Publications by authors named "Bright Opoku Ahinkorah"

148 Publications

Does attitude towards wife beating determine infant feeding practices during diarrheal illness in sub-Saharan Africa?

Trop Med Health 2021 Oct 9;49(1):80. Epub 2021 Oct 9.

School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada.

Background: Inappropriate feeding practices of children during illness remains a public health problem globally, particularly in sub-Saharan Africa (SSA). One strategy to improve child health outcomes is through women empowerment-measured by wife beating attitude. However, the role of attitude towards wife beating in child feeding practices has not been comprehensively studied. Therefore, we investigated the association between women's attitude towards wife beating and child feeding practices during childhood diarrhea in 28 countries in SSA.

Methods: We analyzed data from the Demographic and Health Survey on 40,720 children under 5 years. Bivariate and multivariate binary logistic regression analyses were applied to assess the association between women's attitude towards wife beating and child feeding practices. The results were presented using adjusted odds ratio (aOR) with 95% confidence intervals (CIs).

Results: The pooled results showed that appropriate feeding practices during diarrheal illness among under-five children was 9.3% in SSA, varying from 0.4% in Burkina Faso to 21.1% in Kenya. Regarding regional coverage, the highest coverage was observed in Central Africa (9.3%) followed by East Africa (5.5%), Southern Africa (4.8%), and West Africa (4.2%). Women who disagreed with wife-beating practices had higher odds of proper child feeding practices during childhood diarrhea compared to those who justified wife-beating practices (aOR = 2.02, 95% CI; 1.17-3.48).

Conclusion: The findings suggest that women's disagreement with wife beating is strongly associated with proper child feeding practices during diarrheal illness in SSA. Proactive measures and interventions designed to change attitudes towards wife-beating practices are crucial to improving proper feeding practices in SSA.
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http://dx.doi.org/10.1186/s41182-021-00369-1DOI Listing
October 2021

Sub-regional disparities in the use of antenatal care service in Mauritania: findings from nationally representative demographic and health surveys (2011-2015).

BMC Public Health 2021 Oct 9;21(1):1818. Epub 2021 Oct 9.

School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada.

Background: Skilled antenatal care (ANC) has been identified as a proven intervention to reducing maternal deaths. Despite improvements in maternal health outcomes globally, some countries are signaling increased disparities in ANC services among disadvantaged sub-groups. Mauritania is one of sub-Saharan countries in Africa with a high maternal mortality ratio. Little is known about the inequalities in the country's antenatal care services. This study examined both the magnitude and change from 2011 to 2015 in socioeconomic and geographic-related disparities in the utilization of at least four antenatal care visits in Mauritania.

Methods: Using the World Health Organization's Health Equity Assessment Toolkit (HEAT) software, data from the 2011 and 2015 Mauritania Multiple Indicator Cluster Surveys (MICS) were analyzed. The inequality analysis consisted of disaggregated rates of antenatal care utilization using four equity stratifiers (economic status, education, residence, and region) and four summary measures (Difference, Population attributable risk, Ratio and Population attributable fraction). A 95% Uncertainty Interval was constructed around point estimates to measure statistical significance.

Results: Substantial absolute and relative socioeconomic and geographic related disparities in attending four or more ANC visits (ANC4+ utilization) were observed favoring women who were richest/rich (PAR = 19.5, 95% UI; 16.53, 22.43), educated (PAF = 7.3 95% UI; 3.34, 11.26), urban residents (D = 19, 95% UI; 14.50, 23.51) and those living in regions such as Nouakchott (R = 2.1, 95% UI; 1.59, 2.56). While education-related disparities decreased, wealth-driven and regional disparities remained constant over the 4 years of the study period. Urban-rural inequalities were constant except with the PAR measure, which showed an increasing pattern.

Conclusion: A disproportionately lower ANC4+ utilization was observed among women who were poor, uneducated, living in rural areas and regions such as Guidimagha. As a result, policymakers need to design interventions that will enable disadvantaged subpopulations to benefit from ANC4+ utilization to meet the Sustainable Development Goal (SDG) of reducing the maternal mortality ratio (MMR) to 140/100, 000 live births by 2030.
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http://dx.doi.org/10.1186/s12889-021-11836-zDOI Listing
October 2021

Effects of antenatal care visits and health facility delivery on women's choice to circumcise their daughters in sub-Saharan Africa: evidence from demographic and health surveys.

Int Health 2021 Oct 6. Epub 2021 Oct 6.

School of Public Health, Faculty of Health, University of Technology Sydney, Australia.

Background: This study examines the association between maternal healthcare service utilisation and circumcision of daughters in sub-Saharan Africa (SSA).

Methods: This study is based on a cross-sectional study design that draws on analysis of pooled data from current demographic and health surveys conducted between 2010 and 2019 in 12 countries in SSA. Both bivariate and multivariable binary logistic regression models were employed.

Results: Mothers who had four or more antenatal care visits were less likely to circumcise their daughters compared with those who had zero to three visits. Mothers who delivered at a health facility were less likely to circumcise their daughters than those who delivered at home. With the covariates, circumcision of daughters increased with increasing maternal age but decreased with increasing wealth quintile and level of education. Girls born to married women and women who had been circumcised were more likely to be circumcised.

Conclusions: This study established an association between maternal healthcare service utilisation and circumcision of girls from birth to age 14 y in SSA. The findings highlight the need to strengthen policies that promote maternal healthcare service utilisation (antenatal care and health facility delivery) by integrating female genital mutilation (FGM) information and education in countries studied.
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http://dx.doi.org/10.1093/inthealth/ihab066DOI Listing
October 2021

Maternal and child factors associated with early initiation of breastfeeding in Chad: evidence from nationally representative cross-sectional data.

Int Health 2021 Oct 6. Epub 2021 Oct 6.

University of Parakou, Faculty of Medicine, Parakou, Benin.

Background: Early initiation of breastfeeding (EIB) is an inexpensive practice but has a substantial potential to reduce neonatal morbidity. Therefore, this study investigated the maternal and child-related factors associated with EIB and makes recommendations that could help improve the practice in Chad.

Methods: We used data from the children's recode file of the 2014-2015 Chad Demographic and Health Survey. A total of 3991 women ages 15-49 y who had last-born children in the 2 y preceding the survey were included in our study. The outcome variable for the study was EIB. Both descriptive (frequencies and percentages) and inferential (binary logistic regression) analyses were carried out. All results of the binary logistic analyses are presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).

Results: We found the prevalence of EIB in Chad to be 23.8%. In terms of maternal factors, the likelihood of EIB was high among non-working women (aOR 1.37 [95% CI 1.18 to 1.59]), the richest wealth quintile women (aOR 1.37 [95% CI 1.04 to 1.79]) and non-media-exposed women (aOR 1.58 [95% CI 1.24 to 2.02]) compared with working women, the poorest wealth quintile women and media-exposed women, respectively. EIB was lower among children whose mothers had one to three antenatal care visits (ANC; aOR 0.73 [95% CI 0.61 to 0.87]) and four or more ANC visits (aOR 0.80 [95% CI 0.66 to 0.97]) compared with those who had no ANC visits. With the child factors, EIB was higher among mothers of children who were smaller than average size at birth compared with those of larger than average birth size (aOR 1.47 [95% CI 1.24 to 1.74]). Mothers of children of fifth-order or more births compared with those of first-order births (aOR 1.51 [95% CI 1.07 to 2.12]) and those who were delivered through vaginal birth compared with those delivered through caesarean section (aOR 4.71 [95% CI 1.36 to 16.24]) were more likely to practice EIB.

Conclusions: Maternal and child-related factors play roles in EIB in Chad. Hence, it is important to consider these factors in maternal and neonatal health interventions. Such initiatives, including training of outreach health workers, health education, counselling sessions and awareness-raising activities on breastfeeding geared towards EIB should be undertaken. These should take into consideration the employment status, wealth quintile, exposure to mass media, size of the baby at birth, ANC visits, parity and delivery method.
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http://dx.doi.org/10.1093/inthealth/ihab060DOI Listing
October 2021

Under-5 mortality in sub-Saharan Africa: is maternal age at first childbirth below 20 years a risk factor?

BMJ Open 2021 Sep 30;11(9):e049337. Epub 2021 Sep 30.

School of Public Health, University of Technology Sydney, Sydney, New South Wales, Australia

Objectives: This study aimed at examining the association between young maternal age at first childbirth and under-5 mortality in sub-Saharan Africa (SSA).

Design And Setting: This cross-sectional study pooled nationally-representative data from the most recent Demographic and Health Surveys conducted in 30 countries in SSA from 2010 to 2019.

Participants: 116 379 mothers of children under 5.

Results: The prevalence of adolescent childbirth and death in children under 5 in SSA were 57.36% (95% CI 53.73% to 60.99%) and 4.10% (95% CI 3.65% to 4.54%), respectively. Children born to mothers whose first childbirth occurred at <20 years were 11% more likely to die before the age of 5 compared with those whose mothers' first childbirth occurred at age ≥20 years (adjusted odds ratio (aOR) 1.11; 95% CI 1.05 to 1.18). In terms of the covariates, the likelihood of under-5 mortality was higher among children born to single (aOR 1.54; 95% CI 1.41 to 1.67) and cohabiting mothers (aOR 1.10; 95% CI 1.01 to 1.21) compared with married mothers. Children born to mothers who were obese were more likely to die before the age of 5 compared with those born to mothers with normal body weight (aOR 1.17; 95% CI 1.09 to 1.26). The odds of under-5 mortality were higher among children whose weight at birth was <2500 g compared with those whose weight was ≥2500 g at birth (aOR 1.83; 95% CI 1.64 to 2.03).

Conclusions: The findings call for the need to enhance policies aimed at reducing under-5 mortality in SSA by reducing adolescent pregnancy and childbirth through family planning, comprehensive sexuality education, and the elimination of child marriage. Again, Since under-5 mortality among adolescent mothers is linked with their poor socio-economic status, there is the need for government and non-governmental organisations in SSA to introduce poverty alleviation programmes and improve access to both formal and informal education as a way of enhancing the socioeconomic status of adolescent mothers. Public health education, through continuous advocacy programmes should be done to encourage adolescent mothers to access antenatal care and health facility deliveries as a way of enhancing the survival status of their children. These interventions should be implemented, taking into consideration other characteristics of mothers such marital status and BMI and child's characteristics such as child's weight, which were found to be associated with high under-5 mortality.
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http://dx.doi.org/10.1136/bmjopen-2021-049337DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8487196PMC
September 2021

Noncompliance with the WHO's Recommended Eight Antenatal Care Visits among Pregnant Women in Sub-Saharan Africa: A Multilevel Analysis.

Biomed Res Int 2021 17;2021:6696829. Epub 2021 Sep 17.

University of Parakou, Faculty of Medicine, Parakou, Benin.

Background: In 2016, the World Health Organization (WHO) introduced a minimum of eight antenatal care (ANC) visits for positive pregnancy outcomes. This study examined the prevalence of noncompliance with 8+ ANCvisits and its associated factors in sub-Saharan Africa (SSA).

Methods: We used data from the Demographic and Health Surveys of eight countries in SSA. A pooled sample of 63,266 pregnant women aged 15-49 years who had given birth to children within 5 years prior to the surveys was included in this study. To examine the factors associated with noncompliance with ANC 8+ visits, multilevel binary logistic regression analysis was conducted, and the results were reported using odds radios at 95% confidence interval (CI).

Results: The pooled prevalence of noncompliance with ANC 8+ visits was 92.3% (95% CI: 91.1%-93.3%) with the highest and lowest prevalence in Zambia (98.7%, 95% CI: 98.3%-99.1%) and Libya (73.4%, 95% CI: 70.4%-76.2%), respectively. With the individual level factors, women's age (44-49 years-aOR = 0.33, 9% CI: 0.14-0.78), health insurance registration, (yes-aOR = 0.53, 95% CI: 0.29-0.98), and economic status (richest-aOR = 0.16, 95% CI: 0.05-0.49) were negatively associated with noncompliance with 8+ ANC visits, while parity (five or more children-aOR = 1.68, 95% CI: 1.12-2.52) was positively associated with noncompliance with 8+ ANC visit. With the community level factors, community level literacy was negatively associated with noncompliance with 8+ ANC visit (high-aOR = 0.56, 95% CI: 0.32-0.99).

Conclusion: About eight out of ten pregnant women did not comply with the WHO's recommended minimum of eight ANC visits for positive pregnancy outcomes in SSA. Empowering the economic status of women , enhancing health insurance and education coverage, and giving more attention to young pregnant women and those with more children are crucial for improving the coverage of ANC 8+ visits in the region.
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http://dx.doi.org/10.1155/2021/6696829DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8476249PMC
September 2021

Complex Multilevel Modelling of the Individual, Household and Regional Level Variability in Predictors of Undernutrition among Children Aged 6-59 Months in Ethiopia.

Nutrients 2021 Aug 29;13(9). Epub 2021 Aug 29.

Faculty of Health, School of Public Health, University of Technology Sydney, Sydney, NSW 2007, Australia.

Worldwide, ten and a half million children under five die every year, with 98% of these deaths in low- and middle-income countries, including Ethiopia. Undernutrition is a serious public health problem in Ethiopia and children are the most affected segments of the population. This study, therefore, sought to investigate the socio-economic, demographic, health and environmental factors associated with undernutrition among children aged 6-59 months in Ethiopia. Data were obtained from the 2016 Ethiopian Demographic and Health Survey. In this study, anthropometric data (height and weight) and other variables of 9461 children were measured. Descriptive statistics and multilevel logistic regression models were fitted. The descriptive results revealed that about 27.5% of the children aged between 6-59 months were undernourished. Place of residence, employment status of the mother, educational status of the mother, the mother's nutritional status, age of the child, birth order of children, source of drinking water, diarrhea and fever among children in the two weeks before the survey were the most important factors associated with undernutrition among children aged 6-59 months in Ethiopia. The findings indicate that it is useful to support health care and food security programs in rural areas to directly address food insecurity and undernutrition problems of the poor and exposed communities in rural parts of the country. The education sector must increase mothers' access to education in all areas to help identify the quality of healthcare and the required attention needed for their children. The health sector should increase their health education programs on the importance of exclusive breastfeeding.
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http://dx.doi.org/10.3390/nu13093018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8467235PMC
August 2021

Comprehensive HIV/AIDS knowledge and safer sex negotiation among adolescent girls and young women in sub-Saharan Africa.

J Biosoc Sci 2021 Sep 24:1-13. Epub 2021 Sep 24.

School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.

Globally, HIV/AIDS remains a public health issue, especially in sub-Saharan Africa (SSA). Despite the increased advocacy and dissemination of comprehensive HIV/AIDS information in SSA, it appears that little progress has been made to reduce the incidence of HIV/AIDS in the sub-region. This study, therefore, examined the association between comprehensive HIV/AIDS knowledge and safer sex negotiation among adolescent girls and young women in SSA. Data were taken from the Demographic and Health Surveys conducted between 2010 and 2019 in 30 countries in SSA. The study sample comprised 37,364 adolescent girls and young women aged 15-24. A multivariable binary logistic regression analysis was done to test the hypothesis that there is a positive association between comprehensive HIV/AIDS knowledge and safer sex negotiation. Adolescent girls and young women who had comprehensive knowledge on HIV/AIDS were more likely to negotiate for safer sex compared with those who had no comprehensive knowledge on HIV/AIDS (AOR=1.31, 95% CI: 1.22-1.41). At the country level, the positive association between comprehensive knowledge on HIV/AIDS and safer sex negotiation was significant in Chad, Congo DR, Gambia, Guinea, Liberia, Ethiopia and Malawi. On the other hand, in Togo, adolescent girls and young women who had comprehensive HIV/AIDS knowledge were less likely to negotiate for safer sex. These findings can inform policies and programmes on the crucial role of comprehensive HIV/AIDS education and knowledge in increasing safer sex negotiation among adolescent girls and young women in SSA. The study recommends that Togo needs to address certain practices such as intimate partner violence against adolescent girls and young women, which prevent them from negotiating for safer sex, despite their higher knowledge on comprehensive HIV/AIDS. Lessons can be learnt from Chad, Congo DR, Gambia, Guinea, Liberia, Ethiopia and Malawi about the scale-up of programmes and interventions targeted at young women.
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http://dx.doi.org/10.1017/S0021932021000493DOI Listing
September 2021

Unequal access and use of contraceptives among parenting adolescent girls in sub-Saharan Africa: a cross-sectional analysis of demographic and health surveys.

BMJ Open 2021 Sep 22;11(9):e051583. Epub 2021 Sep 22.

Population Dynamics and Sexual and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya.

Objective: We examined the divergent patterns, prevalence and correlates of contraceptive use among parenting adolescents in sub-Saharan Africa using the Demographic and Health Survey datasets of 17 countries.

Design: We included a weighted sample of 9488 parenting adolescent girls in our analysis. Current contraceptive use was defined as the use of any methods to delay or avoid getting pregnant at the survey time. We reported the prevalence of any contraceptive use for all countries and used multilevel binary logistic regression analysis to examine the individual and contextual factors associated with contraceptive use.

Outcome Measures: Contraceptive use.

Results: We found an overall contraceptive prevalence of 27.12% (CI 27.23% to 28.03%) among parenting adolescent girls in sub-Saharan Africa, ranging from 70.0% (CI 61.76% to 77.16%) in South Africa to only 5.10% (CI 3.04% to 8.45%) in Chad. The prevalence of contraceptive use was lowest in West andCentral Africa, with most countries having less than 20% prevalence. Increasing age (adjusted OR (aOR)=1.46, 95% CI 1.28 to 1.65), being married (aOR=1.63, 95% CI 1.43 to 1.87), having a secondary or higher level of education (aOR=2.72, 95% CI 2.25 to 2.3.27), and media exposure (aOR=1.21, 95% CI 1.08 to 1.36), were associated with higher odds of contraceptive use in the pooled data but preference for a higher number of children (more than five children) (aOR=0.61, 95% CI 0.52 to 0.72) was related to lower likelihood of use. Significant heterogeneity was observed in the country-level disaggregated results.

Conclusion: African countries differ widely when it comes to contraceptive use among parenting adolescent girls, with only three countries having a relatively high prevalence of use. The governments of countries in sub-Saharan Africa, particularly those in West and Central Africa, should invest in expanding access to contraceptives for adolescent mothers to prevent repeat pregnancy and improve the overall well-being of parenting adolescent girls.
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http://dx.doi.org/10.1136/bmjopen-2021-051583DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8461275PMC
September 2021

Obesity, Disability and Self-Perceived Health Outcomes in Australian Adults: A Longitudinal Analysis Using 14 Annual Waves of the HILDA Cohort.

Clinicoecon Outcomes Res 2021 7;13:777-788. Epub 2021 Sep 7.

Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia.

Background: Both obesity and disability have been widely recognised as major public health challenges because they play significant roles in determining self-perceived general and mental health. Longitudinal studies of the relationship between obesity and disability with self-reported health outcomes are scarce. Therefore, the objective of the present study is to examine the relationship between obesity and disability with self-perceived general and mental health among Australian adults aged 15 years and above.

Methods: Data were extracted from the most recent 14 waves (waves 6 through 19) of the annual individual person dataset of the Household, Income and Labour Dynamics in Australia (HILDA) survey. The longitudinal random-effects logistic regression model was adopted to investigate the relationships between obesity and disability with self-reported health outcomes.

Results: The results revealed that obese individuals and adults with some form of disability are more likely to report poor or fair general and mental health. The odds of self-reporting poor or fair general health were 2.40 and 6.07 times higher among obese (aOR: 2.40, 95% CI: 2.22-2.58) and adults with some form of disability (aOR: 6.07, 95% CI: 5.77-6.39), respectively, relative to adults with healthy weight and those without disability . The results also showed that self-rated poor or fair mental health were 1.22 and 2.40 times higher among obese adults (aOR: 1.22, 95% CI: 1.15-1.30) and adults with disability (aOR: 2.40, 95% CI: 2.30-2.51), respectively, compared to their healthy weight peers and peers without disability.

Conclusion: As governmental and non-governmental organisations seek to improve the community's physical and mental well-being, these organisations need to pay particular attention to routine health care prevention, specific interventions, and treatment practices, especially for obese and/or people with disabilities.
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http://dx.doi.org/10.2147/CEOR.S318094DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8434893PMC
September 2021

Beyond counting intended pregnancies among young women to understanding their associated factors in sub-Saharan Africa.

Int Health 2021 Sep 14. Epub 2021 Sep 14.

United Nations Population Fund, UNFPA, Bamako, Mali.

Background: In this article we report the prevalence and determinants of intended or wanted pregnancies among young women 15-24 y of age in selected sub-Saharan African countries.

Methods: This cross-sectional study used pooled data from current Demographic and Health Surveys conducted between 1 January 2010 and 31 December 2019 in 29 countries in sub-Saharan Africa (SSA). The sample size comprised 14 257 young women (15-24 y of age). Multivariable binary logistic regression models were used to present the results as adjusted odds ratios.

Results: The prevalence of intended pregnancies was 67.7%, with the highest and lowest prevalence in Gambia (89.9%) and Namibia (37.7%), respectively. Intended pregnancy was lower among young women who had knowledge of modern contraceptives, those with a secondary/higher education and those with four or more births. Lower odds of intended pregnancy were observed among young women in the richer wealth quintile and those who lived in southern Africa.

Conclusions: To reduce intended pregnancies in sub-Saharan African countries such as Gambia, Burkina Faso and Nigeria, there is a need for government and non-governmental organisations to recalibrate current and past interventions such as investment in increasing formal education for women and poverty alleviation programmes, as well as augmenting job creation, including skill-building. These interventions have to be sensitive to the cultural realities of each setting, especially with regards to early marriages and womanhood.
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http://dx.doi.org/10.1093/inthealth/ihab056DOI Listing
September 2021

Exposure to interparental violence and justification of intimate partner violence among women in sexual unions in sub-Saharan Africa.

Arch Public Health 2021 Sep 9;79(1):162. Epub 2021 Sep 9.

School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.

Background: Justification of intimate partner violence (IPV) is one of the critical factors that account for the high prevalence of IPV among women. In this study, we examined the association between exposure to interparental violence and IPV justification among women in sexual unions in sub-Saharan Africa (SSA).

Methods: Data for this study were obtained from the most recent Demographic and Health Surveys (DHS) of 26 countries in SSA conducted between 2010 and 2020. A total of 112,953 women in sexual unions were included in this study. A multivariable binary logistic regression analysis was carried out. The results of the regression analysis were presented using crude odds ratios (cOR) and adjusted odds ratios (aOR) with their respective 95% confidence intervals (CIs).

Results: The prevalence of interparental violence in the countries considered in this study was 23.8%, with the highest (40.8%) and lowest (4.9%) in Burundi and Comoros, respectively. IPV justification was 45.8%, with the highest and lowest prevalence in Mali (80.9%) and South Africa (4.6%) respectively. Women who were exposed to interparental violence were more likely to justify IPV compared to those who were not exposed [aOR = 1.53, 95% CI = 1.47-1.59]. We found higher odds of justification of IPV among women who were exposed to interparental violence compared to those who were not exposed in all the countries, except Burkina Faso, Comoros, Gambia, and Rwanda.

Conclusion: The findings call for several strategies for addressing interparental violence. These may include empowerment services targeting both men and women, formation of stronger social networks to improve women's self-confidence, and the provision of evidence-based information and resources at the community level. These interventions should pay critical attention to young people exposed to interparental violence. Public health education and messaging should emphasise on the negative health and social implications of interparental violence and IPV.
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http://dx.doi.org/10.1186/s13690-021-00684-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8428140PMC
September 2021

Socio-demographic determinants of pregnancy termination among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa.

BMC Pregnancy Childbirth 2021 Sep 4;21(1):598. Epub 2021 Sep 4.

School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.

Background: Most of the unintended pregnancies that occur among adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) end up in pregnancy termination. In this study, the socio-demographic determinants of pregnancy termination among AGYW (aged 15-24) in selected countries with high fertility rates in SSA were examined.

Methods: This was a cross-sectional analysis of data from the most recent Demographic and Health Surveys of nine countries in SSA. The countries included are Angola, Burkina Faso, Burundi, Chad, Gambia, Mali, Niger, Nigeria, and Uganda. A total of 62,747 AGYW constituted the sample size for the study. Fixed and random effects models were used to examine the determinants of pregnancy termination with statistical significance at p < 0.05.

Results: Higher odds of pregnancy termination were found among AGYW aged 20-24, those who were cohabiting and married, those who listened to radio and watched television at least once a week and those who lived in communities with high literacy level. Conversely, the odds of pregnancy termination were lower among AGYW with three or more births and those with secondary/higher education.

Conclusion: The socio-demographic determinants of pregnancy termination among AGYW in this study were age, level of education, marital status, exposure to radio and television, parity, and community literacy level. The findings provide the needed information for designing health interventions to reduce unwanted pregnancies and unsafe abortions in countries with high fertility rates in SSA. It is recommended that governments and non-governmental organisations in these countries should enhance sexuality education and regular sensitization of adolescent sexual and reproductive health programmes targeted at AGYW who are at risk of pregnancy termination.
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http://dx.doi.org/10.1186/s12884-021-04064-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8417988PMC
September 2021

Alcohol consumption among tertiary students in the Hohoe municipality, Ghana: analysis of prevalence, effects, and associated factors from a cross-sectional study.

BMC Psychiatry 2021 09 3;21(1):431. Epub 2021 Sep 3.

Department of Family and Community Health, School of Public Health, University of Health and Allied Sciences, Ho, Ghana.

Background: Alcohol consumption constitutes a major public health problem as it has negative consequences on the health, social, psychological, and economic outcomes of individuals. Tertiary education presents students with unique challenges and some students resort to the use of alcohol in dealing with their problems. This study, therefore, sought to determine alcohol use, its effects, and associated factors among tertiary students in the Hohoe Municipaility of Ghana.

Methods: An institutional-based cross-sectional study was conducted among 418 tertiary students in the Hohoe Municipality of Ghana using a two-stage sampling technique. Data were collected using structured questionnaires. A binary logistic regression modelling was used to determine the strength of the association between alcohol consumption and the explanatory variables. The level of significance was set at p < 0.05. Stata version 16.0 was used to perform the analysis.

Results: The lifetime prevalence of alcohol consumption was 39.5%. Out of them, 49.1% were still using alcohol, translating to an overall prevalence of 19.4% among the tertiary students. Self-reported perceived effects attributed to alcohol consumption were loss of valuable items (60.6%), excessive vomiting (53.9%), stomach pains/upset (46.1%), accident (40.0%), unprotected sex (35.1%), risk of liver infection (16.4%), depressive feelings (27.3%), diarrhoea (24.2%), debt (15.2%), and petty theft (22.4%). In terms of factors associated with alcohol consumption, students aged 26 years and above were more likely to have consumed alcohol [AOR = 4.4, 95%CI = 1.74, 11.14] than those in 16-20 years group. Muslim students had lower odds of alcohol consumption compared to Christians [AOR = 0.1, 95% CI = 0.02, 0.31]. It was also found that students who had peer influence [AOR = 3.7, 95%CI = 2.31, 5.82] and those who had academic adjustment problems [AOR = 3.6, 95% CI = 2.01, 6.46] were more likely to consume alcohol.

Conclusion: Lifetime prevalence of alcohol consumption is high among tertiary students in the Hohoe Municipality of Ghana, with several physical, psychosocial and economic consequences. Alcohol-related education should be intensified in tertiary institutions and counseling units should be equipped with relevant assessment tools to assess and help students who are at risk and those who are already consuming alcohol.
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http://dx.doi.org/10.1186/s12888-021-03447-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414877PMC
September 2021

Factors associated with food safety knowledge and practices among meat handlers in Bangladesh: a cross-sectional study.

Environ Health Prev Med 2021 Aug 28;26(1):84. Epub 2021 Aug 28.

Department of Food Microbiology, Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh.

Background: Food handlers can play a vital role into reducing foodborne diseases by adopting appropriate food handling and sanitation practices in working plants. This study aimed to assess the factors associated with food safety knowledge and practices among meat handlers who work at butcher shops in Bangladesh.

Methods: A cross-sectional study was conducted among 300 meat handlers from January to March, 2021. Data were collected through in-person interviews using a structured questionnaire. The questionnaire consisted of three parts; socio-demographic characteristics, assessments of food safety knowledge, and food safety practices. A multiple logistic regression model was used to identify the factors associated with food safety knowledge and practices.

Results: Only 20% [95% confidence interval, (CI) 15.7-24.7] and 16.3% (95% CI 12.3-20.7) of the respondents demonstrated good levels of food safety knowledge and practices, respectively. The factors associated with good levels of food safety knowledge were: having a higher secondary education [adjusted odds ratio (AOR) = 4.57, 95% CI 1.11-18.76], income above 25,000 BDT/month (AOR = 10.52, 95% CI 3.43-32.26), work experience of > 10 years (AOR = 9.31, 95% CI 1.92-45.09), ≥ 8 h per day of work (AOR = 6.14, 95% CI 2.69-13.10), employed on a daily basis (AOR = 4.05, 95% CI 1.16-14.14), and having food safety training (AOR = 8.98 95% CI 2.16-37.32). Good food safety knowledge (AOR = 5.68, 95% CI 2.33-13.87) and working ≥ 8 h per day (AOR = 8.44, 95% CI 3.11-22.91) were significantly associated with a good level of food safety practice.

Conclusions: Poor knowledge and practices regarding food safety were found among Bangladeshi meat handlers. Findings may help public health professionals and practitioners develop targeted strategies to improve food safety knowledge and practices among this population. Such strategies may include education and sensitization on good food safety practices.
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http://dx.doi.org/10.1186/s12199-021-01004-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8403395PMC
August 2021

Understanding the association between exposure to family planning messages and consistent condom use among never married men in Ghana.

PLoS One 2021 24;16(8):e0255325. Epub 2021 Aug 24.

Faculty of Psychology and Sport Sciences, Neurocognition and Action-Biomechanics-Research Group, Bielefeld University, Bielefeld, Germany.

Background: Despite considerable efforts to promote condom use, sexually active people in sub-Sahara Africa still engage in risky sexual behaviours, with condom use relatively low. With this high vulnerability of these persons to HIV and sexually transmitted infections, research related to exposure to family planning messages to help curb this trend remains sparse. This study examined how exposure to family planning messages in the midst of some socio-demographic factors is associated with consistent condom use among sexually active never married men in Ghana.

Methods: Data were obtained from the 2014 Demographic and Health Survey (DHS) of Ghana. Only never married men (15-64 years) who have had sexual experience in the last 12 months were included in the analysis (N = 971). Frequencies, percentages, chi-square tests and binary logistic regression analyses were carried out. Results of the binary logistic regression analysis were presented using crude odds ratios (cOR) and adjusted odds ratios (aOR).

Results: The results showed that only 26.15% of sexually active never married men in Ghana consistently used condom during sex. Men who were exposed to family planning messages were 51% more likely use condom consistently compared to those who are not exposed [aOR = 1.51, CI = 1.04-2.18]. In terms of the covariates, the likelihood of consistent condom use among men in Ghana was lower among those aged 35 years and above compared to those aged 15-24 [aOR = 0.46 CI = 0.21-0.99]. The odds of consistent condom use among men increased with level of education, with men with higher level of education having the highest odds of consistent condom use compared to those with no formal education [aOR = 9.98, CI = 2.05-48.46]. Men of the richest wealth quintile were more likely to use condom consistently compared to those of the poorest wealth quintile [aOR = 2.62, CI = 1.30-5.27]. Higher odds of consistent condom use was found among men who dwelled in the Central, Northern, and Upper East regions compared to those of the Western region.

Conclusion: Our findings have established a strong association between exposure to family planning messages alongside age, educational level, wealth, and region of residence and consistent condom use. Men exposed to family planning messages were more likely to use condoms consistently. Designed programs should use intervention strategies that focus on interactive and participatory educational activities to improve sexually active men's interpersonal communication on family planning messages, especially on consistent condom use with their sexual partners.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0255325PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8384178PMC
August 2021

Maternal age at first childbirth and under-five morbidity in sub-Saharan Africa: analysis of cross-sectional data of 32 countries.

Arch Public Health 2021 Aug 24;79(1):151. Epub 2021 Aug 24.

School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia.

Background: The prevalence of childhood morbidity remains high in low-and middle-income countries, including sub-Saharan Africa (SSA). In this study, the association between maternal age at first childbirth and under-five morbidity in SSA was examined.

Methods: This was a cross-sectional study involving nationally-representative data from the most recent Demographic and Health Surveys conducted in 32 countries in SSA from 2010 to 2019. A sample size of 311,603 mothers of children under-five was considered. The outcome variable for this study was under-five morbidity. This variable was derived from the experience of fever, cough, and diarrhoea among children under-five. Both multilevel and binary logistic regression models were used to test the hypothesis that adolescent childbirth is associated with under-five morbidity. The results were presented as crude odds ratios (cORs) and adjusted odds ratios (aORs), with 95 % confidence intervals (CIs).

Results: Children born to mothers whose first childbirth occurred at < 20 years were 16 % times more likely to suffer from under-five morbidity, compared to those whose mothers' first childbirth occurred at age ≥ 20 years [cOR = 1.16; CI = 1.13-1.19], and this persisted but with reduced odds after controlling for covariates [aOR = 1.10; CI = 1.07-1.12]. At the country level, children born to mothers whose first childbirth occurred at < 20 years were more likely to suffer from under-five morbidity, compared to those whose mothers' first childbirth occurred at age ≥ 20 years in Angola, Burundi, Congo DR, Guinea, Kenya, and Uganda.

Conclusions: In this study, an association between adolescent childbirth and morbidity in children under five in SSA has been established. The study concludes that under-five morbidity is higher among children born to mothers whose first childbirth occurred before 20 years compared to those whose mothers' first childbirth occurred at 20 years and above. The findings indicate that in order to reduce under-five morbidity, there is the need to deal with adolescent childbearing through cultural and social change, coupled with engagement of adolescents and stakeholders in adolescent sexual and reproductive health programmes.
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http://dx.doi.org/10.1186/s13690-021-00674-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8383451PMC
August 2021

Demographic and health surveys showed widening trends in polio immunisation inequalities in Guinea.

Acta Paediatr 2021 Aug 19. Epub 2021 Aug 19.

School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada.

Aim: This study examined trends in absolute and relative socio-economic, gender and geographical inequalities in the coverage of polio immunisation in Guinea, West Africa, from 1999 to 2016.

Methods: Data from the 1999, 2005 and 2012 Guinea Demographic and Health Survey and the 2016 Guinea Multiple Indicator Cluster Survey were analysed using the World Health Organization's health equity assessment toolkit. We disaggregated polio immunisation coverage using five equity stratifiers: household economic status, maternal educational level, place of residence, child's gender and region. The four summary measures used were the difference, ratio, population attributable risk and population attributable fraction. A 95% confidence interval (CI) was constructed around point estimates to measure statistical significance.

Results: A total of 4778 1-year-old children were included. Polio immunisation coverage in 1999, 2005, 2012 and 2016 were 43.4%, 50.7%, 51.2% and 38.6%, respectively. Socio-economic and geographical inequalities in polio immunisation favoured children with educated mothers who came from richer families living in urban areas. There were also differences in the eight regions over the 1999-2016 study period.

Conclusion: Targeting children from disadvantaged subgroups must be prioritised to ensure equitable immunisation services that help to eradicate polio in Guinea.
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http://dx.doi.org/10.1111/apa.16076DOI Listing
August 2021

Prevalence and predictors of long-acting reversible contraceptive use among sexually active women in 26 sub-Saharan African countries.

Int Health 2021 Aug 18. Epub 2021 Aug 18.

John's Hopkins Centre for Communications Programs, 111 Market Place Suite 310 Baltimore, MD, USA.

Background: Long-acting reversible contraceptives (LARCs) are associated with high efficacy rates and continuity of use. Based on the foregoing, we sought to examine the prevalence and factors associated with LARC use among sexually active women in 26 countries in sub-Saharan Africa(SSA).

Methods: Secondary data from Demographic and Health Surveys conducted in 26 countries in SSA between January 2010 and December 2019 were pooled and analysed. A total of 56 067 sexually active women 15-49 y of age met the inclusion criteria. Bivariate and multivariate regression analyses were performed to examine the association between selected factors and the use of LARCs in SSA. Results were presented as crude odds ratios and adjusted odds ratios (aORs) with statistical precision at <0.05.

Results: The prevalence of LARC use was 21.73%, ranging from 1.94% in Namibia to 54.96% in Benin. Sexually active women with secondary or higher education (aOR 1.19 [95% confidence interval {CI} 1.08 to 1.32]), those cohabiting (aOR 1.25 [95% CI 1.06 to 1.47]) and those with four or more children (aOR 2.22 [95% CI 1.78 to 2.78]) were more likely to use LARCs compared with those without education, never married and with no biological child.

Conclusions: The use of LARCs in the 26 countries in SSA was relatively low. Hence, the identified contributory factors of LARC use should be tackled with appropriate interventions. These include continuous campaigns on the efficacy of LARCs in reducing unintended pregnancy, maternal mortality and morbidity.
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http://dx.doi.org/10.1093/inthealth/ihab053DOI Listing
August 2021

Intimate partner violence as a predictor of marital disruption in sub-Saharan Africa: A multilevel analysis of demographic and health surveys.

SSM Popul Health 2021 Sep 17;15:100877. Epub 2021 Jul 17.

School of International Development and Global Studies, University of Ottawa, Ottawa, Canada.

Introduction: Intimate partner violence has gained momentum as health, social, and human right issue across the globe. Women within sub-Saharan Africa often do not report any case of violence due to the acceptance of violence which is rooted in their socio-cultural beliefs and practices. With a high prevalence of marital disruption in sub-Saharan Africa, it is important that we understand the role intimate partner violence plays in this phenomenon. Hence, this present study assessed the association between intimate partner violence and marital disruption among women in sub-Saharan Africa.

Methods: This study involved a cross-sectional analysis of data from the Demographic and Health Survey of 25 countries in sub-Saharan Africa. Multilevel binary logistic regression analysis was carried out and the results were presented as adjusted odds ratios (aOR) at 95% Confidence Interval (CI).

Results: The prevalence of physical, emotional, and sexual violence in the 25 countries considered in this study were 29.3%, 28%, and 11.5%, respectively. The highest prevalence of physical violence was in Sierra Leone (50.0%) and the lowest prevalence was in Comoros (5.7%). For emotional violence, the highest prevalence was in Sierra Leone (45.9%) and the lowest prevalence was in Comoros (7.9%). The highest prevalence of sexual violence was in Burundi (25.5%) and the lowest prevalence was in Comoros (1.8%). The average prevalence of marital disruption was 7.7%. This ranged from 1.3% in Burkina Faso to 20.2% in Mozambique. We found that women who had ever experienced physical violence were more likely to experience marital disruptions compared to those who had never experienced physical violence [aOR = 1.42, 95% CI = 1.35-1.50]. Women who had ever experienced sexual violence were more likely to experience marital disruption compared to those who had never experienced sexual violence [aOR = 1.29, 95% CI = 1.21-1.37]. Finally, women who had ever experienced emotional violence were more likely to experience marital disruption compared to those who had never experienced emotional violence [aOR = 1.86, 95% CI = 1.76-1.96].

Conclusion: Findings from this study call for proven effective intimate partner violence reduction interventions such as strengthening laws against intimate partner violence in sub-Saharan Africa. Again, marital counseling and health education interventions should be implemented to address the role of intimate partner violence on the wellbeing of women and the stability of couples in sub-Saharan Africa.
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http://dx.doi.org/10.1016/j.ssmph.2021.100877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8334722PMC
September 2021

Factors associated with healthcare seeking for childhood illnesses among mothers of children under five in Chad.

PLoS One 2021 5;16(8):e0254885. Epub 2021 Aug 5.

School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.

Background: Poor healthcare-seeking behaviour is a major contributing factor for increased morbidity and mortality among children in low- and middle-income countries. This study assessed the individual and community level factors associated with healthcare-seeking behaviour for childhood illnesses among mothers of children under five in Chad.

Methods: The study utilized data from the 2014-2015 Chad Demographic and Health Survey. A total of 5,693 mothers who reported that their children under five had either fever accompanied by cough or diarrhea or both within the two weeks preceding the survey were included in this study. The outcome variable for the study was healthcare-seeking behaviour for childhood illnesses. The data were analyzed using Stata version 14.2. Multilevel binary logistic regression model was employed due to the hierarchical nature of the dataset. Results were presented as adjusted odds ratios (aOR) at 95% confidence interval (CI).

Results: Out of the 5,693 mothers who reported that their children under five had either fever accompanied by cough, diarrhea or both at any time in the 2 weeks preceding the survey, 79.6% recalled having sought treatment for their children's illnesses. In terms of the individual level factors, mothers who faced financial barriers to healthcare access were less likely to seek healthcare for childhood illnesses, relative to those who faced no financial barrier (aOR = 0.80, 95% CI = 0.65-0.99). Mothers who reported that distance to the health facility was a barrier were less likely to seek healthcare for childhood illnesses, compared to those who faced no geographical barrier to healthcare access (aOR = 79, 95% CI = 0.65-0.95). Mothers who were cohabiting were less likely to seek healthcare for childhood illnesses compared to married mothers (aOR = 0.62 95% CI = 0.47-0.83). Lower odds of healthcare seeking for childhood illnesses was noted among mothers who did not listen to radio at all, relative to those who listened to radio at least once a week (aOR = 0.71, 95% CI = 0.55-0.91). Mothers who mentioned that their children were larger than average size at birth had a lesser likelihood of seeking childhood healthcare, compared to those whose children were of average size (aOR = 0.79, 95% CI = 0.66-0.95). We further noted that with the community level factors, mothers who lived in communities with medium literacy level were less likely to seek childhood healthcare than those in communities with high literacy (aOR = 0.73, 95% CI = 0.53-0.99).

Conclusion: The study revealed that both individual (financial barriers to healthcare access, geographical barriers to healthcare access, marital status, frequency of listening to radio and size of children at birth) and community level factors (community level literacy) are associated with healthcare-seeking behaviour for childhood illnesses in Chad. The government of Chad, through multi-sectoral partnership, should strengthen health systems by removing financial and geographical barriers to healthcare access. Moreover, the government should create favourable conditions to improve the status of mothers and foster their overall socio-economic wellbeing and literacy through employment and education. Other interventions should include community sensitization of cohabiting mothers and mothers with children whose size at birth is large to seek healthcare for their children when they are ill. This can be done using radio as means of information dissemination.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254885PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8341616PMC
August 2021

A multilevel analysis of individual and contextual factors associated with the practice of safe disposal of children's faeces in sub-Saharan Africa.

PLoS One 2021 2;16(8):e0254774. Epub 2021 Aug 2.

Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany.

Background: Over the years, sanitation programs over the world have focused more on household sanitation, with limited attention towards the disposal of children's stools. This lack of attention could be due to the misconception that children's stools are harmless. The current study examined the individual and contextual predictors of safe disposal of children's faeces among women in sub-Saharan Africa (SSA).

Methods: The study used secondary data involving 128,096 mother-child pairs of under-five children from the current Demographic and Health Surveys (DHS) in 15 sub-Saharan African countries from 2015 to 2018. Multilevel logistic analysis was used to assess the individual and contextual factors associated with the practice of safe disposal of children's faeces. We presented the results as adjusted odds ratios (aOR) at a statistical significance of p< 0.05.

Results: The results show that 58.73% (57.79-59.68) of childbearing women in the 15 countries in SSA included in our study safely disposed off their children's stools. This varied from as high as 85.90% (84.57-87.14) in Rwanda to as low as 26.38% (24.01-28.91) in Chad. At the individual level, the practice of safe disposal of children's stools was more likely to occur among children aged 1, compared to those aged 0 [aOR = 1.74; 95% CI: 1.68-1.80] and those with diarrhoea compared to those without diarrhoea [aOR = 1.17, 95% CI: 1.13-1.21]. Mothers with primary level of education [aOR = 1.42, 95% CI: 1.30-1.5], those aged 35-39 [aOR = 1.20, 95% CI: 1.12-1.28], and those exposed to radio [aOR = 1.23, 95% CI: 1.20-1.27] were more likely to practice safe disposal of children's stools. Conversely, the odds of safe disposal of children's stool were lower among mothers who were married [aOR = 0.74, 95% CI: 0.69-0.80] and those who belonged to the Traditional African Religion [aOR = 0.64, 95% CI: 0.51-0.80]. With the contextual factors, women with improved water [aOR = 1.13, 95% CI: 1.10-1.16] and improved toilet facility [aOR = 5.75 95% CI: 5.55-5.95] had higher odds of safe disposal of children's stool. On the other hand, mothers who lived in households with 5 or more children [aOR = 0.89, 95% CI: 0.86-0.93], those in rural areas [aOR = 0.86, 95% CI: 0.82-0.89], and those who lived in Central Africa [aOR = 0.19, 95% CI: 0.18-0.21] were less likely to practice safe disposal of children's stools.

Conclusion: The findings indicate that between- and within-country contextual variations and commonalities need to be acknowledged in designing interventions to enhance safe disposal of children's faeces. Audio-visual education on safe faecal disposal among rural women and large households can help enhance safe disposal. In light of the strong association between safe stool disposal and improved latrine use in SSA, governments need to develop feasible and cost-effective strategies to increase the number of households with access to improved toilet facilities.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0254774PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328335PMC
August 2021

Factors associated with modern contraceptive use among women with no fertility intention in sub-Saharan Africa: evidence from cross-sectional surveys of 29 countries.

Contracept Reprod Med 2021 Aug 1;6(1):22. Epub 2021 Aug 1.

Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.

Background: In sub-Saharan Africa, the majority of women of reproductive age who want to avoid pregnancy do not use any method of contraception. This study sought to determine the factors associated with  modern contraceptive use among women with no fertility intention in sub-Saharan Africa.

Methods: This study used data from the Demographic and Health Surveys of 29 countries in sub-Saharan Africa. A total of 87,554 women aged 15-49 with no fertility intention and who had completed information on all the variables of interest were considered in this study. Using a multilevel logistic regression analysis, four models were used to examine the individual and contextual factors associated with modern contraceptive use. The results were presented as adjusted odds ratios (aOR), with their respective confidence intervals (CIs). Statistical significance was set at p< 0.05.

Results: The prevalence of modern contraceptive use was 29.6%. With the individual-level factors, women aged 45-49 had lower odds of using modern contraceptives (aOR = 0.33, 95% CI = 0.28, 0.39). Women who had their first sex at age 15-19 (aOR = 1.12, 95% CI = 1.07, 1.17), those with higher education (aOR = 1.93, 95% CI = 1.75, 2.13), and women who were exposed to newspaper (aOR = 1.15, 95% CI = 1.10, 1.20) and radio (aOR = 1.21, 95% CI = 1.17, 1.26) had higher odds of modern contraceptive use. In terms of the contextual factors, women living in urban areas (aOR = 1.06, 95% CI = 1.02, 1.11), women in the richest wealth quintile (aOR = 1.55, 95% CI = 1.43, 1.67), and those in communities with medium literacy level (aOR = 1.11, 95% CI = 1.06, 1.16) and medium community socio-economic status (aOR = 1.17, 95% CI = 1.10, 1.23) had higher odds of modern contraceptive use. Across the geographic regions in sub-Saharan Africa, women in Southern Africa had higher odds of modern contraceptive use (aOR = 5.29, 95% CI = 4.86, 5.76).

Conclusion: There is a relatively low prevalence of modern contraceptive use among women with no fertility intention in sub-Saharan Africa, with cross-country variations. Women's age, age at first sex, level of education, mass media exposure, place of residence, community literacy level and community socio-economic status were found to be associated with modern contraceptive use. It is, therefore, important for policy makers  to consider these factors when designing and implementing programmes or policies  to increase contraceptive use among women who have no intention to give birth. Also, policymakers and other key stakeholders should intensify mass education programmes to address disparities in modern contraceptive use among women.
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http://dx.doi.org/10.1186/s40834-021-00165-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8325798PMC
August 2021

Household cooking fuel type and childhood anaemia in sub-Saharan Africa: analysis of cross-sectional surveys of 123, 186 children from 29 countries.

BMJ Open 2021 07 20;11(7):e048724. Epub 2021 Jul 20.

School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada.

Objective: This study sought to investigate the joint effect of household cooking fuel type and urbanicity (rural-urban residency) on anaemia among children under the age of five in sub-Saharan Africa.

Design: We analysed cross-sectional data of 123, 186 children under the age of five from 29 sub-Saharan African countries gathered between 2010 and 2019 by the Demographic and Health Survey programme. Bivariate (χ test of independence) and multilevel logistic regression were used to examine the effect of urbanicity-household cooking fuel type on childhood anaemia. Results were reported as adjusted odds ratios (aORs) with 95% CIs at p<0.05.

Outcome Measures: Anaemia status of children.

Results: More than half (64%) of children had anaemia. The percentage of children who suffered from anaemia was high in those born to mothers in Western Africa (75%) and low among those born in Southern Africa (54%). Children from rural households that depend on unclean cooking fuels (aOR=1.120; 95% CI 1.033 to 1.214) and rural households that depend on clean cooking fuels (aOR=1.256; 95% CI 1.080 to 1.460) were more likely to be anaemic as compared with children from urban households using clean cooking fuel. Child's age, sex of child, birth order, perceived birth size, age of mother, body mass index of mother, education, marital status, employment status, antenatal care, wealth quintile, household size, access to electricity, type of toilet facility, source of drinking water and geographic region had significant associations with childhood anaemia status.

Conclusions: Our study has established a joint effect of type of household cooking fuel and urbanicity on anaemia among children under the age of five in sub-Saharan Africa. It is therefore critical to promote the usage of clean cooking fuels among households and women in rural areas. These should be done taking into consideration the significant child, maternal, household, and contextual factors identified in this study.
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http://dx.doi.org/10.1136/bmjopen-2021-048724DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8292815PMC
July 2021

Maternal and child factors associated with timely initiation of breastfeeding in sub-Saharan Africa.

Int Breastfeed J 2021 07 19;16(1):55. Epub 2021 Jul 19.

Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana.

Background: The probability of not breastfeeding within the first hour after delivery (timely initiation of breastfeeding) is particularly pronounced in sub-Saharan Africa. In this study, we examined the maternal and child factors associated with timely initiation of breastfeeding in sub-Saharan Africa.

Methods: We pooled data from 29 sub-Saharan African countries' Demographic and Health Surveys conducted from 2010 to 2018. A total of 60,038 childbearing women were included. Frequencies, percentages, and binary logistic regression analyses were carried out. Binary logistic regression was used to examine the maternal and child factors associated with timely initiation of breastfeeding and the results were presented as adjusted odds ratios (aOR) at 95% confidence interval (CI).  RESULTS: We found a prevalence of 55.81% of timely initiation of breastfeeding in the sub-region. The country with the highest prevalence of timely initiation of breastfeeding was Burundi (86.19%), whereas Guinea had the lowest prevalence (15.17%). The likelihood of timely initiation of breastfeeding was lower among married women, compared to never married women (aOR 0.91; 95% CI 0.85, 0.98); working women compared to non-working women (aOR 0.90; 95% CI 0.87, 0.93); women who watched television at least once a week, compared to those who never watched television (aOR 0.74; 95% CI 0.70, 0.78); women who delivered through caesarean section, compared to vaginal birth (aOR 0.30; 95% CI 0.27, 0.32); and those with multiple births, compared to those with single births (aOR 0.67; 95% CI 0.59, 0.76). Women who lived in Central Africa were less likely to initiate breastfeeding timely compared to those who lived in West Africa (aOR 0.80; 95% CI 0.75, 0.84).

Conclusions: The findings call for the need for a behavioural change communication programmes, targeted at timely initiation of breastfeeding, to reverse and close the timely initiation of breastfeeding gaps stratified by the maternal and child factors. Prioritising policies to enhance timely initiation of breastfeeding is needed, particularly among Cental African countries where timely initiation of breastfeeding remains a challenge. Sufficient supportive care, especially for mothers with multiple births and those who undergo caesarean section, is needed to resolve timely initiation of breastfeeding inequalities.
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http://dx.doi.org/10.1186/s13006-021-00402-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8287803PMC
July 2021

Individual/Household and Community-Level Factors Associated with Child Marriage in Mali: Evidence from Demographic and Health Survey.

Biomed Res Int 2021 22;2021:5529375. Epub 2021 Jun 22.

University of Parakou, Faculty of Medicine, Parakou, Benin.

Background: Child marriage is a major public health problem globally, and the prevalence remains high in sub-Saharan African countries, including Mali. There is a dearth of evidence about factors associated with child marriage in Mali. Hence, this studyaimed at investigating the individual/household and community-level factors associated with child marriage among women in Mali.

Methods: Using data from the 2018 Mali Demographic and Health Survey, analysis was done on 8,350 women aged 18-49 years. A Chi-square test was used to select candidate variables for the multilevel multivariable logistic regression models. Fixed effects results weree xpressed as adjusted odds ratios (aOR) at 95% confidence intervals (CI). Stata version 14 software was used for the analysis.

Results: The results showed that 58.2% (95% CI; 56.3%-60.0%) and 20.3% (95%; 19.0%-21.6%) of women aged 18-49 years were married before their 18 and 15 birthday, respectively. Educational status of women (higher education: aOR = 0.25, 95% CI; 0.14-0.44), their partner's/husband's educational status (higher education: aOR = 0.64, 95% CI; 0.47-0.87), women's occupation (professional, technical, or managerial: aOR = 0.50, 95% CI; 0.33-0.77), family size (five and above: aOR = 1.16, 95% CI; 1.03-1.30), and ethnicity (Senoufo/Minianka: aOR = 0.73, 95% CI; 0.58-0.92) were the identified individual/household level factors associated with child marriage, whereas region (Mopti: aOR = 0.27, 95% CI; 0.19-0.39) was the community level factor associated with child marriage.

Conclusions: This study has revealed a high prevalence of child marriage in Mali. To reduce the magnitude of child marriage in Mali, enhancing policies and programs that promote education for both girls and boys, creating employment opportunities, improving the utilization of family planning services, and sensitizing girls and parents who live in regions such as Kayes on the negative effects of child marriage is essential. Moreover, working with community leaders so as to reduce child marriage in the Bambara ethnic communities would also be beneficial.
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http://dx.doi.org/10.1155/2021/5529375DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8241519PMC
October 2021

Socio-economic and geographical inequalities in adolescent fertility rate in Ghana, 1993-2014.

Arch Public Health 2021 Jul 6;79(1):124. Epub 2021 Jul 6.

Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.

Background: Despite public health interventions to control adolescent fertility, it remains high in sub-Saharan Africa. Ghana is one of the countries in sub-Saharan Africa with the highest adolescent fertility rates. We examined the trends and socio-economic and geographical patterns of disparities in adolescent fertility in Ghana from 1993 to 2014.

Methods: Using the World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the 1993-2014 Ghana Demographic and Health surveys were analyzed. First, we disaggregated adolescent fertility rates (AFR) by four equity stratifiers: wealth index, education, residence and region. Second, we measured the inequality through summary measures, namely Difference (D), Population Attributable Risk (PAR), Ratio (R) and Population Attributable Fraction (PAF). A 95 % confidence interval was constructed for point estimates to measure statistical significance.

Results: We observed substantial absolute and relative wealth-driven inequality in AFR (PAR=-47.18, 95 % CI; -49.24, -45.13) and (PAF= -64.39, 95 % CI; -67.19, -61.59) respectively in favour of the economically advantaged subpopulations. We found significant absolute (D = 69.56, 95 % CI; 33.85, 105.27) and relative (R = 3.67, 95 % CI; 0.95, 6.39) education-based inequality in AFR, with higher burden of AFR among disadvantaged subpopulations (no formal education). The Ratio measure (R = 2.00, 95 % CI; 1.53, 2.47) indicates huge relative pro-urban disparities in AFR with over time increasing pattern. Our results also show absolute (D, PAR) and relative (R, PAF) inequality in AFR across subnational region, between 2003 and 2014. For example, in the 2014 survey, the PAR measure (D=-28.22, 95 % CI; -30.58, -25.86) and the PAF measure (PAF=-38.51, 95 % CI; -41.73, -35.29) indicate substantial absolute and relative regional inequality.

Conclusions: This study has indicated the existence of inequality in adolescent fertility rate in Ghana, with higher ferlitiy rates among adolescent girls who are poor, uneducated, rural residents and those living in regions such as Northern, Brong Ahafo, and Central region, with increasing disparity over the time period of the study. There is the need for policy interventions that target adolescent girls residing in the rural areas and those in the low socioeconomic subgroups to enable the country to avert the high maternal/newborn morbidity and mortality usually associated with adolescent childbearing.
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http://dx.doi.org/10.1186/s13690-021-00644-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8259447PMC
July 2021

A multi-country analysis of the prevalence and factors associated with bullying victimisation among in-school adolescents in sub-Saharan Africa: evidence from the global school-based health survey.

BMC Psychiatry 2021 07 1;21(1):325. Epub 2021 Jul 1.

School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia.

Background: Over the past few years, there has been growing public and research interest in adolescents' experiences with various forms of bullying victimisation because of their psychological, emotional, and/ or physical consequences. The present study examined the prevalence of bullying victimisation and its associated factors among in-school adolescents in sub-Saharan Africa.

Methods: Using data from the Global School-based Health Survey (GSHS) from 2010 to 2017 of eleven sub-Saharan African countries, a sample of 25,454 in-school adolescents was used for analysis. Statistical analyses included frequencies, percentages, Pearson chi-square and multivariable logistic regression. Results were presented as adjusted odds ratios (aOR) at 95% confidence intervals (CIs).

Results: The overall prevalence of bullying victimisation among the respondents was 38.8%. The prevalence was lowest in Mauritius (22.2%) and highest in Sierra Leone (54.6%). Adolescents who felt lonely [aOR = 1.66, 95% CI = 1.53, 1.80], had history of anxiety [aOR = 1.53, 95% CI = 1.41, 1.66], suicidal ideation [aOR = 1.28, 95% CI = 1.17, 1.39], suicidal attempt [aOR = 1.86, 95% CI = 1.72, 2.02], current users of marijuana [aOR = 1.59, 95% CI = 1.38, 1.84], and truants at [aOR = 1.43, 95% CI = 1.34, 1.52] were more likely to be victims of bullying. Conversely, adolescents who had peer support were less likely to be victims of bullying [aOR = 0.78, 95% CI = 0.73, 0.82]. Adolescents aged 15 years or older had lower odds of experiencing bullying victimization compared to their counterparts aged 14 years or younger [aOR = 0.74, 95% CI = 0.69, 0.78].

Conclusion: Our findings suggest that age, loneliness, anxiety, suicidal ideation, suicidal attempt, and current use of marijuana are associated with increased risk of bullying victimisation. School-wide preventative interventions (e.g., positive behavioural strategies- Rational Emotive Behavioral Education, [REBE], peer educator network systems, face-face counseling sessions, substance use cessation therapy) are essential in promoting a positive school climate and reduce students' bullying victimisation behaviours.
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http://dx.doi.org/10.1186/s12888-021-03337-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252267PMC
July 2021

Prevalence and Factors Associated with the Triple Burden of Malnutrition among Mother-Child Pairs in Sub-Saharan Africa.

Nutrients 2021 Jun 15;13(6). Epub 2021 Jun 15.

School of International Development and Global Studies, University of Ottawa, Ottawa, ON K1N 6N5, Canada.

Despite concerns about the coexistence of overnutrition, undernutrition and micronutrient deficiencies, which is compositely referred to as the triple burden of malnutrition (TBM), little is known about the phenomenon in sub-Saharan Africa (SSA). We, therefore, aimed to examine the prevalence and investigate the factors associated with TBM in SSA. This study uses cross-sectional survey data collected through the Demographic and Health Surveys (DHS) Program from 2010 to 2019. Data from 32 countries in SSA were used for the analysis. The prevalence of TBM were presented in tables and maps using percentages. The predictors of TBM were examined by fitting a negative log-log regression to the data. The results were then presented using adjusted odds ratios (aORs) at 95% Confidence Intervals (CIs). Out of the 169,394 children, 734 (1%) suffered from TBM. The highest proportion of children with TBM in the four geographic regions in SSA was found in western Africa (0.75%) and the lowest in central Africa (0.21%). Children aged 1 [aOR = 1.283; 95% CI = 1.215-1.355] and those aged 2 [aOR = 1.133; 95% CI = 1.067-1.204] were more likely to experience TBM compared to those aged 0. TBM was less likely to occur among female children compared to males [aOR = 0.859; 95% CI = 0.824-0.896]. Children whose perceived size at birth was average [aOR = 1.133; 95% CI = 1.076-1.193] and smaller than average [aOR = 1.278; 95% CI = 1.204-1.356] were more likely to suffer from TBM compared to those who were larger than average at birth. Children born to mothers with primary [aOR = 0.922; 95% CI = 0.865-0.984] and secondary [aOR = 0.829; 95% CI = 0.777-0.885] education were less likely to suffer from TBM compared to those born to mothers with no formal education. Children born to mothers who attended antenatal care (ANC) had lower odds of experiencing TBM compared to those born to mothers who did not attend ANC [aOR = 0.969; 95% CI = 0.887-0.998]. Children born to mothers who use clean household cooking fuel were less likely to experience TBM compared to children born to mothers who use unclean household cooking fuel [aOR = 0.724; 95% CI = 0.612-0.857]. Essentially, higher maternal education, ANC attendance and use of clean cooking fuel were protective factors against TBM, whereas higher child age, low size at birth and being a male child increased the risk of TBM. Given the regional variations in the prevalence and risk of TBM, region-specific interventions must be initiated to ensure the likelihood of those interventions being successful at reducing the risk of TBM. Countries in Western Africa in particular would have to strengthen their current policies and programmes on malnutrition to enhance their attainment of the SDGs.
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http://dx.doi.org/10.3390/nu13062050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8232587PMC
June 2021
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