Anthony Idowu Ajayi

Use of non-emergency contraceptive pills and concoctions as emergency contraception among Nigerian University students: results of a qualitative study

BackgroundEmergency contraception (EC) can significantly reduce the rate of unintended pregnancies and unsafe abortions especially in sub-Saharan Africa. Despite the increasing awareness of EC among educated young women in Nigeria, the rate of utilisation remains low. This study therefore explores the main barriers to the use of EC among female university students by analysing their knowledge of emergency contraception, methods ever used, perceived efficacy, and its acceptability.MethodsThis paper brings together the findings from several focus groups (N = 5) and in-depth interviews (N = 20) conducted amongst unmarried female undergraduate students in two Nigerian universities.ResultsParticipants considered the use of condom and abstinence as the most effective methods of preventing unplanned pregnancy. However, many participants were misinformed about emergency contraception. Generally, participants relied on unconventional and unproven ECs; Ampiclox, “Alabukun”, salt water solution, and lime and potash and perceived them to be effective in preventing unplanned pregnancies. Furthermore, respondents’ narratives about methods of preventing unwanted pregnancies revealed that inadequate information on emergency contraception, reliance on unproven crude contraceptive methods, and misconception about modern contraception constitute barriers to the use of emergency contraception.ConclusionsThe findings suggested that female university students are misinformed about emergency contraception and their reliance on unproven ECs constitutes a barrier to the use of approved EC methods. These barriers have serious implications for prevention of unplanned pregnancies in the cohort. Behavioural interventions targeting the use of unproven emergency contraceptive methods and misperceptions about ECs would be crucial for this cohort in Nigeria.

Demographic, clinical and behavioural determinants of HIV serostatus non-disclosure to sex partners among HIV-infected pregnant women in the Eastern Cape, South Africa

Objectives Drawing from a baseline sample of a cohort study, the study examines the extent and correlates of serostatus non-disclosure to sex partners and family members, and reasons for non-disclosure among HIV-infected pregnant women in the Eastern Cape Province, South Africa. Methods This longitudinal cohort study recruited 1709 pregnant women living with HIV who attended three of the largest maternity centres in the Eastern Cape, South Africa, for delivery between September 2015 and May 2016. Relevant items on demographics, serostatus awareness, disclosure to sex partners and family members, and lifestyle behaviours were obtained using structured interviews. Age-stratified binary logistic regression models were used to determine the significant correlates of non-disclosure among the participants. Results A higher rate of HIV serostatus non-disclosure to sex partners (25.6%) in comparison to family members (20%) was reported by the participants. Younger age, not living with partners and alcohol use were significantly associated with non-disclosure of HIV serostatus to sex partners. Non-disclosure of HIV serostatus to sex partners was significantly (p<0.05) associated with poor adherence to the highly active anti-retroviral therapy (HAART), failure to keep clinic appointments and high viral load at the delivery of the baby. Perceived fear of intimate partner violence, fear of rejection, guilt of not disclosing at the onset of the relationship, sex partner’s non-disclosure of HIV serostatus, and guilt of unfaithfulness were some of the reasons for non-disclosure of HIV serostatus to sex partners. Conclusions Non-disclosure of HIV serostatus is a public health concern with serious implications for both mother-to-child transmission, as well as horizontal transmission, in our setting. Strategic efforts toward ending the epidemic of HIV and AIDS in South Africa should address the sociocultural and behavioural determinants of non-disclosure.

Who benefits from free institutional delivery? evidence from a cross sectional survey of North Central and Southwestern Nigeria

BackgroundThe reasons for low utilisation of maternal health services in settings where the user-fee removal policy has been implemented continue to generate scholarly debates. Evidence of whether user-fee removal benefits the poor women in underserved settings is scanty and inconsistent. This article examines use of maternal health care services in the context of free maternal healthcare and profiles the beneficiaries of user-fee removal.MethodsThe study adopted a descriptive design. A three-stage cluster sampling method was used to select a representative sample of 1227 women who gave birth between 2011 and 2015. Questionnaires were administered using a face-to-face interview approach and data generated were analysed using descriptive and inferential statistics.ResultsThe analysis shows that the use of maternal healthcare services has improved considerably in North Central and Southwestern Nigeria. While socioeconomic and geographical inequality in the use of maternal healthcare services appear to be disappearing in Southwestern Nigeria, it appears to be widening in North Central Nigeria. The findings indicate that 33.6% of women reported to have benefitted from the free child-delivery programme; however, substantial variation exists across the two regions. The proportion of beneficiaries of user-fee removal policy was highest in urban areas (35.9%), among women belonging to the middle income category (38.3%), among women who gave birth in primary health centres (63.1%) and among women who resided in communities where there was availability of health facilities (37.2%).ConclusionThe study concludes that low coverage of the free maternal health programme, especially among women of low socioeconomic status residing in underserved settings is among the reasons for persistent poor maternal health outcomes in the context of free maternal healthcare. A model towards improving maternal health in underserved settings, especially in North Central Nigeria, would entail provisioning of health facilities as well as focusing on implementing equitable maternal health policies.

Cross-sectional study of patients with type 2 diabetes in OR Tambo district, South Africa

Objectives South Africa has pledged to the sustainable development goal of promoting good health and well-being to all residents. While this is laudable, paucity of reliable epidemiological data for different regions on diabetes and treatment outcomes may further widen the inequalities of access and quality of healthcare services across the country. This study examines the sociodemographic and clinical determinants of uncontrolled type 2 diabetes mellitus (T2DM) in individuals attending primary healthcare in OR Tambo district, South Africa. Design A cross-sectional analytical study. Setting Primary healthcare setting in OR Tambo district, South Africa. Participants Patients treated for T2DM for 1 or more years (n=327). Primary outcome measure Prevalence of uncontrolled T2DM. Secondary outcome measure Determinants of uncontrolled T2DM (glycosylated haemoglobin (HbA1c) ≥7%). Results Out of the 327 participants, 274 had HbA1c≥7% (83.8%). Female sex (95% CI 1.3 to 4.2), overweight/obesity (95% CI 1.9 to 261.2), elevated low-density lipoprotein cholesterol (95% CI 4.4 to 23.8), sedentary habits (95% CI 7.2 to 61.3), lower monthly income (95% CI 1.3 to 6.5), longer duration of T2DM (95% CI 4.4 to 294.2) and diabetes information from non-health workers (95% CI 1.4 to 7.0) were the significant determinants of uncontrolled T2DM. There was a significant positive correlation of uncontrolled T2DM with increasing duration of T2DM, estimated glomerular filtration rate and body mass index. However, a significant negative correlation exists between monthly income and increasing HbA1c. Conclusions We found a significantly high prevalence (83.8%) of uncontrolled T2DM among the patients, possibly attributable to overweight/obesity, sedentary living, lower income and lack of information on diabetes. Addressing these determinants will require re-engineering of primary healthcare in the district.

Maternal health care visits as predictors of contraceptive use among childbearing women in a medically underserved state in Nigeria

BackgroundHealth care visits during pregnancy, childbirth and after childbirth may be crucial in expanding the uptake of contraceptive care in resource-poor settings. However, little is known about how health care visits influence the uptake of modern contraception in Nigeria. The focus of this paper was to examine how health care visits influence the use of contraceptives among parous women in a medically underserved setting.MethodsThe study adopted a descriptive survey design. Data was collected from 411 women who gave birth between 2010 and 2015 selected through a two-stage cluster random sampling technique. Health care visits for antenatal care services, childbirth, postnatal care and modern contraceptive were dichotomised (yes, no). Descriptive analyses were performed, and percentages, frequencies and means were reported. Multiple logistic regressions were computed, and odds ratios and 95% confidence intervals were calculated.ResultsKnowledge of all contraceptive methods was lowest among women who reside in rural areas. Health care visits for antenatal care (UOR 4.5; 95% CI 2.0–10.5), childbirth (UOR2.1; 95% CI 1.4–3.2) and postnatal care services (UOR 2.3; 95% CI 1.5–3.5) independently predict ever use of any contraceptive methods. Likewise, health care visits for antenatal care (UOR 5.6; 95% CI 2.1–14.8), childbirth (UOR 2.3; 95% CI 1.5–3.6) and postnatal care services (UOR 2.8; 95% CI 1.8–4.5) were independent predictors of current use of modern contraceptive methods. In the adjusted model, health care visits for antenatal care services (AOR 3.2; 95% CI 1.1–8.8) were significantly associated with the use of modern contraceptive methods.ConclusionHealth care visits significantly predict the use of modern contraceptive methods. Expanding access to health care services would potentially increase contraceptive use among childbearing women in the medically underserved settings.

Determinants of condom use among parous women in North Central and South Western Nigeria: a cross-sectional survey

ObjectivesThere appears to be an increasing trend of condom use for pregnancy prevention among nulliparous and multiparous women in developing countries. Drawing from a cross-sectional survey involving 1227 women selected using a 3-stage cluster random sampling technique, the study examines the rates of condom use and its determinants among parous women in three states in North Central and South Western Nigeria.ResultsThe rate of condom use among parous women was 13.8% and 23.2% among women using any form of contraceptives. After adjusting for confounding factors (religion and marital status, socioeconomic status and access to a health facility in the resident community), women aged 26–35 (AOR 2.7; CI 1.6–4.5), urban residence (AOR: 3.6; CI 2.2–5.8), no income (AOR: 2.7; CI 1.4–4.9), living in Ekiti State (AOR: 1.8; CI 1.2–2.8) and having a tertiary level of education (AOR: 4.5; CI 1.3–15.6) were the independent predictors of condom use. There is an increasing trend of condom use among parous women.

Driving to Better Health: Screening for Hypertension and Associated Factors Among Commercial Taxi Drivers in Buffalo City Metropolitan Municipality, South Africa

RESEARCH ARTICLE Driving to Better Health: Screening for Hypertension and Associated Factors Among Commercial Taxi Drivers in Buffalo City Metropolitan Municipality, South Africa Aanuoluwa Odunayo Adedokun, Daniel Ter Goon, Eyitayo Omolara Owolabi, Oladele Vincent Adeniyi and Anthony Idowu Ajayi Department of Nursing Science, Faculty of Health Sciences, University of Fort Hare, East London, South Africa Walter Sisulu University, Faculty of Health Sciences, Mthatha, South Africa Department of Sociology, University of Fort Hare, East London, South Africa

The Prevalence and Correlates of Pre-Diabetes and Diabetes Mellitus Among Public Category Workers in Akure, Nigeria

Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria. Department of Family Medicine, Cecilia Makiwane Hospital, East London Hospital Complex, Walter Sisulu University, East London, South Africa. Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria. Nigeria State Health Investment Project, Oke eda, Akure, Nigeria. School of Nursing Sciences, Faculty of Science and Agriculture, University of Fort Hare, East London, South Africa. Department of Sociology, Faculty of Social Sciences and Humanities, University of Fort Hare, East London, South Africa. Department of Family Medicine, Walter Sisulu University, Mthatha, South Africa.

Pattern and correlates of obesity among public service workers in Ondo State, Nigeria: a cross-sectional study

Abstract Background: Obesity is the third leading cause of mortality and has become a global epidemic. There is a continuous increase in its prevalence both in the developed and in developing countries. Obesity is closely associated with chronic health conditions, thus increasing the overall burden of disease and disability at the population level. Several factors have been identified as contributors to the obesity epidemic, and may include the work environment and lifestyle behaviours. This study sought to determine the correlates of obesity among public service workers in Akure, Ondo State, Nigeria. Method: This was a cross-sectional study involving 4 828 public civil service workers across 47 ministries, departments and agencies in Ondo State, Nigeria. Relevant demographic and lifestyle measures were obtained using the World Health Organization (WHO) STEPwise Questionnaire. Height and weight were measured using standardised procedures. Obesity and overweight were defined according to the WHO Criteria as a body mass index (BMI) of ≥ 30 kg/m2 and 25–29.9 kg/m2, respectively. Bivariate and multivariate (logistic regression models) analyses were used to determine the significant predictors of obesity. Results: Of the total participants (n = 4828), there was a male to female ratio of 1:1 (male = 2 299 and female = 2 529). One in every five participants was found to be obese with 55% of the participants having a BMI ≥ 25 kg/m2. In the bivariate analysis, female sex (p < 0.000), age above 41 years (p < 0.000), post-primary education level (p < 0.001), marriage (p < 0.000), no alcohol consumption (p < 0.001), diabetes (p < 0.000) as well as hypertension (p < 0.000) were significantly associated with obesity. In the multivariate analysis, after adjusting for confounders, only female sex (AOR = 5.7, CI = 4.7–6.9), age (AOR = 1.4, CI = 1.1–1.8), level of education (AOR = 0.8, CI = 0.7–0.9), marital status (AOR = 2.1, CI = 1.7–2.), alcohol consumption (AOR = 0.7, CI = 0.5–0.9), diabetes mellitus (AOR = 0.7, CI = 0.5–0.9) and hypertension (AOR = 0.5, CI = 0.4–0.6) were the significant and independent predictors of obesity. Conclusion: This study found a high prevalence of obesity among public service workers in Akure, Nigeria, possibly attributed to ageing, being of female gender, being married, and having other non-communicable diseases. A well-implemented workplace policy focusing on integrated screening for obesity and non-communicable diseases should be prioritised in Nigeria.