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Kim J, Eom YJ, Ko S, Subramanian SV, Kim R. Problems accessing health care and under-5 mortality: a pooled analysis of 50 low- and middle-income countries. J Public Health (Oxf) 2024; 46:315-325. [PMID: 38684342 DOI: 10.1093/pubmed/fdae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 02/27/2024] [Accepted: 04/05/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Access to health care remains suboptimal in low- and middle-income countries (LMICs) and continues to hinder survival in early childhood. We systematically assessed the association between problems accessing health care (PAHC) and under-five mortality (U5M). METHODS Child mortality data on 724 335 livebirths came from the latest Demographic and Health Surveys of 50 LMICs (2013-2021). Reasons for PAHC were classified into three domains: 'money needed for treatment' (economic), 'distance to health facility' (physical), 'getting permission' or 'not wanting to go alone' (socio-cultural). Multivariable logistic regression was used to estimate the association between PAHC (any and by each type) and U5M. RESULTS In our pooled sample, 47.3 children per 1000 livebirths died before age of 5, and 57.1% reported having experienced PAHC (ranging from 45.3% in Europe & Central Asia to 72.7% in Latin America & Caribbean). Children with any PAHC had higher odds of U5M (OR: 1.05, 95% CI: 1.02, 1.09), and this association was especially significant in sub-Saharan Africa. Of different domains of PAHC, socio-cultural PAHC was found to be most significant. CONCLUSIONS Access to health care in LMICs needs to be improved by expanding health care coverage, building health facilities, and focusing more on context-specific socio-cultural barriers.
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Affiliation(s)
- Jinseo Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul 02841, Republic of Korea
| | - Yun-Jung Eom
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul 02841, Republic of Korea
| | - Soohyeon Ko
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul 02841, Republic of Korea
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard T H Chan School of Public Health, Boston, MA 02115, USA
- Harvard Center for Population and Development Studies, Cambridge, MA 02138, USA
| | - Rockli Kim
- Interdisciplinary Program in Precision Public Health, Department of Public Health Sciences, Graduate School of Korea University, Seoul 02841, Republic of Korea
- Division of Health Policy and Management, College of Health Sciences, Korea University, Seoul 02841, Republic of Korea
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Obi C, Ojiakor I, Etiaba E, Onwujekwe O. Collaborations and Networks Within Communities for Improved Utilization of Primary Healthcare Centers: On the Road to Universal Health Coverage. Int J Public Health 2024; 69:1606810. [PMID: 38887723 PMCID: PMC11180759 DOI: 10.3389/ijph.2024.1606810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
Objectives Community involvement depends on the level of linked and targeted activities for health by community members. This study examines the collaborations employed within communities to ensure sustainable access and improved use of healthcare in the community. Methods This study was conducted in rural and urban local government areas in Anambra, Kano, and Akwa-Ibom, Nigeria. About 90 in-depth interviews and 12 focus group discussions were conducted with community stakeholders and service users. The findings were transcribed and coded via thematic analysis, guided by the Expanded Health Systems framework. Results Various horizontal collaborations in communities foster increased use of PHC services; promoting community health. Major horizontal collaborations in these communities were community-led, primary health facility-led, and Individual-led collaborations. Their actions revolved around advocacy, building and renovating PHC centers, equipping facilities, and sensitization to educate community members on the need to utilize services at PHC centers. Conclusion Strategic involvements and collaborations of local actors within communities give rise to improvements in the utilization of primary healthcare centres, reportedly resulting in improved access to PHC healthcare services for community members.
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Affiliation(s)
- Chinelo Obi
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Iheomimichineke Ojiakor
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Enyi Etiaba
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Health Administration and Management, Faculty of Health Science and Technology, University of Nigeria, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Health Administration and Management, Faculty of Health Science and Technology, University of Nigeria, Enugu, Nigeria
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Adetutu OM, Oyinlola FF, Oyelakin TE, Ofili FL. Influence of intimate partner violence and male involvement on maternal healthcare services utilisation in Nigeria. Front Glob Womens Health 2024; 5:1353117. [PMID: 38559815 PMCID: PMC10978718 DOI: 10.3389/fgwh.2024.1353117] [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: 12/09/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Low maternal health care services utilisation, especially antenatal care attendance and skilled birth attendance, has been documented to be responsible for maternal mortality and morbidity in Nigeria. While available evidence suggests mixed findings on uptake of maternal health care services in the context of abusive spousal relationships, male involvement in household and health decision-making has been established to promote uptake of maternal health care services. Yet, studies which consider mediating influence of intimate partner violence on male involvement and maternal health care services uptake are sorely missing in Nigeria. We hypothesised that maternal health care services uptake in abusive marital unions has implications for male involvement in pregnancy care and this has been largely overlooked in Nigeria. Materials and methods This study extracted data from the 2018 Nigeria Demographic and Health Survey (NDHS). The 2018 NDHS is a nationally representative secondary data which collected population, demographic and health information on women, men and households in Nigeria. The secondary data used a two-stage stratified and multistage sampling technique to collect information from the respondents. In this study, data were extracted for women who were sexually active, within the reproductive age (15-49 years) and not pregnant in five years prior the survey (n = 7,847). Results The results indicated (77%) antenatal care attendance and (47%) skilled delivery. The mediating influence of IPV on male involvement resulted in women who experienced sexual violence more likely to use heath facility for antenatal care (OR = 3.20; C.I: 1.20-8.50). Women whose partners were involved in health decision making had lower odds of antenatal care attendance (OR = 0.64; C.I: 0.44-0.94). Also, women whose partners were involved in spending their earnings had lower probability of antenatal care attendance (OR = 0.72; C.I: 0.55-0.96). Yet, the mediating influence of intimate partner violence on male involvement resulted in a lower likelihood of use of skilled delivery for emotionally abused women (OR = 0.58; C.I: 0.39-0.85). Women whose partners were involved in spending their earnings had higher odds of using skilled delivery (OR = 2.15; C.I: 1.79-2.56). Yet, women whose partners were involved in their health decision-making had lower odds of using skilled delivery (OR = 0.46; C.I: 0.34-0.62). Conclusion This study held the philosophical stance that intimate partner violence mediated the influence of male involvement on maternal health care uptake while intimate partner violence had an inconsistent influence on maternal health care uptake. Policies and interventions should aim at addressing deep-rooted gender norms which promote IPV and limit male involvement in pregnancy care in Nigeria. Programme and policy interventions should focus on enhancing socioeconomic status of women.
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Affiliation(s)
- O. M. Adetutu
- Department of Demography and Social Statistics, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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Adeyinka DA, Muhajarine N. Disentangling the link between social determinants of health and child survival in Nigeria during the Sustainable Development Goals era: a hierarchical path analysis of time-to-event outcome. J Biosoc Sci 2024; 56:357-375. [PMID: 38095080 DOI: 10.1017/s0021932023000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
While social determinants of health have been perennially linked to child survival in resource-limited countries, the precise and tested pathways to effect are not clearly understood. The objective of this study was therefore to identify the critical pathways as posited a priori in a model through which social factors (at maternal, household, and community levels) determine neonatal, infant, and under-five mortalities in Nigeria. Using a novel analytic approach (hierarchical path modelling for predicting accelerated failure time) to estimate (in)direct and total effects of social determinants of child survival, we analysed 30,960 live births (weighted data for representativeness), obtained from the 2016/2017 Nigeria Multiple Indicator Cluster Survey. There were three outcome variables: time until occurrence of neonatal, infant, and under-five mortalities. The independent variables were layered factors related to child, maternal, household and community. Geographical region, rurality of residence, infrastructural development, maternal education, contraceptive use, marital status, and maternal age at birth were found to operate more indirectly on neonatal, infant, and under-five survival. Child survival is due to direct effects of child's sex (female), gestational type (singleton), birth spacing (children whose mothers delivered at least two years apart), and maternal age at delivery (20-34 years). According to the path coefficients, the indirect effects of geographical regions are the most influential determinants of child survival, accounting for 30% (neonatal), 37.1% (infant) and 39.9% (under-five) of the total effects. This study offers comprehensive set of factors, and linked pathways, at the maternal, household, and community levels that are associated with child survival in Nigeria. To accelerate progress towards Sustainable Development Goal targets for child survival and reduce geographical inequities, stakeholders should implement more impactful policies that promote maternal education, contraceptive use and improve living conditions of women (especially in rural areas of northern Nigeria). Future research should focus on identifying the most effective interventions for addressing these social determinants of child survival in Nigeria.
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Affiliation(s)
- Daniel Adedayo Adeyinka
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, SK, Canada
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
- Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Nazeem Muhajarine
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, SK, Canada
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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Rodrigo-Gallardo PK, Caira-Chuquineyra B, Fernandez-Guzman D, Urrunaga-Pastor D, Alejandro-Salinas R, Vasquez-Chavesta AZ, Toro-Huamanchumo CJ. Determinants of non-institutional childbirth: Evidence from the Peruvian demographic and health survey. Eur J Obstet Gynecol Reprod Biol X 2023; 20:100250. [PMID: 37942028 PMCID: PMC10628643 DOI: 10.1016/j.eurox.2023.100250] [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: 06/27/2023] [Revised: 09/13/2023] [Accepted: 10/11/2023] [Indexed: 11/10/2023] Open
Abstract
Objective We aimed to evaluate the determinants of non-institutional delivery among women of childbearing age in Peru. Methods We conducted a secondary analysis of data from the Peru 2019 Demographic and Family Health Survey (ENDES). This multi-stage survey sampling is representative at the urban-rural, regional, and national levels. The outcome variable was place of delivery, collected by self-reporting. Binary logistic regression models were used to assess the factors associated with non-institutionalized delivery. Thus, we estimated crude and adjusted odd ratios (aOR). For the multivariable model, the manual forward selection method and the Wald test were used to obtain a final parsimonious model. Results The final sample included 14,061 women of reproductive age between the ages of 15 and 49. The prevalence of non-institutional delivery was 7.8 %. Multivariate regression analysis found that having a secondary education (aOR:0.48; 95 % confidence interval [CI]:0.39-0.58) or higher (aOR:0.57; 95 %CI:0.42-0.78); belonging to the second (aOR:0.26; 95 %CI:0.20-0.33), third (aOR:0.28; 95 %CI:0.21-0.38), fourth (aOR:0.21; 95 %CI:0.13-0.33), or fifth wealth quintile (aOR:0.15; 95 %CI:0.09-0.27); and suffering intimate partner violence (aOR:0.76; 95 %CI:0.64-0.91) were associated with lower odds of non-institutional delivery, while not having some type of health insurance (aOR:3.12; 95 %CI:2.47-3.95), living in a rural area (aOR:1.93; 95 %CI:1.54-2.42), and having had three or more deliveries (aOR:1.36; 95 %CI:1.07-1.72), were associated with higher odds of non-institutional delivery. Conclusions We found that not having health insurance, residing in a rural area, and having had three or more deliveries were factors associated with non-institutional delivery in women of childbearing age. We propose that should focus public health strategies towards providing education to women about maternal health, and likewise, facilitating access to specialized health centers for rural populations.
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Affiliation(s)
| | | | - Daniel Fernandez-Guzman
- Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco, Cusco, Peru
| | - Diego Urrunaga-Pastor
- Facultad de Ciencias de la Salud, Carrera de Medicina Humana, Universidad Científica del Sur, Lima, Peru
| | - Rodrigo Alejandro-Salinas
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Sociedad Científica de Estudiantes de Medicina - UPC, Lima, Peru
| | | | - Carlos J. Toro-Huamanchumo
- Unidad para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- OBEMET Center for Obesity and Metabolic Health, Lima, Peru
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Okonkwo ON, Hassan AO, Bogunjoko T, Akinye A, Akanbi T, Agweye C. Low rates of optical coherence tomography utilization in the diagnosis and management of retinovascular diseases in a lower middle-income economy. Niger J Clin Pract 2023; 26:1011-1016. [PMID: 37635588 DOI: 10.4103/njcp.njcp_911_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
Background Optical coherence tomography (OCT) is widely used as the standard of care in evaluating macular and retinovascular diseases. However, the degree of OCT utilization is yet to be researched in a resource-limited country where wide gaps exist in access to healthcare. Aim To determine the rate of utilization of the OCT in diagnosis, pre-treatment, and post-treatment evaluation of macular and retinovascular diseases treated with intravitreal anti-vascular endothelial growth factor injection (IVI). Patients and Methods Retrospective, consecutive, and non-comparative case series of eyes diagnosed and treated from Jan 2017 to Jan 2022 for seven macular and retinovascular diseases in five eye clinics in Nigeria. Data extracted include demographics, indication for IVI, eye treated, use or non-use of OCT at the diagnosis (pre-treatment) and after the last IVI (post-treatment), and central macular thickness (CMT) of pre-treatment OCT scans. Results Seven hundred and forty two eyes were diagnosed with retinovascular and macular diseases (389 right eyes and 353 left eyes).The male to female ratio was 430: 312 eyes. The mean age was, 63.89 years (SD 12.58). Four hundred and fifty two eyes (60.9%) had a pre-treatment OCT, 235 eyes (31.7%) had a post-treatment OCT, and 190 eyes (25.6%) had both pre- and post-treatment OCTs. The rate of pre-treatment OCT varied with the diagnosis (P = 0.000); DME had the highest rate, 74.4%, and HRVO had the lowest, 40%. Post-treatment OCT rate varied with the diagnosis (P = 0.009); non-AMD CNVM had the highest rate, 49.1%, and PCV had the lowest, 24.6%. Pre-treatment OCT rate was influenced by clinic location (P = 0.000); higher in clinics having an OCT. Post-treatment OCT was not influenced by clinic location (P = 0.37). A CRVO eye had the highest maximum CMT (1031 microns) of all the pre treatment eyes and the lowest minimum CMT of all the pre treatment eyes was in a BRVO eye (138 microns). Mean CMT was highest in HRVO (475.33 microns) and lowest in CNVM (307.62 microns). Conclusion Though OCT is the standard of care for managing retinovascular and macular diseases, this research quantifies the extent of its use in Nigeria and finds it to be low. A post-treatment OCT rate of 32% suggests that urgent steps are required to improve access to OCT for IVI patients.
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Affiliation(s)
- O N Okonkwo
- Department of Ophthalmology, Eye Foundation Hospital, Lagos State, Nigeria
| | - A O Hassan
- Department of Ophthalmology, Eye Foundation Hospital, Lagos State, Nigeria
| | - T Bogunjoko
- Department of Ophthalmology, Eye Foundation Hospital, Lagos State, Nigeria
| | - A Akinye
- Department of Ophthalmology, Eye Foundation Hospital, Ogun State, Nigeria
| | - T Akanbi
- Department of Ophthalmology, Eye Foundation Hospital, Abuja, Nigeria
| | - C Agweye
- Department of Ophthalmology, University of Calabar Teaching Hospital, Cross River State, Nigeria
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Fentie EA, Asmamaw DB, Shewarega ES, Negash WD, Teklu RE, Alemu TG, Eshetu HB, Belay DG, Aragaw FM, Fetene SM. Socioeconomic inequality in modern contraceptive utilization among reproductive-age women in sub-Saharan African countries: a decomposition analysis. BMC Health Serv Res 2023; 23:185. [PMID: 36814248 PMCID: PMC9945375 DOI: 10.1186/s12913-023-09172-6] [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: 08/04/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Family planning services allow individuals to achieve desired birth spacing, family size, and contribute to improved health outcomes for infants, children, women, and families, and prevent unintended pregnancy. Births resulting from unintended pregnancies can have negative consequences Children from unintended pregnancies are more likely to experience poor mental and physical health during childhood. Even though many international organizations work to ensure universal access to sexual and reproductive health services, reproductive health service utilization is concentrated among individuals with rich socioeconomic status. Therefore, this study aimed to assess the presence of socioeconomic inequality in modern contraceptive utilization and its contributors in sub-Saharan African countries. METHODS A total of 466,282 weighted reproductive-aged women samples from DHS data SSA countries were included in the study. Erreygers normalized concentration index and its concentration curve were used to assess socioeconomic-related inequality in modern contraceptive utilization. Decomposition analysis was performed to identify factors contributing to socioeconomic-related inequality. RESULTS The weighted Erreygers normalized concentration index for modern contraceptive utilization was 0.079 with Standard error = 0.0013 (P value< 0.0001); indicating that There is small amount but statistically significant pro rich distribution of wealth related in equalities of modern contraceptive utilization among reproductive age women. The decomposition analysis revealed that mass media exposure, wealth index., place of residency, and distance of health facility were the major contributors to the pro-rich socioeconomic inequalities in modern contraceptive utilization. CONCLUSION AND RECOMMENDATION In this study, there is a small amount but statistically significant pro rich distribution of modern contraceptive utilization. Therefore, give priority to modifiable factors such as promoting the accessibility of health facilities, media exposure of the household, and improving their country's economy to a higher economic level to improve the wealth status of the population.
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Affiliation(s)
- Elsa Awoke Fentie
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Desale Bihonegn Asmamaw
- grid.59547.3a0000 0000 8539 4635Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ever Siyoum Shewarega
- grid.59547.3a0000 0000 8539 4635Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia ,grid.472268.d0000 0004 1762 2666Department of Reproductive Health, School of Public Health, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Wubshet Debebe Negash
- grid.59547.3a0000 0000 8539 4635Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Rediet Eristu Teklu
- grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- grid.59547.3a0000 0000 8539 4635Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habitu Birhan Eshetu
- grid.59547.3a0000 0000 8539 4635Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia ,grid.59547.3a0000 0000 8539 4635Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- grid.59547.3a0000 0000 8539 4635Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Samrawit Mihret Fetene
- grid.59547.3a0000 0000 8539 4635Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Joseph FI, Falade A, Earland J. Time to recovery and its predictors among children 6-59 months with acute malnutrition admitted to community inpatient therapeutic feeding centers in Katsina State, Northwest Nigeria: a retrospective review of health records (2010-2016). JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:10. [PMID: 36800992 PMCID: PMC9936680 DOI: 10.1186/s41043-023-00352-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 02/07/2023] [Indexed: 02/19/2023]
Abstract
BACKGROUND Severe acute malnutrition (SAM) among children under five years of age remains a huge public health and economic burden in Sub-Saharan Africa. We investigated time to recovery and its predictors among children aged 6 to 59 months admitted into Community-based Management of Acute Malnutrition (CMAM) stabilisation centres for complicated severe acute malnutrition and whether the outcomes met the minimum Sphere standards. METHODS The study was a retrospective cross sectional quantitative review of data recorded in six CMAM stabilization centres registers in four Local Government Areas, Katsina state, Nigeria from September 2010 to November 2016. Records of 6925 children, aged 6-59 months with complicated SAM were reviewed. Descriptive analysis was used to compare performance indicators with Sphere project reference standards. Cox proportional hazard regression analysis was used to estimate the predictors of recovery rate at p < 0.05 and Kaplan-Meier curve to predict the probability of surviving different forms of SAM. RESULTS Marasmus was the most common form of severe acute malnutrition (86%). Overall, the outcomes met the minimum sphere standards for inpatient management of SAM. Children with oedematous SAM (13.9%) had the lowest survival rate on Kaplan-Meier graph. The mortality rate was significantly higher during the 'lean season'-May to August (Adjusted Hazard Ratio (AHR) = 0.491, 95% CI = 0.288-0.838). MUAC at Exit (AHR = 0.521, 95% CI = 0.306-0.890), marasmus (AHR = 2.144, 95% CI = 1.079-4.260), transfers from OTP (AHR = 1.105, 95% CI = 0.558-2.190) and average weight gain (AHR = 0.239, 95% CI = 0.169-0.340) were found to be significant predictors of time-to-recovery with p values < 0.05. CONCLUSION The study showed that, despite a high turnover of complicated SAM cases in the stabilization centres, the community approach to inpatient management of acute malnutrition enabled early detection and reduced delays in access to care of complicated SAM cases. In the face of health workforce shortage in rural communities to provide pediatric specialist care for SAM children, we recommend task shifting to community health care workers through in service training could bridge the gap and save more lives of children dying from the complication of SAM in rural communities in Nigeria.
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Affiliation(s)
- Friday Ilop Joseph
- Department of Paediatrics, Federal Teaching Hospital, Katsina, Katsina State, Nigeria.
| | - Adewale Falade
- Department of Public Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Jane Earland
- Department of Public Health and Policy, School of Medicine, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
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Adejumo PO, Aniagwu TIG, Awolude OA, Adedokun B, Kochheiser M, Sowunmi A, Popoola A, Ojengbede O, Huo D, Olopade OI. Cancer Genetic Services in a Low- to Middle-Income Country: Cross-Sectional Survey Assessing Willingness to Undergo and Pay for Germline Genetic Testing. JCO Glob Oncol 2023; 9:e2100140. [PMID: 36854077 PMCID: PMC10166413 DOI: 10.1200/go.21.00140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
PURPOSE Cancer genetic testing (CGT), a pathway to personalized medicine, is also being embraced in Nigeria. However, little is known about the influence of demographics and perceptions on individuals' willingness to access and pay for CGT. This study assessed patients' willingness to undergo CGT in southwest Nigeria as a catalyst for sustainable Cancer Risk Management Program. METHODS This was a cross-sectional study using semistructured questionnaire to interview 362 patients with cancer and 10 referred first-degree relatives between July 2018 and February 2020. Participants from three Nigerian teaching hospitals-University College Hospital, Ibadan, Lagos State University Teaching Hospital, Lagos, and Lagos University Teaching Hospital, Lagos, received genetic counseling and had subsequent CGT. Primary outcomes were willingness to undergo CGT in determining cancer risk and the willingness to pay for it. Ethical approval was from appropriate ethics committees of participating hospitals. Data were analyzed with SPSS version 22. Univariate comparison of categorical variables was performed by χ2 test, multivariate analysis by logistic regression. RESULTS The participants from University College Hospital (56.2%), Lagos State University Teaching Hospital (26.3%), and Lagos University Teaching Hospital (17.5%) were mostly female (98.4%). Mean age was 48.8 years ± 11.79. Three hundred twenty-two (86.6%) patients and first-degree relatives were willing to take the test, of whom 231 (71.1%) were willing to pay for it. more than half (53.6%) of the participants were willing to pay between N10,000 and N30,000, which is less than $100 US dollars. Sociodemographic variables and willingness to test showed no association (P > .05). Education and ethnicity were found to be associated with their willingness to pay for CGT (P ≤ .05). CONCLUSION Learning clinically relevant details toward cancer prevention informs health-related decisions in patients and relatives, a motivator for willingness to pay for genetic testing in low- and middle-income countries. Increased awareness may influence outcomes of cancer risk management.
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Affiliation(s)
- Prisca O Adejumo
- Department of Nursing, College of Medicine, University of Ibadan, Nigeria
| | - Toyin I G Aniagwu
- School of Occupational Health Nursing, University College Hospital, Ibadan, Nigeria
| | - Olutosin A Awolude
- Department of Obstetrics and Gynaecology, University College Hospital, Ibadan, Oyo, Nigeria
| | - Babatunde Adedokun
- Center for Clinical Cancer Genetics & Global Health, Department of Medicine, The University of Chicago, Chicago, IL
| | - Makayla Kochheiser
- Center for Clinical Cancer Genetics & Global Health, Department of Medicine, The University of Chicago, Chicago, IL
| | | | | | - Oladosu Ojengbede
- Center for Population and Reproductive Health, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Dezheng Huo
- Department of Public Health Sciences, The University of Chicago, Chicago, IL
| | - Olufunmilayo I Olopade
- Center for Clinical Cancer Genetics & Global Health, Department of Medicine, The University of Chicago, Chicago, IL
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Oko AB, Jennifer A, Chinyere AJ, Nelson NJ, Omokhudu I, Edward OC, Dennis A. Assessment of integrated community case management of childhood illness (ICCM) practices by trained patent and proprietary medicine vendors (PPMVs) in Ebonyi and Kaduna states, Nigeria. BMC Health Serv Res 2023; 23:57. [PMID: 36658517 PMCID: PMC9854073 DOI: 10.1186/s12913-023-09067-6] [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: 05/03/2022] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION An Integrated Community treatment of Childhood disease (ICCM)- focused intervention involving a large number of Patent and proprietary medicine vendors (PPMVs) was conducted by Society for Family Health Nigeria to improve management of childhood, malaria, pneumonia and diarrhea with an intervention approach focused on knowledge and skill improvement. The intervention was conducted in Kaduna and Ebonyi state; recruited and trained 15 interpersonal communication agents (IPCAs) who were saddled with the responsibility to sensitize and mobilize caregivers with children within the age bracket of 2 months to 5 years to our mapped PPMVs within the communities, on the account of Malaria, Diarrhea, and Pneumonia; while the IPCAs in return monitor the quality-of-service delivery. Following the intervention, the Society for Family health conducted a study to demonstrate the effectiveness of interventions such as ICCM training, supervision and linkage to quality ICCM commodities, among PPMVs to achieve high levels of knowledge and performance in diagnosing and treating common childhood illnesses. METHODS Longitudinal research (before and after study) was adopted for the study. From the 387 PPMVs recruited and trained by SFH, 165 PPMVs were systematically selected to participate in the study, before and after the implementation of the intervention. Using SPSS version 22, data from the observation and completed questionnaires were analyzed and a chi-square test was used to examine the associations between the categorical information collected prior and after the intervention. The analysis was conducted at 5% level of significance. RESULTS More than 50 % of the study participants were females (56.4%) and majority were either Junior community extension workers (35%) or Senior community extension worker (27%). About 21.8% trained PPMVs could not appropriately treat malaria in the first quarter of the intervention, however, there was a significant decrease to 1.8% in second quarter in the number of those that cannot appropriately diagnose and treat malaria. There was also a decrease in the number of those who could not treat cough and fast breathing from 47(28.5%) to 14(8.5%) in the second quarter and for diarrhea from 33.3% in the first quarter to 2.4% in the second quarter. CONCLUSION The study revealed a significant improvement in the quality of treatment provided by the trained PPMVs across the three disease areas. PPMVs in hard-to-reach areas should be trained and supported to continuously provide quality services to change the indices of under-5 mortality in Nigeria.
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Affiliation(s)
- Akpu Blessing Oko
- grid.452827.e0000 0004 9129 8745Society for Family Health, Abuja, Nigeria
| | - Anyanti Jennifer
- grid.452827.e0000 0004 9129 8745Society for Family Health, Abuja, Nigeria
| | | | | | - Idogho Omokhudu
- grid.452827.e0000 0004 9129 8745Society for Family Health, Abuja, Nigeria
| | | | - Aizobu Dennis
- grid.452827.e0000 0004 9129 8745Society for Family Health, Abuja, Nigeria
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11
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Avogo WA. Community characteristics and the risk of non-communicable diseases in Ghana. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000692. [PMID: 36962739 PMCID: PMC10021620 DOI: 10.1371/journal.pgph.0000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 12/12/2022] [Indexed: 06/18/2023]
Abstract
Non-communicable Diseases (NCDs) are rising quickly in low- and middle- income countries. In Ghana, chronic diseases are major causes of morbidity and mortality, yet data and the evidence- base for awareness, detection, and management of NCDs are lacking. Using data from the 2014 Ghana Demographic and Health Survey (GDHS), the first national study with information on hypertension and other risk factors, we examine the correlates and community characteristics associated with the risk of hypertension, obesity, and anemia among women. We find that hypertension prevalence in Ghana was 16 percent and 17 percent were overweight/obese, while 41 percent had anemia of any form. On community characteristics, the level of poverty in a community was significantly associated with lower risks of all three NCDs, while the aggregate level of employment had higher risks. On individual characteristics, the wealth of a household, women's educational level and urban residence were significant predictors of NCDs. We interpret the findings within the literature on neighborhood characteristics, the social gradient of health and in the context of speeding up the attainment of the Sustainable Development Goals (SGDS) to reduce premature deaths by one-third by 2030.
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Affiliation(s)
- Winfred A. Avogo
- Department of Sociology and Anthropology, Illinois State University, Normal, Illinois, United States of America
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Awotidebe TO, Fasakin OM, Oyewole OO, Bello UE, Ademoyegun AB, Onigbinde AT, Mbada CE, Odunlade AJ, Adedoyin RA. Nigerian physiotherapists’ knowledge, attitude, and practice of digital physical therapy: a cross-sectional study. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2023. [PMCID: PMC9970850 DOI: 10.1186/s43161-022-00118-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Background The increasing demand for physical therapy services worldwide calls for innovations to be made to meet the challenges of service delivery. However, little is known about the knowledge, attitude, and practice (KAP) of digital physical therapy among Nigerian physiotherapists. Hence, this study aimed to evaluate the level of KAP of digital physical therapy among physiotherapists in Nigeria. Methods This cross-sectional study purposively recruited 150 Nigerian physiotherapists. Copies of modified and validated questionnaires on the KAP of digital physical therapy from a previous study were sent to registered and licensed physiotherapists via electronic survey to assess the KAP of digital physical therapy. Descriptive and inferential statistics were used to analyze the data. Alpha level was set at p < 0.05. Results The mean age of the respondents was 29.76 ± 6.95 years. Most participants (81.3%) have a knowledge level above average, while 18.7% have below average. Furthermore, most (76.0%) of the respondents had a positive attitude toward digital physical therapy. In addition, more than two-thirds, 69.3% uses digital physical therapy platforms for physical therapy practice. Knowledge, attitude, and practice were not significantly associated with sociodemographic characteristics (p > 0.05). Furthermore, there was no significant association between knowledge, attitude, and practice (p > 0.05). Conclusion Many Nigerian physiotherapists demonstrated adequate knowledge, positive attitude, and good practice of digital physical therapy. However, knowledge, attitude, and practice of digital physical therapy were not influenced by sociodemographic characteristics. Supplementary Information The online version contains supplementary material available at 10.1186/s43161-022-00118-3.
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Affiliation(s)
- Taofeek Oluwole Awotidebe
- grid.10824.3f0000 0001 2183 9444Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olufesola Motunrayo Fasakin
- grid.413450.7Nursing Services Department, Veterans Affairs Medical Center, 4500 South Lancaster Road, Dallas, TX 75216 USA
| | - Olufemi Oyeleye Oyewole
- grid.412349.90000 0004 1783 5880Department of Physiotherapy, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State Nigeria
| | - Usman Eniola Bello
- grid.414821.aDepartment of Physiotherapy, Federal Medical Centre, Idi – Aba, Abeokuta, Ogun State Nigeria
| | - Adekola Babatunde Ademoyegun
- grid.412422.30000 0001 2045 3216Department of Physiotherapy, Osun State University Teaching Hospital, Osogbo, Osun State Nigeria
| | - Ayodele Teslim Onigbinde
- grid.10824.3f0000 0001 2183 9444Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Chidozie E. Mbada
- grid.25627.340000 0001 0790 5329Department of Health Professions, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Adekola John Odunlade
- grid.10824.3f0000 0001 2183 9444Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Rufus Adesoji Adedoyin
- grid.10824.3f0000 0001 2183 9444Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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Tesema GA, Wolde M, Tamirat KS, Worku MG, Fente BM, Tsega SS, Tadesse A, Teshale AB. Factors associated with short birth interval among reproductive-age women in East Africa. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231209879. [PMID: 37955253 PMCID: PMC10644753 DOI: 10.1177/17455057231209879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 08/26/2023] [Accepted: 09/28/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Child and maternal mortality continue as a major public health concern in East African countries. Optimal birth interval is a key strategy to curve the huge burden of maternal, neonatal, infant, and child mortality. To reduce the incidence of adverse pregnancy outcomes, the World Health Organization recommends a minimum of 33 months between two consecutive births. Even though short birth interval is most common in many East African countries, as to our search of literature there is limited study published on factors associated with short birth interval. Therefore, this study investigated factors associated with short birth intervals among women in East Africa. OBJECTIVE To identify factors associated with short birth intervals among reproductive-age women in East Africa based on the most recent demographic and health survey data. DESIGN A community-based cross-sectional study was conducted based on the most recent demographic and health survey data of 12 East African countries. A two-stage stratified cluster sampling technique was employed to recruit the study participants. METHODS AND ANALYSIS A total weighted sample of 105,782 reproductive-age women who had two or more births were included. A multilevel binary logistic regression model was fitted to identify factors associated with short birth interval. Four nested models were fitted and a model with the lowest deviance value (-2log-likelihood ratio) was chosen. In the multivariable multilevel binary logistic regression analysis, the adjusted odds ratio with the 95% confidence interval was reported to declare the statistical significance and strength of association between short birth interval and independent variables. RESULTS The prevalence of short birth interval in East Africa was 16.99% (95% confidence interval: 16.76%, 17.21%). Women aged 25-34 years, who completed their primary education, and did not perceive the distance to the health facility as a major problem had lower odds of short birth interval. On the contrary, women who belonged to the poorest household, made their own decisions with their husbands/partners or by their husbands or parents alone, lived in households headed by men, had unmet family planning needs, and were multiparous had higher odds of having short birth interval. CONCLUSION Nearly one-fifth of births in East Africa had short birth interval. Therefore, it is essential to promote family planning coverage, improve maternal education, and empower women to decrease the incidence of short birth intervals and their effects.
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Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Maereg Wolde
- Department of Health Education and Behavioral Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Misganaw Gebrie Worku
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bezawit Melak Fente
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sintayehu Simie Tsega
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Aster Tadesse
- Department of Nursing, College of Health Sciences, Debre Markos University, Markos, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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King C, Siddle M, Adams O, Ahmar S, Ahmed T, Bakare AA, Bakare D, Burgess RA, Colbourn T, McCollum ED, Olowookere T, Salako J, Uchendu O, Graham HR, Falade AG. Prevalence of pneumonia and malnutrition among children in Jigawa state, Nigeria: a community-based clinical screening study. BMJ Paediatr Open 2022; 6:e001640. [PMID: 36645778 PMCID: PMC9577914 DOI: 10.1136/bmjpo-2022-001640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To estimate the point prevalence of pneumonia and malnutrition and explore associations with household socioeconomic factors. DESIGN Community-based cross-sectional study conducted in January-June 2021 among a random sample of households across all villages in the study area. SETTING Kiyawa Local Government Area, Jigawa state, Nigeria. PARTICIPANTS Children aged 0-59 months who were permanent residents in Kiyawa and present at home at the time of the survey. MAIN OUTCOME MEASURES Pneumonia (non-severe and severe) defined using WHO criteria (2014 revision) in children aged 0-59 months. Malnutrition (moderate and severe) defined using mid-upper arm circumference in children aged 6-59 months. RESULTS 9171 children were assessed, with a mean age of 24.8 months (SD=15.8); 48.7% were girls. Overall pneumonia (severe or non-severe) point prevalence was 1.3% (n=121/9171); 0.6% (n=55/9171) had severe pneumonia. Using an alternate definition that did not rely on caregiver-reported cough/difficult breathing revealed higher pneumonia prevalence (n=258, 2.8%, 0.6% severe, 2.2% non-severe). Access to any toilet facility was associated with lower odds of pneumonia (aOR: 0.56; 95% CI: 0.31 to 1.01). The prevalence of malnutrition (moderate or severe) was 15.6% (n=1239/7954) with 4.1% (n=329/7954) were severely malnourished. Being older (aOR: 0.22; 95% CI: 0.17 to 0.27), male (aOR: 0.77; 95% CI: 0.66 to 0.91) and having head of compound a business owner or professional (vs subsistence farmer, aOR 0.71; 95% CI: 0.56 to 0.90) were associated with lower odds of malnutrition. CONCLUSIONS In this large, representative community-based survey, there was a considerable pneumonia and malnutrition morbidity burden. We noted challenges in the diagnosis of Integrated Management of Childhood Illness-defined pneumonia in this context.
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Affiliation(s)
- Carina King
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Morgan Siddle
- Institute for Global Health, University College London, London, UK
| | - Osebi Adams
- Save the Children International, Abuja, Nigeria
| | | | | | - Ayobami Adebayo Bakare
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Community Medicine, University College Hospital Ibadan, Ibadan, Nigeria
| | - Damola Bakare
- Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria
| | | | - Tim Colbourn
- Institute for Global Health, University College London, London, UK
| | - Eric D McCollum
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Julius Salako
- Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria
| | - Obioma Uchendu
- Department of Community Medicine, University College Hospital Ibadan, Ibadan, Nigeria
- Department of Community Medicine, University of Ibadan, Ibadan, Nigeria
| | - Hamish R Graham
- Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria
- International Child Health, MCRI, Royal Children's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Adegoke Gbadegesin Falade
- Paediatrics, University College Hospital Ibadan, Ibadan, Nigeria
- College of Medicine, University of Ibadan, Ibadan, Nigeria
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Okoli CI, Hajizadeh M, Rahman MM, Khanam R. Geographic and socioeconomic inequalities in the survival of children under-five in Nigeria. Sci Rep 2022; 12:8389. [PMID: 35590092 PMCID: PMC9120155 DOI: 10.1038/s41598-022-12621-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 04/27/2022] [Indexed: 11/09/2022] Open
Abstract
Despite a substantial decline in child mortality globally, the high rate of under-five mortality in Nigeria is still one of the main public health concerns. This study investigates inequalities in geographic and socioeconomic factors influencing survival time of children under-five in Nigeria. This is a retrospective cross-sectional quantitative study design that used the latest Nigeria Demographic Health Survey (2018). Kaplan–Meier survival estimates, Log-rank test statistics, and the Cox proportional hazards were used to assess the geographic and socioeconomic differences in the survival of children under-five in Nigeria. The Kaplan–Meier survival estimates show most under-five mortality occur within 12 months after birth with the poorest families most at risk of under-five mortality while the richest families are the least affected across the geographic zones and household wealth index quintiles. The Cox proportional hazard regression model results indicate that children born to fathers with no formal education (HR: 1.360; 95% CI 1.133–1.631), primary education (HR: 1.279; 95% CI 1.056–1.550) and secondary education (HR: 1.204; 95% CI 1.020–1.421) had higher risk of under-five mortality compared to children born to fathers with tertiary education. Moreover, under-five mortality was higher in children born to mothers’ age ≤ 19 at first birth (HR: 1.144; 95% CI 1.041–1.258). Of the six geopolitical zones, children born to mothers living in the North-West region of Nigeria had 63.4% (HR 1.634; 95% CI 1.238–2.156) higher risk of under-five mortality than children born to mothers in the South West region of Nigeria. There is a need to focus intervention on the critical survival time of 12 months after birth for the under-five mortality reduction. Increased formal education and target interventions in geopolitical zones especially the North West, North East and North Central are vital towards achieving reduction of under-five mortality in Nigeria.
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Affiliation(s)
- Chijioke Ifeanyi Okoli
- School of Business, and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia. .,Department of Health Administration and Management, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria.
| | | | - Mohammad Mafizur Rahman
- School of Business, and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Rasheda Khanam
- School of Business, and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
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Kunnuji M, Wammanda RD, Ojogun TO, Quinley J, Oguche S, Odejimi A, Weiss W, Abba BI, King R, Franca-Koh A. Health beliefs and (timely) use of facility-based care for under-five children: lessons from the qualitative component of Nigeria's 2019 VASA. BMC Public Health 2022; 22:850. [PMID: 35484514 PMCID: PMC9047270 DOI: 10.1186/s12889-022-13238-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 03/14/2022] [Indexed: 11/22/2022] Open
Abstract
Background Nigeria’s under-five health outcomes have improved over the years, but the mortality rates remain unacceptably high. The qualitative component of Nigeria’s 2019 verbal and social autopsy (VASA) showed that caregivers’ health beliefs about causes of illnesses and efficacious treatment options contribute to non-use/delay in use of facility-based healthcare for under-five children. This study explored how these health beliefs vary across zones and how they shape how caregivers seek healthcare for their under-five children. Methods Data for this study come from the qualitative component of the 2019 Nigeria VASA, comprising 69 interviews with caregivers of under-five children who died in the five-year period preceding the 2018 Nigeria Demographic and Health Survey (NDHS); and 24 key informants and 48 focus group discussions (FGDs) in 12 states, two from each of the six geo-political zones. The transcripts were coded using predetermined themes on health beliefs from the 2019 VASA (qualitative component) using NVivo. Results The study documented zonal variation in belief in traditional medicine, biomedicine, spiritual causation of illnesses, syncretism, and fatalism, with greater prevalence of beliefs discouraging use of facility-based healthcare in the southern zones. Driven by these beliefs and factors such as availability, affordability, and access to and perceived quality of care in health facilities, caregivers often choose one or a combination of traditional medicines, care from medicine vendors, and faith healing. Most use facility-based care as the last option when other methods fail. Conclusion Caregivers’ health beliefs vary by zones, and these beliefs influence when and whether they will use facility-based healthcare services for their under-five children. In Nigeria’s northern zones, health beliefs are less likely to deter caregivers from using facility-based healthcare services, but they face other barriers to accessing facility-based care. Interventions seeking to reduce under-five deaths in Nigeria need to consider subnational differences in caregivers’ health beliefs and the healthcare options they choose based on those beliefs.
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Affiliation(s)
- Michael Kunnuji
- Department of Sociology, University of Lagos, Lagos, Nigeria.
| | - Robinson Daniel Wammanda
- Department of Paediatrics, Ahmadu Bello University/Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | | | - John Quinley
- Social Solution International, CIRCLE Project, Rockville, USA
| | - Stephen Oguche
- Department of Paediatrics, Faculty of Clinical Sciences, College of Health Sciences, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Adeyinka Odejimi
- Department of Health Planning, Research and Statistics, Federal Ministry of Health, Abuja, Nigeria
| | - William Weiss
- USAID Senior Monitoring & Evaluation Advisor, IPA Mobility Program/Johns Hopkins University, Baltimore, USA
| | | | - Rebekah King
- Social Solutions International (United States), Rockville, USA
| | - Ana Franca-Koh
- Social Solutions International (United States), Rockville, USA
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Socioeconomic inequality in barriers for accessing health care among married reproductive aged women in sub-Saharan African countries: a decomposition analysis. BMC Womens Health 2022; 22:130. [PMID: 35468770 PMCID: PMC9036791 DOI: 10.1186/s12905-022-01716-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accessibility of health care is an essential for promoting healthy life, preventing diseases and deaths, and enhancing health equity for all. Barriers in accessing health care among reproductive-age women creates the first and the third delay for maternal mortality and leads to the occurrence of preventable complications related to pregnancy and childbirth. Studies revealed that barriers for accessing health care are concentrated among individuals with poor socioeconomic status which creates health inequality despite many international organizations top priority is enhancing universal health coverage. Therefore, this study aimed to assess the presence of socioeconomic inequality in barriers for accessing health care and its contributors in Sub-Saharan African countries. METHODS The most recent DHS data of 33 sub-Saharan African countries from 2010 to 2020 were used. A total sample of 278,501 married reproductive aged were included in the study. Erreygers normalized concentration index (ECI) and its concentration curve were used while assessing the socioeconomic-related inequality in barriers for accessing health care. A decomposition analysis was performed to identify factors contributing for the socioeconomic-related inequality. RESULTS The weighted Erreygers normalized Concentration Index (ECI) for barriers in accessing health care was - 0.289 with Standard error = 0.005 (P value < 0.0001); indicating that barriers in accessing health care was disproportionately concentrated among the poor. The decomposition analysis revealed that wealth index (42.58%), place of residency (36.42%), husband educational level (5.98%), women educational level (6.34%), and mass media exposure (3.07%) were the major contributors for the pro-poor socioeconomic inequalities in barriers for accessing health care. CONCLUSION In this study, there is a pro-poor inequality in barriers for accessing health care. There is a need to intensify programs that improve wealth status, education level of the population, and mass media coverage to tackle the barriers for accessing health care among the poor.
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Alamneh TS, Teshale AB, Yeshaw Y, Alem AZ, Ayalew HG, Liyew AM, Tessema ZT, Tesema GA, Worku MG. Barriers for health care access affects maternal continuum of care utilization in Ethiopia; spatial analysis and generalized estimating equation. PLoS One 2022; 17:e0266490. [PMID: 35452475 PMCID: PMC9032438 DOI: 10.1371/journal.pone.0266490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 03/21/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Although Ethiopia had made a significant change in maternal morbidity and mortality over the past decades, it remains a major public health concern. World Health Organization designed maternal continuum of care to reduce maternal morbidity and mortality. However, majority of the mothers didn't utilize the maternal continuum of care. Therefore, this study aimed to assess the spatial distribution of incomplete utilization of maternal continuum of care and its associated factors in Ethiopia. METHODS This study was based on 2016 Demographic and Health Survey data of Ethiopia. A total weighted sample of 4,772 reproductive aged women were included. The study used ArcGIS and SaTScan software to explore the spatial distribution of incomplete utilization of maternal continuum of care. Besides, multivariable Generalized Estimating Equation was fitted to identify the associated factors of incomplete utilization of maternal continuum of care using STATA software. Model comparison was made based on Quasi Information Criteria. An adjusted odds ratio with 95% confidence interval of the selected model was reported to identify significantly associated factors of incomplete utilization of maternal continuum of care. RESULTS The spatial analysis revealed that incomplete utilization of maternal continuum of care had significant spatial variation across the country. Primary clusters were detected at Somali, North-Eastern part of Oromia, and East part of Southern Nation Nationalities while secondary clusters were detected in the Central Amhara region. In multivariate GEE, rural residency, secondary education, higher education, Protestant religious follower's, Muslim religious follower's, poorer wealth index, richer wealth index, richest wealth index, currently working, having barriers for accessing health care, and exposure for mass media were significantly associated with incomplete utilization maternal continuum of care. CONCLUSION Incomplete utilization of maternal continuum of care had significant spatial variations in Ethiopia. Residence, wealth index, education, religion, and barriers for health care access, mass media exposure, and currently working were significantly associated with incomplete utilization of maternal continuum of care. Therefore, public health interventions targeted to enhance maternal service utilization and women empowerment in hotspot areas of incomplete utilization of maternal continuum of care are crucial for reducing maternal morbidity and mortality.
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Affiliation(s)
- Tesfa Sewunet Alamneh
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yigizie Yeshaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Department of Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Hiwotie Getaneh Ayalew
- Department of midwifery, school of nursing and midwifery, college of medicine and health sciences, Wollo University, Dessie, Ethiopia
| | - Alemneh Mekuriaw Liyew
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Misganaw Gebrie Worku
- Department of Human Anatomy, University of Gondar, College of Medicine and Health Science, School of Medicine, Gondar, Ethiopia
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Adedini SA, Abatan SM, Ogunsakin AD, Alex-Ojei CA, Babalola BI, Shittu SB, Odusina EK, Ntoimo LFC. Comparing the timeliness and adequacy of antenatal care uptake between women who married as child brides and adult brides in 20 sub-Saharan African countries. PLoS One 2022; 17:e0262688. [PMID: 35025949 PMCID: PMC8758032 DOI: 10.1371/journal.pone.0262688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/02/2022] [Indexed: 11/18/2022] Open
Abstract
CONTEXT Considering the persistent poor maternal and child health outcomes in sub-Saharan Africa (SSA), this study undertook a comparative analysis of the timing and adequacy of antenatal care uptake between women (aged 20-24 years) who married before age 18 and those who married at age 18 or above. METHOD Data came from Demographic and Health Surveys of 20 SSA countries. We performed binary logistic regression analysis on pooled data of women aged 20-24 (n = 33,630). RESULTS Overall, the percentage of child brides in selected countries was 57.1%, with the lowest prevalence found in Rwanda (19.1%) and the highest rate in Chad (80.9%). Central and West African countries had the highest prevalence of child marriage compared to other sub-regions. Bivariate results indicate that a lower proportion of child brides (50.0%) had 4+ ANC visits compared to the adult brides (60.9%) and a lower percentage of them (34.0%) initiated ANC visits early compared to the adult brides (37.5%). After controlling for country of residence and selected socio-economic and demographic characteristics, multivariable results established significantly lower odds of having an adequate/prescribed number of ANC visits among women who married before age 15 (OR: 0.63, CI: 0.57-0.67, p<0.001), and women who married at ages 15-17 (OR: 0.81, CI: 0.75-0.84, p<0.001) compared to those who married at age 18+. Similar results were established between age at first marriage and timing of first ANC visit. Other interesting results emerged that young women who married earlier than age 18 and those who married at age 18+ differ significantly by several socio-economic and demographic characteristics. CONCLUSION Efforts to improve maternal and child health outcomes in SSA must give attention to address the underutilization and late start of antenatal care uptake among child brides.
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Affiliation(s)
- Sunday A. Adedini
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
- Programme in Demography and Population Studies, University of the Witwatersrand, Schools of Public Health and Social Sciences, Johannesburg, South Africa
- * E-mail:
| | - Sunday Matthew Abatan
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Adesoji Dunsin Ogunsakin
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Christiana Alake Alex-Ojei
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Blessing Iretioluwa Babalola
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Sarafa Babatunde Shittu
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Emmanuel Kolawole Odusina
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
| | - Lorretta Favour C. Ntoimo
- Faculty of Social Sciences, Demography and Social Statistics Department, Federal University Oye-Ekiti, Oye-Ekiti, Nigeria
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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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21
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Adedini SA, Mobolaji JW, Adetutu OM, Abe JO, Oyinlola FF. Influence of child marriage on institutional delivery and high-risk births among young women in 31 sub-Saharan African countries. Women Health 2021; 62:85-93. [PMID: 34937521 DOI: 10.1080/03630242.2021.2020201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
While child marriage persists in sub-Saharan Africa (SSA), little is known about its influence on institutional delivery/high-risk births (IDHRB). We analyzed pooled data on young women aged 15-24 (N = 113,588) from the most recent Demographic and Health Surveys of 31 SSA countries to examine the influence of child marriage on IDHRB. Binary logistic regression analysis was done to explore statistically significant relationships. Findings showed that unskilled delivery was significantly higher among women who married before age 15 (67.2%) and at ages 16-17 (48.2%) compared to those who married at age 18+ (30.2%). The prevalence of high-risk birth was higher among women who married before age 15 (97.2%) and at ages 16-17 (80.8%) compared to those who married at 18+ (48.4%). Inferential analysis showed that respondents who married before age 15 and at ages 16-17, respectively, had five-fold and two-fold higher odds of experiencing unskilled delivery compared to those who married at age 18 +. Odds of having high-risk births were significantly higher among child-brides compared to those who had first marriage as adults. This study concludes that policies/programs that would successfully delay first marriage among women must be pursued to reduce high-risk births and unskilled delivery in SSA.
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Affiliation(s)
- Sunday A Adedini
- Demography and Social Statistics Department, Faculty of Social Sciences, Federal University, Oye-Ekiti, Nigeria.,Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jacob Wale Mobolaji
- Demography and Social Statistics Department, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olufemi Mayowa Adetutu
- Demography and Social Statistics Department, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - John Olugbenga Abe
- Demography and Social Statistics Department, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Funmilola F Oyinlola
- Demography and Social Statistics Department, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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22
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Rizkianti A, Saptarini I, Rachmalina R. Perceived Barriers in Accessing Health Care and the Risk of Pregnancy Complications in Indonesia. Int J Womens Health 2021; 13:761-772. [PMID: 34429661 PMCID: PMC8375221 DOI: 10.2147/ijwh.s310850] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Accessing immediate health care during pregnancy is key to preventing and treating pregnancy-related complications, which are the leading cause of maternal morbidity and mortality. As the largest archipelago country in the world, Indonesia faces the challenges of disparity in access to healthcare services across geographical regions and socioeconomic groups. Objective This study aims to assess the relationship between perceived barriers to accessing health care and the risk of pregnancy-related complications among women of reproductive age in Indonesia. Methods Data from a nationally representative sample of 15,021 last births within 5 years preceding the 2017 Indonesia Demographic and Health Survey were analyzed to examine barriers in accessing health care and the risk of having complications during pregnancy. The statistical model of logistic regression was used to investigate the effect of barriers on the risk of pregnancy complications, and results were presented as odds ratios (ORs) with 95% confidence intervals (CIs). Results The majority of women in Sumatra and Maluku-Papua regions encountered physical, cultural, and financial barriers to accessing health care. The results indicate significantly higher odds of having complications in mothers who had distance barriers (OR: 1.46, 95% CI: 1.20-1.77), relative to mothers who reported no barriers, after adjusting for women's characteristics. Conclusion The findings suggest that it is necessary to tackle specific physical barriers by providing more developed health-care systems in rural and geographically isolated areas, to bring health services closer to home.
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Affiliation(s)
- Anissa Rizkianti
- Center for Research and Development of Public Health Efforts, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Ika Saptarini
- Center for Research and Development of Public Health Efforts, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
| | - Rika Rachmalina
- Center for Research and Development of Public Health Efforts, National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
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Ojima WZ, Olawade DB, Awe OO, Amusa AO. Factors Associated with Neonatal Mortality among Newborns Admitted in the Special Care Baby Unit of a Nigerian Hospital. J Trop Pediatr 2021; 67:6344870. [PMID: 34363078 DOI: 10.1093/tropej/fmab060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND With Nigeria being one of the countries with the highest neonatal mortality rate globally, identifying the risk factors associated with neonatal mortality is essential as we strive to proffer sustainable solutions. AIM This retrospective hospital-based survey aimed to bridge this gap by evaluating the trends and risk factors associated with neonatal mortality in a teaching hospital in Southwestern Nigeria. METHODS Records of newborns admitted at the special care baby unit from January 2018 to December 2019 (n = 1098) were accessed, and available data were extracted. Descriptive analysis and inferential statistics were performed at 0.05 level of significance. RESULTS The mortality rate was determined to be 16.9% (inborn babies- 12.9% and out-born babies- 22.3%), with 83.3% of the newborns dying within the first week. Some of the factors associated with neonatal mortality were proximity of newborns' mothers home to the hospital [p = 0.041; Odds Ratio (OR) = 0.670; 95% Confidence Interval (CI) = 0.455-0.985], maturity of the baby at delivery (p < 0.001; OR = 0.514; CI = 0.358-0.738), place of delivery-inborn or out-born (p < 0.001; OR = 0.515; CI = 0.375-0.709), place of delivery-in a hospital or a non-hospital setting (p = 0.048; OR = 0.633; CI = 0.401-0.999), and baby's weight (p < 0.001; CI = -0.684 to -0.411). CONCLUSION Findings from the study indicate that newborns delivered at home, traditional birth attendant centres or hospitals without essential healthcare facilities have a higher mortality risk. This suggests that measures to improve the accessibility of pregnant women to essential healthcare services are a prerequisite to reducing the neonatal mortality rate in Nigeria.
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Affiliation(s)
- Wada Zechariah Ojima
- Division of Sustainable Development, College of Science and Engineering, Hamad Bin Khalifa University, Doha 34110, Qatar.,Department of Environmental Health Sciences, University of Ibadan, Ibadan, Oyo State 200212, Nigeria
| | - David Bamidele Olawade
- Center for Population and Reproductive Health, University of Ibadan, Ibadan, Oyo State 200212, Nigeria.,Department of Environmental Health Sciences, University of Ibadan, Ibadan, Oyo State 200212, Nigeria
| | - Olabisi O Awe
- School of Midwifery, Ekiti State University Teaching Hospital, Ado-Ekiti 360281, Nigeria
| | - Aminat Opeyemi Amusa
- Department of Medicine and Surgery, University of Ibadan, Ibadan, Oyo State 200212, Nigeria
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Majamanda MD, Joshua Gondwe M, Makwero M, Chalira A, Lufesi N, Dube Q, Desmond N. Capacity Building for Health Care Workers and Support Staff in Pediatric Emergency Triage Assessment and Treatment (ETAT) at Primary Health Care Level in Resource Limited Settings: Experiences from Malawi. Compr Child Adolesc Nurs 2021:1-16. [PMID: 34029495 DOI: 10.1080/24694193.2021.1916127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
Primary health care facilities offer an entry point to the health care system in Malawi. Challenges experienced by these facilities include limited resources (both material and human), poor or inadequate knowledge, skills and attitudes of health care workers in emergency management, and delay in referral from primary care level to other levels of care. These contribute to poor outcomes including children dying within the first 24 hours of hospital admission. Training of health care workers and support staff in Emergency Triage Assessment and Treatment (ETAT) at primary care levels can help improve care of children with acute and severe illnesses. Health care workers and support staff in the primary care settings were trained in pediatric ETAT. The training package for health care workers was adapted from the Ministry of Health ETAT training for district and tertiary health care. Content for support staff focused on non-technical responsibility for lifesaving in emergency situations. The primary health care facilities were provided with a minimum treatment package comprising emergency equipment, supplies and drugs. Supportive supervisory visits were conducted quarterly. The training manual for health care workers was adapted from the Ministry of Health package and the support staff training manual was developed from the adapted package. Eight hundred and seventy-seven participants were trained (336 health care workers and 541 support staff). Following the training, triaging of patients improved and patients were managed as emergency, priority or non-urgent. This reduced the number of referral cases and children were stabilized before referral. Capacity building of health care workers and support staff in pediatric ETAT and the provision of a basic health center package improved practice at the primary care level. The practice was sustained through institutional mentorship and pre-service and in-service training. The practice of triage and treatment including stabilization of children with dangerous signs at the primary health care facility improves emergency care of patients, reduces the burden of patients on referral hospitals and increases the number of successful referrals.
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Affiliation(s)
- Maureen Daisy Majamanda
- Department of Medical and Surgical Nursing, Kamuzu College of Nursing, University of Malawi, Blantyre, Malawi
- Consortium for Advanced Research Training in Africa (CARTA), Nairobi, Kenya
| | - Mtisunge Joshua Gondwe
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Behaviour and Health Group, Malawi-Liverpool Wellcome Trust, Clinical Research Programme, Blantyre, Malawi
| | - Martha Makwero
- Department of Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi
| | - Alfred Chalira
- Department of Clinical Services, Ministry of Health, Lilongwe, Malawi
| | - Norman Lufesi
- Department of Clinical Services, Ministry of Health, Lilongwe, Malawi
| | - Queen Dube
- Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Nicola Desmond
- Behaviour and Health Group, Malawi-Liverpool Wellcome Trust, Clinical Research Programme, Blantyre, Malawi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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Does Birth Interval Matter in Under-Five Mortality? Evidence from Demographic and Health Surveys from Eight Countries in West Africa. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5516257. [PMID: 34055975 PMCID: PMC8147536 DOI: 10.1155/2021/5516257] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 05/08/2021] [Indexed: 11/26/2022]
Abstract
In sub-Saharan Africa (SSA), every 1 in 12 children under five dies every year compared with 1 in 147 children in the high-income regions. Studies have shown an association between birth intervals and pregnancy outcomes such as low birth weight, preterm birth, and intrauterine growth restriction. In this study, we examined the association between birth interval and under-five mortality in eight countries in West Africa. A secondary analysis of the Demographic and Health Survey (DHS) data from eight West African countries was carried out. The sample size for this study comprised 52,877 childbearing women (15-49 years). A bivariate logistic regression analysis was carried out and the results were presented as crude odds ratio (cOR) and adjusted odds ratios (aOR) at 95% confidence interval (CI). Birth interval had a statistically significant independent association with under-five mortality, with children born to mothers who had >2 years birth interval less likely to die before their fifth birthday compared to mothers with ≤2 years birth interval [cOR = 0.56; CI = 0.51 − 0.62], and this persisted after controlling for the covariates [aOR = 0.55; CI = 0.50 − 0.61]. The country-specific results showed that children born to mothers who had >2 years birth interval were less likely to die before the age of five compared to mothers with ≤2 years birth interval in all the eight countries. In terms of the covariates, wealth quintile, mother's age, mother's age at first birth, partner's age, employment status, current pregnancy intention, sex of child, size of child at birth, birth order, type of birth, and contraceptive use also had associations with under-five mortality. We conclude that shorter birth intervals are associated with higher under-five mortality. Other maternal and child characteristics also have associations with under-five mortality. Reproductive health interventions aimed at reducing under-five mortality should focus on lengthening birth intervals. Such interventions should be implemented, taking into consideration the characteristics of women and their children.
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Sato R, Belel A. Effect of performance-based financing on health service delivery: a case study from Adamawa state, Nigeria. Int Health 2021; 13:122-129. [PMID: 32530041 PMCID: PMC7902678 DOI: 10.1093/inthealth/ihaa026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The Nigeria State Health Investment Project (NSHIP) was implemented in three Nigerian states between 2013 and 2018. Under the NSHIP, some local government areas were randomly assigned to Performance-Based Financing (PBF) intervention while others received decentralized facility financing (DFF) for comparison. This article evaluates the effect of PBF compared with DFF on health service delivery indicators in Adamawa state, under this quasi-experimental design, using the difference-in-differences technique. The analysis used health facility monthly data collected by the Health Management Information System through the District Health Information Software 2 (DHIS2). The PBF intervention group significantly increased the quantity of most of its service delivery indicators, such as antenatal care visits and deliveries by skilled personnel compared with the comparison group (DFF) after the introduction of NSHIP, although the baseline level of service delivery between PBF and DFF health facilities was statistically identical prior to the introduction of the intervention. We also conducted robustness check analysis to confirm the effect of PBF. Overall, we found a significant positive effect of PBF on most service delivery outcomes, except full vaccinations and post-natal care. One important policy implication is that we should carefully use PBF for targeted indicators.
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Affiliation(s)
- Ryoko Sato
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 90 Smith Street, Boston, MA, 02120 USA
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Ibeneme C, Ewurum O, Nnaji T, Ikefuna A. Healthcare-seeking behavior of parents and guardians of school children with skin diseases in Umuahia, South East Nigeria. NIGERIAN JOURNAL OF MEDICINE 2021. [DOI: 10.4103/njm.njm_103_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Yaya S, Anjorin SS, Adenini SA. Intimate partner violence, contextual factors and under-5 mortality: a multilevel analysis of cross-sectional surveys from 20 Sub-Saharan African countries. BMJ Glob Health 2020; 5:e003531. [PMID: 33272941 PMCID: PMC7716669 DOI: 10.1136/bmjgh-2020-003531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/17/2020] [Accepted: 10/17/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Under-5 mortality remains a public health concern in low-income and middle-income countries. Africa contributes about one-fifth of the burden of global under-5 mortality; intimate partner violence (IPV) and polygyny, which are highly prevalent on the continent, have been linked to under-5 mortality at the individual level. This study examined the relationship between IPV and polygyny as contextual factors and the experience of under-5 mortality among women in Sub-Saharan Africa (SSA). METHODS We used data from the Demographic and Health Surveys (DHS) of 20 African countries with available data between 2010 and 2018 as of April 2020. We defined the experience of under-5 mortality as a woman's loss of at least one child before their fifth birthday. The DHS primary sampling unit was used to define contextual factors. The study involved a multilevel logistic regression analysis of 227 121 women of childbearing age (15-49). RESULTS A quarter (24.5%) of women have lost at least one child under 5 years old, more than two-thirds (40.1%) have experienced at least one form of IPV, and about two-thirds of women were in polygynous union. Our multilevel logistic regression showed that parity, polygynous union and experience of IPV were strongly associated with women's experience of under-5 mortality. The results showed that 39.9% and 19.2% of variances in odds of a woman losing a child before their fifth birthday are attributable to community-level and country-level factors, respectively. Contextual prevalence of IPV, polygynous union and gender equity attenuate the strength of associations observed at the individual level. The interaction between contextual prevalence of polygyny and IPV exacerbates the risk of under-5 mortality. Women in SSA countries with higher Human Development Index were less likely to experience under-5 mortality. CONCLUSION This study established that beyond individual-level effects, contextual prevalence of IPV and polygyny and their interactions shape women's experience of under-5 mortality in Africa. In designing policies and interventions to address under-5 mortality, contextual factors, especially those linked to culturally laden social norms and practices, must be considered to ensure effectiveness and sustainable impact.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa Faculty of Social Sciences, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, United Kingdom
| | - Seun Stephen Anjorin
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, University of Warwick, Coventry, West Midlands, United Kingdom
| | - Sunday A Adenini
- Programme in Demography and Population Studies, Schools of Public Health and Social Sciences, University of Witwatersrand CISA, Johannesburg, South Africa
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Banigbe BF, Itanyi IU, Ofili EO, Ogidi AG, Patel D, Ezeanolue EE. High prevalence of undiagnosed hypertension among men in North Central Nigeria: Results from the Healthy Beginning Initiative. PLoS One 2020; 15:e0242870. [PMID: 33253296 PMCID: PMC7703905 DOI: 10.1371/journal.pone.0242870] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The prevalence of hypertension in Nigeria is high and growing. The burden and risk factor distribution also vary by geographical zone. Information about prevalence, risk factors and disease status awareness are needed to guide evidence based public health response at the national and sub- national levels. PURPOSE This paper describes the prevalence of hypertension and its correlates, as well as hypertension status awareness among men in North Central, Nigeria. METHODS A cross sectional survey was administered to male partners of pregnant women participating in the Healthy Beginning Initiative program from 2016-2018. Information on socio-demographic characteristics, risk factors, physical measurement and blood pressure readings were collected using a standardized protocol. Data was analyzed with simple and multiple logistic regression. RESULTS The 6,538 men had a median age of 31 years [IQR: 26-37]. The prevalence of hypertension was 23.3% (95% CI: 22.3%-24.4%), while 46.7% had prehypertension. The odds of hypertension was associated with increasing age (OR:1.02, CI:1.01-1.03), being overweight (aOR:1.5,CI:1.3-1.8), being obese (aOR:2.6,CI:2.0-3.3), living in an urban area (aOR:1.6,CI:1.2-2.1), and alcohol use in the 30 days prior (aOR:1.2,CI:1.1-1.4). Overall, 4.5% (297/6,528) of participants had ever been told they have hypertension. Among the 23.3% (1,527/6,528) with hypertension, 7.1% (109/1,527) were aware of their disease status. Men aged 41-50 years (aOR: 1.8, CI: 1.0-3.3), and > 50 years (aOR: 2.2, CI: 1.1-4.3), had higher odds disease status awareness. Living in an urban area was associated with lower odds (aOR: 0.2, CI: 0.03-0.7) of hypertension status awareness. CONCLUSION This study showed that hypertension is already a significant public health burden in this population and that disease awareness level is very low. Alcohol use and obesity were associated with hypertension, highlighting some modifiable cardiovascular disease risk factors that are prevalent in the study population. Taken together, these findings can inform the design of interventions for primary and secondary cardiovascular disease prevention in Nigeria and similar settings.
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Affiliation(s)
- Bolanle Feyisayo Banigbe
- APIN Public Health Initiatives, Abuja, Nigeria
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria Nsukka, Enugu, Nigeria
| | - Elizabeth Odilile Ofili
- Clinical Research Center, Morehouse School of Medicine, Atlanta, Georgia, United States of America
- Department of Medicine, Morehouse School of Medicine, Atlanta, Georgia, United States of America
| | - Amaka Grace Ogidi
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
| | - Dina Patel
- Healthy Sunrise Foundation, Las Vegas, Nevada, United States of America
| | - Echezona Edozie Ezeanolue
- Center for Translation and Implementation Research, University of Nigeria Nsukka, Enugu, Nigeria
- Healthy Sunrise Foundation, Las Vegas, Nevada, United States of America
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Risk factors affecting maternal health outcomes in Rivers State of Nigeria: Towards the PRISMA model. Soc Sci Med 2020; 265:113520. [PMID: 33250317 DOI: 10.1016/j.socscimed.2020.113520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 10/14/2020] [Accepted: 11/10/2020] [Indexed: 12/29/2022]
Abstract
Existing research suggests that Nigeria accounts for about 23% of the world's maternal mortality ratio, with negative impacts on women's wellbeing and the country's socio-economic development. The underlying risk factors can be categorized into political influences, poor access to healthcare, inadequate utilization of health facilities, poor family planning support and complex pregnancy-related illness. Yet, the complex interrelations amongst the factors makes it difficult to ascertain the riskiest ones that affect women's reproduction and child death, with the existing intervening strategies failing to address the problem. This study identifies maternal health risk factors and prioritizes their management in Rivers State of Nigeria, using the Prevention and Recovery Information System for Monitoring and Analysis (PRISMA) model. Taking a quantitative turn, we applied exploratory factor analysis to analyze 174 returned questionnaires from healthcare professionals working in Rivers State and used the results to establish relationships between maternal health risk factors, prioritizing the riskiest factors. The outcomes indicate that the PRISMA model provides an effective framework for identifying and managing maternal mortality risks that can enable healthcare experts and managers to address the avoidable risk factors and mitigate the unavoidable patient-related risk factors in Nigeria. The implications for theory, practice and policy are discussed.
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Tesema GA, Tessema ZT, Tamirat KS. Decomposition and Spatio-temporal analysis of health care access challenges among reproductive age women in Ethiopia, 2005-2016. BMC Health Serv Res 2020; 20:760. [PMID: 32807148 PMCID: PMC7433138 DOI: 10.1186/s12913-020-05639-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 08/10/2020] [Indexed: 11/24/2022] Open
Abstract
Background The high maternal mortality, home delivery, unwanted pregnancies, incidence of unsafe abortion, and unmeet family planning needs are maternal health gaps attributed to health care access barriers and responsible for the observed health care disparities. Over the last decades remarkable achievements have made in relation to maternal health problems and the reduction of health care access barriers. Thus, this study aimed to assess the decomposition and spatial-temporal analysis of health care access challenges among reproductive-age women in Ethiopia. Methods Secondary data analysis was conducted based on the three consecutive Ethiopian Demographic and Health Surveys (2005–2016 EDHSs). A total weighted sample of 46,235 reproductive-age women was included in this study. A logit based multivariate decomposition analysis was employed for identifying factors contributing to the overall decrease in health care access challenges over time. For the spatial analysis, ArcGIS version 10.6 and SaTScan™ version 9.6 were used to explore hotspot areas of health care access challenges in Ethiopia over time. Variables with p-value < 5% in the multivariable Logit based multivariate decomposition analysis were considered as significantly contributed predictors for the decrease in health care access challenges over time. Result The mean age of the women was 27.8(±9.4) years in 2005, 27.7(±9.2) years in 2011, and 27.9 (±9.1) years in 2016. Health care access challenges have been significantly decreased from 96% in 2005 to 70% in 2016 with the Annual Rate of Reduction (ARR) of 2.7%. In the decomposition analysis, about 85.2% of the overall decrease in health care access challenge was due to the difference in coefficient and 14.8% were due to differences in the composition of the women (endowment) across the surveys. Socio-demographic characteristics (age, residence, level of education, female household head, better wealth and media exposure) and service utilization history before the survey (facility delivery and had ANC follow up) contribute to the observed decrease over time. The spatial analysis revealed that health care access challenges were significantly varied across the country over time. The SaTScan analysis identified significant hotspot areas of health care access challenges in the southern, eastern, and western parts of Ethiopia consistently over the surveys. Conclusion Perceived health care access challenges have shown a remarkable decrease over time but there was variation in barriers to health care access across Ethiopia. Media exposure improved mothers’ health care access in Ethiopia. Public health programs targeting rural, uneducated, unemployed, and women whose husband had no education would be helpful to alleviate health care access problems in Ethiopia. Besides, improving mother’s media exposure plays a significant role to improve mothers’ health care access. Health care access challenges have significantly varied across the country. This suggests that further public health interventions are important for further reduction of health care access barriers through the uplifting socio-demographic and economic status of the population.
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Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Read SK, Jibril A, Tongo O, Akindolire A, Abdulkadir I, Nabwera H, Sinha I, Allen S. Parents' perceptions of core outcomes in neonatal research in two Nigerian neonatal units. BMJ Paediatr Open 2020; 4:e000669. [PMID: 32548311 PMCID: PMC7279647 DOI: 10.1136/bmjpo-2020-000669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 04/20/2020] [Accepted: 05/06/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is a scarcity of information regarding the most important outcomes for research in neonatal units in low-resource settings. Identification of important outcomes by different stakeholder groups would inform the development of a core outcome set (COS) for use in neonatal research. OBJECTIVE To determine the perceptions and opinions of parents of newborn babies regarding what outcomes were most important to them in order to contribute towards development of a COS for neonatal research in sub-Saharan Africa. METHODS Semistructured interviews were undertaken with parents, mostly mothers, of babies admitted to one neonatal unit in North central and one in Southwest Nigeria. Participants were purposively sampled to include parents of babies with common neonatal problems such as prematurity. RESULTS We conducted 31 interviews. The most frequently raised outcomes were breast feeding, good health outcomes for their baby, education, growth and financial cost. Parents placed more emphasis on quality of life and functional status than health complications. CONCLUSIONS The opinions of parents need to be considered in developing a COS for neonatal research in low-resource settings. Further research should assess the opinions of families in other low-resource settings and also engage a broader range of stakeholders.
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Affiliation(s)
- Sarah Kathryn Read
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Aisha Jibril
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Olukemi Tongo
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Abimbole Akindolire
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Isa Abdulkadir
- Department of Paediatrics, Faculty of Clinical Sciences, College of Medical Sciences, Ahmadu Bello University, Zaria, Kaduna, Nigeria
| | - Helen Nabwera
- International Public Health, Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Ian Sinha
- Respiratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, Liverpool, UK
| | - Stephen Allen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Department of Gastroenterology, Alder Hey Children's NHS Foundation Trust, Liverpool, Merseyside, UK
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Ayamolowo LB, Odetola TD, Ayamolowo SJ. Determinants of choice of birth place among women in rural communities of southwestern Nigeria. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020. [DOI: 10.1016/j.ijans.2020.100244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ilinca S, Di Giorgio L, Salari P, Chuma J. Socio-economic inequality and inequity in use of health care services in Kenya: evidence from the fourth Kenya household health expenditure and utilization survey. Int J Equity Health 2019; 18:196. [PMID: 31849334 PMCID: PMC6918604 DOI: 10.1186/s12939-019-1106-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 12/09/2019] [Indexed: 11/27/2022] Open
Abstract
Background Kenya is experiencing persistently high levels of inequity in health and access to care services. In 2018, decades of sustained policy efforts to promote equitable, affordable and quality health services have culminated in the launch of a universal health coverage scheme, initially piloted in four Kenyan counties and planned for national rollout by 2022. Our study aims to contribute to monitoring and evaluation efforts alongside policy implementation, by establishing a detailed, baseline assessment of socio-economic inequality and inequity in health care utilization in Kenya shortly before the policy launch. Methods We use concentration curves and corrected concentration indexes to measure socio-economic inequality in care use and the horizontal inequity index as a measure of inequity in care utilization for three types of care services: outpatient care, inpatient care and preventive and promotive care. Further insights into the individual and household level characteristics that determine observed inequality are derived through decomposition analysis. Results We find significant inequality and inequity in the use of all types of care services favouring richer population groups, with particularly pronounced levels for preventive and inpatient care services. These are driven primarily by differences in living standards and educational achievement, while the region of residence is a key driver for inequality in preventive care use only. Pro-rich inequalities are particularly pronounced for care provided in privately owned facilities, while public providers serve a much larger share of individuals from lower socio-economic groups. Conclusions Through its focus on increasing affordability of care for all Kenyans, the newly launched universal health coverage scheme represents a crucial step towards reducing disparities in health care utilization. However in order to achieve equity in health and access to care such efforts must be paralleled by multi-sectoral approaches to address all key drivers of inequity: persistent poverty, disparities in living standards and educational achievement, as well as regional differences in availability and accessibility of care.
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Affiliation(s)
- Stefania Ilinca
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland. .,European Centre for Social Welfare Policy and Research, Vienna, Austria.
| | | | - Paola Salari
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland
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Challenges and Strategies for Improving Training of Mid-Level Research Personnel in Nigeria. Ann Glob Health 2019; 85. [PMID: 31225955 PMCID: PMC6634317 DOI: 10.5334/aogh.2405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Contextual research evidence is needed to reduce morbidity and mortality due to chronic but preventable diseases in low- and middle-income countries. Nigeria, Africa’s most populous country, is particularly burdened by these diseases despite its academic and research infrastructure. A major impediment to developing robust evidence on sustainable disease prevention and treatment strategies is the lack of skilled research personnel. Objective: This study aimed to identify (1) training barriers for research assistants and coordinators and (2) potential strategies to counter these barriers using a Nominal Group Technique (NGT) exercise conducted at the 2017 conference of the Nigeria Implementation Science Alliance (NISA). Method: A one-hour NGT exercise was conducted with 26 groups of 2–9 persons each (N = 134) drawn from conference attendees. Group members were presented with questions related to the two objectives. Each member was asked to generate, list, discuss and vote on ideas that were eventually ranked by the group. Qualitative Thematic Analysis (QTA) was conducted for the collated responses. Findings: The QTA identified 166 training gaps and 147 potential solutions, out of which 104 were ranked. Themes that emerged for gaps included: 1) inadequate mentorship; 2) inadequate training/lack of organized curriculum; 3) limited access to opportunities for training and employment; 4) lack of government funding; 5) lack of interest, motivation; and 6) lack of research culture. Themes for potential strategies to address the gaps were: 1) trainings/curriculum development; 2) research modules implemented in secondary and tertiary institutions; 3) creating a sustainable forum for research-related questions and answers; and 4) advocating for and accessing more government funding for research training. Conclusion: This study identified actionable strategies that reflect practical realities in implementation research in Nigeria, which can guide government agencies, policy makers, research organizations, and local foundations as they work together to increase research capacity in Nigeria.
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Ogbuabor DC, Onwujekwe OE. Aligning public financial management system and free healthcare policies: lessons from a free maternal and child healthcare programme in Nigeria. HEALTH ECONOMICS REVIEW 2019; 9:17. [PMID: 31197493 PMCID: PMC6734425 DOI: 10.1186/s13561-019-0235-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 06/06/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Relatively little is known about how public financial management (PFM) systems and health financing policies align in low- and middle-income countries. This study assessed the alignment of PFM systems with health financing functions in the free maternal and child healthcare programme (FMCHP) of Enugu State, Nigeria. METHODS Data were collected through quantitative and qualitative document review, and semi-structured, in-depth interview with 16 purposively selected policymakers involved in FMCHP. Data collection and analysis were by guided a framework for assessing alignment of PFM systems and health financing policies. Revenue and expenditure trend analyses were done using descriptive statistics and analysis of variance (ANOVA). Level of significance was set at ρ < 0.05. Qualitative data were analysed using a framework approach. RESULTS The results showed that no more than 50% of FMCHP fund were collected despite that the promised fund remained unchanged since inception. Revenue generation significantly varied between 2010 and 2016 (ρ < 0.05). Level of pooling was limited by non-compliance with contribution rules, recurrent unauthorised expenditure and absence of expenditure caps. The unauthorised expenditure significantly varied between 2010 and 2016 (ρ < 0.05). Misalignment of budget monitoring and purchasing revealed absence of auditing and delays in provider payment. Refunds to providers significantly varied between 2010 and 2016 (ρ < 0.05) due to weak Steering Committee, weak vetting team, paper-based claims management and institutional conflicts between Ministry of Health and district-level officials. CONCLUSIONS This study identified important lessons to align PFM systems and FMCHP. A realistic and evidence-informed budget and enforcement of contribution rules are critical to adequate and sustainable revenue generation. Clarity of roles for various FMCHP committees and use of clear resource allocation strategy would strengthen pooling and fund management. Enforcement of provider payment standards, regular auditing, and a stronger role for the parliament in budgetary processes are warranted.
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Affiliation(s)
- Daniel Chukwuemeka Ogbuabor
- Department of Health Systems and Policy, Sustainable Impact Resource Agency, University of Nigeria Enugu Campus (UNEC), 22 Ogidi Street, Asata, Enugu, P.O. Box 15534, Enugu State, Nigeria
- Department of Health Administration and Management, University of Nigeria Enugu Campus, Enugu, Enugu State Nigeria
| | - Obinna Emmanuel Onwujekwe
- Department of Health Administration and Management, University of Nigeria Enugu Campus, Enugu, Enugu State Nigeria
- Health Policy Research Group, College of Medicine, University of Nigeria Enugu Campus, Enugu, Enugu State Nigeria
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Sato R. The impacts of quantity and quality of health clinics on health behaviors and outcomes in Nigeria: analysis of health clinic census data. BMC Health Serv Res 2019; 19:377. [PMID: 31196212 PMCID: PMC6567526 DOI: 10.1186/s12913-019-4141-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 05/02/2019] [Indexed: 11/21/2022] Open
Abstract
Background Past studies have identified that inconvenient access to health clinics is one of the important barriers to health service utilization and health outcomes. However, establishing the link between the lack of access to health clinics and the high maternal and child morbidity and mortality in Nigeria has been a challenge due to the lack of data. This paper overcomes this problem by using the country’s health clinic census data. Methods Using the Nigerian health clinic census, we evaluate the intercorrelation between the quantity and the quality of health clinics available across the country. We also examine the correlation between the access to health clinics and health behaviors/outcomes for residents by merging the health clinic census data with data from the demographic and health survey (DHS). The health clinic census data makes it possible to capture the overall geographical allocation of health services across the country as well as their comprehensive relationship with health outcomes. Results We find a strong positive correlation between the quality of a health clinic and the quantity and quality of neighboring clinics. The high quality clinics are concentrated in areas where the density of clinics is high, and where more of the clinics around them are also of high quality. We also find that an increase in access to health clinics of high quality that are in close proximity is significantly and positively correlated with an improvement in health behaviors as well as health outcomes. Women who are more disadvantaged benefit more from the access to high quality clinics than others. Conclusions Health clinics of good quality are unevenly distributed geographically in Nigeria. The quality of health clinics should be of a level that can support the promotion of recommended health behaviors and achieve improved health outcomes throughout the country. Further studies are necessary to evaluate the optimal distribution of clinics of good quality, given that residents in less populated areas gain a higher marginal benefit from improved access to health service, despite the higher costs of supplying the service in those areas.
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Affiliation(s)
- Ryoko Sato
- Harvard T.H. Chan School of Public Health, 90 Smith St, Boston, MA, 02120, USA.
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Yaya S, Uthman OA, Okonofua F, Bishwajit G. Decomposing the rural-urban gap in the factors of under-five mortality in sub-Saharan Africa? Evidence from 35 countries. BMC Public Health 2019; 19:616. [PMID: 31113395 PMCID: PMC6528236 DOI: 10.1186/s12889-019-6940-9] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 05/03/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Understanding urban-rural gap in childhood survival is essential for health care interventions and to explain disparities in the determinants of Under-5 mortality. There is dearth of information about the factors explaining differentials in urban-rural Under-5 mortality especially in sub-Saharan Africa (SSA). In this study, we sought to quantify the contributions of bio-demographic, socioeconomic and proximate factors in explaining the urban-rural gap in Under-5 mortality in SSA. METHODS This study utilized secondary data from Demographic and Health Survey (DHS) in 35 sub-Saharan countries conducted between 2006 and 2016. Child (aged 0 and 59 months) death was the outcome variable in this study. Oaxaca-Blinder decomposition was used to decipher urban-rural gap in the factors of Under-5 mortality. RESULTS Significant urban-rural differentials were observed in Under-5 mortality across bio-demographic, socioeconomic and proximate factors. In the decomposition model, about 44.27% of urban group and 74.71% of rural group had Under-5 mortality in sub-Saharan countries. Maternal age, education, use of newspaper, TV, wealth index, total children ever born, size of baby and age at first birth contributed towards explaining urban-rural gap inUnder-5 mortality. CONCLUSION These findings could be contributory to health care system improvement and socioeconomic developmental plans to address under-5 mortality in SSA. Strengthening maternal and child health (MCH) programmes, specifically in rural areas and improving health care services would help to ensure overall child survival.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, 120, University Private, Ottawa, ON Canada
| | - Olalekan A. Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Friday Okonofua
- Women’s Health and Action Research Centre, Benin City, Nigeria
- University of Medical Sciences, Ondo City, Ondo State Nigeria
- Centre of Excellence in Reproductive Health Innovation (CERHI), University of Benin, Benin City, Nigeria
| | - Ghose Bishwajit
- School of International Development and Global Studies, University of Ottawa, 120, University Private, Ottawa, ON Canada
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Humphries B, Irwin A, Zoratti M, Xie F. How do financial (dis)incentives influence health behaviour and costs? Protocol for a systematic literature review of randomised controlled trials. BMJ Open 2019; 9:e024694. [PMID: 31023752 PMCID: PMC6501998 DOI: 10.1136/bmjopen-2018-024694] [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: 11/30/2022] Open
Abstract
INTRODUCTION In this era of rising healthcare costs, there is a growing interest in understanding how funding policies can be used to improve health and healthcare efficiency. Financial incentives (eg, vouchers or access to health insurance) or disincentives (eg, fines or out-of-pocket costs) affect behaviours. To date, reviews have explored the effects of financial (dis)incentives on patient health and behaviour by focusing on specific behaviours or geographical areas. The objective of this systematic review is to provide a comprehensive overview on the use of financial (dis)incentives as a means of influencing health-related behaviour and costs in randomised trials. METHODS AND ANALYSIS We will search electronic databases, clinical trial registries and websites of health economic organisations for randomised controlled trials. The initial searches, which were conducted on 13 January 2018, will be updated every 12 months until the completion of data analysis. The reference lists of included studies will be manually screened to identify additional eligible studies. Two researchers will independently review titles, abstracts and full texts to determine eligibility according to a set of predetermined inclusion criteria. Data will be extracted from included studies using a form developed and piloted by the research team. Discrepancies will be resolved through discussion with a third reviewer. Risk of bias will be assessed using the Cochrane Collaboration tool. ETHICS AND DISSEMINATION Ethics approval is not required since this is a review of published data. Results will be disseminated through publication in peer-reviewed journals and presentations at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42018097140.
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Affiliation(s)
- Brittany Humphries
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Andrew Irwin
- Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York City, New York, USA
| | - Michael Zoratti
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Centre for Health Economics and Policy Analysis (CHEPA), McMaster University, Hamilton, Canada
- Program for Health Economics and Outcome Measures (PHENOM), McMaster University, Hamilton, Ontario, Canada
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Alcohol Drinking by Husbands/Partners is Associated with Higher Intimate Partner Violence against Women in Angola. SAFETY 2019. [DOI: 10.3390/safety5010005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Intimate partner violence (IPV), as the most prevalent form of violence against women, is a commonly encountered phenomenon across sub-Saharan African countries, including Angola. As a fast-growing economy, Angola is experiencing a booming alcohol industry and persistent IPV and women’s rights issues, along with weak prohibition and enforcement against this practice. However, so far, there is no systematic research investigating the predictors of IPV in Angola and whether spousal alcohol drinking has any relationship with women’s experience of IPV. Therefore, in this study, we aimed to assess the predictors of IPV (defined as physical, emotional, and sexual violence) among Angolan women with a special focus on their partners’ alcohol drinking habit. Cross-sectional data on 7669 women aged 15–49 years from the Angola Demographic and Health Survey were used for this study. Data were analyzed using descriptive and logistic regression methods. Results indicated that physical IPV (32.3%, 95% Confidence Interval = 30.3 to 34.5) was most prevalent, followed by emotional (27.3%, 95% CI = 25.3 to 29.4) and sexual IPV (7.4%, 95% CI = 6.6 to 8.4). In the multivariate analysis, higher education and household wealth status showed protective effects against certain forms of IPV. Alcohol drinking by husbands/partners was associated with significantly higher odds of experiencing physical [OR = 2.950; 95% CI = 2.632, 3.306], emotional [OR = 2.470; 95% CI = 2.187,2.789], and sexual IPV [OR = 2.729; 95% CI = 2.220, 3.354] among women. Women who reported experiencing physical IPV had increased odds of drinking alcohol [OR = 1.474; 95% CI = 1.290, 1.684] compared with those who did not. These findings reflect the widespread prevalence of IPV in sub-Saharan African countries. Special focus should be given to married men with alcohol drinking habits to reduce women’s vulnerability to IPV and dependence on alcohol use.
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Nwankwor OC, McKelvie B, Frizzola M, Hunter K, Kabara HS, Oduwole A, Oguonu T, Kissoon N. A National Survey of Resources to Address Sepsis in Children in Tertiary Care Centers in Nigeria. Front Pediatr 2019; 7:234. [PMID: 31245338 PMCID: PMC6579914 DOI: 10.3389/fped.2019.00234] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/22/2019] [Indexed: 01/11/2023] Open
Abstract
Background: Infections leading to sepsis are major contributors to mortality and morbidity in children world-wide. Determining the capacity of pediatric hospitals in Nigeria to manage sepsis establishes an important baseline for quality-improvement interventions and resource allocations. Objectives: To assess the availability and functionality of resources and manpower for early detection and prompt management of sepsis in children at tertiary pediatric centers in Nigeria. Methods: This was an online survey of tertiary pediatric hospitals in Nigeria using a modified survey tool designed by the World Federation of Pediatric Intensive and Critical Care Societies (WFPICCS). The survey addressed all aspects of pediatric sepsis identification, management, barriers and readiness. Results: While majority of the hospitals 97% (28/29) reported having adequate triage systems, only 60% (16/27) follow some form of guideline for sepsis management. There was no consensus national guideline for management of pediatric sepsis. Over 50% of the respondents identified deficit in parental education, poor access to healthcare services, failure to diagnose sepsis at referring institutions, lack of medical equipment and lack of a definitive protocol for managing pediatric sepsis, as significant barriers. Conclusions: Certain sepsis-related interventions were reportedly widespread, however, there is no standardized sepsis protocol, and majority of the hospitals do not have pediatric intensive care units (PICU). These findings could guide quality improvement measures at institutional level, and healthcare policy/spending at the national level.
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Affiliation(s)
- Odiraa C Nwankwor
- Division of Critical Care Medicine, Department of Pediatrics, Alfred I. DuPont Hospital for Children, Wilmington, DE, United States.,Division of Critical Care Medicine, Department of Pediatrics, Cooper University Hospital, Camden, NJ, United States
| | - Brianna McKelvie
- Department of Pediatrics, Children's Hospital, Western University, London, ON, Canada
| | - Meg Frizzola
- Division of Critical Care Medicine, Department of Pediatrics, Alfred I. DuPont Hospital for Children, Wilmington, DE, United States
| | - Krystal Hunter
- Cooper University Hospital, Cooper Research Institute, Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Halima S Kabara
- Department of Anaesthesia/Intensive Care Unit, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Abiola Oduwole
- Department of Paediatrics, Lagos University Teaching Hospital/College of Medicine, University of Lagos, Lagos, Nigeria
| | - Tagbo Oguonu
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Niranjan Kissoon
- Department of Pediatrics and Emergency Medicine, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
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Okonofua FE, Ogu RN, Ntoimo LF, Gana M, Okike ON, Durodola A, Galadanci HS. Where do delays occur when women receive antenatal care? A client flow multi-site study in four health facilities in Nigeria. Ghana Med J 2018; 52:8-14. [PMID: 30013255 DOI: 10.4314/gmj.v52i1.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives The objective of the study was to identify where delays occur when women present for antenatal care in four Nigerian referral hospitals, and to make recommendations on ways to reduce delays in the course of provision of antenatal care in the hospitals. Design Prospective observational study. Setting Four Nigerian (1 tertiary and 3 secondary) Hospitals. Participants Women who presented for antenatal care. Interventions A process mapping. The National Health Service (NHS) Institute Quality and Service Improvement Tool was used for the assessment. Main outcome measures The time women spent in waiting and receiving antenatal care in various departments of the hospitals. Results Waiting and total times spent varied significantly within and between the hospitals surveyed. Mean waiting and total times spent were longest in the outpatients' departments and shortest in the Pharmacy Departments. Total time spent was an average of 237.6 minutes. χ2= 21.074; p= 0.0001. Conclusion There was substantial delay in time spent to receive care by women seeking routine antenatal health services in the four secondary and tertiary care hospitals. We recommend managers in health facilities include the reduction of waiting times in the strategic plans for improving the quality of antenatal care in the hospitals. This should include the use of innovative payment systems that excludes payment at time of service delivery, adoption of a fast-track system such as pre-packing of frequently used commodities and the use of new tech informational materials for the provision of health education. Funding The Alliance for Health Policy and Systems Research, World Health Organization, Geneva; Protocol ID A65869.
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Affiliation(s)
- Friday E Okonofua
- Department of Obstetrics & Gynaecology, University of Benin, Benin City, Nigeria.,University of Medical Sciences, Ondo, Ondo State, Nigeria
| | - Rosemary N Ogu
- Department of Obstetrics & Gynaecology, University of Port Harcourt, Port Harcourt, Rivers State, Nigeria.,Centre of Excellence in Reproductive Health CERHI, University of Benin, Benin City, Nigeria
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Yaya S, Bishwajit G, Okonofua F, Uthman OA. Under five mortality patterns and associated maternal risk factors in sub-Saharan Africa: A multi-country analysis. PLoS One 2018; 13:e0205977. [PMID: 30359408 PMCID: PMC6201907 DOI: 10.1371/journal.pone.0205977] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 10/04/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Under-5 mortality rate in the sub-Saharan region has remained unabated. Worse still, information on the regional trend and associated determinants are not readily available. Knowledge of the trend and determinants of under-5 mortality are essential for effective design of intervention programmes that will enhance their survival. We aimed to examine the mortality patterns in under-5 children and maternal factors associated with under-5 deaths. METHODS Demographic and Health Survey (DHS) data from five sub-Sahara Africa countries; Chad, Democratic Republic of Congo, Mali, Niger and Zimbabwe were used in this study. The sample size consisted of 68,085 women aged 15-49 years with at least one history of childbirth. The outcome variable was under-five mortality rate. Relevant information on maternal factors were extracted for analysis. Multivariable Cox proportional hazards regression was used to model maternal factors associated with under-five mortality. RESULTS The current under-5 mortality rate (per 1,000 live births) was; 133 in Republic of Chad, 104 in Democratic Republic of Congo, 95 in Mali, 127 in Niger, and 69 in Zimbabwe. Several maternal and child level factors were found to be significantly associated with under-five mortality. Lack of spousal support (not currently married) resulted to increase in under-five mortality (Chad- Hazard Ratio [HR] = 1.11, 95%CI = 0.97-1.25; DR Congo- HR = 1.24, 95%CI = 1.11-1.40; Mali- HR = 2.43, 95%CI = 1.63-3.64; Niger- HR = 1.59, 95%CI = 1.24-2.03; Zimbabwe- HR = 1.33, 95%CI = 1.06-1.67). Delivery by caesarean section was significantly associated with under-five mortality (Chad- HR = 1.32, 95%CI = 1.00-1.77; DR Congo- HR = 1.20, 95%CI = 1.01-1.43; Mali- HR = 1.42, 95%CI = 1.08-1.85; Niger- HR = 1.43, 95%CI = 1.06-1.92; Zimbabwe- HR = 1.49, 95%CI = 1.03-2.15). CONCLUSION Despite concerted effort by government and several stakeholders in health to improve childhood survival, the rate of under-5 mortality is still high. Our findings provided evidence on the contribution of maternal age, place of residence, household wealth index, level of education, employment, marital status, religious background, birth type, birth order and interval, sex and size of child, place and mode of delivery, to Under-5 mortality rate in SSA. The position of prominent risk factors for under-five mortality should be addressed through effective design of timely and efficient intervention aimed at reducing childhood mortality.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- * E-mail:
| | - Ghose Bishwajit
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
| | - Friday Okonofua
- Women’s Health and Action Research Centre, Benin City, Nigeria
| | - Olalekan A. Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Forde I, Tripathi V. Association of Place of Residence and Under-Five Mortality in Middle- and Low-Income Countries: A Meta-Analysis. CHILDREN-BASEL 2018; 5:children5040051. [PMID: 29670054 PMCID: PMC5920397 DOI: 10.3390/children5040051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/08/2018] [Accepted: 04/11/2018] [Indexed: 11/16/2022]
Abstract
This review evaluated the association of place of residence (urban/rural) and under-five mortality in middle- and low-income countries. Both English and Spanish language studies conducted during the Millennium Development Goal (MDG) period (1990 to 2015) were reviewed. Twenty-six cross-sectional studies, all in the English language, were selected for further review. Published data were used for this analysis. A funnel plot was produced to ascertain the presence of publication bias. The combined relative risk for under-five mortality was estimated using a random-effects model and a meta-regression was conducted on 15 of the 26 studies. The studies had a combined effect size of 1.47 (95% confidence interval, 1.27–1.67). The results of the meta-regression showed a positive association between the relative risk and the percentage of the rural population for the various regions/countries. The coefficient for the variable rural population percentage was 0.007, indicating that for every one percent increase in the rural population percentage, there was a 0.007 increase in the relative risk for under-five mortality. However, this was not significant (p-value = 0.3). Rural disadvantage persists in middle- and low-income countries. This is important to evaluate policies and programmes designed to remove the gap in under-five mortality rates between urban and rural areas.
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Affiliation(s)
- Ian Forde
- Foundation and Prior Learning, University of Trinidad and Tobago, Wrightson Rd, Port of Spain, Trinidad and Tobago.
| | - Vrijesh Tripathi
- Department of Mathematics and Statistics, The University of the West Indies, St. Augustine, Trinidad and Tobago.
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Odunyemi FT, Ndikom CM, Oluwatosin OA. Effect of Nursing Intervention on Mothers' Knowledge of Cervical Cancer and Acceptance of Human Papillomavirus Vaccination for their Adolescent Daughters in Abuja - Nigeria. Asia Pac J Oncol Nurs 2018; 5:223-230. [PMID: 29607384 PMCID: PMC5863433 DOI: 10.4103/apjon.apjon_75_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/20/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of this study is to evaluate the effect of nursing intervention on mothers' knowledge of cervical cancer and acceptance of human papillomavirus (HPV) vaccination for their adolescent daughters in Abuja, Nigeria. METHODS This was a quasi-experimental study that utilized two groups pre and post-test design. The study was carried out among civil servant mothers in Bwari (experimental group [EG]) and Kwali (control group[CG]) Area Councils of Abuja, Nigeria. One hundred and forty-six women who met the inclusion criteria were purposively selected for this study. EG consists of 69 women while 77 are from CG. The intervention consisted of two days workshop on cervical cancer and HPV vaccination. Descriptive and inferential analyses of the data were performed using SPSS software 20 version. RESULTS The mean age of the respondents was 35 years ± 6.6 in the EG and 41 years ± 8.2 in the CG. The mean knowledge score of cervical cancer was low at baseline in both EG (9.58 ± 7.1) and CG (11.61 ± 6.5). However, there was a significant increase to 21.45 ± 6.2 after the intervention in EG (P < 0.0001). The baseline acceptance of HPV vaccination was high in EG after intervention from 74% to 99%. Exposure to nursing intervention and acceptance of HPV vaccination was statistically significant after intervention (P < 0.0001). CONCLUSIONS The nursing intervention has been found to increase mothers' knowledge of cervical cancer and acceptance of HPV vaccination. It is therefore recommended that nurses should use every available opportunity in mothers' clinic to educate on cervical cancer and HPV vaccination.
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Affiliation(s)
- Funmilola T. Odunyemi
- Department of Nursing, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Chizoma M. Ndikom
- Department of Nursing, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - O. Abimbola Oluwatosin
- Department of Nursing, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
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Abstract
Purpose To estimate the frequency of exfoliation syndrome (XFS) and its association with ocular diseases in Northern Nigeria. Materials and methods Consecutive patients who presented to the outpatient department of ECWA Eye Hospital Kano from February 2015 to May 2015 were included in the study. Each patient had a complete ophthalmic examination. The anterior segment examination included tonometry, gonioscopy, and detailed slit-lamp examination to assess for the presence or absence of exfoliation material, inflammatory cells, and other abnormal findings. Patients with exfoliation material on the anterior lens surface and/or pupillary margin in either or both eyes were considered to have XFS. Statistical analysis was performed using the Statistical Package for the Social Sciences version 16.0. Results A total of 620 patients living in Northern Nigeria from the 6 geopolitical zones were examined. The majority of them (34.5%) were indigenous Hausas. There was a male preponderance of 56.6%, while the mean age at presentation for examination in all age groups was 55.7±13.7 years. There were 9 patients with XFS; the frequency was 1.5%, with most of the patients being 70-80 years old. In patients who were ≥50 years, the frequency was 2.5%. Patients with XFS had a higher mean age of 68±4.9 years. The frequency of XFS among glaucoma patients was 4.4%, while among cataract patients it was 3.7%. No other associated ocular disease was found in the patients with XFS. Conclusion This study shows that XFS does exist in Northern Nigeria, as was found in the South. The prevalence of XFS was, however, not reported in the Nigerian National Blindness and Visual Impairment Survey. Therefore, a population-based study is still needed to determine the true prevalence of XFS in Northern Nigeria.
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Affiliation(s)
| | - Olusola Olawoye
- Department of Ophthalmology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Robert Ritch
- Einhorn Clinical Research Center, Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
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Ogbuabor DC, Onwujekwe OE. The community is just a small circle: citizen participation in the free maternal and child healthcare programme of Enugu State, Nigeria. Glob Health Action 2018; 11:1421002. [PMID: 29343213 PMCID: PMC5774396 DOI: 10.1080/16549716.2017.1421002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/05/2017] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND There is a gap in knowledge about how citizen participation impacts governance of free healthcare policies for universal health coverage in low- and middle-income countries. OBJECTIVE This study provides evidence about how social accountability initiatives influenced revenue generation, pooling and fund management, purchasing and capacity of health facilities implementing the free maternal and child healthcare programme (FMCHP) in Enugu State, Nigeria. METHODS The study adopted a descriptive, qualitative case-study design to explore how social accountability influenced implementation of the FMCHP at the state level and in two health districts (Isi-Uzo and Enugu Metropolis) in Enugu State. Data were collected from policymakers (n = 16), providers (n = 16) and health facility committee leaders (n = 12) through in-depth interviews. We also conducted focus-group discussions (n = 4) with 42 service users and document review. Data were analysed using thematic analysis. RESULTS It was found that health facility committees (HFCs) have not been involved in the generation of funds, fund management and tracking of spending in FMCHP. The HFCs did not also seem to have increased transparency of benefits and payment of providers. The HFCs emerged as the dominant social accountability initiative in FMCHP but lacked power in the governance of free health services. The HFCs were constrained by weak legal framework, ineffectual FMCHP committees at the state and district levels, restricted financial information disclosure, distrustful relationships with policymakers and providers, weak patient complaint system and low use of service charter. CONCLUSION The HFCs have not played a significant role in health financing and service provision in FMCHP. The gaps in HFCs' participation in health financing functions and service delivery need to be considered in the design and implementation of free maternal and child healthcare policies that aim to achieve universal health coverage.
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Affiliation(s)
- Daniel C. Ogbuabor
- Department of Health Administration and Management, University of Nigeria Enugu Campus, Enugu, Nigeria
- Department of Health Systems and Policy, Sustainable Impact Resource Agency, Enugu, Nigeria
| | - Obinna E. Onwujekwe
- Department of Health Administration and Management, University of Nigeria Enugu Campus, Enugu, Nigeria
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
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Ogu RN, Ntoimo LFC, Okonofua FE. Perceptions of women on workloads in health facilities and its effect on maternal health care: A multi-site qualitative study in Nigeria. Midwifery 2017; 55:1-6. [PMID: 28886398 DOI: 10.1016/j.midw.2017.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/07/2017] [Accepted: 08/27/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE of the study was to explore women's perception of maternal health care providers' workload and its effects on the delivery of maternal healthcare in secondary and tertiary hospitals in Nigeria. RESEARCH DESIGN, SETTING, PARTICIPANTS: five focus groups discussions (FGDs) were conducted with women in each of eight secondary and tertiary hospitals in 8 States in four geo-political zones of the country. In all, 40 FGDs were held with women attending antenatal and post-natal clinics in the hospitals. We elicited information on women's perceptions of workloads of maternal health providers and the effects of the workloads on maternity care. The discussions were audio-taped and transcribed while thematic analysis was carried out using Atlas.ti computer software. FINDINGS the majority of the participants submitted that the health providers are burdened with heavy workloads in the provision of maternal health care. Examples of heavy workload cited included complaints from health providers, evidence of stress and strain in care provision by providers and the sheer numbers of patients that are left unattended to in health facilities. Poor quality care, insufficient time to carry out necessary investigations on patients, and prolonged waiting time experienced by women in accessing care featured as consequences of heavy workload, with the secondary result that women are reluctant to seek care in the health facilities because of the belief that they would spend a long time in receiving care. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE we conclude that women are concerned about heavy workloads experienced by healthcare providers and may partly account for the low utilization of referral health facilities for maternal health care in Nigeria. Efforts to address this problem should include purposeful human resource policy development, the development of incentives for health providers, and the proper re-organization of the health system.
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Affiliation(s)
- R N Ogu
- Department of Obstetrics and Gynaecology, University of Port Harcourt, Rivers State, Nigeria; Women's Health and Action Research Centre/WHO/FMOH/MNCH Implementation Research Group, Benin City, Nigeria; Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria.
| | - L F C Ntoimo
- Department of Demography and Social Statistics, Federal University Oye-Ekiti, Ekiti State, Nigeria; Women's Health and Action Research Centre/WHO/FMOH/MNCH Implementation Research Group, Benin City, Nigeria.
| | - F E Okonofua
- University of Medical Sciences, Ondo City, Ondo State, Nigeria; Women's Health and Action Research Centre/WHO/FMOH/MNCH Implementation Research Group, Benin City, Nigeria; Centre of Excellence in Reproductive Health Innovation, University of Benin, Benin City, Nigeria.
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Abstract
Background Infant mortality rate in Nigeria is among the highest world-wide. Utilization of modern health care facilities during pregnancy and at delivery reduces infant mortality rate. We examined the relationship between Infant Mortality (IM) and Maternal Health Care Services Access Index (MHCI) in Nigeria. Methods This cross-sectional study utilized 2013 NDHS data and included women aged 15–49 years (n=12511). MHCI was obtained from information on antenatal visit, antenatal attendance, tetanus toxoid injection during pregnancy, place of delivery and birth attendance. Cox-proportional hazard and Brass models were used for the analysis (α=0.05). Results Mean MHCI was higher among women with lower prevalence of IM. About 5.1% and 3.4% of the women with none and complete MHCI had experienced infant deaths respectively. The hazard of experienced infant deaths was 1.497(1.068–2.098) and 1.466(1.170–1.836) significantly higher among women with no and low MHCI respectively than those with complete MHCI. This pattern was observed when other factors were used as control. The refined IM probability (range=0.0482–0.1102) and IM rates (range=50–119) increased with reduction in the level of MHCI. The IM rate reduces from 119 per 1,000 live births among women whose MHCI score was zero to 50 per 1,000 live births among those with complete MHCI score. Conclusion Infant death was least experienced among women who had complete MHCI. If women optimize utilization of health facility during pregnancy and delivery, infant deaths will reduce in Nigeria.
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Affiliation(s)
- Adebowale Sa
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Udjo E
- 2Bureau of Marketing Research, University of South Africa, South Africa
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Adenike OB, Adejumoke J, Olufunmi O, Ridwan O. Maternal characteristics and immunization status of children in North Central of Nigeria. Pan Afr Med J 2017; 26:159. [PMID: 28588745 PMCID: PMC5446779 DOI: 10.11604/pamj.2017.26.159.11530] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 03/06/2017] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Routine immunization coverage in Nigeria is one of the lowest national coverage rates in the world. The objective of this study was to compare the mother' characteristics and the child's Immunization status in some selected rural and urban communities in the North central part of Nigeria. METHODS A descriptive cross sectional study, using a multistage sampling technique to select 600 respondent women with an index child between 0-12 months. RESULTS Mean age of rural respondents was 31.40±7.21 years and 32.72+6.77 years among urban respondents, though there was no statistically significant difference in age between the 2 locations (p-0.762). One hundred and ninetyseven (65.7%) and 241(80.3%) of rural and urban respondents respectively were aware of immunization, the difference was statistically significant (p-0.016). knowledge in urban areas was better than among rural respondents. There was statistically significant association between respondents age, employment status, mothers' educational status and the child's immunization status (P<0.05), while variables like parity, age at marriage, marital status, No of children, household income and place of index were not statistically associated with immunization status as P>0.05. More than half 179(59.7%) of rural and 207(69.0%) of urban had good practice of immunization though the difference was not statistically significant (p-0.165). CONCLUSION The immunization coverage in urban community was better than that of the rural community. The result of this study has clearly indicated that mothers in Nigeria have improved on taking their children for immunization in both rural and urban area compared to previous reports.
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Affiliation(s)
- Olugbenga-Bello Adenike
- Department of Community Medicine, Faculty of Clinical Sciences, College of Health Sciences, Ladoke Akintola University of Technology (LAUTECH), P.M.B. 4400, Osogbo, Osun State, Nigeria
| | | | - Oke Olufunmi
- Department of Community Medicine, LAUTECH Teaching Hospital, P.M.B. 4008, Ogbomoso, Oyo State, Nigeria
| | - Oladejo Ridwan
- Institute of Education, department of Economics and Education, University of Ibadan, Oyo State, Nigeria
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