Clifford Odimegwu

Influence of Religion on Adolescent Sexual Attitudes and Behaviour among Nigerian University Students: Affiliation or Commitment?

Religion plays a significant role in the life of individuals in any society. Its role as a moral builder has been variously acknowledged. This study examines the role of religion in adolescent sexual attitudes and behaviour in Nigeria. The study was conducted in two national universities in Nigeria with student population of more than 40,000. The institutions are located in the eastern and western parts of the country. Data for the study were collected from a representative sample of students resident in the universities. A total of 1,870 students were successfully interviewed but because of the age restriction for adolescents, information from 1,153 campus-based adolescents aged 10-24 years was analysed. Logistic regression model was used to do the analysis both at the adjusted and unadjusted levels. Findings are consistent with existing literature. There is a strong relationship between religiosity and adolescent sexual attitudes and behaviour, although religious commitment is more important than religious affiliation in affecting adolescent sexual attitudes and behaviours. This paper calls for further investigation to be able to disentangle the relationship between religiosity and adolescent sexuality, especially with the use of longitudinal data. Since religion affects the sexual lifestyles of adolescents, religious leaders can do a lot by mobilising their members towards supporting HIV/AIDS prevention initiatives in the country.

Men's role in emergency obstetric care in Osun State of Nigeria

This study was conducted among the Yoruba of South-West Nigeria to examine the role of men in emergency obstetric care, as men determine whether and when their spouses visit health clinics in most cultures. Simple random sampling was used to select 900 households from three communities in Osun State, south-west Nigeria. Separate interviewers interviewed the man and his wife in each of the households. In polygamous families, two wives of reproductive age were also interviewed. The quantitative survey was complemented with a number of focus group discussions, in-depth interviews and key informant interviews. There was high level of awareness of emergency obstetric conditions by men, particularly in relation to pregnancy signs and labour pains (53.2%). Respondents reported that men play useful roles during their partners obstetric conditions (89.2%). Women take decisions on health-seeking behaviour during emergency obstetric conditions in the absence of the male partner. Education is found to be the major determinant of this change in male knowledge and behaviour. There is a need to further promote universal basic education in the country especially in areas where the observable change in this study has not been noted. There is also a need to extend the study to other zones in Nigeria in order to have a national picture.

Parental characteristics and adolescent sexual behaviour in Bida local government area of Niger State Nigeria.

This study was conducted in Bida Local Government Area of Niger State, Nigeria, to examine how parental attributes influence adolescent sexual activity. Data were gathered through structured interview with 400 adolescents aged 12-24 years using a three-stage random sampling procedure. Findings show that more than one third of the adolescents interviewed had sexual intercourse in the month proceeding the survey. Less than one fifth of the sexually active adolescents were using a method of contraception to either prevent infections or avoid unwanted pregnancy. Further analysis confirmed the fact that adolescents with whom parents had discussed family life issues were less likely to be sexually active than those with whom parents had never discussed family life issues. The study also found a negative effect of family instability on adolescent sexuality. These findings call for the need for family-sensitive programs that will enhance family stability especially economically. The need for parental empowerment to be able to cope with the challenges of adolescent life in Nigeria is also stressed since adolescents who have family life education from parents are less likely to be sexually active.

Determinants of Maternal Health Care Utilization in Nigeria: a multilevel approach

Introduction Fourteen percent of maternal deaths globally occur in Nigeria. Low utilization of maternal health services for delivery may partially explain the high maternal mortality. The aim of this study was to examine the contribution of community factors in explaining variations in the use of health facilities for delivery in Nigeria. Methods Our sample consisted of 17,542 women aged 15-49 years drawn from 2008 Nigeria Demographic and Health Survey, who had had their last birth in the five years before the survey. We employed multilevel analysis to identify community factors related to the use of delivery care. Results In addition to several individual factors, region of residence was significantly associated with facility delivery. Women who lived in Northern Nigeria were less likely to deliver in a health facility than those who resided in the Southern part of the country. Residence in communities with a high proportion of women who had secondary and higher education significantly increased the odds of facility delivery whereas ethnic diversity was negatively associated with health facility delivery. Conclusion Interventions aimed at promoting the use of health facility for childbirth should not only be implemented at the individual level but also tailored to the community level as interventions conceived without consideration for community context are likely to have limited impact. Increasing womens education in disadvantaged communities and region-specific interventions that increase access to health facilities are likely to have far-reaching impacts in reducing maternal mortality.

REGIONAL VARIATIONS IN INFANT AND CHILD MORTALITY IN NIGERIA: A MULTILEVEL ANALYSIS

Summary There 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 childs sex, birth order, birth interval, maternal education, maternal age and wealth index) are important determinants of infant/child mortality in Nigeria. For instance, the results show a lower risk of death in infancy for children of mothers residing in communities with a high proportion of hospital delivery (HR: 0.70, p<0.05) and for children whose mothers had secondary or higher education (HR: 0.84, p<0.05). Although community factors appear to influence the association between individual-level factors and death during infancy and childhood, the findings consistently indicate that community-level characteristics are more important in explaining regional variations in child mortality, while individual-level factors are more important for regional variations in infant mortality. The results of this study underscore the need to look beyond the influence of individual-level factors in addressing regional variations in infant and child mortality in Nigeria.

HIV/AIDS stigma and utilization of voluntary counselling and testing in Nigeria

BackgroundDespite 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.MethodsA 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 South-West and Imo State (Igbo ethnic group) in the South East. Multivariate logistic regression was the model used to examine the association of interest.ResultsIt 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.ConclusionsCurrent 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.

Barriers to accessing health care in Nigeria: implications for child survival

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 15–49) 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: 1.32–1.57, p<0.001), and those whose mothers had physical barriers (HR: 1.13, CI: 1.04–1.24, p<0.001), 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.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 15-49) 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: 1.32-1.57, p<0.001), and those whose mothers had physical barriers (HR: 1.13, CI: 1.04-1.24, p<0.001), 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.

Contextual Determinants of Maternal Health Care Service Utilization in Nigeria

Despite the high maternal mortality ratio in Nigeria, the use of maternal health care services is very poor. Attempts to explain this situation has focused on individual level factors and the influence of community contextual factors have not received much attention. This study examined the relation of community factors to the use of antenatal care in Nigeria, and explored whether community factors moderated the association between individual characteristics and antenatal care visits. Data were drawn from the 2008 Nigeria Demographic and Health Survey among 16,005 women aged 15–49 years who had had their last delivery in the five years preceding the survey. Results from multi-level models indicated that living in communities with a high proportion of women who delivered in a health facility was associated with four or more antenatal care visits. Residence in high-poverty communities decreased the likelihood of antenatal care attendance. Living in communities with a high proportion of educated women was not significantly related to antenatal care visits. Community factors acted as moderators of the association between educational attainment and antenatal care attendance. Improvement in antenatal care utilization may therefore be enhanced by targeting poverty reduction programs and increasing health facility delivery in disadvantaged communities.

Ethnic differentials in under-five mortality in Nigeria

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.

The cost of being a man: social and health consequences of Igbo masculinity

In the bid to explain reproductive health outcomes in most developing countries, men have often been seen as the cause of the problem. However, no systematic attempt has been made to examine mens perception of their own social and health needs, including how ideologies of masculinity impact mens social and physical health. This study examines the Igbo context and shows how men understand and interpret masculinity and the consequences of this for social and health behaviours. Data from adolescent and adult Igbo men aged 15–75 were collected using both quantitative survey interviews (n = 1372) and qualitative techniques such as focus-group discussion (n = 20), in-depth interviews (n = 10) and key informant interviews (n = 10) in selected areas of south-eastern Nigeria. We collected data on gender role ideologies and sexuality issues and practices. Our analysis shows that there are social and health costs associated with adherence to masculine ideologies and a strong association between masculine ideologies and mens health, risk-taking and health-seeking behaviours in the study population. We conclude that all sexual and reproductive health programmes should include services that address the specific needs of men and those negative aspects of masculinity that tend to expose men to adverse health outcomes.