Life expectations in early adolescence and the timing of first sex and marriage: evidence from a longitudinal survey in Ethiopia.

BACKGROUND: Raising the median age at first sexual intercourse and first marriage among females is a policy goal of the Ethiopian government. Education figures prominently in the government's plans for achieving its goals, including primary and secondary schools; higher education; and out-of-school interventions such as youth centers, peer clubs, and youth associations In this study, we tested whether adolescents and youth who had high educational and occupational expectations at younger ages were at a lower risk of first sexual intercourse and marriage during adolescence and early adulthood. METHODS: Data came from multiple waves of a longitudinal survey of households and adolescents conducted in southwestern Ethiopia. A measure of career expectations was created from educational and occupational expectations measured at baseline when the adolescents were ages 13-17. The occurrence and timing of first sexual intercourse (called first sex) and marriage were measured four years later in a wave 3 survey. Discrete-time logistic hazard regression models were applied to a person-year file to predict first sex for males and females separately and first marriage for females. RESULTS: Male and female adolescents who had high career expectations at young ages were at a significantly lower risk of first sex during adolescence and early adulthood. Unlike the delaying effect of being in school, the effect of high career expectations did not wear off as adolescents aged. Among female adolescents, delaying first sex, staying in school, and having parents who desired them to marry at older ages were all associated with a significantly lower risk of marriage during adolescence and early adulthood. CONCLUSIONS: The educational and occupational expectations and family plans that youth develop early in adolescence influence the timing of the transition into sexual activity and marriage. Ethiopian youth who develop high career expectations delay first sex, which for female youth is a key predictor of age at first marriage. Adolescents' perceptions of parents' expectations for them are strongly associated with their own expectations and behavior.

Raising the median age of their first heterosexual intercourse, or first sex, and marriage for females is a policy goal of the Ethiopian government. Research in Africa has found evidence of a positive association between higher levels of completed schooling and older ages at first sex and marriage among females. A substantial body of research conducted in the United States shows that youth who develop high educational and occupational expectations at young ages also tend to delay first sex and marriage. High expectations motivate youth to stay in school longer and avoid behaviors, such as early sex and marriage, that put their goals at risk. Evidence of a similar association in Ethiopia, however, has been lacking because of the scarcity of longitudinal data. In this study, we used data from the Jimma Longitudinal Family Survey of Youth conducted in southwestern Ethiopia to examine the impact of early career expectations and marriage plans on the risk of first sex during adolescence among male and female youth and on the risk of first marriage during adolescence among females. Using discrete-time logistic hazard regression models, we found that adolescents who had high career expectations at ages 13­17 were significantly less likely to have their first sexual intercourse over the following four years. We also found that the protective effects of being in school on delaying first sex wore off with time, but the effect of high career expectations persisted. Finally, we found that parents' desire for an older age at marriage for their daughters had a significant delaying effect on daughter's marriage.

Obtaining Prevalence Estimates of Coronavirus Disease 2019: A Model to Inform Decision-Making.

We evaluated whether randomly sampling and testing a set number of individuals for coronavirus disease 2019 (COVID-19) while adjusting for misclassification error captures the true prevalence. We also quantified the impact of misclassification error bias on publicly reported case data in Maryland. Using a stratified random sampling approach, 50,000 individuals were selected from a simulated Maryland population to estimate the prevalence of COVID-19. We examined the situation when the true prevalence is low (0.07%-2%), medium (2%-5%), and high (6%-10%). Bayesian models informed by published validity estimates were used to account for misclassification error when estimating COVID-19 prevalence. Adjustment for misclassification error captured the true prevalence 100% of the time, irrespective of the true prevalence level. When adjustment for misclassification error was not done, the results highly varied depending on the population's underlying true prevalence and the type of diagnostic test used. Generally, the prevalence estimates without adjustment for misclassification error worsened as the true prevalence level increased. Adjustment for misclassification error for publicly reported Maryland data led to a minimal but not significant increase in the estimated average daily cases. Random sampling and testing of COVID-19 are needed with adjustment for misclassification error to improve COVID-19 prevalence estimates.

Estimating the association between being seropositive for cysticercosis and the prevalence of epilepsy and severe chronic headaches in 60 villages of rural Burkina Faso.

BACKGROUND: Individuals diagnosed with neurocysticercosis often present with epilepsy and sometimes with progressively worsening severe chronic headaches (WSCH). While cross-sectional associations between seropositivity to cysticercal antigens and epilepsy have been reported, few large scale studies have been conducted in West Africa and none have measured the association between seropositivity to cysticercal antigens and headaches. This study aimed at filling these knowledge gaps by estimating the strength of the cross-sectional association between seropositivity to cysticercal antigens and the prevalence of epilepsy and WSCH in 60 villages of Burkina Faso, West Africa. METHODOLOGY/PRINCIPAL FINDINGS: Baseline data from a cluster randomized controlled trial collected from January 2011 to February 2012 in 60 villages across three provinces in Burkina Faso were used. Between 78 and 80 individuals were screened for epilepsy and WSCH in each village, and those screened positive were confirmed by a physician. Seventy-five percent of all participants were asked to provide a blood sample to test for Taenia solium cysticercus circulating antigens. Hierarchical multivariable logistic models were used to measure the association between seropositivity to cysticercal antigens and epilepsy (lifetime and active) as well as WSCH. Among 3696 individuals who provided a blood sample, 145 were found to have epilepsy only, 140 WSCH only and 19 both. There were positive associations between seropositivity to cysticercal antigens and active epilepsy (prevalence odds ratio (POR): 2.40 (95%CI: 1.15-5.00)) and WSCH (POR: 2.59 (1.34-4.99)). CONCLUSIONS/SIGNIFICANCE: Our study is the first to demonstrate a cross-sectional association between seropositivity to cysticercal antigens and WSCH in a large community-based study conducted in West Africa. The measured cross-sectional association had a strength similar to the ones previously observed between seropositivity to cysticercal antigens and lifetime or active epilepsy. As a result, preventing new cysticercosis cases in communities may reduce the prevalence of these two important neurological disorders.

The impact of imperfect screening tools on measuring the prevalence of epilepsy and headaches in Burkina Faso.

BACKGROUND: Epilepsy and progressively worsening severe chronic headaches (WSCH) are the two most common clinical manifestations of neurocysticercosis, a form of cysticercosis. Most community-based studies in sub-Saharan Africa (SSA) use a two-step approach (questionnaire and confirmation) to estimate the prevalence of these neurological disorders and neurocysticercosis. Few validate the questionnaire in the field or account for the imperfect nature of the screening questionnaire and the fact that only those who screen positive have the opportunity to be confirmed. This study aims to obtain community-based validity estimates of a screening questionnaire, and to assess the impact of verification bias and misclassification error on prevalence estimates of epilepsy and WSCH. METHODOLOGY/PRINCIPAL FINDINGS: Baseline screening questionnaire followed by neurological examination data from a cluster randomized controlled trial collected between February 2011 and January 2012 were used. Bayesian latent-class models were applied to obtain verification bias adjusted validity estimates for the screening questionnaire. These models were also used to compare the adjusted prevalence estimates of epilepsy and WSCH to those directly obtained from the data (i.e. unadjusted prevalence estimates). Different priors were used and their corresponding posterior inference was compared for both WSCH and epilepsy. Screening data were available for 4768 individuals. For epilepsy, posterior estimates for the sensitivity varied with the priors used but remained robust for the specificity, with the highest estimates at 66.1% (95%BCI: 56.4%;75.3%) for sensitivity and 88.9% (88.0%;89.8%) for specificity. For WSCH, the sensitivity and specificity estimates remained robust, with the highest at 59.6% (49.7%;69.1%) and 88.6% (87.6%;89.6%), respectively. The unadjusted prevalence estimates were consistently lower than the adjusted prevalence estimates for both epilepsy and WSCH. CONCLUSIONS/SIGNIFICANCE: This study demonstrates that in some settings, the prevalence of epilepsy and WSCH can be considerably underestimated when using the two-step approach. We provide an analytic solution to obtain more valid prevalence estimates of these neurological disorders, although more community-based validity studies are needed to reduce the uncertainty of the estimates. Valid estimates of these two neurological disorders are essential to obtain accurate burden values for neglected tropical diseases such as neurocysticercosis that manifest as epilepsy or WSCH. TRIAL REGISTRATION: ClinicalTrials.gov NCT03095339.

Effectiveness of a community-based educational programme in reducing the cumulative incidence and prevalence of human Taenia solium cysticercosis in Burkina Faso in 2011-14 (EFECAB): a cluster-randomised controlled trial.

BACKGROUND: The effectiveness of drug-free interventions in controlling human cysticercosis is not well known. We aimed to estimate the effectiveness of a community-based educational intervention in reducing the frequency of human cysticercosis in Burkina Faso. METHODS: We did a cluster-randomised controlled trial between 2011 and 2014. 60 eligible villages from three provinces (Boulkiemdé, Sanguié, and Nayala) were randomly allocated to the intervention or control group. Villages raising pigs, that were not a regional capital or located on a main road, that were more than 20 km from Ouagadougou or 5 km from one another, were eligible. In each village, 60 participants were asked for blood samples at baseline, 18 months later (before randomisation), and 18 months after randomisation. Villages were block randomised (1:1) by pig-raising department immediately after the pre-randomisation visit. The intervention aimed to improve knowledge of Taenia solium transmission and control through screening and structured discussion of a 52-min movie, and to increase community self-efficacy through a Self-esteem, Associative strengths, Resourcefulness, Action planning, Responsibility (SARAR) approach via the Participatory Hygiene and Sanitation Transformation (PHAST) model. The primary outcome was active cysticercosis, defined as the presence of circulating antigens detected by use of B158/B60 ELISA. Effectiveness measured at the village level was estimated by use of three Bayesian hierarchical models. This study is registered with ClinicalTrials.gov, number NCT0309339. FINDINGS: Two villages in the same randomisation block were excluded, resulting in a final sample size of 58 villages. Overall, the intervention tended towards a decrease in the cumulative incidence of active cysticercosis from baseline to after randomisation (adjusted cumulative incidence ratio 0·65, 95% Bayesian credible interval [95% CrI] 0·39-1·05) and a decrease in active cysticercosis prevalence from baseline to after randomisation (adjusted prevalence proportion ratio 0·84; 95% CrI 0·59-1·18). The intervention was shown to be effective in Nayala and Sanguié but not in Boulkiemdé. INTERPRETATION: Community-engaged participatory interventions can be effective at reducing the incidence and prevalence of cysticercosis in some low-resource settings. FUNDING: US National Institutes of Health (National Institute of Neurological Disorders and Stroke, Fogarty International Center, and National Institute of General Medical Sciences).

Nasopharyngeal Pneumococcal Serotypes Before and After Mass Azithromycin Distributions for Trachoma.

Twenty-four Ethiopian communities were randomized to receive either (1) quarterly mass azithromycin distributions for trachoma for 1 year or (2) delayed treatment. Nasopharyngeal swabs collected from separate cross-sectional population-based samples of children were processed for Streptococcus pneumoniae Mass azithromycin did not significantly alter the pneumococcal serotype distribution, and hence it would not be expected to alter vaccine coverage.

Prevalence of and Factors Associated with Human Cysticercosis in 60 Villages in Three Provinces of Burkina Faso.

BACKGROUND: Taenia solium, a zoonotic infection transmitted between humans and pigs, is considered an emerging infection in Sub-Saharan Africa, yet individual and community-level factors associated with the human infection with the larval stages (cysticercosis) are not well understood. This study aims to estimate the magnitude of association of individual-level and village-level factors with current human cysticercosis in 60 villages located in three Provinces of Burkina Faso. METHODOLOGY/PRINCIPAL FINDINGS: Baseline cross-sectional data collected between February 2011 and January 2012 from a large community randomized-control trial were used. A total of 3609 individuals provided serum samples to assess current infection with cysticercosis. The association between individual and village-level factors and the prevalence of current infection with cysticercosis was estimated using Bayesian hierarchical logistic models. Diffuse priors were used for all regression coefficients. The prevalence of current cysticercosis varied across provinces and villages ranging from 0% to 11.5%. The results obtained suggest that increased age, being male and consuming pork as well as a larger proportion of roaming pigs and percentage of sand in the soil measured at the village level were associated with higher prevalences of infection. Furthermore, consuming pork at another village market had the highest increased prevalence odds of current infection. Having access to a latrine, living in a household with higher wealth quintiles and a higher soil pH measured at the village level decreased the prevalence odds of cysticercosis. CONCLUSIONS/SIGNIFICANCE: This is the first large-scale study to examine the association between variables measured at the individual-, household-, and village-level and the prevalence odds of cysticercosis in humans. Factors linked to people, pigs, and the environment were of importance, which further supports the need for a One Health approach to control cysticercosis infection.

HIV status, knowledge of mother-to-child transmission of HIV and antenatal care use among Ethiopian women.

OBJECTIVE: To determine whether HIV status and knowledge of mother-to-child-transmission (MTCT) of HIV are associated with antenatal care (ANC) use. METHODS: Data were obtained from the 2011 Ethiopia Demographic and Health Survey among women aged 15-49years who agreed to HIV testing and who reported giving birth in the preceding five years. The two exposures of interest were HIV status and knowledge of MTCT. Unadjusted and adjusted prevalence ratios for ANC use were estimated by fitting modified Poisson regression models. RESULTS: Among the 7392 women in the sample, ANC use was lowest among HIV-negative, low MTCT knowledge women (31.6% [95% confidence interval: 28.1-35.1]), and highest among HIV-positive, high knowledge women (81.9% [69.8-94.0%]). ANC use was significantly higher among HIV-positive, high knowledge (adjusted prevalence ratio [APR]=1.60 [1.32-1.94]) and HIV-negative, high knowledge women (1.37 [1.24-1.51]) compared with HIV-negative, low knowledge women. There was no statistically significant difference in ANC use by HIV status among low knowledge women (1.26 [0.71-2.25]). CONCLUSIONS: HIV-positive women generally had better MTCT knowledge. Among HIV-negative women, the prevalence of ANC use was greater among women with higher knowledge. Increasing MTCT knowledge may facilitate ANC use and in turn may eliminate MTCT.