Dissertations / Theses on the topic 'Public health laws – Nigeria'

Consequences of the well-known world’s pandemic under which we still live had their impact on every country. The global community has got one more reason for its internal differently directed changes to give a rather quick reaction for its further existence and development in conditions of the fight against COVID-2019. Due to this fact, Nigerian law is on the way of its transformation to be effective for the further development and prosperity of the state and welfare of the people.

As the global demand for oil increases, human health implications related to its discovery and transport remain a serious concern. The Niger Delta has been the site of severe environmental degradation since the oil boom of the 1970s. While some researchers have examined the environmental effects of oil procurement, few have explored human health implications in this region. This phenomenological study investigated the human physical and mental health consequences of oil-related environmental degradation through the perceptions and lived experiences of villagers in Koluama, Nigeria. The conceptual framework for the study was based on research conducted by Morello-Frosch, Zuk, Jerrett, Shamasunder and Kyle (2011) on the public health consequences of environmental pollution to which marginalized populations are vulnerable. Participants included a random sample of 33 residents of Koluama. Data were collected via individual semistructured interviews and 3 focus groups and analyzed using: interpretative phenomenological analysis. Themes that emerged from analysis included children's health issues, including asthma and other breathing problems; and death rates among the elderly in the area. The villagers, aware of the increase in mortality and illness in the area, also suffered from anxiety and depression. The research findings demonstrated the perception of the participants that the oil companies appeared not to be concerned about the lack of health care in the area; although illness increased in the area of the oil fields. This study might be beneficial in eliciting positive social change at the individual and organizational levels by illuminating oil-related health problems and may lead to better health care access for the population.

Maternal mortality, an example of poor maternal health outcomes, is widely accepted as an indicator of the overall health of a population. One of the Millennium Development Goals was reduction in maternal mortality by 3 quarters by 2015. These goals were not met in Nigeria and it is important to look at some of the reasons why. Education has been shown to have positive impact on pregnancy outcomes; however, the characteristics of pregnant women, their health literacy level, their usage of antenatal care services and how these impact pregnancy outcomes are yet to be analyzed in Lagos, Nigeria. Guided by the social cognitive theory and health belief model, the purpose of this cross-sectional quantitative study was to determine if there is a relationship between maternal health literacy, antenatal care visits, development of medical conditions during pregnancy, and pregnancy outcomes (measured by healthy or unhealthy baby) in Lagos, Nigeria. The research question for this study tested if there was a relationship between these variables. Lisa Chew’s health literacy assessment tool was used in a sample of 130 women in Shomolu local government in Nigeria who met the inclusion criteria. Using binary logistic correlations, only problems developed during pregnancy is statistically significant with pregnancy outcomes (p < .05). The results suggested an increase in problems developed during pregnancy most likely will increase the chance of having negative pregnancy outcomes. Results from this study could promote positive social change by helping health professionals identify the characteristics of at-risk women during antenatal education sessions. The results could also help health professionals in the development of targeted antenatal care interventions.

Caregivers’ compliance with polio vaccine regimens and timely receipt of the recommended 4 doses of polio vaccine are pivotal to eliminating polio. This cross sectional study, conducted in Lagos State, Nigeria, examined polio vaccine compliance and demographic attributes of caregivers’ for statistically significant associations. Using an adapted health belief model theoretical framework, 1,200 participants were recruited from well-baby clinics in 8 local government areas in Lagos State. Participants completed a brief demographic survey providing data on caregivers’ age, gender, residence (rural or urban), and their level of education as well as records from their children’s immunization cards. Data obtained were tested for associations between caregiver’s demographic information and their children’s receipt of polio doses within specified timelines using chi-square and logistic regression analysis. Fisher’s exact analysis were conducted for variables with frequencies less than 5. The only significant association recorded was between the receipt of Polio Dose A and location of caregivers’ residence: Rural dwelling caregivers were less likely to receive the first dose of polio. Results showed Polio Dose D to be the dose most likely received in an untimely manner as well as most likely missed of the 4 doses. Logistic regression analysis did not show any variable to be of greater odds in predicting completion of the 4 doses or compliance with timelines of their receipt. Study’s results may inspire polio program planners to develop interventions that broaden the immunization coverage for rural dwellers to include nontraditional maternity locations. Positive social change will ensue by the improvement caregivers’ compliance with full polio dose receipts with timelines, maximizing immunity.

There is a need for epilepsy-based health education programs to enlighten Nigerian communities and reduce the stigma associated with epilepsy. Epilepsy in Nigeria is viewed by some as a contagious and an infectious disease or a condition imposed from the gods, possessed by demons, as the work of witchcraft, or punishment from ancestral spirits, which are all related to a lack of knowledge about epilepsy leading to stigmatization of persons with epilepsy. Guided by the stigma theory, the purpose of this community-based, cross sectional study was to quantitatively examine the effect of an educational program on interpersonal, internalized, and institutional stigma of epilepsy in terms of knowledge, attitude, and treatment gained. Two hundred and fifty participants completed a general domain instrument which had been used in different countries, including South Eastern Nigeria, and revised for greater validity via a pilot study. Chi-square tests were used to examine any significant differences in participants' responses between pre- and post-test surveys regarding knowledge, attitude, and treatment gained of all 3 identified stigma levels. According to study results, the educational program reduced all 3 stigma levels in terms of attitude, knowledge, and treatment gained of epilepsy (p< 0.001). This study contributed to positive social change by providing information to public health workers on how to increase the knowledge and awareness of the South Eastern Nigerian community that epilepsy is not contagious or infectious and there is no need to isolate persons with epilepsy from their societies.

There is a need for epilepsy-based health education programs to enlighten Nigerian communities and reduce the stigma associated with epilepsy. Epilepsy in Nigeria is viewed by some as a contagious and an infectious disease or a condition imposed from the gods, possessed by demons, as the work of witchcraft, or punishment from ancestral spirits, which are all related to a lack of knowledge about epilepsy leading to stigmatization of persons with epilepsy. Guided by the stigma theory, the purpose of this community-based, cross sectional study was to quantitatively examine the effect of an educational program on interpersonal, internalized, and institutional stigma of epilepsy in terms of knowledge, attitude, and treatment gained. Two hundred and fifty participants completed a general domain instrument which had been used in different countries, including South Eastern Nigeria, and revised for greater validity via a pilot study. Chi-square tests were used to examine any significant differences in participants' responses between pre- and post-test surveys regarding knowledge, attitude, and treatment gained of all 3 identified stigma levels. According to study results, the educational program reduced all 3 stigma levels in terms of attitude, knowledge, and treatment gained of epilepsy (p< 0.001). This study contributed to positive social change by providing information to public health workers on how to increase the knowledge and awareness of the South Eastern Nigerian community that epilepsy is not contagious or infectious and there is no need to isolate persons with epilepsy from their societies.

Full (complete) childhood immunization against tuberculosis, poliomyelitis, diphtheria, tetanus, hepatitis B, yellow fever, measles, and the maternal retention of immunization documentation are the most cost-effective interventions against vaccine-preventable childhood diseases. The full childhood immunization rate in Nigeria has not reached the expected target level of compliance at 90%. Using the social ecological model, this study investigated the influence of maternal satisfaction with postnatal services and paternal support on full childhood immunization status; it also examined the association between maternal factors and the maternal retention of immunization documentation in Owerri, Nigeria. The hypotheses were that maternal satisfaction with postnatal services and paternal support were associated with full childhood immunization status. This study was a quantitative, cross-sectional survey design that included validated modified WHO/EPI-30 cluster immunization survey information from the cluster sample of 560 mothers of children between the ages of 12 and 23 months old. The multivariate logistic regression analysis (at the .05 level) indicated that the odds of full childhood immunization status were lower for participants who indicated no maternal satisfaction with postnatal services compared with those who indicated satisfaction with postnatal services. Public health workers and policymakers should invest more resources in maternal and child health care resources to increase maternal satisfaction with postnatal services. The study outcomes may help to evolve a system that may increase childhood immunization status and reduce vaccine-preventable diseases in Owerri, and serve as a model for other countries.

Postpartum depression (PPD) is internationally recognized as one of the most prevalent and severe but neglected maternal mental health complications of childbirth. Previous studies have indicated that there is a high burden of disease associated with PPD in both developed and developing countries. However, there remain gaps in the current literature regarding the recognition and management of PPD in remote parts of the developing world. Therefore, the purpose of this study was to understand the perceptions, attitudes, and beliefs of health professionals towards PPD and examine the factors that either facilitated or hindered its recognition and management in a remote setting in Nigeria. The pen-3 cultural model was the conceptual framework used in this study. The study focused specifically on professionals with regard to the recognition and management of PPD in a rural hospital in Nigeria. Ten semi structured qualitative interviews were conducted with doctors and nurses from a rural hospital in Nigeria. Data were analyzed via phenomenological interpretative analysis. Results from the study revealed that health professionals in a remote setting in Nigeria have a working knowledge of PPD and perceived the condition as a serious public health concern, but were faced with numerous barriers from the institutional, organizational, and community level that hindered their ability to recognize and manage PPD in a timely manner. These results make an important contribution to the existing literature and can enhance social change initiatives through the enhancement of awareness of PPD, and the need for improvement of policies on comprehensive maternal mental health in remote parts of Nigeria.

Access to primary medical care and prevention services in Nigeria is limited, especially in rural areas, despite national and international efforts to improve health service delivery. Using a conceptual framework developed by Penchansky and Thomas, this case study explored the perceptions of community residents and healthcare providers regarding residents' access to primary healthcare services in the rural area of Isu. Using a community-based research approach, semistructured interviews and focus groups were conducted with 27 participants, including government healthcare administrators, nurses and midwives, traditional healers, and residents. Data were analyzed using Colaizzi's 7-step method for qualitative data analysis. Key findings included that (a) healthcare is focused on children and pregnant women; (b) healthcare is largely ineffective because of insufficient funding, misguided leadership, poor system infrastructure, and facility neglect; (c) residents lack knowledge of and confidence in available primary healthcare services; (d) residents regularly use traditional healers even though these healers are not recognized by local government administrators; and (e) residents can be valuable participants in community-based research. The potential for positive social change includes improved communication between local government, residents, and traditional healers, and improved access to healthcare for residents.

Sexual activity among unmarried adolescents is a major public health problem in Nigeria, because unmarried pregnant girls are more likely to have multiple sex partners and are less likely to use contraceptives, putting them at greater risk for sexually transmitted diseases (STD), unplanned pregnancy, abortion, social isolation, and poverty. Teen pregnancy and STD rates are on the rise in Nigeria, yet few data exist on the experience of the adolescents themselves. This phenomenological study was designed to explore the in-depth experiences of 10 pregnant, unmarried adolescent girls aged 16-19, including the factors contributing to their sexual activity. An ecological model served as the conceptual framework to permit individual experiences to be understood in their social and ecological context. Semistructured interviews and Hycner's method of analysis were used to collect and analyze the data. Results showed that the decision to initiate sexual activity among these girls was influenced by many factors, including: the need for financial support and a socially condoned system of "sugar daddies" who support girls in return for sex; peer pressure to have a sex partner; a romantic knowledge of sexual behavior based primarily on the mass media; and inadequate sex education. As a result of their pregnancy, the girls experienced negative reactions from their families and community, and serious psychological and financial concerns about their prospects for future marriage and their child's identity. A comprehensive community-based reproductive health program is called for, with reliable sex education, cooperation from the mass media, and support from family and community members. The social change implication of this study is to potentially lead to a decrease in unplanned pregnancy, STDs, social isolation, and poverty among adolescent girls in Nigeria.

Includes abstract.
Includes bibliographical references.
This study investigates three issues connected with governance and citizens welfare in Nigeria. One of the current debates in the political economy literature focuses on the bene ts of democracies to ordinary citizens, especially in developing countries, and particularly in sub-Saharan African countries. Most Nigerians have been questioning the bene ts of transition from military rule to democratic rule in 1999 to ordinary citizens. This concern relates to the lack of credibility of electoral processes in the country. Politicians in Nigeria have embarked on various unlawful strategies both to win and perpetuate positions of power, with no regard for the principles of free and fair elections. Non-credible elections often lead to capture of political power at both national and sub-national levels in the country by special interest groups headed by political godfathers (1). This thesis examines whether transition from an autocratic military regime to a relatively competitive democratic regime results in higher provision of public goods and a reduction in health inequality, given the prevalence of political capture due to lack of credible electoral competition in Nigeria. The thesis questions the assumption that transition from a military dictatorship to relatively competitive democratic rule will ensure an increase in the provision of public goods and a reduction in health inequality.

Background Noma, also known as cancrum oris, is a gangrenous infection of the oral cavity, which causes widespread orofacial destruction. If untreated, noma has a reported 90% mortality rate within weeks after the onset of first symptoms. Noma progresses through distinct stages defined by the World Health Organisation (WHO); Stage 0: simple gingivitis; Stage 1: acute necrotizing gingivitis; Stage 2: oedema; Stage 3: gangrene; Stage 4: scarring. Stage 5: sequelae. It is unclear how many patients with the early stages of noma will progress to the later stages of disease. Treatment in the early reversible stages with antibiotics, wound debridement and nutritional support greatly reduces morbidity and mortality. Acute noma is most often reported in children aged between two and five years. Many patients who survive the acute stages of the disease suffer into adulthood with disfigurement and disability of varying degrees. Noma is thought to be most prevalent in developing countries in Africa and Asia. Estimates for noma prevalence and incidence vary. In 1998, the WHO estimated an annual incidence of 140,000 cases of acute noma and 770,000 noma survivors living with sequelae. Two Nigerian studies estimated the burden of disease ranged from seven cases per 1,000 children aged between one and 16 years (2003) to 6.4 per 1,000 children (2003). A study from 2019 estimated the period prevalence of noma from 2010 to 2018 was 1.6 per 100,000 population at risk in Nigeria. These estimates are based on expert opinion, number of hospital admissions and retrospectively collected hospital-based data and it is unclear which stages of noma were included. Risk factors for the disease include poor oral hygiene, malnutrition, comorbidities and low socioeconomic status. Despite its ancient history (reported by Hippocrates (460 - 370 BC)), noma-related literature remains mainly confined to case reports and case series. By employing both qualitative and quantitative methods, we sought to examine the biopsychosocial features of noma, its epidemiology and treatment in northwest Nigeria in order to inform advocacy and prevention efforts. The three overarching objectives to fulfil this aim were to assess the distribution of noma among children in northwest Nigeria; identify factors associated with noma (including factors influencing health-seeking behaviour and risk factors for the development of noma) and gain an understanding of the biomedical and non-biomedical care provided to noma patients in this setting. The knowledge gained through this thesis will support the assessment of the need for advocacy around noma, effective resource allocation and the planning of intervention strategies. Methods We conducted a scoping literature review, three quantitative studies (risk factors, outcomes, prevalence) and two qualitative studies (language and beliefs and traditional healing practices) in northwest Nigeria. Data were collected from patient caretakers at the Noma Children's Hospital, hospital staff, children and traditional healers in villages within Sokoto and Kebbi States. Data collection methods included quantitative surveys, oral screenings, anthropometric measurements, quality of life questionnaires, qualitative in-depth interviews and focus group discussions. Consenting adult respondents answered questionnaires and participated in interviews, and where applicable, data was collected from assenting children. Quantitative analyses included descriptive statistics as well as univariable and multivariable risk factor analyses. Qualitative data was manually coded and analysed thematically. Findings We included 74 cases (noma patients presenting at the hospital in the year preceding data collection) and 222 controls (both median age of five years (inter-quartile range 3, 15 years)) in the risk factor study. Vaccination coverage for polio and measles was below 7% in both cases and controls. The multivariable analysis identified the child being fed pap every day (adjusted odds ratio (aOR) 9.8; 95% confidence interval (CI 1.5, 62.7) as a risk factor. The mother being the primary caretaker (aOR 0.08; CI 0.01, 0.5) and the caretaker being married (aOR 0.006; CI 0.0006, 0.5) were protective factors. Of the 37 patients with noma sequelae included in the outcomes study, 21 (56.8%) were male and 22 (62.9%) were aged six years or older. Fifteen patients (40.5%) had two to three surgeries. The most frequently used surgical procedure was a deltopectoral flap (n=16 patients; 43.2%). Trismus was released in 12 patients (32.4%), of these; none had a normal mouth opening at the follow-up visit. Despite this finding, all respondents reported that the surgery had improved their quality of life. In the cross-sectional study assessing the prevalence of all stages of noma, we included 3,499 households and 7,122 children aged <15 years; 4,239 (59.8%) were aged 0 to 5 years. Simple gingivitis was identified in 3.1% (n=181; CI 2.6-3.8), acute necrotizing gingivitis in 0.1% (n=10; CI 0.1-0.3), and oedema in 0.05% (n=3; CI 0.02-0.2). No cases of late-stage noma were detected. Naming of the disease differed between caretakers and healthcare workers in the language and beliefs study. Beliefs about the causes of noma were varied (spirits, animals, insects, previous infections). Noma patient caretakers spoke of the mental health strain due to stigmatization as a key issue. Difficulty in accessing care was evident. A lack of trust in the health system was mentioned as a barrier to care. Traditional healers offered specialised forms of care for specific conditions and referral guidance. They viewed the stages of noma as different conditions with individualised remedies and were willing to refer noma patients. Caretakers trusted traditional healers. Conclusion Social conditions and childhood feeding practices are associated with the occurrence of noma in northwest Nigeria. This thesis has shown that following their last surgical intervention, noma patients do experience some improvements in their quality of life, but continue to face functional challenges that inhibit their daily life. We found many, widely distributed, early-stage noma cases in northwest Nigeria indicating a large population at risk of progressing to the later stages of disease. Caretaker and practitioner perspectives may enlighten efforts to improve case finding, and to understand barriers to accessing health care. Differences in disease naming illustrated the difference in beliefs about the disease. Traditional healers could play a crucial role in the early detection of noma and the health-seeking decision-making process of patients. Intervention programmes should include traditional healers through training and referral partnerships. In conclusion, this thesis provides a unique view of the biopsychosocial features, epidemiology and treatment options for noma in northwest Nigeria. Noma is a disease, which is indicative of a weak health system and socio-economic environments of extreme deprivation. Intervention programmes should include widespread health system improvements that could address a host of risk factors for noma, and simultaneously other childhood diseases. These include increasing access to quality health care (including vaccinations), ensuring effective referral mechanisms, predominantly in rural areas, and the creation of a robust surveillance network. Health financing initiatives would need to be paired with these improvements. Nutritional programs aimed at caretakers of young children and community-based oral health initiatives could be effective mechanisms to curb the number of noma cases. Awareness-building initiatives targeting healthcare workers and community members are necessary to improve the detection and timely management of noma in endemic settings. The combined findings of this thesis highlight the neglected nature of noma and make a strong case for placing noma on the WHO neglected tropical diseases list. This initiative could foster awareness among policy-makers and governments and direct much needed funding to facilitate further research, surveillance and targeted health interventions that would contribute to the eradication of noma.

Full (complete) childhood immunization against tuberculosis, poliomyelitis, diphtheria, tetanus, hepatitis B, yellow fever, measles, and the maternal retention of immunization documentation are the most cost-effective interventions against vaccine-preventable childhood diseases. The full childhood immunization rate in Nigeria has not reached the expected target level of compliance at 90%. Using the social ecological model, this study investigated the influence of maternal satisfaction with postnatal services and paternal support on full childhood immunization status; it also examined the association between maternal factors and the maternal retention of immunization documentation in Owerri, Nigeria. The hypotheses were that maternal satisfaction with postnatal services and paternal support were associated with full childhood immunization status. This study was a quantitative, cross-sectional survey design that included validated modified WHO/EPI-30 cluster immunization survey information from the cluster sample of 560 mothers of children between the ages of 12 and 23 months old. The multivariate logistic regression analysis (at the .05 level) indicated that the odds of full childhood immunization status were lower for participants who indicated no maternal satisfaction with postnatal services compared with those who indicated satisfaction with postnatal services. Public health workers and policymakers should invest more resources in maternal and child health care resources to increase maternal satisfaction with postnatal services. The study outcomes may help to evolve a system that may increase childhood immunization status and reduce vaccine-preventable diseases in Owerri, and serve as a model for other countries.

Public Health
Ph.D.
The use of mobile communication devices (MCDs) by drivers is a significant public health problem. Research suggests that MCD use plays a role in almost 400,000 traffic crashes each year, resulting in over 3,000 deaths (NHTSA, 2013). Drivers using an MCD are as much as four times more likely to crash as other motorists (Redelmeier & Tibshirani, 1997). Since 2001 forty-eight states have adopted one or more laws aimed at reducing the use of MCDs by drivers, many of which have been strengthened through subsequent amendments. Evaluations have yielded a mixed picture of their effectiveness (Braitman & McCartt, 2010; Highway Loss Data Institute, 2010; McCartt & Geary, 2004; McCartt, Hellinga, Strouse, & Farmer, 2010). Existing studies, however, have been limited by various design features. This study employs time-series methods to explore whether laws prohibiting use of MCDs by young drivers effectively reduce crash fatalities. The quasi-experimental design relies on an identification strategy that is common in empirical legal studies but has not yet been applied to laws regulating driver MCD use. The implementation of the identification strategy leverages the developing concept of legal epidemiology. Four state laws are ultimately evaluated. The primary analytic approach is difference-in-difference. In two of the four instances, there is some evidence suggesting a protective effect could be attributed to the law. However, this evidence was limited and differed in relation to specification choices. These findings cast doubt on some fifty state panel analyses that have suggested that laws are effectively decreasing MCD use and associated harms.
Temple University--Theses

The street food sector continues to grow in Nigeria in a largely unregulated environment. The lack of regulation poses a significant public health risk for consuming unsafe street foods such as suya. Quantitative research has revealed high levels of microbiological contamination of suya, despite qualitative findings that suggest that food handlers are knowledgeable about safe food handling practices. This discrepancy reveals a gap in understanding about what influences safe food handling practices besides knowledge. This qualitative study was therefore designed to gain a deeper understanding of the beliefs and attitudes that influence hygienic practices among suya producers. Guided by the social cognitive theory, a phenomenological design was used to investigate and describe the hygiene phenomenon. Ten suya operators were recruited in Abuja, the Federal Capital Territory of Nigeria, to participate in the study. Data were collected from interviews and observation of participants. Semistructured, open-ended questionnaires were used in face-to-face interviews to elicit participants' views on hygiene. Hygiene practices among participants were also observed. Information gathered was recorded, stored, transcribed, and analyzed using the NVivo software and based on emerging themes. The findings revealed that participants' understanding of hygiene was related to popular culture rather than science. Furthermore, findings also revealed that family, religious, and cultural beliefs, as well as environmental factors such as consumer attitude influenced their hygiene practices. These findings may provide evidence-based guidance for public health interventions for safer suya production processes with positive social change implications for improved consumer health.

Low Human Immunodeficiency Virus [HIV] test uptake and multiple partnerships among men in Nigeria are contributing factors to HIV transmission. The purpose of this quantitative cross-sectional study was to examine the relationship between HIV test uptake, sociodemographic characteristics, HIV knowledge, attitude, and multiple sexual partnerships. The health belief model provided the framework for the study. Data were collected from the 2013 Nigerian National Demographic Health Survey, which surveyed 17,359 Nigerian men ages 15-49 years. Chi-square and binary logistic regression analysis showed that sociodemographic variables (age, residence, marital status, religion, wealth status, ethnicity, and educational level), HIV test uptake, HIV knowledge, and attitudes toward negotiating safer sex are significantly associated with multiple sexual partnerships. Findings showed that multiple sexual partnerships were higher among middle-aged men (25-39 years) in Nigeria and lower among Hausa Muslims. Findings showed that HIV testing is a significant predictor of multiple sexual partnerships, those that have been tested are more likely to be engaged in multiple sexual partnerships than those never tested. A well-tailored intervention that will promote follow up with men after HIV test uptake is essential to reduce the practice of multiple sexual partners among them. This may result in positive social change by presenting public health experts, donor agencies, and health teachers with valuable information about how multiple sexual partners and HIV testing can influence sexual risk behaviors among men. This may advance HIV prevention and control practices among men in Nigeria.

Maternal health services (MHS) provide primary, secondary, and tertiary levels of prevention to achieve better pregnancy outcomes. However, use of prenatal and natal services among Nigerian women has been ranked among the lowest in the world and, consequently, the country is among the 10 countries with the highest maternal mortality ratio. Moreover, nationwide community-based studies on the use of maternal health services in Nigeria are limited. To address this gap, this quantitative, cross-sectional study analyzed the 2008 Nigerian Demographic and Health Survey (NDHS) data to identify whether Nigerian women's biological, cultural, and socioeconomic characteristics are associated with their use of MHS and pregnancy outcome as measured by number of antenatal visits, place of delivery, and fetal outcome. The Anderson's health behavior model was used as the theoretical framework for this study. Respondents were women aged 15 - 49 years (N= 31,985), who had given birth between January 2003 and December 2008. Bivariate and multiple logistic regressions were conducted. The results indicated that religion, education, income, and availability of skilled health workers showed consistent significant statistical association with both the number of ante natal care (ANC) visits and place of delivery even after controlling for covariates. Overall, these findings have potential for social change on the choice of public health interventions with collaboration with social services such as education, community, and labor sectors. Further, a systematic involvement of local communities is needed to drive specific culturally-sensitive interventions.

This research project, undertaken for a MPH dissertation investigated and analysed the situation of diabetes and diabetic retinopathy services and management systems in four (4) government hospitals in Akwa Ibom State Nigeria using the World Health Organisation (WHO) Tool for the Assessment of Diabetic Retinopathy and Diabetes Management Systems (TADDS). Part A is the research protocol, which explains the background and the key components of this research study. This is a cross sectional descriptive case study involving primary data collection. We conducted the case study using the WHO TADDS to survey health personnel involved in the management of diabetes mellitus (DM) and diabetic retinopathy (DR) in four (4) government hospitals in Akwa Ibom State. Concurrently, semi-structured interviews were conducted with key informants to investigate and analyse the situation of DM and DR services in Akwa Ibom State in Nigeria. Part B is a structured literature review of published articles, online reports, and summaries related to DR. It covers the review of scientific evidence (clinical overview) about the aetiology and prevention of DR and the known risk factors; the review of epidemiological evidence on DM and DR globally and in sub-Saharan Africa (SSA); and the review of the evidence on effectiveness and cost-effectiveness of public health and health system interventions for the prevention and management of DR. Part C is the journal-ready manuscript. In this part, the format of the journal Ophthalmic Epidemiology was used to present the research project and its main findings. Part D contains all the relevant appendices used during the research project.

Thesis (Ph.D.)--Indiana University, School of Health, Physical Education and Recreation, 2009.
Title from PDF t.p. (viewed on Jul 22, 2010). Source: Dissertation Abstracts International, Volume: 70-12, Section: B, page: 7516. Adviser: Susan E. Middlestadt.

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Bachelors
Health and Public Affairs
Legal Studies

The focus of this thesis is to explore the legality, the issues, and the remedy to a controversial statute in the State of Illinois. This thesis will explain how the First Amendment relates to the Illinois statute and its desire of a citizen is right to report information that is not being granted. Moreover, this paper will further go into a recent legislative bill to amend the Illinois statute, its failure, the media surrounding the issue, and the consequences of amending or not amending the statute. It will further review state law in regard to citizens recording police officers, and explain how some states deal with the statute.
B.S.
Bachelors
Health and Public Affairs
Legal Studies

The use of human immunodeficiency virus (HIV) counselling and testing (HCT) is a necessary component of implementing HIV prevention and control programs in Nigeria. Knowledge, acceptance, and use of HCT remain low in Nigeria, especially among young people ages 15 to 24 years. The purpose of this study was to ascertain how sociodemographic factors (i.e., gender, place of residence, level of education, geopolitical zone, and socioeconomic status [SES]); cognitive factors (i.e., HCT awareness, knowledge of HIV prevention, and knowledge of HIV transmission); and knowledge of sexual risk behaviors affected HCT uptake among young people in Nigeria using data from the 2013 National HIV/AIDS and Reproductive Health Survey Plus. The study was guided by the social cognitive theory. The sample was composed of 10,091 young people ages 15 to 24 years from all geopolitical zones, SES, and educational backgrounds in Nigeria. Multiple regressions and multivariate comparisons revealed a significant relationship between HCT awareness and HCT uptake (p < .001) and between knowledge of HIV prevention and HCT uptake (p < .001). Sociodemographic variables of gender, place of residence, level of education, geopolitical zone, and SES were also significantly associated with HCT uptake. The sexual risk behavior variables tested were not significantly associated with HCT uptake among young people in Nigeria. The implications for positive social change include providing public health professionals with data to plan and implement HCT awareness and knowledge programs for young people in Nigeria that could increase HCT uptake and reduce the incidence of HIV/AIDS.

A lack of adherence to antiretroviral therapy (ART) increases the risk of onward human immunodeficiency virus (HIV) transmission and mortality. The purpose of this cross-sectional study based on Andersen's conceptual framework was to test the associations between age, marital status, job/occupational status, education, membership in a peer support group, community, and facility ARV drug refill and alcohol and substance use, and adherence to ART among female sex workers (FSWs) who are 15 years and older in Rivers and Cross Rivers states Nigeria. Data were abstracted from existing program data collected between January 2015 and December 2017 by Heartland Alliance International, Nigeria. Results from chi-square statistics showed that age, job/employment, and marital status were not associated with adherence to ART. Binary logistic regression analyses showed that respondents with senior secondary education were 1.385 times more likely to adhere to ART than other education levels (OR = 1.385, 95% CI = 1.203, 1.593). Respondents who had ARV refill in the facility were 1.737 times more likely to adhere to ART than respondents who had community ARV refill (OR= 1.737, 95% CI: 1.297, 2.326). Also, respondents who were a member of a support group were 6.430 times more likely to adhere to ART compared to those not in a support group (OR= 6.430, 95% CI: 4.682, 8.831). Lastly, respondents who did not abuse alcohol or substance were 1.820 times likely to adhere to ART compared to those who did (OR= 1.820, 95%: CI: 1.356, 2.444). All-inclusive key population policies could aid in lessening the barriers the FSWs face in receiving comprehensive health services as well as endorsing interventions such as alcohol and drug rehabilitation, counseling, and incentives to join peer support groups that could benefit FSWs, their clients, and families.

Nigeria is one of the countries most affected by the HIV/AIDS pandemic, third only to India and South Africa. With about 10% of the global HIV/AIDS cases estimated to be in the country, the public health and socio-economic implications are enormous. This thesis has two broad aims: the first is to develop statistical models which adequately describe the spatial distribution of the Nigerian HIV/AIDS epidemic and its associated ecological risk factors; the second, to develop models that could reconstruct the HIV incidence curve, obtain an estimate of the hidden HIV/AIDS population and a short term projection for AIDS incidence and a measure of precision of the estimates. To achieve these objectives, we first examined data from various sources and selected three sets of data based on national coverage and minimal reporting delay. The data sets are the outcome of the National HIV/AIDS Sentinel Surveillance Survey conducted in 1999, 2001, 2003 and 2005 by the Federal Ministry of Health; the outcome of the survey of 1057 health and laboratory facilities conducted by the Nigerian Institute of Medical Research in 2000; and case by case HIV screening data collected from an HIV/AIDS centre of excellence. A thorough review of methods used by WHO/UNAIDS to produce estimates of the Nigerian HIV/AIDS scenario was carried out. The Estimation and Projection Package (EPP) currently being used for modelling the epidemic partitions the population into at-risk, not-at-risk and infected sub-populations. It also requires some parameter input representing the force of infection and behaviour or high risk adjustment parameter. It may be difficult to precisely ascertain the size of these population groups and parameters in countries as large and diverse as Nigeria. Also, the accuracy of vital rates used in the EPP and Spectrum program is doubtful. Literature on ordinary back-calculation, nonparametric back-calculation, and modified back-calculation methods was reviewed in detail. Also, an indepth review of disease mapping techniques including multilevel models and geostatistical methods was conducted. The existence of spatial clusters was investigated using cluster analysis and some measure of spatial autocorrelation (Moran I and Geary c coefficients, semivariogram and kriging) applied to the National HIV/AIDS Surveillance data. Results revealed the existence of spatial clusters with significant positive spatial autocorrelation coefficients that tended to get stronger as the epidemic developed through time. GAM and local regression fit on the data revealed spatial trends on the north-south and east - west axis. Analysis of hierarchical, spatial and ecological factor effects on the geographical variation of HIV prevalence using variance component and spatial multilevel models was performed using restricted maximum likelihood implemented in R and empirical and full Bayesian methods in WinBUGS. Results confirmed significant spatial effects and some ecological factors were significant in explaining the variation. Also, variation due to various levels of aggregation was prominent. Estimates of cumulative HIV infection in Nigeria were obtained from both parametric and nonparametric back-calculation methods. Step and spline functions were assumed for the HIV infection curve in the parametric case. Parameter estimates obtained using 3-step and 4-step models were similar but the standard errors of these parameters were higher in the 4-step model. Estimates obtained using linear, quadratic, cubic and natural splines differed and also depended on the number and positions of the knots. Cumulative HIV infection estimates obtained using the step function models were comparable with those obtained using nonparametric back-calculation methods. Estimates from nonparametric back-calculation were obtained using the EMS algorithm. The modified nonparametric back-calculation method makes use of HIV data instead of the AIDS incidence data that are used in parametric and ordinary nonparametric back-calculation methods. In this approach, the hazard of undergoing HIV test is different for routine and symptom-related tests. The constant hazard of routine testing and the proportionality coefficient of symptom-related tests were estimated from the data and incorporated into the HIV induction distribution function. Estimates of HIV prevalence differ widely (about three times higher) from those obtained using parametric and ordinary nonparametric back-calculation methods. Nonparametric bootstrap procedure was used to obtain point-wise confidence interval and the uncertainty in estimating or predicting precisely the most recent incidence of AIDS or HIV infection was noticeable in the models but greater when AIDS data was used in the back-projection model. Analysis of case by case HIV screening data indicate that of 33349 patients who attended the HIV laboratory of a centre of excellence for the treatment of HIV/AIDS between October 2000 and August 2006, 7646 (23%) were HIV positive with females constituting about 61% of the positive cases. The bulk of infection was found in patients aged 15-49 years, about 86 percent of infected females and 78 percent of males were in this age group. Attendance at the laboratory and the proportion of HIV positive tests witnessed a remarkable increase when screening became free of charge. Logistic regression analysis indicated a 3-way interaction between time period, age and sex. Removing the effect of time by stratifying by time period left 2-way interactions between age and sex. A Correction factor for underreporting was ascertained by studying attendance at the laboratory facility over two time periods defined by the cost of HIV screening. Estimates of HIV prevalence obtained from corrected data using the modified nonparametric back-calculation are comparable with UN estimates obtained by a different method. The Nigerian HIV/AIDS pandemic is made up of multiple epidemics spatially located in different parts of the country with most of them having the potential of being sustained into the future given information on some risk factors. It is hoped that the findings of this research will be a ready tool in the hands of policy makers in the formulation of policy and design of programs to combat the epidemic in the country. Access to data on HIV/AIDS are highly restricted in the country and this hampers more in-depth modelling of the epidemic. Subject to data availability, we recommend that further work be done on the construction of stratification models based on sex, age and the geopolitical zones in order to estimate the infection intensity in each of the population groups. Uncertainties surrounding assumptions of infection intensity and incubation distribution can be minimized using Bayesian methods in back-projection.

In Nigeria, childhood tuberculosis (TB), a debilitating and deadly disease, is highly prevalent and case reporting is poor due to weak health systems. Globally, children account for at least 10 percent of the TB burden, yet they remain neglected in TB prevention and control efforts. Research studies integrating family and community-centered strategies have been recommended by stakeholders to address the paucity of current local prevention and management strategies for childhood TB. This observational cross-sectional study explored the relationship between caregivers’ quality of life (QOL), gender, and socioeconomic status (SES) and the incidence of TB in children aged 0–14 years. Using the abbreviated version of World Health Organization’s (WHO) QOL tool, the WHOQOL-BREF, data were collected individually in a face-to-face setting from caregivers (n = 47) whose children had been diagnosed with TB in Bauchi State, Northeastern Nigeria, over a 5-year period. Data were collected in the same manner from another set of caregivers of children without TB (n = 47) within the same period and setting. Results from logistic regression indicated a statistically significant relationship (p < .001) between the caregivers’ QOL and the occurrence childhood TB. However, the caregivers’ gender and SES were not significantly related to the incidence of childhood TB. This finding underscores the need to identify the factors that positively impact the QOL of caregivers of childhood TB cases. It also reflects the importance of integrating QOL interventions as part of TB control programs seeking to improve childhood TB reporting. This can mitigate the disease burden in vulnerable age-groups living in resource limited settings, thereby contributing to positive social change in the society.

Malaria is a mosquito transmitted tropical disease that accounts for more cases and deaths in Nigeria than in any other country worldwide. Globally malaria accounts for 300,000 deaths among young children and pregnant women annually. The promotion of the use of insecticide treated nets (ITNs) to reduce pregnant women's contact with mosquitoes has been the focus of malaria prevention efforts in Nigeria. However, the use of ITNs during pregnancy has been inexplicably low in Nigeria. A quantitative cross-sectional study was conducted to examine barriers to the utilization of ITNs among pregnant women in rural Nigeria. The social ecological model was utilized to analyze secondary data from a 2015 survey conducted in Nigeria in which 4,834 pregnant women between 15 to 49 years of age participated. The relationship between the use of ITNs and the knowledge of ITNs, traditional medicine, education, and family income was examined using multiple logistic regression modeling. Results showed that there was a significant relationship between the knowledge of ITN (p = 0.000), family income (p = 0.000), education of pregnant women (p = 0.000) and the use of ITN among pregnant women in rural Nigeria. However, there was no relationship between the use of traditional medicine (p = >0.5), and the use of ITN, perhaps because most of the women surveyed did not respond to the question about use of traditional medicine. Results of the study have important implications for positive social changes among pregnant women in Nigeria. These findings will inform strategies to increase the uptake of ITNs during pregnancy in Nigeria, improving birth outcomes, increasing maternal and child survival, and decreasing the economic burden due to malaria morbidity and mortality in rural Nigeria.

Sexual activity among unmarried adolescents is a major public health problem in Nigeria, because unmarried pregnant girls are more likely to have multiple sex partners and are less likely to use contraceptives, putting them at greater risk for sexually transmitted diseases (STD), unplanned pregnancy, abortion, social isolation, and poverty. Teen pregnancy and STD rates are on the rise in Nigeria, yet few data exist on the experience of the adolescents themselves. This phenomenological study was designed to explore the in-depth experiences of 10 pregnant, unmarried adolescent girls aged 16-19, including the factors contributing to their sexual activity. An ecological model served as the conceptual framework to permit individual experiences to be understood in their social and ecological context. Semistructured interviews and Hycner's method of analysis were used to collect and analyze the data. Results showed that the decision to initiate sexual activity among these girls was influenced by many factors, including: the need for financial support and a socially condoned system of "sugar daddies" who support girls in return for sex; peer pressure to have a sex partner; a romantic knowledge of sexual behavior based primarily on the mass media; and inadequate sex education. As a result of their pregnancy, the girls experienced negative reactions from their families and community, and serious psychological and financial concerns about their prospects for future marriage and their child's identity. A comprehensive community-based reproductive health program is called for, with reliable sex education, cooperation from the mass media, and support from family and community members. The social change implication of this study is to potentially lead to a decrease in unplanned pregnancy, STDs, social isolation, and poverty among adolescent girls in Nigeria.

This is a two-stage study of HIV/AIDS prevention. In Stage One, the study examines the HIV/AIDS approach of Western aid organisations (INGOs) and compares it to the lived realities of people who are most 'at risk', sex workers, unemployed street youth, and married low income families, in the poor migrant community of Ajegunle in Nigeria�s Lagos state. The study found that INGOs and their client NGOs emphasised Western medical models of HIV/AIDS for both intervention (e.g. testing and ARV drugs for management) and prevention (e.g. through education and behaviour change). In contrast, among 'at-risk' groups, the study revealed a high degree of knowledge about the transmission of HIV/AIDS (contrary to Western medical assumptions), but also detected strong feelings of powerlessness in being able to address it. INGOs and their client organisations were operating at the levels of tertiary or curative and secondary or behaviour change prevention, whereas the views of the local 'at-risk people' indicated relevance of the primary prevention level, the social structural conditions of the people. In analysing the results of the first stage of the study, the findings identified a process of 'talking past each other' by official aid agencies and those most at risk, thereby inhibiting effective prevention. The INGOs and NGOs used their financial power, based on the gross inequality in the world distribution of resources, to dictate their own agendas, omitting primary intervention and instead concentrating on secondary and tertiary prevention. The study suggests that new thinking about multi-sectoral responses with full community participation is necessary in order to engage in more effective preventive action. The study then sought out alternative sources of power that might permit that to happen, notably the strengths of the local Ajegunle community. As a poor community, they lacked financial resources and human capital, such as skilled workers, but they had significant knowledge capital about their own circumstances and the realities people faced. The community also had considerable cultural capital and local organisations with considerable relational capital around community links, broad based support and commitment to such action. This analysis suggests the need to identify and work through the power differentials using community development processes, especially seeking to empower local communities to take part in decision-making over prevention, if effective action is to take place. The process required is one of a negotiated, inclusive partnerships for sharing information, experience, and decision-making, involving all the relevant stakeholders - the International Organisations (INGOs), National NGOs, Community Groups and the community itself.

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Bachelors
Health and Public Affairs
Legal Studies

Access to primary medical care and prevention services in Nigeria is limited, especially in rural areas, despite national and international efforts to improve health service delivery. Using a conceptual framework developed by Penchansky and Thomas, this case study explored the perceptions of community residents and healthcare providers regarding residents' access to primary healthcare services in the rural area of Isu. Using a community-based research approach, semistructured interviews and focus groups were conducted with 27 participants, including government healthcare administrators, nurses and midwives, traditional healers, and residents. Data were analyzed using Colaizzi's 7-step method for qualitative data analysis. Key findings included that (a) healthcare is focused on children and pregnant women; (b) healthcare is largely ineffective because of insufficient funding, misguided leadership, poor system infrastructure, and facility neglect; (c) residents lack knowledge of and confidence in available primary healthcare services; (d) residents regularly use traditional healers even though these healers are not recognized by local government administrators; and (e) residents can be valuable participants in community-based research. The potential for positive social change includes improved communication between local government, residents, and traditional healers, and improved access to healthcare for residents.

Secondary school students in Nigeria face challenges regarding their oral health. Few researchers have investigated oral health knowledge, attitudes, and behaviors in Nigerian populations. The purpose of this study was to assess the level of oral health knowledge, behaviors, and practices among secondary school students in Enugu State, Nigeria, in relation to their oral health status. The theoretical framework of this study was based on the health belief model. A cross-sectional study was conducted to collect data from 12 secondary schools in Enugu State, using a close-ended questionnaire as well as oral examination (dental caries and periodontal diseases) of the students who attended junior secondary (JSS) I, II, and III classes. A total stratified sample of 671 students was included in the study. Bivariate nonparametric tests and logistic regression were used to analyze the data. According to the results of the study, the levels of dental caries and periodontal diseases were relatively low. However, only one fourth of the students had received professional fluoridation, and almost 50% of the participants had never visited a dentist. Students from a missionary school had lower levels of periodontal diseases than those from public schools, with an odds ratio of 0.612 (95% CI [0.402, 0.934]). Students from JSS III class tended to have a lower level of periodontal diseases than those of JSS I class (OR: 0.567, 95% CI [0.363, 0.886]). The social change implications of this study can be the development and incorporation of oral health promotion programs into the school curriculum. These programs may increase the adoption of preventive oral health strategies by students, such as regular dental attendance, to maintain their good oral health for a life time.

Meningitis and cholera have remained major health burden in Nigeria, especially in the heavily populated northwest region – which is identified as one of the “hotspots” of climate change. The strong sensitivity that both diseases exhibit to climate is raising concern that future anthropogenic climate change may exacerbate the occurrence of the diseases. This thesis aimed at modelling the influences of climate on the incidence of the selected diseases, and assessing their future risk in northwest Nigeria. The aim is achieved by first, investigating and understanding the spatial and time characteristics of both meteorological and diseases conditions in the region. This was followed by developing and validating suites of empirical statistical models capable of explaining and predicting both diseases. Models that are specifically designed for climate change studies were applied to estimate the future impact of climate change, by forcing them with simulations from an ensemble of statistically downscaled Atmosphere-ocean Global Climate Models (AOGCMs), for three different scenarios in the early and late 21st century. Results from developed models indicate the significant roles of both meteorological and socioeconomic factors on incidence of diseases. Evaluation of models developed with 1-month lagged explanatory variables suggest the potential to predict both diseases cases up to a month to aid decision making. Projection results suggest that future temperature increases due to climate change has the potential to significantly increase diseases cases in all scenarios and time slices. It is noteworthy that the projections result represents only the climatological potential for increased cases due to climate change, assuming that the present prevention strategies remain similar in the future.

Type 2 diabetes is a complex metabolic disorder characterized by hypoglycemia or hyperglycemia that affects fat, protein, and carbohydrate metabolism. Researchers have identified that for individuals with Type 2 diabetes, staying on interventions for diabetes self-management is sometimes difficult and challenging. It is an increasing public health concern, especially in certain minority populations and in many developing and developed nations. This is especially true for the population of women 40 years and older in Mgbidi, Nigeria. In the Enugu State of Nigeria, women bear most of the burden of Type 2 diabetes when compared to the males in the state. This study explored and evaluated the impediments to self-managed Type 2 diabetes among Mgbidi women in the Enugu State of Nigeria, West Africa, using a qualitative phenomenological approach. The concept of impediments influencing cultural behavior was used as the guiding framework. The participants were a group of 9 women 40 years and older who live with Type 2 diabetes. Face-to-face in-depth structured and unstructured interviews were used for the data collection. The responses of the participants were recorded using a tape recorder with their consent. Their responses were analyzed using aspects of Hycner's and Colaizzi's approach for analyzing phenomenological data. The result of this study supported and expanded on the findings of the current literature review. Individual and social challenges and barriers came to light; such as lack of or non-functioning care centers, lack of diabetes related education, and misconceptions like ignorance, social support and medications behaviors. The use of the concept of impediments influencing culturally sensitive self-management behavior of type 2 Diabetes strengthened the study. The findings could help to enhance cultural sensitive diabetes education for this population and other populations who have diabetes in this community.

Caregivers' compliance with polio vaccine regimens and timely receipt of the recommended 4 doses of polio vaccine are pivotal to eliminating polio. This cross sectional study, conducted in Lagos State, Nigeria, examined polio vaccine compliance and demographic attributes of caregivers' for statistically significant associations. Using an adapted health belief model theoretical framework, 1,200 participants were recruited from well-baby clinics in 8 local government areas in Lagos State. Participants completed a brief demographic survey providing data on caregivers' age, gender, residence (rural or urban), and their level of education as well as records from their children's immunization cards. Data obtained were tested for associations between caregiver's demographic information and their children's receipt of polio doses within specified timelines using chi-square and logistic regression analysis. Fisher's exact analysis were conducted for variables with frequencies less than 5. The only significant association recorded was between the receipt of Polio Dose A and location of caregivers' residence: Rural dwelling caregivers were less likely to receive the first dose of polio. Results showed Polio Dose D to be the dose most likely received in an untimely manner as well as most likely missed of the 4 doses. Logistic regression analysis did not show any variable to be of greater odds in predicting completion of the 4 doses or compliance with timelines of their receipt. Study's results may inspire polio program planners to develop interventions that broaden the immunization coverage for rural dwellers to include nontraditional maternity locations. Positive social change will ensue by the improvement caregivers' compliance with full polio dose receipts with timelines, maximizing immunity.

Confidentiality is considered an integral component of medical practise, yet there has been debate within the medical community as to whether there should be exceptions to the obligation to protect patient’s confidences. In the cases involving medical patients with deadly sexually transmittable disease like HIV/AIDS, physicians feel caught between two basic principles – keeping of medical confidentiality and public safety. Bioethicists would favour breaking of confidentiality when the public safety and the life of someone are endangered. However, considering the complexities and discrimination in connection with HIV/AIDS in Nigerian context, many would be tempted to discourage the notification of partners who risk being infected, through the moral obligation of 'duty to warn', but some others would argue that not notifying people of such threat to life would only help in spreading the virus to ignorant partners of an index patient. I argued that there is an overridden utilitarian principle to save others from harm, but some others cite the negative effects the breaking of medical confidentiality would have on the healthcare system as a reason not to favour partner notification. Nevertheless, people would appreciate the value of breaching confidentiality in HIV/AIDS related cases when various forms of discrimination and stigmatisations are criminalised and policies to protect the fundamental rights of people living with HIV/AIDS (PLWHA) are strictly adhered to.

Policies mandating HIV status disclosure to decrease incidence create ethical challenges for physicians on whether to breach or maintain infected patients' confidentiality. In Sub-Saharan Africa where HIV incidence is high, there is a need for clear guidelines/policies on making confidentiality decisions. The purpose of this quantitative quasi experiment was to determine whether the gender, gender orientation, and sexual relationship of an infected patient and physicians' demographics predicted physicians' decisions to breach confidentiality. In Plateau State, Nigeria, 222 physicians were given vignette questionnaires containing 6 different descriptions of gender, gender orientation, and sexual relationships of a hypothetical patient. Each physician decided to maintain or breach a patient's confidentiality in a variant. The utilitarian framework was applied, and data were analyzed using logistic regression models. A majority of the participants (70%) indicated a breach by directly informing sex partners or informing or referring to the health department. Only physicians' feature of previous confidentiality breach significantly predicted the decision to breach [p =.028, Exp (B) =.1.345, 95%CI (1.032, 1.753)]. The results suggested that regardless of patients' characteristics, physicians will breach confidentiality to protect sex partners potentially at risk of HIV infection. These findings may bring about positive social change by clarifying reasons for physicians' breach decisions, by informing the development of physicians' decision guidelines that would enhance physicians' practices in managing discordant couples, which could reduce HIV transmission among discordant couples leading to better and longer lives.

The custom of female genital mutilation/cutting (FGM/C) is a traditional practice inimical to women's health with profound implications. There is a gap in the literature on the lived experiences of women who have undergone FGM/C and their statuses within their communities. Guided by the social cognitive theory and the ecological model, this qualitative study aimed at explicating the attitudes and perceptions of women in the northwest region of Nigeria towards the practice of FGM/C, to illuminate how the women view themselves in their society and the inspiration for the continued practice of FGM/C. Interview and observation data were gathered from 10 women, ages 18 to 59 who had undergone FGM/C. Participants were voluntarily recruited using purposeful snowball sampling techniques. Data were analyzed through inductive coding techniques to extract and compare recurrent themes and patterns. Four major themes emerged: (a) traditional beliefs; (b) pain, happy, and approval; (c) pain, distress, and disapproval; and (e) ignorance of the law. Results indicated that ethnocultural beliefs, religion, and customs had a strong influence on the decision to undergo FGM/C. Women who viewed themselves as heroes of the practice strongly supported the continuation of FGM/C. The women who viewed themselves as victims of FGM/C disapproved the practice as an instrument to instill fear and control. The potential for social change could improve the knowledge of public health professionals, international organizations, federal, state, and local governments to influence policies on decreasing FGM/C without undermining the culture of communities regardless of any personal belief that sees FGM/C as detrimental to women.

Maternal mortality, an example of poor maternal health outcomes, is widely accepted as an indicator of the overall health of a population. One of the Millennium Development Goals was reduction in maternal mortality by 3 quarters by 2015. These goals were not met in Nigeria and it is important to look at some of the reasons why. Education has been shown to have positive impact on pregnancy outcomes; however, the characteristics of pregnant women, their health literacy level, their usage of antenatal care services and how these impact pregnancy outcomes are yet to be analyzed in Lagos, Nigeria. Guided by the social cognitive theory and health belief model, the purpose of this cross-sectional quantitative study was to determine if there is a relationship between maternal health literacy, antenatal care visits, development of medical conditions during pregnancy, and pregnancy outcomes (measured by healthy or unhealthy baby) in Lagos, Nigeria. The research question for this study tested if there was a relationship between these variables. Lisa Chew's health literacy assessment tool was used in a sample of 130 women in Shomolu local government in Nigeria who met the inclusion criteria. Using binary logistic correlations, only problems developed during pregnancy is statistically significant with pregnancy outcomes (p < .05). The results suggested an increase in problems developed during pregnancy most likely will increase the chance of having negative pregnancy outcomes. Results from this study could promote positive social change by helping health professionals identify the characteristics of at-risk women during antenatal education sessions. The results could also help health professionals in the development of targeted antenatal care interventions.

Secondary school students in Nigeria face challenges regarding their oral health. Few researchers have investigated oral health knowledge, attitudes, and behaviors in Nigerian populations. The purpose of this study was to assess the level of oral health knowledge, behaviors, and practices among secondary school students in Enugu State, Nigeria, in relation to their oral health status. The theoretical framework of this study was based on the health belief model. A cross-sectional study was conducted to collect data from 12 secondary schools in Enugu State, using a close-ended questionnaire as well as oral examination (dental caries and periodontal diseases) of the students who attended junior secondary (JSS) I, II, and III classes. A total stratified sample of 671 students was included in the study. Bivariate nonparametric tests and logistic regression were used to analyze the data. According to the results of the study, the levels of dental caries and periodontal diseases were relatively low. However, only one fourth of the students had received professional fluoridation, and almost 50% of the participants had never visited a dentist. Students from a missionary school had lower levels of periodontal diseases than those from public schools, with an odds ratio of 0.612 (95% CI [0.402, 0.934]). Students from JSS III class tended to have a lower level of periodontal diseases than those of JSS I class (OR: 0.567, 95% CI [0.363, 0.886]). The social change implications of this study can be the development and incorporation of oral health promotion programs into the school curriculum. These programs may increase the adoption of preventive oral health strategies by students, such as regular dental attendance, to maintain their good oral health for a life time.

The 2003 to 2004 revolt against the Oral Polio Vaccine (OPV) in Nigeria provides a case study for investigating how a new scientific phenomenon becomes part of common sense in a culture with high levels of religiosity. Moscovici’s Social Representations Theory about how society familiarises itself with the unfamiliar provides a framework for the research which includes two media analyses, historical texts, online and paper administered surveys and interviews. The media analyses examine the OPV controversy and science in the media. Correspondence analysis provides a geometric tool for visualising how the variables in both media analyses position themselves for the construction of genres of science news. Factor analysis groups the attitude items in the survey while logistic regression predicts outcomes controlling for other variables. The media analyses found coverage of science in the period under review was generally positive and grew continually. The coverage of the OPV controversy was also generally positive but did not always mirror faithfully public opinion. Just as some Parisians in Moscovoci’s study likened psychoanalysis to a “symptom of an American invasion”, the initial description of the OPV by the people of northern Nigeria was a “western conspiracy against Muslims.” The survey found different levels of trust in public institutions with scientists and religious leaders similarly rated. Pessimism, fear and progress characterise the attitude variables but the association with knowledge is not linear and confirms the influence of cultural values. Interviewees also confirm survey findings in that they simultaneously have faith in religion and in science. Common sense in Nigeria is a mixture of science and religiosity and the public hold both in reverence: a phenomenon Moscovici refers to as cognitive polyphasia. The study also supports Durkheim’s view that science (in Nigeria) depends on public opinion.

Globally, the implementation of environmental change strategies, such as smoke-free policies, has been found to reduce exposure to secondhand smoke (SHS) among women and children (Faber, Been, Reiss, Mackenbach, & Sheikh, 2016). However, implementation of such strategies in Nigeria must first be supported by data indicative of need and feasibility within the local community. In this cross-sectional descriptive study, the self-efficacy construct was used as a theoretical framework to explore the self-efficacy and support for environmental change strategies among pregnant and non-pregnant women living in Kaura Namoda, Nigeria. A self-administered questionnaire survey was adapted and completed by 300 women (age 18 – 67 years) in August 2016. Descriptive statistical analyses and logistic regression were performed. The non-pregnant respondents (47%) reported greater self-efficacy in reducing children’s exposure to SHS than the pregnant respondents (53%). Among the pregnant respondents, higher self-efficacy was predictive of the support for the following environmental change strategies: smoke-free cars (OR = 4.18, 95% CI [2.25, 7.77]), smoke-free homes (OR = 1.69, 95% CI [1.14, 2.52]), smoke-free indoor public places (OR = 2.40, 95% CI [1.53, 3.76]), and smoke-free outdoor public places (OR = 1.60, 95% CI [1.09, 2.34]). However, self-efficacy was only significantly different on the demographic variable of the decision maker at home (F (2, 246) = 10.87, p < 0.001). These findings support the promotion of self-efficacy among pregnant women and the implementation of smoke-free policies in Nigeria. More research is also needed to fully understand the contextual factors that promote self-efficacy in reducing exposure to SHS in Nigeria.

Efforts by the Federal Republic of Nigeria and international nongovernmental agencies to reduce the impact of HIV in Nigeria have not yielded the anticipated results. This study focused on the association between attitude, religious beliefs, knowledge of HIV, sexual risk behavior, and HIV epidemiology in rural and urban Nigeria. This quantitative study used social-cognitive theory and problem theory. The study was based on the Nigerian Demographic and Health Survey (NDHS) 2013 data including a sample of 33,006 participants. Specific covariates including gender, sexual partners over the past years, age at first sexual encounter, socioeconomic status, and literacy level were obtained from the sample. Two hypotheses from each research question were tested to guide the study methodology. Linear regression results suggested that knowledge, attitude, location, and religion predicted sexual risk behavior. Muslims showed the least sexual risk behaviors compared to other religions while more positive attitudes and more knowledge increased sexual risk behaviours. Location had no significant impact on sexual risk behavior. Spearman correlation results depicted a relationship between knowledge and sexual risk behaviors of urban and rural Nigerians separately. More knowledge depicted an increase in sexual risk behaviors. The study results may be useful to Ministry of Health and program planners in constructing culturally based HIV interventions. The significant relationship between knowledge, attitude towards sex, and religious practices may be incorporated with theoretical knowledge on social-cognitive variables to enhance further understanding of the way in which individuals may engage in preventive behaviors to reduce HIV and its effects in Nigeria. Reductions in the spread of HIV/AIDS would lead to a healthy and more productive society.

From 2004 to 2015, the health sector in Nigeria was substantially underfunded despite the existence of a federal health policy committing 15% of the national budget to health care financing. The purpose of this narrative and phenomenological study was to explore the nature and significance of economic claims made in this policy. The central research question examined the extent to which these economic claims were perceived to be realistic, attainable, and successful in meeting their intended policy objectives and impact. The study's conceptual framework combined Kingdon's ambiguity and multiple streams theory, Roe's narrative policy analysis, and Skocpol's policy feedback theory. Seventeen major health policy documents and transcripts from key informant interviews with a convenience sample of 15 representative health policy experts, were imported into a data software. Twenty-six nodes were identified and then manually organized into 3 themes to generate the findings. Policy experts perceived the 147 economic claims in the policy documents as marginally realistic, and a majority of these experts assessed the claims as unattainable and with limited chance of succeeding in addressing the underfunding of Nigeria's health sector. The study opened a new area of research inquiry in health policy and health care financing by linking the veracity of economic claims made in the national health policy with the actual financing of health care. Health policy experts can use study results to promote the formulation and use of evidence-based economic claims in future health policies. Increased use of specific, measurable, attainable, realistic, and time-bound economic claims will enhance future health policy contributions to human wellbeing and positive social change.

This dissertation provides an analysis and evaluation of factors influencing states to enact inpatient health care transparency laws between 1971 and 2006 inclusive, using event history analysis. The primary research question investigates "What factors influence a state legislature to enact a health care transparency law?" To narrow the scope of study, I focus on factors influencing states to enact health care transparency laws to collect and publicly report inpatient data.

The Unified Model of State Policy Innovation, developed by F.S. Berry and W.D. Berry (1990, 1999), provides the framework for the study hypotheses and the analysis of inpatient health care transparency law enactments by states. The Unified Model of State Policy Innovation posits a unified explanation for state policy adoptions. The model unifies the internal determinants and regional diffusion approaches of analysis for state policy adoption.

This study tests eight hypotheses using event history analysis (EHA). EHA is an analytical technique that allows for the testing of a state government innovation theory that incorporates internal determinants and regional influences on state policy adoption. Although there are numerous methods to conduct event history analysis, this study uses the Cox proportional hazards model (also known as Cox regression). Cox regression is a popular method for studying time-to-event data for policy adoption and diffusion studies. This study's quantitative analysis provides support for legislative ideology and unified party control of state government acting as factors influencing inpatient health care transparency law enactments by states. Additionally, the health care crisis and neighbors variables were statistically significant, but in an opposite direction than predicted.

The findings of this research suggest that state adopters of an inpatient health care transparency law are more likely to enact an inpatient health care transparency law when the state government is increasing in liberalism and when unified political party control of the governor and the governorship of both houses of the state legislature is increasing.

To generate new insights into the enactment of inpatient health care transparency laws, I conduct a case study of a national health care data professional association using several techniques, including telephone interviews. The qualitative analysis provides support for professional associations and policy champions as diffusion agents for inpatient health care transparency law enactments by states.

This dissertation supports variables traditionally used in policy adoption research including legislative ideology and unified political party control in state government. However, it will be interesting to see whether internal determinants such as professional associations gain traction over the traditional regional diffusion influences such as states sharing borders as factors influencing state policy adoption. Meanwhile, as evidenced in this study, there continues to be support for a model incorporating both internal and regional influences to explain policy adoption by states. The theory of policy innovation and diffusion to predict the factors influencing the spread of policies and the use of Berry & Berry's (1990, 1999) Unified Model of State Policy Innovation prosper as their applicability to numerous public policy areas, including health care, are continually demonstrated. Similarly, event history analysis and specifically the Cox regression method continue to gain support as their value as analytical methods and appropriateness for use in public policy studies is repeatedly demonstrated.

The outlook for the future of the health care transparency movement looks promising. The health care transparency movement promotes improved access to information, patient empowerment, improved patient safety and quality of care, improved provider accountability, and lower health care costs. This movement is not a fad, but rather a permanent change being implemented in all health care settings across the United States. Improved health through reliable, accessible data and data-supported decisions is increasingly becoming the norm and less an idealistic scenario to be realized in the distant future.

Despite the ongoing investments in programs to increase sexual health awareness among young adults globally, many youths remain vulnerable to sexually transmitted diseases (STDs). Two-thirds of all STDs occur among youths engaging in high-risk sexual behaviors, which put young adults at higher risk of STDs and can result in serious consequences including infertility. Additionally, the social consequences of STD affect families and communities. While a need exists for increased public awareness of STDs among young adults, extant intervention and prevention activities should be informed by a cultural perspective, including the integration of community and government roles. The purpose of this social ecological study was to investigate the perceptions of STDs and the potential factors responsible for the increased frequency of STDs based on the lived experiences of 20 young adults with STDs in Akwa Ibom State, Nigeria. Through a qualitative approach using a phenomenological research design, this study employed semi-structured interviews, and the resultant data were analyzed and coded. The findings indicated that college-aged students increasingly engaged in sexually risky behavior with multiple sexual partners for financial gain and power. Additionally, while institutions promoted abstinence as an effective strategy to reduce STD infections, the findings indicated a strong relationship between the phenomenon and individual interconnectedness with the larger society. Because the sexual behavior of young adults in Akwa Ibom State, Nigeria, is influenced at multiple ecological levels, effective and sustaining culturally appropriate STD interventions must involve the larger society including young adults in all stages of intervention development and implementation.

Philosophiae Doctor - PhD
Over the last two decades, budgetary allocations to both the Health and Education sectors have been on the increase in Nigeria, while a counter-factual feedback on its effects for various economic groups and distributional effect for different population households has not been defined and well known. The resultant effect has been gross inefficiency and sub-optimality in terms of observed outcomes of the fiscal framework. In-addition, there have been a continuous quest by the citizenry for increased allocations to these sectors because of its supposed impact on the poverty index and standard of living. Although this is a compelling reason, but what is worrisome and equally troubling, is that the increasing incidence of poverty and expanding inequality in the Nigerian society have not mitigated, despite the scaling up of funding on the social sectors. Furthermore, the current level of socioeconomic development in Nigeria is not in tandem with the distributive outcome targets set by the 2004 reforms. Thus, understanding the current structure of poverty in Nigeria as well as beneficiaries of public sector spending provides a sound basis for tackling inequality and redesigning the current pro-poor frameworks. However, our analysis is focused on the distributional spread of beneficiaries from services and the counterfactual reciprocity of expenditure benefits rather than measuring the exact value to recipients of government-sponsored services. Our research methodology used the 2004 Nigerian Living Standard Survey; 2010 Harmonized Nigerian Living Standard Survey; Recent Cros-sectional data (2014) in South East Nigeria and secondary sources. Econometric methods (Error Correction Method); Marginal Odds estimation techniques, Concentration Curves and Ordered Logistic Regression were used for our analysis. Statistical and Econometric Software’s (E-Views; SPSS; DAD and STATA) were used for estimations. Econometric results showed misalignments between population dynamics and public sector expenditure on education, health and economic services. The government consumption expenditure was not sensitive to demographic changes. The derived adjustment coefficients of -1.38, -1.51 and 0.51 respectively, for education, health and economic services indicate huge gaps in terms of what optimal spending should have been, giving the population dynamics. Our benefit incidence analysis indicates that substantive gains have been made at the primary education and health care level, at the state level for SE Nigeria but there is a gross misapplication of funds at the secondary and tertiary levels of both education and health sectors. Results show that the state governments’ is subsidizing the rich at the levels of both secondary and tertiary for education and health care. In addition, country wide results indicate that apart from public primary education and health care for urban residents, no other level of social service was absolutely progressive in general terms, by gender or by location while the tertiary level of both services were regressive as shown by the 2010 survey results, in comparism to the 2004 survey results. Using the Ordered Logistic Regression, our result inclines to the lifecycle hypothesis which maintains that poverty oscillates depending on the age. At a younger age, it tends to be on the high side and decreases during the middle ages and increases with age. Our results discards the feminization of poverty general framework that women or female headed households are more prone to poverty due principally to low education and lack of opportunity to own assets such as land amongst others. This wasn’t the case for the South East Region of Nigeria. Estimates indicate that education status, health status and access to health facilities affected the category of welfare of head of households and invariable, the entire household. In general, our analysis shows misalignment of social expenditure for various population groups, both at the federal and state levels; making doubtful the realization of basic MDGs. Nigeria has to combine growth policies and assuring that demographics count, with the poor fully participating in economic development. Also, the need for a refocusing in resource allocation taking into cognizance gender dimensions cannot be overemphasized. A general re-allocation of spending going to females and the poorer households would lead to improvement in gender equality and health status of women and children. Expediting actions towards qualitative education will lead directly to an acceleration of many of the other MDGs, especially those focusing on the reduction of poverty and inequality. To attain MDG targets (post 2015) within a shorter period of time, there is the need to improve the quality of social infrastructure and services. Furthermore, research should be focused on improving knowledge and understanding of what policies, technologies and investments matter for sustained growth in the country. This will create the much needed multiplier effect on other aggregates. The degree to which the poor participate in the growth process and share in its proceeds matter; both in the pace and pattern of growth. It is therefore important to have categorization of the population into economic groups when formulating a developmental framework for poverty reduction programmes. The study recommends sequencing of interventions, strengthening of institutions and other several interrelated areas to attain effectiveness of public sector spending.