Men's education and intimate partner violence-Beyond the victim-oriented perspective: Evidence from demographic and health surveys in Central Africa.

BACKGROUND: Intimate partner violence (IPV) has increasingly received attention in the last three decades. However, IPV-related studies in both high- and low- and middle-income countries adopted a victim-oriented perspective in which men are perpetrators and women, the victims. Using socio-cultural and resource theories as guiding frameworks, this paper assessed the associations between men's education and IPV in Central Africa, using nationally representative data of married and cohabiting women of reproductive ages. METHODS: Data included in the analyses come from Demographic and Health Surveys (DHSs) in the Democratic Republic of the Congo (DRC), Cameroon, Gabon, and Chad. Analyzed sub-samples consisted of 3421, 5023, 3930, and 3221 married/cohabiting women of reproductive ages in Chad, DRC, Cameroon, and Gabon, respectively. RESULTS: Findings indicated significant variations of IPV prevalence within and across countries. Previous research demonstrated that men's education is a protective factor in health-related studies. The present study, however, provide no clear evidence on the linkages between men's education and IPV. In contrast, the paper substantiated that highly educated women were at higher risks of IPV when spouses/partners were less educated. CONCLUSION: These findings have policy and programmatic implications because they might impede progress towards SDG goals on the elimination of all forms of violence against girls and women in Central Africa, which recorded the worst development indicators in sub-Saharan Africa. On a methodological note, studies are increasingly using pooled data to increase statistical power. Those studies can be very limited to devise effective IPV-interventions since they mask geographical variations within and across countries. More effective IPV-interventions should be culturally rooted and accounting for geographical variations because some areas are more affected than others.

High-risk fertility behaviours among women of reproductive ages in the Democratic Republic of the Congo: Prevalence, correlates, and spatial distribution.

BACKGROUND: High-risk fertility behaviour remains a major public health in the Democratic Republic of the Congo, like other sub-Saharan Africa countries, especially because Total Fertility Rate (TFR) is very high in the country, estimated at 6.6 children. Despite the commendable progress in reducing maternal deaths in the region, sub-Saharan Africa is still lagging very behind compared with other regions. Yet, high-risk fertility behaviours are pivotal to improve maternal and child health. This study aims to assess geographical variations of, and to identify risk factors associated with high-risk fertility behaviours among married women in the Democratic Republic of the Congo using the 2013-14 Demographic and Health Survey. METHODS: Overall, 11,497 married women were selected from a nationally representative using a two-stage sampling design. Standard logistic regressions were performed to identify individual- and household/community-level factors associated with high-risk fertility behaviours. Additionally, interactions between women's age and education, and urban residence were tested. Bernoulli based spatial scan statistics were used to identify the presence of high-risk fertility behaviours spatial clusters using Kulldorff's SaTScan version 9.6 software. ArcGIS 10.7 was used to visualize the spatial variations of high-risk fertility behaviours. Geographically weighted regression (GWR) analysis was employed using Multiscale GWR version 2.0 software. RESULTS: Findings indicated that more than two-third of married women exhibited high-risk fertility behaviours in the Democratic Republic of the Congo. Multivariate logistic regression showed that education was negatively and significantly associated with the odds of high-risk fertility behaviours. In contrast, women's age significantly increased the odds of high-risk fertility behaviours. Interactions between urban residence and women's education and age confirmed the urban advantage identified from previous studies. Finally, high-risk fertility behaviours were highly clustered in the Northeastern provinces of the country. CONCLUSION: The study showed that there were significant geographical variations of high-risk fertility behaviours across provinces in the Democratic Republic of the Congo. The paper also identified significant-high hot spots of high-risk fertility behaviours in the Northeastern provinces of the country. To reduce high-risk fertility behaviours, and ultimately improve maternal and child outcomes in the country, policymakers and health planners need to strategically address these inequalities. Finally, this paper highlighted the persistent needs of country-specific studies due to differences across sub-Saharan African countries in terms of social development and cultures.

Poverty, education and health insurance coverage among women of reproductive ages in the Democratic Republic of the Congo: a cross-sectional and multilevel analysis.

OBJECTIVE: To investigate inequalities of health insurance coverage (outcome) at subnational level, and the effects of education and poverty on the outcome. DESIGN: Secondary analysis of Demographic and Health Surveys. The outcome variable was health insurance ownership. SETTING: The Democratic Republic of the Congo. SUBJECTS: Women aged 15-49 years (n=18 827). RESULTS: Findings indicated significant spatial variations of the health insurance ownership which ranged from 1.2% in Bandundu and Kasaï Oriental to 15.5% in Kinshasa the Capital City. Furthermore, findings showed that an additional year of women education increased by 10% the chance of health insurance ownership (adjusted OR, AOR 1.098; 95% CI 1.065 to 1.132). Finally, living in better-off households increased by 150% the chance of owing a health insurance (AOR 2.501; 95% CI 1.620 to 3.860) compared with women living in poor households. CONCLUSIONS: Given the low levels of health insurance coverage, the Democratic Republic of the Congo will not reach the Sustainable Development Goal 3, aimed at improving maternal and child health unless a serious programmatic health shift is undertaken in the country to tackle inequalities among poor and uneducated women via universal health coverage.

WOMEN'S EDUCATION AND UTILIZATION OF MATERNAL HEALTH SERVICES IN AFRICA: A MULTI-COUNTRY AND SOCIOECONOMIC STATUS ANALYSIS.

There is an abundant literature on the relationship between women's education and maternal and child outcomes, including antenatal and postnatal care, onset of antenatal care and skilled birth attendance. However, few studies have adopted the 'equity' lens, despite increasing evidence that inequities between rich and poor are increasing although maternal and child mortality is declining. This study examined the differential effects of women's education within different socioeconomic strata in Africa. The most recent Demographic and Health Surveys (DHS) conducted in the Democratic Republic of the Congo, Egypt, Ghana, Nigeria and Zimbabwe were used. In each country, the original sample was stratified into three socioeconomic groups: poor, middle and rich. For each maternal health service utilization variable, the gross and net effects of women's education, controlling for age, parity, religion, marital status, health insurance, access to health facilities, partner's education and current place of residence, were estimated using logistic regression, taking into account the complex sampling design of the DHS. The findings revealed country-specific variations in maternal health service utilization, and for most indicators there was a clear gradient among socioeconomic strata: women living in better-off households exhibited greater access to, and utilization of, maternal health services. Multivariate analyses revealed that women's education had a positive association with type of antenatal care provider, timing and frequency of antenatal care visits, place of delivery and presence of a skilled birth attendant at delivery. Many other factors were found to be significantly associated with maternal health service utilization. For instance, parity had a negative and significant association with timing of first antenatal care visit. Likewise, partner's education was positively and statistically associated with timing of first antenatal care visit. It is argued that an over-generalization of the association between women's education and maternal health service utilization can be misleading. Efforts to improve maternal health service utilization in Africa must adopt an 'equity' approach, taking into account the specific needs of sub-populations.

Fostering accurate HIV/AIDS knowledge among unmarried youths in Cameroon: do family environment and peers matter?

BACKGROUND: The last three decades have seen a series of HIV interventions in sub-Saharan Africa. However, youths still have a mixture of correct and incorrect HIV/AIDS knowledge of transmission routes and prevention strategies. Previous studies have identified parents and peers as the most important socializing agents for youths. This paper assesses the relationships between family structure, family/peer communication about sexuality and accurate knowledge of transmission routes and prevention strategies. METHODS: Data were drawn from the Cameroon Family Life and Health Survey (CFHS) conducted in 2002. The CFHS collected information on a representative sample of 4950 people aged 10 years and over nested within 1765 selected households from the 75 localities forming the administrative prefecture of Bandjoun, using detailed questionnaires about family, HIV/AIDS/STDs knowledge, sexual behaviors, contraception, health, media exposure, household assets and neighborhood characteristics. The survey cooperation rates were high (97%). For the purpose of this study, a sub-sample of 2028 unmarried youths aged 12-29 years was utilized. RESULTS: Overall, 42% of respondents reported accurate knowledge of documented HIV transmission routes whereas 21% of them had inaccurate knowledge such as AIDS can be transmitted through mosquito bites or casual contact with an infected person. Only 9% of respondents were knowledgeable about all HIV prevention strategies. Multivariate analyses showed that family structure, communication with parents/guardians and peers about sexual topics were significantly associated with accurate HIV knowledge. Additionally, age, education, sexual experience and migration had significant effects on accurate knowledge. Finally, living in poor households and disadvantaged neighborhoods significantly increased inaccurate knowledge of HIV transmission modes and prevention strategies. CONCLUSIONS: This paper evidenced the limited effects of HIV interventions/programmes in sub-Saharan Africa. Indeed, few respondents reported accurate knowledge about HIV transmission routes and prevention strategies. Findings showed that the role of family environment as source of accurate HIV knowledge transmission routes and prevention strategies is of paramount significance; however, families have been poorly integrated in the design and implementation of the first generation of HIV interventions. There is an urgent need that policymakers work together with families to improve the efficiency of these interventions. Peer influences is likely controversial because of the double positive effect of peer-to-peer communication on both accurate and inaccurate knowledge of HIV transmission routes.