Multi-Level Correlates of the Nutritional Status of Nigerian Women of Reproductive Age.

Poor nutrition compromises the capacity of women to perform their vital roles as mothers and productive workers in their families, communities and society. Using a conceptual framework developed by the United Nations Children's Fund, this study determines individual-, household- and community-level factors associated with the nutritional status of Nigerian women of reproductive age. A secondary analysis of pooled data from the Nigeria Demographic and Health Survey (NDHS) for 2003, 2008, 2013 and 2018 was conducted involving 82,734 non-pregnant women aged 15-49 years. Multinomial logistic regression was used to determine predictors of nutritional status. Study results show that a significant proportion of the women had poor nutritional status; the prevalence of underweight, overweight and obesity were 12.1%, 16.8% and 7.2% respectively. Statistically significant factors associated with poor nutritional status were found at all three levels, highlighting the need for effective multidimensional, multisectoral policy interventions to address the double burden of malnutrition among women in Nigeria.

Dietary intake and status of selenium in breast milk and serum of lactating mothers in Awka, South East Nigeria.

Background: Selenium is an essential micronutrient for human growth and development. Breast milk is usually the primary source of this nutrient for infants which is fundamental for their healthy brain development; its deficiency can lead to severe neurocognitive outcomes. The concentration of selenium in breast milk is dependent on the maternal diet. Aim: This study assessed associations between maternal diet and levels of selenium concentrations in breastmilk and serum of 124 lactating mothers. Methods: Breast milk and serum samples were collected from lactating mothers whose breast-fed infant was at least one month old. A validated food frequency questionnaire was used to collect information on dietary intake. Descriptive statistics were used to summarize the data while paired t-test was used to determine any statistically significant differences between sample means. Spearman's rank correlation analysis was used to determine associations between breast milk and serum selenium concentrations and study variables. Results: Average time postpartum was 2.9 months while mean concentrations of selenium in breast milk and serum were 6.57 ± 2.69 and 68.48 ± 26.86 µg/L, respectively. Levels of selenium in breast milk and serum were deficient for more than half of the lactating mothers. No statistically significant associations were found between breast milk selenium concentration and time postpartum as well as maternal diet except for eggs (r = 0.23, p = 0.01). Conclusion: The evidence of deficient concentrations of breast milk selenium indicates a poor correlation with maternal diet and suggests the need for postpartum screening of breastfeeding mothers.

"Girls Are the Ones Who Save the Family": Factors and Consequences of Engaging in Age-Disparate Transactional Sex Relationships.

The 2019 Kenya Violence Against Children Survey highlighted the increased prevalence of sexual violence experienced by girls; 62.6% of girls who have experienced childhood sexual violence reported multiple incidents before age 18. Studies have shown that transactional sex (TS) relationships are a source of sexual violence, particularly age-disparate TS. TS is defined as sex that is a nonmarital, noncommercial relationship driven by the assumption that sex is exchanged for material support or other benefits. TS is common among adolescents and young women in sub-Saharan Africa, with the prevalence varying from as low as 5% to as high as 80%. This qualitative study explored the factors influencing age-disparate TS relationships in two rural districts, Mutomo and Ikutha Wards of Kitui South Sub County, Kenya. Four focus group discussions were conducted with primary (12-14 years of age) and secondary schoolgirls (15-18 years of age). The study results identified several main themes, which were grouped into two major themes: influencing factors and consequences. Influencing factors include material/basic needs, school-related influences, parental influence, peer pressure, and perpetrator access, while consequences include health and social consequences. Our study found that girls' sense of agency, social pressure, and economic vulnerability impacted their decision to engage in age-disparate TS. These relationships' power dynamics and exploitative nature increase girls' risk of experiencing gender-based sexual violence and adverse health and social outcomes. Our study suggests that explicitly addressing individual risk behaviors will not effectively reduce the incidence of TS relationships. Interventions should be focused on understanding the social-cultural beliefs of TS and shifting the narrative that has continued to fuel a patriarchal society in which women and girls have limited decision-making power in relationships.

Submit to survive: an exploration of sexual cleansing as an act of violence against widows in the Luo community of Kenya.

In this paper, the sexual 'cleansing' of widows and subsequent inheritance is assessed for its socio-cultural significance. Although the practice has been well studied in the context of HIV in Sub-Saharan Africa, it has not been widely examined as an act of sexual violence against women. To address this gap, in-depth interviews were conducted with 27 widows aged 29 to 90 years in Siaya County in Southwest Kenya. A majority of participants stated the cleansing ritual was forcefully initiated, violently fulfilled, and frequently seen as rape. Findings from this study necessitate the identification of the cultural practice of widow cleansing as an act of violence against women. Doing so will facilitate the creation of a legal framework with which to act to eliminate the practice.

Exploring physicians' experiences under the national health insurance scheme in Southeastern Nigeria.

BACKGROUND: A number of low-and middle-income countries have implemented National Health Insurance Schemes (NHIS) as part of efforts to increase access to quality healthcare and financial protection from regressive out-of-pocket payments. This study explored physicians' experiences under the Nigerian (NHIS) to identify factors that may influence efficient health care delivery. METHODS: A convenient sample of 85 physicians residing in South-East Nigeria who had active contracts with the NHIS were surveyed via self-administered questionnaire for this study. Descriptive statistics were used to summarize the data while Kruskal-Wallis tests were used to determine if there were statistically significant associations between physician professional characteristics and their responses to key statements that assessed their experiences and behavior. Also, thematic analysis was used to assess additional qualitative data provided by study participants. RESULTS: Provider experiences were affected by the perceived inadequacy of reimbursement rates, delays in payment and services not covered by the NHIS. Participants' responses to statements on inadequacy of reimbursement was significantly associated with location using Kruskal-Wallis test (χ2 (1) = 7.24, p = 0.027) while billing patients for services not covered under the NHIS was significantly associated with length of years of practice (χ2 (1) = 15.5, p = 0.001) and place of employment (χ2 (1) = 5.82, p = 0.054). CONCLUSION: Physician experiences and challenges they face under the NHIS program in Nigeria have unintended effects on the delivery of health care services. It is imperative that these issues are addressed to improve health service delivery.

"I was forced into it": The continued violation of widows from the Luo community of Kenya through sexual cleansing rituals.

Sexual cleansing is part of the social transition process for widows to become eligible to remarry after the death of her husband. This ritual is conducted to cleanse the widow of evil spirits resulting from the death of her husband. This qualitative study explored the sexual cleansing ritual in the Luo community in southwest Kenya. This paper aims to examine the widows' perceptions of the social constructs surrounding the practice of the sexual cleansing ritual that maintains its continued existence in this community. Twenty-seven face-to-face in-depth interviews were conducted with widows who had undergone sexually cleansing. Data was analyzed using conventional content analysis. Three main themes emerged in the exploration of the social construction of the sexual cleansing ritual of widows. The findings therein highlight the precarious situation of widows and the need for social support services for women who have been sexually cleansed.

The Impact of Macroeconomic Policies on Healthcare Delivery in Kenya: An Analysis of the National Sexual Violence Prevention and Care Response.

Sexual violence is one of the most common forms of violence against women in Kenya. This study documents the care of sexual violence survivors from the perspective of health care practitioners based on an analytic framework developed in studies of the political-economy of health to examine the effects of International Financial Institutions' conditionalities on the allocation of national fiscal resources. The study documented the working conditions of practitioners and myriad challenges that they experience in providing quality services to sexual violence survivors. The issues reflected in the results are grounded in social structural inequities driven by the global political economic policies that perpetuate poverty and dependency throughout Africa and the developing world. Macro-level variables associated with health care provision are assessed with a focus on global macroeconomic policies established by the International Monetary Fund and World Bank, their impact on Kenya's health economy and their ultimate impact on the capacity of the health system to meet the complex needs of survivors of sexual violence. In this paper, study results are analysed within the context of these macroeconomic policies and their legacy.

A Comparison of Mental and Behavioral Health Risks Factors Associated With Current Dual Use of Electronic Cigarette and Conventional Tobacco Cigarettes With Exclusive Tobacco Cigarette Use and Nonuse Among Adults in the United States.

BACKGROUND AND OBJECTIVES: While health risks associated with tobacco cigarette use are well-known, additional risks of dual use are poorly understood. This study compared mental and behavioral health risk factors associated with the current dual use of e-cigarettes and conventional tobacco cigarettes with current exclusive users of tobacco cigarettes and nonusers of either e-cigarettes or tobacco cigarettes. METHODS: Data from the 2016 National Behavioral Risk Factor Surveillance System (BRFSS) were analyzed (N = 277,034). Current dual use was defined as the current use of tobacco cigarettes and the use of e-cigarettes, everyday or some days. Multivariate logistic regression analysis was used to assess associations between dual use and mental and behavioral health risks compared with exclusive tobacco cigarette users and nonusers. RESULTS: Compared with nonusers, current dual use was associated with increased odds of having more than 14 days of self-reported poor physical health (adjusted odd ratio [AOR], 1.9; P < .01), more than 14 days of self-reported poor mental health (AOR, 1.8; P < .01), a diagnosis of depression (AOR, 2.2; P < .001); using smokeless tobacco products (AOR, 1.6; P < .05), alcohol use (AOR, 1.6; P < .01), and marijuana use (AOR, 8.3; P < .001) than current exclusive users of tobacco cigarettes. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: The concurrent use of e-cigarettes and tobacco cigarettes is associated with increased odds of having behavioral and mental health problems. These findings may be indicative of increased health risks associated with dual use, compared with the exclusive use of tobacco cigarettes, and have important implications for public health interventions and policies aimed at mitigating health risk behaviors. (Am J Addict 2020;00:00-00).

"She Is NOT a Genuine Client": Exploring Health Practitioner's Mistrust of Rape Survivors in Nairobi, Kenya.

Sexual violence is one of the most common forms of violence against women in Kenya. Recognizing this, the Kenyan government introduced health care sector guidelines for survivors of sexual violence. This study explores the care of rape survivors from the perspective of health-care practitioners and identifies a number of recommendations for improving the quality of care. Qualitative interviews were conducted with 28 health practitioners from eight post-rape care facilities located in Nairobi, Kenya. Data were analyzed using the Colaizzi's 1978 analytical model. The study uncovered a troubling tendency of health practitioners questioning the authenticity of a woman's claim, deeming some not to be genuine rape survivors. Doubts about the veracity of the client's story led to additional emotional drain on health practitioners. This judgment negatively impacted the quality of care for rape survivors and in some cases, leading practitioners to deny services and exposing survivors to secondary victimization.

Assessment of the use of different forms of tobacco products among Nigerian adults: Implications for tobacco control policy.

INTRODUCTION: This study assessed the determinants of tobacco use among adults in Nigeria, exploring associations between different types of tobacco products and gender. METHODS: Study data were derived from the 2013 Nigerian Demographic and Health Survey (NDHS). The NDHS is a nationally representative household survey of 39 902 women, 17 359 men and 38 522 households. Country weighted data were collected on participants' demographic characteristics and current tobacco use by type. Weighted prevalence estimates and 95% confidence intervals (CI) were performed to examine individual sociodemographic factors and tobacco use. A multivariate logistic regression was also performed to assess the relationship between tobacco use, adjusting for sociodemographic characteristics. RESULTS: Overall prevalence of any tobacco use in 2013 was 2.9% (n=1621, 95% CI: 2.8-3.0). The prevalence of any tobacco use was 8.3% (95%CI: 7.8-8.8, p<0.001) in men and 0.4% (95%CI: 0.3-0.5, p<0.001) in women. Cigarettes and snuff were the most commonly used tobacco products in men and women. Dual (smoking and smokeless tobacco products) use was associated with increased odds among men (AOR=26.1, 95%CI: 11.7-58.5, p<0.001), aged 45-59 years (AOR=5.6, 95%CI: 2.1-15.2, p<0.01) and completely/semi-illiterate (AOR=1.8, 95CI: 1.1-2.9, p<0.05). CONCLUSIONS: Men and women differed in their preference of type of tobacco product and the associated risk factors. Tobacco control policies need to take these specific differences into consideration for the design and implementation of interventions aimed at addressing tobacco use.

Gambling involvement indicative of underlying behavioral and mental health disorders.

BACKGROUND AND OBJECTIVES: In spite of increased gambling opportunities, risk factors associated with recreational gambling remain poorly understood. This study assessed behavioral risk factors associated with frequency of recreational gambling. METHODS: Data were derived from the 2013 Massachusetts Behavioral Risk Factor Surveillance System. Gambling frequency was divided into two or more times per week, 1-4 times a month, less than 10 times in total, and not at all. Health risk behaviors included smoking, drinking, obesity, seat belt use, and sleep patterns. Multivariate logistic regression was used to assess relationships between overall gambling participation and gambling frequency and behavioral risk behaviors. Final analytical sample included 3,988 survey respondents. Statistical analyses were performed using STATA. RESULTS: Significant differences exist in the socio-demographic characteristics of recreational gamblers. Highest gambling frequency is associated with increased odds of alcohol consumption (ie, having at least one alcohol drink during the past 30 days) (OR 1.9; p < .05), binge drinking (ie, having five or more alcohol drinks at least once during the past 30 days) (OR 3.7; p < .001), and tobacco use (ie, having smoked at least 100 cigarettes in a lifetime) (OR 3.4; p < .001). The odds of having fourteen days of poor mental health are twofold for recreational gamblers who gamble two or more times per week (OR 2.2; p < .05). CONCLUSION AND SCIENTIFIC SIGNIFICANCE: Differing behavioral and mental health risk factors emerge among recreational gamblers by gambling frequency. Gambling frequency may be a better proxy for assessing the risk of developing gambling related behavioral disorders than overall endorsement of gambling participation.