Decomposing Education-Based Inequalities in Pre-Exposure Prophylaxis Knowledge for HIV Prevention Among Women in Cote d'Ivoire.

Background: Antiretroviral chemoprophylaxis is a promising strategy for preventing the spread of human immunodeficiency virus (HIV). The knowledge of pre-exposure prophylaxis (PrEP) is required for intervention uptake and adherence to prevent the spread of HIV. This study aimed to decompose education-based inequalities in PrEP knowledge for HIV prevention among reproductive-aged women in Cote d'Ivoire. Methods: A cross-sectional study design with a nationally representative sample of 12,934 women aged 15-49 years was analyzed from the 2021 Cote d'Ivoire Demographic and Health Survey. The survey was conducted between September to December, 2021. The outcome variable was the knowledge of PrEP for HIV prevention. Statistical analysis was conducted using percentage, concentration index, and Lorenz curve. The level of significance was set at p<0.05. Results: A weighted prevalence of 14.5% (95% CI: 12.5-16.3%) was estimated for PrEP knowledge for HIV prevention. Overall, educated women had a higher knowledge of PrEP for HIV prevention (Conc. Index= 0.225; SE= 0.012; p<0.001). Across the levels of women's characteristics, the results showed higher PrEP knowledge for HIV prevention among educated women. Education (Contri: 40.7327%, Ec: 0.5390), exposure to internet (Contri: 20.1039%, Ec: 0.3484), place of residence (Contri: 12.9801%, Ec: -0.0537), household wealth (Contri: 10.0062%, Ec: 0.0642) and religion (Contri: 5.7509%, Ec: 0.0354) were positive contributors to PrEP knowledge for HIV prevention. On the other hand, age (Contri: -8.8298%, Ec: -0.0950) and region (Contri: -3.5942, Ec: -0.0768) were negative contributors to PrEP knowledge regarding HIV prevention among women of reproductive age in Cote d'Ivoire. Conclusion: There is limited knowledge of PrEP for HIV prevention among women in Cote d'Ivoire. Educated women had greater knowledge of PrEP for HIV prevention. The results of this study could guide interventions targeted to enhance the knowledge of PrEP as an HIV prevention option.

Contextual factors associated with diarrhea among under-five children in the Gambia: a multi-level analysis of population-based data.

BACKGROUND: Diarrhea poses a significant threat to the lives of children in The Gambia, accounting for approximately 9% of all deaths among children under the age of five. Addressing and reducing child mortality from diarrhea diseases is crucial for achieving the Sustainable Development Goal (SDG) 3, specifically target 3.2, which aims to eliminate preventable deaths in newborns and children under the age of five by 2030. Thus, this research aims to assess the prevalence and contextual factors associated with diarrhea among under-five children in The Gambia. METHODS: This research employed secondary data from the 2019/20 Gambia Demographic Health Survey (GDHS). The study initially involved 8,362 women aged between 15 and 49 years. Of these, 6,929 women with children under five were included in this analysis. Data were analyzed using STATA with cross-tabulation and model fitting. Multilevel logistic regression was applied to accommodate the hierarchical structure of the demographic health survey data. The model comparison parameters were BIC, AIC, deviance, and LLR. Variables with a p-value less than 0.05 were selected for multivariable analysis. The statistical significance of the factors was determined using an adjusted odds ratio with a 95% confidence interval (CI) and a p-value of less than 0.05. RESULTS: The prevalence of diarrhea in under-five children was 53.2% in males and 46.8% in females. In the final model, Kerewan (aOR = 0.58; 95% CI = 0.33-0.98) and Basse (aOR = 0.59; 95% CI = 0.35-0.98) have significantly lower odds of childhood diarrhea compared to Banjul, female children show slightly lower, yet significant, odds of diarrhea compared to males (aOR = 0.96; 95% CI = 0.86-0.98), deliveries at government health centers are associated with higher odds of childhood diarrhea compared to home births (aOR = 1.24; 95% CI = 1.01-1.52). Mothers with post-secondary education had significantly lower odds of having children with diarrhea than those without any education (aOR = 0.50; 95% CI = 0.26-0.99) after controlling for confounders. CONCLUSION: The study findings indicate that several factors significantly impact the risk of childhood diarrhea in The Gambia. These factors include region of residence, sex of the child, place of delivery, and education level of the mother. The study suggests that existing interventions aimed at improving child health outcomes in the country should take into consideration these influential factors. Addressing these modifiable factors can enhance the effectiveness of interventions and promote better health outcomes for children in Gambia.

Prevalence and factors associated with pre-exposure prophylaxis awareness among cisgender women of reproductive age in Burkina Faso.

BACKGROUND: HIV remains a global public health concern, and women continue to be disproportionately affected. Understanding the factors associated with pre-exposure prophylaxis awareness among women is crucial as an effective HIV prevention strategy. OBJECTIVES: We investigated the prevalence and associated factors of pre-exposure prophylaxis awareness among women in Burkina Faso. DESIGN: This was a cross-section study that used population-based data. METHODS: A total of 17,659 women of reproductive age (15-49 years) from the 2021 Burkina Faso Demographic and Health Survey were analyzed. Percentage and multivariable logistic regression model were used to examine the prevalence and factors associated with pre-exposure prophylaxis awareness. RESULTS: The prevalence of pre-exposure prophylaxis awareness was 8.2% (95% confidence interval = 7.8%-8.6%). Women's age was positively associated pre-exposure prophylaxis awareness. Women with primary and secondary education had 39% and 48% higher odds of pre-exposure prophylaxis awareness, when compared with women with no formal education. The odds of pre-exposure prophylaxis awareness were 1.40 (95% confidence interval = 1.19-1.66) times higher among Christians when compared with the Muslims. Women who were exposed to mass media including newspaper or magazine, radio, TV, and Internet had higher odds of pre-exposure prophylaxis awareness, when compared with those without exposure to mass media channels. Women who have previously tested for HIV had 37% higher odds of pre-exposure prophylaxis awareness, when compared with those who have not been tested (adjusted odds ratio = 1.37; 95% confidence interval = 1.09-1.72). CONCLUSION: This study found women's age, geographical region, education, religion, exposure to mass media channels, employment, and HIV testing to be associated with pre-exposure prophylaxis awareness. These findings can inform the development of targeted interventions and public health campaigns to increase awareness and practice to pre-exposure prophylaxis, particularly among key population.

Socioeconomic disparities in Rwanda's under-5 population's growth tracking and nutrition promotion: findings from the 2019-2020 demographic and health survey.

BACKGROUND: Regular growth monitoring can be used to evaluate young children's nutritional and physical health. While adequate evaluation of the scope and quality of nutrition interventions is necessary to increase their effectiveness, there is little research on growth monitoring coverage measurement. The purpose of this study was to investigate socioeconomic disparities in under-5 Rwandan children who participate in growth monitoring and nutrition promotion. METHODS: We used data from the 2019-2020 Rwanda Demographic and Health Survey (RDHS), which included 8092under-5 children. Percentage was employed in univariate analysis. To examine the socioeconomic inequalities, concentration indices and Lorenz curves were used in growth monitoring and nutrition promotion among under-5 children. RESULTS: A weighted prevalence of 33.0% (95%CI: 30.6-35.6%) under-5 children growth monitoring and nutrition promotion was estimated. Growth monitoring and nutrition promotion among under-5 children had higher uptake in the most disadvantaged cohort, as the line of equality sags below the diagonal line in Lorenz curve. Overall, there was pro-poor growth monitoring and nutrition promotion among under-5 in Rwanda (Conc. Index = 0.0994; SE = 0.0111). Across the levels of child and mother's characteristics, the results show higher coverage of under-5 growth monitoring and nutrition promotion in the most socioeconomic disadvantaged cohort. CONCLUSION: The study found a pro-poor disparity in growth monitoring and nutrition promotion among under-5 children in Rwanda. By implication, the most disadvantaged children had a higher uptake of growth monitoring and nutrition promotion. The Rwanda government should develop policies and programmes to achieve the universal health coverage for the well-off and underserved population.

Estimating vaccine coverage in conflict settings using geospatial methods: a case study in Borno state, Nigeria.

Reliable estimates of subnational vaccination coverage are critical to track progress towards global immunisation targets and ensure equitable health outcomes for all children. However, conflict can limit the reliability of coverage estimates from traditional household-based surveys due to an inability to sample in unsafe and insecure areas and increased uncertainty in underlying population estimates. In these situations, model-based geostatistical (MBG) approaches offer alternative coverage estimates for administrative units affected by conflict. We estimated first- and third-dose diphtheria-tetanus-pertussis vaccine coverage in Borno state, Nigeria, using a spatiotemporal MBG modelling approach, then compared these to estimates from recent conflict-affected, household-based surveys. We compared sampling cluster locations from recent household-based surveys to geolocated data on conflict locations and modelled spatial coverage estimates, while also investigating the importance of reliable population estimates when assessing coverage in conflict settings. These results demonstrate that geospatially-modelled coverage estimates can be a valuable additional tool to understand coverage in locations where conflict prevents representative sampling.

Achieving the UNAIDS first '95' in prenuptial HIV/AIDS testing among reproductive-aged Rwandese women: A multilevel analysis of 2019-20 population-based data.

A significant public health concern that disproportionately affects women is human immunodeficiency virus (HIV). Prenuptial HIV testing is no doubt a major step for people to learn their HIV status. In this study, the coverage of prenuptial HIV testing and its associated factors were examined among reproductive-aged Rwandese women. This study included a total of 14,634 reproductive-aged Rwandese women using 2019-20 Rwanda Demographic and Health Survey (RDHS). The coverage of prenuptial HIV/AIDS testing and the variables influencing it were evaluated using percentage and multilevel logit model. The level of significance was set at p<0.05. The weighted prevalence of prenuptial HIV/AIDS testing was 45.9% (95%CI: 44.8%-47.1%). The respondents who attained primary and secondary+ education had 31% (OR = 1.31; 95%CI: 1.09-1.59) and 56% (OR = 1.56; 95%CI: 1.25-1.95) higher odds of prenuptial HIV/AIDS testing, when compared with uneducated women. Those who got married or had their first sex at an adult age (18+ years), had higher odds of prenuptial HIV/AIDS testing, when compared with women who got married before age 18 years or never had sex respectively. Women's age, nativity and region were associated with prenuptial HIV testing. Women with knowledge of HIV test kits, had higher odds of prenuptial HIV/AIDS testing (OR = 1.45; 95%CI: 1.30-1.63), when compared with those with no knowledge of HIV test kits. The respondents from female-headed households had 12% reduction in prenuptial HIV/AIDS testing (OR = 0.88; 95%CI: 0.80-0.97), when compared with their male-headed counterparts. The moderately (OR = 1.16; 95%CI: 1.03-1.31) and highly (OR = 1.55; 95%CI: 1.37-1.75) enlightened women had higher odds of prenuptial HIV/AIDS testing, when compared with those with low enlightenment. The uptake of prenuptial HIV/AIDS testing was relatively low among Rwandese women. We recommend improving women's education, enlightenment, delay in sexual debut, marriage at adult age (18years) and increasing knowledge about HIV testing among women.

Differentials in the Prevalence of Acute Respiratory Infections Among Under-Five Children: An Analysis of 37 Sub-Saharan Countries.

Objective: We investigated the prevalence and risk factors of ARI in children under 5 years old in 37 SSA countries. Methods: Data from Demographic and Health Survey (DHS) of 37 African countries was examined in this analysis. Data from children under the age of 5 years old were examined. Forest plot was used to identify disparities in the occurrence of ARIs across SSA countries. Results: We observed a higher prevalence of ARI among children under 5 in Uganda, Kenya, Sao Tome and Principe (9% each), Gabon, Chad, Eswatini (8% each), Burundi, Ethiopia, Congo Democratic Republic (7.0% each). The prevalence of ARI among under-five children who sought medical advice/treatment from health facility was higher in South Africa (88%), Sierra Leone (86%), Tanzanian (85%), Guinea (83%) and Uganda (80%). The prevalence rate of ARI among under-five children who received antibiotics was higher in Tanzania (61%), Sao Tome and Principe (60%), Rwanda and Congo (58% each), Angola (56.0%), Mozambique (54.0%), Kenya (53.0%), Namibia (52.0%) and Gabon (50.0%). This study found that the household wealth index, maternal education, and urban residence were significantly associated with ARI (p <0.001). A higher prevalence of ARI was observed among urban residents, low income families, and those with mothers with lower education. Conclusion: ARI prevalence could be reduced by improving household socioeconomic status, child nutrition and community awareness of indoor and outdoor pollution. Interventions and programs focused on early diagnosis, treatment and prevention of ARIs are crucial in reducing ARIs particularly in developing countries.

Baseline prevalence of molecular marker of sulfadoxine/pyrimethamine resistance in Ebonyi and Osun states, Nigeria: amplicon deep sequencing of dhps-540.

BACKGROUND: Chemoprevention plays an important role in malaria control strategy. Perennial malaria chemoprevention (PMC) using sulfadoxine/pyrimethamine (SP) is a WHO-approved strategy to combat malaria in young children and may lead to drug pressure. Introducing SP-PMC may therefore be compromised due to the emergence of Plasmodium falciparum resistant to SP, particularly mutation at K540E of the dihydropteroate synthase (dhps) gene. Molecular surveillance of resistance markers can support assessment of antimalarial efficacy and effectiveness. High prevalence of 540E is associated with reduced effectiveness of SP, and areas with more than 50% prevalence are considered unsuitable for intermittent preventative treatment in pregnancy (IPTp) implementation. Assessing 540E prevalence is an important undertaking before implementation of SP-PMC. METHODS: We conducted a rapid surveillance of dhps-540E to assess the suitability of SP as PMC in field studies from Ebonyi and Osun states in Nigeria. We used an in-house developed amplicon deep-sequencing method targeting part of the dhps gene. RESULTS: Our data reveal that 18.56% of individuals evaluated carried the 540E mutation mixed with the WT K540. Mutant variant 540E alone was not found, and 80% of isolates harboured only WT (K540). Clonal analysis of the sequencing data shows a very low proportion of 540E circulating in both states. CONCLUSIONS: Our data show that both states are suitable for SP-PMC implementation and, based on this finding, SP-PMC was implemented in Osun in 2022. Continuous monitoring of 540E will be required to ensure the chemoprevention effectiveness of SP in Nigeria.

Qualitative content analysis of Nigerian heads-of-state and presidents' inaugural addresses: text mining, topic modelling and sentiment analysis.

Political speech acts are critical for politicians launching a regime because they can provide information that can be used to control people's thoughts and opinions. The purpose of this study was to conduct a qualitative content analysis of the inaugural and ascension addresses of Nigerian heads of state and presidents. The textual data used in this analysis were the ascension and inaugural addresses of Nigerian Heads of State and Presidents from 1960 to 2019. They were extracted and analysed using text-mining techniques. Textual data were clustered about their topical content using Latent Dirichlet Allocation (LDA), and speech cohesion between these addresses was examined using a similarity matrix and heatmap. Furthermore, term frequency and association analyses were performed to examine the high-frequency terms (tokens) and the terms (tokens) that are strongly correlated within each of the ascension/inaugural addresses (corpus). The summarization of characters and words in the ascension and inaugural addresses reveals that the Civilian Presidents used more characters and words than the Military Heads of State. There was an increase in the number of characters and words in the ascension and inaugural addresses among those who had served the nation multiple times. The total sentiment score in the ascension/inaugural addresses from 1960 to 2019 by Civilian Presidents and Military Heads of State revealed that the Civilian Presidents expressed more trust, surprise, sadness, joy, fear, disgust and anticipation in their addresses than the Military Heads of State. The most occurring term (token) in the ascension/inaugural addresses was the word government which appeared 221 times. The most token in the corpus government was found to be moderately correlated with the following tokens: loss, existing and majority. Similarly, economic was found to be moderately correlated with these tokens: inflation, building, education, exchange, loan, workers and technical. In this study, all the ascension/inaugural addresses share similar topic distribution: as seen in Abacha's and Muritala's addresses; and Shonekan's inaugural address was very similar to Balewa, Azikwe and Babangida's addresses; Babangida's ascension, Abdulsalam's 1998 ascension, Jonathan's 2010 inaugural and Buhari's 2015 inaugural addresses discussed similar topics to Obasanjo's 1976 ascension address. The highest average sentiment score was observed in Obasanjo's 2003 inaugural address and the lowest score was in Buhari's 1983 ascension address. The sentiment score for the ascension/inaugural addresses showed that Civilian Presidents inaugural addresses expressed more positive, joy, trust and anticipation than Military Heads of State. These emotions showed that the Civilian President's inaugural addresses are better when compared to Military Heads of State in terms of the sentiment scores.

Measuring the Uptake of Growth Monitoring and Nutrition Promotion among under-5 Children: Findings from the Rwanda Population-Based Study.

Regular growth monitoring can be used to evaluate the nutritional and physical health of children. Ample evaluation of the reach and quality of nutrition interventions is necessary to increase their effectiveness, but there is little research on improving coverage measurement. The aim of this study was to explore the coverage of growth monitoring, nutrition promotion, and associated factors by Rwandan caregivers of children under the age of five. Data from 2019−2020 Rwanda Demographic and Health Survey with a total of 8092 children under the age of five were used for this study. Prevalence of growth monitoring and nutrition promotion were reported and the factors influencing this were evaluated using multivariable logistic regression model. The prevalence of growth monitoring and nutrition promotion among under-5 children was 33.0% (95%CI: 30.6−35.6%). Older children, caregivers who were native residents, those with a health insurance, in a marital relationship, employed, and residing in rural areas had higher odds to participate in growth monitoring and nutrition promotion compared to their counterparts. Rwanda has a low rate of coverage for growth monitoring and nutrition promotion among children <5 and public health nutrition interventions should prioritize nutritional counseling as well as the availability of growth monitoring and promotion services.

Prevalence and Correlates of Underweight among Women of Reproductive Age in Nepal: A Cross-Sectional Study.

This study aimed to examine the prevalence of underweight and determine the sociodemographic and household environmental correlates of underweight among women of reproductive age in Nepal. This study also compared the time trends in the prevalence of underweight with the trends in the prevalence of overweight and obesity. This cross-sectional study was a secondary data analysis of the nationally representative population-based Nepal Demographic and Health Surveys (NDHSs). Firstly, the time trends of the prevalence of underweight (body mass index (BMI) < 18.5 kg/m2) among women aged 15-49 years were examined at five-year intervals, from the 1996, 2001, 2006, 2011, and 2016 NDHSs (n = 33,507). Secondly, the sociodemographic and household environmental correlates of underweight were examined from the latest NDHS 2016 (n = 6165). Univariable and multivariable logistic regression analyses were performed to examine the sociodemographic and household environmental correlates of underweight. From 1996 to 2016, the prevalence of underweight decreased from 25.3% (95% confidence interval (CI) 23.8%, 26.8%) to 16.9% (95%CI 16.0%, 17.8%), while the prevalence of overweight and obesity increased from 1.6% (95%CI 1.2%, 2.1%) to 15.6% (95%CI 14.7%, 16.5%) and 0.2% (95%CI 0.1%, 0.4%) to 4.1% (95%CI 3.6%, 4.6%), respectively. Sociodemographic factors, such as age, educational status, marital status, wealth index, and religion, were independently associated with the risk of underweight. Similarly, household environmental factors, such as province of residence, ecological zone, type of toilet facility, and household possessions, including television and mobile phone, were independently associated with the risk of underweight. Despite the declining trends, the prevalence of underweight among Nepalese women remains a public health challenge. Understanding the key sociodemographic and household environmental correlates of underweight may assist in streamlining the content of health promotion campaigns to address undernutrition and potentially mitigate adverse health outcomes.

Inequalities in the prevalence of stunting, anemia and exclusive breastfeeding among African children.

BACKGROUND: Childhood stunting and anemia are on the increase in many resource-constrained settings, without a counter increase in proper feeding practices such as exclusive breastfeeding. The objective of this study was to explore the prevalence of stunting, anemia and exclusive breastfeeding across African countries. METHODS: Demographic and Health Survey (DHS) data from 39 African countries was analyzed. Data from under 5 children were analyzed. Forest plot was used to determine inequalities in the prevalence of the outcome variables. RESULTS: The prevalence of stunting was highest in Burundi (56%), Madagascar (50%) and Niger (44%). In addition, Burkina Faso (88%), Mali (82%), Cote d'Ivoire and Guinea (75% each) and Niger (73%) had the highest prevalence of anemia. Furthermore, Burundi (83%), Rwanda (81%) and Zambia (70%) had the highest exclusive breastfeeding. We found statistical significant difference in the prevalence of stunting, anemia and exclusive breastfeeding (p < 0.001). Higher prevalence of stunting and anemia were estimated among the male, rural residents, those having mothers with low education and from poor household wealth. CONCLUSION: Concerted efforts are required to improve childhood health, survival and proper feeding practice. Reduced stunting and anemia could be achieved through sustained socioeconomic improvement that is shared in equity and equality among the population. Interventions aimed at increasing food availability can also aid in the reduction of hunger, particularly in impoverished communities.

Association between socio-economic factors and HIV self-testing knowledge amongst South African women.

Background: Self-testing for HIV is an effective and alternative method of increasing HIV testing rates and a strategy for reaching populations that are underserved by HIV testing services. Nonetheless, many resource-constrained settings are yet to adopt HIV self-testing (HIVST) into their national HIV programmes. Objectives: This study aimed to examine the association between socio-economic factors and HIVST knowledge amongst South African women. Method: We used nationally representative data from the 2016 South African Demographic and Health Survey. A sample of 8182 women of reproductive age was analysed. The outcome variable was HIVST knowledge. This was measured dichotomously; know versus do not know about HIVST. The multivariable logistic model was used to examine the measures of association, with the level of significance set at P < 0.05. Results: The prevalence rate of HIVST knowledge was found to be approximately 24.5% (95% confidence interval [CI]: 22.9-26.1) amongst South African women. Women with tertiary education were 3.93 times more likely to have HIVST knowledge, when compared with those with no formal education (odds ratio [OR]: 3.93; 95% CI: 1.37-11.26). Rural residents had a 33% reduction in HIVST knowledge when compared with those residing in urban areas (OR: 0.67; 95% CI: 0.51-0.89). The odds of interaction between the richer and richest women who have good knowledge of HIV infection were 1.88 and 2.24 times more likely to have HIVST knowledge, respectively, when compared with those from the poorest wealth household who have good knowledge of HIV infection. Conclusion: Based on the low level of HIVST knowledge, the findings emphasise the importance of developing effective HIVST educational campaigns. Moreover, programmes should be designed to address the unique needs of the socio-economically disadvantaged women.

Skin-to-skin contact and breastfeeding practices in Nigeria: a study of socioeconomic inequalities.

BACKGROUND: The effects of breastfeeding practices on children's health are undoubtedly of great interest. However, inequalities in breastfeeding practices and mother and newborn skin-to-skin contact (SSC) exist in many resource-constrained settings. This study examined the regional prevalence and socioeconomic inequalities in exclusive breastfeeding (EBF), early initiation of breastfeeding and SSC in Nigeria. METHODS: Data on 2936 infants under six months were extracted from the 2018 Nigeria Demographic and Health Survey (NDHS) to determine EBF. In addition, data on 21,569 children were analysed for early initiation of breastfeeding and SSC. Concentration index and curves were used to measure socioeconomic inequalities in EBF, early initiation of breastfeeding and SSC. RESULTS: The prevalence of EBF, early initiation of breastfeeding and SSC were 31.8, 44.2 and 12.1% respectively. Furthermore, Ogun state had the highest prevalence of EBF (71.4%); while Bayelsa state had the highest prevalence of SSC (67.8%) and early initiation of breastfeeding (96.2%) respectively. Urban dwellers had higher prevalence of EBF, SSC and early initiation of breastfeeding across household wealth quintile and by levels of mothers' education in contrast to their rural counterparts. We quantified inequalities in early initiation of breastfeeding, EBF, and SSC according to household wealth and maternal education. The study outcomes had greater coverage in higher household wealth, in contrast to the lower household wealth groups; early initiation of breastfeeding (concentration index = 0.103; p = 0.002), EBF (concentration index = 0.118; p < 0.001), and SSC (concentration index = 0.152; p < 0.001) respectively. Furthermore, early initiation of breastfeeding (concentration index = 0.091; p < 0.001), EBF (concentration index = 0.157; p < 0.001) and SSC (concentration index = 0.156; p < 0.001) had greater coverage among mothers with higher educational attainment. CONCLUSION: Low prevalence and socioeconomic inequalities in early initiation of breastfeeding, EBF and SSC were identified. We recommend that health promotion programs targeted and co-designed with disadvantaged mothers are critical to meet global breastfeeding targets. Also, future researchers should conduct further studies especially clinical control trials and qualitative studies to unravel the possible reasons for differences in the indicators.

Prevalence and factors associated with unplanned pregnancy in The Gambia: findings from 2018 population-based survey.

BACKGROUND: Unplanned pregnancy is a public health issue that has detrimental implications for the mother and baby alike. However, few studies have been conducted in The Gambia on this subject. As a result, the prevalence of unplanned pregnancy among women of reproductive age in The Gambia was investigated, as well as the factors associated with it. METHODS: The Gambia's Multiple Indicators Cluster Survey (MICS) was used to evaluate the 2018 results. Data was obtained from 3790 women aged 15 to 49 who had also given birth. The univariate analysis was conducted using percentage. The adjusted odds ratios (AOR) were determined using a multivariable logistic regression model (with corresponding 95% confidence interval (CI)). The degree of statistical significance was set at 5%. RESULTS: Approximately 25.3% (95% CI: 23.1%-27.6%) of the women reported unplanned pregnancy. Women aged 30-34 years had 45% reduction in unplanned pregnancy, when compared with those aged 15-19 years (AOR = 0.55; 95% CI: 0.32-0.94). The Fula and non-Gambian women had 30% and 45% reduction in unplanned pregnancy respectively, when compared with Mandinka women. Those who had no functional difficulties had 47% reduction in unplanned pregnancy, when compared with women who had functional difficulties (AOR = 0.53; 95% CI: 0.30, 0.91). Respondents who had given births to 3-4 and 5 + children were 1.79 and 3.02 times as likely to have unplanned pregnancy, when compared with women who had given birth to 1-2 children. Single/unmarried women were 11.38 times as likely to have unplanned pregnancy, when compared with women currently married/in union (AOR = 11.38; 95% CI: 6.38, 20.29). Local Government Area of residence was significantly associated with unplanned pregnancy. Furthermore, women who were neither happy nor unhappy and 18 + at sexual debut were 1.39 and 1.34 times as likely to have unplanned pregnancy, when compared with the very happy women and those < 18 at sexual debut respectively. CONCLUSION: The rate of unintended pregnancies was large (25.3%). Several causes have been linked to unplanned pregnancies. These results suggest that further efforts are required to enhance women's sex education, expand access to family planning services, and provide affordable health care to high-risk women in order to minimize unintended pregnancies.

Effects of socioeconomic factors and booking time on the WHO recommended eight antenatal care contacts in Liberia.

Antenatal care (ANC) is an important intervention that has been linked to reduce maternal and newborn adverse outcomes. However, the long years of war in Liberia may have contributed to the poor health indices including the uptake of maternal health care services. The objective of this study was to determine the marginal interaction effects between booking time and socioeconomic factors in eight or more ANC contacts. A total sample of 4,185 women who had given birth were included in this study. The 2020 Liberia Demographic and Health Survey (LDHS) dataset was analyzed. The outcome variable was eight or more ANC contacts. Percentage and Chi-square test were used in univariate and bivariate analyses respectively. The marginal interaction effects between booking time and socioeconomic factors of eight or more ANC contacts were estimated. The statistical significance was determined at 5%. The weighted prevalence of eight or more ANC contacts was 26.6% (95% CI: 23.8%, 29.6%). The uptake of eight or more ANC contacts increased steadily by increasing women's level of education and household wealth index. Women with higher educational attainment had a prevalence of 49.0% (95%CI: 36.5%, 61.6%) and those in the richest households had an estimated prevalence of 31.4% (95%CI: 24.9%, 38.8%) respectively. Furthermore, the urban dwellers had a weighted eight or more ANC contacts prevalence of 29.0% (95%CI: 24.6%, 34.0%). The key finding is increased marginal interaction effects for higher education and early booking (48.4%), richest households and early booking (35.4%), and urban residential status and early booking (36.2%) respectively. Overall, the prevalence of eight or more ANC contacts was low. However, we found higher coverage of eight or more ANC contacts among women who initiated ANC within the first trimester and among those with higher socioeconomic status. We recommend the Liberian government to design and/or support programmes targeted at promoting early ANC initiation and supporting the disadvantaged women such as the uneducated, poor and those living in rural or remote settings.

What does early initiation and duration of breastfeeding have to do with childhood mortality? Analysis of pooled population-based data in 35 sub-Saharan African countries.

BACKGROUND: Breastfeeding practices and their impact on infant health and survival are unquestionably of global interest. The aim of this study was to examine the link between breastfeeding initiation within one hour of birth, breastfeeding duration and childhood mortality in sub-Saharan Africa. METHODS: This study used data from the Demographic and Health Survey, which was conducted in 35 Sub-Saharan African countries between 2008 and 2017. Early initiation and duration of breastfeeding, food consumption indices, and infant mortality were all important variables. Analysis used percentage, median/interquartile range, and regression models (logistic, linear, Cox). RESULTS: Early initiation of breastfeeding within one hour after birth was lowest in Chad (23.0%) and highest in Burundi (85.0%). The pooled median duration of breastfeeding was 12 months. Female children had 3% significant lower odds of consuming tinned, powdered or fresh milk, compared with male children (OR 0.97; 95% CI 0.94, 0.99). Conversely, female children were more likely to be put to breast within one hour after birth, compared with male children (OR 1.03; 95% CI 1.01, 1.05). Results from the pooled sample showed approximately 20% (HR 0.80; 95% CI 0.67, 0.96) and 21% (HR 0.79; 95% CI 0.77, 0.80) reduction in infant mortality for children breastfed within one hour after birth and for every unit increase in the months of breastfeeding respectively. In addition, countries with the leading infant mortality rate include; Sierra Leone (92 deaths per 1000 live births), Chad (72 deaths per 1000 live births), Nigeria (69 deaths per 1000 live births), Cote d' Ivoire (68 deaths per 1000 live births), Guinea (67 deaths per 1000 live births), Burkina-Faso (65 deaths per 1000 live births) and Mozambique (64 deaths per 1000 live births) respectively. CONCLUSIONS: The findings from this study underscores the need for early breastfeeding initiation and prolong breastfeeding to be considered in programmes on improving childhood survival. Efforts should be made to improve optimal breastfeeding practices as only about half of children in the pooled sample had best practices of breastfeeding.

Resilient and Accelerated Scale-Up of Subcutaneously Administered Depot-Medroxyprogesterone Acetate in Nigeria (RASuDiN): A Mid-Line Study in COVID-19 Era.

BACKGROUND: Injectable contraceptives are fast becoming the method of choice among women in sub-Saharan Africa (SSA). Specifically, the subcutaneously administered depot-medroxyprogesterone acetate (DMPA-SC) is gaining traction as a convenient, private and effective method to address unmet need for family planning (FP). The objective of this study was to determine the trend in DMPA-SC use in Nigeria. METHODS: Data was extracted from the National Health Management Information System (NHMIS) FP register on DMPA-SC uptake in public health facilities and through community-oriented resource providers (CORPS) in 10 Nigerian states. The linear trend model was adopted in data analysis based on lowest measure of dispersion and/or highest adjusted coefficient of determination (R2). The statistical significance was determined at 5%. RESULTS: There was an upward trend in the use of DMPA-SC among clients who received the service through health providers, CORPS and self-injection in the 10 project states over a period of 12 months (August 2019-July 2020). In addition, the linear trend model showed that for every unit increase in months, the average number of women expected to use DMPA-SC through health providers, CORPS and self-injection will increase by 1308.3 (Yt = 3799.7 +1308.3*t), 756.73 (Yt = -1030.8 +756.73*t) and 77.864 (Yt = -159.7 +77.864*t) respectively. In all models, the adjusted coefficient of determination was 99.9% which showed good model fitness. The results also showed that the number of DMPA-SC clients varied across the project states with Niger (32,988) and Oyo (31,511) states reporting the highest number of clients over the period of 12 months. CONCLUSION: There was an increasing use of DMPA-SC and self-injection among clients over time. Health facility and community-based FP programs should be strengthened to ensure improved access to FP services.

Socioeconomic inequalities in early initiation and exclusive breastfeeding practices in Bangladesh: findings from the 2018 demographic and health survey.

BACKGROUND: Optimal breastfeeding practices including early initiation of breastfeeding and exclusive breastfeeding (EBF) are associated with positive health outcomes. Socioeconomic inequalities in key breastfeeding indicators may play a role in the prevalence of breastfeeding practices. The objective of this study was to examine the socioeconomic inequalities in early initiation of breastfeeding and EBF practices in Bangladesh based on the 2018 Bangladesh Demographic and Health Survey (BDHS). METHODS: This was a secondary data analysis of the nationally representative 2018 BDHS. Data on 4950 women of reproductive age who had ever given birth and 924 children aged 0-5 months were extracted, for early initiation of breastfeeding and EBF. Early initiation of breastfeeding was determined from children who were put to the breast within the first hour of birth. Exclusive breastfeeding was estimated from children aged 0-5 months who were exclusively breastfed. RESULTS: The weighted prevalence of early initiation of breastfeeding and EBF were 60.8% (95% CI; 59.0, 62.6%) and 66.8% (95% CI; 63.1, 70.3%), respectively. The estimated prevalence of early initiation among the poorest, poorer, middle, richer and richest households were 67.8, 66.3, 58.4, 56.3 and 54.4%, respectively. Similarly, early initiation prevalence of 64.4, 65.0, 61.1 and 52.3% were estimated among women with no formal education, primary, secondary and higher education, respectively. The estimated prevalence of EBF among the poorest, poorer, middle, richer and richest households were 63.0, 65.2, 67.7, 66.7 and 69.9%, respectively. Similarly, the estimated EBF prevalence were 62.5, 66.0, 66.3 and 68.9% among women with no formal education, primary, secondary and higher education, respectively. Early initiation of breastfeeding was higher among lower household wealth (Conc. Index = - 0.049; SE = 0.006) and lower educational attainment groups (Conc. Index = - 0.035; SE = 0.006). CONCLUSIONS: Improving optimal breastfeeding practices in Bangladesh should be given utmost priority. A need to address the socioeconomic inequalities in breastfeeding practices was also identified.