Tobacco use in Haiti: findings from demographic and health survey.

INTRODUCTION: Although tobacco has harmful effects on the physical and mental health of individuals, its use remains significant, according to the World Health Organization. To understand this phenomenon, studies have been carried out in many countries around the world, while in Haiti where more than 5,000 people die each year due to tobacco use, little is known about the use of this substance. The aim of this study was to examine the prevalence and the factors associated with tobacco use in Haiti. METHODS: We used data from the 2016/17 Haitian Demographic Health Survey. Both descriptive and multivariate analyses were conducted using STATA 16.0 software to assess the prevalence and identify factors associated with tobacco use. Results were reported as adjusted odds ratios with 95% confidence intervals. Statistical significance was declared at p < 0.05. RESULTS: The prevalence of tobacco use was estimated at 9.8% (95% CI: 9.2-10.4) among men and 1.7% (95% CI: 1.5-1.9) among women. Although the prevalence of tobacco use was low among young people, it increased with age. Respondents aged 35 and above, with no formal education, non-Christians, divorced/separated/widowed, from poorest households, rural areas, "Aire Métropolitaine de Port-au-Prince" region, with high media exposure had a higher likelihood of tobacco use. CONCLUSION: The low prevalence of tobacco use among Haitian women and youth represents a public policy opportunity to prevent these vulnerable groups from starting smoking. Adult male smokers should also be targeted by appropriate policy to reduce the different health burdens associated with tobacco, both for the smokers and other people they may expose to passive smoking. Government and health sector stakeholders, along with community leaders, should create and enforce awareness strategies and rules to control advertisements that encourage irresponsible and health-risky consumption behaviors.

Individual and community-level factors associated with caesarean section in Haiti: secondary analysis of data from the 2016-2017 Haitian Demographic and Health Survey.

INTRODUCTION: For several decades, the rate of caesarean section (CS) has been increasing in the world. In some countries, the CS rate is below the WHO recommended range (10-15%), while in other countries, it is significantly higher. The aim of this paper was to identify individual and community-level factors associated with CS in Haiti. METHODS: Secondary data analysis was conducted on nationally representative cross-sectional survey data from the 2016-2017 Haitian Demographic and Health Survey (HDHS). The analysis was restricted to 6303 children born in 5 years prior the survey (of the interviewed women). The study population' characteristics, and the prevalence of CS were analysed using descriptive analysis (univariate/bivariate). In addition, multilevel binary logistic regression analysis was performed to identify factors associated with CS. Both descriptive and multivariate analysis were conducted using STATA 16.0 software (Stata Corp, Tex, USA). Statistical significance was declared at p < 0.05. RESULTS: The overall prevalence of CS delivery was estimated at 5.4% (95% CI 4.8-6.0) in Haiti. Results also revealed that mothers aged 35 and above (aOR = 1.38; 95% CI 1.00-1.96); who attended secondary (aOR = 1.95; 95% CI 1.39-2.76) and higher education level (aOR = 3.25; 95% CI 1.92-5.49); who were covered by health insurance (aOR = 2.57; 95% CI 1.57-4.19); with less than 3 children (aOR = 4.13; 95% CI 2.18-7.85) or 3-4 children (aOR = 2.07; 95% CI 1.09-3.94); who received 9 or more antenatal visits (aOR = 2.21; 95% CI 1.40-3.50) were significantly more likely to deliver by CS. Children in communities with high preponderance of private health facilities had greater odds to be delivered through CS (aOR = 1.90; 95% CI 1.25-2.85). Furthermore, children with an average birth weight (aOR = 0.66; 95% CI 0.48-0.91) were less likely to be delivered through CS than their counterparts with high birth weight. CONCLUSIONS: While the CS prevalence was low in Haiti, it masks significant geographic, social and economic disparities. To better develop and implement maternal and child health programs that address CS deliveries, the government authorities and NGOs operating in the field of women's health in Haiti should take these disparities into account.

Inequalities in anemia among Peruvian children aged 6-59 months: A decomposition analysis.

Objective: To quantify the inequalities of anemia in Peruvian children aged 6-59 months and uncover its contributing factors. Materials and methods: We conducted a cross-sectional study based on the secondary data analysis of the 2021 Peruvian Demographic and Health Survey (DHS). Our sample included Peruvian children aged 6-59 months with complete data for the variables of interest. Anemia was defined as having a hemoglobin level of less than 11 g/dL, adjusted by altitude. Erreygers Concentration Index (ECI) and concentration curves were computed to estimate the socio-economic inequality in anemia among Peruvian children. Moreover, ECI was decomposed to figure out the contributing factors to the inequality of anemia and the residual variation. Results: Nationwide, the prevalence of anemia in Peruvian children was 29.47%. We found a pro-poor inequality regarding anemia at the national level (ECI = -0.1848). The determinants included in the model explained 81.85% of the overall socio-economic inequality in anemia. The largest contribution to inequality was from household- and community-related factors. Having a higher mother's education level (26.26%) and being from the highlands (24.91%) were the major significant contributors to the overall health inequality. Conclusion: Almost one-third of Peruvian children have anemia. A pro-poor inequality of anemia in Peruvian children was found. Public policies ought to address the major contributing factors of anemia inequality.

Knowledge of the ovulatory cycle and its determinants among women of childbearing age in Haiti: a population-based study using the 2016/2017 Haitian Demographic Health Survey.

BACKGROUND: The knowledge of ovulatory cycle (KOC) is the base for natural family planning methods, yet few studies have paid attention to women's KOC. This study aimed to assess the prevalence of correct KOC and its determinants among women of childbearing age in Haiti. METHODS: Data from the nationally representative cross-sectional Haiti Demographic and Health Survey 2016/17 were used. STATA/SE version 14 was employed to analyse the data by computing descriptive statistics, Chi­square, and binary logistic regression model to assess the socio-economic and demographic predictors of correct KOC. P-value less than 0.05 was taken as a significant association. RESULTS: Out of 14,371 women of childbearing age who constituted our sample study, 24.1% (95% CI 23.4-24.8) had correct KOC. In addition, the findings showed that place of residence, respondent's education level, wealth index, currently working, husband/partner's education level, contraceptive use, exposure to mass media FP messages, and fieldworker visit were significantly associated with correct KOC. CONCLUSION: Policies should include increasing the literacy at community level as well as of individual women and their partners. Moreover, increasing awareness about family planning should be prioritized, especially for women from poor households and rural areas.

Association Between Intimate Partner Violence and Depressive Symptoms among Women Aged 15 to 45 Years in Peru: A Three-Year Analysis of the Demographic and Health Survey.

We conducted a secondary data analysis based on the 2014, 2015, and 2016 Demographic and Health Surveys to determine the association between intimate partner violence (IPV) and depressive symptoms in Peruvian women aged 15-45 years. Depressive symptoms were assessed through the PHQ-9, while IPV was assessed through the CTS-2. A total of 24,099 subjects were included. The prevalence of depressive symptoms and IPV was 6.98% and 64.72%, respectively. Victims of IPV were 2.47 times more likely to have depressive symptoms compared to those who were never assaulted. In conclusion, there is a strong association between IPV and depressive symptoms.

Missed opportunities for vaccination in Peru 2010-2020: A study of socioeconomic inequalities.

Background: Missed Opportunities for Vaccination (MOV) represent a major risk in the re-emergence of immunopreventable diseases. However, in the region, there are few published studies on MOVs using national databases such as demographic and health surveys (DHS). This study aims to describe the frequency and trends of MOVs for the first dose of vaccines against the leading causes of infant morbidity and mortality, their complete vaccination coverage, and trends in socioeconomic inequalities at the national and departmental levels for an 11-years period. Methods: Using DHS data from an 11-year period (2010-2020), we calculated frequencies and trends in MOVs of vaccines for the leading causes of child morbidity and mortality, estimated inequalities in MOVs using the Slope Inequality Index (SII) and conducted a spatial autocorrelation test to identify clusters of higher or lower inequality in MOVs at the national level. Findings: We found that, at the national level, greater inequality was concentrated in the wealthiest categories of each socioeconomic variable. We identified that departments with higher poverty rates concentrated higher levels of inequality in the MOVs in the lowest strata of the socioeconomic variables. In addition, we found that some departments with similar geographic and socioeconomic characteristics had spatially correlated levels of inequality on MOVs. Interpretation: These findings can help to identify the heterogeneity that exists in the distribution of MOVs among departments and socioeconomic strata, which would help to prioritize specific areas and subpopulations for national immunization strategies. Funding: No additional funding source was required for this study.

Media Use and Men's Approval of Intimate Partner Violence in Honduras.

Intimate partner violence (IPV) is a widespread issue that affects millions of individuals each year. Prior research suggests that IPV approval is associated with an increased likelihood of IPV perpetration. However, scant research has examined predictors of IPV approval, and even less has examined the predictors of IPV approval in Latin America. Social cognitive theory describes the acquisition of ideas, values, attitudes, and behaviors through social observation, including through media. This study uses social cognitive theory to examine the effects of media use on men's approval of IPV in Honduras, while controlling for demographic variables and IPV risk factors. We hypothesized that greater engagement with media (via television, radio, and newspapers or magazines) would be associated with decreases in the approval of IPV. Using ordinal logistic regression, we analyzed data from the Men's Survey Module of the 2011-2012 Honduras Demographic and Health Survey. The final sample included 4,760 currently partnered men. Results suggest that listening to the radio one or more times per week was associated with greater IPV approval, while newspaper/magazine and television use were not significantly associated with IPV approval. Education, marital status, increased age at first cohabitation, and having a female partner or someone else making decisions about earnings were all protective against IPV approval. Further investigation into the content of Honduran radio and other media is called for in order to inform interventions to reduce acceptance of IPV.

Facility readiness and counseling during antenatal care and the relationship with early breastfeeding in Haiti and Malawi.

BACKGROUND: Early initiation of breastfeeding (within an hour of birth) has benefits for newborn health and survival. Optimal breastfeeding supports growth, health, and development. Health facilities provide essential pregnancy, maternal, and newborn care and offer support for early breastfeeding. We examined the relationship between the breastfeeding-related health service environment during antenatal care (ANC) and early initiation of breastfeeding. METHODS: Using data from recent Service Provision Assessment (SPA) surveys in Haiti and Malawi, we defined three indicators of the health service environment: availability of facilities with ANC services reporting routine breastfeeding counseling; provider training on breastfeeding; and breastfeeding counseling during ANC. We linked SPA data geographically to Demographic and Health Surveys (DHS) data from Haiti and Malawi. Multilevel, multivariable logistic regressions examined associations between the health service environment and early initiation of breastfeeding, controlling for women's background characteristics, with separate analyses for urban and rural residence. RESULTS: Over 95% of facilities in Haiti and Malawi reported routinely providing breastfeeding counseling during ANC. Only 40% of both urban and rural providers in Malawi and 29 and 26% of providers at urban and rural facilities in Haiti (respectively) received recent training in counseling on breastfeeding. Further, only 4-10% of clients received counseling. Breastfeeding counseling was generally more common among clients who attended ANC with a provider who had received recent training. After linking SPA and DHS data, our analysis showed that having more providers recently trained on breastfeeding was significantly associated with increased odds of early breastfeeding among women in urban areas of Haiti and Malawi. Additionally, women in urban areas of Malawi lived near facilities with more counseling during ANC were more likely to begin breastfeeding within an hour of birth compared with women in areas with less counseling. CONCLUSIONS: Our study identified gaps in the health system's capacity to implement the recommended global guidelines in support of optimal breastfeeding practices. While breastfeeding counseling during ANC can promote early breastfeeding, counseling was not common. The study provides evidence that provider training could help improve counseling and support for early initiation of breastfeeding.

Ex post adjustment for measurement error in stunting calculations: an illustration from Egypt.

OBJECTIVE: The present study provides ranges for the magnitude of bias caused by measurement error in stunting rates, a widely used a proxy for long-term nutritional status. DESIGN: Stunting, which is determined by the number of cases that fall below -2 sd from the mean height-for-age in the population, mechanically increases with higher variance. This variance stems from both natural heterogeneity in the population and measurement error. To isolate the effect of measurement error, we model the true distributions which could give rise to the observed distributions after subtracting a simulated measurement error. SETTING: We analyse information from three rounds of the Demographic and Health Survey (DHS) in Egypt (2005, 2008 and 2014). Egypt ranks high among developing countries with low-quality anthropometric data collected in the DHS, currently the main source of anthropometry in the country. PARTICIPANTS: The study relies on re-analysis of existing DHS data, which record height, weight and age data for children under 5 years old. RESULTS: Under the most conservative assumptions about measurement error, the stunting rate falls by 4 percentage points for the most recent DHS round, while assuming higher levels of measurement error reduces the stunting rate more dramatically. CONCLUSIONS: Researchers should be aware of and adjust for data quality concerns in calculating stunting rates for cross-survey comparisons or in communicating to policy makers.

Long-Term Trends in Reproductive Behavior Among Young Women in Four Countries, 1995-2009.

PURPOSE: Identification of trends in the ability of young single women to protect themselves from unwelcome pregnancy is essential for evaluation and development of policies and programs. We document trends over a 15-year period in sexual activity, contraceptive use, and reproductive outcomes in four countries for single women aged 15-24 years. METHODS: Using retrospective month-by-month reproductive and contraceptive calendars, we constructed annual sexual, contraceptive, and reproductive profiles. The analysis was applied to all four countries (Colombia, Kenya, Peru, and Zimbabwe) that had collected complete reproductive calendars in three consecutive Demographic and Health Surveys. Women-years were classified as sexually inexperienced (i.e., virgin), sexually experienced but using contraception, and sexually experienced without contraception. Conception rates were calculated and those ending in live births were classified as wanted or unwanted. RESULTS: While virginity decreased over time in the Latin American countries, it increased in the African settings. The contribution of condom to the sexually active time protected by contraception use increased in all countries. While the percentage of conceptions ending in spontaneous or induced abortion increased in Colombia and Peru to around 15% of the total pregnancy outcomes, it decreased in the African countries to less than 6%. CONCLUSIONS: Delayed sexual debut remains the major restraint on pregnancy in these four countries with the result that conception rates are very low. Condoms remain the most common method of contraception even in the two countries without severe HIV risks and efforts to displace condoms by nonbarrier methods should be pursued with caution.

Caesarean delivery and anaemia risk in children in 45 low- and middle-income countries.

Caesarean delivery (CD) may reduce placental transfusion and cause poor iron-related haematological indices in the neonate. We aimed to explore the association between CD and anaemia in children aged <5 years utilising data from Demographic and Health Surveys conducted between 2005 and 2015 in 45 low- and middle-income countries (N = 132,877). We defined anaemia categories based on haemoglobin levels, analysed each country's data separately using propensity-score weighting, pooled the country-specific odds ratios (ORs) using random effects meta-analysis, and performed meta-regression to determine whether the association between CD and anaemia varies by national CD rate, anaemia prevalence, and gross national income. Individual-level CD was not associated with any anaemia (OR 0.95, 95% confidence interval (CI) [0.86, 1.06]; I2  = 40.2%), mild anaemia (OR 0.91, 95% CI [0.81, 1.02]; I2  = 24.8%), and moderate/severe anaemia (OR 0.97, 95% CI [0.85, 1.11]; I2  = 47.7%). CD tended to be positively associated with moderate/severe anaemia in upper middle-income countries and negatively associated with mild anaemia in lower middle-income countries; however, meta-regression did not detect any variation in the association between anaemia and CD by the level of income, CD rate, and anaemia prevalence. In conclusion, there was no evidence for an association between CD and anaemia in children younger than 5 years in low- and middle-income countries. Our conclusions were consistent when we looked at only countries with CD rate >15% with data stratified by individual-level wealth status and type of health facility of birth.

Health Outcomes for Children in Haiti Since the 2010 Earthquake: A Systematic Review.

BACKGROUND: Haiti remains the poorest country in the Americas and one of the poorest in the world. Children in Haiti face many health concerns, some of which were exacerbated by the 2010 earthquake. This systematic review summarizes published research conducted since the 2010 earthquake, focusing on health outcomes for children in Haiti, including physical, psychological, and socioeconomic well-being. METHODS: A literature search was conducted identifying articles published from January 2010 through May 2016 related to pediatric health outcomes in Haiti. Two reviewers screened articles independently. Included research articles described at least one physical health, psychological health, or socioeconomic outcome among children less than 18 years of age in Haiti since the January 2010 earthquake. RESULTS: Fifty-eight full-length research articles were reviewed, covering infectious diseases (non-cholera [N=12] and cholera [N=7]), nutrition (N=11), traumatic injuries (N=11), mental health (N=9), anemia (N=4), abuse and violence (N=5), and other topics (N=3). Many children were injured in the 2010 earthquake, and care of their injuries is described in the literature. Infectious diseases were a significant cause of morbidity and mortality among children following the earthquake, with cholera being one of the most important etiologies. The literature also revealed that large numbers of children in Haiti have significant symptoms of posttraumatic stress disorder (PTSD), peri-traumatic stress, depression, and anxiety, and that food insecurity and malnutrition continue to be important issues. CONCLUSIONS: Future health programs in Haiti should focus on provision of clean water, sanitation, and other measures to prevent infectious diseases. Mental health programming and services for children also appear to be greatly needed, and food insecurity/malnutrition must be addressed if children are to lead healthy, productive lives. Given the burden of injury after the 2010 earthquake, further research on long-term disabilities among children in Haiti is needed. Dube A , Moffatt M , Davison C , Bartels S . Health outcomes for children in Haiti since the 2010 earthquake: a systematic review. Prehosp Disaster Med. 2018;33(1):77-88.