Sunday Adedini | Obafemi Awolowo University (original) (raw)

Papers by Sunday Adedini

Global Health Action, 2014

Background: Resolution of public health problems in Africa remains a challenge because of insuffi... more Background: Resolution of public health problems in Africa remains a challenge because of insufficient skilled human resource capacity. The Consortium for Advanced Research Training in Africa (CARTA) was established to enhance capacity in multidisciplinary health research that will make a positive impact on population health in Africa. Objective: The first cohort of the CARTA program describes their perspectives and experiences during the 4 years of fellowship and puts forward suggestions for future progress and direction of research in Africa. Conclusions: The model of training as shown by the CARTA program is an effective model of research capacity building in African academic institutions. An expansion of the program is therefore warranted to reach out to more African academics in search of advanced research training.

African Population Studies, 2014

Despite global decline in childhood mortality, under-5 mortality remains high in Nigeria. While m... more Despite global decline in childhood mortality, under-5 mortality remains high in Nigeria. While many studies have reported individual level factors as important determinants of under-five mortality in Nigeria, similar studies on the effects of neighbourhood contexts have been minimal. Hence, this study examines the effects of neighbourhood contexts on under-5 mortality in Nigeria. Using 2003 and 2008 Nigeria Demographic and Health Survey (NDHS) data, multilevel Cox regression analysis was performed on a nationally representative sample of 6,028 children (2003 NDHS) and 28,647 children (2008 NDHS). Results indicated neighbourhood context as important factor for child survival. For instance, findings showed that being born or raised in poor neighbourhoods (HR:1.54,p<0.05), rural communities (HR:1.25,p<0.05), and Northeastern region of Nigeria (HR:1.56,p<0.05) was associated with elevated hazards of death before age 5. Findings of this study suggest that achieving improved neighbourhood contexts holds great potentials for acceleration of under-five mortality reduction in Nigeria.

Clinical Infectious Diseases, 2019

Despite reductions over the past 2 decades, childhood mortality remains high in low- and middle-i... more Despite reductions over the past 2 decades, childhood mortality remains high in low- and middle-income countries in sub-Saharan Africa and South Asia. In these settings, children often die at home, without contact with the health system, and are neither accounted for, nor attributed with a cause of death. In addition, when cause of death determinations occur, they often use nonspecific methods. Consequently, findings from models currently utilized to build national and global estimates of causes of death are associated with substantial uncertainty. Higher-quality data would enable stakeholders to effectively target interventions for the leading causes of childhood mortality, a critical component to achieving the Sustainable Development Goals by eliminating preventable perinatal and childhood deaths. The Child Health and Mortality Prevention Surveillance (CHAMPS) Network tracks the causes of under-5 mortality and stillbirths at sites in sub-Saharan Africa and South Asia through compr...

Journal of Health Population and Nutrition, Mar 25, 2015

well-stressed in the demographic and public health literature, and several studies have documente... more well-stressed in the demographic and public health literature, and several studies have documented the consequences of low or non-use of contraceptives. For instance, high levels of fertility have been linked with low contraceptive-use (7). Bankole and Ezeh (8) opined that fertility level has remained high in sub-Saharan Africa due to failure of family planning services and high unmet need in the region. In addition, issue of poverty has been linked with high fertility, particularly in countries with limited opportunities and high unemployment rates (3). Another consequence of excessive population growth arising from low contraceptive-use is the threat to environmental sustainability. Also, rapid population growth has been seen as having a great public-health consequence, particularly for maternal and child health. For instance, Cleland et al. projected that increasing contraceptive-use in countries with high fertility rates has the potential of averting about 32% of all maternal deaths and 10% of childhood deaths (3). While unmet need for modern contraception is regarded as marginal in the middle-income countries (9), it remains unprecedentedly high in most of the sub-Saharan African countries.

African journal of reproductive health, 2013

This study examined sexual practices in a Nigerian University community with a view to understand... more This study examined sexual practices in a Nigerian University community with a view to understanding the role of family structure and poverty on risky sexual behaviours. A representative sample of 1,301 undergraduate students was randomly selected from the various faculties that made up the University. Using a questionnaire instrument, information was obtained on sexual behaviours of interest such as sexual initiation, multi-partnered sexual activity and condom use. Findings showed a noticeable variation in the relationship between family structure and risky sexual behaviour. Contrary to expectations, students from single parent homes showed lower likelihood of having multiple sexual partners. Also poverty was found not to be a critical determinant of risky sexual behaviour. Given the unclear nature of the findings, future study should explore further understanding of the relationship between family characteristics, poverty rating and risky sexual behaviour among students.

Global Health Action, 2014

Background: Existing studies indicate that about one in every six children dies before age five i... more Background: Existing studies indicate that about one in every six children dies before age five in Nigeria. While evidence suggests that improved access to adequate health care holds great potential for improved child survival, previous studies indicate that there are substantial barriers to accessing health care in Nigeria. There has not been a systematic attempt to examine the effects of barriers to health care on under-five mortality in Nigeria. This study is designed to address this knowledge gap. Data and method: Data came from a nationally representative sample of 18,028 women (aged 15Á49) who had a total of 28,647 live births within the 5 years preceding the 2008 Nigeria Demographic and Health Survey. The risk of death in children below age five was estimated using Cox proportional hazard models and results are presented as hazards ratios (HR) with 95% confidence intervals (CI). Results: Results indicate higher under-five mortality risks for children whose mothers had cultural barriers and children whose mothers had resource-related barriers to health care (HR: 1.44, CI: 1.32Á1.57, p B0.001), and those whose mothers had physical barriers (HR: 1.13, CI: 1.04Á1.24, p B0.001), relative to children whose mothers reported no barriers. Barriers to health care remained an important predictor of child survival even after adjusting for the effects of possible confounders. Conclusion: Findings of this study stressed the need for improved access to adequate health care in Nigeria through the elimination of barriers to access. This would enable the country to achieve a significant reduction in childhood mortality.

Journal of Biosocial Science, 2014

SummaryThere are substantial regional disparities in under-five mortality in Nigeria, and evidenc... more SummaryThere are substantial regional disparities in under-five mortality in Nigeria, and evidence suggests that both individual- and community-level characteristics have an influence on health outcomes. Using 2008 Nigeria Demographic and Health Survey data, this study (1) examines the effects of individual- and community-level characteristics on infant/child mortality in Nigeria and (2) determines the extent to which characteristics at these levels influence regional variations in infant/child mortality in the country. Multilevel Cox proportional hazard analysis was performed on a nationally representative sample of 28,647 children nested within 18,028 mothers of reproductive age, who were also nested within 886 communities. The results indicate that community-level variables (such as region, place of residence, community infrastructure, community hospital delivery and community poverty level) and individual-level factors (including child's sex, birth order, birth interval, mat...

Ethnicity & Health, 2014

Objective. There are huge regional disparities in under-five mortality in Nigeria. While a region... more Objective. There are huge regional disparities in under-five mortality in Nigeria. While a region within the country has as high as 222 under-five deaths per 1000 live births, the rate is as low as 89 per 1000 live births in another region. Nigeria is culturally diverse as there are more than 250 identifiable ethnic groups in the country; and various ethnic groups have different sociocultural values and practices which could influence child health outcome. Thus, the main objective of this study was to examine the ethnic differentials in under-five mortality in Nigeria. Design. The study utilized 2008 Nigeria Demographic and Health Survey (NDHS) data. We analyzed data from a nationally representative sample drawn from 33,385 women aged 15-49 that had a total of 104,808 live births within 1993-2008. In order to examine ethnic differentials in under-five mortality over a sufficiently long period of time, our analysis considered live births within 15 years preceding the 2008 NDHS. The risks of death in children below age five were estimated using Cox proportional regression analysis. Results were presented as hazard ratios (HR) with 95% confidence intervals (CI). Results. The study found substantial differentials in under-five mortality by ethnic affiliations. For instance, risks of death were significantly lower for children of the Yoruba tribes (HR: 0.39, CI: 0.37-0.42, p < 0.001), children of Igbo tribes (HR: 0.58, CI: 0.55-0.61, p < 0.001) and children of the minority ethnic groups (HR: 0.66, CI: 0.64-0.68, p < 0.001), compared to children of the Hausa/Fulani/Kanuri tribes. Besides, practices such as plural marriage, having higher-order births and too close births showed statistical significance for increased risks of under-five mortality (p < 0.05). Conclusion. The findings of this study stress the need to address the ethnic norms and practices that negatively impact on child health and survival among some ethnic groups in Nigeria.

BMC Public Health, 2013

Background: Despite the recognition of stigma as a hindrance to public health treatment and preve... more Background: Despite the recognition of stigma as a hindrance to public health treatment and prevention there are gaps in evidence on the relationship between HIV stigma and VCT services utilization in Nigeria. The purpose of this study was to examine a community's perceptions, feelings and attitudes towards people living with HIV/AIDS and how this is associated with access to utilization of voluntary counselling and treatment in Nigeria. Methods: A cross-sectional random study of Nigerians, using a mixed-method approach was carried out in two distinct ethnic areas of the country. Both quantitative and qualitative methods (mixed-methods) were used to collect data in Osun State (Yoruba ethnic group) in the SouthWest and Imo State (Igbo ethnic group) in the South East. Multivariate logistic regression was the model used to examine the association of interest. Results: It is shown that Nigerian public attitudes to HIV/AIDS and those infected with the disease are negative. The markers for stigma on the overall stigma index are significant predictors of utilization of voluntary counselling and testing. As the sum of negative feelings increases, there is less likelihood to using voluntary counselling and testing (VCT) and vice versa. Conclusions: Current national efforts at addressing the AIDS pandemic can only be successful when the issue of AIDS is de-stigmatized and is made a critical part of those efforts. One way to do this is through well-designed messages that should be posted in the media, community halls, health centers and other public places aimed at humanizing the disease and those affected and infected by it.

African Population Studies, 2013

The paper presents the interaction effect of poverty-wealth status and autonomy on modern contrac... more The paper presents the interaction effect of poverty-wealth status and autonomy on modern contraceptive use in Nigeria and Namibia with a view to examining whether poor women with less autonomy are less likely to use modern contraception than other women. A weighted sample of 3,451 currently married women in 2006-07 Namibia Demographic and Health Survey (DHS) and 23,578 in 2008 Nigeria (DHS) are used in the analysis. In Nigeria, the odds of using modern contraception is nearly 15 times higher among rich women with more autonomy than their counterparts who are poor and less autonomous, and 5.5 times higher among Namibian women. The study concluded that contraceptive behaviour of currently married women of Namibia and Nigeria are not independent of the linkage between poverty and autonomy and thus recommended that more concerted efforts be made in addressing poverty and improving the autonomous status of women in sub-Sahara Africa.

Global Health Action, 2015

Background: Family planning expansion has been identified as an impetus to harnessing Nigeria's d... more Background: Family planning expansion has been identified as an impetus to harnessing Nigeria's demographic dividend. However, there is a need for data to address pockets of inequality and to better understand cultural and social factors affecting contraceptive use and health benefits. This paper contributes to addressing these needs by providing evidence on the trends and sub-national patterns of modern contraceptive prevalence in Nigeria and the association between contraceptive use and high-risk births in Nigeria. Design: The study utilised women's data from the last three Demographic and Health Surveys (2003, 2008, and 2013) in Nigeria. The analysis involved descriptive, bivariate, and multivariate analyses. The multivariate analyses were performed to examine the relationship between high-risk births and contraceptive use. Associations were examined using Poisson regression. Results: Findings showed that respondents in avoidable high-risk birth categories were less likely to use contraceptives compared to those at no risk [rate ratio 0.82, confidence interval: 0.76Á0.89, p B0.001]. Education and wealth index consistently predicted significant differences in contraceptive use across the models. Conclusions: The results of this study suggest that women in the high-risk birth categories were significantly less likely to use a modern method of contraception relative to those categorised as having no risk. However, there are huge sub-national variations at regional and state levels in contraceptive prevalence and subsequent high-risk births. These results further strengthen evidence-based justification for increased investments in family planning programmes at the state and regional levels, particularly regions and states with high unmet needs for family planning.

AAS Open Research

Background: West Africa historically has a high prevalence of girl-child marriage and requires su... more Background: West Africa historically has a high prevalence of girl-child marriage and requires substantial reduction to meet the United Nation’s Sustainable Development Goals (SDG) target of ending child marriage by 2030, but current data on progress is sparce. We aimed to determine the trend in child marriage in West Africa and assess the influence of selected socio-demographic factors. Methods: We analysed data on women aged 18-24 years from the two most recent Demographic and Health Surveys (conducted between 2006 and 2014) for 11 West African countries to determine the prevalence and trend of girl-child marriage. Multivariable logistic regression analysis was used to assess the relationship between girl-child marriage and selected socio-demographic factors. Results: The prevalence of child marriage in West Africa is 41.5%. An overall decrease of 4.6% (annual rate of 0.01%) was recorded over a seven-year inter-survey period. Three countries (Cote d’Ivoire, Nigeria, and Niger) rec...

Background: Family planning expansion has been identified as an impetus to harnessing Nigeria’s d... more Background: Family planning expansion has been identified as an impetus to harnessing Nigeria’s demo-graphic dividend. However, there is a need for data to address pockets of inequality and to better under-stand cultural and social factors affecting contraceptive use and health benefits. This paper contributes to addressing these needs by providing evidence on the trends and sub-national patterns of modern contraceptive prevalence in Nigeria and the association between contraceptive use and high-risk births in Nigeria. Design: The study utilised women’s data from the last three Demographic and Health Surveys (2003, 2008, and 2013) in Nigeria. The analysis involved descriptive, bivariate, and multivariate analyses. The multivariate analyses were performed to examine the relationship between high-risk births and contraceptive use. Associations were examined using Poisson regression. Results: Findings showed that respondents in avoidable high-risk birth categories were less likely to u...

PLOS ONE

Context Considering the persistent poor maternal and child health outcomes in sub-Saharan Africa ... more Context Considering the persistent poor maternal and child health outcomes in sub-Saharan Africa (SSA), this study undertook a comparative analysis of the timing and adequacy of antenatal care uptake between women (aged 20–24 years) who married before age 18 and those who married at age 18 or above. Method Data came from Demographic and Health Surveys of 20 SSA countries. We performed binary logistic regression analysis on pooled data of women aged 20–24 (n = 33,630). Results Overall, the percentage of child brides in selected countries was 57.1%, with the lowest prevalence found in Rwanda (19.1%) and the highest rate in Chad (80.9%). Central and West African countries had the highest prevalence of child marriage compared to other sub-regions. Bivariate results indicate that a lower proportion of child brides (50.0%) had 4+ ANC visits compared to the adult brides (60.9%) and a lower percentage of them (34.0%) initiated ANC visits early compared to the adult brides (37.5%). After con...

Development Southern Africa

What role has gender equality played in fertility transitions in Africa? This article addresses t... more What role has gender equality played in fertility transitions in Africa? This article addresses this and other questions with a focus on the fertility levels of two selected countries in Africa. Using Demographic and Health Surveys datasets of Nigeria (2008) and Kenya (2008-09), the article examines the relationship between the current level of gender systems and fertility transitions in Africa. The prospects for future decline in fertility levels in the selected countries are also discussed.

South African Journal of Child Health, 2020

Background . Improving access to quality healthcare can contribute to reducing childhood mortalit... more Background . Improving access to quality healthcare can contribute to reducing childhood mortality. Therefore, understanding the patterns of healthcare utilisation for common childhood conditions as well as barriers to healthcare use is important in planning appropriate public health programmes and interventions. Objective . The objective of the present study was to examine patterns of child healthcare uptake and barriers that affect access to healthcare in two South African (SA) low-income urban settings. Methods . A healthcare utilisation survey was conducted between April and September 2015, using a cross-sectional study design. Data were analysed using descriptive and inferential statistics. Information was collected on 531 children and their caregivers from 503 randomly selected households. Results . Our findings revealed that 81.9% of respondents preferred clinics as their first choice, and 84.2% preferred hospitals as their second point of call. About 5% of caregivers preferr...

Poor maternity care uptake (MCU) persists in Nigeria. Evidence shows that this is partly responsi... more Poor maternity care uptake (MCU) persists in Nigeria. Evidence shows that this is partly responsible for the country’s high maternal mortality ratio of 560 deaths per 100,000 live births and under-five mortality rate of 128 deaths per 1,000 live births. Also, wide gap in partners' age difference (PAD) coupled with lack of control over own health and that of their children persist among women in patriarchal societies, especially Nigeria. Given this situation, this study examined the influence of PAD on MCU in Nigeria. Binary logistic regression analysis was performed on 7023 couples in 2013 Nigeria Demographic and Health Survey data. Results indicated significantly lower odds of utilizing maternal and child health care [i.e. antenatal care (ANC), skilled delivery (SD) and postnatal care (PNC)] among women that were far younger than their partners, relative to much older women. For instance, PAD of 10 years or higher was significantly associated with lower odds of utilizing ANC ...

Background. The burden of under-five mortality in sub-Saharan Africa (SSA) is highest during the ... more Background. The burden of under-five mortality in sub-Saharan Africa (SSA) is highest during the neonatal period, with over 40% of cases occurring during the first month of life. There is a paucity of evidence on the influence of women’s household position on neonatal survival in SSA. Objective. To assess the influence of women’s household position on neonatal survival in SSA. Methods. We analysed pooled data ( N =191 514) from the demographic and health surveys of 18 countries in SSA. Cox proportional hazards regression analysis was used to explore statistically significant relationships. Results. Findings support the hypothesis that a low position of a woman in the household is significantly associated with high neonatal mortality, as children of women who experienced a high position in the household had a significantly lower risk of neonatal mortality (hazard ratio 0.85, confidence interval 0.76 - 0.95; p <0.05) than those whose mothers experienced a low household position....

Global Health Action, 2014

Background: Resolution of public health problems in Africa remains a challenge because of insuffi... more Background: Resolution of public health problems in Africa remains a challenge because of insufficient skilled human resource capacity. The Consortium for Advanced Research Training in Africa (CARTA) was established to enhance capacity in multidisciplinary health research that will make a positive impact on population health in Africa. Objective: The first cohort of the CARTA program describes their perspectives and experiences during the 4 years of fellowship and puts forward suggestions for future progress and direction of research in Africa. Conclusions: The model of training as shown by the CARTA program is an effective model of research capacity building in African academic institutions. An expansion of the program is therefore warranted to reach out to more African academics in search of advanced research training.

African Population Studies, 2014

Despite global decline in childhood mortality, under-5 mortality remains high in Nigeria. While m... more Despite global decline in childhood mortality, under-5 mortality remains high in Nigeria. While many studies have reported individual level factors as important determinants of under-five mortality in Nigeria, similar studies on the effects of neighbourhood contexts have been minimal. Hence, this study examines the effects of neighbourhood contexts on under-5 mortality in Nigeria. Using 2003 and 2008 Nigeria Demographic and Health Survey (NDHS) data, multilevel Cox regression analysis was performed on a nationally representative sample of 6,028 children (2003 NDHS) and 28,647 children (2008 NDHS). Results indicated neighbourhood context as important factor for child survival. For instance, findings showed that being born or raised in poor neighbourhoods (HR:1.54,p<0.05), rural communities (HR:1.25,p<0.05), and Northeastern region of Nigeria (HR:1.56,p<0.05) was associated with elevated hazards of death before age 5. Findings of this study suggest that achieving improved neighbourhood contexts holds great potentials for acceleration of under-five mortality reduction in Nigeria.

Clinical Infectious Diseases, 2019

Despite reductions over the past 2 decades, childhood mortality remains high in low- and middle-i... more Despite reductions over the past 2 decades, childhood mortality remains high in low- and middle-income countries in sub-Saharan Africa and South Asia. In these settings, children often die at home, without contact with the health system, and are neither accounted for, nor attributed with a cause of death. In addition, when cause of death determinations occur, they often use nonspecific methods. Consequently, findings from models currently utilized to build national and global estimates of causes of death are associated with substantial uncertainty. Higher-quality data would enable stakeholders to effectively target interventions for the leading causes of childhood mortality, a critical component to achieving the Sustainable Development Goals by eliminating preventable perinatal and childhood deaths. The Child Health and Mortality Prevention Surveillance (CHAMPS) Network tracks the causes of under-5 mortality and stillbirths at sites in sub-Saharan Africa and South Asia through compr...

Journal of Health Population and Nutrition, Mar 25, 2015

well-stressed in the demographic and public health literature, and several studies have documente... more well-stressed in the demographic and public health literature, and several studies have documented the consequences of low or non-use of contraceptives. For instance, high levels of fertility have been linked with low contraceptive-use (7). Bankole and Ezeh (8) opined that fertility level has remained high in sub-Saharan Africa due to failure of family planning services and high unmet need in the region. In addition, issue of poverty has been linked with high fertility, particularly in countries with limited opportunities and high unemployment rates (3). Another consequence of excessive population growth arising from low contraceptive-use is the threat to environmental sustainability. Also, rapid population growth has been seen as having a great public-health consequence, particularly for maternal and child health. For instance, Cleland et al. projected that increasing contraceptive-use in countries with high fertility rates has the potential of averting about 32% of all maternal deaths and 10% of childhood deaths (3). While unmet need for modern contraception is regarded as marginal in the middle-income countries (9), it remains unprecedentedly high in most of the sub-Saharan African countries.

African journal of reproductive health, 2013

This study examined sexual practices in a Nigerian University community with a view to understand... more This study examined sexual practices in a Nigerian University community with a view to understanding the role of family structure and poverty on risky sexual behaviours. A representative sample of 1,301 undergraduate students was randomly selected from the various faculties that made up the University. Using a questionnaire instrument, information was obtained on sexual behaviours of interest such as sexual initiation, multi-partnered sexual activity and condom use. Findings showed a noticeable variation in the relationship between family structure and risky sexual behaviour. Contrary to expectations, students from single parent homes showed lower likelihood of having multiple sexual partners. Also poverty was found not to be a critical determinant of risky sexual behaviour. Given the unclear nature of the findings, future study should explore further understanding of the relationship between family characteristics, poverty rating and risky sexual behaviour among students.

Global Health Action, 2014

Background: Existing studies indicate that about one in every six children dies before age five i... more Background: Existing studies indicate that about one in every six children dies before age five in Nigeria. While evidence suggests that improved access to adequate health care holds great potential for improved child survival, previous studies indicate that there are substantial barriers to accessing health care in Nigeria. There has not been a systematic attempt to examine the effects of barriers to health care on under-five mortality in Nigeria. This study is designed to address this knowledge gap. Data and method: Data came from a nationally representative sample of 18,028 women (aged 15Á49) who had a total of 28,647 live births within the 5 years preceding the 2008 Nigeria Demographic and Health Survey. The risk of death in children below age five was estimated using Cox proportional hazard models and results are presented as hazards ratios (HR) with 95% confidence intervals (CI). Results: Results indicate higher under-five mortality risks for children whose mothers had cultural barriers and children whose mothers had resource-related barriers to health care (HR: 1.44, CI: 1.32Á1.57, p B0.001), and those whose mothers had physical barriers (HR: 1.13, CI: 1.04Á1.24, p B0.001), relative to children whose mothers reported no barriers. Barriers to health care remained an important predictor of child survival even after adjusting for the effects of possible confounders. Conclusion: Findings of this study stressed the need for improved access to adequate health care in Nigeria through the elimination of barriers to access. This would enable the country to achieve a significant reduction in childhood mortality.

Journal of Biosocial Science, 2014

SummaryThere are substantial regional disparities in under-five mortality in Nigeria, and evidenc... more SummaryThere are substantial regional disparities in under-five mortality in Nigeria, and evidence suggests that both individual- and community-level characteristics have an influence on health outcomes. Using 2008 Nigeria Demographic and Health Survey data, this study (1) examines the effects of individual- and community-level characteristics on infant/child mortality in Nigeria and (2) determines the extent to which characteristics at these levels influence regional variations in infant/child mortality in the country. Multilevel Cox proportional hazard analysis was performed on a nationally representative sample of 28,647 children nested within 18,028 mothers of reproductive age, who were also nested within 886 communities. The results indicate that community-level variables (such as region, place of residence, community infrastructure, community hospital delivery and community poverty level) and individual-level factors (including child's sex, birth order, birth interval, mat...

Ethnicity & Health, 2014

Objective. There are huge regional disparities in under-five mortality in Nigeria. While a region... more Objective. There are huge regional disparities in under-five mortality in Nigeria. While a region within the country has as high as 222 under-five deaths per 1000 live births, the rate is as low as 89 per 1000 live births in another region. Nigeria is culturally diverse as there are more than 250 identifiable ethnic groups in the country; and various ethnic groups have different sociocultural values and practices which could influence child health outcome. Thus, the main objective of this study was to examine the ethnic differentials in under-five mortality in Nigeria. Design. The study utilized 2008 Nigeria Demographic and Health Survey (NDHS) data. We analyzed data from a nationally representative sample drawn from 33,385 women aged 15-49 that had a total of 104,808 live births within 1993-2008. In order to examine ethnic differentials in under-five mortality over a sufficiently long period of time, our analysis considered live births within 15 years preceding the 2008 NDHS. The risks of death in children below age five were estimated using Cox proportional regression analysis. Results were presented as hazard ratios (HR) with 95% confidence intervals (CI). Results. The study found substantial differentials in under-five mortality by ethnic affiliations. For instance, risks of death were significantly lower for children of the Yoruba tribes (HR: 0.39, CI: 0.37-0.42, p < 0.001), children of Igbo tribes (HR: 0.58, CI: 0.55-0.61, p < 0.001) and children of the minority ethnic groups (HR: 0.66, CI: 0.64-0.68, p < 0.001), compared to children of the Hausa/Fulani/Kanuri tribes. Besides, practices such as plural marriage, having higher-order births and too close births showed statistical significance for increased risks of under-five mortality (p < 0.05). Conclusion. The findings of this study stress the need to address the ethnic norms and practices that negatively impact on child health and survival among some ethnic groups in Nigeria.

BMC Public Health, 2013

Background: Despite the recognition of stigma as a hindrance to public health treatment and preve... more Background: Despite the recognition of stigma as a hindrance to public health treatment and prevention there are gaps in evidence on the relationship between HIV stigma and VCT services utilization in Nigeria. The purpose of this study was to examine a community's perceptions, feelings and attitudes towards people living with HIV/AIDS and how this is associated with access to utilization of voluntary counselling and treatment in Nigeria. Methods: A cross-sectional random study of Nigerians, using a mixed-method approach was carried out in two distinct ethnic areas of the country. Both quantitative and qualitative methods (mixed-methods) were used to collect data in Osun State (Yoruba ethnic group) in the SouthWest and Imo State (Igbo ethnic group) in the South East. Multivariate logistic regression was the model used to examine the association of interest. Results: It is shown that Nigerian public attitudes to HIV/AIDS and those infected with the disease are negative. The markers for stigma on the overall stigma index are significant predictors of utilization of voluntary counselling and testing. As the sum of negative feelings increases, there is less likelihood to using voluntary counselling and testing (VCT) and vice versa. Conclusions: Current national efforts at addressing the AIDS pandemic can only be successful when the issue of AIDS is de-stigmatized and is made a critical part of those efforts. One way to do this is through well-designed messages that should be posted in the media, community halls, health centers and other public places aimed at humanizing the disease and those affected and infected by it.

African Population Studies, 2013

The paper presents the interaction effect of poverty-wealth status and autonomy on modern contrac... more The paper presents the interaction effect of poverty-wealth status and autonomy on modern contraceptive use in Nigeria and Namibia with a view to examining whether poor women with less autonomy are less likely to use modern contraception than other women. A weighted sample of 3,451 currently married women in 2006-07 Namibia Demographic and Health Survey (DHS) and 23,578 in 2008 Nigeria (DHS) are used in the analysis. In Nigeria, the odds of using modern contraception is nearly 15 times higher among rich women with more autonomy than their counterparts who are poor and less autonomous, and 5.5 times higher among Namibian women. The study concluded that contraceptive behaviour of currently married women of Namibia and Nigeria are not independent of the linkage between poverty and autonomy and thus recommended that more concerted efforts be made in addressing poverty and improving the autonomous status of women in sub-Sahara Africa.

Global Health Action, 2015

Background: Family planning expansion has been identified as an impetus to harnessing Nigeria's d... more Background: Family planning expansion has been identified as an impetus to harnessing Nigeria's demographic dividend. However, there is a need for data to address pockets of inequality and to better understand cultural and social factors affecting contraceptive use and health benefits. This paper contributes to addressing these needs by providing evidence on the trends and sub-national patterns of modern contraceptive prevalence in Nigeria and the association between contraceptive use and high-risk births in Nigeria. Design: The study utilised women's data from the last three Demographic and Health Surveys (2003, 2008, and 2013) in Nigeria. The analysis involved descriptive, bivariate, and multivariate analyses. The multivariate analyses were performed to examine the relationship between high-risk births and contraceptive use. Associations were examined using Poisson regression. Results: Findings showed that respondents in avoidable high-risk birth categories were less likely to use contraceptives compared to those at no risk [rate ratio 0.82, confidence interval: 0.76Á0.89, p B0.001]. Education and wealth index consistently predicted significant differences in contraceptive use across the models. Conclusions: The results of this study suggest that women in the high-risk birth categories were significantly less likely to use a modern method of contraception relative to those categorised as having no risk. However, there are huge sub-national variations at regional and state levels in contraceptive prevalence and subsequent high-risk births. These results further strengthen evidence-based justification for increased investments in family planning programmes at the state and regional levels, particularly regions and states with high unmet needs for family planning.

AAS Open Research

Background: West Africa historically has a high prevalence of girl-child marriage and requires su... more Background: West Africa historically has a high prevalence of girl-child marriage and requires substantial reduction to meet the United Nation’s Sustainable Development Goals (SDG) target of ending child marriage by 2030, but current data on progress is sparce. We aimed to determine the trend in child marriage in West Africa and assess the influence of selected socio-demographic factors. Methods: We analysed data on women aged 18-24 years from the two most recent Demographic and Health Surveys (conducted between 2006 and 2014) for 11 West African countries to determine the prevalence and trend of girl-child marriage. Multivariable logistic regression analysis was used to assess the relationship between girl-child marriage and selected socio-demographic factors. Results: The prevalence of child marriage in West Africa is 41.5%. An overall decrease of 4.6% (annual rate of 0.01%) was recorded over a seven-year inter-survey period. Three countries (Cote d’Ivoire, Nigeria, and Niger) rec...

Background: Family planning expansion has been identified as an impetus to harnessing Nigeria’s d... more Background: Family planning expansion has been identified as an impetus to harnessing Nigeria’s demo-graphic dividend. However, there is a need for data to address pockets of inequality and to better under-stand cultural and social factors affecting contraceptive use and health benefits. This paper contributes to addressing these needs by providing evidence on the trends and sub-national patterns of modern contraceptive prevalence in Nigeria and the association between contraceptive use and high-risk births in Nigeria. Design: The study utilised women’s data from the last three Demographic and Health Surveys (2003, 2008, and 2013) in Nigeria. The analysis involved descriptive, bivariate, and multivariate analyses. The multivariate analyses were performed to examine the relationship between high-risk births and contraceptive use. Associations were examined using Poisson regression. Results: Findings showed that respondents in avoidable high-risk birth categories were less likely to u...

PLOS ONE

Context Considering the persistent poor maternal and child health outcomes in sub-Saharan Africa ... more Context Considering the persistent poor maternal and child health outcomes in sub-Saharan Africa (SSA), this study undertook a comparative analysis of the timing and adequacy of antenatal care uptake between women (aged 20–24 years) who married before age 18 and those who married at age 18 or above. Method Data came from Demographic and Health Surveys of 20 SSA countries. We performed binary logistic regression analysis on pooled data of women aged 20–24 (n = 33,630). Results Overall, the percentage of child brides in selected countries was 57.1%, with the lowest prevalence found in Rwanda (19.1%) and the highest rate in Chad (80.9%). Central and West African countries had the highest prevalence of child marriage compared to other sub-regions. Bivariate results indicate that a lower proportion of child brides (50.0%) had 4+ ANC visits compared to the adult brides (60.9%) and a lower percentage of them (34.0%) initiated ANC visits early compared to the adult brides (37.5%). After con...

Development Southern Africa

What role has gender equality played in fertility transitions in Africa? This article addresses t... more What role has gender equality played in fertility transitions in Africa? This article addresses this and other questions with a focus on the fertility levels of two selected countries in Africa. Using Demographic and Health Surveys datasets of Nigeria (2008) and Kenya (2008-09), the article examines the relationship between the current level of gender systems and fertility transitions in Africa. The prospects for future decline in fertility levels in the selected countries are also discussed.

South African Journal of Child Health, 2020

Background . Improving access to quality healthcare can contribute to reducing childhood mortalit... more Background . Improving access to quality healthcare can contribute to reducing childhood mortality. Therefore, understanding the patterns of healthcare utilisation for common childhood conditions as well as barriers to healthcare use is important in planning appropriate public health programmes and interventions. Objective . The objective of the present study was to examine patterns of child healthcare uptake and barriers that affect access to healthcare in two South African (SA) low-income urban settings. Methods . A healthcare utilisation survey was conducted between April and September 2015, using a cross-sectional study design. Data were analysed using descriptive and inferential statistics. Information was collected on 531 children and their caregivers from 503 randomly selected households. Results . Our findings revealed that 81.9% of respondents preferred clinics as their first choice, and 84.2% preferred hospitals as their second point of call. About 5% of caregivers preferr...

Poor maternity care uptake (MCU) persists in Nigeria. Evidence shows that this is partly responsi... more Poor maternity care uptake (MCU) persists in Nigeria. Evidence shows that this is partly responsible for the country’s high maternal mortality ratio of 560 deaths per 100,000 live births and under-five mortality rate of 128 deaths per 1,000 live births. Also, wide gap in partners' age difference (PAD) coupled with lack of control over own health and that of their children persist among women in patriarchal societies, especially Nigeria. Given this situation, this study examined the influence of PAD on MCU in Nigeria. Binary logistic regression analysis was performed on 7023 couples in 2013 Nigeria Demographic and Health Survey data. Results indicated significantly lower odds of utilizing maternal and child health care [i.e. antenatal care (ANC), skilled delivery (SD) and postnatal care (PNC)] among women that were far younger than their partners, relative to much older women. For instance, PAD of 10 years or higher was significantly associated with lower odds of utilizing ANC ...

Background. The burden of under-five mortality in sub-Saharan Africa (SSA) is highest during the ... more Background. The burden of under-five mortality in sub-Saharan Africa (SSA) is highest during the neonatal period, with over 40% of cases occurring during the first month of life. There is a paucity of evidence on the influence of women’s household position on neonatal survival in SSA. Objective. To assess the influence of women’s household position on neonatal survival in SSA. Methods. We analysed pooled data ( N =191 514) from the demographic and health surveys of 18 countries in SSA. Cox proportional hazards regression analysis was used to explore statistically significant relationships. Results. Findings support the hypothesis that a low position of a woman in the household is significantly associated with high neonatal mortality, as children of women who experienced a high position in the household had a significantly lower risk of neonatal mortality (hazard ratio 0.85, confidence interval 0.76 - 0.95; p <0.05) than those whose mothers experienced a low household position....