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Effect of intervention delivered by lay maternal care providers to improve outcome and parenting skills among adolescents with perinatal depression in Nigeria (the RAPiD study): a cluster randomized controlled trial
(Elsevier, 2022) Gureje, O.; Oladeji, B. D.; Kola, L.; Bello, T.; Ayinde, O.; Faregh, N.; Bennett, I.; Zelkowitz, P.
Background: Perinatal depression is more common and is associated with greater negative consequences among adolescents than adults. Psychosocial interventions designed for adults may be inadequate at addressing the unique features of adolescent perinatal depression. Methods: In a two-arm parallel cluster randomized trial conducted in thirty primary maternal care clinics in Ibadan, Nigeria (15-intervention and 15-control) we compared age-appropriate intervention consisting of problem-solving therapy, behavioral activation, parenting skills training, and parenting support from a self- identified adult to care as usual. Pregnant adolescents (aged <20 years) at fetal gestational age16–36 weeks with moderate to severe depression were recruited. Primary outcomes were depression symptoms (Edinburgh Postnatal Depression Scale, EPDS) and parenting practices (Infant-Toddler version of the Home Inventory for Measurement of the Environment, HOME-IT) at six-months postnatal. Results: There were 242 participants (intervention arm: 141; Control arm: 101), with a mean age of 18∙0 (SD- 1∙2). Baseline mean EPDS score was 14∙2 (SD-2.1); 80∙1 % completed the six-month postnatal follow-up. The intervention group had lower level of depressive symptoms than the control group, mean EPDS scores: 5∙5 (SD- 3∙6) versus 7∙2 (SD-4∙0) (adjusted mean difference -1∙84 (95%CI- 3∙06 to 0∙62; p =0∙003) and better parenting practices, mean total HOME-IT scores: 29∙8 (SD-4∙4) versus 26∙4 (SD-4∙2) (adjusted mean difference 3∙4 (95%Cl- 2∙12 to 4∙69, p =0∙001). Limitations: This study explored the effect of complex interventions making it difficult to know precisely what aspects produced the outcomes. Conclusions: An age-appropriate psychosocial intervention package holds promise for scaling up care for adolescents with perinatal depression especially in resource-constrained settings.
Evaluation of the iCARE Nigeria pilot intervention using social media and peer navigation to promote HIV testing and linkage to care among high-risk young men: a nonrandomized controlled trial
(2022-02) Garofalo, R.; Adetunji, A.; Kuhns, L. M.; Omigbodun, O.; Johnson, A. K.; Kuti, K. M.; Awolude, O. A.; Berzins, B.; Janulis, P.; Okonkwor, O.; Oladeji, B.; Muldoon, A. L.; Amoo, O. P.; Atunde, H.; Kapogiannis, B.; Taiwo, B. O.
IMPORTANCE Nigeria has the fourth-largest HIV epidemic globally, yet high levels of social stigma inhibit HIV testing among Nigerian youths and young men who have sex with men (MSM). OBJECTIVE To report pilot data from iCARE Nigeria (Intensive Combination Approach to Roll Back the Epidemic in Nigerian Adolescents), a combination intervention using social media and peer navigation to promote HIV testing and linkage to care among high-risk youths and young men (hereinafter referred to as young men), including predominantly young MSM. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized controlled study assessed an organizational and community-level 12-month, preintervention-postintervention pilot trial of a combination intervention designed to increase HIV testing uptake, increase the rate of identified seropositive cases, and improve linkage to care among young men, including MSM, using social media outreach and peer navigation. Data were collected from June 1, 2019, to May 30, 2020. Participants were young men aged 15 to 24 years in the city of Ibadan, Nigeria, and surrounding areas. Frequencies and percentages were examined, and a Fisher exact test was used to evaluate outcomes compared with historical surveillance data. Linkage to care was defined as 2 clinic visits, including HIV confirmation, within 2 months of a positive rapid test result. INTERVENTION Four peer navigators conducted social media outreach promoting sexual health and guiding individuals to HIV counseling and rapid testing in clinical, community, or home-based settings. MAIN OUTCOMES AND MEASURES Primary outcomes included the number of young men tested for HIV at university-based iCARE catchment clinics or by iCARE peer navigators in the community, the postintervention HIV seroprevalence of these groups, and linkage to care of participants diagnosed with HIV infection. RESULTS A total of 339 participants underwent testing for HIV (mean [SD] age, 21.7 [1.9] years), with 283 (83.5%) referred through social media. The main referral sources for social media were WhatsApp (124 [43.8%]), Facebook (101 [35.7%]), and Grindr (57 [20.1%]). Regarding testing location, participants chose home (134 [39.5%]), community-based (202 [59.6%]), or clinic (3 [0.9%]) settings. Eighty-six participants reported no prior HIV testing. Thirty-six participants (10.6%) were confirmed as HIV seropositive; among those, 18 (50.0%) reported negative test results within the past year, and 31 (86.1%) were linked to care. In two 6-month follow-up periods, the intervention increased HIV testing by 42%and 31%, respectively, and seroprevalence increased compared with historical trends with odds ratios of 3.37 (95%CI, 1.43-8.02; P = .002) and 2.74 (95%CI, 1.10-7.11; P = .02), respectively. CONCLUSIONS AND RELEVANCE These findings suggest that use of iCARE Nigeria was associated with increased HIV testing and linkage to care in a high-risk, difficult-to-reach population, making it a promising combination intervention for young MSM.
Prevalence and correlates of depression among pregnant adolescents in primary maternal care in Nigeria
(Springer, 2022) Oladeji, B. D.; Bello, T.; Ayinde, O.; Idowu, P.; Gureje, O.
To examine the prevalence as well as the clinical and psychosocial factors associated with depression and depression severity in pregnant adolescents. Participants were consecutively registered pregnant adolescents presenting to 30 selected primary maternal and child healthcare centers in Ibadan, Nigeria, who were screened for enrolment into an intervention trial for perinatal depression (depression defined as a score of ≥ 12 on the Edinburg Postnatal Depression Scale [EPDS] and met the DSM-IV diagnostic criteria for depression). Of the 1359 pregnant adolescents screened, 246 (18.1%) had depression. Mean age was 18.4 (sd 1.00), 58.9% were either married or cohabiting, 91.4% were primipara, and the mean gestational age was 23.8 weeks (sd 5.4 weeks). Food insecurity (going to bed hungry at least once in the previous week because there was no food to eat) was reported by 13.3%. In bivariate analysis, younger age, not living with a partner, unemployment, and food insecurity were associated with depression. In bivariate analysis, younger age, not living with a partner, unemployment and food insecurity were associated with depression, while younger age, being single and food insecurity were independently associated with being depressed in multivariate analysis. Severity of depression was related to age, higher anxiety and disability scores, lower quality of life scores across all domains and poorer attitudes towards pregnancy. Depression was associated with indices of higher social disadvantage among adolescents. Delaying childbearing and measures aimed at alleviating poverty may be important in preventing depression in this vulnerable group.
Theory-driven development of a mobile phone supported intervention for adolescents with perinatal depression
(Springer, 2021-11) Kola, L.; Abiona, D.; Oladeji, B. D.; Ayinde, O.; Bello, T.; Gureje, O.
Purpose This paper describes the design of a theory-informed pragmatic intervention for adolescent perinatal depression in primary care in Nigeria. Methods We conducted Focus Group Discussions (FGDs) among 17 adolescent mothers and 25 maternal health care providers with experience in the receipt and provision of care for perinatal depression. The Consolidated Framework for Implementation Research (CFIR) was used to systematically examine the barriers and facilitators affecting adolescent mothers' use of an existing intervention package for depression. The Theoretical Domain Framework (TDF) and the Capability, Opportunity, Motivation, Behaviour (COM-B) model were used to analyze the results of the data across the five CFIR domains. Results FGD analysis revealed that care providers lacked knowledge on approaches to engage young mothers in treatment. Young mothers had poor treatment engagement, low social support, and little interest in parenting. A main characteristic of the newly designed intervention is the inclusion of age-appropriate psychoeducation supported with weekly mobile phone calls, to address treatment engagement and parenting behaviours of young mothers. Also in the outer setting, low social support from relatives was addressed with education, “as need arises” phone calls, and the involvement of "neighborhood mothers”. In the inner settings, care providers’ behaviour is addressed with training to increase their capacity to engage young mothers in treatment. Conclusion A theory-based approach helped develop an age-appropriate intervention package targeting depression and parenting skills deficit among perinatal adolescents in primary maternal care and in which a pragmatic use of mobile phone was key.
Soil Transmitted Helminthes Infection among Pregnant Women in Peri-Urban Areas of Ibadan, Nigeria: A cross-sectional study
(Federal Teaching Hospital, Abakaliki, Nigeria, 2018-04) Umezurike, C. E.; Adeoye, I. A.; Oluwatoba, O. A.; Oluwasola T. A. O.
cross sectional facility-based study was conducted among the 326 pregnant women attending antenatal care clinics in six selected Primary Health Care centers, in the peri-urban areas of Ibadan Oyo State. An interviewer administered questionnaire was used to obtain information on the socio-demographic, maternal, environmental characteristics and hygiene practices. Kato-Katz method was used to identify the presence of STH from stool samples. Data were analysed using chi-square and bivariate logistic analysis. RESULTS: The overall prevalence of STH was 13.8%; 95% CI (10.0 -17.7). Ascaris lumbricoides 13.2%: 95% CI (9.5 -16.9) was the most prevalent followed by hookworm infection 0.6% 95% CI (-0.2 – 0.15) and Trichuris trichuria 0.3% 95% CI (- 0.2 – 0.9). Majority of the infection were of light intensity (44 out of 45). Walking bare footed in the home environment increased the likelihood of being infected with STH [OR 1.93 95% CI (1.01 -3.72) p=0.048] compared with women who wore shoes. CONCLUSION: STH infection is prevalent among pregnant women in the peri-urban region of Ibadan. Therefore public health interventions like active surveillance of STH and the prescription of deworming drugs for pregnant women.