Rotimi Felix Afolabi

Effective containment measures are necessary due to the rapid transmission of infectious diseases over international borders, as demonstrated by the COVID-19 pandemic. This research ascertained and measured the social and cultural elements that may influence adherence to institutional isolation and quarantine protocols during multi-nation health crises in Nigeria. literature emphasizes the significance of socio-cultural elements, such as religious practices, social conventions, and cultural beliefs, in influencing health behaviors, there is still a dearth of actual data to distinct the variables towards adherence supporting these claims. The study closed this knowledge gap and offer guidance for creating socially and culturally competent public health initiatives. A cross-sectional design was carried out in South-West Nigeria by the use of a multistage sampling technique, with 1,267 persons in purposively selected. Post-hoc Tests was used to investigate interaction effects of variables within socio and cultural factors that influence adherence to Q&I. participant Adherence to isolation and quarantine shows significant predictors to resident status, occupation, age and monthly income. Higher income levels have an influence on adherence rates. Adherence was also found to be positively influenced by societal attitudes and cultural norms but cultural norms contributed 3.5% of the variation, while social attitude 0.5%.

South Africa has one of the highest intimate partner violence (IPV) prevalence in Africa. Studies have linked IPV with negative health and socio-economic outcomes, especially during pregnancy which often led to termination of pregnancy (TOP). However, sub-national differences in the relationship between IPV and TOP have not been adequately examined in South Africa. The study aimed to examine subnational variations of the association between IPV and TOP in South Africa. Data were extracted for 2354 ever-in-union women aged 15–49 years with valid and complete information on the domestic violence module in the 2016 South African Demographic and Health Surveys dataset. The exposure variable was IPV, operationally defined as ever-experienced at least one of the physical, sexual, emotional violence, and partner controlling behaviour IPV forms. The logistic regression analysis was employed, to examine the association between IPV and TOP, while the odds ratios including their 95% confidence interval were reported. Overall, 15.3% had ever terminated pregnancy ranging from 9.5% in Northern Cape to 21.2% in Kwazulu-Natal. About 55.8% of the women had experienced IPV. The IPV, was strongly associated with about a 2-fold increase in TOP at national-level (aOR = 1.62; CI: 1.27–2.07). At subnational-level, women who had experienced IPV were associated with as high as a 2- and 8-fold significant increase in Limpopo and Kwazulu-Natal. The tendency of having a pregnancy terminated was significantly higher among ever-experienced physical violence women resident in Northern Cape (aOR = 4.26; CI: 1.28–14.16) and Kwazulu-Natal (aOR = 4.99; CI: 1.60-15.58) relative to their counterparts who had never experienced physical violence. Among women who had ever experienced emotional and partner control, Northern Cape and North West, and Kwazulu-Natal residents were at higher risk of pregnancy termination, respectively. There was evidence of varying strong associations between IPV, including its forms, and pregnancy termination in multiple provinces. Context-specific maternal health interventions targeted at curbing intimate partner violence may substantially reduce the burden of pregnancy termination in South Africa and other similar settings.

Background: Nigeria is among the countries with a high burden of Teenage Pregnancy and Motherhood (TPM) in sub-Saharan Africa. The adverse effect of TPM on young girls is enormous and often compromises their future socioeconomic advancement, including education. Limited number of studies have assessed the trends in TPM and the decomposition of its contributing factors. This study aimed to assess the levels, trends, and drivers of changes in TPM, between 2003 and 2018, in Nigeria. Methods: This study used a cross-sectional design with four consecutive rounds (2003, 2008, 2013, and 2018) of Nigeria Demographic and Health Survey datasets. Women aged 20–49 years who had ever terminated pregnancy, reported at least one childbirth or stillbirth before attaining age 20, were analysed. The outcome variable was having experienced TPM as a teenager. Data were analysed using trend and multivariate decomposition analyses at a 5% significance level. Results: The prevalence of TPM was 56.1%, ranging from 64.7% in 2003 to 55.7% in 2018. Overall, the prevalence of TPM decreased significantly by 10.7% over the studied period (p < 0.001). The change was due to a composite of a positive significant effect of the net compositional change (126%) and a negative effect of the net behavioural change (26%). The identified significant drivers of shift in TPM due to changes in the composition of women included current age, educational level, employment status, timing of marriage, age at first sexual intercourse, contraceptive use, ethnicity, and region of residence. Due to the change in behaviour, TPM reduced by 20% among South-South residents compared with their North-Central counterparts. However, TPM increased by 260% among teens who had their first sexual initiation. Conclusions: The TPM prevalence remained high in Nigeria, though a decreasing trend was observed within the studied period. Government and other stakeholders should focus pragmatic interventions on the identified drivers of TPM change over the last two decades in their efforts to alleviate TPM in Nigeria.

Globally, childbearing is a major concern for women living with HIV (WLWH). This study examined parity progression and its predictors among WLWH in Ibadan, Southwest Nigeria. We analysed dataset from a cross-sectional study on childbearing progression among 933 respondents aged 18–49 years receiving care at the HIV Program, University College Hospital, Ibadan. Multistate model was employed for analysis. The adjusted total fertility rate was 3.54. More than 70% were likely to progress from first-to-second birth (HR = 1.77; CI: 1.40, 2.23)but none of the covariates analysed were associated with progression. WLWH were less likely of progression from second-to-third birth (HR = 0.14; 95% CI: 0.13, 0.16). Having 1–2 children at HIV diagnosis (HR = 0.59; CI: 0.48, 0.71), being widowed (HR = 1.36; CI: 1.04, 1.80), having a partner with secondary education(HR = 1.23; 95% CI: 1.02, 1.49), partner’s employment status (HR = 1.40; 95% CI: 1.04, 1.80),, knowledge of partner’s HIV status (Negative) (HR = 0.75; 95% CI: 0.61, 0.94) were associated with progression to third birth. The estimated total fertility rate was lower than the national and the Southwest estimates. Different factors were associated with birth progression from one parity to another.

Introduction The COVID-19 pandemic has had a substantial negative impact on the utilisation of essential health services (EHS) globally, especially in resource-limited settings such as Nigeria. High maternal deaths associated with low access to and utilisation of EHS such as antenatal care (ANC) and skilled birth attendants (SBAs) remain a concern during the COVID-19 era. The study assessed the COVID-19 pandemic effects on ANC and SBA utilisation across regions in Nigeria. Methods Monthly data on ANC and SBA between January 2017 and July 2021 were obtained from the Federal Ministry of Health database. An interrupted time-series analysis, implemented using the Prophet model, was conducted to compare the regional variation of outcomes during the COVID-19 pandemic. Average percentage changes (PC) between the observed and predicted outcomes including their 95% CI were reported. Results From March 2020 to July 2021, the number of ANC visits was significantly lower than expected by a 16%–43% change in five of the six regions in Nigeria. The highest significant reduction was in North-West (PC=−43.4; 95% CI: −52.6 to –34.1) and the least in South-West (PC=−15.5; 95% CI: −24.8 to –6.1), with no significant change in the South-East. The number of deliveries by SBA was significantly lower than expected by a 18%–43% change in all the regions (pConclusion There was a substantial reduction in ANC and SBA utilisation due to the COVID-19 pandemic in Nigeria, especially in the northern regions. Targeted and contextually relevant interventions should be implemented to alleviate the impact of emergency response on access to EHS and promote access to care during the pandemic.

Background: Private entities play a major role in health globally. However, their contribution has not been fully optimized to strengthen delivery of public health services. The COVID-19 pandemic has overwhelmed health systems and precipitated coalitions between public and private sectors to address critical gaps in the response. We conducted a study to document the public and private sector partnerships and engagements to inform current and future responses to public health emergencies. Methods: This was a multi-country cross-sectional study conducted in the Democratic Republic of Congo, Nigeria, Senegal and Uganda between November 2020 and March 2021 to assess responses to the COVID-19 pandemic. We conducted a scoping literature review and key informant interviews (KIIs) with private and public health sector stakeholders. The literature reviewed included COVID-19 country guidelines and response plans, program reports and peer-reviewed and non-peer-reviewed publications. KIIs elicited information on country approaches and response strategies specifically the engagement of the private sector in any of the strategic response operations. Results: Across the 4 countries, private sector strengthened laboratory systems, COVID-19 case management, risk communication and health service continuity. In the DRC and Nigeria, private entities supported contact tracing and surveillance activities. Across the 4 countries, the private sector supported expansion of access to COVID-19 testing services through establishing partnerships with the public health sector albeit at unregulated fees. In Senegal and Uganda, governments established partnerships with private sector to manufacture COVID-19 rapid diagnostic tests. The private sector also contributed to treatment and management of COVID-19 cases. In addition, private entities provided personal protective equipment, conducted risk communication to promote adherence to safety procedures and health promotion for health service continuity. However, there were concerns related to reporting, quality and cost of services, calling for quality and price regulation in the provision of services. Conclusions: The private sector contributed to the COVID-19 response through engagement in COVID-19 surveillance and testing, management of COVID-19 cases, and health promotion to maintain health access. There is a need to develop regulatory frameworks for sustainable public–private engagements including regulation of pricing, quality assurance and alignment with national plans and priorities during response to epidemics.

Background Globally COVID-19 has caused death among millions of people and new cases continue to be reported daily, including in Nigeria. With the efforts of the Nigerian government to ensure everyone gets vaccinated, the vaccination attitude and its predictors among persons with chronic health conditions remains unclear. The study was therefore conducted to assess vaccination attitude and determine its associated factors among people living with chronic health conditions. Methods A descriptive cross-sectional study was conducted among 423 patients attending the medical outpatient clinic of University College Hospital, Ibadan, Oyo State, Nigeria; before COVID-19 vaccination commencement. Data were collected on socio-demographic and COVID-19 related characteristics, via Open Data Kit (ODK) software. The Vaccine Attitude Examination (Vax) Scale including its four subscales was adopted to assess attitude towards COVID-19 vaccine uptake. The main outcome was vaccine attitude status defined as positive if a VAX sum score was above the median value; otherwise, non-positive’. Data were analysed using Chi-square and multivariate logistic regression analyses at 5% significance level. Results Hypertension (27.4%), diabetes mellitus (22.0%) and heart conditions/diseases (19.6%) were the top three conditions being managed by the participants. The overall proportion of patients with a positive attitude towards the uptake of COVID-19 vaccination was 46.6%; while 29.6% trusted the vaccine benefit, 46.6% were not worried about the aftermath effect of the vaccine and 11.1% were not concerned about the vaccine commercial profiteering. Factors associated with overall vaccine attitude were level of education, income, knowledge of COVID-19, living room arrangement, and confidence in government (pConclusion Less than half of people living with a chronic medical condition had a positive attitude towards the COVID vaccine. The attitudes are mediated strongly by confidence in the government and several sociodemographic and COVID related characteristics. A lot still needs to be done to achieve the prescribed herd immunity.

Inter-birth interval lengthening is a key component of fertility decline. Although South Africa fertility rate remains the lowest in sub-Saharan Africa, information on the effect of education on the interval between first- and second-birth across residential contexts is rarely documented. The study investigated the relationship between maternal education and second-birth interval (SbI) by residence among South African women. The study analyzed the 2016 South Africa Demographic and Health Survey data on 6,039 women aged 15 to 49 years who had reported at least one childbirth at the time of survey. Survival analysis methods were applied at 5% significance level. The SbI was significantly longer ( p < 0.001) among urban (76 months) relative to rural (66 months) women. About a fifth of rural women and about a tenth of urban women had at most a primary education. Women who had a secondary education (aHR = 0.86; 95% CI [0.76, 0.96]) were 14% times more likely to delay second-birth compared to those who had at most a primary education in rural setting. Other determinants of SbI included region in rural; age at-first-birth and household wealth in urban; ethnicity, marital status at-first-birth and employment in both residential settings. The length of SbI remains long in both residential contexts, but longer in urban. Findings demonstrated rural-urban differentials in the relationship between maternal education and second birth interval, suggesting contextual impact. Fertility strategies targeted at strengthening health education for improved maternal and child health should be residential-context specific.

Adult mortality rate is one of the important demographic indices often used to assess the state of health in any nation. Globally, adult mortality has reduced in the past few decades, although, the disease of poverty and emerging/re-emerging diseases constitute a serious challenge to the survival chances of adults in developing countries, sub-Saharan Africa (SSA) in particular. This study provides a descriptive account of what is known and what should be known in the next decades about adult mortality in SSA. Data and information were obtained from numerous sources to address the study’s objectives. Adult mortality has reduced across countries in SSA between 1950 and 2020, but almost all the countries in this world sub-region will have adult mortality rate of above 100 per 1,000 by the year 2050. Most estimation methods used in adult mortality studies in SSA were based on data from census and survey sources and in a rare situation, demographic surveillance sites. Lack of either adequate or non-existence of credible vital statistics necessitates the use of the indirect demographic approach for estimation and projection of adult mortality in the region. Almost all the demography and population studies programmes in SSA’s tertiary institutions teach methods of estimating adult mortality, but the utilization of these methods are yet to be fully translated into research practice.

Background: Fertility decline characterised by inter-birth intervals remains rather slow or stall in many countries of sub-Saharan African (SSA). Non-adherence to optimal inter-birth intervals often occasioned by low prevalence of contraceptive use and high fertility desires often lead to poor maternal and child health outcomes. Additionally, information on the influence of contraception and fertility desire on interval between first and second births (SBI) is rarely available. This study therefore aimed to examine the influence of fertility desire and contraception on SBI among women in four SSA countries.Methods: We analysed cross-sectional data on women aged 15–49 years who participated in the recent Demographic and Health Surveys in DR Congo, Ethiopia, Nigeria and South Africa. Semi-parametric Cox proportional hazards regression was employed for the analysis at 5% significance level.Results: The median time to second birth was 34 months in DR Congo; 35 months, Nigeria; 42 months, Ethiopia; and 71 months, South Africa. About 70% of the women desired additional child(ren) and two-thirds have never used contraceptive in both Nigeria and DR Congo. The hazard of second birth was significantly lower among women who desired additional child(ren) compared to desired for no more child in DR Congo (aHR = 0.93; CI: 0.89–0.97), Ethiopia (aHR = 0.64; CI: 0.61–0.67) and South Africa (aHR = 0.51; CI: 0.47–0.55). Women who had never used contraceptive were 12%, 20% and 24% more likely to lengthen SBI than those who were current users in DR Congo, Nigeria and South Africa respectively. DR Congo and Nigerian women were about two times more likely to shorten SBI compared with their South African counterparts. Other significant determinants of SBI include ethnicity, rural residential, age and marital status at first birth, wealth and employment status.Conclusion: Findings showed differentials in the linkage between second birth interval and the desired fertility and contraception by country, demonstrating the importance of context. The contribution of these factors to second birth interval requires country context-specific attention if further decline in fertility and poor health outcomes associated with sub-optimal inter-birth interval is to be attained in SSA.