This paper provides some evidence on the determinants of inequalities in chronic diseases in Braz... more This paper provides some evidence on the determinants of inequalities in chronic diseases in Brazil and Russia, focusing on three specific diseases: heart disease, hypertension and diabetes. In both countries poorer households face considerably higher probability of being affected by chronic diseases. The concentration index in Russia starts at -0.021 in 2000, peaks at -0.046 in 2003, and is equal to -0.035 in 2004. In Brazil the concentration changes from -0.028 in 1998 to 0.003 in 2003. The health inequity index is around -0.01 in Russia (with rising trend) and -0.06 in Brazil. Standardising variables have opposite effects in each country, reducing the level of observed health inequality in Brazil, but increasing in Russia, which suggests a differential impact of recent economic changes on the socioeconomic inequality among demographic groups in each country. Socioeconomic status, co-morbidities and education are the most important factors explaining worsening health inequalities over the time, with the bulk of this effect due to changes in elasticities with respect to the determinants of chronic diseases, rather than changes in the concentration of such determinants. The results suggest that efforts to relieve the burden of chronic diseases from poorer households should aim to maximise the impact of externalities from other policy areas.
The epidemiological burden of chronic diseases is increasing worldwide and there is very little e... more The epidemiological burden of chronic diseases is increasing worldwide and there is very little empirical evidence regarding the economic impact of chronic diseases on individuals and households. The primary objective of this paper is to explore the evidence on how chronic diseases affect household healthcare expenditure, non-health consumption, labour (earned) income, and to demonstrate how transfers may provide some insurance against shocks from chronic diseases. We have explicated a two-part Heckit model on household level data obtained from the Living Standard Measurement Surveys (LSMS) from Russia to control for nontrivial proportion of zeros in the dependent variables, skewed distribution of expenditure data and endogeneity. The results indicate that chronic diseases are significantly associated with higher levels of household healthcare expenditure in Russia and productivity losses reflected by reduced labour supply and reduced household labour income. Non-healthcare expenditure also increased. Results suggest that households are able to insure non-health consumption against chronic diseases, possibly from transfers, which also increased. In addition, socioeconomic status indicators significantly explained the impact of chronic diseases on households. Insurance and higher average education in households were associated with higher healthcare expenditure. Household transfers were significant in Russia despite an appreciable level of insurance cover. We conclude that households depend on informal coping mechanisms in the face of chronic diseases, irrespective of insurance cover. These results have implications for policies regarding the financing of treatment and control of chronic diseases in the country studied.
Antenatal care (ANC) and facility delivery are essential maternal health services, but uptake rem... more Antenatal care (ANC) and facility delivery are essential maternal health services, but uptake remains low in north-western Nigeria. This study aimed to assess the psychosocial influences on pregnancy and childbirth behaviours in Nigeria. Data were from a cross-sectional population-based survey of randomly sampled women with a child under 2 years conducted in Kebbi, Sokoto and Zamfara states of north-western Nigeria in September 2019. Women were asked about their maternal health behaviours during their last pregnancy. Psychosocial metrics were developed using the Ideation Model of Strategic Communication and Behaviour Change. Predicted probabilities for visiting ANC four or more times (ANC4+) and giving birth in a facility were derived using mixed-effects logistic regression models adjusted for ideational and socio-demographic variables. Among the 3039 sample women, 23.6% (95% CI: 18.0-30.3%) attended ANC4+ times and 15.5% (95% CI: 11.8-20.1%) gave birth in a facility. Among women wh...
Additional file 2. Sample of Pictograms, on the back of color-coded SP administration cards, desi... more Additional file 2. Sample of Pictograms, on the back of color-coded SP administration cards, designed by CBHV supervisors.
Additional file 5. Adjusted Associations between selected variables and the mean head circumferen... more Additional file 5. Adjusted Associations between selected variables and the mean head circumference (HC) of newborns, between April and November 2015 (without October).
Additional file 4. Unadjusted mean Head Circumference (HC) in millimeters (mm) among live newborn... more Additional file 4. Unadjusted mean Head Circumference (HC) in millimeters (mm) among live newborns born between April and November 2015 (without October), and differences in mean HC by available variables.
Background With an annual estimated 276,000 neonatal deaths, Nigeria has the second highest of an... more Background With an annual estimated 276,000 neonatal deaths, Nigeria has the second highest of any country in the world. Global progress in accelerating neonatal deaths is hinged to scaled-up interventions in Nigeria. We used routine data of chlorhexidine digluconate 7.1 % gel utilized by 36,404 newborns delivered by 36,370 mothers, to study lessons associated with at-scale distribution in Sokoto State, North West Nigeria. Methods and Findings Under state government leadership, a community-based distribution system overseen by 244 ward development committees and over 3,440 community-based health volunteers and community drug keepers, was activated to deliver two locally stored medicines to women when labor commenced. Newborns and their mothers were tracked through 28 days and 42 days respectively, including verbal autopsy results. 36,404 or 26.3 % of expected newborns received the gel from April 2013 to December 2013 throughout all 244 wards in the State. 99.97 % of newborns survive...
Background Early initiation of breastfeeding (EIBF) within the first hour of birth and exclusive ... more Background Early initiation of breastfeeding (EIBF) within the first hour of birth and exclusive breastfeeding (EBF) for the first six months of life are beneficial for child survival and long-term health. Yet breastfeeding rates remain sub-optimal in Northwestern Nigeria, and such practices are often influenced by complex psychosocial factors at cognitive, social and emotional levels. To understand these influences, we developed a set of breastfeeding-related ideational factors and quantitatively examined their relationship with EIBF and EBF practices. Methods A cross‐sectional population‐based survey was conducted in Kebbi, Sokoto, and Zamfara states from September through October 2019. A random sample of over 3000 women with at least one child under 2 years was obtained. Respondents were asked about their health behaviors including breastfeeding practices for their youngest child under 2 years. Breastfeeding-related ideations were developed using the Ideation Model of Strategic C...
Background Northwestern Nigeria faces a situation of high fertility and low contraceptive use, dr... more Background Northwestern Nigeria faces a situation of high fertility and low contraceptive use, driven in large part by high-fertility norms, pro-natal cultural and religious beliefs, misconceptions about contraceptive methods, and gender inequalities. Social and behavior change (SBC) programs often try to shift drivers of high fertility through multiple channels including mass and social media, as well as community-level group, and interpersonal activities. This study seeks to assist SBC programs to better tailor their efforts by assessing the effects of intermediate determinants of contraceptive use/uptake and by demonstrating their potential impacts on contraceptive use, interpersonal communication with partners, and contraceptive approval. Methods Data for this study come from a cross-sectional household survey, conducted in the states of Kebbi, Sokoto and Zamfara in northwestern Nigeria in September 2019, involving 3000 women aged 15 to 49 years with a child under 2 years. Using...
BackgroundAntenatal care (ANC) and facility delivery are essential maternal health services, but ... more BackgroundAntenatal care (ANC) and facility delivery are essential maternal health services, but uptake remains low in northwestern Nigeria. To increase service use, social and behavior change (SBC) programs target psychosocial influences across cognitive, emotional and social domains including knowledge, beliefs, self-efficacy, and social norms. Yet there remains limited research that measures and quantitatively examines the role of psychosocial influences on pregnancy and childbirth behaviors in Nigeria or elsewhere. MethodsA cross-sectional population-based survey of randomly sampled women with a child under two years was conducted in Kebbi, Sokoto and Zamfara states of northwestern Nigeria in September 2019. Women were asked about maternal health behaviors during their last pregnancy. New psychosocial metrics were developed using the Ideation Model of Strategic Communication and Behavior Change. Predicted probabilities for visiting ANC four or more times (ANC4+) and giving birth...
Neonatal infections caused by unsafe umbilical cord practices account for the majority of neonata... more Neonatal infections caused by unsafe umbilical cord practices account for the majority of neonatal deaths in Nigeria. We examined the trends in umbilical cord care practices between 2012 and 2015 that coincided with the introduction of chlorhexidine digluconate 7.1% gel in Bauchi and Sokoto States. We obtained data from three rounds of lot quality assurance samples (LQAS) surveys conducted in 2012, 2013 and 2015. Households were randomly sampled in each round that totaled 1140 and 1311 households in Bauchi and Sokoto States respectively. Mothers responded to questions on cord care practices in the last delivery. Coverage estimates of practice indicators were obtained for each survey period. Local Government Area (LGA) estimates for each indicator were obtained with α ≤ 5%, and β ≤20% statistical errors and aggregated to State-level estimates with finite sample correction relative to the LGA population. Over 75 and 80% of deliveries in Bauchi and Sokoto States respectively took place...
International journal for quality in health care : journal of the International Society for Quality in Health Care / ISQua, Jan 10, 2016
This study assessed the correlation between compliance with set performance standards and materna... more This study assessed the correlation between compliance with set performance standards and maternal and neonatal deaths in health facilities. Baseline and three annual follow-up assessments were conducted, and each was followed by a quality improvement initiative using the Standards Based Management and Recognition (SBM-R) approach. Twenty-three secondary health facilities of Bauchi state, Nigeria. Health care workers and maternity unit patients. We examined trends in: (i) achievement of SBM-R set performance standards based on annual assessment data, (ii) the use of maternal and newborn health (MNH) service delivery practices based on data from health facility registers and supportive supervision and (iii) MNH outcomes based on routine service statistics. At the baseline assessment in 2010, the facilities achieved 4% of SBM-R standards for MNH, on average, and this increased to 86% in 2013. Over the same time period, the study measured an increase in the administration of uterotonic...
Evidence has shown that quality skilled care during labor and delivery is essential to improve ma... more Evidence has shown that quality skilled care during labor and delivery is essential to improve maternal and newborn health outcomes. Unfortunately, analyses of Demographic and Health Survey (DHS) data show that there are a substantial number of women around the world that not only do not have access to skilled care but also deliver alone with no one present (NOP). Among the 80 countries with data, we found the practice of delivering with NOP was concentrated in West and Central Africa and parts of East Africa. Across these countries, the prevalence of giving birth with NOP was higher among women who were poor, older, of higher parity, living in rural areas, and uneducated than among their counterparts. As women increased use of antenatal care services, the proportion giving birth with NOP declined. Using census data for each country from the US Census Bureau's International Database and data on prevalence of delivering with NOP from the DHS among countries with surveys from 2005...
This paper provides some evidence on the determinants of inequalities in chronic diseases in Braz... more This paper provides some evidence on the determinants of inequalities in chronic diseases in Brazil and Russia, focusing on three specific diseases: heart disease, hypertension and diabetes. In both countries poorer households face considerably higher probability of being affected by chronic diseases. The concentration index in Russia starts at -0.021 in 2000, peaks at -0.046 in 2003, and is equal to -0.035 in 2004. In Brazil the concentration changes from -0.028 in 1998 to 0.003 in 2003. The health inequity index is around -0.01 in Russia (with rising trend) and -0.06 in Brazil. Standardising variables have opposite effects in each country, reducing the level of observed health inequality in Brazil, but increasing in Russia, which suggests a differential impact of recent economic changes on the socioeconomic inequality among demographic groups in each country. Socioeconomic status, co-morbidities and education are the most important factors explaining worsening health inequalities over the time, with the bulk of this effect due to changes in elasticities with respect to the determinants of chronic diseases, rather than changes in the concentration of such determinants. The results suggest that efforts to relieve the burden of chronic diseases from poorer households should aim to maximise the impact of externalities from other policy areas.
The epidemiological burden of chronic diseases is increasing worldwide and there is very little e... more The epidemiological burden of chronic diseases is increasing worldwide and there is very little empirical evidence regarding the economic impact of chronic diseases on individuals and households. The primary objective of this paper is to explore the evidence on how chronic diseases affect household healthcare expenditure, non-health consumption, labour (earned) income, and to demonstrate how transfers may provide some insurance against shocks from chronic diseases. We have explicated a two-part Heckit model on household level data obtained from the Living Standard Measurement Surveys (LSMS) from Russia to control for nontrivial proportion of zeros in the dependent variables, skewed distribution of expenditure data and endogeneity. The results indicate that chronic diseases are significantly associated with higher levels of household healthcare expenditure in Russia and productivity losses reflected by reduced labour supply and reduced household labour income. Non-healthcare expenditure also increased. Results suggest that households are able to insure non-health consumption against chronic diseases, possibly from transfers, which also increased. In addition, socioeconomic status indicators significantly explained the impact of chronic diseases on households. Insurance and higher average education in households were associated with higher healthcare expenditure. Household transfers were significant in Russia despite an appreciable level of insurance cover. We conclude that households depend on informal coping mechanisms in the face of chronic diseases, irrespective of insurance cover. These results have implications for policies regarding the financing of treatment and control of chronic diseases in the country studied.
Antenatal care (ANC) and facility delivery are essential maternal health services, but uptake rem... more Antenatal care (ANC) and facility delivery are essential maternal health services, but uptake remains low in north-western Nigeria. This study aimed to assess the psychosocial influences on pregnancy and childbirth behaviours in Nigeria. Data were from a cross-sectional population-based survey of randomly sampled women with a child under 2 years conducted in Kebbi, Sokoto and Zamfara states of north-western Nigeria in September 2019. Women were asked about their maternal health behaviours during their last pregnancy. Psychosocial metrics were developed using the Ideation Model of Strategic Communication and Behaviour Change. Predicted probabilities for visiting ANC four or more times (ANC4+) and giving birth in a facility were derived using mixed-effects logistic regression models adjusted for ideational and socio-demographic variables. Among the 3039 sample women, 23.6% (95% CI: 18.0-30.3%) attended ANC4+ times and 15.5% (95% CI: 11.8-20.1%) gave birth in a facility. Among women wh...
Additional file 2. Sample of Pictograms, on the back of color-coded SP administration cards, desi... more Additional file 2. Sample of Pictograms, on the back of color-coded SP administration cards, designed by CBHV supervisors.
Additional file 5. Adjusted Associations between selected variables and the mean head circumferen... more Additional file 5. Adjusted Associations between selected variables and the mean head circumference (HC) of newborns, between April and November 2015 (without October).
Additional file 4. Unadjusted mean Head Circumference (HC) in millimeters (mm) among live newborn... more Additional file 4. Unadjusted mean Head Circumference (HC) in millimeters (mm) among live newborns born between April and November 2015 (without October), and differences in mean HC by available variables.
Background With an annual estimated 276,000 neonatal deaths, Nigeria has the second highest of an... more Background With an annual estimated 276,000 neonatal deaths, Nigeria has the second highest of any country in the world. Global progress in accelerating neonatal deaths is hinged to scaled-up interventions in Nigeria. We used routine data of chlorhexidine digluconate 7.1 % gel utilized by 36,404 newborns delivered by 36,370 mothers, to study lessons associated with at-scale distribution in Sokoto State, North West Nigeria. Methods and Findings Under state government leadership, a community-based distribution system overseen by 244 ward development committees and over 3,440 community-based health volunteers and community drug keepers, was activated to deliver two locally stored medicines to women when labor commenced. Newborns and their mothers were tracked through 28 days and 42 days respectively, including verbal autopsy results. 36,404 or 26.3 % of expected newborns received the gel from April 2013 to December 2013 throughout all 244 wards in the State. 99.97 % of newborns survive...
Background Early initiation of breastfeeding (EIBF) within the first hour of birth and exclusive ... more Background Early initiation of breastfeeding (EIBF) within the first hour of birth and exclusive breastfeeding (EBF) for the first six months of life are beneficial for child survival and long-term health. Yet breastfeeding rates remain sub-optimal in Northwestern Nigeria, and such practices are often influenced by complex psychosocial factors at cognitive, social and emotional levels. To understand these influences, we developed a set of breastfeeding-related ideational factors and quantitatively examined their relationship with EIBF and EBF practices. Methods A cross‐sectional population‐based survey was conducted in Kebbi, Sokoto, and Zamfara states from September through October 2019. A random sample of over 3000 women with at least one child under 2 years was obtained. Respondents were asked about their health behaviors including breastfeeding practices for their youngest child under 2 years. Breastfeeding-related ideations were developed using the Ideation Model of Strategic C...
Background Northwestern Nigeria faces a situation of high fertility and low contraceptive use, dr... more Background Northwestern Nigeria faces a situation of high fertility and low contraceptive use, driven in large part by high-fertility norms, pro-natal cultural and religious beliefs, misconceptions about contraceptive methods, and gender inequalities. Social and behavior change (SBC) programs often try to shift drivers of high fertility through multiple channels including mass and social media, as well as community-level group, and interpersonal activities. This study seeks to assist SBC programs to better tailor their efforts by assessing the effects of intermediate determinants of contraceptive use/uptake and by demonstrating their potential impacts on contraceptive use, interpersonal communication with partners, and contraceptive approval. Methods Data for this study come from a cross-sectional household survey, conducted in the states of Kebbi, Sokoto and Zamfara in northwestern Nigeria in September 2019, involving 3000 women aged 15 to 49 years with a child under 2 years. Using...
BackgroundAntenatal care (ANC) and facility delivery are essential maternal health services, but ... more BackgroundAntenatal care (ANC) and facility delivery are essential maternal health services, but uptake remains low in northwestern Nigeria. To increase service use, social and behavior change (SBC) programs target psychosocial influences across cognitive, emotional and social domains including knowledge, beliefs, self-efficacy, and social norms. Yet there remains limited research that measures and quantitatively examines the role of psychosocial influences on pregnancy and childbirth behaviors in Nigeria or elsewhere. MethodsA cross-sectional population-based survey of randomly sampled women with a child under two years was conducted in Kebbi, Sokoto and Zamfara states of northwestern Nigeria in September 2019. Women were asked about maternal health behaviors during their last pregnancy. New psychosocial metrics were developed using the Ideation Model of Strategic Communication and Behavior Change. Predicted probabilities for visiting ANC four or more times (ANC4+) and giving birth...
Neonatal infections caused by unsafe umbilical cord practices account for the majority of neonata... more Neonatal infections caused by unsafe umbilical cord practices account for the majority of neonatal deaths in Nigeria. We examined the trends in umbilical cord care practices between 2012 and 2015 that coincided with the introduction of chlorhexidine digluconate 7.1% gel in Bauchi and Sokoto States. We obtained data from three rounds of lot quality assurance samples (LQAS) surveys conducted in 2012, 2013 and 2015. Households were randomly sampled in each round that totaled 1140 and 1311 households in Bauchi and Sokoto States respectively. Mothers responded to questions on cord care practices in the last delivery. Coverage estimates of practice indicators were obtained for each survey period. Local Government Area (LGA) estimates for each indicator were obtained with α ≤ 5%, and β ≤20% statistical errors and aggregated to State-level estimates with finite sample correction relative to the LGA population. Over 75 and 80% of deliveries in Bauchi and Sokoto States respectively took place...
International journal for quality in health care : journal of the International Society for Quality in Health Care / ISQua, Jan 10, 2016
This study assessed the correlation between compliance with set performance standards and materna... more This study assessed the correlation between compliance with set performance standards and maternal and neonatal deaths in health facilities. Baseline and three annual follow-up assessments were conducted, and each was followed by a quality improvement initiative using the Standards Based Management and Recognition (SBM-R) approach. Twenty-three secondary health facilities of Bauchi state, Nigeria. Health care workers and maternity unit patients. We examined trends in: (i) achievement of SBM-R set performance standards based on annual assessment data, (ii) the use of maternal and newborn health (MNH) service delivery practices based on data from health facility registers and supportive supervision and (iii) MNH outcomes based on routine service statistics. At the baseline assessment in 2010, the facilities achieved 4% of SBM-R standards for MNH, on average, and this increased to 86% in 2013. Over the same time period, the study measured an increase in the administration of uterotonic...
Evidence has shown that quality skilled care during labor and delivery is essential to improve ma... more Evidence has shown that quality skilled care during labor and delivery is essential to improve maternal and newborn health outcomes. Unfortunately, analyses of Demographic and Health Survey (DHS) data show that there are a substantial number of women around the world that not only do not have access to skilled care but also deliver alone with no one present (NOP). Among the 80 countries with data, we found the practice of delivering with NOP was concentrated in West and Central Africa and parts of East Africa. Across these countries, the prevalence of giving birth with NOP was higher among women who were poor, older, of higher parity, living in rural areas, and uneducated than among their counterparts. As women increased use of antenatal care services, the proportion giving birth with NOP declined. Using census data for each country from the US Census Bureau's International Database and data on prevalence of delivering with NOP from the DHS among countries with surveys from 2005...
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Papers by Dr. Dele Abegunde