CPRH Research

Research

Family Planning is central to gender equality and women’s empowerment, and it is a key factor in reducing poverty. The common reasons associated with non-use of contraceptives by women include logistical problems, such as supplies running out at health clinics or difficulty travelling to health facilities (http://www.unfpa.org/family-planning).

The ongoing research is to strengthen the effective and efficient delivery of family planning services in Nigeria using the Infant Welfare Clinic (IWC) as an entry point. This is to improve access and uptake of family planning services to nursing mothers through IWC. The research will leverage on the attendance of routine IWCs services available in this clinics by mothers with their children, which include routine immunization, screening and treatment of common under-5 illness.


Specific Objectives of the Research
- To update and improve the knowledge of nursing women and their families on modern contraceptive use.
- To integrate family planning FP counseling and services through provision of IEC materials and contraceptive commodities
- To offer onsite FP services to nursing mothers at IWC
- To determine willingness of health workers on IWC-FP integration program
- To train health care providers on FP service skills – counseling, consultation and provision of commodities to their clientele.

Background: Unmet need of modern contraception is one of the root causes of failure to attain MDG 5 in developing countries. Most innovative approaches used have not provided desired drive to melt down the population explosion, and consequently reduce MMR. Presence of husbands during childbirth was explored as a probable catalyst to improve contraceptive use that has remained an albatross in Nigeria.


Objective of the study: The specific objectives are as follows:
1. To compare the desire for contraceptive uptake between the experimental and control groups
2. To compare the time between delivery and eventual uptake of contraception between the group
3. To compare contraceptive use at the post natal clinic between experimental and control groups
4. To compare the initiator of contraceptive uptake between the two groups
5. To identify other benefits of social supports i.e. assistance in house chores, care of the baby.

Methods: The new trial is a factorial design involving four arms, and eligible pregnant women were all enrolled at 28 weeks.


The inclusion criteria for the study were women with:
o Currently married or cohabiting
o Anticipated vaginal delivery
o No previous caesarean section
o Singleton pregnancy
o No abnormal lie or presentation
o No Antepartum hemorrhage (placenta previa, abruptio placenta)
o No hemoglobinopathy (sickle cell disease)
The trial thus far has enrolled 1000 participants and about 800 of the women were seen at delivery.

The study, entitled “WAVE”, Well-being of Adolescents in Vulnerable Environments, is a two-phased research study designed to understand the factors that facilitate and hinder disadvantaged adolescents from obtaining the health information and services they need to secure good health. The study is being conducted in six global sites among which Ibadan, Nigeria is one. The first phase of the study which is the formative research stage is on-going and is utilizing qualitative research methods which include key informant interviews, in-depth interviews, focus groups, community mapping, and photovoice methods. The approximate sample size for the first phase in Ibadan North local government is 130 (20 key informant interviews, 80 adolescents in community mapping/focus group, 10 photovoice participants and 20 in-depth interviews). Transcription/translation of all recordings is currently being done. It is hoped that the first phase of the study will lay the groundwork to understand disadvantaged adolescents’ connections to health as well as its regional and gender-based differences and also provide useful information for the second phase of the study.

A collaborative effort between University of Chicago, Novartis, University College hospital of the University of Ibadan (UI) and the Lagos State university teaching hospital (LASUTH), Nigeria, with an aim to describing and comparing the genetic architecture of breast cancer samples in Nigerian as well as in Caucasian and African American women with breast cancer. The project enhanced a sustainable translational research infrastructure in Nigeria and also educated the Nigerian personnel on cancer genetics; targeting cancer therapies and increased patient awareness on the same topics.

The Household Air Pollution (HAP) project is a randomized controlled trail (RCT) evaluating the impact of HAP on pregnancy outcomes. HAP is responsible for over 4million premature deaths in developing countries annually, with 95,000 annual deaths in Nigeria attributed to HAP according to WHO. The goal of the study is to investigate the impact of exposure to HAP on risk of ALRI including pneumonia, atopy and asthma in children under five. Cleancook ethanol cookstove are being used for this study. The research study is ongoing and the goal is that the research findings will improve our understanding of the health impact of exposure to HAP and highlight the effectiveness of an ethanol stove in improving indoor air quality. We are hopeful that final results from the study will also influence policy on appropriate cooking fuels, home construction standards and advocacy for rural electrification.

Our partnership with Global Health Initiative, University of Chicago USA is currently conducting a large community survey on incidence of Breast Cancer and Genetics in Nigeria. The target populations are women with breast cancer in the community and the sample size is 2000 weighted among the three major ethnic groups in Nigeria (Yoruba, Hausa and Igbo). The study aims to explore the health disparity hypothesis of non-communicable diseases especially breast cancer in black population. Presently, about 480 controls (women between the ages of 18-65years) have been recruited for the second phase of the study which commenced towards the end of year 2011; to be matched with hospital cases based on their ages and ethnicity. Out of this, a hundred and eighty (180) were recruited from the Hausa community. The remaining three hundred (300) were recruited from semi urban settlements where participants are majorly of the Yoruba ethnic group, although few are of other ethnic background. CPRH is utilizing her community experience to coordinate and conduct the research and recruitment is still ongoing.

The performance of development indicators in UNFPA’s areas of mandate over the past ten years, vis-a-vis investments and other intervening variables over the period of 2003 – 2013 were illustrated through an in-depth analysis methodology. The findings from the analysis were to better position UNFPA to strategically orient her development cooperation in Nigeria within the framework of the post 2015 development agenda and in continuation of the unfinished ICPD agenda. Data from the 2008 NDHS and the 2012 NARHS surveys were used for trend analysis. For the Qualitative Analysis Key Informant Interview KII were conducted for respondents: Officials of Government Agencies, Development partners, State Government officials, Reproductive health experts.

Some of the findings from the Key Indicators revealed geographical disparities. Literacy rates, an Indicator of the 3rd MDG (promoting gender equality and empowering women), showed a north-south divide being lower in the northern zones than in the southern zones. Literacy rates appeared to increase between 2003 and 2008 in most zones, a decline was seen in the southeast among females (85.6% to 81.3%), and in southwest amongst males (93.0% to 89.6%) and in both sexes in the northeast (25.6 and 22.8 for fem ales; 59.9% to 53.8% for males). Literacy rates were lower among older women and men compared with women holding other factors in the model constant. Literacy rates were higher in richer compared with poorer Nigerians.

Infant mortality rate indicator revealed a decrease between the 2003 and 2008 surveys in all zones except the South East zone where rates increased over time from 66% to 95%. Infant deaths reported over the ten year period preceding each survey were higher amongst males compared with female infants; morality among infants was higher in the North East, South South and South East zones compared with the South West. After adjusting for other factors, fewer infant deaths were reported by older women compared with teenagers, women with higher education compared with those with no formal education, and women in the highest wealth tertile compared with those in the lowest tertile. Similarly, lower odds of infant death were reported among infants who were second or third in the birth order compared with first born, infants of mothers who received ANC, compared with those who did not and infants of mothers who received at least two doses of tetanus toxoid compared with those whose mothers received none. In addition, fewer deaths were reported among infants born by cesarean section compared with those who were not.

Indicators related to MDG 5 (improve maternal health) - previous demographic and health survey reports indicate there has been a decline in maternal mortality, though the figures remain high with wide regional variations. The measurement of maternal mortality has been a challenge, with different methods being used over the years. The NDHS uses the direct variant of the sisterhood method which uses mortality histories of female siblings related to pregnancy and childbirth and person years of exposure to determine the mortality rates by age group. These rates were then combined with the general fertility rate to obtain the maternal mortality ratio. In this assessment: a variable was computed by assigning any woman who reported having lost a sibling to pregnancy-related causes as having the outcome. The proportion of women reporting sibling pregnancy- related deaths over the five year period preceding the survey was highest in Zamfara (8.5%) and Borno (6.1%) states and lowest in Oyo (0.4%), Ondo (0.6%), Ogun (0.8%), Delta (0.8%) and Plateau (0.8%) states. A closely related index to maternal mortality is the proportion of births attended by a skilled attendant. The trends in the number of births attended by skilled health personnel between increased by 15 percentage points occurred in the period under review. The proportion of births attended by skilled health personnel was greater in the southern states than the northern states in all three surveys. The Proportion of births attended to by skilled health attendants comparing 2008 to 2003, appears to have reduced in the multiple logistic regression model. The odds of a skilled health personnel attending a birth was significantly higher among women with some education, compared with those with no education. Wealthier compared with poorer women; women in South East compared with South West Zone and women who attended ANC compared with those that did not.

The family health and wealth study is a multi-center and multi-country longitudinal study that aims to examine individual-and-family level health and economic consequences of family size on wide ranges of reproductive health issues with special emphasis on family planning. As a follow-up to the sampling of 502 households in the first phase of the study in year 2010, a 2-week training was conducted for 30 Research Assistants, 2 field workers and 3 supervisors in Ibadan between September and October, 2011. Following this, the field work was commenced from October to December 2011. Of the 502 households sampled in the first round, 307 were successfully followed up. A very high migration rate was observed among the households. An additional 550 households were then selected from a sampling frame of 1100 from appropriately selected and randomized enumeration areas in the same local government area but different from the enumeration area of phase I. Over 500 of these have been surveyed at the moment. Data entry and analysis for both groups is presently ongoing and should be concluded shortly, following which analysis of the data will be carried out.