Publications by authors named "Nicholas Kofi Adjei"

15 Publications

  • Page 1 of 1

Individual-, household-, and community-level factors associated with pregnant married women's discriminatory attitude towards people living with HIV in sub-Saharan Africa: A multicountry cross-sectional study.

Health Sci Rep 2021 Dec 27;4(4):e430. Epub 2021 Oct 27.

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

Background And Aims: Discriminatory attitude towards people living with human immunodeficiency virus (HIV) remains a major problem in the prevention and treatment of HIV in sub-Sahara Africa (SSA). Understanding the multiple factors linked to discriminatory attitude towards people living with HIV/AIDS (PLWHA) in SSA is necessary for developing appropriate interventions. This study aimed at investigating the individual, household, and community-level factors associated with pregnant married women's discriminatory attitude towards people living with HIV/AIDS.

Methods: We used data from the Demographic and Health Surveys of 12 sub-Saharan African countries conducted between 2015 and 2019. Data on 17 065 pregnant married women were analyzed. Bivariate (chi-squared test) and multivariable multilevel logistic regression analyses were applied to investigate the factors associated with discriminatory attitude towards PLWHA. The results were reported as adjusted odds ratio (aOR) at 95% confidence interval (CI).

Results: The mean age of participants was 31.2 ± 8.5. The prevalence of discriminatory attitude towards PLWHA was 36.2% (95% CI: 33.4%-39.1%). Individual/household-level factors associated with discriminatory attitude towards PLWHA were women's educational level (secondary school-aOR = 0.49, 95% CI: 0.26-0.93), husband's educational level (higher education-aOR = 0.35, 95% CI: 0.16-0.76), decision-making power (yes-aOR = 0.51, 95% CI: 0.38-0.69), wife-beating attitude (disagreement with wife beating-aOR = 0.58, 95% CI: 0.43-0.79), and religion (Muslim-aOR = 1.92, 95% CI: 1.22-3.04). Community socioeconomic status (medium-aOR = 0.61, 95% CI: 0.41-0.93) was the only community-level factor associated with discriminatory attitude towards PLWHA.

Conclusion: More than one-third of pregnant married women in SSA had discriminatory attitude towards PLWHA. Women's educational level, husband's educational level, decision-making power, wife-beating attitude, religion, and community socio-economic status were associated with discriminatory attitude towards PLWHA. To lessen the prevalence of discriminatory attitude towards PLWHA, considering these significant factors is needed. Therefore, governments and other stakeholders in the respective countries need to increase education coverage. Moreover, empowering women through education and economy is crucial. Finally, working with religious leaders to increase awareness about HIV and discriminatory attitude towards PLWHA should also be a priority in SSA.
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http://dx.doi.org/10.1002/hsr2.430DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8549109PMC
December 2021

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
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8501539PMC
October 2021

Association between intimate partner violence during pregnancy and risk of preterm birth.

BMC Public Health 2021 09 3;21(1):1610. Epub 2021 Sep 3.

Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.

Background: Preterm birth is a risk factor for child survival in both the short and long term. In Zimbabwe, the prevalence of preterm birth is rising, and there are growing concerns about the adverse consequences. This study explored the association between intimate partner violence (IPV) during pregnancy and preterm birth in Zimbabwe.

Methods: Using data from the 2015 Zimbabwe Demographic and Health Survey, we applied propensity score matching to estimate the effect of IPV during pregnancy on preterm birth among women of reproductive age (15-49 years). A total of 4833 pregnant women who gave birth during the five years preceding the survey were analysed.

Results: We successfully matched 79 women who were exposed to IPV during pregnancy to 372 unexposed during pregnancy. Using the matched sample, the probability of preterm delivery was significantly higher among women who were exposed to IPV during pregnancy than those who were not exposed. The findings showed that 7 out of 79 (8.9%) of women exposed to IPV during pregnancy experienced preterm delivery, and 11 out of 372 (3.0%) of those who were not exposed to IPV during pregnancy experienced preterm delivery. In the urban areas, those exposed to IPV during pregnancy were almost five times more likely to experience preterm delivery (OR = 4.8, 95% CI 2.0-11.6), but the association was not significantly different among women in rural areas.

Conclusion: The findings showed that women exposed to IPV during pregnancy were at increased risk of preterm birth. Some of the risk factors associated with IPV were urban residence, low economic status and unemployment. Effective policies and programmes are required to address the issue of IPV in Zimbabwe.
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http://dx.doi.org/10.1186/s12889-021-11625-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414853PMC
September 2021

Predictors of skilled birth attendance among married women in Cameroon: further analysis of 2018 Cameroon Demographic and Health Survey.

Reprod Health 2021 Mar 25;18(1):70. Epub 2021 Mar 25.

Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.

Background: In Cameroon, maternal deaths remain high. The high maternal deaths in the country have been attributed to the low utilization of maternal healthcare services, including skilled birth attendance. This study examined the predictors of skilled birth services utilization among married women in Cameroon.

Methods: Data from the 2018 Cameroon Demographic and Health Survey was analyzed on 7881 married women of reproductive age (15-49 years). Both bivariate and multivariable logistic regression analyses were carried out to determine the predictors of skilled childbirth services. The results were presented with crude odds ratio (cOR) and adjusted odds ratio (aOR) and 95% confidence interval (CI).

Results: The coverage of skilled birth attendance among married women of reproductive age in Cameroon was 66.2%. After adjusting for potential confounders, media exposure (aOR = 1.46, 95% CI: 1.11-1.91), higher decision making (aOR = 1.88, 95% CI: 1.36-2.59), maternal education (aOR = 2.38, 95% CI; 1.65-3.42), place of residence (aOR = 0.50, 95% CI; 0.33-0.74), religion (aOR = 0.55, 95% CI; 0.35-0.87), economic status (aOR = 5.16, 95% CI; 2.58-10.30), wife beating attitude (aOR = 1.32, 95% CI; 1.05-1.65), parity (aOR = 0.62, 95% CI; 0.41-0.93) and skilled antenatal care (aOR = 14.46, 95% CI; 10.01-20.89) were found to be significant predictors of skilled birth attendance.

Conclusions: This study demonstrates that social, economic, regional, and cultural factors can act as barriers to skilled childbirth services utilization in Cameroon. Interventions that target women empowerment, antenatal care awareness and strengthening are needed, especially among the rural poor, to reduce barriers to care seeking. Maternal healthcare services utilization interventions and policies in Cameroon need to focus on specific equity gaps that relate to socio-economic status, maternal education, and the economic empowerment of women. Such policies and interventions should also aim at reducing geographical barriers to access to maternal healthcare services, including skilled birth attendance. Due to the presence of inequities in the use of skilled birth attendance services, programs aimed at social protection and empowerment of economically disadvantaged women are necessary for the achievement of the post-2015 targets and the Sustainable Development Goals. Globally, Cameroon is one of the countries with high maternal deaths. Low utilization of maternal healthcare services, including skilled birth attendance have been found to account for the high maternal deaths in the country. This study sought to examine the factors associated with skilled childbirth services utilization among married women in Cameroon. Using data from the 2018 Cameroon Demographic and Health Survey, we found that the coverage of skilled birth attendance among married women of reproductive age in Cameroon is high. Factors such as higher decision-making power, higher maternal education, place of residence, religion, higher economic status, wife beating attitude, parity and skilled antenatal care were found to be the significant predictors of skilled birth attendance. This study has shown that socio-economic, regional and cultural factors account for the utilization of skilled childbirth services utilization in Cameroon. Interventions aimed at enhancing the utilization of skilled childbirth services in Cameroon should target women empowerment, antenatal care awareness creation and sensitization, especially among the rural poor, to reduce barriers to care seeking. Maternal healthcare services utilization interventions and policies in Cameroon need to focus on specific equity gaps that relate to socio-economic status, maternal education, and the economic empowerment of women.
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http://dx.doi.org/10.1186/s12978-021-01124-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993505PMC
March 2021

Modern contraceptive utilization and its associated factors among married women in Senegal: a multilevel analysis.

BMC Public Health 2021 01 28;21(1):231. Epub 2021 Jan 28.

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

Background: Utilization of modern contraceptives is still low in low-and middle-income countries, although fertility and population growth rates are high. In Senegal, modern contraceptive utilization is low, with few studies focusing on its associated factors. This study examined modern contraceptive use and its associated factors among married women in Senegal.

Methods: Data from the 2017 Continuous Demographic and Health Survey (C-DHS) on 11,394 married women was analysed. We examined the associations between the demographic and socioeconomic characteristics of women and their partners and modern contraceptive use using multilevel logistic regression models. Adjusted odds ratios with 95% confidence intervals (CI) were estimated.

Results: The utilization of modern contraceptives among married women was 26.3%. Individual level factors associated with modern contraceptive use were women's age (45-49 years-aOR = 0.44, 0.30-0.63), women's educational level (higher-aOR = 1.88, 1.28-2.76) husband's educational level (higher-aOR = 1.43, 1.10-1.85)), number of living children (5 or more children-aOR = 33.14, 19.20-57.22), ideal number of children (2 children-aOR = 1.95, 1.13-3.35), desire to have more children (wants no more-aOR = 2.46, 2.06-2.94), ethnicity (Diola-aOR = 0.70, 0.50-0.99), media exposure (yes-aOR = 1.44, 1.16-1.79)), wealth index (richer-aOR = 1.31, 1.03-1.67) and decision making power of women (decision making two-aOR = 1.20, 1.02-1.41). Whereas, region (Matam-aOR = 0.35, 0.23-0.53), place of residence (rural-aOR = 0.76, 0.63-0.93), community literacy level (high-aOR = 1.31, 1.01-1.71) and community knowledge level of modern contraceptives (high-aOR = 1.37, 1.13-1.67) were found as significant community level factors.

Conclusions: The findings indicate that both individual and community level factors are significantly associated with modern contraceptive use among married women in Senegal. Interventions should focus on enhancing literacy levels of women, their husbands and communities. Furthermore, strengthening awareness and attitude towards family planning should be given priority, especially in rural areas and regions with low resources.
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http://dx.doi.org/10.1186/s12889-021-10252-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7845035PMC
January 2021

Proximate and socio-economic determinants of under-five mortality in Benin, 2017/2018.

BMJ Glob Health 2020 08;5(8)

Leibniz Institute for Prevention Research and Epidemiology, Bremen, Bremen, Germany.

Background: Globally, under-five mortality has declined significantly, but still remains a critical public health problem in sub-Saharan African countries such as Benin. Yet, there is no empirical information in the country using a nationally representative data to explain this phenomenon. The aim of this study was to examine how proximate and socio-economic factors are associated with mortality in under-five children in Benin.

Methods: We analysed data of 5977 under-five children using the 2017 to 2018 Benin Demographic and Health Surveys. Multivariable hierarchical logistic regression modelling technique was applied to investigate the factors associated with under-five mortality. The fit of the models were assessed using variance inflation factor and Pseudo R. Results were reported as adjusted odds ratios (aORs). All comparisons were considered to be statistically significant at p<0.05.

Results: The study revealed an under-five mortality rate of 96 deaths per 1000 live births in Benin. Regarding the socio-economic determinants, the risk of death was found to be higher in children born in the Plateau region (aOR=3.05; 95% CI: 1.29 to 7.64), in rural areas (aOR=1.45; 95% CI: 1.07 to 1.98) and children with ≥4 birth rank and >2 years of birth interval (aOR=1.52; 95% CI: 1.07 to 2.17). Among the proximate determinants, we found the probability of death to be higher in children whose mothers had no postnatal check-up (PNC) visits after delivery (aOR=1.79; 95% CI: 1.22 to 2.63), but there was no significant association between individual-level/household-level factors and under-five mortality.

Conclusion: This study has established that socio-economic and proximate factors are important determinants of under-five mortality in Benin. Our findings have shown the need to implement both socio-economic and proximate interventions, particularly those related to PNC visits when planning on under-five mortality. To achieve this, a comprehensive, long-term public health interventions, which consider the disparity in the access and utilisation of healthcare services in Benin are key.
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http://dx.doi.org/10.1136/bmjgh-2020-002761DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7449341PMC
August 2020

Determinants and impact of role-related time use allocation on self-reported health among married men and women: a cross-national comparative study.

BMC Public Health 2020 Aug 5;20(1):1204. Epub 2020 Aug 5.

The Institute for Future Studies, Stockholm, Sweden.

Background: Research on the effects of marriage on health maintains that there is a gender-specific gradient, with men deriving far greater benefits than women. One reason provided for this difference is the disproportionate amount of time spent by women on housework and childcare. However, this hypothesis has yet to be explicitly tested for these role-related time use activities. This study provides empirical evidence on the association between role-related time use activities (i.e. housework, childcare and paid work) and self-reported health among married men and women.

Methods: Data from the Multinational Time Use Study (MTUS) on 32,881 men and 26,915 women from Germany, Italy, Spain, the UK and the US were analyzed. Seemingly unrelated regression (SUR) models and multivariable logistic regression were used to estimate the association between role-related time use activities and self-reported health among married men and women.

Results: The findings showed that education, occupation and number of children under 18 years old in the household were the most consistent predictors of time allocation among married men and women. Significant gender differences were also found in time allocation, with women sacrificing paid working time or reducing time devoted to housework for childcare. Men, in contrast, were less likely to reduce paid working hours to increase time spent on childcare, but instead reduced time allocation to housework. Allocating more time to paid work and childcare was associated with good health, whereas time spent on housework was associated with poor health, especially among women.

Conclusions: Time allocation to role-related activities have differential associations on health, and the effects vary by gender and across countries. To reduce the gender health gap among married men and women, public policies need to take social and gender roles into account.
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http://dx.doi.org/10.1186/s12889-020-09306-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404928PMC
August 2020

Work-life balance and self-reported health among working adults in Europe: a gender and welfare state regime comparative analysis.

BMC Public Health 2020 Jul 16;20(1):1052. Epub 2020 Jul 16.

Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.

Background: The pressing demands of work over the years have had a significant constraint on the family and social life of working adults. Moreover, failure to achieve a 'balance' between these domains of life may have an adverse effect on their health. This study investigated the relationship between work-life conflict and self-reported health among working adults in contemporary welfare countries in Europe.

Methods: Data from the 6th European Working Conditions Survey 2015 on 32,275 working adults from 30 countries in Europe were analysed. Multivariate logistic regression models were used to examine the associations between work-life balance and self-reported health among men and women. We further used a 2 stage multi-level logistic regression to assess variations in self-reported health among welfare state regimes by gender.

Results: The results showed a strong association between work-life conflict and poor self-reported health among working adults in Europe (aOR = 2.07; 95% CI: 1.93-2.23). However, the magnitude of the effect differed slightly by gender (men: aOR = 1.97; 95% CI: 1.78-2.18 vs women: aOR = 2.23; 95% CI: 2.01-2.47). Furthermore, we found variations in the relationship between work-life conflict and poor self-reported health between welfare states regimes. The association was found to be weaker in the Nordic and Southern welfare states than the Liberal, Conservative, and Central Eastern European welfare states. Although the associations were more consistent among men than women in the Conservative welfare states regime, we found higher associations for women than men in the Southern, Nordic, Liberal, and Central Eastern European welfare states.

Conclusions: This study provides evidence of some variations in the association between work-life conflict and poor self-reported health among men and women across welfare states regimes in Europe. The results demonstrate the need for governments, organizations and policymakers to provide conducive working conditions and social policies for working adults to deal with competing demands from work and family activities.
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http://dx.doi.org/10.1186/s12889-020-09139-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7364652PMC
July 2020

Racial/ethnic differences in the prevalence and incidence of metabolic syndrome in high-income countries: a protocol for a systematic review.

Syst Rev 2020 06 8;9(1):134. Epub 2020 Jun 8.

Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, D-28359, Bremen, Germany.

Background: Metabolic syndrome is a constellation of various cardiovascular and type 2 diabetes risk factors, such as abdominal obesity, atherogenic dyslipidemia, high blood pressure, and high blood glucose, but its prevalence varies widely by geographical region, sex, and race/ethnicity. The objective of this study is to examine the prevalence and incidence of metabolic syndrome among adults of different racial/ethnic origins in high-income countries.

Methods: We designed and registered a study protocol for a systematic review of descriptive epidemiological data. Observational studies (e.g., cross sectional and cohort studies) reporting morbidity data of metabolic syndrome and conducted in a wide range of adult people (e.g., different racial/ethnic origins, including migrants) will be included. The primary outcome will be the prevalence and incidence of metabolic syndrome. Secondary outcomes will be the prevalence and incidence of individual components of metabolic syndrome (e.g., abdominal obesity, dyslipidemia, high blood pressure, and high blood glucose). Literature searches will be conducted in several electronic databases (from inception onwards), including MEDLINE, Web of Science Core Collection (Science Citation Index and Social Science Citation Index), CINAHL, and Cochrane Library. Two investigators will independently screen all reference titles, abstracts, and full-text articles. The methodological quality (or potential bias) of selected studies will be appraised using an appropriate tool. Our results will be described narratively. Random-effects meta-analysis will be conducted, if feasible and appropriate. Additional analyses will be conducted to explore the potential sources of heterogeneity.

Conclusion: This systematic review will identify, evaluate, and integrate prevalence and incidence data of metabolic syndrome, with focus on racial/ethnic differences in high-income countries. We anticipate our findings may guide policy formulation and identify knowledge gaps in the literature that future research should address.

Systematic Review Registration: PROSPERO, CRD42020157189.
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http://dx.doi.org/10.1186/s13643-020-01400-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282095PMC
June 2020

Social Capital, Deprivation and Psychological Well-Being among Young Adolescents: A Multilevel Study from England and Wales.

Int J Environ Res Public Health 2020 05 14;17(10). Epub 2020 May 14.

Leibniz Institute for Prevention Research & Epidemiology-BIPS, Achterstrasse 30, 28359 Bremen, Germany.

Examining the mechanisms influencing mental health and life satisfaction simultaneously allows for a better understanding of adolescents psychological well-being. Six indicators of neighbourhood social capital (NSC), neighbourhood socioeconomic deprivation (SecD) and their association with psychological well-being among young adolescents aged 10-15 from England and Wales were investigated. Using a random sample of 5201 adolescents (7253 observations) from the UK Household Longitudinal Study merged to aggregated local area census measures, we fitted a series of multilevel models. The findings showed that not being worried about crime and friendship networks mitigated the negative effects of deprivation on adolescent's psychological well-being. These findings suggest that some forms of NSC may have a buffering and protective function, with the strongest effects in deprived neighbourhoods. We further found that psychological well-being of adolescents is dependent on both individual vulnerabilities and neighbourhood context. However caution is required if, and when public health policies are formulated to address this issue, given significant variations (27-36%) in the inter- and intra-individual psychological well-being were found among this group over time. Thus, policies designed to improve psychological well-being among adolescents should take into account the role of social processes in transmitting deprivation's effects, as well as the various forms of social capital.
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http://dx.doi.org/10.3390/ijerph17103420DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7277447PMC
May 2020

Trends in prevalence and correlates of intimate partner violence against women in Zimbabwe, 2005-2015.

BMC Int Health Hum Rights 2020 01 20;20(1). Epub 2020 Jan 20.

Health Sciences Bremen, University of Bremen, Bremen, Germany.

Background: Intimate partner violence (IPV) is a widespread problem affecting all cultures and socioeconomic groups. This study explored the trends in prevalence and risk factors associated with IPV among Zimbabwean women of reproductive age (15-49 years) from 2005 to 2015.

Methods: Data from the 2005/2006, 2010/2011 and 2015 Zimbabwe Demographic and Health Survey (ZDHS) on 13,409 women (survey year: 2005/2006; n = 4081), (survey year: 2010/2011; n = 4411) and (survey year: 2015; n = 4917) were analyzed. Multiple logistic regressions and hierarchical modelling techniques were applied to examine the associations between demographic characteristics, socioeconomic status, media exposure and IPV against women. We further estimated IPV prevalence by type (physical, sexual and emotional) over time.

Results: The prevalence of IPV decreased from 45.2% in 2005 to 40.9% in 2010, and then increased to 43.1% in 2015. Some of the risk factors associated with IPV were younger age, low economic status, cohabitation and rural residence. Educational attainment of women was however not significantly associated with IPV.

Conclusions: The findings indicate that women of reproductive age are at high and increasing risk of physical and emotional violence. There is thus an urgent need for an integrated policy approach to address the rise of IPV related physical and emotional violence against women in Zimbabwe.
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http://dx.doi.org/10.1186/s12914-019-0220-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971918PMC
January 2020

Trends in Prevalence and Related Risk Factors of Overweight and Obesity among Women of Reproductive Age in Zimbabwe, 2005-2015.

Int J Environ Res Public Health 2019 08 2;16(15). Epub 2019 Aug 2.

Clinical Research Centre, Africa University, Mutare, Zimbabwe.

: The prevalence of non-communicable diseases is rising in low and middle-income countries (LMICs) such as Zimbabwe, yet, the risk factors associated with overweight and obesity among women in the country have not been explored. This study investigated the trends in prevalence and demographic, socioeconomic and behavioral risk factors of overweight and obesity among Zimbabwean women of reproductive age (15-49 years) from 2005-2015. : Data from the 2005/2006, 2010/2011 and 2015 Zimbabwe Demographic and Health Survey (ZDHS) were analyzed. Multiple logistic regression models were used to examine the associations between demographic, socioeconomic, behavioral risk factors and obesity and overweight (body mass index (BMI) ≥ 25.0 kg/m). We further estimated the prevalence of overweight and obesity over the period covered by the surveys. The prevalence of overweight and obesity increased substantially from 25.0% in 2005 to 36.6% in 2015. Some of the risk factors for overweight and obesity were older age (40+) (adjusted odds ratio (aOR) = 4.73; 95% confidence interval (CI) = 3.73-6.01) in 2015, being married, high economic status, being employed, residence in urban areas and alcohol use. Educational attainment and smoking status were not associated with overweight and obesity across all surveys. : We provide the first detailed analysis of trends and risk factors for overweight and obesity between 2005 and 2015 among women in Zimbabwe. The findings indicate that women of reproductive age are at high, and increasing, risk of excess weight. Thus, prevention and control measures are needed to address the high prevalence of overweight and obesity in Zimbabwe.
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http://dx.doi.org/10.3390/ijerph16152758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695964PMC
August 2019

Time spent on work-related activities, social activities and time pressure as intermediary determinants of health disparities among elderly women and men in 5 European countries: a structural equation model.

Int J Equity Health 2018 08 16;17(1):121. Epub 2018 Aug 16.

Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Unit Social Epidemiology, Achterstrasse 30, D-28359, Bremen, Germany.

Background: Psychosocial factors shape the health of older adults through complex inter-relating pathways. Besides socioeconomic factors, time use activities may explain gender inequality in self-reported health. This study investigated the role of work-related and social time use activities as determinants of health in old age. Specifically, we analysed whether the impact of stress in terms of time pressure on health mediated the relationship between work-related time use activities (i.e. housework and paid work) on self-reported health.

Methods: We applied structural equation models and a maximum-likelihood function to estimate the direct and indirect effects of psychosocial factors on health using pooled data from the Multinational Time Use Study on 11,168 men and 14,295 women aged 65+ from Italy, Spain, UK, France and the Netherlands.

Results: The fit indices for the conceptual model indicated an acceptable fit for both men and women. The results showed that socioeconomic status (SES), demographic factors, stress and work-related time use activities after retirement had a significant direct influence on self-reported health among the elderly, but the magnitude of the effects varied by gender. Social activities had a positive impact on self-reported health but had no significant impact on stress among older men and women. The indirect standardized effects of work-related activities on self-reported health was statistically significant for housework (β = - 0.006; P < 0.001 among men and β = - 0.008; P < 0.001 among women) and paid work (β = 0.012; P < 0.01 among men and β = 0.000; P > 0.05 among women), which implied that the paths from paid work and housework on self-reported health via stress (mediator) was very weak because their indirect effects were close to zero.

Conclusions: Our findings suggest that although stress in terms of time pressure has a direct negative effect on health, it does not indirectly influence the positive effects of work-related time use activities on self-reported health among elderly men and women. The results support the time availability hypothesis that the elderly may not have the same time pressure as younger adults after retirement.
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http://dx.doi.org/10.1186/s12939-018-0840-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6097401PMC
August 2018

Investigating the associations between productive housework activities, sleep hours and self-reported health among elderly men and women in western industrialised countries.

BMC Public Health 2018 01 11;18(1):110. Epub 2018 Jan 11.

Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Germany, Unit Social Epidemiology, Achterstrasse 30, D-28359, Bremen, Germany.

Background: After retirement, elderly men and women allocate more time to housework activities, compared to working-age adults. Nonetheless, sleep constitutes the lengthiest time use activity among the elderly, but there has not been any study on the associations between time spent on housework activities, sleep duration and self-reported health among the older population. This study not only examined individual associations between self-reported health and both housework activities and sleep duration, but it also explored self-reported health by the interaction effect between housework activities and sleep duration separately for men and women.

Methods: Pooled data from the Multinational Time Use Study (MTUS) on 15,333 men and 20,907 women from Germany, Italy, Spain, UK, France, the Netherlands and the US were analysed. Multiple binary logistic regression models were used to examine the associations between three broad categories of housework activities ((1) cooking, cleaning and shopping, (2) gardening and maintenance; (3) childcare) and health. We further investigated the extent to which total housework hours and sleep duration were associated with self-reported health for men and women separately.

Results: We found a positive association between time devoted to housework activities, total housework and health status among elderly men and women. Compared to those who spent 1 to 3 h on total productive housework, elderly people who spent >3 to 6 h/day had higher odds of reporting good health (OR = 1.25; 95% CI = 1.14-1.37 among men and OR = 1.10; 95% CI = 1.01-1.20 among women). Both short (<7 h) and long (>8 h) sleep duration were negatively associated with health for both genders. However, the interactive associations between total productive housework, sleep duration, and self-reported health varied among men and women. Among women, long hours of housework combined with either short or long sleep was negatively associated with health.

Conclusions: Although time allocation to housework activities may be beneficial to the health among both genders, elderly women have higher odds of reporting poor health when more time is devoted total housework combined with either short or long sleep duration.
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http://dx.doi.org/10.1186/s12889-017-4979-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5763579PMC
January 2018

Gender inequality in self-reported health among the elderly in contemporary welfare countries: A cross-country analysis of time use activities, socioeconomic positions and family characteristics.

PLoS One 2017 26;12(9):e0184676. Epub 2017 Sep 26.

Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.

Background: Paradoxically, despite their longer life expectancy, women report poorer health than men. Time devoted to differing social roles could be an explanation for the observed gender differences in health among the elderly. The objective of this study was to explain gender differences in self-reported health among the elderly by taking time use activities, socio-economic positions, family characteristics and cross-national differences into account.

Methods: Data from the Multinational Time Use Study (MTUS) on 13,223 men and 18,192 women from Germany, Italy, Spain, UK and the US were analyzed. Multiple binary logistic regression models were used to examine the association between social factors and health for men and women separately. We further identified the relative contribution of different factors to total gender inequality in health using the Blinder-Oaxaca decomposition method.

Results: Whereas time allocated to paid work, housework and active leisure activities were positively associated with health, time devoted to passive leisure and personal activities were negatively associated with health among both men and women, but the magnitude of the association varied by gender and country. We found significant gender differences in health in Germany, Italy and Spain, but not in the other countries. The decomposition showed that differences in the time allocated to active leisure and level of educational attainment accounted for the largest health gap.

Conclusions: Our study represents a first step in understanding cross-national differences in the association between health status and time devoted to role-related activities among elderly men and women. The results, therefore, demonstrate the need of using an integrated framework of social factors in analyzing and explaining the gender and cross-national differences in the health of the elderly population.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0184676PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5614435PMC
October 2017
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