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Maternal health is a global public health concern. The paucity of antenatal care (ANC) during pregnancy is directly associated with maternal mortality. This study assessed the individual and community-level determinants of quality ANC in six South-Asian countries. Data were obtained from a Demographic health survey of six South-Asian countries. This study included a sample of 180,567 (weighted) women aged 15-49 who had given birth in the preceding three years prior to the survey. The quality of ANC was determined by assessing whether a woman had received blood pressure monitoring, urine and blood sample screening, and iron supplements at any ANC visits. Frequency, percentage distribution, and inferential analysis (multilevel mixed-effects model) were conducted. The proportion of quality antenatal care utilization in South Asia was 66.9%. The multilevel analysis showed that women aged 35-49 years (AOR = 1.16; 95% CI = 1.09-1.24), higher education (AOR = 2.84; 95% CI = 2.69-2.99), middle wealth status (AOR = 1.55; 95% CI = 1.49-1.62), richest wealth status (AOR = 3.21; 95% CI = 3.04-3.39), unwanted pregnancy (AOR = 0.92; 95% CI = 0.89-0.95) and 2-4 birth order (AOR = 0.86; 95% CI = 0.83-0.89) were among the individual-level factors that were significantly associated with quality ANC utilization. In addition, rural residence (AOR = 0.77; 95% CI = 0.74-0.8), and big problem - distance to health facility (AOR = 0.63; 95% CI: 0.53-0.76) were the among community level factors there were also significantly associated with use of quality ANC. Meanwhile, women who lived in India (AOR: 22.57; 95% CI: 20.32-25.08) and Maldives (AOR: 33.33; 95% CI: 31.06-35.76) had higher odds of quality ANC than those lived in Afghanistan. Educational status, wealth status, pregnancy wantedness, sex of household head, birth order, place of residence, and distance to health facility were associated with quality ANC. Improving educational status, improving wealth status, reducing the distance to health facilities, and providing rural area-friendly interventions are important to increase the quality of ANC in South Asia.
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Atención Prenatal , Calidad de la Atención de Salud , Humanos , Femenino , Adulto , Atención Prenatal/estadística & datos numéricos , Embarazo , Persona de Mediana Edad , Adolescente , Adulto Joven , Asia , Factores SocioeconómicosRESUMEN
BACKGROUND: High completed fertility among married and cohabiting women has profound consequences, including straining resources, increasing healthcare challenges, and contributing to educational and gender inequalities. This study examined the factors associated with high completed fertility among married and cohabiting women aged 40-49 years in Ghana. METHODS: Data for the study was sourced from the 2022 Ghana Demographic and Health Survey (GDHS). A spatial map was used to present the women's geographic variations in high completed fertility. A mixed-effect multilevel binary logistic regression analysis was performed to identify the factors associated with high completed fertility. The findings were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI). RESULTS: The national proportion of high completed fertility among married and cohabiting women aged 40-49 years in Ghana was 52.0% [48.8, 55.2]. Women who were Ga/Dangme/Ewe by tribe [aOR = 2.32, 95% CI = 1.06, 5.08] had higher odds of high completed fertility than Akans. Women who indicated 6 + as their ideal number of children had a higher [aOR = 5.60, 95% CI = 2.90, 10.82] likelihood of high completed fertility compared to those whose ideal number of children was 0-3. Those who were using contraceptives at the time of the survey had a higher [aOR = 2.31, 95% CI = 1.17, 4.55] likelihood of high completed fertility compared to those who were not using contraceptives. Women with secondary/higher education [aOR = 0.32, 95% CI = 0.17, 0.58] had lower odds of high completed fertility than those without no formal education. Women with females as household heads [aOR = 0.56, 95% CI = 0.33, 0.95] had lower odds of high completed fertility than males. Women in Volta, Western North, Ahafo, and Bono regions had lower odds of high completed fertility compared to those living in the Northeast region, with the lowest odds among those living in the Volta region [aOR = 0.08, 95% CI = 0.02, 0.40]. CONCLUSION: High completed fertility is prevalent in Ghana, with more than half of married and cohabiting women having at least five or more children. The government and policymakers in Ghana should promote education for women, increase culturally sensitive family planning programs, increase access to family planning resources, address ideal family size preferences, and improve understanding of contraceptive use.
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Fertilidad , Encuestas Epidemiológicas , Factores Socioeconómicos , Humanos , Femenino , Adulto , Ghana/epidemiología , Persona de Mediana Edad , Composición Familiar , Conducta Anticonceptiva/estadística & datos numéricos , Servicios de Planificación Familiar/estadística & datos numéricos , Factores SociodemográficosRESUMEN
As Ghana has embraced the concept of women's empowerment as a vital tool for sustainable development, it has become crucial to evaluate the role that women's empowerment plays in the fertility preferences of married and cohabiting women in the country. The study's objective was to examine the association between women's empowerment, the ideal number of children and women's ability to have their desired number of children. This cross-sectional study used data from the 2014 Ghana Demographic and Health Survey. Both Poisson and binary logistic regression analyses were carried out. Women who had justification for wife-beating (incidence rate ratio [IRR] 0.98 [95% confidence interval {CI} 0.96 to 0.99]) and those who were autonomous (IRR 0.94 [95% CI 0.93 to 0.95]) had lower rates of having the ideal number of children. Moreover, women who had justification for wife-beating (adjusted odds ratio [aOR] 1.25 [95% CI 1.13 to 1.39]) and those who were involved in decision-making (aOR 1.31 [95% CI 1.19 to 1.44]) had higher odds of having the ability to have the desired number of children. However, autonomous women (aOR 0.78 [95% CI 0.71 to 0.86]) had lower odds of having the ability to have the desired number of children. Significant associations were found between women's empowerment (women's attitude towards justification for wife-beating, autonomy), an ideal number of children and the ability to have the desired number of children. These findings present target areas for policies and interventions aimed at determining Ghanaian women's fertility preferences and empowering them.
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INTRODUCTION: Despite the advancement in sexual and reproductive healthcare services and several public health measures aimed at controlling fertility rates, countries in sub-Saharan Africa (SSA) still experience higher adolescent fertility rates than other low-and middle-income countries. This study examined the disparities in adolescent fertility in 39 countries in SSA, focusing on socioeconomic and residence-based dimensions. METHODS: This study involved a secondary analysis of data obtained from 39 recent Demographic and Health Surveys conducted in SSA. The measures of difference (D), ratio (R), population attributable fraction (PAF), and population attributable risk (PAR) were estimated using the Health Equity Assessment Tool (HEAT) software version 3.1 developed by the World Health Organization. The measures: D, R, PAF, and PAR were used to examine the inequalities in adolescent fertility across the socioeconomic and residence-based dimensions. RESULTS: Out of the 39 countries included in the study, Guinea (D=27.70), Niger (D=27.50), Nigeria (D=23.90), and Côte d'Ivoire (D=23.60) exhibited the most significant residence-based inequalities in the rate of adolescent fertility, with the higher rate observed among adolescents in rural areas. Rwanda was the sole country that showed a slight inclination towards rural inequality in terms of the rate of adolescent fertility, with a value of D = -0.80. The burden of adolescent fertility was disproportionately higher among young women with low economic status across all the countries, exacerbating wealth-based inequities. The countries with the largest absolute discrepancies were Nigeria (D=44.70), Madagascar (D=41.10), Guinea (D=41.00), and Cameroon (D=40.20). We found significant disparities in educational attainment contributing to unequal inequalities in adolescent fertility, particularly among young women who lack access to formal education. Countries such as Madagascar (D=59.50), Chad (D=55.30), Cameroon (D=54.60), and Zimbabwe (D=50.30) had the most significant absolute disparities. CONCLUSION: This study revealed that young women residing in rural areas, those in households with low economic status and those with limited educational opportunities experience a disproportionately high burden of adolescent fertility across the 39 countries in SSA. The current findings offer valuable information to governmental entities at all levels regarding the need to ensure the provision of equitable, accessible, and dependable sexual and reproductive health services to the populace, particularly for young women. Therefore, the various stakeholders need to enhance the effectiveness of health policies and legislation pertaining to adolescent women living in rural areas, those from economically disadvantaged households, and those with limited or no access to formal education. Such interventions could potentially reduce adolescent fertility rates and mitigate the adverse maternal and child outcomes associated with high adolescent fertility in SSA.
Adolescent fertility is a major health problem for many developing countries, especially those in sub-Saharan Africa (SSA). Although several sexual and reproductive health initiatives have been introduced in these countries, the number of births among adolescents continues to be high. The present study looked at the socioeconomic and geographical differences in adolescent fertility across 39 countries in SSA using data from the Demographic and Health Surveys embedded into the World Health Organization's Health Equity Assessment Toolkit (WHO HEAT) software. The study found that in countries like Guinea, Niger, Nigeria, and Côte d'Ivoire, the rates of adolescent fertility varied a lot, with higher rates in rural areas. Generally, poorer young women were more likely to have babies, which made the gap between the rich and the poor even wider. Nigeria, Madagascar, Guinea, and Cameroon had the biggest differences. Education also played a role. In countries like Madagascar, Chad, Cameroon, and Zimbabwe, young women who did not go to school (had no education) were more likely to have children as teenagers. The study showed that in all 39 countries, young women living in rural areas, those who were poorer and those who did not go to school (had no education) faced a bigger problem with adolescent fertility. The study suggests that if people who make health policies pay more attention to teenage girls in the rural areas, those who are poor and do not have much education, they could make a significant difference in reducing adolescent fertility.
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Tasa de Natalidad , Embarazo en Adolescencia , Factores Socioeconómicos , Humanos , Adolescente , Femenino , Tasa de Natalidad/tendencias , Embarazo en Adolescencia/estadística & datos numéricos , Masculino , Adulto Joven , Embarazo , África del Sur del Sahara , Población Rural/estadística & datos numéricos , FertilidadRESUMEN
BACKGROUND: The empowerment of women has implications on the health and dietary needs of children. Using the survey-based women's empowerment index (SWPER), we examined the association between women's empowerment and dietary diversity among children aged 6-23 months in sub-Saharan Africa. METHODS: Data from the Demographic and Health Surveys of 21 countries were utilized. Descriptive spatial map was used to present the proportions of dietary diversity among the children. Multilevel binary logistic regression was used to examine the association between SWPER and dietary diversity. RESULTS: Overall, 22.35% of children aged 6-23 months had adequate minimum dietary diversity (MDD) in sub-Saharan Africa. The countries with the highest proportions of adequate MDD were Angola, Benin, Madagascar, Rwanda, Sierra Leone, and South Africa. South Africa had the highest proportion of MDD (61.00%), while Liberia reported the least (9.12%). Children born to mothers who had high social independence were more likely to have adequate MDD compared to those with low social independence [aOR = 1.31, 95% CI 1.21, 1.41]. In addition, children born to women with medium [aOR = 1.12; 95% CI 1.03, 1.21] and high decision-making [aOR = 1.25, 95% CI 1.14, 1.37] were more likely to receive MDD than those with low decision-making. CONCLUSIONS: Insufficient dietary diversity is evident among children aged 6-23 months in sub-Saharan Africa. MDD in children is influenced by women's empowerment. Policies and interventions promoting women's empowerment can enhance MDD, especially for vulnerable groups in rural and poorer households. It is crucial to leverage media and poverty reduction strategies to improve MDD among children in sub-Saharan African countries.
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BACKGROUND: Breast cancer is currently the most commonly diagnosed cancer in Ghana and the leading cause of cancer mortality among women. Few published empirical evidence exist on cultural beliefs and perceptions about breast cancer diagnosis and treatment in Ghana. This systematic review sought to map evidence on the socio-cultural beliefs and perceptions influencing the diagnosis and treatment of breast cancer among Ghanaian women. METHODS: This review was conducted following the methodological guideline of Joanna Briggs Institute and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. The literature search was conducted in PubMed, CINAHL via EBSCOhost, PsycINFO, Web of Science, and Embase. Studies that were conducted on cultural, religious, and spiritual beliefs were included. The included studies were screened by title, abstract, and full text by three reviewers. Data were charted and results were presented in a narrative synthesis form. RESULTS: After the title, abstract, and full-text screening, 15 studies were included. Three categories were identified after the synthesis of the charted data. The categories included: cultural, religious and spiritual beliefs and misconceptions about breast cancer. The cultural beliefs included ancestral punishment and curses from the gods for wrongdoing leading to breast cancer. Spiritual beliefs about breast cancer were attributed to spiritual or supernatural forces. People had the religious belief that breast cancer is a test from God and they resorted to prayers for healing. Some women perceived that breast cancer is caused by spider bites, heredity, extreme stress, trauma, infections, diet, or lifestyle. CONCLUSION: This study adduces evidence of the socio-cultural beliefs that impact on the diagnosis and treatment of breast cancer among women in Ghana. Taking into consideration the diverse cultural and traditional beliefs about breast cancer diagnosis and treatment, there is a compelling need to intensify nationwide public education on breast cancer to clarify the myths and misconceptions about the disease. We recommend the need to incorporate socio-cultural factors influencing breast cancer diagnosis and treatment into breast cancer awareness programs, education, and interventions in Ghana.
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Neoplasias de la Mama , Conocimientos, Actitudes y Práctica en Salud , Humanos , Femenino , Ghana/etnología , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/psicología , Neoplasias de la Mama/etnología , Neoplasias de la Mama/terapia , Cultura , EspiritualidadRESUMEN
INTRODUCTION: Human immunodeficiency virus (HIV) remains a significant health challenge affecting many people including those from sub-Saharan Africa (SSA). Even though HIV can be transmitted through various means, mother-to-child transmission (MTCT) remains the major route of transmission in children under the age of five. This study examined the correlates of knowledge of HIV transmission during pregnancy among reproductive-age women in Ghana. METHODS: Data for this study were obtained from the 2014 Ghana Demographic and Health Survey. The sample consisted of 9,106 women aged 15 to 49 years. We conducted both descriptive and multivariable logistic regression analyses to determine the prevalence and factors associated with knowledge of HIV transmission during pregnancy. The results were presented using frequencies, percentages, and adjusted odds ratios (aOR) with their corresponding 95% confidence intervals (CI). RESULTS: Approximately, 69.41% of women of reproductive age knew of HIV transmission during pregnancy. Women who had two (aOR = 1.32, 95% CI [1.01, 1.72]) or three (aOR = 1.37, 95% CI [1.07, 1.76]) births were more knowledgeable of HIV transmission during pregnancy. Women who read the newspaper (aOR = 1.56, 95% CI [1.31, 1.86]), listened to the radio (aOR = 1.23, 95% CI [1.05, 1.45]), lived in rural areas (aOR = 1.30, 95% CI [1.09, 1.54]) or ever been tested for HIV (aOR = 1.20, 95% CI [1.05, 1.37]) were more likely to be knowledgeable of HIV transmission during pregnancy than their counterparts in the reference categories. Compared to those in the Western Region, women in the Upper East (aOR = 0.45, 95% CI [0.32, 0.63]), Upper West (aOR = 0.54, 95% CI [0.35, 0.85]), Ashanti (aOR = 0.75, 95% CI [0.58, 0.97]) and Greater Accra Regions (aOR = 0.74, 95% CI [0.56, 0.98]) were less knowledgeable of HIV transmission during pregnancy. CONCLUSIONS: The study highlights a gap in the knowledge of HIV transmission during pregnancy among women in Ghana. Continuous public education is required to educate women on HIV transmission from mothers to their children during pregnancy and how this may be interrupted. Such programs should involve the use of the media and take into consideration the demographic and geographic characteristics highlighted as determinants in this study. This will ultimately contribute to the reduction of MTCT of HIV in Ghana.
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Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Complicaciones Infecciosas del Embarazo , Humanos , Femenino , Embarazo , Ghana/epidemiología , Adulto , Infecciones por VIH/transmisión , Infecciones por VIH/epidemiología , Adolescente , Adulto Joven , Persona de Mediana Edad , Complicaciones Infecciosas del Embarazo/virología , Complicaciones Infecciosas del Embarazo/epidemiología , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Estudios Transversales , PrevalenciaRESUMEN
BACKGROUND: The practice of female genital mutilation is associated with harmful social norms promoting violence against girls and women. Various studies have been conducted to examine the prevalence of female genital mutilation and its associated factors. However, there has been limited studies conducted to assess the association between female genital mutilation and markers of women's autonomy, such as their ability to negotiate for safer sex. In this study, we examined the association between female genital mutilation and women's ability to negotiate for safer sex in sub-Saharan Africa (SSA). METHODS: We pooled data from the most recent Demographic and Health Surveys (DHS) conducted from 2010 to 2020. Data from a sample of 50,337 currently married and cohabiting women from eleven sub-Saharan African countries were included in the study. A multilevel binary logistic regression analysis was used to examine the association between female genital mutilation and women's ability to refuse sex and ask their partners to use condom. Adjusted odds ratios (aORs) with a 95% confidence interval (CI) were used to present the findings of the logistic regression analysis. Statistical significance was set at p<0.05. RESULTS: Female genital mutilation was performed on 56.1% of women included in our study. The highest and lowest prevalence of female genital mutilation were found among women from Guinea (96.3%) and Togo (6.9%), respectively. We found that women who had undergone female genital mutilation were less likely to refuse sex from their partners (aOR = 0.91, 95% CI = 0.86, 0.96) and ask their partners to use condoms (aOR = 0.82, 95% CI = 0.78, 0.86) compared to those who had not undergone female genital mutilation. CONCLUSION: Female genital mutilation hinders women's ability to negotiate for safer sex. It is necessary to implement health education and promotion interventions (e.g., decision making skills) that assist women who have experienced female genital mutilation to negotiate for safer sex. These interventions are crucial to enhance sexual health outcomes for these women. Further, strict enforcement of policies and laws aimed at eradicating the practice of female genital mutilation are encouraged to help contribute to the improvement of women's reproductive health.
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Circuncisión Femenina , Sexo Seguro , Humanos , Femenino , Circuncisión Femenina/psicología , Circuncisión Femenina/estadística & datos numéricos , África del Sur del Sahara/epidemiología , Adulto , Sexo Seguro/estadística & datos numéricos , Adulto Joven , Adolescente , Persona de Mediana Edad , Encuestas Epidemiológicas , Negociación , Parejas Sexuales/psicología , Condones/estadística & datos numéricosRESUMEN
Background and Aim: The positioning of eliminating all forms of malnutrition within the spirit of the Sustainable Development Goals and the adoption of the United Nations resolution for a Decade of Action on Nutrition are a testament to strong global commitment to combat the double burden of malnutrition (DBM). Yet, there is a knowledge gap in sub-Saharan Africa (SSA) regarding the influence of socioeconomic status on DBM. We investigated the associative effect of socioeconomic status on DBM in SSA. Methods: Data for the study were extracted from the most recent Demographic and Health Surveys (DHS) of 29 countries in SSA conducted from 2010 to 2020. Bivariate and multivariate logistic regression models were fitted to examine the association between socioeconomic status and DBM. The results were presented using adjusted odds ratio (aOR) and 95% confidence interval (CI). Results: Children of obese mothers were less likely to be stunted compared to those born to mothers who were not overweight/obese [aOR = 0.70; 95% CI = 0.66-0.77]. The odds of stunting increased with wealth index, with children born to poorest mothers having the highest odds compared to those born to richest mother [aOR = 1.79; 95% CI = 1.64-1.95]. The odds of stunting among children was highest among those born to mothers with no formal education compared to those whose mothers had higher education [aOR = 2.73; 95% CI = 2.34-3.18]. Conclusion: DBM among children in SSA is predicted by maternal level of education, and wealth status. These results underscore the urgency of tailored interventions and policies that address DBM among women of reproductive age, with a particular focus on the socioeconomic disparities in SSA. To effectively combat this pressing public health issue, it is imperative to direct efforts towards empowering women to attain higher levels of education and to implement strategies that consider the specific needs of women across varying socioeconomic statuses.
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BACKGROUND: Intimate partner violence (IPV) is high among women of reproductive age in sub-Saharan Africa (SSA). However, empowering women enables them to confront and mitigate IPV. In this study, we examined the association between the survey-based women's empowerment index (SWPER) and IPV in SSA. METHODS: We used data from the Demographic and Health Surveys of 19 countries conducted from 2015 to 2021. Our study was restricted to a weighted sample of 82,203 women of reproductive age who were married or cohabiting. We used spatial maps to show the proportions of women who experienced past-year IPV. A five-modelled multilevel binary logistic regression analysis was adopted to examine the association between SWPER and IPV. The results were presented using the adjusted odds ratio (AOR) with their respective 95% confidence interval (CI). Statistical significance was set at p < 0.05. RESULTS: With physical and emotional violence, the country with the highest prevalence was Sierra Leone, with a prevalence of 39.00% and 38.97% respectively. Rwanda (10.34%), Zambia (11.09%), Malawi (15.00%), Uganda (16.88%), and Burundi (20.32%) were the hotspot countries for sexual violence. Angola (34.54%), Uganda (41.55%), Liberia (47.94%), and Sierra Leone (59.98%) were the hotspot countries for IPV. A high SWPER score in attitudes to violence significantly decreased the odds of IPV [AOR = 0.70; 95% CI = 0.66, 0.75]. Also, women with medium score in decision-making were less likely to experience IPV compared to those with lower scores [AOR = 0.89; 95% CI = 0.83, 0.95]. However, higher odds of experiencing IPV was found among women with medium score in autonomy compared to those with low scores [AOR = 1.07; 95% CI = 1.01, 1.14]. CONCLUSIONS: Our study has shown that the three dimensions of SWPER significantly predict IPV among women. Consequently, it is crucial that sub-Saharan African countries implement various initiatives, such as IPV advocacy programs and economic livelihood empowerment initiatives. These initiatives should not only aim to improve women's attitudes to domestic violence but also to enhance their social independence, autonomy, and decision-making capacity.
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Empoderamiento , Violencia de Pareja , Humanos , Femenino , África del Sur del Sahara/epidemiología , Violencia de Pareja/estadística & datos numéricos , Violencia de Pareja/psicología , Adulto , Adulto Joven , Adolescente , Persona de Mediana Edad , Prevalencia , Derechos de la MujerRESUMEN
Background and Aims: The use of contraceptives has been considered relevant in reducing unintended pregnancies in sub-Saharan Africa (SSA). However, despite evidence of knowledge of contraceptives, their use remains low in SSA. This study examined the association between knowledge of contraceptive methods and the use of contraceptives in SSA. Methods: Data for the study were extracted from the Demographic and Health Surveys of 21 countries in SSA spanning from 2015 to 2021. A weighted sample of 200,498 sexually active women of reproductive age were included in the final analysis. We presented the results on the utilization of contraceptives using percentages with their respective 95% confidence intervals (CI). We examined the association between knowledge of contraceptive methods and the use of contraceptives using multilevel binary logistic regression analysis. Results: Overall, 24.32% (95% CI: 24.15-24.50) of women in SSA used contraceptives. Chad had the lowest prevalence of contraceptive use (5.07%) while Zimbabwe had the highest prevalence (66.81%). The odds of using any method of contraception were significantly higher for women with medium [Adjusted odds ratio (AOR) = 1.89; 95% CI = 1.80-1.98] and high [AOR = 2.22; 95% CI = 2.10-2.33] knowledge of contraceptive methods compared to those with low knowledge, after adjusting for all covariates. Conclusion: Our study has shown that the use of contraceptives among women in SSA is low. Women's knowledge of any contraception method increases their likelihood of using contraceptives in SSA. To improve contraceptive use in SSA, targeted interventions and programmes should increase awareness creation and sensitization, which can improve women's knowledge on methods of contraception. Also, programmes implemented to address the low uptake of contraceptives should consider the factors identified in this study. In addition, specific subregional strategies could be implemented to narrow the subregional disparities.
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BACKGROUND: Improving women's access to and use of modern contraceptives is a key global strategy for improving the sexual and reproductive health of women. However, the use of modern contraceptives among adolescent girls and young women in sub-Saharan Africa (SSA) remains relatively low, despite the numerous interventions to increase patronage. This study examined adolescent girls and young women's receipt of quality contraceptive counselling and its associated factors in SSA. METHODS: Data for the study were extracted from the recent Demographic and Health Surveys of 20 countries in SSA, spanning from 2015 to 2021. A sample of 19,398 adolescent girls and young women aged 15 to 24 years was included in the study. We presented the proportion of adolescent girls and young women who received quality contraceptive counselling using a spatial map. Multilevel binary logistic regression analysis was carried out to examine the factors associated with the receipt of quality contraceptive counselling. RESULTS: Overall, 33.2% of adolescent girls and young women had access to quality contraceptive counselling, ranging from 13.0% in Cameroon to 67.0% in Sierra Leone. The odds of receiving quality contraceptive counselling was higher among adolescent girls and young women aged 20-24 (AOR = 1.48, CI: 1.32-1.67), those with primary (AOR = 1.32, CI: 1.11-1.57) and secondary or higher education (AOR = 1.31, CI: 1.09-1.58), and those married (AOR = 1.32, CI: 1.15-1.52), cohabiting (AOR = 1.47, CI: 1.23-1.76), and previously married (AOR = 1.48, CI: 1.20-1.83) compared to their counterparts in the reference groups. Adolescent girls and young women who were currently working (AOR = 1.22, CI: 1.09-1.37), those who heard of family planning from radio in the last few months (AOR = 1.34, CI:1.21-1.50), those who visited the health facility in the last 12 months (AOR = 1.69, CI: 1.52-1.88), and those residing in the Southern (AOR = 5.01, CI: 3.86-6.51), Eastern (AOR = 2.54, CI: 1.96-3.30), and Western (AOR = 4.09, CI: 3.19-5.25) SSA were more likely to receive quality contraceptive counselling compared to their counterparts in the reference groups. Conversely, adolescent girls and young women who used the internet, those who had problem getting permission to seek medical help, those facing problem in seeking medical help for not wanting to go alone, those from the middle and richest wealth indices, and those from the rural areas were less likely to receive quality contraceptive counselling compared to their counterparts in the reference groups. CONCLUSION: Receipt of quality contraceptive counselling among adolescent girls and young women was low. Considering the importance of quality contraceptive counselling on the uptake and continuation of contraception, policymakers need to institute measures that improve adolescent girls and young women's access to quality contraceptive counselling in SSA, especially in countries like Cameroon, Angola, Madagascar, Mauritania, and Guinea, taking into consideration the factors identified in the study. Increasing adolescent girls and young women's access to quality contraceptive counselling could greatly minimize the risk of unintended pregnancies and its associated maternal and child health burden in SSA and subsequently contribute to the attainment of the Sustainable Development Goal 3, target 3.7.
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BACKGROUND: Overweight/obesity remains a major risk factor for non-communicable diseases and their associated morbidities and mortalities. Yet, limited studies have comprehensively examined factors contributing to the rural-urban disparities in overweight/obesity among women in sub-Saharan Africa. Thus, our study sought to decompose the rural-urban disparities in overweight/obesity among women in sub-Saharan Africa (SSA) using nationally representative datasets. METHODS: We performed a cross-sectional analysis of data from the Demographic and Health Surveys of 23 sub-Saharan African countries conducted from 2015 to 2022. A sample of 177,329 women was included in the analysis. Percentages with confidence intervals (CIs) were used to summarize the prevalence of overweight/obesity per rural-urban strata and pooled level. A multivariate non-linear decomposition analysis was used to identify the factors contributing to the rural-urban disparities in overweight/obesity. The results were presented using coefficients and percentages. RESULTS: The pooled prevalence of overweight/obesity among the women was higher in urban areas (38.9%; 95% CI = 38.2-39.6) than rural areas (19.1%; 95% CI = 18.7-19.6). This pattern was observed in all the countries surveyed, except in South Africa, where women in rural areas (53.1%; 95% CI = 50.0-56.4) had a higher prevalence of overweight/obesity than those in urban areas (46.0%; 95% CI = 43.2-48.9). Approximately 54% of the rural-urban disparities in overweight/obesity was attributable to the differences in the women's characteristics or explanatory variables. More than half of the rural-urban disparities in overweight/obesity would be reduced if the disparities in women's characteristics were levelled. Among the women's characteristics, frequency of watching television (29.03%), wealth index (26.59%), and level of education (9.40%) explained approximately 65% of the rural-urban differences in overweight/obesity. CONCLUSION: The prevalence of overweight/obesity among women in SSA remains high and skewed towards women in urban areas. Increased frequency of watching television, high wealth index, and higher educational attainment contributed largely to the rural-urban disparities in overweight/obesity among women in SSA. Thus, interventions aimed at reducing overweight/obesity among women in SSA could be targeted at reducing the frequency of television watching as well as promoting physical activities among wealthy women and those with higher education, particularly in urban areas.
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OBJECTIVE: To examine the prevalence of alcohol use and its associated factors among in-school adolescents in Sierra Leone. DESIGN: Data for the study was sourced from the 2017 Sierra Leone Global School-Based Student Health Survey, a nationally representative survey conducted among in-school adolescents aged 10-19 years using a multistage sampling methodology. Percentages were used to present the prevalence of alcohol use among in-school adolescents. Multivariable binary logistic regression analysis was performed to examine the factors associated with alcohol use among in-school adolescents. The results were presented using adjusted odds ratios (aOR) with their respective 95% confidence interval (CI). SETTING: Sierra Leone. PARTICIPANTS: A weighted sample of 1730 in-school adolescents in Sierra Leone. OUTCOME MEASURE: Current alcohol use. RESULTS: The prevalence of alcohol use among in-school adolescents was 10.7% (7.3, 15.3). In-school adolescents in senior secondary schools were more likely to use alcohol compared with those in junior secondary school (aOR=2.13; 95% CI 1.37, 3.30). The odds of alcohol use was higher among in-school adolescents who were truant at school relative to those who were not (aOR=2.24; 95% CI 1.54, 3.26). Also, in-school adolescents who were bullied (aOR=1.85; 95% CI 1.24, 2.76), ever engaged in sexual intercourse (aOR=2.06; 95% CI 1.39, 3.06), and used marijuana (aOR=3.36; 95% CI 1.72, 6.53) were more likely to use alcohol compared with those who were not. However, in-school adolescents who reported that their parents understood their problems (aOR=0.52; 95% CI 0.33, 0.82) had a lower likelihood of consuming alcohol. CONCLUSION: Our study has shown that alcohol use is prevalent among in-school adolescents in Sierra Leone. Grade level, experiences of being bullied, history of sexual intercourse, truancy at school, and previous use of marijuana were the factors influencing alcohol use among in-school adolescents. The findings emphasise the necessity of creating school-based health interventions in Sierra Leone that can effectively identify in-school adolescents potentially vulnerable to alcohol-related issues. Also, existing policies and programmes aimed at reducing alcohol use among in-school adolescents need to be strengthened.
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Consumo de Bebidas Alcohólicas , Trastornos Relacionados con Alcohol , Humanos , Adolescente , Factores de Riesgo , Sierra Leona/epidemiología , Consumo de Bebidas Alcohólicas/epidemiología , Encuestas y Cuestionarios , Instituciones Académicas , PrevalenciaRESUMEN
BACKGROUND: Intimate partner violence (IPV) has increasingly received attention in the last three decades. However, IPV-related studies in both high- and low- and middle-income countries adopted a victim-oriented perspective in which men are perpetrators and women, the victims. Using socio-cultural and resource theories as guiding frameworks, this paper assessed the associations between men's education and IPV in Central Africa, using nationally representative data of married and cohabiting women of reproductive ages. METHODS: Data included in the analyses come from Demographic and Health Surveys (DHSs) in the Democratic Republic of the Congo (DRC), Cameroon, Gabon, and Chad. Analyzed sub-samples consisted of 3421, 5023, 3930, and 3221 married/cohabiting women of reproductive ages in Chad, DRC, Cameroon, and Gabon, respectively. RESULTS: Findings indicated significant variations of IPV prevalence within and across countries. Previous research demonstrated that men's education is a protective factor in health-related studies. The present study, however, provide no clear evidence on the linkages between men's education and IPV. In contrast, the paper substantiated that highly educated women were at higher risks of IPV when spouses/partners were less educated. CONCLUSION: These findings have policy and programmatic implications because they might impede progress towards SDG goals on the elimination of all forms of violence against girls and women in Central Africa, which recorded the worst development indicators in sub-Saharan Africa. On a methodological note, studies are increasingly using pooled data to increase statistical power. Those studies can be very limited to devise effective IPV-interventions since they mask geographical variations within and across countries. More effective IPV-interventions should be culturally rooted and accounting for geographical variations because some areas are more affected than others.
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Escolaridad , Encuestas Epidemiológicas , Violencia de Pareja , Humanos , Femenino , Masculino , Violencia de Pareja/estadística & datos numéricos , África Central/epidemiología , Adulto , Adolescente , Persona de Mediana Edad , Adulto Joven , PrevalenciaRESUMEN
BACKGROUND: Suicide represents a major public health concern, affecting a significant portion of individuals. However, there remains a gap in understanding the age and sex disparities in the occurrence of suicide. Therefore, this study aimed to investigate the sex-related inequalities in suicide rates in Ghana from 2000 to 2019. METHODS: We utilized data from the WHO Health Equity Assessment Toolkit (HEAT) online software. We analysed sex differences in both crude and age-standardized suicide rates in Ghana spanning from 2000 to 2019. Crude and age-adjusted suicide rates were calculated based on the International Classification of Diseases (ICD) definition and coding of suicide mortality. We measured inequality in terms of sex. Two inequality indicators were used to examine the suicide rates: the difference (D) and the ratio (R). RESULTS: Age-standardized and crude suicide rates in Ghana were higher among men from 2000 to 2019. Between 2000 and 2007, the age-standardized suicide rate for women rose steadily and declined slightly between 2008 and 2019. Age-standardized suicide rates for men increased consistently from 2000 to 2010, then declined steadily from 2011 to 2019. The crude suicide rates among men and women followed similar patterns. The widest absolute inequality in crude suicide rates (D) was recorded in 2013 (D=-11.91), while the smallest difference was observed in 2000 (D=-7.16). We also found the greatest disparity in age-standardized rates in 2011 (D=-21.46) and the least in 2000 (D=-14.32). The crude suicide rates increased with age for both men and women aged 15-54 years and 55-85+ years respectively. However, the increased rate was higher in men than in women across all age groups surveyed. A similar pattern was observed for relative inequality in both crude and age-standardized rates of suicide. CONCLUSION: The suicide rate in Ghana has declined over time. Suicide is more common among older men. Inequalities in suicide rates, in both absolute and relative terms, are similar. There is a need to monitor suicide trends in Ghana, especially among older men. Moreover, the findings could serve as a basis for future studies on suicide in Ghana.
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Suicidio , Humanos , Masculino , Femenino , Anciano , Ghana , Conducta Sexual , Encuestas y Cuestionarios , Caracteres Sexuales , Factores SocioeconómicosRESUMEN
BACKGROUND: HIV/AIDS is a global health challenge and continues to threaten lives in sub-Saharan African countries such as Ghana. One of the important interventions for controlling its transmission is through testing and receiving medication. In this study, we present findings on the prevalence and factors associated with HIV testing among young women in Ghana. METHODS: We used data from the 2014 Ghana Demographic and Health Survey comprising young women aged 15-24 years. We calculated the proportion of these young women who have ever been tested for HIV. The multivariable logistic regression analysis was used to assess the determinants of HIV testing at a 95% confidence interval (CI), and adjusted odds ratio (aORs) and p-values were reported. All analyses were adjusted using survey weights to account for unequal sampling probabilities. RESULTS: The results showed that 31.4% (95% CI [29.63, 32.81]) of young women in Ghana had tested for HIV. The odds of HIV testing were likely to be higher among young women aged 20-24 (aOR = 2.24, 95% CI [1.75, 2.87]), those who were pregnant (aOR = 3.17, 95% CI [2.03, 4.95]) and those with one (aOR = 7.99, 95% CI [5.72, 11.17]), two (aOR = 10.43, 95% CI [6.47, 16.81]) or three or more children (aOR = 14.60, 95% CI [8.37, 25.48]) compared to their counterparts in the reference category. Women who had attained secondary education or higher (aOR = 2.66, 95% CI [1.67, 4.23]), were sexually active (aOR = 2.82, 95% CI [2.00, 3.97]), and in richer (aOR = 1.98, 95% CI [1.17, 3.34]) and richest wealth index (aOR = 1.99, 95% CI [1.10, 3.61]) were more likely to test for HIV than those with no formal education, who had not had sex before or in the poorest wealth index. Women from the Eastern (aOR = 1.69, 95% CI [1.04,2.72]) and Upper East regions (aOR = 2.62, 95% CI [1.44, 4.75]) were more likely than those in the Western region to get tested for HIV. However, the odds of testing for HIV were lower among women belonging to other religions (aOR = 0.43, 95% CI [0.23,0.82]) than Christians. CONCLUSION: The findings show that HIV testing is low among young women in Ghana. To address this issue, it is recommended that both government and non-governmental organizations collaborate to create effective programmes and strategies. These may include continuous health education, regular sensitization programs and making HIV testing services much more accessible and affordable, taking into consideration the sociodemographic characteristics of young women.
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Infecciones por VIH , Prueba de VIH , Embarazo , Niño , Humanos , Femenino , Encuestas Epidemiológicas , Ghana/epidemiología , Prevalencia , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiologíaRESUMEN
BACKGROUND: Brief intervention services provide rapid, mobile and flexible short-term delivery of interventions to resolve mental health crises. These interventions may provide an alternative pathway to the emergency department or in-patient psychiatric services for children and young people (CYP), presenting with an acute mental health condition. AIMS: To synthesise evidence on the effectiveness of brief interventions in improving mental health outcomes for CYP (0-17 years) presenting with an acute mental health condition. METHOD: A systematic literature search was conducted, and the studies' methodological quality was assessed. Five databases were searched for peer-reviewed articles between January 2000 and September 2022. RESULTS: We synthesised 30 articles on the effectiveness of brief interventions in the form of (a) crisis intervention, (b) integrated services, (c) group therapies, (d) individualised therapy, (e) parent-child dyadic therapy, (f) general services, (g) pharmacotherapy, (h) assessment services, (i) safety and risk planning and (j) in-hospital treatment, to improve outcomes for CYP with an acute mental health condition. Among included studies, one study was rated as providing a high level of evidence based on the National Health and Medical Research Council levels of evidence hierarchy scale, which was a crisis intervention showing a reduction in length of stay and return emergency department visits. Other studies, of moderate-quality evidence, described multimodal brief interventions that suggested beneficial effects. CONCLUSIONS: This review provides evidence to substantiate the benefits of brief interventions, in different settings, to reduce the burden of in-patient hospital and readmission rates to the emergency department.
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Background and Aims: Sexually transmitted infections (STIs) pose a considerable concern for global healthcare systems. We examined the prevalence and correlates of self-reported STIs (SR-STIs) among men and women in Papua New Guinea. Methods: A total of 7,195 women and 4,069 men from Papua New Guinea who participated in the 2016-2018 Demographic and Health Survey were included in this study. Percentages were used to summarize the prevalence of SR-STIs among men and women. A multivariable multilevel binary logistic regression was used to examine the correlates of SR-STIs in men and women. Results: An overall 5.9% and 4.6% prevalence of SR-STIs were recorded among women and men, respectively, in Papua New Guinea. The odds of SR-STIs were higher among women who ever tested for HIV (aOR = 2.47, CI: 1.80-3.39), those who had first sex below 20 years (aOR = 1.76, CI: 1.10-2.80), those who watched television less than once a week (aOR = 1.83, CI: 1.13-2.95) and those from the Highlands and Momase regions (aOR = 5.55, CI: 3.30-9.33) compared to their counterparts who never tested for HIV, who had their first sexual intercourse when they were 20 years and above, who did not watch television at all, and those from the Southern Region. For men, the odds of SR-STIs were high among those who ever tested for HIV (aOR = 1.65, CI: 1.11-2.45), those with one (aOR= 2.08, CI: 1.05-4.14) and two or more (aOR = 3.77, CI: 1.49, 9.52) sexual partners excluding spouse in the 12 months preceding the survey, those living in the Highlands region (aOR = 2.52, CI: 1.48-4.29), and those living in communities with medium literacy level (aOR = 2.33, CI: 1.38-3.94) compared to their counterparts who had never tested for HIV, those with zero sexual partners excluding their spouse in the 12 months preceding the survey, those living in the Southern region, and those living in communities with low literacy levels. Conclusion: We recommend that the National AIDS Council of Papua New Guinea through the National HIV and STI 2018-2022 Strategy program should be realigned to address these correlates and ensure that more sexual and reproductive health resources are provided to men and women in the Highlands and Momase regions.
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BACKGROUND: Female genital mutilation/cutting (FGM/C) is considered a social norm in many African societies, with varying prevalence among countries. Mali is one of the eight countries with very high prevalence of FGM/C in Africa. This study assessed the individual and contextual factors associated with female FGM/C among girls aged 0-14 years in Mali. METHODS: We obtained data from the 2018 Mali Demographic and Health Survey. The prevalence of FGM/C in girls was presented using percentages while a multilevel binary logistic regression analysis was conducted to assess the predictors of FGM/C and the results were presented using adjusted odds ratios with associated 95% confidence intervals (CIs). RESULTS: The results indicate that more than half (72.7%, 95% CI = 70.4-74.8) of women in Mali with daughters had at least one daughter who has gone through circumcision. The likelihood of circumcision of girls increased with age, with women aged 45-49 having the highest odds compared to those aged 15-19 (aOR = 17.68, CI = 7.91-31.79). A higher likelihood of FGM/C in daughters was observed among women who never read newspaper/magazine (aOR = 2.22, 95% CI = 1.27-3.89), compared to those who read newspaper/magazine at least once a week. Compared to women who are not circumcised, those who had been circumcised were more likely to have their daughters circumcised (aOR = 53.98, 95% CI = 24.91-117.00). CONCLUSION: The study revealed the age of mothers, frequency of reading newspaper/magazine, and circumcision status of mothers, as factors associated with circumcision of girls aged 0-14 in Mali. It is, therefore, imperative for existing interventions and new ones to focus on these factors in order to reduce FGM/C in Mali. This will help Mali to contribute to the global efforts of eliminating all harmful practices, such as child, early and forced marriage and female genital mutilation by 2030.