Leaving no one behind: addressing the sexuality of people with disabilities.

Addressing the sexuality of individuals with disabilities is important within the framework of global health and societal inclusivity. Despite comprising 16% of the world's population, this demographic faces sexual autonomy inequality. Acknowledging this intersection is pertinent for achieving inclusive healthcare and upholding the commitments of the 1994 International Conference on Population and Development and the 2006 United Nations Convention on the Rights of Persons with Disabilities. Dispelling stereotypes and promoting dialogue are key to empowering individuals with disabilities and ensuring equitable access to sexual health resources. Integrating sexual health and rights into broader healthcare systems is vital for creating an inclusive society where no one is left behind. This article advocates for the need to address the specific sexual health needs and rights of individuals with disabilities, to implement inclusive policies, and to foster a healthcare environment that respects and supports their autonomy and dignity.

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

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

Intersecting Epidemics: The Predictors of Continued Utilization of HIV Care and Treatment Services During the COVID-19 Outbreak Among People Living with HIV in ZIMBABWE.

Globally, there have been considerable achievements towards HIV care and treatment. AIDS-related deaths have been reduced by 60% since the peak in 2004. Potentially, the fight against the HIV epidemic was made more difficult with the outbreak of COVID-19. Thus, this study examined the implications of COVID-19 in the utilization of HIV care and treatment services among people living with HIV on antiretroviral therapy (ART) in Zimbabwe. The study aimed to identify the critical factors defining the utilization of HIV services at the advent of COVID-19 using the fifth revision of the Anderson Behavioral Model of Healthcare Utilization. The study utilized a concurrent triangulation design of which only one data collection phase was used. The quantitative data was collected from 2,157 people living with HIV on antiretroviral viral therapy through a structured interviewer-administered questionnaire. On the other hand, qualitative data was collected through in-depth interviews. Regarding accessing ART refills, the study findings revealed that adolescents aged 15-19 (aOR = 2.16; 95% CI: 1.18-3.96) had higher odds of utilizing ART refills compared to their counterparts who were aged 20-24. Living in a rural area was associated with higher odds of utilizing the ART refill service (aOR = 2.20; 95% CI: 1.49-3.24). Regarding accessing viral load monitoring adults aged 25-39 (aOR = 0.41; 95% CI: 0.26-0.66) were less likely to utilize viral load monitoring compared to young people aged 20-24. Being vaccinated for COVID-19 was significantly associated with higher odds of utilizing the viral load monitoring service (aOR = 1.97; 95% CI: 1.36-2.87) than those not yet vaccinated. Living in a rural area was associated with higher odds of utilizing viral load monitoring (aOR = 1.50; 95% CI: 1.09-2.08). Regarding tuberculosis preventative therapy, adults aged 25-39 (aOR = 0.30; 95% CI: 0.20-0.47) were less likely to utilize tuberculosis preventative therapy compared to young people aged 20-24. Being vaccinated for COVID-19 was significantly associated with higher odds of utilizing tuberculosis preventative therapy (aOR = 1.59; 95% CI: 1.12-2.25) than those not yet vaccinated. Living in a rural area was associated with higher odds of utilizing tuberculosis preventive therapy (aOR = 1.58; 95% CI: 1.19-2.08). Regarding tuberculosis screening being vaccinated for COVID-19 was significantly associated with higher odds of utilizing tuberculosis screening services (aOR = 1.89; 95% CI: 1.41-2.54) than those not yet vaccinated. Although the severity of the COVID-19 pandemic has dwindled, COVID-19 appears to come and go in waves, and a few countries are still recording relatively high cases. It is therefore likely that the factors associated with utilization of HIV services identified by the study such as age, residence, type of health facility, vaccination of COVID-19 and fear of contracting COVID-19, among others, need to be included when planning to improve access to health utilization.

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

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

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

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

A multilevel mixed effect analysis of neighbourhood and individual level determinants of risky sexual behaviour among young people in South Africa.

BACKGROUND: Despite national and international commitments and efforts to prevent risky sexual behaviours, a high proportion of young people in South Africa are engaged in risky sexual behaviour. However, most efforts are currently directed toward addressing individual-level factors at the expense of not addressing neighbourhood-level determinants such as social disorganisation, contributing to risky sexual behaviour among young people in South Africa. This study investigated the multilevel factors of risky sexual behaviours among young people by gender in South Africa, using the lens of socio-ecological and social disorganisation frameworks. METHODS: Data from a nationally representative sample of 1268 males and 2621 females aged 15-24 years, giving a total of, 3889 never-married youths, were drawn from the 2016 South Africa Demographic and Health Survey. Analysis was conducted using multilevel mixed-effect logistic regressions with random community-level effects. RESULTS: Findings show that youth who were from a heterogeneous ethnic group (AOR = 0.49, CI: 0.35-0.67), household size of 5 + members (AOR = 0.78, CI: 0.54-1.15), community education (AOR = 0.97, CI: 0.72-1.32) were associated with low engagement in multiple sexual partnerships. Youths who were employed (AOR = 0.84, CI: 0.59-1.18), and from high-level community poverty (AOR = 0.76, CI: 0.58-1.00) were also associated with reduced odds of unprotected sex. In addition, older youth aged 20-24 years (AOR = 12.6, CI: 9.93-16.00); secondary education attainment (AOR = 1.01, CI 0.58-1.77); family structure (AOR = 1.37, CI: 0.75-1.15); Gauteng province (AOR = 1.45 CI: 0.92-2.28); residential mobility (AOR = 1.25, CI: 1.02-1.53), community media exposure to contraceptives (unprotected sex) (AOR = 1.38, CI: 1.09-1.76) were more likely to engage in risky sexual behaviour. CONCLUSION: The study revealed that neighbourhood and individual-level factors were important in explaining the factors associated with risky sexual behaviour among young people in South Africa. In addition, engagement in risky sexual behaviour was high, with minimal variation among young females and males in South Africa. It specifies that the practice of risky sexual behaviour is significantly associated with multilevel factors of social disorganisation that cut across gender. These results imply that there is a need to review policies of sexual risks reduction for each gender, which might help mitigate the adverse effects of social disorganisation for women and men youths in South Africa.

Risky sexual behaviour is most common among young people aged 15­24 years and is associated with an increase in sexually transmitted infections, including HIV/AIDS among this young productive age category. However, no adequate progress has been made in the reduction of these infectious diseases at the community level in South Africa. In this study, we investigate the effect of neighbourhood and individual-level factors leading to two measures of risky sexual behaviour; unprotected sex (non-condom use) and multiple sexual partnerships among young people. In this study, the target for young people in the South African context was because the country has a youthful population. Understanding the influence of neighbourhood and individual-level factors on the sexual behaviour of young people can help them live healthy as they transition to adulthood. We utilized cross-sectional data from the most recent South Africa Demographic and Health Survey, which was analyzed separately for males and females respectively, due to the cultural differences in sexual practices observed in many communities in South Africa. Our results confirmed an association between the neighbourhood and individual-level factors with youth engagement in risky sexual behaviour in South Africa. These results, imply that there is a need to review policies regarding the community-based interventions for sexual and reproductive health in other to reduce risky sexual behaviour among young people in South Africa.

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

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

Involuntary Childlessness and Marital Infidelity Among Women in Sub-Saharan African Countries: An Assessment of the Moderating Role of Women's Education.

A considerable number of married women in sub-Saharan African countries are childless and may be likely to engage in marital infidelity to avoid social stigma, economic insecurities, and other debilitating experience associated with being involuntarily childless. This study sought to investigate the relationship between involuntary childlessness and marital infidelity and how it may be moderated by women's educational attainment. Data were obtained from 23,847 women in their first union for at least 2 years and participated in the demographic and health surveys of five sub-Saharan African countries comprising Cameroon, Gabon, Lesotho, Liberia, and Sierra Leone. Data were analyzed using multivariate logistic regression, adjusted for socioeconomic, union, and partner characteristics. Involuntarily childless women in Cameroon (AOR: 2.34, 95% CI 1.62-3.39) and Sierra Leone (AOR: 2.22, 95% CI 1.42-3.49) were about two times more likely to engage in marital infidelity compared to non-childless married women. In Gabon, Lesotho, and Liberia, the odds of marital infidelity did not significantly differ between involuntarily childless and non-childless married women. Although involuntarily childless women with secondary or higher education reported higher levels of marital infidelity than non-childless women with a similar level of education, we found no statistical evidence in all the countries that the relationship between involuntary childlessness and marital infidelity was moderated by women's educational attainment. These findings suggest that involuntary childlessness is a critical factor potentially related to marital infidelity and may be an important target for intervention and prevention, particularly in settings with high levels of sexually transmitted infections.

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

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

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

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

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

Contraceptive use in Eswatini: do contextual influences matter?

This study sought to investigate the determinants of current use of modern contraceptives beyond the individual level in Eswatini (formerly Swaziland). Previous studies have overlooked the role of community characteristics such as socioeconomic development, women's empowerment and fertility norms in shaping contraceptive use. Hierarchical structured subsample data of 4112 sexually experienced women from the 2007 Eswatini Demographic Health Survey were analysed using multilevel logistic regression to identify factors contributing to community/cluster variations in women's current use of modern contraceptives. Less than half (44.2%) of the sexually active women were using modern contraceptive methods in 2007. At the community level, the odds of contraceptive use decreased for rural women (AOR = 0.82, 95% CI: 0.68-0.98) and among women residing in communities with high-fertility norms (AOR = 0.77, 95% CI: 0.66-0.89). After adjusting for both individual- and community-level factors, no community-level variables considered for the study were significantly associated with contraceptive use. The findings highlight in all four models, from the empty to full model, that there is a small and decreasing significant variation in women's contraceptive use across communities (MOR, 1.37-1.17). In 2007, the findings suggest individual rather than community factors account for some contextual variability in contraceptive use. The study proposes the use of ethnographic techniques to unravel community factors that promote modern contraceptive use in Eswatini.

Correlates of antenatal care usage among adolescent mothers in Nigeria: a pooled data analysis.

This study examined selected correlates of timing and frequency of antenatal care visits among adolescent mothers aged 15-19 in Nigeria. Data from the women's recode dataset of the Nigeria Demographic and Health Surveys between 2003 and 2018 were pooled, with a sample size of 4,775. Multivariate data analysis was carried out using binary logistic regression. It was found that being educated (aOR = 1.54; CI = 1.14-2.08; aOR = 1.64; CI = 1.11-2.42); higher wealth status (aOR = 1.88; CI = 1.45-2.43; aOR = 1.92; CI = 1.33-2.76); contributing to health decision-making (aOR = 1.44, CI = 1.15-1.81); having an educated partner (aOR = 1.73; CI = 1.31-2.30; aOR = 2.44; CI = 1.84-3.25); and living in the South West region (aOR = 3.68; CI = 1.72-7.87) were associated with higher complete antenatal care utilization. Having difficulty getting permission to go to the health facility (aOR = 0.75, CI = 0.57-0.99) and with the distance to the health facility (aOR = 0.61, CI = 0.49-0.75) were associated with lower likelihood of ANCU. Respondents with secondary and higher education were more likely to start ANC early (aOR = 1.57, CI = 1.05-2.34), but Muslim mothers (aOR = 0.61, CI = 0.40-0.32) and those living in the North West (aOR = 0.43, CI = 0.26-0.71), South-South (aOR = 0.30, CI = 0.17-0.53) and South West (aOR = 0.29, CI = 0.12-0.69) were less likely to begin ANC early. Therefore, interventions to increase antenatal care must be region-specific, and focus attention on lower status adolescent mothers with less autonomy.

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

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

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

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

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

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

How long was the honeymoon? Accelerated failure time model of spousal violence onset among women in sub-Saharan Africa.

For primary prevention of spousal violence which is highly prevalent in sub-Saharan Africa (SSA), an important empirical question is "how early in a marital relationship does spousal violence commence? In this study, we employed descriptive statistics, Kaplan-Meier method and accelerated failure time models to estimate prevalence of parental history of spousal violence; estimate the timing of onset of spousal violence for sub-regions of SSA and assess the associated factors. We analyzed a weighted sample of 62,274 women aged 15-49 years from the domestic violence module of Demographic and Health Surveys conducted in 14 SSA countries between 2015 and 2018. Prevalence of spousal violence among ever married women ranged from 20.5% in Nigeria to 45.9%% in Burundi. The median time to first spousal violence after marriage in Western, Middle, Eastern, and Southern Africa was 2 years. Results from accelerated failure time models showed that age at marriage, educational attainment, and parental history of spousal violence were independently associated with early onset of spousal violence in all SSA subregions (West: TR = 0.21, CI 0.19-0.24; Middle: TR = 0.38, CI 0.34-0.43; East: TR = 0.46, CI 0.44-0.49; South: TR = 0.50, CI 0.46-0.54). Adolescents, youth, and older adults should be targeted for preventive and corrective interventions for spousal violence.

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

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

Contraceptive Use in Nigeria: Does Social Context Matter?

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

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

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

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

A comparative analysis of disability measures in Cameroonian surveys.

BACKGROUND: Although identifying vulnerable groups is an important step in shaping appropriate and efficient policies for targeting populations of disabled people, it remains a challenge. This study aims to evaluate for the first time the comparability of the different disability measurements used in Cameroon. This is done by comparing them with the international standards proposed by the Washington Group (WG). It also evaluates the consistency of the association between the disability as measured by these surveys and the sociodemographic characteristics. METHOD: We used data from the third Cameroonian Population and Housing Census (3RGPH) of 2005, the third Cameroonian Household survey (ECAM3) of 2007, the Demographic Health and Multiple Indicator Cluster Survey (DHS-MICS) of 2011 and a survey conducted on adults in Yaoundé (HandiVIH) in 2015 with the WG tool. The proportion and their confidence intervals, chi-square tests and multivariate logistic regressions are used for analyses. RESULTS: In the city of Yaoundé and for the 15-49 age group, disability prevalence was estimated at 3.6% (CI = [2.5, 5.1]), 2.7% CI = [2.1, 3.5]), 2.6% (CI = [2.4, 2.7]) and 1.0% (CI = [1.0, 1.10]), according to DHS-MICS, ECAM3, HandiVIH and 3RGPH, respectively. The prevalence of severe motor and mental disabilities in DHS-MICS (0.4% CI = [0.2, 0.8], 1.1% CI = [0.7, 1.8] and 0.5% CI = [0.2, 1.1], respectively) are not significantly different from the findings of HandiVIH (0.3% CI = [0.2, 0.3], 0.8% CI = [0.7, 0.9] and 0.5% CI = [0.5, 0.6], respectively). Only motor disability prevalence in ECAM3 (0.8%, CI = [0.5, 1.2]) is not different from that of HandiVIH. When the WG screening tool is used in HandiVIH, disability is positively associated with age, negatively associated with educational level, being in a union and socioeconomic status (SES) and it is not associated with sex. Severe disability, for its part, is not associated with SES and is positively associated with being a male. A different association trend is observed with 3RGPH, ECAM3 and DHS-MICS. CONCLUSION: None of the instruments used in the nationally representative Cameroonian surveys produced both disability prevalence and association trends that are exactly similar to those obtained when using the WG disability screening tool, thus highlighting the necessity to include the WG questions in nationally representative surveys.