FACULTY OF PUBLIC HEALTH
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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 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 Regional differences in adolescent childbearing in Nigeria(Institute for Population and Social Research, Mahidol University, Thailand, 2016) Adebowale, A. S.; Fagbamigbe, A. F.; Adebayo, A. M.Nigeria’s total fertility rate (TFR) and adolescent first birth rate are among the highest worldwide, but variation exists by region. Unfortunately, data to monitor the level of adolescent first births is still scarce in Nigeria. This study examines regional differences in the level of adolescent first birth among women ages 20-49 years (n=23,801) in Nigeria. Data were analyzed using Chi-square and Cox proportional hazard models (α=0.05). Mean age at first birth was lower in the regions of higher TFR, among less educated and poorer women. In the South East, as for other regions in Nigeria, the mean children ever born was 6.13±2.8, 5.18±2.8, 4.1±2.4 and 2.97±1.9 for women who had their first birth at ages <15, 15-19, 20-24 and ≥25 respectively. The adolescent first birth was highest in the North West (74.8%, TFR=6.7) and lowest in the South West (32.1%, TFR=4.6). The hazard-ratio of beginning first birth was 1.58 (CI=1.46-1.70), 2.87 (CI=2.68-3.07), 3.43 (CI=3.23-3.67) and 1.74 (CI=1.61-1.88) higher in the North Central, North East, North West and South South, respectively, than the South West. Regional differences exist in adolescent first birth in Nigeria and TFR was higher in the regions where adolescent first birth was prevalent. Improving women’s education, particularly in the core northern regions, can raise the age at first birth in Nigeria.Item Survival analysis of time to uptake of modern contraceptives among sexually active women of reproductive age in Nigeria(BMJ Open, 2015) Fagbamigbe, A. F.; Adebowale, A. S.; Morhason-Bello, I. O.Objective: To assess the timing of modern contraceptive uptake among married and never-married women in Nigeria. Design: A retrospective cross-sectional study. Data and method: We used nationally representative 2013 Demographic and Health Survey data in Nigeria. Modern contraceptive uptake time was measured as the period between first sexual intercourse and first use of a modern contraceptive. Non-users of modern contraceptives were censored on the date of the survey. Kaplan–Meier survival curves were used to determine the rate of uptake. A Cox proportional hazards model was used to determine variables influencing the uptake at 5% significance level. Participants: A total of 33 223 sexually active women of reproductive age. Outcome measure: Time of uptake of a modern contraceptive after first sexual intercourse. Results: The median modern contraceptive uptake time was 4 years in never-married and 14 years among ever-married women. Significant differences in modern contraceptive uptake existed in respondents’ age, location, education and wealth status. Never-married women were about three times more likely to use a modern contraceptive than ever-married women (aHR=3.24 (95% CI 2.82 to 3.65)). Women with higher education were six times more likely to use a modern contraceptive than those without education (aHR=6.18 (95% CI 5.15 to 7.42)). Conclusions: The rate of modern contraceptive uptake is low, and timing of contraceptive uptake during or after first sexual intercourse differed according to marital status. Age and number of children ever born influenced modern contraceptive uptake among the never-married women, but religion and place of residence were associated with the probability of modern contraceptive uptake among ever-married women.Item Current and predicted fertility using poisson regression model: evidence from 2008 nigerian demographic health survey(Women's Health and Action Research Centre, 2014) Fagbamigbe, A. F.; Adebowale, A. S.Nigeria with persistent high growth rate is among top ten most populous countries. Monitoring key mechanisms of population dynamics particularly fertility in Nigeria is long overdue. Periodical availability of data on fertility and other demographic indices is scarce, hence this study. Our objective was to build a non-linear model to identify fertility determinants and predict fertility using women’s background characteristics. We used 2008 Nigeria Demography and Health Survey dataset consisting of 33,385 women with 31.4% from urban area. Fertility was measured using children ever born (CEB) and fitted into multi-factors additive Poisson regression models. Respondents mean age was 28.64±9.59years, average CEB of 3.13±3.07 but higher among rural women than urban women (3.42±3.16 vs 2.53±2.79). Women aged 20-24years were about twice as likely to have higher CEB as those aged 15-19years (IRR=2.06, 95% CI: 1.95-2.18). Model with minimum deviance was selected and was used to predict CEB by the woman.Item Assessing full immunisation coverage using lot quality assurance sampling in urban and rural districts of southwest Nigeria(Royal Society of Tropical Medicine and Hygiene., 2013) Fatiregun, A. A.; Adebowale, A. S.; Ayoka, R. O.; Fagbamigbe, A. F.Background: This study was conducted to identify administrative wards (lots) with unacceptable levels of full child immunisation coverage, and to identify factors associated with achievement of a complete child immunisation schedule in Ibadan North East (IBNE) and Ido local government areas (LGAs) of Oyo State, Nigeria. Methods: A cross-sectional survey involving 1178 mothers, 588 from IBNE LGAs and 590 from Ido LGAs, with children 12–23 months of age was conducted. Children were considered ‘fully-immunised if they received all the vaccines included in the immunisation schedule. Lot quality assurance sampling was used to determine lots with acceptable and non-acceptable coverage. Samples were weighted based on the population by lot to estimate overall coverage in the two LGAs and a logistic regression model was used to identify factors associated with the fully immunised child. Results: Mean age of the mothers was 28.5+5.6 and 28.1+6.0 years in IBNE and Ido LGAs, respectively. Eleven of 12 wards in IBNE and all the wards in Ido had unacceptable coverage. The proportion of fully immunised children was 40.2% in IBNE and 41.3% in Ido. Maternal age ≥30 years, retention of an immunisation card, completion of tertiary education, or secondary education, hospital birth and first-order birth were significant predictors of complete childhood immunisation. Conclusion: The level of full immunisation coverage was unacceptable in almost all the wards. Educational inter vention on the importance of completion of immunisation schedule should target young, uneducated mothers, mothers who delivered their babies at home and those with a high birth order.Item Statistical modeling of social risk factors for sexually transmitted diseases among female youths in Nigeria(Open Learning on Enteric Pathogens, 2013) Adebowale, A. S.; Titiloye, M.; Fagbamigbe, A. F.; Akinyemi, O. J.Introduction: Sexually transmitted diseases (STDs) are preventable, but the social risks factors connected to them are often not understood, particularly by female youths. There has been a dearth of information on the identification of social risk factors influencing STDs among female youths in Nigeria, hence we conducted this study. Methodology: This retrospective cross-sectional study utilized the Nigeria Demographic and Health Survey, 2008. It focused on female youths aged 15-24 (n=7,736) who ever had sexual intercourse. Data was analyzed using Chi-square and logistic regression models. Results: The mean age of the respondents was 20.2±2.5years. More female youths aged between 20 and 24 years contracted STDs in the last 12 months (2.5%) than those between the ages of 15 and 19 months (1.4%). A year prevalence of STDs among female youths in Nigeria was 2.1%. Socio-demographic factors such as age, education, wealth index, marital status, shared toilet, residence, contraceptive use, and total life-time number of sexual partners were found to be associated risk factors for contracting STDs (p<0.05). Controlling for potential confounding variables at the fifth iteration, the identified predictors of contracting STDs were wealth index, total lifetime number of sexual partners, awareness of HIV/AIDS, and shared toilet facility (p<0.05). Conclusions: The data confirmed the considerable impact of wealth index and awareness of HIV/AIDS as important predictors of STDs acquisition. Providing free condoms, along with teaching the importance of abstinence and improving knowledge of HIV/AIDS, can help to reduce the risk of STDs transmission.Item Survival probability and predictors for woman experience childhood death in Nigeria: “analysis of north–south differentials”(Biomed Central, 2012) Adebowale, A. S.; Yusuf, B. O.; Fagbamigbe, A. F.Background: Childhood mortality rate is high in Nigeria. There is dearth of information on the comparison of childhood mortality probability and its causal factors in the Northern and Southern Nigeria. This study was designed to fill these gaps. Methods: Nigeria Demographic and Health Survey, 2008 data was used. The first part of this study focused on women aged 15–49 who ever given birth to a child (n = 23,404), irrespective of the survival status of the child and the second part utilized all women aged 15–49 (N = 33,385). The outcome variable was experienced childhood mortality. Data was analyzed using Chi-square, logistic regression and Brass logit model. Results: Results showed that similar patterns of children’s death were observed in the two regions, but variation existed. Childhood mortality experienced was more pronounced in the North than the South, even when the potential confounding variables were used as control. Levels of education and wealth index showed an inverse relationship with childhood death in the regions (p < 0.05). The gap in childhood mortality experienced between the poorest and richest was wider in the North than the South. There was no significant difference in the risk of childhood mortality experienced by women in the urban and rural areas in the North (p > 0.05), but the difference was significant in the South (p < 0.05). The life-table mortality levels were lower in the North than the South, an indication of higher previous childhood mortality experience in the North than in the South. Across all childhood ages, the smoothed childhood mortality probabilities were consistently higher in the North than the South. Conclusion: Childhood mortality is higher in the Northern than Southern Nigeria. Improving women’s education, particularly in the North will alleviate childhood mortality in Nigeria.