Prevalence and correlates of tobacco use in Botswana: evidence from the 2014 Botswana STEPwise survey.

BACKGROUND: Tobacco use is one of the notable risk factors for non-communicable diseases globally. The objective of this study was to assess the prevalence of tobacco use and identify its correlates in the general population of Botswana aged 15 to 69 years. METHODS: This study used a nationally representative WHO STEPwise Approach to Non-Communicable Disease Risk Factor Surveillance (STEPS) risk factors conducted in 2014 to explore the prevalence of tobacco use and its correlates in Botswana. Using IBM SPSS version 27, data on 4062 people aged 15 to 69 years who had been selected using multistage cluster sampling and had successfully completed the individual questionnaire were analysed. The prevalence of current tobacco smoking and smokeless tobacco use was determined using descriptive statistics while multivariable logistic regression was employed to assess correlates of current tobacco smoking and smokeless tobacco use. All comparisons were statistically significant at 5% significance level. RESULTS: From a total sample of 4062 participants the prevalence of current tobacco smoking was estimated to be 12.9% while smokeless tobacco use was 3.2%. Adjusted results indicate that the odds of current tobacco smoking were eight times (AOR = 8.57, C.I = 6.28-11.7) higher among males compared to their female counterparts; six(AOR = 6.52, C.I 3.64-11.6) and three (AOR = 3.27, C.I. =2.07-5.15) times higher among respondents with no education and primary level education respectively, compared to their counterparts with tertiary or higher education; while for alcohol users the odds of current tobacco smoking were four times (AOR = 4.28, C.I = 2.93-6.24) higher than among non-alcohol users. The odds of smokeless tobacco use were significantly higher among women compared to men (AOR = 7.34, C.I = 4.01-13.4); individuals aged 50-59 (AOR = 1.15, C.I = 1.06-3.37) and 60-69 years (AOR = 1.23, C.I. =1.08-3.63) compared to 15-29 years; individuals with no education (AOR = 2.07, C.I = 1.03-4.02) and primary education (AOR = 1.05, C.I = 1.01-2.23) compared to individuals with tertiary education. However, the odds of smokeless tobacco use were significantly lower among individuals who consume alcohol (AOR = 0.48, C.I. = 0.29-0.80) compared to non-alcohol consumers. CONCLUSION: Findings of this study indicate the need to strengthen existing national policies to reduce harmful use of tobacco among men, women, older adults, no or primary education level individuals and alcohol users.

The influence of childhood socioeconomic status on non-communicable disease risk factor clustering and multimorbidity among adults in Botswana: a life course perspective.

Childhood socioeconomic circumstances have a great influence on the health of individuals in adult life. We used cross-sectional data from a non-communicable disease (NCD) survey conducted in 2016, and respondents aged ≥15 y were selected from 3 cities/towns, 15 urban villages and 15 rural areas using a multistage probability-sampling technique. The total sample for the study was 1178. Two multinomial logistic regression models were fitted to data to ascertain the association between childhood socioeconomic status (SES) and NCD risk factor clustering and multimorbidity, using SPSS version 27. All comparisons were considered to be statistically significant at a 5% level. The prevalence of multiple NCD risk factors and multimorbidity was 30.1 and 5.3%, respectively. The odds of reporting NCD risk factor clustering were significantly high among individuals who reported low (adjusted OR [AOR]=1.88, 95% CI 1.21 to 2.78) and middle (AOR=1.22, 95% CI 1.02 to 2.05) childhood SES compared with high childhood SES. Conversely, individuals from a low SES background were more likely to report both single (AOR=1.17, 95% CI 1.00 to 2.01) and multiple NCD conditions (AOR=1.78, 95% CI 1.11 to 2.68) compared with those with a high childhood SES background. There is a need to stimulate policy debate and research to take cognisance of childhood socioeconomic circumstances in health policy planning.

Gender differences in dietary behaviours, health-related habits and prevalence of non-communicable diseases in Botswana.

The aim of this study was to assess gender differences in the prevalence non-communicable diseases (NCDs) and in associated health-related habits, weight status and common risk factors in Botswana. Data were from the cross-sectional, population-based Botswana STEPS Survey II conducted in 2014. A total sample of 2947 survey participants aged 25-64 years were included the study. The results showed that a statistically significant higher percentage of men used tobacco compared with women (34.4%, 95% CI: 33.5-35.1 vs 4.4%, 95% CI: 4.3-4.5). Men also had consistently and statistically significantly greater heavy alcohol consumption and lower fruit and/or vegetable consumption than women. Physical inactivity among women was higher than in men. Controlling for other factors, men had a higher probability of being overweight (28.7%, 95% CI: 28.6-28.8 vs 18.3%, 95% CI: 18.0-18.6) and obese (25.8%, 95% CI: 25.4-26.2 vs 10.2%, 95% CI: 9.9-10.5) than women. Women were at a greater risk of developing NCDs compared with men since their adjusted prevalence of having at least three common risk factors was higher than men's. Women had a higher adjusted predicted prevalence of suffering from hypertension than men (39.4%, 95% CI: 38.9-40.0 vs 26.1%, 95% CI: 25.5-26.8). Appropriate policies and programmes need to be adopted to urgently address the problem of NCDs in Botswana.

Side Effects and Perceptions of COVID-19 Vaccination in Saudi Arabia: A Cross-Sectional Study.

Background: Vaccination against any disease is critical in improving and maintaining public health. However, the overall effectiveness of a vaccine largely depends on the willingness of a population to receive it. The main aim of this study was to assess the side effects and perceptions about COVID-19 vaccines among adults following vaccination in Saudi Arabia. Methods: An online cross-sectional survey was conducted from July 13 to July 20, 2021, among adults aged 18 years and older who had taken one or both doses of COVID-19 vaccines in Saudi Arabia. The survey included questions on socio-demographics, health behavior, vaccine type, knowledge about sources of information about COVID-19 vaccines, and perceptions and beliefs following vaccination. Bivariate and multivariable regression analyses were the major data analytic tools employed in the study. Results: The most common vaccine side effects reported were tiredness/fatigue (52.6%), swelling (38%), fever (31.3%), headache (29.1%), and muscle pain (22.2%). In multivariable analyses, the odds of experiencing severe side effects were significantly higher among males [adjusted odds ratio (aOR) = 2.76, 95% confidence interval (CI) = 1.71-4.45, p < 0.01], those aged 40-49 years (aOR = 3.10, 95% CI = 1.10-8.72, p < 0.1), and Saudi nationals (aOR = 3.64, 95% CI = 1.58-8.38, p < 0.05) compared to their counterparts. The odds of believing that COVID-19 vaccines are safe in the long-term were significantly higher among men (aOR = 1.76, 95% CI = 1.16-2.65, p < 0.01) and among individuals who had received two doses (aOR = 1.62, 95% CI = 1.09-2.40, p < 0.05), and the odds of advising others to get vaccinated for COVID-19 were also significantly higher among respondents who had received two doses (aOR = 2.81, 95% CI = 1.60-4.93, p < 0.01) compared to their counterparts. Conclusion: This study identified the most common COVID-19 vaccine side effects in Saudi Arabia, therefore making them predictable. This information will help reduce vaccine hesitancy as booster doses become available.

Prevalence of and factors associated with hypertension, diabetes, stroke and heart attack multimorbidity in Botswana: Evidence from STEPS 2014 survey.

BACKGROUND: Botswana, like other Sub-Saharan Africa (SSA) countries is currently undergoing demographic and epidemiological transitions which are shown by an increase in chronic non-communicable diseases (NCDs) and their associated risk factors. The aim of this study was to examine the prevalence of and factors associated with hypertension, diabetes and stroke/heart attack multimorbidity in Botswana. The definition of multimorbidity used in this study is the presence of two or more NCDs in an individual. METHODS: This study used secondary data derived from the Botswana WHO STEPS 2014 survey. The survey employed a nationally representative multi-stage sampling design. The study sample consisted of 3527 respondents aged 20-69 years of age who had successfully completed the questionnaire and met the inclusion criteria. Multivariable logistic regression analyses were used to assess factors associated with multimorbidity. All comparisons were considered to be statistically significant at 5% level. Statistical tests were performed using Statistical Package for Social Sciences (SPSS) version 25. RESULTS: Prevalence of hypertension, diabetes and stroke/heart attack multimorbidity was estimated to be at 3.5% in the sampled population. The odds of reporting multimorbidity were highest among females (AOR = 9.73, 95% CI = 8.30-11.42) than males and among respondents aged 35-49 (AOR = 1.20, 95% C.I. = 1.10-1.31) and 50-69 years (AOR = 1.52, 95% C.I. = 1.23-1.67) than individuals aged 20-24 years. Moreover, the odds of multimorbidity were significantly higher among married (AOR = 15.92, 95% C.I. = 13.40-18.92) and living together (AOR = 6.68, 95% C.I. = 5.72-7.81) couples; and individuals who reported that they earn an average annual household income of BWP ≥20 000 (AOR = 2.25, 95% CI = 1.84-2.75) compared to their counterparts. Behavioural risk factors significantly associated with higher odds of multimorbidity were obesity (AOR = 6.79, 95% C.I. = 6.20-7.90), physical inactivity (AOR = 4.41, 95% C.I. = 3.65-5.31) and hazardous alcohol consumption (AOR = 1.49, 95% CI = 1.23-1.81). On the other hand the odds of reporting multimorbidity were significantly low among individuals with sufficient consumption of fruits and vegetables (AOR = 0.47, 95% C.I. = 0.39-0.56) and non-tobacco users (AOR = 0.58, 95% CI = 0.49-0.68). CONCLUSION: Multimorbidity was more common among females, the elderly people and was associated with obesity, poor fruit and vegetable intake, and tobacco use. Strategies to combat NCDs and multimorbidity should be aimed to target early stages of life since behavioural factors and lifestyles that increase the likelihood of disease are entrenched in earlier stages of life.

Acceptance of the District Health Information System Version 2 Platform for Malaria Case-Based Surveillance By Health Care Workers in Botswana: Web-Based Survey.

BACKGROUND: Similar to many low- and middle-income countries, Botswana has identified eHealth as a means of improving health care service provision and delivery. The National Malaria Programme (NMP) in Botswana has implemented the District Health Information System version 2 (DHIS2) to support timely malaria case reporting across its 27 health districts; however, the implementation of an eHealth system is never without challenges. Barriers to the implementation of eHealth innovations within health care settings may arise at the individual or organizational levels. As such, the evaluation of user perceptions of the technology is an important step that can inform its sustainable implementation. The DHIS2 was implemented without evaluating user perceptions beforehand; therefore, the Botswana Ministry of Health and Wellness was uncertain about the likelihood of acceptance and use of the platform. OBJECTIVE: We aimed to determine the acceptance of the DHIS2 platform by the NMP in Botswana to gauge whether adoption would be successful. METHODS: The study's design was informed by constructs of the technology acceptance model. A survey, with items assessed using a 7-point Likert scale, and focus group discussions were undertaken with DHIS2 core users from 27 health districts and NMP personnel at the Ministry of Health and Wellness. The web-based survey was administered from August 3, 2020 to September 30, 2020. RESULTS: Survey participants were core users (n=27). Focus group participants were NMP personnel (n=5). Overall, participants' survey responses (frequently occurring scores of 7) showed their confidence in the DHIS2 platform for case-based surveillance of malaria; however, participants also noted some organizational issues that could compromise user acceptance of the DHIS2 platform. CONCLUSIONS: Participants' responses indicated their acceptance of the DHIS2 platform; however, the consideration of factors related to organizational readiness could further enhance successful acceptance, and consequently, successful adoption of the platform by the malaria program in Botswana.

Individual, household, and community-level predictors of modern contraceptive use among married women in Cameroon: a multilevel analysis.

BACKGROUND: Unintended pregnancy remains a major public health and socio-economic problem in sub-Saharan African countries, including Cameroon. Modern contraceptive use can avert unintended pregnancy and its related problems. In Cameroon, the prevalence of modern contraceptive use is low. Therefore, this study investigated the individual/household and community-level predictors for modern contraceptive use among married women in Cameroon. METHODS: Data for this study were derived from the nationally representative 2018-2019 Cameroon Demographic and Health Survey. Analysis was done on 6080 married women in the reproductive age group (15-49 y) using Stata version 14 software. Pearson χ2 test and multilevel logistic regression analysis were conducted to examine the individual/household and community-level predictors of modern contraceptive use. Descriptive results were presented using frequencies and bar charts. Inferential results were presented using adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS: The results show only 18.3% (95% CI 16.8 to 19.8) of married women in Cameroon use modern contraceptives. Women's age (45-49 y; aOR 0.22 [95% CI 0.12 to 0.39]), education level (secondary education; aOR 2.93 [95% CI 1.90 to 4.50]), occupation (skilled manual; aOR 1.46 [95% CI 1.01 to 2.11]), religion (Muslim; aOR 0.63 [95% CI 0.47 to 0.84]), wealth quintile (richest; aOR 2.22 [95% CI 1.35 to 3.64]) and parity (≥5; aOR 3.59 [95% CI 2.61 to 4.94]) were significant individual/household-level predictors. Region (East; aOR 3.63 [95% CI 1.97 to 6.68]) was identified as a community-level predictor. CONCLUSIONS: Modern contraceptive use among married women in Cameroon is low. Women's education and employment opportunities should be prioritized, as well as interventions for married women, ensuring equity in the utilization of modern contraceptives across regions.

Patterns and correlates of ownership and utilization of insecticide-treated bed-nets for malaria control among women of reproductive age (15-49 years) in Malawi.

Malaria is a major public health concern in Malawi. This study explored the patterns and correlates of ownership and utilization of ITNs for malaria control among women of reproductive age in Malawi. Data were derived from the multi-stage cross-sectional Malaria Indicator Survey (MIS) conducted in 2017, which followed ITN distribution in 2012 and 2015. Of the 3860 sampled women aged 15-49 years, 88% (3398/3860) and 64% (2473/3860) reported that they owned and utilized ITNs, respectively. Adjusted multivariate logistic regression analysis showed that the odds of ownership of ITNs were significantly low among women with no education (AOR = 0.36, CI = 0.18-0.72), those with primary education (AOR = 0.50, CI = 0.27-0.94) and poor women (AOR = 0.70, CI = 0.51-0.97). Similarly, the odds of utilization of ITNs were significantly low among women with no education, (AOR = 0.40, CI = 0.26-0.63), primary education (AOR = 0.53, CI = 0.36-0.78) and poor women (AOR = 0.70, CI = 0.51-0.97). Furthermore, the odds of utilization of ITNs were significantly low among women living in households without a radio (AOR = 0.79, CI = 0.67-0.93) and those who have not seen or heard a malaria message in the last 6 months (AOR = 0.74, CI = 0.64-0.87). In order to prevent malaria morbidity and mortality among women of reproductive age, especially those from poor households, the Malawi government and relevant stakeholders need to continue the free distribution of ITNs to the poor and encourage social behaviours that promote the ownership and utilization of ITNs.

Trends in socio-economic, sex and geographic disparities in childhood underweight in Mauritania: evidence from Multiple Indicator Cluster Surveys (2007-2015).

BACKGROUND: Underweight is one of the largest contributors to child morbidity and mortality and is considered to be the largest contributor to the global burden of diseases in low-and middle-income countries. In Mauritania, where one-fifth of children are underweight, there is a dearth of evidence on socio-economic, sex and geographic disparities in childhood underweight. As a result, this study aimed at investigating the socio-economic, sex and geographic disparities in childhood underweight in Mauritania. METHODS: Using the World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the Mauritania Multiple Indicator Cluster Surveys (MICSs) conducted between 2007 and 2015 were analysed. Childhood underweight was disaggregated by five equity stratifiers: education, wealth, residence, region and sex. In addition, absolute and relative inequality measures, namely difference (D), population attributable risk (PAR), ratio (R) and population attributable fraction (PAF) were calculated to understand inequalities from wider perspectives. Corresponding 95% confidence intervals (CIs) were computed to measure statistical significance. RESULTS: Substantial absolute and relative socio-economic, sex and geographic disparities in underweight were observed from 2007 to 2015. Children from the poorest households (PAR=-12.66 [95% CI -14.15 to -11.16]), those whose mothers were uneducated (PAF=-9.11 [95% CI -13.41 to -4.81]), those whose mothers were rural residents (R=1.52 [95% CI 1.37 to 1.68]), residents of HodhCharghy (PAF=-66.51 [95% CI -79.25 to -53.76]) and males (D=4.30 [95% CI 2.09 to 6.52]) experienced a higher burden of underweight. Education-related disparities decreased from 2007 to 2015. The urban-rural gap in underweight similarly decreased over time with the different measures showing slightly different reductions. Wealth-driven disparities decreased marginally from 2011 to 2015. The sex-based and regional disparities increased, at least on average, over the 8-y intersurvey period. CONCLUSIONS: The burden of underweight was significantly higher among children from disadvantaged subpopulations, those with uneducated and poorest/poor mothers, those living in rural areas and those living in HodhCharghy. Special nutrition intervention and efforts focused on these deprived subpopulations are required to reduce childhood morbidity and mortality associated with underweight and help achieve the Sustainable Development Goals.

Determining Prevalence of Anemia and Its Associated Factors in Cameroon: A Multilevel Analysis.

BACKGROUND: Anemia constitutes a major public health concern, which is associated with maternal and perinatal mortality. In low- and middle-income countries, the burden of anemia is profoundly high. Cameroon, as one of the low- and middle-income countries, has a disproportionate anemia burden. Factors associated with anemia prevalence are largely unknown in Cameroon. Hence, we determined the prevalence of anemia and its individual/household and community-level factors among adult women in Cameroon. METHODS: We derived data from the 2018 Cameroon Demographic and Health Survey for analysis in this study. Using the Stata version 14 software, univariate multilevel logistic regression analysis was used to select variables that had significant association with anemia at p < 0.05. Statistically significant variables were included in a multivariable multilevel logistic regression modelling to examine their associations with anemia. Results were reported using adjusted odds ratios (AOR) with their respective 95% confidence interval (CI). RESULTS: A total of 6,809 women aged 15-49 years were involved in this study with a mean age 30 ± 11.87 years. Approximately two-fifths of women were anemic. Of them, 0.8% were severely anemic, while 17.4% and 21.5% were moderately and mildly anemic, respectively. Current employment status (yes AOR = 0.77, 95% CI; 0.61-0.96) and parity (1-2 children AOR = 0.61, 95% CI; 0.44-0.86) were the main individual level factors associated with anemia, whereas region (Douala region AOR = 2.65, 95% CI; 1.61-4.36, North-West region AOR = 0.53, 95% CI; 0.28-0.99) was the community-level factor associated with anaemia. CONCLUSION: Empowerment of women through employment opportunities as well as focusing special attention in region where high prevalence of anemia could be crucial to decrease the burden of anemia and related maternal and perinatal mortality in the country.

Association between Attitude towards Wife Beating and Childhood Diarrhea: A Demographic and Health Survey-Based Study in 25 Sub-Saharan African Countries.

BACKGROUND: Childhood diarrhea remains a major public health problem in sub-Saharan Africa (SSA). Women empowerment reduces child mortality, and wife beating attitude is one of the indicators of women empowerment. There is a dearth of evidence about wife beating attitudes and childhood diarrhea in SSA. Therefore, the present study aimed to examine the association between attitude towards wife beating and diarrhea among under-five children. METHODS: We used Demographic and Health Surveys from 25 countries in SSA that were conducted between 2010 and 2020. Using Stata version 14 software, we carried out the analysis on 153,864 children under five. Bivariate and multivariate logistic regression analyses were applied, and the results were presented using adjusted odd ratios (aOR) at 95% confidence interval (CI). RESULTS: The pooled results show that 71.4% of married women disagreed with wife beating. About 20.5% of under-five children of married women had diarrhea. Childhood diarrhea varied from highest prevalence in Chad (27.9%) to the lowest prevalence in Sierra-Leone (8.5%). The study showed lower odds of diarrhea among children of married women who disagreed with wife beating (aOR = 0.66 95% CI; 0.54-0.80) compared to children of married women who agreed with wife beating. Moreover, the study results show that women's age (35-39 years-aOR = 0.48, 95% CI; 0.31-0.74, 40-44 years-aOR = 0.57, 95% CI; 0.35-0.93, 45-49 years-aOR = 0.35, 95% CI; 0.16-0.79) was negatively associated with childhood diarrhea, while husband's education (primary school-aOR = 1.36, 95% CI; 1.05-1.77), parity (ever born 3-4 children-aOR = 1.36, 95% CI; 1.09-1.70, and 5+ children-aOR = 1.56, 95% CI; 1.14-2.12), and religion (Muslim-aOR = 3.56, 95% CI; 1.44-8.83) were positively associated with diarrhea among under-five children. CONCLUSIONS: The study shows association between women attitude towards wife beating and childhood diarrhea. Therefore, empowering women, especially young women by increasing awareness about domestic violence, their rights, and empowering them through education and economic advancement need to be considered in order to reduce childhood diarrhea. Moreover, fertility control or birth spacing and working closely with religious leaders are important factors to consider in reducing childhood diarrhea.

Sub-regional disparities in the use of antenatal care service in Mauritania: findings from nationally representative demographic and health surveys (2011-2015).

BACKGROUND: Skilled antenatal care (ANC) has been identified as a proven intervention to reducing maternal deaths. Despite improvements in maternal health outcomes globally, some countries are signaling increased disparities in ANC services among disadvantaged sub-groups. Mauritania is one of sub-Saharan countries in Africa with a high maternal mortality ratio. Little is known about the inequalities in the country's antenatal care services. This study examined both the magnitude and change from 2011 to 2015 in socioeconomic and geographic-related disparities in the utilization of at least four antenatal care visits in Mauritania. METHODS: Using the World Health Organization's Health Equity Assessment Toolkit (HEAT) software, data from the 2011 and 2015 Mauritania Multiple Indicator Cluster Surveys (MICS) were analyzed. The inequality analysis consisted of disaggregated rates of antenatal care utilization using four equity stratifiers (economic status, education, residence, and region) and four summary measures (Difference, Population attributable risk, Ratio and Population attributable fraction). A 95% Uncertainty Interval was constructed around point estimates to measure statistical significance. RESULTS: Substantial absolute and relative socioeconomic and geographic related disparities in attending four or more ANC visits (ANC4+ utilization) were observed favoring women who were richest/rich (PAR = 19.5, 95% UI; 16.53, 22.43), educated (PAF = 7.3 95% UI; 3.34, 11.26), urban residents (D = 19, 95% UI; 14.50, 23.51) and those living in regions such as Nouakchott (R = 2.1, 95% UI; 1.59, 2.56). While education-related disparities decreased, wealth-driven and regional disparities remained constant over the 4 years of the study period. Urban-rural inequalities were constant except with the PAR measure, which showed an increasing pattern. CONCLUSION: A disproportionately lower ANC4+ utilization was observed among women who were poor, uneducated, living in rural areas and regions such as Guidimagha. As a result, policymakers need to design interventions that will enable disadvantaged subpopulations to benefit from ANC4+ utilization to meet the Sustainable Development Goal (SDG) of reducing the maternal mortality ratio (MMR) to 140/100, 000 live births by 2030.

Factors associated with and socioeconomic inequalities in breast and cervical cancer screening among women aged 15-64 years in Botswana.

BACKGROUND: The most commonly diagnosed cancers among women are breast and cervical cancers, with cervical cancer being a relatively bigger problem in low and middle income countries (LMICs) than breast cancer. METHODS: The main aim of this study was to asses factors associated with and socioeconomic inequalities in breast and cervical cancer screening among women aged 15-64 years in Botswana. This study is part of the broad study on Chronic Non-Communicable Diseases in Botswana conducted (NCD survey) in 2016. The NCD survey was conducted across 3 cities and towns, 15 urban villages and 15 rural areas of Botswana. The survey collected information on several NCDs and risk factors including cervical and breast cancer screening. The survey adopted a multistage sampling design and a sample of 1178 participants (males and females) aged 15 years and above was selected in both urban and rural areas of Botswana. For this study, a sub-sample of 813 women aged 15-64 years was selected and included in the analysis. The inequality analysis was conducted using decomposition analysis using ADePT software version 6. Logistic regression models were used to show the association between socioeconomic variables and cervical and breast cancer screening using SPSS version 25. All comparisons were considered statistically significant at 5%. RESULTS: Overall, 6% and 62% of women reported that they were screened for breast and cervical cancer, respectively. Women in the poorest (AOR = 0.16, 95% CI = 0.06-0.45) and poorer (AOR = 0.37, 95% CI = 0.14-0.96) wealth quintiles were less likely to report cervical cancer screening compared to women in the richest wealth quintile. Similarly, for breast cancer, the odds of screening were found to be low among women in the poorest (AOR = 0.39, 95% CI = 0.06-0.68) and the poorer (AOR = 0.45, 95% CI = 0.13-0.81)) wealth quintiles. Concentration indices (CI) showed that cervical (CI = 0.2443) and breast cancer (CI = 0.3975) screening were more concentrated among women with high SES than women with low SES. Wealth status was observed to be the leading contributor to socioeconomic inequality observed for both cervical and breast cancer screening. CONCLUSIONS: Findings in this study indicate the need for concerted efforts to address the health care needs of the poor in order to reduce cervical and breast cancer screening inequalities.

Patterns and determinants of modern contraceptive use and intention to usecontraceptives among Malawian women of reproductive ages (15-49 years).

BACKGROUND: Malawi is one of the countries in SSA with the highest TFR. This study aimed to explore factors associated with modern contraceptive use and intention to use contraceptives among women of reproductive ages (15-49 years) in Malawi. METHODS: The study used secondary data from 2015 to 16 Malawi Demographic and Health Survey (MDHS) dataset. Logistic regression models were used to derive adjusted odd ratios as the measures of association between need, predisposing and enabling factors, and contraceptive use and the intention to use contraceptives among women. The sample constituted 24,562 women who were successfully interviewed during the MDHS. All comparisons are considered statistically significant at 5% level. RESULTS: Overall 54.8% of women were currently using contraceptives, while 69.1% had the intention to use contraceptives. The odds of contraceptive use were significantly low among, women aged 15-19 years, 20-24 years, 25-29 years, 30-34 years, 35-39 years and 40-44 years compared to women aged 45-49 years; women of Tonga ethnic group (OR = O.60, CI = 0.43 0.84) compared to women of Nyanga ethnic group; women from poor households (OR = 0.78, CI = 0.68-0.90) and middle income households (OR = 0.84, CI = 0.74-0.95) compared to women from rich household. Nonetheless, women with no past experience of terminated pregnancy (OR = 1.50, CI = 1.34-1.68) were more likely to use contraceptives compared to women with past experience of terminated pregnancy. Similarly, Women with primary education (OR = 1.56, CI = 1.16-2.09) and secondary education (OR = 1.39, CI = 1.04-1.85) were more likely to use contraceptives compared to women with higher education. While the odds of intending to use contraceptives were significantly high with age only thus among women aged 15-19 years, (OR = 15.18, CI = 5.94-38.77); 20-24 years (OR = 16.77, CI = 7.46-37.71); 25-29 years (OR = 6.75, CI = 3.16-14.45); 30-34 years (OR = 7.75, CI = 3.61-16.65) and 35-39 years (OR = 5.05, CI = 2.29-11.12) compared to women aged 45-49 years. CONCLUSION: As direct policy measure; information, education and communication programmes on family planning among poor and middle income women, and all women in reproductive ages should be strengthened.

Utilization of deworming medication and its associated factors among pregnant married women in 26 sub-Saharan African countries: a multi-country analysis.

BACKGROUND: Deworming is one of the strategies to reduce the burden of anemia among pregnant women. Globally, pregnant women in sub-Saharan Africa are more affected by anemia. Therefore, this study examined both the coverage and demographic, socioeconomic, and women empowerment-related factors associated with the utilization of deworming medication among pregnant married women in sub-Saharan Africa. METHODS: We used data from the most recent Demographic and Health Surveys of 26 countries in sub-Saharan Africa conducted between 2010 and 2019. Using Stata version-14 software, analysis was done on 168,910 pregnant married women. Bivariate and multivariable logistic regression analyses were conducted to examine the factors associated with the utilization of deworming medication. The results were presented using adjusted odds ratios (aORs) at 95% confidence intervals (CIs). RESULTS: The pooled results showed that about 50.7% (95% CI 48.2-53.3%) of pregnant married women in the studied countries took deworming medications, and this varied from as high as 84.1% in Sierra Leone to as low as 2% in Angola. Regarding sub-regional coverage, the highest and lowest coverages were seen in East Africa (67.6%, 95% CI 66.0-69.1%) and West Africa (24.3%, 95% CI 22.4-26.4%) respectively. We found higher odds of utilization of deworming medication among older pregnant married women (aOR=1.93, 95% CI 1.32-2.84), women with educated husbands (aOR=1.40, 95% CI 1.11-1.77), wealthier women (aOR=3.12, 95% CI 1.95-4.99), women exposed to media (aOR=1.46, 95% CI 1.18-1.80), and those who had four or more antenatal care visits (aOR=1.51, 95% CI 1.24-1.83). CONCLUSIONS: Enhancing women's education, disseminating information about maternal healthcare services through mass media, and ensuring that women from economically disadvantaged households benefit from national economic growth can be considered as deworming medication improvement strategies in sub-Saharan Africa. Moreover, providing more attention to adolescents or young pregnant women and increasing the number of antenatal care visits could be considered to increase deworming uptake among pregnant married women.

Urban-rural disparities in wife-beating attitude among married women: a decomposition analysis from the 2017 Senegal Continuous Demographic and Health Survey.

BACKGROUND: Globally, intimate partner violence is one of the most common forms of gender-based violence, and wife beating is one component of intimate partner violence, with the problem being more severe among women living in rural settings. Little is known about the factors that explain the urban-rural disparity in the prevalence of wife beating attitude in Senegal. In this paper, we aimed to decompose the urban-rural disparities in factors associated with wife beating attitude among married women in Senegal. METHODS: Data were derived from the 2017 Senegal Continuous Demographic and Health Survey. We used the Blinder-Oaxaca decomposition method to decompose and explain the variation in the prevalence of disagreement to wife beating between urban and rural areas in Senegal. RESULTS: The results show that 48.9% of married women in Senegal disagreed with wife-beating. About 69% of urban women disagreed with wife beating, but only 36% of rural women disagreed with wife beating. About 68.7% of women in the sample reported that they disagreed to wife beating by their husbands for burning food and nearly 50% of women reported that they disagreed with wife beating when they refuse to have sex with their husbands. About 86% of the urban-rural disparities in disagreement with wife beating are explained in this study. Economic status (45.2%), subnational region (22.4%), women's educational status (13.3%), and husband's educational status (10.7%) accounted for 91.6% of the disparities. CONCLUSIONS: The study shows urban-rural disparities in the prevalence of wife-beating attitude (disagreement with wife beating) and this disfavored rural residents. We suggest the need for the government of Senegal to consider pro-rural equity strategies to narrow down the observed disparities. Moreover, socioeconomic empowerment and attitudinal changing interventions using existing socio-cultural institutions as platforms can be used to deliver such interventions.

Women's empowerment and female genital mutilation intention for daughters in Sierra Leone: a multilevel analysis.

BACKGROUND: Female genital mutilation is common in Sierra Leone. Evidence indicates that empowering women provides protective benefits against female genital mutilation/cutting (FGM/C). Yet, the relationship between women's empowerment and their intention to cut their daughters has not been explored in Sierra Leone. The aim of this study was to assess the association between women's empowerment and their intention to have their daughters undergo FGM/C in the country. METHODS: Data for this study are from the 2013 Sierra Leone Demographic and Health Survey. A total of 7,706 women between the ages of 15 and 49 were included in the analysis. Analysis entailed generation of descriptive statistics (frequencies and percentages), and estimation of multi-level logistic regression models to examine the association between women's empowerment, contextual factors and their intentions to cut their daughters. RESULTS: A significantly higher proportion of women who participated in labour force reported that they intended to cut their daughters compared to those who did not (91.2%, CI = 90.4-91.9 and 86.0%, CI = 84.1-87.8, respectively). Similarly, the proportion intending to cut their daughters was significantly higher among women who accepted wife beating than among those who rejected the practice (94.9%, CI = 93.8-95.8 and 86.4% CI = 84.9-87.8, respectively). A significantly higher proportion of women with low decision-making power intended to cut their daughters compared to those with high decision-making power (91.0%, CI = 89.0-92.8 and 85.0% CI = 82.2-87.4, respectively). Results from multivariate regression analysis showed that the odds of intending to cut daughters were significantly higher among women who participated in labour force (aOR = 2.5, CI = 1.3-4.7) and those who accepted wife beating than among those who did not (aOR = 2.7, CI = 1.7-4.5). In contrast, the likelihood of intending to cut daughters was significantly lower among women with high than low knowledge (aOR = 0.4, CI = 0.3-0.7), and among those aged 45-49  than among those aged 15-19  (aOR = 0.2, CI = 0.0-0.6). CONCLUSION: The findings underscore the need to align anti-FGM/C policies and programmes to women who have undergone FGM/C, those with low knowledge, women who support wife beating and young women. Such interventions could highlight the adverse implications of the practice by stressing the psychological, health and social implications of FGM/C on its survivors.

Socio-Economic and Demographic Correlates of Non-communicable Disease Risk Factors Among Adults in Saudi Arabia.

Background: Over the past two decades, Saudi Arabia has made significant improvements in its population's health standards. These improvements have been coupled with an increase in risk factors related to non-communicable diseases (NCD) and a dramatic shift in the burden of disease profile. This study aims to provide empirical evidence on the socio-economic and demographic correlates of NCD risk factors among adults in Saudi Arabia. Methods: The data used for this study is secondary data derived from the Saudi Health Interview Survey (SHIS) conducted in 2013. The SHIS used a cross-sectional survey design to derive a multistage representative sample of adults to estimate the prevalence of NCD risk factors. Risk factors considered for analyses in this study were; current tobacco use, low fruit and vegetable consumption, low physical activity, overweight/obesity and hypertension. The survey covered all regions in Saudi Arabia using probability proportional to size measures. A total of 10,735 adults aged 15 years and above completed the survey questionnaire. Logistic regression analysis was conducted to examine the socio-economic and demographic correlates of NCD risk factors among adults in Saudi Arabia. Results: The prevalence of NCD risk factors were as follows: current tobacco use, 12.1%; low fruit and vegetable consumption, 87%; low physical activity, 94.9%; overweight/obesity 65.1%; and hypertension, 37.5%. The multivariate analysis results indicate that significant correlates of overweight/obesity and hypertension were being female, a government employee, income level, and education levels. On the other hand, current tobacco use and low fruit and vegetable consumption were generally associated with age, self-employment and being a student. For lifestyle factors, overweight/obesity was high among individuals who reported low fruit and vegetable consumption, while hypertension was high among current tobacco users and overweight/obese adults. All comparisons were statistically significant at p < 0.05. Conclusions: This study's findings indicate a high prevalence of chronic NCD risk factors in Saudi Arabia's adult population. This study implied that there is a need for a reduction in life-damaging behaviors among the adults through the adoption of healthy lifestyles such as physical activity and nutritious diets. Moreover, a reduction in the prevalence of chronic NCD risk factors among different socio-economic groups in Saudi Arabia through healthy lifestyles will have far-reaching results.

Examining barriers to healthcare access and utilization of antenatal care services: evidence from demographic health surveys in sub-Saharan Africa.

BACKGROUND: Antenatal care utilization is one of the means for reducing the high maternal mortality rates in sub-Saharan Africa. This study examined the association between barriers to healthcare access and implementation of the 2016 WHO antenatal care services model among pregnant women seeking antenatal care in selected countries in sub-Saharan Africa. METHODS: This study considered only Demographic and Health Survey data collected in 2018 in sub-Saharan Africa. Hence, the Demographic and Health Survey data of four countries in sub-Saharan Africa (Nigeria, Mali, Guinea and Zambia) were used. A sample of 6761 from Nigeria, 1973 from Mali, 1690 from Guinea and 1570 from Zambia was considered. Antenatal care visits, categorized as < 8 visits or ≥8 visits, and time of the first antenatal care visit, categorized as ≤3 months or > 3 months (as per the WHO recommendations) were the outcome variables for this study. Both descriptive statistics and ordinal logistic regression were used to analyze the data. Crude odds ratios (cOR) and adjusted odds ratios (aOR) and p-values < 0.05 were used for the interpretation of results. RESULTS: With timing of antenatal care visits, getting money needed for treatment (aOR = 1.38, 95% CI = 1.03-1.92) influenced early timing of antenatal care visits in Mali whereas getting permission to visit the health facility (aOR = 1.62, 95% CI = 1.15-2.33) motivated women to have early timing of antenatal care visits in Guinea. We found that women who considered getting money needed for treatment as not a big problem in Nigeria were more likely to have the recommended number of antenatal care visits (aOR = 1.38, 95% CI= 1.11-1.73). On the contrary, in Guinea, Zambia and Mali, getting permission to visit health facilities, getting money for treatment, distance to the health facility and not wanting to go alone were not barriers to having ≥ 8 antenatal care visits. CONCLUSION: Our study has emphasized the role played by barriers to healthcare access in antenatal care utilization across sub-Saharan African countries. There is the need for governmental and non-governmental organizations to ensure that policies geared towards improving the quality of antenatal care and promoting good interaction between health care seekers and health care providers are integrated within the health system.

Breaking Barriers to Healthcare Access: A Multilevel Analysis of Individual- and Community-Level Factors Affecting Women's Access to Healthcare Services in Benin.

Background: In low-income countries such as Benin, most people have poor access to healthcare services. There is scarcity of evidence about barriers to accessing healthcare services in Benin. Therefore, we examined the magnitude of the problem of access to healthcare services and its associated factors. Methods: We utilized data from the 2017-2018 Benin Demographic and Health Survey (n = 15,928). We examined the associations between the demographic and socioeconomic characteristics of women using multilevel logistic regression. The outcome variable for the study was problem of access to healthcare service. Adjusted odds ratios (AORs) with 95% confidence intervals (95% CI) were estimated. Results: Overall, 60.4% of surveyed women had problems in accessing healthcare services. Partner's education (AOR = 0.70; 95% CI; 0.55-0.89), economic status (AOR = 0.59; 95% CI; 0.47-0.73), marital status (AOR = 0.44; 95% CI; 0.39-0.51), and parity (AOR = 1.85; 95% CI; 1.45-2.35) were significant individual-level factors associated with problem of access to healthcare. Region (AOR = 5.24; 95% CI; 3.18-8.64) and community literacy level (AOR = 0.69; 95% CI; 0.51-0.94) were the main community-level risk factors. Conclusions: Enhancing husband education through adult education programs, economic empowerment of women, enhancing national education coverage, and providing priority for unmarried and multipara women need to be considered. Additionally, there is the need to ensure equity-based access to healthcare services across regions.