School Attendance in Nigeria: Understanding the Impact and Intersection of Gender, Urban-Rural Residence and Socioeconomic Status

"When I suffer from fever, I eat mangos." Determinants of health-seeking beliefs and behaviors of rural older women in Sylhet, Bangladesh

Poverty, poor living conditions, religious values and norms, lack of education, and gender discrimination influence the beliefs and behaviors of rural older women in many low-income countries. This paper aims to report the socio-ecological determinants of health-seeking beliefs and behaviors of rural older women in North-eastern Bangladesh and how these behaviors impact their recognition within the setting. It involved semi-structured interviews with 25 older women and 11 healthcare professionals. The findings revealed various determinants at the personal level (awareness of illness, mistrust toward medical treatment, self-treatment, and religious values and norms), the interpersonal level (isolation in family and communication with clinicians), community level (community perception of aging, neighboring and community organizations), and in the sphere of human rights (care affordability, social safety-net coverage and national policy). Four core determinants (poverty, education, gender and religiosity) were intertwined in shaping beliefs and behaviors.

Community based screening for sickle haemoglobin among pregnant women in Benue State, Nigeria: I-Care-to-Know, a Healthy Beginning Initiative

Background

Haemoglobin genotype screening at prenatal care offers women an opportunity to be aware of their genotype, receive education on sickle cell disease (SCD) and may increase maternal demand for SCD newborn screening. In developed countries, most pregnant women who access prenatal care and deliver at the hospital receive haemoglobin genotype screening. In settings with low prenatal care attendance and low hospital deliveries, community-based screening may provide similar opportunity for pregnant women. We assessed the feasibility and acceptability of integrating haemoglobin genotype screening into an existing community-based HIV program.

Methods

Onsite community-based integrated testing for HIV, hepatitis B virus and haemoglobin electrophoresis, were conducted for pregnant women and their male partners. Community Health Advisors implementing the NIH and PEPFAR-supported Healthy Beginning Initiative (HBI) program provided education on SCD, collected blood sample for haemoglobin electrophoresis and provided test results to participants enrolled into the HBI program. We concurrently conducted a cross-sectional study using a pretested, semi-structured, interviewer administered questionnaire to collect demographic data and assess awareness of individual haemoglobin “genotype” among HBI pregnant women participants.

Results

In this study, 99.9% (10,167/10,168) of pregnant women who received education on SCD accepted and completed the survey, had blood drawn for haemoglobin electrophoresis and received their results. A majority of participating pregnant women (97.0%) were not aware of their haemoglobin “genotype”. Among the participants who were incorrect about their haemoglobin “genotype”, 41.1% (23/56) of women who reported their haemoglobin “genotype” as AA were actually AS. The odds of haemoglobin “genotype” awareness was higher among participants who were in younger age group, completed tertiary education, had less number of pregnancies, and attended antenatal care. Overall prevalence of sickle cell trait (AS) was 18.7%.

Conclusions

It is feasible to integrate haemoglobin “genotype” testing into an existing community-based maternal-child program. Most pregnant women who were unaware of their haemoglobin “genotype” accepted and had haemoglobin genotype testing, and received their test results. Increasing parental awareness of their own haemoglobin “genotype” could increase their likelihood of accepting newborn screening for SCD.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03974-4.

Determinants of Delayed Presentation and Advanced-Stage Diagnosis of Breast Cancer in Africa: A Systematic Review and Meta-Analysis

Background/Objective:

Breast cancer (BC) mortality is exceptionally high in Africa due to late presentation and advanced-stage diagnosis. Previous studies examining barriers to early BC presentation are markedly inconsistent, showing conflicting findings within and between African regions, making resource allocation and designing interventional campaigns challenging. Our objective was to assess the strength or magnitude of the association between determinants/risk factors and delayed presentation/advanced-stage diagnosis of BC in Africa.

Methods:

Electronic searches in PubMed, AJOL, Google, ResearchGate, ScienceDirect, and PubMed Central found eligible articles between 2000 and 2020. The meta-analytical procedure in Meta-XL used the quality effect model. I-squared (I²) above 75% indicated high heterogeneity. The summary effect size was the odds ratio with 95% confidence intervals.

Results:

The effect of socio-economic and demographic determinants on delay varies across African regions. Low level of education (1.63, 95% CI 1.01-2.63), and not performing breast self examination (BSE) (13.59, 95% CI 3.33-55.4) were significantly associated with delayed presentation. Younger patients had more significant delays in West Africa (WA, 1.41, 95%CI 1.08-1.85), and the reverse occurred in North Africa (0.68, 95%CI 0.48-0.97). Lack of BC knowledge (1.59, 95% CI 1.29-1.97), not performing BSE, or no history of undergoing clinical breast examination (CBE) (2.45, 95% CI 1.60-3.40), were associated with advanced-stage disease at diagnosis. Older patients had significantly more advanced disease in WA, and the reverse occurred in South Africa. Aggressive molecular BC subtypes [Triple negative (OR 1.62, 95% CI 1.27-2.06) or HER2 positive (1.56, 95% CI 1.10-2.23)] were significant determinants of advanced-stage diagnosis.

Conclusion:

Promoting early presentation and reducing advanced-stage BC throughout Africa should focus on modifiable factors, including providing quality education, improving breast health awareness and BC knowledge, and developing strategies to increase BSE and CBE. Interventions targeting socio-demographic determinants should be context-specific.

"We didn't get much schooling because we were fishing all the time": Potential impacts of irregular school attendance on the spread of epidemics

Objectives

Especially in traditional, rural, and low‐income areas, children attend school irregularly. School‐based interventions are common mitigation strategies for infectious disease epidemics, but if daily attendance is not the norm, the impact of schools on disease spread might be overestimated.

Methods

We use an agent‐based model of an early 20th century Newfoundland community to compare epidemic size and duration in three scenarios: (1) all school‐aged children attend school each weekday, (2) students aged 10–15 have a chance of engaging in adult activities each day, and (3) students aged 10–15 have a chance of being reassigned to adult roles at the start of each simulation and thus never attend school.

Results

As the probability of not attending school increases, epidemics become smaller and peak earlier. The change in final size is larger with permanent reassignment (35% at baseline, 18% at maximum reassignment) than with daily nonattendance (35% vs. 22%). For both scenarios, the peak occurs 3 days earlier with maximum absence compared to the baseline. Benefits extend beyond the reassigned agents, as all school‐aged agents are more likely to escape infection with increasing reassignment, and on average, 3–6 additional agents (2.6%–5.3%) escape infection compared to the baseline.

Conclusions

This study demonstrates that absenteeism can have important impacts on epidemic outcomes. Thus, socioeconomic and other reasons for nonattendance of school, as well as how rates vary in different contexts, must be considered in models predicting epidemic outcomes or evaluating public health interventions in the face of major pandemics.

Who gets to learn in a pandemic? Exploring the digital divide in remote learning during the COVID-19 pandemic in Nigeria

This study investigates the digital divide in access to remote learning for children in Nigeria, as a result of the COVID-19 pandemic. The data used in this study is from a survey conducted by The Education Partnership (TEP) Centre and the Nigerian Economic Summit Group (NESG), which sampled 557 students and 626 parents living in Nigeria. From the survey, we found: a relationship between the socioeconomic status and the digital divide in accessing remote learning, significant differences in students' access to remote learning opportunities during the pandemic, and significant differences in access to digital tools between students in government schools and their private school counterparts. We also found a statistically significant association between parental level of education and the ability to support children's remote learning during the pandemic.

The Association Between Vaginal Microbiota Dysbiosis, Bacterial Vaginosis, and Aerobic Vaginitis, and Adverse Pregnancy Outcomes of Women Living in Sub-Saharan Africa: A Systematic Review

Background: Previous studies have described the association between dysbiosis of the vaginal microbiota (VMB) and related dysbiotic conditions, such as bacterial vaginosis (BV) and aerobic vaginitis (AV), and various adverse pregnancy outcomes. There is limited overview of this association from countries in sub-Saharan Africa (SSA), which bear a disproportionally high burden of both vaginal dysbiotic conditions and adverse pregnancy outcomes. This systematic review assesses the evidence on the association between VMB dysbiosis, BV, and AV, and late adverse pregnancy outcomes in women living in SSA.

Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis Statement (PRISMA) guidelines were followed. Three databases [PubMed, Embase (Ovid), and Cochrane] were used to retrieve observational and intervention studies conducted in SSA that associated VMB dysbiosis, BV, or AV and preterm birth/labor/delivery, preterm rupture of membranes (PROM), low birthweight, small for gestational age, intrauterine growth restriction, intrauterine infection, intrauterine (fetal) death, stillbirth, perinatal death, or perinatal mortality.

Results: Twelve studies out of 693 search records from five SSA countries were included. One study identified a positive association between VMB dysbiosis and low birthweight. Despite considerable differences in study design and outcome reporting, studies reported an association between BV and preterm birth (7/9), low birthweight (2/6), PROM (2/4), intrauterine infections (1/1), and small for gestational age (1/1). None of the retrieved studies found an association between BV and pregnancy loss (5/5) or intrauterine growth retardation (1/1). At least two studies support the association between BV and PROM, low birthweight, and preterm birth in Nigerian pregnant women. No reports were identified investigating the association between AV and late adverse pregnancy outcomes in SSA.

Conclusion: Two of the included studies from SSA support the association between BV and PROM. The remaining studies show discrepancies in supporting an association between BV and preterm birth or low birthweight. None of the studies found an association between BV and pregnancy loss. As for the role of VMB dysbiosis, BV, and AV during pregnancy among SSA women, additional research is needed. These results provide useful evidence for prevention efforts to decrease vaginal dysbiosis and its contribution to adverse pregnancy outcomes in SSA.

Significant Burden and Psychological Distress Among Caregivers of Children With Nephrotic Syndrome: A Cross-Sectional Study

Background:

Childhood nephrotic syndrome (NS) follows a chronic course in most children. However, little is known about the psychosocial burden of NS on the caregivers despite evidence that caregiver burden or impairment in their well-being may alter the outcome of chronic childhood illnesses.

Objectives:

To determine the frequency and predictors of significant caregiver burden and psychological distress among caregivers of children with NS.

Design:

A cross-sectional study.

Setting:

Two pediatric nephrology clinics in Lagos, Nigeria.

Patients:

We included primary caregivers of children with idiopathic NS for at least 6 months.

Measurements:

The primary outcomes were psychological distress and significant caregiver burden among caregivers.

Methods:

We interviewed caregivers using the 12-item General Health Questionnaire (GHQ-12) and the 6-item Zarit Burden Interview (ZBI-6). The GHQ-12 scores ≥ 3 and ZBI-6 scores ≥ 6 indicated psychological distress and significant caregiver burden, respectively.

Results:

The caregivers were mostly mothers (77.9%) and married (92.4%), whereas the children (n = 172) were mainly male (65.1%). Most of the children (n = 152; 88.4%) had steroid-sensitive NS including 24 (14%) children with frequent relapses or steroid dependence and 20 (11.6%) with steroid-resistant NS. Of the 172 caregivers, 53 (30.8%) and 30 (17.4%) reported psychological distress and significant burden, respectively. Caregivers of children in relapse had adjusted an odds ratio (aOR) with 95% confidence interval (CI) of 2.45 (1.05-5.67) and 3.30 (1.22-8.92) of psychological distress and significant caregiver burden, respectively. Furthermore, caregivers of male children and those who needed help paying for health care had an aOR of 4.61 (1.34-15.68) and 3.06 (1.06-8.87) of significant caregiver burden, respectively.

Limitations:

The study was limited by its cross-sectional design and the use of generic rather than disease-specific instruments.

Conclusion:

One in every 6 caregivers of children with idiopathic NS reported significant caregiver burden, and it was associated with psychological distress. Our findings underscore the need for psychosocial support for caregivers of children with NS, especially those with identifiable vulnerability.

Impact of a school-based water, sanitation, and hygiene intervention on school absence, diarrhea, respiratory infection, and soil-transmitted helminths: results from the WASH HELPS cluster-randomized trial

Background

Water, sanitation, and hygiene (WASH) in schools is promoted by development agencies as a modality to improve school attendance by reducing illness. Despite biological plausibility, the few rigorous studies that have assessed the effect of WASH in schools (WinS) interventions on pupil health and school attendance have reported mixed impacts. We evaluated the impact of the Laos Basic Education, Water, Sanitation and Hygiene Programme – a comprehensive WinS project implemented by UNICEF Lao People’s Democratic Republic (Lao PDR) in 492 primary schools nationwide between 2013 and 2017 – on pupil education and health.

Methods

From 2014-2017, we conducted a cluster-randomized trial among 100 randomly selected primary schools lacking functional WASH facilities in Saravane Province, Lao PDR. Schools were randomly assigned to either the intervention (n = 50) or comparison (n = 50) arm. Intervention schools received a school water supply, sanitation facilities, handwashing facilities, drinking water filters, and behavior change education and promotion. Comparison schools received the intervention after research activities ended. At unannounced visits every six to eight weeks, enumerators recorded pupils’ roll-call absence, enrollment, attrition, progression to the next grade, and reported illness (diarrhea, respiratory infection, conjunctivitis), and conducted structured observations to measure intervention fidelity and adherence. Stool samples were collected annually prior to de-worming and analyzed for soil-transmitted helminth (STH) infection. In addition to our primary intention-to-treat analysis, we conducted secondary analyses to quantify the role of intervention fidelity and adherence on project impacts.

Results

We found no impact of the WinS intervention on any primary (pupil absence) or secondary (enrollment, dropout, grade progression, diarrhea, respiratory infection, conjunctivitis, STH infection) impacts. Even among schools with the highest levels of fidelity and adherence, impact of the intervention on absence and health was minimal.

Conclusions

While WinS may create an important enabling environment, WinS interventions alone and as currently delivered may not be sufficient to independently impact pupil education and health. Our results are consistent with other recent evaluations of WinS projects showing limited or mixed effects of WinS.

Transforming Screening Uptake in Low-resource and Underinformed Populations: A Preliminary Study of Factors Influencing Women's Decisions to Uptake Screening

OBJECTIVES

The objective of this study was to assess the factors influencing women's decision to uptake screening mammography in an underinformed population.

STUDY DESIGN

The study is a cross-sectional survey of factors influencing screening uptake.

METHODS

A modified breast cancer awareness measure was used to assess women's knowledge of breast cancer, mammography, and factors that influence screening uptake. A second questionnaire investigated health professionals' (HPs') attitude to screening and the criteria for screening recommendation. Descriptive statistics were used to assess women's breast cancer awareness, factors that influence screening uptake, and HPs' attitude to breast cancer education and mammography recommendation. We ranked HPs' responses pertaining to criteria for screening recommendation using a Kendall's W test.

RESULTS

Sixty-nine percent (n = 180) of women were aware of breast cancer, and half of them had performed breast self-examination (n = 131). About 53% (n = 138) of women were not aware of mammography, and only 15.4% (n = 40) of them have had a screening mammogram. Women's awareness of breast cancer risk factors and symptoms was poor. Many women would consider having a screening mammogram if instructed to do so by their husbands (87.7%; n = 228), HPs (96.2%; n = 250), and if government-funded screening programmes are available (90%; n = 234). Less than 40% (n = 21) of HPs had referred at least one woman for screening mammography within the last 6 months. Family history, age, and reproductive factors ranked as the highest criteria for screening recommendation.

CONCLUSIONS

Spouses and HPs may be crucial to changing the current status quo around screening utilisation and government-funded screening programmes may increase screening uptake.

School-Based versus Community-Based Sampling for Trachoma Surveillance

Trachoma surveillance is typically performed via random sampling of endemic districts. This strategy minimizes bias and allows examination of preschool children, but is also expensive. Surveillance for some other neglected tropical diseases is carried out in schools, which is logistically easier. In the present study, the prevalence of trachomatous inflammation-follicular (TF) from a population-based sample of children from each of 70 communities in Ethiopia was compared with the corresponding school-based estimate, which was calculated for each community by performing examinations in all primary schools in the district. The overall prevalence of TF was 39.1% (95% confidence interval [CI]: 35.0-43.1%) among children aged 1-9 years in the community-based sample and 18.8% (95% CI: 15.9-21.7%) among children in grades 1-3 of the school-based sample. School-based estimates of TF explained 35% of the variation in the community-based prevalences (P < 0.001). When TF prevalence was used as a diagnostic test for detecting a community with > 5% prevalence of ocular chlamydia, the area under the receiver operating characteristic curve was 0.73 (95% CI: 0.60-0.85) for the school-based sample and 0.71 (0.58-0.83) for the community-based sample (P = 0.76). Thus, although school-based monitoring was necessarily biased relative to population-based monitoring of 1- to 9-year olds, the two methods provided a similar amount of information about the community burden of ocular chlamydia in this trachoma-hyperendemic setting. The generalizability of these findings to areas with less prevalent trachoma is unclear.

Household structure vs. composition: Understanding gendered effects on educational progress in rural South Africa

BACKGROUND

Demographers have long been interested in the relationship between living arrangements and gendered outcomes for children in sub-Saharan Africa. Most extant research conflates household structure with composition and has revealed little about the pathways that link these components to gendered outcomes.

OBJECTIVES

First, we offer a conceptual approach that differentiates structure from composition with a focus on gendered processes that operate in the household; and second, we demonstrate the value of this approach through an analysis of educational progress for boys and girls in rural South Africa.

METHODS

We use data from the 2002 round of the Agincourt Health and Demographic Surveillance System. Our analytical sample includes 22,997 children aged 6-18 who were neither parents themselves nor lived with a partner or partner's family. We employ ordinary least squares regression models to examine the effects of structure and composition on educational progress of girls and boys.

RESULTS

The results suggest that non-nuclear structures are associated with similar negative effects for both boys and girls compared to children growing up in nuclear households. However, the presence of other kin in the absence of one or both parents results in gendered effects favouring boys.

CONCLUSION

The absence of any gendered effects when using a household structure typology suggests that secular changes to attitudes about gender equity trump any specific gendered processes stemming from particular configurations. On the other hand, gendered effects that appear when one or both parents are absent show that traditional gender norms and/or resource constraints continue to favour boys.

CONTRIBUTION

Despite the wealth of literature on household structure and children's educational outcomes in sub-Saharan Africa, the conceptual basis of these effects has not been well articulated. We have shown the value of unpacking household structure to better understand how gender norms and gendered resource allocations impact education.

Academic Achievement and Psychosocial Profile of Egyptian Primary School Children in South Sinai

BACKGROUND

Population of South Sinai has suffered from negligence for many years. Solving educational problems of this population is the main concern nowadays.

AIM

To assess academic achievement in primary school children in South Sinai in relation to intelligence and psychosocial profile.

SUBJECTS AND METHODS

A descriptive cross-sectional survey was conducted on 407 Bedouin and urban students randomly selected from twelve public primary schools in six cities in South Sinai. Intelligence was assessed using Goodenough-Harris test. The midyear Arabic language and Arithmetic scores were used to assess academic achievement. The teachers completed a Pediatric-Symptom Checklist for evaluation of children behaviour.

RESULTS

A statistically significant difference in academic achievement (P < 0.001), total psychosocial scores, (P < 0.05), and externalization (P < 0.05) was found between urban and Bedouin students with significant gender differences (P < 0.05). Highly significant positive correlations were observed between IQ percentile and mid-year Arabic language scores and Arithmetic scores (P < 0.001), and significant negative correlations with the total score of PSCL and its subscale scores (externalising, inattention, and internalising behaviour) (P < 0.001) among the students.

CONCLUSION

Comorbid academic and psychosocial dysfunction in primary school children were observed in South Sinai. A national strategy to minimise the educational gap between Bedouin and urban areas should be implemented.

A cluster-randomized trial assessing the impact of school water, sanitation, and hygiene improvements on pupil enrollment and gender parity in enrollment

We employed a cluster randomized trial design to measure the impact of a school based water, sanitation, and hygiene (WASH) improvement on pupil enrollment and on gender parity in enrollment, in primary schools in Nyanza Province, Kenya (2007-2009). Among schools with poor water access during the dry season, those that received a water supply, hygiene promotion and water treatment (HP&WT) and sanitation improvement, demonstrated increased enrollment (β=0.091 [0.009, 0.173] p=0.03), which translates to 26 additional pupils per school on average. The proportion of girls enrolled in school also increased by 4% (prevalence ratio (PR)=1.04 [1.00, 1.07] p=0.02). Among schools with better baseline water access during the dry season (schools that didn't receive a water source), we found no evidence of increased enrollment in schools that received a HP&WT intervention (β=0.016 [-0.039, 0.072] p=0.56) or the HP&WT and sanitation intervention (β=0.027 [-0.028, 0.082]p=0.34), and there was no evidence of improved gender parity (PR=0.99 [0.96, 1.02] p=0.59, PR=1.00 [0.97, 1.02] p=0.75, respectively). Our findings suggest that increased school enrollment and improved gender parity may be influenced by a comprehensive WASH program that includes an improved water source; schools with poor water access during the dry season may benefit most from these interventions.