Richest Wealth Research Articles

Breast and cervical cancer screening among women at reproductive age in Cambodia: A secondary analysis of Cambodia Demographic and Health Survey 2022.

Breast and cervical cancers are the most prevalent diagnosed in women worldwide, significantly contributing to maternal morbidity and mortality. We examined socio-demographic and behavioral factors associated with breast and cervical cancer screening among Cambodian women aged 15-49 years old. We analyzed women's data from the 2022 Cambodia Demographic and Health Survey (CDHS). In total, 19,496 women were interviewed. Multiple logistic regression was performed using STATA V17 to examine factors associated with breast and cervical cancer screening. The proportion of breast and cervical cancer screenings was 10.6% and 15.3%, respectively. After being adjusted, factors independently associated with breast cancer screening included age group 20-29 years [AOR = 2.51; 95% CI: 1.55-4.06], 30-39 years [AOR = 4.34; 95% CI: 2.66-7.09], and 40-49 years [AOR = 4.66; 95% CI: 2.81-7.71], higher education [AOR = 1.92; 95% CI: 1.26-2.93], exposure media [AOR = 1.66; 95% CI: 1.32-2.10], and rich wealth quintile [AOR = 1.50; 95% CI: 1.25-1.80]. Similarly, the odds of having cervical cancer screening were age group 20-29 years [AOR = 2.88; 95% CI: 1.76-4.71], 30-39 years [AOR = 5.94; 95% CI: 3.58-9.83], and 40-49 years [AOR = 7.61; 95% CI: 4.55-12.73], higher education [AOR = 1.55; 95% CI: 1.55-2.73], exposure media [AOR = 1.62; 95% CI: 1.35,1.95], and rich wealth quintile [AOR = 2.14; 95% CI: 1.78-2.5f8]. In conclusion, this study shows the low screening proportion for both breast and cervical cancers, and it also highlights that socio-economic factors are significantly important in determining the health care seeking for these two main cancer screening services among women aged 15-49 years in Cambodia. Therefore, increase of exposure media with health education focusing on these cancer screenings should be made better accessible to women, particularly those of low socio-economic status.

Ethnobotanical Survey of the Plants Used In the Treatment of Diabets in Adilabad and Nirmal Districts of Telangana State

The paper deals with the plants based folk role practices used in the treatment of diabetes. The study was conducted in two districts (Adilabad and Nirmal) of Telangana State India, and the state of Telangana a rich in floral diversity. Even though modern medical facilities are available in these Places, people in villages still are plant therapy to a considerable extent. This may be attributed to the rich floral wealth of the state, which makes the access to the medicinal plants comparatively easy, the lower cost factor, and to a popular belief that plant derived medicines are better suited for the body. The impact of modernization and preservation of these practices are essential.

Spatial distribution and determinants of improved shared sanitation facilities among households in Ethiopia: Using 2019 mini-Ethiopian Demographic and Health Survey.

Limited or shared sanitation services are considered improved sanitation facilities, but they are shared between two or more households. Globally, 600 million people use shared toilet facilities. Although shared facilities are not classified as improved sanitation due to potential infection risks, inaccessibility, and safety concerns, this is a significant issue in developing countries like Ethiopia. Evidence on the distribution of shared sanitation services and their determinants in Ethiopia is limited. Therefore, this study aimed to assess the extent of shared toilet facilities and their determinants among households in Ethiopia. The 2019 Ethiopian Demographic and Health Survey (EDHS) served as the basis for the cross-sectional secondary data analysis. The analysis included a total of 7,770 households from the weighted sample. STATA 14 software was used to clean, weigh, and analyze the data. To explore the distribution and determine the factors associated with shared toilet facilities in Ethiopia, both spatial and mixed-effect analyses were utilized. A p-value of less than 0.05 was used to display the relationships between the dependent and independent variables, employing adjusted odds ratios and 95% confidence intervals. The magnitude of improved shared sanitation facilities among households in Ethiopia, according to the EDHS 2019, was 10.5% (95% CI: 9.88, 11.24). The prevalence was highest in Addis Ababa at 70.2% and lowest in the Southern Nations, Nationalities, and Peoples' Region at 2.4%. Individual-level variables significantly associated with the use of improved shared toilet facilities included being a household head aged 55 years or older [AOR = 0.48; 95% CI: 0.33, 0.71], having secondary education or higher [AOR = 2.43; 95% CI: 1.80, 3.28], and belonging to middle or rich wealth status [middle: AOR = 2.32; 95% CI: 1.35, 3.96; rich: AOR = 6.23; 95% CI: 3.84, 10.11]. Community-level characteristics such as residing in urban areas [AOR = 7.60; 95% CI: 3.47, 16.67], the metropolitan region [AOR = 25.83; 95% CI: 10.1, 66.3], and periphery regions [AOR = 5.01; 95% CI: 2.40, 10.48] were also associated with the use of shared toilet facilities. The usage of improved shared toilet facilities among households in Ethiopia is relatively low. Significant factors related to the use of shared toilet facilities were being 55 years of age or older, possessing secondary or higher education, having a middle or rich wealth status, living in urban areas, and residing in metropolitan or peripheral regions. To improve access to and utilization of shared sanitation facilities, Ethiopian policy should emphasize user education and awareness.

Woody species composition and diversity of agroforestry homegardens along altitudinal gradient in southwest Ethiopia.

Homegarden agroforestry systems that integrate trees with agricultural practices are usually valued for the conservation of farm biodiversity. Despite the system having a significant conservation role, litle is known on woody species composition and diversity following the elevation belt of southwest Ethiopia. A complete enumeration of 72 homegardens (24 each from altitudinal gradient) was purposively selected for woody species inventory. A total of 55 woody species belonging to 31 families and 45 genera were recorded. Of which, 56.4% of woody species are indigenous and two are endemic to Ethiopia. Family Fabaceae was the most represented family with eight species. The highest species richness (42) was observed at high altitudes followed by 39 species at middle and 31 species at low altitudes but no significant difference between them. Species richness significantly (P < 0.001) increased with increasing wealth status. The overall richness distribution was 46, 40, and 27 across rich, medium, and poor wealth classes respectively. Shannon diversity index differed significantly between poor and rich households. Pearson correlation result shows a strong positive and significant correlation between richness and wealth status. The mean woody species density was 89.06±9.25 and 1236.22±131.42 per garden and hectare, respectively. Stem density was significantly higher (P < 0.001) in wealthier farms. We found that, in southwestern Ethiopia wealthier agroforestry farms can support more woody species diversity in homegardens.

Survival analysis of early initiation of antenatal care visits and associated factors among pregnant women in Ethiopia.

Early initiation of antenatal care visits creates an opportunity for early detection of high-risk pregnancies, pregnancy complications, health education, and counseling about successful care and nutrition of the mother and the fetus. Thus, the main objective of this study was to identify the factors associated with the early initiation of antenatal care visits in Ethiopia. The study was conducted based on the children's data set of the 2019 Ethiopia mini-demographic and health survey. The study employed a retrospective cohort study design using the data downloaded from the Measure Demographic and Health Survey website. The study included a random sample of 2922 pregnant women who had complete information about their first antenatal care visits. A gamma-accelerated failure time model was employed to identify the factors associated with the early initiation of antenatal care visits in Ethiopia. In Ethiopia, 62% of the pregnant women started their first antenatal care visit early. The higher birth order of the current pregnancy (ϕ = 2.215, 95% CI: 1.8901, 2.5966), mothers being rural residents (ϕ = 1.239, 95% CI: 1.1633 1.3195), mothers aged 25-34 (ϕ = 1.692, 95% CI: 1.5588, 1.8369), and mothers aged above 34 (ϕ = 1.826, 95% CI: 1.6392, 2.0336) were associated with an accelerated time to initiation of antenatal care visits. However, mothers attained higher education (ϕ = 0.830, 95% CI: 0.7345, 0.9373) and rich wealth index (ϕ = 0.869, 95% CI: 0.8156, 0.9259) were associated with a shorter time to initiation of antenatal care visits. A higher proportion of urban and educated pregnant women initiated their antenatal care visits earlier than the other groups. We recommend that stakeholders at the federal and regional levels should focus on providing special concern for information, education, and communication regarding the importance of early antenatal care visits initiation.

THE LEGAL PROTECTION OF PATENTS ON PHYTOPHARMACEUTICAL PRODUCTS IN INDONESIA: CASE STUDIES AND THEORETICAL PERSPECTIVES

Indonesia has great potential in the development of biowealth-based phytopharmaceutical products, considering its rich natural wealth and traditional medicine traditions. This study uses theories of legal utilitarianism, distributive justice, and legal positivism to explore the challenges facing Indonesia, as well as opportunities for more inclusive and adaptive reforms. This analysis employs a normative juridical approach, focusing on the analysis of written laws, regulations, doctrines and legal interpretations related to patent protection for phytopharmaceutic products. This approach enables a thorough understanding of the patent legal framework in Indonesia and its practical implementation. The case study method is used to evaluate several patents registered with the Directorate General of Intellectual Property (DJKI). The results show that Indonesia is facing a number of complex legal challenges in the patent registration process, ranging from barriers to novelty criteria and inventive steps to lengthy administrative processes. In addition, Indonesia needs to strengthen its national patent system and intellectual property protection strategies to ensure that local communities benefit fairly from the use of their traditional knowledge. This research could investigate how these mechanisms influence innovation within local communities and their role in fostering sustainable practices.

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.

Sociodemographic factors associated with knowledge and adequate attitudes about HIV in women of reproductive age from Peru.

To determine the sociodemographic factors associated with knowledge and adequate attitudes about HIV in women of reproductive age from Peru in 2021. Analytical cross-sectional study. We analyzed a demographic and family health survey (ENDES) 2021 carried out in women of reproductive age (12 to 49 years of age). The dependent variables were the adequate level of knowledge and adequate attitudes about HIV, the independents were sociodemographic variables. The statistical analysis was carried out with a Poisson regression model with robust variance obtaining the adjusted prevalence ratio (PRa) and confidence intervals. Thirty-four percent (CI 95%: 32,9-35,1) had an adequate level of knowledge about HIV and 32,9% (CI 95%: 31,7-34,0) had adequate attitudes. In the multivariate analysis, the main variables associated with the adequate level of knowledge about HIV were the higher level of education (PRa = 1,19; CI 95%: 1,15-1,23) and very rich wealth quintile (PRa = 1,15; CI 95%: 1,01-1,20); while the main variables associated with adequate attitudes on HIV were higher level of education (PRa = 1,44; CI 95%: 1,40-1,48), high-school education level (PRa = 1,21; CI 95%; 1,18-1,24), very rich wealth quintile (PRa = 1,18; CI 95%: 1,14-1,22), and age range between 35 and 49 years (PRa = 1,18; CI 95%: 1,15-1,21). The sociodemographic factors associated with knowledge and adequate attitudes about HIV in Peruvian women of reproductive age were mainly higher level of wealth, higher level of education, and a higher age range. Other sociodemographic variables presented a weak association with knowledge and adequate attitudes about HIV.

Factors influencing the first dose of measles vaccination uptake in 42 low- and middle-income countries

ObjectivesVaccination against measles still stands as a highly impactful public health strategy for mitigating childhood morbidity and mortality. Relatively poor immunization coverage among children has been observed in low and middle-income countries (LMICs). Our study intended to determine socio-demographic factors associated with the 1st dose of measles vaccination among South Asian (SA) and SubSaharan African (SSA) countries children. Study designThis was a cross-sectional study. MethodsThis study utilized demographic and health survey data from 42 low-and middle-income countries (LMICs) in SA and SSA. The children's dataset yielded 255,775 children between the ages of 12 and 59 months. The independent predictors were determined by using crude and adjusted odds ratios with 95% confidence intervals (CI). ResultsThe prevalence of first-dose measles-immunized children was 55.5% for the selected LMICs. The multivariable analysis for combined regions (SA and SSA) showed that parents with a higher level of education, rich wealth quintile, mothers with media access, mothers with more than four antenatal care (ANC) visits and baby postnatal check-up (PNC) within two months were significantly associated with the first dose of measles vaccination among children. ConclusionThe first dose measles immunization coverage in the selected LMICs was considerably low. To boost the uptake of childhood measles vaccination, public health interventions particularly need to focus on children born to uneducated parents, poor families, and those who have not used health services (ANC and PNC). Financial funding is crucial for establishing mobile vaccination clinics to improve immunization rates among the impoverished.

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.

Undernutrition and associated factors among lactating mothers in Chiro district, eastern Ethiopia: a community-based cross-sectional study.

Maternal undernutrition during lactation is a worldwide public health problem. It causes impaired cognitive ability, poor productivity, irreversible loss, and intergenerational malnutrition, which has harmful effects on the next generation. Overall, there is little information on undernutrition and risk factors among lactating mothers, especially in resource-poor settings, including Ethiopia. This study assessed undernutrition and associated factors among lactating mothers in rural Chiro district, eastern Ethiopia. A community-based cross-sectional study was conducted among 629 lactating mothers in the Chiro district from July 2-30, 2019. Data were collected from participants using pretested, structured questionnaires and anthropometric measurements. Data were entered using EpiData version 3.1 and analyzed using SPSS version 27. Multivariable logistic regression analyses were used to identify factors associated with undernutrition. Undernutrition among lactating mothers was 26.9% (95% CI: 23.2%, 30.2%). Female-headed household (AOR = 0.34, 95% CI:0.13, 0.94), medium (AOR = 0.58, 95% CI: 0.38, 0.95) and rich (AOR = 0.30, 95% CI: 0.18, 0.51) wealth quintiles, lack of dietary advice (AOR = 1.62, 95% CI: 1.10, 2.39), chewing khat (AOR = 1.82, 95% CI: 1.23, 2.70), low dietary diversity (AOR = 3.10, 95% CI: 1.82, 5.29), and household food insecurity (AOR = 3.67, 95% CI:1.47, 9.20) were factors significantly associated with undernutrition. Around one in every four lactating mothers in rural eastern Ethiopia had undernutrition. Poor wealth, lack of dietary feeding advice, substance use disorder, low minimum dietary diversity, and household food insecurity were factors significantly associated with the undernutrition of lactating mothers. Thus, focusing on implementing existing strategies/programs for effective nutritional interventions and poverty alleviation that enhance food security status would be essential to improving the nutritional status of lactating mothers and children.

Prevalence and determinants of skilled birth attendance among young women aged 15–24 years in Northern Nigeria: evidence from multiple indicator cluster survey 2011 to 2021

BackgroundChildbirth among adolescents and young mothers has been linked to various complications, including perinatal mortality, preterm births, low birth weight, and infections, which collectively contribute to the high burden of neonatal and maternal mortality. Despite some progress, the prevalence of skilled birth attendance, proven to improve maternal and newborn health outcomes, remains consistently low in Northern Nigeria. This study assessed the prevalence and determinants of Skilled Birth Attendance (SBA) among young women ages 15–24 years in Northern Nigeria.MethodsThis pooled cross-sectional study included 6,461 young women aged 15–24 years from 2011, 2016 and 2021 multiple indicator cluster surveys in Nigeria. We used a binary logistic regression model to assess the factors associated with skilled birth attendance at 95% confidence intervals (CIs) with computed adjusted odds ratios (aORs).ResultsThe prevalence of skilled birth attendance among young women in Northern Nigeria increased from 25.6% in 2011 to 33.1% in 2021. Women who were atleast 18 years of age at first marriage had 2.48 higher odds of SBA (aOR 2.48, 95% CI = 1.54–4.00) compared those less than 18 years of age at first marriage after controlling for confounders. Young women from rich household wealth quintile were more likely to utilize SBA (aOR 1.84, 95% CI = 1.11–3.14) compared to young women from poor household wealth quintile. In terms of education, those women who had secondary (aOR = 2.52, 95% CI = 1.77–3.56) and higher education (aOR = 10.01, 95% CI = 2.21–49.31) had higher odds of SBA compared to those with no education. Individual women with media exposure had 59% higher likelihood (aOR = 1.59, 95% CI = 1.16–2.19), women who attended 4 or more antenatal care visits during their last pregnancy demonstrated 2.28 times higher odds (aOR = 2.28, 95% CI = 1.67–3.09), while those who reported no intention for their last pregnancy were 37% less likely (aOR = 0.63, 95% CI = 0.42–0.96) to utilize SBA.ConclusionA slight increase in the prevalence of skilled birth attendance was observed over the 10-year period. For a significant boost in skilled birth attendance among young women in Northern Nigeria, particular attention needs to be paid to girls’ child education, delay in marriage, economic empowerment of young women, and strategic ways of leveraging trained community health workers (CHIPs) to bring reproductive healthcare close to young women living in rural areas.

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.

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.

Pooled prevalence, spatial variation and associated factors of HIV testing uptake among multiple sexual partners in Sub Saharan Africa: Spatial and multilevel analysis.

Uptake of HIV testing is vital for the early diagnosis of HIV infection and initiation of treatment, which are used to eliminate the disease's progression and reduce HIV-related mortality. Even if determining HIV testing is imperative to prevent HIV/AIDS among multiple sexual partners who are at higher risk of sexually transmitted infections, most of the countries in Sub Saharan Africa did not fulfil the global targets of UNAIDS. Moreover there is a paucity of literature on spatial variation and factors associated with HIV testing among high-risk groups in SSA. This study aimed to assess the pooled prevalence, spatial variation and determinants of HIV testing uptake among multiple sexual partners in Sub Saharan Africa. The Demographic and Health Surveys data conducted between 2011 and 2021 in 30 Sub-Saharan Africa countries was used to analyze total weighted sample of 56,210 multiple sexual partners. Exploratory spatial data analysis, with countries as the unit of analysis was conducted using ArcGIS V10.7.1 and Sat Scan V 10.1 soft wares. A multilevel binary logistic regression model was used to identify the factors associated with the HIV testing uptake. The Adjusted odds Ratio with a 95% confidence interval was reported to declare the strength of association and their statistical significance. The spatial patterns of HIV testing uptake were found to be non-random. Primary clusters were identified around western and central sub- regions. Multiple sexual partners who were ever married, those attended primary level and above education, those from rich wealth status, aged above 24 years, having good HIV related knowledge, and exposed to media were positive association with HIV testing uptake. However, being male, having working status and living in rural area were negatively associated with HIV testing uptake. At the community-level, multiple sexual partners from communities in Eastern and southern sub regions, countries with upper middle income and countries with the survey year after 2014 were more likely to utilize HIV testing services compared with their counterparts. In this study, the pooled prevalence of the HIV testing uptake among multiple sexual partners was found to be lower than the universal target and showed differences in HIV testing uptake across Sub-Saharan Africa region. Both individual and community-level factors affected HIV testing uptake among multiple sexual partners. Stakeholders should implement interventions to help increase the uptake of HIV testing among those risky groups in this region.

Minimum milk feeding frequency and its associated factors among non-breastfed children aged 6–23 months in sub-saharan Africa: a multilevel analysis of the recent demographic and health survey data

BackgroundPoor infant and child feeding practices, in combination with increased rates of infectious diseases, are the main immediate causes of malnutrition during the first two years of life. Non-breastfed children require milk and other dairy products, as they are rich sources of calcium and other nutrients. As far as our search is concerned, there is no evidence on the pooled magnitude and determinants of minimum milk feeding frequency among non-breastfed children in sub-Saharan Africa conducted using the most recent indicators for assessing infant and young child feeding practices published in 2021. Therefore, this study is intended to determine the magnitude and associated factors of minimum milk feeding frequency among non-breastfed children aged 6–23 months in sub-Saharan Africa using the most recent guideline and demographic and health survey dataset.MethodsData from the most recent health and demographic surveys, which were carried out between 2015 and 2022 in 20 sub-Saharan African countries, were used. The study comprised a weighted sample consisting of 13,315 non-breastfed children between the ages of 6 and 23 months. STATA/SE version 14.0 statistical software was used to clean, recode, and analyze data that had been taken from DHS data sets. Utilizing multilevel mixed-effects logistic regression, the factors associated with the outcome variable were identified. Model comparison and fitness were assessed using deviance (-2LLR), likelihood ratio test, median odds ratio, and intra-class correlation coefficient. Finally, variables with a p-value < 0.05 and an adjusted odds ratio with a 95% confidence interval were declared statistically significant.ResultsThe pooled magnitude of minimum milk feeding frequency among non-breastfed children aged 6–23 months in sub-Saharan African countries was 12.39% (95% CI: 11.85%, 12.97%). Factors like maternal educational level [AOR = 1.61; 95% CI (1.35, 1.91)], marital status of the mother [AOR = 0.77; 95% CI (0.67, 0.89)], maternal working status [AOR = 0.80; 95% CI (0.71, 0.91)], media exposure [AOR = 1.50; 95% CI (1.27, 1.77)], wealth index [AOR = 1.21; 95% CI (1.03, 1.42)], place of delivery [AOR = 1.45; 95% CI (1.22, 1.72)], ANC visit attended during pregnancy [AOR = 0.49; 95% CI (0.39, 0.62)], PNC checkup [AOR = 1.57; 95% CI (1.40, 1.76)], child’s age [AOR = 0.70; 95% CI (0.53, 0.93)], and residence [AOR = 2.15; 95% CI (1.87, 2.46)] were significantly associated with minimum milk feeding frequency.ConclusionsIn sub-Saharan Africa, the proportion of minimum milk feeding frequency among non-breastfed children aged between 6 and 23 months was low. The likelihood of minimum milk feeding frequency increases with high levels of education, unemployment, media exposure, rich wealth status, being unmarried, having a child born in a health facility, getting PNC checks, being between 6 and 8 months old, and living in an urban area. Hence, promoting women’s education, increasing the economic status of the household, disseminating nutrition information through media, strengthening maternal health service utilization like health facility delivery and PNC services, and giving prior attention to mothers with older children and from rural areas are strongly recommended.

Only 9% of mothers have eight and more ANC visit in 14 sub-saharan African countries; evidence from the most recent DHS 2018–2023: a multilevel analysis

BackgroundThe world health organization’s global health observatory defines maternal mortality as annual number of female deaths, regardless of the period or location of the pregnancy, from any cause related to or caused by pregnancy or its management (aside from accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy and an estimated 287 000 women worldwide passed away from maternal causes between 2016 and 2020, that works out to be about 800 deaths per day or about one every two minutes.MethodThe most recent 2018–2023 DHS data set of 14 SSA countries was used a total of 89,489 weighted mothers who gave at list one live birth 3 years preceding the survey were included, a multilevel analysis was conducted. In the bi-variable analysis variables with p-value ≤ 0.20 were included in the multivariable analysis, and in the multivariable analysis, variables with p-value less than ≤ 0.05 were considered to be significant factors associated with having eight and more ANC visits.ResultThe magnitude of having eight and more ANC visits in 14 sub-Saharan African countries was 8.9% (95% CI: 8.76–9.13) ranging from 3.66% (95% CI: 3.54–3.79) in Gabon to 18.92% (95% CI: 18.67–19.17) in Nigeria. The multilevel analysis shows that maternal age (40–44, AOR;2.09, 95%CI: 1.75–2.53), maternal occupational status (AOR;1.14, 95%CI; 1.07–1.22), maternal educational level (secondary and above, AOR;1.26, 95%CI; 1.16–1.38), wealth status(AOR;1.65, 95%CI; 1.50–1.82), media exposure (AOR;1.20, 95%CI; 1.11–1.31), pregnancy intention (AOR;1.12, 95%CI; 1.05–1.20), ever had terminated pregnancy (AOR;1.16 95%CI; 1.07–1.25), timely initiation of first ANC visit (AOR;4.79, 95%CI; 4.49–5.10), empowerment on respondents health care (AOR;1.43, 95%CI; 1.30–1.56), urban place of residence (AOR;1.33, 95%CI; 1.22–1.44) were factors highly influencing the utilization of AN. On the other hand higher birth order (AOR;0.54, 95%CI; 0.53–0.66), not using contraceptive (AOR;0.80, 95%CI; 0.75–0.86) and survey year (AOR;0.47, 95%CI; 0.34–0.65) were factors negatively associated with having eight and more ANC visits.ConclusionIn the 14 SSA included in this study, there is low adherence to WHO guidelines of eight and more ANC visits. Being educated, having jobs, getting access to media being from rural residence and rich wealth group contribute to having eight and more ANC visits, so we highly recommend policy implementers to advocate this practices.