Intimate partner violence and malnutrition among women of reproductive age in Western Africa: A geostatistical analysis.

Intimate partner violence (IPV) is a public health issue, and the experience varies among population sub-groups in Africa. In the West African sub-region, IPV perpetrated against women remains high and is exacerbated by the pertaining cultural milieu. It affects women's health, wellbeing, and nutritional status. We examined the association between women's lifetime experiences of physical, sexual, and emotional IPV and undernutrition by quantifying the association at smaller geographical settings in West African countries. We used a bivariate probit geostatistical technique to explore the association between IPV and undernutrition, combining data from the latest Demographic and Health Survey conducted in ten Western African countries. Bayesian inference relies on Markov chain Monte Carlo simulation. The findings demonstrate spatial clustering in the likelihood of experiencing IPV and being underweight in the regions of Mali, Sierra Leone, Liberia and neighboring Cote d'Ivoire, Ghana, Togo, Benin, Cameroon, and Nigeria. The pattern of clustering was somewhat similar when physical violence was combined with underweight and emotional violence combined with underweight. The findings also indicate protective effects of education, wealth status, employment status, urban residence, and exposure to mass media. Further, the likelihood of experiencing IPV and the likelihood of being underweight or thin declined with age and age-gap between the woman and her partner. The findings provide insight into the location-specific variations that can aid targeted interventions, and underscore the importance of empowering women holistically, in the domains of education, socio-economic and socio-cultural empowerment, in addressing women's vulnerability to IPV and malnutrition (underweight and thinness). Furthermore, IPV prevention programmes will need to address gender inequality and cultural factors such as male dominance that may heighten women's risk of experiencing IPV.

Non-use of modern contraceptives among women in humanitarian contexts: evidence from a qualitative study in Akwa Ibom State, Nigeria.

The continuing conflict situation in Nigeria have created over 2 million displaced persons. In 2019, women and children accounted for about 80% of the internally displaced population in the country. Displacement increases the need for reproductive health services. This study explored the reasons for non-use of modern contraceptives among forcibly displaced Bakassi women in Akwa Ibom State, southern Nigeria. Focus group discussions were used to collect data from a convenience sample of 40 women of reproductive age (15-49 years) in two makeshift resettlement camps in the region in January and February 2020. Data were analysed using a qualitative inductive approach, with thematic organization and analysis of the transcribed responses from the focus group discussions. The findings revealed that many of the women were not using modern contraceptives at the time of the study, and the major reasons they gave for non-use were misconceptions, costs, religious beliefs, desire for more children and the inaccessibility and unavailability of contraceptive services. The use of family planning services can be a life-saving intervention in unstable, crisis environments. Programme implementation to address non-use of contraceptive services among women in crisis contexts should target social norm change, reproductive health education, empowerment programmes and health service provision.

Risk assessment for COVID-19 transmission at household level in sub-Saharan Africa: evidence from DHS.

Household habitat conditions matter for diseases transmission and control, especially in the case of the novel coronavirus (COVID-19). These conditions include availability and adequacy of sanitation facilities, and number of persons per room. Despite this, little attention is being paid to these conditions as a pathway to understanding the transmission and prevention of COVID-19, especially in Africa, where household habitat conditions are largely suboptimal. This study assesses household sanitation and isolation capacities to understand the COVID-19 transmission risk at household level across Africa. We conducted a secondary analysis of the Demographic and Health Surveys of 16 African countries implemented between 2015 and 2018 to understand the status of households for prevention of COVID-19 transmission in home. We assessed handwashing capacity and self-isolation capacity using multiple parameters, and identified households with elderly persons, who are most at risk of the disease. We fitted two-level random intercept logit models to explore independent relationships among the three indicators, while controlling for the selected explanatory variables. Handwashing capacity was highest in Tanzania (48.2%), and lowest in Chad (4.2%), varying by household location (urban or rural), as well as household wealth. Isolation capacity was highest in South Africa (77.4%), and lowest in Ethiopia (30.9%). Senegal had the largest proportion of households with an elderly person (42.1%), while Angola (16.4%) had the lowest. There were strong, independent relationships between handwashing and isolation capacities in a majority of countries. Also, strong associations were found between isolation capacity and presence of older persons in households. Household capacity for COVID-19 prevention varied significantly across countries, with those having elderly household members not necessarily having the best handwashing or isolation capacity. In view of the age risk factors of COVID-19 transmission, and its dependence on handwashing and isolation capacities of households, each country needs to use the extant information on its risk status to shape communication and intervention strategies that will help limit the impact of the disease in its population across Africa. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s41118-021-00130-w.

Fertility preferences among couples in Nigeria: a cross sectional study.

BACKGROUND: The persistently high and stalled total fertility in Sub-Saharan Africa, including in Nigeria, calls for new efforts towards fertility reduction. Most efforts on fertility desire in sub-Saharan Africa have focused either on individual men or women with little focus on couples as a unit of analysis. Moreover, the influences of different types of marriages in which couples reproduce have not been adequately explored. Therefore, this study examined fertility desires among couples in Nigeria. METHODS: This paper used data from the Nigeria Demographic and Health Survey (NDHS) of 2018 to assess fertility desire by marriage type among couples in Nigeria. In addition, the association between fertility desire and disparity in couples' educational attainment, place of residence, region, religion, occupation, wealth status, children ever born and contraceptive use were considered. The participants consisted of 6813 couples aged between 15-49 years. Couples' characteristics were reported using frequency and percentage distribution tables. Descriptive and logistic regression analyses were conducted. RESULTS: Overall, the study revealed that 73.8% of couples were in monogamous relationships while 26.2% were in polygynous relationships. The mean ideal number of children for men and women were 7.2 and 6.1, respectively. Also, 49.3% of the couples reported husbands desired more children, 43.9% claimed wives desired more children, while 6.8% indicated equal number of desired children among wives and husbands. The results of binary logistic regression showed that couples in polygynous relationships were 4.3 times as likely to desire more children, compared to couples in monogamous relationships (OR = 4.3; 95% CI: 3.5, 5.3). Couples in polygynous relationships wanted as many as four times the number of children desired by couples in monogamous relationships. Fertility desire was significantly higher among couples who indicated the following: either was using contraceptives (OR = 2.3; 95% CI: 1.6-3.4), both were not using contraceptives (OR = 2.8; 95% CI: 1.9, 4.1), lived in North East (OR = 2.0; 95% CI: 1.5, 2.6) and North West (OR = 1.7; 95% CI: 1.3, 2.3), both were not working (OR = 1.33, 95% CI; 1.1, 1.6) and were adherents of Islam (OR = 1.8; 95% CI; 1.5, 2.4). CONCLUSION: These findings reflect the role of region, use of contraceptives, work status and religion in the fertility desire of couples. Implementing programmes and policies on sexual education and reproductive rights of couples and individuals may reduce high fertility desire and its adverse consequences, such as child and maternal morbidity and mortality in Nigeria.

Contraceptive Use in Nigeria: Does Social Context Matter?

Contraceptive use in Nigeria has remained low despite the efforts of government and non-governmental agencies to increase its uptake. Most studies on contraceptive use have focused on individual-level determinants and evidence is sparse on the influence of social or community context. This study examines the influences of contextual factors on modern contraceptive use in Nigeria. We used data from the 2013 Nigeria Demographic and Health Survey, and a sample of 12,186, currently married women aged 15-49 years. Multilevel logistic regression which provides a flexible modeling for hierarchical data was used to examine the effects of contextual factors on contraceptive use. Findings revealed considerable low usage of contraception across the regions of Nigeria. Living in high and moderate ethnically diverse communities and communities that have high proportion of educated women was significantly associated with increased usage. The findings provide useful information for policy makers to consider the social milieu in which women live for effective family planning interventions.

Regional variations in the use of postnatal care in Nigeria: a spatial analysis.

Maternal health outcomes vary considerably in Nigeria, with maternal mortality ratio ranging from 165 per 100,000 live births in the South-west to 1549 per 100,000 live births in the North-east. One important maternal health indicator is an adequate use of postnatal care (PNC); however, the evidence is sparse on its spatial distribution across regions in Nigeria. This paper thus examined the spatial distribution of uptake of postnatal care in Nigeria using data from the 2013 Nigeria Demographic and Health Survey, with a sample of 12,127 women aged 15-49 years. The Bayesian-structured additive regression of the logit model was used to examine the spatial relationships. The results revealed a north-south divide in the use of postnatal care, with higher PNC uptake established in the latter. Interestingly, results showed significant intra-region residual spatial variations with higher PNC use in Yobe and Bauchi in North-east Nigeria compared to other states within the region. The findings indicate the need for policymakers to develop state- and region-specific health policy and intervention programs to address the inequity in postnatal care coverage and usage across regions in Nigeria.

Complicating causality: patient and professional perspectives on obstetric fistula in Nigeria.

Obstetric fistula, a preventable maternal morbidity characterised by chronic bladder and/or bowel incontinence, is widespread in Nigeria. This qualitative, multi-site study examined the competing narratives on obstetric fistula causality in Nigeria. Research methods were participant observation and in-depth interviews with 86 fistula patients and 43 healthcare professionals. The study found that both patient and professional narratives identified limited access to medical facilities as a major factor leading to obstetric fistula. Patients and professionals beliefs regarding the access problem, however, differed significantly. The majority of fistula patients reported either delivering or attempting to deliver in medical facilities and most patients attributed fistula to a lack of trained medical staff and mismanagement at medical facilities. Conversely, a majority of health professionals believed that women developed obstetric fistula because they chose to deliver at home due to women's traditional beliefs about womanhood and childbirth. Both groups described financial constraints and inadequate transport to medical facilities during complicated labour as related to obstetric fistula onset. Programmatic insights derived from these findings should inform fistula prevention interventions both with healthcare professionals and with Nigerian women.

Unmet need for family planning: implication for under-five mortality in Nigeria.

There are gaps in evidence on whether unmet need for family planning has any implication for under-five mortality in Nigeria. This study utilized 2008 Nigeria Demographic and Health Survey data to examine the effect of unmet need on under-five mortality. Cox regression analysis was performed on 28,647 children born by a nationally-representative sample of 18,028 women within the five years preceding the survey. Findings indicated elevated risks of under-five death for children whose mothers had unmet need for spacing [Hazard ratio (HR): 1.60, confidence interval (CI) 1.37-1.86, p<0.001] and children whose mothers had unmet need for limiting (HR: 1.78, CI 1.48-2.15, p<0.001) compared to children whose mothers had met need. These findings were consistent after adjusting for the effects of factors that could confound the association. Findings of this study underscore the need to address the present level of unmet need for family planning in Nigeria, if the country would achieve meaningful reduction in under-five mortality.

Ethnic differentials in under-five mortality in Nigeria.

OBJECTIVE: There are huge regional disparities in under-five mortality in Nigeria. While a region within the country has as high as 222 under-five deaths per 1000 live births, the rate is as low as 89 per 1000 live births in another region. Nigeria is culturally diverse as there are more than 250 identifiable ethnic groups in the country; and various ethnic groups have different sociocultural values and practices which could influence child health outcome. Thus, the main objective of this study was to examine the ethnic differentials in under-five mortality in Nigeria. DESIGN: The study utilized 2008 Nigeria Demographic and Health Survey (NDHS) data. We analyzed data from a nationally representative sample drawn from 33,385 women aged 15-49 that had a total of 104,808 live births within 1993-2008. In order to examine ethnic differentials in under-five mortality over a sufficiently long period of time, our analysis considered live births within 15 years preceding the 2008 NDHS. The risks of death in children below age five were estimated using Cox proportional regression analysis. Results were presented as hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: The study found substantial differentials in under-five mortality by ethnic affiliations. For instance, risks of death were significantly lower for children of the Yoruba tribes (HR: 0.39, CI: 0.37-0.42, p < 0.001), children of Igbo tribes (HR: 0.58, CI: 0.55-0.61, p < 0.001) and children of the minority ethnic groups (HR: 0.66, CI: 0.64-0.68, p < 0.001), compared to children of the Hausa/Fulani/Kanuri tribes. Besides, practices such as plural marriage, having higher-order births and too close births showed statistical significance for increased risks of under-five mortality (p < 0.05). CONCLUSION: The findings of this study stress the need to address the ethnic norms and practices that negatively impact on child health and survival among some ethnic groups in Nigeria.

REGIONAL VARIATIONS IN INFANT AND CHILD MORTALITY IN NIGERIA: A MULTILEVEL ANALYSIS.

There are substantial regional disparities in under-five mortality in Nigeria, and evidence suggests that both individual- and community-level characteristics have an influence on health outcomes. Using 2008 Nigeria Demographic and Health Survey data, this study (1) examines the effects of individual- and community-level characteristics on infant/child mortality in Nigeria and (2) determines the extent to which characteristics at these levels influence regional variations in infant/child mortality in the country. Multilevel Cox proportional hazard analysis was performed on a nationally representative sample of 28,647 children nested within 18,028 mothers of reproductive age, who were also nested within 886 communities. The results indicate that community-level variables (such as region, place of residence, community infrastructure, community hospital delivery and community poverty level) and individual-level factors (including child's sex, birth order, birth interval, maternal education, maternal age and wealth index) are important determinants of infant/child mortality in Nigeria. For instance, the results show a lower risk of death in infancy for children of mothers residing in communities with a high proportion of hospital delivery (HR: 0.70, p < 0.05) and for children whose mothers had secondary or higher education (HR: 0.84, p < 0.05). Although community factors appear to influence the association between individual-level factors and death during infancy and childhood, the findings consistently indicate that community-level characteristics are more important in explaining regional variations in child mortality, while individual-level factors are more important for regional variations in infant mortality. The results of this study underscore the need to look beyond the influence of individual-level factors in addressing regional variations in infant and child mortality in Nigeria.

Intimate partner violence and the utilization of maternal health care services in Nigeria.

Our aim in this study is to examine the association between women's lifetime experiences of physical, sexual, and emotional intimate partner violence (IPV) and the use of maternal health care services. We used data from the 2008 Nigeria Demographic and Health Survey. Analysis was based on responses from 17,476 women (for antenatal care [ANC]) and 17,412 (for delivery assisted by a skilled health provider) who had had deliveries in the 5 years preceding the survey. We found an overall IPV prevalence rate of 33.4%. Physical IPV was associated with low use of ANC. Emotionally abused women were less likely to use delivery assistance from skilled health care providers. Based on our findings, we suggest the importance of designing interventions to address the health care needs of women who have experienced violence from their partners.

Determinants of Maternal Health Care Utilization in Nigeria: a multilevel approach.

INTRODUCTION: Fourteen percent of maternal deaths globally occur in Nigeria. Low utilization of maternal health services for delivery may partially explain the high maternal mortality. The aim of this study was to examine the contribution of community factors in explaining variations in the use of health facilities for delivery in Nigeria. METHODS: Our sample consisted of 17,542 women aged 15-49 years drawn from 2008 Nigeria Demographic and Health Survey, who had had their last birth in the five years before the survey. We employed multilevel analysis to identify community factors related to the use of delivery care. RESULTS: In addition to several individual factors, region of residence was significantly associated with facility delivery. Women who lived in Northern Nigeria were less likely to deliver in a health facility than those who resided in the Southern part of the country. Residence in communities with a high proportion of women who had secondary and higher education significantly increased the odds of facility delivery whereas ethnic diversity was negatively associated with health facility delivery. CONCLUSION: Interventions aimed at promoting the use of health facility for childbirth should not only be implemented at the individual level but also tailored to the community level as interventions conceived without consideration for community context are likely to have limited impact. Increasing women's education in disadvantaged communities and region-specific interventions that increase access to health facilities are likely to have far-reaching impacts in reducing maternal mortality.

Does it really matter where women live? A multilevel analysis of the determinants of postnatal care in Nigeria.

Although postnatal care is one of the major interventions recommended for the reduction of maternal and newborn deaths worldwide, almost two-third (56 %) of women in Nigeria do not receive postnatal care. Attempts to explain this situation have focused on individual and household level factors, but the role of community characteristics has received less attention.This study examines community factors associated with the receipt of postnatal care in Nigeria and the moderating effects of community factors on the association between individual factors and postnatal care. Data was drawn from the 2008 Nigeria Demographic and Health Survey, and a sample of 17,846 women aged 15-49 years was selected. We employed a multilevel logistic regression analysis to identify community factors associated with postnatal care. Our findings showed that significant variations in receiving postnatal care exist across communities. Specifically, Nigerian women's likelihood of receiving postnatal care is a function of where they reside. Living in communities with a high proportion of educated women (OR = 2.04; 95 % CI = 1.32-3.16; p < 0.001) and a high proportion of those who have had a health facility delivery (OR = 17.86; 95 % CI = 8.34-38.24; p < 0.001) was significantly associated with an increased likelihood of receiving postnatal care. Community women's education moderated the association between ethnic origin and postnatal care. Community variance in postnatal care was significant (τ = 10.352, p = 0.001). Community interventions aimed at improving postnatal care should take into account the community context in which women live. To close the gap in community variations in postnatal care, secondary and higher education for women, and health facility delivery should be increased in disadvantaged communities.

Variations in unmet need for contraception in Zambia: does ethnicity play a role?

Ethnicity has been found to be a significant indicator of social position, and many studies have also established that ethnicity is a significant determinant of contraceptive use. This study aims to examine whether ethnicity is an important predictor of unmet need for contraception. Analysis was based on data for 4343 ever-married women drawn from the 2007 Zambia Demographic and Health Survey. Descriptive analysis indicates that in all ethnic groups except the Barotse and Tonga, women aged 15-49 years were married at an average age below 18. The highest mean number of children among the ethnic groups was 6.7, among the Bemba; the lowest was 5.9, among the Barotse. The highest proportion of women with an unmet need for contraception resided in the Eastern region. Multivariate logistic analyses reveal that children ever-born and region of residence were the most important predictors of unmet need for spacing, whereas for unmet need for limiting predictors were age at first marriage and partner's desire for children. Moreover, unmet need for spacing and limiting among women with secondary or higher education was significantly lower (47% and 50%, respectively) compared with those with no education. Ethnicity was not a significant predictor of unmet need for contraception. The findings stress the need for programmes aimed at enhancing the socioeconomic status of women.

Contextual determinants of maternal health care service utilization in Nigeria.

Despite the high maternal mortality ratio in Nigeria, the use of maternal health care services is very poor. Attempts to explain this situation has focused on individual level factors and the influence of community contextual factors have not received much attention. This study examined the relation of community factors to the use of antenatal care in Nigeria, and explored whether community factors moderated the association between individual characteristics and antenatal care visits. Data were drawn from the 2008 Nigeria Demographic and Health Survey among 16,005 women aged 15-49 years who had had their last delivery in the five years preceding the survey. Results from multi-level models indicated that living in communities with a high proportion of women who delivered in a health facility was associated with four or more antenatal care visits. Residence in high-poverty communities decreased the likelihood of antenatal care attendance. Living in communities with a high proportion of educated women was not significantly related to antenatal care visits. Community factors acted as moderators of the association between educational attainment and antenatal care attendance. Improvement in antenatal care utilization may therefore be enhanced by targeting poverty reduction programs and increasing health facility delivery in disadvantaged communities.

HIV/AIDS stigma and utilization of voluntary counselling and testing in Nigeria.

BACKGROUND: Despite the recognition of stigma as a hindrance to public health treatment and prevention there are gaps in evidence on the relationship between HIV stigma and VCT services utilization in Nigeria. The purpose of this study was to examine a community's perceptions, feelings and attitudes towards people living with HIV/AIDS and how this is associated with access to utilization of voluntary counselling and treatment in Nigeria. METHODS: A cross-sectional random study of Nigerians, using a mixed-method approach was carried out in two distinct ethnic areas of the country. Both quantitative and qualitative methods (mixed-methods) were used to collect data in Osun State (Yoruba ethnic group) in the South-West and Imo State (Igbo ethnic group) in the South East. Multivariate logistic regression was the model used to examine the association of interest. RESULTS: It is shown that Nigerian public attitudes to HIV/AIDS and those infected with the disease are negative. The markers for stigma on the overall stigma index are significant predictors of utilization of voluntary counselling and testing. As the sum of negative feelings increases, there is less likelihood to using voluntary counselling and testing (VCT) and vice versa. CONCLUSIONS: Current national efforts at addressing the AIDS pandemic can only be successful when the issue of AIDS is de-stigmatized and is made a critical part of those efforts. One way to do this is through well-designed messages that should be posted in the media, community halls, health centers and other public places aimed at humanizing the disease and those affected and infected by it.