Sociodemographic factors underlying lifetime fertility among ever-married Swazi women.

Fertility rates remain high in certain subgroups of the population, and there is limited research about the sociodemographic factors influencing fertility, particularly in Eswatini where women are often considered minors. This study aims to investigate the changes in lifetime fertility, and the associations between sociodemographic factors and lifetime fertility among ever-married women. The study used secondary cross-sectional data from the 2010 and 2014 Eswatini Multiple Indicator Cluster Surveys (MICS), with a sample size of 2,295 and 2,351 women, respectively. The data was analysed using descriptive statistics and multivariable Poisson regression. The results showed that fertility rates decreased from 3.47 to 3.21 children between 2010 and 2014. The study found that child loss and age (25+ years) were significant factors associated with higher fertility, while delayed age at marriage and sexual debut (20+ years), at least secondary education, and being rich were strong predictors of lower fertility rates. The study recommends creating awareness about and strengthening laws to abolish early sexual debut and marriage. It also suggests empowering women through education, encouraging the use of contraceptives, and providing maternal and child health services in rural areas where fertility rates tend to be higher.

Les taux de fécondité restent élevés dans certains sous-groupes de la population, et les recherches sur les facteurs sociodémographiques influençant la fécondité sont limitées, en particulier à Eswatini où les femmes sont souvent considérées comme mineures. Cette étude vise à étudier les changements dans la fécondité au cours de la vie et les associations entre les facteurs sociodémographiques et la fécondité au cours de la vie chez les femmes déjà mariées. L'étude a utilisé des données transversales secondaires des enquêtes par grappes à indicateurs multiples (MICS) d'Eswatini de 2010 et 2014, avec un échantillon de 2 295 et 2 351 femmes, respectivement. Les données ont été analysées à l'aide de statistiques descriptives et d'une régression de Poisson multivariée. Les résultats ont montré que les taux de fécondité ont diminué de 3,47 à 3,21 enfants entre 2010 et 2014. L'étude a révélé que la perte d'enfants et l'âge (25 ans et plus) étaient des facteurs importants associés à une fécondité plus élevée, tandis qu'un âge plus tardif au mariage et aux débuts sexuels (20 ans et plus) ), au moins une éducation secondaire, et le fait d'être riche étaient de puissants prédicteurs de taux de fécondité plus faibles. L'étude recommande de sensibiliser et de renforcer les lois visant à abolir les premiers rapports sexuels et le mariage précoces. Il suggère également d'autonomiser les femmes grâce à l'éducation, d'encourager l'utilisation de contraceptifs et de fournir des services de santé maternelle et infantile dans les zones rurales où les taux de fécondité ont tendance à être plus élevés.

Women's socioeconomic status and attitudes toward intimate partner violence in Eswatini: A multilevel analysis.

INTRODUCTION: Attitudes supportive of spousal violence retards developmental efforts worldwide, and in particular in patriarchal African settings. It is important to curb this behavior by designing preventative evidence-based policies. This study examines the acceptance of intimate partner violence among women residing in Eswatini and determines whether attitudes supportive of intimate partner violence are associated with women's low socioeconomic status both at the individual- and community-level. METHODS: Cross-sectional secondary data from two Eswatini Multiple Indicator Cluster Surveys (MICS) conducted in 2010 and 2014 with representative samples of 4,686 and 4,761 women, respectively were analyzed using descriptive statistics and multilevel (random effect) logistic regressions. RESULTS: Overall, the prevalence of acceptance of intimate partner violence declined significantly between 2010 and 2014 in Eswatini (29.0% vs. 19.8%, p<0.001). In both surveys, socioeconomic factors associated with women's supportive attitudes toward intimate partner violence were educational level, marital structure, and community socioeconomic disadvantage. Overall, primary or lower educational attainment, single/unmarried relationships, and women living in a community with a high socioeconomic disadvantage were key factors associated with supportive attitudes toward intimate partner violence. CONCLUSIONS: Secondary or higher education for individual women and a high proportion of women in the community with low socioeconomic disadvantage are important socioeconomic predictors of reducing women's supportive attitudes toward intimate partner violence. Therefore, further gains in non-supportive attitudes toward acceptance of intimate partner violence could be achieved through efforts and intervention in the education of individual women and improving women's socioeconomic status in the community.

Prevalence and determinants of inconsistent condom use among unmarried sexually active youth. a secondary analysis of the 2016-2017 Eswatini HIV incidence measurement survey.

Introduction: In sub-Saharan Africa, youth continue to have a high burden of sexually transmitted infections and unplanned pregnancies that could be reduced through improved condom use. We aimed to investigate inconsistent condom use with the three most recent sexual partners among unmarried sexually active youth in Eswatini. Methods: Data were analysed for 1,324 youth from the 2016-2017 Swaziland HIV incidence measurement survey (SHIMS2) using multivariable logistic regression method. Results: The prevalence of inconsistent condom use among youth was 56.8% in 2017. Higher odds of inconsistent condom use were observed among youth aged 20-24, residents in the Lubombo region, those aged less than 18 years at sexual debut and those who had two or more sexual partners in the last 12 months before the survey. Lower odds of inconsistent condom use were observed among males, and those that knew their partners reported HIV status to be negative. Conclusion: Our findings highlight a notable prevalence of inconsistent condom use among youth in Eswatini. Programs that aim to reduce the incidence of HIV infections and STIs among youth in Eswatini should focus on these factors associated with inconsistent condom use.

Factors associated with HIV testing among youth in a generalised hyperendemic setting: findings from a national survey in Eswatini.

Aim: Even though Eswatini was the first country in Africa to achieve the UNAIDS 95-95-95 targets among people living with HIV nationally, youth aged 15-24 years lag behind in HIV testing. This study determined the overall prevalence of HIV testing among the youth and the factors associated with HIV testing.Methods: Data were analysed for 1 834 young people from the 2016-2017 Swaziland HIV Incidence Measurement Survey (SHIMS2) using multivariable logistic regression.Results: Overall, 66% of the young people had tested for HIV in the past 12 months before SHIMS2. Lower odds of HIV testing were observed among males, among those aged 15-17 years, the never married/cohabited, those with primary and secondary education, and among those who had high perceived stigma towards people living with HIV and AIDS. Youth from households classified in the poor and middle quintiles had higher odds of testing for HIV compared to those from rich households.Conclusion: Efforts to increase HIV testing should consider the sociodemographic and behavioural factors identified as determinants of HIV non-testing in this age group.

Factors associated with poor maternal health care services utilization in Eswatini: A secondary analysis of a nationally representative household survey.

BACKGROUND: This study investigated the prevalence and factors associated with poor maternal health care services utilization (MHCSU) i.e., having < 4 antenatal care (ANC) visits, not delivering at a health facility, and not receiving institutional postnatal care (PNC). METHODS: We conducted a secondary analysis of data from the 2014 Eswatini Multiple Cluster Indicator Survey, a cross-sectional, nationally representative household survey. Participants were childbearing women (15-49 years) who had a live birth in the past two years preceding the survey. Multivariable logistic regression analyses were performed for each outcome variable. RESULTS: The prevalence of poor MHCSU was 22.1% (202/903) for ANC, 10.4% (102/899) for institutional delivery or intrapartum care (IPC), and 26.9% (123/598) for PNC. Being younger, having a low education level, being never married, having no access to mass media, being a household head of low education, coming from a household of poor/middle wealth index, being a primipara, having an unintended pregnancy, and having a longer length of stay in the postpartum ward were significantly associated with poor MHCSU. CONCLUSION: Midwives should pay special attention to women who present with the factors associated with poor MHCSU identified in this study, as early as the first booking for ANC to intervene early.

Prevalence and sociodemographic determinants of alcohol consumption among adults living with HIV in Eswatini.

Aim: Alcohol consumption contributes to a significant burden of illnesses, health conditions and premature deaths globally. There is limited knowledge of alcohol consumption among people living with HIV (PLWH) in Eswatini. This study sought to determine the prevalence, and examine the sociodemographic determinants of alcohol consumption among adult people living with HIV in Eswatini.Methods: Using the Swaziland HIV Incidence Measurement Survey 2, a recent national representative cross-sectional survey conducted in Eswatini between August 2016 and March 2017, a subsample of 2 832 adults (aged 18 and older) living with HIV was extracted. Multinomial logistic regression was used to assess the sociodemographic factors associated with alcohol consumption (i.e. use or misuse).Results: The prevalence of alcohol misuse (hazardous drinking) was 10.9% (23% male v 4.5% female), whereas alcohol use (moderate drinking) was estimated at 8.5% (14.7% male v 5.2% female). Men were more likely to engage in alcohol use (adjusted relative risk ratio [aRRR] = 3.46 [95% CI 3.46-6.62]) and misuse (aRRR = 6.12 [95% CI 6.12-11.47]) than females. Those who reported HIV stigma had a higher likelihood of alcohol misuse compared to those who did not report HIV stigma (aRRR = 1.43 [95% CI 1.04-1.98]).Conclusion: Our findings highlight a notable prevalence of alcohol use or misuse among PLWH in Eswatini. Males, those with no education, never married and those who reported HIV stigma were more likely to report alcohol misuse. The study thus recommends innovative policies and strategies to curb alcohol-related harm in the Eswatini population, specifically among PLWH.

Contraceptive use in Eswatini: do contextual influences matter?

This study sought to investigate the determinants of current use of modern contraceptives beyond the individual level in Eswatini (formerly Swaziland). Previous studies have overlooked the role of community characteristics such as socioeconomic development, women's empowerment and fertility norms in shaping contraceptive use. Hierarchical structured subsample data of 4112 sexually experienced women from the 2007 Eswatini Demographic Health Survey were analysed using multilevel logistic regression to identify factors contributing to community/cluster variations in women's current use of modern contraceptives. Less than half (44.2%) of the sexually active women were using modern contraceptive methods in 2007. At the community level, the odds of contraceptive use decreased for rural women (AOR = 0.82, 95% CI: 0.68-0.98) and among women residing in communities with high-fertility norms (AOR = 0.77, 95% CI: 0.66-0.89). After adjusting for both individual- and community-level factors, no community-level variables considered for the study were significantly associated with contraceptive use. The findings highlight in all four models, from the empty to full model, that there is a small and decreasing significant variation in women's contraceptive use across communities (MOR, 1.37-1.17). In 2007, the findings suggest individual rather than community factors account for some contextual variability in contraceptive use. The study proposes the use of ethnographic techniques to unravel community factors that promote modern contraceptive use in Eswatini.

A multilevel analysis of individual, household and community level factors on stunting among children aged 6-59 months in Eswatini: A secondary analysis of the Eswatini 2010 and 2014 Multiple Indicator Cluster Surveys.

INTRODUCTION: Child stunting is a significant public health problem in Eswatini. It is associated with a range of child health outcomes, including morbidity, physical and cognitive growth. OBJECTIVE: To determine the individual, household, and community-level factors associated with child stunting in Eswatini in 2010 and 2014. METHODS: Using the Eswatini Multiple Indicator Cluster Surveys conducted in 2010 and 2014, a secondary analysis was done of the children surveyed, aged 6-59 months. A total of 1,891 were surveyed in 2010, and 1,963 children in 2014. Univariate, bivariable analysis and multivariable multilevel logistic regression were used to establish the factors associated with stunting. RESULTS: The study found that stunting decreased significantly between 2010 and 2014, from 31.4% to 25.5% (p<0.001). In both 2010 and 2014, lower odds of stunting were observed among female children, in children born to women with tertiary education compared to those born to women with no formal education. Lower odds of stunting were observed among children from rich households compared to poorest households. In both 2010 and 2014, increased odds of stunting were observed among children aged 12-23, 24-35 and 36-47 months compared to children aged 6-11 months. At the household level, higher odds of stunting were observed among children from households with two and more children under five years of age compared to those with only one child and in 2010, among children from households with a pit latrine and no toilet facility compared to households with a flush toilet. At the community level, in 2010, higher odds of stunting were observed among children from the Shiselweni compared to those from the Lubombo region. CONCLUSION: The findings highlight the individual, household, and community-level factors significantly associated with stunting and the changes between the two surveys.

The Proximate Determinants of Fertility in Eswatini.

Accelerating downwards the fertility rate remains a priority issue for developmental planning of any country. Fertility transition for most African countries has been slow since attaining their independence. In a period of almost four decades Eswatini experienced high fertility above replacement level fertility of 2.1; total fertility rate has declined from 6 to 4 children per woman from 1968 to 2007. This paper examines the impact of each proximate factor (contraception, postpartum infecundability, abortion and sexual activity) on fertility. Using the cross-sectional data from the 2006-7 Eswatini Demographic and Health Survey (DHS), the revised Bongaarts proximate determinants model of fertility was applied at national level and the analysis was extended to observe educational variation among women aged 15-49. The analysis showed that contraception had the greatest impact of fertility reduction, then sexual activity, postpartum infecundability and induced abortion. Women's educational level had huge negative influence on fertility and positive implication on reproductive choice of using contraception, delaying sexual activity/marriage and childbearing. The results guide on selection of potential social variables amenable to policy aimed at improving women's reproductive behaviour in Eswatini through better educational attainment.