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 A comparative analysis of the infuence of contraceptive use and fertility desire on the duration of second birth interval in four sub-Saharan African countries(BioMed Central, 2021) Afolabi, R. F.; Fagbamigbe, A. F.; Palamuleni, M. E.Background: Fertility decline characterised by inter-birth intervals remains rather slow or stall in many countries of sub-Saharan African (SSA). Non-adherence to optimal inter-birth intervals often occasioned by low prevalence of contraceptive use and high fertility desires often lead to poor maternal and child health outcomes. Additionally, information on the influence of contraception and fertility desire on interval between first and second births (SBI) is rarely available. This study therefore aimed to examine the influence of fertility desire and contraception on SBI among women in four SSA countries. Methods: We analysed cross-sectional data on women aged 15–49 years who participated in the recent Demo graphic and Health Surveys in DR Congo, Ethiopia, Nigeria and South Africa. Semi-parametric Cox proportional hazards regression was employed for the analysis at 5% significance level. Results: The median time to second birth was 34 months in DR Congo; 35 months, Nigeria; 42 months, Ethiopia; and 71 months, South Africa. About 70% of the women desired additional child(ren) and two-thirds have never used contraceptive in both Nigeria and DR Congo. The hazard of second birth was significantly lower among women who desired additional child(ren) compared to desired for no more child in DR Congo (aHR=0.93; CI: 0.89–0.97), Ethiopia (aHR=0.64; CI: 0.61–0.67) and South Africa (aHR=0.51; CI: 0.47–0.55). Women who had never used contraceptive were 12%, 20% and 24% more likely to lengthen SBI than those who were current users in DR Congo, Nigeria and South Africa respectively. DR Congo and Nigerian women were about two times more likely to shorten SBI compared with their South African counterparts. Other significant determinants of SBI include ethnicity, rural residential, age and marital status at first birth, wealth and employment status. Conclusion: Findings showed differentials in the linkage between second birth interval and the desired fertility and contraception by country, demonstrating the importance of context. The contribution of these factors to second birth interval requires country context-specific attention if further decline in fertility and poor health outcomes associated with sub-optimal inter-birth interval is to be attained in SSA.Item Situation assessment and natural dynamics of COVID-19 pandemic in Nigeria, 31 May 2020(Elsevier B.V., 2021) Adebowale, S.; Fagbamigbe, A. F.; Akinyemi, J. O.; Obisesan, K. O.; Awosanya, E. J.; Afolabi, R. F.; Alarape, S. A.; Obabiyi, S. O.Background: The coronavirus disease (COVID-19) remains a global public health issue due to its high transmission and case fatality rate. There is apprehension on how to curb the spread and mitigate the socio-economic impacts of the pandemic, but timely and reliable daily confirmed cases’ estimates are pertinent to the pandemic’s containment. This study therefore conducted a situation assessment and applied simple predictive models to explore COVID-19 progression in Nigeria as at 31 May 2020. Methods: Data used for this study were extracted from the websites of the European Centre for Disease Control (World Bank data) and Nigeria Centre for Disease Control. Besides descriptive statistics, four predictive models were fitted to investigate the pandemic natural dynamics. Results: The case fatality rate of COVID-19 was 2.8%. A higher number of confirmed cases of COVID-19 was reported daily after the relaxation of lockdown than before and during lockdown. Of the 36 states in Nigeria, including the Federal Capital Territory, 35 have been affected with COVID-19. Most active cases were in Lagos (n = 4064; 59.2%), followed by Kano (n = 669; 9.2%). The percentage of COVID-19 recovery in Nigeria (29.5%) was lower compared to South Africa (50.3%), but higher compared to Kenya (24.1%). The cubic polynomial model had the best fit. The projected value for COVID-19 cumulative cases for 30 June 2020 in Nigeria was 27,993 (95% C.I: 27,001–28,986). Conclusion: The daily confirmed cases of COVID-19 are increasing in Nigeria. Increasing testing capacity for the disease may further reveal more confirmed cases. As observed in this study, the cubic polynomial model currently offers a better prediction of the future COVID-19 cases in Nigeria.Item Survival analysis of time interval between first and second childbirth among women in Nigeria(College of Medicine, University of Ibadan, 2020) Fagbamigbe, A. F.; Ojo, A. E.; Onyeike, N. O.; Okafor, I. P.; Atilola, S. O.; Olabuyi, R. A.; Afolabi, R. F.Background: Birth spacing, especially between first and second births, could impact on fertility, and on maternal and child health. While the interval between marriage and first-birth has been widely studied, information on intervals between first and second births (SBI) and its determinants is scarce. We investigated the timing of second childbirth and its determinants among women in Nigeria. Methods: Using the 2013 Nigeria Demographic and Health Survey, we analysed data on 27451 women of reproductive age who had reported at least one childbirth as of the survey date. We used Kaplan-Meier survival analysis and Cox proportional-hazard regression with 95% confidence interval (CI) computed. Results: The median SBI among women in Nigeria was 34 months (CI: 33.7–34.3). The hazard of second-birth was higher among women from rural (HR=1.161; CI: 1.13-1.19) compared to those from the urban areas. While women living in other regions had tendencies to shorten SBI compared with the North Central, those from South West were 9% (aHR=0.91; CI: 0.86–0.96) less likely to delay it. For every one year age-at-first birth delayed among women, the hazard of second-birth increased by 1.9%. Wealth status, contraceptive use, being employed, higher education among women and spouses, and first-child survival are protective of SBI. Conclusions: Contraceptive use, being employed, living in an urban area, belonging to higher wealth quintile and higher educational attainment could lead to longer second birth interval which could lead to a healthier child, safer motherhood, and reduced fertility. Women should be encouraged to delay SBI as a fertility-control-strategyItem 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 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 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 Demand and unmet needs of contraception among sexually active in-union women in Nigeria: distribution, associated characteristics, barriers, and program implications(Sage Publishing, 2018) Fagbamigbe, A. F.; Afolabi, R. F.; Idemudia, E. S.It is not clear whether the 16% unmet need for contraceptives in Nigeria indicates a success story. This study assessed the contraceptive prevalence rate (CPR), total contraceptive demand, and unmet needs and determined the distribution, determinants, and barriers to contraceptive demands and unmet needs in Nigeria. The fertility, breastfeeding, and contraceptive use information provided by 27,829 women who were either currently married or in a sexual union in the 2013 Nigeria Demographic and Health Survey (NDHS) were extracted. Associations between having unmet needs and the demographic, socioeconomic, and reproductive profiles of the respondents were assessed using bivariate and multiple logistic regression at 5% significance level. Multiple response data analysis techniques were used to assess barriers to nonuse of contraceptives. Data were weighted to reflect differentials in the population of in-union women in each geographical state. The modern CPR was 9.8% while total demand for contraception was 31.2%, consisting of unmet need at 16.1% and met needs at 15.1%. Unmet need for family planning was higher among rural women compared with urban women (16.8% vs. 14.9%); younger women (adjusted odds ratio [aOR] = 4.29; confidence interval [CI] = [3.03, 6.07]), women belonging to poorer economic status (aOR = 2.27, CI = [1.92, 2.68]), and women with no education (aOR = 3.23, CI = [2.60, 4.02]) had higher odds of unmet needs. The low unmet need should not be mistaken for a good progress in family planning programming in Nigeria; the success is better measured using the level of total demand for contraceptives and CPR. Interventions to improve the socioeconomic status of women, increase the knowledge of modern contraceptives, and improve women’s decision-making power should be prioritized.Item Multilevel modelling of the predictors of post-stroke depression in South-West Nigeria(Biomedical Communications Group, 2019) Agbola, O. E.; Akpa, O. M.||; Ojagbemi, A.; Afolabi, R. F.Abstract :Recent decline in stroke mortality engendered by improved treatment has led to an increase in post-stroke morbidity and related healthcare cost. Most of post-stroke morbidity is due to depression. Few studies have examined the association of contextual factors with post-stroke depression (PSD) using a multilevel framework. This study used multilevel modelling to examine both individual and contextual predictors of PSD in southwest, Nigeria. The study used secondary data from a comparative cross sectional study of one hundred and thirty (130) stroke survivors. Participants were consenting adult (aged ≥18 years) residing in southwest Nigeria who have survived stroke in the last 3 to 24 months preceding the time of the study. Data were preliminarily analyzed using descriptive statistics including percentages and frequency tables. Bivariate association tests were carried out using Chi-square test. Multivariate analyses were performed using multilevel logit modeling and results were presented as odds ratio and their 95% Confidence Intervals (95% CI). All analyses were performed at 5% significance level. The mean (±standard deviation) age of participants was 59.54 ± 11.08 and most participants (53.6%) were female. Exactly half of the participants were retirees while most of them were currently married (82.3%), resided in urban (76.7%), and never used alcohol (73.8%). Prevalence of PSD in this study was 41.5%. Post-stroke depression was more likely among younger stroke survivors (OR=1.47; 95% CI: 1.16, 1.85), female (OR=1.37; 95% CI: 1.16, 1.60), alcohol users (OR=1.21; 95% CI: 1.04, 1.47), and the retired (OR=1.23; 95% CI: 1.04, 1.45). PSD was significantly associated with history of stressful life events and all depressed stroke survivors had considered suicide. Post stroke depression was common in younger survivors. Female survivors and alcohol users were more depressed. History of stressful life event is predictive of post stroke depression in this sample. Interventions focusing on women, alcohol users and people with history of stressful life events that had survived a stroke may reduce the burden of post stroke depression and possibilities of suicide.