Coverage-level and predictors of maternity continuum of care in Nigeria: implications for maternal, newborn and child health programming.

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.

COVID-19 surveillance in Democratic Republic of Congo, Nigeria, Senegal and Uganda: strengths, weaknesses and key Lessons.

INTRODUCTION: As part of efforts to rapidly identify and care for individuals with COVID-19, trace and quarantine contacts, and monitor disease trends over time, most African countries implemented interventions to strengthen their existing disease surveillance systems. This research describes the strengths, weaknesses and lessons learnt from the COVID-19 surveillance strategies implemented in four African countries to inform the enhancement of surveillance systems for future epidemics on the continent. METHODS: The four countries namely the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda, were selected based on their variability in COVID-19 response and representation of Francophone and Anglophone countries. A mixed-methods observational study was conducted including desk review and key informant interviews, to document best practices, gaps, and innovations in surveillance at the national, sub-national, health facilities, and community levels, and these learnings were synthesized across the countries. RESULTS: Surveillance approaches across countries included - case investigation, contact tracing, community-based, laboratory-based sentinel, serological, telephone hotlines, and genomic sequencing surveillance. As the COVID-19 pandemic progressed, the health systems moved from aggressive testing and contact tracing to detect virus and triage individual contacts into quarantine and confirmed cases, isolation and clinical care. Surveillance, including case definitions, changed from contact tracing of all contacts of confirmed cases to only symptomatic contacts and travelers. All countries reported inadequate staffing, staff capacity gaps and lack of full integration of data sources. All four countries under study improved data management and surveillance capacity by training health workers and increasing resources for laboratories, but the disease burden was under-detected. Decentralizing surveillance to enable swifter implementation of targeted public health measures at the subnational level was a challenge. There were also gaps in genomic and postmortem surveillance including community level sero-prevalence studies, as well as digital technologies to provide more timely and accurate surveillance data. CONCLUSION: All the four countries demonstrated a prompt public health surveillance response and adopted similar approaches to surveillance with some adaptations as the pandemic progresses. There is need for investments to enhance surveillance approaches and systems including decentralizing surveillance to the subnational and community levels, strengthening capabilities for genomic surveillance and use of digital technologies, among others. Investing in health worker capacity, ensuring data quality and availability and improving ability to transmit surveillance data between and across multiple levels of the health care system is also critical. Countries need to take immediate action in strengthening their surveillance systems to better prepare for the next major disease outbreak and pandemic.

Spatio-temporal analysis of childhood vaccine uptake in Nigeria: a hierarchical Bayesian Zero-inflated Poisson approach.

BACKGROUND: Globally, child mortality and morbidity remain a serious health challenge and infectious diseases are the leading causes. The use of count models together with spatial analysis of the number of doses of childhood vaccines taken is limited in the literature. We used a Bayesian zero-inflated Poisson regression model with spatio-temporal components to assess the number of doses of childhood vaccines taken among children aged 12-23 months and their associated factors. METHODS: Data of 19,564 children from 2003, 2008, 2013 and 2018 population-based cross-sectional Nigeria Demographic and Health Survey were used. The childhood vaccines include one dose of Bacillus-Calmette-Guérin; three doses of Diphtheria-Pertussis-Tetanus; three doses of Polio and one dose of Measles. Uptake of all nine vaccines was regarded as full vaccination. We examined the multilevel factors associated with the number of doses of childhood vaccines taken using descriptive, bivariable and multivariable Bayesian models. Analysis was conducted in Stata version 16 and R statistical packages, and visualization in ArcGIS. RESULTS: The prevalence of full vaccination was 6.5% in 2003, 14.8% in 2008, 21.8% in 2013 and 23.3% in 2018. Full vaccination coverage ranged from 1.7% in Sokoto to 51.9% in Anambra. Factors associated with the number of doses of childhood vaccines taken include maternal age (adjusted Incidence "risk" Ratio (aIRR) = 1.05; 95% Credible Interval (CrI) = 1.03-1.07) for 25-34 years and (aIRR = 1.07; 95% CrI = 1.05-1.10) for 35-49 years and education: (aIRR = 1.11, 95% CrI = 1.09-1.14) for primary and (aIRR = 1.16; 95% CrI = 1.13-1.19) for secondary/tertiary education. Other significant factors are wealth status, antenatal care attendance, working status, use of skilled birth attendants, religion, mother's desire for the child, community poverty rate, community illiteracy, and community unemployment. CONCLUSION: Although full vaccination has remained low, there have been improvements over the years with wide disparities across the states. Improving the uptake of vaccines by educating women on the benefits of hospital delivery and vaccines through radio jingles and posters should be embraced, and state-specific efforts should be made to address inequality in access to routine vaccination in Nigeria.

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.

Preventable multiple high-risk birth behaviour and infant survival in Nigeria.

BACKGROUND: Globally, infant mortality has declined considerably but has remained unacceptably high in sub-Saharan Africa, especially Nigeria where infant mortality rate is 67/1000 live births. To facilitate infant mortality reduction in Nigeria, an understanding of the synergistic effect of bio-demographic characteristics of mothers known as High Risk Birth Behaviours (HrBBs) is important. We therefore investigated the influence of HrBBs on infant survival in Nigeria. METHODS: This cross-sectional study design utilized data from the 2018 round of Nigerian Demographic Health Survey. The study participants were a representative sample of women of reproductive age (n = 21,350) who had given birth within the 5 years preceding the survey. HrBBs was measured through integration of information on maternal age at child's birth, parity, and preceding birth interval with respect to the most recent child. The HrBBs was categorized as none, single and multiple. Data were analysed using descriptive statistics, Log-rank test and Cox proportional hazard model (α =0.05). RESULTS: The mean age of the women was 29.7 ± 7.2 and 4.1% had experienced infant death. Infant mortality was highest among women with multiple HrBBs (5.1%). Being a male, having small size at birth, failure to receive tetanus injection, non-use of contraceptives and living in the core-north (North West and North East) predisposed children to higher risk of dying before 12 months of age. The hazard ratio of infant mortality was significantly higher among infants of mothers in multiple HrBBs category (aHR = 1.66; CI: 1.33-2.06) compared to their counterparts with no HrBBs. CONCLUSION: Multiple HrBBs increase the chances of dying among infants in Nigeria. Screening women for HrBBs for special health attention during pregnancy, birth and postnatal period will alleviate infant death in Nigeria.

Patterns of diarrhoeal disease among under-five children in Plateau State, Nigeria, 2013-2017.

BACKGROUND: Diarrhoea is the second commonest cause of under-five mortality accounting for over half a million deaths annually. Although the prevalence of diarrhoea in Plateau State is lower than the national figure, the level remains high despite remarkable progress in the reduction of under-five mortality. This study seeks to determine the pattern of diarrhoea disease among under-fives in Plateau State. METHODS: We extracted data from the Integrated Disease Surveillance and Response platform between January 2013 and December 2017 and analysed the trends of diarrhoea, age-specific case fatality rate (ASCFR), and seasonal patterns. We modelled the quarterly pattern of diarrhoea cases using additive time series and predicted the expected cases for 2018-2020. RESULTS: We documented 60,935 cases of diarrhoea with age group 12-59 months having the highest number of cases (49.3%). The age group < 1 month had the highest ASCFR of 0.53%. Seasonal variation showed cases peaked in the first and third quarters of each year, except for the year 2016. The time series projection estimated 16,256, 17,645 and 19,034 cases in the year 2018, 2019 and 2020 respectively. CONCLUSION: Seasonal variation exists, and trends show an increased pattern of diarrhoeal disease among under-fives. There is a need to strengthen the implementation of diarrhoeal preventive and control strategy in the state and to improve the quality of data reporting.

The spread of COVID-19 outbreak in the first 120 days: a comparison between Nigeria and seven other countries.

BACKGROUND: COVID-19 is an emerging public health emergency of international concern. The trajectory of the global spread is worrisome, particularly in heavily populated countries such as Nigeria. The study objective was to assess and compare the pattern of COVID-19 spread in Nigeria and seven other countries during the first 120 days of the outbreak. METHODS: Data was extracted from the World Bank's website. A descriptive analysis was conducted as well as modelling of COVID-19 spread from day one through day 120 in Nigeria and seven other countries. Model fitting was conducted using linear, quadratic, cubic and exponential regression methods (α=0.05). RESULTS: The COVID-19 spread pattern in Nigeria was similar to the patterns in Egypt, Ghana and Cameroun. The daily death distribution in Nigeria was similar to those of six out of the seven countries considered. There was an increasing trend in the daily COVID-19 confirmed cases in Nigeria. During the lockdown, the growth rate in Nigeria was 5.85 (R2=0.728, p< 0.001); however, it was 8.42 (R2=0.625, p< 0.001) after the lockdown was relaxed. The cubic polynomial model (CPM) provided the best fit for predicting COVID-19 cumulative cases across all the countries investigated and there was a clear deviation from the exponential growth model. Using the CPM, the predicted number of cases in Nigeria at 3-month (30 September 2020) was 155,467 (95% CI:151,111-159,824, p< 0.001), all things being equal. CONCLUSIONS: Improvement in COVID-19 control measures and strict compliance with the COVID-19 recommended protocols are essential. A contingency plan is needed to provide care for the active cases in case the predicted target is attained.

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.

Spousal age difference and associated predictors of intimate partner violence in Nigeria.

BACKGROUND: The growth in Intimate Partner Violence (IPV) cases among couples in Nigeria has been significant in recent years. Victims, which are often females, face numerous health challenges, including early death. I examined the linkages between spousal age differences and IPV in Nigeria. METHOD: The couples recode data section of the 2013 Nigeria Demographic Health and Survey was used (n = 6765). Intimate partner violence was measured using 13-item questions. Data were analyzed using the logistic regression model (α = .05). RESULTS: The mean spousal age difference was 8.20 ± 5.0 years. About 23.5, 18.0, 13.5 and 4.7% of couples surveyed had experienced some form of IPV, emotional, physical and sexual violence respectively. Also, IPV prevalence was 27.0, 23.7, 22.0 and 18.7% among couples with age differences of 0-4, 5-9, 10-14 and ≥15 years respectively; this pattern was exhibited across all domains of IPV. Among women who experienced physical violence, 20.5% had only bruises, 8.0% had at least one case of eye injuries, sprains and/or dislocations, and 3.7% had either one or more cases of wounds, broken bones or broken teeth. The identified predictors of IPV were: family size, ethnicity, household wealth, education, number of marital unions and husband drinks alcohol. The unadjusted likelihood of IPV was 1.60 (C.I = 1.30-1.98, p < 0.001) and 1.35 (C.I = 1.10-1.64, p < 0.01) higher in households where the spousal age difference was 0-4 and 5-9 years respectively, than the likelihoods among those with a spousal age difference ≥ 15 years, but the strength of the association weakens when other variables were included in the model. CONCLUSION: The level of IPV was generally high in Nigeria, but it reduced with increasing spousal age difference. This study underscores the need for men to reach a certain level of maturity before marriage, as this is likely to reduce the level of IPV in Nigeria.

Sexual hazards, life experiences and social circumstances among male sex workers in Nigeria.

The sexual health and rights needs of male sex workers in Nigeria remain poorly understood and served. Men who sell sex are at high risk of discrimination and violation because of laws criminalising same-sex activity and sex work. This paper examines the experiences, social circumstances, vulnerabilities and sexual hazards experienced by male sex workers in Nigeria. In-depth interviews were used to explore the experiences of six male sex workers who were selected by means of convenience sampling from among those who came for counselling. Findings reveal that economic disadvantage drives some men to engage in sex work and risky sexual behaviour. Subsequently, sex work may put their lives and health at risk as a result of violation by the police and clients, including ritual murder. Men's extreme vulnerability points to the need for appropriate interventions to improve well-being. Sexual health and rights programmes must identify ways of making male sex workers less vulnerable to abuse, and devise strategies for protecting their health and human rights, while empowering them economically to reduce their dependency on often risky sexual behaviour for livelihoods.

Nigerian men and modern contraceptives: who are the non-users and what are their perceptions about family planning?

Introduction: the decision of men is pertinent to contraceptive uptake in a patriarchal society like Nigeria. Earlier studies on contraception in Nigeria have focused majorly on women. In this paper, we identified factors influencing contraceptive use, and non-users' perceptions about family planning among Nigerian men. Methods: using data from the 2018 Nigeria Demographic and Health Survey, this retrospective cross-sectional study focused on men aged 15-59 years. Three outcome variables were analysed: modern contraceptive use categorised as non-users or users; perception about contraception captured using two statements- "contraception is woman's business"; "women who use contraception may become promiscuous". Data were analyzed using multivariable logit model with robust standard errors (α= 0.05). Results: mean age of the men was 37.3 years (SD=10.2). Out of 9622 study participants, 71.0% do not use any modern contraceptive method; 19.9% believed that contraception is woman's business while 38.1% believed that women who used contraceptives may become promiscuous. Significant predictors of non-use of contraceptives and perceptions about family planning were older age, low education, Islamic religion, exposure to family planning messages, desire for more children and residence in Northern part of Nigeria. Conclusion: large proportion of contraceptive non-users had negative perceptions. Educational intervention and advocacy among Nigerian men are essential to increase contraceptive uptake.

Regional differences in the utilisation of antenatal care and skilled birth attendant services during the COVID-19 pandemic in Nigeria: an interrupted time series analysis.

INTRODUCTION: The COVID-19 pandemic has had a substantial negative impact on the utilisation of essential health services (EHS) globally, especially in resource-limited settings such as Nigeria. High maternal deaths associated with low access to and utilisation of EHS such as antenatal care (ANC) and skilled birth attendants (SBAs) remain a concern during the COVID-19 era. The study assessed the COVID-19 pandemic effects on ANC and SBA utilisation across regions in Nigeria. METHODS: Monthly data on ANC and SBA between January 2017 and July 2021 were obtained from the Federal Ministry of Health database. An interrupted time-series analysis, implemented using the Prophet model, was conducted to compare the regional variation of outcomes during the COVID-19 pandemic. Average percentage changes (PC) between the observed and predicted outcomes including their 95% CI were reported. RESULTS: From March 2020 to July 2021, the number of ANC visits was significantly lower than expected by a 16%-43% change in five of the six regions in Nigeria. The highest significant reduction was in North-West (PC=-43.4; 95% CI: -52.6 to -34.1) and the least in South-West (PC=-15.5; 95% CI: -24.8 to -6.1), with no significant change in the South-East. The number of deliveries by SBA was significantly lower than expected by a 18%-43% change in all the regions (p<0.01). North-East (PC=-43.3; 95% CI: -51.7 to -34.9) and South-West (PC=-18.3; 95% CI: -25.2 to -11.5), respectively, had the highest and the least decline in SBA utilisation. Overall, ANC and SBA patterns of change were relatively similar across the north-south divide though the change effect was considerably pronounced in the north. CONCLUSION: There was a substantial reduction in ANC and SBA utilisation due to the COVID-19 pandemic in Nigeria, especially in the northern regions. Targeted and contextually relevant interventions should be implemented to alleviate the impact of emergency response on access to EHS and promote access to care during the pandemic.

What made primary health care resilient against COVID-19? A mixed-methods positive deviance study in Nigeria.

INTRODUCTION: The SARS-CoV-2 (COVID-19) pandemic overwhelmed some primary health care (PHC) systems, while others adapted and recovered. In Nigeria, large, within-state variations existed in the ability to maintain PHC service volumes. Identifying characteristics of high-performing local government areas (LGAs) can improve understanding of subnational health systems resilience. METHODS: Employing a sequential explanatory mixed-methods design, we quantitatively identified 'positive deviant' LGAs based on their speed of recovery of outpatient and antenatal care services to prepandemic levels using service volume data from Nigeria's health management information system and matched them to comparators with similar baseline characteristics and slower recoveries. 70 semistructured interviews were conducted with LGA officials, facility officers and community leaders in sampled LGAs to analyse comparisons based on Kruk's resilience framework. RESULTS: A total of 57 LGAs were identified as positive deviants out of 490 eligible LGAs that experienced a temporary decrease in PHC-level outpatient and antenatal care service volumes. Positive deviants had an average of 8.6% higher outpatient service volume than expected, and comparators had 27.1% lower outpatient volume than expected after the initial disruption to services. Informants in 12 positive deviants described health systems that were more integrated, aware and self-regulating than comparator LGAs. Positive deviants were more likely to employ demand-side adaptations, whereas comparators primarily focused on supply-side adaptations. Barriers included long-standing financing and PHC workforce gaps. CONCLUSION: Sufficient flexible financing, adequate PHC staffing and local leadership enabled health systems to recover service volumes during COVID-19. Resilient PHC requires simultaneous attention to bottom-up and top-down capabilities connected by strong leadership.

Consequences of school closures due to COVID-19 in DRC, Nigeria, Senegal, and Uganda.

In 2020 and 2021, Governments across the globe instituted school closures to reduce social interaction and interrupt COVID-19 transmission. We examined the consequences of school closures due to COVID-19 across four sub-Saharan African countries: the Democratic Republic of Congo (DRC), Nigeria, Senegal, and Uganda. We conducted a qualitative study among key informants including policymakers, school heads, students, parents, civil society representatives, and local leaders. The assessment of the consequences of school closures was informed by the Diffusion of Innovations theory which informed the interview guide and analysis. Interview transcripts were thematically analysed. Across the four countries, schools were totally closed for 120 weeks and partially closed for 48 weeks. School closures led to: i) Desirable and anticipated consequences: enhanced adoption of online platforms and mass media for learning and increased involvement of parents in their children's education. ii) Desirable and unanticipated consequences: improvement in information, communication, and technology (ICT) infrastructure in schools, development and improvement of computer skills, and created an opportunity to take leave from hectic schedules. iii) Undesirable anticipated consequences: inadequate education continuity among students, an adjustment in academic schedules and programmes, and disrupted student progress and grades. iv) Undesirable unanticipated: increase in sexual violence including engaging in transactional sex, a rise in teenage pregnancy, and school dropouts, demotivation of teachers due to reduced incomes, and reduced school revenues. v) Neutral consequences: engagement in revenue-generating activities, increased access to phones and computers among learners, and promoted less structured learning. The consequences of school closures for COVID-19 control were largely negative with the potential for both short-term and far-reaching longer-term consequences. In future pandemics, careful consideration of the type and duration of education closure measures and examination of their potential consequences in the short and long term is important before deploying them.

Decomposition of factors associated with housing material inequality in under-five deaths in low and middle-income countries.

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.

Factors Influencing Satisfaction with Service Delivery Among National Health Insurance Scheme Enrollees in Ibadan, Southwest Nigeria.

Perceived quality of care is a determinant of uptake of health services. This study aimed to assess the determinants of quality of care of enrollees in the National Health Insurance Scheme (NHIS) in Nigeria. The outcome was satisfaction with health care services, which was used as a proxy for quality. Findings will assist in the intervention to enhance enrollment in the scheme and for universal health coverage attainment. This was a descriptive cross-sectional study conducted among enrollees in selected NHIS facilities in Ibadan, Nigeria. Data on satisfaction with health care were collected among selected 432 enrollees with the aid of an adapted semi-structured WHO-USAID interviewer-administered questionnaire. Data were analyzed using chi-square and multiple logistic regression models (α = 0.05). Among predictors of satisfaction with health services were younger age (OR = 1.85, 95% CI = 1.05-3.25, p = .024), working in the private sector (OR = 1.84, 95% CI = 1.03-3.28, p = .022), and seeking information about quality of services prior enrollment (OR = 1.63, 95% CI = 1.04-2.53, p = .013). Targeted intervention based on the findings of this study should be implemented to improve satisfaction with the services offered.

Ethnicity as a cultural factor influencing complete vaccination among children aged 12-23 months in Nigeria.

Achieving complete vaccination for children has been challenging in Nigeria. Yet, addressing Nigeria's completeness of vaccination requires ethno-cultural diversity consideration rather than nationally population based. This study explored patterns and determinants of complete vaccination among children of Hausa/Fulani, Igbo and Yoruba, the predominant ethnicities in Nigeria. The study used a cross-sectional data involving 3980 children aged 12-23 months extracted from the 2018 Nigeria Demographic and Health Survey dataset. In this study, complete vaccination is defined as a child who received all recommended vaccinations. A generalized linear mixed model applied to clustered data was used for data analysis (α = 0.05). The prevalence of complete vaccinations was 56.3%, 40.8% and 18.2% among Igbo, Yoruba and Hausa/Fulani children, respectively. The likelihood of complete vaccination was higher among children who were of Igbo (aOR = 1.38; CI: 1.20-1.59) compared with Hausa/Fulani. Predictors of complete vaccination were maternal age-at-childbirth, education, prenatal-care attendant and place of delivery among Hausa/Fulani; place of residence and perceived access to self-medical help, among Igbo; while prenatal-care attendance, among Yoruba. The odds of complete vaccination were higher among Hausa/Fulani (aOR = 1.65; CI: 1.04-2.61), Igbo (aOR = 2.55; CI: 1.20-5.44) and Yoruba (aOR = 4.22; CI: 1.27-13.96) children from higher wealth-quintile households compared to those from poor households. There was evidence of variability in the likelihood of complete vaccination in all the ethnic groups. The Hausa/Fulani tribe had the lowest complete vaccination coverage for children aged 12-23 months. Context-specific program intervention to improve complete vaccination is needed to ensure that the SDG target for vaccination is met.

Situation assessment and natural dynamics of COVID-19 pandemic in Nigeria, 31 May 2020.

BACKGROUND: The coronavirus disease (COVID-19) remains a global public health issue due to its high transmission and case fatality rate. There is apprehension on how to curb the spread and mitigate the socio-economic impacts of the pandemic, but timely and reliable daily confirmed cases' estimates are pertinent to the pandemic's containment. This study therefore conducted a situation assessment and applied simple predictive models to explore COVID-19 progression in Nigeria as at 31 May 2020. METHODS: Data used for this study were extracted from the websites of the European Centre for Disease Control (World Bank data) and Nigeria Centre for Disease Control. Besides descriptive statistics, four predictive models were fitted to investigate the pandemic natural dynamics. RESULTS: The case fatality rate of COVID-19 was 2.8%. A higher number of confirmed cases of COVID-19 was reported daily after the relaxation of lockdown than before and during lockdown. Of the 36 states in Nigeria, including the Federal Capital Territory, 35 have been affected with COVID-19. Most active cases were in Lagos (n = 4064; 59.2%), followed by Kano (n = 669; 9.2%). The percentage of COVID-19 recovery in Nigeria (29.5%) was lower compared to South Africa (50.3%), but higher compared to Kenya (24.1%). The cubic polynomial model had the best fit. The projected value for COVID-19 cumulative cases for 30 June 2020 in Nigeria was 27,993 (95% C.I: 27,001-28,986). CONCLUSION: The daily confirmed cases of COVID-19 are increasing in Nigeria. Increasing testing capacity for the disease may further reveal more confirmed cases. As observed in this study, the cubic polynomial model currently offers a better prediction of the future COVID-19 cases in Nigeria.

Association between household environmental conditions and nutritional status of women of childbearing age in Nigeria.

Maternal undernutrition remains a leading cause of morbidity and mortality in Nigeria. Yet, most interventional programmes are focused on infant and child nutrition outcomes and not on maternal nutrition-related outcomes. Evidence suggests that the integration of household environmental interventions into nutrition actions can make a difference in reducing the burden of maternal undernutrition. This study examined the influence of household environmental conditions (HHEC) on the nutritional status of women of childbearing age in Nigeria using secondary data from the 2013 Nigeria Demographic and Health Survey. The original sample of 38,948 women age 15-49 years was selected using multi-stage probability sampling. The sample for the current analysis was 23,344 after exclusion of women due to health status or provision of incomplete information. The dependent and main independent variables were undernutrition (defined as Body Mass Index below 18.5) and HHEC (generated from cooking fuel, toilet type, source of drinking water, and housing materials) respectively. Data were analysed using descriptive statistics, Chi-square, and logistic regression model at 5% level of significance. The prevalence of undernutrition among women living in houses with unimproved and improved HHEC was 17.2% and 7.2% respectively. The adjusted odds of undernutrition was significantly higher among women who lived in houses with unimproved HHEC (aOR = 2.02, C.I = 1.37-2.97, p <0.001). The odds of undernutrition are greater in young women (aOR = 2.38, C.I. = 1.88-3.00, p <0.001) compared to older, and those of lower wealth status (aOR = 2.14, CI = 1.69-2.71, p <0.001) compared to higher. Other predictors of undernutrition in women of reproductive age in Nigeria include the level of education, marital status, and working status. Living in a house with unimproved environmental conditions is a predictor of undernutrition in women. The integration of environmental and nutrition programmes could assist in addressing this burden in Nigeria.

Parental educational homogamy and under-five mortality in sub-Saharan Africa: Clarifying the association's intricacy.

Worldwide, under-five mortality (U5M) rate is highest in sub-Saharan Africa (SSA). There exists a gap in knowledge on the pathway through which Parental Educational Homogamy (PEH) influences U5M in SSA. In this study, we tested the research hypothesis' PEH is not associated with under-five children's survival probability in SSA. Demographic and health survey datasets for 21 SSA countries were analyzed. Cross-sectional design and multi-stage cluster sampling technique were used for sample selection in each of the countries under investigation. The dependent variable was the survival status of a newborn to age 59 months while the main independent variable was PEH generated from information on wife's and husband's level of education. Data were analyzed using Chi-square test, Cox-proportional hazard model and Brass-adjusted model (α=0.05). Under-five mortality rate ranges from 56/1,000 live born in South Africa to 190/1,000 live born in Sierra-Leone. Across countries, U5M rate was higher among the children of parents with at most primary education than that of parents who had at least secondary education. This pattern of U5M rate was also observed for children of parents where husbands were more educated than their wives. Maternal age at birth, sex of the child, toilet facility, type of cooking fuel, tetanus injection during pregnancy, and birth weight were significantly associated with U5M in 14, 11, 8, 7, 11, 14 and 20 countries respectively. A significant relationship was established between PEH and U5M in 11 of the 21 studied countries but was identified as a predictor of U5M in Congo Democratic Republic, Gambia and Zimbabwe. Parental educational homogamy exhibits a pattern of relationship with U5M in SSA. Ensuring that individuals particularly women have at least secondary education before childbearing will facilitate an U5M reduction in SSA.