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 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 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 Implementing oncology clinical trials in Nigeria: A model for Capacity building.(Springer Nature, 2020) Ntekim, A.; Ibraheem, A.; Sofoluwe, A.; Adepoju, T.; Oluwasanu, M.; Aniagwu, M.; Awolude, O.; Balogun,W.; Kotila, K.; Adejumo, P.; Babalola, C. P.; Arinola, G.; Ojengbede, O.; Olopade, C. O.; Olopade, O. I.Background: There is both higher mortality and morbidity from cancer in low and medium income countries (LMICs) compared with high income countries (HICs). Clinical trial activities and development of more effective and less toxic therapies have led to signi¦ cant improvements in morbidity and mortality from cancer in HICs. Unfortunately, clinical trials remain low in LMICs due to poor infrastructure and paucity of experienced personnel to execute clinical trials. There is an urgent need to build local capacity for evidence based treatment for cancer patients in LMICs. Methods: We conducted a survey at facilities in four Teaching Hospitals in South West Nigeria using a checklist of information on various aspects of clinical trial activities. The gaps identi¦ ed were addressed using resources sourced in partnership with investigators at HIC institutions. Results: De¦ cits in infrastructure were in areas of patient care such as availability of oncology pharmacists, standard laboratories and diagnostic facilities, clinical equipment maintenance and regular calibrations, trained personnel for clinical trial activities, investigational products handling and disposals and lack of standard operating procedures for clinical activities. There were two GCP trained personnel, two study coordinators and one research pharmacist across the four sites. Interventions were instituted to address the observed de¦ cits in all four sites which are now well positioned to undertake clinical trials in oncology. Training on all aspects of clinical trial was also provided. Conclusions: Partnerships with institutions in HICs can successfully identify, address, and improve de¦ cits in infrastructure for clinical trial in LMICs. The HICs should lead in providing funds, mentorship and training for LMIC institutions to improve and expand clinical trials in LMIC countries.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 dynamics of COVID-19 outbreak in Nigeria: A sub-national analysis(Elsevier B.V., 2021) Ayodele, K. P.; Jimoh, H.; Fagbamigbe, A. F.; Onakpoya, O. H.The African health crisis feared at the beginning of the COVID-19 pandemic has not materialized, and there is interest globally in understanding possible peculiarities in COVID-19 outbreak dynamics in the tropics and sub-tropics that have led to a much milder African outbreak than initial projections. Towards this, Susceptible-Infected-Recovered-Dead compartmental models were fitted to COVID-19 data from all Nigerian states in this study, from which four parameters were estimated per state. A density-based clustering method was used to identify states with similar outbreak dynamics, and the stage of the outbreak determined per state. Subsequently, outbreak dynamics were correlated with absolute humidity, temperature, population density and distance to the international passenger travel gateways in the country. The models revealed that while the outbreak is still increasing nationally, outbreaks in at least 12 states have peaked. A total of at least 519,672 confirmed cases were predicted by January 2021, with a worst case scenario of at least 14,785,457. Weak positive correlations were found between COVID-19 spread and absolute humidity (Pearson’s Coefficient = 0.136, p< 0.05) and temperature (Pearson’s Coefficient = 0.021, p< 0.05). While many studies have established links between temperature and humidity and COVID-19 spread, the correlation has most usually been negative where it exists. The findings in this study of possible positive correlation is in line with a number of previous studies showing such unexpected correlations in the tropics or subtropics. This highlights even more the importance of additional studies on COVID-19 dynamics in Africa.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 Modelling determinants of geographical patterns in the marital statuses of women in Nigeria(Springer, 2021) Ononokpono, D. N.; Adebola, O. G.; Gayawan, E.; Fagbamigbe, A. F.Marriage is an important social, cultural, and biological aspect of human life but is often affected by societal changes leading to differences in family formation and reproductive behaviour. Changes in marital patterns are component of transformations in a society’s social structure. Variations in marriage patterns exist within and across countries and over time. We examine the trends and spatial patterns of marital statuses among women of reproductive age (15–49 years) in Nigeria and further determine the associated factors based on the country’s north–south divide. Data were sourced from the Nigeria demographic and health survey conducted in 2003, 2008, 2013, and 2018, and the marital patterns were classified into four categories: never married, married, cohabiting, and formerly married. A Bayesian multinomial spatial model that simultaneously estimates parameters of different forms through a geo-additive predictor was adopted, and inference was based on Markov chain Monte Carlo. Findings reveal a north–south divide in marriage patterns. Women in the northern part of the country have a higher likelihood of being in marital union, while those in the south have a higher likelihood of cohabitation. A somewhat east– west divide was obtained for formerly married. Religion and ethnicity were found to be the major factors that account for differences in marital patterns across the divide and based on rural and urban residency. Cultural practices dictated by these variables would, therefore, continue to shape marital patterns and, by extension, fertility in Nigeria. The factors are hence important to be considered in marriage related policy formulation.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 How soon does modern contraceptive use starts after sexual debut in Africa? Survival analysis of timing and associated factors among never-in-union women(Elsevier B.V., 2021) Fagbamigbe, A. F.While studies abound on the utilization of modern contraceptive (MC), the timing of its uptake after sexual debut has not been given fair attention in the literature. This study estimated the time to MC uptake after sexual debut and identified the factors associated with the timings among the ever-had sex never-in-union (EHS-NIU) women in Mozambique, Nigeria and Cote d’Ivoire and adopted the health belief model. This was a cross sectional study using the Mozambique, 2011, Nigeria, 2013 and Cote d’Ivoire, 2014 DHS data. The analysis was limited to 8,251 EHS-NIU women: Mozambique (1800), Nigeria (4082) and Cote d’Ivoire (2369). Descriptive statistics, survival analysis, log-rank tests, and multivariable Cox proportional hazard regression were used at p = 0.05. Over a third (38%) of the EHS-NIU women had ever used MC: Mozambique (26%), Nigeria (47%) and Cote d’Ivoire (32%). While the median time to first MC use was 2 years across the countries, the overall median survival time was 11 years: Nigeria (7 years), Cote d’Ivoire (17 years) and Mozambique (18 years). The hazard of MC was 92% (Hazard Ratio (HR)=1.92, 95% Confidence Interval (CI): 1.74–2.12) higher among EHS-NIU women in Nigerian compared to those in Cote d’Ivoire. Compared with the EHS-NIU women aged 15–19 years, the hazard of MC uptake was 71% lower in Nigeria (adjusted Hazard Ratio (aHR)=0.29, 95% CI: 0.52–0.65), 43% lower in Mozambique (aHR=0.57, 95% CI: 050–0.67) and 49% lower in Cote d’Ivoire (aHR=0.51, 95% CI: 040–0.65) among those aged 20–24 years. EHS-NIU women with higher education, who lives in urban areas, who delayed sexual debut, who frequently listened to the radio, in richest wealth quintiles had earlier uptake of MC. There were low lifetime prevalence and late uptake of MC among ever-had sex never-in-union women in Mozambique, Nigeria, and Cote d’Ivoire. The timing of MC uptake was associated with respondents’ age, age at sexual debut, place of residence, educational attainment, wealth quintile, number of children ever born, radio listening frequency and regions of residence.