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Ending preventable maternal and child deaths in western Nigeria: Do women utilize the life lines?

ABSTRACT: INTRODUCTION:Nigeria which constitutes just one percent of the world population, accounts for 13% of the world maternal and under-five mortality. Utilization of health care services has been an important determinant of maternal and child outcomes. The vast majority of maternal and child deaths could be prevented if women utilize the available life lines. The study objective was to determine utilization of maternal and child health care services among women of child bearing age in Western Nigeria. METHODS:A community based, cross sectional study was done in Oshodi/Isolo Local Government Area among women of child bearing age (15-49 years) with at least one child under five years. Multistage sampling was used to select 371 respondents. Data was collected with a structured, pretested, interviewer administered questionnaire and analyzed with Epi info 3.5.1. Summary and inferential statistics were done. Level of significance was set at 5%(p<0.05). RESULTS:Of the 371 respondents interviewed, the health facility was used for antenatal care (74.3% n = 276), delivery (59.9% n = 222), postnatal services (77.9% n = 289), family planning services (28.8% n = 107), immunization (95.1% n = 353), growth monitoring (77.4% n = 287), nutritional services (64.7% n = 240) and treatment of childhood illness (49.6% n = 184). Only 31.5% (n = 117) of the respondents practiced exclusive breastfeeding and 82% (n = 263) of the mothers used oral rehydration solution for diarrhoea management. Maternal education significantly influenced utilization. In addition maternal age, employment status, number of children, spouse employment and educational status played significant roles. CONCLUSION:Utilization of maternal and child health services among respondents was above national average but not optimal, especially family planning services, exclusive breastfeeding and curative services for children. Interventions that improve maternal educational status and wealth creation should be undertaken to achieve the SDGs.

SUBMITTER: Olaitan T

PROVIDER: S-EPMC5436634 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Ending preventable maternal and child deaths in western Nigeria: Do women utilize the life lines?

Olaitan Titilayo T Okafor Ifeoma P IP Onajole Adebayo T AT Abosede Olayinka A OA

PloS one 20170518 5

<h4>Introduction</h4>Nigeria which constitutes just one percent of the world population, accounts for 13% of the world maternal and under-five mortality. Utilization of health care services has been an important determinant of maternal and child outcomes. The vast majority of maternal and child deaths could be prevented if women utilize the available life lines. The study objective was to determine utilization of maternal and child health care services among women of child bearing age in Western ...[more]

PMID: 28545093

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Project description:BackgroundIn February 2015, the World Health Organization (WHO) released "Strategies toward ending preventable maternal mortality (EPMM)" (EPMM Strategies), a direction-setting report outlining global targets and strategies for reducing maternal mortality in the Sustainable Development Goal (SDG) period. In May 2015, the EPMM Working Group outlined a plan to develop a comprehensive monitoring framework to track progress toward the achievement of these targets and priorities. This monitoring framework was developed in two phases. Phase I, which focused on identifying indicators related to the proximal causes of maternal mortality, was completed in October 2015. This paper describes the process and results of Phase II, which was completed in November 2016 and aimed to build consensus on a set of indicators that capture information on the social, political, and economic determinants of maternal health and mortality.FindingsA total of 150 experts from more than 78 organizations worldwide participated in this second phase of the process to develop a comprehensive monitoring framework for EPMM. The experts considered a total of 118 indicators grouped into the 11 key themes outlined in the EPMM report, ultimately reaching consensus on a set of 25 indicators, five equity stratifiers, and one transparency stratifier.ConclusionThe indicators identified in Phase II will be used along with the Phase I indicators to monitor progress towards ending preventable maternal deaths. Together, they provide a means for monitoring not only the essential clinical interventions needed to save lives but also the equally important political, social, economic and health system determinants of maternal health and survival. These distal factors are essential to creating the enabling environment and high-performing health systems needed to ensure high-quality clinical care at the point of service for every woman, her fetus and newborn. They complement and support other monitoring efforts, in particular the "Survive, Thrive, and Transform" agenda laid out by the Global Strategy for Women's, Children's and Adolescents' Health (2016-2030) and the SDG3 global target on maternal mortality.

Project description:Data from the 2016-17 Multiple Indicator Cluster Survey from Nigeria are used to study the relationship between child stature, mother's years of education, and indicators of early childhood development (ECD). The relationships are contrasted between two empirical approaches: the conventional approach whereby control variables are selected in an ad-hoc manner, and the double machine-learning (DML) approach that employs data-driven methods to select controls from a much wider set of variables and thus reducing potential omitted variable bias. Overall, the analysis confirms that maternal education and the incidence of chronic malnutrition have a significant direct effect on measures of early childhood development. The point estimates based on the ad-hoc specification tend to be larger in absolute value than those based on the DML specification. Frequently, the point estimates based on the ad-hoc specification fall inside the confidence interval of the DML point estimates, suggesting that in these cases the omitted variable bias is not serious enough to prevent making causal inferences based on the ad-hoc specification. However, there are instances where the omitted variable bias is sufficiently large for the ad hoc specification to yield a statistically significant relationship when in fact the more robust DML specification suggests there is none. The DML approach also reveals a more complex picture that highlights the role of context. In rural areas, mother's education affects early childhood development both directly and indirectly through its impact on the nutritional status of both older and younger children. In contrast, in urban areas, where the average level of maternal education is much higher, increases in a mother's education have only a direct effect on child ECD measures but no indirect effect through child nutrition. Thus, DML provides a practical and feasible approach to reducing threats to internal validity for robust inferences and policy design based on observational data.

Project description:The evolution of human diets led to preferences towards polyunsaturated fatty acid (PUFA) content with ‘Western’ diets enriched in w-6 PUFA1. Mounting evidence points to w-6 PUFA excess limiting metabolic and cognitive processes that define longevity in humans2. When chosen during pregnancy, w-6 PUFA-enriched ‘Western’ diets can reprogram maternal bodily metabolism with maternal nutrient supply precipitating the body-wide imprinting of molecular and cellular adaptations at the level of long-range intercellular signaling networks in the unborn fetus2,3. Even though unfavorable neurological outcomes are amongst the most common complications of intrauterine w-6 PUFA excess3, cellular underpinnings of life-long modifications to brain architecture remain unknown. Here, we show that nutritional w-6 PUFA-derived endocannabinoids desensitize CB1 cannabinoid receptors, thus inducing epigenetic repression of transcriptional regulatory networks controlling neuronal differentiation. We found that cortical neurons lose their positional identity and axonal selectivity once exposing mouse fetuses to excess w-6 PUFAs in utero. Conversion of w-6 PUFAs into endocannabinoids disrupted the temporal precision of signaling at neuronal CB1 cannabinoid receptors, chiefly deregulating Stat3-dependent transcriptional cascades otherwise required to execute neuronal differentiation programs. Global proteomics identified the immunoglobulin family of cell adhesion molecules (IgCAMs) as direct substrates with DNA methylome analysis and ATAC-seq uncovering epigenetic reprogramming at >1,400 sites in neurons after prolonged cannabinoid exposure. We find anxiety and depression-like behavioral traits to manifest in adult offspring, which is compatible with genetic models of reduced IgCAM expression to suggest causality to cortical wiring defects4. Overall, our data uncover a regulatory mechanism whose disruption by maternal food choices could limit the offsprings’ brain function for life.

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Ending preventable maternal and child deaths in western Nigeria: Do women utilize the life lines?

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Ending preventable maternal and child deaths in western Nigeria: Do women utilize the life lines?

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