Sleep pattern and disorders among pregnant women in Ibadan, Southwest Nigeria.

BACKGROUND: Sleep is essential for pregnant women's and the offspring's health and wellbeing. Poor sleep and disorders have been linked with adverse fetal outcomes and delivery conditions. However, pregnant women often experience several forms of sleep disruption, which has been scarcely reported in low and middle-income countries (LMIC), including Nigeria where the influence of lifestyle factors has also been lacking. We investigated sleep patterns and disorders and the associated factors among pregnant women in Southwest, Nigeria. METHOD: A cross-sectional study was conducted among five hundred (500) pregnant women attending Adeoyo Maternity Teaching Hospital. A semi-structured questionnaire was used to examine different domains of sleep and associated disorders, namely sleep quality (Pittsburgh Sleep Quality Index (> 5 and ≤ 5)), insomnia (Insomnia Severity Index (> 8 and ≤ 8)), restless leg syndrome (Restless Leg Syndrome Rating Scale (> 10 and ≤ 10). Significant covariates such as physical activity, minimum dietary diversity, smoking and alcohol intake were also assessed. We conducted bivariate and multivariate analysis at p < 0.05 significance level. RESULTS: The mean age of participants was 30.4 ± 4.8 years. The pattern of sleep disorder in pregnant were poor sleep quality (50%), restless leg syndrome (58.2%) and insomnia (33.4%). Being currently married (AOR = 6.13; 95% CI: (1.65-22.23)), increasing gestational age: second trimester (AOR = 8.25;95% CI: (1.78-38.17)) to third trimester (AOR = 10.98; 95% CI: (2.44-49.48)) increased the odds of poor sleep quality. Factors associated with restless leg syndrome were marital status [AOR = 3.60; 95% CI; (1.25-10.35)], religion, rigorous physical activities [AOR = 1.52; 95% CI: (1.05-2.21)] and alcohol consumption [AOR = 3.51; 95% CI: (1.00-12.27)]. Factors associated with insomnia were maternal age [AOR = 1.83; 95% CI: (1.11-3.01)], income [AOR = 2.99 (1.26-7.16)] and rigorous physical activity [AOR = 2.55 (1.61-4.02)]. CONCLUSION: Poor sleep quality, restless leg syndrome and insomnia were typical among pregnant women in Ibadan, Southwest Nigeria. Thus, awareness and education on the importance of sleep and its risk and protective factors, such as alcohol consumption, smoking, rigorous activity and spousal and family support, should be increased to reduce poor sleep quality and sleep disorders (restless leg syndrome and insomnia) during the pregnancy period.

Postpartum length of hospital stay among obstetric patients in Ibadan, Nigeria.

BACKGROUND: Postpartum Length of hospital stay (PLOHS) is an essential indicator of the quality of maternal and perinatal healthcare services. Identifying the factors associated with PLOHS will inform targeted interventions to reduce unnecessary hospitalisations and improve patient outcomes after childbirth. Therefore, we assessed the length of hospital stay after birth and the associated factors in Ibadan, Nigeria. METHODS: We used the Ibadan Pregnancy Cohort Study (IbPCS) data, and examined the 1057 women who had information on PLOHS the mode of delivery [spontaneous vagina delivery (SVD) or caesarean section (C/S)]. The outcome variable was PLOHS, which was described as the time interval between the delivery of the infant and discharge from the health facility. PLOHS was prolonged if > 24 h for SVD and > 96 h for C/S, but normal if otherwise. Data were analysed using descriptive statistics, a chi-square test, and modified Poisson regression. The prevalence-risk ratio (PR) and 95% confidence interval (CI) are presented at the 5% significance level. RESULTS: The mean maternal age was (30.0 ± 5.2) years. Overall, the mean PLOHS for the study population was 2.6 (95% CI: 2.4-2.7) days. The average PLOHS for women who had vaginal deliveries was 1.7 (95%CI: 1.5-1.9) days, whereas those who had caesarean deliveries had an average LOHS of 4.4 (95%CI: 4.1-4.6) days. About a third had prolonged PLOHS: SVD 229 (32.1%) and C/S 108 (31.5%). Factors associated with prolonged PLOHS with SVD, were high income (aPR = 1.77; CI: 1.13, 2.79), frequent ANC visits (> 4) (aPR = 2.26; CI: 1.32, 3.87), and antenatal admission: (aPR = 1.88; CI: 1.15, 3.07). For C/S: maternal age > 35 years (aPR = 1.59; CI: 1.02, 2.47) and hypertensive disease in pregnancy (aPR = 0.61 ; CI: 0.38, 0.99) were associated with prolonged PLOHS. CONCLUSION: The prolonged postpartum length of hospital stay was common among our study participants occurring in about a third of the women irrespective of the mode of delivery. Maternal income, advanced maternal age, ANC related issues were predisposing factors for prolonged LOHS. Further research is required to examine providers' perspectives on PLOHS among obstetric patients in our setting.

Spread and seasonality of COVID-19 pandemic confirmed cases in sub-Saharan Africa: experience from Democratic Republic of Congo, Nigeria, Senegal, and Uganda.

BACKGROUND: The COVID-19 pandemic has impacted the world negatively with huge health and socioeconomic consequences. This study estimated the seasonality, trajectory, and projection of COVID-19 cases to understand the dynamics of the disease spread and inform response interventions. METHOD: Descriptive analysis of daily confirmed COVID-19 cases from January 2020 to 12th March 2022 was conducted in four purposefully selected sub-Saharan African countries (Nigeria, Democratic Republic of Congo (DRC), Senegal, and Uganda). We extrapolated the COVID-19 data from (2020 to 2022) to 2023 using a trigonometric time series model. A decomposition time series method was used to examine the seasonality in the data. RESULTS: Nigeria had the highest rate of spread (ß) of COVID-19 (ß = 381.2) while DRC had the least rate (ß = 119.4). DRC, Uganda, and Senegal had a similar pattern of COVID-19 spread from the onset through December 2020. The average doubling time in COVID-19 case count was highest in Uganda (148 days) and least in Nigeria (83 days). A seasonal variation was found in the COVID-19 data for all four countries but the timing of the cases showed some variations across countries. More cases are expected in the 1st (January-March) and 3rd (July-September) quarters of the year in Nigeria and Senegal, and in the 2nd (April-June) and 3rd (October-December) quarters in DRC and Uganda. CONCLUSION: Our findings show a seasonality that may warrant consideration for COVID-19 periodic interventions in the peak seasons in the preparedness and response strategies.

Sugar-sweetened beverage consumption among pregnant women attending general and teaching hospitals in Ibadan, Nigeria : SSB consumption during pregnancy.

BACKGROUND: Sugar-sweetened beverages (SSBs) have become a global health concern because of their adverse health effects and their association with the obesity pandemic. It has not received much attention in sub-Saharan Africa, including Nigeria, especially among pregnant women. The pattern, frequency and factors associated with SSBs among pregnant women in Ibadan, Nigeria, were investigated. DESIGN: Data were from the Ibadan Pregnancy Cohort Study - a prospective cohort study investigating 1745 pregnant women from four comprehensive obstetric facilities in Ibadan. A qualitative food frequency questionnaire (FFQ) was used to assess the pregnant women's intake of food and drinks over the previous months. Sugar-sweetened beverage variable and scores were also generated using the principal component analysis with varimax rotation. Factors associated with high SSB scores were examined using multivariate logistics regression analyses at a 5% significance level. RESULTS: The most commonly consumed SSBs were cocoa-sweetened beverages, soft drinks, malt drinks, and fruit juice. A quarter of the women (75th percentile) consumed SSB more than once weekly. The factors associated with high SSB on multivariate analysis were; being employed (AOR: 1.52, 95% CI 1.02-2.26), maternal obesity (AOR: 0.065, 95% CI 0.47-0.89), high fruit intake (AOR:3.62, 95% CI 2.62-4.99), high green vegetable consumption (AOR:1.99, 95% CI 1.06-3.74), high milk intake (AOR: 2.13, 95% CI 1.65- 2.74), frequent fast food outlet visit (AOR: 2.19, 95% CI 1.53-1.70), all of these remained significant after adjusting for confounding variables. CONCLUSION: SSBs were common among our study population. Factors associated with high SSBs intake are crucial for implementing locally relevant public health interventions.

Alcohol consumption and tobacco exposure among pregnant women in Ibadan, Nigeria.

BACKGROUND: Alcohol consumption and tobacco exposure during pregnancy are hazardous behaviours which are increasing significantly in low and middle-income countries, including sub-Saharan Africa. However, they have received little attention in Nigeria's maternal health research and services. The prevalence, pattern and predictors of alcohol consumption and tobacco exposure among pregnant women in Ibadan, Nigeria, were investigated. METHODS: This is a part of a prospective cohort study among pregnant women in Ibadan, Nigeria (Ibadan Pregnancy Cohort Study (IbPCS), which investigated the associations between maternal obesity, lifestyle characteristics and perinatal outcomes in Ibadan. Alcohol consumption and tobacco exposure of 1745 pregnant women were assessed during enrollment by self-reports using an interviewer-administered questionnaire. Bivariate and multiple logistic regression analyses examined the associations at a 5% level of statistical significance. RESULTS: The prevalence of pre-pregnancy alcohol consumption and alcohol consumption during pregnancy were 551 (31.7%) and 222 (12.7%), respectively, i.e. (one in every eight pregnancies is exposed to alcohol). Palm wine (52%) and beer (12%) were the most common alcohol consumed among pregnant women. The predictors of alcohol consumption during were pre-pregnancy alcohol use [AOR = 10.72, 95% CI: 6.88-16.70) and religion i.e. Muslims were less likely to consume alcohol during pregnancy compared to Christians: [AOR = 0.60, 95% CI: 0.40-0.92). The prevalence of tobacco exposure in the index pregnancy was 64 (3.7%), i.e. one in every 27 pregnancies is exposed to tobacco. In contrast, cigarette smoking, second-hand smoke and smokeless tobacco were 0.4, 1.7 and 1.8%, respectively. Pre-pregnancy cigarette smoking was reported by 33(1.9%) and was the most significant predictor [AOR = 12.95; 95% CI: 4.93, 34.03) of tobacco exposure during pregnancy in our study population. CONCLUSIONS: Alcohol consumption and tobacco exposure are not uncommon and have been an ongoing but neglected threat to maternal and child health in Nigeria. Alcohol and tobacco control policy and programmes to prevent the use among pregnant and reproductive-age women in Nigeria should be implemented primarily during antenatal care.

Prevalence, associated factors and perinatal outcomes of antepartum depression in Ibadan Nigeria.

BACKGROUND: Antepartum depression is the most common mental health disorder in pregnancy and it is also a risk factor for adverse perinatal outcomes. Low and middle income countries like Nigeria bear a higher burden of antepartum depression compared with high income countries. Prioritizing mental health issues among pregnant women is crucial to achieving the Sustainable Development Goals. We determined the prevalence, associated factors and perinatal outcomes of antepartum depression among pregnant women in Ibadan, Nigeria. METHODS: A prospective cohort study was conducted among 1745 pregnant women enrolled early in pregnancy (≤ 20 weeks) at four comprehensive obstetric facilities within Ibadan metropolis. Antepartum depression was ascertained during the third trimester using the Edinburg Postpartum Depression Scale ≥ 12. The primary exposure was antepartum depression and the outcome variables were the perinatal outcomes. The associated factors assessed included sociodemographic, obstetric, psychological, and lifestyle characteristics. Bi-variate logistic and Poisson regression analyses were used to assess the factors and relative risk for perinatal outcomes of antepartum depression. RESULTS: The prevalence of antepartum depression was 14.1%. The significant factors associated with APD after adjusting for confounders were: high income (≥ 20, 000) which was protective (AOR) = 0.59; 95% CI: (0.40 - 0.88); p-value: 0.010] and perceived stress increased the odds of APD in a monotonic fashion: moderate stress [AOR = 2.39; 95% CI: (1.01 - 5.7); p-value: 0.047], high stress [AOR = 6.43; 95% CI: (2.28 - 18.2); p-value: < 0.001]. Preterm delivery was the only significant perinatal outcome [Relative Risk (RR) = 1.66; 95% CI (1.14 - 2.39); p-value =  0.007]. Depression did not increase the risk of having low birth weight babies (p = 0.513), macrosomia (p = 0.894), birth asphyxia (p = 0.317), and caesarean section (p = 0.298). CONCLUSIONS: APD was prevalent among our study population. The significant factors identified in this study can be targeted to reduce the occurrence of APD among pregnant women in Nigeria through appropriate social and public health interventions which include APD screening, counselling, and the provision of emotional support for pregnant women during antenatal care.

Prevalence, risk factors and outcome of congenital anomalies among neonatal admissions in OGBOMOSO, Nigeria.

BACKGROUND: Congenital anomalies (CA) are a major cause of neonatal morbidity and mortality, especially in developing countries. Data on these anomalies are still poorly collated in developing countries. We aimed to assess the prevalence, pattern, risk factors and outcome of congenital anomalies among neonatal admissions in Ogbomoso Town, Nigeria. METHODS: A cross-sectional retrospective study in which a review of the records of all neonates admitted in the neonatal unit of the Bowen University Teaching Hospital, Ogbomoso over a five-year period (January 2012-December 2016) was undertaken. The occurrence rate and pattern of anomalies were determined, while factors associated with the occurrence and outcome of anomalies were calculated with the odds ratio and 95% confidence interval. Data entry and analysis were performed using SPSS version 21. RESULTS: CA were found in 67 of the 1057 neonatal admissions, giving a prevalence rate of 6.3%. Anomalies of the cardiovascular and digestive systems were the most common. A higher proportion of babies referred from other facilities had CA, and this was found statistically significant. There was no significant association between CA and low birth weight, sex, maternal age or parity. The mortality rate among neonates with CA was 10.4%. Although, CA was associated with reduced risk of neonatal mortality compared to those with other acute conditions, this was not statistically significantly. CONCLUSION: CA is a major indication for neonatal admissions in Ogbomoso. There is the need to establish a surveillance system for CA and efforts should be made to raise awareness of the occurrence and risk factors of CA in developing countries.

What is the Link between Malaria Prevention in Pregnancy and Neonatal Survival in Nigeria?

Neonatal mortality has been recognized as a global public health challenge and Nigeria has the highest prevalence in Africa. Malaria during pregnancy jeopardizes neonatal survival through placental parasitaemia, maternal anaemia, and low birth weight. This study investigated association between the malaria prevention in pregnancy and neonatal survival using a nationally representative data - Nigeria Demographic Health Survey 2013. Child recode data was used and the outcome variable was neonatal death. The main independent variables were the use of at least 2 doses of intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPT-SP) and proportion of pregnant women who reported Insecticide Treated Net (ITN) use the night before the survey. Data were analyzed using Pearson Chi-square (x 2 ) test of association and survival analysis techniques. Total neonatal mortality rate was 38 per1000 live births. Cox proportional hazard model showed that low birth weight (HR 1.49, 95% CI (1.15 - 1.93 p=0.003) and adequate number of ANC visits (≥ 4 visits) (HR 0.68, 95% CI (0.53 - 0.93) were associated with neonatal survival. The use of at least 2 doses of IPT-SP was not an independent factor for neonatal survival (HR 0.72, 95% CI (0.53 - 1.15). Malaria prevention in pregnancy is crucial for neonatal survival through the prevention of low birth weight.

Dental caries and oral hygiene status: Survey of schoolchildren in rural communities, Southwest Nigeria.

PURPOSE: Dental caries and poor oral hygiene cause pain and have an effect on activities of children such as playing, sleeping, eating and school attendance. Previous studies on the prevalence of dental caries and poor oral hygiene have focused more on urban than rural communities in the developing countries. The objective of the study was to assess dental caries and oral hygiene status of schoolchildren in rural communities. MATERIALS AND METHODS: It was a cross-sectional study involving 778 schoolchildren from 12 public primary schools. A pre-tested, semi-structured interviewer-administered questionnaire was used to obtain information on socio-demographics and oral health practice. Dental caries was assessed using the decayed, missing and filled teeth (DMFT) index and oral hygiene status by the simplified oral hygiene and gingival indices. RESULTS: The mean age of the children was 11.0 ± 1.8 years, and the prevalence of dental caries was 12.2% with a mean DMFT/dmft of 0.2 ± 0.7. Children aged 10-12 years were 3 times more likely to have caries on ≥1 tooth (P = 0.01, confidence interval = 1.3-6.7). Herbal remedies were more often (35.3%) used to manage dental problems. The mean simplified oral hygiene and gingival indices were 1.7 ± 0.9 and 1.1 ± 0.5, respectively. CONCLUSION: The occurrence of dental caries appears to be increasing in rural Nigerian schoolchildren, but still within WHO limits. Oral hygiene status was poor and gingivitis was common.

Barriers to acceptance of post-partum family planning among women in Montserrado County, Liberia.

BACKGROUND: Maternal mortality in Liberia is one of the highest in Sub-Saharan Africa. Post-partum family planning (PPFP) can reduce the risk of maternal mortality by preventing unwanted and closely spaced pregnancies. Yet, the uptake of PPFP is low in Liberia. OBJECTIVE: We investigated the barriers to acceptance of PPFP use among women in Montserrado County, Liberia. MATERIALS AND METHODS: A cross-sectional facility-based survey was conducted using a multistage sampling technique to select 378 women within 12 months' post-partum period. RESULTS: About half of our respondents were <25 years (52.9%), 24.1% were married, 66.4% had at least secondary education and 92.1% were Christians. The most commonly reported barriers were the fear of side effects (22.0%) and the post-partum abstinence (22.2%). Binary logistic regression analysis showed that being within the early post-partum period, i.e., within the first 6 months (adjusted odds ratio [AOR] = 0.23, 95% confidence interval [CI] [0.09-0.60] and lack of access to PPFP [AOR = 0.22, 95% CI [0.09-0.52]). Importantly, women who were married [AOR = 1.686, 95% CI (0.65, 4.36)] and those who were aware of PPFP [AOR 3.69, 95% CI (1.224, 11.096)] increased the likelihood of using PPFP. CONCLUSION: Important barriers to the utilisation of PPFP in Liberia were being within early post-partum period, lack of access and awareness of PPFP including myths and misconception. Therefore, health communication targeting mothers for PPFP at every contact with maternal and childcare services should be encouraged.

What are the factors that interplay from normal pregnancy to near miss maternal morbidity in a Nigerian tertiary health care facility?

Researchers in Nigeria examined the epidemiological characteristics and factors associated with maternal outcomes using a mixed method approach: a prospective case control study design involving 375 pregnant women who received maternal care from a tertiary facility and in-depth interviews reporting the experience of near-miss survivors. A generalized ordered logit model was used to generate the estimates of partial proportional odds ratios (and 95% confidence intervals) across categories of the outcome variable. Factors strongly associated with maternal morbidity were late referral of women, presence of complications at booking antenatal visits, low birth weight, and severe birth asphyxia. The nearmiss women were further characterized, and a low proportion (25%) had organ dysfunction or failure. The challenge of such diagnoses in resource-constrained settings raises questions about the appropriateness of using organ dysfunction criteria in developing countries.

Prevalence and correlates of intimate partner violence towards female students of the University of Ibadan, Nigeria.

BACKGROUND: In Nigeria, there is paucity of information on the IPV burden and experience among young women in courtship and dating relationships. This study assesses the prevalence and correlates of IPV in female undergraduate and postgraduate students in a tertiary institution. METHODS: The study was a cross-sectional survey. A four-stage sampling technique was used to select 1,100 undergraduate and 255 postgraduate female students from the University of Ibadan, Nigeria. Data was collected using a 43-item self-administered structured questionnaire. Descriptive statistics and multivariate analyses were carried out at 0.05 level of significance. RESULTS: The life-time prevalence of IPV was 42.3% (postgraduate: 34.5%, undergraduate: 44.1%; P < 0.05). Lifetime experience of psychological, physical and sexual IPV were 41.8%, 7.9% and 6.6% respectively. Recent experience (within the previous 12 months) of violence was also more frequently reported by respondents who had a previous history of physical (62.5%) (OR = 2.65; 95% CI: 2.02-3.49) and sexual (53.2%) (OR = 1.63; 95% CI:1.12-2.35) violence than respondents who had no such history. Postgraduate (OR = 0.64; 95% CI: 0.46-0.87) and married (OR = 0.53; 95% CI: 0.35-0.78) students were less likely to have experienced IPV than undergraduate and single students respectively. Students who smoked (OR = 2.46; 95% CI: 1.58-3.83); consumed alcohol (OR = 2.36; 95% CI: 1.82- 3.06); and with history of interparental violence (OR = 2.40; 95% CI: 1.88- 3.07) had a higher likelihood of experiencing violence than students who were not exposed to these behaviors. Adverse effects (such as the inability to concentrate) of IPV on academic performance were reported by 10.3% of victims. CONCLUSION: The prevalence of IPV was high. There is the urgent need for interventions that will reduce vulnerability by addressing modifiable risk factors like smoking and alcohol consumption. Interventions should also encourage seeking health care following violence to reduce its consequences.

Influence of postpartum depression on maternal-infant bonding and breastfeeding practices among mothers in Abeokuta, Ogun state.

BACKGROUND: Postpartum Depression (PPD) is a severe mental health condition that adversely affects mothers and their infants. The influence of PPD on maternal-infant bonding and breastfeeding practices has been scarcely reported in Nigeria. Therefore, we examined the prevalence of PPD, the associated factors, and the relationship with maternal-infant bonding and breastfeeding practices in Abeokuta, Nigeria. METHOD: A descriptive cross-sectional survey was conducted among 600 mothers within the extended postpartum period (≤ 1 year) from three government-owned immunisation clinics at primary, secondary, and tertiary health facilities in Abeokuta, Ogun State. PPD was assessed using the Edinburgh postnatal depression Scale (EPDS ≥ 13), and maternal-infant bonding was evaluated using the Postpartum Bonding Questionnaire (PBQ ≥ 50). We also examined breastfeeding practices (i.e. the time to initiation by 30 min, exclusive breastfeeding for 6 months and early commencement of complementary feeding by 2 months). Data was analysed using chi-square and logistics regression models at a 5% significance level. RESULTS: The prevalence of PPD was 21.8%, 95% CI (18.7-25.3). Factors associated with PPD were maternal age: 25-34 years [AOR = 0.52; 95% CI (0.29-0.90)]; ≥ 35 years [AOR = 0.44; 95% CI (0.20-0.96)], being married [AOR = 0.43; 95% CI (0.21-0.85)], perceived stress increased the odds of PPD: moderate stress level [AOR = 8.38; 95% CI (3.50-19.9)]; high-stress level [AOR = 47.8; 95% CI (8.65-263.7)] and self-reported history of emotional problems [AOR = 3.25; 95% CI (1.43-7.38)]. There was a significant direct association between PPD and poor maternal-infant bonding [AOR = 3.91; 95% CI (1.04-4.60)]. PPD reduces the odds of early breastfeeding initiation [AOR = 0.43; 95% CI (0.28-0.68)], but no association was found between PPD and exclusive breastfeeding [AOR = 1.07; 95% CI (0.07-1.67)]. CONCLUSION: The prevalence of PPD was high in our study population and associated with poor maternal-infant bonding and late breastfeeding initiation but not with exclusive breastfeeding. Promoting maternal mental health to foster stronger mother-infant relationships and better breastfeeding practices has become crucial.

Incidence, determinants and perinatal outcomes of near miss maternal morbidity in Ile-Ife Nigeria: a prospective case control study.

BACKGROUND: Maternal mortality ratio in Nigeria is one of the highest in the world. Near misses occur in larger numbers than maternal deaths hence they allow for a more comprehensive analysis of risk factors and determinants as well as outcomes of life-threatening complications in pregnancy. The study determined the incidence, characteristics, determinants and perinatal outcomes of near misses in a tertiary hospital in South-west Nigeria. METHODS: A prospective case control study was conducted at the maternity units of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife Nigeria between July 2006 and July 2007. Near miss cases were defined based on validated disease-specific criteria which included severe haemorrhage, hypertensive disorders in pregnancy, prolonged obstructed labour, infection and severe anemia. Four unmatched controls of pregnant women were selected for every near miss case. Three categories of risk factors (background, proximate, clinical) which derived from a conceptual framework were examined. The perinatal outcomes were also assessed. Bi-variate logistic regressions were used for multivariate analysis of determinants and perinatal outcomes of near miss. RESULTS: The incidence of near miss was 12%. Severe haemorrhage (41.3%), hypertensive disorders in pregnancy (37.3%), prolonged obstructed labour (23%), septicaemia (18.6%) and severe anaemia (14.6%) were the direct causes of near miss. The significant risk factors with their odds ratio and 95% confidence intervals were: chronic hypertension [OR=6.85; 95% CI: (1.96 - 23.93)] having experienced a phase one delay [OR=2.07; 95% CI (1.03 - 4.17)], Emergency caesarian section [OR=3.72; 95% CI: (0.93 - 14.9)], assisted vaginal delivery [OR=2.55; 95% CI: (1.34 - 4.83)]. The protective factors included antenatal care attendance at tertiary facility [OR=0.19; 95% CI: (0.09 - 0.37)], knowledge of pregnancy complications [OR=0.47; 95% CI (0.24 - 0.94)]. Stillbirth [OR=5.4; 95% CI (2.17 - 13.4)] was the most significant adverse perinatal outcomes associated with near miss event. CONCLUSIONS: The analysis of near misses has evolved as a useful tool in the investigation of maternal health especially in life-threatening situations. The significant risk factors identified in this study are amenable to appropriate public health and medical interventions. Adverse perinatal outcomes are clearly attributable to near miss events. Therefore the findings should contribute to Nigeria's effort to achieving MDG 4 and 5.

Prevalence, predictors and pregnancy outcomes of unprescribed and herbal medicine use in Ibadan, Nigeria.

BACKGROUND: Unprescribed and herbal medicines use among pregnant women is a public health concern in low and middle-income countries because of the potential teratogenic effects, insufficient safety and weak drug regulatory systems. Unprescribed and herbal medicines are common among pregnant women in Nigeria, and only a few researchers have documented the prevalence and the risk factors. However, evidence on the associated pregnancy outcomes is still lacking. We assessed the prevalence, predictors and pregnancy outcomes of unprescribed and herbal medicines use among pregnant women in Ibadan, Nigeria. METHODS: This study was a component of the Ibadan Pregnancy Cohort Study, a prospective cohort study, among pregnant women in Ibadan, Nigeria, who were enrolled at ≤ 20 weeks gestation at their first antenatal visit and followed up till delivery. In all, 571 women participated in the maternal drug use assessment during the third trimester using a pretested interviewer-administered questionnaire. The primary outcomes were unprescribed and herbal medicines use and pregnancy outcomes, secondary outcomes, were abstracted from medical records. The predictors assessed included sociodemographic, obstetric, antenatal care utilization, and lifestyle characteristics. Bi-variate logistic and Poisson regression analyses were used to evaluate the predictors and relative risk for the pregnancy outcomes of unprescribed and herbal medicines at 5% significance. RESULTS: The prevalence of unprescribed and herbal medicine use was 31.9% and 21.7%, respectively. On bivariate analysis, the significant predictors of unprescribed medicine (which were protective) were tertiary education, increasing income, adequate antenatal care (≥ 4 visits), and at least two doses of sulfadoxine-pyrimethamine. However, high parity and having an antenatal admission increased the risk. However, after adjusting for confounders, the significant factors associated with unprescribed medicines were; tertiary education (AOR) = 0.23; 95% CI: (0.06 - 0.95); p-value: 0.043] and obtaining at least two doses of sulfadoxine-pyrimethamine [AOR = 0.33; 95% CI: (0.29 - 3.60); p-value: 0.048]. For herbal medicines, the predictors were similar to unprescribed drugs. However, after adjusting for confounders, none was significant for herbal medicines. Unprescribed and herbal medicines were not significantly associated with pregnancy outcomes. CONCLUSIONS: Unprescribed and herbal medicines use were common among pregnant women in Ibadan, Nigeria, particularly among women with low economic status and those with poor utilization of antenatal care services. These significant predictors can be targeted for public health intervention. Specifically, health education that discourages the use of unprescribed and herbal medications to pregnant women during antenatal care.

Gestational weight gain among pregnant women in Ibadan, Nigeria: Pattern, predictors and pregnancy outcomes.

BACKGROUND: Gestational weight gain (GWG) is a risk factor for adverse pregnancy outcomes, future obesity and chronic diseases among women. However, has not received much attention in many low and middle-income countries such as Nigeria. We investigated the pattern, associated factors and pregnancy outcomes of GWG in Ibadan, Nigeria, using the Ibadan Pregnancy Cohort Study (IbPCS). METHODOLOGY: The IbPCS is a multicentre prospective cohort study conducted among 1745 pregnant women recruited from four health facilities in Ibadan, Nigeria. GWG, the primary outcome, was categorised according to the Institute of Medicine's classification into insufficient, adequate and excessive weight gain. Pregnancy outcomes were the secondary outcome variables. Logistic regression analysis (Adjusted odds ratios and 95% confidence interval CI) was used to examine associations, and Poisson regression analyses were used to investigate associations with outcomes. RESULTS: Only 16.9% of women had optimal GWG, 56.8% had excessive GWG, and 26.9% had insufficient GWG. Excessive GWG was associated with high income '> #20,000-' (AOR: 1.64, 95% CI: 1.25-2.17), being overweight (AOR: 2.12, 95% CI: 1.52-2.95) and obese (AOR: 1.47, 95% CI: 1.02-2.13) after adjusting for confounders. In contrast, increased odds of insufficient GWG have associated women with depression (AOR: 1.70, 95% CI 1.17-2.47). There was no significant association between inappropriate GWG and pregnancy outcomes However, there was an increased odds for postpartum haemorrhage (AOR: 2.44, 95% CI 1.14-5.22) among women with obesity and excessive GWG. CONCLUSIONS: Excessive GWG was the most typical form of GWG among our study participants and was associated with high maternal income, and being overweight or obese. GWG needs to be monitored during antenatal care, and interventions that promote appropriate GWG should be implemented among pregnant women in Nigeria.

Pattern and correlates of physical activity and sedentary behaviours of pregnant women in Ibadan, Nigeria: Findings from Ibadan pregnancy cohort study.

Globally, physical inactivity is the fourth leading risk factor for premature death. Pregnancy is associated with reduced physical activity because of physiological and anatomical changes and socio-cultural barriers. Even though physical activity provides many benefits, such as improved insulin sensitivity and reduced cardiometabolic risk, it is not emphasized among pregnant women in Nigeria. This study described the pattern of physical activity and sedentary behaviours of pregnant women from the Ibadan Pregnancy Cohort Study in Ibadan, Nigeria. The Ibadan Pregnancy Cohort Study (IbPCS) is a prospective cohort study investigating the associations between maternal obesity, lifestyle factors on glycaemia control, gestational weight gain, pregnancy and postpartum outcomes among pregnant women in Ibadan. The Pregnancy Physical Activity Questionnaire (PPAQ) was used to assess physical activity and sedentary behaviour. Sedentary time was estimated from the time spent watching television, sitting at work and the computer. Bivariate and multivariate logistic regression analyses were done to investigate associations at a 5% level of statistical significance. None of the pregnant women met the WHO recommendation of 150mins of moderate-intensity activity per week. The average time spent engaged in moderate-intensity activity was 26.3 ± 22.9 mins. The mean daily sedentary time was 6.5 ± 4.2 hours. High parity para ≥ 4: [AOR 0.57 95% CI: (0.36-0.89) p = 0.014] and being employed [AOR 0.23 95% CI: (0.15-0.33) p <0.001] reduced the odds of having inadequate physical activity. Correlates of sedentary behavior after adjusting for confounders were high parity: para 1-3 AOR 0.73, 95% CI: (0.58-0.91) p = 0.004], tertiary education: AOR 2.39 95% CI: (1.16-4.91) p = 0.018] and earning a higher income: AOR 1.40: 95% CI: (1.11-1.78) p = 0.005]. Pregnant women's physical activity and sedentary behaviours are emerging public health issues, especially in Nigeria. The level of physical activity was inadequate among pregnant women, while the sedentary time was high. There is a need to implement programmes that promote physical activity and discourage sedentary behaviour among pregnant women in Nigeria.

Dietary patterns and associated factors among pregnant women in Ibadan, Nigeria: Evidence from Ibadan pregnancy cohort study.

BACKGROUND: Maternal nutrition is vital for an optimal intrauterine environment, foetal development, birth weight, pregnancy and neonatal outcomes. We assessed the maternal dietary patterns using a data-driven technique and the associated sociodemographic factors among pregnant women in Ibadan, Nigeria. METHODOLOGY: Dietary assessment was performed during the enrolment of participants for the Ibadan Pregnancy Cohort Study, a prospective cohort study, conducted among 1745 pregnant women enrolled early in pregnancy (≤ 20 weeks) at four comprehensive obstetric facilities within the Ibadan metropolis. A qualitative food frequency questionnaire was used to assess the pregnant population's intake of food and drinks three months prior to their enrollment. We determined dietary patterns by applying principal component analysis with a varimax rotation. Multivariate analysis was used to investigate the association between sociodemographic factors and dietary patterns at 5% statistical significance. RESULTS: Mean age and gestational age at enrolment were 29.8 (± 5.3) years and 16.4 (±4.2) weeks, respectively. White rice was the most frequently consumed meal [794 (45.5%) daily, 898 (51.4%)] weekly in our study population. Five major dietary patterns were identified, and they accounted for 28.8% of the total variation: "protein-rich diet with non-alcoholic beverages" (15.6%); "fruits" (4.1%); "typical diet with alcohol" (3.8%); "legumes" (2.8%), "refined grains" (2.6%). Maternal education and income were inversely associated with the consumption of a "protein-rich diet with non-alcoholic beverages", "typical diet with alcohol", and "legumes" in a dose-response fashion. Also, employed women had a higher mean intake of fruits [adjusted ß: 0.33 (0.02; 0.65) p = 0.040] compared with women without employment. CONCLUSIONS AND RECOMMENDATION: We described five dietary patterns of pregnant women using a data-driven technique, principal component analysis, in Nigeria. We also identified factors influencing maternal dietary patterns, which can inform public health interventions, especially behavioural change communication during antenatal care.

Investigating the transmission dynamics of SARS-CoV-2 in Nigeria: A SEIR modelling approach.

This study was designed to investigate the transmission dynamics of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to inform policy advisory vital for managing the spread of the virus in Nigeria. We applied the Susceptible-Exposed-Infectious-Recovered (SEIR)-type predictive model to discern the transmission dynamics of SARS-CoV-2 at different stages of the pandemic; incidence, during and after the lockdown from 27th March 2020 to 22nd September 2020 in Nigeria. Our model was calibrated with the COVID-19 data (obtained from the Nigeria Centre for Disease Control) using the "lsqcurvefit" package in MATLAB to fit the "cumulative active cases" and "cumulative death" data. We adopted the Latin hypercube sampling with a partial rank correlation coefficient index to determine the measure of uncertainty in our parameter estimation at a 99% confidence interval (CI). At the incidence of SARS-CoV-2 in Nigeria, the basic reproduction number (R0 ) was 6.860; 99%CI [6.003, 7.882]. R0 decreased by half (3.566; 99%CI [3.503, 3.613]) during the lockdown, and R0 was 1.238; 99%CI [1.215, 1.262] after easing the lockdown. If all parameters are maintained (as in after easing the lockdown), our model forecasted a gradual and perpetual surge through the next 12 months or more. In the light of our results and available data, evidence of human-to-human transmission at higher rates is still very likely. A timely, proactive, and well-articulated effort should help mitigate the transmission of SARS-CoV-2 in Nigeria.

Serological markers and risk factors associated with Hepatitis B virus infection among Federal Capital Territory prison inmates, Nigeria: Should we be concerned?

INTRODUCTION: Hepatitis B virus (HBV) infection is hyper-endemic in Nigeria. Prisons are high-risk environments for the spread of infectious diseases. Worldwide, seroprevalence of HBV infection is substantially higher among individuals in correctional facilities when compared to general population. We determined the seroprevalence and risk factors associated with HBV infection among Kuje prison inmates, Nigeria. MATERIAL AND METHODS: We conducted a prison facility based cross-sectional study. Interviewer administered questionnaires were used to obtain information on participants socio-demographic characteristics, HBV risk factors, previous HBV test and vaccination history. Blood samples collected from participants were analysed for HBsAg, HBsAb, HBcAb, HBeAg and HBeAb markers using rapid lateral chromatographic immunoassay kit. Univariate, bivariate, and multivariate analysis were performed. RESULTS: A total of 271 inmates (63 convicts and 208 awaiting trial inmates) were recruited into the study as participants. The mean age of the participants was 32.7 SD±9 years. HBV seroprevalence (HBsAg) of 13.7% (95% CI: 9.8-18.3) was found. 55.4% (95% CI: 49.2-61.4) of inmates were susceptible to HBV infection, 20.7% (95%CI; 16.0-26.0) had past HBV infection while 10.3% (95% CI: 7.0-14.6) had acquired natural or artificial HBV immunity. Factors found to be associated with current HBV infection (HBsAg) include age-group ≤25years (aOR = 8.0,95% CI: 2.9-22.3), being ever married (aOR = 4.2, 95% CI: 1.7-10.4) and history of alcohol consumption (aOR = 3.4, 95% CI: 1.3-8.4). CONCLUSION: This study reveals a high seroprevalence of HBV infection among Kuje Prison inmates, hence the need to introduce prison-focused health intervention initiatives such as HBV screening, vaccination and care to reduce the transmission of HBV infection among inmates and ultimately the general population.