FACULTY OF PUBLIC HEALTH
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Item Derivation and appraisal of maternal mortality estimates in Nigeria from the 2012 National HIV/AIDS and Reproductive Health Survey(College of Medicine, University of Ibadan, 2017) Akinyemi, J. O.; Yusuf, O. B.; Fagbamigbe, A. F.; Bamgboye, E. A.; Kawu, I. B.; Ngige, E.; Amida, P.; Bashorun, A.Background Despite the huge burden of in Nigeria, accurate and reliable data fur maternal mortality measurement arc locking The federal Ministry of Health in collaboration with development partners included questions that allow indirect estimation of maternal mortality m us 2012 National HIV/AIDS and Reproductive Health Survey (NARHS) The aim of this paper was to derive estimates of Maternal Mortality Ratio (MMR) and Lifetime Risk of maternal death (LTR) from the 2012 NARHS data Methods: This was a secondary analysis of data from the maternal mortality module of NARHS 2012. During the survey, respondents (men aged 15-59 years and women aged 15-49 years) were selected via a multi-stage cluster sampling technique and data collected by trained field workers. In this study, report on survival or otherwise of adult female siblings were analysed to derive estimates of life tune risk of maternal death using the indirect sisterhood method. Results: Data from 15,596 men and 15,639 women were analysed A total of 12.810 adult female siblings had been exposed to the risk of death out of which 377 (2.9*4) have died of the 377 adult female deaths. 70 (18 6%) were pregnancy related the estimates of LTR and MMR were I in 71 women and 256 (95% CT. 196 - 316) maternal deaths per 100,000 live births respectively. There were north-south and rural-urban differences. Conclusion: The high level of maternal mortality is worrisome, concerted efforts aimed at reduction and provision of routine data for its measurement should be intensified.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.Item Controlling malaria in pregnancy: how far from the Abuja targets?(Dutch Malaria Foundation, 2016) Yusuf, O. B.; Akinyemi, J. O.; Fagbamigbe, A. F.; Ajayi, I. O.; Bamgboye, E. A.; Ngige, E.; Issa, K.; Abatta, E.; Ezire, O.; Amida, P.; Bashorun, A.Background. The Roll Back Malaria (RBM) initiative recommended that all pregnant women receive Intermittent Preventive Treatment (IPTp) and that by 2010 at least 80% of people at risk of malaria (including pregnant women) use insecticide-treated bednets (ITN) in areas with stable transmission. We evaluated ITN/IPTp coverage, explored its associated factors, and estimated the number of pregnancies protected from malaria. Materials and methods. This analysis was based on data from the 2012 National HIV/AIDS and Reproductive Health Survey (NARHS Plus). To assess ITN coverage, we used the population of women that was pregnant (n=22,438) at the time of the survey. For IPTp coverage, we used women that had a live birth in the 5 years preceding the survey (n= 118,187) and extracted the population of pregnant women that, during their last pregnancy, received drugs for protection against malaria. We estimated the number of live births using the projected population of females in each state, population of women of child -bearing age and the total fertility rate. The estimated number of pregnancies covered/protected by ITN and IPTp was obtained from a product of the estimated live births and the reported coverage. Multivariate logistic regression was used to determine factors associated with ITN and IPTp use. Results. We estimated that there were 5,798,897 live births in Nigeria in 2012, of which 3,537,327 and 2,302,162 pregnancies were protected by ITN and IPTp, respectively. Four of 36 states achieved the 80% RBM target for ITN coverage. No state achieved the 100% target for IPTp. Education and socio-economic status were associated with IPTp use. Conclusion. ITN coverage was higher than in previous estimates even though it is still below the RBM targets. However, IPTp coverage remained low in 2012 and was not likely to increase to match the 2015 target coverage of 100%.Item The Nigeria wealth distribution and health seeking behaviour: evidence from the 2012 national HIV/AIDS and reproductive health survey(Springer-Verlag GmbH, 2015) Fagbamigbe, A. F.; Bamgboye, E. A.; Yusuf, B. O.; Akinyemi, J. O.; Issa, B. K.; Ngige, E.; Amida, P.; Bashorun, A.; Abatta, E.Background: Recently, Nigeria emerged as the largest economy in Africa and the 26th in the world. However, a pertinent question is how this new economic status has impacted on the wealth and health of her citizens. There is a dearth of empirical study on the wealth distribution in Nigeria which could be important in explaining the general disparities in their health seeking behavior. An adequate knowledge of Nigeria wealth distribution will no doubt inform policy makers in their decision making to improve the quality of life of Nigerians. Method: This study is a retrospective analysis of the assets of household in Nigeria collected during the 2012 National HIV/AIDS and Reproductive Health Survey (NARHS Plus 2). We used the principal component analysis methods to construct wealth quintiles across households in Nigeria. At 5% significance level, we used ANOVA to determine differences in some health outcomes across the WQs and chi-square test to assess association between WQs and some reproductive health seeking behaviours. Result: The wealth quintiles were found to be internally valid and coherent. However, there is a wide gap in the reproductive health seeking behavior of household members across the wealth quintiles with members of households in lower quintiles having lesser likelihood (33.0%) to receive antenatal care than among those in the highest quintiles (91.9%). While only 3% were currently using modern contraceptives in the lowest wealth quintile, it was 17.4% among the highest wealth quintile (p < 0.05). Conclusion: The wealth quintiles showed a great disparity in the standard of living of Nigerian households across geo-political zones, states and rural–urban locations which had greatly influenced household health seeking behavior.Item A comparative analysis of fertility differentials in Ghana and Nigeria(Women's Health and Action Research Centre, 2014) Olatoregun, O.; Fagbamigbe, A. F.; Akinyemi, O. J.; Yusuf, O. B.; Bamgboye, E. A.Nigeria and Ghana are the most densely populated countries in the West African sub-region with fertility levels above world average. Our study compared the two countries’ fertility levels and their determinants as well as the differentials in the effect of these factors across the two countries. We carried out a retrospective analysis of data from the Nigeria and Ghana Demographic Health Surveys, 2008. The sample of 33,385 and 4,916 women aged 15-49 years obtained in Nigeria and Ghana respectively was stratified into low, medium and high fertility using reported children ever born. Data was summarized using appropriate descriptive statistics. Factors influencing fertility were identified using ordinal logistic regression at 5% significance level. While unemployment significantly lowers fertility in Nigeria, it wasn’t significant in Ghana. In both countries, education, age at first marriage, marital status, urban-rural residence, wealth index and use of oral contraception were the main factors influencing high fertility levels.Item Re-analysis of Nigerian 2006 census age distribution using growth rate and mortality level(Population Association of Southern Africa, 2014) Adebowale, S. A.; Fagbamigbe, F. A.; Bamgboye, E. A.The usefulness of human population age structure in public health research is enormous, but age misreporting and an incomplete Vital Registration System (VRS) in Nigeria constitute a serious challenge. Age misreporting affects the true estimate of basic demographic parameters which are part of yardsticks for measuring the growth, development and well-being of a nation, thus the need to refine the age structure in Nigeria is important. This study was conceived with the view to refining the 2006 census age distribution using growth rate and mortality level. The Logit transformation system and Coale-Demeny life-table were used for data analyses. This study revealed that there was a gross age misstatement across all age categories, but age errors were more pronounced among females than males. The pattern of either under-reporting or over reporting of ages was similar for both sexes. Also, there was tendency to under-report ages 0 to 19 years and above 55 years, whereas gross over-reporting of age was observed in ages between 20 and 55 years. Good VRS and showing certificate of birth as evidence of age during census enumeration will reduce the errors in age reporting in future censuses in Nigeria.Item Contraceptive use: implication for completed fertility, parity progression and maternal nutritional status in Nigeria(Women's Health and Action Research Centre, 2011) Adebowale, S. A.; Fagbamigbe, F. A.; Bamgboye, E. A.The study identified socio-demographic factors influencing contraceptive use while using nutritional status, completed fertility and parity progression as key variables. NDHS, 2008 dataset on married women aged 45-49 was used. Chi-square, ordinary linear and logistic regression models were used for the analysis. The mean age of the women and CEB were 46.8±1.5 years and 6.9±3.1 respectively. About 26.0% of the women ever used contraception, while 9.0% of the women were underweight. Parity progression from parity 0 to 4 was consistently higher among never-users than women who ever used contraception. The tempo changes for all parities above four as ever-users now progress at lower rate during these periods. The completed fertility and the risk of undernourishment were significantly higher among never users of contraception than ever users. The level of risk persists even when the potential confounding variables were used as controlItem Gender variation in self-reported likelihood of HIV infection in comparison with HIV test results in rural and urban Nigeria(Biomed Central, 2011) Fagbamigbe, A. F.; Akinyemi, J. O.; Adedokun, B. O.; Bamgboye, E. A.Background: Behaviour change which is highly influenced by risk perception is a major challenge that HIV prevention efforts need to confront. In this study, we examined the validity of self-reported likelihood of HIV infection among rural and urban reproductive age group Nigerians. Methods: This is a cross-sectional study of a nationally representative sample of Nigerians. We investigated the concordance between self-reported likelihood of HIV and actual results of HIV test. Multivariate logistic regression analysis was used to assess whether selected respondents’ characteristics affect the validity of self-reports. Results: The HIV prevalence in the urban population was 3.8% (3.1% among males and 4.6% among females) and 3.5% in the rural areas (3.4% among males and 3.7% among females). Almost all the respondents who claimed they have high chances of being infected with HIV actually tested negative (91.6% in urban and 97.9% in rural areas). In contrast, only 8.5% in urban areas and 2.1% in rural areas, of those who claimed high chances of been HIV infected were actually HIV positive. About 2.9% and 4.3% from urban and rural areas respectively tested positive although they claimed very low chances of HIV infection. Age, gender, education and residence are factors associated with validity of respondents’ self-perceived risk of HIV infection. Conclusion: Self-perceived HIV risk is poorly sensitive and moderately specific in the prediction of HIV status. There are differences in the validity of self-perceived risk of HIV across rural and urban populations.Item Modelling morbidity related absenteeism among workers in University of Ibadan Community, Nigeria: Poisson regression(Academic Journals, 2011) Apau, G. S.; Fagbamigbe, A. F.; Adebowale, S. A.; Bamgboye, E. A.Globally, sickness absenteeism is a contemporary public health problem, particularly in developing countries. However, very few studies had addressed the theoretical and methodological aspects of health related absenteeism among University workers. A retrospective study of sickness records of 4447 employees of University of Ibadan made available at the University Staff Clinic (Jaja). The health records of each staff for the whole 12 months in 2007 were reviewed. Data analysis was performed using descriptive statistics and Poisson distribution model was used in the data modeling. The prevalence of sick-off leave at the staff clinic was 4.7%. Also, 12.4% of all the staff had been sick at least once during the study period. There was a slight differential in absent rate by sex, age, marital status and years of service. However, differential existed in absent rate among subgroup of workers by different occupational groups and staff category. Majority of the spells lasted for between one and two days. The Poisson regression model showed that staff category and occupational group are the only predictors of days sick-off. Among the dependent variables considered, only sick-off days followed Poisson distribution model. Also, Poisson regression model is adequate to describe and predict the pattern of sickness absenteeism in the study area.Item Rural-urban differential in maternal mortality estimate in Nigeria, sub-Saharan Africa(Cenresin Publications, 2010) Adebowale, S. A.; Fagbamigbe, F. A.; Bamgboye, E. A.In developing countries, the traditional sources of demographic statistics in which the estimates of demographic indices are based are either non-existence or incomplete. Data requirements on maternal deaths are always very large and costly. The indirect method (sisterhood method) for estimating maternal deaths was designed primarily as check to these problems. The study used Nigeria Demographic and Health Survey (NDHS), 2008 data. A total of 18,250 (6,894 urban and 11,356 rural) adults responded to questions essential for the estimation of maternal mortality. The P/F ratio method was used to adjust the total fertility rates (TFR) in urban and rural areas. Thereafter, the life-time risks of maternal deaths (LTRMD) were estimated for the two areas. These were later converted to maternal mortality ratio (MMR). Data analyses revealed that the adjusted total fertility rates for urban and rural areas were 5.26 and 7.12 respectively. The LTRMD in urban was 0.0221 (1 in 45) whereas, in rural area it was 0.0309 (1 in 32). These results correspond to MMR of 424/100,000 and 440/100,000 live births in urban and rural areas respectfully. These are not far from the national estimate of 436/100,000 live births as evidence in this study. This method provided a robust estimate of MMR in both urban and rural areas and shows that the MMR in Nigeria is reducing. However, the figures at the two locations are still high. Government and international agencies should put appropriate mechanisms in place for further reduction in the prevalence.