Institute of Child Health
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Item Exploring the reasoned and reactive pathways for substance use by adolescents living in Nigerian urban slums using the Prototype Willingness Model: a case study(Faculty of Basic Medical Sciences, College of Medicine, University of Ibadan, 2023) Balogun F. M.; Quadri O. H.; Adeladan L.The process of initiation and continued use of substances among adolescents in Africa is understudied despite the high prevalence of substance use among them. Understanding the process that leads to the initiation and subsequent use of substances by adolescents is pivotal for focused and context-specific interventions to address the problem. This exploratory qualitative study used case study design to explore the life histories of three out-of-school adolescents with established substance use from selected slum communities of Ibadan, Nigeria. Content analysis was used for data analysis based on the constructs of the Prototype Willingness Model (PWM). There were two males and a female adolescents aged 15 and 18, and 17 years respectively. The initiation and subsequent use of substances followed both the reasoned and reactive pathways of the PMW. For the reasoned construct, there was a low perception of risk for the negative effects of substance use and both their peers, as well as younger family members used substances. Also, the reactive construct showed that prototype favorability of substance users was important for the initiation and subsequent substance use by the adolescents. Substance use was initiated in social settings and with peers. The PWM explained both initiation and subsequent substance use by these adolescents. Further studies with quantitative data could provide more details about the process of substance use based on PMW by adolescents in Nigeria.Item Comparison of Haematologic parameters among adolescents with and without asymptomatic malaria in Ibadan, Nigeria(Olad Resolution Print, 2022) Balogun F. M.; Ademola S. A.; Olutogun T.Background and Objectives: Asymptomatic malaria results from partial immunity resulting from recurrent exposure to the malaria parasite and it has been shown not to be benign as it was earlier believed. Adolescents are likely to have partial immunity to malaria which can predispose them to the asymptomatic form of malaria, but malaria is understudied in this age group. This study was conducted to compare the haematologic parameters among secondary school adolescents with and without asymptomatic malaria in Ibadan. Methods: A cross-sectional study was conducted and data regarding sociodemographic characteristics, presence or otherwise of malaria parasite (using microscopy) and haematological parameters (obtained using haematology auto- analyser and microscopy) were documented. Malaria parasite density was categorised as 1-100 and >100/μL. Other haematological parameters were classified as categorical variables. Associations were determined using Chi square test and level of significance was p<0.05. Results: A total of 103 students were recruited with a mean age of 15.6±2.02 years and 61(59.2%) were boys. Those from the low socioeconomic class were 86 (83.5%), 24 (23.3%) had asymptomatic malaria while 22 (21.4%) had parasite density of >100/μL. Haematological abnormalities detected were anaemia (11.7%), leucopenia (4.9%), thrombocytopenia (11.7%), reduced MCV and reduced MCH (88.3%). All participants had low MCHC. Abnormal peripheral blood film was found in 79.5% but this was not associated with the presence of malaria parasite. Older adolescence (age ≥ 15 years) was significantly associated with parasite density of>100/μL (p = 0.02) and a higher proportion of those from the low socioeconomic class had asymptomatic malaria (24.4% vs 17.6%). Conclusion: Although some haematologic parameters of the study participants were affected by asymptomatic malaria, there were other unexplained blood abnormalities. There is a need to address asymptomatic malaria among these adolescents and other causes of abnormal blood profile should be tackled.Item Trends of infant vaccination timeliness and completion in selected urban slum communities in Ibadan, Southwestern Nigeria: A four-year review(PLoS ONE, 2023) Balogun F. M.; Bamgboye E. A.; Orimadegun A. E.Background Suboptimal infant vaccination is common in Nigeria and multiple interventions have been deployed to address the situation. Child health indicators are reported to be worse in urban slums compared with other urban areas, but urban data are usually not disaggregated to show these disparities. Examining the timeliness and completion of infant vaccination in urban slums is important to determine the effectiveness of existing interventions in improving infant vaccination among this vulnerable population. This study explored the trends of infant vaccination in selected urban slum communities in Ibadan, Southwest Nigeria between November 2014 and October 2018. Methods This was a cross sectional study where infant vaccination data were extracted from the immunization clinic records of six primary health care centers that were providing infant vaccination services for seven urban slum communities. Data was analyzed using descriptive statistics and Chi square test at α = 05. Results A total of 5,934 infants vaccination records were reviewed, 2,895 (48.8%) were for female infants and 3,002(50.6%) were from Muslim families. Overall, only 0.6% infants had both timely and complete vaccination during the four years under study. The highest number of infants with timely and complete vaccination were seen in 2015(12.2%) and least in 2018 (2.9%). Regarding timeliness of the vaccines, BCG, was the least timely among the vaccines given at birth and the pentavalent and oral polio vaccines’ timeliness reduced as the age of the infants increased. Both yellow fever and measles vaccines were timelier than th(12.1%). Those from Muslim families significantly had delayed and incomplete vaccinations compared with those from Chrisitan families (p = 0.026). Conclusion Infant vaccinations were significantly delayed and incomplete in the study communities during the years reviewed. More focused interventions are required to ensure optimal vaccination of the infants. epentavalent vaccines. Vaccines were most timely in 2016(31.3%) and least timely in 2018Item Stated preferences for human Papillomavirus vaccination for adolescents in selected communities in Ibadan, Southwest Nigeria: A discrete choice experiment(2022) Balogun F. M.; Omotade O. O.Administration of the human papillomavirus (HPV) vaccine in early adolescence is effective in preventing cervical cancer, a common cancer in sub-Saharan Africa. Nigeria is in the pre-introduction era of the HPV vaccine. Understanding the preferences of the population for the vaccine can help design the HPV immunization program to ensure high uptake of the vaccine. This study explored the preferences for the HPV vaccine among stakeholders in selected communities in Ibadan, Nigeria. A discrete choice experiment survey based on six attributes of the HPV vaccine (which were the number of doses, the efficacy of the vaccine, cost of the vaccine, location of the service point, other benefits of the vaccine apart from prevention of cervical cancer and the odds of a side effect from the vaccine) was carried out in five communities. Data were analyzed using conditional and mixed logit models. Seven hundred community members were recruited, 144 (20.7%) were adolescents and 248 (35.4%) were males. In line with expectations, respondents preferred vaccines with higher efficacy, less severe side effects and lower costs. Preference heterogeneity was identified for adolescents that were less price-sensitive and other community members who were less likely to prefer using schools as the service point. The high socio-economic class preferred a vaccine that also prevents genital warts. There were variabilities in the preferences for the attributes of the HPV vaccine in the study communities. These variabilities need to be considered in the introduction of the HPV vaccine to ensure high uptake of the vaccine.Item Improving timeliness and completion of infant vaccination among infants in Nigerian urban slums through older women's participation(Frontiers Media, 2022) Balogun F. M.; Bamgboye E. A.; Akindolire A. E.Nigerian urban slums have a high population of infants with suboptimal vaccination despite previous interventions. Older women traditionally play supervisory roles in infant care in Nigeria but their influence is untapped in infant vaccination. This study sought to determine if training of older women (_35 years) in urban slum communities in Ibadan, South west Nigeria, and involving them in infant vaccination will improve infant vaccination timeliness and completion. This was a randomized experimental community study and pregnant women in their third trimester, residing in seven urban slum communities were randomized using their antenatal clinics (ANCs) into intervention (six ANCs) and control groups (six ANCs). The older women who will supervise the care of the infants of pregnant women in the intervention group had seven sessions of training on the importance of infant vaccination timeliness and completion. The vaccinations of the infants from both groups were compared from birth till 9 months. Data were analyzed using descriptive statistics and Chi square test at a = 0.05. There were 96 older women, 198 pregnant women (105 in intervention group and 93 controls) and 202 infants (109 in intervention group and 93 controls). Infants in the intervention group (67.9%) significantly had both timely and complete vaccinations compared with those in the control group (36.6%). Vaccines given at birth were the least timely in both groups. More infants whose older women caregiver were married had timely and complete vaccinations. Also, a higher proportion of male infants, low birth weight babies and infants with older women caregiver with at most two children had timely and completed vaccinations but these were not statistically significant. Training of older women caregivers improved infant vaccination timeliness and completion in these urban slum communities. This model may improve infant vaccination in other similar urban slum settings.Item Facilitators and barriers of healthcare workers’ recommendation of HPV vaccine for adolescents in Nigeria: views through the lens of theoretical domains framework(BioMed Central., 2022) Balogun F. M.; Omotade O. O.Background: The human Papillomavirus (HPV) vaccine has demonstrated efficacy in the prevention of cervical cancer when given in early adolescence. The recommendation of the vaccine by health care workers (HCW) is crucial to the uptake of the vaccine by adolescents and the process of this recommendation is important as it determines subsequent uptake of the vaccine. Understanding of the facilitators and barriers of recommendation of this vaccine can help in the development of strategies to improve its recommendation rates and uptake. This study therefore explored the facilitators and barriers for the recommendation of HPV vaccine for adolescents by HCW in Ibadan, Nigeria using the Theoretical Domain Framework (TDF). Methods: Key informant interviews were conducted with 14 purposively selected HCW who were in charge of vaccination. Content analysis was used after deductive coding of the data using the domains of the TDF. Relevant concepts for facilitators and barriers of HPV vaccine recommendation and quotes were then identified. Results: Mean age of the HCW was 47.7 ± 6.5 years and they consisted of eight nurses, four medical doctors, one medical social worker and one health visitor. Ten domains of the TDF were represented among the facilitators and barriers against the recommendation of HPV vaccination by the HCW, except the goals; memory, attention, decision process; emotion; and behavioral regulation domains. The domains with the highest frequency of concepts were: knowledge, skills, social/professional role and identity, beliefs about capabilities, beliefs about consequences, intention and environmental context and resources. Domains with conflicting statements in the concept were: environmental context and resources, and beliefs about consequences. While those with perceived strength of concept were: social influences, reinforcement and optimism. Conclusion: All the 10 identified domains of the TDF are potential areas of focus for strategies for improving the recommendation of HPV vaccine for adolescents by health care workers in Nigeria and other countries with similar sociocultural settings.Item Parental intention to vaccinate adolescents with HPV vaccine in selected communities in Ibadan, Southwest Nigeria: an application of Integrated Behavioral Model(Taylor and Francis Online, 2022) Balogun F. M.; Omotade O. O.Parents have important roles to play for adolescents to get the human papillomavirus (HPV) vaccine, an effective measure in the prevention of cervical and other HPV-related cancers. It is important to understand the intention of parents to have their adolescents vaccinated for optimal uptake of the vaccine in Nigeria. This study investigated the intention of parents in five selected communities to get their adolescents vaccinated with HPV vaccine in Ibadan, Nigeria using the Integrated Behavioral Model (IBM). Cross sectional study design was employed and 678 parents were interviewed. Pearson correlation, chi-square test and multiple regression were used for data analysis at α = 0.05. Mean age of the parents was 42.5 ± 10.0 years and 230(33.9%) were males. Almost all of the parents (96.8%) had the intention to vaccinate their adolescents with HPV vaccine. This intention was significantly correlated with experiential attitude (r = 0.74, p = <.01), instrumental attitude (r = 0.33, p = <.01), injunctive norm (r = 0.39, p = <.01), descriptive norm (r = 0.32, p = <.01), perceived control (r = 0.32, p = <.01) and self-efficacy (r = 0.46, p ≤ .01). A higher proportion of parents older than 65 years significantly had no intention to vaccinate their adolescents with HPV vaccine. Intention to vaccinate adolescents with HPV vaccine was predicted by experiential attitude (OR = 0.88, 95% CI: 0.80– 0.95), personal agency (OR = 0.22, 95% CI: 0.15–0.29) and injunctive norm (OR = 0.08, 95% CI: 0.02–0.13). Parental intention to vaccinate adolescents with HPV vaccine was high among the parents in this study. The reluctance of older parents about HPV vaccine for adolescents requires further investigation.Item Sex inequality in under-five deaths and associated factors in low and middle- income countries: a Fairlie decomposition(BioMed Central, 2022) Fagbamigbe A. F.; Morakinyo O. M.; Balogun F. M.Background: There exist sex disparities in the burden of Under-five deaths (U5D) with a higher prevalence among male children. Factors explaining this inequality remain unexplored in Low-and Medium-Income Countries (LMIC). This study quantified the contributions of the individual- and neighborhood-level factors to sex inequalities in U5D in LMIC. Methods: Demographic and Health Survey datasets (2010-2018) of 856,987 under-five children nested in 66,495 neighborhoods across 59 LMIC were analyzed. The outcome variable was U5D. The main group variable was the sex of the child while individual-level and neighborhood-level factors were the explanatory variables. Fairlie decomposition analysis was used to quantify the contributions of explanatory factors to the male-female inequalities in U5D at p<0.05. Results: Overall weighted prevalence of U5D was 51/1000 children, 55 among males and 48 among females (p<0.001). Higher prevalence of U5D was recorded among male children in all countries except Liberia, Kyrgyz Republic, Bangladesh, Nepal, Armenia, Turkey and Papua New Guinea. Pro-female inequality was however not significant in any country. Of the 59 countries, 25 had statistically significant pro-male inequality. Different factors contributed to the sex inequality in U5D in different countries including birth order, birth weight, birth interval and multiple births. Conclusions: There were sex inequalities in the U5D in LMIC with prominent pro-male-inequality in many countries. Interventions targeted towards the improvement of the health system that will, in turn, prevent preterm delivery and improve management of prematurity and early childhood infection (which are selective threats to the male child survival) are urgently required to address this inequality.Item Recurrent spinal bifida prevention and folic acid use(Samdavies Publishers, 2021) Osuji P. N.; Balogun F. M.; Balogun J. A.Background: Spinal bifida (SB) is a disabling congenital abnormality with folic acid (FA) deficiency, recognized as a predisposing factor. Existing literature reports reduction in its incidence following peri-conceptual supplementation with Folic acid. However, there is limited literature on maternal subsequent pregnancy following SB occurrence with regards to awareness and usage of folic acid supplementation and dietary consumption of folate in our local environment. Materials and Methods: A cross-sectional study on the awareness and practice of peri-conception FA supplementation among mothers with children affected with SB, in affected and subsequent pregnancy, was done. Data was obtained using an interviewer-administered questionnaire with analysis done with descriptive analysis. Results: There were 12 respondents with majority of them (91.7%) less than 30 years old at the time of their first pregnancy and the mean of current age was 24.8 + 1.3 years. While just 2(16.7%) used FA in the pre-conception period in the SB pregnancy, only eight (66.7%) of the mothers used FA in the pre-conception period of the subsequent pregnancy despite increased awareness from 8(66.7%) to 12(100%). The dietary consumption of folate rich food was poor. Subsequent pregnancies were planned and there was no recurrence Conclusions: Improvement in the peri-conceptual usage of folic acid in mothers with a child previously affected with SB and no recorded recurrence. National policies on folic acid supplementation and pre-conceptual care have been further validated.Item Prevalence and predictors of problematic smart phone use among pre-varsity young people in Ibadan, Nigeria(The PAMJ, 2020) Balogun F. M.; Olatunde O. E.Introduction: smart phone possession and use among young people is on the increase in Africa and phone addiction has been shown to be similar to substance use dependence. However, there is barely any literature focused on the effect of smart phone use on young people in Nigeria. This study looked at the prevalence of problematic smart phone use and associated factors among prevarsity young people in Ibadan. Methods: problematic smart phone use was assessed using the 27-item mobile phone problem use scale and scored on a 5-point Likert scale. Scores 27-76 indicated low-moderate degree and scores ≥ 77 indicated moderate-severe degree of problematic smart phone use. Chi square test was used to compare problematic phone use with some selected respondents' characteristics and p was 0.05. Results: five hundred and seventy five participants were recruited, age range 14-24 years and 46.0% were males. Almost all (96.7%) of the respondents had smart phone access and 46.5% had moderate severe problematic phone use. Young people who were males, had their parents paying for the data they use, had high extroversion, low conscientiousness and low intellect scores were likely to have problematic phone use. The identified predictors for problematic phone use were male gender (OR=1.77, 95% CI: 1.26-2.50), high extroversion (OR=1.68, 95% CI: 1.16-2.43) and low conscientiousness (OR=2.09, 95% CI: 1.41-3.09). Conclusion: there was a high rate of problematic phone use among these young people. Interventions to promote responsible smart phone use are required to counter this problem.