FACULTY OF PUBLIC HEALTH
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Item Contraceptive use among Nigerian women with no fertility intention: interaction amid potential causative factors(Union for African Population Studies, 2013-10) Adebowale, S. A.; Adeoye, I. A; Palamuleni, M. E.High fertility (HF) remains a public health problem and the intention to reduce fertility is a global phenomenon. The health hazards and economic burden of HF on women are enormous. Contraception is widely known as a fertility reduction method. Achieving desirable MDGs and PoA of 1994ICPD will be an illusion if research on the relationship between fertility intention and contraceptive use is neglected. The study which focused on 2,257 women of childbearing age who do not have any intention to bear more children utilized the Nigeria Demographic Health Survey, 2008 dataset. Data was analysed using Chi-square, binary and multinomial logistic regression (=5.0%). The mean ages of the women and children ever born were 40.91±5.73 years and 6.28±2.62 respectively. The prevalence of Current Use of Any Contraceptive Method (CUACM) was 37.6%, with 12.4% and 25.2% currently using natural and modern family planning methods respectively. About 7.0% of women in the poorest wealth quintile are CUACM compared to 61.8% of those in the richest wealth quintile. The current use of modern contraceptive prevalence rate was strikingly higher among Yorubas (41.8%) than Hausas (3.6%). Multivariate analysis identified age, region, residence, education, ethnicity and family planning media exposure as significant predictors of CUACM. In addition, religion and decisions on how to spend family income were identified as predictors of current use of modern contraceptive methods (p<0.05). The use of contraceptives is not adequately practised in Nigeria. The identified predictors of contraceptive use in this study should be considered while designing strategies to improve the contraceptive prevalence rate in Nigeria.Item Incidence, determinants and perinatal outcomes of near miss maternal morbidity in Ile-Ife, Nigeria: a prospective case control study(Springer Nature, 2013-04) Adeoye, I. A.; Onayade, A. A.; Fatusi, A. O.Maternal mortality ratio in Nigeria is one of the highest in the world. Near misses occur in larger numbers than maternal deaths hence they allow for a more comprehensive analysis of risk factors and determinants as well as outcomes of life-threatening complications in pregnancy. The study determined the incidence, characteristics, determinants and perinatal outcomes of near misses in a tertiary hospital in South-west Nigeria. Methods: A prospective case control study was conducted at the maternity units of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife Nigeria between July 2006 and July 2007. Near miss cases were defined based on validated disease-specific criteria which included severe haemorrhage, hypertensive disorders in pregnancy, prolonged obstructed labour, infection and severe anaemia. Four unmatched controls of pregnant women were selected for every near miss case. Three categories of risk factors (background, proximate, clinical) which derived from a conceptual framework were examined. The perinatal outcomes were also assessed. Bi-variate logistic regressions were used for multivariate analysis of determinants and perinatal outcomes of near miss. Results: The incidence of near miss was 12%. Severe haemorrhage (41.3%), hypertensive disorders in pregnancy (37.3%), prolonged obstructed labour (23%), septicaemia (18.6%) and severe anaemia (14.6%) were the direct causes of near miss. The significant risk factors with their odds ratio and 95% confidence intervals were: chronic hypertension [OR=6.85; 95% CI: (1.96 – 23.93)] having experienced a phase one delay [OR=2.07; 95% CI (1.03 – 4.17)], Emergency caesarean section [OR=3.72; 95% CI: (0.93 – 14.9)], assisted vaginal delivery [OR=2.55; 95% CI: (1.34 – 4.83)]. The protective factors included antenatal care attendance at tertiary facility [OR=0.19; 95% CI: (0.09 – 0.37)], knowledge of pregnancy complications [OR=0.47; 95% CI (0.24 – 0.94)]. Stillbirth [OR=5.4; 95% CI (2.17 – 13.4)] was the most significant adverse perinatal outcomes associated with near miss event. Conclusions: The analysis of near misses has evolved as a useful tool in the investigation of maternal health especially in life-threatening situations. The significant risk factors identified in this study are amenable to appropriate public health and medical interventions. Adverse perinatal outcomes are clearly attributable to near miss events. Therefore, the findings should contribute to Nigeria’s effort to achieving MDG 4 and 5.Item Analysis of alcohol policy in Nigeria: multi-sectoral action and the integration of the WHO “best-buy” interventions(Springer Nature, 2019) Adebayo, A. M.; Oluwasola, T. A. O.; Oluwasanu, M. M.; Fawole, A. O .Background: Harmful alcohol use is a modifiable risk factor contributing to the increasing burden of non-communicable diseases and deaths and the implementation of policies focused on primary prevention is pivotal to address this challenge. Policies with actions targeting the harmful use of alcohol have been developed in Nigeria. This study is an in-depth analysis of alcohol-related policies in Nigeria and the utilization of WHO Best Buy interventions (BBIs) and multi-sectoral action (MSA) in the formulation of these policies. Methods: A descriptive case study design and the Walt and Gilson framework of policy analysis was utilized for the research. Components of the study included a scoping review consisting of electronic search of Google and three online databases (Google Scholar, Science Direct and PubMed) to identify articles and policy documents with no language and date restrictions. Government institution provided documents which were not online. Thirteen policy documents, reports or articles relevant to the policy formulation process were identified. Other components of the study included interviews with 44 key informants (Bureaucrats and Policy Makers) using a pretested guide. The qualitative data were coded and analyzed using thematic analysis. Results: Findings revealed that policy actions to address harmful alcohol use are proposed in the 2007 Federal Road Safety Act, the Non-communicable Diseases Prevention and Control Policy and the Strategic Plan of Action. Only one of the best buy interventions, (restricted access to alcohol) is proposed in these policies. Multi-sectoral action for the formulation of alcohol-related policy was low and several relevant sectors with critical roles in policy implementation were not involved in the formulation process. Overall, alcohol currently has no holistic, health-sector led policy document to regulate the marketing, promotion of alcohol and accessibility. A major barrier is the low government budgetary allocation to support the process. Conclusions: Nigeria has few alcohol-related policies with weak multi-sectoral action. Funding constraint remains a major threat to the implementation and enforcement of proposed policy actions.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.