Cervical cancer screening among women with comorbidities: evidence from the 2022 Tanzania demographic and health survey.

BACKGROUND: The aim of this study is to examine cervical cancer screening (CCS) uptake among women living with hypertension and HIV in Tanzania. METHODS: We used the recently released 2022 Tanzania Demographic and Health Survey. The outcome variable assessed in the study was CCS, whereas chronic morbidities constituted the main explanatory variable. Data analysis was based on observations from 6,298 women aged 30-49 years. Multivariable logistic regression models were used to determine the association between hypertension and HIV status, and CCS uptake. The analyses were computed in STATA 18. RESULTS: Out of the 6,298 respondents, only 805 (12.8%) had undergone CCS with higher screening uptake among those living with either one of the disease (28.5%) than among those living with neither hypertension or HIV. The highest proportion was found among those who had ever been diagnosed with hypertension (24.1%) and among women with positive HIV test results (36.7%). There was a significantly higher likelihood of undergoing screening for cervical cancer among women living with at least one of the diseases [AOR = 2.4; 95% CI: 1.4-2.8], compared to those without these conditions. Women diagnosed with hypertension showed increased likelihood of undergoing CCS [AOR = 1.4; 95%CI: 1.1-1.7]. Similarly, women with a positive HIV test result demonstrated higher odds of screening uptake [AOR = 5.2; 95%CI: 4.0-6.7]. CONCLUSION: The study found a positive association between comorbidities and CCS uptake in Tanzanian women. Our findings emphasize the critical importance of ensuring accessibility and adherence to essential screenings for individuals with chronic morbid conditions. Future efforts should focus on strengthening existing integrated services and identifying potential barriers to accessing CCS within these healthcare settings to optimize cervical cancer prevention efforts for individuals with chronic morbidities.

Early age at menarche and history of sexually transmitted infections significantly predict cervical cancer screening uptake among women aged 25-49 years: evidence from the 2021 Côte d'Ivoire demographic and health survey.

INTRODUCTION: Cervical cancer is the second dominant type of cancer among Ivorian women with an estimated age-standardised incidence and mortality rate of 31.2 cases and 22.8 deaths per 100,000 women in 2020, respectively. The Ivorian government through its Ministry of Health implemented the National Cancer Control Programme (NCCP) in 2003 with the aim of improving the prevention, early detection and treatment of cancers in Côte d'Ivoire. Yet, there is a low uptake of CCS (1.2%). Thus, making CCS uptake an important public health concern in the country. Understanding of the extent to which reproductive factors predict CCS uptake is limited in literature. This study aimed to investigate reproductive factors as a predictor of women's uptake of CCS in Côte d'Ivoire. METHODS: Data from the 2021 Côte d'Ivoire Demographic and Health Survey. A sample of 9,078 women aged 25-49 years were analyzed. The outcome variable was CCS uptake while other variables considered included age at menarche, history of STI, sexual debut, parity, age, educational level, wealth index, health insurance, place of residence, and media exposure. A multivariable logistic regression model was fitted to examine the association between the outcome of interest and predictors at 95% confidence interval. RESULTS: Approximately, 7.52% of women aged 25-49 years had ever undergone testing for cervical cancer by a healthcare provider. Early menarche was associated with lower odds of CCS uptake [AOR = 0.78; CI = 0.65-0.95]. Compared to those who had no STI, women with a history of STI were more likely to screen for cervical cancer [AOR = 2.63; CI = 2.02-3.42]. Increasing age, higher educational attainment, having health insurance, and being exposed to media were significantly associated with CCS uptake. CONCLUSION: In Cote d'Ivoire, age at menarche and STI history constitute reproductive factors that were significantly associated with women's uptake of CCS. It is imperative for public policy to focus on increasing CCS in these higher-risk women (i.e., women who experienced early menarche, women with early sexual debut and higher parity) through increased sensitization on cervical cancer risk factors.

Utilisation of traditional medicine among women diagnosed with breast cancer in Ghana: a descriptive phenomenological study.

BACKGROUND: Women living with breast cancer (BC) rely on traditional medicine (TM) in addition to orthodox medicine. There is a need to understand how and why women diagnosed with BC utilise TM. This study explored and described the lived experiences of women living with BC in terms of their utilisation of traditional medicine. METHODS: A descriptive phenomenology design was used to purposively conduct 20 face-to-face in-depth interviews using a semi-structured interview guide. Data were analysed using NVivo-12 based on Collaizzi's framework for thematic data analysis. RESULTS: Overall, five main themes emerged, namely: sources of knowledge on TM, motivations for using TM, treatment modalities, timing for the initiation of TM, the reasons for discontinuing use of TM, and the decision to seek orthodox medicine. Under the category of motivations for using TM, four themes emerged: financial difficulties and perceived cost effectiveness of TM, influence of social networks, including family and friends, assurance of non-invasive treatment, delays at the healthcare facility, and side effects of orthodox treatment. Non-invasive treatments included herbal concoctions, natural food consumption, and skin application treatments. Regarding the timing of initiation, TM was used in the initial stage of symptom recognition prior to the decision to seek orthodox medicine, and was also used complementarily or as an alternative after seeking orthodox medicine. However, patients eventually stopped using TM due to the persistence of symptoms and the progression of cancer to a more advanced stage, and disapproval by orthodox practitioners. CONCLUSION: Women living with BC in Ghana utilise traditional medicine (TM) for many reasons and report their family, friends and the media as a main source of information. A combination of herbal concoctions and skin application modalities is obtained from TM practitioners to treat their BC. However, they eventually discontinue TM when symptoms persist or when disapproval is expressed by their orthodox healthcare providers. We conclude that there is an opportunity to better integrate TM into the standard of oncological care for BC patients.

Being the nurse for my child at home: A qualitative analysis of parental recognition, appraisal, and reactions to childhood cancer in Ghana.

Parental involvement in childhood cancer care is of utmost importance, but the understanding of parental recognition, appraisal, and reactions to childhood cancer in settings such as Ghana is limited. We conducted an empirical phenomenological study to explore these aspects among Ghanaian parents. Twenty parents were purposively sampled to participate in semi-structured interviews between June and September 2022. All interviews were transcribed and analysed using an inductive thematic approach. We found that parents recognised symptoms through personal observation and their child's self-report, often perceiving them as non-severe. Emotional reactions upon receiving their child's cancer diagnosis included psychological distress, fear, doubts, and confusion. Enduring emotions experienced by parents were fears of disease recurrence and impending death of their child. Parents assumed the role of nurses at home, monitoring therapy effects, managing pain and symptoms, and dressing wounds. In conclusion, parents in Ghana play a crucial role in the recognition, diagnosis, and treatment pathways of childhood cancer. To enhance their ability to recognise symptoms and take timely actions, it is recommended to implement media programs and health education initiatives targeting parents.

Impact of childhood and adolescence cancer on family caregivers: a qualitative analysis of strains, resources and coping behaviours.

BACKGROUND: The physical demands of caring for children and adolescents diagnosed with cancer, over a lengthy period, exert significant strain on the health and well-being of family caregivers. The capacity of family caregivers to surmount and cope with the various strains they experience due to the diagnosis and treatment trajectory is essential to the quality of life of the child and adolescent who has been diagnosed with cancer. However, the experiences of family caregivers have been under-explored. This study explored the strains, resources, and coping strategies of family caregivers of children and adolescents diagnosed with cancer in Ghana. METHODS: Guided by a descriptive phenomenological design, 20 semi-structured interviews with family caregivers were conducted at a tertiary health facility that provides paediatric oncology services. The study was conducted between June and October 2022. The interviews were transcribed verbatim, translated and coded using NVivo software. An inductive thematic analysis approach using Vaismoradi et al.'s thematic analysis framework was followed in analysing the data. RESULTS: The study revealed that family caregivers of children diagnosed with cancer experienced three main strains: somatic strains (poor sleep quality, loss of appetite, and unintended weight loss), economic strains (financial burden and loss of economic livelihood), and psychosocial strains (isolation from social activities and network, frustration and helplessness, and balancing multiple family needs). The following themes emerged as coping resources: family cohesiveness, community support, and support from health care providers. Coping strategies that emerged included trusting in God and being self-motivated. CONCLUSION: The study concludes that family caregivers experience somatic, economic, and psychosocial strains. However, they can leverage available resources (family cohesiveness, community support, and support from healthcare providers) to cope with these strains. There is a need to educate and sensitize family caregivers about the potential strains that they are likely to experience prior to the assumption of care roles. Also, the formal inclusion of non-governmental organizations and religious bodies will ensure that family caregivers receive sufficient community support to cope with the strains of caregiving.

Expectations and barriers to the utilization of specialist palliative care services among persons living with cancer in Ghana: an exploratory qualitative study.

Background: The need for palliative care among patients living with cancer is increasing globally. This need is far greater in resource-constrained settings like Ghana where there is a high unmet need for palliative care services. Consequently, there are lapses in the current palliative care regime, thus, resulting in suboptimal utilization. Objective: The study aims to explore patients living with cancer's expectations of palliative care services and examine the barriers that impede palliative care utilization. Design: Descriptive exploratory qualitative design. Methods: A total of 15 patients living with cancer and receiving treatment in a tertiary health facility were purposively sampled to participate in this study. Semi-structured interviews were conducted. The data were transcribed and inductively analysed following Collaizi's qualitative analysis framework. Results: From the analysis, the findings were grouped under two main categories: perceived expectations and barriers to utilizing palliative care. The participants expected to receive meaningful communication about their condition and prognosis; they also expected to be actively involved in palliative care decision-making. Regarding the barriers, the following themes emerged: financial constraints, unfavourable health appointment schedules, problems with the distance to the health facility, poor referral and follow-up from oncology specialists and being unaware of the availability of palliative care services. Conclusion: In conclusion, there is a need to actively involve patients and their families in all decision-making along the continuum of palliative care service delivery. The study underscores the need for Ghana to implement an integration of palliative care services in primary healthcare facilities to avert the challenges that distance to tertiary healthcare facilities poses to palliative care utilization. Service providers must implement awareness programmes to enable patients to better comprehend palliative care services.

Impact of cancer diagnosis and treatment: a qualitative analysis of strains, resources and coping strategies among elderly patients in a rural setting in Ghana.

BACKGROUND: Rurality is fraught with numerous difficulties including a lack of advanced health facilities to provide health services, and an absence of specialist cancer services, and qualified personnel, among others. These factors exacerbate the challenges of elderly patients diagnosed with cancer and further pose limitations to activities/instrumental activities of daily living. Yet, there is limited scholarship on the strains that affect elderly patients diagnosed with cancer and the resources that helps them to overcome them. This study explores the strains, resources, and coping strategies of elderly patients diagnosed with cancer and undergoing treatment in rural Ghana. METHODS: An exploratory, descriptive qualitative design was adopted. Purposive sampling was used to recruit 20 individuals to participate in in-depth interviews. The collected data was analysed inductively using Collaizi's framework. QSR NVivo-12 was used in managing the data. RESULTS: The results were grouped into two main categories, namely: strains and resources. Within the category of strains, three main themes with their corresponding sub-themes emerged: cancer-related strains (systemic side effects from treatment, altered physical appearance and body image, and experience of pain), elderly strains (altered functional ability, limited social interactions and participation, psycho-emotional reactions, limited/restricted economic participation, and financial strains), and health system strains (negative attitude and insensitive communication, delay in diagnosis, lack of geriatric oncology care, lack of community-based specialist cancer centre and long travel distance to access care, and limited availability of essential cancer medicines and other radiations services). Four types of resources were available to cancer patients: personal resources, family resources, community resources, and healthcare systems resources. CONCLUSION: In conclusion, elderly patients diagnosed with cancer experience physical, economic, psychological, and emotional strains that threaten their health and well-being. However, they are able to leverage family, community, and health system-related resources to navigate through the strains. There is, therefore, a need to expand advanced health facilities with geriatric oncology units and specialists to improve access to cancer care in rural areas. The government needs to assist elderly persons with costs associated with their diagnosis and treatment through the expansion of the National Health Insurance Scheme to include this as part of the benefits package.

Nurses' knowledge on nosocomial infections preventive measures and its associated factors in Ghana: a cross-sectional study.

BACKGROUND: Nosocomial infections (NCIs) have been associated with several adverse outcomes including extended hospitalization, persistent disability, heightened antimicrobial resistance, amplified socio-economic disruption, and elevated mortality rates. The adoption of infection prevention strategies has the greatest tendency to significantly reduce the risk and occurrence of NCIs among the population, particularly in resource constrained health systems. This study assessed nurses' knowledge on NCI preventive measures and its associated factors in Ghana. METHODS: A cross-sectional study was conducted from July to August 2021. A sample of 237 healthcare workers in the Hohoe Municipality was selected to participate in the study. Data was collected with a questionnaire designed in Google Forms and analyzed using Stata version 16.0. RESULTS: Overall, most of the participants (69.2%) were not knowledgeable about the preventive measures of NCIs. Nurses who were within the age group of 20-40 years [aOR = 0.25 (95% CI = 0.09-0.69), p = 0.007] and 41-60 years [aOR = 0.05 (95% CI = 0.01-0.29), p = 0.001] were significantly less likely to be knowledgeable about the preventive measures of NCIs compared to those who those aged less than 20 years. Nurses who attended in-service training or workshop were approximately 10 times more likely to be knowledgeable about preventive measures of nosocomial infection compared to those who had never attended in-service training or workshop [aOR = 9.55 (95% CI = 1.23-74.36), p = 0.031]. CONCLUSION: The study concludes that age and participation in-service training or workshop are significant factors that influence the knowledge of healthcare workers in preventive measures for nosocomial infections. These results highlight the importance of providing ongoing training and professional development opportunities to nurses to enhance their knowledge and improve their ability to prevent and control nosocomial infections. Additionally, the study emphasizes the need for targeted training programs that consider the age of nurses, to ensure that training is tailored to their specific needs.

Barriers to the integration of palliative care in Ghana: evidence from a tertiary health facility.

Background: Integration of palliative care (PC) in cancer management is critical to improving the overall quality of life of cancer patients and their families. Nevertheless, only a few people in need of PC services actually receive them. Objective: The study explored the barriers to the successful integration of PC in cancer management in Ghana. Design: The design was an exploratory descriptive qualitative research design. Methods: In all, we conducted 13 interviews with service providers (7), patients (4) and caregivers (2). An inductive thematic analysis was carried out. Data were managed using QSR NVivo 12. Results: Our study reveals the different levels of barriers that adversely affect the successful integration of PC and cancer management. Emerging from the findings are patient- and family-level barriers (denial of the primary diagnosis and understanding of PC and financial constraints), service provider-level barriers (healthcare providers' misunderstanding of PC and late referrals), and institutional and policy-level barriers (infrastructural and logistical constraints, non-inclusion of PC in the National Health Insurance Scheme, low staff strength). Conclusion: We conclude that different levels of barriers are encountered in the integration of PC in cancer management. There is a need for policymakers to develop comprehensive guidelines and protocols for the integration of PC into cancer management. These guidelines should address the various levels of factors that serve as barriers to PC integration. The guidelines should also emphasise the importance of early referral for PC and educate service providers on the benefits of PC for patients with life-limiting illnesses. Our findings underscore a need to include PC services and medication in the benefits package of the health insurance scheme to reduce the financial burden on patients and their families. In addition, continuous professional training of all cadre of service providers is needed to facilitate PC integration.

Prostate cancer screening uptake in Kenya: An analysis of the demographic and health survey.

BACKGROUND: Prostate cancer (PCa) screening is a cost-effective strategy to promote early detection and treatment. Understanding the determinants of PCa screening uptake would help policy makers to identify high-risk populations and ensure the cost-effectiveness of health promotion interventions. This study aims to estimate the prevalence of PCa screening uptake and assess its associated factors among Kenyan men. METHODS: The study relied on data from the 2014 Kenya Demographic and Health Survey. Both descriptive and inferential analyses were performed. Firth logistic regression was employed using the "firthlogit" command in STATA. The adjusted odds ratio and 95% confidence interval were presented. RESULTS: Overall, the prevalence of PCa screening uptake was 4.4%. The odds of PCa screening uptake were high among men aged 50-54 [aOR= 2.08; CI= 1.23, 3.52], those who had health insurance coverage [aOR= 1.69; CI= 1.28, 2.23], those who read at least once in a week [aOR= 1.52; CI= 1.10, 2.10], and among those who watched TV at least once in a week [aOR= 1.73; CI= 1.18, 2.52]. Men who resided in the Eastern [aOR= 2.23; CI= 1.39, 3.60], Nyanza [aOR= 2.13; CI= 1.29, 3.53], and Nairobi [aOR= 1.97; CI= 1.01, 3.86] had a higher likelihood of getting screened for PCa. CONCLUSION: In conclusion, the uptake of PCa screening in Kenya is low. To ensure the cost-effectiveness of health-promoting interventions that aim to improve PCa screening uptake in Kenya, men without health insurance coverage should be targeted and prioritized. Increasing literacy rate, sensitization via television, and increasing the insurance coverage in the country would significantly contribute to a higher uptake of PCa screening. POLICY SUMMARY: To improve the uptake of PCa screening, there would be a need to implement a national advocacy campaign that will sensitize Kenyan men about the need to undergo PCa screening. This national advocacy campaign to increase the uptake of PCa screening in Kenya must leverage mass media platforms.

High-risk fertility behaviour and undernutrition among children under-five in sub-Saharan Africa: a cross-sectional study.

OBJECTIVE: The study examined high-risk fertility behaviour and its association with under-five undernutrition in sub-Saharan Africa (SSA). DESIGN: We conducted a cross-sectional analysis of data from 32 sub-Saharan African countries' Demographic and Health Surveys. A weighted sample of 110 522 mother-child pairs was included in final analysis. Multilevel binary logistic regression was used to examine the association between high-risk fertility behaviour and undernutrition. The results were presented using adjusted odds ratio (aOR) with their respective 95% confidence intervals (CIs). SETTING: Thirty-two countries in SSA. OUTCOME MEASURE: Stunting, wasting, and underweight. RESULTS: The pooled prevalence of stunting was 31.3%, ranging from 15.0% in Gabon to 51.7% in Burundi. Wasting was highest among children from Burkina Faso (19.1%) and lowest among those from South Africa (1.6%). The overall prevalence of wasting was 8.1%. The prevalence of underweight was 17.0%, with the highest among children in Niger (37.1%) and lowest in South Africa (4.8%). Mothers who gave birth at the age less than 18 years and those with short birth interval were more likely to have their children being stunted, wasted, and underweight. The odds of stunting and wasting were high among children born to women with high parity. However, maternal age at birth more than 34 was associated with lower odds of childhood underweight as against those with age at birth less than 34. CONCLUSION: Countries in SSA are encouraged to address the issue of maternal age at birth less than 18, high parity, and shorter birth intervals in order to meet the Global Nutrition targets, which aim to achieve a 40% reduction in the number of stunted children under the age of 5 and to reduce and maintain childhood wasting to less than 5% by 2025.

Benefits of integrating palliative care: a qualitative exploration of the perspectives of palliative care providers in a tertiary health facility in Ghana.

Background: Integration of palliative care (PC) services entails combining administrative, organisational, clinical and service elements to ensure continuity of care between all parties participating in the care network of patients. There is a need to understand the benefits of integrating PC to inform policy making and advance advocacy, especially in resource-constrained settings such as Ghana where PC is sub-optimally implemented. Yet, existing research in Ghana is sparse on what benefits are likely to be experienced as a result of integrating PC. Objective: The study explored service providers' perspectives on the benefits of integrating PC in Ghana. Design: The design was an exploratory descriptive qualitative research design. Methods: A total of seven in-depth interviews were conducted using semi-structured interview guides. The data were managed using NVivo-12. Inductive thematic analysis was carried out following Haase's modification of Colaizzi's approach to qualitative research analysis. The study follows the COREQ guidelines and the ICMJE recommendations. Result: Two main themes emerged: patient-related outcomes, and system/institution-related outcomes. For the patient-related outcomes, the following sub-themes emerged: restored hope, appreciated care and better preparation for the end of life (EoL). The emerging sub-themes under the system/institution-related outcomes include the following: early initiation of care, enhanced communication between primary healthcare providers and the PC team and strengthening staff capacity to provide PC services. Conclusion: In conclusion, there are substantial benefits to be experienced from integrating PC. For the patients, it would restore shattered hopes, result in appreciated care and better preparation for the EoL. For the healthcare system, it would promote early initiation of care, enhance communication between primary healthcare providers and the PC team and strengthen service providers' capacity to provide PC services. This study, thus, furthers the case for a more integrated PC service in Ghana.

Risky health behaviours and chronic conditions among aged persons: analysis of SAGE selected countries.

BACKGROUND: Increasing trends in risky health behaviours contribute to chronic health problems among the rapidly growing ageing population. Therefore, we examined the association between risky health behaviours and chronic health conditions among persons 50 years and older. METHODS: This study was a secondary analysis of longitudinal survey data from the 2007 Study on Global Ageing and Adult Health (SAGE Wave 1) conducted by the World Health Organization. Multilevel logistic regression techniques were used to examine high social cohesion among the aged. The output was reported as odds ratios (OR) and adjusted odds ratios (aOR). RESULTS: Generally, the level of chronic conditions was 81.5% for all countries. Older adults in Ghana had the highest chronic conditions (94.0%) while the Russian Federation recorded the lowest (58.6%). The risk of chronic conditions was higher among the oldest-old (OR = 1.70, 95% CI = 1.29, 2.25), those who smoke tobacco (OR = 1.13, 95% CI = 1.01, 1.25) or drink alcohol (OR = 1.17, 95% CI = 1.06,1.29), and among those who live in rural areas (OR = 1.31, 95% CI = 1.16, 1.49). However, the odds were lower among females (OR = 0.88, 95% CI = 0.69,0.85), and those who were not working (OR = 0.52, 95% CI = 0.47, 0.58). CONCLUSION: We conclude that it is important to improve the health status of older people. To achieve this, there must be interventions and policies to facilitate the adoption of healthy or physically active lifestyles among older people. This could be achieved by strengthening advocacy and health education about the dangers of living a sedentary lifestyle, consuming alcohol and tobacco. Whatever behavioural change interventions, advocacy and health education must target high-risk sub-populations including the oldest-old, and those with low economic status. Given the regional disparities identified, it is necessary to prioritise older people residing in rural areas. The study underscores a need to provide more primary healthcare facilities in the rural areas of the countries included in this study. Such an initiative is likely to increase accessibility to healthcare services and information that would impact positively on the lifestyle behaviours of older people.

Prevalence and determinants of breast self-examination practices among women in their reproductive age in Namibia: an analysis of the 2013 Namibia demographic and Health Survey.

BACKGROUND: In resource-constrained settings like Namibia, breast self-examination (BSE) is considered an important cost-effective intervention that is critical to the early detection of breast cancer, and better prognosis. Even though BSE is a simple, quick, and cost-free procedure, its practice varies across different contexts. Knowing the determinants of BSE is necessary to inform the implementation of policies and targeted interventions to improve the practice across the population. In Namibia, estimating the magnitude of BSE practice and its determinants using nationally representative data has received limited scholarly attention. Hence, the present study sought to examine the prevalence and determinants of BSE practices among women of reproductive age in Namibia. METHODS: This study relied on the 2013 Namibia Demographic and Health Survey (NDHS), analysing data from women aged 15-49 years. Statistical analyses including bivariate and multivariate logistic regression analyses were done using Stata version 14. Adjusted odds ratio (AOR) and confidence interval (CI) are presented. We followed the 'Strengthening the Reporting of Observational Studies in Epidemiology' (STROBE) statement. RESULTS: Only 30.67% of the respondents practiced BSE. The odds of performing BSE were higher among those with health insurance coverage [AOR = 1.59, 95% CI: 1.34, 1.89], those who were separated from their spouses [AOR = 1.36, 95% CI: 1.03, 1.80], those within the richest wealth index [AOR = 1.69, 95% CI: 1.23, 2.33, p ≤ 0.001], and among Catholics [AOR = 0.84, 95% CI: 0.71, 0.98]. Women with secondary [AOR = 2.44, 95% CI:1.78, 3.35, p ≤ 0.001] or higher education [AOR = 3.39, 95%CI:2.24, 5.14] had higher odds of performing BSE. Women aged between 20-49 years had a significantly higher likelihood to practice BSE. Compared to women who live in Khomas, those living in Erongo, Karas, and Omaheke, were more likely to practice BSE than those in Kavango, Ohangwena, Omusati, Oshana, and Oshikoto. CONCLUSION: We conclude that the determinants of BSE practice are age, educational level, marital status, health insurance coverage, religion, mobility in the last 12 months, early sexual debut, parity, household wealth index, and region of residence. Any policy or intervention to improve BSE practice among Namibian women of reproductive age must target adolescent girls, those with no formal education, those without health insurance coverage, multiparous women, and those in the poorest wealth index.

Towards a cervical cancer-free future: women's healthcare decision making and cervical cancer screening uptake in sub-Saharan Africa.

OBJECTIVE: We investigated the association between women's healthcare decision making and cervical cancer screening uptake in sub-Saharan Africa. DESIGN: Secondary data from the Demographic and Health Surveys of six countries in sub-Saharan Africa were used. We employed multilevel binary logistic regression modelling. SETTING: Sub-Saharan Africa. PARTICIPANTS: Women aged 15-49 years in Benin (n=5282), Côte d'Ivoire (n=1925), Cameroon (n=7558), Kenya (n=6696), Namibia (n=1990) and Zimbabwe (n=5006). PRIMARY OUTCOME MEASURES: Cervical cancer screening uptake. RESULTS: The overall prevalence of cervical cancer screening across the six sub-Saharan African countries was 13.4%. Compared with women whose healthcare decisions were made solely by husbands/partners/someone else, the likelihood of cervical cancer screening uptake was significantly higher among women who took healthcare decisions in consultation with their husbands/partners (aOR=1.38; 95% CI 1.19 to 1.59), but highest among those who made healthcare decisions alone (aOR=1.66; 95% CI 1.44 to 1.91). Women aged between 40 and 45 years (aOR=5.18; 95% CI 3.15 to 8.52), those with higher education (aOR=2.13; 95% CI 1.57 to 2.88), those who had ever heard of cervical cancer (aOR=32.74; 95% CI 20.02 to 53.55), read newspaper or magazine at least once a week (aOR=2.11; 95% CI 1.83 to 2.44), listened to the radio at least once a week (aOR=1.35; 95% CI1.18 to 1.52) and those in households with richest wealth index (aOR=1.55; 95% CI 1.20 to 2.00) had significantly higher odds of screening for cervical cancer compared to their counterparts. CONCLUSION: Women who are able to make autonomous healthcare decisions and those who practice shared decision making are more likely to uptake cervical cancer screening. Therefore, policy interventions should focus on empowering women to be able to take autonomous healthcare decisions or shared decision making while targeting subpopulations (ie, multiparous and rural-dwelling women, as well as those in other religious affiliations aside from Christianity) that are less likely to uptake cervical cancer screening. Also, the radio and print media could be leveraged in raising awareness about cervical cancer screening to accelerate cervical cancer screening uptake in sub-Saharan Africa.

Was there any change in tobacco smoking among adults in Bangladesh during 2009-2017? Insights from two nationally representative cross-sectional surveys.

OBJECTIVE: This study assessed the changes in prevalence and associated factors of tobacco smoking among Bangladeshi adults over time. DESIGN: Nationally representative cross-sectional surveys. SETTING: Two most recent Global Adults Tobacco Survey (GATS) data from Bangladesh, carried out in 2009 and 2017. PARTICIPANTS: Adult population aged 15 and above (n=9629 in 2009; n=12 783 in 2017). OUTCOME MEASURES: Current use of tobacco smoke, including cigarettes, bidi, hukkah, cigars or pipes, which was dichotomised ('yes'/'no'). METHODS: We analysed data from two recent rounds of GATS (2009 and 2017). Multivariate logistic regression analysis was used. RESULTS: The overall prevalence of tobacco smoking among Bangladeshi adults was noted (23.00%, 95% CI 22.98 to 23.00 in 2009; 16.44%, 95% CI 16.43 to 16.45 in 2017). Being male (adjusted OR (AOR)=59.72, CI 40.56 to 87.93 for 2009; AOR=71.17, CI 41.08 to 123.32 for 2017), age between 25 and 64 years (all AORs >2 and p<0.05), smoking permissible at home (AOR=7.08, CI 5.88 to 8.52 for 2009; AOR=5.90, CI 5.34 to 6.95 for 2017), and watching tobacco smoking product use in movie/drama scenes (AOR=1.26, CI 1.11 to 1.44 for 2009; AOR=1.34, CI 1.17 to 1.54 for 2017) were found to be significantly associated with increased tobacco smoking among adults both in 2009 and in 2017. However, being offered free tobacco sample products (AOR=0.66, CI 0.57 to 0.77 for 2009; AOR=0.87, CI 0.76 to 0.99 for 2017) and having primary, secondary or higher education (all AORs <1 and p<0.05) as well as being a student (AOR=0.16, CI 0.09 to 0.29 for 2009; AOR=0.32, CI 0.19 to 0.53) were associated with lower odds of tobacco smoking in both surveys. CONCLUSIONS: Although the prevalence of tobacco smoking has declined over the period, it is still high among those who were relatively older, men, less educated and exposed to a movie/drama where tobacco smoking is promoted. Therefore, appropriate interventions are required to stop tobacco smoking among the Bangladeshi population.

Prevalence, progress, and social inequalities of home deliveries in Ghana from 2006 to 2018: insights from the multiple indicator cluster surveys.

BACKGROUND: Delivery in unsafe and unsupervised conditions is common in developing countries including Ghana. Over the years, the Government of Ghana has attempted to improve maternal and child healthcare services including the reduction of home deliveries through programs such as fee waiver for delivery in 2003, abolishment of delivery care cost in 2005, and the introduction of the National Health Insurance Scheme in 2005. Though these efforts have yielded some results, home delivery is still an issue of great concern in Ghana. Therefore, the aim of the present study was to identify the risk factors that are consistently associated with home deliveries in Ghana between 2006 and 2017-18. METHODS: The study relied on datasets from three waves (2006, 2011, and 2017-18) of the Ghana Multiple Indicator Cluster surveys (GMICS). Summary statistics were used to describe the sample. The survey design of the GMICS was accounted for using the 'svyset' command in STATA-14 before the association tests. Robust Poisson regression was used to estimate the relationship between sociodemographic factors and home deliveries in Ghana in both bivariate and multivariable models. RESULTS: The proportion of women who give birth at home during the period under consideration has decreased. The proportion of home deliveries has reduced from 50.56% in 2006 to 21.37% in 2017-18. In the multivariable model, women who had less than eight antenatal care visits, as well as those who dwelt in households with decreasing wealth, rural areas of residence, were consistently at risk of delivering in the home throughout the three data waves. Residing in the Upper East region was associated with a lower likelihood of delivering at home. CONCLUSION: Policies should target the at-risk-women to achieve complete reduction in home deliveries. Access to facility-based deliveries should be expanded to ensure that the expansion measures are pro-poor, pro-rural, and pro-uneducated. Innovative measures such as mobile antenatal care programs should be organized in every community in the population segments that were consistently choosing home deliveries over facility-based deliveries.

Cervical cancer screening prevalence and its correlates in Cameroon: secondary data analysis of the 2018 demographic and health surveys.

BACKGROUND: Cervical cancer, although preventable, is the fourth most common cancer among women globally, and the second most common and deadliest gynaecological cancer in low-and-middle-income countries. Screening is key to the prevention and early detection of the disease for treatment. A few studies estimated the prevalence of cervical cancer screening and its correlates in Cameroon but relied on data that were limited to certain regions of the country. Therefore, this study sought to examine the prevalence and correlates of cervical cancer screening among Cameroonian women using current data that is nationally representative of reproductive-age women. METHODS: We used secondary data from the 2018 Cameroon Demographic and Health Survey. Summary statistics were used for the sample description. We employed the Firth logistic regression using the "firthlogit" command in STATA-14 to perform the bivariate analyses between the outcome variable and each of the explanatory variables. Given that all the explanatory variables were statistically significant correlates, they were all adjusted for in a multivariable analysis. All analyses were performed in STATA version 14. RESULTS: The proportion of Cameroonian women who have ever screened for cervical cancer continue to remain low at approximately 4%. In the adjusted model, women with the following sociodemographic characteristics have a higher likelihood of undergoing cervical cancer screening: ever undergone HIV screening (AOR = 4.446, 95% CI: 2.475, 7.986), being 24-34 years (AOR = 2.233, 95% CI: 1.606, 3.103) or 35-44 years (AOR = 4.008, 95% CI: 2.840, 5.657) or at least 45 years old (AOR = 5.895, 95% CI: 3.957, 8.784), having attained a post-secondary education (AOR = 1.849, 95% CI: 1.032, 3.315), currently (AOR = 1.551, 95% CI: 1.177, 2.043) or previously married (AOR = 1.572, 95% CI: 1.073, 2.302), dwelling in the richest household (AOR = 4.139, 95% CI: 1.769, 9.682), and residing in an urban area (AOR = 1.403, 95% CI: 1.004,1.960). Except for the North-West region, residing in some five regions, compared to Yaounde, was negatively associated with cervical cancer screening. CONCLUSION: Cervical cancer screening programs and policies should target Cameroonian women who are younger, less educated, and those in poor households and rural areas.