Lower Wealth Status Research Articles

Multilevel analysis of factors associated with perinatal intimate partner violence among postpartum population in Southern Ethiopia

Violence around pregnancy is critical in nature and major public health problem worldwide. Thus, the present study aims to determine the extent of perinatal partner violence and to identify its individual and community-level factors among postpartum women in Southern Ethiopia. A total of 1342 postpartum women nested in 38 ‘Kebles’ (clusters) were enumerated using multistage-clustered sampling techniques for multilevel analysis. Different parameters were computed for model comparison and model fitness. The overall prevalence of intimate partner violence before, during, and/or after pregnancy was estimated to be 39.9% [95% CI 36.9–44.5]. About 18% of women reported continuous abuse over the perinatal period. Postpartum women who live in rural areas [adjusted odds ratio (AOR) = 2.46; 95% CI 1.21–5.01], or in neighborhoods with high IPV favoring norms [AOR = 1.49; 95%CI 1.01–2.20], high female literacy [AOR = 2.84; 95%CI 1.62–5.01], high female autonomy [AOR = 2.06; 95%CI 1.36–3.12], or in neighborhoods with lower wealth status [AOR = 1.74; 95%CI 1.14–2.66] were more likely to encounter PIPV. The complex patterns of interplaying factors operating at different levels could put pregnant or postpartum women at higher risk of IPV victimization. Therefore, policies that prioritize the improvement of contextual factors, particularly norms toward IPV and women’s empowerment are likely to be the most effective interventions.

Socioeconomic correlates of Adequate Maternal Care in Bangladesh: Analysis of the Bangladesh Demographic and Health Survey 2017-18.

In recent times, Bangladesh has made significant improvements in various health outcomes, but not so much in maternal death. The current flat trend in reducing maternal mortality in Bangladesh has been mainly due to the lower coverage of maternal health care. To improve the coverage, it is essential to find biosocial factors related to adequate maternal health care. Therefore, this study is aimed at finding out the socioeconomic correlates of adequate maternal health care in Bangladesh. The study used data from the Bangladeshi demographic and health survey 2017-18. The total unweighted sample of 4012 women who reported pregnancy before three years of the survey was analyzed. A composite binary indicator of adequate maternal care has been constructed using the variables-access to maternal care service, four antenatal care visits, at least one visit with qualified providers, and institutional delivery. A binary logistic regression model was employed to find out the socioeconomic correlate of adequate maternal care. Only 24.4% percent of sample women received adequate maternal care. The result of the logistic regression model shows that urban, Khulna, Rajshahi, and Rangpur were associated with an increase in the odds of having adequate maternal care. High education and health care decisions taken by the partner or husband were also associated with an increased odd of adequate maternal care. Islam and lower wealth status were associated with a lower probability of adequate maternal care. Policymakers and health administration should pay attention to the variation in the utilization of maternal health care across residence, region, religion, education, and wealth status to ensure safe motherhood.

Barriers for multiparous women to using long-term contraceptive methods in Southeast Asia: case study in Philippines and Indonesia

BackgroundMultiparous women are supposed to be able to end their reproductive cycle to decrease population growth. This study aimed to analyze barriers for multiparous women to use long-term contraceptive methods (LTCM) in the Philippines and Indonesia.MethodsThe study population was women aged 15–49 years old who have given birth to a live baby > 1 in the Philippines and Indonesia. The weighted sample size was 12,085 Philippines women and 25,543 Indonesian women. To identify variables associated with the use of LTCM, we analyzed place of residence, age group, education level, marital status, employment status, and wealth status. The final step employed multinomial logistic regression.ResultsIn both countries, the results showed that variables associated with non-user LTCM were younger women, living in rural areas with poor education. Women without partner and unemployed had higher probability to not use LTCM. Finally, low wealth status had a higher probability than the richest multiparous to not use LTCM.ConclusionThe study concluded that there were six barriers for multiparous women to use LTCM in the Philippines and Indonesia. The six obstacles were living in rural areas, being younger, poor education, single, unemployed, and low wealth.

Poor Self-Care Practices and Being Urban Resident Strongly Predict Chronic Complications Among Patients with Type 2 Diabetes in Eastern Ethiopia: A Hospital-Based Cross-Sectional Study.

BackgroundDiabetes, together with its complications, has a considerable negative influence on people’s quality of life and healthcare delivery and raises diabetic mortality. However, there is limited information about the diabetes-associated chronic complications in the study setting. Therefore, this study aimed to determine the burden and factors related to the chronic complications among patients with type 2 diabetes (T2D) in Eastern Ethiopia.MethodsA hospital-based cross-sectional study was conducted among 879 patients with T2D at two public hospitals in Harar. The data were collected through interviews using a structured questionnaire. Data related to the diagnosis of chronic complications and biochemical tests were extracted from medical records. The outcome variable was the number of chronic complications that happened to the patients. A generalized Poisson regression model with robust variance estimation was used to investigate the association of independent variables with chronic complications. An adjusted prevalence ratio with a 95% CI was reported to show an association using a p-value ≤0.05.ResultsOne or more chronic complications were presented in 43% of T2D (95% CI: 39.65, 46.19). Macrovascular and microvascular complications were found in 27.6% and 23.5% of patients, respectively. Urban residence (APR = 2.64; 95% CI: 1.54, 4.54), low wealth status (APR = 1.80; 95% CI: 1.17, 2.76), diabetes duration ≥5 years (APR = 1.46; 95% CI: 1.05, 2.01), hypertriglyceridemia (APR = 1.48; 95% CI: 1.07, 2.09) and poor self-care practices (APR = 1.62; 95% CI: 1.18, 2.23) were factors significantly associated with the chronic complications.ConclusionThe burden of chronic complications was high, with nearly half of T2D patients experiencing one or more chronic complications. Almost one in ten patients suffered from multiple chronic complications. The complications were mainly influenced by being urban resident, low wealth status, and poor self-care practices. Therefore, health care providers need to educate patients and promote self-care practices and healthy lifestyles to achieve treatment goals and lower the risk of chronic complications.

Prevalence of and factors associated with tobacco smoking in the Gambia: a national cross-sectional study.

ObjectivesTo examine the prevalence of and risk factors associated with tobacco smoking in the Gambia.DesignA nationwide cross-sectional study.SettingThe Gambia.ParticipantsThe study participants were both women and men aged between 15 and 49 years old. We included 16,066 men and women in our final analysis.Data analysisWe analysed data from the Gambia Demographic and Health Survey (DHS), 2019–2020. DHS collected nationally stratified data from local government areas and rural–urban areas. The outcome variable was the prevalence of tobacco smoking. Descriptive analysis, prevalence and logistic regression methods were used to analyse data to identify the potential determinants of tobacco smoking.ResultsThe response rate was 93%. The prevalence of current tobacco smoking was 9.92% in the Gambia in 2019–2020, of which, 81% of the consumers smoked tobacco daily. Men (19.3%) smoked tobacco much higher than women (0.65%) (p<0.001). People aged 40–49 years, with lower education, and manual workers were the most prevalent group of smoking in the Gambia (p<0.001).Men were 33 times more likely to smoke tobacco than women. The chance of consuming smoked tobacco increased with the increase of age (adjusted OR (AOR) 9.08, 95% CI 5.08 to 16.22 among adults aged 40–49 years, p<0.001). The strength of association was the highest among primary educated individuals (AOR 5.35, 95% CI 3.35 to 8.54).Manual workers (AOR 2.73) and people from the poorest households (AOR 1.86) were the risk groups for smoking. However, place of residency and region were insignificantly associated with smoking in the Gambia.ConclusionsMen, older people, manual workers, individuals with lower education and lower wealth status were the vulnerable groups to tobacco smoking in the Gambia. Government should intensify awareness programmes on the harmful effects of smoking, and introduce proper cessation support services among tobacco smoking users prioritising these risk groups.

Determinants of modern contraceptive utilization among married women in sub-Saharan Africa: multilevel analysis using recent demographic and health survey

BackgroundFamily planning is a low-cost, high-impact public health and development strategy to improve child and maternal health. However, there is a lack of evidence on modern contraceptive use and determinants in sub-Saharan Africa. Hence, this study aimed at determining the pooled prevalence and determinants of modern contraceptive utilization among married women of sub-Saharan Africa.MethodsThirty-six sub-Saharan African countries' demographic and health survey (DHS) data were used for pooled analysis. A total weighted sample of 322,525 married women was included. Cross tabulations and summary statistics were done using STATA version 14 software. The pooled prevalence of modern contraceptive utilization with a 95% Confidence Interval (CI) was reported. Multilevel regression analysis was used to identify the determinants of modern contraceptive use among married women. Four models were fitted to select the best-fitted model using the Likelihood Ratio (LLR) and Deviance test. Finally, the model with the highest LLR and the smallest deviance was selected as the best-fitted model.ResultsThe pooled estimate of modern contraception use in sub–Saharan African countries was 18.36% [95% CI: 18.24, 18.48], with highest in Lesotho (59.79%) and the lowest in Chad (5.04%). The odds of modern contraception utilization were high among women living in East Africa [AOR = 1.47 (1.40, 1.54)], urban areas [AOR = 1.18 (1.14, 1.24)], and women with primary [AOR = 1.49 (1.44, 1.55)] and secondary and above educational level [AOR = 1.66 (1.58, 1.74)]. Moreover, husbands with primary educational level [AOR = 1.38 (1.33, 1.42)], middle [AOR = 1.17, (1.14, 1.21)], rich wealth status [AOR = 1.29 (1.25, 1.34)], media exposure [AOR = 1.25 (1.22, 1.29)], and postnatal care (PNC) utilization [AOR = 1.25 (1.22, 1.29)] had higher odds of modern contraceptive utilization compared with their counter parts. Furthermore, deliver at health facility [AOR = 1.74 (1.69, 1.79)] and birth order 2–4 [AOR = 1.36 (1.31, 1.41)] had higher odds of modern contraceptive utilization. On the other hand, women living in Central [AOR = 0.23 (0.22, 0.24)], Western regions [AOR = 0.46 (0.40, 0.54)], women who decided with husband [AOR = 0.90 (0.87, 0.93)], and decisions by husband alone [AOR = 0.73 (0.71, 0.75)] decreased the odds of modern contraceptive utilization.ConclusionThe uptake of modern contraception in sub-Saharan Africa is low. Modern contraceptive utilization is affected by different factors. More attention needs to be given to rural residents, illiterate women, and communities with low wealth status.

Spatial Distribution and Determinant Factors of Handwashing Practice With Essential Agents Among Households in Ethiopia.

Objectives: This study aimed to assess the spatial distribution and determinant factors of handwashing practice using essential handwashing agents (soap and water) among households in Ethiopia. Methods: A two-stage stratified cluster sampling technique was used. Mixed-effect logistic regression analysis was also used to identify determinants of handwashing practice with essential agents. Results: In Ethiopia, household handwashing practices with essential agents had spatial variation (Moran’s Index 0.62, p < 0.001). The Amhara and Somali regions were identified as significant hotspots with low handwashing practice using essential agents. Conclusion: In Ethiopia, handwashing practice with essential agents showed spatial variation across the country with a very low rate. Areas with low handwashing practice with essential agents need high priority in the allocation of resources to ensure communities’ access to fixed and portable handwashing facilities, soap, and reliable water supplies. Households with low access to improved sanitation facilities, low wealth status, and low educational status should be targeted for the intervention.

Socioeconomic vulnerability and frailty among community-dwelling older adults: cross-sectional findings from longitudinal aging study in India, 2017\u201318

IntroductionThe Indian population is rapidly aging with huge proportion of illiterate and socioeconomically disadvantaged people and there is a dearth of research on the relationships between factors of socioeconomic vulnerability and frailty in older people. The present study examined the cross-sectional associations between socioeconomic vulnerability and physical frailty in community-dwelling older individuals in India.Materials and methodsThe data for the study were obtained from the Longitudinal Aging Study in India (LASI), which was conducted in 2017–18. The effective sample size was 14,652 older males and 15,899 older females aged 60 and over. The outcome variable was physical frailty phenotype measured from exhaustion, unintentional weight loss, weak grip strength, low physical activity, and slow walking time. The main explanatory variable was vulnerability status based on education, wealth and caste. The study carried out bivariate analysis to observe the association between vulnerability status and physical frailty. Further, multivariable binary logistic regression analysis was conducted to fulfil the objective of the study.ResultsA proportion of 10.5 and 14.4% of older males and females respectively were in the overall vulnerable category. The prevalence of physical frailty was high among older males from vulnerable population (31.4% vs 26.9%; p < 0.001). The adjusted estimates from multivariate analysis revealed that older adults from vulnerable category had 14% significantly higher odds of being frail in comparison to non-vulnerable category [AOR: 1.14; CI: 1.06,1.24]. The adjusted model further revealed that there were no significant gender differentials in physical frailty among older adults. Model-3 (adjusted model) revealed that older males and females from vulnerable population had 18% [AOR: 1.18; CI: 1.04,1.34] and 8% [AOR: 1.08; CI: 1.01,1.21] significantly higher odds of being physically frail in comparison to older males from non-vulnerable population respectively.ConclusionsAdverse socioeconomic circumstances such as low education, lower wealth and caste status that are associated with increased prevalence of physical frailty raise urgent questions both for public health practitioners and clinicians. The current findings may help to adapt public policies focusing on screening physical frailty in the clinical settings, especially among vulnerable populations as a marker of a possibly reversible vulnerability to adverse outcomes in old age.

Risk Factors of Stunting and Wasting among Children Aged 6-59 Months in Household Food Insecurity of Jima Geneti District, Western Oromia, Ethiopia: An Observational Study.

Undernutrition is the most difficult and widespread public health concern in low-income nations including Ethiopia. Therefore, this study aimed to investigate the associated risk factors of stunting and wasting among children aged 6–59 months in Jima Geneti district, Western Oromia, Ethiopia. A community-based cross-sectional study was conducted on 500 children from December 1 to 28, 2020. A multiple-stage sampling method was performed to select children from each kebele. Anthropometric measurements were taken, and the nutritional status was generated using WHO Anthro v. 3.2.1. Data analysis was performed using the SPSS version 20.0. Bivariate and multivariate logistic regression analyses were carried out to identify the associated risk factors of stunting and wasting among children in the study area. Statistical significance was set at p < 0.05. The study results showed that the prevalence of stunting and wasting among children was 27% and 11.8%, respectively. The findings of this study also revealed that the prevalence of household food insecurity and poor dietary diets was 19.6% and 52.2%, respectively. Low wealth status (AOR = 2.5; 95% CI: 1.1, 5.55) and poor dietary diets (AOR = 4.7; 95% CI: 2.5, 8.83) were associated risk factors for stunting. However, child meal frequency (AOR = 3.9; 95% CI: 1.23, 12.6), and children who did feed leftover food (AOR = 2.75; 95% CI: 1.02, 7.44) were associated risk factors for wasting. Poor dietary diets (AOR = 2.65; 95% CI: 1.06, 6.66) were also associated risk factors for wasting. The findings of this study concluded that the prevalence of stunting and wasting was high in the study area. Therefore, addressing family-level risk factors which are major drivers of children's nutritional status is crucial to ensure the nutritional status of children.

Underweight and associated factors among children under five years in North Shewa Zone, Oromia, Ethiopia: An observational community-based study

Background: Acute and chronic child undernutrition is a continuous problem in Ethiopia. Therefore, this study was initiated to compare the prevalence of underweight and its associated factors among children aged 6-23 months in the Kuyu district, North Shewa zone, Oromia, Ethiopia. Methods: An observational community-based study was conducted on 612 children (304 from household security and 308 from household food insecurity). A structured and standardize questionnaire was used in this study. Anthropometric measurements were generated using WHO standardize. Data was analyzed using SPSS version 20.0. Bivariate and multivariate logistic regression analysis was used to identify the independent variables associated with underweight (weight-for-age) among children in household food security and insecurity, a p value less than 0.05 with 95%CI was considered as statistically significant. Results: The results indicated that 30.9% [95%CI; 25.7, 36.2] and 36.7% [95% CI; 31.8, 42.5] of children were underweight for their age in household food security and insecurity. Low wealth status (AOR=3.2; 95%CI: 1.099, 9.275), poor dietary diets (AOR=5.2; 95%CI: 2.046, 13.27), and lack of breastfeeding for two years (AOR= 2.1; 95%CI= 1.78, 5, 42) were associated with underweight children in household food security. Whereas lack of antenatal care visits (AOR=0.52; 95%CI: 0.12, 0.68) and poor dietary diets (AOR=3.01; 95%CI= 2.1, 17.4) were other independent variables associated with underweight children in household food insecurity. Conclusions: This study established that there was a high prevalence of underweight in children from Oromia. Therefore, introducing household income generating activities are vital interventions in order to overcome the problem of undernutrition in this region.

Poor dietary practice and associated factors among type-2 diabetes mellitus patients on follow-up in Nigist Eleni Mohammed Memorial Teaching Hospital, Ethiopia.

Introductiongood dietary practice is one of the top pillars of self-care among patients of diabetes mellitus. However, the dietary practice of patients attending health institutions in the study area was not studied. Therefore, the prevalence and associated factors of poor dietary practice were determined among diabetic patients on follow-up in Nigist Eleni Mohammed Memorial Referral and Teaching Hospital, Southern Ethiopia.Methodsfacility-based cross-sectional study design was employed on type-2 diabetes mellitus adult patients. The study was conducted from March to April 2020. Total sample size was 322. Systematic random sampling method was used to select the study respondents. Odds ratio and their 95% confidence intervals together with P-value ≤0.05 were used to identify independent predictors of poor dietary practice during multivariable logistic regression.Resultsthe prevalence of the poor dietary practice among type diabetes patients was 53.7% (n=168). Low wealth status AOR 3.34, 95% CI: 1.50-7.41; p-value=0.003 and absence of family and friends support AOR 4.80, 95% CI: 2.54-9.0 and P-value<0.001 were associated factors with poor dietary practice among type-2 diabetes patients.Conclusionthe overall prevalence of poor dietary practice among type-2 diabetic adult patients was high that not going in line with international recommendations on dietary management of the diabetes mellitus. Integrated governmental and non-governmental activities should be in place to improve the economic status of type-2 diabetic patients. Support from the family members is found to be essential factor to promote dietary practice among type-2 diabetic adult patients.

Universal coverage of the first antenatal care visit but poor continuity of care across the maternal and newborn health continuum among Nepalese women: analysis of levels and correlates

BackgroundRoutine maternity care visits (MCVs) such as antenatal care (ANC), institutional delivery, and postnatal care (PNC) visits are crucial to utilisation of maternal and newborn health (MNH) interventions during pregnancy-postnatal period. In Nepal, however, not all women complete these routine MCVs. Therefore, this study examined the levels and correlates of (dis)continuity of MCVs across the antenatal-postnatal period.MethodsWe conducted further analysis of the 2016 Nepal Demographic and Health Survey. A total of 1,978 women aged 15–49 years, who had live birth two years preceding the survey, were included in the analysis. The outcome variable was (dis)continuity of routine MCVs (at least four ANC visits, institutional delivery, and PNC visit) across the pathway of antennal through to postnatal period. Independent variables included several social determinants of health under structural, intermediary, and health system domains. Multinomial logistic regression was conducted to identify the correlates of routine MCVs. Relative risk ratios (RR) were reported with 95% confidence intervals at a significance level of p<0.05.ResultsApproximately 41% of women completed all routine MCVs with a high proportion of discontinuation around childbirth. Women of disadvantaged ethnicities, from low wealth status, who were illiterate had higher RR of discontinuation of MCVs (compared to completion of all MCVs). Similarly, women who speak Bhojpuri, from remote provinces (Karnali and Sudurpaschim), who had a high birth order (≥4), who were involved in the agricultural sector, and who had unwanted last birth had a higher RR of discontinuation of MCVs. Women discontinued routine MCVs if they had poor awareness of health mother-groups and perceived the problem of not having female providers.ConclusionsRoutine monitoring using composite coverage indicators is required to track the levels of (dis)continuity of routine MCVs at the maternity care continuum. Strategies such as raising awareness on the importance of maternity care, care provision from female health workers could potentially improve the completion of MCVs. In addition, policy and programmes for continuity of maternity care are needed to focus on women with socioeconomic and ethnic disadvantages and from remote provinces.

Empirical analysis of socio-economic determinants of maternal health services utilisation in Burundi

BackgroundTimely and appropriate health care during pregnancy and childbirth are the pillars of better maternal health outcomes. However, factors such as poverty and low education levels, long distances to a health facility, and high costs of health services may present barriers to timely access and utilisation of maternal health services. Despite antenatal care (ANC), delivery and postnatal care being free at the point of use in Burundi, utilisation of these services remains low: between 2011 and 2017, only 49% of pregnant women attended at least four ANC visits. This study explores the socio-economic determinants that affect utilisation of maternal health services in Burundi.MethodsWe use data from the 2016–2017 Burundi Demographic and Health Survey (DHS) collected from 8941 women who reported a live birth in the five years that preceded the survey. We use multivariate regression analysis to explore which individual-, household-, and community-level factors determine the likelihood that women will seek ANC services from a trained health professional, the number of ANC visits they make, and the choice of assisted childbirth.ResultsOccupation, marital status, and wealth increase the likelihood that women will seek ANC services from a trained health professional. The likelihood that a woman consults a trained health professional for ANC services is 18 times and 16 times more for married women and women living in partnership, respectively. More educated women and those who currently live a union or partnership attend more ANC visits than non-educated women and women not in union. At higher birth orders, women tend to not attend ANC visits. The more ANC visits attended, and the wealthier women are; the more likely they are to have assisted childbirth. Women who complete four or more ANC visits are 14 times more likely to have an assisted childbirth.ConclusionsIn Burundi, utilisation of maternal health services is low and is mainly driven by legal union and wealth status. To improve equitable access to maternal health services for vulnerable population groups such as those with lower wealth status and unmarried women, the government should consider certain demand stimulating policy packages targeted at these groups.

1312Population-attributable fraction estimates for factors of different types of anaemia among women: multilevel multinomial analysis

Abstract Background Anaemia is one indicator of poor health in women and responsible for substantial mortality. Assessing the relative impact of predictors for anaemia among women could help to prioritize targeted preventions strategies. This study aimed to quantify the attributable burden of modifiable factors for different severity levels of anaemia among Ethiopian women. Methods Adjusted odds ratio and exposure prevalence for selected factors were used to calculate population attributable fractions using the 2016 Ethiopian Demographic and Health Surveys data. Adjusted odds ratios (AOR) with 95% confidence intervals (CIs) were computed using multilevel multinomial regression models. Results In Ethiopia, an estimated 14.6% (95% confidence interval, CI: 3.4, 24.5) of mild anaemia was attributable to no formal education, 11.2% (95%CI: 1.2, 19.9) to high gravidity (≥ 4) and 5.2% (95%CI: 0, 10.7) to currently breastfeeding. Similarly, proportion of moderate-severe anaemia attributable to rural residence was 38.1% (95%CI: 15.9, 54.8), poorest wealth quantile was 12.6% (95%CI: 2.9, 24.6), previous five years birth was 10.5% (95%CI: 2.9, 18.2), and unimproved latrine was 17% (95% CI: 0, 32.5). Conclusions The result suggests that low education, low wealth status, high parity, rural residency, pregnancy and breastfeeding contribute substantially to the occurrence of anaemia among women. Key messages Mild anaemia could be reduced by setting intervention strategies targeting women with low education, multigravida women, and breastfeeding women, while preventing moderate-to-severe anaemia may require increasing income, and improving living environments like hygienic latrines.

Multilevel geospatial analysis of factors associated with unskilled birth attendance in Ghana.

Globally, about 810 women die every day due to pregnancy and its related complications. Although the death of women during pregnancy or childbirth has declined from 342 deaths to 211 deaths per 100,000 live births between 2000 and 2017, maternal mortality is still higher, particularly in sub-Saharan Africa and South Asia, where 86% of all deaths occur. A secondary analysis was carried out using the 2014 Ghana Demographic and Health Survey. A sample total of 4,290 women who had a live birth in the 5 years preceding the survey was included in the analysis. GIS software was used to explore the spatial distribution of unskilled birth attendance in Ghana. The Geographic Weighted Regression (GWR) was employed to model the spatial relationship of some predictor of unskilled birth attendance. Moreover, a multilevel binary logistic regression model was fitted to identify factors associated with unskilled birth attendance. In this study, unskilled birth attendance had spatial variations across the country. The hotspot, cluster and outlier analysis identified the concerned districts in the north-eastern part of Ghana. The GWR analysis identified different predictors of unskilled birth attendance across districts of Ghana. In the multilevel analysis, mothers with no education, no health insurance coverage, and mothers from households with lower wealth status had higher odds of unskilled birth attendance. Being multi and grand multiparous, perception of distance from the health facility as not a big problem, urban residence, women residing in communities with medium and higher poverty level had lower odds of unskilled birth attendance. Unskilled birth attendance had spatial variations across the country. Areas with high levels of unskilled birth attendance had mothers who had no formal education, not health insured, mothers from poor households and communities, primiparous women, mothers from remote and border districts could get special attention in terms of allocation of resources including skilled human power, and improved access to health facilities.

Exploring the reasons and factors influencing the choice of home delivery of births in rural Bangladesh: a community-based cross-sectional study

PurposeThe aim of this study was to explore the reasons for preferring home as a birth delivery place and identify the socio-economic and cultural factors influencing the choice of delivery place in rural Bangladesh.Design/methodology/approachThe data for the study come from a community-based cross-sectional study conducted among 464 mothers in a rural sub-district of Bangladesh in 2019. Respondents were selected randomly from the frame listing all mothers with inclusion criteria, using a two-stage cluster sampling design. Data were collected through a face-to-face interview. Both descriptive and inferential statistics and logistic regression models were used for data analysis.FindingsThe results indicate a very high rate (58%) of home delivery. About 20% mothers never received ANC visit. Preference for home delivery was high (63%). Mothers with no education, aged 30 and above, multi-parity, low wealth status, lack of knowledge about institutional delivery, no or &lt;4 ANC visits, received no advice about the delivery place, no pregnancy complications, decision about health care, and prior plan for home delivery were identified as significant predictors of home delivery. Cost of services, cultural practices and attitude towards health facility, lack of a female delivery assistant, perceived fear of caesarian section, poor quality of services, and lack of knowledge about maternity services appeared as important barriers for institutional delivery.Originality/valueBased on primary data from a rural area, this study would help understand reasons and factors affecting home delivery and developing an appropriate strategy for the improvement of institutional delivery and maternity care services in Bangladesh.

Effect of Community-Based Health Insurance on Healthcare-Seeking Behavior for Childhood Illnesses Among Rural Mothers in Aneded District, East Gojjam Zone, Amhara Region, Northwest Ethiopia.

BackgroundCommunity-based health insurance (CBHI) schemes have been implemented in developing countries to facilitate modern medical care access. However, studies conducted on the effect of CBHI on healthcare-seeking behavior (HSB) have been limited and revealed inconsistent results. Therefore, this study aimed to assess the effect of CBHI on mothers’ HSB for common under-five childhood illnesses.MethodsA community-based comparative cross-sectional study was conducted among 410 rural mothers (205 insured and 205 non-insured), and a multistage random sampling technique was used to select the study participants. Binary logistic regression and propensity score matching were used to identify factors associated with the mothers’ HSB, and estimate the effect of CBHI on mothers’ HSB, respectively.ResultsThe overall mother’s HSB for childhood illnesses was 48.8% (200/410). From those mothers who visited healthcare, 92.0% were married, 86.0% were unable to read and write, 94.5% were farmers, and 54.5% were from low wealth status, 58.50% had a family size of ≤5, 54.0% had children less than 24 months of age. Besides, 63.0% were members of CBHI, 37.0% perceived their child’s illness as severe, 78.0% made a shared decision to visit a health facility, and 67.5% lived within less than five Kms from the nearby health facilities. Being a member of CBHI, the child’s age, decision to visit a health facility, and perceived disease severity were predictors of HSB. The CBHI had a significant effect on the HSB for childhood illnesses with ATT of 28.7% (t = 3.959).ConclusionThe overall mothers’ HSB for common childhood illnesses was low though the CBHI has a significant effect. CBHI should be strengthened to improve the mothers’ HSB. It is also crucial to strengthen awareness creation regarding joint decision-making and educate mothers to visit the health facilities regardless of children’s age and disease severity.

Factors Associated with Stunting Among Children Aged 24-59 Months in Food Secure and Insecure Households of Kuyu District, Northern Oromia, Ethiopia: &lt;i&gt;A Comparative Cross-Sectional Study&lt;/i&gt;

Background: Stunting is the most challenging and prevalent public health problems particularly in low socioeconomic settings. The major aim of this study was to assess and compare factors associated with stunting among children aged 24-59 months in food secure and insecure households of Kuyu district, North Shewa Zone, central Oromia. Methods: A comparative, cross-sectional study was done on 618 children (309 children from food secure and 309 from insecure households) between February and March 2019. Multiple stages sampling method was performed to select children from each kebele. Anthropometric data were taken and calculated using WHO Anthro v. 3.2.2. The data analysis was performed using SPSS version 20.0. Logistic regressions analysis was carried out in the statistical analysis. Results : The prevalence of stunting was 43.1% and 48.3% for children in food secure and insecure households, respectively. The multivariate analysis showed that low wealth status (AOR=7.44; 95% CI: 3.02, 18.46), a child who did not eat all food types (AOR=2.1; 95%CI: 1.12, 4.24) and low dietary diversity (AOR=8.3; 95%CI: 4.46, 15.5) were significantly linked with stunting in food-secure households. Whereas, in food, insecure households, poor dietary diversity (AOR=4.7; 95%CI: 2.5, 8.83), low wealth status (AOR=2.5; 95%CI: 1.1, 5.55) and child who did not eat breakfast (AOR=2.04; 95%CI: 1.1, 3.78) were predictors for children stunting. Conclusions: The prevalence of stunting among children under five years old was very high in the study area. Therefore, ensuring food security status using the Productive Safety Net Program (PSNP) in harmony with the participation of all responsible bodies should be intensified to overcome the problem of undernutrition in the study area. Funding: The Innovation and Technology Transfer Grant from Wollega University supported this work. Declaration of Interest: None to declare. Ethical Approval: The study was reviewed and approved by the Institutional Review Board (IRB) of the college of medicine and health sciences of Hawassa University.

The Barrier to Contraceptive Use among Multiparous Women in Indonesia.

Background:The lack of perception related to the risk of pregnancy and contraceptive use's side effects is the main reason for not using contraceptives.Objective:This study aimed to analyze barriers to contraceptive use among multiparous women in Indonesia.Methods:This study employed the 2017 Indonesia Demographic and Health Survey. The analysis unit was multiparous women aged 15–49 years old, and the sample was 25,543 women. The contraceptive use was the dependent variable, while the independent variables analyzed were residence, age, education, employment, wealth, and insurance. The study used a binary logistic regression to determine the barriers.Results:Women in urban areas were 1.100 times more likely not to use contraceptives than women in rural areas. All categories of age group are more likely to use contraception than the 45–49 age group. Multiparous women who had low education had a higher possibility of not using contraceptives. Unemployed multiparous women were 1.008 times more likely not to use contraceptives than employed multiparous women. In terms of wealth status, women with all wealth status tended not to use contraceptives than the richest.Conclusions:Multiparous women in Indonesia had five barriers to not using contraceptives. These included living in urban, being at younger ages, having no education, being unemployed, and having low wealth status.

Tuberculosis and HIV/AIDS-Attributed Mortalities and Associated Socioeconomic Demographic Factors in Papua New Guinea: Evidence From the Comprehensive Health and Epidemiological Surveillance System

Background: Tuberculosis (TB) and HIV/AIDS have been recently identified as the leading specific causes of deaths (COD) in Papua New Guinea (PNG). However, little is known about the socioeconomic demographic factors of mortalities attributed to these diseases. Objective: This study examines the socioeconomic and gender inequality in mortality attributed to TB and HIV/AIDS among the population by analyzing the associations of socioeconomic demographic factors of the deceased and CODs in the population in PNG to inform policy. Method: Mortality data from 926 verbal autopsy (VA) interviews were collected from the population living within the catchment areas of the Comprehensive Health and Epidemiological Surveillance System (CHESS), established in five provinces, including Central, Eastern Highlands, East New Britain, East Sepik, Madang and Port Moresby, the National Capital in the period 2018-2020, using the WHO 2016 VA tool. InterVA-5 cause of deaths (COD) diagnostic tool was used to assign possible CODs. Mortality data were linked with household socioeconomic data from CHESS database for analysis of socioeconomic factors associated with mortalities from TB and HIV/AIDS using multinomial logistic regression (MLR) models to provide estimates odds ratios (unadjusted and adjusted ORs) and 95% confidential intervals (CI). Result: TB and HIV/AIDS were the first and the third leading CODs, attributed to 9% and 8% of the total deaths recorded in the population. The prevalence of TB and HIV/AIDS co-morbidities was about 6% of all TB and HIV/AIDS-attributed deaths. Males were more likely to die from TB than females (aOR: 1.2; 95% CI: 0.62-1.83). The population aged 25-34 years had the highest proportion of deaths from TB (20% of deaths in this age group), and the risk of dying from TB in this age group was three folds more than those aged 75+ years (aOR: 2.7; 95% CI: 1.59-19.5). People from middle household wealth quintile had highest proportion of deaths from TB (15% of deaths in this population) and the risk of dying from TB in this quintile was doubled than the richest quintile (aOR: 2.14; 95% CI: 1.30-3.27). Rural population was more likely to die from TB than urban population. The risks of dying from TB were 50% higher in Central and Madang, but 50% lower in POM compared to East New Britain. HIV/AIDS-attributed deaths accounted for 11% of female deaths, compared to 5% of male deaths. Young population aged 25-34 years had the highest proportion of deaths attributed to HIV/AIDS (18%) and the risk of dying from HIV/AIDS in this population was twice higher than those aged 75+ years (aOR: 1.99; 95% CI: 0.77-20.3). HIV/AIDS-attributed deaths accounted for 5% of deaths among children aged 0-4 years. The highest proportion of HIV/AIDS mortality was found among the population from middle household wealth quintile (10% of deaths in this population), and this population was 85% more likely to die from HIV/AIDS than the richest quintile (aOR: 1.85; 95%CI: 0.91-3.21). About 9% of deaths in rural population was due to HIV/AIDS, compared to 6% in urban population. The proportion of people died from HIV/AIDS was highest in EHP (12%), followed by Madang (10%). The risks of dying from HIV/AIDS were higher in EHP and Madang than East New Britain (aOR: 1.3 [95% CI: 0.4-2.5] and aOR: 2.0 [95% CI: 0.8-3.6], respectively). Conclusion: TB and HIV/AIDS were the top leading causes of death in PNG population, and attributed to highest proportions of mortalities among the young people aged 24-35 years, are evidence of failed TB and HIV/AIDS programs. Death of children aged 0-4 years to HIV/AIDS suggested that the prevention of mother-to-child transmission was failed to protect newborns from HIV/AIDS. More targeted public health interventions are needed to reduce premature mortalities from TB and HIV/AIDS among the population in rural areas, particularly those are young females in Madang and EHP, and those are from households with low wealth status. Funding Information: The CHESS was operated with financial supported from the PNG Government through the Department of National Planning and Monitoring (PIP No. 02704). Declaration of Interests: No potential conflict of interest was reported by the authors. Ethics Approval Statement: The CHESS was granted ethics approvals from Institutional Review Board of PNG Institute of Medical Research (IRB’s Approval no. 18.05) and the Medical Research Advisory Committee of Papua New Guinea (MRAC’s Approval no. 18.06). These approvals covered all the data components under the CHESS, including the mortality data which were used in this manuscript. Informed consent was sought from self-identified close relatives of the deceased. They were informed about their right to withdraw from the study at any stage.