FACULTY OF PUBLIC HEALTH
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Item A comparative analysis of the infuence of contraceptive use and fertility desire on the duration of second birth interval in four sub-Saharan African countries(BioMed Central, 2021) Afolabi, R. F.; Fagbamigbe, A. F.; Palamuleni, M. E.Background: Fertility decline characterised by inter-birth intervals remains rather slow or stall in many countries of sub-Saharan African (SSA). Non-adherence to optimal inter-birth intervals often occasioned by low prevalence of contraceptive use and high fertility desires often lead to poor maternal and child health outcomes. Additionally, information on the influence of contraception and fertility desire on interval between first and second births (SBI) is rarely available. This study therefore aimed to examine the influence of fertility desire and contraception on SBI among women in four SSA countries. Methods: We analysed cross-sectional data on women aged 15–49 years who participated in the recent Demo graphic and Health Surveys in DR Congo, Ethiopia, Nigeria and South Africa. Semi-parametric Cox proportional hazards regression was employed for the analysis at 5% significance level. Results: The median time to second birth was 34 months in DR Congo; 35 months, Nigeria; 42 months, Ethiopia; and 71 months, South Africa. About 70% of the women desired additional child(ren) and two-thirds have never used contraceptive in both Nigeria and DR Congo. The hazard of second birth was significantly lower among women who desired additional child(ren) compared to desired for no more child in DR Congo (aHR=0.93; CI: 0.89–0.97), Ethiopia (aHR=0.64; CI: 0.61–0.67) and South Africa (aHR=0.51; CI: 0.47–0.55). Women who had never used contraceptive were 12%, 20% and 24% more likely to lengthen SBI than those who were current users in DR Congo, Nigeria and South Africa respectively. DR Congo and Nigerian women were about two times more likely to shorten SBI compared with their South African counterparts. Other significant determinants of SBI include ethnicity, rural residential, age and marital status at first birth, wealth and employment status. Conclusion: Findings showed differentials in the linkage between second birth interval and the desired fertility and contraception by country, demonstrating the importance of context. The contribution of these factors to second birth interval requires country context-specific attention if further decline in fertility and poor health outcomes associated with sub-optimal inter-birth interval is to be attained in SSA.Item Economic status, a salient motivator for medicalisation of FGM in sub-Saharan Africa: Myth or reality from 13 national demographic health surveys(Elsevier Ltd., 2020) Morhason-Bello, I. O.; Fagbamigbe, A. F.; Kareem, Y. O.; Ojengbede, O. A.Female Genital Mutilation or Cutting (FGM) and its medicalisation remain a challenge in sub-Sahara African (SSA). Early identification of at-risk women might help in instituting focused counselling against FGM medicalisation. We hypothesised that the risk of medicalised FGM by girls/women is associated with socioeconomic status (SES) their household belongs. We used 2010–2019 Demographic and Health surveys data from 13 countries in SSA. We analysed information on 214,707 women (Level 1) nested within 7299 neighbourhoods (Level 2) from the 13 countries (Level 3). We fitted 5 multivariable binomial multilevel logistic regression models using the MLWin 3.03 module in Stata. The estimation algorithms adopted was the first order marginal quasi-likelihood linearisation using the iterative generalised least squares. The odds of FGM medicalisation increased with the wealth status of the household of the woman, with 29%, 45%- and 75%-times higher odds in the middle, richer and richest household wealth quintiles, respectively than those from the poorest households (p < 0.05). The more educated a woman and the better a woman’s community SES was, the higher her odds of reporting medicalisation of FGM. Rural community was associated with higher odds of medicalised FGM than urban settings. Medicalised FGM is common among women from a high socioeconomic, educational background and rural settings of SSA. We recommend a culturally sensitive policy that will discourage perpetuation of FGM, particularly by healthcare providers. Future studies should focus on identifying drivers of FGM among the high social class families in the society in SSA.Item Parental educational homogamy and under-five mortality in sub-Saharan Africa: Clarifying the association’s intricacy(Elsevier B.V., 2020) Adebowale, A. S.; Fagbamigbe, A. F.; Morakinyo, O.; Obembe, T.; Afolabi, R. F.; Palamuleni, M. E.Worldwide, under-five mortality (U5M) rate is highest in sub-Saharan Africa (SSA). There exists a gap in knowledge on the pathway through which Parental Educational Homogamy (PEH) influences U5M in SSA. In this study, we tested the research hypothesis’ PEH is not associated with under-five children’s survival probability in SSA. Demographic and health survey datasets for 21 SSA countries were analyzed. Cross sectional design and multi-stage cluster sampling technique were used for sample selection in each of the countries under investigation. The dependent variable was the survival status of a newborn to age 59 months while the main independent variable was PEH generated from information on wife’s and husband’s level of education. Data were analyzed using Chi-square test, Cox-proportional hazard model and Brass-adjusted model (α=0.05). Under-five mortality rate ranges from 56/1,000 live born in South Africa to 190/1,000 live born in Sierra-Leone. Across countries, U5M rate was higher among the children of parents with at most primary education than that of parents who had at least secondary education. This pattern of U5M rate was also observed for children of parents where husbands were more educated than their wives. Maternal age at birth, sex of the child, toilet facility, type of cooking fuel, tetanus injection during pregnancy, and birth weight were significantly associated with U5M in 14, 11, 8, 7, 11, 14 and 20 countries respectively. A significant relationship was established between PEH and U5M in 11 of the 21 studied countries but was identified as a predictor of U5M in Congo Democratic Republic, Gambia and Zimbabwe. Parental educational homogamy exhibits a pattern of relationship with U5M in SSA. Ensuring that individuals particularly women have at least secondary education before child bearing will facilitate an U5M reduction in SSA.Item Influence of the WHO framework convention on tobacco control on tobacco legislation and policies in sub-Saharan Africa(Springer Nature, 2018) Wisdom, J. P.; Juma, P.; Mwagomba, B.; Ndinda, C.; Mapa-Tassou, C.; Assah, F.; Nkhata,M.; Mohamed, S. F.; Oladimeji, O.; Oladunni, O.; Oluwasanu, M.; Sanni, S.; Jean-Claude, M.; Kyobutung, C"Background: The World Health Organization’s Framework Convention on Tobacco Control, enforced in 2005, was a watershed international treaty that stipulated requirements for signatories to govern the production, sale, distribution, advertisement, and taxation of tobacco to reduce its impact on health. This paper describes the timelines, context, key actors, and strategies in the development and implementation of the treaty and describes how six sub-Saharan countries responded to its call for action on tobacco control. Methods: A multi-country policy review using case study design was conducted in Cameroon, Kenya, Nigeria, Malawi, South Africa, and Togo. All documents related to the WHO Framework Convention on Tobacco Control and individual country implementation of tobacco policies were reviewed, and key informant interviews related to the countries’ development and implementation of tobacco policies were conducted. Results: Multiple stakeholders, including academics and activists, led a concerted effort for more than 10 years to push the WHO treaty forward despite counter-marketing from the tobacco industry. Once the treaty was enacted, Cameroon, Kenya, Nigeria, Malawi, South Africa, and Togo responded in unique ways to implement tobacco policies, with differences associated with the country’s socio-economic context, priorities of country leaders, industry presence, and choice of strategies. All the study countries except Malawi have acceded to and ratified the WHO tobacco treaty and implemented tobacco control policy. Conclusions: The WHO Framework Convention on Tobacco Control provided an unprecedented opportunity for global action against the public health effects of tobacco including non-communicable diseases. Reviewing how six sub-Saharan countries responded to the treaty to mobilize resources and implement tobacco control policies has provided insight for how to utilise international regulations and commitments to accelerate policy impact on the prevention of non-communicable diseases."Item Eliminating mother-to-child transmission of the human immunodeficiency virus in sub-Saharan Africa: The journey so far and what remains to be done(Elsevier, 2016) Adetokunboh,O. O.; Oluwasanu, M."This review was carried out to provide a comprehensive overview of efforts toward elimination of mother-to-child transmission (MTCT) of human immune deficiency virus (HIV) with respect to progress challenges, and recommendations in 21 sub-Saharan African priority countries. We reviewed literature published from 2011 to April 2015 using 3 databases; PubMed, Scopus, and Web of Science, as well as the 2014 Global Plan Progress Report. A total of 39 studies were included. Between 2009 and 2013, there was a 43% reduction in new HIV infections, the final MTCT rate was reduced from 28% to 18%, and antiretroviral therapy (ART) coverage increased from 11% to 24%. Challenges included poor adherence to antiretroviral therapy, poor linkage between mother—child pairs and post-natal healthcare services low early infant diagnosis coverage, low pediatric ART coverage, and high unmet needs for contraceptive services. Future recommendations include identification of key barriers, health system strengthening, strengthening community involvement, and international collaboration. There has been significant progress toward eliminating MTCT of HIV, but more effort is still needed.Item Knowledge, attitudes and practices of West Africans on genetic studies of stroke: Evidence from the SIREN Study(World Stroke Organization Reprints and permissions, 2018) Akinyemi R. O.; Sarfo F. S.; Akinyemi J.; Singh A.; Akpa M. O.; Akpalu A.; Owolabi L.; Adeoye A. M.; Obiako R.; Wahab K.; Sanya E.; Komolafe M.; Ogbole G.; Fawale M.; Adebayo P.; Osaigbovo G.; Sunmonu T.; Olowoyo P.; Chukwuonye I.; Obiabo Y.; Adeniji O.; Fakunle G.; Melikam E.; Saulson R.; Yaria J.; Uwanruochi K.Background: It is crucial to assess genomic literacy related to stroke among Africans in preparation for the ethical, legal and societal implications of the genetic revolution which has begun in Africa. Objective: To assess the knowledge, attitudes and practices (KAP) of West Africans about stroke genetic studies. Methods: A comparative cross-sectional study was conducted among stroke patients and stroke-free controls recruited across 15 sites in Ghana and Nigeria. Participants’ knowledge of heritability of stroke, willingness to undergo genetic testing and perception of the potential benefits of stroke genetic research were assessed using interviewer-administered questionnaire. Descriptive, frequency distribution and multiple regression analyses were performed. Results: Only 49% of 2029 stroke patients and 57% of 2603 stroke-free individuals knew that stroke was a heritable disorder. Among those who knew, 90% were willing to undergo genetic testing. Knowledge of stroke heritability was associated with having at least post-secondary education (OR 1.51, 1.25–1.81) and a family history of stroke (OR 1.20, 1.03–1.39) while Islamic religion (OR¼0.82, CI: 0.72–0.94), being currently unmarried (OR ¼ 0.81, CI: 0.70–0.92), and alcohol use (OR ¼ 0.78, CI: 0.67–0.91) were associated with lower odds of awareness of stroke as a heritable disorder. Willingness to undergo genetic testing for stroke was associated with having a family history of stroke (OR 1.34, 1.03– 1.74) but inversely associated with a medical history of high blood pressure (OR ¼ 0.79, 0.65–0.96). Conclusion: To further improve knowledge of stroke heritability and willingness to embrace genetic testing for stroke, individuals with less formal education, history of high blood pressure and no family history of stroke require targeted interventionsItem Short-term pilot feasibility study of a nurse-led intervention to improve blood pressure control after stroke in Nigeria(Elsevier B.V, 2017) Wahab K. W.; Owolabi M.; Akinyemi R.; Jenkins C.; Arulogun O.; Akpa O.; Gebregziabher M.; Uvere E.; Saulson R.; Ovbiagele B.Background: Given the paucity of neurologists in Sub-Saharan Africa (SSA), task-shifting post-stroke care to nurses could be a viable avenue for enhancing post-stroke outcomes. This pilot study assessed the feasibility and short-term impact of a nurse-led intervention to manage blood pressure (BP) control in recent stroke survivors in Nigeria. Methods: A randomized pilot trial allocated patients within one month of an index stroke from two participating hospitals in Nigeria to either nurse-led group clinic or standard care for 14 days. Key study endpoints were successful execution of the protocol, subject retention, and short-term BP effects. Results: There were no significant differences between the intervention (n = 17) and control (n = 18) groups at baseline. At the post-intervention clinic, patient retention rate was 100%. In the intervention group, both the systolic and diastolic BPs measured at home were lower than the clinic BPs post-interven tion (127 ± 12.88/78.13 ± 19.26 mmHg versus 137.50 ± 23.05/84.06 ± 9.67 mmHg; p = 0.05). However, there was no significant change in clinic blood pressure (BP) recordings in both the intervention and control groups. Conclusion: It is possible to initiate a nurse-led group clinic intervention to address BP management among stroke survivors in SSA with good early retention of participants. A larger and longer-term trial is being planned.Item Phenotyping stroke in Sub-Saharan Africa: stroke investigative research and education network (SIREN) phenomics protocol(Karger Publishers, 2015) Akpalu, A.; Sarfo, F. S.; Ovbiagele, B.; Akinyemi, R.; Gebregziabher, M.; Obiako, R.; Owolabi, L.; Sagoe, K.; Jenkins, C.; Arulogun, O.; Adamu, S.; Appiah, L. T.; Adadey, M. A.; Agyekum, F.; Quansah, J. A.; Mensah, Y. B.; Adeoye, A. M.; Singh, A.; Tosin, A. O.; Ohifemen, O.; Sani, A. A.; Tabi-Ajayi, E.; Phillip, I. O.; Isah, S. Y.; Tabari, N. A.; Mande, A.; Agunloye, A. M.; Ogbole, G. I.; Akinyemi, J. O.; Akpa, O. M.; Laryea, R.; Melikam, S. E.; Adinku, D.; Uvere, E.; Burkett, N.-S.; Adekunle, G. F.; Kehinde, S. I.; Azuh, P. C.; Dambatta, A. H.; Ishaq, N. A.; Arnett, D.Background: As the second leading cause of death and the leading cause of adult-onset disability, stroke is a major public health concern particularly pertinent in Sub-Saharan Africa (SSA), where nearly 80% of all global stroke mortalities occur, and stroke burden is projected to increase in the coming decades. However, traditional and emerging risk factors for stroke in SSA have not been well characterized, thus limiting efforts at curbing its devastating toll. The Stroke Investigative Research and Education Network (SIREN) project is aimed at comprehensively evaluating the key environmental and genomic risk factors for stroke (and its subtypes) in SSA while simultaneously building capacities in phenomics, biobanking, genomics, biostatistics, and bioinformatics for brain research. Methods: SIREN is a transnational, multicentre, hospital and community-based study involving 3,000 cases and 3,000 controls recruited from 8 sites in Ghana and Nigeria. Cases will be hospital-based patients with first stroke within 10 days of onset in whom neurovascular imaging will be performed. Etiological and topographical stroke sub types will be documented for all cases. Controls will be hospital- and community-based participants, matched to cases on the basis of gender, ethnicity, and age (±5 years). Information will be collected on known and proposed emerging risk factors for stroke. Study Significance: SIREN is the largest study of stroke in Africa to date. It is anticipated that it will shed light on the phenotypic characteristics and risk factors of stroke and ultimately provide evidence base for strategic interventions to curtail the burgeoning burden of stroke on the sub-continent.