Prevalence and predictive factors for early initiation of breastfeeding in Nigeria: Evidence from the Nigerian demographic and health survey (2003-2018).

Early initiation of breastfeeding (EIBF) is an essential first step in exclusive breastfeeding that is expected to commence within an hour after childbirth. This study examined the prevalence and the factors associated with EIBF among nursing mothers in Nigeria based on an analysis of the 2003, 2008, 2013, and 2018 Nigerian Demographic Health Survey (NDHS) data. The prevalence of early breastfeeding initiation by women's demographic, socio-economic and reproductive characteristics were computed for each of the survey rounds. The differences in the prevalence estimates for early breastfeeding initiation between the last two survey periods were calculated. A crude and adjusted model to examine association between explanatory variables and early breastfeeding initiation were fitted using Poisson regression model. The mean age of respondents was 29 years (SD=7.3). The prevalence of EIBF increased from 31.5% in 2003 (95% CI 28.4-34.5) to 43.8% in 2018 (95% CI 42.6-45.0), with a decline to 35.3% in 2013 (95% CI 34.0-36.7). The identified risk factors associated with EIBF were being 35-39 years, having at least a primary education, lower wealth quintiles, multiparity, and delivery in a public hospital. EIBF was lower among women that had skilled occupation, access to media, decided to delay pregnancy, history of previous caesarean section, small size baby at birth, and women who received antenatal care. The results indicate that the proportion of women with EIBF in Nigeria is low. Addressing the barriers identified in this paper will help promote EIBF practices in the country.

Missed opportunities for HIV counselling and testing service delivery among pregnant women in Nigeria: Evidence from the 2018 National nutrition and health survey.

According to UNAIDS, the 90-90-90 strategy calls for 90% of HIV-infected individuals to be diagnosed by 2020, 90% of whom will be on anti-retroviral therapy (ART) and 90% of whom will achieve sustained virologic suppression. HIV counselling and testing (HCT) is an important entry point for effective prevention of mother-to-child transmission of HIV. However, evidence abounds that HCT is often missed by pregnant women during antenatal care in Nigeria. We used secondary data from the 2018 Nigerian National Nutrition and Health Survey (NNHS) to determine the pattern of missed opportunities within the HCT algorithm and the factors associated with the missed opportunities. Of the 8,329 eligible women, 2,327 (27.9%) missed HCT because of lack of antenatal care; 1,493 (24.9%) missed HIV pre-test counselling; 180 (4.0%) missed HIV testing after participating in pre-test counselling, while 793 (18.2%) missed collection of HIV result and post-test counselling. Generally, most of the women that missed HCT were from the North West (43.3%) and had their antenatal care with traditional birth attendants. The odds of missing ANC were higher in women in the Northern and Southern regions. Concerning pre-test HIV counselling, the odds of missing it were higher among women in the Northwest and Southeast while the odds of missing post-test counselling of HIV test were higher among women in the Northeast and Southeast relative to other regions. Using TBA as a care provider was associated with higher odds of women missing pre-test and post-test counselling of HIV during ANC compared to those that used doctors or midwives or CHEWs. Missed opportunities are common in different stages of HIV counselling and testing pathway in Nigeria, particularly in the Northern regions. Future studies would need to identify the specific reasons for these missed opportunities, enabling the targeting of more specific policy reform and interventions.

Prevalence and patterns of anthropometric failure among under-five children in Nigeria: Evidence from the National nutrition and health survey, 2018.

Globally, malnutrition among under-five children remains a public health concern. There is increasing concern at research and policy levels about anthropometric failure and the double burden of child malnutrition across different groups of children. The objective of this study was to describe the magnitude and distribution of various forms of anthropometric failure (AF) among children under age five in Nigeria. We used the 2018 National Nutrition and Health Survey data collected among 19,471 under-five children in Nigeria. The most prevalent AF was stunting only (17.7%) followed by stunting and underweight (13.9%). Wasting, stunting and underweight was found among 3.5% of the sample. Wasting, stunting and underweight was most common in age 6-11 months (7.0%) and 12-23 months (6.9%). Overall, about 1 out of 5 under-five children has multiple anthropometric failure. The peak age group for multiple AFs was between six months and 35 months. Multiple AF was less likely among females compared to males (RR=0.74, CI: 0.69, 0.80). The risk of multiple AF was higher in both North East (RR=2.15, CI: 1.78, 2.59) and North West (RR=2.98, CI: 2.51, 3.55) relative to the North Central. In contrast, the risk was lesser in the South East (RR=0.75, CI: 0.59, 0.95) and other southern regions. The study showed that multiple anthropometric failure is a common problem among children in Nigeria. Programmes that will support prevention and early identification of different types of malnutrition among under-five children across States in Nigeria are recommended.

Uptake of modern and traditional contraceptive methods in Nigeria: Lessons from a nationwide initiative on programming for results (2015-2018).

In general, family planning uptake promotes healthy living among couples and their children, in addition to aiding national development. This study was a secondary analysis of data collected from two nationally representative data - 2015 and 2018 National Nutrition and Health Surveys (NNHS) - aimed at measuring the uptake of modern and traditional contraceptive methods among women of reproductive age in Nigeria. The data were analysed by presenting differentials in prevalence of modern and traditional contraceptives between 2015 and 2018. The results showed that during the periods modern contraceptive uptake in Nigeria ranged between 10% and 17%. By contrast, the prevalence of the traditional methods was 8.3% and 10.0%. Within four years (2015-2018), the average national modern contraceptive uptake among women increased by 7%, while the traditional contraceptive uptake reduced by 2%. The uptake of both modern and traditional contraceptive methods varied by ages group of women, geo-political regions, and State of residence. We conclude that the uptake of modern contraception is below expectation in all regions in Nigeria. The uptake is worse in the northern regions as compared to the southern regions. Government needs to invest more to increase access to and utilization of modern contraceptive methods.

Assessment of diagnostic accuracy and adherence to maternal and child health guidelines as a measure of clinical competence of frontline healthcare workers in Nigeria.

Clinical competence of primary healthcare (PHC) workers is important in the delivery of maternal and child health care and services. In this cross-sectional study, we investigated the diagnostic accuracy and adherence to clinical guidelines for the management of some clinical conditions such as malaria, diarrhea, pneumonia, neonatal asphyxia and postpartum hemorrhage, as a proxy to measure the clinical competence of frontline health workers in PHCs in selected states in Nigeria. Ninety PHC facilities were randomly selected in each State and the FCT. Of the 3330 health workers, only 36.0% were able to correctly diagnose the five selected medical conditions. There was a significant difference in the diagnostic accuracy of the health workers with the doctors having highest diagnostic accuracy (65.5%) compared to other health workers (p <0.001). Adherence to the management guidelines was generally poor across all cadres of health workers and this pattern appear similar across the geopolitical regions in the country. The highest adherence to guidelines was observed among medical doctors (38.2%). The diagnostic accuracy and adherence to national guidelines for managing patients was poor among health workers, particularly, among other cadres except doctors. PHC workers in Nigeria need continuous training to enhance their clinical competence to improve quality of maternal and child health care.

Individual and ecological analyses of antenatal care: Prospects for delivery assistance and use of modern family planning in Nigeria.

Despite the availability of healthcare centres for the provision of antenatal care (ANC) services in Nigeria, the services are still underutilized by pregnant women. ANC services not only reduce maternal mortality and birth defects, but also have a strong link to many causes of maternal deaths. This study explored the individual and ecological relationships between antenatal care, skilled birth assistance during delivery, and family planning use across states in Nigeria. This study was a secondary analysis of data from the 2018 National Nutrition and Health Survey (NNHS) carried out among 24,985 women aged 15-49 years in the 36 states and the Federal Capital Territory (FCT) in Nigeria. Analysis was carried out at the level of individual women and at the ecological level. Only 68.3% visited a health professional (doctors, nurses, midwives, community health extension workers, and community health officers) for ANC in the most recent pregnancy before the survey. At delivery, 44.9% were assisted by delivery attendants with about half (50.1%) assisted by non-professional (traditional birth attendants, relatives and friends) during delivery. There was a significant variation in use of modern family planning (FP) across types of ANC provider. There was a strong positive correlation between ANC utilisation and skilled birth attendance (SBA) (r=0.706, p <0.001), and between SBA and FP (r=0.730, p <0.001). These results have implications for the design of appropriate interventions for strengthening the role of healthcare providers to enhance ANC patronage, utilization of safe delivery services and sustained use of reproductive health services.

Hierarchical modelling of factors associated with anaemia among under-five children in Nigeria.

This study used a nationally representative cross-sectional data from 2018 Nigeria Demographic Health Survey (NDHS) to investigate the prevalence and factors associated with anaemia in children aged less than five years in Nigeria. Anaemia was defined as haemoglobin level <11.0g/dl, while explanatory variables included parental profile, social and environmental factors. Descriptive analyses and multivariable Poisson regression models were fitted using Stata 15 software. Associated factors were quantified using Prevalence Ratio (PR) with 95% confidence interval (CI). Of the 5834 children aged 6-59 months, 51.9% were male. The prevalence of anaemia among under-five children was 71.6% (95% CI: 69.9-73.2). Childhood anaemia was associated with history of maternal anaemia (PR 1.06; CI 1.05-1.08); having underweight mothers (PR 1.02; CI 1.00-1.05); being a Muslim (PR 1.05; CI 1.02-1.08), Igbo (PR 1.07; CI 1.01-1.14) and Hausa (PR 1.04; CI 1.01-1.07) ethnic group. Further, children from South-South (PR 1.09; CI 1.06-1.13) and South-West (PR 1.06; CI 1.02-1.10) and those currently breastfeeding (PR 1.06; CI 1.04-1.07) had higher risk of anaemia. However, children from middle (PR 0.94; CI 0.91-0.97), or higher wealth indices were less likely to have anaemia. Maternal socio-economic and nutritional characteristics were identified as key predictors of under-five anaemia. Strategies are needed to mitigate the effect of poverty and tweak new and existing nutritional intervention programs to make them responsive to socio-cultural peculiarities across the various geo-political regions of Nigeria.

An appraisal of convergence failures in the application of logistic regression model in published manuscripts.

BACKGROUND: Logistic regression model is widely used in health research for description and predictive purposes. Unfortunately, most researchers are sometimes not aware that the underlying principles of the techniques have failed when the algorithm for maximum likelihood does not converge. Young researchers particularly postgraduate students may not know why separation problem whether quasi or complete occurs, how to identify it and how to fix it. OBJECTIVE: This study was designed to critically evaluate convergence issues in articles that employed logistic regression analysis published in an African Journal of Medicine and medical sciences between 2004 and 2013. METHODS: Problems of quasi or complete separation were described and were illustrated with the National Demographic and Health Survey dataset. A critical evaluation of articles that employed logistic regression was conducted. RESULTS: A total of 581 articles was reviewed, of which 40 (6.9%) used binary logistic regression. Twenty-four (60.0%) stated the use of logistic regression model in the methodology while none of the articles assessed model fit. Only 3 (12.5%) properly described the procedures. Of the 40 that used the logistic regression model, the problem of convergence occurred in 6 (15.0%) of the articles. CONCLUSION: Logistic regression tends to be poorly reported in studies published between 2004 and 2013. Our findings showed that the procedure may not be well understood by researchers since very few described the process in their reports and may be totally unaware of the problem of convergence or how to deal with it.

Factors influencing gender based violence among men and women in selected states in Nigeria.

This study determined the factors associated with gender based violence among 3000 men and women in selected states in Nigeria. Respondents who had experienced physical violence were 806 (26.9%), comprising 353 (11.8%) males and 453 (15.1%) females (p<0.001). Respondents who had experienced sexual violence were 364 (12.1%) of which 221 (7.4%) were males and 143 (4.8%) were females (p<0.0001). Married female respondents were more likely to experience physical violence than single respondents (OR= 1.71, 95%CI: 1.15-2.53 p=0.008). In addition, lower risk of experiencing sexual violence among males was observed among those who do not drink alcohol. The study has shown that gender based violence still constitutes a problem in Nigeria, affecting women more than men. However, efforts should be geared towards addressing the factors that promote violence among both sexes through increased awareness and education.

Malaria prevention practices among mothers delivering in an urban hospital in southwest Nigeria.

BACKGROUND & OBJECTIVES: The pregnant woman is more prone to malaria than her non-pregnant counterpart with grave consequences for both mother and baby. This study aims at determining the malaria prevention practices among pregnant women in an area hyper-endemic for malaria. METHODS: For the study 983 parturient mothers were enrolled in Ibadan, southwest Nigeria. Information was collected on sociodemographic characteristics, use of malaria chemoprophylaxis, use of anti-vector measures, and malaria parasitaemia. RESULTS: Most mothers [956/972 (98.4%)] reported the use of anti-vector measures for malaria prevention. These include, window screens (78.9%), insecticides spray (69.9%), mosquito coils (25.3%), untreated bednets (2.5%), and insecticide-treated nets (1.1%). Most mothers used anti-vector measures either singly or in combination. About 86% (840/972) of the mothers used drugs for chemoprophylaxis. Thirteen (1.3%) mothers used chemoprophylaxis alone (CP), 135 (13.9%) used anti-vector measures alone (AV) while 820 (84.4%) used chemoprophylaxis plus anti-vector (CPAV). Weekly dose of pyrimethamine [214 (25%)] and intermittent preventive treatment with sulphadoxine-pyrimethamine [598 (71.2%)] were the widely used chemoprophylactic drugs. The prevalence of patent parasitaemia at delivery was 7.7% (1/13), 12.1% (99/820) and 16.3% (22/135) among CP, CPAV and AV groups respectively. Geometric mean parasite densities among the respective groups were 7840/microl, 1228/microl and 8936/microl. CONCLUSION: Window screens and insecticide sprays were widely used for malaria prevention while the use of ITN was very low among enrolled mothers. There is a need to pay concerted efforts to improve ITN usage rate in Nigeria.

Community effectiveness of artemisinin-based combination therapy for malaria in rural southwestern Nigeria.

A descriptive cross sectional survey using an interviewer-administered questionnaire was carried out among 700 caregivers whose children had fever during the previous two weeks. The aim was to determine the community effectiveness of malaria treatment using arthemeter-lumefantrine (AL) among under-5-year-olds in a rural community in southwestern Nigeria. A total of 353 (50.9%) children received AL. About half of these children (49%) were said to have been treated within 24 hours of onset of symptoms; 44% took the drug for the stipulated period of time; 42% received the correct dosage; and only 4% received all the treatment steps. With a drug efficacy of 100%, AL achieved a community effectiveness of 4%. The greatest effort in the home management of malaria strategy should be in reducing delay in treatment and improving dosage and duration of treatment.

Self medication practices among workers in a tertiary hospital in Nigeria.

Studies in most developing countries revealed (70-95%) of illnesses are treated through self medication. Poor accessibility to medical services have been associated with this practice. This study determines the pattern of self medication among workers at the University College Hospital, Ibadan, Nigeria. In a cross sectional study, workers were selected using a stratified random sampling technique. A high proportion of workers (73%) reported the practice of self medication and 95.6% of them correctly use appropriate drugs. About 80% of these workers stock their drugs at home. Also, 80.4% procure their drugs in chemist shops. A higher proportion of workers directly involved with medical care services (90.9%) practice self medication compared to those involved with non-medical care services (62.9%), P < 0.01. Also, the higher the education of workers the more is the proportion that practice self medication. (P < 0.05). Self-medication is commonly practiced among the hospital population who have relatively easy access to medical care services. Thus self medication may be a real health option.

Factors associated with malaria treatment failures in Ibadan.

This study aims to find out factors associated with anti-malarial drug resistance in some selected areas in Ibadan. One thousand one hundred and two subjects were interviewed using a semi structured questionnaire. Respondents were put into two groups (high and low resistant areas). The Results revealed a high level of drug use for treating malaria particularly choloroquine and sulfadoxine-pyrimethamine ("Fansidar"). The Results also showed that the two groups were not significantly different with respect to clearance of infection, but there was a significant difference between clearance of infection and whether or not the respondent completed the course of treatment in each group (P<0.05). When both groups were combined, the Mantel-Haenszel test showed that the response difference between the two groups was significant. (OR = 3.44 (CI = 1.8 to 6.51)) i.e those that completed the treatment were 3 times more likely to have their infection cleared than those that did not complete the treatment. A significant finding was that non-compliance with treatment was a major factor associated with treatment failure The prevalence of drug resistance was a little higher in the high resistant group compared to the low resistant group; but this difference was not statistically significant. These results underscore the need for adequate health education about the treatment of malaria and the importance of compliance in this community.