Factors associated with anaemia among pregnant women in Rwanda: an analysis of the Rwanda demographic and health survey of 2020.

BACKGROUND: Anaemia in pregnancy is associated with several adverse outcomes for mothers and newborns, as well as their families. In this study, we assessed the prevalence of anaemia and the associated factors among pregnant women in Rwanda. METHODS: Secondary data from the 2020 Rwanda Demographic and Health Survey (RDHS) was used. Multistage stratified sampling was used to select 435 pregnant women included in the study. Anaemia among pregnant women was defined as a haemoglobin value < 11 g/dL. Multivariable logistic regression was used to assess the associated factors with anaemia in pregnancy, using SPSS (version 26). RESULTS: Of the 435 pregnant women, 24.6% (95%CI: 21.1-29.3) were anaemic (1 in 4 pregnant women). Not working (AOR = 2.45; 95%CI: 1.14-5.26), being unmarried (AOR = 1.23; 95%CI: 1.24-3.57), low wealth index (AOR = 9.19; 95%CI: 1.64-51.56), having difficulty accessing a nearby health facility (AOR = 5.40; 95%CI: 2.21-13.23), and normal body mass index (AOR = 3.33; 95%CI: 1.46-7.59) were associated with higher odds of being anaemic. However, not taking iron supplements (AOR = 0.16; 95% CI: 0.04-0.67), having no exposure to television (AOR = 0.35; 95%CI: 0.14-0.91), being from the southern region (AOR = 0.14; 95% CI: 0.03-0.66), and low husband/partner's education (AOR = 0.08; 95% CI: 0.01-0.59) were associated with lower odds of being anaemic. CONCLUSIONS: The study findings indicate a high prevalence of anaemia in pregnancy, which was associated with several socio-demographics. There is a need for setting up mobile clinics and health facilities in hard-to-reach areas for easy accessibility to early anaemia screening services. Conducting mass screening for anaemia targeting pregnant women who are not working, the unmarried, and those with a low wealth index would also be beneficial. The intake of locally available iron rich foods and/ or bio-fortified foods is also recommended.

Comprehensive knowledge about HIV/AIDS and associated factors among adolescent girls in Rwanda: a nationwide cross-sectional study.

BACKGROUND: Limited comprehensive knowledge of HIV/AIDS is highlighted as one of the major factors linked to the high prevalence of HIV among adolescents and young girls. Thus, it is crucial to identify factors that facilitate or hinder adolescent girls from having comprehensive knowledge of HIV/AIDS. We, therefore, assessed the prevalence of comprehensive knowledge about HIV/AIDS and associated factors among adolescent girls in Rwanda. METHODS: We used secondary data from the Rwanda Demographic and Health Survey (RDHS) 2020 comprising 3258 adolescent girls (aged 15 to 19 years). Comprehensive knowledge was considered if an adolescent girl answered correctly all the six indicators; always using condoms during sex can reduce the risk of getting HIV, having one sexual partner only who has no other partners can reduce the risk of getting HIV, a healthy-looking person can have HIV, can get HIV from mosquito bites, can get HIV by sharing food with persons who have AIDS, and can get HIV by witchcraft or supernatural means. We, then, conducted multivariable logistic regression to explore the associated factors, using SPSS (version 25). RESULTS: Of the 3258 adolescent girls, 1746 (53.6%, 95%CI: 52.2-55.6) had comprehensive knowledge about HIV/AIDS. Adolescent girls with secondary education (AOR = 1.40, 95% CI: 1.13-3.20), health insurance (AOR = 1.39, 95% CI: 1.12-1.73), a mobile phone (AOR = 1.26, 95% CI: 1.04-1.52), exposure to television (AOR = 1.23, 95% CI: 1.05-1.44), and a history of an HIV test (AOR = 1.26, 95% CI: 1.07-1.49) had higher odds of comprehensive HIV knowledge, compared to their respective counterparts. However, girls residing in Kigali (AOR = 0.65, 95% CI: 0.49-0.87) and Northern (AOR = 0.75, 95% CI: 0.59-0.95) regions, and those of Anglican religion (AOR = 0.82, 95% CI: 0.68-0.99) had less odds of comprehensive knowledge compared to those in Southern region and of the Catholic religion. CONCLUSIONS: To increase the comprehensive understanding of the disease at a young age, the need for expanded access to HIV preventive education through formal educational curriculum, and mass and social media via mobile phones is highlighted. In addition, the continued involvement of key decision-makers and community actors, such as religious leaders, is vital.

Prevalence and Factors Associated with Risky Sexual Behaviors Among Sexually Active Female Adolescents in Zambia.

Despite decades long commitment to women's reproductive health rights, sexually transmitted diseases and unintended pregnancies continue to be major public health concerns in sub-Saharan Africa. In order to provide an evidence base for future policy and services, this study aims to explore the prevalence and factors associated with risky sexual behaviors (RSB) among sexually active Zambian female adolescents using a nationally representative sample. Data on females, aged 15-19 (n = 3000), were obtained from the 2018 Zambia Demographic and Health Survey, an interviewer-administered, nationally representative survey that used multistage sampling. The study conducted multiple logistic regression to explore the correlates of RSB. Of the 3000 respondents, 49.7% (1490) reported ever having sexual intercourse of which 71.1% reported engaging in RSB. Among sexually active female adolescents, the following RSB percentage were reported: intercourse before age 16 (50.6%), nonuse of condoms at last intercourse (37.8%), engaging in transactional sex (6.2%), alcohol use at last intercourse (4.6%), and multiple sexual partners (1.9%). Educational attainment and household wealth showed strong inverse trends with RSB risk and there were notably large geographic differences in RSB within Zambia (22.1% in Lusaka region vs. 62.4% in Western province). The multiple logistic regression results revealed that those who were younger, unmarried, with less than secondary education, without access to Internet, and residents of Western Zambia were significantly more likely to have engaged in RSB (AOR: 1.74-7.69, p < 0.05). Given the negative health outcomes associated with RSB, Zambian adolescent health care programs may strategically target limited resources to the identified risk groups.

Determinants of quality contraceptive counselling information among young women in Sierra Leone: insights from the 2019 Sierra Leone demographic health survey.

BACKGROUND: The quality of contraceptive counseling information received by prospective clients of family planning services can greatly influence both the uptake and continued use of contraceptives. Therefore, an understanding of the level and determinants of quality contraception information among young women in Sierra Leon could inform family programs, with the aim of reducing the high unmet need in the country. METHODS: We analyzed secondary data from the 2019 Sierra Leone Demographic Health Survey (SLDHS). Participants were young women aged 15-24 years, who were using a family planning method (n = 1,506). Good quality family planning counselling was defined a composite variable that included; a woman being told about side effects, how to deal with side effects, and the availability of other family planning methods/options. Logistic regression was performed using SPSS software version 25. RESULTS: Out of 1,506 young women, 955 (63.4%, 95% CI: 60.5-65.3) received good quality family planning counselling services. Of the 36.6% that received inadequate counselling, 17.1% received no counselling at all. Good quality family planning counselling services was positively associated with receiving family planning services from government health facilities (aOR: 2.50, 95% CI: 1.83-3.41), having no major challenges with distance to access healthcare (aOR: 1.45, 95% CI: 1.10-1.90), having visited a health facility (AOR: 1.93, 95% CI: 1.45-2.58), and having been visited by a health field worker within the last 12 months (aOR: 1.67, 95% CI: 1.24-2.26) while residing in the southern region ( aOR: 0.39, 95% CI: 0.22-0.69) and belonging to the richest wealth quintile (aOR: 0.49, 95% CI: 0.24-0.98) were associated with less odds of receiving good quality family planning counselling services. CONCLUSION: About 37% of the young women in Sierra Leone do not receive good quality family planning counselling services of which 17.1% received none. Based on the study's findings, it is important to emphasize the need to ensure that all young women have access to proper counselling services especially for those receiving these services from private health units, from the southern region and richest wealth quintile. Ensuring easier access through increasing affordable and friendly access points and strengthening field health workers' capacity in providing family planning services could also help improve access to good quality family planning services.

Prevalence and factors associated with teenage pregnancy in Sierra Leone: evidence from a nationally representative Demographic and Health Survey of 2019.

BACKGROUND: Globally, teenage pregnancy remains a public health concern because of the associated maternal and perinatal morbidity and mortality. To address the extensive social, political and economic effects of teenage pregnancy, there is need for current epidemiological evidence on its prevalence and associated factors, especially from low resource settings where the burden is highest. METHODS: We used data from the 2019 Sierra Leone Demographic and Health Survey (SLDH), which included 3,427 female adolescents. Multistage stratified sampling was used to select study participants. Teenage pregnancy was defined as those who had ever either had a child, or terminated a pregnancy, or were currently pregnant. Multivariable logistic regression was conducted to determine the factors associated with teenage pregnancy using SPSS version 25(Armonk, NY: IBM Corp). RESULTS: The prevalence of teenage pregnancy was 22.1% [758/3,427]. Of these, 17.8%, (608/3427), had ever had childbirth, 4.2%, (144/3427), were pregnant, and 1.2%, (40/3427) had ever terminated a pregnancy. After adjusting for confounders, the odds of teenage pregnancy among married girls were about 15 times more than the odds among those who were not married (aOR; 15.31, 95% CI: 11.17-20.98) while the odds of teenage pregnancy among girls from the poorest households were 2.5 times more than the odds among girls from the richest households. CONCLUSION: The prevalence of teenage pregnancy in Sierra Leone is high. To reduce teenage pregnancy, the government of Sierra Leone and its partners should target married, older teenagers and those from poor households. Policies giving teenage mothers a second chance by encouraging them to return to school after childbirth should be encouraged as an alternative to early marriages.

Uptake of prostate cancer screening and associated factors among men aged 50 years and above in Lira city, Uganda: a cross-sectional study.

BACKGROUND: Prostate cancer is the most common cancer among men globally, with over 1.2 million cases reported in 2018. About 90% of men with prostate cancer are diagnosed when the disease is in an advanced stage. We assessed the factors associated with the uptake of prostate cancer screening among men aged ≥ 50 years in Lira city. METHODS: This was a cross-sectional study involving 400 men aged ≥ 50 years in Lira city who were sampled using multistage cluster sampling method. Uptake of prostate cancer screening was defined as the proportion of men who received prostate cancer screening in the past one year prior to the interview. Multivariable logistic regression analyses were performed to assess the factors associated with the uptake of prostate cancer screening. Data were analyzed using Stata version 14.0 statistical software. RESULTS: Of the 400 participants, only 18.5% (74/400) had ever been screened for prostate cancer. However, 70.7% (283/400) were willing to screen/rescreen if provided with the opportunity. Majority of the study participants, 70.5% (282/400) had ever heard about prostate cancer, mostly from a health worker (40.8% (115/282)). Less than half of the participants had high knowledge of prostate cancer. The factors that were significantly associated with prostate cancer screening were age ≥ 70 years, Adjusted Odds Ratio (AOR) 3.29: 95% Confidence Interval (CI): 1.20-9.00) and having a family history of prostate cancer, AOR 2.48 (95%CI: 1.32-4.65). CONCLUSION: There was low uptake of prostate cancer screening among men in Lira City, but majority of men were willing to screen. We encourage policymakers in Uganda to ensure prostate cancer screening services are readily available and accessible by men so as to improve on early identification and treatment of the disease.

Prevalence of risk factors for human immunodeficiency virus among sexually active women in Rwanda: a nationwide survey.

BACKGROUND: The Human Immunodeficiency Virus (HIV) remains a global health burden, and despite the advancements in antiretroviral therapy and various strategies employed to curb HIV infections, the incidence of HIV remains disproportionately high among women. Therefore, this study aimed to determine the prevalence of the risk factors for the acquisition of HIV among sexually active women in Rwanda. METHODS: Secondary data from the 2020 Rwanda Demographic Health Survey, comprising 10,684 sexually active women, was used. Multistage stratified sampling was employed to select the study participants. Multivariable logistic regression was conducted to determine the associated risk factors using the SPSS (version 25). RESULTS: Of the 10,684 sexually active women, 28.7% (95% confidence interval (CI): 27.5-29.4) had at least one risk factor for HIV acquisition. Having no education (AOR = 3.65, 95%CI: 2.16-6.16), being unmarried (AOR = 4.50, 95%CI: 2.47-8.21), being from female-headed households (AOR = 1.75, 95%CI: 1.42-2.15), not having health insurance (AOR = 1.34, 95%CI: 1.09-1.65), no HIV test history (AOR = 1.44, 95%CI: 1.01-2.08), being from the poorest wealth quintile (AOR = 1.61, 95%CI: 1.14-2.27) and lack of exposure to mass media (AOR = 1.30, 95%CI: 1.07-1.58) were associated with higher odds of exposure to at least one HIV acquisition risk factor. In contrast, age groups of 25-34 (AOR = 0.56, 95%CI: 0.44-0.71) and 35-44 years (AOR = 0.62, 95%CI: 0.48-0.80), rural residence (AOR = 0.63, 95%CI: 0.49-0.81) and being from the western region (AOR = 0.67, 95%CI: 0.48-0.94) were associated with less odds of exposure to at least one HIV acquisition risk factor. CONCLUSION: More than a quarter of sexually active women in Rwanda had exposure to at least one risk factor for HIV acquisition. There is a need to maximize the use of mass media in disseminating HIV prevention and behavioral change messages. Engagement of religious leaders and promotion of HIV testing, especially among the never-testers, may be vital strategies in successful HIV prevention programs.

Maternal and umbilical cord blood lactate for predicting perinatal death: a secondary analysis of data from a randomized controlled trial.

BACKGROUND: In high resource settings, lactate and pH levels measured from fetal scalp and umbilical cord blood are widely used as predictors of perinatal mortality. However, the same is not true in low resource settings, where much of perinatal mortality occurs. The scalability of this practice has been hindered by difficulty in collecting fetal scalp and umbilical blood sample. Little is known about the use of alternatives such as maternal blood, which is easier and safer to obtain. Therefore, we aimed to compare maternal and umbilical cord blood lactate levels for predicting perinatal deaths. METHODS: This was secondary analysis of data from a randomized controlled trial assessing the effect of sodium bicarbonate on maternal and perinatal outcomes among women with obstructed labour at Mbale regional referral hospital in Eastern Uganda. Lactate concentration in maternal capillary, myometrial, umbilical venous and arterial blood was measured at the bedside using a lactate Pro 2 device (Akray, Japan Shiga) upon diagnosis of obstructed labour. We constructed Receiver Operating Characteristic curves to compare the predictive ability of maternal and umbilical cord lactate and the optimal cutoffs calculated basing on the maximal Youden and Liu indices. RESULTS: Perinatal mortality risk was: 102.2 deaths per 1,000 live births: 95% CI (78.1-130.6). The areas under the ROC curves were 0.86 for umbilical arterial lactate, 0.71 for umbilical venous lactate, and 0.65 for myometrial lactate, 0.59 for maternal lactate baseline, and 0.65 at1hr after administration of bicarbonate. The optimal cutoffs for predicting perinatal death were 15 0.85 mmol/L for umbilical arterial lactate, 10.15mmol/L for umbilical venous lactate, 8.75mmol/L for myometrial lactate, and 3.95mmol/L for maternal lactate at recruitment and 7.35mmol/L after 1 h. CONCLUSION: Maternal lactate was a poor predictor of perinatal death, but umbilical artery lactate has a high predictive value. There is need for future studies on the utility of amniotic fluid in predicting intrapartum perinatal deaths.

Women empowerment indices and utilization of health facilities during childbirth: evidence from the 2019 Sierra Leone demographic health survey.

BACKGROUND: Women empowerment is recognized as a potential enabling factor to the utilization of health facilities during childbirth. However, the association between women empowerment and utilization of health facilities is poorly studied, especially in counties with high maternal mortality. Therefore, we investigated the association between women empowerment indices and the utilization of health facilities during childbirth in Sierra Leone. METHODS: We analyzed secondary data from the 2019 Sierra Leone Demographic and Health Survey (SLDHS). We included 5,997 married women who had given birth in the five years before the survey, and had been sampled for the women empowerment questionnaire. The study employed the gender roles framework developed by the Harvard Institute for International Development in the selection and classification of women empowerment indices, which include influencing, resource and decision-making factors. We conducted logistic regression analyses using SPSS version 25.0 complex samples package to determine the association between women empowerment indices and utilization of health facilities. RESULTS: The overall prevalence of health facility utilization during childbirth was 84.1% (5,042/5,997): 95% CI: 83.6 to 85.4. Among the influencer domain variables, women from the southern (aOR = 2.25, 95% CI: 1.34-3.78), northern (aOR = 1.69,95% CI: 1.01-2.82) and eastern regions (aOR = 3.71, 95% CI: 2.03-6.77) had higher odds of health facility utilization compared to women in the western region, while women in polygamous marriages (aOR = 0.82, 95% CI: 0.69-0.98) had lower odds of utilizing health facilities compared to their counterparts in monogamous marriages. Furthermore, women who had their first birth when they were less than 18 years, had higher odds of utilizing health facilities (aOR = 1.22, 95% CI: 1.02-1.45) compared to those who were 18 years and above. Among the resource domain variables, women with post-primary education (aOR = 1.58, 95% CI: 1.21-2.06) had higher odds of utilizing health facilities compared to their counterparts with no education and women who belonged to the richest wealth quintile (aOR = 2.42, 95% CI: 1.31-4.46) had higher odds of utilizing health facilities compared to their counterparts belonging in the poorest quintile. None of the variables in the decision making domain was significantly associated with health facility utilization. CONCLUSION: These findings emphasize that, successful implementation of health facility utilization interventions should prioritize women empowerment with more pragmatic efforts. Policies and programme should aim at all women with more focus on those having lower education (primary and below), belonging to the poorest wealth quintile, give birth before reaching18 years and in polygamous marriages.

Prevalence of risk factors for human immunodeficiency virus among women of reproductive age in Sierra Leone: a 2019 nationwide survey.

BACKGROUND AND AIM: For over 40 years of the HIV/AIDS global epidemic, no effective cure nor vaccine is yet available, making the current control strategies focused on curbing new infections through risk reduction. The study aimed to determine the prevalence of HIV risk factors and their associated socio-demographics among women of reproductive age in Sierra Leone. METHODS: We used weighted data from the Sierra Leone Demographic and Health Survey (SLDHS) of 2019 for 12,005 women aged 15-49 years. Multistage sampling was used to select study participants. Exposure to HIV risk factors was considered if a woman reported at least one of the following; having multiple sexual partners, transactional sex, non-condom use for the unmarried, and having other sexually transmitted infections (STIs). We, then, conducted multivariable logistic regression to explore the associated socio-demographics. All the analyses were done using SPSS (version 25). RESULTS: Of the 12,005 women, 38.1% (4577/12005) (95% confidence interval (CI) 37.3-39.0) had at least one of the four risk factors. Women of 15 to 19 years (adjusted odds ratio (AOR) = 1.34, 95% CI 1.00-1.80) and 20 to 34 years (AOR = 1.25, 95% CI 1.05-1.49) had more odds of having HIV risk factors compared to those of 35 to 49 years. Urban residents (AOR = 1.49, 95% CI 1.17-1.89) and those from the Northwestern region (AOR = 1.81, 95% CI 1.26-2.60) were also more likely to encounter HIV risk factors compared to their respective counterparts. Moreover, unmarried women (AOR = 111.17, 95% CI 87.55-141.18) and those working (AOR = 1.38, 95% CI 1.14-1.67) also had higher odds of having HIV risk factors, compared to their respective counterparts. Sex of household head and parity were also significant associates. CONCLUSIONS: More than a third of women in Sierra Leone had encountered at least one HIV risk factor, and this was associated with age, place of residence, region, marital status, working status, household head and parity. There is a need for strengthening HIV/AIDS education programs, laws and policies targeting the young, working, unmarried and urban-resident women.

Evaluating continuum of maternal and newborn healthcare in Rwanda: evidence from the 2019-2020 Rwanda demographic health survey.

BACKGROUND: Access to a complete continuum of maternal and child health care has been recommended globally for better pregnancy outcomes. Hence this study determined the level (pooled prevalence) and predictors of successfully completing continuum of care (CoC) in Rwanda. METHODS: We analyzed weighted secondary data from the 2019-2020 Rwanda Demographic and Health Survey (RDHS) that included 6,302 women aged 15 to 49 years who were selected using multistage stratified sampling. We analyzed complete continuum of care as a composite variable of three maternal care services: at least four ANC contacts, SBA, maternal and neonatal post-natal care. We used the SPSS version 25 complex samples package to conduct multivariable logistic regression. RESULTS: Of the 6,302 women, 2,131 (33.8%) (95% CI: 32.8-35.1) had complete continuum of care. The odds of having complete continuum of care were higher among women who had exposure to newspapers (adjusted odds ratio (AOR): 1.30, 95% CI: 1.11-1.52), those belonging to the eastern region (AOR): 1.24, 95% CI: 1.01-1.52), southern region (AOR): 1.26, 95% CI: 1.04-1.53), those with health insurance (AOR): 1.55, 95% CI: 1.30-1.85), those who had been visited by a field health worker (AOR: 1.31, 95% CI: 1.15-1.49), those with no big problems with distance to health facility (AOR): 1.25, 95% CI: 1.07-1.46), those who were married (AOR): 1.35, 95% CI: 1.11-1.64), those with tertiary level of education (AOR): 1.61, 95% CI: 1.05-2.49), those belonging to richer households (AOR): 1.33, 95% CI: 1.07-1.65) and those whose parity was less than 2 (AOR): 1.52, 95% CI: 1.18-1.95). CONCLUSION: We have identified modifiable factors (exposure to mass media, having been visited by a field health worker, having health insurance, having no big problems with distance to the nearest health facility, belonging to richer households, being married and educated), that can be targeted to improve utilization of the entire continuum of care. Promoting maternity services through mass media, strengthening the community health programmes, increasing access to health insurance and promoting girl child education to tertiary level may improve the level of utilization of maternity services.

Exposure to different types of mass media and timing of antenatal care initiation: insights from the 2016 Uganda Demographic and Health Survey.

BACKGROUND: Early initiation of antenatal care (ANC) within the first trimester is highly recommended in the current 2016 World Health Organization (WHO) guidelines. Mass media has the potential to promote early initiation of ANC because it has been used successfully in several programs. However, there is paucity of literature on the effect of exposure to different types of media on the timing of ANC initiation in Uganda. Our study aimed at exploring associations between exposure to different types of mass media and timing of ANC initiation among women in Uganda. METHODS: We used a cross sectional study design, to conduct a secondary analysis of data collected in the 2016 Uganda Demographic and Health Survey (UDHS). We included weighted data of all the 10,152 women of reproductive age (15-49 years). Multistage stratified sampling was used to select study participants. Multivariable logistic regression was used to determine the association between exposure to different types of mass media and early initiation of ANC. RESULTS: Almost a third of the women (2953/10,152, 29.1%, 95% CI 27.9-29.6) initiated their first ANC contact in the first trimester. Women who listened to radio at least once a week (adjusted OR (aOR 1.14, 95% CI 1.01-1.30) and those who watched television less than once a week (aOR 1.28, 95% CI 1.07-1.53) had higher odds of initiating ANC earlier compared to their counterparts not exposed to radio and television respectively. CONCLUSION: Exposure to radio and television is associated with timing of ANC initiation in Uganda. Importantly, the two types of mass media have the potential to reach women with low levels of education and encourage them to utilize maternal health services. The Ugandan government needs to prioritize and intensify the use of radio and television to promote the benefits associated with timing of ANC initiation.

Women empowerment and health insurance utilisation in Rwanda: a nationwide cross-sectional survey.

BACKGROUND: Health insurance coverage is one of the several measures being implemented to reduce the inequity in access to quality health services among vulnerable groups. Although women's empowerment has been viewed as a cost-effective strategy for the reduction of maternal and child morbidity and mortality, as it enables women to tackle the barriers to accessing healthcare, its association with health insurance usage has been barely investigated. Our study aims at examining the prevalence of health insurance utilisation and its association with women empowerment as well as other socio-demographic factors among Rwandan women. METHODS: We used Rwanda Demographic and Health Survey (RDHS) 2020 data of 14,634 women aged 15-49 years, who were selected using multistage sampling. Health insurance utilisation, the outcome variable was a binary response (yes/no), while women empowerment was assessed by four composite indicators; exposure to mass media, decision making, economic and sexual empowerment. We conducted multivariable logistic regression to explore its association with socio-demographic factors, using SPSS (version 25). RESULTS: Out of the 14,634 women, 12,095 (82.6%) (95% CI 82.0-83.2) had health insurance, and the majority (77.2%) were covered by mutual/community organization insurance. Women empowerment indicators had a negative association with health insurance utilisation; low (AOR = 0.85, 95% CI 0.73-0.98) and high (AOR = 0.66, 95% CI 0.52-0.85) exposure to mass media, high decision making (AOR = 0.78, 95% CI 0.68-0.91) and high economic empowerment (AOR = 0.63, 95% CI 0.51-0.78). Other socio-demographic factors found significant include; educational level, wealth index, and household size which had a negative association, but residence and region with a positive association. CONCLUSIONS: A high proportion of Rwandan women had health insurance, but it was negatively associated with women's empowerment. Therefore, tailoring mass-media material considering the specific knowledge gaps to addressing misinformation, as well as addressing regional imbalance by improving women's access to health facilities/services are key in increasing coverage of health insurance among women in Rwanda.

Association between exposure to family planning messages on different mass media channels and the utilization of modern contraceptives among young women in Sierra Leone: insights from the 2019 Sierra Leone Demographic Health Survey.

BACKGROUND: Access to sexual and reproductive health information enables young women to make appropriate decisions. We examined the association between exposure to family panning messages on different mass media and the use of modern contraceptives among young women in Sierra Leone. METHODS: This was a secondary analysis of the 2019 Sierra Leone Demographic and Health Survey data of young women aged 15-24 years. Multistage stratified sampling was used to select study participants in the survey. We used multivariable logistic regression to determine the association between exposure to family panning messages on different types mass media channels and utilization of modern contraceptives. All our analyses were done using SPSS version 25. RESULTS: Out of 6055 young women, 1506 (24.9%, 95% CI 24.0-26.2) were utilizing a modern contraceptive method with the prevalence higher among urban women (26.5%) compared to rural women (23.1%). Less than half (45.6%) had been exposed to family planning messages on mass media (radio 28.6%, television 10.6%, mobile phones 4.2% and newspapers or magazines 2.2%). Young women who had exposure to family planning messages on radio (AOR: 1.26, 95% CI 1.06-1.50) and mobile phones (AOR: 1.84, 95% CI 1.25-2.69) had higher odds of using modern contraceptives compared to their counterparts without the same exposure. Furthermore, having access to internet (AOR: 1.45, 95% CI 1.19-1.78), working (AOR: 1.49, 95% CI 1.27-1.74), being older (20-24 years) (AOR: 1.75, 95% CI 1.46-2.10), being married (AOR: 0.33, 95% CI 0.26-0.42), having visited a health facility within the last 12 months (AOR: 1.34, 95% CI 1.10-1.63), having secondary (AOR: 2.83, 95% CI 2.20-3.64) and tertiary levels of education (AOR: 3.35, 95% CI 1.83-6.13), higher parity (having above one child) AOR: 1.57, 95% CI 1.19-2.08) and residing in the southern (AOR: 2.11, 95% CI 1.61-2.79), northwestern (AOR: 1.87, 95% CI 1.39-2.52), northern (AOR: 2.11, 95% CI 1.59-2.82) and eastern (AOR: 1.68, 95% CI 1.27-2.22) regions of residence were associated with higher odds of modern contraceptives utilization. CONCLUSION: In Sierra Leon, only one in four young women were using modern contraception and more than half of them had not had any exposure to family planning messages on the different types of mass media channels. Behavior change communicators can prioritize family planning messages using radio, mobile phones and the internet. In order to publicize and encourage young women to adopt healthy behaviours and increase uptake of modern contraceptive.

Utilisation of modern contraceptives by sexually active adolescent girls in Rwanda: a nationwide cross-sectional study.

BACKGROUND: Modern contraceptive use has been shown to influence population growth, protect women's health and rights, as well as prevent sexually transmitted infections (STIs) for barrier contraceptive methods such as condoms. The present study aimed at assessing the level of utilization and factors associated with modern contraceptive use among sexually active adolescent girls in Rwanda. METHODS: We used secondary data from the Rwanda Demographic and Health Survey (RDHS) 2020 data of 539 sexually active adolescent girls (aged 15 to 19 years). Multistage stratified sampling was used to select study participants. We conducted multivariable logistic regression to assess the association between various socio-demographics and modern contraceptive use using SPSS version 25. Modern contraception included the use of products or medical procedures that interfere with reproduction from acts of sexual intercourse. RESULTS: Of the 539 sexually active girls, only 94 (17.4%, 95% CI: 13.8-20.1) were using modern contraceptives. Implants (69.1%) and male condoms (12.8%) were the most used options. Modern contraceptive use was positively associated with older age (AOR = 10.28, 95% CI: 1.34-78.70), higher educational level (AOR = 6.98, 95% CI: 1.08-45.07), history of having a sexually transmitted infection (AOR = 8.27, 95% CI: 2.54-26.99), working status (AOR = 1.72, 95% CI: 1.03-2.88) and being from a female-headed household (AOR = 1.96, 95% CI: 1.12-3.43). However, not being in a union (AOR = 0.18, 95% CI: 0.10-0.35) and region (AOR = 0.28, 95% CI: 0.10-0.80) had negative associations. CONCLUSIONS: To promote utilisation of modern contraceptives, family planning campaigns need to place more emphasis on the younger, unmarried adolescents, as well as those with lower educational levels. Consideration of household and regional dynamics is also highlighted.

Rural-urban correlates of modern contraceptives utilization among adolescents in Zambia: a national cross-sectional survey.

BACKGROUND: Modern contraceptive use among adolescents is low despite the adverse effects of adolescent pregnancies. Understanding correlates of modern contraceptive use in different settings is key to the design of effective context-specific interventions. We aimed to determine factors associated with modern contraceptives use among adolescents in rural and urban settings of Zambia. METHODS: We analyzed secondary data from 2018 Zambia demographic and health survey (ZDHS) focusing on adolescent girls aged 15-19 years. We used multivariable logistic regression in SPSS version 25 to examine rural-urban variations in factors associated with modern contraceptive utilization. RESULTS: Overall, 12.0% (360/3000, 95% CI: 10.9-13.2) of adolescents in Zambia were using modern contraceptives. Use of modern contraceptives was higher in rural areas at 13.7% (230/1677, 95% CI: 12.1-15.3) compared to 9.8% (130/1323, 95% CI: 8.3-11.6) in urban areas. In the rural areas, having a child (aOR = 13.99; 95% CI 8.60-22.77), being married (aOR = 2.13; 95% CI 1.42-3.18), being older at 19 years (aOR = 3.90; 95% CI 1.52-10.03), having been visited by a field health worker (aOR = 1.62; 95% CI 1.01-2.64), having been exposed to family planning messages on mass media (aOR = 2.87; 95% CI 1.01-8.18) and belonging to the richest wealth quintile (aOR = 2.27; 95% CI 1.43-3.62) were associated with higher odds of contraceptive utilization. Furthermore, adolescents in the Northern (aOR = 0.29; 95% CI 0.11-0.80) and Luapula (aOR = 0.35; 95% CI 0.15-0.81) provinces were associated with less odds of utilizing contraceptives compared to those in Western province. In the urban areas, older age at 19 years (aOR = 4.80; 95% CI 1.55-14.84) and having a child (aOR = 18.52; 95% CI 9.50-36.14) were the only factors significantly associated with modern contraceptive utilization. CONCLUSION: Age and having a child were associated with modern contraceptive use in both rural and urban areas. In rural areas (province, marital status, being visited by field health workers, family planning messages exposure and wealth index) were the only associated factors. This indicates that interventions aiming to increase contraceptive utilization should be context specific.

Prevalence and factors associated with utilisation of postnatal care in Sierra Leone: a 2019 national survey.

BACKGROUND: Within Sub-Saharan Africa, some countries still report unacceptably high rates of maternal and perinatal morbidity and mortality, despite improvements in the utilisation of maternity care services. Postnatal care (PNC) is one of the recommended packages in the continuum of maternity care aimed at reducing maternal and neonatal mortality. This study aimed to determine the prevalence and factors associated with PNC utilisation in Sierra Leone. METHODS: We used Sierra Leone Demographic and Health Survey (UDHS) 2019 data of 7326 women aged 15 to 49 years. We conducted multivariable logistic regression to determine the factors associated with PNC utilisation, using SPSS version 25. RESULTS: Out of 7326 women, 6625 (90.4, 95% CI: 89.9-91.2) had at least one PNC contact for their newborn, 6646 (90.7, 95% CI: 90.2-91.5) had a postnatal check after childbirth and 6274 (85.6, 95% CI: 85.0-86.6) had PNC for both their babies and themselves. Delivery by caesarean section (aOR 8.01, 95% CI: 3.37-19.07), having a visit by a health field worker (aOR 1.80, 95% CI: 1.46-2.20), having had eight or more ANC contacts (aOR 1.37, 95% CI: 1.08-1.73), having tertiary education (aOR 2.71, 95% CI: 1.32-5.56) and having no big problems seeking permission to access healthcare (aOR 1.51, 95% CI: 1.19-1.90) were associated with higher odds of PNC utilisation. On the other hand, being resident in the Northern (aOR 0.48, 95% CI: 0.29-0.78) and Northwestern regions (aOR 0.54, 95% CI: 0.36-0.80), belonging to a female headed household (aOR 0.69, 95% CI: 0.56-0.85) and being a working woman (aOR 0.66, 95% CI: 0.52-0.84) were associated with lower odds of utilizing PNC. CONCLUSION: Factors associated with utilisation of PNC services operate at individual, household, community and health system/policy levels. Some of them can be ameliorated by targeted government interventions to improve utilisation of PNC services.

Status of the latest 2016 World Health Organization recommended frequency of antenatal care contacts in Sierra Leone: a nationally representative survey.

BACKGROUND: Timely and increased frequency of quality antenatal care (ANC) contacts is one of the key strategies aimed at decreasing maternal and neonatal deaths. In 2016, the World Health Organization (WHO) revised the ANC guidelines to recommend at least eight ANC contacts instead of four. This study aimed to determine the proportion of women who received eight or more ANC contacts and associated factors in Sierra Leone. METHODS: We used Sierra Leone Demographic and Health Survey (UDHS) 2019 data of 5,432 women aged 15 to 49 years who had a live birth, within three years preceding the survey. Multistage stratified sampling was used to select study participants. We conducted multivariable logistic regression to identify factors associated with utilisation of eight or more ANC contacts using SPSS version 25 complex samples package. RESULTS: Out of 5,432 women, 2,399 (44.8%) (95% CI: 43.1-45.7) had their first ANC contact in the first trimester and 1,197 (22.0%) (95% CI: 21.2-23.4) had eight or more ANC contacts. Women who had their first ANC contact after first trimester (adjusted odds ratio, aOR, 0.58, 95% CI 0.49-0.68) and women aged 15 to 19 years had less odds of having eight or more contacts (aOR 0.64, 95% CI 0.45 to 0.91). Working (aOR 1.33, 95%CI 1.10 to 1.62) and wealthier women had higher odds of having eight or more contacts compared to poorer ones and those not working respectively. Women residing in the southern region, those using internet and less parous (less than five) women were associated with higher odds of having eight or more ANC contacts. Women who had no big problem obtaining permission to go health facilities also had higher odds of having eight or more ANC contacts compared to those who had big problems. CONCLUSION: Sierra Leone's adoption of eight or more ANC contacts is low and less than half of the women initiate ANC in the first trimester. To ensure increased access to recommended ANC visits, timely ANC should be encouraged. Attributes of women empowerment such as workings status, socio-economic status, and decision-making should also be emphasized.

Factors associated with utilization of quality antenatal care: a secondary data analysis of Rwandan Demographic Health Survey 2020.

BACKGROUND: Over the last decade, progress in reducing maternal mortality in Rwanda has been slow, from 210 deaths per 100,000 live births in 2015 to 203 deaths per 100,000 live births in 2020. Access to quality antenatal care (ANC) can substantially reduce maternal and newborn mortality. Several studies have investigated factors that influence the use of ANC, but information on its quality is limited. Therefore, this study aimed to identify the determinants of quality antenatal care among pregnant women in Rwanda using a nationally representative sample. METHODS: We analyzed secondary data of 6,302 women aged 15-49 years who had given birth five years prior the survey from the Rwanda Demographic and Health Survey (RDHS) of 2020 data. Multistage sampling was used to select RDHS participants. Good quality was considered as having utilized all the ANC components. Multivariable logistic regression was conducted to explore the associated factors using SPSS version 25. RESULTS: Out of the 6,302 women, 825 (13.1%, 95% CI: 12.4-14.1) utilized all the ANC indicators of good quality ANC); 3,696 (60%, 95% CI: 58.6-61.1) initiated ANC within the first trimester, 2,975 (47.2%, 95% CI: 46.1-48.6) had 4 or more ANC contacts, 16 (0.3%, 95% CI: 0.1-0.4) had 8 or more ANC contacts. Exposure to newspapers/magazines at least once a week (aOR 1.48, 95% CI: 1.09-2.02), lower parity (para1: aOR 6.04, 95% CI: 3.82-9.57) and having been visited by a field worker (aOR 1.47, 95% CI: 1.23-1.76) were associated with more odds of receiving all ANC components. In addition, belonging to smaller households (aOR 1.34, 95% CI: 1.10-1.63), initiating ANC in the first trimester (aOR 1.45, 95% CI: 1.18-1.79) and having had 4 or more ANC contacts (aOR 1.52, 95% CI: 1.25-1.85) were associated with more odds of receiving all ANC components. Working women had lower odds of receiving all ANC components (aOR 0.79, 95% CI: 0.66-0.95). CONCLUSION: The utilization of ANC components (13.1%) is low with components such as having at least two tetanus injections (33.6%) and receiving drugs for intestinal parasites (43%) being highly underutilized. Therefore, programs aimed at increasing utilization of ANC components need to prioritize high parity and working women residing in larger households. Promoting use of field health workers, timely initiation and increased frequency of ANC might enhance the quality of care.

Dimensions of women empowerment on access to antenatal care in Uganda: A further analysis of the Uganda demographic health survey 2016.

BACKGROUND: Women empowerment has been viewed as a good strategy in the reduction of global maternal morbidity and mortality. Most of the recent studies in Uganda have focussed on antenatal care (ANC) frequency and the associated factors with no focus on the effect of women empowerment. Our study aims at examining the prevalence of optimal access to ANC by considering the timing of initiation, type of ANC provider and ANC frequency and their association with women empowerment. METHODS: We used Uganda Demographic and Health Survey 2016 data of 9957 women aged 15-49 years. Multistage stratified sampling was used to select study participants and we conducted multivariable logistic regression to establish the association between women empowerment and access to ANC using Statistical package for the social sciences version 25. RESULTS: Out of 9957 women, 2953 (29.7%: 95% CI: 28.5.0-30.2) had initiated ANC in first trimester, 6080 (61.1%: 95% CI: 60.4-62.3) had 4 or more ANC contacts, and 9880 (99.2%: 95% CI: 99.0-99.3) had received ANC from a skilled provider. Overall, 2399 (24.1%: 95% CI: 23.0-24.6) had optimal access to ANC. Economic empowerment and exposure to media were the only women empowerment indices that were positively associated with optimal access to ANC. Other factors that were significant include; region, wealth index, age, level of education and working status. CONCLUSION: To ensure increased access to ANC, policy-makers and other stakeholders should prioritise the use of mass media in maternal health programs, equitable allocation of the limited financial resources with a focus on older, poor and uneducated women.