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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 Investigation of a measles outbreak in a Rural Nigerian community – the aladura experience(Academic Journals, 2010-03) Adeoye, I. A.; Dairo, M. D.; Adekunle, L. V.; Adedokun, H. O.; Makanjuola, J.The global burden of measles has remained a public health challenge. Worldwide, measles is the fifth leading cause of death among under-five children with an estimate of 197,000 deaths in 2007. In Nigeria, measles is an important cause of childhood morbidity and mortality. Measles outbreaks have been increasingly common in the country with 30, 194 and 256 outbreaks reported in 2006, 2007 and 2008 respectively. This paper describes the investigation, findings and mitigation efforts of a measles outbreak in Ogunmakin, a rural community in South-western Nigeria from 7th January to 15th February 2009. The study design was descriptive and cross-sectional in nature. The investigation was multidisciplinary in nature performed based on the national guidelines for investigating a measles outbreak. This involved data and blood sample collection from the initial cases, notification of the local government health authority, active search and line listing of cases from other health facilities. A household survey was conducted to find additional cases as well as to define the extent of the outbreak. Qualitative techniques were also employed to explore the issues associated with the uptake of immunization in the community. A total of 29 measles cases were identified, all were less than five years old. There were two deaths giving a case fatality rate of 6.9%. Majority of the cases (96.5%) were not immunized against measles. The epidemic spanned 5 weeks with majority of the cases occurring in the 2nd week. There was a clustering of cases in one of the five quarters/settlement – Otesile. The measles immunization coverage for the community was estimated as 22.9%. The stated reasons for the poor uptake of immunization were lack of time, not regarding it as important. A total of 432 children aged 9 months to 15 years received measles antigen during the response vaccination campaign. The measles outbreak in Ogunmakin village was due to low routine immunization coverage resulting in an accumulation of susceptible children. Socio-cultural factors and weak health infrastructure contribute significantly to the low uptake of immunization. There is the need mobilized the entire community on the importance of immunization as well as strengthen the provision of routine immunization.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 Coverage-level and predictors of maternity continuum of care in Nigeria: implications for maternal, newborn and child health programming(BioMed Central, 2023) Oyedele, O. K.; Fagbamigbe, A. F.; Akinyemi, O. J.; Adebowale, A. S.Background Completing maternity continuum of care from pregnancy to postpartum is a core strategy to reduce the burden of maternal and neonatal mortality dominant in sub-Saharan Africa, particularly Nigeria. Thus, we evaluated the level of completion, dropout and predictors of women uptake of optimal antenatal care (ANC) in pregnancy, continuation to use of skilled birth attendants (SBA) at childbirth and postnatal care (PNC) utilization at postpartum in Nigeria. Methods A cross-sectional analysis of nationally representative 21,447 pregnancies that resulted to births within five years preceding the 2018 Nigerian Demographic Health Survey. Maternity continuum of care model pathway based on WHO recommendation was the outcome measure while explanatory variables were classified as; socio-demographic, maternal and birth characteristics, pregnancy care quality, economic and autonomous factors. Descriptive statistics describes the factors, backward stepwise regression initially assessed association (p<0.10), multivariable binary logistic regression and complementary-log–log model quantifies association at a 95% confidence interval (α=0.05). Results Coverage decrease from 75.1% (turn-up at ANC) to 56.7% (optimal ANC) and to 37.4% (optimal ANC and SBA) while only 6.5% completed the essential continuum of care. Dropout in the model pathway however increase from 17.5% at ANC to 20.2% at SBA and 30.9% at PNC. Continuation and completion of maternity care are positively drive by women; with at least primary education (AOR=1.27, 95%CI=1.01–1.62), average wealth index (AOR=1.83, 95%CI=1.48 –2.25), southern geopolitical zone (AOR=1.61, 95%CI=1.29–2.01), making health decision alone (AOR=1.39, 95%CI=1.16–1.66), having nurse as ANC provider (AOR=3.53, 95%CI=2.01–6.17) and taking at least two dose of tetanus toxoid vaccine (AOR=1.25, 95%CI=1.06–1.62) while women in rural residence (AOR=0.78, 95%CI=0.68–0.90) and initiation of ANC as late as third trimester (AOR=0.44, 95%CI=0.34–0.58) negatively influenced continuation and completion. Conclusions 6.5% coverage in maternity continuum of care completion is very low and far below the WHO recommended level in Nigeria. Women dropout more at postnatal care than at skilled delivery and antenatal. Education, wealth, women health decision power and tetanus toxoid vaccination drives continuation and completion of maternity care. Strategies optimizing these factors in maternity packages will be supreme to strengthen maternal, newborn and child health.Item Perception of healthcare workers and end-users about the implementation of the Abiye Scheme in Ondo State, Nigeria(College of Medicine, University of Ibadan, 2022) Fagbamigbe, A. F.; Obembe, T. A.; Owumi, B. E.Background: To upturn the poor maternal, children and neonatal health indicators in a South-west Nigerian state, the Abiye Scheme was inaugurated in 2009. This study assessed the perception of healthcare workers and end-users in Ondo State about the implementation of the four strategies proposed to actualise this scheme. Methods: This qualitative study employed the use of 15 key informant interviews (KIIs) conducted among 15 healthcare workers and eight focus group discussions (FGDs) conducted among 72 pregnant and nursing mothers to generate essential data. The Abiye scheme strategies assessed were the establishment of a health insurance scheme; utilization of health rangers (HR); upgrade and renovation of peripheral health facilities; and establishment of mother and child hospitals. All interviews were audio-recorded, transcribed verbatim, coded, and analysed with Nvivo 10 software using framework analysis via deductive methods. Results: The study respondents perceived the Abiye scheme as a well-conceptualized program with good intentions. Only the establishment of the mother and child hospitals strategy of the Abiye scheme was perceived to be properly implemented by our study respondents. According to the respondents, the health insurance scheme was nearly non-existent. Conclusion: Abiye scheme is undisputedly a well conceptualized program that has impacted positively its users. Nonetheless, the laid down strategies have not been fully implemented. To achieve maximal impact, the health rangers must be enabled to perform their duties; the health insurance component must be strengthened and properly implemented; and the peripheral health facilities should be quickly and actively co-opted into the scheme.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 A randomized, open-label trial of combined nitazoxanide and atazanavir/ritonavir for mild to moderate COVID-19(Frontiers Media SA, 2022) Fowotade, A.; Bamidele, F.; Egbetola, B.; Fagbamigbe, A. F.; Adeagbo, B. A.; Adefuye, B. O.; Olagunoye, A.; Ojo, T. O.; Adebiyi, A. O.; Olagunju, O. I.; Ladipo, O. T.; Akinloye, A.; Onayade, A.; Bolaji, O. O.; Rannard, S.; Happi, C.; Owen, A.; Olagunju, A.Background: The nitazoxanide plus atazanavir/ritonavir for COVID-19 (NACOVID) trial investigated the efficacy and safety of repurposed nitazoxanide combined with atazanavir/ritonavir for COVID-19. Methods: This is a pilot, randomized, open-label multicenter trial conducted in Nigeria. Mild to moderate COVID-19 patients were randomly assigned to receive standard of care (SoC) or SoC plus a 14-day course of nitazoxanide (1,000 mg b.i.d.) and atazanavir/ritonavir (300/100 mg od) and followed through day 28. Study endpoints included time to clinical improvement, SARS-CoV-2 viral load change, and time to complete symptom resolution. Safety and pharmacokinetics were also evaluated (ClinicalTrials.gov ID: NCT04459286). Results: There was no difference in time to clinical improvement between the SoC (n = 26) and SoC plus intervention arms (n = 31; Cox proportional hazards regression analysis adjusted hazard ratio, aHR = 0.898, 95% CI: 0.492–1.638, p = 0.725). No difference was observed in the pattern of saliva SARS-CoV2 viral load changes from days 2–28 in the 35% of patients with detectable virus at baseline (20/57) (aHR = 0.948, 95% CI: 0.341–2.636, p = 0.919). There was no significant difference in time to complete symptom resolution (aHR = 0.535, 95% CI: 0.251–1.140, p = 0.105). Atazanavir/ritonavir increased tizoxanide plasma exposure by 68% and median trough plasma concentration was 1,546 ng/ml (95% CI: 797–2,557), above its putative EC90 in 54% of patients. Tizoxanide was undetectable in saliva. Conclusion: Nitazoxanide co-administered with atazanavir/ritonavir was safe but not better than standard of care in treating COVID-19. These findings should be interpreted in the context of incomplete enrollment (64%) and the limited number of patients with detectable SARS-CoV-2 in saliva at baseline in this trial.Item Decomposition of factors associated with housing material inequality in under-five deaths in low and middle-income countries(BioMed Central, 2022) Morakinyo, O. M.; Fagbamigbe, A. F.; Adebowale, A. S.Background: Low-and Medium-Income Countries (LMIC) continue to record a high burden of under-five deaths (U5D). There is a gap in knowledge of the factors contributing to housing materials inequalities in U5D. This study examined the contributions of the individual- and neighbourhood-level factors to housing materials inequalities in influencing U5D in LMIC. Methods: We pooled data from the most recent Demographic and Health Surveys for 56 LMIC conducted between 2010 and 2018. In all, we analysed the data of 798,796 children living in 59,791 neighbourhoods. The outcome variable was U5D among live births within 0 to 59 months of birth. The main determinate variable was housing material types, categorised as unimproved housing materials (UHM) and improved housing materials (IHM) while the individual-level and neighbourhood-level factors are the independent variables. Data were analysed using the Fairlie decomposition analysis at α = 0.05. Results: The overall U5D rate was 53 per 1000 children, 61 among children from houses built with UHM, and 41 among children from houses built with IHM (p < 0.001). This rate was higher among children from houses that were built with UHM in all countries except Malawi, Zambia, Lesotho, Gambia, Liberia, Sierra Leone, Indonesia, Maldives, Jordan, and Albania. None of these countries had significant pro-IHM inequality. The factors explaining housing inequalities in U5D include household wealth status, residence location, source of drinking water, media access, paternal employment, birth interval, and toilet type. Conclusions: There are variations in individual- and neighbourhood-level factors driving housing materials inequalities as it influences U5D in LMIC. Interventions focusing on reducing the burden of U5D in households built with UHM are urgently needed.Item Sex inequality in under-five deaths and associated factors in low and middle-income countries: a Fairlie decomposition analysis(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.