Multilevel Logistic Regression Research Articles

Effects of disability on adverse health outcomes and anthropometric deficits among under-five children in South Asian countries: evidence from multiple indicator cluster surveys

Children with disabilities face an increased risk of adverse health outcomes and poor anthropometric deficits, although the focus on them is limited in the South Asian context thus far and need newer and more evidence. This study investigates the effects of disability on adverse health outcomes and anthropometric deficits among 2-4 years aged children in South Asian countries. We analyzed data from 93,180 children aged 2-4 years across Bangladesh, Nepal, Pakistan, and Afghanistan using Multiple Indicator Cluster Surveys (2017-2023). Disability status was the primary exposure, and outcomes included adverse health outcome (acute respiratory infection, diarrhea, fever), anthropometric deficit (stunting, wasting, underweight), and healthcare service sources during adverse health events (care received from skilled healthcare personnel, care received from non-professional personnel, and care received from health facility workers other than skilled healthcare personnel). Using multilevel and multinomial logistic regression models, we examined associations between exposure and outcome variables, adjusting for covariates. We found average disability prevalence in South Asia was 8.7% (8.3-9.0; n=8072), varying from 3.4% (3.0-3.8; n=446) in Bangladesh to 12.3% (11.4-13.3; n=1259) in Afghanistan. Common health issues included fever (n=24,982, 26.8%, 26.2-27.4) and diarrhea (n=14,081, 15.1%, 14.7-15.6), while prevalent poor anthropometric deficits were stunting (n=39,766, 42.7%, 42.0-43.3) and underweight (n=22,390, 24.0%, 23.5-24.5). Children with disability had 1.30 (95% CI: 1.21-1.40) to 1.60 (95% CI: 1.47-1.75) times and 1.17 (95% CI: 1.05-1.29) to 1.39 (95% CI: 1.30-1.48) times higher likelihoods of adverse health outcomes and anthropometric deficits, respectively, with variations observed among countries and different disability types. Individuals with disability were 1.16 (95% CI: 1.00-1.35) to 1.26 (95% CI: 1.01-1.58) times more likely to receive healthcare services from skilled healthcare personnel compared to health facility workers other than skilled healthcare personnel. This study findings emphasizes the need for community-level awareness programs to improve anthropometric well-being and healthcare of the children with disability. This research did not receive any specific funds.

Factors associated with medical consumable availability in level 1 facilities in Malawi: a secondary analysis of a facility census.

Medical consumable stock-outs negatively affect health outcomes not only by impeding or delaying the effective delivery of services but also by discouraging patients from seeking care. Consequently, supply chain strengthening is being adopted as a key component of national health strategies. However, evidence on the factors associated with increased consumable availability is limited. In this study, we used the 2018-19 Harmonised Health Facility Assessment data from Malawi to identify the factors associated with the availability of consumables in level 1 facilities, ie, rural hospitals or health centres with a small number of beds and a sparsely equipped operating room for minor procedures. We estimate a multilevel logistic regression model with a binary outcome variable representing consumable availability (of 130 consumables across 940 facilities) and explanatory variables chosen based on current evidence. Further subgroup analyses are carried out to assess the presence of effect modification by level of care, facility ownership, and a categorisation of consumables by public health or disease programme, Malawi's Essential Medicine List classification, whether the consumable is a drug or not, and level of average national availability. Our results suggest that the following characteristics had a positive association with consumable availability-level 1b facilities or community hospitals had 64% (odds ratio [OR] 1·64, 95% CI 1·37-1·97) higher odds of consumable availability than level 1a facilities or health centres, Christian Health Association of Malawi and private-for-profit ownership had 63% (1·63, 1·40-1·89) and 49% (1·49, 1·24-1·80) higher odds respectively than government-owned facilities, the availability of a computer had 46% (1·46, 1·32-1·62) higher odds than in its absence, pharmacists managing drug orders had 85% (1·85, 1·40-2·44) higher odds than a drug store clerk, proximity to the corresponding regional administrative office (facilities greater than 75 km away had 21% lower odds [0·79, 0·63-0·98] than facilities within 10 km of the district health office), and having three drug order fulfilments in the 3 months before the survey had 14% (1·14, 1·02-1·27) higher odds than one fulfilment in 3 months. Further, consumables categorised as vital in Malawi's Essential Medicine List performed considerably better with 235% (OR 3·35, 95% CI 1·60-7·05) higher odds than other essential or non-essential consumables and drugs performed worse with 79% (0·21, 0·08-0·51) lower odds than other medical consumables in terms of availability across facilities. Our results provide evidence on the areas of intervention with potential to improve consumable availability. Further exploration of the health and resource consequences of the strategies discussed will be useful in guiding investments into supply chain strengthening. UK Research and Innovation as part of the Global Challenges Research Fund (Thanzi La Onse; reference MR/P028004/1), the Wellcome Trust (Thanzi La Mawa; reference 223120/Z/21/Z), the UK Medical Research Council, the UK Department for International Development, and the EU (reference MR/R015600/1).

Socio-economic factors related to premature death from colorectal cancer in Santiago de Chile, 2014–2018: a cross-sectional study

ObjectivesIn Chile, colorectal cancer (CRC) is the fourth cause of death by cancer. Few studies have evaluated the role of contextual and individual socio-economic variables associated with premature death by CRC (<70 years). We analyzed the association between socio-economic factors (at individual and contextual levels) and premature death from CRC in Santiago de Chile. Study designThis was a cross-sectional study. MethodsWe analyzed deaths from CRC between 2014 and 2018 using data published by the Ministry of Health. Individual predictors were sex, marital status, and educational level. Contextual variable included the Social Priority Index (SPI) of the commune where the deceased lived. The association was assessed through multilevel logistic regression models. ResultsDuring the period, 4762 deaths occurred (51.7% women); 39.3% were premature. At the individual level, male sex (odds ratio [OR] 1.36; 95% confidence interval [CI] 1.20–1.53) and single marital status (OR 1.45; 95% CI 1.24–1.68) were associated with premature death from CRC. Primary or lower education was a protective factor (OR 0.53; 95% CI 0.47–0.60). At the contextual level, communes with a higher SPI were three times more at risk than those with a lower SPI (OR 3.13; 95% CI 2.15–4.57). ConclusionsThis study showed that individual and contextual socio-economic variables are related to premature death from CRC. Residing in communes with greater socio-economic vulnerability was associated with greater risk. To reduce this gap, it is urgent to design and implement structural policies to reduce social inequities and improve access to health care.

Who believes in a just world? A multilevel latent profile analysis of Justice Capital using the European Social Survey.

Justice Capital provides a theoretical framework for explaining individual differences in the belief in a just world (BJW). However, this framework has yet to receive empirical validation. Using Round 9 of the European Social Survey, a large (n = 43,209) multi-country (N = 29) sample, I conduct multilevel latent profile analysis and multilevel multinomial logistic regression to determine the latent profiles that emerge at a population level and map the demographic and experiential covariates of these profiles. Incorporating measures of general BJW, distributive and procedural justice, and the belief in equality of opportunity, I find three latent profiles: meritocrats, moderates, and egalitarians. Compared with egalitarians, meritocrats (strong just world believers) are more likely to be male; younger; have a higher income; have attained more years of education; to be politically conservative; and have no recent experience of discrimination or crime. Meritocrats were overrepresented in countries with a higher Human Development Index. This study demonstrates the feasibility of Justice Capital for understanding individual variation in general BJW and related justice beliefs; discussion centers on anomalous findings and extension of this theoretical framework.

Does structural racism impact receipt of NCCN guideline-concordant breast cancer treatment?

Disparities in breast cancer survival remain a challenge. We aimed to analyze the effect of structural racism, as measured by the Index of Concentration at the Extremes (ICE), on receipt of National Cancer Center Network (NCCN) guideline-concordant breast cancer treatment. We identified patients treated at two institutions from 2005 to 2017 with stage I-IV breast cancer. Census tracts served as neighborhood proxies. Using 5-year estimates from the American Community Survey, 5 ICE variables were computed to create 5 models, controlling for economic segregation, non-Hispanic Black (NHB) segregation, NHB/economic segregation, Hispanic segregation, and Hispanic/economic segregation. Multi-level logistic regression models were used to determine the association between individual and neighborhood-level characteristics on receipt of NCCN guideline-concordant breast cancer treatment. 5173 patients were included: 55.2% were Hispanic, 27.5% were NHW, and 17.3% were NHB. Regardless of economic or residential segregation, a NHB patient was less likely to receive appropriate treatment [(OR)Model1 0.58 (0.45-0.74); ORModel2 0.59 (0.46-0.78); ORModel3 0.62 (0.47-0.81); ORModel4 0.53 (0.40-0.69); ORModel5 0.59(0.46-0.76); p < 0.05]. To our knowledge, this is the first analysis assessing receipt of NCCN guideline-concordant treatment by ICE, a validated measure for structural racism. While much literature emphasizes neighborhood-level barriers to treatment, our results demonstrate that compared to NHW patients, NHB patients are less likely to receive NCCN guideline-concordant breast cancer treatment, independent of economic or residential segregation. Our study suggests that there are potential unaccounted individual or neighborhood barriers to receipt of appropriate care that go beyond economic or residential segregation.

Modern contraceptive utilization and associated factors among younger and older married youth women in Ethiopia: Evidence from Ethiopia Mini Demographic and Health Survey 2019.

Utilization of modern contraceptives increases over time but it was still low and varies across ages among married youth woman. This study revealed the prevalence of modern contraceptives and its associated factors among younger and older married youth women. A cross-sectional study design was applied to the sample of EMDHS 2019. Multilevel logistic regressions were carried out using STATA version 16 to identify the individual and community-level factors of modern contraceptive utilization. Adjusted odds ratios with a 95% confidence interval and variables with a p-value < 0.05 were considered to be significant determinants of modern contraceptive utilization. In the EMDHS 2019, a total of 3290 married women between ages 15 and 34 were included. Among these 1210 (36.7%) and 2080 (63%) women, they were age groups of 15-24 and 25-34 years, respectively. Modern contraceptive utilization among women aged 15-24 and 25-34 years was 54.23% and 52.6%, respectively. Injection is a commonly used modern contraceptive method. In this study, factors associated with modern contraceptive utilization among women aged 15-24 years include women who had primary education [AOR = 2.22; 95% CI: 1.02-4.83], who had three or more children in the household [AOR = 14.29; 95% CI: 1.61-126.25], Protestants [AOR = 0.29; 95% CI: 0.14-0.61], five to seven households [AOR = 0.34; 95% CI: 0.17-0.69], and region [AOR = 6.98; 95%:2.30-21.16]. On other hand, factors associated with modern contraceptive utilization among women aged 25-34 were women who had one or two under-five children in the household [AOR = 1.66; 95% CI: 1.03-2.68] and region [AOR = 3.54; 95%CI: 1.79-6.97]. More than 50% of participants used modern contraceptives in both age groups and, the associated factor of modern contraceptive utilization varied among this age group. Health managers and policymakers need to consider age group, region, educational status, religion, and fertility level in planning of family planning program.

Spatial variation and predictors of incomplete pneumococcal conjugate vaccine (PCV) uptake among children aged 12–35 months in Ethiopia: spatial and multilevel analyses

BackgroundDespite the Ethiopian government included the Pneumococcal Conjugate Vaccine (PCV) in the national expanded program for immunization in 2011, only 56% of children aged 12–23 months received the full dose of PCV. Despite some studies on PCV uptake in Ethiopia, there was a dearth of information on the geographical distribution and multilevel factors of incomplete PCV uptake. Hence, this study aimed to identify the spatial variations and predictors of incomplete PCV uptake among children aged 12–35 months in Ethiopia.MethodsThe study was based on an in-depth analysis of 2016 Ethiopia Demographic Health Survey data, using a weighted sample of 3,340 women having children aged 12–35 months. Arc-GIS version 10.7 and SaTScan version 9.6 statistical software were used for the spatial analysis. To explore spatial variation and locate spatial clusters of incomplete PCV, the Global Moran's I statistic and Bernoulli-based spatial scan (SaTScan) analysis were carried out, respectively. A multilevel mixed-effect multivariable logistic regression was done by STATA version 16. Adjusted odds ratio (AOR) with its corresponding 95% CI was used as a measure of association, and variables with a p &amp;lt; 0.05 were deemed as significant determinants of incomplete PCV.ResultsThe overall prevalence of incomplete PCV in Ethiopia was found to be 54.0% (95% CI: 52.31, 55.69), with significant spatial variation across regions (Moran's I = 0.509, p &amp;lt; 0.001) and nine most likely significant SaTScan clusters. The vast majority of Somali, southeast Afar, and eastern Gambela regions were statistically significant hot spots for incomplete PCV. Lacking ANC visits (AOR = 2.76, 95% CI: 1.91, 4.00), not getting pre-birth Tetanus injections (AOR = 1.84, 95% CI: 1.29, 2.74), home birth (AOR = 1.72, 95% CI: 1.23, 2.34), not having a mobile phone (AOR = 1.64, 95% CI: 1.38, 1.93), and residing in a peripheral region (AOR = 4.63; 95% CI: 2.34, 9.15) were identified as statistically significant predictors of incomplete PCV.ConclusionThe level of incomplete PCV uptake was found to be high in Ethiopia with a significant spatial variation across regions. Hence, the federal and regional governments should collaborate with NGOs to improve vaccination coverage and design strategies to trace those children with incomplete PCV in peripheral regions. Policymakers and maternal and child health program planners should work together to boost access to maternal health services like antenatal care and skilled delivery services to increase immunization coverage.

The resilient self-employability of women and senior people after sudden economic shocks

AbstractIn recent times, various crises have negatively affected the financial stability, job security, and health of countless individuals. According to research, different factors that operate at both the individual and contextual levels can play a prominent role in influencing people's self-employment during periods of economic downturn. This study investigates the changes in the likelihood of self-employment by gender and age across various contexts following sudden shocks. By analyzing the intersection of occupational choice and business cycle theories, this research offers insights into how crises affect people's ability to work for themselves. Using a sample of over 250,000 individuals from sixteen countries and applying a multilevel binary logistic regression analysis, the results confirm that women and older individuals are less inclined to be self-employed in general. However, unexpected economic recessions may lead to a slight increase in their likelihood of self-employment. Furthermore, when women and seniors live in a higher GDP per capita context, this context positively moderates the relationship between gender, age, and the propensity for entrepreneurship. These findings offer valuable insights for policymakers seeking to promote resilient self-employment among vulnerable individuals for post-crisis recovery.

Risk factors associated with Rohingya refugee girls' education in Bangladesh: A multilevel analysis of survey data.

In Bangladesh, the world's largest refugee settlement currently shelters approximately onemillion Rohingya refugees who fled Myanmar to escape military persecution. Educating a significant number of young Rohingya, roughly half of whom are female, presents a significantchallenge. Despite the presence of learning centres (LCs) across refugee camps, Rohingya girls may encounter specific barriers to accessing education due to exposure to various risks, such as violence, child marriage, and trauma stemming from past military oppression. This paper investigates the association between these risk factors and Rohingya girls' likelihood of attending LCs, and how this association may vary across refugee camps. Using survey data and employing three-level multilevel logistic regression models, I find that girls are less likely to attend LCs if they are at risk of encountering sexual abuse, child marriage, and psychological distress or trauma. These factors explain considerable variation in girls' LC attendance between camps and between households. In addition to providing more schooling opportunities to Rohingya children, prioritising girls' safety, protecting them from forced and child marriage, and supporting their psychological well-being require increased policy attention.

Investigating home-based opioid use among youth with sickle cell disease using ecological momentary assessment.

Opioids are a common and essential treatment for acute sickle cell disease (SCD) pain. However, opioids carry well-known adverse side effects, including potential development of hyperalgesia and nociplastic pain. We characterized opioid use in youth with SCD using ecological momentary assessment (EMA) data, and investigated the relationships between home-based opioid use, pain, and a range of biopsychosocial factors. Eighty-eight youth with SCD (aged 8-17years) completed EMAs assessing home-based opioid use, pain, and related factors. Analyses consisted of descriptive and multilevel logistic regression to predict daily home opioid use. Youth averaged 3.64weeks of EMAs. Approximately 35% of the sample (n=31) took an opioid during the EMA period, and used them on only 24% of reported pain days. Youth who took opioids reported a higher percentage of pain days (t=-2.67, p<.05) and mean pain severity scores (t=-2.30, p<.05) than youth who did not take opioids. Multilevel logistic regression analyses indicated that high daily pain severity (odds ratio [OR]=1.02, p<.01), older age (OR=1.324, p<.01), and low positive affect (OR=0.91, p<.01) were each related to an increased likelihood of opioid use. Youth with SCD take opioids appropriately in response to their pain, based on daily self-report. Beyond daily pain severity, age, and daily variation in positive affect were related to home-based opioid use. This suggests that behavioral interventions that enhance positive affect may promote reduced opioid use among youth with SCD.

Utilization of reproductive health services among undergraduate regular class students in Assosa University, BGRS: a comparison among three varieties of multilevel binary logistic regression models

IntroductionReproductive health service (RHS) helps for people to have a delighted and safe sex through their life journey. It enables especially for women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant. Therefore, this study aimed to identify the significant determinants of RHS utilization among undergraduate regular class students in Assosa University by using advanced methodology.MethodsWe used cross-sectional study design to collect RHS data from 362 students in Assosa University from 5 to 16, may 2021. These students were selected using stratified random sampling technique. We also used cross-tabulation to summarize the extents of RHS utilization across all predictors in terms of percentage and three varieties of multilevel binary logistic regression model to model the determinants of RHS.Results42.27% of undergraduate regular class students in Assosa University utilize at least one type of RHS during their time at Assosa University whereas, 57.73% of undergraduate regular class students in this University are not utilized it. Among three varieties of multilevel binary logistic regression models, the random slopes two-level model was selected as a best fitted model for the datasets. At 5% level of significance, awareness about RHS, gender, preference of service fees and student’s monthly average income were significant predictor variables in this model. In addition, the covariates; age, gender and preference of service fees have a significant random effects on utilization of RHS across all colleges/school.ConclusionStudents who; preferred service fee as usual rate, have awareness about RHS, are females and have high monthly average income were more likely to utilize RHS. RHS utilization among undergraduate regular students in Assosa University is likely to increase more effectively with interventions that address these factors.

Associations of obesity, movement behaviors, and socioeconomic status with fundamental movement skills in children: Results from the REACT project.

To investigate the relationship of biological characteristics (age, sex, and obesity), movement behaviors (physical activity and sedentary time), and family socioeconomic status with fundamental movement skills (FMS) in primary school children. This cross-sectional study sampled 1014 children (537 girls) aged 6 to 10 years from 25 primary schools in Matosinhos, north of Portugal. Five object control skills (dribbling, kicking, catching, throwing, and underarm rolling) were assessed with a categorical scale using the Meu Educativo® platform. Body Mass Index (BMI) was calculated and transformed into z-scores. Moderate-to-vigorous physical activity (MVPA) and sedentary time were monitored with accelerometry (ActiGraph wGT3X-BT) for seven consecutive days. Family socioeconomic status (SES) was obtained from the Portuguese social support system. Ordinal multilevel logistic regression was used to analyze the associations of weight status, MVPA, sedentary time and SES with FMS, adjusted for sex and age. Boys (odds ratio (OR) = 6.54; 95% CI: 5.13-8.36) and older children (OR = 2.04; 95% CI: 1.85-2.26) were more likely to achieve higher FMS scores. Children with obesity (OR = 0.60; 95% CI: 0.45-0.80), those less active (OR = 0.56; 95% CI: 0.42-0.75) and children with more sedentary time (OR = 0.86; 95%CI: 0.77-0.97) were less likely to score high on FMS. Family SES was not significantly associated with FMS scores. Primary school children's FMS are significantly related to biological and behavioral factors but not to family SES. These findings highlight the need for suitable strategies to enhance children's FMS proficiency, considering differences in these characteristics. Fostering adequate motor skill proficiency levels will assist in establishing a robust foundation for healthy lifestyles of all children.

Knowledge of fertility period among reproductive age women in Kenya: a multilevel analysis based on 2022 Kenyan demographic and health survey

BackgroundKnowledge of the fertility period aids women in refraining and engaging in sexual intercourse to avoid and to get pregnant, respectively. The effect of community-level factors on knowledge of the fertility period was not yet known in Kenya. Therefore, we aimed to investigate the community- and individual-level determinants of knowledge of fertility period among women of childbearing age in Kenya.MethodsThe 2022 Kenyan Demography and Health Survey data was used for the current study. This study included 16,901 women of reproductive age. To account for the clustering effects of DHS data and the binary nature of the outcome variable, a multilevel binary logistic regression model was applied. An adjusted odds ratio with a 95% confidence interval was reported to declare the statistical significance. In addition, the model that had the lowest deviance was the one that best fit the data.ResultsThe overall prevalence of knowledge of the fertility period among Kenyan women was 38.1% (95%CI = 37.3, 38.9). Women’s age, women’s education status, heard FP, contraceptive use, media exposure, and distance from health facility significant individual factors while place of residence, and community-level education, were all of factors were found to be strongly associated with knowledge of fertility period.ConclusionAs per the findings of our study, Knowledge of the fertility period among reproductive women was low in Kenya. In the era of increasing refusal of hormone-based family planning, fertility-awareness-based family planning methods may be an option. Promoting the correct fertility period through education and media outreach may be helpful strategies for enhancing fertility decision-making.

Access to drinking safe water and its associated factors among households in East Africa: a mixed effect analysis using 12 East African countries recent national health survey

BackgroundMore than half of the population in Sub-Saharan Africa (SSA) faces limited access to safe drinking water. Unimproved water sources can pose risks to the health of entire households, particularly women and children. Despite the fact that East African countries have some of the poorest drinking water infrastructures globally, there is a lack of published data on this issue. Consequently, the objective of this study was to examine access to safe drinking water and its determinants among households in East Africa, utilizing recent nationally representative data.MethodsThis study analyzed data from recent demographic and health surveys conducted in 12 East African nations between 2011 and 2022. Data were gathered from 204,275 households. A stratified two-stage cluster sampling method was employed, with enumeration areas serving as the main sampling units and households serving as the secondary sampling units. Binary and multiple multilevel logistic regression were used to examine the relevant factors associated with the use of different sources of drinking water in the region. In binary regression and multiple regression, P values of ≤ 0.2 and < 0.05, respectively, were used to determine the statistical significance of variables in the final model.ResultsApproximately 72.62% (95% CI = 72.43, 72.83) of households have utilized improved sources of drinking water. Household heads aged 25–35 years (AOR = 1.09, 95% CI = 1.04, 1.14), 36–45 years (AOR = 1.09, 95% CI = 1.04, 1.14), and > 45 years (AOR = 1.08, 95% CI = 1.04, 1.14), those with secondary/higher education (AOR = 1.24, 95% CI = 1.20–1.29), and individuals in wealth index categories of poorest (AOR = 0.17, 95% CI = 0.16, 0.18), poorer (AOR = 0.21, 95% CI = 0.19, 0.22), middle (AOR = 0.25, 95% CI = 0.24, 0.27), and richer (AOR = 0.36, 95% CI = 0.34, 0.38) were associated with improved sources of drinking water. Additionally, female household leaders (AOR = 1.23, 95% CI = 1.20, 1.26), > 30 min of time taken to access the water source (AOR = 2.00, 95% CI = 1.95, 2.05), improved toilet facilities (AOR = 2.25, 95% CI = 2.19, 2.31), rural residence (AOR = 0.43, 95% CI = 0.42, 0.45), high community wealth (AOR = 1.31, 95% CI = 1.13–1.51), community media exposure (AOR = 1.32, 95% CI = 1.15, 1.51) were associated with improved sources of drinking water, respectively.ConclusionApproximately three-quarters of the population in East Africa has access to improved drinking water, although the quality of water in the region is still considered poor. It is important for relevant organizations to collaborate in order to improve the quality of drinking water, with special attention given to high-risk groups such as communities with high poverty and low literacy rates, poor households, and rural residents. Strengthening women’s empowerment and increasing mass media exposure can also play a crucial role in accelerating the adoption of improved drinking water sources in East Africa.

Pooled prevalence and associated factors of teenage pregnancy among women aged 15 to 19 years in sub-Saharan Africa: evidence from 2019 to 2022 demographic and health survey data

BackgroundTeenage pregnancy is becoming one of the most common social and public health problems worldwide, with the highest prevalence in sub-Saharan Africa. Health risks and adverse outcomes of pregnancy and childbirth among adolescent girls are the commonest cause of the global burden of maternal morbidity and mortality. This study is intended to determine the pooled prevalence and determinants of teenage pregnancy in sub-Saharan Africa using the most recent demographic and health survey data (2019–2022).MethodsA cross-sectional study was conducted using data from the most recent demographic and health surveys of four countries (Kenya, Tanzania, Gabon, and Cameroon) in sub-Saharan Africa conducted between 2019 and 2022. A total weighted sample of 12,829 teenagers aged 15 to 19 years was included in the study. Data extracted from demographic and health survey data sets were cleaned, recorded, and analyzed using STATA/SE version 14.0 statistical software. Multilevel mixed-effects logistic regression was used to determine the factors associated with the dependent variable. Finally, variables with a p-value ≤ 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant.ResultsThe pooled prevalence of teenage pregnancy among women aged 15 to 19 years was 18.15% (95% CI: 17.49, 18.83). Teenage pregnancy was positively associated with the respondent’s age [AOR = 2.97; 95% CI (2.55, 3.46)], educational status [AOR = 2.21; 95% CI (1.62, 3.03)] and [AOR = 1.80; 95% CI (1.54, 2.12)], wealth status [AOR = 2.61; 95% CI (2.12, 3.22)] and [AOR = 1.65; 95% CI (1.33, 2.05)], relation to the household head [AOR = 2.09; 95% CI (1.60, 2.72)], and unmet need for contraception [AOR = 14.3; 95% CI (11.5, 17.8)]. On the other hand, it was negatively associated with marital status [AOR = 0.08; 95% (0.07, 0.10)], working status [AOR = 0.75; 95% CI (0.64, 0.88)], age at first sex [AOR = 0.68; 95% CI (0.58, 0.80)], contraceptive use [AOR = 0.25; 95% CI (0.20, 0.30)], contraceptive knowledge [AOR = 0.27; 95% CI (0.19, 0.40)], and community contraceptive utilization [AOR = 0.85; 95% CI (0.73, 0.99)].ConclusionIn the current study, one out of six young women aged 15 to 19 experienced teenage pregnancy. Therefore, addressing unmet needs for family planning, improving women’s educational status, and giving special attention to teenagers with low educational and economic status are recommended.

Examining determinants of stunting in Urban and Rural Indonesian: a multilevel analysis using the population-based Indonesian family life survey (IFLS).

In Indonesia, chronic malnutrition leading to stunted growth in children represents a significant issue within the public health domain. The prevalence of stunting varies between urban and rural areas, reflecting disparities in access to nutrition, healthcare, and other socioeconomic factors. Understanding these disparities is crucial for developing targeted interventions to address the issue. The study used data from the fifth wave of the Indonesian Family Life Survey (IFLS), which is a national cross-sectional population-based survey conducted across approximately 13 provinces in Indonesia in 2014-2015. Multivariate and Multilevel logistic regression models were utilized in the analysis to determine the factors associated with the prevalence of stunting in Indonesian children. The multivariate logistic regression analysis indicated that among children aged 24-59 months in Indonesia, stunting was associated with the age of the child, birth weight, maternal nutritional status, and residence. Subsequently, the multilevel logistic regression analysis revealed that in rural areas, the age of the child and birth weight exhibited significant associations with stunting. Conversely, in urban areas, stunted children were influenced by 7 factors, including the child's age (months), age of weaning, birth weight (kg), mother and father's age, place of birth, and maternal nutritional status. Variations in childhood stunting between urban and rural regions in Indonesia were observed, indicating a differential prevalence. The study's findings suggests the importance of age-appropriate nutritional support, healthcare interventions, and growth monitoring. Focused interventions are vital, potentially encompassing initiatives such as improving access to maternal and child healthcare services, promoting adequate nutrition during pregnancy and infancy, and facilitate greater parental engagement in childcare responsibilities.

Adolescent’s explicit and implicit cigarette cognitions predict experimentation with both cigarettes and e-cigarettes

ABSTRACT Background: Past year, month, and lifetime adolescent e-cigarette use rates remain persistently high, despite falling cigarette use rates. Previous investigations have noted a strong relationship between an individual’s positive and negative cognitions related to a behavior, and subsequent initiation of that behavior. Objective: This investigation was conducted to determine the impact positive and negative explicit and implicit cigarette-related cognitions may have on the use of cigarettes and e-cigarettes among at-risk, cigarette-naive adolescents. Methods: A three-year longitudinal investigation evaluated the relationship between cigarette-related cognitions and subsequent cigarette and e-cigarette use among 586 alternative high school students (female: 50.8%; mean age: 17.4 years; Hispanic/Latino: 75.0%) who had never smoked cigarettes at the baseline assessment. Multilevel logistic regression models were used to generate demographics-adjusted odds ratios (OR) and 95% confidence intervals (95% CI). Results: Students with higher positive explicit cigarette cognitions at the baseline had greater odds of subsequent cigarette use (OR = 1.72, 95% CI 1.11–2.68). If students also reported an increase over time in positive (OR = 3.45, 95% CI 2.10–5.68) or negative (OR = 1.93, 95% CI 1.03–3.61) explicit cigarette cognitions, the odds of cigarette use increased. The odds of dual use of cigarettes and e-cigarettes were greater among students who had higher negative implicit cigarette cognitions at the baseline (OR = 2.07, 95% CI 1.03–4.17) compared to those with lower levels of negative implicit cognitions. Conclusion: Prevention programming that focuses on decreasing positive cognitions related to nicotine and tobacco use may have greater overall effect on decreasing use compared to programs that only focus on increasing negative cognitions individuals form surrounding cigarette or e-cigarettes.

The effect of dietary diversity on anemia levels among children 6-23 months in sub-Saharan Africa: A multilevel ordinal logistic regression model.

Anemia is the most common hematologic disorder of children worldwide. Since dietary diversity is a main requirement of children is to get all the essential nutrients, it can thus use as one of the basic indicator when assessing the child's anemia. Although dietary diversity plays a major role in anemia among children in sub-Saharan Africa, there is little evidence of an association between the dietary diversity and anemia level to identified potential strategies for prevention of anemia level in sub-Saharan Africa. To examine the association between dietary diversity and anemia levels among children aged 6-23 months in sub-Saharan Africa. The most recent Demographic and Health Surveys from 32 countries in SSA were considered for this study, which used pooled data from those surveys. In this study, a total weighted sample of 52,180 children aged 6-23 months was included. The diversity of the diet given to children was assessed using the minimum dietary diversity (MDD), which considers only four of the seven food groups. A multilevel ordinal logistic regression model was applied due to the DHS data's hierarchical structure and the ordinal nature of anemia. With a p-value of 0.08, the Brant test found that the proportional odds assumption was satisfied. In addition, model comparisons were done using deviance. In the bi-variable analysis, variables having a p-value ≤0.2 were taken into account for multivariable analysis. The Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was presented for potential determinants of levels of anemia in the multivariable multilevel proportional odds model. The overall prevalence of minimum dietary diversity and anemia among children aged 6-23 months were 43% [95% CI: 42.6%, 43.4%] and 72.0% [95% CI: 70.9%, 72.9%] respectively. Of which, 26.2% had mild anemia, 43.4% had moderate anemia, and 2.4% had severe anemia. MDD, being female child, being 18-23 months age, born from mothers aged ≥25, taking drugs for the intestinal parasite, higher level of maternal education, number of ANC visits, middle and richer household wealth status, distance of health facility and being born in Central and Southern Africa were significantly associated with the lower odds of levels of anemia. Contrarily, being 9-11- and 12-17-months age, size of child, having fever and diarrhea in the last two weeks, higher birth order, stunting, wasting, and underweight and being in West Africa were significantly associated with higher odds of levels of anemia. Anemia was a significant public health issue among children aged 6-23 months in sub-Saharan Africa. Minimum dietary diversity intake is associated with reduced anemia in children aged 6 to 23 months in sub-Saharan Africa. Children should be fed a variety of foods to improve their anemia status. Reducing anemia in children aged 6-23 months can be achieved by raising mother education levels, treating febrile illnesses, and improve the family's financial situation. Finally, iron fortification or vitamin supplementation could help to better reduce the risk of anemia and raise children's hemoglobin levels in order to treat anemia.

Determinants of tobacco use among pregnant women in sub-Saharan Africa. A multilevel mixed-effect logistic regression model.

Although it is known that maternal tobacco use during pregnancy substantially declined in higher-income countries, information on the magnitude and determinants of tobacco use among pregnant women in sub-Saharan Africa (SSA) remains limited. Establishing evidence on maternal tobacco during pregnancy is crucial for guiding targeted interventions in SSA. This study aimed to determine the overall prevalence of tobacco use and its determinants among pregnant women in SSA countries. The study used data from Demographic and Health Surveys conducted in 33 countries across SSA from 2010 and 2021. Our analysis included a total weighted sample of 40,291 pregnant women. A multilevel logistic regression model was used to identify factors associated with maternal tobacco use during pregnancy. The measure of association between explanatory variables and the outcome was reported using adjusted odds ratios (AORs) with 95% confidence intervals (CIs). The pooled prevalence of tobacco use among pregnant women in SSA was 1.76% (95% CI: 1.41, 2.12). Our findings showed that pregnant women in the age groups of 25-34 years (AOR 1.44; 95% CI: 1.14, 1.82) and 35+ years (AOR 2.18; 95% CI: 1.68, 2.83) had higher odds of tobacco use during pregnancy. Pregnant women who attained primary education (AOR 0.57; 95% CI: 0.46, 0.70) and secondary or higher education (AOR 0.39; 95% CI: 0.30, 0.53) were associated with lower odds of tobacco use. Similarly, pregnant women who resided in households with a high wealth index (AOR 0.36; 95% CI: 0.55 0.90) and those with media exposure (AOR 0.81; 95% CI: 0.67, 0.99) were less likely to use tobacco during pregnancy. This study revealed that the overall prevalence of maternal tobacco use during pregnancy was relatively low in SSA, but some countries exhibited higher estimates. To address this, it is crucial to implement targeted smoking prevention and cessation strategies, particularly for young pregnant women, those facing socioeconomic disadvantages, and those with lower educational status.

Multilevel analysis on prevalence and associated factors of modern contraceptive uptake in Somaliland: based on The Somaliland Health and Demographic Survey 2020

IntroductionContraception is the deliberate prevention of unwanted pregnancy through various contraceptive methods. Its uptake is low in Sub-Saharan African countries, particularly in east Africa. This might be linked to the high prevalence of unwanted pregnancies and the high fertility rate in the area. Although studies reporting the prevalence and associated factors of modern contraceptive uptake are available in other African countries, no study has been conducted in Somaliland. Therefore, the current study aimed to assess its prevalence and associated factors in Somaliland using Somaliland Health and Demographic Survey (SLHDS) data.Methods and materialsThe study used Somaliland Demographic Health Survey (SLDHS) 2020 data. The survey was a national-level survey using a cross-sectional study design. A total of 3656 reproductive-age women were included in the current study. To determine independent predictors of modern contraceptive uptake, a multi-level multivariable logistic regression analysis was done. Random effect analysis, standard error (SE) and intra-cluster correlation (ICC) were computed.ResultsThe proportion of modern contraceptive uptake among reproductive age groups in Somaliland is 1%. Modern contraceptive uptake is significantly associated with the residence, educational level and wealth index of participants. Women from nomadic communities had lower odds (AOR: 0.25; 95% CI: 0.10, 0.66) of modern contraceptive uptake compared to those from urban areas. Being in the highest wealth quintiles (AOR: 17.22; 95% CI: 1.99, 155.92) and having a tertiary educational level (AOR: 2.11; 95% CI: 1.29, 9.11) had higher odds of using the modern contractive method compared to those with the lowest wealth quintiles and non-formal education, respectively.ConclusionThe prevalence of modern contraceptive uptake in Somaliland was very low. It is associated with the level of education, wealth index and residence of the women.