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Item Survival analysis and prognostic factors of the timing of first antenatal care visit in Nigeria(Elsevier Ltd., 2019) Fagbamigbe, A. F.; Abel, C.; Mashabe, B.; Adebowale, A. S.Objectives: This study assessed the timing of the first ANC visit among pregnant women and identified its prognostic factors. Design: Data obtained from 2013 Nigerian DHS, a cross-sectional and nationally representative survey, were used. Methods: We included women who had had at least a childbirth or got a pregnancy terminated within the five years preceding the survey or currently pregnant as of the time of the survey. The outcome variable is the timing of the first ANC visit to skilled ANC service provider. Those who were either currently pregnant or lost pregnancy but have not accessed ANC were censored. Basic descriptive statistics and survival analysis techniques involving four models were used to analyze the data at p = 0.05. Data was weighted and adjustment made for survey design and sampling errors. Results: Almost half of the respondents were aged 25–34 years. Only 65.5% had at least one contact with skilled ANC providers and such visits were initiated mostly (58%) in the second trimester. The overall incidence rate of accessing ANC per month is 110 per 1000 women. Women with higher education had a higher adjusted hazard of accessing ANC than uneducated women (aHR = 2.89, 95% CI: 2.68–3.11). Older women from households in richer wealth quintile are more likely to initiate ANC. Women from households in richer wealth quintiles, those who had no problem in accessing ANC facilities, those with higher education, residing in urban areas and in the Southern region had a higher tendency of earlier ANC initiation. Conclusion: ANC utilization in Nigeria is low and the timings of first visits are delayed. For Nigeria to achieve timely and adequate use of ANC services, health facilities should be more accessible and women should be empowered in terms of education, autonomy, and earnings in addition to changes in social cultural practices that prevent ANC uptakes.Item An assessment of the nutritional status of ART receiving HIV-orphaned and vulnerable children in South-West Nigeria(Elsevier Ltd, 2019) Fagbamigbe, A. F.; Adebowale, A. S.; Ajayi, I.Introduction: Good nutritional status is pertinent to the optimal outcome of effective ART among children. Against this backdrop, the objective of the current study is to assess the nutritional indices of children receiving ART in South-West Nigeria. Methods: The study was cross-sectional in design. We randomly selected three urban and six rural ART sites from the ones offering ART services in Oyo state. All consented children receiving ART treatments in the aforementioned sites participated in the study. A total of 390 HIV-positive children and adolescents aged 6–18 years were interviewed using a semi-structured interviewer-administered questionnaire. Children were assessed and growth curves were constructed using the 2007 World Health Organisation (WHO) growth reference standard for children as well as adolescents. Data were presented using descriptive statistics. Results: About 52% of the children are male, 136 (34.9%) have lost at least one parent, 52 (13.3%) have lost either parent to HIV/AIDS. Among the males, 19%, 27%, and 27% were underweight, stunted and thin, respectively when compared with 17%, 23% and 23%, respectively, among females. The male and female weight-for-age average z-score were (-0.98 vs -1.04), height-for-age (-1.12 vs -1.07), and BMI-for-age (-1.19 vs -1.18). Irrespective of age, sex, parental survival, and residence, weight-for-age and BMI-for-age analysis revealed substantial underweight, with the worst outcomes being among those orphaned by HIV/AIDS. Conclusion: All nutritional indices considered in this study fell short of the WHO standard. HIV positive children in the ART sites included in this study are faced with a high burden of undernourishment despite been placed on daily ART regimens. In addition to efficient ART, interventions to ameliorate poor nutritional status is needed.Item Trend analysis of teenage pregnancy in Nigeria (1961-2013): how effective is the contraceptive use campaign?(Institute of Advanced Engineering and Science, 2019) Fagbamigbe, A. F.; Afolabi, R. F.; Yusuf, O. B.Teenage pregnancy (TP) is a recurrent global and public health problem. It poses both social and health challenges. Considering the massive campaign on the use of modern contraceptives to prevent TP in recent decades, we assessed trends in TP in Nigeria between 1961 and 2013. Pregnancy and contraception history of 70,811 women who were at least 20 years old when the Nigerian DHS was conducted in 1990, 2003, 2008, and 2013 respectively were used for the study, and descriptive statistics, time analysis techniques and multiple logistic regression were used to analyze the data at 5% significance level. The overall prevalence of TP between 1961 and 2013 was 49.5% which fluctuated insignificantly during the studied period. The TP prevalence among women who entered adulthood in 1961 was 39.2%; it peaked in 1978 at 58.9% before its unsteady decline to 39.6% in 2012, and then rose sharply to 55.6% in 2013. We predicted TP prevalence as 49.0%, 49.9% and 51.0% in 2014, 2015 and 2016 respectively. The odds of TP were over 4 times higher in the North East and 5 times higher in the North West than in the South West. Teenagers with no education had higher odds of TP and it was higher among teenagers from the poorest households (OR=5.64, 95% CI: 5.36-5.94). Rather than reducing with the worldwide acknowledged increase in contraceptive campaigns, TP increased over the years studied. As far as TP is concerned in Nigeria, the impact of the campaign on MC use is far from being effective. To achieve the objective of fewer TPs, fewer resources should be spent on access to contraception and instead diverted to areas more likely to achieve results such as improvements in educational achievement amongst girls.Item Survival analysis and prognostic factors associated with the timing of first forced sexual act among women in Kenya, Zimbabwe and Cote d‘Ivoire(Elsevier B.V, 2019) Fagbamigbe, A. F.; Abi, R.; Akinwumi, T.; Ogunsuji, O.; Odigwe, A.; Olowolafe, T.The paucity of information on the age at which Forced Sexual Act (FSA) among women occur and the factors affecting the timings in Africa necessitated this study. We assessed the timing of first FSA and its prognostic factors among women in three African countries. We used sexual violence data of 18,528 women aged 15–49 years who participated in Zimbabwe (2011), Kenya (2014), and Cote d’Ivoire (2014) demographic and health surveys. The time of first FSA was censored as the current age of women who had not experienced FSA. Kaplan-Meier methods and Cox proportional hazard model were used at p = 0.05. The proportion who had ever experienced FSA was 13.9%, 21.7% & 27.2% while median time to FSA was 17, 20 & 18 years in Kenya, Zimbabwe, and Cote d’Ivoire respectively. The highest (41.8%) lifetime prevalence of forced sexual act was among divorced/separated women in Cote D’Ivoire. Women aged 15–19 years had earlier risk of FSA: Kenya (aHR = 3.60 (95% CI:2.43–5.34)), Zimbabwe (aHR = 2.91 (95% CI:2.32–3.65)), and Cote d’Ivoire (aHR = 2.72 (95% CI:2.22–3.33)) than women aged 40–49 years. Other significant prognostic factors of time of FSA are marital status, place of residence, employment status, religion, wealth index, and education. There are generational shifts in timing of first forced sexual act among women with girls born in the 1990s becoming victims at earlier ages than those born in the 1960s and 1970s. There is a need for a multi-sectoral approach to reduce the prevalence and halt the negative trend in forced sexual act in Africa.Item Application of the exponentiated log-logistic Weibull distribution to censored data(Nigerian Society of Physical Sciences, 2019) Fagbamigbe, A. F.; Basele, G. K.; Makubate, B.; Oluyede, B. O.In a recent paper, a new model called the Exponentiated Log-Logistic Weibull (ELLoGW) distribution with applications to reliability, survival analysis and income data was proposed. In this study, we applied the recently developed ELLoGW model to a wide range of censored data. We found that the ELLoGW distribution is a very competitive model for describing censored observations in life-time reliability problems such as survival analysis. This work shows that in certain cases, the ELLoGW distribution performs better than other parametric model such as the Log-Logistic Weibull, Exponentiated Log-Logistic Exponential, Log-Logistic Exponential distributions and the non-nested Gamma-Dagum (GD)Item Unobserved heterogeneity in the determinants of under-five mortality in Nigeria: Frailty modeling in survival analysis(African Journal of Applied Statistics, 2019) Fagbamigbe, A. F.; Afolabi, R. F.; Alade, K. Y.; Adebowale, A. S.; Yusuf, B. O.Childhood mortality is one of the measure of socio-economic status of a population. Several studies have been conducted to identify determinants of childhood mortality but the random effect and heterogeneity nature in most clustered survey data has not been well documented. The present study was designed to use shared frailty model to assess determinants of Under-Five Mortality (U5M) using an hierarchical data in Nigeria.Item What is the link between malaria prevention in pregnancy and neonatal survival in Nigeria?(Women’s Health and Action Research Centre, 2019) Adeoye, I. A.; Fagbamigbe, A. F.Neonatal mortality has been recognized as a global public health challenge and Nigeria has the highest prevalence in Africa. Malaria during pregnancy jeopardizes neonatal survival through placental parasitaemia, maternal anaemia, and low birth weight. This study investigated association between the malaria prevention in pregnancy and neonatal survival using a nationally representative data - Nigeria Demographic Health Survey 2013. Child recode data was used and the outcome variable was neonatal death. The main independent variables were the use of at least 2 doses of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPT-SP) and proportion of pregnant women who reported Insecticide Treated Net (ITN) use the night before the survey. Data were analyzed using Pearson Chi-square (x 2 ) test of association and survival analysis techniques. Total neonatal mortality rate was 38 per1000 live births. Cox proportional hazard model showed that low birth weight (HR 1.49, 95% CI (1.15 – 1.93 p=0.003) and adequate number of ANC visits (≥ 4 visits) (HR 0.68, 95% CI (0.53 – 0.93) were associated with neonatal survival. The use of at least 2 doses of IPT-SP was not an independent factor for neonatal survival (HR 0.72, 95% CI (0.53 – 1.15). Malaria prevention in pregnancy is crucial for neonatal survival through the prevention of low birth weight.Item Bayesian geo-additive spatial modelling of HIV prevalence using data from population-based surveys(Polish AIDS Research Society, 2019) Adebayo, S. B.; Gayawan, E.; Fagbamigbe, A. F.; Bello, F. W.Introduction: Estimates of human immunodeficiency virus (HIV) prevalence in Nigeria have been based on the data from HIV surveillance and sentinel studies among pregnant women attending antenatal clinics at some selected sentinel sites. However, such data overestimate HIV prevalence. This paper explores possible geographical variations in HIV prevalence among the general population of males and females based on two waves of the National HIV/acquired immune deficiency syndrome (AIDS) and Reproductive Health Surveys. Material and methods: Data were extracted from the cross-sectional 2007 and 2012 National HIV/ AIDS and Reproductive Health Serological Surveys of men (15-64 years) and women (15-49 years) covering all states of Nigeria. Bayesian geo-additive modelling technique was employed for analysis. Appropriate prior distributions were assigned to the different types of variables in the models and inference was based on the Markov Chain Monte Carlo (MCMC) technique. Models of different specifications were considered. Results: The findings reveal significant spatial variations at a highly disaggregated level of states in Nigeria. The nonlinear effects of respondents’ age show a similar pattern of HIV prevalence for male, female and the combined respondents, implying that HIV prevalence is peak among middle-age individuals, from where it declines with age. Also, the results reveal a downward change in HIV prevalence in Nigeria between 2007 and 2012. Conclusions: When these findings are taken into consideration in designing intervention strategies, it is believed that each state can be targeted with the right intervention(s). This can also lead to efficient utilization of the scarce resources witnessed globally and more importantly with the economic recession in Nigeria.Item On the discriminatory and predictive accuracy of the RDT against the microscopy in the diagnosis of malaria among under-five children in Nigeria(BioMed Central, 2019) Fagbamigbe, A. F.Background: Accurate identifcation of malaria cases is crucial to the management of cases and the eventual success of malaria eradication agenda. This study is designed to evaluate the discriminatory and predictive accuracy of malaria rapid diagnostic tests (RDTs) in Nigeria. Methods: The data obtained during the 2015 Nigeria Malaria Indicator Survey was used to quantify the discriminatory accuracy of the RDT against the microscopy through the analysis of its sensitivity, specifcity, positive (LR+) and negative (LR−) likelihood ratio. The positive (PPV) and negative (NPV) predictive values, area under the receiver operating characteristic curve, and diagnostic odds ratio were used to assess the predictive accuracy of the RDTs using expert microscopy as a gold standard at p=0.05. The McNemar paired test and the Kappa statistics were used to assess the level of agreement between the diagnostic tests. Results: There was a significant but not an excellent agreement between the results of the RDT and microscopy tests (p<0.001). The overall sensitivity of the RDT was 87.6% (85.9–89.2%), specificity was 75.8% (74.4–77.1%), while the diagnostic accuracy stood at 79.0% (77.9–80.0%). The LR+, LR−, PPV and NPV were 3.6 (3.4–3.8) and 0.16 (0.14–0.19), 57.5% (56.1–58.9%) and 94.2% (93.5–94.9%), respectively. The sensitivity of RDT increased as the age of the children increased, from 85.7% among those aged 0–6 months to 86.1% in 7–23 month olds to 88.1% among those aged 24–59 months, but the reverse was the specificity. For children with severe anaemia, the sensitivity of the RDT was nearly 100% compared with a specificity of 39%. While the sensitivity and the PPV reduced with children’s level of anaemia, the higher the severity of anaemia, the lower the NPV, specificity, the diagnostic accuracy of the RDT. The odds of RDT being sensitive was about 50% [adjusted Odds Ratio (aOR)=0.52 (95% CI 0.30–0.90)] lower among children aged 7–23 months compared with those aged 24–59 months while the odds of RDT being sensitive was 2 times [aOR=2.15 (95% CI 1.67–2.77)] higher among those 7–23 months than among those aged 24–59 months. Conclusions: Although there was a significant agreement in the outcomes of RDT and microscopy tests, the discriminatory accuracy of RDT was weak. Also, the predictive accuracy, especially the PPV of the RDTS, were very low. These measures of accuracies differed across the age of the children, level of anaemia, recent experience of malaria and other characteristics. Without an accurate, efficient and reliable diagnosis of malaria, the goal of eliminating malaria and reduction of malaria-related deaths to zero by 2020 will only remain elusive.Item Parametric survival analysis of menarche onset timing among Nigerian girls(Elsevier Ltd., 2018) Fagbamigbe, A. F.; Obiyan, M. O.; Fawole, O. I.Background: This study was a response to the dearth of information on the timing of menarche in low-income countries, and the need to update knowledge on the condition. It thereby enables the provision of adequate support to young girls during menarche. The study determined the timing and range of onset of menarche and identified the factors influencing the timing. Methods: We used data on girls’ sexual and reproductive processes from a nationally representative population survey of girls aged 15e24 years in Nigeria. Descriptive statistics, and survival analysis techniques were used for data analysis at p ¼ 0$05. Finding: A quarter of the respondents (26%) had commenced menstruation by age 12. Almost all, (90%) had experienced menstruation by age 17. Girls aged 20e24 years reported later menarche (time ratio 1$066, 95% CI: 1$045-1$087) compared to those aged 15e19 years. An increase of respondents age by one year resulted in 0$8% delay in onset timing. Significant differences were also found in the zone of residence among the sampled population. Compared with girls from the South East, the timing of menstruation was generally delayed among the girls from South-South by 5%, North Central by 9%, South West by 10%, North East by 16% and 17% among girls from the North West. Interpretation: There was a wide range in menarcheal age in Nigerian girls with a peak at 13e14 years and the possibility of a secular trend in the timing of onset. Early family life education is recommended.