FACULTY OF PUBLIC HEALTH
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Item Evaluating the performance of different Bayesian count models in modelling childhood vaccine uptake among children aged 12– 23 months in Nigeria(BioMed Central, 2023) Fagbamigbe, A. F.; Lawal, T. V.; Atoloye, K. A.Background Choosing appropriate models for count health outcomes remains a challenge to public health researchers and the validity of the fndings thereof. For count data, the mean–variance relationship and proportion of zeros is a major determinant of model choice. This study aims to compare and identify the best Bayesian count modelling technique for the number of childhood vaccine uptake in Nigeria. Methods We explored the performances of Poisson, negative binomial and their zero-inflated forms in the Bayesian framework using cross-sectional data pooled from the Nigeria Demographic and Health Survey conducted between 2003 and 2018. In multivariable analysis, these Bayesian models were used to identify factors associated with the number of vaccine uptake among children. Model selection was based on the -2 Log-Likelihood (-2 Log LL), Leave-One-Out Cross-Validation Information Criterion (LOOIC) and Watanabe-Akaike/Widely Applicable Information Criterion (WAIC). Results Exploratory analysis showed the presence of excess zeros and overdispersion with a mean of 4.36 and a variance of 12.86. Observably, there was a significant increase in vaccine uptake over time. Significant factors included the mother’s age, level of education, religion, occupation, desire for last-child, place of delivery, exposure to media, birth order of the child, wealth status, number of antenatal care visits, postnatal attendance, healthcare decision maker, community poverty, community illiteracy, community unemployment, rural proportion and number of health facilities per 100,000. The zero-inflated negative binomial model was best ft with -2Log LL of -27171.47, LOOIC of 54464.2, and WAIC of 54588.0. Conclusion The Bayesian zero-inflated negative binomial model was most appropriate to identify factors associated with the number of childhood vaccines received in Nigeria due to the presence of excess zeros and overdispersion. Improving vaccine uptake by addressing the associated risk factors should be promptly embraced.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 Perception of healthcare workers and end-users about the implementation of the Abiye Scheme in Ondo State, Nigeria(College of Medicine, University of Ibadan, 2022) Fagbamigbe, A. F.; Obembe, T. A.; Owumi, B. E.Background: To upturn the poor maternal, children and neonatal health indicators in a South-west Nigerian state, the Abiye Scheme was inaugurated in 2009. This study assessed the perception of healthcare workers and end-users in Ondo State about the implementation of the four strategies proposed to actualise this scheme. Methods: This qualitative study employed the use of 15 key informant interviews (KIIs) conducted among 15 healthcare workers and eight focus group discussions (FGDs) conducted among 72 pregnant and nursing mothers to generate essential data. The Abiye scheme strategies assessed were the establishment of a health insurance scheme; utilization of health rangers (HR); upgrade and renovation of peripheral health facilities; and establishment of mother and child hospitals. All interviews were audio-recorded, transcribed verbatim, coded, and analysed with Nvivo 10 software using framework analysis via deductive methods. Results: The study respondents perceived the Abiye scheme as a well-conceptualized program with good intentions. Only the establishment of the mother and child hospitals strategy of the Abiye scheme was perceived to be properly implemented by our study respondents. According to the respondents, the health insurance scheme was nearly non-existent. Conclusion: Abiye scheme is undisputedly a well conceptualized program that has impacted positively its users. Nonetheless, the laid down strategies have not been fully implemented. To achieve maximal impact, the health rangers must be enabled to perform their duties; the health insurance component must be strengthened and properly implemented; and the peripheral health facilities should be quickly and actively co-opted into the scheme.Item Gender differentials in the timing and prognostic factors of pubarche in Nigeria(Public Library of Science, 2022) Fagbamigbe, A. F.; Obiyan, M.; Fawole, O. I.Paucity of data exists on the timing of puberty, particularly the pubarche, in developing coun tries, which has hitherto limited the knowledge of the timing of pubarche, and assistance offered by physicians to anxious young people in Nigeria. Factors associated with the timings of puberty and pubarche are not well documented in Nigeria. We hypothesized that the timing of pubarche in Nigeria differs by geographical regions and other characteristics. We assessed the timing of pubarche among adolescents and young adults in Nigeria and identified prognostic factors of the timing by obtaining information on youths’ sexual and reproductive developments in a population survey among in-school and out-of-school youths aged 15 to 24 years in Nigeria. A total of 1174 boys and 1004 girls provided valid information on pubarche. Results of time-to-event analysis of the data showed that mean age at pubarche among males aged 15 to 19 years and 20 to 24 years was 13.5 (SD = 1.63 years) and 14.2 (SD = 2.18 years) (respectively) compared with 13.0 (SD = 1.57 years) and 13.5 (SD = 2.06 years) among females of the same age. Median time to pubarche was 14 (Interquartile range (IQR) = 3) years and 13 (IQR = 3) years among the males and females, respectively. Cumulatively, 37% of the males had attained pubarche by age 13 years versus 53% among females, 57% vs 72% at age 14, and 73% vs 81% at age 15. The likelihood of pubarche among males was delayed by 5% compared with females (Time Ratio (TR) = 1.05: 95% CI = 1.03–1.05). Every additional one-year in the ages of both males and females increases the risk of pubarche by 1%. Similar to the females, males residents in Northeast (aTR = 1.14, 95% CI: 1.07–1.21), in the Northwest (aTR = 1.20, 95% CI: 1.13–1.27) and in the Southwest (aTR = 1.18, 95% CI: 1.11–1.26) had delayed pubarche than males from the South East. Yoruba males had delayed pubarche than Ibo males (aTR = 1.06, 95% CI: 1.01–1.12). Age at pubarche among adolescents and young adults in Nigeria differed among males and females with earlier onset among females. Pubarche timing varied mainly by ethnicity, region, and location of residence. Our findings will aid medical practitioners in providing appropriate advice and support on pubarche-related issues among adolescents in Nigeria as it could help douse pubarche anxiousness in relation to request for medical assistance.Item A randomized, open-label trial of combined nitazoxanide and atazanavir/ritonavir for mild to moderate COVID-19(Frontiers Media SA, 2022) Fowotade, A.; Bamidele, F.; Egbetola, B.; Fagbamigbe, A. F.; Adeagbo, B. A.; Adefuye, B. O.; Olagunoye, A.; Ojo, T. O.; Adebiyi, A. O.; Olagunju, O. I.; Ladipo, O. T.; Akinloye, A.; Onayade, A.; Bolaji, O. O.; Rannard, S.; Happi, C.; Owen, A.; Olagunju, A.Background: The nitazoxanide plus atazanavir/ritonavir for COVID-19 (NACOVID) trial investigated the efficacy and safety of repurposed nitazoxanide combined with atazanavir/ritonavir for COVID-19. Methods: This is a pilot, randomized, open-label multicenter trial conducted in Nigeria. Mild to moderate COVID-19 patients were randomly assigned to receive standard of care (SoC) or SoC plus a 14-day course of nitazoxanide (1,000 mg b.i.d.) and atazanavir/ritonavir (300/100 mg od) and followed through day 28. Study endpoints included time to clinical improvement, SARS-CoV-2 viral load change, and time to complete symptom resolution. Safety and pharmacokinetics were also evaluated (ClinicalTrials.gov ID: NCT04459286). Results: There was no difference in time to clinical improvement between the SoC (n = 26) and SoC plus intervention arms (n = 31; Cox proportional hazards regression analysis adjusted hazard ratio, aHR = 0.898, 95% CI: 0.492–1.638, p = 0.725). No difference was observed in the pattern of saliva SARS-CoV2 viral load changes from days 2–28 in the 35% of patients with detectable virus at baseline (20/57) (aHR = 0.948, 95% CI: 0.341–2.636, p = 0.919). There was no significant difference in time to complete symptom resolution (aHR = 0.535, 95% CI: 0.251–1.140, p = 0.105). Atazanavir/ritonavir increased tizoxanide plasma exposure by 68% and median trough plasma concentration was 1,546 ng/ml (95% CI: 797–2,557), above its putative EC90 in 54% of patients. Tizoxanide was undetectable in saliva. Conclusion: Nitazoxanide co-administered with atazanavir/ritonavir was safe but not better than standard of care in treating COVID-19. These findings should be interpreted in the context of incomplete enrollment (64%) and the limited number of patients with detectable SARS-CoV-2 in saliva at baseline in this trial.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 Sex inequality in under-five deaths and associated factors in low and middle-income countries: a Fairlie decomposition analysis(BioMed Central, 2022) Fagbamigbe, A. F.; Morakinyo, O. M.; Balogun, F. M.Background: There exist sex disparities in the burden of Under-five deaths (U5D) with a higher prevalence among male children. Factors explaining this inequality remain unexplored in Low-and Medium-Income Countries (LMIC). This study quantified the contributions of the individual- and neighborhood-level factors to sex inequalities in U5D in LMIC. Methods: Demographic and Health Survey datasets (2010-2018) of 856,987 under-five children nested in 66,495 neighborhoods across 59 LMIC were analyzed. The outcome variable was U5D. The main group variable was the sex of the child while individual-level and neighborhood-level factors were the explanatory variables. Fairlie decomposition analysis was used to quantify the contributions of explanatory factors to the male-female inequalities in U5D at p<0.05. Results: Overall weighted prevalence of U5D was 51/1000 children, 55 among males and 48 among females (p<0.001). Higher prevalence of U5D was recorded among male children in all countries except Liberia, Kyrgyz Republic, Bangladesh, Nepal, Armenia, Turkey and Papua New Guinea. Pro-female inequality was however not significant in any country. Of the 59 countries, 25 had statistically significant pro-male inequality. Different factors contributed to the sex inequality in U5D in different countries including birth order, birth weight, birth interval and multiple births. Conclusions: There were sex inequalities in the U5D in LMIC with prominent pro-male-inequality in many countries. Interventions targeted towards the improvement of the health system that will, in turn, prevent preterm delivery and improve management of prematurity and early childhood infection (which are selective threats to the male child survival) are urgently required to address this inequality.Item Multivariate decomposition of trends, inequalities and predictors of skilled birth attendants’ utilisation in Nigeria (1990–2018): a cross-sectional analysis of change drivers(BMJ Publishing Group Ltd, 2022) Fagbamigbe, A. F.; Oyedele, O. K.Objectives Literature has assessed skilled birth attendants (SBAs) utilisation, but little is known about what contributes to the changes in SBA use. Multivariate decomposition analysis was thus applied in this study to examine; levels, trends, inequalities and drivers of changes in SBA utilisation. Design and setting A cross-sectional analysis of five waves of NDHS-data (1990, 2003, 2008, 2013, and 2018), collected through similar multistage sampling across the 36 states and the federal-capital-territory of Nigeria. Participants Women of reproductive age (15–49 years), and with at least one birth in the last 5 years preceding each of the surveys .Main outcome measure SBA use is the response variable while explanatory variables were classified into; Demographics, Health, Economic and Corporal factors. Methods Chi-square test for trends of proportions across the ordered survey years assessed trends in SBA use. MDA that quantifies and partition predictors effect into endowment and coefficient components evaluated contributors to changes in SBA use. Statistical analysis was carried out at a 95% confidence interval in Stata 16. Results SBA use increased with significant (p<0.05) linear trends by 12% between 2003 and 2018. The decomposition analysis showed that differences in characteristics (endowment) accounted for 11.5% of the changes while the remaining 88.5% were due to differences in effects (coefficient). SBA utilisation rises by 61% when respondents decided on her health compared to when such decisions were made by the spouse. Utilisation of SBA, however, fell by 88% among women who reside in the states with high rural populations percentage. Conclusions SBA use remained low in Nigeria, and slowly increase at the rate of <1% yearly. Women health decision-making power contributed most to positive changes. Residing in states with high rural populations has a negative impact on SBA use. Maternal health programmes that strengthen women’s health autonomy and capacity building in rural communities should be encouraged.Item Factors contributing to household wealth inequality in under-five deaths in low[1]and middle-income countries: decomposition analysis(BioMed Central, 2022) Fagbamigbe, A. F.; Adeniji, F. I. P.; Morakinyo, O. M.Background: The burden of under-5 deaths is disproportionately high among poor households relative to economically viable ones in developing countries. Despite this, the factors driving this inequality has not been well explored. This study decomposed the contributions of the factors associated with wealth inequalities in under-5 deaths in low and middle-income countries (LMICs). Methods: We analysed data of 856,987 children from 66,495 neighbourhoods across 59 LMICs spanning recent Demographic and Health Surveys (2010-2018). Under-5 mortality was described as deaths among live births within 0 to 59 months of birth and it was treated as a dichotomous variable (dead or alive). The prevalence of under-five deaths was stratified using household wealth status. A Fairlie decomposition analysis was utilized to investigate the relative contribution of the factors associated with household wealth inequality in under-5 deaths at p<0.05. The WHO health equity assessment toolkit Plus was used to assess the diferences (D) ratios (R), population attributable risk (PAR), and population attributable fraction (PAF) in household wealth inequalities across the countries. Results: The proportion of children from poor households was 45%. The prevalence of under-5 deaths in all samples was 51 per 1000 children, with 60 per 1000 and 44 per 1000 among children from poor and non-poor households (p<0.001). The prevalence of under-5 deaths was higher among children from poor households than those from non-poor households in all countries except in Ethiopia, Tanzania, Zambia, Lesotho, Gambia and Sierra Leone, and in the Maldives. Thirty-four of the 59 countries showed significantly higher under-5 deaths in poor households than in non-poor households (pro-non-poor inequality) and no significant pro-poor inequality. Rural-urban contexts, maternal education, neighborhood socioeconomic status, sex of the child, toilet kinds, birth weight and preceding birth intervals, and sources of drinking water are the most significant drivers of pro-poor inequities in under-5 deaths in these countries. Conclusions: Individual-level and neighbourhood-level factors were associated with a high prevalence of under-5 deaths among poor households in LMICs. Interventions in countries should focus on reducing the gap between the poor and the rich as well as improve the education and livelihood of disadvantaged people.Item Implications of WHO COVID-19 interim guideline 2020.5 on the comprehensive care for infected persons in Africa Before, during and after clinical management of cases(Elsevier B.V., 2022) Fagbamigbe, A. F.; Tolba, M. F.; Amankwaa, E. F.; Mante, P. K.; Sylverken, A. A.; Zahouli, J. Z. B.; Goonoo, N.; Mosi, L.; Oyebola, K.; Matoke-Muhia, D.; de Souza, D. K.; Badua, K.; Dukhi, N.The novel coronavirus disease 2019 (COVID-19) is one of the biggest public health crises globally. Although Africa did not display the worst-case scenario compared to other continents, fears were still at its peak since Africa was already suffering from a heavy load of other life-threatening infectious diseases such as HIV/AIDS and malaria. Other factors that were anticipated to complicate Africa’s outcomes include the lack of resources for diagnosis and contact tracing along with the low capacity of specialized management facilities per capita. The current review aims at assessing and generating discussions on the realities, and pros and cons of the WHO COVID-19 interim guidance 2020.5 considering the known peculiarities of the African continent. A comprehensive evaluation was done for COVID-19-related data published across PubMed and Google Scholar (date of the last search: August 17, 2020) with emphasis on clinical management and psychosocial aspects. Predefined filters were then applied in data screening as detailed in the methods. Specifically, we interrogated the WHO 2020.5 guideline viz-a-viz health priority and health financing in Africa, COVID-19 case contact tracing and risk assessment, clinical management of COVID-19 cases as well as strategies for tackling stigmatization and psychosocial challenges encountered by COVID-19 survivors. The outcomes of this work provide links between these vital sub-themes which may impact the containment and management of COVID-19 cases in Africa in the long-term. The chief recommendation of the current study is the necessity of prudent filtration of the global findings along with regional modelling of the global care guidelines for acting properly in response to this health threat on the regional level without exposing our populations to further unnecessary adversities.