Enablers and Barriers to the Utilization of Antenatal Care Services in India.

Antenatal care (ANC) reduces adverse health outcomes for both mother and baby during pregnancy and childbirth. The present study investigated the enablers and barriers to ANC service use among Indian women. The study used data on 183,091 women from the 2015-2016 India Demographic and Health Survey. Multivariate multinomial logistic regression models (using generalised linear latent and mixed models (GLLAMM) with the mlogit link and binomial family) that adjusted for clustering and sampling weights were used to investigate the association between the study factors and frequency of ANC service use. More than half (51.7%, 95% confidence interval (95% CI): 51.1-52.2%) of Indian women had four or more ANC visits, 31.7% (95% CI: 31.3-32.2%) had between one and three ANC visits, and 16.6% (95% CI: 16.3-17.0%) had no ANC visit. Higher household wealth status and parental education, belonging to other tribes or castes, a woman's autonomy to visit the health facility, residence in Southern India, and exposure to the media were enablers of the recommended ANC (≥4) visits. In contrast, lower household wealth, a lack of a woman's autonomy, and residence in East and Central India were barriers to appropriate ANC service use. Our study suggests that barriers to the recommended ANC service use in India can be amended by socioeconomic and health policy interventions, including improvements in education and social services, as well as community health education on the importance of ANC.

Diarrhoea deaths and disability-adjusted life years attributable to suboptimal breastfeeding practices in Nigeria: findings from the global burden of disease study 2016.

Background: In Nigeria, diarrhoea contributes significantly to childhood morbidity and mortality, with suboptimal breastfeeding practices playing a key role. The present study aimed to report on diarrhoea deaths and disability-adjusted life years (DALYs) among children aged under five years attributable to suboptimal breastfeeding practices in Nigeria. Methods: This study used data from the Global Burden of Disease study 2016, which estimated mortality from diarrhoea in the Cause of Death Ensemble model. Suboptimal breastfeeding was assessed as a combination of non-exclusive breastfeeding and discontinued breastfeeding. The comparative risk assessment approach was used to estimate the attributable burden of diarrhoea deaths and DALYs due to suboptimal breastfeeding practices in the spatial-temporal Gaussian Process Regression tool. Results: In 2016, suboptimal breastfeeding practices accounted for an estimated 56.5% (95% uncertainty intervals [UI]: 47.5, 68.3) of diarrhoea deaths in the late neonatal period, 39.0% (31.0, 46.3) in post-neonatal period, 39.0% (31.3, 46.20) in infancy period and 22.8% (16.9, 29.9) in children aged under five years in Nigeria. In the same year, 22,371 (14,259, 32,746) total diarrhoea deaths in children under five years could be attributed to suboptimal breastfeeding practices. DALYs from diarrhoea attributable to suboptimal breastfeeding practices was 1.9 million (1.2, 2.8 million) among children under five years in 2016. Between 1990 and 2016, the proportion of children who died from diarrhoea due to suboptimal breastfeeding did not change substantially across all age groups in Nigeria. Conclusions: Suboptimal breastfeeding practices remain a significant contributor to diarrhoea mortality and disability among children under five years in Nigeria. The study builds on previously published works on breastfeeding practices in Nigeria and provides evidence to support calls for the scale-up of efforts to improve infant feeding outcomes and reduce diarrhoea burden in Nigeria.

Trends and determinants of complementary feeding practices in Tanzania, 2004-2016.

BACKGROUND: Following the successful implementation of the Millennium Development Goals (MDGs) strategy in Tanzania, improvements in child health indicators were observed. However, it remains unclear whether complementary feeding practices have improved given the renewed global agenda on child nutrition. This study investigated trends and socioeconomic and health service factors of complementary feeding practices in Tanzania for the period spanning from 2004 to2016. METHODS: The study was based on the Tanzania Demographic and Health Survey data for the years 2004-2005 (n = 2480), 2010 (n = 2275) and 2015-2016 (n = 2949) to estimate the trends in complementary feeding practices. Multivariate logistic regression models that adjusted for year of the survey, clustering and sampling weights were used to investigate the association between the modifiable study factors (socioeconomic and health service factors) and complementary feeding practices among children aged 6-23 months in Tanzania. RESULTS: Over the study period, minimum dietary diversity (MDD) and minimum acceptable diet (MAD) have worsened from 46% (95% confidence interval [95% CI] 41.5-50.7%) in 2004-2005 to 30% (95% CI 25.7-32.9%) in 2015-2016 and 16.9% (95% CI 14.9-18.9%) in 2004-2005 to 6.0% (95% CI 4.9-7.1%) in 2015-2016, respectively. Minimum meal frequency (MMF) remained unchanged, 37% in 2004-2005 and 2015-2016. The introduction of solid, semi-solid and soft foods improved from 79% (95% CI 74.5-83.9%) in 2004-2005 to 87% (95% CI 83.7-90.9%) in 2015-2016. Multivariate analyses revealed that higher maternal education and household wealth, mother's employment, health facility birthing and postnatal care (PNC) visit were associated with MDD, MAD and MMF. Traditional birth attendant-assisted births and PNC visits were associated with the introduction of complementary foods. In contrast, birthing in the health facility was associated with the delayed introduction of complementary foods. CONCLUSION: Between 2004 and 2016, the prevalence and determinants of complementary feeding practices varied in Tanzania. Improving complementary feeding practices is feasible in Tanzania given the renewed focus on child nutrition in the country. Child nutrition policy interventions should target all mothers, particularly mothers from low socioeconomic background and those with limited access to health services to maximise results.

Tuberculosis disease burden and attributable risk factors in Nigeria, 1990-2016.

BACKGROUND: According to the World Health Organization, Nigeria is one of the countries with a high burden of tuberculosis (TB) worldwide. Improving the burden of TB among HIV-negative people would require comprehensive and up-to-date data to inform targeted policy actions in Nigeria. The study aimed to describe the incidence, prevalence, mortality, disability-adjusted life years (DALYs) and risk factors of tuberculosis in Nigeria between 1990 and 2016. METHODS: This study used the most recent data from the global burden of disease study 2016. TB deaths were estimated using the Cause of Death Ensemble model, while TB incidence, prevalence and DALYs, as well as years of life lost and years of life lived with disability were calculated in the DisMod-MR 2.1, a Bayesian meta-regression tool. Using a comparative risk assessment approach, TB burden attributable to risk factors was estimated in a spatial-temporal Gaussian Process Regression tool. RESULTS: In 2016, the prevalence of TB among HIV-negative people was 27% (95% uncertainty interval [95% UI] 23-31%) in Nigeria. TB incidence rate (new and relapse cases) was 158 per 100,000 people (95% UI; 128-193), while the total number of TB mortality was 39,933 deaths (95% UI; 30,488-55,039) in 2016. Between 2000 and 2016, the age-standardised prevalence and incidence rates of TB-HIV negative decreased by 20.0 and 87.6%, respectively. The age-standardised mortality rate also dropped by 191.6% over the same period. DALYs due to TB among HIV-negative Nigerians was high but varied across the age groups. Of the risk factors studied, alcohol use accounted for the highest number of TB deaths and DALYs, followed by diabetes and smoking in 2016. CONCLUSION: The study shows an improving trend in TB disease burden among HIV-negative individuals in Nigeria from 1990 to 2016. Despite this progress, this study suggests that additional efforts are still needed to ensure that Nigeria is not left behind in the current global strategy to end TB disease. Reducing TB disease burden in the country will require a multipronged approach that includes increased funding, health system strengthening and improved TB surveillance, as well as preventive efforts for alcohol use, smoking and diabetes.

Assessment of provider-initiated HIV screening in Nigeria with sub-Saharan African comparison.

BACKGROUND: Despite Nigeria's high HIV prevalence, voluntary testing and counselling rates remain low. UNAIDS/WHO/CDC recommends provider-initiated testing and counselling (PITC) for HIV in settings with high HIV prevalence. We aimed to assess the acceptability and logistical feasibility of the PITC strategy among adolescents and adults in a secondary health care centre in Idekpa Benue state, Nigeria. METHOD: All patients (aged ≥ 13 years) who visited the out-patient department and antenatal care unit of General Hospital Idekpa, Benue state, Nigeria were offered PITC for HIV. The intervention was implemented by trained health professionals for the period spanning (June to December 2010). RESULTS: Among the 212 patients who were offered PITC for HIV, 199 (94%) accepted HIV testing, 10 patients (4.7%) opted out and 3 patients (1.4%) were undecided. Of the 199 participants who were tested for HIV, 9% were HIV seropositive. The PITC strategy was highly acceptable and feasible, and increased the number of patients who tested for HIV by 5% compared to voluntary counselling and testing. Findings from this assessment were consistent with those from other sub-Saharan African countries (such as Uganda and South Africa). CONCLUSION: PITC for HIV was highly acceptable and logistically feasible, and resulted in an increased rate of HIV testing among patients. Public health initiatives (such as the PITC strategy) that facilitate early detection of HIV and referral for early treatment should be encouraged for broader HIV control and prevention in Nigerian communities.

Infant feeding practices and diarrhoea in sub-Saharan African countries with high diarrhoea mortality.

BACKGROUND: The impacts of optimal infant feeding practices on diarrhoea have been documented in some developing countries, but not in countries with high diarrhoea mortality as reported by the World Health Organisation/United Nations Children's Fund. We aimed to investigate the association between infant feeding practices and diarrhoea in sub-Saharan African countries with high diarrhoea mortality. METHOD: The study used the most recent Demographic and Health Survey datasets collected in nine sub-Saharan African countries with high diarrhoea mortality, namely: Burkina Faso (2010, N = 9,733); Demographic Republic of Congo (2013; N = 10,458); Ethiopia (2013, N = 7,251); Kenya (2014, N = 14,034); Mali (2013, N = 6,365); Niger (2013, N = 7,235); Nigeria (2013, N = 18,539); Tanzania (2010, N = 5,013); and Uganda (2010, N = 4,472). Multilevel logistic regression models that adjusted for cluster and sampling weights were used to investigate the association between infant feeding practices and diarrhoea in these nine African countries. RESULTS: Diarrhoea prevalence was lower among children whose mothers practiced early initiation of breastfeeding, exclusive and predominant breastfeeding. Early initiation of breastfeeding and exclusive breastfeeding were significantly associated with lower risk of diarrhoea (OR = 0.81; 95% confidence interval (CI): 0.77-0.85, P<0.001 and OR = 0.50; 95%CI: 0.43-0.57, respectively). In contrast, introduction of complementary foods (OR = 1.31; 95%CI: 1.14-1.50) and continued breastfeeding at one year (OR = 1.27; 95%CI: 1.05-1.55) were significantly associated with a higher risk of diarrhoea. CONCLUSION: Early initiation of breastfeeding and exclusive breastfeeding are protective of diarrhoea in sub-Saharan African countries with high diarrhoea mortality. To reduce diarrhoea mortality and also achieve the health-related sustainable development goals in sub-Saharan African, an integrated, multi-agency strategic partnership within each country is needed to improve optimal infant feeding practices.

Trends and Predictors of Prelacteal Feeding Practices in Nigeria (2003-2013).

Prelacteal feeding practices are associated with an increased risk of diarrhoea and many early-life diseases. This paper examined trends and predictors of prelacteal feeding practices in Nigeria. A sample of 6416 infants aged 0-6 months from the Nigeria Demographic and Health Survey data for the period (2003-2013) was used. Trends and multilevel logistic regression analyses were used to determine the predictors. The trends of prelacteal feeding rates fluctuated between 55% and 66% over the study period and were significantly lower among mothers with secondary or higher levels of education (13.1%, 95% confidence interval (CI): 0.54-25.9, p-value = 0.041), delivered at the health facility (13.7%, CI: 1.39-25.9, p-value = 0.029), from more affluent households (18.7%, CI: 1.53-35.9, p-value = 0.033), and lived in urban areas (26.9%, CI: 18.3-35.5, p-value < 0.001). Multivariable analyses revealed that mothers with no schooling, younger mothers (aged 15-24 years), mothers who delivered at home, and delivered by caesarean section were more likely to introduce prelacteal feeds. Many mothers still engage in prelacteal feeding practices in Nigeria, with prelacteal feeding more prevalent in young mothers, mothers with no schooling, and mothers who delivered at home. Interventions involving community health volunteers are needed to improve feeding practices in Nigeria.