FACULTY OF PUBLIC HEALTH
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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 An assessment of the nutritional status of ART receiving HIV-orphaned and vulnerable children in South-West Nigeria(Elsevier Ltd, 2019) Fagbamigbe, A. F.; Adebowale, A. S.; Ajayi, I.Introduction: Good nutritional status is pertinent to the optimal outcome of effective ART among children. Against this backdrop, the objective of the current study is to assess the nutritional indices of children receiving ART in South-West Nigeria. Methods: The study was cross-sectional in design. We randomly selected three urban and six rural ART sites from the ones offering ART services in Oyo state. All consented children receiving ART treatments in the aforementioned sites participated in the study. A total of 390 HIV-positive children and adolescents aged 6–18 years were interviewed using a semi-structured interviewer-administered questionnaire. Children were assessed and growth curves were constructed using the 2007 World Health Organisation (WHO) growth reference standard for children as well as adolescents. Data were presented using descriptive statistics. Results: About 52% of the children are male, 136 (34.9%) have lost at least one parent, 52 (13.3%) have lost either parent to HIV/AIDS. Among the males, 19%, 27%, and 27% were underweight, stunted and thin, respectively when compared with 17%, 23% and 23%, respectively, among females. The male and female weight-for-age average z-score were (-0.98 vs -1.04), height-for-age (-1.12 vs -1.07), and BMI-for-age (-1.19 vs -1.18). Irrespective of age, sex, parental survival, and residence, weight-for-age and BMI-for-age analysis revealed substantial underweight, with the worst outcomes being among those orphaned by HIV/AIDS. Conclusion: All nutritional indices considered in this study fell short of the WHO standard. HIV positive children in the ART sites included in this study are faced with a high burden of undernourishment despite been placed on daily ART regimens. In addition to efficient ART, interventions to ameliorate poor nutritional status is needed.Item Trend analysis of teenage pregnancy in Nigeria (1961-2013): how effective is the contraceptive use campaign?(Institute of Advanced Engineering and Science, 2019) Fagbamigbe, A. F.; Afolabi, R. F.; Yusuf, O. B.Teenage pregnancy (TP) is a recurrent global and public health problem. It poses both social and health challenges. Considering the massive campaign on the use of modern contraceptives to prevent TP in recent decades, we assessed trends in TP in Nigeria between 1961 and 2013. Pregnancy and contraception history of 70,811 women who were at least 20 years old when the Nigerian DHS was conducted in 1990, 2003, 2008, and 2013 respectively were used for the study, and descriptive statistics, time analysis techniques and multiple logistic regression were used to analyze the data at 5% significance level. The overall prevalence of TP between 1961 and 2013 was 49.5% which fluctuated insignificantly during the studied period. The TP prevalence among women who entered adulthood in 1961 was 39.2%; it peaked in 1978 at 58.9% before its unsteady decline to 39.6% in 2012, and then rose sharply to 55.6% in 2013. We predicted TP prevalence as 49.0%, 49.9% and 51.0% in 2014, 2015 and 2016 respectively. The odds of TP were over 4 times higher in the North East and 5 times higher in the North West than in the South West. Teenagers with no education had higher odds of TP and it was higher among teenagers from the poorest households (OR=5.64, 95% CI: 5.36-5.94). Rather than reducing with the worldwide acknowledged increase in contraceptive campaigns, TP increased over the years studied. As far as TP is concerned in Nigeria, the impact of the campaign on MC use is far from being effective. To achieve the objective of fewer TPs, fewer resources should be spent on access to contraception and instead diverted to areas more likely to achieve results such as improvements in educational achievement amongst girls.Item Parametric survival analysis of menarche onset timing among Nigerian girls(Elsevier Ltd., 2018) Fagbamigbe, A. F.; Obiyan, M. O.; Fawole, O. I.Background: This study was a response to the dearth of information on the timing of menarche in low-income countries, and the need to update knowledge on the condition. It thereby enables the provision of adequate support to young girls during menarche. The study determined the timing and range of onset of menarche and identified the factors influencing the timing. Methods: We used data on girls’ sexual and reproductive processes from a nationally representative population survey of girls aged 15e24 years in Nigeria. Descriptive statistics, and survival analysis techniques were used for data analysis at p ¼ 0$05. Finding: A quarter of the respondents (26%) had commenced menstruation by age 12. Almost all, (90%) had experienced menstruation by age 17. Girls aged 20e24 years reported later menarche (time ratio 1$066, 95% CI: 1$045-1$087) compared to those aged 15e19 years. An increase of respondents age by one year resulted in 0$8% delay in onset timing. Significant differences were also found in the zone of residence among the sampled population. Compared with girls from the South East, the timing of menstruation was generally delayed among the girls from South-South by 5%, North Central by 9%, South West by 10%, North East by 16% and 17% among girls from the North West. Interpretation: There was a wide range in menarcheal age in Nigerian girls with a peak at 13e14 years and the possibility of a secular trend in the timing of onset. Early family life education is recommended.Item Factors contributing to the duration of postpartum abstinence among Nigerian women: semi-parametric survival analysis(Elsevier Ltd., 2018) Fagbamigbe, A. F.; Awoyelu, I. E.; Akinwale, O. L.; Akinwande, T. Y.; Enitilo, B. K.; Bankole, O.Background: The duration of postpartum abstinence is on the decrease but has not been met with increased uptake of contraceptive in Nigeria. This imbalanced transition could result in shorter birth intervals and worsen maternal and child health outcomes. There is a paucity of information on the duration and predictors of time to end of postpartum abstinence in Nigeria. This study was aimed at understanding the time to end of postpartum abstinence and factors predicting the duration in Nigeria. Methods: The NDHS 2013 data was used. Data of all women who had ever given birth were included. The time to end of postpartum abstinence was censored among currently breastfeeding mothers. The Kaplan Meier Product Limit method was used to estimate the survival and hazard function while the Cox regression was used to fit a model for time to end of postpartum abstinence at 5% significance level. Data were weighed and provisions were made for multicollinearity. Results: The overall average duration of postpartum abstinence in Nigeria is 3 month. In all, 58% ended postpartum abstinence within the first three months while 18%, 10%, and 14% ended it within 4e6 months, 7e12 months and after one year respectively. Postpartum abstinence did not last beyond 3 months among 83% of the women in the North-West region, compared with 23% in the North Central region, and 34% in the South East. The Muslims had the highest proportion of women who ended postpartum abstinence within the first three months after delivery at 72% compared with Catholic women (31%). The median time to end of postpartum abstinence was lowest (2 months) among women from North West, Muslims, in poorest wealth quintiles and those with no education. The “hazard” of earlier resumption of sexual activity after birth was over 3 times more likely among women in the North West than those in the North Central (aHR ¼ 3.09, 95% CI: 2.95e3.24). Women using contraceptives had a 40% hazard of ending postpartum abstinence earlier. Rural women were 7.6% times less likely to end postpartum abstinence compared to their urban counterpart. Women from rich households have an excess risk of 14% to end postpartum abstinence early compared to women from poor households. Conclusion: Women of reproductive age in the North West, who are Muslims and with no education are at higher risk of ending postpartum abstinence early. Hence, policymakers and reproductive health stakeholders should design effective intervention targeted at this group of women as a means of controlling fertility.Item Mapping 123 million neonatal, infant and child deaths between 2000 and 2017(Nature portfolio, 2019) Burstein, R.; Henry, N. J.; Collison, M. L.; Marczak, L. B.; Abdollahi, M.; Oluwasanu, M. M.Objective: The aim of the descriptive, cross sectional, questionnaire-based study reported here was to explore the causes of low productivity in non-communicable diseases research among postgraduate scholars and early career researchers in Nigeria and identify measures that could facilitate increased research output. Results: The 89 respondents were masters-level, doctoral scholars and resident doctors who attended a workshop. Majorities of the respondents (over 70%) either agreed or strongly agreed that factors contributing to poor non-communicable diseases research productivity include a dearth of in-country researchers with specialized skills, inability of Nigerian researchers to work in multidisciplinary teams, poor funding for health research, sub-optimal infrastructural facilities, and limited use of research findings by policy makers. Almost all the respondents (over 90%) agreed that potential strategies to facilitate non-communicable diseases research output would include increased funding for research, institutionalization of a sustainable, structured capacity building program for early career researchers, establishment of Regional Centers for Research Excellence, and increased use of research evidence to guide government policy actions and programs.Item Analysis of alcohol policy in Nigeria: multi-sectoral action and the integration of the WHO “best-buy” interventions(Springer Nature, 2019) Abiona, O.; Oluwasanu, M.; Oladepo, O. 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.