FACULTY OF PUBLIC HEALTH
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Item Survival analysis and prognostic factors of time to first domestic violence after marriage among Nigeria, Kenya, and Mozambique women(Elsevier Ltd, 2020) Fagbamigbe, A. F.; Akintayo, A. O.; Oshodi, O. C.; Makinde, F. T.; Babalola, M.; Araoye, E. D.; Enabor, O. C.; Dairo, M. D.Objectives: How soon an ever-married woman falls a victim of domestic violence after marriage is not documented in Africa. This study sought to assess the timing of first domestic violence (FDV) against women after marriage and determined the factors associated with the timings in Nigeria, Kenya, and Mozambique. Study design: This is a cross-sectional study. Methods: Data of 29,793 ever-married women of reproductive age consisting of 21,564, 4237 and 3992 from Demographic and Health Survey conducted in Nigeria (2013), Kenya (2014) and Mozambique (2011), respectively, were used. The timing of FDV was the time interval between marriage date and date of the FDV for those with reported violence but censored as the time interval between marriage date and the survey date for those without domestic violence. Survival analysis techniques were used to assess the timing and the factors influencing the timing at (P ¼ 0.05). Results: The lifetime prevalence of domestic violence among the ever-married women in Nigeria, Kenya and Mozambique was 15.4%, 39.0% and 31.0%, respectively. The overall median time to FDV was 3 years. The risk of FDV was twice higher in Kenya (adjusted hazard ratio (aHR) ¼ 1.934; 95% confidence interval (CI): 1.729e2.132) and 15% higher in Mozambique (aHR ¼ 1.156; 95% CI: 1.156e1.223) than in Nigeria. The hazard of domestic violence was significantly higher among separated/divorced women across the three countries (aHR ¼ 1.326; 95% CI: 1.237e1.801). Other factors associated with the timing of FDV against women were respondents' education, age at first marriage, region and location of residence, religion, ethnicity, employment status, wealth quintile, spouse consuming alcohol and husbands' educational attainment. Conclusions: Domestic violence against married women by their intimate partners is prevalent across Mozambique, Nigeria and Kenya, with earlier occurrences in Kenya and Mozambique. Age at first marriage, education factors, religion, ethnicity and region of residence in each country affected the timing of the first incidence of domestic violence.Item Survival analysis and prognostic factors associated with the timing of first forced sexual act among women in Kenya, Zimbabwe and Cote d‘Ivoire(Elsevier B.V, 2019) Fagbamigbe, A. F.; Abi, R.; Akinwumi, T.; Ogunsuji, O.; Odigwe, A.; Olowolafe, T.The paucity of information on the age at which Forced Sexual Act (FSA) among women occur and the factors affecting the timings in Africa necessitated this study. We assessed the timing of first FSA and its prognostic factors among women in three African countries. We used sexual violence data of 18,528 women aged 15–49 years who participated in Zimbabwe (2011), Kenya (2014), and Cote d’Ivoire (2014) demographic and health surveys. The time of first FSA was censored as the current age of women who had not experienced FSA. Kaplan-Meier methods and Cox proportional hazard model were used at p = 0.05. The proportion who had ever experienced FSA was 13.9%, 21.7% & 27.2% while median time to FSA was 17, 20 & 18 years in Kenya, Zimbabwe, and Cote d’Ivoire respectively. The highest (41.8%) lifetime prevalence of forced sexual act was among divorced/separated women in Cote D’Ivoire. Women aged 15–19 years had earlier risk of FSA: Kenya (aHR = 3.60 (95% CI:2.43–5.34)), Zimbabwe (aHR = 2.91 (95% CI:2.32–3.65)), and Cote d’Ivoire (aHR = 2.72 (95% CI:2.22–3.33)) than women aged 40–49 years. Other significant prognostic factors of time of FSA are marital status, place of residence, employment status, religion, wealth index, and education. There are generational shifts in timing of first forced sexual act among women with girls born in the 1990s becoming victims at earlier ages than those born in the 1960s and 1970s. There is a need for a multi-sectoral approach to reduce the prevalence and halt the negative trend in forced sexual act in Africa.Item Survival analysis and prognostic factors of timing of first childbirth among women in Nigeria(BioMed Central, 2016) Fagbamigbe, A. F.; Idemudia, E. S.Background: First childbirth in a woman’s life is one of the most important events in her life. It marks a turnaround when she might have to drop roles of career building and education, for motherhood and parenthood. The timing of the commencement of these roles affects the child bearing behavior of women as they progress in their reproductive ages. Prevalent early first childbirth in Nigeria has been reported as the main cause of high population growth and high fertility, mortality and morbidity among women, but little has been documented on the progression into first birth as well as factors affecting it in Nigeria. This paper modelled timing of first birth among women in Nigeria and determined socio-demographic and other factors affecting its timing. Methods: We hypothesized that background characteristics of a woman will influence her progression into having first birth. We developed and fitted a survival analysis model to understand the timing of first birth among women in Nigeria using a national representative 2013 NDHS data. Women with no children were right censored as of the date of the survey. The Kaplan Meier survival function was used to estimate the probabilities of first birth not occurring until certain ages of women while Cox proportional hazard regression was used to model the timing of first births at 5 % significance level. Results: About 75.7 % of the respondents had given birth in the Northern region of Nigerian compared with 63.8 % in the South. Half (50.1 %) of the first childbirth occurred within the 15–19 years age bracket and 38.1 % within 20–29 years. The overall median survival time to first birth was 20 years (North 19, South 22), 27 years among women with higher education and 18 years for those with no formal education. The adjusted hazard of first birth was higher in the Northern region of Nigeria than in the South (aHR = 1.24, 95 % CI: 1.20-1.27), and higher in rural areas than in urban areas (aHR = 1. 15, 95 % CI: 1.12-1.19). Also, hazard of earlier first birth tripled among women with no education (aHR = 3.36, 95 % CI: 3. 17-3.55) compared to women with higher education. The significant factors affecting age at first birth are education, place and zone of residence, age at first marriage, religion, ethnicity and use of contraceptives. Conclusions: This study showed that progression into early first birth is most affected by the education standing of women as well as age at first marriage. Delay of first childbirths as a strategy for fertility reduction and maternal health improvement can be achieved if women are empowered early in life with quality education. Stakeholders should therefore, give adequate attention to educating the girl child. Adverse socio-cultural norms of betrothing and marrying young girls should be abrogated, while health education and promotion of need to delay child bearing must be intensified especially among rural dwellers and also in Northern Nigeria.Item Barriers to antenatal care use in Nigeria: evidences from non-users and implications for maternal health programming(BioMed Central, 2015) Fagbamigbe, A. F.; Idemudia, E. S.Background: In Nigeria, over one third of pregnant women do not attend Antenatal Care (ANC) service during pregnancy. This study evaluated barriers to the use of ANC services in Nigeria from the perspective of non-users. Methods: Records of the 2199 (34.9%) respondents who did not use ANC among the 6299 women of childbearing age who had at least one child within five years preceding the 2012 National HIV/AIDS and Reproductive Health Survey (NARHS Plus II), were used for this analysis. The barriers reported for not visiting any ANC provider were assessed vis-à-vis respondents’ social demographic characteristics, using multiple response data analysis techniques and Pearson chi-square test at 5% significance level. Results: Of the mothers who did not use ANC during five years preceding the survey, rural dwellers were the majority (82.5%) and 57.3% had no formal education. Most non-users (96.5%) were employed while 93.0% were currently married. North East with 51.5% was the geographical zone with highest number of non-users compared with 14.3% from the South East. Some respondents with higher education (2.0%) and also in the wealthiest quintiles (4.2%) did not use ANC. The reasons for non-use of ANC varied significantly with respondents’ wealth status, educational attainment, residence, geographical locations, age and marital status. Over half (56.4%) of the non-users reported having a problem with getting money to use ANC services while 44.1% claimed they did not attend ANC due to unavailability of transport facilities. The three leading problems: “getting money to go”, “Farness of ANC service providers” and “unavailability of transport” constituted 44.3% of all barriers. Elimination of these three problems could increase ANC coverage in Nigeria by over 15%. Conclusion: Non-use of ANC was commonest among the poor, rural, currently married, less educated respondents from Northern Nigeria especially the North East zone. Affordability, availability and accessibility of ANC providers are the hurdles to ANC utilization in Nigeria. Addressing financial and other barriers to ANC use, quality improvement of ANC services to increase women’s satisfaction and utilization and ensuring maximal contacts among women, society, and ANC providers are surest ways to increasing ANC coverage in Nigeria.