Mediating effects of hypertension in association between household wealth disparities and diabetes among women of reproductive age: analysis of eight countries in sub-Saharan Africa.

BACKGROUND: Diabetes prevalence appears to be increasing in low- and middle-income countries, yet little is known about how hypertension status mediates the association between household wealth and diabetes. This study examined the mediation effects of hypertension in associations between household wealth and diabetes in eight sub-Saharan African (SSA) countries. METHODS: This is a cross-sectional study of 71 577 women from recent Demographic and Health Surveys for eight SSA countries. Sample-weighted logistic regression and causal mediation analyses were conducted. RESULTS: Of the 71 577 women, 1.1% (782) reported ever being diagnosed with diabetes. Women with diabetes were more likely to have hypertension compared with those without diabetes (54.9% vs 9.9%). The odds of diabetes were significantly higher among women with hypertension (adjusted odds ratio [OR] 5.71 [95% confidence interval {CI} 4.62 to 7.05]) and women from rich households (adjusted OR 1.65 [95% CI 1.23 to 2.22]) compared with their respective counterparts. Hypertension status mediated 27.4% of the association between household wealth and diabetes status. CONCLUSIONS: Hypertension status partly contributes to the associations between household wealth disparities and diabetes status among women in the selected countries. Further research and targeted interventions are needed to explore specific mechanisms and confounding factors related to household wealth disparities, hypertension status and diabetes prevalence in this population.

Individual and neighborhood socioeconomic status and long-term individual trajectories of sleep duration among Black and White adults: the Southern Community Cohort Study.

STUDY OBJECTIVES: Sleep duration can change over the life course; however, previous studies rarely investigated the association between socioeconomic status (SES) and individual sleep trajectories over time. We examined the association between baseline socioeconomic characteristics and long-term sleep trajectories among Black and White adults. METHODS: This study used data from the Southern Community Cohort Study (N = 45 035). Diverse trajectories of sleep duration were constructed using self-reported sleep duration at baseline and after ~10 years of follow-up. The associations between baseline socioeconomic characteristics and sleep trajectories were examined using multinomial logistic regression. RESULTS: Both Black and White participants experienced similar long-term individual sleep trajectories for baseline educational attainment and employment status albeit the associations appeared stronger among White participants. Lower education and unemployment were associated with higher odds of various suboptimal sleep trajectories suggesting worsening long-term sleep patterns among both racial groups. However, there were some racial differences in the experience of long-term sleep trajectories for household income and neighborhood SES. Household income was notably more important among White than Black individuals; lower household income was associated with higher odds of more suboptimal long-term sleep trajectories for White than Black individuals. Also, neighborhood SES was slightly more important among White than Black individuals; lower neighborhood SES was associated with higher odds of a few suboptimal long-term sleep trajectories for both racial groups. CONCLUSIONS: Lower socioeconomic characteristics were associated with various suboptimal long-term sleep trajectories among Black and White participants. Substantial improvements in socio-economic characteristics may contribute to improved sleep patterns.

Socioeconomic determinants of cumulative fertility in Ghana.

The pace of decline in fertility rates in sub-Saharan Africa appears to have slowed or stalled in the last few decades. This study examines the socioeconomic associated with cumulative fertility in Ghana. Negative binomial regression models were used to estimate determinants of cumulative fertility using data from the Ghana Demographic and Health Surveys of 2003, 2008, and 2014. The composition of children ever born by women did not change considerably over the study periods. Socioeconomic disparities in educational attainment, household wealth, employment, and employer status are significantly associated with cumulative fertility risks in Ghana. The current age of women, age at sexual debut, and marital status, among others, are also linked to cumulative fertility levels. Place and region of residence are also linked to fertility in Ghana. Cumulative fertility levels in Ghana are underscored by considerable socioeconomic disparities among women of reproductive age. Fertility regulation policies should hinge on improving the socio-economic wellbeing of women in Ghana.

Levels and socioeconomic correlates of nonmarital fertility in Ghana.

Childbirth outside marriage has several negative implications for the well-being of children, women, and families globally. In sub-Saharan Africa, however, the phenomenon appears to be under-studied. In this study, we examine the levels and socioeconomic correlates of nonmarital fertility in Ghana. Using pooled data from the 2003, 2008, and the 2014 Ghana Demographic and Health Surveys, logistic regression models were used in determining significantly predictive factors of nonmarital fertility. The results show that nonmarital fertility levels have been on the rise over time without any sign of reduction (24.0%, 33.0%, and 40.0% for 2003, 2008, and 2014, respectively). Some socioeconomic characteristics are linked to nonmarital fertility levels with women without formal education, women from poor households, and self-employed women having significantly higher nonmarital fertility risks. Also, older unmarried women, women who have an early sexual debut, cohabiters, women with unmet need for family planning are all associated with considerably higher risks of nonmarital childbearing. A few significant regional disparities also exist, with the Central Region having higher whereas the Upper West Region has lower risks of nonmarital fertility compared to the Greater Accra Region. Childbirth outside marriage is a social concern among women in Ghana. The findings have possible implications for bridging socioeconomic disparities among unmarried women.

Effect of socioeconomic inequalities and contextual factors on induced abortion in Ghana: A Bayesian multilevel analysis.

There is a dearth of information on induced abortion in Ghana, possibly owing to the sensitive nature of the subject. In this study, we examine the effect of socioeconomic and contextual factors on induced abortion in Ghana. This study draws on data from the 2017 Ghana Maternal Health Survey. The study used a Bayesian multilevel logistic regression analysis to estimate both individual- and contextual-level factors affecting induced abortion levels in Ghana. The results show a total induced abortion prevalence of 19.6% coupled with considerable district-level disparities. Induced abortion is significantly associated with socioeconomic factors such as educational attainment, wealth status, and marital status at the individual-level. The risk of induced abortion is considerably higher among the educated, wealthy, and cohabiting women. The current age of women, age at first sex, religious affiliation, parity, and type of residence are the demographic factors having an association with induced abortion levels. At the contextual-level, district health insurance coverage and poverty rate have a significant association with induced abortion. Induced abortion appears to be prevalent in Ghana and is underpinned by both individual-level socioeconomic and aggregate-level factors. Addressing induced abortion levels in Ghana may require policies that take a multilevel approach by focusing on the socioeconomic status of women and district-level contextual factors.

Spatial variations and socioeconomic determinants of modern contraceptive use in Ghana: A Bayesian multilevel analysis.

The literature on spatial patterns and contextual factors affecting modern contraceptive use is not well-documented in Ghana. This study describes the spatial variations and estimates the socioeconomic determinants of modern contraception among women in reproductive age in Ghana. Using data from the 2014 Ghana Demographic and Health Survey, both global and local Moran's I test were performed to show spatial autocorrelation and Bayesian multilevel models estimated to determine socioeconomic factors affecting modern contraceptive use. The results show evidence of low prevalence and spatial clustering of modern contraception use across the country. There were also notable regional disparities in contraceptive use that favour mostly the southern regions. Modern contraceptive use is significantly associated with socioeconomic factors such as educational attainment, work status, and marital status, as well as age, religious affiliation, and parity. Contextual factors such as the convenient location of health facility and family planning messages exposure also have a considerable positive effect on modern contraceptive use. Uneducated, unemployed and never-married women are considerably disadvantaged in the utilisation of modern contraception in Ghana. Socioeconomic and contextual factors play a key role in modern contraceptive use in Ghana.

Male support for cervical cancer screening and treatment in rural Ghana.

Men have a critical role to play in reducing cervical cancer burden. Yet, there is little information on male involvement in the cervical cancer screening and treatment process in Ghana. In this study, we explore male knowledge and support during cervical cancer screening and treatment in a rural setting in Ghana. In-depth interviews and focus group discussions were conducted among a total of 41 respondents to collect qualitative data from cervical cancer patients, their male partners and other married men in the North Tongu District, Ghana. A thematic approach was used for data analysis and presentation of the results. The results show that male partners have little or no knowledge about cervical cancer. Some men provide various forms of support-financial, social, material and emotional-to their partners during the screening and treatment stages of the disease. Some men, however, abandoned their partners during the screening and treatment process of the disease. Men whose partners did not have cervical cancer said they were willing to provide financial, social, emotional and material support to their partners if they should contract the disease. Some men said they were willing to support their female partners but lacked education on the disease. This study underscores the need for cervical cancer education programmes to target Ghanaian men. The education should focus on the causes of the disease, screening and treatment methods of the disease, and, ultimately, promote spousal support during the screening and treatment processes.

Prevalence and correlates of contraceptive use among female adolescents in Ghana.

BACKGROUND: Adolescence is a critical stage in the life course and evidence suggests that even though contraceptive use has been steadily increasing among women in Ghana over the past years, contraceptive prevalence and determinants among female adolescents is quite lacking. This paper examines the prevalence and correlates of contraceptive use among female adolescents in Ghana. METHODS: The paper used data from the 2008 Ghana Demographic and Health survey. Bivariate analysis was carried out to determine the contraceptive prevalence among female adolescents while logistic regression analysis was applied to examine the correlates of female adolescent contraceptive use. RESULTS: The study founded that female adolescent contraceptive use was significantly determined by age of adolescent, education, work status, knowledge of ovulatory cycle, visit of health facility and marital status. CONCLUSIONS: This has implications for adolescent sexual and reproductive health programmes in Ghana. It is therefore essential to intensify girl child education and strengthen the provision of family planning information and services for female adolescents in the country.