Prevalence, trend and determinants of adolescent childbearing in Burundi: a multilevel analysis of the 1987 to 2016-17 Burundi Demographic and Health Surveys data.

BACKGROUND: Very little is known about factors influencing adolescent childbearing despite an upward trend in adolescent childbearing prevalence in Burundi, and its perceived implications on the rapid population growth and ill-health of young mothers and their babies. To adress this gap, this study aimed to examine the prevalence, trends and determinants of adolescent childbearing in Burundi. METHODS: Secondary analyses of the 1987, 2010 and 2016-17 Burundi Demographic and Health Surveys (BDHS) data were conducted using STATA. Weighted samples of 731 (1987 BDHS), 2359 (2010 BDHS) and 3859 (2016-17BDHS) adolescent girls aged 15-19 years old were used for descriptive and trend analyses. Both bivariable and multivariable two-level logistic regression analyses were performed to identify the main factors associated with adolescent childbearing using only the 2016-17 BDHS data. RESULTS: The prevalence of adolescent childbearing increased from 5.9% in 1987 to 8.3% in 2016/17. Factors such as adolescent girls aged 18-19 years old (aOR =5.85, 95% CI: 3.54-9.65, p <  0.001), adolescent illiteracy (aOR = 4.18, 95% CI: 1.88-9.30, p <  0.001), living in poor communities (aOR = 2.19, 95% CI: 1.03-4.64, p = 0.042), early marriage (aOR = 9.28, 95% CI: 3.11-27.65, p <  0.001), lack of knowledge of any contraceptive methods (aOR = 5.33, 95% CI: 1.48-19.16, p = 0.010), and non-use of modern contraceptive methods (aOR = 24.48, 95% CI: 9.80-61.14), p <  0.001) were associated with higher odds of adolescent childbearing. While factors such as living in the richest household index (aOR = 0.52, 95% IC: 0.45-0.87, p = 0.00), living in West region (aOR = 0.26, 95%CI: 0.08-0.86, p = 0.027) or in South region (aOR = 0.31, 95% CI: 0.10-0.96, p = 0.041) were associated with lower odds of adolescent childbearing. CONCLUSION: Our study found an upward trend in adolescent childbearing prevalence and there were significant variations in the odds of adolescent childbearing by some individual and community-level factors. School-and community-based intervention programs aimed at promoting girls' education, improving socioeconomic status, knowledge and utilization of contraceptives and prevention of early marriage among adolescent girls is crucial to reduce adolescent childbearing in Burundi.

Body image perceptions and avoidance behaviours among a Moroccan group of adolescents.

BACKGROUND: Adolescents are a vulnerable group to body dissatisfaction that causes unhealthy attitudes and behaviours. It has been shown that many factors affect body image dissatisfaction. AIM: To describe body image size perception, degree of body dissatisfaction, avoidance behaviours, and their relationship with gender, age, and weight status, and to assess the relationship between body dissatisfaction and avoidance behaviours among a group of Moroccan adolescents. SUBJECTS AND METHODS: This cross-sectional survey was comprised of a sample of 487 adolescents. Stunkard's Figure Rating Scale was used to assess perceptions of current and ideal body image and body dissatisfaction. Body Image Avoidance Questionnaire was employed to assess avoidance behaviours. RESULTS: Body dissatisfaction was found to be strongly associated with weight status in both male and female adolescents. Avoidance behaviours were positively associated with gender, age, weight status, and body dissatisfaction. Indeed, avoidance behaviours were frequently reported among females, young adolescents, those with high BMI z-score, and those seeking to lose weight. Adolescents tended to behave under the influence of two factors: clothing and weighing-grooming. CONCLUSION: Weight status is an important factor that deeply impacts adolescent body dissatisfaction. Adolescents resort to behaviour avoidance and physical appearance control to cope with body dissatisfaction.

La morbidité maternelle : situation et déterminants entre 2020 et 2021 dans la province d'Essaouira, Maroc.

Introduction : Maternal morbidity is a public health problem in developing countries.Purpose of research : The aim of this study was to determine the prevalence of maternal morbidity among women of reproductive age in the province of Essaouira (Morocco) and to describe the factors associated with it. The authors conducted a cross-sectional structured interview survey of 1300 married women aged 18 to 49. Data entry and statistical processing were performed by the SPSS-PC 18 program.Results : The prevalence of maternal morbidity was 66.8%. The main morbidities were sexually transmitted infections (48.8%) and anemia (46.6%). Multivariate analysis showed that frequency of postnatal visits, literacy of the couple and socioeconomic level were statistically associated with maternal morbidity.Conclusion : The use of postnatal care, the fight against illiteracy and the improvement of the socio-economic level of households, are factors that would reduce maternal morbidity.

Self-reported postpartum morbidity: prevalence and determinants among women in Marrakesh, Morocco.

BACKGROUND: Maternal mortality is a public health problem particularly in developing countries. This is mainly related to maternal morbidity, especially during the post-partum period (Haemorrhage, infections…). In Morocco, little is known about maternal morbidity within the population. The aim of this study is to determine the prevalence of self-reported postpartum morbidity and grasp its determinants. METHODS: This descriptive and analytic cross-sectional survey was carried out in six health centers drawn randomly in Marrakesh, Morocco. A total of 1,029 women of reproductive age (15-49) giving birth in the year preceding the survey were enrolled. Women were examined in these health centers during the study period. A questionnaire gathered information about socio-demographic, health and reported postpartum morbidity. Bivariate and multiple analyses were used to identify associated factors with the self-reported postpartum morbidity. Statistical significance was set at p < 0.05. RESULTS: The self-reported postpartum morbidity prevalence was 13.1% while haemorrhage, pregnancy-induced hypertension and fever were the main complications: 71.92%; 12.18% and 10.64% respectively. According to the multiple logistic regression model, the illiteracy among women and the number of pregnancies greater than 3 determine independently this morbidity (OR = 1.24; CI 95%: 1.09-1.54; and OR = 1.69; CI 95%:1.04-2.70 respectively). CONCLUSION: Reducing female illiteracy and fertility will help the fight against postpartum maternal morbidity, which is critical to the wellbeing of women and their infants.

Heterogeneous effects of socio-economic and cultural factors on fertility differentials in Burundi and Morocco during their fertility transition periods: a retrospective, cross-sectional and comparative study.

Introduction: few studies have examined the factors influencing fertility differentials and the variation in their effects in countries with different socioeconomic and cultural backgrounds and different fertility transition paces. To address this gap, our study sought to first identify the factors that influenced fertility differentials in Morocco and Burundi during their fertility transition periods, and then to compare the effects of these factors between the two countries. Methods: using data from the 2003-4 Morocco and 2010 Burundi Demographic and Health Surveys, bivariable and multivariable Poisson regression analyses offset by the natural logarithm of the women´s age were performed to identify the socioeconomic and cultural factors that influenced fertility differentials in Morocco and Burundi during their fertility transition. Results: our main findings showed that the total number of children ever born ranged from 0 to 17 with a mean of 2.71 ± 2.89 in Burundi and from 0 to 16 with a mean of 1.88 ± 2.80 in Morocco. In Burundi, both socioeconomic and cultural factors like rural residence adjusted incident rate ratio (AIRR) = 1.159, 95% CI: 1.103 - 1.217, P=0.020), women´s illiteracy (AIRR=1.465, 95% CI: 1.241- 1.729, P <0.001) and agricultural profession (AIRR=1. 332, 95% CI: 1.263 - 1.401, P = 0.004), household poverty (AIRR= 1.381, 95% CI: 1.223 - 1.431, p<0.001), infant mortality (AIRR= 1.602, 95% CI: 1.562 - 1.643, p<0.001), early marriage (AIRR= 1.313, 95% CI: 1.264 - 1.364, p<0.001), lack of knowledge of any contraceptives (AIRR= 1.263, 95% CI: 1.125 - 1.310, p = 0.003) and failure to use modern contraceptives (AIRR= 1.520, 95% CI: 1.487 - 1.611, p<0.001) were associated with high number of children ever born. However, in Morocco socioeconomic factors like residence place, women´s agricultural profession and household poverty were not significant. In this country, women´s illiteracy (AIRR=1.428, 95% CI: 1.315 - 1.551, P <0.001), lack of access to mass media (AIRR= 1.241, 95% CI: 1.108 - 1.375, p = 0.006), infant mortality (AIRR=1.222, 95%CI: 1.184 - 1.361, p<0.001), early marriage (AIRR1.481, 95% CI: 1.435 - 1.529, p<0.001), lack of knowledge of any contraceptives (AIRR1.508, 95% CI: 1.409 - 1.613, p<0.001) and failure to use modern contraceptives (AIRR1.745, 95% CI: 1.627 - 1.863, p<0.001) were associated with high fertility but with different effects than in Burundi. Conclusion: the evidence from this study suggests that interventions to accelerate the fertility transition processes in Burundi and many other countries with slow fertility transitions should be designed and implemented according to each country's local context.

Determinants of fertility differentials in Burundi: evidence from the 2016-17 Burundi demographic and health survey.

INTRODUCTION: although fertility control remains a major priority for the Burundian government and most of its partners, few studies on Burundi´s fertility determinants are available to guide interventions. To address this gap, our study aims to examine the most factors influencing fertility differentials in Burundi by using the latest Burundi demographic and health survey data. METHODS: using data from the 2016-17 Burundi demographic and health survey, one-way analysis of variance was performed to describe variations in mean number of children ever born across categories of correlate variables. Then univariable and multivariable poisson regression analyses were carried out to identify the most factors influencing fertility differentials in Burundi. RESULTS: in our sample, the total number of children ever born ranged from 0 to 15 children by women with a mean number of 2.7 children (±2.8 SD). Factors such as urban residence (aIRR 0.769, 95% CI: 0.739 - 0.782, p = 0.008), increase in the level of education of both women and husbands (aIRRs of 0.718, 95% CI: 0.643 - 0.802, P<0.001 and 0.729, 95% CI: 0.711 - 0.763, p<0.001 respectively), no history of infant mortality experience (aIRR 0.722, 95% IC: 0.710 - 0.734, p<0.001) and increase in age at first marriage or first birth (aIRRs of 0.864, 95% CI: 0.837 - 0.891, P<0.001 and 0.812, 95% CI: 0.781 - 0.845, p<0.001 respectively) are associated with a low fertility rate while factors such as residence especially in Southern region (aIRR 1.129, 95% IC: 1.077 - 1.184, p<0.001), women and husband´s agricultural profession (aIRRs of 1.521, 95% CI: 1.429 - 1.568, P<0.001 and 1.294, 95% CI: 1.211 - 1.316, p<0.001 respectively), household poverty (aIRR 1.117, 95% IC: 1.080 - 1.155, p<0.001), lack of knowledge of any contraceptive method (aIRR 1.502, 95% IC: 1.494 - 1.564, p<0.001) and non-use of modern contraceptive methods (aIRR 1.583, 95% IC: 1.562 - 1.607, p<0.001) are associated with a high fertility rate. CONCLUSION: the results of this study suggest that actions aimed at promoting education in general especially female education, improving child survival, women´s socio-economic status, agriculture mechanization and increasing number and scope of family planning services, could help reduce Burundi fertility rate.

[Obstetric care: Supply and demand care in three valleys of the western High Atlas region of Morocco (Anougal, Azgour and Imnane)]. / Demande et offre de soins obstétricaux dans le Haut Atlas occidental.

This article analyses the data of an exhaustive retrospective survey of maternal morbidity among 656 women from 3 valleys of the Western High Atlas mountains of Morocco who gave birth within the previous 5 years and from the obstetric register of the hospital providing obstetric care in the study area. This analysis reveals a very large gap between the prevalence of symptoms of maternal morbidity recorded in the High Atlas valleys we studied and those measured on a regional and national scale. Only a minority of women have either prenatal or postnatal care, and delivery in a medically monitored environment is uncommon. Although morbidity during pregnancy should lead women to give birth in such a setting, only one third of the women with morbidity during pregnancy gave birth in a medical facility. This situation increases the risk of complications and morbidity during pregnancy, delivery and the postpartum period. This inadequate utilisation of preventive and curative healthcare appears to be related not only to sociocultural representations and socio-economic conditions but also to inadequate provision of obstetric care by the health-care system for complications and the poor quality of pre- and postnatal consultations. The proportion of serious complications of pregnancy or delivery complications requiring emergency obstetric care admitted to the hospital does not exceed 4.5%, while the acceptable level is 15%. Among these cases, nearly half were subsequently referred to Marrakech, to a second-level referral centre.

Assessment of nutritional status in the Amazigh children of Amizmiz (Azgour Valley, High Atlas and Morocco).

The Berbers of the High Atlas (Amazigh) live in very severe socio-economic and climatic conditions, which expose children to the risk of malnutrition. In this study we used anthropometry and bioelectrical impedance analysis for the assessment of nutritional status. Height, weight and bioelectrical parameters were taken on 71 children (28 boys and 43 girls). Height and BMI were standardized using the 2007 WHO reference. The results show that 36.6% of the children were classified as stunted and 8.5% as wasted. Based on the Bioelectrical Impedance Vector Analysis, children from the High Atlas had an adequate body cell mass, but a high risk of dehydration (42.3%).

Socio-economic, cultural and demographic profile of a group of Moroccan anaemic pregnant women.

BACKGROUND: Anemia is a major public health problem in Morocco especially among vulnerable groups including pregnant women. Several studies have confirmed that anemia is associated with demographic, socioeconomic and cultural factors. OBJECTIVE: The objective of this study is to describe the socioeconomic, cultural and demographic profile of a group of anemic pregnant women and to determine the conditions influencing the development of anemia in the Moroccan context. METHODS: A retrospective cross-sectional study was conducted by structured interview among a group of Moroccan pregnant women (300 of anemic women and 425 of non-anemic). Data were collected on biodemographic and socio-economic variables, the socio-cultural conditions of the women, the characteristics of the pregnancy and information relating to anemia. RESULTS: Using the WHO classification criterion according to the severity of anemia, 40.6%, 56.6% and 2.8% of anaemic women were respectively mildly, moderately and severely anemic. Primiparity, unemployment, lower socio-economic level and illiteracy, were found to be associated with the development of anemia in pregnant women. CONCLUSION: In Morocco, nutritional problems hamper human development and improvement of health status. Knowledge of the strictness of deficiencies and factors associated are necessary to develop adapted strategies intervention to the national context.

Postnatal Care: Levels and Determinants in Morocco.

BACKGROUND: Despite the importance of the postnatal consultation, in Morocco, only 22% of women attended these consultations. The aim of this study was to identify associated factors with these consultations and offer suggestions to improve their use. METHODS: This study was conducted in 2014 in Marrakech. A sample of women in reproductive age (15-49 yr) giving birth during 2013 year was enrolled. They were examined in the public health centers for postnatal consultation or for the BCG. A descriptive and analytic cross-sectional survey was conducted. All participants (n=1029) provided consent before participating in the survey. A questionnaire makes it possible to collect information about socio-demographic, knowledge and perception of women regarding these consultations. RESULTS: The proportion of women who attended a postnatal consultation was 30.1%. Lack of information (87%), lack of complications (68.6%); health professional poor reception (42%) and financial difficulties (3.3%) were the main reasons that hinder these consultations. In addition, women of rural origin, low education level, and low socioeconomic status are important determinants associated with non-use of postnatal consultation. CONCLUSION: This study confirmed the low rate of these consultations. Various determinants explain this fact. The fight against illiteracy, improving household living standards, sensitization of women on the importance of postpartum care, awareness and capacity building of health professionals in the postnatal consultation and communication, and the development of a system of home visits for non-users of postnatal care allow improving the postnatal consultation rate.