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Nigeria's population is projected to increase from 200 million in 2019 to 450 million in 2050 if the fertility level remains at the current level. Thus, we examined the shifts in the age pattern of fertility, timing of childbearing and trend in fertility levels from 2003 and 2018 across six regions of Nigeria. This study utilised the 2003, 2008, 2013, and 2018 Nigeria Demographic and Health Survey datasets. Each survey was a cross-sectional population-based design, and a two-stage cluster sampling technique was used to select women aged 15-49 years. The changes in the timing of childbearing were examined by calculating the corresponding mean ages at the birth of different birth orders for each birth order separately to adjust the Quantum effect for births. The Gompertz Relational Model was used to examine the age pattern of fertility and refined fertility level. In Nigeria, it was observed that there was a minimal decline in mean children ever born (CEB) between 2003 and 2018 across all maternal age groups except aged 20-24 years. The pattern of mean CEB by the age of mothers was the same across the Nigeria regions except in North West. Nigeria's mean number of CEB to women aged 40-49 in 2003, 2008, 2013 and 2018 surveys was 6.7, 6.6, 6.3 and 6.1, respectively. The mean age (years) at first birth marginally increased from 21.3 in 2003 to 22.5 in 2018. In 2003, the mean age at first birth was highest in South East (24.3) and lowest in North East (19.4); while South West had the highest (24.4) and both North East and North West had the lowest (20.2) in 2018. Similar age patterns of fertility existed between 2003 and 2018 across the regions. Nigeria's estimated total fertility level for 2003, 2008, 2013 and 2018 was 6.1, 6.1, 5.9 and 5.7, respectively. The findings showed a reducing but slow fertility declines in Nigeria. The decline varied substantially across the regions. For a downward change in the level of fertility, policies that will constrict the spread of fertility distribution across the region in Nigeria must urgently be put in place.

Background Despite the relatively high prevalence of Sickle cell trait (SCT) in Nigeria, there has been little research into the correlates of having children with SCT among Nigerian mothers, particularly in terms of socio-demographic differentials. This study aims to investigate the maternal socio-demographic correlates of having under-five children with SCT in Nigeria. Method Data from the 2018 Nigeria Demographic and Health Survey (Household Person Recode and Children Recode) were merged. Mothers with at least one under-five child whose genotype was known ( n  = 7,493) served as the unit of analysis. Three forms of outcome variable were explored. First was the number of children with SCT by each mother. Second, the number of children with SCT was categorized as zero, one, two or more. Lastly, each mother was categorized as either having no child(ren) with SCT or having at least one child with SCT. Subsequently, we assessed multilevel Poisson, ordinal and binary logit models to identify the best fitting model using Akaike and Bayesian Information Criterion. Multilevel binary logistic regression model was identified as best fit used to identify factors associated with having children with SCT. Adjusted Odds Ratio with 95% Confidence Interval (CI) were reported as measures of association. Result Nearly 62% of the mothers lived in rural areas, 38.2% had no formal education and 37.4% had ever given birth to at least five children. About 26.1% (95% CI = 25.2–26.9) of the mothers had children with SCT. By geographical variation, the Northwest region had the highest proportion of mothers of under-five children with SCT. Results from the multilevel binary logistic regression revealed that women who were traditionalists (AOR = 1.77; 95% CI = 1.04–3.02) were more likely of having children with SCT. Conclusion Though SCT is a genetic outcome, findings from this study suggest that important socio-demographic factors such as religion, and region of residence are significantly associated with having children with SCT in Nigeria. Sustained efforts on awareness campaigns on SCT are recommended.

The relationship between physical and cognitive health among Africans, known for a rising incidence of frailty, cardiometabolic, and cognitive disorders, is unclear. We investigated the relationship between hand grip strength (HGS), and cognitive impairment among older adults in an urban settlement in Ibadan, South West Nigeria. In this study, we assessed 608 participants from the Vascular heAlth, fraiLty, and cognItion in Ageing Nigerians sTudy [VALIANT] - a population-based cohort of 1021 older persons in Ibadan, a city in Southwestern Nigeria. They were recruited through a multi-stage, stratified cluster random sampling method. Data on HGS were obtained using a digital hand dynamometer while cognitive function was assessed via a consensus diagnosis. The relationship between cognitive impairment and HGS was investigated using a multivariable-adjusted logistic regression analysis. The mean (SD) age of the study participants was 64.6 ± 11.5 years and 67.6% were females. The proportion of participants with cognitive dysfunction was 22.9%, while the mean (SD) HGS (in kg) was 18.16 (8.06). The mean (SD) HGS was lower among participants with cognitive dysfunction (13.44 ± 5.45) compared to those without cognitive impairment (19.58 ± 8.38; p-value <0.001). After adjustment for age, sex, clinical frailty, level of education, and other metabolic risk markers, high HGS showed a protective association with cognitive impairment, aORs (95%CI) 0.91 (0.87-0.95). This protective association [aORs (95% CI)] was consistent for individuals aged <65 years [0.87 (0.80-0.94] and ≥65 years [0.90 (0.85-0.96)], as well as males 0.88 (0.78-0.99) and females 0.91 (0.84-0.99). HGS was independently associated with cognitive impairment, buttressing the intricate link between physical and cognitive health in this unique West African population. Future work will explore the predictive ability of grip strength as an early indirect non-invasive biomarker of incident cognitive decline and the utility of targeted resistance training exercises in the primary prevention of neurocognitive disorders.

Background Intra-household dynamics play crucial roles in utilisation of healthcare services for children. We investigated the influence of household relationships on healthcare seeking behaviour for common childhood illnesses in four sub-Sahara African regions. Methods Data on 247,061 under-five children were extracted from recent Demographic and Health Surveys conducted between 2012 and 2016 in 25 countries. Data were combined and analysed per sub-region. Dependent variables (DVs) were uptake of health facility care for diarrhea and Acute Respiratory Tract Infection (ARI) symptoms. The main independent variable (IV) was household relationship which was represented by maternal marital profile (marital status, family type and number of marriages) and maternal relationship to household head. Mixed effects logit models were fitted to assess independent relationship between the IVs and DVs with adjustment for relevant demographic and socio-economic characteristics at 5% significance level. Results The percentage of children who received care for diarrhea and ARI symptoms from health facilities across sub-regions was: Western Africa (WA) 42.4, 44.1%; Central Africa (CA) 32.6, 33.9%; Eastern Africa (EA) 41.5, 48.7% and Southern Africa (SA) 58.9, 62.7%. Maternal marital profile was not associated with healthcare seeking behaviour for diarrhea and ARI symptoms in any of the sub-regions. Children whose mothers were daughter/daughter-in-law to household head were significantly less likely to be taken to health facility for diarrhea treatment in Eastern Africa (AOR = 0.81, CI: 0.51–0.95). Having a mother who is the head of household was significantly associated with higher odds of facility care for ARI symptoms for children from Western (AOR = 1.20, CI: 1.02–1.43) and Southern Africa (AOR = 1.49, CI: 1.20–1.85). Conclusion The type of relationship between mother of under-fives and head of households affect health seeking behaviour for treatment of diarrhea and ARI symptoms in Eastern, Western and Southern Africa. Countries in these regions need to adapt best practices for promoting healthcare utilisation for children such that household relationship does not constitute barriers.

Background Reduction in ideal number of children has been suggested as a necessary precursor for fertility decline especially in high fertility countries of Western and Central Africa. In this study, we explored the social contexts of fertility desires by documenting the effects of individual, household as well as contextual characteristics among young men and women in Nigeria. Methods Data source was the male and female recode file of 2018 Nigeria Demographic and Health Survey. Analytical sample comprised 2674 males and 9637 females aged 15–24 years. The main outcome variable was desire for large family size (DLFS) defined as ideal number of children greater than four. Analysis involved use of descriptive statistics and random-effect logit models fitted in four stages. Results DLFS was 71% among young men and 53% in women. Individual-level factors associated with DLFS among men includes Islam religion (OR = 3.95, CI 2.68–5.83), household size (OR = 1.05) and richer (OR = 0.47, CI 0.29–0.75) or richest wealth index (OR = 0.28, CI 0.16–0.75). Geo-political region and high level of negative attitude to family planning (OR = 1.72, CI 1.23–2.40) were the main contextual factors associated with DLFS. For women, individual-level correlates were education, religion, ethnicity, marital status, household size, and wealth index. Contextual factors include geo-political region, community education (OR = 0.68, CI 0.52–0.89), child mortality experience (OR = 1.29, CI 1.11–1.51) and negative attitude to family planning (OR = 1.36, CI 1.13–1.65). The influence of religion, household wealth and attitude to family planning differ between young men and women. Conclusion Active communication and programmatic interventions are needed so that desire for large family size by young men and women do not become a clog for fertility transition in Nigeria. Plain Language Summary Reduction in ideal number of children has been suggested as a necessary condition for fertility decline especially in high fertility countries of Western and Central Africa. In this study, we explored the effects of individual, household as well as community characteristics on fertility desires among young men and women aged 15–24 years in Nigeria. We analysed data for 2674 males and 9637 females aged 15–24 years extracted from the 2018 Nigeria Demographic and Health Survey. The outcome variable was desire for large family size (DLFS) defined as ideal number of children greater than four. Results showed that DLFS was 71% among men and 53% in women. Individual-level factors associated with DLFS among men include Islam religion, household size and wealth status. Geo-political region and high level of negative attitude to family planning were the main community-level factors associated with DLFS. For women, individual-level positively associated with DLFS were Islam religion, and being currently married. Compared to Yoruba, other ethnic groups were more likely to favour DLFS. The negative factors associated with DLFS among young women include higher education and wealth status. At the community-level, Northern geo-political regions, child mortality experience and negative attitude to family planning were positively associated with DLFS. The influence of religion, household wealth and attitude to family planning differ between young men and women. Multi-dimensional strategies with active communication and programmatic interventions are needed so that desire for large family size by young men and women do not slow down fertility transition in Nigeria.

Background Hand‐grip strength (HGS) is known to be a surrogate marker of not only fitness and frailty, but of cognitive and cardiometabolic health. It is cheap, readily deployed and can be a valuable tool in resource‐limited settings. Little however is known about the determinants and correlates of HGS in sub‐Saharan Africa, where stroke and vascular cognitive disorders are projected to exponentially increase. We examined the determinants of HGS among older adults in a rural community in Ibadan, South West Nigeria. Method Vascular heAlth, fraiLty and cognition in Ageing Nigerians (VALIANT) Study is an ongoing longitudinal community‐based cohort study aimed at exploring the association between cardiovascular health, cognition and frailty in Nigeria. One thousand (1000) participants have so far been recruited (via a multistage, stratified cluster random sampling method) and have been taken through a battery of cardiovascular, cognitive and frailty assessment tools. Data on HGS, obtained using a digital hand dynamometer, was available for 480 men and women aged ≥50years. A multivariable adjusted linear regression analysis was used to assess the determinants of HGS. All associations were reported as coefficients with 95% confidence intervals (CI) Result The mean age was 64.5 (11.8) with 35% males. The mean HGS was higher among males (22.86 10.1) than in females (16.26 6.1) (p<0.001) and decreased with increasing age and in the left hand. Using the Rockwood frailty scale, 66 (13.8%) of the study participants were vulnerable to frail while 80% had cognitive impairment (MoCA <26). In the multivariable linear regression analysis, the independent determinants of hand grip strength with corresponding beta coefficients (95%CI) were attainment of tertiary/postgraduate education 5.19 (1.70; 8.68), being a widow/widower ‐2.75 (‐5.47; ‐0.03), lower MoCA score<19 ‐2.50 (‐4.42; ‐0.59) and higher IDEA‐IADL score 0.23 (0.02, 0.44) Conclusion Amongst older adults in rural Nigeria, attainment of tertiary/postgraduate education was independently associated with higher HGS; while being a widow/widower and presence of low cognitive reserve were independently associated with lower HGS. This study has identified unique determinants of HGS among West Africans.

Although Nigeria has made some progress in malaria control, there are variations across States. We investigated the factors associated with utilisation of long-lasting insecticide-treated net (LLIN) and parasitaemia among under-five children in 13 States with high malaria burden. Data from the 2015 Nigeria Malaria Indicator Survey and 2018 Demographic and Health Survey were obtained and analysed. The 2015 and 2018 data were compared to identify States with increase or reduction in parasitaemia. Analysis was done for all the 13 study States; four States with increased parasitaemia and nine States with reduction. Random-effects logit models were fitted to identify independent predictors of LLIN utilisation and parasitaemia. LLIN was used by 53.4% of 2844 children, while parasitaemia prevalence was 26.4% in 2018. Grandchildren (AOR = 5.35, CI: 1.09-26.19) were more likely to use LLIN while other relatives (AOR = 0.33, CI: 0.11-0.94) were less likely compared to children of household-heads. LLIN use was more common in children whose mother opined that only weak children could die from malaria (AOR = 1.83, CI: 1.10-3.10). Children whose mothers obtained net from antenatal or immunisation clinics (AOR = 5.30, CI: 2.32-12.14) and campaigns (AOR = 1.77, CI: 1.03-3.04) were also more likely to use LLIN. In contrast, LLIN utilisation was less likely among children in female-headed households (AOR = 0.51, CI: 0.27-0.99) and those in poor-quality houses (AOR = 0.25, CI: 0.09-0.72). Children aged 24-59 months compared to 0-11 months (AOR = 1.78, CI: 1.28-2.48), those in whom fever was reported (AOR = 1.31, CI: 1.06-1.63) and children of uneducated women (AOR = 1.89, CI: 1.32-2.70) were more likely to have parasitaemia. The likelihood of parasitaemia was higher among children from poor households compared to the rich (AOR = 2.06, CI: 1.24-3.42). The odds of parasitaemia were 98% higher among rural children (AOR = 1.98, CI: 1.37-2.87). The key drivers of LLIN utilisation were source of net and socioeconomic characteristics. The latter was also a key factor associated with parasitaemia. These should be targeted as part of integrated malaria elimination efforts.

Background Childbearing is a major concern for women living with HIV especially in low-middle income countries. There are fears about access to care, risk of vertical transmission, health challenges, maternal and child morbidity/mortality. Investigation of childbearing progression and its associated factors among these women will be useful for design of reproductive healthcare services of these women and ultimately address their multifaceted concerns. This study examined childbearing progression and its correlates another among women living with HIV in Ibadan. Method The study used a dataset from a cross-sectional study on childbearing progression among 933 respondents aged (18–49) receiving HIV care at the University College Hospital, Ibadan. Synthetic Relational Gompertz method was used to estimate fertility rate in the study population while a multistate model was developed to identify the factors associated with progression from one birth to the next. Results The average age of participants was 38 years, with majority being Yoruba tribe (80.5%). Nearly all had at least basic education (93%), and about half had 1–2 children at the time of their HIV diagnosis (47.6%). The likelihood of progressing from the first to a second birth was 77%, though no specific factors were statistically significant. However, progression to a third birth was significantly less likely (86% lower), and associated with factors such as: Having 1–2 children at HIV diagnosis (59% less likely to progress). Having more than 2 children at HIV diagnosis (94% more likely to progress), marital status (widowed women were 36% more likely to progress), partner’s education (secondary education increased the likelihood by 23%), partner’s employment status (unemployed partners increased the likelihood by 40%), desire for more children, partner’s HIV-negative status. Progression to fourth and subsequent births showed a continued decline, with the likelihood of a fourth birth being 82% lower and a fifth or sixth birth 85% lower. Women with secondary education were significantly less likely to progress to fifth births. Conclusion Overall, the corrected total fertility rate is 3.54, it’s below the national estimates and Southwest region which implies fertility is declining among women living with HIV in Ibadan. The findings revealed the relevance of socio-economic and demographic factors in childbearing progression among women living with HIV. Focused interventions should aim to provide better family planning support and integrate reproductive health counseling into HIV care programs.

There is an increasing prevalence of obesity among college/university students in low- and middle-income countries, similar to the trend observed in high-income countries. This study aimed to describe the trend and burden of overweight/obesity and emerging associated chronic disease risks among students at the University of Ibadan (UI), Nigeria. This is a ten-year retrospective review of medical records of students (undergraduate and post-graduate) admitted between 2009 and 2018 at UI. Records of 60,168 participants were analysed. The Body Mass Index (BMI) categories were determined according to WHO standard definitions, and blood pressure was classified according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC7). The mean age of the participants was 24.8, SD 8.4 years. The majority were ≤ 40 years (95.1%). There was a slight male preponderance (51.5%) with a male-to-female ratio of 1.1:1; undergraduate students constituted 51.9%. The prevalence of underweight, overweight, and obesity were 10.5%, 18.7% and 7.2%, respectively. We found a significant association between overweight/obesity and older age, being female and undergoing postgraduate study (p = 0.001). Furthermore, females had a higher burden of coexisting abnormal BMI characterised by underweight (11.7%), overweight (20.2%) and obese (10.4%). Hypertension was the most prevalent obesity-associated non-communicable disease in the study population, with a prevalence of 8.1%. Also, a third of the study population (35.1%) had prehypertension. Hypertension was significantly associated with older age, male sex, overweight/obesity and family history of hypertension (p = 0.001). This study identified a higher prevalence of overweight and obesity than underweight among the participants, a double burden of malnutrition and the emergence of non-communicable disease risks with potential lifelong implications on their health and the healthcare system. To address these issues, cost-effective interventions are urgently needed at secondary and tertiary-level educational institutions.

Background By 2050, the prevalence of dementia is projected to triple with the greatest increases anticipated in Africa and Asia – largely attributable to population growth and cardiometabolic disorder. Hand‐grip strength (HGS) is a known predictor of cardiometabolic and cognitive health. The relationship between HGS and cognitive impairment (CI) among elderly West Africans is not known. We examined the relationship between HGS and cognitive impairment among older adults in a rural community in Ibadan, South West Nigeria. Method The Vascular heAlth, fraiLty and cognition in Ageing Nigerians (VALIANT) Study is an ongoing longitudinal community‐based cohort study aimed at exploring the association between cardiovascular health, cognition and frailty in Nigeria. One thousand participants have been recruited via a multistage, stratified cluster random sampling method recruited from a rural community in Ibadan and taken through a battery of cardiovascular, cognitive and frailty assessment tools. Data on HGS, obtained using a digital hand dynamometer, was available for 480 men and women aged≥50years. The Relationship between cognitive impairment (using MoCA <18) and HGS was examined using a multivariable adjusted logistic regression analysis. All associations were reported as ORs with the corresponding 95% confidence intervals (CI). Result The mean age of study participants was 64.5 (11.8) with predominant females (65%). Most participants (62.2%) were hypertensivewhile 22.9% were obese. The mean MOCA score in males and females were 22.155.7 and 17.82 6.6 respectively. Approximately 36% had moderate‐severe CI (MoCA<18), 43% had mild CI (MoCA 18‐25), 21% were normal (>25). There was a significant positive correlation between HGS and MoCA 0.45 (p <0.001). The independent determinants of moderate‐severe cognitive impairment in descending order of aOR (95%CI) were age 1.07 (1.03‐ 1.11), higher HGS 0.94 (0.90 ‐0.98), attainment of primary education 0.14 (0.07 – 0.29), secondary education 0.06 (0.02 – 0.16) and tertiary education 0.01 (0.01 – 0.14) Conclusion Besides older age and attainment of any form of education, higher HGS was independently associated with moderate‐severe cognitive impairment among elderly Nigerians. Further exploration of the link between HGS and early clinical/neuroimaging biomarkers of dementia is desirable.