Accurate identification of malaria cases is crucial to the management of cases and the eventual success of malaria eradication agenda. This study is designed to evaluate the discriminatory and ...predictive accuracy of malaria rapid diagnostic tests (RDTs) in Nigeria.
The data obtained during the 2015 Nigeria Malaria Indicator Survey was used to quantify the discriminatory accuracy of the RDT against the microscopy through the analysis of its sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratio. The positive (PPV) and negative (NPV) predictive values, area under the receiver operating characteristic curve, and diagnostic odds ratio were used to assess the predictive accuracy of the RDTs using expert microscopy as a gold standard at p = 0.05. The McNemar paired test and the Kappa statistics were used to assess the level of agreement between the diagnostic tests.
There was a significant but not an excellent agreement between the results of the RDT and microscopy tests (p < 0.001). The overall sensitivity of the RDT was 87.6% (85.9-89.2%), specificity was 75.8% (74.4-77.1%), while the diagnostic accuracy stood at 79.0% (77.9-80.0%). The LR+, LR-, PPV and NPV were 3.6 (3.4-3.8) and 0.16 (0.14-0.19), 57.5% (56.1-58.9%) and 94.2% (93.5-94.9%), respectively. The sensitivity of RDT increased as the age of the children increased, from 85.7% among those aged 0-6 months to 86.1% in 7-23 month olds to 88.1% among those aged 24-59 months, but the reverse was the specificity. For children with severe anaemia, the sensitivity of the RDT was nearly 100% compared with a specificity of 39%. While the sensitivity and the PPV reduced with children's level of anaemia, the higher the severity of anaemia, the lower the NPV, specificity, the diagnostic accuracy of the RDT. The odds of RDT being sensitive was about 50% adjusted Odds Ratio (aOR) = 0.52 (95% CI 0.30-0.90) lower among children aged 7-23 months compared with those aged 24-59 months while the odds of RDT being sensitive was 2 times aOR = 2.15 (95% CI 1.67-2.77) higher among those 7-23 months than among those aged 24-59 months.
Although there was a significant agreement in the outcomes of RDT and microscopy tests, the discriminatory accuracy of RDT was weak. Also, the predictive accuracy, especially the PPV of the RDTS, were very low. These measures of accuracies differed across the age of the children, level of anaemia, recent experience of malaria and other characteristics. Without an accurate, efficient and reliable diagnosis of malaria, the goal of eliminating malaria and reduction of malaria-related deaths to zero by 2020 will only remain elusive.
Neonatal (NMR), infant (IMR) and under-five (U5M) mortality rates remain high in Nigeria. Evidence-based knowledge of trends and drivers of child mortality will aid proper interventions needed to ...combat the menace. Therefore, this study assessed the trends and drivers of NMR, IMR, and U5M over a decade in Nigeria. A nationally representative data from three consecutive Nigeria Demographic and Household Surveys (NDHS) was used. A total of 66,158 live births within the five years preceding the 2003 (6029), 2008 (28647) and 2013 (31482) NDHS were included in the analyses. NMR was computed using proportions while IMR and U5 were computed using life table techniques embedded in Stata version 12. Probit regression model and its associated marginal effects were used to identify the predisposing factors to NMR, IMR, and U5M. The NMR, IMR, and U5M per 1000 live births in 2003, 2008 and 2013 were 52, 41, 39; 100, 75, 69; and 201, 157, 128 respectively. The NMR, IMR, and U5M were consistently lower among children whose mothers were younger, living in rural areas and from richer households. Generally, the probability of neonate death in 2003, 2008 and 2013 were 0.049, 0.039 and 0.038 respectively, the probability of infant death was 0.093, 0.071 and 0.064 while the probability of under-five death was 0.140, 0.112 and 0.092 for the respective survey years. While adjusting for other variables, the likelihood of infant and under-five deaths was significantly reduced across the survey years. Maternal age, mothers' education, place of residence, child's sex, birth interval, weight at birth, skill of birth attendant, delivery by caesarean operation or not significantly influenced NMR, IMR, and U5M. The NMR, IMR, and U5M in Nigeria reduced over the studied period. Multi-sectoral interventions targeted towards the identified drivers should be instituted to improve child survival.
ObjectivesTo assess the compliance of WHO guidelines on the timeliness of antenatal care (ANC) initiation in Nigeria and its associated factors and to provide subcountry analysis of disparities in ...the timing of the first ANC in Nigeria.DesignCross-sectional.SettingNationally representative data of most recent pregnancies between 2013 and 2018 in Nigeria.ParticipantsWomen with pregnancies within 5 years before the study.Primary and secondary outcome measuresThe outcome variable was the trimesters of the first ANC contact. Data were analysed using descriptive statistics, bivariable and multivariable multinomial logistic regression at 5% significance level.ResultsOf all the 21 785 respondents, 75% had at least one ANC contact during their most recent pregnancies within the five years preceding the data collection. Among which 24% and 63% started in the first and second trimester, respectively. The proportion who started ANC in the first trimester was highest in Benue (44.5%), Lagos (41.4%) and Nasarawa (39.3%) and lowest in Zamfara (7.6%), Kano (7.4%) and Sokoto (4.8%). Respondents aged 40–49 years were 65% (adjusted relative risk ratio (aRRR: 1.65, 95 % CI: 1.10 to 2.45) more likely to initiate ANC during the first trimester of pregnancy relative to those aged 15–19 years. Although insignificant, women who participate in their healthcare utilisation were 4% (aRRR: 1.04, 95 % CI: 0.90 to 1.20) times more likely to have early initiation of ANC. Other significant factors were respondents’ and spousal educational attainment, household wealth quintiles, region of residence, ethnicity, religion and birth order.ConclusionsOnly a quarter of pregnant women, initiated ANC contact during the first trimester with wider disparities across the states in Nigeria and across the background characteristics of the pregnant women. There are needs to enhance women’s autonomy in healthcare utilisation. Concerted efforts on awareness creation and empowerment for women by all stakeholders in maternal and child healthcare are antidotes for early ANC contact initiation.
The use of inappropriate methods for estimating the effects of covariates in survival data with frailty leads to erroneous conclusions in medical research. This study evaluated the performance of 13 ...survival regression models in assessing the factors associated with the timing of complications in implant-supported dental restorations in a Swedish cohort. Data were obtained from randomly selected cohort (n = 596) of Swedish patients provided with dental restorations supported in 2003. Patients were evaluated over 9 years of implant loss, peri-implantitis or technical complications. Best Model was identified using goodness, AIC and BIC. The loglikelihood, the AIC and BIC were consistently lower in flexible parametric model with frailty (df = 2) than other models. Adjusted hazard of implant complications was 45% (adjusted Hazard Ratio (aHR) = 1.449; 95% Confidence Interval (CI): 1.153-1.821, p = 0.001) higher among patients with periodontitis. While controlling for other variables, the hazard of implant complications was about 5 times (aHR = 4.641; 95% CI: 2.911-7.401, p<0.001) and 2 times (aHR = 2.338; 95% CI: 1.553-3.519, p<0.001) higher among patients with full- and partial-jaw restorations than those with single crowns. Flexible parametric survival model with frailty are the most suitable for modelling implant complications among the studied patients.
Paucity of data exists on the timing of puberty, particularly the pubarche, in developing countries, which has hitherto limited the knowledge of the timing of pubarche, and assistance offered by ...physicians to anxious young people in Nigeria. Factors associated with the timings of puberty and pubarche are not well documented in Nigeria. We hypothesized that the timing of pubarche in Nigeria differs by geographical regions and other characteristics. We assessed the timing of pubarche among adolescents and young adults in Nigeria and identified prognostic factors of the timing by obtaining information on youths’ sexual and reproductive developments in a population survey among in-school and out-of-school youths aged 15 to 24 years in Nigeria. A total of 1174 boys and 1004 girls provided valid information on pubarche. Results of time-to-event analysis of the data showed that mean age at pubarche among males aged 15 to 19 years and 20 to 24 years was 13.5 (SD = 1.63 years) and 14.2 (SD = 2.18 years) (respectively) compared with 13.0 (SD = 1.57 years) and 13.5 (SD = 2.06 years) among females of the same age. Median time to pubarche was 14 (Interquartile range (IQR) = 3) years and 13 (IQR = 3) years among the males and females, respectively. Cumulatively, 37% of the males had attained pubarche by age 13 years versus 53% among females, 57% vs 72% at age 14, and 73% vs 81% at age 15. The likelihood of pubarche among males was delayed by 5% compared with females (Time Ratio (TR) = 1.05: 95% CI = 1.03–1.05). Every additional one-year in the ages of both males and females increases the risk of pubarche by 1%. Similar to the females, males residents in Northeast (aTR = 1.14, 95% CI: 1.07–1.21), in the Northwest (aTR = 1.20, 95% CI: 1.13–1.27) and in the Southwest (aTR = 1.18, 95% CI: 1.11–1.26) had delayed pubarche than males from the South East. Yoruba males had delayed pubarche than Ibo males (aTR = 1.06, 95% CI: 1.01–1.12). Age at pubarche among adolescents and young adults in Nigeria differed among males and females with earlier onset among females. Pubarche timing varied mainly by ethnicity, region, and location of residence. Our findings will aid medical practitioners in providing appropriate advice and support on pubarche-related issues among adolescents in Nigeria as it could help douse pubarche anxiousness in relation to request for medical assistance.
Paucity of data exists on the timing of puberty, particularly the pubarche, in developing countries, which has hitherto limited the knowledge of the timing of pubarche, and assistance offered by ...physicians to anxious young people in Nigeria. Factors associated with the timings of puberty and pubarche are not well documented in Nigeria. We hypothesized that the timing of pubarche in Nigeria differs by geographical regions and other characteristics. We assessed the timing of pubarche among adolescents and young adults in Nigeria and identified prognostic factors of the timing by obtaining information on youths' sexual and reproductive developments in a population survey among in-school and out-of-school youths aged 15 to 24 years in Nigeria. A total of 1174 boys and 1004 girls provided valid information on pubarche. Results of time-to-event analysis of the data showed that mean age at pubarche among males aged 15 to 19 years and 20 to 24 years was 13.5 (SD = 1.63 years) and 14.2 (SD = 2.18 years) (respectively) compared with 13.0 (SD = 1.57 years) and 13.5 (SD = 2.06 years) among females of the same age. Median time to pubarche was 14 (Interquartile range (IQR) = 3) years and 13 (IQR = 3) years among the males and females, respectively. Cumulatively, 37% of the males had attained pubarche by age 13 years versus 53% among females, 57% vs 72% at age 14, and 73% vs 81% at age 15. The likelihood of pubarche among males was delayed by 5% compared with females (Time Ratio (TR) = 1.05: 95% CI = 1.03-1.05). Every additional one-year in the ages of both males and females increases the risk of pubarche by 1%. Similar to the females, males residents in Northeast (aTR = 1.14, 95% CI: 1.07-1.21), in the Northwest (aTR = 1.20, 95% CI: 1.13-1.27) and in the Southwest (aTR = 1.18, 95% CI: 1.11-1.26) had delayed pubarche than males from the South East. Yoruba males had delayed pubarche than Ibo males (aTR = 1.06, 95% CI: 1.01-1.12). Age at pubarche among adolescents and young adults in Nigeria differed among males and females with earlier onset among females. Pubarche timing varied mainly by ethnicity, region, and location of residence. Our findings will aid medical practitioners in providing appropriate advice and support on pubarche-related issues among adolescents in Nigeria as it could help douse pubarche anxiousness in relation to request for medical assistance.
The goal is to examine the risk of conception mode-type-1 diabetes using different survival analysis modelling approaches and examine if there are differentials in the risk of type-1 diabetes between ...children from fresh and frozen-thawed embryo transfers. We aimed to compare the performances and fitness of different survival analysis regression models with the Cox proportional hazard (CPH) model used in an earlier study. The effect of conception modes and other prognostic factors on type-1 diabetes among children conceived either spontaneously or by assisted reproductive technology (ART) and its sub-groups was modelled in the earlier study. We used the information on all singleton children from the Swedish Medical Birth Register hosted by the Swedish National Board of Health and Welfare, 1985 to 2015. The main explanatory variable was the mode of conception. We applied the CPH, parametric and flexible parametric survival regression (FPSR) models to the data at 5% significance level. Loglikelihood, Akaike and Bayesian information criteria were used to assess model fit. Among the 3,138,540 singletons, 47,938 (1.5%) were conceived through ART (11,211 frozen-thawed transfer and 36,727 fresh embryo transfer). In total, 18,118 (0.58%) of the children had type-1 diabetes, higher among (0.58%) those conceived spontaneously than the ART-conceived (0.42%). The median (Interquartile range (IQR)) age at onset of type-1 diabetes among spontaneously conceived children was 10 (14–6) years, 8(5–12) for ART, 6 (4–10) years for frozen-thawed embryo transfer and 9 (5–12) years for fresh embryo transfer. The estimates from the CPH, FPSR and parametric PH models are similar. There was no significant difference in the risk of type-1 diabetes among ART- and spontaneously conceived children; FPSR: (adjusted Hazard Ratio (aHR) = 1.070; 95% Confidence Interval (CI):0.929–1.232, p = 0.346) vs CPH: (aHR = 1.068; 95%CI: 0.927–1.230, p = 0.361). A sub-analysis showed that the adjusted hazard of type-1 diabetes was 37% (aHR = 1.368; 95%CI: 1.013–1.847, p = 0.041) higher among children from frozen-thawed embryo transfer than among children from spontaneous conception. The hazard of type-1 diabetes was higher among children whose mothers do not smoke (aHR = 1.296; 95%CI:1.240–1.354, p<0.001) and of diabetic mothers (aHR = 6.419; 95%CI:5.852–7.041, p<0.001) and fathers (aHR = 8.808; 95%CI:8.221–9.437, p<0.001). The estimates from the CPH, parametric models and the FPSR model were close. This is an indication that the models performed similarly and any of them can be used to model the data. We couldn’t establish that ART increases the risk of type-1 diabetes except when it is subdivided into its two subtypes. There is evidence of a greater risk of type-1 diabetes when conception is through frozen-thawed transfer.
Abstract
Background
Nigeria has unimpressive maternal and child health indicators. Compliance with the WHO guidelines on the minimum number of antenatal care (ANC) contacts could improve these ...indicators. We assessed the compliance with WHO recommended standards on ANC contacts in Nigeria and identify the associated factors.
Methods
Nationally representative cross-sectional data during pregnancy of 21,785 most recent births within five years preceding the 2018 Nigeria Demographic Health Survey was used. The number of ANC contacts was categorised into “None”, “1–3”, “4–7” and “8 or more” contacts based on subsequent WHO guidelines. Descriptive statistics, bivariable and multivariable multinomial logistic regression was used at
p
= 0.05.
Results
About 25 % of the women had no ANC contact, 58 % had at least 4 contacts while only 20 % had 8 or more ANC contacts. The highest rate of 8 or more ANC contacts was in Osun (80.2 %), Lagos (76.8 %), and Imo (72.0 %) while the lowest rates were in Kebbi (0.2 %), Zamfara (1.1 %) and Yobe (1.3 %). Respondents with higher education were twelve times (adjusted relative risk (aRR): 12.46, 95 % CI: 7.33–21.2), having secondary education was thrice (aRR: 2.91, 95 % CI: 2.35–3.60), and having primary education was twice (aRR: 2.17, 95 % CI: 1.77–2.66) more likely to make at least 8 contacts than those with no education. Respondents from households in the richest and middle wealth categories were 129 and 67 % more likely to make 8 or more ANC contacts compared to those from households in the lowest wealth category respectively. The likelihood of making 8 ANC contacts was 89 and 47 % higher among respondents from communities in the least and middle disadvantaged groups, respectively, compared to the most disadvantaged group. Other significant variables were spouse education, health care decision making, media access, ethnicity, religion, and other community factors.
Conclusions
Compliance with WHO guidelines on the minimum number of ANC contacts in Nigeria is poor. Thus, Nigeria has a long walk to attaining sustainable development goal’s targets on child and maternal health. We recommend that the maternal and child health programmers should review existing policies and develop new policies to adopt, implement and tackle the challenges of adherence to the WHO recommended minimum of 8 ANC contacts. Women's education, socioeconomic status and adequate mobilization of families should be prioritized. There is a need for urgent intervention to narrow the identified inequalities and substantial disparities in the characteristics of pregnant women across the regions and states.
Despite a total prohibition on the practice of female genital mutilation (FGM), young girls continue to be victims in some African countries. There is a paucity of data on the effect of FGM practice ...in two generations in Africa. This study assessed the current practice of daughters' FGM among women living in 14 FGM-prone countries in Africa as a proxy to assess the future burden of FGM in the continent. We used Demographic and Health Surveys data collected between 2010 and 2018 from 14 African countries. We analyzed information on 93,063 women-daughter pair (Level 1) from 8,396 communities (Level 2) from the 14 countries (Level 3). We fitted hierarchical multivariable binomial logistic regression models using the MLWin 3.03 module in Stata version 16 at p<0.05. The overall prevalence of FGM among mothers and their daughters was 60.0% and 21.7%, respectively, corresponding to 63.8% reduction in the mother-daughter ratio of FGM. The prevalence of FGM among daughters in Togo and Tanzania were less than one per cent, 48.6% in Guinea, with the highest prevalence of 78.3% found in Mali. The percentage reduction in mother-daughter FGM ratio was highest in Tanzania (96.7%) and Togo (94.2%), compared with 10.0% in Niger, 15.0% in Nigeria and 15.9% in Mali. Prevalence of daughters' FGM among women with and without FGM was 34.0% and 3.1% respectively. The risk of mothers having FGM for their daughters was significantly associated with maternal age, educational status, religion, household wealth quintiles, place of residence, community unemployment and community poverty. The country and community where the women lived explained about 57% and 42% of the total variation in FGM procurement for daughters. Procurement of FGM for the daughters of the present generation of mothers in Africa is common, mainly, among those from low social, poorer, rural and less educated women. We advocate for more context-specific studies to fully assess the role of each of the identified risk factors and design sustainable intervention towards the elimination of FGM in Africa.
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