High-risk fertility behaviors and associated factors among married reproductive-age women in sub-Saharan Africa: A multilevel mixed-effect analysis of nationally representative data from 35 countries.

BACKGROUND: Although high-risk fertility behaviors are linked with poor maternal and child health outcomes, their prevalence remains higher in resource-limited countries and varies significantly by context. Evidence on the recent estimates of these fertility risks at the sub-Saharan Africa level is limited. Therefore, this study aimed to examine the pooled prevalence of high-risk fertility behaviors and associated factors among married women in this region. METHODS: Data from DHS of 35 sub-Saharan African countries were used and a weighted sample of 243,657 married reproductive-age women were included in the analysis. A multilevel binary logistic regression models were fitted and the final model was selected based on the log-likelihood and deviance values. A p-value less than 0.05 and an adjusted odds ratio with a corresponding 95% confidence interval were used to identify the factors associated with high-risk fertility behaviors. RESULTS: The pooled prevalence of high-risk fertility behaviors among women in sub-Saharan Africa was 77.7% [95% CI = 77.6%-77.9], where 43.1% [95% CI: 42.9%-43.3%], and 31.4% [95% CI = 31.2%-31.6%] had a single risk and combination of two or three fertility risks, respectively. The highest level of single-risk fertility pattern was observed in Burundi (53.4%) and Chad had the highest prevalence of both at least one (89.9%) and multiple (53.6%) fertility risks. Early and polygamous marriages, low maternal and husband education, poor wealth index, unmet need for contraception, couple's fertility discordance, rural residence, high community-level early marriage practice, and low community-level women empowerment were associated with risky fertility behaviors. CONCLUSIONS: More than three-quarters of married women in SSA were engaged in high-risk fertility behaviors, with significant variations across the included countries. Therefore, addressing the modifiable risk factors like improving access to need-based contraceptive methods and empowering couples through education for a better understanding of their reproductive health with particular attention to rural settings are important in reducing these fertility risks. The results also suggest the need to strengthen the policies regulating the prohibition of early and polygamous marriages.

Factors influencing HIV testing uptake in Sub-Saharan Africa: a comprehensive multi-level analysis using demographic and health survey data (2015-2022).

BACKGROUND: Human Immunodeficiency Virus (HIV) is a global health concern, causing over 35 million deaths, with 97% occurring in developing nations, particularly impacting Sub-Saharan Africa. While HIV testing is crucial for early treatment and prevention, existing research often focuses on specific groups, neglecting general adult testing rates. This study aims to identify predictors of HIV testing uptake among adults in Sub-Saharan Africa. METHOD: Data were obtained from the official Demographic and Health Survey program database, which used a multistage cluster sampling technique to collect the survey data. In this study, a weighted sample of 283,936 adults was included from thirteen Sub-Saharan African countries. Multilevel multivariable logistic regression analysis was employed to identify predictors of HIV testing uptake. Akaike's information criteria guided model selection. Adjusted odds ratios and corresponding 95% confidence intervals determined significant predictor variables. RESULT: Among adults in Sub-Saharan African countries, the prevalence of HIV testing uptake was 65.01% [95% CI (64.84%, 65.17%)]. Influential factors included male sex [AOR: 0.51, 95% CI (0.49,0.53)], varying odds ratios across age groups (20-24 [AOR: 3.3, 95% CI (3.21, 3.46) ], 25-29 [AOR: 4.4, 95% CI (4.23, 4.65)], 30-34 [AOR: 4.6, 95%CI (4.40, 4.87)], 35-39 [AOR: 4.0, 95%CI (3.82, 4.24)], 40-44 [AOR: 3.7, 95%CI (3.50, 3.91)], 45-49 [AOR: 2.7, 95%CI (2.55, 2.87)], 50+ [AOR: 2.7, 95%CI (2.50, 2.92)]), marital status (married [AOR: 3.3, 95%CI (3.16, 3.46)], cohabiting [AOR: 3.1, 95% CI (2.91, 3.28)], widowed/separated/divorced [AOR: 3.4, 95%CI (3.22, 3.63)]), female household headship (AOR: 1.28, 95%CI (1.24, 1.33)), education levels (primary [AOR: 3.9, 95%CI (3.72, 4.07)], secondary [AOR: 5.4, 95%CI (5.16, 5.74)], higher [AOR: 8.0, 95%CI (7.27, 8.71)]), media exposure (AOR: 1.4, 95%CI (1.32, 1.43)), wealth index (middle [AOR: 1.20, 95%CI (1.17, 1.27)], richer [AOR: 1.50, 95%CI (1.45, 1.62)]), Having discriminatory attitudes towards PLWHIV [AOR: 0.4; 95% CI (0.33, 0.37)], had multiple sexual partners [AOR: 1.2; 95% CI (1.11, 1.28)], had comprehensive knowledge about HIV [AOR: 1.6; 95% CI (1.55, 1.67)], rural residence (AOR: 1.4, 95%CI (1.28, 1.45)), and lower community illiteracy (AOR: 1.4, 95%CI (1.31, 1.50)) significantly influenced HIV testing uptake in the region. CONCLUSION: This study highlights the need for tailored interventions to address disparities in HIV testing uptake among adults in Sub-Saharan Africa and progress towards the achievement of 95-95-95 targets by 2030. Thus, tailored interventions addressing key factors are crucial for enhancing testing accessibility and emphasizing awareness campaigns, easy service access, and targeted education efforts to improve early diagnosis, treatment, and HIV prevention in the region.

Geospatial determinants and spatio-temporal variation of early initiation of breastfeeding and exclusive breastfeeding in Ethiopia from 2011 to 2019, a multiscale geographically weighted regression analysis.

BACKGROUND: Breastfeeding offers numerous benefits for infants, mothers, and the community, making it the best intervention for reducing infant mortality and morbidity. The World Health Organization (WHO) recommends initiating breastfeeding within one hour after birth and exclusively breastfeeding for the first six months. This study investigated the trend, spatio-temporal variation, and determinants of spatial clustering of early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) in Ethiopia from 2011 to 2019. METHODS: Data from the Ethiopian Demographic and Health Survey (EDHS), which was conducted in 2011, 2016, and 2019, were analyzed utilizing a weighted sample of 10,616 children aged 0-23 years for EIBF and 2,881 children aged 0-5 months for EBF. Spatial autocorrelation analysis was used to measure whether EIBF and EBF were dispersed, clustered, or randomly distributed and Kriging interpolation was employed to predict the outcome variables in the unmeasured areas. Spatial scan statistics were used to identify spatial clusters with a high prevalence of cases. Both global and local regression modeling techniques were employed to examine the spatial relationships between the explanatory variables and the dependent variables. RESULTS: The trend analysis revealed a notable increase in the prevalence of EIBF from 51.8% in 2011 to 71.9% in 2019. Similarly, the prevalence of EBF increased from 52.7% in 2011 to 58.9% in 2019. Spatial analysis demonstrated significant spatial variation in both EIBF and EBF throughout the country. Cold spots or clusters with a low prevalence of EIBF were observed consistently in the Tigray and Amhara regions, and significant cold spot areas of EBF were observed consistently in the Afar and Somali regions. Multiscale geographically weighted regression analysis revealed significant predictors of spatial variations in EIBF, including the religious affiliation of being a follower of the orthodox religion, parity of 1-2, absence of antenatal care visits, and delivery via cesarean section. CONCLUSIONS: Despite the increase in both EIBF and EBF rates over time in Ethiopia, these rates still fall below the national target. To address this issue, the government should prioritize public health programs aimed at improving maternal healthcare service utilization and maternal education. It is essential to integrate facility-level services with community-level services to achieve optimal breastfeeding practices. Specifically, efforts should be made to promote breastfeeding among mothers who have delivered via cesarean section. Additionally, there should be a focus on encouraging antenatal care service utilization and adapting maternal healthcare services to accommodate the mobile lifestyle of pastoralist communities. These steps will contribute to enhancing breastfeeding practices and achieving better outcomes for maternal and child health.

The level of wasting and associated factors among children aged 6-59 months in sub-Saharan African countries: multilevel ordinal logistic regression analysis.

Background: Despite various interventions to combat child malnutrition in sub-Saharan Africa, wasting remains a critical public health concern for children aged 6-59 months. Wasting is a significant predictor of child survival and development, with a heightened risk of mortality among children. However, there is a lack of recent comprehensive data on the prevalence, severity level, and factors contributing to wasting in this age group. Objective: To identify the severity levels of wasting and its individual and community-level factors contributing to wasting among children aged 6-59 months in Sub-Saharan African countries. Methods: This research utilized Demographic and Health Survey data from 34 Sub-Saharan African countries, spanning the period from 2007 to 2022. The study included a weighted sample of 180,317 6-59-month-old children. We employed a multilevel proportional odds model to identify factors predicting the severity of wasting. Adjusted odds ratios and 95% confidence intervals were reported to demonstrate significant relationships (p < 0.05) in the final model. Results: In Sub-Saharan Africa, 7.09% of children aged 6-59 months experience wasting (95% CI: 6.97, 7.20%). Among these children, the prevalence of moderate wasting is 4.97% (95% CI: 4.90, 5.10%), while severe wasting affects 2.12% (95% CI: 2.0, 2.20%). Factors such as term/post-term babies, wealth, frequency of feeding, improved toilet facilities, water sources, employed and educated mothers, rural residence, high community maternal education, and community media exposure are strongly associated with a lower chance of experiencing severe form of wasting. Conversely, birth order, family size, breastfeeding, diarrhea, cough, and fever, high community poverty, female household heads, and all Sub-Saharan Africa regions are linked to higher levels of wasting. Conclusion: The study findings underscore the persistent challenge of wasting among Sub-Saharan Africa's children, with 7.09% affected, of which 4.97% experience moderate wasting and 2.12% severe wasting. The identified predictors of wasting highlight the complex interplay of socio-economic, environmental, and health-related determinants. To address this issue improve access to healthcare and nutrition services, enhance sanitation infrastructure, promote women's empowerment, and implement community-based education programs. Additionally, prioritize early detection through routine screening and strengthen health systems' capacity to provide timely interventions.

The magnitude of stunting and its determinants among late adolescent girls in East Africa: Multilevel binary logistics regression analysis.

BACKGROUND: Stunting poses a significant health risk to adolescent girls aged 15-19 in low- and middle-income countries, leading to lower education levels, reduced productivity, increased disease vulnerability, and intergenerational malnutrition. Despite the inclusion of adolescent nutrition services in the Sustainable Development Goals, little progress has been made in addressing malnutrition among adolescent girls in several African nations. Limited evidence exists in East Africa due to small sample sizes and methodological limitations. To overcome these constraints, this study utilizes the latest Demographic and Health Survey data to estimate the prevalence and factors influencing stunting among late adolescent girls in ten East African countries. METHODS: This study utilized the most recent Demographic and Health Survey (DHS) data from 10 East African countries, including a total sample weight of 22,504 late-adolescent girls. A multilevel mixed-effect binary logistic regression model with cluster-level random effects was employed to identify factors associated with stunting among these girls. The odds ratio, along with the 95% confidence interval, was calculated to determine individual and community-level factors related to stunting. A p-value less than 0.05 was considered statistically significant in determining the factors influencing stunting among late-adolescent girls. RESULTS: The prevalence of stunting among late adolescent girls in East Africa was found to be 13.90% (95% CI: 0.13-0.14). Religion, relationship to the head, presence of under-five children in the household, lactating adolescent, marital status, Time to get water source, and country of residence were significantly associated with Stunting. CONCLUSION: This study highlights the complexity of stunting in East Africa and identifies key factors that need attention to reduce its prevalence. Interventions should focus on improving water access, supporting lactating girls, addressing socioeconomic disparities, promoting optimal care practices, and implementing country-specific interventions to combat stunting and improve adolescent girls' nutrition.

Determinants of tobacco use among pregnant women in sub-Saharan Africa. A multilevel mixed-effect logistic regression model.

INTRODUCTION: Although it is known that maternal tobacco use during pregnancy substantially declined in higher-income countries, information on the magnitude and determinants of tobacco use among pregnant women in sub-Saharan Africa (SSA) remains limited. Establishing evidence on maternal tobacco during pregnancy is crucial for guiding targeted interventions in SSA. This study aimed to determine the overall prevalence of tobacco use and its determinants among pregnant women in SSA countries. METHODS: The study used data from Demographic and Health Surveys conducted in 33 countries across SSA from 2010 and 2021. Our analysis included a total weighted sample of 40,291 pregnant women. A multilevel logistic regression model was used to identify factors associated with maternal tobacco use during pregnancy. The measure of association between explanatory variables and the outcome was reported using adjusted odds ratios (AORs) with 95% confidence intervals (CIs). RESULTS: The pooled prevalence of tobacco use among pregnant women in SSA was 1.76% (95% CI: 1.41, 2.12). Our findings showed that pregnant women in the age groups of 25-34 years (AOR 1.44; 95% CI: 1.14, 1.82) and 35+ years (AOR 2.18; 95% CI: 1.68, 2.83) had higher odds of tobacco use during pregnancy. Pregnant women who attained primary education (AOR 0.57; 95% CI: 0.46, 0.70) and secondary or higher education (AOR 0.39; 95% CI: 0.30, 0.53) were associated with lower odds of tobacco use. Similarly, pregnant women who resided in households with a high wealth index (AOR 0.36; 95% CI: 0.55 0.90) and those with media exposure (AOR 0.81; 95% CI: 0.67, 0.99) were less likely to use tobacco during pregnancy. CONCLUSION: This study revealed that the overall prevalence of maternal tobacco use during pregnancy was relatively low in SSA, but some countries exhibited higher estimates. To address this, it is crucial to implement targeted smoking prevention and cessation strategies, particularly for young pregnant women, those facing socioeconomic disadvantages, and those with lower educational status.

The effect of dietary diversity on anemia levels among children 6-23 months in sub-Saharan Africa: A multilevel ordinal logistic regression model.

BACKGROUND: Anemia is the most common hematologic disorder of children worldwide. Since dietary diversity is a main requirement of children is to get all the essential nutrients, it can thus use as one of the basic indicator when assessing the child's anemia. Although dietary diversity plays a major role in anemia among children in sub-Saharan Africa, there is little evidence of an association between the dietary diversity and anemia level to identified potential strategies for prevention of anemia level in sub-Saharan Africa. OBJECTIVE: To examine the association between dietary diversity and anemia levels among children aged 6-23 months in sub-Saharan Africa. METHODS: The most recent Demographic and Health Surveys from 32 countries in SSA were considered for this study, which used pooled data from those surveys. In this study, a total weighted sample of 52,180 children aged 6-23 months was included. The diversity of the diet given to children was assessed using the minimum dietary diversity (MDD), which considers only four of the seven food groups. A multilevel ordinal logistic regression model was applied due to the DHS data's hierarchical structure and the ordinal nature of anemia. With a p-value of 0.08, the Brant test found that the proportional odds assumption was satisfied. In addition, model comparisons were done using deviance. In the bi-variable analysis, variables having a p-value ≤0.2 were taken into account for multivariable analysis. The Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was presented for potential determinants of levels of anemia in the multivariable multilevel proportional odds model. RESULTS: The overall prevalence of minimum dietary diversity and anemia among children aged 6-23 months were 43% [95% CI: 42.6%, 43.4%] and 72.0% [95% CI: 70.9%, 72.9%] respectively. Of which, 26.2% had mild anemia, 43.4% had moderate anemia, and 2.4% had severe anemia. MDD, being female child, being 18-23 months age, born from mothers aged ≥25, taking drugs for the intestinal parasite, higher level of maternal education, number of ANC visits, middle and richer household wealth status, distance of health facility and being born in Central and Southern Africa were significantly associated with the lower odds of levels of anemia. Contrarily, being 9-11- and 12-17-months age, size of child, having fever and diarrhea in the last two weeks, higher birth order, stunting, wasting, and underweight and being in West Africa were significantly associated with higher odds of levels of anemia. CONCLUSION: Anemia was a significant public health issue among children aged 6-23 months in sub-Saharan Africa. Minimum dietary diversity intake is associated with reduced anemia in children aged 6 to 23 months in sub-Saharan Africa. Children should be fed a variety of foods to improve their anemia status. Reducing anemia in children aged 6-23 months can be achieved by raising mother education levels, treating febrile illnesses, and improve the family's financial situation. Finally, iron fortification or vitamin supplementation could help to better reduce the risk of anemia and raise children's hemoglobin levels in order to treat anemia.

Human papillomavirus vaccination uptake and determinant factors among adolescent schoolgirls in sub-Saharan Africa: A systematic review and meta-analysis.

Despite the ongoing global vaccination campaign aimed at preventing human papillomavirus (HPV) related health issues, the uptake of the HPV vaccine remains unacceptably low in developing regions, particularly in sub-Saharan Africa (SSA). Therefore, this systematic review and meta-analysis aimed at determining the pooled prevalence and associated factors of HPV vaccine uptake among adolescent school girls in SSA. Electronic bio-medical databases were explored. Pooled prevalence, publication bias, meta-regression, sub-group, and sensitivity analysis were performed. The estimated pooled prevalence of HPV vaccine uptake was 28.53% [95% CI: (5.25, 51.81)]. Having good knowledge and a positive attitude was significantly associated with HPV vaccine uptake in SSA. Subgroup analysis revealed the highest uptake was 62.52% from Kenya and the lowest was 3.77% in Nigeria. The HPV vaccine uptake is low. It underscores the need for community education, school-based immunization, and education programs that promote the uptake of the vaccine to increase coverage.

Levels of stunting associated factors among under-five children in Ethiopia: A multi-level ordinal logistic regression analysis.

INTRODUCTION: Stunting is a major public health problem affecting more than one-third of under five year's old children in Ethiopia. It has short and long (irreversible) consequences, including stunted growth, never reaching physical and cognitive potential, struggles in school, and increased morbidity and mortality due to infections. Though stunting is the leading cause of child mortality in Ethiopia, evidence is scarce on the prevalence and predictors of stunting among under-five years old children in Ethiopia. Therefore, this study aimed to estimate the prevalence and predictors of stunting severity among under-5 children in Ethiopia. MATERIALS AND METHODS: This study was based on 2019 Mini-Ethiopian Demographic and Health Survey (EDHS) data. A weighted total sample of 4972 under-five years old children was included in the study. Height measurement was collected for each child. Anthropometric indicator, height-for-age was determined for children using World Health Organization growth standards (Z-scores for Height-for-Age (HAZ)) to asses stunting level. Given the ordinal nature of stunting and the hierarchical nature of EDHS data, a multilevel ordinal logistic regression model was applied. Brant test was used to check the proportional odds assumption, which was satisfied (P-value ≥0.05). Moreover, deviance was used for model comparison. For the multivariable analysis, variables with a p-value ≤0.2 in the bivariable analysis were considered. The Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was reported as associated factor to the severity levels of stunting in the multivariable multilevel proportional odds model. RESULTS: The overall prevalence of stunting among under-5 children in Ethiopia was 35.7% [95% CI: 34.4%, 37.1%]. Of these, 12.1% were severely stunted, and 24.9% were moderately stunted. Being male [AOR = 0.83, 95% CI: 0.74, 0.93], children aged 6-23 months [AOR = 2.38, 95% CI: 1.84, 3.07], ≥ 24 months [AOR = 4.15, 95% CI: 3.26, 5.28], children whose maternal age 15-24 years [AOR = 0.73, 95% CI: 0.58, 0.92], children from the poorest, poorer, middle, and richer household wealth were [AOR = 1.84, 95% CI: 1.32, 2.57], [AOR = 1.66, 95% CI: 1.20, 2.31], [AOR = 1.78, 95% CI: 1.29, 2.44], and [AOR = 1.62, 95% CI: 1.20, 2.17], children whose maternal educational status of no formal education and primary education had [AOR = 1.90, 95% CI: 1.28, 2.82], [AOR = 1.78, 95% CI: 1.22, 2.60], Tigray [AOR = 2.95, 95% CI: 1.78, 4.86], Afar [AOR = 1.85, 95% CI: 1.11, 3.10], Amhara [AOR = 1.90, 95% CI: 1.14, 3.14] and Harari [AOR = 1.97, 95% CI: 1.20, 3.25]regions, low community maternal education [AOR = 0.76, 95% CI: 0.62, 0.92] were significantly associated with stunting severity levelling. CONCLUSION: Stunting among children under five years of old in Ethiopia remains a major public health issue. Improving access to maternal education is related to appropriate child feeding practices and health, particularly in younger and uneducated mothers. Strengthening the family's wealth status is also recommended to reduce stunting. In addition, it is better to support strategies of preconception care for mothers during pregnancy to reduce stunting in the long term.

Determinants of high-risk fertility behavior among women of reproductive age in Kenya: a multilevel analysis based on 2022 Kenyan demographic and health survey.

BACKGROUND: Women's high-risk fertility behavior (HRFB), which is characterized by narrow birth intervals, high birth order, and younger maternal age at birth, have been scientifically reported to have detrimental effects on the mother and child's health. To date, there has been limited research into the underlying factors contributing to high-risk fertility behavior in Kenya. Thus, the aim of this study is to identify the factors associated with high-risk fertility behavior among women of reproductive age in Kenya. METHOD: The 2022 Kenyan Demography and Health Survey data was used for the current study. This study included 15,483 women of reproductive age. To account for the clustering effects of DHS data and the binary nature of the outcome variable, a multilevel binary logistic regression model was applied. An adjusted odds ratio with a 95% confidence interval was reported to declare the statistical significance. In addition, the model that had the lowest deviance was the one that best fit the data. RESULTS: The overall prevalence of HRFB among Kenyan women were 70.86% (95%CI = 69.96, 71.40). Women with primary, secondary, and higher educational levels, Protestant and Muslim religion followers, women whose husbands/partners had secondary and higher educational levels, a high household wealth index, ever had a terminated pregnancy, and rural residence, all of these factors were found to be strongly associated with high-risk fertility behavior. CONCLUSION: As per the findings of our study, in Kenya a significant proportion of women has experienced HRFB. This is a matter of concern as it poses a significant challenge to the healthcare system. The high prevalence of HRFB indicates that there is an urgent need to take appropriate measures in order to mitigate its impact. The situation calls for a comprehensive and coordinated approach involving all stakeholders to address this issue effectively. It would benefit policymakers to create programs that consider factors like education, wealth, and residence that make women more susceptible to HRFB. Targeting women living in high HRFB-prevalence areas could help address the root causes of the issue. This approach can alleviate negative impacts and ensure effective and sustainable solutions.

Determinants of anemia level among reproductive-age women in 29 Sub-Saharan African countries: A multilevel mixed-effects modelling with ordered logistic regression analysis.

BACKGROUND: Despite the implementation of different nutritional and non-nutritional interventions, 43% of reproductive-age women in Africa suffer from anemia. Recent evidence also shows that none of the Sub-Saharan African (SSA) countries are on the track to achieve the nutrition target of 50% anemia reduction by 2030. To date, information on the level of anemia and its determinants among reproductive-age women at the SSA level is limited. Thus, this study aimed to estimate the pooled prevalence of anemia level and its determinants in SSA countries. METHODS: We used a pooled data of 205,627 reproductive-age women from the recent demographic and health surveys of 29 SSA countries that were conducted between 2010-2021. A multilevel mixed-effects analysis with an ordered logistic regression model was fitted to identify determinants of anemia level and the deviance value was used to select the best-fitted model. First, bivariable ordinal logistic regression analysis was done and the proportional odds assumption was checked for each explanatory variable using a Brant test. Finally, in a multivariable multilevel ordinal logistic regression model, a p-value<0.05 and AOR with the corresponding 95% CI were used to identify determinants of anemia level. All analyses were done using Stata version 17 software. RESULTS: The pooled prevalence of anemia among women of reproductive age in SSA was 40.5% [95% CI = 40.2%-40.7%], where 24.8% [95% CI: 24.6%-25.0%], 11.1% [95% CI = 10.9%-11.2%], and 0.8% [95% CI = 0.7%-0.8%] had mild, moderate, and severe anemia, respectively. The prevalence significantly varied from the lowest of 13% in Rwanda to the highest of 62% in Mali, and anemia was found as a severe public health problem (prevalence of ≥ 40%) in 18 countries. The regression result revealed that polygamous marriage, women and husband illiteracy, poor household wealth, shorter birth interval, non-attendance of antenatal care, underweight, unimproved toilet and water facilities, and low community-level women literacy were positively linked with high anemia level. Additionally, the likelihood of anemia was lower in women who were overweight and used modern contraception. CONCLUSIONS: Overall results showed that anemia among women of reproductive age is a severe public health problem in SSA countries, affecting more than four in ten women. Thus, enhancing access to maternal health services (antenatal care and contraception) and improved sanitation facilities would supplement the existing interventions targeted to reduce anemia. Moreover, strengthening women's education and policies regulating the prohibition of polygamous marriage are important to address the operational constraints.

Suboptimal birth spacing practice and its predictors among reproductive-age women in Sub-Saharan African countries: a multilevel mixed-effects modeling with robust Poisson regression.

BACKGROUND: Despite the availability of exempted family planning services, a significant proportion of women in African countries continue to experience inadequately spaced pregnancies. To the authors' knowledge, evidence of suboptimal birth intervals at the SSA level is lacking and previous studies have been limited to specific geographic area. Therefore, this analysis was aimed to estimate the pooled prevalence of suboptimal birth spacing and its predictors among childbearing women in SSA. METHODS: Pooled DHS data from 35 SSA countries were used and a weighted sample of 221,098 reproductive-age women was considered in the analysis. The survey across all countries employed a cross-sectional study design and collected data on basic sociodemographic characteristics and different health indicators. Forest plot was used to present the overall and country-level prevalence of suboptimal birth spacing. Multilevel mixed-effects models with robust Poisson regression were fitted to identify the predictors of suboptimal birth spacing. Akaike's and Bayesian information criteria and deviance were used to compare the models. In a multivariable regression model, a p-value less than 0.05 and an adjusted prevalence ratio with the corresponding 95% CI were used to assess the statistical significance of the explanatory variables. RESULTS: The pooled prevalence of suboptimal birth spacing among women in SSA was 43.91% (43.71%-44.11%), with South Africa having the lowest prevalence (23.25%) and Chad having the highest (59.28%). It was also found that 14 of the 35 countries had a prevalence above the average for SSA. Rural residence [APR (95% CI) = 1.10 (1.12-1.15)], non-exposure to media [APR (95% CI) = 1.08 (1.07-1.11)], younger maternal age [APR (95% CI) = 2.05 (2.01-2.09)], non-use of contraception [APR (95% CI) = 1.18 (1.16-1.20)], unmet need for family planning [APR (95% CI) = 1.04 (1.03-1.06)], higher birth order [APR (95% CI) = 1.31 (1.28-1.34)], and desire to have at least six children [APR (95% CI) = 1.14 (1.13-1.16)] were the predictors of suboptimal birth spacing practice. CONCLUSION: More than four out of ten reproductive-age women in SSA countries gave birth to a subsequent child earlier than the recommended birth spacing, with considerable variations across the countries. Thus, interventions designed at enhancing optimal birth spacing should pay particular attention to young and socioeconomically disadvantaged women and those residing in rural regions. Strengthening community health programs and improving accessibility and availabilities of fertility control methods that ultimately impacts optimal reproductive behaviors is crucial to address contraceptive utilization and unmet need.

Prevalence and associated factors of active trachoma among 1-9 years of age children in Andabet district, northwest Ethiopia, 2023: A multi-level mixed-effect analysis.

BACKGROUND: Trachoma is the chief cause of preventable blindness worldwide and has been earmarked for elimination as a public health problem by 2030. Despite the five-year Surgery, Antibiotics, Facial cleanliness, and Environmental improvement (SAFE)-based interventions in the Andabet district, the prevalence of trachomatous follicular (TF) was 37%. With such a high prevalence of TF, the determinant factors were not revealed. Besides, there were no reports on the overall prevalence of active trachoma (i.e.TF and or trachomatous intense (TI)). OBJECTIVE: To determine the prevalence and associated factors of active trachoma among 1-9 years of age children in the Andabet district. METHOD: A community-based cross-sectional study was conducted among children aged under nine years from March 1-30, 2023 in Andabet district, Northwest Ethiopia. Multi-stage systematic random sampling was employed to reach 540 children. A multilevel mixed-effect logistic regression analysis was employed to assess factors associated with active trachoma. We fitted both random effect and fixed effect analysis. Finally, variables with p<0.05 in the multivariable multilevel analysis were claimed to be significantly associated with active trachoma. RESULT: In this study, the overall prevalence of active trachoma was 35.37% (95% CI: 31.32%, 39.41%). The prevalence of TF and TI was 31.3% and 4.07% respectively. In the multilevel logistic regression analysis ocular discharge, fly-eye contact, latrine utilization, and source of water were significantly associated with the prevalence of active trachoma. CONCLUSION: In this study, the prevalence of active trachoma was much higher than the World Health Organization (WHO) threshold prevalence. Ocular discharge, fly-eye contact, latrine utilization, and source of water were independent determinants of active trachoma among children (1-9 years). Therefore, paying special attention to these high-risk groups could decrease the prevalence of a neglected hyperendemic disease, active trachoma.

Factors Affecting Satisfaction With Inpatient Services Among Adult Patients Admitted to Arba Minch General Hospital, Southern Ethiopia: A Mixed Method Study.

Previous studies on patient satisfaction in Ethiopia focused on satisfaction with nursing care and outpatient services. Therefore, this study aimed to assess factors affecting satisfaction with inpatient services among adult patients admitted to Arba Minch General Hospital, Southern Ethiopia. A mixed method cross-sectional study was conducted among randomly selected 462 admitted adult patients from March 7 to April 28, 2020. A standardized structured questionnaire and semi-structured interview guide were used to collect data. A total of 8 in-depth interviews were conducted to collect the qualitative data. SPSS version 20 was used to analyze the data, and a P-value <.05 in the multivariable logistic regression was used to declare the statistical significance of the predictor variables. The qualitative data was analyzed thematically. In this study, 43.7% of patients were satisfied with the inpatient services they received. Urban residences (AOR 95% CI 1.67 [1.00, 2.80]), educational status (AOR 95% CI 3.41 [1.21, 9.64]), treatment outcome (AOR 95% CI 2.28 [1.65, 4.32]), use of meal service (AOR 95% CI 0.51 [0.30, 0.85]), and duration of hospital stay (AOR 95% CI 1.98 [1.18, 2.06]) were the predictors of satisfaction with inpatient services. Compared to previous studies, the level of satisfaction with inpatient services was relatively low.

Inpatient Care Service Experience Among Adult Patients Admitted to Arba Minch General Hospital, Southern Ethiopia: Institution-Based Qualitative Study.

Acknowledging patients' experience with the care delivered in healthcare settings is crucial in ensuring the quality of healthcare service delivery. In Ethiopia, qualitative evidence of patients' experience with inpatient care services is limited. This study aimed to explore the experience of inpatient care service among adult patients admitted to Arba Minch General hospital, Southern Ethiopia from April 05-28, 2020. An institution-based qualitative approach was carried out among adult patients discharged from the study hospital. Thirty-one in-depth interviews using a semi-structured interview guide were conducted and audio-recorded data were transcribed verbatim and translated into English. Data were coded, sorted, and themes were developed manually based on the thematic analysis. This study showed that kindness, respecting appointments, and treatment outcomes were the positive experiences highlighted by study participants. Participants reported a lack of drinking water, unpleasant toilet hygiene, lack of bedsheets, and absence of drugs as negative experiences. Therefore, the hospital administration should work on improving the problems mentioned by the participants of this study.

Factors affecting utilization of long-acting reversible contraceptives among sexually active reproductive-age women in the pastoral community of Northeast Ethiopia: A community-based cross-sectional study.

INTRODUCTION: In Ethiopia, only one in ten reproductive-age women use long-acting reversible contraceptives. Evidence on the utilization of these methods and associated factors among sexually active reproductive-age women in the pastoral area of Northeast Ethiopia is limited. Thus, this study aimed to assess the utilization of long-acting reversible contraceptives and associated factors among sexually active reproductive-age women in the pastoral community of Northeast Ethiopia. METHODS: A community-based cross-sectional study was conducted from 1 to 30 April 2021 among 572 reproductive-age women selected by a systematic random sampling method. Data were collected using a structured interviewer-administered questionnaire and entered into Epi-info version 7 and then finally exported to Stata version 16 for further analysis. Bivariable and multivariable binary logistic regression analyses were done to identify factors affecting the utilization of long-acting reversible contraceptives. Odds ratio with the corresponding 95% confidence interval were computed and the statistical significance of the explanatory variables was declared at p-value < 0.05. RESULTS: Overall, the utilization of long-acting reversible contraceptives was (24.3%; 95% confidence interval = 20.9%-28.0%). It was also revealed that being Orthodox (adjusted odds ratio = 4.10; 95% confidence interval = 2.20-7.65) and Protestant (adjusted odds ratio = 7.86; 95% confidence interval = 1.26-18.97) religion followers, attending higher education (adjusted odds ratio = 3.31; 95% confidence interval = 1.37-7.98), and having a husband who attended higher education (adjusted odds ratio = 4.37; 95% confidence interval = 1.98-9.67) were associated with an increased odds of using long-acting reversible contraceptive methods. Besides, having a good (adjusted odds ratio = 6.69; 95% confidence interval = 2.64-16.95) and moderate (adjusted odds ratio = 3.03; 95% confidence interval = 1.06-8.56) knowledge, and positive attitude (adjusted odds ratio = 3.65; 95% confidence interval = 1.90-7.01) toward long-acting reversible contraceptives were also associated with the utilization of these methods. CONCLUSION: Less than one-fourth of sexually active reproductive-age women in the study area were using long-acting reversible contraceptives. Thus, improving women's and husbands' education and women's knowledge and attitude toward long-acting reversible contraceptives is important to scale up the uptake of these contraceptive methods.