Estimating vaccine coverage in conflict settings using geospatial methods: a case study in Borno state, Nigeria.

Reliable estimates of subnational vaccination coverage are critical to track progress towards global immunisation targets and ensure equitable health outcomes for all children. However, conflict can limit the reliability of coverage estimates from traditional household-based surveys due to an inability to sample in unsafe and insecure areas and increased uncertainty in underlying population estimates. In these situations, model-based geostatistical (MBG) approaches offer alternative coverage estimates for administrative units affected by conflict. We estimated first- and third-dose diphtheria-tetanus-pertussis vaccine coverage in Borno state, Nigeria, using a spatiotemporal MBG modelling approach, then compared these to estimates from recent conflict-affected, household-based surveys. We compared sampling cluster locations from recent household-based surveys to geolocated data on conflict locations and modelled spatial coverage estimates, while also investigating the importance of reliable population estimates when assessing coverage in conflict settings. These results demonstrate that geospatially-modelled coverage estimates can be a valuable additional tool to understand coverage in locations where conflict prevents representative sampling.

Facilitators and barriers to seasonal malaria chemoprevention (SMC) uptake in Nigeria: a qualitative approach.

BACKGROUND: SMC was adopted in Nigeria in 2014 and by 2021 was being implemented in 18 states, over four months between June and October by 143000 community drug distributors (CDDs) to a target population of 23million children. Further expansion of SMC is planned, extending to 21 states with four or five monthly cycles. In view of this massive scale-up, the National Malaria Elimination Programme undertook qualitative research in five states shortly after the 2021 campaign to understand community attitudes to SMC so that these perspectives inform future planning of SMC delivery in Nigeria. METHODS: In 20 wards representing urban and rural areas with low and high SMC coverage in five states, focus group discussions were held with caregivers, and in-depth interviews conducted with community leaders and community drug distributors. Interviews were also held with local government area and State malaria focal persons and at national level with the NMEP coordinator, and representatives of partners working on SMC in Nigeria. Interviews were recorded and transcribed, those in local languages translated into English, and transcripts analysed using NVivo software. RESULTS: In total, 84 focus groups and 106 interviews were completed. Malaria was seen as a major health concern, SMC was widely accepted as a key preventive measure, and community drug distributors (CDDs) were generally trusted. Caregivers preferred SMC delivered door-to-door to the fixed-point approach, because it allowed them to continue daily tasks, and allowed time for the CDD to answer questions. Barriers to SMC uptake included perceived side-effects of SMC drugs, a lack of understanding of the purpose of SMC, mistrust and suspicions that medicines provided free may be unsafe or ineffective, and local shortages of drugs. CONCLUSIONS: Recommendations from this study were shared with all community drug distributors and others involved in SMC campaigns during cascade training in 2022, including the need to strengthen communication about the safety and effectiveness of SMC, recruiting distributors from the local community, greater involvement of state and national level pharmacovigilance coordinators, and stricter adherence to the planned medicine allocations to avoid local shortages. The findings reinforce the importance of retaining door-to-door delivery of SMC.

Cross-sectional study on knowledge, attitude and prevalence of domestic violence among women in Kaduna, north-western Nigeria.

BACKGROUND: Domestic violence is a global issue of public health concern with detrimental effects on women's physical, mental and social well-being. There is a paucity of community-based studies assessing the knowledge and attitude of women towards domestic violence in Nigeria. OBJECTIVE: To assess knowledge, attitudes, prevalence and associated factors of domestic violence among women in a community in Kaduna, Nigeria. DESIGN: A descriptive cross-sectional study. SETTING: A selected community in Kaduna South Local Government Area in Kaduna State. PARTICIPANTS: In total, 170 women aged 15-49 years participated in the study. PRIMARY AND SECONDARY OUTCOME MEASURES: The outcomes were knowledge, attitude and prevalence of domestic violence. RESULTS: The mean age of the respondents was 28.7+7.9 years. A total of 113 (66.5%) respondents had high level of knowledge about domestic violence with 114 (67.1%) having non-tolerant attitudes towards domestic violence. The lifetime prevalence and 12-month prevalence of domestic violence were 47.1% and 35.3%, respectively. The results of logistic regression identified the educational status of women as a significant predictor of knowledge of domestic violence (adjusted OR (aOR)=0.32; 95% CI 0.15 to 0.68), while marital status (aOR=0.21; 95% CI 0.05 to 0.96), occupation of women (aOR=2.49; 95% CI 1.13 to 5.49), their tolerance of wife beating (aOR=0.33; 95% CI 0.15 to 0.72) and their partners' consumption habit of alcohol/substance use (aOR=7.91; 95% CI 3.09 to 20.27) were identified as significant predictors of the women's experience of domestic violence. CONCLUSION: Domestic violence was relatively high among women. Though a majority had high level of knowledge about domestic violence, a significant third had tolerant attitudes towards it. Appropriate health interventions need to be implemented by governmental and relevant stakeholders to target negative attitudes and address associated factors of domestic violence against women.

Factors influencing adherence to antiretroviral therapy among HIV-infected adults in Cross River State, Nigeria: a cross-sectional study.

Introduction: improved access to antiretroviral therapy (ART) has significantly increased the survival and quality of life of HIV-infected persons. Strict adherence to antiretroviral therapy (ART) is crucial if viral suppression must remain optimal. We assessed predictors of adherence to ART among adult patients in Cross River State (CRS), Nigeria. Methods: a cross-sectional survey was conducted among 999 adult patients on ART in selected secondary and tertiary health facilities in CRS from January to June 2017. Respondents were recruited using multistage technique. Data were collected using a pre-tested interviewer-administered questionnaire. Adherence was defined as clients taking at least 95% of their pills in the last seven days. Multivariate analysis was performed to determine predictors of adherence at 5% level of significance. Results: majority (70.5%) of the respondents were females with a mean age of 43.7 ± 11.1 years. The self-reported adherence rate was 60.1%. The commonest reasons for non-adherence was client travelling out of home, being busy, forgetting and lack of food. The significant predictor identified in this study was being on first-line drugs (OR=3.677, 95% C.I=2.523-5.358), were 3 times more likely to have good adherence. Predictors of poor-adherence were alcohol intake (OR=0.382, 95% C.I=0.262-0.559), dosing medications (OR=0.502, 95% C.I=0.381-0.661), CD4 cell count ≥ 500 (OR=0.723, 95% C.I=0.543-0.964), poor attitude to HIV status and medication (OR=0.713, 95% C.I=0.512-0.994) and family support (OR=0.736, 95% C.I=0.544-0.995). Conclusion: adherence to ART among clients in this study was fair. Majority of the reasons for poor-adherence were client-related. There is need for targeted counselling to improve adherence.

Prevalence, patterns and correlates of smokeless tobacco use in Nigerian adults: An analysis of the Global Adult Tobacco Survey.

INTRODUCTION: The global tobacco epidemic contributes to more than 8 million deaths annually. However, most tobacco control interventions have been driven by an emphasis on smoked tobacco. Globally and more so in Nigeria, less attention has been paid to the similarly harmful smokeless tobacco (SLT) whose use appeals to a different demography. We examined the prevalence, patterns of use and correlates of SLT in Nigerian adults to guide targeted control efforts. METHODS: We conducted a secondary analysis of the 2012 Global Adult Tobacco Survey (GATS) data. We obtained data on 9,765 non-institutionalised adults aged 15 years and older. Variables included current SLT use, sociodemographic characteristics and perceived harm of SLT use. We used Chi-square test to examine associations and binary logistic regression to assess predictors of current SLT use. All analyses were conducted with sample-weighted data. RESULTS: The prevalence of current SLT use was 1.9% of all adults. About 1.4% were daily users. The main types were snuff by nose (1.6%) and snuff by mouth (0.8%). There were higher odds of current SLT use for those in the South-East region (aOR = 13.99; 95% CI: 4.45-43.95), rural area residents (aOR = 1.56; 95% CI: 1.04-2.35), males (aOR = 4.43; 95% CI: 2.75-7.11), the 45-64 years age-group (aOR = 10.00; 95% CI: 4.12-24.29), those with no formal education (aOR = 2.67; 95% CI: 1.01-7.05), and those with no perception of harm from SLT use (aOR = 3.81, 95% CI: 2.61-5.56). CONCLUSION: The prevalence of SLT use among Nigerian adults was low with clearly identified predictors. While a majority were aware of harm from SLT use, an unacceptably high proportion remain unaware. We recommended targeted interventions to increase awareness of the harmful effects of SLT use especially among residents of the South-East, those in rural areas, males, and individuals with no formal education. We also recommended a follow-up survey.

Use of long-lasting insecticidal nets among women attending antenatal clinic at a tertiary hospital in Bayelsa State, Nigeria 2019.

BACKGROUND: Malaria in pregnancy remains a major contributor to maternal and infant morbidity and mortality despite scale up in interventions. Its prevention is one of the major interventions in reducing maternal and infant morbidity and mortality. The ownership, utilization and predictors of use of long-lasting insecticide-treated nets (LLINs) for malaria prevention among women attending antenatal clinic (ANC) at a tertiary hospital in Bayelsa State Nigeria was assessed. METHODS: A cross-sectional study of 297 women recruited through systematic sampling was carried out. Information on sociodemographic characteristics, ownership, source and utilization of LLINs, were collected with a pre-tested structured interviewer-administered questionnaire. The relationship between use of LLIN and sociodemographic characteristics was examined using chi square and logistic regression at 5% level of significance. RESULTS: The mean age of respondents was 28.8 ± 2.6 years. Most (59.2%) had tertiary education and were mainly (88.2%) urban dwellers. Two hundred and fifty (84.2%) owned LLINs, and 196 (78%) used LLIN the night prior to the interview. Almost half of the respondents purchased their LLINs. Those who purchased LLINs were 3 times more likely to have used it (OR: 3.13, 95% CI 1.62-6.04) compared to those that got it free. Those who were gainfully employed (OR: 3.16, 95% CI 1.59-6.29) and those who earned above the minimum wage (OR: 2.88, 95% CI 1.45-5.72) were 3 times more likely to have used LLIN in their index pregnancy. CONCLUSION: The use of LLIN as a preventive measure against malaria was relatively high among the participants in this study, though still below national target. The major factors determining the use of LLIN among these women were purchase of LLINs and being gainfully employed. It was recommended that efforts should be made to enforce the policy of free LLINs at ANC registration at the tertiary hospitals, as this would further drive up ownership and utilization rates.

Determinants of perinatal mortality in public secondary health facilities, Abuja Municipal Area Council, Federal Capital Territory, Abuja, Nigeria.

INTRODUCTION: in Nigeria, perinatal mortality rate remains high among births at the health facility. Births occur majorly at the secondary healthcare level in Abuja Municipal Area Council (AMAC) of the Federal Capital Territory (FCT). Identifying factors influencing perinatal deaths in this setting would inform interventions on perinatal deaths reduction. We assessed perinatal mortality and its determinants in public secondary health facilities in AMAC. METHODS: delivery and neonatal data from two selected public secondary health facilities between 2013 and 2016 were reviewed and we extracted maternal socio-demographics, obstetrics and neonatal data from hospital delivery, newborns´ admissions and discharge registers. Data were analyzed using descriptive statistics and Cox proportional hazard models (α = 5%). RESULTS: perinatal mortality rate was 129.5 per 1000 births. Asphyxia 475 (34.0%), neonatal infection 279 (20.0%) and prematurity 242 (17.3%) accounted for majority of the 1,398 perinatal deaths. Unbooked status [aHR = 1.8 (95% CI 1.4 - 2.2)], antepartum haemorrhage [aHR = 2.8 (95% CI 1.2 - 6.7)], previous perinatal death [aHR = 2.3 (95% CI 1.7 - 3.1)] and maternal age ≥ 35 years [aHR= 1.4 (95% CI 1.0 - 1.8)] were associated with increased risk of perinatal death. CONCLUSION: perinatal mortality in the studied hospitals was high. Determinants of perinatal death were unbooked antenatal care (ANC) status, antepartum haemorrhage, previous perinatal death and high maternal age. Reducing perinatal deaths would require improving antenatal care attendance with healthcare staff identifying and targeting women at risk of pregnancy complications.

Uptake of intermittent preventive treatment for malaria in pregnancy among women in selected communities of Ebonyi State, Nigeria.

BACKGROUND: Malaria in pregnancy has adverse effects on maternal and child health. Intermittent preventive treatment (IPTp) with three doses of Sulfadoxine/Pyrimethamine is an effective preventive measure for malaria in pregnancy. However, 24.0% of women use this prophylactic regimen in Ebonyi State. Previous studies have focused on the level of uptake with less attention given to factors influencing uptake. Therefore, we examined the predictors of IPTp uptake in the last pregnancy among women in Ebonyi State, Nigeria. METHODS: This was a community-based cross-sectional study among 340 women of reproductive age selected using multistage sampling technique. A semi-structured interviewer administered questionnaire was used to collect data on socio-demographic characteristics of respondents, IPTp uptake and reasons for not taking IPTp. Adherence was judged adequate if three or more doses of IPTp were taken, otherwise inadequate. Data were analyzed using descriptive statistics, Chi- square test and logistic regression model at 5% level of significance. RESULTS: Mean age of respondents was 28.8 ± 5.2 years, 96.5% were married, 19.4% had tertiary education, and 11.2% were from polygamous family. Uptake of IPTp was 74.2%. The level of IPTp uptake was 12.5 and 41.0% among women with no formal and tertiary education respectively. A similar pattern of IPTp uptake was observed among women from monogamous (38.0%) and polygamous (39.5%) families. Women education, husband education and family type were associated with uptake of IPTp, however only husband education remained a predictor of uptake. Women whose husband had secondary education (aOR = 4.1, 95%CI: 1.66-10.06) and tertiary education (aOR = 4.8, 95%CI: 1.76-12.90) were more likely to have IPTp uptake than those whose husbands had below secondary education. CONCLUSION: Adequate IPTp uptake among women in their last pregnancy was below WHO recommendation. Intervention aimed at improving couple's education could facilitate increase in IPTp uptake in Ebonyi State.

Factors Associated with Safe Disposal Practices of Child's Faeces in Nigeria: Evidence from 2013 Nigeria Demographic and Health Survey.

BACKGROUND: Stool disposal practices have been shown to be associated with childhood diarrhea. There exist variations in explanatory variables of safe child's faecal disposal practices depending on the context of the study. Thus, the need for this study to assess factors associated with safe disposal practices of children's faeces in Nigeria. METHODS: This study utilized the 2013 Nigeria Demographic and Health Survey data. Child's faecal disposal practice was classified as safe and unsafe as defined by the World Health Organization/UNICEF Joint Monitoring Program. Binary and multivariate logistic regression models were used to identify factors associated with safe faecal disposal practices. The analysis was restricted to a weighted sample of 19, 288 youngest children in the households. RESULTS: Overall, the prevalence of safe disposal of child's faeces was 59.4%. Safe child's faeces disposal was the highest among older women (64.4%), highly educated women and their husbands (67.1%) and (66.4%), respectively; among rich households (72.3%), Muslim (68.7%), urban areas (68.8%), and in North West zone (78.4%). In multivariate analysis, safe faecal disposal was significantly associated with the age of mother, maternal education level, wealth index, religion, source of water, and type of toilet facility. Marital status, geopolitical zone, having diarrhea in the past 2 weeks before the survey and sex of the child were not significant determinants of safe faecal disposal practice. CONCLUSION: Understanding the prevailing faecal disposal practices is a prerequisite to the formulation of effective intervention strategies. It is pertinent, therefore, that programs and interventions designed to improve safe child's faecal disposal practices need to take into consideration the factors identified in this study.

Healthcare-associated infections and compliance of hand hygiene among healthcare workers in a tertiary health facility, southwest Nigeria.

INTRODUCTION: Healthcare-associated infections (HAIs) are threats in healthcare settings contributing to increased morbidity, mortality and antimicrobial resistance worldwide. Hand hygiene (HH) is the simplest and most important single intervention to reduce HAIs. AIMS/OBJECTIVES: This study sought to determine rates of HAIs as well as compliance of HH among healthcare workers (HCWs) in Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC). METHODS: A cross-sectional study was conducted among 227 HCWs (59 doctors, 129 nurses and 39 ward attendants) selected by multistage sampling across 10 hospital wards. Electronic interviewer-administered questionnaire, HH compliance checklist and point prevalence of HAI were done using World Health Organization and Centers for Disease Control and Prevention toolkits, respectively. RESULTS: Only 20.33% (n = 12) of doctors, 3.88% (n = 5) of nurses and 2.56% (n = 1) of ward attendants had good knowledge of HH (χ2 = 22.22, P value = 0.01). Among doctors, 11.86% (n = 7), 6.98% (n = 9) of nurses and 2.56% (n = 1) of ward attendants had positive perception towards HH (χ2 = 7.87, P value = 0.25). Of the 174 opportunities for HH observed, compliance rates were 42.37%, 55.81% and 68.97% among doctors, nurses and ward attendants, respectively. Point prevalence of HAI was 16.38%. DISCUSSION: Good knowledge and positive perception about HH were uncommon among doctors, nurses and ward attendants. However, ward attendants had the highest compliance to HH. There was a high prevalence of HAIs in this institution.

Predictors of delayed Antenatal Care (ANC) visits in Nigeria: secondary analysis of 2013 Nigeria Demographic and Health Survey (NDHS).

INTRODUCTION: Antenatal Care (ANC) is an important component of maternal health and covers a wide range of activities with huge potential benefits for positive pregnancy out comes. However, large proportions of women do initiate ANC early resulting in adverse consequences. METHODS: The study utilized the nationally-representative sample of women of reproductive age interviewed during the 2013 Nigeria DHS. Analysis was restricted to 20, 467 women aged 15-49 years who had a live birth in the five-year period prior to the survey. Multinomial logistic regression was performed using Stata v13 to determine significant factors related to timing of initiation of ANC. Relative risk ratio (RRR) was used to assess the strength of association between independent and dependent variables. RESULTS: Overall, 27%, 62% and 12% of women initiated ANC in the first, second and third trimesters respectively. In both the two model, the findings reveal that maternal education, level of media exposure, region and place of residence are the uniform predictors of initiation of ANC; having health insurance is a significant predictor of third trimester ANC initiation relative to first to first trimester only. Within the categories of household wealth, levels of participation in household decision-making and region some categories are significant predictors while others are not. CONCLUSION: Maternal education, level of media exposure, region and place of residence are the uniform and consistent predictors of delay in ANC initiation. This suggests that girl-child education, universal health coverage and universal health insurance could be the interventions required to improve service utilization and maternal health.

PATTERN AND OUTCOME OF TETANUS IN A TERTIARY HEALTH FACILITY IN NORTH WEST NIGERIA.

BACKGROUND: Tetanus, a disease that is largely preventable, is still a major public health problem in the developing world and is associated with high morbidity and mortality. There is a paucity of published literature on adult (non-neonatal) tetanus in this study area in Nigeria. METHODS: This was a study describing the clinical characteristics of patients who were clinically diagnosed with tetanus in Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, northwest of Nigeria between January 2001 and December 2014. RESULTS: A total of 91 cases were reviewed. The mean patient age was 20 years, and male to female ratio 2.9:1. The majority (88%) of patients were < 40 years old. The mean onset period was 19 days, nearly all patients (96.7%) had generalized tetanus, and the commonest presenting signs were spasm (93.4%) and trimus (78.0%). The most common site of injury was lower limbs (64.8% of cases). The complication rate was 71.4% and case fatality was 48.4%. CONCLUSION: Tetanus is still a major public health problem in our setting and affects the younger age group with a high case fatality rate. The incidence of tetanus can be reduced drastically by an effective and sustained immunization program.

Determinants of antenatal care, institutional delivery and postnatal care services utilization in Nigeria.

INTRODUCTION: Utilization of antenatal care, institutional delivery and postnatal care services in Nigeria are poor even by african average. METHODS: We analysed the 2013 Nigeria DHS to determine factors associated with utilization of these health MCH indicators by employing both bivariate and multivariate logistic regressions. RESULTS: Overall, 54% of women had at least four ANC visits, 37% delivered in health facility and 29% of new born had postnatal care within two of births. Factors that consistently predict the utilization of the three MCH services are maternal and husband's level education, place of residence, wealth level and parity. Antenatal care strongly predicts both health facility delivery (OR = 2.16, 95%CI: 1.99-2.34) and postnatal care utilization (OR = 4.67, 95%CI: 3.95-5.54); while health facility delivery equally predicting postnatal care (OR = 2.84, 95%CI: 2.20-2.80). CONCLUSION: Improving utilization of these three MCH indicators will require targeting women in the rural areas and those with low level of education as well as creating demand for health facility delivery. Improving ANC use by making it available and accessible will have a multiplier effect of improving facility delivery which will lead to improved postnatal care utilization.

Utilization of non-skilled birth attendants in northern Nigeria: a rough terrain to the health-related MDGs.

Non-skilled birth attendants (NSBAs) are likely to deliver low quality maternity care compared with skilled health workers. A total of 6,809 women (15-49 years) were interviewed in a survey of which 5,091 had delivery information. Among women with a last live birth delivered anytime within the five years prior to the survey, 89% had been assisted by NSBAs. Compared to older women (35+), middle-aged women (20-34 years) were 21% more likely to be assisted by NSBAs. For women < or =20 years, the odds of being assisted by NSBAs more than doubled (AOR=2.14) when compared with older women. Residents of Yobe State were 42% more likely to be assisted by NSBA compared with residents of Katsina State. Key interventions should focus on strengthening health services delivery, radio messages and other communication channels to encourage supervised deliveries and intensifying provision of formal education to enable women better understand information given.

Utilization of non-skilled birth attendants in Northern Nigeria: a rough terrain to the health-related MDGs

Non-skilled birth attendants (NSBAs) are likely to deliver low quality maternity care compared with skilled health workers. A total of 6,809 women (15-49 years) were interviewed in a survey of which 5,091 had delivery information. Among women with a last live birth delivered anytime within the five years prior to the survey, 89% had been assisted by NSBAs. Compared to older women (35+), middle-aged women (20­34 years) were 21% more likely to be assisted by NSBAs. For women ≤20 years, the odds of being assisted by NSBAs more than doubled (AOR=2.14) when compared with older women. Residents of Yobe State were 42% more likely to be assisted by NSBA compared with residents of Katsina State. Key interventions should focus on strengthening health services delivery, radio messages and other communication channels to encourage supervised deliveries and intensifying provision of formal education to enable women better understand information given (Afr. J. Reprod. Health 2010; 14[2]: 37-45)

P - value, a true test of statistical significance? A cautionary note.

While it's not the intention of the founders of significance testing and hypothesis testing to have the two ideas intertwined as if they are complementary, the inconvenient marriage of the two practices into one coherent, convenient, incontrovertible and misinterpreted practice has dotted our standard statistics textbooks and medical journals. This paper examine factors contributing to this practice, traced the historical evolution of the Fisherian and Neyman-Pearsonian schools of hypothesis testing, exposed the fallacies and the uncommon ground and common grounds approach to the problem. Finally, it offers recommendations on what is to be done to remedy the situation.