Disability Among Older Adults in South-Eastern Nigeria.

Disability is a common reason for the loss of independence. There is a dearth of data on older adults with disability in south-eastern Nigeria. Using a multistage sampling technique and disability indexes, we assessed 816 persons aged 65 years and above living with a disability. While respondents' experiences of abuse and property inheritance differ by gender, they have poor health status. Elevated risks of disability were associated with gender, increased age, education, smoking, alcohol use, and engagement in physical exercise. Findings suggest urgency in formulating and implementing ageing welfare policy in this African community undergoing demographic and social changes. While this is underway, we recommend a massive health promotion among older adults in this community. We also suggest the integration of courses on ageing in schools' curriculum since ageing is a life course phenomenon. This in the long run would provide ageing-friendly education that averts old age's deleterious effects.

Intimate partner violence and its association with skilled birth attendance among women in Nigeria: evidence from the Nigeria Demographic and Health Surveys.

BACKGROUND: Intimate Partner Violence (IPV) has been identified as a violation of human rights and a major public health challenge. IPV against women has negative effects on women's mental well-being and leads to unfavourable health outcomes through poor maternal healthcare services utilisation, especially skilled birth attendance (SBA). This study examined the trends in IPV and SBA, as well as the different forms of IPV as predictors of SBA in Nigeria. METHODS: Data for the study were derived from a nationally representative weighted sample of 34,294 women selected and interviewed for the questions on the domestic violence module in the three consecutive Nigeria Demographic and Health Surveys conducted in 2008, 2013 and 2018. Descriptive and analytical analyses were carried out, including frequency distribution and binary logistic regression model at the multivariate level. The results of the explanatory variables were expressed as odds ratio (OR) and 95% confidence intervals (CI). RESULTS: The prevalence of emotional and physical IPV among the sampled women decreased in 2013 from 2008 but later increased in 2018. Sexual IPV increased from 4.1% in 2008 to 7.6% in 2018, while births delivered with the assistance of skilled providers increased from 37.7% in 2008 to 50.8% in 2018. The likelihood of using SBA significantly decreased among women who experienced emotional IPV in 2008 (aOR: 0.74; CI: 0.63-0.87) and sexual IPV in 2018 (aOR: 0.62; CI: 0.45-0.86). Women who experienced physical IPV were more likely to use SBA in 2008, 2013 and 2018 (aOR: 1.72; CI: 1.55-1.92; aOR: 1.40; CI: 1.26-1.56 and aOR: 1.33; CI: 1.15-1.54, respectively). The covariates have varying degrees of influence on SBA across the survey years. CONCLUSIONS: The showed that the prevalence of emotional and physical IPV increased in 2018 after a decrease in 2013, with an increase in sexual IPV and the use of SBA across the survey years. Also, emotional and sexual IPV, unlike physical IPV are associated with low chances of using SBA. There is a need for more pragmatic intervention programmes towards eliminating all forms of violence against all women, reducing maternal and child mortality and promoting the empowerment of women.

Differentials in girl-child marriage and high fertility in Nigeria.

In a patriarchal and natural fertility society like Nigeria, girl-child marriage is synonymous with early sexual debut and a prolonged childbearing period, ultimately affecting fertility outcomes and behaviours. This study explored the differentials in child marriage in Nigeria across socio-economic and regional groups, and its association with fertility. The study analysed secondary data pertaining to women aged 15-49 who were currently or previously married from the 2018 Nigeria Demographic and Health Survey. About 54 percent of Nigerian women married before their eighteenth birthday. The prevalence of child marriage was high in the rural areas (61 percent), in the North West (78 percent) and the North East (70 percent) of Nigeria. Child-brides have higher fertility than women who entered marital life as adults (TFR 6.8 vs 5.9). The early entry into marriage by most women in Nigeria has a profound influence on overall fertility, given that an overwhelming majority of births in Nigeria take place within marriage. Through advocacy and social mobilization, families, communities, and religious leaders will understand the hazards of child marriage and their role and responsibility in eradicating it and empowering the girl-child through formal education.

Ethnicity, sex composition of living children, and unrealized fertility in Nigeria.

While studies in high-income countries have shown that failure to achieve fertility desires is significantly associated with unfavourable personal circumstances, there is barely any empirical evidence on the factors that influence the pattern of unrealized fertility in sub-Saharan Africa. Using data from the 2018 Nigeria Demographic and Health Survey, this paper investigates the roles of ethnicity and the sex composition of living children on unrealized fertility in Nigeria. The results show that the odds of having unrealized fertility were higher among Hausa-Fulani women compared with women of other ethnic groups in Nigeria. Also, having daughters only (no sons) was associated with higher odds of unrealized fertility, after controlling for other important covariates. The findings suggest that cultural norms and pronatalism significantly influence the fertility desires of women in Nigeria, even at the end of their reproductive lifespan.

CONSISTENCY OF THE EFFECTS OF FEMALE EDUCATION ON FERTILITY ACROSS THE NORTH-SOUTH DEMOGRAPHIC DIVIDE IN NIGERIA, 2003-2013.

Most studies examining the association between female education and fertility have reported an inverse association. However, little is known about the consistency of the relationship, or what level of education triggers an inverse association. This study examined the consistency of the association between female education and fertility across the north-south demographic divide in Nigeria. Data on women aged 40-49 were taken from the 2003, 2008 and 2013 Nigerian DHS data sets. The results showed that female education remained significantly and consistently inversely related to fertility in both the north and south of Nigeria. Women with secondary or higher level of education reported a lower number of children ever born (CEB) than those with primary or no education in both the north and south (p<0.05). The findings suggest that female education has a more effective negative effect on fertility in the south, where the level of female schooling is higher, than in the north, with its limited level of female education. Primary-level female education appeared to be ineffective in reducing fertility in the study sample. Women with primary schooling reported a slightly higher CEB than those who did not have any formal education. Also, age at marriage and child mortality were found to be consistent and significant predictors of fertility in both the north and south (p<0.001). Women who married at relatively higher ages and those who had never lost a child reported a smaller CEB consistently in both the north and south (p<0.001). Therefore, to attain sustainable fertility decline throughout Nigeria, it is imperative that policies aimed at increasing the prevalence and quality of female education are pursued, and there must be a focus on social, physical, environmental and cultural factors influencing age at marriage and child mortality.

Effect of Volunteer Household Counseling in Improving Knowledge of Birth Preparedness and Complication Readiness of Pregnant Women in Northwest Nigeria.

Maternal and Child Health Integrated Program (MCHIP), a program by Jhpiego global, implemented maternal and newborn health project between 2006 and 2010 in Kano and Zamfara States, Nigeria. This was evaluated with an objective to characterize the effects of volunteer household counselors (VHCs) upon improving knowledge of birth preparedness and complication readiness (BPCR) among pregnant women. VHCs were trained to educate women and their families at home about BPCR. Knowledge of BPCR was compared among 152 and 594 women who did and did not receive household counseling. Mothers' knowledge of BPCR among those who did and did not receive counseling was 32.2% and 11.2% respectively. Mothers who received counseling had better knowledge of BPCR compared to women who did not (Relative Risk [R.R.] 2.30, 95% [C.I.] 1.50, 3.51, P = 0.0001) in a multivariable logistic regression model adjusting for potential confounders. Mothers who received counseling had better odds of knowledge of danger signs during delivery (R.R. 1.48, 95% C.I. 1.05, 2.09, P = 0.02), and post-partum period (R.R. 1.69, 95% C.I. 1.22, 2.32, P = 0.001), but not during pregnancy (R.R. 1.26, 95% C.I. 0.97, 1.64, P = 0.08), compared with women who received no counseling. VHCs can substantially increase knowledge of BPCR and danger signs among women in Nigeria.

Implementation of Family Life and HIV/AIDS Education in Nigerian Schools: A Qualitative Study on Scope, Delivery and Challenges .

This study utilized data from Focus Group Discussions and In-depth Interviews among secondary school students and teachers to examine the scope, delivery and challenges of FLHE implementation within states and across geopolitical zones in Nigeria. Structural Functionalism, Rational Choice and Differential Association theories were adopted as theoretical framework. Results show that several patterns in classroom teaching of FLHE are identifiable across the country. The study found that FLHE is taught at the Junior Secondary and Senior Secondary levels with variations among States on the beginning levels. The main mode of FLHE delivery is classroom instruction; other modes include assembly talk and sensitization by organizations. Despite paucity of Information, Education and Communication materials and inadequate personnel requirement, different stakeholders noted that FLHE has been beneficial to students. Therefore, effective implementation of FLHE will go a long way to ensuring that young people in Nigeria are equipped with necessary information to enable them exhibit the right attitude and behaviour towards sexuality issues.

Adolescent Sexuality and Life Skills Education in Nigeria: To What Extent have Out-of-School Adolescents Been Reached?

The introduction of school-based adolescent sexuality and life skills education in Nigeria's formal education sector raises the misgiving that out-of-school youths who constitute more than half of the youth population might be neglected. This study investigated the extent to which out-of-school adolescents have been reached with sexuality education in Nigeria. The study took place in the six geopolitical zones and the Federal Capital Territory Abuja, and involved out-of-school adolescents, Non-Governmental Organizations, and community leaders. The qualitative research approaches were employed. Most of the youths had been exposed to sexuality education through seminars, trainings and workshops organized by different organizations. However, states in the south were better served than those in the north. Sexually Transmitted Infections including HIV/AIDS prevention accounted for more than 40% of the content of sexuality and life skills education received by out-of-school adolescents. The programmes have impacted positively on adolescents' disposition and relationship with the opposite sex, knowledge and skill building.

Evaluation of the Implementation of Family Life and HIV Education Programme in Nigeria.

Family Life and HIV Education (FLHE) programme was introduced nationwide in Nigeria in 2003. Since then little is known about the patterns of its implementation across the states in the six geo-political zones in Nigeria. This study represents an attempt to fill this lacuna in the FLHE literature in Nigeria. Quantitative data was collected from the Federal Ministry of Education and the State Ministries of Education on all salient aspects of FLHE implementation. The findings from data collected in 35 states and the Abuja Federal Capital Territory show large variations in the year of adoption of the programme, level of implementation of the programme, the proportion of implementing schools that are reporting to the coordinating government ministries/agencies, the level to which schools have been supplied with relevant curriculum, and promptness of distribution of materials across the zones. All these indices did not show significant level of interdependence. In general, there were higher levels of FLHE activities in the South than the North. Several problems affect implementation of FLHE in Nigeria, most of which will require increased financial and technical support from government and other organizations. The FLHE programme has had positive effects in the states and among schools where the implementation has been effective, underscoring the need for a more effective implementation of the programmes throughout the country.

Methodological issues in HIV-related social research in Nigeria.

This paper is about methodological issues in a community-wide study in Nigeria on an infectious disease, namely HIV/AIDS. The study was designed to ascertain the risk factors that contribute to the spread of HIV/AIDS and how that can be tackled in order to bring about behavioural change. The research team believed at the onset that a study on the interplay between HIV/AIDS and sensitive issues like sexual mores and sexuality requires much more than a straightjacket social science method, such as simply doing a cross-section study and/or using interview schedule. This paper reviews the essence of cross-disciplinary approach; team building; as well as the use of a non-participatory observational approach in data collection. It also shows why ample consideration was given to ethical issues which are often glossed over in social research in developing countries. The lessons from the study underscore the methodological imperatives in social research that focus on sensitive issues in largely non-literate context like Nigeria. Although there are formidable challenges in community-based studies in largely non-literate societies, nevertheless they could easily be surmounted if there are ample time and resources to navigate the various sticking points.

How Do Older Adults in a Sub-Saharan African Community Perceive and Cope With Their Disability? An Interpretive Phenomenological Analysis.

Objective: The study explored the perceptions and coping strategies employed by older adults in a Sub-Saharan African community in relation to their disabilities. Methods: The research utilized an Interpretive Phenomenological Analysis methodology and conducted semi-structured interviews with a purposive sample of households. The study recruited a total of 36 older adults aged 65 years and above, aiming to capture a diverse range of insights and perspectives within the Sub-Saharan African community. Results: Three interrelated themes pertaining to the perception of disability emerged: the impact of old age, disabilities caused by diseases, and disabilities attributed to external factors such as witchcraft. In coping with disability, two interrelated themes emerged: pragmatic coping strategies and unpragmatic coping strategies. Conclusion: This study offers valuable insights into the nuanced perception of disability and coping mechanisms utilized by older adults within the Sub-Saharan African community. By exploring their lived experiences, the findings contribute to a better understanding of the challenges they face. These insights have important implications for policy development and public health initiatives.

Persistence of risky sexual behaviours and HIV/AIDS: evidence from qualitative data in three Nigerian communities.

The behavioural factors that are driving HIV/AIDS remain largely elusive despite vast number of quantitative studies. It is widely acknowledged that sensitive issues like sexual mores are better studied, using the qualitative methods. An ethnographic semi-longitudinal study was conducted in three of Nigeria's communities with high and/or low HIV/AIDS prevalence rates in order to ascertain the risky behavioural factors that are still driving the epidemic despite colossal investment in preventative programmes. The focus group discussion, in-depth interview and key informant methods were utilized to gather data from members of the communities, opinion leaders, policymakers, healthcare practitioners and religious leaders. The nine factors that appear to be driving the infection are: transactional sex, age of sexual debut and lack of parental care, misconceptions about HIV and AIDS, sexual partnership beyond spouses and primary partners, mismatched sexual desire, fatalism, syndrome of denial, condom use, and alcohol. The outcomes of the study have implications for the prevention of the HIV/AIDS epidemic in the country.

Age of sexual debut and patterns of sexual behaviour in two local government areas in southern Nigeria.

The study examines the age of sexual debut and patterns of sexual behavior in Ugep, Cross River State, and Badeku and Olunloyo in Oyo State. A survey of households and individuals was conducted in the three communities; qualitative data were also collected through in-depth interviews and focus group discussion. The median age of first sex among never-married males and females were 17 years and 18 years respectively; more than one in five adolescents have had sex before age 16. Never-married males and females initiated sex earlier than ever-married, older respondents. That 14 percent of married men keep other sexual partners besides their wives is indicative of substantial extramarital relationship; also 12 percent of never-married male respondents with regular sex partners have other sexual partners. Condom use is fairly high, especially in sexual relations involving non-regular partners. The higher likelihood of alcohol use in sexual liaison with non-regular sex partners is suggestive of high prevalence of transactional sex and spontaneous or unplanned sex under the influence of alcohol, with their implications for the spread of HIV and AIDS. The study underscores the need for adolescent sexual and reproductive health education and behaviour change communication among all segments of the population and inculcation of values less favourable for the spread of sexually transmitted infections.

The impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of under-five mortality in Nigeria: a cross-sectional study.

BACKGROUND: Despite the progress in reducing under-five mortality (U-5 M) in recent years, these deaths remain considerably high in Nigeria. This could be attributed to poor health policies including inequality of health insurance coverage and access to adequate healthcare services utilisations which has remained inimical to achieving sustainable development goals (SDGs). Therefore, this study examined the impact of maternal health insurance coverage and adequate healthcare services utilisation on the risk of U-5 M in Nigeria. METHODS: The data for the study were derived from the 2018 Nigeria Demographic and Health Survey and comprised a weighted sample of 127,545 birth histories of childbearing women. Descriptive and analytical analyses were carried out, including frequency tables and multivariate using Cox proportional regression. The results were presented as hazard ratios (HR) with 95% confidence intervals (CIs). Data were analyzed using Stata software version 15.1. RESULTS: The results showed that 14.3% of the sampled birth histories of the childbearing women were children who died before age 5. The results further showed that 97.7% of the children were of mothers who have health insurance and over one-half (56.5%) were children whose mothers had adequate healthcare services utilisation. The risk of under-five death was significantly lower among the children of mothers who were covered by health insurance (HR: 0.66, CI: 0.42-1.02) and those whose mothers utilised adequate healthcare services (HR: 0.78, CI: 0.68-0.90). A similar result was observed among children whose mothers reported that distance to the health facility was not a problem (HR: 0.81, CI: 0.72-0.86). Some mothers' characteristics including educational attainment, wealth quintile and region of residence significantly influenced the risk of U-5 M. CONCLUSIONS: The study established that maternal health insurance coverage and adequate healthcare services utilisation were found to be protective factors against the risk of U-5 M. Also, the revealed low health insurance coverage of mothers calls for more pragmatic policy and intervention programmes through health insurance to achieve SDGs targets of ending preventable deaths of children under 5 years of age and ensuring quality, as well as universal access to maternal and child healthcare services.

Perceptions of Nigerian women on domestic violence: evidence from 2003 Nigeria Demographic and Health Survey.

To facilitate the design of effective programmes to eliminate violence against women in Nigeria, this paper examined women's perceptions of wife beating. The data were derived from the 2003 Nigeria Demographic and Health Survey (NDHS). Both descriptive and analytical methods were used to assess the net effects of socio-demographic factors on women's perceptions of domestic violence. The study demonstrates that a large percentage of Nigerian women agreed that a man is justified in beating or hitting his wife; 66.4% and 50.4% of ever-married and unmarried women respectively expressed consent for wife beating. Respondents' approval of wife beating or abuse varied by personal attributes. Ethnic affiliation, level of education, place of residence, wealth index and frequency of listening to radio were significantly related to concurrence with wife beating. This paper highlights the cultural factors responsible for, and negative effects of, domestic violence against women in Nigeria and makes a case for raising public consciousness against it.

Prevalence of and factors associated with extramarital sex among Nigerian men.

This study used data on currently married and cohabiting men aged 15 to 64 years from the 2003 Nigeria Demographic and Health Survey to examine the prevalence of and factors associated with extramarital sex. The results show that 16% engaged in extramarital sex in the 12 months preceding the survey and had an average of 1.82 partners. The results also show statistically significant association between extramarital sex and ethnicity, religion, age, age at sexual debut, education, occupation, and place of residence. Based on the study results, it could be concluded that significant proportions of Nigerians are exposed to HIV infection through extramarital sex. A fundamental behavioral change expected in the era of HIV/AIDS is the inculcation of marital fidelity and emotional bonding between marital partners. The promotion of condom use among married couples should be intensified to protect women, a large number of whom are exposed to HIV infection from their spouses who engage in unprotected extramarital sex. And, because of gender-based power imbalances within the family, a large number of the women are unable to negotiate consistent condom use by their partners.