Age In Nigeria Research Articles

Individual and community-level factors associated with non-institutional delivery of women of childbearing-age in Nigeria

Maternal health is a major concern in Africa especially due to high level of maternal mortality in the region. A significant cause of high mortality is the unavailability of health facilities and preference for home-based delivery often carried out by unskilled health attendants. Reports reveal that 69% of young women in Nigeria opt for home-based delivery in Nigeria and some of these mothers lose their lives as a result of childbirth complications that are not properly attended to. This trend calls for urgent concern in the nation’s health system. Against this backdrop, this study examined the determinants of non-institutional delivery among women of reproductive age in Nigeria using the country’s National Demographic Health Survey [NDHS] (2018. Demographic health survey data. NPC and ICF, Abuja, Nigeria and Rockville. MD, USA) The data for this study include 12,567 of women of childbearing-age contained in the NDHS data. To analyse the data, the multilevel binary logistic regression was used to examine the determinants of non-institutional delivery among the women of childbearing-age. The results were presented using adjusted odds ratios (AOR) with 95% confidence interval. The result revealed that 56.8% of women preferred to have their children outside health institutions. The findings further revealed that educated women including urban dwellers, women with some level of formal education, high exposure to news media, high level of income and women with significant level of autonomy were less likely to deliver their babies outside health institutions. Based on the findings of the study, that there is the need to expand educational opportunities for Nigerian women, enhance and strengthen advocacy, and utilise focused group discussions, family outreach programmes and peer education to educate mothers on the benefits of using healthcare facilities during childbirth.

ASSESSING PREVALENCE AND FACTORS ASSOCIATED WITH CESAREAN DELIVERY AMONG WOMEN OF REPRODUCTIVE AGE IN NIGERIA

Cesarean section (CS) involves the fetus, membranes, and placenta delivery through abdominal and uterine incisions after fetal viability. Some research on CS use in Nigeria have been undertaken, however, they have all been institutional-based and had small sample sizes. In the country, nationally representative studies on this critical issue are required. As a result, the current study assesses prevalence and factors associated with cesarean delivery among women of reproductive age in Nigeria. The data used in this study were sourced from the 2018 Nigeria Demographic and Health Survey (NDHS). 8216 women of childbearing age were considered in this study. The 2018 survey is the most recent in Nigeria's series of NDHS (at the time of this study). The methods of analysis used for this study are frequency, percentage, chi-square test, and Binary Logistic Regression Analysis. Statistical software used for the analysis was STATA V.15. p<0.05 was considered to be statistically significant. The prevalence of CS in Nigeria was 8.1% in 2018. Factors associated with increased odds of CS were maternal age (35-39 years), the South West regions of Nigeria, urban residency, wealth index (rich), previous terminated pregnancy, less than 9 months of pregnancy, and maternal education (secondary education). The findings will give evidence-based knowledge for decision-making in Nigeria regarding the provision and use of cesarean birth. However, improved availability and access to obstetric care services should be pursued further by following the WHO's EOC guidelines in all Nigerian regions.

Demographic Predictors of HIV Testing in Women of Childbearing Age in Nigeria

Demographic Predictors of HIV Testing in Women of Childbearing Age in Nigeria

Impact of Covid-19 among Women of Reproductive Age in Nigeria

Background: This paper examined the impact of the covid-19 pandemic among women of reproductive age in Nigeria. Pandemics however, are not new to the human society. Nevertheless, humanitarian crises, including health emergencies like covid-19 affect men and women differently. The pandemic exposed sharp economic and social inequalities and widened the already existing gap with the most vulnerable in society, including unequal impacts affecting women and girls by virtue of their gender. This review provided information on the physical, economic and social impact of covid-19 pandemic among women of reproductive age in Nigeria. Methods: Grey literature such as reports and research briefs from WHO, UN, UNICEF, World Bank, Care International, Plan International. Partners West Africa Nigeria and National Demographic Health Survey Nigeria was used for this review. In addition literature searches from peer-reviewed articles published between 2001 to date in databases such as Pubmed and Google Scholar were also used for this review. Conclusion: Some of these impacts, as this review has found, include different types of social and economic problems such as loss of jobs, income decline, increased stress, worries, increase in sexual and gender-based violence and concerns that have had significant impact on the mental health and social well-being of women, children, and other vulnerable groups. Recommendation: Civil Society Organizations and Development Partners should lead interventions around the many forms of violence that women face across their life cycle and in all contexts of their lives- private, public and technology driven spaces. Furthermore, Government should develop operational plans that will include capacity assessments and risk analyses by the State and Local Government authorities; and extending the reach of public health and socioeconomic interventions by civil society and Non-governmental organization.

Bayesian Spatial Analysis of Socio-Demographic Factors Influencing Smoking, Use of Hard Drugs and Its Residual Geographic Variation among Teenagers of Reproductive Age in Nigeria

The use of hard drugs (Alcohol, cocaine and Nicotine) has remained the censorious issue globally and in Nigeria. The use of hard drugs and tobacco smoking is common in the stage of adolescence and youth life, which is a deterrent to education and career advancement. Hence, this study looks into socio-demographic factors that influence the use of hard drugs and tobacco smoking among teenagers between the ages of 15 years to 19 years. To achieve this objective, a cross-sectional data was used and a secondary data was obtained from DHS - National Demographic and Health Surveys (NDHS) from the survey year 2018. Some Bayesian models were developed and Conditional Autoregressive (CAR) model with random walk 1 (RW1) was the best model. The study unveiled a positive significant association of settlement, previous place of residence, education attainment, religion, ethnicity, literacy with reported use of hard drugs amongst teenagers of reproductive age.

Socio-ecological predictors of HIV testing in women of childbearing age in Nigeria

IntroductionHIV remains a public health problem in Nigeria. Women within the age of 15 to 49 years, the childbearing age, have a prevalence rate of 1.9%, higher than that of their male counterparts of the same age group. Women can transmit HIV to their partners and their children. Nigeria accounts for 30% of global transmission of HIV from mother to child. Therefore, the study seeks to identify the socio-ecological predictors of HIV testing because HIV testing is the gateway to HIV prevention to achieve the sustainable development goal of zero new infections by the year 2030.Methodsthe study was a cross-sectional study, analyzing the 2013 Nigeria demographic and health survey data using SPSS V27.Resultsthe result of the study indicated a higher odds ratio for good comprehensive knowledge of HIV (p<0.001, OR=3.81), good attitude to HIV (p<0.001, OR=2.50), and high perceived risk of HIV (p<0.001, OR=2.03). A low odds ratio was observed for good cultural belief despite the significance of the association (p<0.001, OR=0.83).Conclusionsocio-ecological factors of HIV knowledge, attitude to HIV, perceived risk, and cultural belief were significant predictors of HIV testing in women of childbearing age. Programs targeted at women aged 15-19 years will enhance HIV testing as the gateway to HIV prevention and achieve the 95-95-95 target and zero new infections by 2030.

Spatial modelling of the joint burden of malaria and anaemia co-morbidity in children: A Bayesian geoadditive perspective

ABSTRACT Malaria infection, caused by plasmodium parasites, is a serious health challenge for children in the tropical regions. It becomes a serious life-threatening issue when the victim also suffers from anaemia because malaria parasite feeds on the iron particles present in the red blood cells. We consider a latent Gaussian model to jointly estimate the spatial patterns of co-morbidity from malaria and the different levels of anaemia among children under five years of age in Nigeria. The approach allows for response variables of different family of distribution to be jointly considered while accounting for metrical covariates as possible nonlinear effects and categorical variables as linear effects. Parameter estimation was through the integrated nested Laplace approximation. Our findings show similar spatial patterns of co-morbidity between malaria and severe anaemia and malaria and moderate anaemia but in the case of age of the child, the likelihoods of co-morbidity are similar for malaria and severe anaemia and malaria and mild anaemia. Urban residency, mother’s education, and household wealth index are consistently significant to the different forms of co-morbidity. Findings from the spatial effects avail decision-makers with location-specific evidence to prioritize and roll out interventions in a more judicious manner.

Determinants of anaemia prevalence in women of reproductive age in Nigeria: A cross-sectional study using secondary data from Nigeria Demographic and Health Survey 2018.

Anaemia disproportionately affects women of reproductive age in sub-Saharan Africa including Nigeria. Yet, community-based studies on the prevalence and determinants of anaemia among women of reproductive age are scarce in Nigeria. A cross-sectional community-based survey using a nationally representative sample. This study described anaemia prevalence and its associated factors among women of reproductive age, pregnant women, and non-pregnant women in Nigeria. We analysed data from the 2018 Nigeria Demographic and Health Survey. Pregnant women with a haemoglobin level less than 11 g/dL and non-pregnant women with a haemoglobin level less than 12 g/dL were considered anaemic. Anaemia was also categorized as mild, moderate, and severe. Pearson's chi-square test was used to evaluate the association between anaemia status and independent variables. All variables with ρ ⩽ 0.25 in bivariate analyses were further analysed using complex sample logistic regression. Anaemia prevalence was 57.8%, 57.4%, and 61.1% for women of reproductive age, non-pregnant women, and pregnant women, respectively. The prevalence of severe anaemia was 1.6%, 1.5%, and 2.3% for overall women of reproductive age, non-pregnant women, and pregnant women, correspondingly. The southern regions, rural residence, low education, unemployment, low wealth index, and non-use of modern contraceptives significantly increased the likelihood of anaemia and severe anaemia among women of reproductive age and non-pregnant women. The likelihood of being anaemic was significantly increased by large family size among women of reproductive age and by being underweight among non-pregnant women. The South-East region, rural residence, low education, and unemployment were significantly associated with anaemia among pregnant women. The South-South region and unemployment increased the likelihood of severe anaemia among pregnant women. Short stature significantly reduced the odds of being anaemic and severely anaemic among pregnant women. Anaemia prevalence among all categories of women of reproductive age is high in Nigeria. Predictors of anaemia prevalence and severity should be considered in policies intended to reduce anaemia among women of reproductive age in Nigeria.

Multilevel Analysis of Urban-Rural Variations of Body Weights and Individual-Level Factors among Women of Childbearing Age in Nigeria and South Africa: A Cross-Sectional Survey.

Background: An unhealthy body weight is an adverse effect of malnutrition associated with morbidity among women of childbearing age. While there is increasing attention being paid to the body weights of children and adolescents in Nigeria and South Africa, a major surge of unhealthy body weight in women has received less attention in both countries despite its predominance. The purpose of this study was to explore the prevalence of body weights (underweight, normal, overweight, and obese) and individual-level factors among women of childbearing age by urban–rural variations in Nigeria and South Africa. Methods: This study used the 2018 Nigeria Demographic Health Survey data (n = 41,821) and 2016 South Africa Demographic Health Survey (n = 8514). Bivariate, multilevel, and intracluster correlation coefficient analyses were used to determine individual-level factors associated with body weights across urban–rural variations. Results: The prevalence of being overweight or obese among women was 28.2% and 44.9%, respectively, in South Africa and 20.2% and 11.4% in Nigeria. A majority, 6.8%, of underweight women were rural residents in Nigeria compared to 0.8% in South Africa. The odds of being underweight were higher among women in Nigeria who were unemployed, with regional differences and according to breastfeeding status, while higher odds of being underweight were found among women from poorer households, with differences between provinces and according to cigarette smoking status in South Africa. On the other hand, significant odds of being overweight or obese among women in both Nigeria and South Africa were associated with increasing age, higher education, higher wealth index, weight above average, and traditional/modern contraceptive use. Unhealthy body weights were higher among women in clustering areas in Nigeria who were underweight (intracluster correlation coefficient (ICC = 0.0127), overweight (ICC = 0.0289), and obese (ICC = 0.1040). Similarly, women of childbearing age in clustering areas in South Africa had a lower risk of experiencing underweight (ICC = 0.0102), overweight (ICC = 0.0127), and obesity (ICC = 0.0819). Conclusions: These findings offer a deeper understanding of the close connection between body weights variations and individual factors. Addressing unhealthy body weights among women of childbearing age in Nigeria and South Africa is important in preventing disease burdens associated with body weights in promoting Sustainable Development Goal 3. Strategies for developing preventive sensitization interventions are imperative to extend the perspectives of the clustering effect of body weights on a country level when establishing social and behavioral modifications for body weight concerns in both countries.

Evaluation of the Impact of Educational Status and Cultural Beliefs on the Health Seeking Behavior of Women with Obstetric Fistula in South-South and South Eastern Nigeria

Background: Obstetric fistula is a serious health problem affecting women in low and middle-income countries. It continues to exist in Nigeria because the health care system has failed to provide quality, accessible and affordable maternal health care including family planning, skilled care at birth, basic and comprehensive emergency obstetric care and inadequate access to treatment of obstetric fistula cases. The purpose of this study was to evaluate the impact of educational status and cultural beliefs on the health seeking behavior of women with obstetric fistula in South-South and South Eastern Nigeria. Methods: This was a cross-sectional study. Non-probability sampling involving purposive and simple random sampling technique was adopted in the selection of one hundred and fifty (150) post-operative patients. The data was analyzed using thematic analysis frequency tables and percentage distribution. Results: The findings were that educational status and cultural belief exert significant influence on the health seeking behavior of women with obstetric fistula. Conclusion: The study indicated that obstetric fistula is a major reproductive health challenge affecting women of childbearing age in Nigeria. Based on the findings of the study, educational status and cultural belief of women with obstetric fistula are the major serious challenges to health seeking behaviour of the women with Vesico-vaginal fistula (VVF). It was therefore recommended that more awareness on obstetric fistula should be created using strategies such as sex education programmed in secondary schools and churches so as to educate them on issues concerning obstetric fistula as well as health talk on VVF for youths.

Spatial distribution and factors associated with modern contraceptive use among women of reproductive age in Nigeria: A multilevel analysis.

BackgroundEvidence suggests that in countries with high fertility and fecundity rates, such as Nigeria, the promotion of modern contraceptive use prevents approximately 32% and 10% of maternal and child mortality, respectively. Therefore, this study aimed to assess the spatial distribution of modern contraceptive use and its predictors among women of reproductive age in Nigeria.MethodsThe study employed a cross-sectional analysis of population-based data involving 24,281 women of reproductive age in Nigeria. The study adopted both multilevel and spatial analyses to identify the predictors of modern contraceptive use and its spatial clustering among women in Nigeria.ResultsModern contraceptive use among the study population in Nigeria ranged from 0% to 75%, with regional variations. The spatial analysis showed that areas with a low proportion of modern contraceptive use were Sokoto, Yobe, Borno, Katsina, Zamfara, Kebbi, Niger, Taraba and Delta. Areas with a high proportion of modern contraceptive use were Lagos, Oyo, Osun, Ekiti, Federal capital territory, Plateau, Adamawa, Imo, and Bayelsa. The multilevel analysis revealed that at the individual level, women with secondary/higher education, women from the Yoruba ethnic group, those who had four children and above, and those exposed to mass media had higher odds of using modern contraceptives. On the other hand, women who were 35 years and above, those who were married, and women who were practicing Islam were less likely to use modern contraceptives. At the household/community level, women from the richest households, those residing in communities with medium knowledge of modern contraceptive methods, and women residing in communities with a high literacy level were more likely to use modern contraceptives.ConclusionThere were major variations in the use of modern contraception across various regions in Nigeria. As a result, areas with low contraceptive rates should be given the most deserving attention by promoting contraceptive education and use as well as considering significant factors at the individual and household/community levels.

Health facility delivery among women of reproductive age in Nigeria: Does age at first birth matter?

BackgroundHigh maternal mortality ratio in sub-Saharan Africa (SSA) has been linked to inadequate medical care for pregnant women due to limited health facility delivery utilization. Thus, this study, examined the association between age at first childbirth and health facility delivery among women of reproductive age in Nigeria.MethodsThe study used the most recent secondary dataset from Nigeria’s Demographic and Health Survey (NDHS) conducted in 2018. Only women aged15-49 were considered for the study (N = 34,193). Bi-variate and multivariable logistic regression models were used to examine the association between age at first birth and place of delivery. The results were presented as crude odds ratios and adjusted odds ratios (aOR) with corresponding 95% confidence intervals (CIs). Statistical significance was set at p<0.05.ResultsThe results showed that the prevalence of health facility deliveries was 41% in Nigeria. Women who had their first birth below age 20 [aOR = 0.82; 95%(CI = 0.74–0.90)] were less likely to give birth at health facilities compared to those who had their first birth at age 20 and above.ConclusionOur findings suggest the need to design interventions that will encourage women of reproductive age in Nigeria who are younger than 20 years to give birth in health facilities to avoid the risks of maternal complications associated with home delivery. Such interventions should include male involvement in antenatal care visits and the education of both partners and young women on the importance of health facility delivery.

Individual and Contextual Factors Associated with Malaria among Children 6-59 Months in Nigeria: A Multilevel Mixed Effect Logistic Model Approach.

Background/Purpose: Over the last two decades, malaria has remained a major public health concern worldwide, especially in developing countries leading to high morbidity and mortality among children. Nigeria is the world most burdened malaria endemic nation, contributing more than a quarter of global malaria cases. This study determined the prevalence of malaria among children at 6–59 months in Nigeria, and the effects of individual and contextual factors. Methods: This study utilized data from 2018 Nigeria Demographic and Health Survey (NDHS) involving a weighted sample size of 10,185 children who were tested for malaria using rapid diagnostic test (RDT). Given the hierarchical structure of the data set, such that children at Level-1 were nested in communities at Level-2, and nested in states and Federal Capital Territory (FCT) at Level-3, multilevel mixed effect logistic regression models were used for the analysis. Results: The proportion of children 6–59 months of age in Nigeria that had malaria fever positive as assessed by RDTs was 35.5% (3418/10,185), (CI: 33.9–37.1). Kebbi State had 77.7%, (CI: 70.2–83.5), which was the highest proportion of 6–59 months who were malaria positive, next in line was Katsina State with 55.5%, (CI: 47.7–63.1). The Federal Capital Territory (FCT), Abuja had the proportion of 29.6%, (CI: 21.6–39.0), malaria positive children of 6–59 months of age. Children between the age of 48 and 59 months were 2.68 times more likely to have malaria fever than children of ages 6–11 months (AOR = 2.68, 95% CI: 2.03–3.54). In addition, children from the rural area (AOR = 2.12, 95% CI: 1.75–2.57), were more likely to suffer from malaria infection compared to children from urban area. Conclusion: The study identified some individual and contextual predictors of malaria among children in Nigeria. These factors identified in this study are potential areas that need to be considered for policy designs and implementations toward control and total elimination of malaria-related morbidity and mortality among children in Nigeria.

Quantile regression methods for determination of factors associated with nutritional status of women of reproductive age in Nigeria

ObjectivesThe adverse health outcomes of being overweight and obese are overwhelming with more implications while the effects of being underweight have received little consideration. Quantile Regression (QR) was used to determine the effect of factors associated with the Body Mass Index (BMI) of women. MethodsA total of 31,828 women in their reproductive age (15–49 years) from the Nigeria Demographic and Health Survey (NDHS) 2013 data, were included in the study. Quantile regression model was fitted into the data to determine the factors related to the BMI of women ResultsWomen had an average age of 29 years (SD=7 years); about half of the women (49.2%) had no formal education and nearly all were married (96.0%). Quantile regression models were fitted into the data. At the 10th quantile, children ever born (β=0.17, S.E = 0.11; 95% CI: -0.039, 0.387) and place of residence (β=0.06, S.E = 0.08; 95% CI: -0.094, 0.204) did not predict BMI while family size (β=0.16, S.E = 0.07; 95% CI: 0.032, 0.295) contributed significantly to the BMI effect produced. The Pseudo R2 increased with increasing quantile and among all the quantiles, the 90th quantile model (Pseudo R2 = 0.15) better predicts the BMI distribution. ConclusionAt all quantiles; age, level of education and wealth quintiles were determinants of BMI among women of reproductive age. Quantile regression was able to detect the magnitude of the changes depending on the location of the woman in the BMI distribution.

Overweight and obesity among non-pregnant women of reproductive age in Nigeria: findings from the 2008–2018 Nigerian Demographic and Health Survey

ObjectivesOverweight and obesity are known risk factors for diabetes, heart disease, certain cancers and pregnancy-related problems. This study aimed to determine the prevalence and change in prevalence of overweight and obesity among non-pregnant women of reproductive age and relationship with individual- and community-level factors over a decade. Study designThis was a cross-sectional survey with two-stage probability sampling design. MethodsData sets were pooled from the 2008, 2013 and 2018 Nigerian Demographic and Health Survey – a cross-sectional, nationally representative sample of the entire Nigerian population aged 15–49 years. Body mass index (BMI) was used to classify overweight and obesity. Multilevel logistic regression was used to assess associations between overweight (25.0–29.9 kg/m2), obesity (≥30.0 kg/m2) and individual and community factors. ResultsThere were 76,729 non-pregnant women (38.0% in 2008, 44.5% in 2013 vs 17.5% in 2018) with a mean age of 29.0 years and a BMI of 23.0 kg/m2 across the three survey periods. Overweight and obesity prevalence were 16.0% and 6.2% in 2008, 17.2% and 7.5% in 2013 and 18.1% and 9.9% in 2018, respectively. There was 76% (95% confidence interval: 44% to twofold) increased odds of obesity in 2018 compared with 2008 in adjusted analysis. Older women with at least primary education living in urban areas, ever married and from wealthier households are at a greater odd of being overweight and obese. ConclusionOver a decade, overweight and obesity prevalence increased among non-pregnant women of reproductive age in Nigeria. There is an urgent need for public health strategies and interventions to improve on deficient knowledge and low awareness about healthy foods and physical activity at individual and community levels especially in urban areas.

31Effect of Health Education on Knowledge of Tuberculosis among patent Medicine vendors in Enugu

Abstract Background Tuberculosis remains a serious public health threat to people of all sexes and ages in Nigeria. Any intervention that could improve the knowledge of tuberculosis and treatment services is expected to improve case finding and ultimately the cure rates. The world health organization global Tuberculosis report, 2014 shows that Enugu recorded slight increase in all cases of Tuberculosis and reporting remains low. The aim of this study is to determine the effect of a health education intervention on knowledge and management of tuberculosis among patent medicine vendors in Enugu Methods This is an educational interventional study carried out among 400 patent medicine vendors in Enugu. The baseline data on knowledge and management practice was determined using an interviewer-administered semi-structured. Results we found out that level of education was significantly associated with TB-related knowledge and management. The baseline study shows that the patent medicine vendors (PMVs) have poor knowledge of Tuberculosis prior to this study. This agreed to the preliminary investigation which shows that they contribute 65.6% to increase in multi-drug resistant TB, poor case finding /reporting in Enugu. The post assessment results, shows increase in knowledge of tuberculosis and management of TB among the PMVs Conclusions The health education impacted significantly on the knowledge of the PMVs on Tuberculosis. Therefore, emphasis should be laid to more train and retrain the PMVs in toward improving TB case detection. Key messages Health education, Knowledge, tuberculosis, PMVs

350Perception of Nigerian women on violation of Traditional Gender Role-related IPV

Abstract Background Violation of Traditional Gender Roles (TGR) by women has been perceived as a justifiable reason for perpetrating Intimate Partner Violence (IPV). Although higher among males, opinions among women regarding violation of TGR as a justification for IPV vary. This study assessed the perception of Nigerian women on violation of TGR that predispose to IPV. Methods Secondary analysis of the 2018 Nigeria Demographic and Health Survey (NDHS) was done. Complex sample analysis of a subset of 41,821 women of reproductive age was done using SPSS version 23. Descriptive and inferential statistics were done and multivariate logistic regression model was fitted to identify predictors of poor perception of violation of TGR Result Mean age of the respondents was 30.9 ± 7.9years and 10.6% had childhood experience of domestic violence. Poor perception of TGR was found among 28.9% of women with the highest proportion of women with poor perception (46.2%) coming from the north central geo-political zone. The odds of poor perception of TGR-related IPV was 1.4 times and 4.9 times higher among those with childhood experience of domestic violence [OR = 1.4; 95% CI = 1.139-1.694] and women from the North Eastern geopolitical zone [OR = 4.9; 95% CI = 3.696-6.503] respectively. Conclusion Predictors of poor perception of TGR violation among one-third of women of reproductive age in Nigeria are childhood experience of violence and place of residence. Key message IPV reduction interventions should appropriately address perception of TGR among different at risk population.

Individual and community factors associated with unintended pregnancies among women of advanced reproductive age in Nigeria

ABSTRACT Studies have examined individual and community level factors associated with unintended pregnancies. However, existing studies tends to focus the general population of reproductive age women without isolating women of advanced reproductive age (women at the age range of 35–49 years) for specific research attention. There is need for specific attention on this group of women because pregnancies among them whether intended or unintended elevate obstetric risks for both mother and child. This study examines associated individual and community factors of unintended pregnancies among women of advanced reproductive age in Nigeria. Data were extracted from the 2018 Nigeria Demographic and Health Survey. A weighted sample of 12,509 women was analyzed. Three multilevel logistic regression models were estimated. The study revealed a 10.3% prevalence of unintended pregnancies. Individual characteristics such as maternal age, number of living children, delayed marriage, and community characteristics such as high community poverty and high community unmet contraceptive need were significantly associated with unintended pregnancies. Variations in unintended pregnancies across the communities were more attributable to individual factors. Interventions should develop specific strategies tailored toward women of advanced reproductive age.

When Do Nigerian Women of Reproductive Age Initiate and What Factors Influence Their Contraceptive Use? A Contextual Analysis.

BackgroundContraceptive use initiation and continuation is one of the major interventions for reducing maternal deaths worldwide. Nigeria aimed to achieve a 27% prevalence rate of modern contraceptive uptake by 2020, however, this seems to have remained unachieved. The objective of this study was to investigate when Nigerian women initiate contraceptive use and its associated factors, using nationally representative data.MethodsData on 11,382 Nigerian women (aged 15–49 years) from the 2017 Performance Monitoring and Accountability 2020 (PMA2020) survey were used to determine the prevalence of lifetime contraceptive use. The Kaplan–Meier test was used to determine median time (years) to contraceptive uptake. In addition, the factors associated with contraceptive use were determined using multivariable logistic regression model. Statistical significance was determined at 5%.ResultsThe prevalence of modern contraceptive use was 14.2%. There were disparities in the timing (years) of contraceptive use initiation across several women’s characteristics. Women from urban residence, highest household wealth index, nulliparous, unmarried, and highly educated women had the minimum median time (years) to contraceptive use initiation. The multivariable logistic model showed that rural women were 26% less likely to initiate contraceptive use, when compared with the urban dwellers (OR= 0.74; 95% CI: 0.65, 0.84). Furthermore, married women were 24% less likely to initiate contraceptive use, when compared with the unmarried (OR= 0.76; 95% CI: 0.63, 0.93). In addition, geographical region, wealth, television source, ever given birth, education, age, and religion were significantly associated with contraceptive use.ConclusionThe prevalence of contraceptive use is low in Nigeria. There were differences in contraceptive use initiation among women of reproductive age in Nigeria. There is a need to adopt sustainable strategies to improve contraceptive uptake and to re-iterate the benefits of contraception, including providing enlightenment programs among key populations such as the rural dwellers and low income earners.

Postabortion care availability, facility readiness and accessibility in Nigeria and Côte d'Ivoire.

Postabortion care (PAC) is an essential component of emergency obstetric care (EmOC) and is necessary to prevent unsafe abortion-related maternal mortality, but we know little regarding the preparedness of facilities to provide PAC services, the distribution of these services and disparities in their accessibility in low-resource settings. To address this knowledge gap, this study aims to describe PAC service availability, evaluate PAC readiness and measure inequities in access to PAC services in seven states of Nigeria and nationally in Côte d’Ivoire. We used survey data from reproductive-age women and the health facilities that serve the areas where they live. We linked facility readiness information, including PAC-specific signal functions, to female data using geospatial information. Findings revealed less than half of facilities provide basic PAC services in Nigeria (48.4%) but greater PAC availability in Côte d’Ivoire (70.5%). Only 33.5% and 36.9% of facilities with the capacity to provide basic PAC and only 23.9% and 37.5% of facilities with the capacity to provide comprehensive PAC had all the corresponding signal functions in Nigeria and Côte d’Ivoire, respectively. With regard to access, while ∼8 out of 10 women of reproductive age in Nigeria (81.3%) and Côte d’Ivoire (79.9%) lived within 10 km of a facility providing any PAC services, significantly lower levels of the population lived <10 km from a facility with all basic or comprehensive PAC signal functions, and we observed significant inequities in access for poor, rural and less educated women. Addressing facilities’ service readiness will improve the quality of PAC provided and ensure postabortion complications can be treated in a timely and effective manner, while expanding the availability of services to additional primary-level facilities would increase access—both of which could help to reduce avoidable abortion-related maternal morbidity and mortality and associated inequities.