Prevalence and neighbourhood determinants of early sexual debut and multiple sexual partnerships among young people in Rwanda, Ghana and South Africa.

BACKGROUND: The consequences of engaging in risky sexual behaviours (RSB) can lead to HIV infection, sexually transmitted diseases and unintended pregnancy. The relationship between neighbourhood characteristics and youth involvement in RSB such as early sexual debut and multiple sexual partnerships has been of great concern to government, researchers and policymakers. However, there are very few empirical studies using demographic and health surveys to unpack the nature of this relationship in Rwanda, Ghana and South Africa. The objective of this study was to estimate the prevalence and determinants of early sexual debut and condom use, and to explore the neighbourhood factors associated with early sexual debut and condom use in Rwanda, Ghana and South Africa. METHODS: This was a cross-sectional study using the most recent Demographic and Health Survey Data (DHS 2014-2016) from Ghana, Rwanda and South Africa to investigate the relationship between neighbourhood characteristics and risky sexual behaviour among the youth. RESULTS: The prevalence of risky sexual behaviour in the three countries ranges from 56% (South Africa), 30% (Ghana) and 12% (Rwanda). Male youth in the 20-to-24-year-old category had increased odds of engaging in multiple sexual partnerships for the three countries (AOR 4.58; 95% CI 3.40-6.16), Rwanda (AOR 2.72; 95% CI 2.04-3.68) and South Africa (AOR 4.56; 95% CI 3.33-6.24). Meanwhile, at the community level, community education significantly increased the odds of age sexual debut among female adolescents by 50% (South Africa), and 46% (Ghana), while in Rwanda, this factor had decreased odds with higher community education. CONCLUSION: To lower the incidence of risky sexual behaviour in the community, programmes aimed at appropriate policy options must be intensified. The implications of these findings is helpful for a developmental approach aimed at reaching Africa's long-term development goal of eliminating STIs among young people.

Contextual determinants of multiple sexual partnerships amongst young people in South Africa: a multilevel analysis.

BACKGROUND: Risky sexual behaviour (RSB), particularly multiple sexual partnerships (MSP) continues to be a major public health concern and has been linked to the increasing STIs, including HIV/AIDS in many parts of sub-Saharan Africa (SSA), suggesting that there is an association between contextual factors and multiple sexual partnering. However, in South Africa, this association is not well established in recent literature. Hence, this study examined the contextual factors contributing to multiple sexual partnerships among young people in South Africa. MATERIALS AND METHODS: Data was extracted from the 2016 South Africa Demographics and Health Survey (2016 SADHS). A cross-sectional study of 3889 never-married young people. Descriptive and inferential statistics as well as multilevel logistic regression were used to analyse the data on never-married young people aged 15 to 24 years. RESULTS: The results indicated that at the individual level, young males (61.7%) were significantly more likely than their female counterparts (56.1%) to engage in multiple sexual partners, although, the difference was not as significant as expected. At the community level clustering, the likelihood of exposure to multiple sexual partnerships significantly increased among females (OR = 1.47; 95% CI: 1.25-1.73) but decreased among their male counterparts (OR = 0.73; 95% CI: 0.58-0.92), in particular, family disruption, residential instability, and ethnic diversity led young people to engage in multiple sexual partnerships. CONCLUSIONS: There is a need to intensify programmes aimed at considering appropriate policy options to reduce the prevalence of multiple sexual partnerships. Adopting the implications of these findings is essential for a developmental strategy towards achieving the sustainable development goal of ending STIs among young people in South Africa.

A qualitative investigation into pregnancy experiences and maternal healthcare utilisation among adolescent mothers in Nigeria.

BACKGROUND: Adolescent maternal healthcare utilisation is low in Nigeria, and little is understood about the pregnancy experiences and drivers of maternal healthcare utilisation among of adolescent girls. This study investigated the pregnancy experiences and maternal healthcare utilisation among adolescent mothers across Nigeria. METHODS: The study used the qualitative design. Urban and rural communities in Ondo, Imo and Katsina states were selected as research sites. Fifty-five in-depth interviews were conducted with adolescent girls who were currently pregnant or had given birth to a child recently, and nineteen in-depth interviews were conducted with older women who were either mothers or guardians of adolescent mothers. Additionally, key informant interviews were conducted with five female community leaders and six senior health workers. The interviews were transcribed, and resulting textual data were analysed via framework thematic analysis using a semantic and deductive approach, with the aid of NVivo software. RESULTS: The findings showed that the majority of unmarried participants had unintended pregnancies and stigma against pregnant adolescents was common. Social and financial support from family members, maternal support and influence, as well as healthcare preferences shaped by cultural and religious norms were the major drivers of maternal healthcare use among adolescent mothers, and the choice of their healthcare providers. CONCLUSIONS: Interventions to support adolescent mothers and increase maternal healthcare utilisation among them must focus on ensuring the provision of social and financial support for adolescent mothers, and should be culturally sensitive.

Contexts, beliefs and health behaviour: Are individuals who engage in risky sexual behaviour likely to wear facemasks against COVID-19?

Beside age, underlying comorbidities and availability of sanitation facilities, individual health beliefs and behaviour are critical in combating the sustained prevalence of Covid-19. Behaviour has, however, been shown to be consistent but could be context- dependent based on the individual's beliefs. To investigate whether or not individuals' protective behaviour against coronavirus is associated with their behaviour in a previous health context. Facemask usage and engagement in risky sexual behaviour (RSB) were employed as corollaries of Covid-19 protective behaviour and a previous health context respectively. Data on them and other sociodemographic correlates of health behaviour were collected on 522 Nigerians via a web-based survey. The data were analyzed using frequency, Chi Square and Binary Logistics Regression. About 31% of the population wore facemasks in public, 48.1% believed Covid existed and was severe, and 31.6% had engaged in RSB. Individuals who engaged in RSB had lower odds of wearing facemasks in public in both the general population and across the rural-urban divide. The relationship was, however, only statistically significant (OR:0.642, p<0.05) in the adjusted regression model. Other significant determinants of facemask use were gender, place of residence, employment status and beliefs about Covid. The similarity of individual beliefs and behaviours in different health contexts provides an opportunity to model behaviour change communication policies for preventing and combating the spread of coronavirus and other infectious diseases.

Social consequences of COVID-19 on fertility preference consistency and contraceptive use among Nigerian women: insights from population-based data.

BACKGROUND: Emerging evidence from high income countries showed that the COVID-19 pandemic has had negative effects on population and reproductive health behaviour. This study provides a sub-Saharan Africa perspective by documenting the social consequences of COVID-19 and its relationship to fertility preference stability and modern contraceptive use in Nigeria. METHOD: We analysed panel data collected by Performance Monitoring for Action in Nigeria. Baseline and Follow-up surveys were conducted before the COVID-19 outbreak (November 2019-February 2020) and during the lockdown respectively (May-July 2020). Analysis was restricted to married non-pregnant women during follow-up (n = 774). Descriptive statistics and generalized linear models were employed to explore the relationship between selected social consequences of COVID-19 and fertility preferences stability (between baseline and follow-up) as well as modern contraceptives use. RESULTS: Reported social consequences of the pandemic lockdown include total loss of household income (31.3%), food insecurity (16.5%), and greater economic reliance on partner (43.0%). Sixty-eight women (8.8%) changed their minds about pregnancy and this was associated with age groups, higher wealth quintile (AOR = 0.38, CI: 0.15-0.97) and household food insecurity (AOR = 2.72, CI: 1.23-5.99). Fertility preference was inconsistent among 26.1%. Women aged 30-34 years (AOR = 4.46, CI:1.29-15.39) were more likely of inconsistent fertility preference compared to 15-24 years. The likelihood was also higher among women with three children compared to those with only one child (AOR = 3.88, CI: 1.36-11.08). During follow-up survey, 59.4% reported they would feel unhappy if pregnant. This was more common among women with tertiary education (AOR = 2.99, CI: 1.41-6.33). The odds increased with parity. The prevalence of modern contraceptive use was 32.8%. Women aged 45-49 years (AOR = 0.24, CI: 0.10-0.56) were less likely to use modern contraceptives than those aged 15-24 years. In contrast, the odds of contraceptive use were significantly higher among those with three (AOR = 1.82, CI: 1.03-3.20), four (AOR = 2.45, CI: 1.36-4.39) and at least five (AOR = 2.89, CI: 1.25-6.74) children. Unhappy disposition towards pregnancy (AOR = 2.48, CI: 1.724-3.58) was also a significant predictor of modern contraceptive use. CONCLUSION: Some social consequences of COVID-19 affected pregnancy intention and stability of fertility preference but showed no independent association with modern contraceptive use.

Women's attitudes towards negotiating safe sexual practices in Nigeria: Do family structure and decision-making autonomy play a role?

BACKGROUND: The risk of contracting sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) is related to women's sexual attitudes, beliefs, and power dynamics within marriages in developing countries. Despite the interventions towards improving women's sexual health and well-being, women are disproportionately affected by the risk of STIs transmission compared with their male counterparts in most sub-Saharan African countries including Nigeria. This study examined the roles of family structure and decision-making autonomy on women's attitudes towards negotiating safe sexual practices in Nigeria. METHODS: The study involved analyses of data from a nationally representative and weighted sample size of 28,219 ever-married/cohabiting women aged 15-49 years from the 2018 Nigeria Demographic and Health Survey. Descriptive and statistical analyses were carried out, including frequency tables, Pearson's chi-square test, and multivariable binary logistic regression model. RESULTS: The overall prevalence of having positive attitudes towards negotiating safe sexual practices were 76.7% and 69.6% for a wife justified in asking the husband to use a condom if he has an STI and refusing to have sex with the husband if he had sex with other women, respectively. The results further showed that polygamous unions negatively influenced urban and rural women's attitudes towards negotiating safe sexual practices, but women's decision-making autonomy on how to spend their earnings was found to be a protective factor for having positive attitudes towards negotiating safe sexual practices with partners. Surprisingly, there were significant variations in attitudes towards negotiating safe sexual practices among urban and rural women who enjoyed decision-making autonomy on their healthcare (aOR 1.70; CI 1.32-2.18 and aOR 0.52; CI 0.44-0.62, respectively). Plausibly, such women might have constrained them to compromise their sexual relationships for fear of being neglected by partners. CONCLUSION: The outcomes of this study have some policy implications for both maternal and child health. There is the need to intensify programmes aimed at improving women's sexual health and rights towards achieving sustainable development goals of preventing deaths of newborns, ending STIs and creating gender in Nigeria.

Gender relations and the utilization of contraceptives and antenatal care services in Kenya, Namibia and Nigeria.

The impacts of gender relations (GR) on reproductive health in sub-Saharan Africa (SSA) have received little attention. Virtually non-existent are studies that take cognizance of the socio-cultural diversity of SSA countries in assessing the impacts. Using Demographic and Health Survey data from Namibia, Kenya and Nigeria, this study investigated whether feminine gender relations (FGR) predict higher uptake of contraceptives and antenatal care services (ANC) in SSA. Results from univariate, bivariate and multivariate analyses showed that Namibia had the highest prevalence of FGR (20.0%) and contraceptive use (57.8%) while Nigeria had the lowest FGR (5.7%) but highest ANC utilization (42.1%). At the unadjusted levels, FGR predicted higher contraceptive use in Namibia and Nigeria but became insignificant when sociodemographic confounders were controlled for. Masculine gender relations (MGR) however predicted increased contraceptive and ANC utilization in the three countries at the unadjusted levels and contraceptive use in Kenya and Nigeria when adjusted. That MGR predicted higher odds of using contraceptives in a largely gender egalitarian Kenya and patriarchal Nigeria while FGR was insignificant even in the largely feministic Namibia, suggests that promoting equality in GR, rather than emphasizing female autonomy, possesses greater capacity for improving reproductive health outcomes in SSA.

Social contexts of fertility desire among non-childbearing young men and women aged 15-24 years in Nigeria.

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

Reduction in ideal number of children has been suggested as a necessary condition for fertility decline especially in high fertility countries of Western and Central Africa. In this study, we explored the effects of individual, household as well as community characteristics on fertility desires among young men and women aged 15­24 years in Nigeria. We analysed data for 2674 males and 9637 females aged 15­24 years extracted from the 2018 Nigeria Demographic and Health Survey. The outcome variable was desire for large family size (DLFS) defined as ideal number of children greater than four. Results showed that DLFS was 71% among men and 53% in women. Individual-level factors associated with DLFS among men include Islam religion, household size and wealth status. Geo-political region and high level of negative attitude to family planning were the main community-level factors associated with DLFS. For women, individual-level positively associated with DLFS were Islam religion, and being currently married. Compared to Yoruba, other ethnic groups were more likely to favour DLFS. The negative factors associated with DLFS among young women include higher education and wealth status. At the community-level, Northern geo-political regions, child mortality experience and negative attitude to family planning were positively associated with DLFS. The influence of religion, household wealth and attitude to family planning differ between young men and women. Multi-dimensional strategies with active communication and programmatic interventions are needed so that desire for large family size by young men and women do not slow down fertility transition in Nigeria.

Healthcare beliefs and practices of kin caregivers in South Africa: implications for child survival.

BACKGROUND: Appropriate health-seeking practices may have a positive influence on child survival, particularly when practiced by kin caregivers of children who are below the age of 5 years. While literature has shown that children who are raised in kinship care often present with poor health outcomes and often have unmet healthcare needs, the health-seeking behaviours and practices of the children's kin caregivers that ultimately influence these health outcomes remain largely unknown. In this paper, we explored the healthcare beliefs and practices of kin caregivers in South Africa on child survival. METHODS: Overall, 12 structured interviews were conducted with all the participants. Six [6] interviews were conducted in the Eastern Cape province and 6 were conducted in the KwaZulu-Natal province. The sample of participants was obtained by seeking permission from the child welfare authorities in the KwaZulu-Natal and Eastern Cape Department of Social Development (DSD) to assist in identifying a sample of the kin-caregivers who have provided primary care to children below the age of 5. The structured interviews were transcribed and analysed using thematic content analysis. After thematic content analysis was carried out, transcripts were given case numbers and then imported into NViVo version 11 for analysis and interpretation of the findings. RESULTS: The healthcare seeking behaviours and poor use of healthcare services of the caregivers were largely influenced by their notions and perceptions of health and illness. The notions and perceptions that the caregivers hold about the health statuses of the children placed under their care and illness were found to be largely culturally determined and largely influenced by preconceptions and certain healthcare beliefs. Increased reliance on traditional herbs, Notion of witchcraft and Faith healing emerged as key factors that influence health-seeking practices and beliefs of kin caregivers, thus influencing under-five mortality. CONCLUSION: Kin caregivers should be equipped with the necessary guidance, resources and training that facilitate the successful fulfilment of the caregiving role, given the number of unmet needs and challenges that they face. This will in turn translate into positive child health outcomes.

Rural-urban differences in the predictive influence of sex preference on marital dissolution in Nigeria.

This study examined the influence of place of residence on sex preference as a predictor of marital dissolution in Nigeria. It also appraised the mediation of socio-demographic factors on the relationship between sex preference and marital dissolution. Data were sourced from the 2018 demographic and health survey of Nigeria. Analyses involved the use of descriptive statistics, Pearson chi-square test and binary logistic regression models. Generally, marital dissolution significantly occurred more in rural than in urban areas. While more respondents had no child sex preference, preference for boys was significantly more among the urban women compared to the rural women. Irrespective of place of residence, sex preference was not a significant predictor of marital dissolution in Nigeria as the unadjusted models of marital dissolution and sex preference indicated that preference for more boys significantly decreased the odds of marital dissolution in the rural (OR=0.84; p=0.05), urban (OR=0.67; p=0.001), and total population (OR=0.77; p=0.001). In addition, preference for more girls significantly decreased the likelihood of marital dissolution in the rural (OR=0.82; p=0.002) and total populations (OR=0.84; p=0.05). Moreover, in the full adjusted model of the total population, preference for more males (OR=0.57; p=0.002) was also significantly associated with decreased odds of marital dissolution. Conversely, other factors that significantly increased the odds of marital dissolution included educational attainment, intimate partner violence, religion, being employed, polygamous unions, and region of residence. Women should achieve higher levels of education and be engaged in income earning occupations as mitigation measures against marital dissolution. Anti-dissolution campaigns should be initiated, especially in rural areas with high levels of intimate partner violence and in regions with relatively high incidences of marital dissolution/p-/p-1.

Contraceptive Use in Nigeria: Does Social Context Matter?

Contraceptive use in Nigeria has remained low despite the efforts of government and non-governmental agencies to increase its uptake. Most studies on contraceptive use have focused on individual-level determinants and evidence is sparse on the influence of social or community context. This study examines the influences of contextual factors on modern contraceptive use in Nigeria. We used data from the 2013 Nigeria Demographic and Health Survey, and a sample of 12,186, currently married women aged 15-49 years. Multilevel logistic regression which provides a flexible modeling for hierarchical data was used to examine the effects of contextual factors on contraceptive use. Findings revealed considerable low usage of contraception across the regions of Nigeria. Living in high and moderate ethnically diverse communities and communities that have high proportion of educated women was significantly associated with increased usage. The findings provide useful information for policy makers to consider the social milieu in which women live for effective family planning interventions.

How soon do single mothers have another child? A competing risk analysis of second premarital childbearing in sub-Saharan African countries.

BACKGROUND: A considerable number of previous studies have examined the trends, correlates, and consequences of premarital childbearing among adolescents and young women in Africa. However, very little is known about whether and how soon single mothers have another premarital birth in sub-Saharan African countries. This study examines the timing of a second premarital birth among single mothers and assesses how it may differ across key socio-demographic variables. METHODS: We pooled recent Demographic and Health Surveys from 25 sub-Saharan African countries to create a database of 57, 219 single mothers aged 15-49 years. Cumulative incidence graphs and Fine and Gray's competing risk models were used to delineate the timing of a second premarital birth and its socio-demographic correlates. RESULTS: More than one-third of single mothers in 16 countries have had a second premarital birth in their reproductive life. We also observed that more than 15% of the single mothers in Angola, Benin, the Republic of Chad, Liberia, Namibia, Nigeria, Sierra Leone, and Uganda, have had another premarital birth three years after the first. The incidence of a second premarital birth was significantly lower among women with secondary or higher education, compared to women with less than secondary education (p < 0.05) in most countries. Residence in an urban area compared to rural, was also significantly associated with a low incidence of second premarital birth in 10 countries (p < 0.05). CONCLUSIONS: Findings indicate a rapid progression to having a second premarital birth in some sub-Sahara African countries, particularly among socio-economically disadvantaged women. The findings suggest the need for tailored interventions for improving the quality of life of single mothers, to reduce the associated burden and consequences of having a premarital birth.

Patterns of delivery assistance among adolescent mothers in Nigeria.

OBJECTIVE: This study examined the sociodemographic and sociocultural factors associated with the pattern of birth assistance used among adolescent mothers aged 15-19 in Nigeria. DESIGN: The study used a quantitative design, using secondary data from the Nigeria Demographic and Health Surveys conducted between 2003 and 2013. SETTING: The study was nationally representative and conducted across Nigeria. PARTICIPANTS: A weighted sample of 2,096 adolescent mothers aged 15-19. MEASUREMENTS AND FINDINGS: Data were analysed using frequencies, chi square tests and multinomial logistic regression respectively. It was discovered that mothers aged 18 and above had lower odds of using traditional and skilled birth attendants (aORs = 0.68 (0.51-0.92); 0.63 (0.44-0.92)); Igbo mothers had lower odds of using TBAs (aOR = 0.03 (0.002-0.53)); and mothers in female-headed households were less likely to use SBAs (aOR = 0.40 (0.20-0.82)). Rich mothers were more likely to use SBAs (aOR = 2.21 (1.23-3.94)). Mothers whose partners had at least primary education were more likely to use SBAs (aOR = 1.73 (1.09-2.73); 1.64 (1.03-2.59)). Adolescent mothers in the North East (aOR = 5.79 (2.91-11.51)), North West (aOR = 8.24 (4.01-16.93)), South East (aOR = 69.70 (13.96-348.05)) and South South (aOR = 27.84(7.80-99.30)) were more likely to use TBAs, while mothers in the North East (aOR = 0.46 (0.28-0.76)) and North West (aOR = 0.50 (0.29-0.84)) were less likely to use SBAs. Mothers who used partial ANC were more likely to use SBAs (aOR = 5.73 (3.43-9.56)), while those who used full ANC were more likely to use SBA (aOR = 7.33 (4.76-11.29)). KEY CONCLUSIONS: Higher socioeconomic status mothers were more likely to use skilled birth attendance. IMPLICATIONS FOR PRACTICE: Interventions to increase SBA use among adolescent mothers in Nigeria must consider the continued preference for traditional and unskilled birth attendants and unassisted births, and design culturally sensitive programmes.

HIV voluntary counselling and testing and behaviour changes among youths in Nigeria.

Voluntary counselling and testing (VCT) for HIV has been promoted as a strategy to prevent HIV pandemics by changing sexual behaviour. Despite the provision of VCT in countries with generalized or high-burden epidemics, including Nigeria, the extent of its influence on behavioural change remains a conjecture. The main objective of this study was to examine the influence of HIV VCT on sexual behaviour changes among youths in Nigeria. The study utilized 2013 Nigeria Demographic and Health Survey (NDHS) data. Data were analysed from a nationally representative sample drawn from 8046 females and 6031 males aged 15-24 giving a total sample of 14,077 never-married youths. Descriptive and analytical analyses were carried out, including multivariate logistic regression. The study found a low uptake of HIV VCT and regional variation in behavioural changes between female and male youths. Voluntary HIV counselling and testing was found to be a protective factor for condom use at last sex for female youths, but significantly reduced the likelihood of primary sexual abstinence for both females and males, as well as having a single sexual partner for female youths. After controlling HIV VCT with other variables, certain socioeconomic factors were found to be significantly associated with behavioural changes. Thus, the attitudes of most Nigerian youths towards voluntary HIV counselling and testing needs to be improved through socioeconomic factors for healthy sexual activity. To achieve this, government and non-governmental organizations, as well as religious leaders and policymakers, should engage in appropriate and long-term activities directed at the sexual health needs of never-married youths, through voluntary HIV counselling and testing, to encourage them to change their sexual behaviour.

Media communication programmes and HIV transmission risk behaviour among sexually active South African youths.

South Africa houses 30% of sub-Saharan Africa's burden of HIV/AIDS, estimated at 25.7 million cases. To increase awareness among the population and encourage a behavioural change to stem its transmission, several HIV media communication programmes (HCP) have been instituted in the country. Findings on the efficacy of these programmes on HIV transmission risk behaviour have however been divergent. Using the Third National Communications Survey (NCS) in South Africa, this study investigates how exposure to HCP has affected condom use and multiple sexual partnership (MSP) among 2,247 sexually active South African youths aged 16-24. Analysis was done at univariate, bivariate and multivariate levels using Stata statistical software. Results show that 89.7% of the respondents were exposed to at least one form of HCP, 62.2% had low knowledge of HIV transmission, 48.9% used condoms while 12.6% engaged in MSP. Although HCP was associated with increased odds of condom use only among youths with low exposure, it had no statistically significant effect among youths with higher exposure and on MSP. As HCP exerts no influence on HIV risk behaviour among the studied cohort, tailor-made programmes focusing on the sociodemographic confounders of the behaviour might make HCP more effective.

Adult mortality in sub-Saharan Africa: cross-sectional study of causes of death in Zambia.

OBJECTIVE: To describe the age-sex pattern and socio-economic differentials in causes of death among adults between the ages of 15 and 59 years in Zambia. METHODS: Using data from the 2010-2012 Zambia sample vital registration with verbal autopsy survey, we calculated the percentage share of causes of death, the age-/sex cause-specific death ratio and cause-eliminated life expectancy at age 15. RESULTS: HIV/AIDS was the leading cause of death across all socio-economic subgroups contributing 40.7% of total deaths during the study period. This was followed by deaths due to injury and accidents (11.2%). Cause-specific death ratios due to HIV/AIDS increased by age and peaked in the 35-39 age group and were higher among females than males. The second-leading cause of death was injuries and accidents for males and tuberculosis for females. The third-leading cause of death was cardiovascular diseases for females and tuberculosis for males. Cause of death patterns varied notably by socio-economic characteristics. Deaths attributable to non-communicable diseases were more evident in adults aged 45-59 years. Eliminating HIV/AIDS in Zambia as a cause of death could raise life expectancy at age 15 by 5.7 years for males and by 6.4 years for females. CONCLUSION: HIV/AIDS-related health programmes and interventions should be further supported and strengthened, as they would significantly contribute to the reduction in adult mortality in Zambia.

OBJECTIF: Décrire les profilsselon l'âge et le sexe, et les différences socioéconomiques dans les causes de décès chez les adultes âgés de 15 à 59 ans en Zambie. MÉTHODES: En utilisant les données de l'enregistrement de l'état civil d'un échantillon de la Zambie de 2010 à 2012 avec l'enquête sur l'autopsie verbale, nous avons calculé la part en pourcentage des causes de décès, le taux de mortalité selon l'âge et le sexe et l'espérance de vie éliminée à 15 ans. RÉSULTATS: Le VIH/SIDA était la principale cause de décès dans tous les sous-groupes socioéconomiques, contribuant à 40,7% du nombre total de décès au cours de la période de l'étude. Viennent ensuite les décès par blessures et accidents (11,2%). Les taux de mortalité par cause dus au VIH/SIDA ont augmenté avec l'âge et ont culminé dans le groupe d'âge des 35 à 39 ans et étaient plus élevés chez les femmes que chez les hommes. La deuxième cause de décès était les blessures et les accidents chez les femmes et la tuberculose chez les hommes. Latroisième cause de décès était les maladies cardiovasculaires chez les femmes et la tuberculose chez les hommes. Les causes de décès variaient notamment en fonction des caractéristiques socioéconomiques. Les décès imputables aux maladies non transmissibles étaient plus évidents chez les adultes âgés de 45 à 59 ans. L'élimination du VIH/SIDA en Zambie en tant que cause de décès pourrait augmenter l'espérance de vie à 15 ans de 5,77 ans pour les hommes et de 6,40 ans pour les femmes. CONCLUSION: Les programmes et interventions de santé liés au VIH/SIDA devraient être davantage soutenus et renforcés, car ils contribueraient de manière significative à la réduction de la mortalité des adultes en Zambie.

The Proximate Determinants of Fertility in Eswatini.

Accelerating downwards the fertility rate remains a priority issue for developmental planning of any country. Fertility transition for most African countries has been slow since attaining their independence. In a period of almost four decades Eswatini experienced high fertility above replacement level fertility of 2.1; total fertility rate has declined from 6 to 4 children per woman from 1968 to 2007. This paper examines the impact of each proximate factor (contraception, postpartum infecundability, abortion and sexual activity) on fertility. Using the cross-sectional data from the 2006-7 Eswatini Demographic and Health Survey (DHS), the revised Bongaarts proximate determinants model of fertility was applied at national level and the analysis was extended to observe educational variation among women aged 15-49. The analysis showed that contraception had the greatest impact of fertility reduction, then sexual activity, postpartum infecundability and induced abortion. Women's educational level had huge negative influence on fertility and positive implication on reproductive choice of using contraception, delaying sexual activity/marriage and childbearing. The results guide on selection of potential social variables amenable to policy aimed at improving women's reproductive behaviour in Eswatini through better educational attainment.

Does Female Autonomy Affect Contraceptive Use among Women in Northern Nigeria?

Literature identified female empowerment as a predictor of positive health behaviour. However, in the context of conservative and traditional society, this is yet to be explored. This paper explores the role of female autonomy in contraceptive use among currently married women in northern Nigeria. Nationally representative Nigeria Demographic and Health Survey (NDHS, 2013) data for 18,534 currently married women in northern Nigeria was analysed. Complimentary log-logistic regression (cloglog) was used to analyse the data. Current use of modern contraceptive was 6.6% among currently married women in northern Nigeria. Results show that female autonomy was significantly associated with modern contraceptive use. Respondents' education, wealth status and desire for no more children were associated with higher contraceptive use. Despite the conservative and religious context of northern Nigeria, female autonomy significantly predicts modern contraceptive use. Thus, empowering women in northern Nigeria, especially by education, will enable them to participate in healthy contraceptive decision making.

Household relationships and healthcare seeking behaviour for common childhood illnesses in sub-Saharan Africa: a cross-national mixed effects analysis.

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

Does education offset the effect of maternal disadvantage on childhood anaemia in Tanzania? Evidence from a nationally representative cross-sectional study.

BACKGROUND: Despite being preventable, anaemia is a major public health problem that affects a sizable number of children under-five years globally and in Tanzania. This study examined the maternal factors associated with the risk of anaemia among under-five children in Tanzania. We also assessed whether higher maternal education could reduce the risks of anaemia among children of women with poor socio-economic status. METHODS: Data was drawn from the 2015-16 Tanzania demographic and health survey and malaria indicator survey for 7916 children under five years. Adjusted odds ratios were estimated by fitting a proportional odds model to examine the maternal risk factors of anaemia. Stratified analysis was done to examine how the relationship differed across maternal educational levels. RESULTS: The findings revealed that maternal disadvantage evident in young motherhood [AOR:1.43, 95%CI:1.16-1.75], no formal education [AOR:1.53, 95%CI:1.25-1.89], unemployment [AOR:1.31, 95%CI:1.15-1.49], poorest household wealth [AOR:1.50, 95%CI:1.17-1.91], and non-access to health insurance [AOR:1.26, 95%CI: 1.03-1.53] were risk factors of anaemia among children in the sample. Sub-group analysis by maternal education showed that the risks were not evident when the mother has secondary or higher education. However, having an unmarried mother was associated with about four-times higher risk of anaemia if the mother is uneducated [AOR:4.04, 95%CI:1.98-8.24] compared with if the mother is currently in union. CONCLUSION: Findings from this study show that a secondary or higher maternal education may help reduce the socio-economic risk factors of anaemia among children under-5 years in Tanzania.