Risk Assessment Score and Chi-Square Automatic Interaction Detection Algorithm for Hypertension Among Africans: Models From the SIREN Study.

BACKGROUND: This study aimed to develop a risk-scoring model for hypertension among Africans. METHODS: In this study, 4413 stroke-free controls were used to develop the risk-scoring model for hypertension. Logistic regression models were applied to 13 risk factors. We randomly split the dataset into training and testing data at a ratio of 80:20. Constant and standardized weights were assigned to factors significantly associated with hypertension in the regression model to develop a probability risk score on a scale of 0 to 1 using a logistic regression model. The model accuracy was assessed to estimate the cutoff score for discriminating hypertensives. RESULTS: Mean age was 59.9±13.3 years, 56.0% were hypertensives, and 8 factors, including diabetes, age ≥65 years, higher waist circumference, (BMI) ≥30 kg/m2, lack of formal education, living in urban residence, family history of cardiovascular diseases, and dyslipidemia use were associated with hypertension. Cohen κ was maximal at ≥0.28, and a total probability risk score of ≥0.60 was adopted for both statistical weighting for risk quantification of hypertension in both datasets. The probability risk score presented a good performance-receiver operating characteristic: 64% (95% CI, 61.0-68.0), a sensitivity of 55.1%, specificity of 71.5%, positive predicted value of 70.9%, and negative predicted value of 55.8%, in the test dataset. Similarly, decision tree had a predictive accuracy of 67.7% (95% CI, 66.1-69.3) for the training set and 64.6% (95% CI, 61.0-68.0) for the testing dataset. CONCLUSIONS: The novel risk-scoring model discriminated hypertensives with good accuracy and will be helpful in the early identification of community-based Africans vulnerable to hypertension for its primary prevention.

Health service utilisation during the COVID-19 pandemic in sub-Saharan Africa in 2020: a multicountry empirical assessment with a focus on maternal, newborn and child health services.

INTRODUCTION: There are concerns about the impact of the COVID-19 pandemic on the continuation of essential health services in sub-Saharan Africa. Through the Countdown to 2030 for Women's, Children's and Adolescents' Health country collaborations, analysts from country and global public health institutions and ministries of health assessed the trends in selected services for maternal, newborn and child health, general service utilisation. METHODS: Monthly routine health facility data by district for the period 2017-2020 were compiled by 12 country teams and adjusted after extensive quality assessments. Mixed effects linear regressions were used to estimate the size of any change in service utilisation for each month from March to December 2020 and for the whole COVID-19 period in 2020. RESULTS: The completeness of reporting of health facilities was high in 2020 (median of 12 countries, 96% national and 91% of districts ≥90%), higher than in the preceding years and extreme outliers were few. The country median reduction in utilisation of nine health services for the whole period March-December 2020 was 3.9% (range: -8.2 to 2.4). The greatest reductions were observed for inpatient admissions (median=-17.0%) and outpatient admissions (median=-7.1%), while antenatal, delivery care and immunisation services generally had smaller reductions (median from -2% to -6%). Eastern African countries had greater reductions than those in West Africa, and rural districts were slightly more affected than urban districts. The greatest drop in services was observed for March-June 2020 for general services, when the response was strongest as measured by a stringency index. CONCLUSION: The district health facility reports provide a solid basis for trend assessment after extensive data quality assessment and adjustment. Even the modest negative impact on service utilisation observed in most countries will require major efforts, supported by the international partners, to maintain progress towards the SDG health targets by 2030.

Risk assessment for COVID-19 transmission at household level in sub-Saharan Africa: evidence from DHS.

Household habitat conditions matter for diseases transmission and control, especially in the case of the novel coronavirus (COVID-19). These conditions include availability and adequacy of sanitation facilities, and number of persons per room. Despite this, little attention is being paid to these conditions as a pathway to understanding the transmission and prevention of COVID-19, especially in Africa, where household habitat conditions are largely suboptimal. This study assesses household sanitation and isolation capacities to understand the COVID-19 transmission risk at household level across Africa. We conducted a secondary analysis of the Demographic and Health Surveys of 16 African countries implemented between 2015 and 2018 to understand the status of households for prevention of COVID-19 transmission in home. We assessed handwashing capacity and self-isolation capacity using multiple parameters, and identified households with elderly persons, who are most at risk of the disease. We fitted two-level random intercept logit models to explore independent relationships among the three indicators, while controlling for the selected explanatory variables. Handwashing capacity was highest in Tanzania (48.2%), and lowest in Chad (4.2%), varying by household location (urban or rural), as well as household wealth. Isolation capacity was highest in South Africa (77.4%), and lowest in Ethiopia (30.9%). Senegal had the largest proportion of households with an elderly person (42.1%), while Angola (16.4%) had the lowest. There were strong, independent relationships between handwashing and isolation capacities in a majority of countries. Also, strong associations were found between isolation capacity and presence of older persons in households. Household capacity for COVID-19 prevention varied significantly across countries, with those having elderly household members not necessarily having the best handwashing or isolation capacity. In view of the age risk factors of COVID-19 transmission, and its dependence on handwashing and isolation capacities of households, each country needs to use the extant information on its risk status to shape communication and intervention strategies that will help limit the impact of the disease in its population across Africa. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s41118-021-00130-w.

Social contexts of fertility desire among non-childbearing young men and women aged 15-24 years in Nigeria.

BACKGROUND: Reduction in ideal number of children has been suggested as a necessary precursor for fertility decline especially in high fertility countries of Western and Central Africa. In this study, we explored the social contexts of fertility desires by documenting the effects of individual, household as well as contextual characteristics among young men and women in Nigeria. METHODS: Data source was the male and female recode file of 2018 Nigeria Demographic and Health Survey. Analytical sample comprised 2674 males and 9637 females aged 15-24 years. The main outcome variable was desire for large family size (DLFS) defined as ideal number of children greater than four. Analysis involved use of descriptive statistics and random-effect logit models fitted in four stages. RESULTS: DLFS was 71% among young men and 53% in women. Individual-level factors associated with DLFS among men includes Islam religion (OR = 3.95, CI 2.68-5.83), household size (OR = 1.05) and richer (OR = 0.47, CI 0.29-0.75) or richest wealth index (OR = 0.28, CI 0.16-0.75). Geo-political region and high level of negative attitude to family planning (OR = 1.72, CI 1.23-2.40) were the main contextual factors associated with DLFS. For women, individual-level correlates were education, religion, ethnicity, marital status, household size, and wealth index. Contextual factors include geo-political region, community education (OR = 0.68, CI 0.52-0.89), child mortality experience (OR = 1.29, CI 1.11-1.51) and negative attitude to family planning (OR = 1.36, CI 1.13-1.65). The influence of religion, household wealth and attitude to family planning differ between young men and women. CONCLUSION: Active communication and programmatic interventions are needed so that desire for large family size by young men and women do not become a clog for fertility transition in Nigeria.

Reduction in ideal number of children has been suggested as a necessary condition for fertility decline especially in high fertility countries of Western and Central Africa. In this study, we explored the effects of individual, household as well as community characteristics on fertility desires among young men and women aged 15­24 years in Nigeria. We analysed data for 2674 males and 9637 females aged 15­24 years extracted from the 2018 Nigeria Demographic and Health Survey. The outcome variable was desire for large family size (DLFS) defined as ideal number of children greater than four. Results showed that DLFS was 71% among men and 53% in women. Individual-level factors associated with DLFS among men include Islam religion, household size and wealth status. Geo-political region and high level of negative attitude to family planning were the main community-level factors associated with DLFS. For women, individual-level positively associated with DLFS were Islam religion, and being currently married. Compared to Yoruba, other ethnic groups were more likely to favour DLFS. The negative factors associated with DLFS among young women include higher education and wealth status. At the community-level, Northern geo-political regions, child mortality experience and negative attitude to family planning were positively associated with DLFS. The influence of religion, household wealth and attitude to family planning differ between young men and women. Multi-dimensional strategies with active communication and programmatic interventions are needed so that desire for large family size by young men and women do not slow down fertility transition in Nigeria.

Caregiver burden and associated factors amongst carers of women with advanced breast cancer attending a radiation oncology clinic in Nigeria.

BACKGROUND: The responsibility of caring for patients with advanced cancer in sub-Saharan Africa is mostly shouldered by family members because of paucity of institutional facilities. There is a growing concern that the number of women needing treatment for advanced breast cancer is rising at an unprecedented rate in Nigeria. AIM: To assess the caregiver burden and its associated factors amongst family caregivers of women with advanced breast cancer. SETTING: The study was conducted at the radiation oncology clinic of the University College Hospital, Ibadan, Nigeria. METHODS: A cross-sectional descriptive study was conducted amongst 157 eligible family caregivers of women with advanced breast cancer. The family caregivers completed an interviewer-administered questionnaire, which included the socio-demographic data, the caregiving process and the Zarit Burden Interview (ZBI). Logistic regression was used to identify factors, and ethical approval was obtained. RESULTS: Over half (53%) of the respondents were males with spousal caregivers dominantly constituting 27.4% of all respondents, closely followed by daughters (25.5%) of the care recipients. The mean ZBI score was 29.84 ± 13.9. Most (72%) of the caregivers experienced burden. Factors associated with caregiver burden were previous hospitalisation of the care recipient (odds ratio [OR] = 3.74, confidence interval [CI]: 1.67 to 8.38) and perceived dysfunction in patients activities of daily living (OR = 2.57, CI: 1.14 to 5.78). CONCLUSION: Family caregivers of women with advanced breast cancer experience burden of care. Recognition of this vulnerable population and the care recipient as a dyad is a sine qua non in mitigating the burden associated with their caregiving role.

How soon do single mothers have another child? A competing risk analysis of second premarital childbearing in sub-Saharan African countries.

BACKGROUND: A considerable number of previous studies have examined the trends, correlates, and consequences of premarital childbearing among adolescents and young women in Africa. However, very little is known about whether and how soon single mothers have another premarital birth in sub-Saharan African countries. This study examines the timing of a second premarital birth among single mothers and assesses how it may differ across key socio-demographic variables. METHODS: We pooled recent Demographic and Health Surveys from 25 sub-Saharan African countries to create a database of 57, 219 single mothers aged 15-49 years. Cumulative incidence graphs and Fine and Gray's competing risk models were used to delineate the timing of a second premarital birth and its socio-demographic correlates. RESULTS: More than one-third of single mothers in 16 countries have had a second premarital birth in their reproductive life. We also observed that more than 15% of the single mothers in Angola, Benin, the Republic of Chad, Liberia, Namibia, Nigeria, Sierra Leone, and Uganda, have had another premarital birth three years after the first. The incidence of a second premarital birth was significantly lower among women with secondary or higher education, compared to women with less than secondary education (p < 0.05) in most countries. Residence in an urban area compared to rural, was also significantly associated with a low incidence of second premarital birth in 10 countries (p < 0.05). CONCLUSIONS: Findings indicate a rapid progression to having a second premarital birth in some sub-Sahara African countries, particularly among socio-economically disadvantaged women. The findings suggest the need for tailored interventions for improving the quality of life of single mothers, to reduce the associated burden and consequences of having a premarital birth.

Does economic growth reduce childhood stunting? A multicountry analysis of 89 Demographic and Health Surveys in sub-Saharan Africa.

Background: There is mixed evidence and lack of consensus on the impact of economic development on stunting, and likewise there is a dearth of empirical studies on this relationship in the case of sub-Saharan Africa. Thus, this paper examines whether economic growth is associated with childhood stunting in low-income and middle-income sub-Saharan African countries. Methods: We analysed data from 89 Demographic and Health Surveys conducted between 1987 and 2016 available as of October 2018 using multivariable multilevel logistic regression models to show the association between gross domestic product (GDP) per capita and stunting. We adjusted the models for child's age, survey year, child's sex, birth order and country random effect, and presented adjusted and unadjusted ORs. Results: We included data from 490 526 children. We found that the prevalence of stunting decreased with increasing GDP per capita (correlation coefficient=-0.606, p<0.0001). In the unadjusted model for full sample, for every US$1000 increase in GDP per capita, the odds of stunting decreased by 23% (OR=0.77, 95% CI 0.76 to 0.78). The magnitude of the association between GDP per capita and stunting was stronger among children in the richest quintile. After adjustment was made, the association was not significant among children from the poorest quintile. However, the magnitude of the association was more pronounced among children from low-income countries, such that, in the model adjusted for child's age, survey year, child's sex, birth order and country random effect, the association between GDP per capita and stunting remained statistically significant; for every US$1000 increase in GDP per capita, the odds of stunting decreased by 12% (OR=0.88, 95% CI 0.87 to 0.90). Conclusion: There was no significant association between economic growth and child nutritional status. The prevalence of stunting decreased with increasing GDP per capita. This was more pronounced among children from the richest quintile. The magnitude of the association was higher among children from low-income countries, suggesting that households in the poorest quintile were typically the least likely to benefit from economic gains. The findings could serve as a building block needed to modify current policy as per child nutrition-related programmes in Africa.

Patterns of delivery assistance among adolescent mothers in Nigeria.

OBJECTIVE: This study examined the sociodemographic and sociocultural factors associated with the pattern of birth assistance used among adolescent mothers aged 15-19 in Nigeria. DESIGN: The study used a quantitative design, using secondary data from the Nigeria Demographic and Health Surveys conducted between 2003 and 2013. SETTING: The study was nationally representative and conducted across Nigeria. PARTICIPANTS: A weighted sample of 2,096 adolescent mothers aged 15-19. MEASUREMENTS AND FINDINGS: Data were analysed using frequencies, chi square tests and multinomial logistic regression respectively. It was discovered that mothers aged 18 and above had lower odds of using traditional and skilled birth attendants (aORs = 0.68 (0.51-0.92); 0.63 (0.44-0.92)); Igbo mothers had lower odds of using TBAs (aOR = 0.03 (0.002-0.53)); and mothers in female-headed households were less likely to use SBAs (aOR = 0.40 (0.20-0.82)). Rich mothers were more likely to use SBAs (aOR = 2.21 (1.23-3.94)). Mothers whose partners had at least primary education were more likely to use SBAs (aOR = 1.73 (1.09-2.73); 1.64 (1.03-2.59)). Adolescent mothers in the North East (aOR = 5.79 (2.91-11.51)), North West (aOR = 8.24 (4.01-16.93)), South East (aOR = 69.70 (13.96-348.05)) and South South (aOR = 27.84(7.80-99.30)) were more likely to use TBAs, while mothers in the North East (aOR = 0.46 (0.28-0.76)) and North West (aOR = 0.50 (0.29-0.84)) were less likely to use SBAs. Mothers who used partial ANC were more likely to use SBAs (aOR = 5.73 (3.43-9.56)), while those who used full ANC were more likely to use SBA (aOR = 7.33 (4.76-11.29)). KEY CONCLUSIONS: Higher socioeconomic status mothers were more likely to use skilled birth attendance. IMPLICATIONS FOR PRACTICE: Interventions to increase SBA use among adolescent mothers in Nigeria must consider the continued preference for traditional and unskilled birth attendants and unassisted births, and design culturally sensitive programmes.

Mapping 123 million neonatal, infant and child deaths between 2000 and 2017.

Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends. Here we quantified, for the period 2000-2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model. We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality. This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.

Does Female Autonomy Affect Contraceptive Use among Women in Northern Nigeria?

Literature identified female empowerment as a predictor of positive health behaviour. However, in the context of conservative and traditional society, this is yet to be explored. This paper explores the role of female autonomy in contraceptive use among currently married women in northern Nigeria. Nationally representative Nigeria Demographic and Health Survey (NDHS, 2013) data for 18,534 currently married women in northern Nigeria was analysed. Complimentary log-logistic regression (cloglog) was used to analyse the data. Current use of modern contraceptive was 6.6% among currently married women in northern Nigeria. Results show that female autonomy was significantly associated with modern contraceptive use. Respondents' education, wealth status and desire for no more children were associated with higher contraceptive use. Despite the conservative and religious context of northern Nigeria, female autonomy significantly predicts modern contraceptive use. Thus, empowering women in northern Nigeria, especially by education, will enable them to participate in healthy contraceptive decision making.

Does education offset the effect of maternal disadvantage on childhood anaemia in Tanzania? Evidence from a nationally representative cross-sectional study.

BACKGROUND: Despite being preventable, anaemia is a major public health problem that affects a sizable number of children under-five years globally and in Tanzania. This study examined the maternal factors associated with the risk of anaemia among under-five children in Tanzania. We also assessed whether higher maternal education could reduce the risks of anaemia among children of women with poor socio-economic status. METHODS: Data was drawn from the 2015-16 Tanzania demographic and health survey and malaria indicator survey for 7916 children under five years. Adjusted odds ratios were estimated by fitting a proportional odds model to examine the maternal risk factors of anaemia. Stratified analysis was done to examine how the relationship differed across maternal educational levels. RESULTS: The findings revealed that maternal disadvantage evident in young motherhood [AOR:1.43, 95%CI:1.16-1.75], no formal education [AOR:1.53, 95%CI:1.25-1.89], unemployment [AOR:1.31, 95%CI:1.15-1.49], poorest household wealth [AOR:1.50, 95%CI:1.17-1.91], and non-access to health insurance [AOR:1.26, 95%CI: 1.03-1.53] were risk factors of anaemia among children in the sample. Sub-group analysis by maternal education showed that the risks were not evident when the mother has secondary or higher education. However, having an unmarried mother was associated with about four-times higher risk of anaemia if the mother is uneducated [AOR:4.04, 95%CI:1.98-8.24] compared with if the mother is currently in union. CONCLUSION: Findings from this study show that a secondary or higher maternal education may help reduce the socio-economic risk factors of anaemia among children under-5 years in Tanzania.

Screen and Triage by Community Extension Workers to Facilitate Screen and Treat: Task-Sharing Strategy to Achieve Universal Coverage for Cervical Cancer Screening in Nigeria.

Purpose Universal coverage of cervical cancer screening remains elusive in most low- and middle-income countries (LMICs), home to the greatest burden of this preventable disease. Implementation of a cytology-based screening strategy in these countries is challenging. Also, there is shortage of health care workers (HCWs) to implement the low-technology, cheaper, but equally effective, methods like visual inspection with acetic acid. However, the implementation of HIV programs in LMICs has introduced the innovation of task shifting and task sharing, using the community health extension workers (CHEWs) and community health officers (CHOs) to complement clinical HCWs, especially at the primary health care, level with good outcome. Hence, this study leveraged this strategy. Methods We piloted a study to improve knowledge and practice skills of CHEWs and CHOs in a rural community of Oyo state, Nigeria, through training and participatory supervision to screen for cervical cancer using visual inspection with acetic acid and link positive cases for treatment with cryotherapy. Results A total of 51 HCWs, including doctors, nurses, CHEWs, and CHOs, were trained during the study to provide cervical cancer screening services. After the training, cervical cancer and its prevention knowledge improved from 52.4% before training to 91.5% immediate after training. Over 12 months, 950 eligible women were screened, of whom 848 (89.3%) were screened by CHEWs and CHOs. Of the 63 rescreened by CHEWs and CHOs (data grouped), and nurses, 88.1% and 92.3%, respectively, agreed with expert team review, with κ statistics of 0.76 and 0.84, respectively. Conclusion This pilot project showed the ability of CHEWs and CHOs to identify cervical dysplasia was good and that of nurses was very good with appropriate competency training to achieve universal coverage of cervical cancer screening in LMICs.

Maternal Employment and Child Survival During the Era of Sustainable Development Goals: Insights from Proportional Hazards Modelling of Nigeria Birth History Data.

BACKGROUND: One of the targets for the third and fifth Sustainable Development Goals (SDGs) borders on children survival and women economic empowerment, respectively. A robust investigation of the relationship between maternal employment and childhood mortality will provide information useful for programs aimed at ensuring the complementarity of SDG 3 (healthy life for all) and SDG 5 (gender equality, girls and women empowerment). OBJECTIVE: We addressed the following questions: (1) What is the independent relationship between maternal employment and infant (0-11 months) and child (12-59 months) mortality in Nigeria? (2) How does father's occupation, type of residence, and geopolitical region modify the relationship? METHODS: We retrospectively analysed cross-sectional data on weighted sample of 31,828 under-five children extracted from the birth history in the 2013 round of Nigeria Demographic and Health Survey, using Cox proportional hazards models. The outcomes of interest were infant (0-11 months) and child (12-59 months) mortality, and the main explanatory variables include maternal employment, involvement in decision making on work earnings, and father's occupation. Other confounding variables were also controlled. FINDINGS: Results showed that about two-third (68.7%) of under-five children had mothers who were working, with the majority engaged in self-employed occupations such as sales or small businesses, agriculture, and other manual labour. Infant mortality rate amongst children of employed mothers (65 per 1000 live births) was slightly less than the unemployed (70 per 1000 live births). A similar pattern was observed for child mortality. Hazards regression models revealed that the risk of both infant and child mortality was higher amongst unemployed women. Sales and agriculture/manual occupation constituted a higher risk for infant and child mortality. Analysis of interaction effects also revealed variations by father's occupation, type of residence, and geopolitical region. CONCLUSION: The role of maternal employment in child survival is dynamic and depends on the type of occupation, family, and residential and regional context.

Trends, Determinants and Health Risks of Adolescent Fatherhood in Sub-Saharan Africa.

BACKGROUND: This study examined the trends, determinants and health risks of adolescent fatherhood in three selected African countries where adolescent-girl pregnancy/motherhood are decried but with permissive male sexual latitude. METHODS: Adolescent male data were extracted from the malerecode datasets of Demographic Health Survey (2000-2014) for Nigeria, Ethiopia and Zambia. The surveys were grouped into 3-Waves: (2000-2004); (2005-2008) and (2011-2014). The study employed descriptive and binary logistics that tested the log-odds of adolescent fatherhood with respect to selected sexual behaviour indices, and individual and shared demographic variables. RESULTS: The results revealed that the number of lifetime-sexual-partners among the boys is ≥2. The likelihood of adolescent fatherhood is positively associated with increasing age at first cohabitation and multiple sexual partnerships (≥2) having OR=1.673 and OR=1.769 in 2005/2008 and 2011/2014 respectively. Adolescents who had attained tertiary education, and engaged in professional and skilled jobs were 0.313, 0.213 and 0.403 times (respectively) less likely to have ever-fathered a child. The positive association between rural place of residence and adolescent fatherhood in the past shifted to urban residents in 2011/2014. CONCLUSION: The study concludes that early sexual activities and cohabitation are common among male adolescents among the countries of study. The authors recommend discouragement of boy-girl cohabitation, increasing access to higher education and job opportunities in order to stem boy-fatherhood incidence in the study locations and, by extension, other countries in sub-Saharan Africa.

The effect of internal migration, individual and contextual characteristics on contraceptive use among Nigerian women.

We investigated the relation of internal migration to contraceptive use and adjusted for individual and contextual (community) characteristics. Multilevel logistic regression models were fitted to nationally representative data of 28,876 women from 884 communities in Nigeria. Only about one out of every 10 women (10.4%) currently used a contraceptive method. Contraceptive prevalence according to the migration status were rural-urban (12.5%), urban-rural (13.8%), rural nonmigrants (6.2%) and urban nonmigrants (17.1%). The relationship between internal migration and contraceptive use was fully explained by individual and community characteristics. Programs aimed at increasing contraceptive prevalence should address contextual challenges alongside socioeconomic factors.

Patterns and determinants of dropout from maternity care continuum in Nigeria.

BACKGROUND: The maternal, newborn and child health care continuum require that mother/child pair should receive the full package of antenatal, intrapartum and postnatal care in order to derive maximum benefits. Continuity of care is a challenge in sub-Saharan Africa. In this study, we investigate the patterns and factors associated with dropout in the continuum of maternity (antenatal, delivery and postnatal) care in Nigeria. METHOD: Using women recode file from the 2013 Nigeria Demographic and Health Survey, we analysed data on 20,467 women with an index birth within 5 years prior to data collection. Background characteristics and pattern of dropouts were summarised using descriptive statistics. The outcome variable was dropout which we explored in three stages: antenatal, antenatal-delivery, delivery-6 weeks postnatal visit. Multilevel logistic regression models were fitted to identify independent predictors of dropout at each stage. Measure of effect was expressed as Odds Ratio (OR) with 95 % confidence interval (CI). RESULTS: Overall, 12,392 (60.6 %) of all women received antenatal care among whom 38.1 % dropout and never got skilled delivery assistance. Of those who received skilled delivery care, 50.8 % did not attend postnatal visit. The predictors of dropout between antenatal care and delivery include problem with getting money for treatment (OR = 1.18, CI: 1.04-1.34), distance to health facility (OR = 1.31, CI: 1.13-1.52), lack of formal education, being in poor wealth quintile (OR = 2.22, CI: 1.85-2.67), residing in rural areas (OR = 1.98, CI: 1.63-2.41). Regional differences between North East, North West and South West were significant. Between delivery and postnatal visit, the same factors were also associated with dropout. CONCLUSION: The rate of dropout from maternity care continuum is high in Nigeria and driven by low or lack of formal education, poverty and healthcare access problems (distance to facility and difficulty with getting money for treatment). Unexpectedly, dropouts are high in South east and South south as well as in the Northern regions. Intervention programs focusing on community outreach about the benefits of continuum of maternal healthcare package should be introduced especially for women in rural areas and lower socio-economic strata.

Household structure, maternal characteristics and childhood mortality in rural sub-Saharan Africa.

INTRODUCTION: The household dynamics of childhood mortality in rural areas of sub-Saharan Africa is less researched despite the fact that mortality rates are almost two times that of urban settings. This study aimed to investigate the influence of household structure on childhood mortality while controlling for household and maternal characteristics in rural sub-Saharan Africa. METHODS: Eight countries with recent demographic and health survey data not earlier than the year 2010 were selected, two from each sub-region of sub-Saharan Africa. The outcome variables were risk of infant and child death while the main independent variables included sex of household head and household structure. Descriptive statistics were generated for all variables. Mortality rates disaggregated by sex of household head and household structure were estimated using the Kaplan-Meier method. Cox proportional hazard regression models were fitted to investigate the relationship between the outcome and explanatory variables in each country. RESULTS: The percentage of children living in female-headed households (FHHs) ranged from 5.2% in Burkina Faso to 49.1% in Namibia while those living in extended family households ranged from 27.4% in Rwanda to 59.9% in Namibia. Multivariate hazard regression showed that, in the majority of the countries, there was no significant relationship between living in FHHs and childhood mortality, but the direction and magnitude of effect varied across countries. A significant negative effect of FHHs on infant mortality was observed in Burkina Faso (HR=1.64, 95% confidence interval (CI): 1.09-2.48) and Zambia (HR=1.49, 95%CI: 1.02-2.17). Likewise, children in extended family households had a higher risk of child mortality in Burkina Faso (HR=1.33, 95%CI: 1.04-1.69) and Zambia (HR=1.59, 95%CI: 1.02-2.49). There was not much difference in the effect of FHHs between infancy (0-11 months) and childhood (12-59 months) in the other countries. The pooled adjusted hazard ratio (HR) showed that the risk of death in childhood was 23% higher in extended family households (HR=1.23, 95%CI: 1.09-1.39) than in nuclear family households. CONCLUSIONS: In rural sub-Saharan Africa, children in FHHs do not have significantly higher infant and child mortality. Also, there was no difference in infant mortality between nuclear and extended family households but the latter constitute a higher risk for child mortality.

Contemporary profile of acute heart failure in Southern Nigeria: data from the Abeokuta Heart Failure Clinical Registry.

OBJECTIVES: The aim of this study was to determine the contemporary profile, clinical characteristics, and intrahospital outcomes of acute heart failure (AHF) in an African urban community. BACKGROUND: There are limited data on the current burden and characteristics of AHF in Nigerian Africans. METHODS: Comprehensive and detailed clinical and sociodemographic data were prospectively collected from 452 consecutive patients presenting with AHF to the only tertiary hospital in Abeokuta, Nigeria (population about 1 million) over a 2-year period. RESULTS: The mean age was 56.6 ± 15.3 years (57.3 ± 13.4 years for men, 55.7 ± 17.1 years for women), and 204 patients (45.1%) were women. Overall, 415 subjects (91.8%) presented with de novo AHF. The most common risk factor for heart failure was hypertension (pre-existing in 64.3% of patients). Type 2 diabetes mellitus was present in 41 patients (10.0%). Hypertensive heart failure was the most common etiological cause of heart failure, responsible for 78.5% of cases. Dilated cardiomyopathy (7.5%), cor pulmonale (4.4%), pericardial disease (3.3%), rheumatic heart disease (2.4%), and ischemic heart disease were less common (0.4%) causes. The majority of subjects (71.2%) presented with left ventricular dysfunction (mean left ventricular ejection fraction 43.9 ± 9.0%), with valvular dysfunction and abnormal left ventricular geometry frequently documented. The mean duration of hospital stay was 11.4 ± 9.1 days, and intrahospital mortality was 3.8%. CONCLUSIONS: Compared with those in high-income countries, patients presenting with AHF in Abeokuta, Nigeria, are relatively younger and still of working age. It is also more common in men and associated with severe symptoms because of late presentation. Intrahospital mortality is similar to that in other parts of the world.