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Importance: In 2019, Nigeria had the largest number of under-5 child deaths globally and many of these deaths occurred within the first week of life. The World Health Organization recommends infant postnatal care (PNC) attendance to support newborn survival; however, utilization of PNC is known to be low in many contexts. Objective: This study examined coverage and individual-level determinants of infant PNC attendance in Nigeria. Methods: Nigeria Demographic Health Survey (NDHS) 2018 data were used to evaluate infant PNC coverage and determinants. Infant PNC was defined as receipt of care within 2 days of birth. Children delivered up to 2 years before the 2018 NDHS were included. We examined predictors of infant PNC with modified Poisson regression models to estimate relative risks (RRs). Results: The national coverage of infant PNC was 37.3% (95% confidence interval [CI]: 35.8%-38.7%). Significant heterogeneity in PNC attendance existed at state and regional levels. Facility delivery was strongly associated with the uptake of PNC (RR: 6.07; 95% CI: 5.60-6.58). Greater maternal education, maternal employment, urban residence, female head of household, and greater wealth were also associated with an increased likelihood of PNC visits. Interpretation: The uptake of infant PNC is low and interventions are urgently needed to promote equity in access and increase demand for PNC in Nigeria.
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Given the disproportionate burden of childhood diarrhea deaths in Nigeria, this study assessed the prevalence and predictors of the disease and the uptake of ORS and zinc supplementation as treatments in a population-based national survey. Cross-sectional data from the 2018 Nigeria Demographic Health Survey were used. A log-Poisson regression was used to estimate the relative risks (RR) for the individual-level predictors of childhood diarrhea and the uptake of ORS and zinc treatments. A total of 30,713 children under 5 years of age were included in the survey. The period prevalence of reported diarrhea in the last two weeks was 12.9% (95% CI: 12.5%, 13.3%). Among the children with diarrhea, the proportion who received ORS was 39.7% (95% CI: 38.2%, 41.3%), while 29.1% of them received zinc supplements (95% CI: 27.7%, 30.5%), and 21.8% of them received both the ORS and zinc treatments as recommended. Children under 6 months of age with diarrhea had a significantly lower likelihood of being given ORS or zinc when they were compared to the older children. The institutional delivery of them, maternal employment, and improved water sources were also independent predictors of the uptake of ORS and zinc treatments for diarrhea (p-values < 0.05). Interventions to prevent childhood diarrhea and improve the coverage of ORS and zinc treatments may reduce the large burden of childhood diarrhea deaths in Nigeria.
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Background: Adolescents living with HIV (ALHIV) have had worse outcomes compared to adults. They face enormous difficulty in accessing HIV care services. We hypothesize that conditional economic incentives (CEI) and motivational interviewing could increase retention in care, medication adherence and ultimately viral load suppression. Therefore, we evaluated the one-year impact of conditional economic incentives and motivational interviewing on the health outcomes of ALHIV in Anambra State, Nigeria. Methods: Using a cluster-randomised design, we examined the one-year (from December 1, 2018, to November 30, 2019), individual-level impact of an Incentive Scheme comprising conditional economic incentives and motivational interviewing on achieving undetectable viral load (primary outcome), CD4+ count, adherence to antiretroviral therapy and retention in care (secondary outcomes) by ALHIV in Anambra State, Nigeria. Twelve HIV treatment hospitals were stratified according to the type of clinic (secondary or tertiary) and randomly assigned to the intervention arm or control arm to receive the Incentive Scheme or routine care, respectively. ALHIV aged 10-19 years, initiated into HIV care for a minimum of 6 months, and who adhered poorly to medications (<100% adherence rate) were eligible for the study. Participants in the intervention arm received motivational interviewing at the study baseline and every visit. They also received US$5.6 when HIV viral load (VL) was <20 copies/mL at month 3, US$2.8 if the VL remained suppressed at months 6 and 9, and US$5.6 if the VL remained <20 copies/mL at month 12. Results: Of the 246 trial participants, 119 were in the intervention while 127 were in the control arm. There was no difference in the baseline characteristics of the participants between the intervention and control arm except for the number of participants with undetectable viral load and the number of participants with ≥95% adherence. Although participants in the intervention arm had a 10.1% increase while those in the control arm had a 1.6% decrease in proportion with undetectable viral load (≤20 copies/ml) after 12 months, the change in the primary outcome was not statistically significant. Similarly, the differences in the secondary outcomes were not statistically significant. Conclusion: The Incentive Scheme did not improve the virologic outcome of ALHIV after 12 months. Differences in the secondary outcomes after 12 months were also not significantly different from the baseline. Trial registration: We registered the trial retrospectively with The Pan African Clinical Trials Registry: https://pactr.samrc.ac.za/(PACTR201806003040425) on 2/2/2018.
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Background: Information on the determinants of ill-health among elderly, if available, would certainly provide a useful guide to policy makers in their plan for appropriate interventions for this subgroup of the population. This study therefore assessed ill-health status and its associated factors among the elderly in Osun State Nigeria. Methodology: The study design was a descriptive cross-section involving 491 elderly drawn from a simple random sample of five local government areas LGAs in Osun State Nigeria, in 2017. Self-reported illness (es) two weeks before the survey was taken as measure of ill-health among the elderly. Bivariate and multivariate statistical methods were used for data analysis, p< 0.05 was reckoned statistically significant. Results: Overall, 228 (46.4%) reported one health issue or the other two weeks before the survey. Regular source of income [OR=0.63, 95% CI=0.43, 0.95], ever smoked [OR=2.35, 95% CI=1.31, 4.21] and having any source of worry [OR=2.52, 95% CI=1.68, 3.79] were significantly associated with self-reported ill-health among elderly. Whereas, having regular source of income, engaging in physical exercise, and being satisfied with residential status were all found to be protective against illnesses by crude statistical analysis, only having a source of regular income had independent protective association against illness. Conclusions: Prevalence of ill-health among elderly was considerably high. Factors significantly associated with ill-health include not having a regular source of income, ever smoked, and having any source of worry. Financial empowerment schemes and health education for elderly on harmful effect of smoking and excessive worrying on their health are hereby recommended.
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It is a known fact that Randomized Controlled Trials (RCTs) are the gold standard design methods in medical investigations particularly when the aim is comparison of medical therapies or effectiveness of intervention between treatment groups. This design method, once carefully followed, presents the highest level of evidence attainable in the measurement of treatment effect. Oftentimes, researchers confuse concepts related to the design of RCTs and thereby jeopardizing its benefits. Furthermore, in resource-poor settings, a very limited access to educational materials on design, conduct, and reporting of clinical trials exists. This among other reasons explains why most studies in such settings are observational in nature as RCTs are not as popular. This review adopted a narrative synthesis approach to aggregate current knowledge scattered in literatures in respect of selected common design concepts in RCTs so as to elucidate on their meaning and demands. Overall, 25 literatures drawn majorly from the PubMed database including 8 textbook materials were involved in examining the following concepts; Study Population in RCTs Setting, Primary and Secondary Outcome Measures, Single and Multicenter Trials, Pragmatic and Explanatory trials, and Blinding. Appropriate search terms for each of the concepts were entered into the PubMed database and relevant articles accessed. This review article, intended for educational purposes could also serve as a guide, especially for new entrants, in the design of RCTs. It is hoped that this educational material would contribute immensely toward maximizing the benefits of this all-important design method.
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PURPOSE: An allocation strategy that allows for chance placement of participants to study groups is crucial to the experimental nature of randomised controlled trials. Following decades of the discovery of randomisation considerable erroneous opinion and misrepresentations of its concept both in principle and practice still exists. In some circles, opinions are also divided on the strength and weaknesses of each of the random allocation strategies. This review provides an update on various random allocation techniques so as to correct existing misconceptions on this all important procedure. METHODS: This is a review of literatures published in the Pubmed database on concepts of common allocation techniques used in controlled clinical trials. RESULTS: Allocation methods that use; case record number, date of birth, date of presentation, haphazard or alternating assignment are non-random allocation techniques and should not be confused as random methods. Four main random allocation techniques were identified. Minimisation procedure though not fully a random technique, however, proffers solution to the limitations of stratification at balancing for multiple prognostic factors, as the procedure makes treatment groups similar in several important features even in small sample trials. CONCLUSIONS: Even though generation of allocation sequence by simple randomisation procedure is easily facilitated, a major drawback of the technique is that treatment groups can by chance end up being dissimilar both in size and composition of prognostic factors. More complex allocation techniques that yield more comparable treatment groups also have certain drawbacks. However, it is important that whichever allocation technique is employed, unpredictability of random assignment should not be compromised.
