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Itanyi IU, Iwelunmor J, Olawepo JO, Gbadamosi S, Ezeonu A, Okoli A, Ogidi AG, Conserve D, Powell B, Onoka CA, Ezeanolue EE. Acceptability and user experiences of a patient-held smart card for antenatal services in Nigeria: a qualitative study. BMC Pregnancy Childbirth 2023; 23:198. [PMID: 36949403 PMCID: PMC10031993 DOI: 10.1186/s12884-023-05494-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 03/03/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Poor maternal, newborn and child health outcomes remain a major public health challenge in Nigeria. Mobile health (mHealth) interventions such as patient-held smart cards have been proposed as effective solutions to improve maternal health outcomes. Our objectives were to assess the acceptability and experiences of pregnant women with the use of a patient-held smartcard for antenatal services in Nigeria. METHODS Using focus group discussions, qualitative data were obtained from 35 pregnant women attending antenatal services in four Local Government Areas (LGAs) in Benue State, Nigeria. The audio-recorded data were transcribed and analyzed using framework analysis techniques such as the PEN-3 cultural model as a guide. RESULTS The participants were 18-44 years of age (median age: 24 years), all were married and the majority were farmers. Most of the participants had accepted and used the smartcards for antenatal services. The most common positive perceptions about the smartcards were their ability to be used across multiple health facilities, the preference for storage of the women's medical information on the smartcards compared to the usual paper-based system, and shorter waiting times at the clinics. Notable facilitators to using the smartcards were its provision at the "Baby showers" which were already acceptable to the women, access to free medical screenings, and ease of storage and retrieval of health records from the cards. Costs associated with health services was reported as a major barrier to using the smartcards. Support from health workers, program staff and family members, particularly spouses, encouraged the participants to use the smartcards. CONCLUSION These findings revealed that patient-held smart card for maternal health care services is acceptable by women utilizing antenatal services in Nigeria. Understanding perceptions, barriers, facilitators, and supportive systems that enhance the use of these smart cards may facilitate the development of lifesaving mobile health platforms that have the potential to achieve antenatal, delivery, and postnatal targets in a resource-limited setting.
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Affiliation(s)
- Ijeoma Uchenna Itanyi
- Department of Community Medicine, College of Medicine, University of Nigeria Nsukka, Enugu, Nigeria
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Juliet Iwelunmor
- Department of Behavioral Science and Health Education, Saint Louis University, Saint Louis, USA
| | - John Olajide Olawepo
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Semiu Gbadamosi
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Alexandra Ezeonu
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Adaeze Okoli
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Amaka Grace Ogidi
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Donaldson Conserve
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, USA
| | - Byron Powell
- Brown School, Washington University in St. Louis, Washington, USA
| | - Chima Ariel Onoka
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
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Buitendyk M, Kosgei W, Thorne J, Millar H, Alera JM, Kibet V, Bernard CO, Payne BA, Bernard C, Christoffersen-Deb A. Impact of free maternity services on outcomes related to hypertensive disorders of pregnancy at Moi Teaching and Referral Hospital in Kenya: a retrospective analysis. BMC Pregnancy Childbirth 2023; 23:98. [PMID: 36747137 PMCID: PMC9901094 DOI: 10.1186/s12884-023-05381-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 09/27/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Preeclampsia is a major contributor to maternal and neonatal mortality worldwide. Ninety-nine percent of these deaths occur in resource limited settings. One of the greatest barriers to women seeking medical attention remains the cost of care. Kenya implemented a nation-wide policy change in 2013, offering free inpatient maternity services to all women to address this concern. Here, we explore the impact of this policy change on maternal and neonatal outcomes specific to the hypertensive disorders of pregnancy. METHODS We conducted a retrospective cross-sectional chart review of patients discharged or deceased with a diagnosis of gestational hypertension, preeclampsia, eclampsia or HELLP syndrome at a tertiary referral center in western Kenya one year before (June 1, 2012-May 31, 2013) and one year after (June 1, 2013-May 31, 2014) free maternity services were introduced at public facilities across the country. Demographic information, obstetric history, medical history, details of the current pregnancy, diagnosis on admission and at discharge, antepartum treatment, maternal outcomes, and neonatal outcomes were collected and comparisons were made between the time points. RESULTS There were more in hospital births after policy change was introduced. The proportion of women diagnosed with a hypertensive disorder of pregnancy was higher in the year before free maternity care although there was a statistically significant increase in the proportion of women diagnosed with gestational hypertension after policy change. Among those diagnosed with hypertensive disorders, there was no difference in the proportion who developed obstetric or medical complications. Of concern, there was a statistically significant increase in the proportion of women dying as a result of their condition. There was a statistically significant increase in the use of magnesium sulfate for seizure prophylaxis. There was no overall difference in the use of anti-hypertensives between groups and no overall difference in the proportion of women who received dexamethasone for fetal lung maturity. CONCLUSIONS Free maternity services, however necessary, are insufficient to improve maternal and neonatal outcomes related to the hypertensive disorders of pregnancy at a tertiary referral center in western Kenya. Multiple complementary strategies acting in unison are urgently needed.
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Affiliation(s)
- Marie Buitendyk
- School of Medicine, Department of Obstetrics and Gynecology, University of Toronto, 27 King's College Circle, Toronto, ON, M5S, Canada. .,Moi Teaching and Referral Hospital, Eldoret, Kenya.
| | - Wycliffe Kosgei
- grid.513271.30000 0001 0041 5300Moi Teaching and Referral Hospital, Eldoret, Kenya ,grid.79730.3a0000 0001 0495 4256School of Medicine, Department of Obstetrics and Gynecology, Moi University, Eldoret, Kenya
| | - Julie Thorne
- grid.17063.330000 0001 2157 2938School of Medicine, Department of Obstetrics and Gynecology, University of Toronto, 27 King’s College Circle, Toronto, ON M5S Canada ,grid.513271.30000 0001 0041 5300Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Heather Millar
- grid.17063.330000 0001 2157 2938School of Medicine, Department of Obstetrics and Gynecology, University of Toronto, 27 King’s College Circle, Toronto, ON M5S Canada
| | - Joy Marsha Alera
- grid.512535.50000 0004 4687 6948AMPATH (Academic Model Providing Access to Health Care) Kenya, P.O. Box 4606, Eldoret, Kenya
| | - Vincent Kibet
- grid.513271.30000 0001 0041 5300Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Christian Ochieng Bernard
- grid.79730.3a0000 0001 0495 4256School of Medicine, Department of Obstetrics and Gynecology, Moi University, Eldoret, Kenya
| | - Beth A. Payne
- grid.17091.3e0000 0001 2288 9830School of Medicine, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia V6T 1Z4 Canada
| | - Caitlin Bernard
- grid.513271.30000 0001 0041 5300Moi Teaching and Referral Hospital, Eldoret, Kenya ,grid.411377.70000 0001 0790 959XSchool of Medicine, Department of Obstetrics and Gynecology, Indiana University, 107 S Indiana Ave, Bloomington, IN 47405 USA
| | - Astrid Christoffersen-Deb
- grid.513271.30000 0001 0041 5300Moi Teaching and Referral Hospital, Eldoret, Kenya ,grid.17091.3e0000 0001 2288 9830School of Medicine, Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia V6T 1Z4 Canada
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Ekhator-Mobayode UE, Gajanan S, Ekhator C. Does Health Insurance Eligibility Improve Child Health: Evidence From the National Health Insurance Scheme (NHIS) in Nigeria. Cureus 2022; 14:e28660. [PMID: 36196291 PMCID: PMC9526239 DOI: 10.7759/cureus.28660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 11/05/2022] Open
Abstract
Favorable child health outcomes are important for sustainable growth and development, especially for developing economies. However, Nigeria has some of the worst health indicators. The problem seems to be inadequate access to affordable healthcare, especially for children. To improve policies aimed at improving access to affordable healthcare for children in Nigeria through health insurance, it is important to measure the extent to which health insurance affects child health. This study examines the effects of health insurance on child health and healthcare utilization in Nigeria using the implementation and expansion of the National Health Insurance Scheme (NHIS) to introduce the exogenous variation in health insurance eligibility, a natural experiment that fits a difference-in-difference model. The findings suggest that health insurance increases birth weight. It also increases the probability that children receive polio and diphtheria vaccines. The findings suggest that the NHIS in Nigeria is effective in improving the health outcomes of children. Policies strengthening the take-up of the NHIS should be encouraged across all sectors and socio-economic groups in the economy.
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Nasir N, Aderoba AK, Ariana P. Scoping review of maternal and newborn health interventions and programmes in Nigeria. BMJ Open 2022; 12:e054784. [PMID: 35168976 PMCID: PMC8852735 DOI: 10.1136/bmjopen-2021-054784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To systematically scope and map research regarding interventions, programmes or strategies to improve maternal and newborn health (MNH) in Nigeria. DESIGN Scoping review. DATA SOURCES AND ELIGIBILITY CRITERIA Systematic searches were conducted from 1 June to 22 July 2020 in PubMed, Embase, Scopus, together with a search of the grey literature. Publications presenting interventions and programmes to improve maternal or newborn health or both in Nigeria were included. DATA EXTRACTION AND ANALYSIS The data extracted included source and year of publication, geographical setting, study design, target population(s), type of intervention/programme, reported outcomes and any reported facilitators or barriers. Data analysis involved descriptive numerical summaries and qualitative content analysis. We summarised the evidence using a framework combining WHO recommendations for MNH, the continuum of care and the social determinants of health frameworks to identify gaps where further research and action may be needed. RESULTS A total of 80 publications were included in this review. Most interventions (71%) were aligned with WHO recommendations, and half (n=40) targeted the pregnancy and childbirth stages of the continuum of care. Most of the programmes (n=74) examined the intermediate social determinants of maternal health related to health system factors within health facilities, with only a few interventions aimed at structural social determinants. An integrated approach to implementation and funding constraints were among factors reported as facilitators and barriers, respectively. CONCLUSION Using an integrated framework, we found most MNH interventions in Nigeria were aligned with the WHO recommendations and focused on the intermediate social determinants of health within health facilities. We determined a paucity of research on interventions targeting the structural social determinants and community-based approaches, and limited attention to pre-pregnancy interventions. To accelerate progress towards the sustainable development goal MNH targets, greater focus on implementing interventions and measuring context-specific challenges beyond the health facility is required.
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Affiliation(s)
- Naima Nasir
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
- APIN Clinic, Infectious Diseases Unit, Jos University Teaching Hospital, Jos, Plateau State, Nigeria
| | - Adeniyi Kolade Aderoba
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
- Department of Obstetrics and Gynaecology, Mother and Child Hospital, Akure, Ondo, Nigeria
| | - Proochista Ariana
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
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Kunnuji M, Eshiet I, Ahinkorah BO, Omogbemi T, Yaya S. Background predictors of time to death in infancy: evidence from a survival analysis of the 2018 Nigeria DHS data. BMC Public Health 2022; 22:15. [PMID: 34991534 PMCID: PMC8734103 DOI: 10.1186/s12889-021-12424-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Nigeria’s child health profile is quite concerning with an infant mortality rate of 67 deaths per 1000 live births and a significant slowing down in progress towards improving child health outcomes. Nigeria’s 2018 Demographic and Health Survey (DHS) suggests several bio-demographic risk factors for child death, including mother’s poor education, poverty, sex of child, age of mother, and location (rural vs urban) but studies are yet to explore the predictive power of these variables on infant survival in Nigeria. Methods The study extracted data for all births in the last 12 months preceding the 2018 Nigeria DHS and used the Cox proportional hazard model to predict infant survival in Nigeria. Failure in this analysis is death with two possible outcomes – dead/alive – while the survival time variable is age at death. We censored infants who were alive at the time of the study on the day of the interview. Covariates in the analysis were: age of mother, education of mother, wealth quintile, sex of child, location, region, place of delivery, and age of pregnancy. Results The study found that a higher education of a mother compared to no education (β = .429; p-value < 0.05); belonging to a household in the richer wealth quintile (β = .618; p-value < 0.05) or the highest quintile (β = .553; p-value < 0.05), compared to the lowest wealth quintile; and living in North West (β = 1.418; p-value < 0.05) or South East zone (β = 1.711; p-value < 0.05), significantly predict infant survival. Conclusion Addressing Nigeria’s infant survival problem requires interventions that give attention to the key drivers – education, socio-economic status, and socio-cultural contextual issues. We therefore recommend full implementation of the universal basic education policy, and child health education programs targeted at mothers as long- and short-term solutions to the problem of poor child health outcomes in Nigeria. We also argue in favor of better use of evidence in policy and program development in Nigeria.
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Affiliation(s)
- Michael Kunnuji
- Department of Sociology, University of Lagos, Lagos, Nigeria
| | | | | | | | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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Okereke E, Eluwa G, Akinola A, Suleiman I, Unumeri G, Adebajo S. Patterns of financial incentives in primary healthcare settings in Nigeria: implications for the productivity of frontline health workers. BMC Res Notes 2021; 14:250. [PMID: 34193253 PMCID: PMC8243849 DOI: 10.1186/s13104-021-05671-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 06/23/2021] [Indexed: 12/04/2022] Open
Abstract
Objective This study was designed to explore the patterns of financial incentives received by some frontline health workers (including nurses, midwives as well as community health workers in paid employment) and the implications for their productivity within rural settings in Nigeria. A cross-sectional quantitative design in two States in Nigeria was adopted. Structured interviews were conducted with 114 frontline health workers. Bivariate analysis and multivariate regression analysis were carried out to explore relationships between the satisfaction of frontline health workers with the financial incentives received and their productivity in rural settings as well as the extent of any such relationships. Results Bivariate analysis demonstrated a statistically significant relationship (P = 0.013) between satisfaction with incentives received by frontline health workers and their productivity in rural settings. When other predictors were controlled for within a multivariate regression model, those who received incentives and were satisfied with the incentives were about three times more likely to be more productive at work than those who were unsatisfied with incentives (AOR: 3.3; P = 0.009, 95% CI = 1.3–8.2). In conclusion, the determination of type and content of incentives should be done in consultation with all relevant stakeholders, including possibly a cross-section of health workers themselves. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05671-z.
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Affiliation(s)
- Ekechi Okereke
- Population Council, 16 Mafemi Crescent, off Solomon Lar Way, Utako, Abuja, Nigeria.
| | - George Eluwa
- Population Council, 16 Mafemi Crescent, off Solomon Lar Way, Utako, Abuja, Nigeria
| | - Akinwumi Akinola
- Population Council, 16 Mafemi Crescent, off Solomon Lar Way, Utako, Abuja, Nigeria
| | - Ibrahim Suleiman
- Population Council, 16 Mafemi Crescent, off Solomon Lar Way, Utako, Abuja, Nigeria
| | - Godwin Unumeri
- Population Council, 16 Mafemi Crescent, off Solomon Lar Way, Utako, Abuja, Nigeria
| | - Sylvia Adebajo
- Population Council, 16 Mafemi Crescent, off Solomon Lar Way, Utako, Abuja, Nigeria
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Jidong DE, Husain N, Ike TJ, Murshed M, Pwajok JY, Roche A, Karick H, Dagona ZK, Karuri GS, Francis C, Mwankon SB, Nyam PP. Maternal mental health and child well-being in Nigeria: A systematic review. Health Psychol Open 2021; 8:20551029211012199. [PMID: 33996136 PMCID: PMC8111276 DOI: 10.1177/20551029211012199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Maternal mental health distress has a disease burden of severe adverse effects for both mother and child. This review identified maternal mental health concerns, their impact on child growth and the current practice of maternal healthcare for both mothers and their children in Nigeria. The Population, phenomenon of Interest and Context (PICo) model was adopted to formulate the review strategy, and five databases were searched for published articles between 1999 and 2019. Databases include Scopus, PubMed, ProQuest, Applied Social Science Index and Abstracts and Web of Science. Boolean operators (AND/OR/NOT) helped to ensure rigorous use of search terms which include 'maternal', 'pre/peri/postnatal', 'mental health', 'mental illness', 'disorders', 'intervention,' 'Nigeria', 'child', 'infant growth', and 'wellbeing'. Thirty-four studies met the inclusion criteria, and extracted data were qualitatively synthesised and analysed thematically. Five themes emerged. These include (i) marital difficulties, (ii) relationship status of the mother, (iii) child's gender, (iv) mode of child delivery and (v) child growth and development. The review showed a significant paucity of literature on the impact of specific maternal mental health problems on child physical growth and cognitive development. We concluded that culturally appropriate and evidence-based psychological interventions for maternal mental health problems would benefit Nigerian indigenous mothers. Therefore, the study recommends randomised controlled trials that are culturally appropriate and cost-effective for distressed mothers with children.
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Oduenyi C, Banerjee J, Adetiloye O, Rawlins B, Okoli U, Orji B, Ugwa E, Ishola G, Betron M. Gender discrimination as a barrier to high-quality maternal and newborn health care in Nigeria: findings from a cross-sectional quality of care assessment. BMC Health Serv Res 2021; 21:198. [PMID: 33663499 PMCID: PMC7934485 DOI: 10.1186/s12913-021-06204-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 02/22/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor reproductive, maternal, newborn, child, and adolescent health outcomes in Nigeria can be attributed to several factors, not limited to low health service coverage, a lack of quality care, and gender inequity. Providers' gender-discriminatory attitudes, and men's limited positive involvement correlate with poor utilization and quality of services. We conducted a study at the beginning of a large family planning (FP) and maternal, newborn, child, and adolescent health program in Kogi and Ebonyi States of Nigeria to assess whether or not gender plays a role in access to, use of, and delivery of health services. METHODS We conducted a cross-sectional, observational, baseline quality of care assessment from April-July 2016 to inform a maternal and newborn health project in health facilities in Ebonyi and Kogi States. We observed 435 antenatal care consultations and 47 births, and interviewed 138 providers about their knowledge, training, experiences, working conditions, gender-sensitive and respectful care, and workplace gender dynamics. The United States Agency for International Development's Gender Analysis Framework was used to analyze findings. RESULTS Sixty percent of providers disagreed that a woman could choose a family planning method without a male partner's involvement, and 23.2% of providers disagreed that unmarried clients should use family planning. Ninety-eight percent believed men should participate in health services, yet only 10% encouraged women to bring their partners. Harmful practices were observed in 59.6% of deliveries and disrespectful or abusive practices were observed in 34.0%. No providers offered clients information, services, or referrals for gender-based violence. Sixty-seven percent reported observing or hearing of an incident of violence against clients, and 7.9% of providers experienced violence in the workplace themselves. Over 78% of providers received no training on gender, gender-based violence, or human rights in the past 3 years. CONCLUSION Addressing gender inequalities that limit women's access, choice, agency, and autonomy in health services as a quality of care issue is critical to reducing poor health outcomes in Nigeria. Inherent gender discrimination in health service delivery reinforces the critical need for gender analysis, gender responsive approaches, values clarification, and capacity building for service providers.
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Affiliation(s)
- Chioma Oduenyi
- Maternal and Child Survival Program and Jhpiego, Abuja, Plot 971 Reuben Okoya Crescent, Wuye District, P.O. Box 14832, Abuja, FCT, Nigeria.
| | - Joya Banerjee
- Maternal and Child Survival Program and Jhpiego, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA
| | - Oniyire Adetiloye
- Maternal and Child Survival Program and Jhpiego, Abuja, Plot 971 Reuben Okoya Crescent, Wuye District, P.O. Box 14832, Abuja, FCT, Nigeria
| | - Barbara Rawlins
- Maternal and Child Survival Program and Jhpiego, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA
| | - Ugo Okoli
- Maternal and Child Survival Program and Jhpiego, Abuja, Plot 971 Reuben Okoya Crescent, Wuye District, P.O. Box 14832, Abuja, FCT, Nigeria
| | - Bright Orji
- Maternal and Child Survival Program and Jhpiego, Abuja, Plot 971 Reuben Okoya Crescent, Wuye District, P.O. Box 14832, Abuja, FCT, Nigeria
| | - Emmanuel Ugwa
- Maternal and Child Survival Program and Jhpiego, Abuja, Plot 971 Reuben Okoya Crescent, Wuye District, P.O. Box 14832, Abuja, FCT, Nigeria
| | - Gbenga Ishola
- Maternal and Child Survival Program and Jhpiego, Abuja, Plot 971 Reuben Okoya Crescent, Wuye District, P.O. Box 14832, Abuja, FCT, Nigeria
| | - Myra Betron
- Maternal and Child Survival Program and Jhpiego, 1776 Massachusetts Ave, NW, Suite 300, Washington, DC, 20036, USA
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Hill Z, Scheelbeek P, Hamza Y, Amare Y, Schellenberg J. Are We Using the Right Approach to Change Newborn Care Practices in the Community? Qualitative Evidence From Ethiopia and Northern Nigeria. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:383-395. [PMID: 32709596 PMCID: PMC7541120 DOI: 10.9745/ghsp-d-19-00410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 06/12/2020] [Indexed: 11/25/2022]
Abstract
In Ethiopia, high community-level exposure to consistent messages and the perceptions of community health workers and relationships with them drove newborn care behavior change. In Nigeria, exposure to messages was limited, community health workers were less trusted, and behavior change was reported less frequently. Changing behaviors is usually a core component of the role of community health workers (CHWs), but little is known about the mechanisms through which they change behavior. We collected qualitative data from 8 sites in Ethiopia and northern Nigeria where CHWs were active to understand how they change newborn care behaviors. In each country, we conducted 12 narrative interviews and 12–13 in-depth interviews with recent mothers and 4 focus group discussions each with mothers, fathers, grandmothers, and CHWs. We identified 2 key mechanisms of behavior change. The first was linked to the frequency and consistency of hearing messages that led to a perception that change had occurred in community-wide behaviors, collective beliefs, and social expectations. The second was linked to trust in the CHW, obligation, and hierarchy. We found little evidence that constructs that often inform the design of counseling approaches, such as knowledge of causality and perceived risks and benefits, were mechanisms of change.
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Affiliation(s)
| | | | | | - Yared Amare
- Consultancy for Social Development, Addis Ababa, Ethiopia
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Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: an analysis for the Global Burden of Disease Study 2017. THE LANCET. INFECTIOUS DISEASES 2020; 20:60-79. [PMID: 31678026 PMCID: PMC7185492 DOI: 10.1016/s1473-3099(19)30410-4] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/13/2019] [Accepted: 07/05/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite large reductions in under-5 lower respiratory infection (LRI) mortality in many locations, the pace of progress for LRIs has generally lagged behind that of other childhood infectious diseases. To better inform programmes and policies focused on preventing and treating LRIs, we assessed the contributions and patterns of risk factor attribution, intervention coverage, and sociodemographic development in 195 countries and territories by drawing from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) LRI estimates. METHODS We used four strategies to model LRI burden: the mortality due to LRIs was modelled using vital registration data, demographic surveillance data, and verbal autopsy data in a predictive ensemble modelling tool; the incidence of LRIs was modelled using population representative surveys, health-care utilisation data, and scientific literature in a compartmental meta-regression tool; the attribution of risk factors for LRI mortality was modelled in a counterfactual framework; and trends in LRI mortality were analysed applying changes in exposure to risk factors over time. In GBD, infectious disease mortality, including that due to LRI, is among HIV-negative individuals. We categorised locations based on their burden in 1990 to make comparisons in the changing burden between 1990 and 2017 and evaluate the relative percent change in mortality rate, incidence, and risk factor exposure to explain differences in the health loss associated with LRIs among children younger than 5 years. FINDINGS In 2017, LRIs caused 808 920 deaths (95% uncertainty interval 747 286-873 591) in children younger than 5 years. Since 1990, there has been a substantial decrease in the number of deaths (from 2 337 538 to 808 920 deaths; 65·4% decrease, 61·5-68·5) and in mortality rate (from 362·7 deaths [330·1-392·0] per 100 000 children to 118·9 deaths [109·8-128·3] per 100 000 children; 67·2% decrease, 63·5-70·1). LRI incidence declined globally (32·4% decrease, 27·2-37·5). The percent change in under-5 mortality rate and incidence has varied across locations. Among the risk factors assessed in this study, those responsible for the greatest decrease in under-5 LRI mortality between 1990 and 2017 were increased coverage of vaccination against Haemophilus influenza type b (11·4% decrease, 0·0-24·5), increased pneumococcal vaccine coverage (6·3% decrease, 6·1-6·3), and reductions in household air pollution (8·4%, 6·8-9·2). INTERPRETATION Our findings show that there have been substantial but uneven declines in LRI mortality among countries between 1990 and 2017. Although improvements in indicators of sociodemographic development could explain some of these trends, changes in exposure to modifiable risk factors are related to the rates of decline in LRI mortality. No single intervention would universally accelerate reductions in health loss associated with LRIs in all settings, but emphasising the most dominant risk factors, particularly in countries with high case fatality, can contribute to the reduction of preventable deaths. FUNDING Bill & Melinda Gates Foundation.
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Okereke E, Ishaku SM, Unumeri G, Mohammed B, Ahonsi B. Reducing maternal and newborn mortality in Nigeria-a qualitative study of stakeholders' perceptions about the performance of community health workers and the introduction of community midwifery at primary healthcare level. HUMAN RESOURCES FOR HEALTH 2019; 17:102. [PMID: 31870383 PMCID: PMC6929448 DOI: 10.1186/s12960-019-0430-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Rural communities in Nigeria account for high maternal and newborn mortality rates in the country. Thus, there is a need for innovative models of service delivery, possibly with greater community engagement. Introducing and strengthening community midwifery practice within the Nigerian primary healthcare system is a clear policy option. The potential of community midwifery to increase the availability of skilled care during pregnancy, at birth and within postpartum periods in the health systems of developing countries has not been fully explored. This study was designed to assess stakeholders' perceptions about the performance of community health workers and the feasibility of introducing and using community midwifery to address the high maternal and newborn mortality within the Nigerian healthcare system. METHODS This study was undertaken in two human resources for health (HRH) project focal states (Bauchi and Cross River States) in Nigeria, utilizing a qualitative research design. Interviews were conducted with 44 purposively selected key informants. Key informants were selected based on their knowledge and experience working with different cadres of frontline health workers at primary healthcare level. The qualitative data were audio-recorded, transcribed and then thematically analysed. RESULTS Some study participants felt that introducing community midwifery will increase access to maternal and newborn healthcare services, especially in rural communities. Others felt that applying community midwifery at the primary healthcare level may lead to duplication of duties among the health worker cadres, possibly creating disharmony. Some key informants suggested that there should be concerted efforts to train and retrain the existing cadres of community health workers via the effective implementation of the task shifting policy in Nigeria, in addition to possibly revising the existing training curricula, instead of introducing community midwifery. CONCLUSION Applying community midwifery within the Nigerian healthcare system has the potential to increase the availability of skilled care during pregnancy, at birth and within postpartum periods, especially in rural communities. However, there needs to be broader stakeholder engagement, more awareness creation and the careful consideration of modalities for introducing and strengthening community midwifery training and practice within the Nigerian health system as well as within the health systems of other developing countries.
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Affiliation(s)
- Ekechi Okereke
- Population Council, 16 Mafemi Crescent, off Solomon Lar Way, Utako, Abuja, Nigeria
| | | | - Godwin Unumeri
- Population Council, 16 Mafemi Crescent, off Solomon Lar Way, Utako, Abuja, Nigeria
| | | | - Babatunde Ahonsi
- UNFPA China, 1-161 Tayuan Diplomatic Office Building, Beijing, China
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12
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Uneke CJ, Sombie I, Uro-Chukwu HC, Johnson E. Developing equity-focused interventions for maternal and child health in Nigeria: an evidence synthesis for policy, based on equitable impact sensitive tool (EQUIST). Pan Afr Med J 2019; 34:158. [PMID: 32153698 PMCID: PMC7046112 DOI: 10.11604/pamj.2019.34.158.16622] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 08/12/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Among the most critical health systems components that requires strengthening to improve maternal, newborn and child health (MNCH) outcomes in Nigeria is the concept of equity. UNICEF has designed the equitable impact sensitive tool (EQUIST) to enable policymakers improve equity in MNCH and reduce disparities between the most marginalized mothers and young children and the better-off. Methods Using the latest available DHS data sets, we conducted EQUIST situation and scenario analysis of MNCH outcomes in Nigeria by sub-national categorization, wealth and by residence. We then identified the intervention package, the bottlenecks and strategies to address them and the number of deaths avertible. Results EQUIST profile analysis showed that the number of under-five deaths was considerably higher among the poorest and rural population in Nigeria, and was highest in North-West region. Neonatal causes, malaria, pneumonia and diarrhoea were responsible for most of the under-five deaths. Highest maternal mortality was recorded in the North-West Nigeria. Ante-partum, intrapartum and postpartum haemorrhages and hypertensive disorder, were responsible for highest maternal deaths. EQUIST scenario analysis showed that an intervention package of insecticide treated net can avert more than 20,000 under-five deaths and delivery by skilled professionals can avert nearly 17,000 under-five deaths. While as many as 3,370 maternal deaths can be averted by deployment of skilled professionals. Conclusion Scaling up integrated packages of essential interventions across the continuum of care, addressing the human resource shortages in rural area and economic/social empowerment of women are policy recommendations that can improve MNCH outcomes in Nigeria.
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Affiliation(s)
- Chigozie Jesse Uneke
- African Institute for Health Policy and Health Systems, Ebonyi State University, PMB 053 Abakaliki, Nigeria
| | - Issiaka Sombie
- West African Health Organization, 175, Avenue Ouezzin Coulibaly, 01 BP 153 Bobo Dioulasso 01, Burkina Faso
| | | | - Ermel Johnson
- West African Health Organization, 175, Avenue Ouezzin Coulibaly, 01 BP 153 Bobo Dioulasso 01, Burkina Faso
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Vigna‐Taglianti F, Alesina M, Damjanović L, Mehanović E, Akanidomo I, Pwajok J, Prichard G, Kreeft P, Virk HK. Knowledge, attitudes and behaviours on tobacco, alcohol and other drugs among Nigerian secondary school students: Differences by geopolitical zones. Drug Alcohol Rev 2019; 38:712-724. [DOI: 10.1111/dar.12974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Federica Vigna‐Taglianti
- Department of Clinical and Biological SciencesUniversity of Torino Torino Italy
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco Torino Italy
| | - Marta Alesina
- Department of Clinical and Biological SciencesUniversity of Torino Torino Italy
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco Torino Italy
| | - Ljiljana Damjanović
- Department of Clinical and Biological SciencesUniversity of Torino Torino Italy
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco Torino Italy
| | - Emina Mehanović
- Department of Clinical and Biological SciencesUniversity of Torino Torino Italy
- Piedmont Centre for Drug Addiction Epidemiology, ASL TO3, Grugliasco Torino Italy
| | - Ibanga Akanidomo
- United Nations Office on Drugs and Crime, Project Office Lagos Nigeria
| | | | - Glen Prichard
- United Nations Office on Drugs and Crime, Project Office Lagos Nigeria
| | - Peer Kreeft
- Faculty for Education, Health and Social Work, University College Ghent Belgium
| | - Harsheth K. Virk
- United Nations Office on Drugs and Crime, Project Office Lagos Nigeria
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Ogbuabor DC, Onwujekwe OE. Implementation of free maternal and child healthcare policies: assessment of influence of context and institutional capacity of health facilities in South-east Nigeria. Glob Health Action 2019; 11:1535031. [PMID: 30353792 PMCID: PMC6201800 DOI: 10.1080/16549716.2018.1535031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Studies examining how the capacity of health facilities affect implementation of free healthcare policies in low and middle-income countries are limited. OBJECTIVE This study describes how the context and institutional capacity of health facilities influenced implementation of the free maternal and child health programme (FMCHP) in Enugu state, South-east Nigeria. METHODS We conducted a qualitative case study at the state level and in two health districts (Isi-Uzo and Enugu Metropolis) in Enugu State. Data were collected through document review and semi-structured, in-depth interviews with policymakers (n = 16), healthcare providers (n = 16) and health facility committee leaders (n = 12) guided by an existing capacity framework and analysed using a thematic framework approach. RESULTS The findings reveal that active health facility committees, changes in provider payment process, supportive supervision, drug revolving fund, availability of medical equipment, electronic data transmission and staff sanction system enhanced the capacity of health facilities to offer free healthcare. However, ineffective decentralisation, irregular supervision and weak citizen participation limited this capacity. Uncertain provider payment, evidence of tax payment policy and a co-existing fee-exempt scheme constrained health facilities in following the FMCHP guidelines. Poor recording and reporting skills and lack of support from district officials constrained providers' adherence to claims' submission timeline. Poor funding, weak drug supply system, inadequate infrastructure and lack of participatory decision-making constrained delivery of free healthcare. Insufficient trained workforce, mission-inconsistent postings and transfers, and weak staff disciplinary system limited the human resource capacity. CONCLUSIONS Effectiveness of FMCHP at the health facility level depends on the extent of decentralisation, citizen participation, concurrent and conflictive policies, timely payment of providers, organisation of service delivery and human resources practices. Attention to these contextual and institutional factors will enhance responsiveness of health facilities, sustainability of free healthcare policies and progress towards universal health coverage.
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Affiliation(s)
- Daniel C Ogbuabor
- a Department of Health Administration and Management , University of Nigeria Enugu Campus , Enugu , Nigeria.,b Department of Health Systems and Policy , Sustainable Impact Resource Agency , Enugu , Nigeria
| | - Obinna E Onwujekwe
- a Department of Health Administration and Management , University of Nigeria Enugu Campus , Enugu , Nigeria.,c Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine , University of Nigeria Enugu Campus , Enugu , Nigeria
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15
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Ogbo FA, Okoro A, Olusanya BO, Olusanya J, Ifegwu IK, Awosemo AO, Ogeleka P, Page A. Diarrhoea deaths and disability-adjusted life years attributable to suboptimal breastfeeding practices in Nigeria: findings from the global burden of disease study 2016. Int Breastfeed J 2019; 14:4. [PMID: 30647767 PMCID: PMC6327380 DOI: 10.1186/s13006-019-0198-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 01/01/2019] [Indexed: 12/11/2022] Open
Abstract
Background In Nigeria, diarrhoea contributes significantly to childhood morbidity and mortality, with suboptimal breastfeeding practices playing a key role. The present study aimed to report on diarrhoea deaths and disability-adjusted life years (DALYs) among children aged under five years attributable to suboptimal breastfeeding practices in Nigeria. Methods This study used data from the Global Burden of Disease study 2016, which estimated mortality from diarrhoea in the Cause of Death Ensemble model. Suboptimal breastfeeding was assessed as a combination of non-exclusive breastfeeding and discontinued breastfeeding. The comparative risk assessment approach was used to estimate the attributable burden of diarrhoea deaths and DALYs due to suboptimal breastfeeding practices in the spatial-temporal Gaussian Process Regression tool. Results In 2016, suboptimal breastfeeding practices accounted for an estimated 56.5% (95% uncertainty intervals [UI]: 47.5, 68.3) of diarrhoea deaths in the late neonatal period, 39.0% (31.0, 46.3) in post-neonatal period, 39.0% (31.3, 46.20) in infancy period and 22.8% (16.9, 29.9) in children aged under five years in Nigeria. In the same year, 22,371 (14,259, 32,746) total diarrhoea deaths in children under five years could be attributed to suboptimal breastfeeding practices. DALYs from diarrhoea attributable to suboptimal breastfeeding practices was 1.9 million (1.2, 2.8 million) among children under five years in 2016. Between 1990 and 2016, the proportion of children who died from diarrhoea due to suboptimal breastfeeding did not change substantially across all age groups in Nigeria. Conclusions Suboptimal breastfeeding practices remain a significant contributor to diarrhoea mortality and disability among children under five years in Nigeria. The study builds on previously published works on breastfeeding practices in Nigeria and provides evidence to support calls for the scale-up of efforts to improve infant feeding outcomes and reduce diarrhoea burden in Nigeria. Electronic supplementary material The online version of this article (10.1186/s13006-019-0198-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Felix Akpojene Ogbo
- 1Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, NSW Australia.,Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State Nigeria
| | - Anselm Okoro
- Independent Public Health Consultant, 4 Joy Street Cooperative City Gardens, Sabon Lugbe, Abuja, Nigeria
| | - Bolajoko O Olusanya
- 4Centre for Healthy Start Initiative, 286A Corporation Drive, Dolphin Estate, Ikoyi, Lagos, Nigeria
| | - Jacob Olusanya
- 4Centre for Healthy Start Initiative, 286A Corporation Drive, Dolphin Estate, Ikoyi, Lagos, Nigeria
| | - Ifegwu K Ifegwu
- Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State Nigeria
| | - Akorede O Awosemo
- Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State Nigeria
| | - Pascal Ogeleka
- Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State Nigeria
| | - Andrew Page
- 1Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, NSW Australia
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Akinyemi JO, Bolajoko I, Gbadebo BM. Death of preceding child and maternal healthcare services utilisation in Nigeria: investigation using lagged logit models. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2018; 37:23. [PMID: 30404661 PMCID: PMC6222986 DOI: 10.1186/s41043-018-0154-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 10/23/2018] [Indexed: 05/16/2023]
Abstract
BACKGROUND One of the factors responsible for high level of childhood mortality in Nigeria is poor utilization of maternal healthcare (MHC) services. Another important perspective which has been rarely explored is the influence of childhood death on MHC service utilization. In this study, we examined the relationship between death of preceding child and MHC services utilization [antenatal care (ANC), skilled attendant at birth (SAB), and postnatal care (PNC)] among Nigerian women and across the six geo-political zones of the country. METHODOLOGY We analyzed reproductive history dataset for 16,747 index births extracted from the 2013 Nigeria Demographic and Health Survey. The main explanatory variable was survival status of preceding child; therefore, only second or higher order births were considered. Analysis involved the use of descriptive statistics and lagged logit models fitted for each measure of MHC utilization. Association and statistical significance were expressed as adjusted odds ratio (AOR) with 95% confidence interval. RESULTS The use of MCH services for most recent births in the 2013 Nigeria DHS were ANC (56.0%), SAB (34.7%), and PNC (27.3%). Univariate models revealed that the death of preceding child was associated with lesser likelihood of ANC (OR = 0.64, CI 0.57-0.71), SAB (OR = 0.56, CI 0.50-0.63), and PNC (OR = 0.65, CI 0.55-0.69). Following adjustment for maternal socio-economic and bio-demographic variables, statistical significance in the relationship disappeared for the three MHC indicators: ANC (AOR = 1.00, CI 0.88-1.14), SAB (AOR = 0.97, CI 0.81-1.15), and PNC (AOR = 0.95, CI 0.83-1.11). There were no significant variations across the six geo-political regions in Nigeria. The likelihood of ANC utilization was higher when the preceding child died in Northcentral (AOR = 1.19, CI 0.84-1.70), Northeast (AOR = 1.26, CI 0.99-1.59), and South-south (AOR = 1.19, CI 0.72-1.99) regions while the reverse is the case in Southeast (AOR = 0.39, CI 0.23-0.60). For the Southeast, similar result was obtained for ANC, SAB, and PNC. CONCLUSION Death of a preceding child does not predict MHC services use in Nigeria especially when maternal socio-economic characteristics are controlled. Variations across the Northern and Southern regions did not attain statistical significance. Interventions are needed to reverse the pattern such that greater MHC utilization is recorded among women who have experienced child death.
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Affiliation(s)
- Joshua O. Akinyemi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo State Nigeria
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Izzatullah Bolajoko
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo State Nigeria
| | - Babatunde M. Gbadebo
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo State Nigeria
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17
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Ogbo FA, Ogeleka P, Okoro A, Olusanya BO, Olusanya J, Ifegwu IK, Awosemo AO, Eastwood J, Page A. Tuberculosis disease burden and attributable risk factors in Nigeria, 1990-2016. Trop Med Health 2018; 46:34. [PMID: 30262990 PMCID: PMC6156953 DOI: 10.1186/s41182-018-0114-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 09/04/2018] [Indexed: 12/18/2022] Open
Abstract
Background According to the World Health Organization, Nigeria is one of the countries with a high burden of tuberculosis (TB) worldwide. Improving the burden of TB among HIV-negative people would require comprehensive and up-to-date data to inform targeted policy actions in Nigeria. The study aimed to describe the incidence, prevalence, mortality, disability-adjusted life years (DALYs) and risk factors of tuberculosis in Nigeria between 1990 and 2016. Methods This study used the most recent data from the global burden of disease study 2016. TB deaths were estimated using the Cause of Death Ensemble model, while TB incidence, prevalence and DALYs, as well as years of life lost and years of life lived with disability were calculated in the DisMod-MR 2.1, a Bayesian meta-regression tool. Using a comparative risk assessment approach, TB burden attributable to risk factors was estimated in a spatial-temporal Gaussian Process Regression tool. Results In 2016, the prevalence of TB among HIV-negative people was 27% (95% uncertainty interval [95% UI] 23–31%) in Nigeria. TB incidence rate (new and relapse cases) was 158 per 100,000 people (95% UI; 128-193), while the total number of TB mortality was 39,933 deaths (95% UI; 30,488-55,039) in 2016. Between 2000 and 2016, the age-standardised prevalence and incidence rates of TB-HIV negative decreased by 20.0 and 87.6%, respectively. The age-standardised mortality rate also dropped by 191.6% over the same period. DALYs due to TB among HIV-negative Nigerians was high but varied across the age groups. Of the risk factors studied, alcohol use accounted for the highest number of TB deaths and DALYs, followed by diabetes and smoking in 2016. Conclusion The study shows an improving trend in TB disease burden among HIV-negative individuals in Nigeria from 1990 to 2016. Despite this progress, this study suggests that additional efforts are still needed to ensure that Nigeria is not left behind in the current global strategy to end TB disease. Reducing TB disease burden in the country will require a multipronged approach that includes increased funding, health system strengthening and improved TB surveillance, as well as preventive efforts for alcohol use, smoking and diabetes. Electronic supplementary material The online version of this article (10.1186/s41182-018-0114-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Felix Akpojene Ogbo
- 1Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, New South Wales Australia.,Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State Nigeria
| | - Pascal Ogeleka
- Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State Nigeria
| | - Anselm Okoro
- 3Society for Family Health, Justice Ifeyinwa Nzeako House, 8 Port Harcourt Crescent Area 11, Garki, Abuja, Nigeria
| | - Bolajoko O Olusanya
- 4Centre for Healthy Start Initiative, 286A Corporation Drive, Dolphin Estate, Ikoyi, Lagos, Nigeria
| | - Jacob Olusanya
- 4Centre for Healthy Start Initiative, 286A Corporation Drive, Dolphin Estate, Ikoyi, Lagos, Nigeria
| | - Ifegwu K Ifegwu
- Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State Nigeria
| | - Akorede O Awosemo
- Prescot Specialist Medical Centre, Welfare Quarters, Makurdi, Benue State Nigeria
| | - John Eastwood
- 5Ingham Institute for Applied Medical Research, 1 Campbell Street, Liverpool, New South Wales 2170 Australia.,6School of Women's and Children's Health, The University of New South Wales, Kensington, Sydney, New South Wales 2052 Australia.,7School of Public Health, The University of Sydney, Sydney, New South Wales 2006 Australia.,8School of Public Health, Griffith University, Queensland, Gold Coast, 4222 Australia.,Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, 24 Liverpool Rd, Croydon, New South Wales 2132 Australia
| | - Andrew Page
- 1Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, New South Wales Australia
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18
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Atuoye KN, Amoyaw JA, Kuuire VZ, Kangmennaang J, Boamah SA, Vercillo S, Antabe R, McMorris M, Luginaah I. Utilisation of skilled birth attendants over time in Nigeria and Malawi. Glob Public Health 2018; 12:728-743. [PMID: 28441927 DOI: 10.1080/17441692.2017.1315441] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Despite recent modest progress in reducing maternal and infant mortality rates in sub-Saharan Africa, Nigeria and Malawi were still in the top 20 countries with highest rates of mortalities globally in 2015. Utilisation of professional services at delivery - one of the indictors of MDG 5 - has been suggested to reduce maternal mortality by 50%. Yet, contextual, socio-cultural and economic factors have served as barriers to uptake of such critical service. In this paper, we examined the impact of residential wealth index on utilisation of Skilled Birth Attendant in Nigeria (2003, 2008 and 2013), and Malawi (2000, 2004 and 2010) using Demographic and Health Survey data sets. The findings from multivariate logistic regressions show that women in Nigeria were 23% less likely to utilise skilled delivery services in 2013 compared to 2003. In Malawi, women were 75% more likely to utilise skilled delivery services in 2010 than in 2000. Residential wealth index was a significant predictor of utilisation of skilled delivery services over time in both Nigeria and Malawi. These findings illuminate progress made - based on which we make recommendations for achievement of SDG-3: ensure healthy lives and promote well-being for all at all ages in Nigeria and Malawi, and similar context.
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Affiliation(s)
- Kilian N Atuoye
- a Environmental Health and Hazards Lab, Department of Geography , University of Western Ontario , London , Canada
| | - Jonathan A Amoyaw
- b Department of Sociology , University of Western Ontario , London , Canada
| | - Vincent Z Kuuire
- c Department of Geography and Planning , Queen's University , Kingston , Canada
| | - Joseph Kangmennaang
- d Department of Geography and Environmental Management , University of Waterloo , Waterloo , Canada
| | - Sheila A Boamah
- e Arthur Labatt Family School of Nursing, Health Sciences Addition , University of Western Ontario , London , Canada
| | - Siera Vercillo
- a Environmental Health and Hazards Lab, Department of Geography , University of Western Ontario , London , Canada
| | - Roger Antabe
- a Environmental Health and Hazards Lab, Department of Geography , University of Western Ontario , London , Canada
| | - Meghan McMorris
- a Environmental Health and Hazards Lab, Department of Geography , University of Western Ontario , London , Canada
| | - Isaac Luginaah
- f Department of Geography , University of Western Ontario , London , Canada
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Wong KLM, Radovich E, Owolabi OO, Campbell OMR, Brady OJ, Lynch CA, Benova L. Why not? Understanding the spatial clustering of private facility-based delivery and financial reasons for homebirths in Nigeria. BMC Health Serv Res 2018; 18:397. [PMID: 29859092 PMCID: PMC5984741 DOI: 10.1186/s12913-018-3225-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 05/22/2018] [Indexed: 11/24/2022] Open
Abstract
Background In Nigeria, the provision of public and private healthcare vary geographically, contributing to variations in one’s healthcare surroundings across space. Facility-based delivery (FBD) is also spatially heterogeneous. Levels of FBD and private FBD are significantly lower for women in certain south-eastern and northern regions. The potential influence of childbirth services frequented by the community on individual’s barriers to healthcare utilization is under-studied, possibly due to the lack of suitable data. Using individual-level data, we present a novel analytical approach to examine the relationship between women’s reasons for homebirth and community-level, health-seeking surroundings. We aim to assess the extent to which cost or finance acts as a barrier for FBD across geographic areas with varying levels of private FBD in Nigeria. Method The most recent live births of 20,467 women were georeferenced to 889 locations in the 2013 Nigeria Demographic and Health Survey. Using these locations as the analytical unit, spatial clusters of high/low private FBD were detected with Kulldorff statistics in the SatScan software package. We then obtained the predicted percentages of women who self-reported financial reasons for homebirth from an adjusted generalized linear model for these clusters. Results Overall private FBD was 13.6% (95%CI = 11.9,15.5). We found ten clusters of low private FBD (average level: 0.8, 95%CI = 0.8,0.8) and seven clusters of high private FBD (average level: 37.9, 95%CI = 37.6,38.2). Clusters of low private FBD were primarily located in the north, and the Bayelsa and Cross River States. Financial barrier was associated with high private FBD at the cluster level – 10% increase in private FBD was associated with + 1.94% (95%CI = 1.69,2.18) in nonusers citing cost as a reason for homebirth. Conclusions In communities where private FBD is common, women who stay home for childbirth might have mild increased difficulties in gaining effective access to public care, or face an overriding preference to use private services, among other potential factors. The analytical approach presented in this study enables further research of the differentials in individuals’ reasons for service non-uptake across varying contexts of healthcare surroundings. This will help better devise context-specific strategies to improve health service utilization in resource-scarce settings. Electronic supplementary material The online version of this article (10.1186/s12913-018-3225-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kerry L M Wong
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Emma Radovich
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Onikepe O Owolabi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Guttmacher Institute, 125 Maiden Lane 7th Floor, New York, NY, 10038, USA
| | - Oona M R Campbell
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Oliver J Brady
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Centre for Mathematical Modelling for Infectious Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Caroline A Lynch
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Lenka Benova
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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20
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Ogbo FA, Page A, Idoko J, Agho KE. Population attributable risk of key modifiable risk factors associated with non-exclusive breastfeeding in Nigeria. BMC Public Health 2018; 18:247. [PMID: 29439701 PMCID: PMC5812198 DOI: 10.1186/s12889-018-5145-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/01/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Non-exclusive breastfeeding (non-EBF) is a risk factor for many of the 2300 under-five deaths occurring daily in Nigeria - a developing country with approximately 40 million children. This study aimed to quantify and compare the attributable burden of key modifiable risk factors associated with non-EBF in Nigeria to inform strategic policy responses and initiatives. METHODS Relative risk and exposure prevalence for selected modifiable risk factors were used to calculate population attributable fractions based on Nigeria Demographic and Health Surveys data for the period (1999-2013). Scenarios based on feasible impact of community-based interventions in reducing exposure prevalence were also considered to calculate comparative potential impact fractions. RESULTS In Nigeria, an estimated 22.8% (95% Confidence Interval, CI: 9.2-37.0%) of non-EBF was attributable to primary and no maternal education; 24.7% (95% CI: 9.5-39.5%) to middle and poor household wealth, 9.7% (1.7-18.1%) to lower number (1-3) and no antenatal care visits; 18.8% (95% CI: 6.9-30.8%) to home delivery and 16.6% (95% CI: 3.0-31.3%) to delivery assisted by a non-health professional. In combination, more than half of all cases of non-EBF (64.5%; 95% CI: 50.0-76.4%) could be attributed to those modifiable risk factors. Scenarios based on feasible impacts of community-based approaches to improve health service access and human capacity suggest that an avoidable burden of non-EBF practice of approximately 11% (95% CI: -5.4; 24.7) is achievable. CONCLUSION Key modifiable risk factors contribute significantly to non-EBF in Nigerian women. Community-based initiatives and appropriate socio-economic government policies that specifically consider those modifiable risk factors could substantially reduce non-EBF practice in Nigeria.
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Affiliation(s)
- Felix Akpojene Ogbo
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
- Prescot Specialist Medical Centre, Makurdi, Benue State Nigeria
| | - Andrew Page
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
| | - John Idoko
- Department of Medicine, Faculty of Medical Sciences, University of Jos, Jos, Plateau State P.M.B 2084 Nigeria
| | - Kingsley E. Agho
- Translational Health Research Institute, School of Medicine, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
- School of Science and Health, Western Sydney University, Campbelltown Campus, Locked Bag 1797, Penrith, NSW 2571 Australia
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Ravit M, Audibert M, Ridde V, de Loenzien M, Schantz C, Dumont A. Removing user fees to improve access to caesarean delivery: a quasi-experimental evaluation in western Africa. BMJ Glob Health 2018; 3:e000558. [PMID: 29515916 PMCID: PMC5838396 DOI: 10.1136/bmjgh-2017-000558] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/21/2017] [Accepted: 11/26/2017] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Mali and Benin introduced a user fee exemption policy focused on caesarean sections in 2005 and 2009, respectively. The objective of this study is to assess the impact of this policy on service utilisation and neonatal outcomes. We focus specifically on whether the policy differentially impacts women by education level, zone of residence and wealth quintile of the household. METHODS We use a difference-in-differences approach using two other western African countries with no fee exemption policies as the comparison group (Cameroon and Nigeria). Data were extracted from Demographic and Health Surveys over four periods between the early 1990s and the early 2000s. We assess the impact of the policy on three outcomes: caesarean delivery, facility-based delivery and neonatal mortality. RESULTS We analyse 99 800 childbirths. The free caesarean policy had a positive impact on caesarean section rates (adjusted OR=1.36 (95% CI 1.11 to 1.66; P≤0.01), particularly in non-educated women (adjusted OR=2.71; 95% CI 1.70 to 4.32; P≤0.001), those living in rural areas (adjusted OR=2.02; 95% CI 1.48 to 2.76; P≤0.001) and women in the middle-class wealth index (adjusted OR=3.88; 95% CI 1.77 to 4.72; P≤0.001). The policy contributes to the increase in the proportion of facility-based delivery (adjusted OR=1.68; 95% CI 1.48 to 1.89; P≤0.001) and may also contribute to the decrease of neonatal mortality (adjusted OR=0.70; 95% CI 0.58 to 0.85; P≤0.001). CONCLUSION This study is the first to evaluate the impact of a user fee exemption policy focused on caesarean sections on maternal and child health outcomes with robust methods. It provides evidence that eliminating fees for caesareans benefits both women and neonates in sub-Saharan countries.
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Affiliation(s)
- Marion Ravit
- Centre Population et Développement (Ceped), IRD, INSERM, Université Paris Descartes, Paris, France
| | - Martine Audibert
- CNRS, CERDI, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Valéry Ridde
- Institut de Recherche en Santé Publique de Montréal (IRSPUM), Montreal, Quebec, Canada
- Ecole de santé publique de Montréal (ESPUM), Montreal, Quebec, Canada
| | - Myriam de Loenzien
- Centre Population et Développement (Ceped), IRD, INSERM, Université Paris Descartes, Paris, France
| | - Clémence Schantz
- Centre Population et Développement (Ceped), IRD, INSERM, Université Paris Descartes, Paris, France
| | - Alexandre Dumont
- Centre Population et Développement (Ceped), IRD, INSERM, Université Paris Descartes, Paris, France
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Ariyo O, Ozodiegwu ID, Doctor HV. The influence of the social and cultural environment on maternal mortality in Nigeria: Evidence from the 2013 demographic and health survey. PLoS One 2017; 12:e0190285. [PMID: 29287102 PMCID: PMC5747485 DOI: 10.1371/journal.pone.0190285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 12/09/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Reducing maternal mortality remains a priority for global health. One in five maternal deaths, globally, are from Nigeria. Objective This study aimed to assess the sociocultural correlates of maternal mortality in Nigeria. Methods We conducted a retrospective analysis of nationally representative data from the 2013 Nigeria Demographic and Health Survey. The analysis was based on responses from the core women’s questionnaire. Maternal mortality was categorized as ‘yes’ for any death while pregnant, during delivery or two months after delivery (as reported by the sibling), and ‘no’ for deaths of other or unknown causes. Multilevel logistic regression analysis was conducted to test for association between maternal mortality and predictor variables of sociocultural status (educational attainment, community women’s education, region, type of residence, religion, and women’s empowerment). Results Region, Religion, and the level of community women’s education were independently associated with maternal mortality. Women in the North West were more than twice as likely to report maternal mortality (OR: 2.14; 95% CI: 1.42–3.23) compared to those in the North Central region. Muslim women were 52% more likely to report maternal deaths (OR: 1.52; 95% CI: 1.10–2.11) compared to Christian women. Respondents living in communities where a significant proportion of women have at least secondary schooling were 33% less likely to report that their sisters died of pregnancy-related causes (OR: 0.67; 95% CI: 0.48–0.95). Conclusion Efforts to reduce maternal mortality should implement tailored programs that address barriers to health-seeking behavior influenced by cultural beliefs and attitudes, and low educational attainment. Strategies to improve women’s agency should be at the core of these programs; they are essential for reducing maternal mortality and achieving sustainable development goals towards gender equality. Future studies should develop empirically evaluated measures which assess, and further investigate the association between women’s empowerment and maternal health status and outcomes.
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Affiliation(s)
- Oluwatosin Ariyo
- Department of Community and Behavioral Health, East Tennessee State University, Johnson City, Tennessee, United States of America
| | - Ifeoma D Ozodiegwu
- Department of Epidemiology and Biostatistics, East Tennessee State University, Johnson City, Tennessee, United States of America
| | - Henry V Doctor
- Department of Information, Evidence and Research, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt
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Orazulike NC, Alegbeleye JO, Obiorah CC, Nyengidiki TK, Uzoigwe SA. A 3-year retrospective review of mortality in women of reproductive age in a tertiary health facility in Port Harcourt, Nigeria. Int J Womens Health 2017; 9:769-775. [PMID: 29081673 PMCID: PMC5652918 DOI: 10.2147/ijwh.s138052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose To determine the causes of death and associated risk factors among women of reproductive age (WRA) in a tertiary institution in Port Harcourt, Nigeria. Patients and methods This was a retrospective survey of all deaths in women aged 15–49 years at the University of Port Harcourt Teaching Hospital that occurred from January 1, 2013 to December 31, 2015. Data retrieved from ward registers, death registers, and death certificates were analyzed with Epi Info version 7. Comparison of socioeconomic and demographic risk factors for maternal and nonmaternal deaths was done using a multivariate logistic regression model. Results There were 340 deaths in the WRA group over the 3-year period. The majority (155 [45.6%]) of the women were aged 30–39 years. There were 265 (77.9%) nonmaternal deaths and 75 (22.1%) maternal deaths. Among the nonmaternal deaths, 124 (46.8%) had infectious diseases, with human immunodeficiency virus being the most common cause of infection in this group. Breast cancer (13 [4.9%]), cervical cancer (12 [4.5%]), and ovarian cancer (11 [4.2%]) were the most common malignant neoplasms observed. Hypertensive disorders of pregnancy (31 [41.3%]) and puerperal sepsis (20 [26.7%]) were the most common causes of maternal deaths. Age and occupation were significantly associated with deaths in WRA (p<0.05). Older women aged >30 years (odd ratio =1.86, 95% CI =1.07–3.23) and employed women (odds ratio =2.55, 95% CI =1.46–4.45) were more likely to die from nonmaternal than maternal causes. Conclusion Most of the deaths were nonmaternal. Infectious diseases, diseases of the circulatory system, and malignant neoplasms were the major causes of death among WRA, with maternal deaths accounting for approximately a quarter. Public health programs educating women on safer sex practices, early screening for cancers, benefits of antenatal care, and skilled attendants at delivery will go a long way to reducing preventable causes of deaths among these women.
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Affiliation(s)
| | | | - Christopher C Obiorah
- Department of Anatomical Pathology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
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Uneke CJ, Sombie I, Keita N, Lokossou V, Johnson E, Ongolo-Zogo P. An Assessment of National Maternal and Child Health Policy-Makers' Knowledge and Capacity for Evidence- Informed Policy-Making in Nigeria. Int J Health Policy Manag 2017; 6:309-316. [PMID: 28812823 PMCID: PMC5458792 DOI: 10.15171/ijhpm.2016.132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 09/25/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND There is increasing interest globally in the use of more rigorous processes to ensure that maternal, newborn, and child health (MNCH) care recommendations are informed by the best available research evidence use. The purpose of this study was to engage Nigerian MNCH policy-makers and other stakeholders to consider issues around research to policy and practice interface and to assess their existing knowledge and capacity on the use of research evidence for policy-making and practice. METHODS The study design is a cross-sectional evaluation of MNCH stakeholders' knowledge as it pertains different dimensions of research to practice. This was undertaken during a national MNCH stakeholders' engagement event convened under the auspices of the West African Health Organization (WAHO) and the Federal Ministry of Health (FMoH) in Abuja, Nigeria. A questionnaire was administered to participants, which was designed to assess participants' knowledge, capacity and organizational process of generation, synthesis and utilization of research evidence in policy-making regarding MNCH. RESULTS A total of 40 participants signed the informed consent form and completed the questionnaire. The mean ratings (MNRs) of participants' knowledge of electronic databases and capacity to identify and obtain relevant research evidence from electronic databases ranged from 3.62-3.68 on the scale of 5. The MNRs of participants' level of understanding of a policy brief, a policy dialogue and the role of researchers in policy-making ranged from 3.50-3.86. The MNRs of participants' level of understanding of evidence in policy-making context, types and sources of evidence, capacity to identify, select, adapt, and transform relevant evidence into policy ranged from 3.63-4.08. The MNRs of the participants' organization's capacity to cover their geographical areas of operation were generally low ranging from 3.32-3.38 in terms of manpower, logistics, facilities, and external support. The lowest MNR of 2.66 was recorded in funding. CONCLUSION The outcomes of this study suggest that a stakeholders' engagement event can serve as an important platform to assess policy-makers' knowledge and capacity for evidence-informed policy-making and for the promotion of evidence use in the policy process.
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Affiliation(s)
- Chigozie Jesse Uneke
- Knowledge Translation Platform, African Institute for Health Policy and Health Systems Studies, Ebonyi State University, Abakaliki, Nigeria
| | - Issiaka Sombie
- Organisation Ouest Africaine de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Namoudou Keita
- Organisation Ouest Africaine de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Virgil Lokossou
- Organisation Ouest Africaine de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Ermel Johnson
- Organisation Ouest Africaine de la Santé, Bobo-Dioulasso, Burkina Faso
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Kuuire VZ, Kangmennaang J, Atuoye KN, Antabe R, Boamah SA, Vercillo S, Amoyaw JA, Luginaah I. Timing and utilisation of antenatal care service in Nigeria and Malawi. Glob Public Health 2017; 12:711-727. [DOI: 10.1080/17441692.2017.1316413] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Vincent Z. Kuuire
- Department of Geography and Planning, Queen’s University, Kingston, ON, Canada
| | - Joseph Kangmennaang
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, ON, Canada
| | - Kilian N. Atuoye
- Environmental Health and Hazards Lab, Department of Geography, University of Western Ontario, London, ON, Canada
| | - Roger Antabe
- Environmental Health and Hazards Lab, Department of Geography, University of Western Ontario, London, ON, Canada
| | - Sheila A. Boamah
- Arthur Labatt Family School of Nursing, Health Sciences Addition, University of Western Ontario, London, ON, Canada
| | - Siera Vercillo
- Environmental Health and Hazards Lab, Department of Geography, University of Western Ontario, London, ON, Canada
| | - Jonathan A. Amoyaw
- Department of Sociology, University of Western Ontario, London, ON, Canada
| | - Isaac Luginaah
- Department of Geography, University of Western Ontario, London, ON, Canada
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26
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Adebowale AS. Intra-demographic birth risk assessment scheme and infant mortality in Nigeria. Glob Health Action 2017; 10:1366135. [PMID: 28882095 PMCID: PMC5645656 DOI: 10.1080/16549716.2017.1366135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/08/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Infant mortality (IM) is high in Nigeria. High-risk birth can limit a newborn's survival chances to the first year of life. The approach used in investigating the relationship between high-risk birth and IM in this study is yet to be documented in Nigeria. OBJECTIVES The Intra-Demographic Birth Risk Assessment Scheme (IDBRAS) was generated and its relationship with IM was examined. METHODS 2013 Nigeria demographic and health survey data were used. Mothers who gave birth in the 5 years before the survey were investigated (n = 31,155). IDBRAS was generated from information on maternal age at childbirth, parity and preceding birth interval and was disaggregated into low, medium and high. Data were analysed using the Cox proportional hazard and Brass 1-parameter models (α = 0.05). RESULTS Infant mortality rate was 88.4, 104.7 and 211.6 per 1000 live births among women with low, medium and high level of IDBRAS respectively. The rate of increase of reported infant deaths between low and high IDBRAS was 0.1932 (R2 = 0.5326; p < 0.001). The prevalence of medium- and high-risk birth was 24.6 and 4.2% respectively. The identified predictors of IM were place of residence, marital status and size of the child at birth. The hazard ratio of IM was higher among women with medium (HR = 1.35; 95% CI = 1.22-1.48, p < 0.001) and high IDBRAS (HR = 1.73; 95% CI = 1.48-2.02, p < 0.001) than among those with low IDBRAS. Controlling for other correlates barely changed this pattern. CONCLUSIONS The risk and level of IM increased as the level of IDBRAS increases in Nigeria. IDBRAS was an important predictor of IM. Maintaining a low level of IDBRAS will facilitate a reduction in IM rate in Nigeria.
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Affiliation(s)
- Ayo S. Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Visiting Academic, Division of Actuary Research, Faculty of Commerce, University of Cape Town, Cape Town, South Africa
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Ogbo FA, Page A, Idoko J, Claudio F, Agho KE. Diarrhoea and Suboptimal Feeding Practices in Nigeria: Evidence from the National Household Surveys. Paediatr Perinat Epidemiol 2016; 30:346-55. [PMID: 27009844 DOI: 10.1111/ppe.12293] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Globally, Nigeria has the largest burden of infectious diseases (including diarrhoea). Optimal feeding practices have been well-documented to protect against diarrhoea in other contexts; but this benefit has not been broadly studied in Nigeria. The study aimed to examine the association between diarrhoea and childhood feeding practices to provide country-specific evidence. METHOD Data from the Nigeria Demographic and Health Survey for the period spanning 1999-2013 were used. Prevalence of diarrhoea by infant and young child feeding indicators was estimated, and the association between diarrhoea and childhood feeding indicators was examined using multilevel regression analyses. RESULTS Prevalence of diarrhoea was higher among children whose mothers did not initiate breast feeding within the first hour of birth, infants who were not exclusively breastfed, and infants who were prematurely introduced to complementary foods. Early initiation of breast feeding was significantly associated with lower risk of diarrhoea (RR 0.68, 95% confidence interval (CI) 0.63, 0.74). Exclusively breastfed infants were less likely to develop diarrhoea compared to non-exclusively breastfed infants (RR 0.61, 95% CI 0.44, 0.86). Predominant breast feeding was significantly associated with a lower risk of diarrhoea (RR 0.66, 95% CI 0.54, 0.80). Bottle feeding and introduction of complementary foods were associated with a higher risk of diarrhoea. CONCLUSION Early initiation of breast feeding as well as exclusive and predominant breast feeding protect against diarrhoea in Nigeria, while bottle feeding and introduction of complementary foods were risk factors for diarrhoea. Community- and facility-based initiatives are needed to improve feeding practices, and to reduce diarrhoea prevalence in Nigeria.
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Affiliation(s)
- Felix A Ogbo
- Centre for Health Research, School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Andrew Page
- Centre for Health Research, School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - John Idoko
- Office of the Director General, National Agency for the Control of AIDS, Abuja, FCT, Nigeria
| | - Fernanda Claudio
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Kingsley E Agho
- School of Science and Health, Western Sydney University, Penrith, NSW, Australia
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Hussein J, Hirose A, Owolabi O, Imamura M, Kanguru L, Okonofua F. Maternal death and obstetric care audits in Nigeria: a systematic review of barriers and enabling factors in the provision of emergency care. Reprod Health 2016; 13:47. [PMID: 27102983 PMCID: PMC4840864 DOI: 10.1186/s12978-016-0158-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/04/2016] [Indexed: 01/23/2023] Open
Abstract
Background Maternal death reviews and obstetric audits identify causes and circumstances related to occurrence of a maternal death or serious complication and inform improvements in quality of care. Given Nigeria’s high maternal mortality, the lessons learned from past experiences can provide a good evidence base for informed decision making. We aimed to synthesise findings from maternal death reviews and other obstetric audits conducted in Nigeria through a systematic review, seeking to identify common barriers and enabling factors related to the provision of emergency obstetric care. Methods We searched for maternal death reviews and obstetric care audits reported in the published literature from 2000–2014. A ‘best-fit’ framework approach was used to extract data using a structured data extraction form. The articles that met the inclusion criteria were assessed using a nine point quality score. Results Of the 1,841 abstracts and titles at initial screening, 329 full text articles were reviewed and 43 papers fulfilled the inclusion criteria. Four types of barriers were reported related to: transport and referral; health workers; availability of services; and organisational factors. Three elements stand out in Nigeria as contributing to maternal mortality: delays in Caesarean section, unavailability of magnesium sulphate and lack of safe blood transfusion services. Conclusions Obstetric care reviews and audits are useful activities to undertake and should be promoted by improving the processes used to conduct them, as well as extending their implementation to rural and basic level health facilities and to the community. Urgent areas for quality improvement in obstetric care, even in tertiary and teaching hospitals should focus on organisational factors to reduce delays in conducting Caesarean section and making blood and magnesium sulphate available for all who need these interventions.
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Affiliation(s)
- Julia Hussein
- Immpact, University of Aberdeen, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland.
| | - Atsumi Hirose
- Immpact, University of Aberdeen, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland
| | - Oluwatoyin Owolabi
- Women's Health and Action Research centre (WHARC), KM 11 Benin-Lagos Expressway, Igue-Iheya, Benin City, Edo State, Nigeria
| | - Mari Imamura
- Immpact, University of Aberdeen, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland
| | - Lovney Kanguru
- Immpact, University of Aberdeen, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland
| | - Friday Okonofua
- Women's Health and Action Research centre (WHARC), KM 11 Benin-Lagos Expressway, Igue-Iheya, Benin City, Edo State, Nigeria
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Wollum A, Burstein R, Fullman N, Dwyer-Lindgren L, Gakidou E. Benchmarking health system performance across states in Nigeria: a systematic analysis of levels and trends in key maternal and child health interventions and outcomes, 2000-2013. BMC Med 2015; 13:208. [PMID: 26329607 PMCID: PMC4557921 DOI: 10.1186/s12916-015-0438-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 07/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nigeria has made notable gains in improving childhood survival but the country still accounts for a large portion of the world's overall disease burden, particularly among women and children. To date, no systematic analyses have comprehensively assessed trends for health outcomes and interventions across states in Nigeria. METHODS We extracted data from 19 surveys to generate estimates for 20 key maternal and child health (MCH) interventions and outcomes for 36 states and the Federal Capital Territory from 2000 to 2013. Source-specific estimates were generated for each indicator, after which a two-step statistical model was applied using a mixed-effects model followed by Gaussian process regression to produce state-level trends. National estimates were calculated by population-weighting state values. RESULTS Under-5 mortality decreased in all states from 2000 to 2013, but a large gap remained across them. Malaria intervention coverage stayed low despite increases between 2009 and 2013, largely driven by rising rates of insecticide-treated net ownership. Overall, vaccination coverage improved, with notable increases in the coverage of three-dose oral polio vaccine. Nevertheless, immunization coverage remained low for most vaccines, including measles. Coverage of other MCH interventions, such as antenatal care and skilled birth attendance, generally stagnated and even declined in many states, and the range between the lowest- and highest-performing states remained wide in 2013. Countrywide, a measure of overall intervention coverage increased from 33% in 2000 to 47% in 2013 with considerable variation across states, ranging from 21% in Sokoto to 66% in Ekiti. CONCLUSIONS We found that Nigeria made notable gains for a subset of MCH indicators between 2000 and 2013, but also experienced stalled progress and even declines for others. Despite progress for a subset of indicators, Nigeria's absolute levels of intervention coverage remained quite low. As Nigeria rolls out its National Health Bill and seeks to strengthen its delivery of health services, continued monitoring of local health trends will help policymakers track successes and promptly address challenges as they arise. Subnational benchmarking ought to occur regularly in Nigeria and throughout sub-Saharan Africa to inform local decision-making and bolster health system performance.
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Affiliation(s)
- Alexandra Wollum
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA.
| | - Roy Burstein
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA.
| | - Nancy Fullman
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA.
| | - Laura Dwyer-Lindgren
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA.
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, 2301 5th Ave, Suite 600, Seattle, WA, 98121, USA.
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