SSA Countries Research Articles

Anticoagulation control among patients on vitamin K antagonists in nine countries in Sub-Saharan Africa

Vitamin K antagonists (VKA) is the primary anticoagulant in most settings of Sub-Saharan Africa. Understanding the quality of anticoagulation services in the continent is vital in optimising the intended benefits. This study assessed the quality of anticoagulation and associated factors among VKA-treated patients in nine SSA countries. We conducted a retrospective cohort study of randomly selected patients on anticoagulation from 20 clinics in Botswana, the Democratic Republic of Congo, Ethiopia, Gambia, Ghana, Mozambique, Nigeria, Tanzania, and South Africa. Eligible participants were those on VKAs for at least three months and with at least four international normalised ratios (INR) results in 2019–2021. We report the proportion of INR values in the therapeutic range, time-in-therapeutic range (TTR) using the Rosendaal method, and the proportion of patients with TTR ≥ 65% (optimal anticoagulation). The mean age was 51.1(16.1) years, and 64.2% were women. The most common indications for VKA included venous thromboembolism (29.6%), prosthetic valves (26.7%) and atrial fibrillation/flutter (30.1%). We analysed 6743 INR tests from 1011 participants, and of these, 48.5% were sub-therapeutic, 34.1% therapeutic, and 17.4% were supratherapeutic relative to disease-specific reference ranges. TTR was calculated for 660 patients using 4927 INR measurements. The median (interquartile range [IQR]) TTR was 35.8(15.9,57.2) %. Optimal anticoagulation control was evident in 19.2% of participants, varying from 2.7% in Tanzania to 23.1% in Ethiopia. The proportion of patients with TTR ≥ 65% was 15,4% for prosthetic heart valves, 21.1% for venous thromboembolism and 23.7% for atrial fibrillation or flutter. Countries with universal health coverage had higher odds of optimal anticoagulation control (adjusted odds ratio (aOR) 1.79, 95% confidence interval [CI], 1.15– 2.81, p = 0.01). Patients on VKAs for different therapeutic indications in SSA had suboptimal TTR. Universal health coverage increased the odds of achieving TTR by 79%. The evidence calls for more intensive warfarin management strategies in SSA, including providing VKA services without out-of-pocket payments.

Does financial development and institutional quality matter in South-South Trade? Evidence from Sub-Saharan Africa

This study re-evaluates the determinants of international trade in the global south, focusing on intra- and extra-SSA trade while considering financial development and institutional quality as additional predictors. It also examines whether these factors differ for south-south and north–south trade ties. We used a 22-years (ranging from 2000 to 2021) panel of 98 countries (41 from the SSA and the remaining from the ROW). A panel gravity model with Poisson pseudo-maximum likelihood (PPML) estimation is used for the analysis. The results show that financial development in origin and destination countries boosts intra-trade in SSA countries, and the developed financial sector of the destination countries contributes to both intra-bloc and international trade. Financial development of exporting countries also spurs intra-bloc trade in SSA countries and the global south. In addition, apart from common expectations, the institutional quality of exporting countries plays a deterrent role, while the institutional quality of destination countries plays a positive and significant role in trade in the global south. We identified the interaction term for financial development and institutional quality of the exporting countries with a significant and positive coefficient for the global south and the global north, and null for intra-SSA trade. For destination countries, it becomes significantly positive with SSA and the global south but negative with the global north. The findings suggest that as part of the policy measures to boost intra-bloc trade in SSA and the global south, ensuring financial development needs better emphasis.

Uncovering the linkage between sustainable development goals for access to electricity and access to safely managed drinking water and sanitation services

Efforts to improve access to electricity and access to water and sanitation often go hand in hand, as they are essential components of sustainable development. By ensuring access to electricity, communities can have improved access to safe and reliable water supply and sanitation services, leading to better health outcomes, enhanced livelihoods, and overall development. This study investigates the effects of access to electricity on access to safely managed drinking water and sanitation services in 19 African countries from 2000 to 2020. Driscoll-Kraay standard errors and IV-GMM estimation techniques are used to estimate the relationship. The results show that access to electricity is positively associated with the percentage of people using safely managed clean water and sanitation services. The results also show that access to safely managed clean water and sanitation facilities in urban and rural areas turns out to be increased as far as access to electricity increases. The findings indicate that access to electricity reduces urban-rural inequalities in access to clean water and sanitation facilities. The sub-regional analyses conducted reveal that these findings are robust across SSA countries. Lastly, the findings reveal that GDP per capita, globalization, FDI and urbanization are channels through which access to electricity contributes to increasing access to safely managed water and sanitation services. African governments should implement policies that highlight the transformative potential of reliable electricity supply in ensuring sustainable and equitable access to clean water and proper sanitation facilities to safeguard public health and well-being.

Trends and Patterns of Human Capital Development and Economic Growth in Selected Sub-Saharan African Countries

The study analyses the trends and patterns of human capital development in the selected Sub- Saharan African countries during the period 1981-2020. The study variables were economic growth rate; human capital development - proxied by Human Development Index (HDI), physical infrastructure – proxied by Physical Infrastructure Index (PII), technology – proxied by Research and Development (R&D), growth of labour force, share of private investment in GDP, trade openness, financial openness and share of total government expenditure. The result indicates that the trends and patterns over the year for human capital development in SSA countries proxied

Financial access and income inequality in Sub-Saharan Africa: Does ethnic fragmentation give new evidence?

There is a large body of work documenting the non-consensual effects of financial access on income inequality. Despite this extensive literature and the predominance of ethnic fragmentation in Sub Saharan Africa countries (SSA), little is known about its mediating effect on the above relation. This paper focuses on assessing the effect of ethnic fragmentation on financial access income inequality nexus. Based on Kripfganz and Schwarz's (2019) dynamic panel estimator of time-invariant variables in a sample of thirty-seven (37) SSA countries over the period of 1990–2019, it is observed that ethnic fragmentation hinders financial access to reduce inequality in SSA. The results remain stable following several sensitivity tests related to corruption, urbanization, financial literacy and socio-geographic factors. They are also robust to the use of alternative measures of financial access and to change estimation technique.

Compliance towards WHO recommendations on antenatal care for a positive pregnancy experience: Timeliness and adequacy of antenatal care visit in Sub-Saharan African countries: Evidence from the most recent standard Demographic Health Survey data.

Timely and adequate antenatal care (ANC) visits are known to reduce maternal mortality by 20%. Despite the World Health Organization updating its recommendations from four to eight antenatal care contacts, data reporting in the SSA region focused primarily on four visits, and evidence on the timing and adequacy of ANC based on the current recommendation was limited. Hence, this study aimed at assessing the level of timely and adequate ANC visits and their determinants in the 18 Sub-Saharan African countries with the most recent DHS report (2016-2021). The data for this study were pooled from the most recent standardized Demographic and Health Survey data of sub-Saharan African countries from 2016-2021. A total of 171,183 (with a weighted frequency of 171,488) women were included and analyzed by using STATA version 16. To account for data clustering, a multivariable multilevel mixed-effect logistic regression analysis was run to determine the effects of each predictor on the receipt of timely and adequate ANC. Adjusted odds ratio with its corresponding 95% confidence interval was used to declare the statistical significance of the independent variables. The receipt of timely and adequate antenatal care visits was 41.2% (95% CI: 40.9, 41.4) and 10.4% (95% CI: 9.9, 10.2), respectively. Wontedness of pregnancy [AOR = 1.18; 95% CI: 1.13, 1.24], being 1st birth order [AOR = 1.48; 95% CI: 1.41, 2.54], having a mobile phone [AOR = 1.49; 95% CI: 1.26, 2.32], and enrolled in Health insurance schemes [AOR = 2.03; 95% CI: 1.95, 2.42] were significantly associated with early initiation of ANC. Living in a lower community poverty level[AOR = 2.23; 95% CI: 1.90,2.66], being in the richest wealth quintile [AOR = 1.49; 95% CI: 1.36, 1.62], higher educational level [AOR = 3.63; 95% CI: 3.33, 3.96], the timing of ANC visit [AOR = 4.26; 95% CI: 4.08, 4.44], being autonomous in decision making [AOR = 2.29; 95% CI: 1.83, 2.54] and having a mobile phone [AOR = 1.89; 95% CI: 1.76, 2.52] were identified as significant predictors of adequate ANC uptake. The findings revealed a low coverage of timely and adequate ANC visits in SSA countries. Governments and healthcare managers in sub-Saharan African countries should leverage their efforts to prioritize and implement activities and interventions that increase women's autonomy, and economic capability, to improve their health-seeking behavior during pregnancy. More commitment is needed from governments to increase mobile phone distribution across countries, and then work on integrating mHealth into their health system. Finally, efforts should be made to increase the coverage of health insurance schemes enrolment for the citizens.

On the government revenue on economic growth of Sub-Saharan Africa: Does institutional quality matter?

As studies report inconclusive results, the linkage between government revenue and economic growth remains a topic of debate in economic literature. This study investigates the effect of government revenue on the economic growth of Sub-Saharan African countries with the main objective of whether institutional quality matters. The panel data for 43 SSA countries were obtained from dependable data sources: World Development Indicator and Heritage Economic Freedom Index for the period of 2012–2022. The result from system GMM estimation reveals that government revenue adversely affects economic growth while institutional quality positively enhances economic growth before interacting with each other. However, the interactive coefficient of government revenue and economic growth positively affected the real GDP growth rate of SSA countries over the study periods. Precisely, before interacting with institutional quality, a percentage change in government revenue, keeping all other things constant, leads to a 0.0866% decline in economic growth while it marks a 0.2329% upsurge in economic growth in the presence of institutional quality. The result of the study further revealed that government revenue promotes the economic growth of the region when combined with institutional quality. On the other hand, foreign direct investment and openness to trade were the key sources of economic growth whereas the population growth rate adversely impacted economic growth in SSA countries during the study period under consideration. The policy implication of the study is that SSA needs to strengthen government revenue management. Further, the finding of the study implies that SSA countries need to improve institutional quality through promoting efficiency of the regulatory quality and the size of the SSA governments. In addition to this, the fast real GDP growth rate of SSA countries demands improved institutional quality indicators such as the rule of law and extended access to the open market.

IS SUB-SAHARA AFRICA CLOSING THE GENDER INEQUALITY GAPS? A PRINCIPAL COMPONENT-CLUSTER ANALYSIS

Gender inequality in the labor market has long been a source of concern in the global human rights and development agenda, it’s not just a necessary human right but it’s a precondition for economic development. Despite the realization of some MDGs, SDGs, and Agenda 2030 goals, women in SSA continue to be marginalized. Notably, SSA nations have eliminated 66.45 percent of gender disparities in general. The region, in specific, has achieved remarkable strides toward gender parity in education, reducing the gap by approximately 88 percent, 98 percent in health, and 71 percent in economic participation. However, there exist major gender differences in political empowerment, where only 21.8% of the gender gap has been closed. The study recommends that SSA countries should fully implement and live up to the requirements of the ILO and UN conventions and treaties on gender equality for economic prosperity.

Institutions, Investment and Economic Growth: Evidence from Sub-Saharan Africa

Sub Saharan African countries experience low private investment compared to other developing countries in world. For instance, private investment in the region averaged 15% of GDP from 2010 to 2016, as compared to 22%, 18% and 17% for developing countries in Asia, Europe and Latin America respectively. This low investment level constrained the region’s ability to grow and improve social outcomes such as; increase in the real wages and poverty reduction. Low quality institutions could explain this phenomenon. Therefore, this study examined the effect of institutions on investment and economic growth of 37 SSA countries from 1996 to 2017 using dynamic panel data model. The data were retrieved from Worldwide Governance Indicators, World Development Indicators and the Chinn-Ito index. System Generalised Method of Moments was used to estimate the result. The key findings generated by the study confirmed that these measures of institutional variables and there interaction with investment yield a positive and statistically significant result. Indicating that strengthening the quality of these institutions could positively affect investment and economic growth of the region. For instance, unit increase in controlling corruption increases investment by 1.4%. Furthermore, there is evidence showing financial development slows investment growth, which can be attributed to the weak institutional arrangements, as the coefficient of financial development is negative and statistically significant. The study recommends that SSA countries should pay greater attention on institutional reforms particularly; control of corruption and political stability to drive a meaningful growth and development in the region.

Prognostic factors of first intimate partner violence among ever-married women in Sub-Saharan Africa: Gompertz gamma shared frailty modeling.

Violence against women, particularly intimate partner violence, is a significant Concern for public health as well as a violation of the human rights of women especially in low and middle-income countries. However, there was limited evidence how soon an ever-married women experience intimate partner violence in Africa. Therefore, this study aimed to investigate the timing of first intimate partner violence (FIPV) among ever-married women in 30 SSA countries and to identify the risk factors of the timing. The present study has utilized 125,731 weighted samples, who participated in the domestic violence module of the survey from Demographic and Health Surveys of 30 SSA countries. The Gompertz gamma shared frailty model was fitted to determine the predictors. For model evaluation, the theta value, Akaike Information Criteria (AIC), Bayesian Information Criteria (BIC), and deviance were used. The Adjusted Hazard Ratio (AHR) with a 95% Confidence Interval (CI) was reported in the multivariable Gompertz gamma shared frailty model to highlight the strength and statistical significance of the associations. One-third (31.02%) of ever-married women had reported experiencing IPV. The overall incidence rate of FIPV was 57.68 persons per 1000 person-years (95% CI = 50.61-65.76). Age at marriage, age difference, educational status, employment, residence, women's decision-making autonomy, husband who drink alcohol and wealth status were significantly associated with the timing of FIPV. The findings show that ever-married women are at high and increasing risk of violence. Thus, we recommend establishing effective health and legal response services for IPV, strengthening laws governing the sale and purchase of alcohol, empowering women, raising the educational attainment of women, and putting policies in place to combat the culture of societal tolerance for IPV all contribute to the empowerment of women.

How Does Digital Economy Promote Agricultural Development? Evidence from Sub-Saharan Africa

Understanding the impact of the digital economy on agriculture in developing countries holds significant importance in enhancing agricultural production and addressing hunger-related challenges. This study uses panel data of 35 SSA countries from 2006 to 2021 and investigates the relationship between digital economy and agriculture using dynamic regression models. The impact mechanism is also analyzed using mediating models. The results show that the digital economy has a positive impact on agriculture through the increase of agricultural productivity, human capital accumulation and the improvement of government governance. The effects of the digital economy are larger in countries with higher and lower levels of agricultural development, significant in middle-income countries, and insignificant in low-income countries. This study may provide a better understanding of the nexus between digital economy and agricultural development, and offer valuable insights for governments in developing nations to formulate relevant and effective policies.

The Linkage Between Fiscal Policy and Financial Development: Exploring the Moderating Role of Institutional Quality in Emerging Economies

This paper investigates the role of fiscal policy on financial development in Sub-Saharan African economies, drawing on a sample of 23 countries from 2000 to 2021 using the panel ARDL method after evidencing stationarity and co-integration properties among the variables. Our results show that an increase in fiscal policy and institutional quality decreases financial development in the long run. An increase in taxation and expenditure by the government affects the development of finance in SSA countries. Our results also show that an increase in foreign capital and industrial growth increases financial development in the long term. The outcome evidence that the interaction between fiscal policy and institutional quality exhibits a positive effect on financial development. Causality results reveal no directional link between fiscal policy, foreign capital, industrialization, and financial development with institutional quality indicating a single direction. The study suggested that SSA countries should focus on developing policies to track the implementation of adequate fiscal policy systems and structures. Institutional coherence within and between SSA nations is required for efficient fiscal policy development.

Community-based screening enhances hepatitis B virus linkage to care among West African migrants in Spain

BackgroundChronic infection with HBV is responsible for >50% of all hepatocellular cancer cases globally and disproportionately affects sub-Saharan African (sSA) countries. Migration from these countries to Europe has increased substantially in recent years, posing unique challenges to health systems. The aim of this study was to carry out a community-based intervention to increase HBV screening, vaccination, and linkage to care among sSA migrants in Catalonia, Spain.MethodsThis was a prospective cohort study. Participants ≥18 years were offered community-based HBV screening between 20/11/20 and 21/01/22. Rapid HBV testing and blood sample collection utilizing plasma separation cards were carried out and linkage to care was offered to all participants. HBV vaccination and post-test counseling were performed at a second visit in the community. The main outcome was the odds of those with current HBV infection being successfully linked to hepatology. Rates of completing the care cascade of this model were analyzed.ResultsIn the present study, 444 people undergo screening, with 50.6% of participants showing evidence of past or current HBV infection, including an HBsAg prevalence of 9.2%. Migrants with current HBV infection exhibit 5.2 times higher odds of successful linkage to care compared to those in need of post-test counseling or vaccination. The study achieves a successful linkage to care rate of 72% for all participants, with specialist appointments arranged within 15.5 days.ConclusionsThis community-based HBV screening program provides evidence of a successful model for identifying and providing care, including vaccination, to west African migrants at high risk of HBV infection who may otherwise not engage in care.

COVID-19's death transfer to Sub-Saharan Africa

The COVID-19 spread very quickly around the world following its discovery in China, in December 2019. Lockdowns implemented in China and the Global North to control the propagation of the virus and to save human lives have resulted in a global recession. The transmission of the recessionary effects from the Global North to the Global South is reflected in the decline in sub-Saharan Africa's (SSA) GDP and the associated increase in poverty. The purpose of this paper is to illustrate how the recession induced in China and the Global North by COVID-19 lockdowns may have had indirect effects on SSA mortality that are higher than those directly attributed to the pandemic itself. Our methodology relies on a three-step relationship: (i) the impact of lockdowns on the recession in the North, (ii) the impact of the recession in the North on income in SSA countries, and (iii) the impact of a decline in income on mortality in SSA. We show that COVID-19-induced lockdowns in the Global North, through the severe recessions they induced in the Global South, resulted in the transfer of between 538,000 and 679,000 deaths in one year to SSA, including the deaths of 140,000 to 177,000 children aged 0–5 years. This corresponds to a 6–7% increase in the crude death rate and a 5–6% increase in under-5 mortality. These figures are much higher than the number of deaths directly attributable to COVID-19 in SSA. Thus, policymakers must not lose sight of the indirect excess mortality caused by global economic recession triggered by the pandemic. Our results reveal the need to increase the resilience of SSA countries to exogenous shocks, including COVID-19, which, in addition to increasing poverty, may induce excessive mortality due to the high sensitivity of mortality in SSA countries to economic recession.

Multi-Scale information flow between gold and exchange rates among metal exporting countries in SSA: A Frequency-Transfer Entropy Approach

Multi-Scale information flow between gold and exchange rates among metal exporting countries in SSA: A Frequency-Transfer Entropy Approach

Effect of government revenue on economic growth of sub-Saharan Africa: Does institutional quality matter?

Following the approval of sustainable development goals at the global level, the link between fiscal policy, institutional quality, and economic growth has attracted special attention in economic literature. This study scrutinizes the effect of government revenue-institutional quality interaction on the economic growth of 43 Sub-Saharan Africa countries for the period of 2012-2022. Methodology-wise, the study employed the System Generalized Method of Moment (SGMM) to analyze the panel data gained from dependable data sources; the World Development Indicator and the Heritage Economic Freedom Index. The novelty of this study emanates from the estimation technique designated and the introduction of revenue-institutional quality into the economic growth model of SSA. The result of the study reveals that government revenue adversely affects economic growth while institutional quality positively enhances economic growth before interacting with each other. However, the interactive coefficient of government revenue and economic growth positively affected the real GDP growth rate of SSA countries over the study periods. Precisely, before interacting with institutional quality, a percentage change in government revenue, keeping all other things constant, leads to a 0.0866 percent decline in economic growth while it marks a 0.2329 percent upsurge in economic growth in the presence of institutional quality. The result of the study further shows that government revenue promotes the economic growth of the region when combined with institutional quality. On the other hand, foreign direct investment and openness to trade were the key sources of economic growth whereas the population growth rate adversely impacted economic growth in SSA countries. The policy implication of the study is that SSA needs to strengthen government revenue management. Further, the finding of the study implies that SSA countries need to improve institutional quality through promoting efficiency of the regulatory quality and the size of the SSA governments. In addition to this, the fast real GDP growth rate of SSA countries demands improved institutional quality indicators such as the rule of law and extended access to the open market.

Foreign direct investment, gross domestic product and carbon dioxide emission in sub-Saharan Africa: A disaggregated analysis

This paper investigates the heterogeneous effect of sector-level foreign direct investment on carbon dioxide (CO2) emissions in 36 sampled SSA countries from 1990 to 2016. By using the system GMM estimation technique, the study reveals that industry FDI increases CO2 emissions validating the pollution haven hypothesis while Agric FDI and service FDI reduce CO2 emissions. In general, a U shape hypothesis holds for Agric FDI and CO2 emissions, but an inverted U shape for industry FDI and Industry CO2 emissions and a linear and negative relationship between services FDI and services CO2 emissions. Thus, there is a need to evaluate the environmental cost of investment in the industrial sector before granting foreign investors a permit to operate. In addition, there should be specific policies to attract FDI into the agriculture and services sectors to benefit from the positive spillover effect of transfers of cleaner technology.

Married women’s decision-making autonomy on modern contraceptive use and its associated factors in high fertile sub-Saharan Africa countries: a multi-level analysis of Demographic and Health Surveys

BackgroundFor better maternal and child health, women’s independence on reproductive health issues is crucial; however, couples are restricted from discussing openly with their partner. Regarding this, information about women’s decision-making autonomy is low in the world, including Sub-Saharan Africa; therefore, this study was aimed to assess married women’s decision-making autonomy on modern contraceptive utilization in high fertility SSA countries.MethodsData for this study was obtained from the most recent (2010–2018) Demographic and Health Surveys. A total of weighted sample of 14,575 married reproductive age women was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the significant associated factors of decision-making autonomy on modern contraceptive utilization. Finally, the Adjusted Odds Ratio (AOR) with 95% confidence interval was used to declare as statistical significance.ResultsOverall prevalence of married women decision-making autonomy on modern contraceptive utilization in the high fertile SSA countries is 25.28% (95% CI:18.32%, 32.24%). The factors significantly associated with the decision-making autonomy on modern contraceptive utilization were women’s age 25–34 years (AOR = 1.88, 95% CI = 1.84–1.93) and 35–49 years (AOR = 1.90, 95% CI = 1.82–1.92), had media exposure (AOR = 1.13, 95% CI = 1.00- 1.28), Number of alive children, 1–2 (AOR = 2.35, 95% CI = 1.38–4.01), 3–4 (AOR = 2.98, 95% CI = 1.74–5.10), ge 5 (AOR = 2. 82, 95% CI = 1.63–4.86), educational status; primary education (AOR = 1.93, 95% CI = 1.77–2.83), Secondary and higher (AOR = 2.11, 95% CI = 1.78–2.89), Community media exposure (AOR = 1.80, 95% CI = 1.38–2.34), Community level poverty, (AOR = 1.43, 95% CI = 1.09–1.86) and resides in rural (AOR = 0.67, 95% CI = 0.64–0.71).ConclusionWomen’s decision-making autonomy on modern contraception utilization in this study was low. Therefore, the government should promote women’s autonomy on contraceptive use as an essential component of SRH rights through mass media, with particular attention for, women living in the poorest communities, and those residing in rural settings of the country. Moreover, health professionals should counsel the women about the benefits of using modern contraceptive to help them managing their number of children.

Climate variability, armed conflicts and child malnutrition in sub-saharan Africa: A spatial analysis in Ethiopia, Kenya and Nigeria

BackgroundSub-Saharan Africa (SSA) has one of the highest prevalence of malnutrition among children under 5 in the world. It is also the region most vulnerable to the adverse effect of climate change, and the one that records the most armed conflicts. The chains of causality suggested in the literature on the relationship between climate change, armed conflict, and malnutrition have rarely been supported by empirical evidence for SSA countries. MethodsThis study proposes to highlight, under the hypothesis of spatial non-stationarity, the influence of climatic variations and armed conflicts on malnutrition in children under 5 in Ethiopia, Kenya, and Nigeria. To do this, we use spatial analysis on data from Demographic and Health Surveys (DHS), Uppsala Conflict Data Program Georeferenced Event Dataset (UCDP GED), Climate Hazards center InfraRed Precipitation with Station data (CHIRPS) and Moderate Resolution Imaging Spectroradiometer (MODIS). ResultsThe results show that there is a spatial autocorrelation of malnutrition measured by the prevalence of underweight children in the three countries. Also, local geographically weighted analysis shows that armed conflict, temperature and rainfall are positively associated with the prevalence of underweight children in localities of Somali in Ethiopia, Mandera and Turkana of Wajir in Kenya, Borno and Yobe in Nigeria. ConclusionIn conclusion, the results of our spatial analysis support the implementation of conflict-sensitive climate change adaptation strategies.

Prevalence and factors associated with rural mothers' protection against tetanus: a cross-national analysis in 33 sub-Saharan African countries.

Sub-Saharan Africa (SSA) and South Asia account for most new cases of tetanus. Despite efforts by the World Health Organization to eradicate tetanus, it still causes many maternal mortalities. We examined the prevalence and risk factors associated with tetanus protection among rural mothers in 33 SSA countries. Data were extracted from the most recent Demographic and Health Surveys of 33 SSA countries. A sample of 162601 women from rural areas was drawn. Both descriptive and binary logistic regression analyses were conducted. Overall, approximately half (49.3%) of rural mothers were protected against tetanus. The association between maternal age, education, marital status, working status, distance to the health facility and number of antenatal visits were statistically significant with rural mothers' protection from tetanus. Also, relationship to the household head, household size and frequency of listening to radio, reading a newspaper and watching television were statistically significant in predicting rural mothers' protection from tetanus. Policies and interventions by stakeholders must target high-risk populations, including adult women, those of poorer wealth status, those without media exposure and mothers with low educational attainment.