria

OBJECTIVE

There are huge regional disparities in under-five mortality in Nigeria. While a region within the country has as high as 222 under-five deaths per 1000 live births, the rate is as low as 89 per 1000 live births in another region. Nigeria is culturally diverse as there are more than 250 identifiable ethnic groups in the country; and various ethnic groups have different sociocultural values and practices which could influence child health outcome. Thus, the main objective of this study was to examine the ethnic differentials in under-five mortality in Nigeria.

DESIGN

The study utilized 2008 Nigeria Demographic and Health Survey (NDHS) data. We analyzed data from a nationally representative sample drawn from 33,385 women aged 15-49 that had a total of 104,808 live births within 1993-2008. In order to examine ethnic differentials in under-five mortality over a sufficiently long period of time, our analysis considered live births within 15 years preceding the 2008 NDHS. The risks of death in children below age five were estimated using Cox proportional regression analysis. Results were presented as hazard ratios (HR) with 95% confidence intervals (CI).

RESULTS

The study found substantial differentials in under-five mortality by ethnic affiliations. For instance, risks of death were significantly lower for children of the Yoruba tribes (HR: 0.39, CI: 0.37-0.42, p < 0.001), children of Igbo tribes (HR: 0.58, CI: 0.55-0.61, p < 0.001) and children of the minority ethnic groups (HR: 0.66, CI: 0.64-0.68, p < 0.001), compared to children of the Hausa/Fulani/Kanuri tribes. Besides, practices such as plural marriage, having higher-order births and too close births showed statistical significance for increased risks of under-five mortality (p < 0.05).

CONCLUSION

The findings of this study stress the need to address the ethnic norms and practices that negatively impact on child health and survival among some ethnic groups in Nigeria.

Do family structure and poverty affect sexual risk behaviors of undergraduate students in Nigeria?

This study examined sexual practices in a Nigerian University community with a view to understanding the role of family structure and poverty on risky sexual behaviours. A representative sample of 1,301 undergraduate students was randomly selected from the various faculties that made up the University. Using a questionnaire instrument, information was obtained on sexual behaviours of interest such as sexual initiation, multi-partnered sexual activity and condom use. Findings showed a noticeable variation in the relationship between family structure and risky sexual behaviour. Contrary to expectations, students from single parent homes showed lower likelihood of having multiple sexual partners. Also poverty was found not to be a critical determinant of risky sexual behaviour. Given the unclear nature of the findings, future study should explore further understanding of the relationship between family characteristics, poverty rating and risky sexual behaviour among students.

HIV/AIDS stigma and utilization of voluntary counselling and testing in Nigeria

BACKGROUND

Despite the recognition of stigma as a hindrance to public health treatment and prevention there are gaps in evidence on the relationship between HIV stigma and VCT services utilization in Nigeria. The purpose of this study was to examine a community's perceptions, feelings and attitudes towards people living with HIV/AIDS and how this is associated with access to utilization of voluntary counselling and treatment in Nigeria.

METHODS

A cross-sectional random study of Nigerians, using a mixed-method approach was carried out in two distinct ethnic areas of the country. Both quantitative and qualitative methods (mixed-methods) were used to collect data in Osun State (Yoruba ethnic group) in the South-West and Imo State (Igbo ethnic group) in the South East. Multivariate logistic regression was the model used to examine the association of interest.

RESULTS

It is shown that Nigerian public attitudes to HIV/AIDS and those infected with the disease are negative. The markers for stigma on the overall stigma index are significant predictors of utilization of voluntary counselling and testing. As the sum of negative feelings increases, there is less likelihood to using voluntary counselling and testing (VCT) and vice versa.

CONCLUSIONS

Current national efforts at addressing the AIDS pandemic can only be successful when the issue of AIDS is de-stigmatized and is made a critical part of those efforts. One way to do this is through well-designed messages that should be posted in the media, community halls, health centers and other public places aimed at humanizing the disease and those affected and infected by it.