FACULTY OF PUBLIC HEALTH
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Item Coverage-level and predictors of maternity continuum of care in Nigeria: implications for maternal, newborn and child health programming(BioMed Central, 2023) Oyedele, O. K.; Fagbamigbe, A. F.; Akinyemi, O. J.; Adebowale, A. S.Background Completing maternity continuum of care from pregnancy to postpartum is a core strategy to reduce the burden of maternal and neonatal mortality dominant in sub-Saharan Africa, particularly Nigeria. Thus, we evaluated the level of completion, dropout and predictors of women uptake of optimal antenatal care (ANC) in pregnancy, continuation to use of skilled birth attendants (SBA) at childbirth and postnatal care (PNC) utilization at postpartum in Nigeria. Methods A cross-sectional analysis of nationally representative 21,447 pregnancies that resulted to births within five years preceding the 2018 Nigerian Demographic Health Survey. Maternity continuum of care model pathway based on WHO recommendation was the outcome measure while explanatory variables were classified as; socio-demographic, maternal and birth characteristics, pregnancy care quality, economic and autonomous factors. Descriptive statistics describes the factors, backward stepwise regression initially assessed association (p<0.10), multivariable binary logistic regression and complementary-log–log model quantifies association at a 95% confidence interval (α=0.05). Results Coverage decrease from 75.1% (turn-up at ANC) to 56.7% (optimal ANC) and to 37.4% (optimal ANC and SBA) while only 6.5% completed the essential continuum of care. Dropout in the model pathway however increase from 17.5% at ANC to 20.2% at SBA and 30.9% at PNC. Continuation and completion of maternity care are positively drive by women; with at least primary education (AOR=1.27, 95%CI=1.01–1.62), average wealth index (AOR=1.83, 95%CI=1.48 –2.25), southern geopolitical zone (AOR=1.61, 95%CI=1.29–2.01), making health decision alone (AOR=1.39, 95%CI=1.16–1.66), having nurse as ANC provider (AOR=3.53, 95%CI=2.01–6.17) and taking at least two dose of tetanus toxoid vaccine (AOR=1.25, 95%CI=1.06–1.62) while women in rural residence (AOR=0.78, 95%CI=0.68–0.90) and initiation of ANC as late as third trimester (AOR=0.44, 95%CI=0.34–0.58) negatively influenced continuation and completion. Conclusions 6.5% coverage in maternity continuum of care completion is very low and far below the WHO recommended level in Nigeria. Women dropout more at postnatal care than at skilled delivery and antenatal. Education, wealth, women health decision power and tetanus toxoid vaccination drives continuation and completion of maternity care. Strategies optimizing these factors in maternity packages will be supreme to strengthen maternal, newborn and child health.Item Decomposition of factors associated with housing material inequality in under-five deaths in low and middle-income countries(BioMed Central, 2022) Morakinyo, O. M.; Fagbamigbe, A. F.; Adebowale, A. S.Background: Low-and Medium-Income Countries (LMIC) continue to record a high burden of under-five deaths (U5D). There is a gap in knowledge of the factors contributing to housing materials inequalities in U5D. This study examined the contributions of the individual- and neighbourhood-level factors to housing materials inequalities in influencing U5D in LMIC. Methods: We pooled data from the most recent Demographic and Health Surveys for 56 LMIC conducted between 2010 and 2018. In all, we analysed the data of 798,796 children living in 59,791 neighbourhoods. The outcome variable was U5D among live births within 0 to 59 months of birth. The main determinate variable was housing material types, categorised as unimproved housing materials (UHM) and improved housing materials (IHM) while the individual-level and neighbourhood-level factors are the independent variables. Data were analysed using the Fairlie decomposition analysis at α = 0.05. Results: The overall U5D rate was 53 per 1000 children, 61 among children from houses built with UHM, and 41 among children from houses built with IHM (p < 0.001). This rate was higher among children from houses that were built with UHM in all countries except Malawi, Zambia, Lesotho, Gambia, Liberia, Sierra Leone, Indonesia, Maldives, Jordan, and Albania. None of these countries had significant pro-IHM inequality. The factors explaining housing inequalities in U5D include household wealth status, residence location, source of drinking water, media access, paternal employment, birth interval, and toilet type. Conclusions: There are variations in individual- and neighbourhood-level factors driving housing materials inequalities as it influences U5D in LMIC. Interventions focusing on reducing the burden of U5D in households built with UHM are urgently needed.Item Trend and decomposition analysis of risk factors of childbirths with no one present in Nigeria, 1990–2018(BMJ Publishing Group Ltd, 2021) Fagbamigbe, A. F.; Bello, S.; Salawu, M. M.; Afolabi, R. F.; Gbadebo, B. M.; Adebowale, A. S.Objectives To assess the trend and decompose the determinants of delivery with no one present (NOP) at birth with an in-depth subnational analysis in Nigeria. Design Cross-sectional.Setting Nigeria, with five waves of nationally representative data in 1990, 2003, 2008, 2013 and 2018. Participants Women with at least one childbirth within 5 years preceding each wave of data collection. Primary and secondary outcome measures The outcome of interest is giving birth with NOP at delivery defined as childbirth assisted by no one. Data were analysed using Χ2 and multivariate decomposition analyses at a 5% significance level. Results The prevalence of having NOP at delivery was 15% over the studied period, ranges from 27% in 1990 to 11% in 2018. Overall, the prevalence of having NOP at delivery reduced significantly by 35% and 61% within 2003–2018 and 1990–2018, respectively (p<0.001). We found wide variations in NOP across the states in Nigeria. The highest NOP practice was in Zamfara (44%), Kano (40%) and Katsina (35%); while the practice was 0.1% in Bayelsa, 0.8% in Enugu, 0.9% in Osun and 1.1% in Imo state. The decomposition analysis of the changes in having NOP at delivery showed that 85.4% and 14.6% were due to differences in women’s characteristics (endowment) and effects (coefficient), respectively. The most significant contributions to the changes were the decision-maker of healthcare utilisation (49%) and women educational status (24%). Only Gombe experienced a significant increase (p<0.05) in the level of having NOP between 2003 and 2018. Conclusion A long-term decreasing secular trend of NOP at delivery was found in Nigeria. NOP is more prevalent in the northern states than in the south. Achieving zero prevalence of NOP at delivery in Nigeria would require a special focus on healthcare utilisation, enhancing maternal education and healthcare utilisation decision-making power.Item The spread of COVID-19 outbreak in the first 120 days: a comparison between Nigeria and seven other countries(BioMed Central, 2021) Adebowale, A. S.; Fagbamigbe, A. F.; Akinyemi, J. O.; Obisesan, O. K.; Awosanya, E. J.; Afolabi, R. F.; Alarape, S. A.; Obabiyi, S. O.Background: COVID-19 is an emerging public health emergency of international concern. The trajectory of the global spread is worrisome, particularly in heavily populated countries such as Nigeria. The study objective was to assess and compare the pattern of COVID-19 spread in Nigeria and seven other countries during the first 120 days of the outbreak. Methods: Data was extracted from the World Bank’s website. A descriptive analysis was conducted as well as modelling of COVID-19 spread from day one through day 120 in Nigeria and seven other countries. Model fitting was conducted using linear, quadratic, cubic and exponential regression methods (α=0.05). Results: The COVID-19 spread pattern in Nigeria was similar to the patterns in Egypt, Ghana and Cameroun. The daily death distribution in Nigeria was similar to those of six out of the seven countries considered. There was an increasing trend in the daily COVID-19 confirmed cases in Nigeria. During the lockdown, the growth rate in Nigeria was 5.85 (R2 =0.728, p< 0.001); however, it was 8.42 (R2 =0.625, p< 0.001) after the lockdown was relaxed. The cubic polynomial model (CPM) provided the best fit for predicting COVID-19 cumulative cases across all the countries investigated and there was a clear deviation from the exponential growth model. Using the CPM, the predicted number of cases in Nigeria at 3-month (30 September 2020) was 155,467 (95% CI:151,111-159,824, p< 0.001), all things being equal. Conclusions: Improvement in COVID-19 control measures and strict compliance with the COVID-19 recommended protocols are essential. A contingency plan is needed to provide care for the active cases in case the predicted target is attained.Item Dynamics of poverty-related dissimilarities in fertility in Nigeria: 2003-2018(Elsevier B.V, 2020) Adebowale, A. S.; Fagbamigbe, A. F.; Akinyemi, J. O.; Olowolafe, T.; Onwusaka, O.; Adewole, D.; Sadikue, S.; Palamuleni, M.Nigeria is one of the high fertility countries worldwide. Little is known about the differences in fertility experience of women in poor and rich households in Nigeria. We ex amined the relationship between household wealth and fertility in Nigeria with focus on women from poor and rich households.This national representative and cross-sectional design study involved analysis of fourrounds (2003, 2008, 2013, 2018) of Nigeria Demographic Health and Survey data . Theoutcome variable was fertility measured from the full birth history information reported by women of reproductive age. Data were analyzed using descriptive statistics, direct and Gompertz-relational demographic methods, logistic regression and negative binomial re gression models (α=0.05). Across the survey years, the mean number of children ever born (CEB), the total fer tility rate and the percentage of women who had high fertility were consistently higher among the women from poor households than those from the rich households. From 2003 to 2018, declining pattern (slope = -0.87) in percentage of high fertility women was observed among rich unlike the poor women (slope = +0.31) where a slight increase was observed. In 2018 as for other survey rounds, about 18.7% and 38.4% of rich and poor women had high fertility (CEB≥5) respectively. The likelihood of high fertility (CEB≥5) was 2.74 (C.I=2.60-2.89, p<0.001) times higher among poor women than the rich women. In 2018,the fertility incidence risk ratio was about 8.0% higher among the women from the poo rhouseholds than their counterparts from the rich households and this pattern was observed when some other factors were included in the regression model across the survey years (2003-2018).Item Parental educational homogamy and under-five mortality in sub-Saharan Africa: Clarifying the association’s intricacy(Elsevier B.V., 2020) Adebowale, A. S.; Fagbamigbe, A. F.; Morakinyo, O.; Obembe, T.; Afolabi, R. F.; Palamuleni, M. E.Worldwide, under-five mortality (U5M) rate is highest in sub-Saharan Africa (SSA). There exists a gap in knowledge on the pathway through which Parental Educational Homogamy (PEH) influences U5M in SSA. In this study, we tested the research hypothesis’ PEH is not associated with under-five children’s survival probability in SSA. Demographic and health survey datasets for 21 SSA countries were analyzed. Cross sectional design and multi-stage cluster sampling technique were used for sample selection in each of the countries under investigation. The dependent variable was the survival status of a newborn to age 59 months while the main independent variable was PEH generated from information on wife’s and husband’s level of education. Data were analyzed using Chi-square test, Cox-proportional hazard model and Brass-adjusted model (α=0.05). Under-five mortality rate ranges from 56/1,000 live born in South Africa to 190/1,000 live born in Sierra-Leone. Across countries, U5M rate was higher among the children of parents with at most primary education than that of parents who had at least secondary education. This pattern of U5M rate was also observed for children of parents where husbands were more educated than their wives. Maternal age at birth, sex of the child, toilet facility, type of cooking fuel, tetanus injection during pregnancy, and birth weight were significantly associated with U5M in 14, 11, 8, 7, 11, 14 and 20 countries respectively. A significant relationship was established between PEH and U5M in 11 of the 21 studied countries but was identified as a predictor of U5M in Congo Democratic Republic, Gambia and Zimbabwe. Parental educational homogamy exhibits a pattern of relationship with U5M in SSA. Ensuring that individuals particularly women have at least secondary education before child bearing will facilitate an U5M reduction in SSA.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 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 A survival analysis model for measuring association between bivariate censored outcomes: validation using mathematical simulation(Scientific & Academic Publishing, 2017) Fagbamigbe, A. F.; Adebowale, A. S.; Bamgboye, E. A.Bivariate censored data occur in follow-up studies of events that can result in two different outcomes. Many studies have explored methods for inference about the marginal recurrence times of these outcomes. However, very few have focused on the dependence structures between their occurrences or recurrence times especially when these outcomes are censored as evidence in the current study. This theoretical and empirical study used simulated data to monitor and validate the survival analysis model for measuring association between recurrence times of bivariate censored outcomes. Bivariate outcomes would naturally fall into one of four possibilities: only the first, only the second, none or both conditions occurring with different and distinct likelihoods. Using predetermined correlation coefficients, n=100000 bivariate standardized binormal data were simulated. The simulated data were then subjected to different censoring chances while contributions of the likelihoods of the four possibilities were examined and Maximum Likelihood Estimate (MLE) of the association parameter determined. For the data simulated at 50% censoring, MLE of the association parameter tended to zero as the predetermined correlation coefficients fell from +1.0 to -1.0. However, at 0% censoring, the MLE were approximates of the predetermined correlation coefficients. The developed model was robust as the model responded adequately to the dynamics of the predetermined correlation and censoring conditions. The model would be appropriate in studying associations between two censored survival times.