A multilevel Bayesian Markov Chain Monte Carlo Poisson modelling of factors associated with components of antenatal care offered to pregnant women in Nigeria.

BACKGROUND: The most recent WHO guideline on antenatal care (ANC) utilization reaffirmed the necessary and compulsory care and services a pregnant woman should receive to maximize the importance and gains of ANC. While most studies focused on the time of initiation and number of ANC contacts, emphasis was rarely placed on the components of ANC offered to women. This study assessed how complete the components of ANC received by pregnant women are as a proxy for the quality of ANC services offered in Nigeria. We also assessed the clustering of the components and state-level differentials and inequalities in the components of ANC received in Nigeria. METHODS: We used nationally representative cross-sectional data from the 2018 Nigeria Demographic Health Survey. We analysed the data of 11,867 women who had at least one ANC contact during the most recent pregnancy within five years preceding the survey. The assessed components were tetanus injection, blood pressure, urine test, blood test, iron supplement, malaria intermittent preventive treatment in pregnancy (IPTp), and told about danger signs. Others are intestinal parasite drugs (IPD)intermittent and HIV/PMTCT counsel. Descriptive statistics, bivariable and multivariable multilevel Bayesian Monte Carlo Poisson models were used. RESULTS: In all, 94% had blood pressure measured, 91% received tetanus injection, had iron supplement-89%, blood test-87%, urine test-86%, IPTp-24%, danger signs-80%, HIV/PMTC-82% and IPD-22%. The overall prevalence of receiving all 9 components was 5% and highest in Ogun (24%) and lowest in Kebbi state (0.1%). The earlier the initiation of ANC, the higher the number of contacts, and the higher the quality of ANC received. Respondents with higher education have a 4% (adjusted incidence risk ratio (aIRR): 1.04, 95% credible interval (CrI): 1.01-1.09) higher risk of receiving more components of ANC relative to those with no education. The risk of receiving more ANC components was 5% (aIRRR: 1.05, 95% CI: 1.01-1.10) higher among pregnant women aged 40 to 49 years than those aged 15 to 19 years. Women who decide their healthcare utilization alone had a 2% higher risk of getting more components than those whose spouses are the only decision taker of healthcare use. Other significant factors were household wealth status, spouse education, ethnicity, place of ANC, and skill of ANC provider. Pregnant women who had their blood pressure measured were very likely to have blood and urine tests, tetanus injections, iron supplements, and HIV talks. CONCLUSIONS: Only one in every 20 pregnant women received all the 9 ANC components with wide disparities and inequalities across the background characteristics and the States of residence in Nigeria. There is a need to ensure that all pregnant women receive adequate components. Stakeholders should increase supplies, train, and create awareness among ANC providers and pregnant women in particular.

Timing of first antenatal care contact, its associated factors and state-level analysis in Nigeria: a cross-sectional assessment of compliance with the WHO guidelines.

OBJECTIVES: To assess the compliance of WHO guidelines on the timeliness of antenatal care (ANC) initiation in Nigeria and its associated factors and to provide subcountry analysis of disparities in the timing of the first ANC in Nigeria. DESIGN: Cross-sectional. SETTING: Nationally representative data of most recent pregnancies between 2013 and 2018 in Nigeria. PARTICIPANTS: Women with pregnancies within 5 years before the study. PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome variable was the trimesters of the first ANC contact. Data were analysed using descriptive statistics, bivariable and multivariable multinomial logistic regression at 5% significance level. RESULTS: Of all the 21 785 respondents, 75% had at least one ANC contact during their most recent pregnancies within the five years preceding the data collection. Among which 24% and 63% started in the first and second trimester, respectively. The proportion who started ANC in the first trimester was highest in Benue (44.5%), Lagos (41.4%) and Nasarawa (39.3%) and lowest in Zamfara (7.6%), Kano (7.4%) and Sokoto (4.8%). Respondents aged 40-49 years were 65% (adjusted relative risk ratio (aRRR: 1.65, 95 % CI: 1.10 to 2.45) more likely to initiate ANC during the first trimester of pregnancy relative to those aged 15-19 years. Although insignificant, women who participate in their healthcare utilisation were 4% (aRRR: 1.04, 95 % CI: 0.90 to 1.20) times more likely to have early initiation of ANC. Other significant factors were respondents' and spousal educational attainment, household wealth quintiles, region of residence, ethnicity, religion and birth order. CONCLUSIONS: Only a quarter of pregnant women, initiated ANC contact during the first trimester with wider disparities across the states in Nigeria and across the background characteristics of the pregnant women. There are needs to enhance women's autonomy in healthcare utilisation. Concerted efforts on awareness creation and empowerment for women by all stakeholders in maternal and child healthcare are antidotes for early ANC contact initiation.

Exploring the socio-economic determinants of educational inequalities in diarrhoea among under-five children in low- and middle-income countries: a Fairlie decomposition analysis.

BACKGROUND: What explains the underlying causes of educational inequalities in diarrhoea among under-five children in low- and middle-income countries (LMIC) is poorly exploited, operationalized, studied and understood. This paper aims to assess the magnitude of educational-related inequalities in the development of diarrhoea and decompose risk factors that contribute to these inequalities among under-five children (U5C) in LMIC. METHODS: Secondary data of 796,150 U5C from 63,378 neighbourhoods in 57 LMIC was pooled from the Demographic and Health Surveys (DHS) conducted between 2010 and 2019. The main determinate variable in this decomposition study was mothers' literacy levels. Descriptive and inferential statistics comprising of bivariable analysis and binary logistic multivariable Fairlie decomposition techniques were employed at p = 0.05. RESULTS: Of the 57 countries, we found a statistically significant pro-illiterate odds ratio in 6 countries, 14 showed pro-literate inequality while the remaining 37 countries had no statistically significant educational-related inequality. The countries with pro-illiterate inequalities are Burundi (OR = 1.11; 95% CI: 1.01-1.21), Cameroon (OR = 1.84; 95% CI: 1.66-2.05), Egypt (OR = 1.26; 95% CI: 1.12-1.43), Ghana (OR = 1.24; 95% CI: 1.06-1.47), Nigeria (OR = 1.80; 95% CI: 1.68-1.93), and Togo (OR = 1.21; 95% CI: 1.06-1.38). Although there are variations in factors that contribute to pro-illiterate inequality across the 6 countries, the overall largest contributors to the inequality are household wealth status, maternal age, neighbourhood SES, birth order, toilet type, birth interval and place of residence. The widest pro-illiterate risk difference (RD) was in Cameroon (118.44/1000) while the pro-literate risk difference was widest in Albania (- 61.90/1000). CONCLUSIONS: The study identified educational inequalities in the prevalence of diarrhoea in children with wide variations in magnitude and contributions of the risk factors to pro-illiterate inequalities. This suggests that diarrhoea prevention strategies is a must in the pro-illiterate inequality countries and should be extended to educated mothers as well, especially in the pro-educated countries. There is a need for further studies to examine the contributions of structural and compositional factors associated with pro-educated inequalities in the prevalence of diarrhoea among U5C in LMIC.