Household satisfaction with health services and response strategies to malaria in mountain communities of Uganda.

BACKGROUND: Measuring satisfaction with health service delivery in fragile communities provides an opportunity to improve the resilience of health systems to threats including climate change. Additionally, understanding factors associated with the choice of response strategies to certain public health threats provides an opportunity to design context-specific interventions. METHODS: We used polytomous latent class analyses to group participants' responses and an additive Bayesian modelling network to explore satisfaction with health service delivery as well as factors associated with response strategies of households to malaria. We did this with a focus on the rural parts of Uganda in Mount Elgon. RESULTS: We found that approaches to malaria control and management at household level include the use of traditional (54.5%), private (20.5%) and publicly available services (25%). Regarding satisfaction with health services, 66.6% of respondents were satisfied with health service components of information flow, drug/vaccine access and accessibility. Type of housing, livelihood sources, previous malaria experience and health services were strongly associated with responses to malaria occurrence at household level. The rest of the factors were weakly associated with malaria responses. CONCLUSIONS: The indigenous interventions utilised by households to manage and control malaria were largely dependent on their satisfaction with health service delivery components. Interventions thus ought to leverage local existing knowledge to optimise outcomes and ensure sustainable health.

Socioeconomic determinants of male contraceptive use in South Africa: a secondary analysis of the 2016 SADHS data.

BACKGROUND: Historically, family planning discussions have predominantly centred on women, overlooking the crucial role men play in contraception. This is particularly concerning in regions like Sub-Saharan Africa (SSA), where reproductive health challenges are pronounced. South Africa, a key country within SSA, continues to grapple with issues such as high unintended pregnancy rates and increasing pregnancy-related mortality. Understanding the factors that deter male contraceptive use is essential for achieving universal access to sexual and reproductive health (SRH) services. This study investigates the socioeconomic disparities influencing male contraceptive use in South Africa, drawing on data from the 2016 South Africa Demographic Health Survey. METHODS: The study utilised data from the 2016 South African Demographic and Health Survey, which employed a stratified, two-stage sampling design across all provinces based on the 2011 Census. The survey focused on men aged 15-59 using the "Man's Questionnaire." Various socio-demographic and attitudinal variables were analysed using STATA 17. The analysis included multinomial logistic regression to identify determinants of male contraceptive use and the Erreygers Normalized Concentration Index to assess socioeconomic inequalities in contraceptive uptake. RESULTS: Among the surveyed men, 47% reported not using any contraception, 40% used male methods, and 13% relied on their partners' contraceptive use. A majority began sexual activity between the ages of 14-17 (54%), resided in urban areas (56%), were unmarried (67%), and had attained secondary education (70%). Notably, 78% disagreed that contraception is solely a woman's responsibility, and 64% expressed positive attitudes toward contraception. Age, marital status, and education level emerged as significant factors influencing contraceptive use. The study revealed a slight pro-rich inequality in male contraception use, with socioeconomic status (SES) being the most significant contributor to this disparity (223.22%). This suggests that higher SES is associated with increased inequality in the adoption of modern male contraceptive methods. CONCLUSION: These findings highlight the impact of socioeconomic disparities and entrenched cultural beliefs on male contraceptive use in South Africa. To address these challenges, comprehensive strategies that prioritise education, expand family planning media campaigns and ensure equitable access to contraception are urgently needed.

Double burden of malnutrition among women and children in Zimbabwe: a pooled logistic regression and Oaxaca-Blinder decomposition analysis.

Background: The double burden of malnutrition (DBM) is a public health issue characterised by the coexistence of undernutrition and overnutrition within the same population, household, or individual. Undernutrition, manifesting as stunting, wasting, or being underweight, results from insufficient nutrient intake while overnutrition, manifesting as overweight or obesity, results from excessive caloric intake, poor diet quality, and sedentary lifestyles. This dual burden poses significant challenges for health systems due to lost productivity and increased healthcare expenditure. Methods: This study utilised data from the Demographic and Health Surveys (DHS) conducted in Zimbabwe for 2010-2011 and 2015, which provided information on women's and children's health and nutritional status, household characteristics, and socio-economic status. Pooled logistic regression was used to analyse the association between various sociodemographic factors and DBM among women and children. The Oaxaca-Blinder decomposition method explored differences in DBM between 2010-2011 and 2015. Results: The average age of mothers was approximately 31 years, and children's ages averaged around 32 months. From 2010 to 2015, there was a notable socio-economic improvement, with a decrease in the percentage of mothers in the poorest quartile from 20 to 16% and an increase in the richest quartile from 22 to 23%. The study found a slight decrease in overall household DBM among women from 34% in 2010 to 32% in 2015, while DBM among children increased from 12 to 14%. Pooled logistic regression analysis indicated that children in rural areas had statistically significantly higher odds of experiencing DBM than their urban counterparts. The Oaxaca-Blinder decomposition showed that changes in residence status significantly impacted the increase in DBM among children. At the same time, the coefficient effect accounted for most of the unexplained differences in DBM among women. Conclusion: The growing DBM among women and children in Zimbabwe is significantly influenced by changes in residence status. The findings highlight the need for targeted public health interventions to address urban-rural disparities and emphasise the importance of considering socio-economic, environmental, and behavioural factors. Context-specific public health strategies, aligned with WHO's Double Duty Actions, are essential to improve the nutritional health of Zimbabwe's population.

Determinants and Patterns of Contraceptive Use among Sexually Active Women Living with HIV in Ibadan, Nigeria.

Background: Contraception is a strategy to meet the family planning goals of women living with human immunodeficiency virus (WLHIV) as well as to reduce the transmission of HIV. There is limited data from Nigeria, where HIV prevalent is the second-largest in the world. This study aimed to examine contraceptive use and identify factors influencing its use among sexually active WLHIV in Ibadan, Nigeria. Methods: A facility-based cross-sectional study was conducted among 443 sexually active WLHIV across three HIV treatment centers in Ibadan, Oyo State. The inclusion criteria were WLHIV, aged 18-49 years, who asserted being fecund and sexually active. An adopted questionnaire was used to collect data, and the data was analyzedusing the Statistical Package for Social Sciences (SPSS) Windows version 25. Statistical significance was set at p < 0.05. Results: Among sexually active WLHIV (n = 443), 73.1% used contraceptives, with 26.9% having unmet needs. The results revealed a significant association between employment status and the use of contraceptives (AOR = 2.150; 95% CI 1.279-3.612 p=0.004); accessibility to contraceptive methods and the use of contraceptives (AOR = 21.483; 95% CI 7.279-63.402 p=0.00). Also, a significant association was found between payment for service and contraceptive use (AOR = 14.343; 95% CI 2.705-76.051; p = 0.003). Previous reactions towards contraceptive use were also significantly associated with contraceptive use (AOR = 14.343; 95% CI 2.705-76.051 p = 0.003). The dual contraceptives usage rate was 30.7%. Conclusions: Although contraceptive use among sexually active WLHIV was high, the study highlighted the need for increased adoption of dual contraceptive methods to mitigate the risk of unintended pregnancy and HIV re-infection among this population. It emphasized the importance of continuous sensitization and counseling services healthcare providers provide to promote contraceptive use among WLHIV.

Socio-Economic Inequalities in the Double Burden of Malnutrition among under-Five Children: Evidence from 10 Selected Sub-Saharan African Countries.

BACKGROUND: Africa is unlikely to end hunger and all forms of malnutrition by 2030 due to public health problems such as the double burden of malnutrition (DBM). Thus, the aim of this study is to determine the prevalence of DBM and degree of socio-economic inequality in double burden of malnutrition among children under 5 years in sub-Saharan Africa. METHODS: This study used multi-country data collected by the Demographic and Health Surveys (DHS) Program. Data for this analysis were drawn from the DHS women's questionnaire focusing on children under 5 years. The outcome variable for this study was the double burden of malnutrition (DBM). This variable was computed from four indicators: stunting, wasting, underweight and overweight. Inequalities in DBM among children under 5 years were measured using concentration indices (CI). RESULTS: The total number of children included in this analysis was 55,285. DBM was highest in Burundi (26.74%) and lowest in Senegal (8.80%). The computed adjusted Erreygers Concentration Indices showed pro-poor socio-economic child health inequalities relative to the double burden of malnutrition. The DBM pro-poor inequalities were most intense in Zimbabwe (-0.0294) and least intense in Burundi (-0.2206). CONCLUSIONS: This study has shown that across SSA, among under-five children, the poor suffer more from the DBM relative to the wealthy. If we are not to leave any child behind, we must address these socio-economic inequalities in sub-Saharan Africa.

Drivers of socioeconomic inequalities of child hunger during COVID-19 in South Africa: evidence from NIDS-CRAM Waves 1-5.

BACKGROUND: Child hunger has long-term and short-term consequences, as starving children are at risk of many forms of malnutrition, including wasting, stunting, obesity and micronutrient deficiencies. The purpose of this paper is to show that the child hunger and socio-economic inequality in South Africa increased during her COVID-19 pandemic due to various lockdown regulations that have affected the economic status of the population. METHODS: This paper uses the National Income Dynamics Study-Coronavirus Rapid Mobile Survey (NIDS-CRAM WAVES 1-5) collected in South Africa during the intense COVID-19 pandemic of 2020 to assess the socioeconomic impacts of child hunger rated inequalities. First, child hunger was determined by a composite index calculated by the authors. Descriptive statistics were then shown for the investigated variables in a multiple logistic regression model to identify significant risk factors of child hunger. Additionally, the decomposable Erreygers' concentration index was used to measure socioeconomic inequalities on child hunger in South Africa during the Covid-19 pandemic. RESULTS: The overall burden of child hunger rates varied among the five waves (1-5). With proportions of adult respondents indicated that a child had gone hungry in the past 7 days: wave 1 (19.00%), wave 2 (13.76%), wave 3 (18.60%), wave 4 (15, 68%), wave 5 (15.30%). Child hunger burden was highest in the first wave and lowest in the second wave. The hunger burden was highest among children living in urban areas than among children living in rural areas. Access to electricity, access to water, respondent education, respondent gender, household size, and respondent age were significant determinants of adult reported child hunger. All the concentrated indices of the adult reported child hunger across households were negative in waves 1-5, suggesting that children from poor households were hungry. The intensity of the pro-poor inequalities also increased during the study period. To better understand what drove socioeconomic inequalites, in this study we analyzed the decomposed Erreygers Normalized Concentration Indices (ENCI). Across all five waves, results showed that race, socioeconomic status and type of housing were important factors in determining the burden of hunger among children in South Africa. CONCLUSION: This study described the burden of adult reported child hunger and associated socioeconomic inequalities during the Covid-19 pandemic. The increasing prevalence of adult reported child hunger, especially among urban children, and the observed poverty inequality necessitate multisectoral pandemic shock interventions now and in the future, especially for urban households.

Decomposing maternal socioeconomic inequalities in Zimbabwe; leaving no woman behind.

BACKGROUND: Several studies in the literature have shown the existence of large disparities in the use of maternal health services by socioeconomic status (SES) in developing countries. The persistence of the socioeconomic disparities is problematic, as the global community is currently advocating for not leaving anyone behind in attaining Sustainable Development Goals (SDGs). However, health care facilities in developing countries continue to report high maternal deaths. Improved accessibility and strengthening of quality in the uptake of maternal health services (skilled birth attendance, antenatal care, and postnatal care) plays an important role in reducing maternal deaths which eventually leads to the attainment of SDG 3, Good Health, and Well-being. METHODS: This study used the Zimbabwe Demographic Health Survey (ZDHS) of 2015. The ZDHS survey used the principal components analysis in estimating the economic status of households. We computed binary logistic regressions on maternal health services attributes (skilled birth attendance, antenatal care, and postnatal care) against demographic characteristics. Furthermore, concentration indices were then used to measure of socio-economic inequalities in the use of maternal health services, and the Erreygers decomposable concentration index was then used to identify the factors that contributed to the socio-economic inequalities in maternal health utilization in Zimbabwe. RESULTS: Overall maternal health utilization was skilled birth attendance (SBA), 93.63%; antenatal-care (ANC) 76.33% and postnatal-care (PNC) 84.27%. SBA and PNC utilization rates were significantly higher than the rates reported in the 2015 Zimbabwe Demographic Health Survey. Residence status was a significant determinant for antenatal care with rural women 2.25 times (CI: 1.55-3.27) more likely to utilize ANC. Richer women were less likely to utilize skilled birth attendance services [OR: 0.20 (CI: 0.08-0.50)] compared to women from the poorest households. While women from middle-income households [OR: 1.40 (CI: 1.03-1.90)] and richest households [OR: 2.36 (CI: 1.39-3.99)] were more likely to utilize antenatal care services compared to women from the poorest households. Maternal service utilization among women in Zimbabwe was pro-rich, meaning that maternal health utilization favoured women from wealthy households [SBA (0.05), ANC (0.09), PNC (0.08)]. Wealthy women were more likely to be assisted by a doctor, while midwives were more likely to assist women from poor households [Doctor (0.22), Midwife (- 0.10)]. CONCLUSION: Decomposition analysis showed household wealth, husband's education, women's education, and residence status as important positive contributors of the three maternal health service (skilled birth attendance, antenatal care, and postnatal care) utilization outcomes. Educating women and their spouses on the importance of maternal health services usage is significant to increase maternal health service utilization and consequently reduce maternal mortality.

Leaving No Child Behind: Decomposing Socioeconomic Inequalities in Child Health for India and South Africa.

BACKGROUND: The United Nations' 2030 Agenda for Sustainable Development argues for the combating of health inequalities within and among countries, advocating for "leaving no one behind". However, child mortality in developing countries is still high and mainly driven by lack of immunization, food insecurity and nutritional deficiency. The confounding problem is the existence of socioeconomic inequalities among the richest and poorest. Thus, comparing South Africa's and India's Demographic and Health Surveys (DHS) of 2015/16, this study examines socioeconomic inequalities in under-five children's health and its associated factors using three child health indications: full immunization coverage, food insecurity and malnutrition. METHODS: Erreygers Normalized concentration indices were computed to show how immunization coverage, food insecurity and malnutrition in children varied across socioeconomic groups (household wealth). Concentration curves were plotted to show the cumulative share of immunization coverage, food insecurity and malnutrition against the cumulative share of children ranked from poorest to richest. Subsequent decomposition analysis identified vital factors underpinning the observed socioeconomic inequalities. RESULTS: The results confirm a strong socioeconomic gradient in food security and malnutrition in India and South Africa. However, while full childhood immunization in South Africa was pro-poor (-0.0236), in India, it was pro-rich (0.1640). Decomposed results reported socioeconomic status, residence, mother's education, and mother's age as primary drivers of health inequalities in full immunization, food security and nutrition among children in both countries. CONCLUSIONS: The main drivers of the socioeconomic inequalities in both countries across the child health outcomes (full immunization, food insecurity and malnutrition) are socioeconomic status, residence, mother's education, and mother's age. In conclusion, if socioeconomic inequalities in children's health especially food insecurity and malnutrition in South Africa; food insecurity, malnutrition and immunization in India are not addressed then definitely "some under-five children will be left behind".

Socioeconomic inequalities in food insecurity and malnutrition among under-five children: within and between-group inequalities in Zimbabwe.

BACKGROUND: Food insecurity and malnutrition in children are pervasive public health concerns in Zimbabwe. Previous studies only identified determinants of food insecurity and malnutrition with very little efforts done in assessing related inequalities and decomposing the inequalities across household characteristics in Zimbabwe. This study explored socioeconomic inequalities trend in child health using regression decomposition approach to compare within and between group inequalities. METHODS: The study used Demographic Health Survey (DHS) data sets of 2010\11 and 2015. Food insecurity in under-five children was determined based on the WHO dietary diversity score. Minimum dietary diversity was defined by a cut- off point of > 4 therefore, children with at least 3 of the 13 food groups were defined as food insecure. Malnutrition was assessed using weight for age (both acute and chronic under-nutrition) Z-scores. Children whose weight-for-age Z-score below minus two standard deviations (- 2 SD) from the median were considered malnourished. Concentration curves and indices were computed to understand if malnutrition was dominant among the poor or rich. The study used the Theil index and decomposed the index by population subgroups (place of residence and socioeconomic status). RESULTS: Over the study period, malnutrition prevalence increased by 1.03 percentage points, while food insecurity prevalence decreased by 4.35 percentage points. Prevalence of malnutrition and food insecurity increased among poor rural children. Theil indices for nutrition status showed socioeconomic inequality gaps to have widened, while food security status socioeconomic inequality gaps contracted for the period under review. CONCLUSION: The study concluded that unequal distribution of household wealth and residence status play critical roles in driving socioeconomic inequalities in child food insecurity and malnutrition. Therefore, child food insecurity and malnutrition are greatly influenced by where a child lives (rural/urban) and parental wealth.

Malaria patterns across altitudinal zones of Mount Elgon following intensified control and prevention programs in Uganda.

BACKGROUND: Malaria remains a major tropical vector-borne disease of immense public health concern owing to its debilitating effects in sub-Saharan Africa. Over the past 30 years, the high altitude areas in Eastern Africa have been reported to experience increased cases of malaria. Governments including that of the Republic of Uganda have responded through intensifying programs that can potentially minimize malaria transmission while reducing associated fatalities. However, malaria patterns following these intensified control and prevention interventions in the changing climate remains widely unexplored in East African highland regions. This study thus analyzed malaria patterns across altitudinal zones of Mount Elgon, Uganda. METHODS: Times-series data on malaria cases (2011-2017) from five level III local health centers occurring across three altitudinal zones; low, mid and high altitude was utilized. Inverse Distance Weighted (IDW) interpolation regression and Mann Kendall trend test were used to analyze malaria patterns. Vegetation attributes from the three altitudinal zones were analyzed using Normalized Difference Vegetation Index (NDVI) was used to determine the Autoregressive Integrated Moving Average (ARIMA) model was used to project malaria patterns for a 7 year period. RESULTS: Malaria across the three zones declined over the study period. The hotspots for malaria were highly variable over time in all the three zones. Rainfall played a significant role in influencing malaria burdens across the three zones. Vegetation had a significant influence on malaria in the higher altitudes. Meanwhile, in the lower altitude, human population had a significant positive correlation with malaria cases. CONCLUSIONS: Despite observed decline in malaria cases across the three altitudinal zones, the high altitude zone became a malaria hotspot as cases variably occurred in the zone. Rainfall played the biggest role in malaria trends. Human population appeared to influence malaria incidences in the low altitude areas partly due to population concentration in this zone. Malaria control interventions ought to be strengthened and strategically designed to achieve no malaria cases across all the altitudinal zones. Integration of climate information within malaria interventions can also strengthen eradication strategies of malaria in such differentiated altitudinal zones.

Effect of malaria on productivity in a workplace: the case of a banana plantation in Zimbabwe.

BACKGROUND: Malaria is known to contribute to reduction in productivity through absenteeism as worker-hours are lost thus impacting company productivity and performance. This paper analysed the impact of malaria on productivity in a banana plantation through absenteeism. METHODS: This study was carried out at Matanuska farm in Burma Valley, Zimbabwe. Raw data on absenteeism was obtained in retrospect from the Farm Manager. Malaria infection was detected using malaria Rapid Diagnostic Test. Measures of absence from work place were determined and included; incidence of absence (number of absentees divided by the total workforce), absence frequency (number of malaria spells), frequency rate (number of spells divided by the number of absentees), estimated duration of spells (number of days lost due to malaria), severity rate (number of days lost divided by number of spells), incapacity rate (number of days lost divided by the number of absentees), number of absent days (number of spells times the severity rate), number of scheduled working days (actual working days in 5 months multiplied by total number of employees), absenteeism rate. RESULTS: A total of 143 employees were followed up over a 5-month period. Malaria positivity was 21%, 31.5%, 44.8%, 35.7% and 12.6% for January 2014 to May 2014, respectively. One spell of absence [194 (86.6%)] was common followed by 2 spells of absence [30 (13.4%)] for all employees. Duration of spells of absence due to malaria ranged from 1.5 to 4.1 working-days, with general workers being the most affected. Incidence of absence was 143/155 (93.3%), with total of spells of absence of over a 5-month period totalling 224. The frequency rate of absenteeism was 1.6 with severity rate of absence being 2.4. and incapacity rate was 3.7. CONCLUSION: Malaria contributes significantly to worker absenteeism. Employers, therefore, ought to put measures that protect workers from malaria infections. Protecting workers can be done through malaria educative campaigns, providing mosquito nets, providing insecticide-treated work suits, providing repellents and partnering with different ministries to ensure protection of workers from mosquito bites.

Perceived factors associated with boda-boda (motorcycle) accidents in Kampala, Uganda.

Objective: According to the United Nations, nearly 1.25 million people are killed and up to 50 million people are injured on the world's roads every year. Uganda loses about 10 people daily to road accidents, costing about US$1.2 billion annually, which represents about 5% of the gross domestic product (GDP). The objective of this study was to identify causal factors that can be associated with boda-boda accidents in Uganda.Method: A cross sectional study assessed 200 boda-boda riders in the urban areas of Kampala, Uganda. Interviews using semistructured questionnaires were administered to all participants. Data were entered in Excel and imported to STATA for analysis. Multivariate and bivariate analyses were conducted to determine factors that influenced accident risk perception. All variables that were significant at a bivariate level and thought to be theoretically important in influencing the outcome variable were included in a logistic regression model. All tests were performed at a significance of P < .05.Results: Competition for passengers with other public transport operators (83%), negligence of road safety rules (78%), and inadequate helmet usage (62%) were the main factors perceived to be associated with boda-boda accidents. Other factors identified by the respondents include age of the boda-boda rider (58%) and drug use (56%; P < .05). At multivariate analysis, competition for passengers (adjusted odds ratio [AOR] = 17; 95% confidence interval CI, 1.34-26.5) and being in between 18 and 25 years old (AOR = 19; 95% CI, 1.42-27.1) remained statistically significant.Conclusions: This study revealed behavioral factors by all public transport users as the main factors associated with boda-boda accidents in urban Kampala. This demonstrates the need for holistic interventions to address such boda-boda accidents in Uganda. Such interventions can be through digitization of transport system for clients to engage remotely with the transport operators, routine refresher trainings of all transport operators, and construction of lanes for boda-boda riders.