Recommended homemade fluid utilization for the treatment of diarrhea and associated factors among children under five in sub-Saharan African countries: a multilevel analysis of the recent demographic and health survey.

INTRODUCTION: Diarrhea is a common public health problem and the third leading cause of death in the world among children under the age of five years. An estimated 2 billion cases and 1.9 million deaths are recorded among children under the age of five years every year. It causes body fluid loss and electrolyte imbalance. Even though, early initiation of recommended homemade fluid is a simple and effective approach to prevent diarrhea-related complications and mortality of children, recommended homemade fluid utilization for the treatment of diarrhea is still low in sub-Saharan African countries. Therefore, this study aimed to assess the magnitude of recommended homemade fluid utilization for the treatment of diarrhea and associated factors among children under five in sub-Saharan African countries. METHOD: The most recent Demographic and Health Survey dataset of 21 sub-Saharan African countries from 2015 to 2022 was used for data analysis. A total of 33,341 participants were included in this study as a weighted sample. Associated factors were determined using a multilevel mixed-effects logistic regression model. Significant factors in the multilevel mixed-effect logistic regression model were declared significant at p-values < 0.05. The adjusted odds ratio (AOR) and confidence interval (CI) were used to interpret the results. RESULT: The overall recommended homemade fluid utilization for the treatment of diarrhea among children under five in sub-Saharan African countries was 19.08% (95% CI = 18.66, 19.51), which ranged from 4.34% in Burundi to 72.53% in South Africa. In the multivariable analysis, being an educated mother/caregiver (primary and secondary level) (AOR = 1.15, 95% CI: 1.04, 1.27) and (AOR = 1.30, 95% CI: 1.15, 1.1.47), the primary and secondary level of fathers education (AOR = 1.53, 95% CI: 1.37, 1.71) and (AOR = 1.41, 95% CI: 1.19, 1.1.68), having antenatal care follow-up (AOR = 1.16, 95% CI: 1.01, 1.33), having multiple children (AOR = 1.17, 95% CI: 1.07, 1.28), and being an urban dweller (AOR = 1.15, 95% CI: 1.04, 1.27) were factors associated with recommended homemade fluid utilization. CONCLUSION: The overall recommended homemade fluid utilization for the treatment of diarrhea was low. Individual and community-level variables were associated with recommended homemade fluid utilization for the treatment of diarrhea. Therefore, special consideration should be given to rural dwellers and caregivers who have three and below children. Furthermore, better to strengthen the antenatal care service, mother/caregiver education, and father's education to enhance recommended homemade fluid utilization for the treatment of diarrhea.

Rotavirus vaccine dose-two dropout and its associated factors among children who received rotavirus vaccine dose-one in Sub-Saharan African countries: A multilevel analysis of the recent demographic and health survey.

Rotavirus is the most common cause of diarrhea in children worldwide. In 2016, rotavirus infection resulted in 258 173 300 episodes of diarrhea and 128 500 child deaths in the globe. The study aimed to assess the magnitude of Rotavirus vaccine dose-two dropout and associated factors among children who received rotavirus vaccine dose-one in sub-Saharan African countries. The appended and most recent demographic and health survey (DHS) dataset of 17 sub-Saharan African countries was used for data analysis. A total of 73,396 weighted samples were used. Factors associated with the outcome variable were considered significant if their p-values were ≤ .05 in the multilevel mixed-effect logistic regression model. The overall Rotavirus vaccine dose-two dropouts was 10.77% (95% CI 10.55%, 11.00%), which ranged from 2.77% in Rwanda to 37.67% in Uganda. Being younger, late birth order, having difficulty accessing health facilities, having no media exposure, having no work, having home delivery, having no antenatal follow-up, and having no postnatal checkup were factors significantly associated with the outcome variable. The overall Rotavirus vaccine dose-two dropout was higher in sub-Saharan African countries which implies that vaccine dropout is still a great issue in the region. Special attention should be given to those mothers who are young, who have no work, who give birth at home, who experienced difficulty in accessing health facilities, and late birth orders. Furthermore, targeted interventions should be considered for improving access and utilization of media, antenatal care, and postnatal care services.

Prevalence and determinants of two or more doses of tetanus toxoid-containing vaccine immunization among pregnant women in sub-Saharan Africa: Evidence from recent demographic and health survey data.

INTRODUCTION: Tetanus is a major public health problem in low and middle income countries including in sub-Saharan Africa. Tetanus toxoid vaccine immunization during pregnancy is a global strategy against mortality due to maternal and neonatal tetanus. Recent data on tetanus toxoid-containing vaccination during pregnancy provides insight to policymakers for better implementation of the vaccine. Hence, this study aimed to determine prevalence and determinants of immunization with tetanus toxoid containing vaccine among pregnant women in sub-Saharan Africa. METHODS: Secondary analysis of the recent demographic and health survey data was done using a sample of 173,032 pregnant women. Stata 14 statistical software was used for analysis and multilevel logistic regression model was applied to determine associated factors of two or more tetanus toxoid-containing vaccine immunization. P-value less than 0.05 for adjusted odds ratio was used to identify factors significantly associated with the outcome. RESULT: The prevalence of immunization with two and more doses of tetanus toxoid-containing vaccine in sub-Saharan Africa was found to be 49.8 %. Women's age 36-49, women's education, poor household wealth index, unwanted pregnancy, women's occupation, husband education, and community illiteracy were significantly associated with two or more doses of tetanus toxoid-containing vaccine immunization in sub-Saharan Africa. CONCLUSION: In sub-Saharan Africa, less than half of pregnant women were immunized with two or more doses of tetanus toxoid-containing vaccine. Women's education and women's employment positively affected immunization with two or more doses of tetanus toxoid-containing vaccine. Women's age group of 36-49 years, unwanted pregnancy, poor household wealth index, husbands having no formal education, and community illiteracy negatively affected receipt of two or more doses of tetanus toxoid-containing vaccine. Therefore, policymakers should take into account the determinants of tetanus toxoid immunization throughout its implementation so as to boost the coverage of tetanus toxoid immunization in sub-Saharan Africa.

Home delivery among women who had optimal ANC follow-up in Sub-Saharan Africa: A multilevel analysis.

BACKGROUND: Home deliveries, where most births take place, are significantly responsible for the majority of maternal mortality. In order to develop appropriate policies and methods that could aid in addressing the issue, it is important to understand the scope of home delivery and its determinants in developing countries. Therefore, this study aims to ascertain the prevalence and factors associated with home delivery among women who had optimal ANC follow up in the Sub-Saharan Africa countries. METHODS: A population based cross-sectional study was conducted. Data from the most recent Demographic and Health Surveys, which covered 23 Sub-Saharan Africa countries from 2014 to 2020, were used. The study used a total of 180,551 women who had optimal ANC follow up weighted sample. Stata 14 was used to analyze the data. The determinants of home delivery were determined using a multilevel mixed-effects logistic regression model. Factors associated with home delivery in the multilevel logistic regression model were declared significant at p-values <0.05. The adjusted odds ratio and confidence interval were used to interpret the results. RESULTS: In Sub-Saharan Africa, three in ten (30%) women who had optimal ANC follow-up gave birth at home. Individual-level variables such as maternal age (20 to 35 years) (AOR = 1.27, 95% CI: 1.10, 1.46), no formal education (AOR = 3.10, 95% CI: 2.68, 3.59), pregnancy complications (AOR = 0.74, 95% CI: 0.67, 0.82), distance to a health facility (AOR = 1.43, 95% CI: 1.30, 1.58), and poor wealth status (AOR = 2.71, 95% CI: 2.37, 3.10) had higher odds of home delivery. Community-level variables such as rural residence (AOR = 2.83, 95% CI: 2.48, 3.22), living in central Sub-Saharan Africa (AOR = 7.95, 95% CI: 5.81, 10.9), and eastern Sub-Saharan Africa (AOR = 2.74, 95% CI: 2.09, 3.59), were significantly associated with home delivery. CONCLUSIONS AND RECOMMENDATION: This study concludes that home delivery in sub-Saharan Africa among women who had optimal ANC follow-up were high. The study identified that both individual and community-level variables were determinants of home delivery. Therefore, the Government and ministries of health in Sub-Saharan Africa countries should give attention to those women who reported distance as a big problem to health facilities and for rural resident women while designing policies and strategies targeting reducing home delivery in sub-Saharan Africa.