Associations between lifetime pregnancy and sexual risk behaviors among 15-24-year-old adolescent girls and young women in South Africa: Secondary analyses of the 2016 Demographic Health Survey.

Adolescent girls and young women (AGYW) in South Africa are highly vulnerable to HIV and poor sexual and reproductive health (SRH) outcomes. Interventions must respond to the unique needs of different AGYW groups, such as AGYW who have ever been pregnant. The objective of the study is to examine associations between pregnancy and sexual risk behaviors among AGYW in South Africa. This study used the 2016 nationally representative Demographic and Health Survey (DHS) of South Africa (n = 1935, 15-24 years old). Sexual risk behavior outcomes included: early sexual debut (defined as having sexual intercourse before the age of 15 years), age-disparate relationship (defined as having sexual partners who are five years and older in the past one month), multiple sexual partnerships, no condom use at last sex, and lastly, cumulative sexual risk (defined as reporting at least two of the outcomes: early sexual debut, age-disparate relationship, multiple sexual partners, and no condom use at last sex). Data analyses were conducted using logistic regression in STATA version 16. Statistical significance was determined at a P-value less than 0.05, with 95% confidence interval reported. AGYW who experienced lifetime pregnancy were more likely to report early sexual debut (OR = 1.71, 95%CI = 1.30-2.32), age-disparate relationships (OR = 1.58, 95%CI = 1.20-2.08), no condom use at last sex (OR = 2.77, 95%CI = 2.09-3.69), and cumulative sexual risk (OR = 1.82, 95%CI = 1.38-2.41). Multiple sexual partnerships showed no significant associations with lifetime pregnancy. Married or cohabiting AGYW were more likely to report cumulative sexual risk behaviors. (OR = 2.67, 95%CI = 1.91-3.71). Cumulative sexual risk behaviors were lower among AGYW with secondary education (OR = 0.57, 95%CI = 0.33-0.99) and those from rich households (OR = 0.62, 95%CI = 0.43-0.88). The findings underscore the need for interventions promoting safe sex and relationships, especially among AGYW who have experienced pregnancy. Programming should address the structural, socio-economic drivers of early pregnancy.

Decomposing the rural-urban disparities in overweight and obesity among women of reproductive age in Nigeria.

BACKGROUND: Overweight and obese women face various reproductive and other health challenges, and in some cases, even mortality. Despite evidence of rural-urban disparities in overweight and obesity among women of reproductive age, there is limited evidence regarding the predictors of these disparities. This study aims to investigate the factors associated with overweight and obesity and examine the contributors to rural-urban disparities in overweight and obesity among women of reproductive age in Nigeria. METHODS: We utilized the 2018 Nigeria Demographic and Health Survey dataset. The survey employed a two-stage cluster sampling technique based on Nigeria's 2006 census enumeration areas for sample selection. Overweight and obesity were defined as a body mass index (BMI) ≥ 25. Data analyses were conducted using the Logistic Regression Model and the threefold Blinder-Oaxaca decomposition model (α0.05). RESULTS: The study revealed that older women (OR = 2.44; CI = 2.11-2.83), those with higher wealth (OR = 2.05; CI = 1.81-2.31), contraceptive users (OR = 1.41; CI = 1.27-1.57), and residents of the South-South region (OR = 1.24; CI = 1.07-1.45) were more likely to be overweight/obese. The decomposition analysis indicated that the mean predicted prevalence of overweight and obesity is 35.5% in urban areas, compared to 21.1% in rural areas of Nigeria. Factors such as wealth status, educational level, media exposure, and contraceptive use were identified as significant contributors to these disparities. CONCLUSION: The findings underscore the importance of addressing socioeconomic disparities when designing healthcare interventions to reduce the burden of overweight and obesity, particularly in urban areas. Prioritizing these factors can facilitate efforts to promote healthier lifestyles and enhance overall well-being.

Measuring under-5 mortality and fertility through mobile phone surveys: an assessment of selection bias in 34 low-income and middle-income countries.

OBJECTIVES: This study aims to assess sample selection bias in mobile phone survey estimates of fertility and under-5 mortality. DESIGN: With data from the Demographic and Health Surveys, we use logistic regressions to identify sociodemographic correlates of mobile phone ownership and access, and Poisson regressions to estimate the association between mobile phone ownership (or access) and fertility and under-5 mortality estimates. We evaluate the potential reasons why estimates by mobile phone ownership differ using a set of behavioural characteristics. SETTING: 34 low-income and middle-income countries, mostly in sub-Saharan Africa. PARTICIPANTS: 534 536 women between the ages of 15 and 49. OUTCOME MEASURES: Under-5 mortality rate (U5MR) and total fertility rate (TFR). RESULTS: Mobile phone ownership ranges from 23.6% in Burundi to 96.7% in Armenia. The median TFR ratio and U5MR ratio between the non-owners and the owners of a mobile phone are 1.48 and 1.29, respectively. Fertility and mortality rates would be biased downwards if estimates are only based on women who own or have access to mobile phones. Estimates of U5MR can be adjusted through poststratification using age, educational level, area of residence, wealth and marital status as weights. However, estimates of TFR remain biased even after adjusting for these covariates. This difference is associated with behavioural factors (eg, contraceptive use) that are not captured by the poststratification variables, but for which there are also differences between mobile phone owners and non-owners. CONCLUSIONS: Mobile phone surveys need to collect data on sociodemographic background characteristics to be able to weight and adjust mortality estimates ex post facto. Fertility estimates from mobile phone surveys will be biased unless further research uncovers the mechanisms driving the bias.

Socio-demographic correlates and trends in the timing of the onset of parenthood among women of reproductive age in Ghana: evidence from three waves of the demographic and health surveys.

BACKGROUND: Childbearing is one of the central events in a woman's life and the age at which this event occurs has important health, socioeconomic and fertility implications for her.   Methods: We used three waves of the Ghana Demographic and Health Surveys (GDHS) from the individual files of married women aged 15 to 49 years old to explore the trends in the timing of the onset of parenthood among women in Ghana. The Cox proportional hazard model was used to assess the effect of socio-demographic factors on the birth experience of women.   Results: Results showed the median age of the women increases from 17 years in 1998 to 19 years in 2014. Further, results showed that women with secondary education had 0.67, 0.89- and 0.77-times lower hazard risk of early birth than women without any formal education in 1988, 1998, and 2014 respectively. The hazard risk of early childbirth consistently decreased as age increased in all the years of surveys except in the case of the age group 40-44 in 1988, 1998 and 2014.   Conclusions: This study showed that the timing of first childbirth is changing in the direction of a late childbirth regime in Ghana and could facilitate improvement on individual health, job stability and higher level of education. Efforts should be channeled to sensitizing women on the importance of delaying childbearing.

Chasing the Youth Dividend in Nigeria, Malawi and South Africa: What Is the Role of Poverty in Determining the Health and Health Seeking Behaviour of Young Women?

Africa's new source of hope lies in harnessing Demographic Dividend, which may create a window of economic opportunity as fertility levels decrease if the correct policies and programmes are put in place. It has been shown that the health status of young people should be optimal for the realisation of the demographic dividend. This study examined the association between poverty and the health status and health seeking behaviour of young women (15-25), using the Demographic Health surveys of Nigeria 2013, Malawi 2015-2016, and South Africa 2015-2016. Interest variables were household and community-levels of poverty, while the outcomes were pregnancy and HIV testing and health services seeking. Results showed that in Malawi only household poverty was associated with a higher likelihood of pregnancy, while in South Africa household- and community-levels of poverty were associated with a higher likelihood of pregnancy. In Nigeria, household- and community-levels of poverty were not significantly linked to pregnancy but were associated with a lower likelihood of HIV testing and health seeking behaviour. The study shows empirical evidence of the construction of negative health outcomes in poor households and communities in Nigeria, Malawi, and South Africa. Therefore, if the demographic dividend is to be a reality in the near future, it is imperative to ensure that poverty-alleviation urgently occurs.

Induced abortion in Ghana: prevalence and associated factors.

The termination of unwanted pregnancies is a growing health-related issue around the world. This study used the 2017 Ghana Maternal Health Survey to examine the factors associated with the prevalence of induced abortion in Ghana. The study sample included 18,116 women of reproductive age who had a pregnancy in the 5 years preceding the survey. A multivariate logistic regression technique was applied. The prevalence of induced abortion was higher among women aged 25-34 years, those who had secondary-level education, those living in urban areas and in the Ashanti region, those of Akan ethnicity and those belonging to non-Catholic Christian denominations. Moreover, the prevalence was higher among single women, those who had no children, those who started sexual intercourse before the age of 18, those who were currently using a contraceptive, those exposed to media and those who knew about the legality of abortion. The multivariate analysis found that education, place and region of residence, marital status, ethnicity, current contraceptive use, religion, age at sexual debut, media exposure and knowledge about abortion legality were all significant predictors of induced abortion among women in Ghana. The study findings support a call for action to strengthen family planning services and educational programmes on induced abortion in Ghana to reach the target groups identified.

Association between type of birth attendants and neonatal mortality: Evidence from a National survey.

Background: Although Lesotho has one of the highest childhood mortality levels in Southern Africa, there has been limited research on the link between type of birth attendant and neonatal mortality in Lesotho. This study examined the relationship between type of birth attendant and neonatal mortality while controlling for socio-demographic characteristics of mothers in Lesotho. Methods: The study used data from the children's file of 2014 Lesotho Demographic and Health Survey data. Kaplan-Meier method was used to estimate neonatal mortality rate and Cox proportional hazard regression model was used to assess the association between type of birth attendant and neonatal mortality. Results: Result shows that 5.3% of all births attended to by non-SBAs resulted into neonatal mortality compared to 2.8% of those attended to by SBA. Result further shows that regardless of socio-demographic characteristics, the risks of neonatal mortality were significantly higher with non-SBAs compared to SBA in Lesotho (HR: 2.00, CI: 1.31-3.06). Conclusion: The risk of neonatal mortality is two times higher among children delivered by Non-SBA. Scale-up in access and uptake of SBA is recommended in Lesotho. Thus, Policy on scale-up access to SBA at delivery at no costs need to be put in place.

Socio-demographic changes in age at first marriage in Malawi: evidence from Malawi Demographic and Health Survey data, 1992-2016.

This study aimed to identify the social and demographic correlates of the trend in age at first marriage among women in Malawi, using Malawi Demographic and Health Survey data collected between 1992 and 2016. Employing Cox Proportional Hazard modelling, the results showed that the mean age at first marriage during the 18-year period remained constant at 17.4 years. Furthermore, across all the surveys, younger women married at an early age compared with their older counterparts. The results further showed that having no education, residing in the Northern region, working, belonging to the middle and rich wealth index categories, and belonging to Tumbuka, Lomwe, Yao, Ngoni and Amanganja/Anyanja ethnicities increased the risk of early marriage. The findings suggest that policies such as promoting access to education for women and enforcing the law that restricts the legal age at which a woman can marry (18 years) should be maintained and enforced in Malawi.