ABSTRACT
The interplay between population dynamics and the environment has long interested demographers. Although studies have explored how climate patterns affect macrolevel population processes, such as mortality and migration, little is known about their impact on individual-level demographic behaviors. This study fills this research gap by examining the linkages between exposure to drought and women's fertility preferences and contraceptive behaviors in sub-Saharan Africa. We analyze data from the Demographic and Health Surveys Program, focusing on 17 countries in East, Southern, and West Africa. We investigate whether women's recent exposure to drought episodes in their community affects their fertility preferences and modern contraceptive use. Generally, the findings show that drought is relevant to understanding women's fertility preferences and behaviors in the vast majority of countries; however, drought exposure has variable impacts. Moreover, whereas in some countries, drought exposure encourages contraceptive behaviors that align with women's preferences, in select countries it is associated with behavior that is misaligned with women's stated preferences. Overall, the study emphasizes the importance of examining climate events as complex forces that have localized meanings for demographic outcomes.
Subject(s)
Contraception Behavior , Droughts , Female , Humans , Fertility , Contraceptive Agents , Population Dynamics , Family Planning ServicesABSTRACT
BACKGROUND: Evidence-based parenting programmes have strong evidence in preventing and mitigating violence, but in-person programmes are challenging to deliver at scale. ParentApp is an open-source, offline-first app-based adaptation of the Parenting for Lifelong Health for Parents and Teens programme to promote playful and positive parenting, reduce risks for sexual violence victimisation, and prevent violence against adolescents. This study aims to evaluate the effectiveness and cost-effectiveness of ParentApp compared to an attention-control group. METHODS: This study is a two-arm pragmatic cluster-randomised controlled trial to test whether ParentApp reduces adolescent physical abuse, emotional abuse, and sexual violence risks and victimisation at 1 month and 12 months post-intervention. Caregivers of adolescents aged 10-17 years and their adolescent children (N = 2400 caregiver-adolescent dyads) will be recruited in urban and peri-urban communities in the Mwanza region of Tanzania. A total of 80 study clusters will be stratified and randomised (1:1) to the intervention group, who will receive ParentApp with support through a WhatsApp group, or to an attention-control group, who will receive a water, sanitation, and hygiene app. Quantitative data will be collected through outcomes questionnaires with caregivers and adolescents, administered at baseline, 4 months post-baseline, and 16 months post-baseline, as well as through routine implementation data and ParentApp engagement data. Qualitative data will be collected through individual interviews and focus groups with caregivers, adolescents, and implementing partner staff. DISCUSSION: App-based interventions have the potential to expand access to evidence-based parenting support, but currently lack rigorous evidence in low- and middle-income countries. This is the first known randomised control trial of a hybrid digital parenting programme to prevent the abuse of adolescents in low- and middle-income settings. TRIAL REGISTRATION: The trial was registered on the Open Science Framework on 14 March 2023, registration: OSF.IO/T9FXZ .
Subject(s)
Child Abuse , Parenting , Adolescent , Child , Humans , Child Abuse/prevention & control , Parenting/psychology , Parents/psychology , Randomized Controlled Trials as Topic , Tanzania , Violence/prevention & control , Pragmatic Clinical Trials as TopicABSTRACT
Background: Studies elsewhere show that benevolent childhood experiences (BCEs) have protective mental health value. However, this protective value has never been investigated in an African context. Given the need to better understand what might support mental health resilience among African young people, this study explores the relationship between BCEs and depressive symptoms among a South African sample of young adults living in a community dependent on the economically volatile oil and gas industry. Methods: A sample of young adults in an oil and gas community in South Africa (N = 313, mean age 20.3 years, SD = 1.83, range from 18 to 26; majority Black African) completed self-report questionnaires to assess BCEs and depressive symptoms (Beck Depression Inventory-II). The analysis controlled for socio-demographics and experience of family adversity. Multinomial logistic regressions were used to examine the association of BCEs with depressive symptoms using STATA 17. Results: The majority (86.4% of the sample) reported all 10 BCEs. Of the 10 BCEs, having at least one good friend was the most reported (94%) compared to 75% of the sample reporting having a predictable home routine, such as regular meals and a regular bedtime. The unadjusted multinomial logistic regression analysis indicated that having at least one good friend, comforting beliefs, and being comfortable with self were associated with lower odds of moderate depression. The adjusted results showed no association between BCEs and the depression of young adults in this sample. Conclusion: In this South African sample, our results do not show protective associations between BCEs and depression. This could be as a result of the homogeneity in our sample. It is also possible that the BCEs explored could not counteract the effect of chronic risk factors in the lives of the young people in this study context. Further research is needed to understand this complexity.
ABSTRACT
Sexual conflict is a thriving area of animal behaviour research. Yet parallel research in the evolutionary human sciences remains underdeveloped and has become mired by controversy. In this special collection, we aim to invigorate the study of fitness-relevant conflicts between women and men, advocating for three synergistic research priorities. First, we argue that a commitment to diversity is required to innovate the field, achieve ethical research practice, and foster fruitful dialogue with neighbouring social sciences. Accordingly, we have prioritised issues of diversity as editors, aiming to stimulate new connections and perspectives. Second, we call for greater recognition that human sex/gender roles and accompanying conflict behaviours are both subject to natural selection and culturally determined. This motivates our shift in terminology from sexual to gendered conflict when addressing human behaviour, countering stubborn tendencies to essentialise differences between women and men and directing attention to the role of cultural practices, normative sanctions and social learning in structuring conflict battlegrounds. Finally, we draw attention to contemporary policy concerns, including the wellbeing consequences of marriage practices and the gendered implications of market integration. Focus on these themes, combined with attendance to the dangers of ethnocentrism, promises to inform culturally sensitive interventions promoting gender equality worldwide.
ABSTRACT
BACKGROUND: The association between family adversity and young people's mental health outcomes in communities that experience economic instability has not been well explored in the South African context. Furthermore, the overtime interaction between resilience factors, family adversity, and young people's psychological functioning in African settings, like South Africa, is under-investigated. PURPOSE: This study investigates the relationship between family adversity and conduct problems and depression at two-time points in a sample of youths in two South African communities stressed by their dependency on economically volatile oil and gas industries. METHOD: This article draws on longitudinal data generated by the Resilient Youth in Stressed Environments (RYSE) study in South Africa, which included 914 and 528 (wave 1 and 3) adolescents and emerging adults (14-27-year-olds; M age = 18.36 years) living in Secunda/eMbalenhle and Sasolburg/Zamdela. Participants were sampled at baseline (wave 1) and 18-24 months later (wave 3). They self-reported experience of community violence, family adversity, resilience-enabling resources, conduct difficulties, and depression symptoms. Regression analyses were used to examine the unadjusted and adjusted association of family adversity on conduct problem and depression. RESULTS: About 60% of participants reported high family adversity. Regressions, however, revealed no association between family adversity and conduct problems and depression cross-sectionally and over time. Individual resilience, biological sex, and experience of victimization in the community, however, were associated with conduct difficulty while all three resilience factors were associated with decreased depression among participants. CONCLUSION: Our study sheds light on the risk and protective factors for mental health outcomes of adolescents and youths who reside in volatile, turbulent communities and experience ongoing familial challenges. To effectively support the mental well-being of young individuals in such contexts, interventions must consider the potential ambivalence of the resilience factors they aim to strengthen.
Subject(s)
Problem Behavior , Resilience, Psychological , Adult , Humans , Adolescent , Mental Health , Violence , Outcome Assessment, Health CareABSTRACT
Intervention acceptability has become an increasingly key consideration in the development, evaluation and implementation of health and social interventions. However, to date this area of investigation has been constrained by the absence of a consistent definition of acceptability, comprehensive conceptual frameworks disaggregating its components, and few reliable assessment measures. This paper aims to contribute to this gap, by proposing a conceptual framework and exploratory model for acceptability with a specific priority population for health and developmental interventions: adolescents and youth in Africa. We document our multi-staged approach to model development, comprising both inductive and deductive components, and both systematic and interpretative review methods. This included thematic analyses of respective acceptability definitions and findings, from 55 studies assessing acceptability of 60 interventions conducted with young people aged 10-24 in (mainly Southern and Eastern) Africa over a decade; a consideration of these findings in relation to Sekhon et al.'s Theoretical Framework of Acceptability (TFA); a cross-disciplinary review of acceptability definitions and models; a review of key health behavioural change models; and expert consultation with interdisciplinary researchers. Our proposed framework incorporates nine component constructs: affective attitude, intervention understanding, perceived positive effects, relevance, perceived social acceptability, burden, ethicality, perceived negative effects and self-efficacy. We discuss the rationale for the inclusion and definition of each component, highlighting key behavioural models that adopt similar constructs. We then extend this framework to develop an exploratory model for acceptability with young people, that links the framework components to each other and to intervention engagement. Acceptability is represented as an emergent property of a complex, adaptive system of interacting components, which can influence user engagement directly and indirectly, and in turn be influenced by user engagement. We discuss opportunities for applying and further refining or developing these models, and their value as a point of reference for the development of acceptability assessment tools.
Subject(s)
Black People , Health Promotion , Social Work , Adolescent , Humans , Africa , Interdisciplinary StudiesABSTRACT
Acceptability has become a key consideration in the development, evaluation and implementation of health and social interventions. This commentary paper advances key learnings and recommendations for future intervention acceptability research with young people in Africa, aimed at supporting the achievement of developmental goals. It relates findings of the adolescent acceptability work conducted within the Accelerate Hub, since mid 2020, to broader inter-disciplinary literatures and current regional health and social priorities. We argue that, in order to strengthen the quality and applied value of future acceptability work with young people, we need to do three things better. First, we need to consolidate prior findings on acceptability, within and across intervention types, to inform responses to current public health and social challenges and further the conceptual work in this area. Second, we need to better conceptualise acceptability research with young people, by developing stronger conceptual frameworks that define acceptability and its constructs, and predict its relationship with intervention engagement. Third, we need to better contextualise findings by considering acceptability data within a broader social and political context, which in turn can be supported by better conceptualisation. In this paper we describe contributions of our work to each of these three inter-connected objectives, and suggest ways in which they may be taken forward by researchers and practitioners. These include aggregating evidence from past interventions to highlight potential barriers and enablers to current responses in priority areas; involving key actors earlier and more meaningfully in acceptability research; further developing and testing behavioural models for youth acceptability; and working collaboratively across sectors towards programmatic guidance for better contextualisation of acceptability research. Progress in this field will require an inter-disciplinary approach that draws from various literatures such as socio-ecological theory, political economy analysis, health behaviour models and literature on participatory research approaches.
Subject(s)
Research Design , Adolescent , Humans , AfricaABSTRACT
Studies have linked the timing of sexual debut to unplanned pregnancies and sexually transmissible infections, including HIV. Current understandings of sexual debut among Nigerian adolescents focused on the roles of individual and familial characteristics. We leveraged the 2018 Nigeria Demographic and Health Survey data to examine how community features like affluence, ethnic diversity, and women empowerment may be associated with the timing of sexual debut among adolescent girls. The sample comprised 7449 adolescent girls who were usual residents in 6,505 households and 1,352 clusters or communities. Statistical associations between community characteristics and the onset of sexual debut were assessed using a two-level mixed-effects parametric survival model with Weibull distribution. We found that community affluence [aHR:0.43, 95%CI: 0.30-0.62] and community ethnic diversity [aHR: 0.63, 95%CI: 0.42-0.94] are associated with a lower hazard of sexual debut among adolescent girls. We also observed that women that married within the observation period had an earlier sexual initiation than those who were unmarried. The results disaggregated by marital status further shows that higher community level of women's employment [aHR: 2.45, 95%CI: 1.38-4.38] and women's education [aHR:1.85, 95%CI: 1.03-3.33] were associated with a higher hazard of sexual debut among unmarried adolescent girls but not married adolescent girls. Higher community affluence [aHR:0.40, 95%CI: 0.27-0.60] was also associated with a lower hazard of sexual debut among unmarried adolescent girls but not married adolescent girls. Our results illuminate the associated factors of the timing of sexual debut among adolescent girls that moves beyond individual characteristics to community characteristics.
Subject(s)
Marriage , Sexual Behavior , Adolescent , Educational Status , Female , Humans , Marital Status , Nigeria , PregnancyABSTRACT
OBJECTIVE: Interventions aimed at improving adolescent health and social outcomes are more likely to be successful if the young people they target find them acceptable. However, no standard definitions or indicators exist to assess acceptability. Acceptability research with adolescents in low-and-middle-income countries (LMICs) is still limited and no known reviews systhesise the evidence from Africa. This paper maps and qualitatively synthesises the scope, characteristics and findings of these studies, including definitions of acceptability, methods used, the type and objectives of interventions assessed, and overall findings on adolescent acceptability. DESIGN: We conducted a systematic review of peer-reviewed studies assessing intervention acceptability with young adults (aged 10-24) in Africa, published between January 2010 and June 2020. DATA SOURCES: Web of Science, Medline, PsycINFO, SociIndex, CINAHL, Africa-wide, Academic Search Complete and PubMed were searched through July 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Papers were selected based on the following inclusion criteria: if they (1) reported primary research assessing acceptability (based on the authors' definition of the study or findings) of one or more intervention(s) with adolescents and young adults 10-24; (2) assessed acceptability of intervention(s) aimed at positively influencing one or more development outcome(s), as defined by sustainable development goal (SDG) indicators; (3) reported on research conducted in Africa; (4) were in the English Language; (5) were peer-reviewed and and (6) were published between 1 January 2010 and 30 June 2020. DATA EXTRACTION AND SYNTHESIS: Abstracts were reviewed independently by the two first authors to determine relevance. Full text of potentially eligible studies were retrieved and independently examined by the same two authors; areas of disagreement or lack of clarity were resolved through discussion by the two authors and-where necessary-the assessment of a third author. RESULTS: 55 studies were considered eligible for inclusion in the review. Most studies were conducted in Southern Africa, of which 32 jointly in South Africa and Uganda. The majority of interventions assessed for acceptability could be classified as HIV or HPV vaccine interventions (10), E-health (10), HIV testing interventions (8), support group interventions (7) and contraceptive interventions (6). The objectives of most interventions were linked to SDG3, specifically to HIV and sexual and reproductive health. Acceptability was overall high among these published studies. 22 studies provided reasons for acceptability or lack thereof, some specific to particular types of interventions and others common across intervention types. CONCLUSIONS: Our review exposes considerable scope for future acceptability research and review work. This should include extending acceptability research beyond the health (and particularly HIV) sector and to regions in Africa where this type of research is still scarce; including adolescents earlier, and potentially throughout the intervention process; further conceptualising the construct of acceptability among adolescents and beyond; and examining the relationship between acceptability and uptake.
Subject(s)
Health Services , Adolescent , Adult , Child , Humans , Young Adult , Africa, Southern , South Africa , Uganda , Outcome Assessment, Health CareABSTRACT
BACKGROUND: South Africa has a liberal abortion law, yet denial of care is not uncommon, usually due to a woman being beyond the legal gestational age limit for abortion care at that facility. For women successfully obtaining care, time from last menstrual period to confirmation of pregnancy is significantly longer among those having an abortion later in the second trimester compared to earlier gestations. This study explores women's experiences with recognition and confirmation of unintended pregnancy, their understanding of fertile periods within the menstrual cycle as well as healthcare providers' and policy makers' ideas for public sector strategies to facilitate prompt confirmation of pregnancy. METHODS: We recruited participants from July through September 2017, at an urban non-governmental organization (NGO) sexual and reproductive health (SRH) facility and two public sector hospitals, all providing abortion care into the second trimester. We conducted in-depth interviews and group discussions with 40 women to elicit information regarding pregnancy recognition and confirmation as well as fertility awareness. In addition, 5 providers at these same facilities and 2 provincial policy makers were interviewed. Data were analysed using thematic analysis. RESULTS: Uncertainties regarding pregnancy signs and symptoms greatly impacted on recognition of pregnancy status. Women often mentioned that others, including family, friends, partners or colleagues noticed pregnancy signs and prompted them to take action. Several women were unaware of the fertility window and earliest timing for accurate pregnancy testing. Health care providers and policy makers called for strategies to raise awareness regarding risk and signs of pregnancy and for pregnancy tests to be made more readily accessible. CONCLUSION: Early recognition of unintended pregnancy in this setting is frustrated by poor understanding and awareness of fertility and pregnancy signs and symptoms, compounded by a distrust of commercially available pregnancy tests. Improving community awareness around risk and early signs of pregnancy and having free tests readily available may help women confirm their pregnancy status promptly.
South Africa has one of the world's most progressive legal frameworks for abortion, yet it's not uncommon for women to struggle to access safe abortion services. A key reason for this is late recognition of an unplanned pregnancy. This study explored the lived experiences leading up to pregnancy confirmation among women securing abortion care beyond 9 weeks gestational age, the legal limit for home use of medication for abortion. It fills a gap by also including providers' and policy makers' perspectives on ways to strengthen women's prompt recognition of pregnancy. Using group discussions and in-depth interviews we elicited information from 40 women and 7 providers and policy makers in two health subdistricts in the Western Cape Province, South Africa. Our findings highlight the process of pregnancy recognition and confirmation and women's knowledge of fertility, the menstrual cycle and when to test for pregnancy. Our results suggest that factors influencing women's recognition of pregnancy are at the individual and at community level. Health care providers and policy makers suggested the use of community-based services to raise awareness around early pregnancy testing, and to expand easy access to self-testing outside the formal clinic setting as a mechanism to overcome clinic-based barriers.
Subject(s)
Abortion, Induced , Pregnancy, Unplanned , Female , Health Personnel , Health Services Accessibility , Humans , Pregnancy , South AfricaABSTRACT
BACKGROUND: The relationship between migration and fertility has vexed demographers for years. One issue missing in the literature is the lack of careful temporal consideration of when women migrate and specifically, the extent to which they do either before or after live births. OBJECTIVE: Here, we opt for a more appropriate methodological approach to help remedy the complexity of the temporal aspect of migration and childbirth processes: regression models using the episode-splitting method. METHODS: This paper applies a rarely used methodological approach (episode-splitting) in the literature of migration-fertility relationship to investigate how internal in-migration is associated with inter-birth intervals among women in Cotonou, the largest city of Benin. Data comes from the 2017-2018 Benin Demographic and Health Survey (DHS) of women aged 15-49. Estimates from exponential regression models with episode-splitting were compared to estimates from exponential regression models without episode-splitting approach. Sensitivity analysis was also conducted to determine the robustness of the comparison between the two methods. Akaike Information Criteria (AIC) and Bayesian Information Criteria (BIC) were used to identify the method that provides models with best fit. RESULTS: The results from (standard) exponential regression models without episode-splitting show that there is no significant association between migration and interbirth transition rate. However, significant associations between migration and interbirth transition rate emerge after applying the episode splitting method. The hazard ratios (HR) of the transition to the next live birth are higher among migrant women than among nonmigrant women. This trend is persistent even after 10 years spent in Cotonou by migrant women. CONCLUSION: Exponential regression models with episode-splitting were of better fit than exponential regression models without episode-splitting. Sensitivity analysis conducted seems to confirm that models with episode-splitting produce estimates that are accurate, reliable and superior to models without episode-splitting. The results suggest a long-run process adaptation of migrants to lower fertility behaviours in Cotonou and are therefore consistent with the socialization hypothesis.
Subject(s)
Demography , Health Surveys , Human Migration , Adult , Benin , Birth Intervals , Confidence Intervals , Humans , Models, StatisticalABSTRACT
Mentoring is important for improving capacity development in population and public health research in sub-Saharan Africa. A variety of experiences have been documented since Consortium for Advanced Research Training in Africa (CARTA) admitted the first cohort in 2011. However, the experience of mentoring opportunities in CARTA has not been studied. Our study focused on the perceptions, experiences and challenges of mentoring among CARTA fellows. We adopted a descriptive design based on data collected from the fellows using an online semi-structured questionnaire. Out of 143 fellows in the programme, a total of 52 fellows from seven cohorts completed the questionnaire. Fifty-three percent of the respondents were females, more than half belonged to the health sciences while 35% were in the social sciences. Fellows received mentoring from CARTA graduates and experienced researchers in the CARTA network, but they also engaged in peer-mentoring with one another. Teaching, publishing, conference attendance and grant application were considered particularly important in mentoring, but mentors and mentees highlighted personal and social issues such as networking, work-family life balance, and managing stress and time, as challenges. There is a need for more formalised but flexible mentorship initiative in the CARTA fellowship to facilitate enduring relationships for career development.
Subject(s)
Mentoring , Mentors , Africa South of the Sahara , Ecosystem , Female , Humans , Research PersonnelABSTRACT
BACKGROUND: Universal access to contraception is an important strategy adopted by the South African government to reduce the high rate of unintended pregnancies, especially in women living with HIV. In this article, we describe the choices of contraception and also, examine the influencing factors of the choices of contraception in the immediate postpartum period in parturient women with HIV in the Eastern Cape, South Africa. METHODS: In this prospective cross-sectional study, 1617 parturient women with HIV completed a survey on the choice of contraception received in the immediate postpartum period (within 72 h) across three large maternity services in the Eastern Cape between September 2015 to May 2016. Additional information was extracted from their medical records. Choices of contraception were categorised as; short-acting (injectables), long-acting reversible (intrauterine device and implants) and permanent contraception (tubal ligation). Adjusted and unadjusted logistic regression models were employed to determine the influencing factors of the choices of contraception received by the cohort. RESULTS: Participants were predominantly single (69.1%), unemployed (75.1%), had a grade 7-12 level of education (88.4%) and were HIV positive before their index pregnancy (81.3%). The prevalence of immediate postpartum contraception was high (n = 1507; 93.2%) with Injectables being the preferred choice in the majority of the participants (n = 1218; 75.3%). After controlling for all relevant covariates, single marital status was associated with a higher likelihood of immediate postpartum contraceptive initiation (AOR; 1.82 95% CI 1.10-3.03). Overall, women were more likely to initiate a long-acting reversible and irreversible methods when older than 35 years and having had more than two children. CONCLUSIONS: We found a high prevalence of immediate postpartum contraception with a preference for Injectables in the study setting. Long-term monitoring of this cohort will elucidate on contraceptive discontinuation and risk of unintended pregnancies in the region. Ensuring universal access to contraceptives is an important strategy to reduce the rate of unintended pregnancies at the population level. This strategy was adopted by the South African government with a vision of stemming the tide of unintended pregnancies among women living with HIV. In this study, the choices of contraception adopted by women living with HIV following the delivery of their babies were explored. In addition, the study highlights the factors that predict these choices. Participants were asked the choice of contraception they had received prior to being discharged from the maternity centres where they had delivered their babies. The various types of contraception were then categorised by their duration of action. Three distinct groups emerged; short-acting injectables, long acting reversible contraceptives and permanent methods. Of the 1617 women included in the study, 1117 were single and 1314 knew their HIV status prior to the onset of the index pregnancy. Almost all the women (1507 out of 1617) received one form of contraception before leaving the hospital. Many women (1218 out of 1617) chose injectable contraception (short-acting contraception) over the other types of contraception. Women who were older than 34 years and who had three or more children were more likely to choose a long-acting reversible contraceptive and permanent method over the short-acting contraception or nothing. In conclusion, given the short duration of action of the predominant method adopted by these women, a long-term follow up of the study participants will provide more information on the continued use of contraception and risk for unintended pregnancies.
Subject(s)
Contraception/methods , HIV Infections/psychology , Health Services Accessibility , Postnatal Care , Adult , Contraception Behavior , Cross-Sectional Studies , Delivery of Health Care , Female , HIV Infections/drug therapy , Humans , Long-Acting Reversible Contraception , Postpartum Period , Pregnancy , Prevalence , Prospective Studies , South Africa/epidemiology , Young AdultABSTRACT
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.
Subject(s)
Domestic Violence/statistics & numerical data , Marriage/statistics & numerical data , Spouse Abuse/statistics & numerical data , Adolescent , Adult , Africa South of the Sahara/epidemiology , Aged , Female , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Prevalence , Socioeconomic Factors , Time Factors , Young AdultABSTRACT
INTRODUCTION: Despite the prevalence of mental illness among young adults in South Africa, few studies have examined its correlation with social capital using nationally representative data. Sources of social capital are different for youth, which is why understanding the correlation between family and neighbourhood social capital and mental health outcomes is important for designing optimal interventions. The objective of this study was to examine the relationship between social capital and youth mental health. We also sought to understand whether family social capital was more protective for the mental health of youth compared to neighbourhood social capital. METHODS: Using the National Income Dynamics Survey data for South Africa, we examine these associations among 2307 youth aged 15-24 across the four waves. Multilevel logistic regression was used to examine these associations. RESULTS: Our findings emphasize the substantial burden of mental illness among youth in South Africa (26% in wave 4). Although results for parental presence were not significant, family social capital measured by household income significantly decreased the odds of incident depression only for those belonging to the third quintile (aOR 0.74, 95% CI 0.54-1.01). High perception of crime in the neighbourhood was associated with significantly higher odds of incident depression (aOR 1.33, 95% CI 1.06-1.67). CONCLUSIONS: Our results confirm the independent effect of neighbourhood characteristics on youth mental health and did not support family social capital as being protective for developing depression. This implies that youth program planners must focus on community context in improving youth developmental outcomes such as mental health.
Subject(s)
Depression/epidemiology , Residence Characteristics , Social Capital , Adolescent , Adult , Depression/psychology , Family , Female , Humans , Logistic Models , Male , Prevalence , Socioeconomic Factors , South Africa/epidemiology , Surveys and Questionnaires , Young AdultABSTRACT
Optimal birth spacing (defined as a birth spacing of 24-59 months) is incontrovertibly linked to better health outcomes for both mothers and babies. Using the most recent available Demographic and Health Survey data, we examined the patterns and determinants of short and long birth intervals among women in selected sub-Saharan African (SSA) countries.Reproductive health and sociodemographic data of 98,934 women from 8 SSA countries were analyzed. Unadjusted and adjusted multinomial logistic regression models were used to examine the net relationship between all the independent variables and short and long birth intervals.Overall, the majority of women in all the countries optimally spaced births. However, a significant proportion of women had short birth intervals in Chad (30.2%) and the Democratic Republic of Congo (Congo DRC) (27.1%). Long birth spacing was more common in Eastern and Southern African countries, with Zimbabwe having the highest rate of long term birth interval (27.0%). Women who were aged 35 years and above in Uganda (RRRâ=â0.72, CIâ=â0.60-0.87), Tanzania (RRRâ=â0.62, CIâ=â0.49-0.77), Zimbabwe (RRRâ=â0.52, CIâ=â0.31-0.85), Nigeria (RRRâ=â0.82, CIâ=â0.72-0.94) and Togo (RRRâ=â0.67, CIâ=â0.46-0.96) had significantly lower odds of having short birth intervals compared to women aged 15-24 years. Older women (above 34 years) had increased odds for long birth intervals in all countries studied (Chad (RRRâ=â1.44, CIâ=â1.18-1.76), Congo DRC (RRRâ=â1.73, CIâ=â1.33-2.15), Malawi (RRRâ=â1.54, CIâ=â1.23-1.94) Zimbabwe (RRRâ=â1.95, CIâ=â1.26-3.02), Nigeria (RRRâ=â1.85 CIâ=â1.56-2.20), Togo (RRRâ=â2.12, CIâ=â1.46-3.07), Uganda (RRRâ=â1.48, CIâ=â1.15-1.91), Tanzania RRRâ=â2.12, CIâ=â1.53-2.93).The analysis suggested that the determinants of long and birth intervals differ and varies from country to country. The pattern of birth spacing found in this study appears to mirror the contraceptive use and fertility rate in the selected SSA countries. Birth intervals intervention addressing short birth intervals should target younger women in SSA, especially in Chad and Congo DRC, while intervention for long birth spacing should prioritize older, educated and wealthy women.
Subject(s)
Birth Intervals/statistics & numerical data , Developing Countries/statistics & numerical data , Adolescent , Adult , Africa South of the Sahara/epidemiology , Age Factors , Female , Humans , Residence Characteristics/statistics & numerical data , Risk Factors , Socioeconomic Factors , Young AdultABSTRACT
BACKGROUND: Given the paucity of data on recreational drug use and the recent media attention on the abuse of drugs such as codeine cough syrups and tramadol, in Nigeria, our study examined the prevalence and frequency of recreational drug use among young adults from two Nigerian universities. We drew from the Socio-ecological Model to examine the influence of factors at the individual and family level on recreational drug use among adolescents and young adults. METHODS: This cross-sectional study was conducted between February and March 2018 among a final sample of 784 male and female university students selected using stratified random sampling. Binary logistic regression was used to identify significant predictors of ever use and current use of drugs. RESULTS: Our analyses showed that 24.5% of students had ever used drugs for recreational purposes, and 17.5% are current users. The median drug use frequency over the past month was six days among current users (n = 137). In the multivariable analyses, living in the same household as one's mother (AOR 0.28 95% CI 0.16-0.49), adequate family support (AOR 0.48 95% CI 0.26-0.89) and frequent attendance of religious fellowships (AOR 0.13 95% CI 0.07-0.25) were significantly associated with a lower likelihood of recreational drug use. However, male sex (AOR 1.52 95% CI 1.05-2.21) was associated with higher odds of recreational drug use. CONCLUSION: The family should be considered as an important unit to sensitize young people on the harmful effects of drug use. It is also vital that religious leaders speak against drug use in their various fellowships. There is a need to address recreational drug use on Nigerian campuses by educating students about its adverse impacts.
Subject(s)
Substance-Related Disorders/epidemiology , Adolescent , Adult , Amphetamine-Related Disorders/epidemiology , Codeine , Cross-Sectional Studies , Female , Humans , Illicit Drugs , Male , Marijuana Use/epidemiology , Nigeria/epidemiology , Prevalence , Risk Factors , Students/psychology , Surveys and Questionnaires , Tramadol , Universities , Young AdultABSTRACT
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.
Subject(s)
Birth Intervals/ethnology , Birth Intervals/statistics & numerical data , Illegitimacy , Mothers , Single Parent , Single Person , Adolescent , Adult , Africa South of the Sahara/epidemiology , Cross-Sectional Studies , Demography , Female , Humans , Middle Aged , Parity , Pregnancy , Risk Assessment , Socioeconomic Factors , Time Factors , Young AdultABSTRACT
[This corrects the article DOI: 10.1371/journal.pone.0206197.].
ABSTRACT
The prevalence of child marriage in West Africa is one of the highest in the global south. Yet, much of what we know about the harmful effects of early marriage and why it persists comes from research on South Asia. Adopting life course family development perspectives on adolescent sexuality, we examine the linkages between the timing of union formation and childbearing across multiple countries with high rates of child marriage. Using the latest round of data from the Demographic and Health Surveys (DHS), we find that by age 18, 28 percent of adolescents in Nigeria, 25 percent in Burkina Faso, and as high as 60 percent in Niger are in a union, whilst 13 percent of Nigerian adolescents, 12 percent in Burkina Faso, and 27 percent in Niger have had a first birth. The results demonstrate that, net of individual characteristics, community variables are strong predictors of union formation and childbearing. Individual characteristics such as women's education, economic status of households, and residing in female-headed households and rural areas are other salient determinants of adolescent family transitions. We discuss the findings in the context of revamping stalled fertility transitions and the post-2015 framework for development in sub-Saharan Africa.