Richest Wealth Index Research Articles

Provincial distribution and factors associated with self-reported sexually transmitted infections and their symptoms among women in Sierra Leone

BackgroundSexually transmitted infections (STIs) are a significant public health concern worldwide. These infections can have severe consequences for women’s health, including pelvic inflammatory disease, infertility, and increased risk of HIV acquisition. Understanding the prevalence and factors associated with STIs among women in Sierra Leone is crucial to developing effective prevention and treatment strategies. This study investigated the provincial distribution and factors associated with self-reported STIs (SR-STIs) and STI symptoms among women in Sierra Leone.MethodsThe study used data from the 2019 Sierra Leone Demographic and Health Survey, comprising 13,965 women aged 15 to 49 who have ever had sex. Provincial variations in the prevalence of SR-STIs and STI symptoms were presented using a spatial map. A binary logistic regression analysis was performed to assess the factors associated with SR-STIs and STI symptoms among women in Sierra Leone. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI).ResultsThe overall prevalence of SR-STIs and their symptoms was 21.6% [20.4, 22.9] among women in Sierra Leone. Higher odds of SR-STIs and their symptoms were associated with being aged 25–29 (aOR = 1.35, 95% CI = 1.10,1.66), 30–34 (aOR = 1.38, 95% CI = 1.09,1.74), 35–39 (aOR = 1.39, 95% CI = 1.10, 1.77), having tested for HIV (aOR = 1.16, 95% CI = 1.04, 1.29), and having multiple sexual partners (aOR = 2.25, 95% CI = 1.80, 2.83) compared to those in the reference category. Being in the rich wealth index (aOR = 1.32, 95% CI = 1.11, 1.57), living in the Northern (aOR = 2.43, 95% CI = 2.08, 2.83) and Northwestern province (aOR = 3.28, 95% CI = 2.81, 3.83), and being covered by health insurance (aOR = 3.19, 95% CI = 2.62, 3.88) were associated with higher odds of SR-STIs and their symptoms. Lower odds of SR-STIs and their symptoms were found among women with one (aOR = 0.81, 95% CI = 0.68, 0.96), two (aOR = 0.75, 95% CI = 0.61, 0.93), three (aOR = 0.66, 95% CI = 0.53, 0.83), and four or more children (aOR = 0.62, 95% CI = 0.49, 0.77], those residing in rural areas (aOR = 0.81, 95% CI = 0.69, 0.94), and women living in the Southern province (aOR = 0.67, 95% CI = 0.57, 0.80) compared to those in the reference category.ConclusionThe findings indicate that SR-STIs and their symptoms are prevalent among women in Sierra Leone. Our findings underscore the urgent need for targeted public health interventions to address the SR-STIs and their symptoms among women in Sierra Leone. The increased risk among women aged 25–39, those with multiple sexual partners and those from wealthier backgrounds, suggests that educational programmes focusing on safe sexual practices and STI prevention should be prioritized in urban and affluent areas. Additionally, the lower odds of SR-STIs among women with more children and those in rural regions indicate that family dynamics and geographic factors may offer protective benefits, which could be leveraged in public health messaging. Our findings highlight the importance of tailoring health services and outreach efforts to effectively reach and support vulnerable populations, ultimately aiming to reduce the incidence of SR-STIs.

Socioeconomic inequalities in cervical cancer screening in sub-Saharan Africa: Decomposition analysis

Abstract Background Cervical cancer remains prevalent in sub-Saharan Africa (SSA). Despite global efforts to eliminate this disease, its incidence continues to rise due to barriers in screening, vaccination, and treatment access. While studies address access barriers, little has explored inequality, often limited to single countries. Here, we examine socioeconomic inequalities in cervical cancer screening in SSA. Methods Data from the Demographic and Health Surveys of 10 SSA countries was used for the analysis. We stratified the study by wealth index and educational attainment as a measure of socioeconomic status. Socioeconomic status inequalities in cervical cancer screening were constructed using concentration curves. We then computed the concentration index to quantify socioeconomic inequality. To examine the factors associated with high socioeconomic inequality in cervical cancer screening, a decomposition analysis was conducted. Results Concentration curves showed screening uptake skewed towards the wealthy and educated across all countries, reflected by positive concentration indices (CIX=0.21; p-value<0.0001) except in Burkina Faso and Mauritius. Decomposition analysis revealed significant positive concentration indices for women with complete secondary (CIX=0.74) and higher education (CIX=0.91), those in the richest wealth index (CIX=0.35), separated women (CIX=0.08), currently working women (CIX=0.02), as well as those who were exposed to reading newspaper/magazine (CIX=0.19), listening to radio (CIX=0.10), and watching TV (CIX=0.44). Conclusions Cervical cancer screening in SSA exhibits pro-rich and pro-higher educational inequalities. Urgent interventions are needed to restructure existing screening programs to prioritize accessibility and inclusion, particularly for women from poorer households and with a lower level of education. These findings are vital for policymakers and public health practitioners to address cervical cancer screening disparities in SSA. Key messages • Addressing socioeconomic inequalities in cervical cancer screening is crucial for improving public health in sub-Saharan Africa. • Combatting socioeconomic disparities in cervical cancer screening is critical for achieving health equity in sub-Saharan Africa.

Factors associated with under-five mortality in Scheduled Tribes in India: An analysis of national family health survey-5 (2019-2021).

Background & objectives Under-five mortality is high among the Scheduled Tribes (ST) in India compared with the general population. This study examined the association of different maternal, child, socio demographic, and household factors associated with under-five mortality among Scheduled Tribes in India. Methods Data from the National Family and Health Survey (NFHS)-5 (2019-2021) for the ST, across all Indian States and Union Territories were used for analyses. Binary and multivariate logistic regression were performed to identify the association of maternal, child, socio-demographic, and household factors with under-five mortality among the ST population. Results Different maternal, child, socio demographic, and household factors were significantly associated with under-five mortality. The odds of under-five mortality were highest among women who gave birth to their children at home [Adjusted odds ratio (AOR): 1.42; 95% confidence interval (CI): 1.268-1.59] as compared with women who gave birth at institution. Literate women have lesser odds of under-five mortality than women with no formal education (AOR: 0.666; 95% CI: 0.501-0.885). The risk of under-five mortality was higher among four or more birth order children (AOR: 1.422; 95% CI: 1.246-1.624) compared with the first to third birth order children. The odds of under-five mortality decreased among children with a rich wealth index (AOR: 0.742; 95% CI: 0.592-0.93) compared to children with a poor wealth index. Interpretation & conclusions Analyses of under-five mortality among ST in India showed a significant association between different maternal, child, sociodemographic, and household factors. Grass-roots-level interventions such as promoting female education, addressing vast wealth differentials, and providing family planning services with a focus on reducing under-five mortality are essential in improving the survival of under-five children among the ST population in India.

Urban-rural disparities and change in postnatal care use from 2016 to 2019 in Ethiopia: Multivariate decomposition analysis.

Postnatal care (PNC) is essential for early identification and management of life-threatening obstetric complications. Despite efforts by the Ethiopian government to improve maternal and child health service use, PNC service has remained low, and disparity across geographic locations is a major public health problem. This study aimed to investigate the change and contributing factors in PNC service use across geographical locations (rural-urban) and over time (2016 to 2019) in Ethiopia. We analyzed data on women who gave birth from the 2016 and 2019 Ethiopian Demographic and Health Surveys. A total of 6,413 weighted samples (4,308 in 2016 and 2,105 in 2019) were included in the analysis. A multivariate decomposition analysis technique was used to determine the change and identify factors that contributed to the change across geographical locations and over time. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05. The prevalence of PNC use was higher among urban residents, and the urban-rural disparity reduced from 32.59% in 2016 to 19.08% in 2019. The difference in the composition of explanatory variables was the only statistically significant for the urban-rural disparity in PNC use in both surveys. Specifically, female household heads (4.51%), delivery at a health facility (83.45%), and birth order of two to three (5.53%) and four or more (-12.24%) in 2016 significantly contributed to the urban-rural gap. However, in 2019, middle wealth index (-14.66%), Muslim religion (3.84%), four or more antennal care contacts (18.29%), and delivery at a health facility (80.66%) significantly contributed to the urban-rural gap. PNC use increased from 16.61% in 2016 to 33.86% in 2019. About 60% of the explained change was due to the difference in the composition of explanatory variables. Particularly, urban residence (-5.79%), a rich wealth index (2.31%), Muslim (3.42%), and other (-2.76%) religions, having radio or television (1.49%), 1-3 (-1.13%), and 4 or more (11.09%) antenatal care contacts, and delivery at a health facility (47.98%) were statistically significant contributors to the observed change. The remaining 40% of the overall change was due to the difference in unknown behaviors (coefficient) of the population towards PNC. There was a significant change in PNC service use by residence location and over time in Ethiopia, with urban women in both surveys being more likely to use PNC service. The urban-rural disparity in PNC uptake was due to the difference in the composition of explanatory variables, whereas the change over time was due to the change in both the composition of explanatory variables and population behavior towards PNC. Increased antenatal care contacts and delivery at a health facility played a major role in explaining the gap in PNC services across residences and over time in Ethiopia, highlighting the importance of stepping up efforts to enhance their uptake in rural settings.

Caesarean section and associated factors in Nigeria: assessing inequalities between rural and urban areas—insights from the Nigeria Demographic and Health Survey 2018

IntroductionWhen medically indicated, caesarean section (CS) can be a life-saving intervention for mothers and their newborns. This study assesses the prevalence of CS and its associated factors, focussing on inequalities between rural and urban areas in Nigeria.MethodsWe disaggregated the Nigeria Demographic and Health Survey 2018 and performed analyses separately for Nigeria’s overall, rural, and urban residences. We summarised data using frequency tabulations and identified factors associated with CS through multivariable logistic regression analysis.ResultsCS prevalence was 2.7% in Nigeria (overall), 5.2% in urban and 1.2% in rural areas. The North-West region had the lowest prevalence of 0.7%, 1.5% and 0.4% for the overall, urban and rural areas, respectively. Mothers with higher education demonstrated a greater CS prevalence of 14.0% overall, 15.3% in urban and 9.7% in rural residences. Frequent internet use increased CS prevalence nationally (14.3%) and in urban (15.1%) and rural (10.1%) residences. The southern regions showed higher CS prevalence, with the South-West leading overall (7.0%) and in rural areas (3.3%), and the South-South highest in urban areas (8.5%). Across all residences, rich wealth index, maternal age ≥ 35, lower birth order, and ≥ eight antenatal (ANC) contacts increased the odds of a CS. In rural Nigeria, husbands’ education, spouses’ joint healthcare decisions, birth size, and unplanned pregnancy increased CS odds. In urban Nigeria, multiple births, Christianity, frequent internet use, and ease of getting permission to visit healthcare facilities were associated with higher likelihood of CS.ConclusionCS utilisation remains low in Nigeria and varies across rural-urban, regional, and socioeconomic divides. Targeted interventions are imperative for uneducated and socioeconomically disadvantaged mothers across all regions, as well as for mothers in urban areas who adhere to Islam, traditional, or ‘other’ religions. Comprehensive intervention measures should prioritise educational opportunities and resources, especially for rural areas, awareness campaigns on the benefits of medically indicated CS, and engagement with community and religious leaders to promote acceptance using culturally and religiously sensitive approaches. Other practical strategies include promoting optimal ANC contacts, expanding internet access and digital literacy, especially for rural women (e.g., through community Wi-Fi programs), improving healthcare infrastructure and accessibility in regions with low CS prevalence, particularly in the North-West, and implementing socioeconomic empowerment programs, especially for women in rural areas.

Spatial variation of skilled birth attendance and associated factors among reproductive age women in Ethiopia, 2019; a spatial and multilevel analysis.

The majority of maternal deaths were associated with a lack of access to skilled birth attendance. Because childbirth accounts for most maternal deaths, skilled birth attendance is crucial for reducing maternal mortality. The use of skilled birth attendance in Ethiopia is low, and it is crucial to identify factors that determine the use of skilled birth attendance. Hence, this study aimed to assess the spatial distribution, wealth-related inequality, and determinants for skilled birth attendance in Ethiopia. Secondary data analysis was done with a total weighted sample of 5,251 reproductive-aged women using the 2019 mini EDHS. The concentration index and graph were used to assess wealth-related inequalities. Spatial analysis was done to identify the spatial distribution and multilevel logistic regression analysis was used to identify predictors of skilled birth attendance in Ethiopia. Analysis was done using STATA version 14, ArcGIS, and SaTscan software. The prevalence of skilled birth attendance was 50.04% (95% CI: 48.69%, 51.40%) in Ethiopia. Old age, being married, being educated, having television and radio, having ANC visits, being multiparous, having large household sizes, having a rich wealth index, living in rural residence, and living in a high level of community poverty and women's education were significant predictors of skilled birth attendance. Skilled birth attendance was disproportionately concentrated in rich households [C = 0.482; 95% CI: 0.436, 0.528]. High prevalence of unskilled birth attendance was found in Somalia, SNNP, Afar, and southern parts of the Amhara regions. Primary clusters of unskilled birth attendance Somalia and some parts of Oromia region of Ethiopia. Half of the women in Ethiopia did not utilize skilled birth attendants with significant spatial clustering. Age, marital status, educational status, ANC Visit, having television and radio, parity, household size, wealth index, residence, community level poverty, and community level of women's education were significant predictors of skilled birth attendance. Skilled birth attendance was unevenly concentrated in rich households. The regions of Somalia, SNNP, Afar, and southern Amhara were identified as having a high prevalence of using unskilled birth attendance. Public health interventions should target those women at high risk of using unskilled birth attendants.

The risk factors of infant mortality in Somalia: evidence from the 2018/2019 Somali health & demographic survey

BackgroundGlobally, infant mortality is one of the major public health threats, especially in low-income countries. The infant mortality rate of Somalia stands at 73 deaths per 1000 live births, which is one of the highest infant death rates in the region as well as in the world. Therefore, the aim of this study was to ascertain the risk factors of infant mortality in Somalia using national representative data.MethodIn this study, data from the Somali Health and Demographic Survey (SHDS), conducted for the first time in Somalia in 2018/2019 and released in 2020, were utilized. The analysis of the data involved employing the Chi-square test as a bivariate analysis. Furthermore, a multivariate Cox proportional hazard model was applied to accommodate potential confounders that act as risk factors for infant death.ResultsThe study found that infant mortality was highest among male babies, multiple births, and those babies who live in rural areas, respectively, as compared to their counterparts. Those mothers who delivered babies with small birth size and belonged to a poor wealth index experienced higher infant mortality than those mothers who delivered babies with average size and belonged to a middle or rich wealth index. Survival analysis indicated that mothers who did use ANC services (HR = 0.740; 95% CI = 0.618–0.832), sex of the baby (HR = 0.661; 95% CI = 0.484–0.965), duration of pregnancy (HR = 0.770; 95% CI = 0.469–0.944), multiple births (HR = 1.369; 1.142–1.910) and place of residence (HR = 1.650; 95% CI = 1.451–2.150) were found to be statistically significantly related to infant death.ConclusionThe study investigated the risk factors associated with infant mortality by analyzing data from the first Somali Health and Demographic Survey (SHDS), which included a representative sample of the country’s population. Place of residence, gestational duration, infant’s gender, antenatal care visits, and multiple births were identified as determinants of infant mortality. Given that infant mortality poses a significant public health concern, particularly in crisis-affected countries like Somalia, intervention programs should prioritize the provision of antenatal care services, particularly for first-time mothers. Moreover, these programs should place greater emphasis on educating women about the importance of receiving antenatal care and family planning services, in order to enhance their awareness of these vital health services and their positive impact on infant survival rates.

Drivers of breast cancer and cervical cancer screening among women of reproductive age: insights from the Ghana Demographic and Health Survey

BackgroundThe two major causes of cancer-related deaths among women in Ghana are breast cancer (BC) and cervical cancer (CC). These types of cancers typically do not show any symptoms until they have progressed. Therefore, it is important to screen for early detection. This research aimed to investigate the rate of breast cancer and cervical cancer screening, as well as the factors associated with it, among women of reproductive age in Ghana.MethodsThis study analysed data from the 2022 Ghana Demographic and Health Survey. A total of 15,014 women aged 15 to 49 years were included in the analysis. Descriptive statistics and binary logistic regression were employed to analyse the data with the aid of STATA/SE, version 17.ResultsIt was found that 18.4% and 5.0% of the women had screened for BC and CC, respectively. Women aged 45–49 years were about three times more likely (aOR = 2.83, 95% CI: 1.88–4.24) to screen for BC compared to those aged 15–19 years. Women who had tested for HIV had increased odds (aOR = 1.88, 95% CI: 1.56–2.25) of screening for BC compared to their counterparts. Women within the richest wealth index (aOR = 1.95, 95% CI: 1.40–2.72) had increased odds of screening for BC compared to those in the poorest wealth index. Regarding CC screening, women with higher education (aOR = 2.56, 95% CI: 1.53–4.29) were two times more likely to screen for CC compared to those with no formal education. Women who did not use tobacco (aOR = 0.45, 95% CI: 0.21–0.96) had decreased odds of CC screening compared to their counterparts.ConclusionsThis study showed that the uptake of BC and CC screening services among women in Ghana was very low. The drivers of BC and CC screening included enabling, predisposing, and need factors. Stakeholders can leverage the mass media to raise awareness and educate women in reproductive age about the importance of BC and CC screening. This study provides relevant information that can inform BC and CC policies and programmes in Ghana.

Decoding India's Child Malnutrition Puzzle: A Multivariable Analysis Using a Composite Index.

This study examines the levels and predictors of malnutrition in Indian children under 5 years of age. Composite Index of Anthropometric Failure was applied to data from the India National Family Health Survey 2019-2021. A multivariable logistic regression model was used to assess the predictors. 52.59% of children experienced anthropometric failure. Child predictors of lower malnutrition risk included female gender (adjusted odds ratio (AOR) = 0.881) and average or large size at birth (AOR = 0.729 and 0.715, respectively, compared to small size). Higher birth order increased malnutrition odds (2nd-4th: AOR = 1.211; 5th or higher: AOR = 1.449) compared to firstborn. Maternal predictors of lower malnutrition risk included age 20-34 years (AOR = 0.806), age 35-49 years (AOR = 0.714) compared to 15-19 years, normal BMI (AOR = 0.752), overweight and obese BMI (AOR = 0.504) compared to underweight, and secondary or higher education vs. no education (AOR = 0.865). Maternal predictors of higher malnutrition risk included severe anemia vs. no anemia (AOR = 1.232). Protective socioeconomic factors included middle (AOR = 0.903) and rich wealth index (AOR = 0.717) compared to poor, and toilet access (AOR = 0.803). Children's malnutrition risk also declined with paternal education (primary: AOR = 0.901; secondary or higher: AOR = 0.822) vs. no education. Conversely, malnutrition risk increased with Hindu (AOR = 1.258) or Islam religion (AOR = 1.369) vs. other religions. Child malnutrition remains a critical issue in India, necessitating concerted efforts from both private and public sectors. A 'Health in All Policies' approach should guide public health leadership in influencing policies that impact children's nutritional status.

Factors associated with the use of dental services in diabetic people

The use of dental services prevents oral diseases where its prevalence is associated with chronic diseases such as diabetes mellitus (DM) that also has increased risks with age. Therefore, this observational, analytical and crosssectional study was conducted among 3,882 people. Data used for analysis in this research was collected from the Demographic and Family Health Survey of Peru (ENDES) from 2019 to 2021. Results from poisson regression analysis showed female gender had 1.02 times the probability of going to the dental service; likewise, people who were 91 to 100 years old had 12% more, the probability, like those with secondary education, had 8% more and those with the highest average, richest and richest wealth index had 20% more, 29% more and 29% more, respectively, the probability of going to the dental health service, as opposed to those who were very poor. The study concluded that there are several sociodemographic factors (such as being female, age progressed, natural region, those with high school, wealth index, type of residence) and personal factors (history of hypertension (HTN), physical disability) associated with a lack of access to dental services in people over 60 years old.

Why does the number of antenatal care visits in Ethiopia remain low?: A Bayesian multilevel approach.

Antenatal care (ANC) visit is a proxy for maternal and neonatal health. The ANC is a key indicator of access and utilization of health care for pregnant women. Recently, eight times ANC visits have been recommended during the pregnancy period. However, nearly 57% of women received less than four ANC visits in Ethiopia. Therefore, the objective of this study is to identify factors associated withthe number of ANC visits in Ethiopia. A community-based cross-sectional study design was conducted from March 21 to June 28/2019. Data were collected using interviewer-administered questionnaires from reproductive age groups. A stratified cluster sampling was used to select enumeration areas, households, and women from selected households. A Bayesian multilevel negative binomial model was applied for the analysis of this study. There is an intra-class correlation (ICC) = 23.42% and 25.51% for the null and final model, respectively. Data were analyzed using the STATA version 17.0. The adjusted incidence risk ratio (IRR) with 95% credible intervals (CrI) was used to declare the association. A total of 3915 pregnant women were included in this study. The mean(SD) age of the participants was 28.7 (.11) years. Nearly one-fourth (26.5%) of pregnant women did not have ANC visits, and 3% had eight-time ANC visits in Ethiopia. In the adjusted model, the age of the women 25-28 years (IRR:1.13; 95% CrI: 1.11, 1.16), 29-33 years (IRR: 1.15; 95% CrI: 1.15, 1.16), ≥34 years (IRR:1.14; 95% CrI: 1.12, 1.17), being a primary school (IRR: 1.22, 95% CrI: 1.21, 1.22), secondary school and above (IRR: 1.26, 95% CrI: 1.26, 1.26), delivered in health facility (IRR: 1.93; 95% CrI: 1.92, 1.93), delivered with cesarian section (IRR: 1.18; 95% CrI: 1.18, 1.19), multiple (twin) pregnancy (IRR: 1.11; 95% CrI: 1.10, 1.12), richest (IRR:1.23; 95% CrI: 1.23, 1.24), rich family (IRR: 1.34, 95% CrI: 1.30, 1.37), middle income (IRR: 1.29, 95% CrI: 1.28, 1.31), and poor family (IRR = 1.28, 95% CrI:1.28, 1.29) were shown to have significant association with higher number of ANC vists, while, households with total family size of ≥ 5 (IRR: 0.92; 95% CrI: 0.91, 0.92), and being a rural resident (IRR: 0.92, 95% CrI: 0.92, 0.94) were shown to have a significant association with the lower number of ANC visits. Overall, 26.5% of pregnant women do not have ANC visits during their pregnancy, and 3% of women have eight-time ANC visits. This result is much lower as compared to WHO's recommendation, which states that all pregnant women should have at least eight ANC visits. In this study, the ages of the women 25-28, 29-33, and ≥34 years, being a primary school, secondary school, and above, delivered in a health facility, delivered with caesarian section, multiple pregnancies, rich, middle and poor wealth index, were significantly associated with the higher number of ANC visits, while households with large family size and rural residence were significantly associated with a lower number of ANC visits in Ethiopia.

Factors associated with miscarriage in Nepal: Evidence from Nepal Demographic and Health Surveys, 2001-2016.

Miscarriage is a major public health concern in low and middle-income countries (LMICs) like Nepal. This study aims to examine the factors associated with miscarriage among pregnant women of reproductive age (15-49 years) in the past 15 years. There were a total of weighted sample of 26,376 cross-sectional pregnancy data from Nepal Demographic and Health Surveys (NDHS) 2001, 2006, 2011, and 2016 combined together, which was used in the study. Multilevel logistic regression analysis that adjusted for cluster and survey weights was used to identify factors associated with miscarriage among pregnant women of reproductive age in Nepal. The results showed that maternal age, contraception, tobacco smoking, wealth index, respondents' educational status, and, caste/ethnicity were found to be strong factors of miscarriage in Nepal. The likelihood of having a miscarriage among older women (≥40 years) was more than 100% (aOR = 2.12, 95% CI [1.73, 2.59]), among non-users of contraception was 88.9% (aOR = 1.88, 95% CI [1.68, 2.11]) (p<005) and non-smoking women had a 19% lower odds of miscarriage (aOR = 0.81, 95% CI [0.69, 0.95]). Respondents from the richest wealth index had 50% (aOR = 1.50, 95% CI [1.22, 1.85]) higher likelihood of miscarriage. Mothers with only primary education had a 25% higher chance of miscarriage (aOR = 1.25, 95% CI [1.09, 1.44]) compared to those with secondary and higher secondary education. In relation to caste/ethnicity, Dalits had 13% lesser likelihood (aOR = 0.87, 95% CI [0.74, 1.02]) and Janajatis had 26% lower chances of a miscarriage than Brahmin/Chettri (aOR = 0.74, 95% CI [0.64, 0.85]). Findings from this study show that miscarriages are associated with maternal age, use of contraception, smoking, wealth index, caste, and ethnicity. Interventions aimed to improve use of contraceptives, avoiding smoking and pregnancy planning on the basis of maternal age, are needed to prevent miscarriage. Also, women from Brahmin ethinicity and those with the highest income index require greater attention when it comes to miscarriage prevention strategies in Nepal.

Prevalence and factors associated with HIV testing among young women in Ghana

BackgroundHIV/AIDS is a global health challenge and continues to threaten lives in sub-Saharan African countries such as Ghana. One of the important interventions for controlling its transmission is through testing and receiving medication. In this study, we present findings on the prevalence and factors associated with HIV testing among young women in Ghana.MethodsWe used data from the 2014 Ghana Demographic and Health Survey comprising young women aged 15–24 years. We calculated the proportion of these young women who have ever been tested for HIV. The multivariable logistic regression analysis was used to assess the determinants of HIV testing at a 95% confidence interval (CI), and adjusted odds ratio (aORs) and p-values were reported. All analyses were adjusted using survey weights to account for unequal sampling probabilities.ResultsThe results showed that 31.4% (95% CI [29.63, 32.81]) of young women in Ghana had tested for HIV. The odds of HIV testing were likely to be higher among young women aged 20–24 (aOR = 2.24, 95% CI [1.75, 2.87]), those who were pregnant (aOR = 3.17, 95% CI [2.03, 4.95]) and those with one (aOR = 7.99, 95% CI [5.72, 11.17]), two (aOR = 10.43, 95% CI [6.47, 16.81]) or three or more children (aOR = 14.60, 95% CI [8.37, 25.48]) compared to their counterparts in the reference category. Women who had attained secondary education or higher (aOR = 2.66, 95% CI [1.67, 4.23]), were sexually active (aOR = 2.82, 95% CI [2.00, 3.97]), and in richer (aOR = 1.98, 95% CI [1.17, 3.34]) and richest wealth index (aOR = 1.99, 95% CI [1.10, 3.61]) were more likely to test for HIV than those with no formal education, who had not had sex before or in the poorest wealth index. Women from the Eastern (aOR = 1.69, 95% CI [1.04,2.72]) and Upper East regions (aOR = 2.62, 95% CI [1.44, 4.75]) were more likely than those in the Western region to get tested for HIV. However, the odds of testing for HIV were lower among women belonging to other religions (aOR = 0.43, 95% CI [0.23,0.82]) than Christians.ConclusionThe findings show that HIV testing is low among young women in Ghana. To address this issue, it is recommended that both government and non-governmental organizations collaborate to create effective programmes and strategies. These may include continuous health education, regular sensitization programs and making HIV testing services much more accessible and affordable, taking into consideration the sociodemographic characteristics of young women.

Multi-level factors associated with utilization of water, sanitation and hygiene services by mothers in Nepal.

Providing improved water, sanitation, and hygiene (WASH) at a household level remains one of the major public health challenges in Nepal. Household mothers are likely to have limited access to combined WASH services, this is influenced by individual, and community factors. Individual components of an improved water source, sanitary toilet, fixed place for handwashing, and availability of soap and water were merged into one and called combined WASH. This paper aimed to identify the individual and community factors associated with combined WASH facilities and practices among mothers with children under five years in Nepal. A cross-sectional study was conducted using data from the Nepal Demographic and Health Survey (NDHS), 2016. The weighted sample size of this study was 4887 mothers with children under five years. The independent variables within the mothers included age, education, occupation, and caste/ethnicity in addition to education of the husband, wealth index, exposure to the newspaper, radio and television, residence, ecological zones, provinces, distance and participation in health mother groups were analyzed with the outcome variable of combined WASH. A multi-level mixed effects logistic regression model was used to assess the relationship of explanatory variables with WASH. At an individual level, a rich wealth index was positively associated with combined WASH (AOR = 6.29; 95%CI: 4.63-8.54). Higher education levels and exposure to television had higher odds of having combined WASH. At the community level, the hill zone, urban residence, and Sudurpashim Provinces were positively associated with combined WASH while Madesh and Karnali Provinces and distance to water source greater than 31 minutes were associated with lower access to combined WASH. Educated and rich household have positive association with combined WASH. It is recommended that both the health and other sectors may be instrumental in improving the combined WASH service for mothers at households.

Spatial variation and determinants of mother and newborn skin-to-skin contact care practices in Ethiopia: A spatial and multilevel mixed-effect analysis.

Skin-to-skin contact care practice is placing a naked baby on the mother's chest with no cloth separating them, in a prone position covered by a cloth or blanket. It improves the survival of newborns by preventing hypothermia, improving breastfeeding, and strengthening mother-to-child bonding. Nevertheless, it remains under-practiced in many resource-constrained settings. Therefore, the main objective of this study is to explore the spatial variation and determinants of mother and newborn skin-to-skin contact care practices in Ethiopia. The study was done using the 2016 Ethiopian Demographic and Health Survey data. A weighted sample of 10417 mothers who gave live birth before the five-year survey was extracted for the analysis. Arc GIS version 10.3 and SaTscan version 10.0.2 were used for the spatial analysis. A multilevel mixed logistic regression model was fitted to identify factors associated with skin-to-skin contact care practices of mothers and newborns. Finally, a statistically significant association was declared at a P-value of < 0.05. In this study, skin-to-skin contact care practice of mothers and newborns was non-random across Ethiopia with Moran's I: 0.48, p < 0.001. The most likely significant primary and secondary clusters were found in Addis Ababa (RR = 2.39, LLR = 116.80, p <0.001) and Dire Dewa and Harari (RR = 2.02, LLR = 110.45, p <0.001), respectively. In this study, place of delivery (AOR = 12.29, 95%CI:10.41, 14.54), rich wealth index (AOR = 1.29, 95% CI: 1.05,1.59), medium wealth index (AOR = 1.38, 95% CI:1.17, 1.68), having 1-3 antenatal care visits(AOR = 1.86,95% CI: 1.56, 2.29), having ≥4 antenatal care visits (AOR = 1.93,95% CI: 1.56, 2.39), initiating breastfeeding within the first hour (AOR = 1.75,95% CI:1.49,2.05) and media exposure (AOR = 1.20,95%CI 1.02,1.41) were factors associated with skin to skin contact care practice of mothers and newborns. This study concludes that the Skin-to-skin contact care practices of mother and newborn is not random in Ethiopia. Therefore, the implementation of essential newborn care packages should be regularly monitored and evaluated, particularly in the cold spot areas of skin-to-skin contact care practices. Besides, media advertising regarding the importance of Skin-to-skin contact care practices for mothers and newborns should be scaled up to increase the practices.

Double burden of malnutrition and associated factors among mother-child pairs at household level in Bahir Dar City, Northwest Ethiopia: community based cross-sectional study design.

The double burden of malnutrition refers to the simultaneous presence of under nutrition and overweight, obesity, or diet-related non-communicable diseases which might occur at the population, household, and individual level. The simultaneous presence of overweight/obese mothers with undernourished children in the same household, as well as overweight children with underweight mothers, holds particular significance. This phenomenon primarily impacts low-income and middle-income countries. The prevalence of double-burden malnutrition at the household level has increased significantly in sub-Saharan African countries. However, there is limited knowledge regarding the extent and factors associated with the double burden of malnutrition among mother-child pairs in Ethiopia. Consequently, the objective of this study was to assess the prevalence and determinants of the double burden of malnutrition among mother-child pairs at the household level in Bahir Dar City, Ethiopia. In the year 2021, a community-based cross-sectional study design was employed among 702 mother-child pairs in Bahir Dar City from February 28 to March 23. A multistage sampling technique was used to identify study participants who were interviewed using an interviewer-administered questionnaire. The nutritional status of children was evaluated using WHO Anthro Software. To determine the strength of the association, multivariable logistic regression analysis was performed, and adjusted odds ratios with their respective 95% confidence intervals were computed. The prevalence of the double burden of malnutrition among mother-child pairs was 14.5% (95% CI: 12.8, 15.7%}. Participants who were in the richest wealth index were 2.72 {AOR = 2.72, 95% CI 2.01, 5.63} times more odds of double burden of malnutrition than the poorest. The odds of the double burden of malnutrition among children who had high dietary diversity decreased by 63% {AOR = 0.37, 95% CI 0.22, 0.61} than low dietary diversity. Food secure households were 1.96 {AOR = 1.96, 95% CI 1.13, 3.39} times more likely to have the double burden of malnutrition than food insecure households. The odds of the double burden of malnutrition among mothers who completed college and above decreased by 74% {AOR = 0.26 95% CI 0.121, 0.549} than those unable to read and write. The magnitude of the double burden of malnutrition was lower than the Ethiopian Demographic and Health Survey. Wealth index, dietary diversity, food security, and educational status were significantly associated with the double burden of malnutrition. Therefore, it is recommended to implement public health interventions that target the identified associated factors in order to reduce the burden of double malnutrition.

What predicts health facility delivery among women? analysis from the 2021 Madagascar Demographic and Health Survey

BackgroundOne of the pivotal determinants of maternal and neonatal health outcomes hinges on the choice of place of delivery. However, the decision to give birth within the confines of a health facility is shaped by a complex interplay of sociodemographic, economic, cultural, and healthcare system-related factors. This study examined the predictors of health facility delivery among women in Madagascar.MethodsWe used data from the 2021 Madagascar Demographic and Health Survey. A total of 9,315 women who had a health facility delivery or delivered elsewhere for the most recent live birth preceding the survey were considered in this analysis. Descriptive analysis, and multilevel regression were carried out to determine the prevalence and factors associated with health facility delivery. The results were presented as frequencies, percentages, crude odds ratios and adjusted odds ratios (aORs) with corresponding 95% confidence intervals (CIs), and a p-value < 0.05 was used to declare statistical significance.ResultsThe prevalence of health facility delivery was 41.2% [95% CI: 38.9–43.5%]. In the multilevel analysis, women aged 45–49 [aOR = 2.14, 95% CI = 1.34–3.43], those with secondary/higher education [aOR = 1.62, 95% CI = 1.30–2.01], widowed [aOR = 2.25, 95% CI = 1.43–3.58], and those exposed to mass media [aOR = 1.18, 95% CI = 1.00-1.39] had higher odds of delivering in health facilities compared to those aged 15-49, those with no formal education, women who had never been in union and not exposed to mass media respectively. Women with at least an antenatal care visit [aOR = 6.95, 95% CI = 4.95–9.77], those in the richest wealth index [aOR = 2.74, 95% CI = 1.99–3.77], and women who considered distance to health facility as not a big problem [aOR = 1.28, 95% CI = 1.09–1.50] were more likely to deliver in health facilities compared to those who had no antenatal care visit. Women who lived in communities with high literacy levels [aOR = 1.54, 95% CI = 1.15–2.08], and women who lived in communities with high socioeconomic status [aOR = 1.72, 95% CI = 1.28–2.31] had increased odds of health facility delivery compared to those with low literacy levels and in communities with low socioeconomic status respectively.ConclusionThe prevalence of health facility delivery among women in Madagascar is low in this study. The findings of this study call on stakeholders and the government to strengthen the healthcare system of Madagascar using the framework for universal health coverage. There is also the need to implement programmes and interventions geared towards increasing health facility delivery among adolescent girls and young women, women with no formal education, and those not exposed to media. Also, consideration should be made to provide free maternal health care and a health insurance scheme that can be accessed by women in the poorest wealth index. Health facilities should be provided at places where women have challenges with distance to other health facilities. Education on the importance of antenatal care visits should also be encouraged, especially among women with low literacy levels and in communities with low socioeconomic status.

Trends and factors associated with teenage pregnancy in Ethiopia: multivariate decomposition analysis

Teenage is a time of transition from childhood to adulthood. This stage is a time of change and needs particular care and ongoing support. Adolescent pregnancy remains a common health care problem in low- and middle-income countries, and it is associated with higher maternal and neonatal complications. Thus, this study aimed to determine the trends and factors associated with them that either positively or negatively contributed to the change in teenage pregnancy in Ethiopia. Ethiopian Demographic and Health Survey data from 2005 to 2016 were used for this study. A total weighted sample of 10,655 (3265 in 2005, 4009 in 2011, and 3381 in 2016) teenagers was included. Trends and the proportion of teenage pregnancies for each factor over time were explored. Then, a logit-based multivariate decomposition analysis for a non-linear response model was fitted to identify the factors that contributed to the change in teenage pregnancy. Statistical significance was declared at p-value < 0.05 and the analysis was carried out on weighted data. Teenage pregnancy declined significantly from 16.6% (95% CI: 15.4, 17.9) to 12.5% (95% CI: 11.4, 13.6) in the study period, with an annual reduction rate of 2.5%. About 49.8% of the decrease in teenage pregnancy was attributed to the change in the effect of the characteristics. The compositional change in primary educational status (41.8%), secondary or above educational status (24.55%), being from households with a rich wealth index (1.41%) were factors positively contributed to the decline in teenage pregnancy, whereas being from a Muslim religion (−12.5%) was the factor that negatively contributed to the reduction in teenage pregnancy. This study has shown that teenage pregnancy declined significantly; however, it is still unacceptably high. The changes in compositional factors of teenagers were responsible for the observed reduction in the prevalence of teen pregnancy rates in Ethiopia. Educational status, religion, and wealth index were found to be significant factors that contributed to the reduction in teenage pregnancy. Therefore, intervention programs targeting adolescents should address the socio-economic inequalities of these influential factors to reduce teenage pregnancy and related complications.

Trend and determinants of unmet need for family planning among married women in Ethiopia, evidence from Ethiopian demographic and health survey 2000-2016; multilevel analysis.

Unmet need refers to the gap between women's desires and contraception use to monitor their fertility level. According to the data, unplanned pregnancies are more likely to result in miscarriage and other obstetric difficulties, have poor maternal health care usage, and have a higher risk of having babies who are underweight. Information on the trend of unmet family planning needs in Ethiopia is scarce. The aim of this study was to examine the trend and determinants of unmet need for family planning among married or in union women in Ethiopia from 2000 to 2016. Cross-sectional study design from secondary data was performed. Data for the study was obtained from four consecutive Ethiopian Demographic Health Surveys 2000 to 2016. The survey employs a nationally representative sample of households using a multistage stratified sampling technique. A descriptive analysis was done to see the trend in unmet need. Multivariable, multilevel logistic regression was performed to assess individual and community-level determinants. An adjusted odds ratio (AOR) at a 95% confidence interval and a p-value of 0.05 were used to declare the level of significance. Unmet need declined by 40.2%, from 37.3% to 22.3%, from 2000 to 2016. Rural (AOR = 1.42; 95% CI: 1.27-1.59), number of living children > = 5 (AOR = 1.14 (1.04-1.24), age at first marriage > = 18 years (AOR = 1.15; 95% CI: 1.09-1.21), knowing at least one method of Family Planning (FP) (AOR = 1.57; 95% CI: 1.43-1.72), and no previous use of FP (1.27 (1.20-1.36) were associated with increased unmet need. While women between the ages of 20 and 24 (AOR = 0.71; 95% CI: 0.64-0.79), 25-29 (AOR = 0.62; 95% CI: 0.55-0.70), 40-44 (AOR = 0.43; 95% CI: 0.39-0.50), 45-49 (AOR = 0.21; 95% CI: 0.18-0.24), the richest wealth index (AOR = 0.88; 95% CI: 0.80-0.96. The level of unmet need has decreased significantly in Ethiopia over the past 16 years. Age, educational level, media exposure, number of living children, age at first marriage, parity, previous use of FP, knowledge of FP, wealth index, regional setting, residence (rural), and survey year all have an association with an unmet need for family planning.

Examining the influence of wealth status on prehypertension risk in women aged 30–49: evidence from the 2018 Benin demographic and health survey

BackgroundThere is an interest in the extent to which the wealth status of women predicts their risk of being pre-hypertensive. This understanding is lacking in the current body of empirical literature, particularly within the context of Benin. Thus, indicating a knowledge gap that must be filled. To this end, the present study aimed to assess the association between wealth status and the risk of prehypertension among women aged 30–49 years in Benin.MethodsThis study used a secondary data from the recent (2018) Demographic and Health Survey of Benin. Bivariate and multivariate logistic regression models were computed to examine the association between wealth index and the risks of prehypertension using Stata version 14. Findings were presented in adjusted odds ratio at 95% confidence level.ResultsWomen in the richest wealth index were significantly more likely to have prehypertension than those in the poorest wealth index [AOR = 1.4; 95%CI: 1.26–2.26]. Women aged 45–49 years were more likely to have prehypertension [AOR = 1.5; 95%CI: 1.15–1.98] compared to younger women. Women who used unclean cooking fuel were less likely to have prehypertension compared to those using clean cooking fuel [AOR = 0.6; 95%CI: 0.37,0.87].ConclusionThe study concludes that wealth status is a significant predictor of prehypertension among women in Benin. Therefore, the Ministry of Health in Benin should prioritize health education and prehypertension awareness campaigns specifically targeting women in affluent communities and households. These campaigns should focus on promoting healthy dietary choices and encouraging physical activity to mitigate the elevated risk associated with wealth status. Recognizing the influence of age on prehypertension risk, it is imperative for older-middle aged women to be targeted as primary beneficiaries of health education programs and prehypertension screening programs.