Prenatal anaemia and risk of postpartum haemorrhage: a cohort analysis of data from the Predict-PPH study.

BACKGROUND: Most previous clinical studies investigating the connection between prenatal anaemia and postpartum haemorrhage (PPH) have reported conflicting results. OBJECTIVES: We examined the association between maternal prenatal anaemia and the risk of PPH in a large cohort of healthy pregnant women in five health institutions in Lagos, Southwest Nigeria. METHODS: This was a prospective cohort analysis of data from the Predict-PPH study that was conducted between January and June 2023. The study enrolled n = 1222 healthy pregnant women giving birth in five hospitals in Lagos, Nigeria. The study outcome, WHO-defined PPH, is postpartum blood loss of at least 500 milliliters. We used a multivariable logistic regression model with a backward stepwise conditional approach to examine the association between prenatal anaemia of increasing severity and PPH while adjusting for confounding factors. RESULTS: Of the 1222 women recruited to the Predict-PPH study between January and June 2023, 1189 (97·3%) had complete outcome data. Up to 570 (46.6%) of the enrolled women had prenatal anaemia while 442 (37.2%) of those with complete follow-up data had WHO-defined PPH. After controlling for potential confounding factors, maternal prenatal anaemia was independently associated with PPH (adjusted odds ratio = 1.37, 95% confidence interval: 1.05-1.79). However, on the elimination of interaction effects of coexisting uterine fibroids and mode of delivery on this association, a sensitivity analysis yielded a lack of significant association between prenatal anaemia and PPH (adjusted odds ratio = 1.27, 95% confidence interval: 0.99-1.64). We also recorded no statistically significant difference in the median postpartum blood loss in women across the different categories of anaemia (P = 0.131). CONCLUSION: Our study revealed that prenatal anaemia was not significantly associated with PPH. These findings challenge the previously held belief of a suspected link between maternal anaemia and PPH. This unique evidence contrary to most previous studies suggests that other factors beyond prenatal anaemia may contribute more significantly to the occurrence of PPH. This highlights the importance of comprehensive assessment and consideration of various maternal health factors in predicting and preventing this life-threatening obstetric complication.

Expanding Youth-Friendly HIV Self-Testing Services During the COVID-19 Pandemic: Qualitative Analysis of a Crowdsourcing Open Call in Nigeria.

BACKGROUND: HIV self-testing (HIVST) among young people is an effective approach to enhance the uptake of HIV testing recommended by the World Health Organization. However, the COVID-19 pandemic disrupted conventional facility-based HIV testing services, necessitating the exploration of innovative strategies for the effective delivery of HIVST. OBJECTIVE: This study analyzed the outcomes of a digital World AIDS Day crowdsourcing open call, designed to elicit youth responses on innovative approaches to promote HIVST among young people (14-24 years) in Nigeria during COVID-19 restrictions. METHODS: From November 2 to 22, 2020, a World AIDS Day 2020 crowdsourcing open call was held digitally due to COVID-19 restrictions. The crowdsourcing open call followed World Health Organization standardized steps, providing a structured framework for participant engagement. Young people in Nigeria, aged 10-24 years, participated by submitting ideas digitally through Google Forms or email in response to this crowdsourcing open call prompt: "How will you promote HIV self-testing among young people during COVID-19 pandemic?" Data and responses from each submission were analyzed, and proposed ideas were closely examined to identify common themes. Four independent reviewers (AE, SM, AZM, and TG) judged each submission based on the desirability, feasibility, and impact on a 9-point scale (3-9, with 3 being the lowest and 9 being the highest). RESULTS: The crowdsourcing open call received 125 eligible entries, 44 from women and 65 from men. The median age of participants was 20 (IQR 24-20) years, with the majority having completed their highest level of education at the senior secondary school level. The majority of participants lived in the South-West region (n=61) and Lagos state (n=36). Of the 125 eligible entries, the top 20 submissions received an average total score of 7.5 (SD 2.73) or above. The panel of judges ultimately selected 3 finalists to receive a monetary award. Three prominent themes were identified from the 125 crowdsourcing open call submissions as specific ways that HIVST can adapt during the COVID-19 pandemic: (1) digital approaches (such as gamification, photoverification system, and digital media) to generate demand for HIVST and avoid risks associated with attending clinics, (2) awareness and sensitization through existing infrastructures (such as churches, schools, and health facilities), and (3) partnerships with influencers, role models, and leaders (such as religious and youth leaders and social influencers in businesses, churches, organizations, and schools) to build trust in HIVST services. CONCLUSIONS: The crowdsourcing open call effectively engaged a diverse number of young people who proposed a variety of ways to improve the uptake of HIVST during the COVID-19 pandemic. Findings contribute to the need for innovative HIVST strategies that close critical knowledge and practice gaps on ways to reach young people with HIVST during and beyond the pandemic. TRIAL REGISTRATION: ClinicalTrials.gov NCT04710784; https://clinicaltrials.gov/study/NCT04710784.

Development of antepartum risk prediction model for postpartum hemorrhage in Lagos, Nigeria: A prospective cohort study (Predict-PPH study).

OBJECTIVES: There is currently a limited ability to accurately identify women at risk of postpartum hemorrhage (PPH). We conducted the "Predict-PPH" study to develop and evaluate an antepartum prediction model and its derived risk-scoring system. METHODS: This was a prospective cohort study of healthy pregnant women who registered and gave birth in five hospitals in Lagos, Nigeria, from January to June 2023. Maternal antepartum characteristics were compared between women with and without PPH. A predictive multivariable model was estimated using binary logistic regression with a backward stepwise approach eliminating variables when P was greater than 0.10. Statistically significant associations in the final model were reported when P was less than 0.05. RESULTS: The prevalence of PPH in the enrolled cohort was 37.1%. Independent predictors of PPH such as maternal obesity (adjusted odds ratio [aOR] 3.25, 95% confidence interval [CI] 2.47-4.26), maternal anemia (aOR 1.32, 95% CI 1.02-1.72), previous history of cesarean delivery (aOR 4.24, 95% CI 3.13-5.73), and previous PPH (aOR 2.65, 95% CI 1.07-6.56) were incorporated to develop a risk-scoring system. The area under the receiver operating characteristic curve (AUROC) for the prediction model and risk scoring system was 0.72 (95% CI 0.69-0.75). CONCLUSION: We recorded a relatively high prevalence of PPH. Our model performance was satisfactory in identifying women at risk of PPH. Therefore, the derived risk-scoring system could be a useful tool to screen and identify pregnant women at risk of PPH during their routine antenatal assessment for birth preparedness and complication readiness.

Gender differentials on productivity of rice farmers in south western Nigeria: An Oaxaca-Blinder decomposition approach.

Gender differences in productivity are one of the major obstacles impeding the development of agriculture in Africa and Nigerian particularly. With the Oaxaca-Blinder (OB) and exogenous switching treatment regression (ESTER) models, this study investigates the causes of the productivity differences among 360 sampled rice farmers in Nigeria as well as gender inequality in agricultural productivity. The findings showed that there is an inequalities between men and women, which contributes to a gender productivity gap of almost 29 % in favour of men. As a result, plots managed by women are 29 % less productive than plots handled by men. The analysis of the factors influencing gender variations in production reveals that the endowment component, which accounts for 15 % of the productivity gap, is significantly influenced by marital status, education, farm size, and access to market information. Similarly, the ESTER results show that the rice yield of FHHs would have decreased by 25.41 kg/ha (a 1.02 % reduction) if they had been assigned the same returns to the observed features of MHHs. This difference is significant at the 1 % level. Thus, the findings imply that the FHHs are not at a yield disadvantage when compared to the MHHs. Therefore, it can be said that there are gender productivity disparities in the Nigerian agricultural industry. As such, policy interventions aimed at empowering women must take these disparities into consideration as well as the causes that contribute to them. Overall, the results demonstrate that although policymakers and their development partners can use improved technologies to increase MHH and FHH yields, reducing the difference in market linkages is necessary to close the gender gap in rice productivity and provide FHHs with equal access to the market.

Knowledge and Willingness to Utilize Hepatitis B Preventive Measures among Pregnant Women in Ado-Ekiti, Southwest, Nigeria.

Introduction: Mother-to-child transmission remains an important mode of transmission of hepatitis B infection particularly in endemic areas. The knowledge and practices of pregnant women about mother-to-child transmission (MTCT) of hepatitis B virus (HBV) may influence the uptake of strategies to reduce mother-to-child transmission of infection. Objectives: This study assessed the knowledge and willingness to uptake hepatitis B virus infection preventive services among pregnant women in Ado-Ekiti, Nigeria. Methods: This was a cross-sectional study that involved 373 pregnant women at the Ekiti State University Teaching Hospital (EKSUTH) and Maternal Child Specialist Clinics, Ado-Ekiti, Nigeria. A structured questionnaire was used to assess their knowledge, practices, and perceptions about MTCT of hepatitis B infection. Results: Only 52.5% (196) of the respondents had good knowledge, although the majority 290 (77.7%) had heard of hepatitis B infection prior to the survey. Only 147 (39.4%) of the respondents had ever had hepatitis B screening. More persons with professional jobs had good knowledge about hepatitis B infection compared with other occupations (p < 0.001). However, more respondents aged 30-34 years had poor knowledge about hepatitis B infection compared with other age groups (p = 0.045). Respondents with good knowledge about hepatitis B infection were willing to uptake hepatitis B infection prevention services (p < 0.001). Conclusion: This study showed that respondents with professional jobs had good knowledge about hepatitis B infection and those who had good knowledge about the infection were willing to utilize hepatitis B preventive measures. Awareness of MTCT of HBV did not translate into good practice as only few respondents had screened for hepatitis B. There is a need to intensify education about modes of transmission of hepatitis B infection with an emphasis on promoting good preventive practices.

A New Global Air Quality Health Index Based on the WHO Air Quality Guideline Values With Application in Cape Town.

Objectives: This study developed an Air Quality Health Index (AQHI) based on global scientific evidence and applied it to data from Cape Town, South Africa. Methods: Effect estimates from two global systematic reviews and meta-analyses were used to derive the excess risk (ER) for PM2.5, PM10, NO2, SO2 and O3. Single pollutant AQHIs were developed and scaled using the ERs at the WHO 2021 long-term Air Quality Guideline (AQG) values to define the upper level of the "low risk" range. An overall daily AQHI was defined as weighted average of the single AQHIs. Results: Between 2006 and 2015, 87% of the days posed "moderate to high risk" to Cape Town's population, mainly due to PM10 and NO2 levels. The seasonal pattern of air quality shows "high risk" occurring mostly during the colder months of July-September. Conclusion: The AQHI, with its reference to the WHO 2021 long-term AQG provides a global application and can assist countries in communicating risks in relation to their daily air quality.

The use of Qigong and Tai Chi in the management of temporomandibular joint dysfunction: A systematic review.

Background and Aims: Qigong and Tai Chi (QTC) are mind-body exercises involving a sequence of graceful movements, which promote self-healing, meditation, and self-cultivation. There is growing evidence that Qigong and/or Tai Chi therapy may improve the physical and psychological health among adults with multiple health conditions including joint movement. This systematic review aims to synthesize the available evidence on the type and effectiveness of QTC therapies used in the management of temporomandibular joint (TMJ) dysfunction. Methods: This systematic review followed the AMSTAR-2 guideline, and it was reported based on guidelines in the PRISMA checklist. The review involved a systematic search of nine electronic databases. After deduplication and screening of the literature retrieved from the search, only one article was included based on the review's inclusion criteria. Data was extracted from this article and synthesized. Results: The only included article was on a non-randomized control trial which investigated the role of Tai Chi Qigong (a form of Qigong) therapy in improving joint mobility and alleviating trismus among 52 survivors of nasopharyngeal carcinoma who had TMJ disorders. The study reported, at different time intervals (at pretest; at mid-intervention; at posttest; and at follow-up posttest), that no significant difference (p > 0.05) was observed concerning mouth opening capacity between the intervention group and the control group. However, over time, less severe deterioration in mouth-opening was noted among the participants in the intervention group (p = 0.181) as compared to the control group (p < 0.001). Conclusion: The role of QTC therapies in improving joint mobility and alleviating trismus is not yet fully understood, but it seems promising. The available evidence is inadequate to categorically conclude on the efficacy of these therapies. Further studies will be required to fully assess the effectiveness of QTC therapies in the management of TMJ dysfunction.

Why move abroad? Factors influencing migration intentions of final year students of health-related disciplines in Nigeria.

BACKGROUND: Limited human resource for health may impede the attainment of health-related sustainable development goals in low-income countries. This study aims to identify migration factors among final-year students of health-related disciplines at a Nigerian university, reflecting trends in Nigeria and sub-Saharan African countries. METHODS: A cross-sectional study was conducted using a semi-structured, self-administered questionnaire to collect data from 402 final-year students of Medicine/Dentistry, Nursing, Pharmacy and Occupational therapy Physiotherapy at Obafemi Awolowo University, Ile Ife. Univariate, bivariate and multivariate data analysis were conducted and a p-value < 0.05 was taken as statistically significant. RESULTS: The mean age of the respondents was 24.3 ± 2.3 years. Most (326; 81.1%) respondents had intentions to migrate and majority (216; 53.7%) of respondents had an unfavourable attitude towards practising in Nigeria. Students of Nursing constitute the highest proportion (68; 91.9%) of those willing to migrate (p = 0.009). The common preferred destinations for those who intend to migrate were the United Kingdom (84; 25.8%), Canada (81; 24.8%), and the United States of America (68; 20.9%). Respondents who had favourable attitude towards practicing abroad (AO.R: 2.9; 95% C.I 1.6-5.2; p = 0.001) were three times more likely to have migration intentions compared with those who had an unfavourable attitude towards practicing abroad, while the odds for those who had favourable attitude towards practicing in Nigeria (AO.R: 0.4; 95% C.I 0.2-0.7; p = 0.002) was two times less than those who had an unfavourable attitude towards practice in Nigeria. Respondents who desire specialist training (AO.R: 3.0; 95% C.I 1.7-5.4; p < 0.001) were three times more likely to have intention to migrate abroad when compared to those who were undecided or had no desire to pursue specialist training. CONCLUSION: Most respondents had the intention to migrate abroad after graduation and this could be attributed to the desire for specialist training and their attitude towards practising in Nigeria. Interventions aimed at improving specialist training in Nigeria and incentivizing health care practice may reduce migration trends among Nigeria's health professionals in training.

The determinants of crop productivity and its effect on food and nutrition security in rural communities of South Africa.

Introduction: High crop productivity has the potential to improve the food and nutrition security status of not only smallholder farmers but also households in general. However, smallholder farmers operate in a dynamic environment whereby their crop production is affected by various factors that hinder it from lessening food insecurity and malnutrition in rural areas. The study investigated the determinants of crop productivity and its effect on household food and nutrition security status in South Africa. Methods: This study employed a quantitative research method. A total of 1520 households were selected using the multi-stage stratified random sampling technique. Out of the total sample size of 1520, 386 were crop producers, 176 producers were from Mpumalanga province, and 210 producers were from the Limpopo province. Results and discussion: Most of the smallholder farmers do not have access to the irrigation system, mechanization, and agricultural inputs. The Household Food Insecurity Access Scale showed that most smallholder farmers were food insecure, with 78% of the farmers in each province found to be food insecure. The results from Household Dietary Diversity Score (HDDS) showed that in the overall sampled population, 50% of smallholder farmers had highly diverse diets. Only 50% of the smallholder farmers had high dietary diversity in each province. Irrigation systems and involvement in crop production had a positive influence on the crop productivity of smallholder farmers. The results from the Conditional Mixed Process (CMP) model showed that ownership of livestock, harvest, and disability in the family negatively impacted smallholder farmers' food security status while household size had a positive effect on the food security of smallholder farmers. The results also showed that social grants, agricultural assistance, and harvest had a negative impact on the nutrition status of smallholder farmers. While household size had a positive impact on the nutrition status of smallholder farmers. Conclusion and recommendations: Factors such as irrigation systems and involvement in crop production influenced crop productivity. Household size influenced the nutritional status of smallholder farmers while harvest size affected the food security status. There is a need to encourage more households to get involved in farming. Government and nongovernmental organizations need to support smallholder farmers with agricultural productive resources like irrigation systems to improve their crop productivity.

What factors are associated with anaemia in pregnancy among Nigerian women? Evidence from a national survey.

Background: Anaemia in pregnancy remains a severe public health problem in sub-Saharan African countries including Nigeria. Objectives: To assess factors associated with anaemia in pregnancy among Nigerian women. Methods: A secondary analysis of the 2018 Nigeria demographic health survey was conducted to determine the predictors of anaemia among Nigerian pregnant women (N=1522). SAS 9.4 was used for the analysis. Results: The prevalence of anaemia in pregnancy was 61.1%. On multivariable logistic regression analysis, women in the North-central (AOR=2.52, CI=1.46-4.35) and South-south (AOR=2.21, CI=1.06-4.59) had increased odds of anaemia in pregnancy, compared to those in the Northwest. Women with no education (AOR=2.38, CI=1.28-4.44), primary education (AOR=3.06, CI=1.58-5.96) and secondary education (AOR=1.75, CI=1.04-2.94) had increased odds of anaemia in pregnancy compared to women with teriary education. Also, women not in marital union had increased odds of anaemia in pregnancy compared to women in a union (AOR=2.56, CI=1.15-5.72). Women in the second (AOR=2.42, CI=1.79-3.29) and third trimesters of pregnancy (AOR=2.83, CI=2.07-3.89) had increased odds of anaemia. Conclusion: These findings are important for the control of anemia among pregnant Nigerian women. Women in the Northcentral and Southsouth zones are particularly at risk for anaemia in pregnancy and should receive special attention during antenatal care.

Cervical cancer screening and treatment for PLWHIV: experiences from an innovative program in Nigeria.

BACKGROUND: We evaluated cervical cancer program for women living with HIV (WLHIV) to determine program screening rate, primary case finder screening accuracy and treatment and post-treatment screening rate among screen-positive patients. METHODS: A ten-month review of cervical cancer program data among WLHIV aged 15-49 years on HIV care across forty-one comprehensive ART sites, supported by APIN (a PEPFAR implementing partner) for cervical cancer screening and treatment in Nigeria, was conducted from October 2020 to July 2021. Initial screening was done using visual inspection with acetic acid (VIA) followed by a gynaecologist expert review through a program-designed software named AVIVA, as a confirmatory test. Associations were measured between the primary case finder screening accuracy and study covariates at p-value of 0.05. RESULTS: About 10,289 asymptomatic women aged 15-49 years living with HIV were screened for cervical cancer by primary case finders using VIA-based screening test. About 732 (7.1%) had a positive screening test suggestive of precancerous lesions or cervical cancer. Three hundred and fifteen (43.0%) of VIA positive women had treatment using thermal ablation and less than one-third (21.6%) of those treated came back for post-treatment screening test. Primary case finder screening sensitivity, specificity, positive predictive and negative predictive accuracy using gynaecologist review as confirmatory test were 60.8%, 71.5%, 41.7% and 84.5% respectively. Overall screening accuracy was 68.8%. CONCLUSION AND RECOMMENDATIONS: This innovative approach to cervical cancer screening among WLHIV yielded modest results in preventing program error and wastages. Wider deployment of expert-based reviews of VIA though AVIVA software might be a veritable approach to improve screening accuracy in low resource settings.

Cholera outbreak in Syria amid humanitarian crisis: the epidemic threat, future health implications, and response strategy - a review.

The war in Syria, which started over 11 years ago, has devastated the country's water sources, healthcare system, and other vital facilities for healthy living. The country is vulnerable to outbreaks, especially epidemic-prone ones like cholera, due to its fragile health system. Syria experienced its last hit of cholera in 2009, which led to the deaths of several Syrian children and affected about 1,000 people. The current cholera resurgence in Syria calls for public concern. Considering the poor access to clean water, the forced relocation of people, and other destruction caused by the war, these factors have exposed Syrian children to infectious diseases like cholera. We argued for more efforts toward the implementation of Water, Sanitation and Hygiene (WASH) in the country. We also pointed out the need for proper education and sensitization campaigns using all available resources to educate the populace, mass chlorination of wells, mapping vulnerable areas, and implementing WASH while encouraging vaccination coverage for cholera as a strategy to reduce its incidence. Improving the national surveillance systems will aid in the timely and appropriate reporting of any outbreak. Again, more negotiations should be done to seek a lasting solution to ending the war and restoring peace and serenity in the country.

Geo-epidemiology of malaria incidence in the Vhembe District to guide targeted elimination strategies, South-Africa, 2015-2018: a local resurgence.

In South Africa, the population at risk of malaria is 10% (around six million inhabitants) and concern only three provinces of which Limpopo Province is the most affected, particularly in Vhembe District. As the elimination approaches, a finer scale analysis is needed to accelerate the results. Therefore, in the process of refining local malaria control and elimination strategies, the aim of this study was to identify and describe malaria incidence patterns at the locality scale in the Vhembe District, Limpopo Province, South Africa. The study area comprised 474 localities in Vhembe District for which smoothed malaria incidence curve were fitted with functional data method based on their weekly observed malaria incidence from July 2015 to June 2018. Then, hierarchical clustering algorithm was carried out considering different distances to classify the 474 smoothed malaria incidence curves. Thereafter, validity indices were used to determine the number of malaria incidence patterns. The cumulative malaria incidence of the study area was 4.1 cases/1000 person-years. Four distinct patterns of malaria incidence were identified: high, intermediate, low and very low with varying characteristics. Malaria incidence increased across transmission seasons and patterns. The localities in the two highest incidence patterns were mainly located around farms, and along the rivers. Some unusual malaria phenomena in Vhembe District were also highlighted as resurgence. Four distinct malaria incidence patterns were found in Vhembe District with varying characteristics. Findings show also unusual malaria phenomena in Vhembe District that hinder malaria elimination in South Africa. Assessing the factors associated with these unusual malaria phenome would be helpful on building innovative strategies that lead South Africa on malaria elimination.

A Review of the COVID-19 Mental Health Impact in Post-Conflict Settings: Bridging the Mental Health Gap with Case Exemplars from an Implementation Science Lens.

The COVID-19 pandemic has further aggravated the burden of mental health and presents an opportunity for public health research to focus on evidence-based interventions appropriate for populations residing in resource-constrained, post-conflict settings. Post-conflict settings have a higher service gap in mental health and fewer protective factors, such as economic and domestic security. Post-conflict settings are defined as locations where open warfare has ended but resulting challenges have remained for years. A strong emphasis on the engagement of diverse stakeholders is needed to arrive at sustainable and scalable solutions to mental health service delivery. This review discusses mental health service delivery gaps in post-conflict settings, highlights the urgency of the matter in the context of the COVID-19 pandemic, and provides recommendations for service gaps from evidence-based case study exemplars with an implementation science lens using the Consolidated Framework for Implementation Research (CFIR) as guide to improving adaptation and uptake.

Contribution of Fruits and Vegetables to the Household Food Security Situation of Rural Households in Limpopo.

Food insecurity continues to be a burden for many South Africans. The production and consumption of fruits and vegetables have a potential role in improving household food security and are considered one of the critical pathways for reducing food insecurity and malnutrition levels in the country. This paper set out to determine the effect of fruits and vegetables on the food security status of rural households in the Limpopo province. Data (secondary) for this study were collected from 2043 respondents who were selected through stratified random selection based on the population size of the district municipalities in Limpopo. This study used a quantitative research approach, and data were analyzed using a descriptive analysis, the household food insecurity access scale (HFIAS), and a Poisson regression model with an endogenous treatment model. The findings revealed that gender and involvement in agricultural production had a positive significant relationship with the consumption of fruits and vegetables, while disability grants had a negative impact. Age, household size, and receiving a disability grant had a positive significant impact on determining the household food insecurity status; however, gender had a negative significant relationship. This study concluded that the consumption of fruits and vegetables considerably influenced the food security status of the household. There is a need for government officials and local leaders to provide food security interventions that prioritize women and elders. These may include promoting household production and consumption of diversified fruits and vegetables.

Analysis of the 2007-2018 National Health Interview Survey (NHIS): Examining Neurological Complications among Children with Sickle Cell Disease in the United States.

This study compared neurological complications among a national sample of United States children with or without sickle cell disease (SCD) and evaluated health status, healthcare and special education utilization patterns, barriers to care, and association of SCD status and demographics/socioeconomic status (SES) on comorbidities and healthcare utilization. Data was acquired from the National Health Interview Survey (NHIS) Sample Child Core questionnaire 2007-2018 dataset that included 133,542 children. An affirmation from the guardian of the child determined the presence of SCD. Regression analysis was used to compare the associations between SCD and demographics/SES on neurological conditions at p < 0.05. Furthermore, adjusted odds ratios (AORs) were estimated for having various neurological conditions. Of the 133,481 children included in the NHIS, the mean age was 8.5 years (SD: 0.02) and 215 had SCD. Of the children with SCD, the sample composition included male (n = 110), and Black (n = 82%). The SCD sample had higher odds of having neuro-developmental conditions (p < 0.1). Families of Black children (55% weighted) reported household incomes < 100% of federal poverty level. Black children were more likely to experience longer wait times to see the doctor (AOR, 0.3; CI 0.1-1.1). Compared to children without SCD, those with SCD had a greater chance of seeing a medical specialist within 12 months (AOR 2.3; CI 1.5-3.7). This representative sample of US children with SCD shows higher odds of developing neurological complications, increased healthcare and special education services utilization, with Black children experiencing a disproportionate burden. This creates the urgency to address the health burden for children with SCD by implementing interventions in healthcare and increasing education assistance programs to combat neurocognitive impairments, especially among Black children.

Estimating the distributional impact of innovation platforms on income of smallholder maize farmers in Nigeria.

This research studies the distributional effects of IP adoption on the farm income of smallholder maize farmers in Nigeria in an effort to move beyond the standard mean impact assessment of agricultural interventions. In order to account for selection bias that may result from both observed and unobserved factors, the study used a conditional instrumental variable quantile treatment effects (IV-QTE) strategy. The use of IPs greatly affects the revenue distributions of maize producers, as empirical evidence from the outcomes shows. Particularly, the impacts of adoption are stronger at the lower tails and just above the mean of the income distributions, indicating that impoverished farming households benefit more from the strategic functions of IP adoption in boosting income. These findings highlight how important it is to effectively target and disseminate improved agricultural technologies in order to increase the revenue of smallholder maize farmers in Nigeria from maize production. Agricultural research information and access to extension services are two policy tools that can help improve the successful adoption and diffusion of any agricultural intervention without favoring any particular groups.

Determinants of COVID-19 vaccine uptake among Nigerians: evidence from a cross-sectional national survey.

BACKGROUND: COVID-19 ranks as one of the largest public health threats in recent times. It is associated with huge health, economic and social consequences. Although vaccination is an effective control measure, COVID-19 vaccine uptake has been suboptimal in many low/middle income countries. Hence this study assessed the factors influencing COVID-19 vaccine uptake among Nigerian households. DATA AND METHODS: This study analyzed secondary data from the COVID-19 High-Frequency Phone Survey of Households that was collected by the National Bureau of Statistics between November 2021 and January 2022. Relevant data were analyzed using descriptive statistical tools and the Multivariate Regression model. RESULTS: Out of 2370 respondents, only 32.8% of the respondents were vaccinated against COVID-19. Respondents living in urban areas (34.4%) had a higher level of COVID-19 vaccine uptake relative to those living in rural Nigeria (30.9%). Results from the Multivariate Regression model revealed that adults aged ≥ 60 years (OR 2.20; p = 0.012), respondents with primary (OR 1.72; p = 0.032), secondary (OR 1.77; p = 0.025) and tertiary education (OR 3.03; p < 0.001), respondents with access to health insurance (OR 1.68; p = 0.004), those who obtained vaccine information from health workers (OR 3.92; p < 0.001), the government (OR 3.22; p < 0.001), and the mass media (OR 1.75; p = 0.003) were more likely to be vaccinated. Also, respondents living in North Central (OR 2.02; p < 0.001), North East (OR 1.48; p = 0.039), South West (OR 2.63; p < 0.001), and South South (OR 1.49; p = 0.031) regions had higher odds of being vaccinated. CONCLUSIONS: The study recommends increased media campaigns and advocacy for COVID-19 vaccination in the South East and North West regions. Persons with no formal education and younger persons aged 18-29 years should be targeted with COVID-19 vaccine-related information given that they were less likely to be vaccinated. Dissemination of relevant information through government sources, mass media and health workers is encouraged so as to positively influence decisions to receive COVID-19 vaccines among citizens.

An Analysis of the Prevalence and Factors Influencing Food Insecurity among University Students Participating in Alcohol Consumption in KwaZulu-Natal Province.

Food insecurity among the student population is a prominent issue in South African university institutions. However, personal experiences and the myriad of underlying factors contributing to the issue remain poorly documented. Among other factors, these universities are characterized by the admission of a majority of their student population from poor backgrounds with limited financial capabilities, and this affects their food security status. The purpose of this study was to view the patterns of food insecurity among students, with a focus on alcohol consumption as one of the various factors influencing student food security status. Data were collected from 156 student respondents from the University of KwaZulu-Natal, Durban University of Technology, Mangosuthu University of Technology, and the University of Zululand. The Household Food Insecurity Access Scale revealed that from the total sample, only 21.79% reported themselves as food secure, whilst the remainder reported varying levels of food insecurity with 17.31% of students being food insecure, 16.03% mildly food insecure, and 44.87% severely food insecure. On the other hand, a prevalence of 73.08% (n = 114) of alcohol consumption was found among the sampled students. Ordered probit models results suggested that students' alcohol consumption prevalence was determined by gender, level of study, exercise/playing sport, marital status, and distance to campus, which all had statistically significant effects on students' alcohol consumption. Most crucially, gender, institution and campus positively affected students' food security status, while the income variable made a negative significant contribution towards student food security status. Therefore, a link between students' finances and food insecurity was evident. However, further research is required to delve into the link between the level and impact of students' alcohol consumption and its implications on their financial status, and thus food security status. This is crucial information which will help policymakers understand these underlying factors and experiences and thus find solutions for issues related with food insecurity.

Characterisation of medical conditions of children with sickle cell disease in the USA: findings from the 2007-2018 National Health Interview Survey (NHIS).

OBJECTIVES: We used the National Health Interview Survey (NHIS) data set to examine the prevalence of comorbid medical conditions; explore barriers to accessing healthcare and special educational services; and assess the associations between sickle cell disease (SCD) status and demographics/socioeconomic status (SES), and social determinants of health (SDoH) on comorbidities among children in the USA. DESIGN: Cross-sectional. SETTING: NHIS Sample Child Core questionnaire 2007-2018 data set. PARTICIPANTS: 133 481 children; presence of SCD was determined by an affirmative response from the adult or guardian of the child. MAIN OUTCOME MEASURES: Multivariate logistic regression was used to compare the associations between SCD status, SES and SDoH for various medical conditions for all races and separately for black children at p<0.05. RESULTS: 133 481 children (mean age 8.5 years, SD: 0.02), 215 had SCD and ~82% (weighted) of the children with SCD are black. Children with SCD were more likely to suffer from comorbid conditions, that is, anaemia (adjusted OR: 27.1, p<0.001). Furthermore, children with SCD had at least two or more emergency room (ER) visits (p<0.001) and were more likely to have seen a doctor 1-15 times per year (p<0.05) compared with children without SCD. Household income (p<0.001) and maternal education were lower for children with SCD compared with children without SCD (52.4% vs 63.5% (p<0.05)). SCD children with a maternal parent who has < / > High School degree were less likely to have no ER visits or 4-5 ER visits, and more likely to have 2-3 ER visits within 12 months. CONCLUSION: Children with SCD experienced significant comorbid conditions and have high healthcare usage, with black children being disproportionately affected. Moreover, maternal education status and poverty level illustrates how impactful SES can be on healthcare seeking behaviour for the SCD population. SDoH have significant implications for managing paediatric patients with SCD in clinical settings.