Towards the prevention of sexually transmitted infections (STIs): Healthcare-seeking behaviour of women with STIs or STI symptoms in sub-Saharan Africa

Objective: Sexually transmitted infections (STIs) constitute major public health problems because of their prevalence and contribution to mortality and morbidity worldwide. Healthcare seeking for STIs plays a significant role in the global prevention of STIs. We examined the prevalence and factors associated with healthcare seeking for STIs or STI symptoms among women in sub-Saharan Africa (SSA). Methods: Data on 38 394 women of reproductive age from the most recent Demographic and Health Surveys of 28 countries in SSA were analysed. Percentages were used to summarise the prevalence of healthcare seeking for STIs or STIs symptoms. The factors associated with healthcare seeking for STIs or STI symptoms were examined using multilevel binary logistic regression analysis. We presented the results using adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results: Overall, the proportion of women with STIs or STI symptoms who sought healthcare was 66.1%, with the highest and lowest proportion found in Liberia (85.6%) and Ethiopia (37.9%) respectively. The likelihood of seeking healthcare for STIs or STI symptoms increased with increasing wealth quintile and level of education. Working women, older women, cohabiting women, women with comprehensive HIV/AIDS knowledge, women exposed to mass media, those who had no barrier to healthcare access, and those covered by health insurance had greater odds of seeking treatment for STIs or STI symptoms. On the contrary, the odds of seeking treatment for STIs or STI symptoms was lower among married women and women who lived in rural areas. Conclusion: The findings of the study call for strengthening of policies, programmes, and interventions geared towards improving the healthcare-seeking behaviour of women with STIs, taking into consideration the factors identified in this study

Awareness of obstetric fistula and its associated factors among women of reproductive age in sub-Saharan Africa

Background Awareness about obstetric fistula and its concomitant factors is central to efforts to eliminate obstetric fistula in sub-Saharan Africa. We, therefore, assessed the magnitude of obstetric fistula awareness and its associated factors among women of reproductive age in sub-Saharan Africa. Methods Data for the study were extracted from the most recent Demographic and Health Surveys of 14 countries in sub-Saharan Africa. We included 185,388 women aged 15-49 years in this study. Percentages were used to summarise the prevalence of obstetric fistula awareness across the 14 countries studied. We adopted a multivariable multilevel binary logistic regression to examine the factors associated with obstetric fistula awareness in sub-Saharan Africa. We presented the results of the regression analysis using adjusted odds ratios with their 95% confidence intervals. Statistical significance was set at p < 0.05. Results The average prevalence of obstetric fistula awareness was 37.9%, ranging from 12.8% in Gambia to 63.9% in Uganda. Awareness of obstetric fistula was low among never married and cohabiting women compared to married women. Compared with women with parity 4 or more, those with no birth had the lowest odds of obstetric fistula awareness. The study also showed that obstetric fistula awareness was lower among women who were working, those who are not exposed to mass media, those in the poorest wealth category, those who have never had sex, and those in communities with low literacy level. The study however found that the odds of obstetric fistula awareness increased with age and education, and was higher in urban areas compared to rural areas. Women, who had ever terminated a pregnancy were more likely to be aware of obstetric fistula compared to those who had never terminated a pregnancy. Conclusion The study demonstrated a low awareness of obstetric fistula among women in sub-Saharan Africa. Educative and sensitisation interventions should incorporate the factors identified in the present study during its implementation. To raise women's awareness of obstetric fistula, there is the need for sub-Saharan African countries to consciously raise community literacy rate, increase access to mass media platforms and invest intensively in formal education for women

Determinants of birth registration in sub-Saharan Africa: evidence from demographic and health surveys

Background: Birth registration is a crucial aspect of ensuring that children have access to their rights and benefits, including health care, education, and citizenship. In sub-Saharan Africa (SSA), birth registration rates remain low, with millions of children going unregistered each year. Understanding the predictors of birth registration among children in this sub-region is important for developing targeted interventions to improve registration rates. The study examines the predictors of birth registration among children in SSA. Methods: We performed a cross-sectional analysis of secondary data pooled from the Demographic and Health Survey of 17 countries conducted from 2015 to 2021. A weighted sample of 162,500 children was included in the final analysis. We summarized the proportion of birth registration among children in SSA using a forest plot. We utilized a multilevel binary logistic regression analysis to examine the predictors of birth registration. The results were presented using adjusted odds ratios (aOR) with 95% confidence intervals (CIs). Results: We found that 48.32% [48.15–48.49] of births in SSA were registered. The lowest and highest prevalence of birth registration were found in Ethiopia (2.70 [2.38–3.02]) and Sierra Leone (92.93 [92.36–93.50]), respectively. Increasing child’s age was found to be significantly associated with a higher likelihood of birth registrations, with those aged 4 years [aOR = 1.55; CI = 1.49, 1.62] having the highest odds of birth registration compared to those aged below 1 year. Children born to mothers with primary [aOR = 1.17; CI = 1.11, 1.24], secondary [aOR = 1.44; CI = 1.34, 1.54], and higher education [aOR = 1.71; CI = 1.48, 1.99] were more likely to be registered than those born to mothers who had no formal education. Also, children born in health facilities were more likely to be registered [aOR = 1.60; CI = 1.48, 1.74] than those born at home. The odds of birth registration were significantly higher among children whose mothers received assistance during delivery [aOR = 1.88; CI = 1.72, 2.04], those in the richest wealth index [aOR = 3.91; CI = 3.54, 4.33], and those in rural areas [aOR = 1.92; CI = 1.76, 2.10]. Conclusion: There is low childbirth registration coverage in SSA. The predictors of this phenomenon are the child’s age, maternal level of education, wealth index, place of residence, sub-region, maternal age, place of delivery, assistance during delivery, marital status, and sex of household head. Interventions and policies developed to improve childbirth registration coverage in SSA should prioritize mothers with no formal education, those who deliver at home, those with low socioeconomic status, those living in female headed household, and adolescent mothers

Correlates of repeat pregnancies among adolescent girls and young women in sub-Saharan Africa

Background: Adolescent girls and young women are vulnerable populations who are at risk of several adverse sexual and reproductive health outcomes, including unintended pregnancies, sexually transmitted infections, unsafe abortions, and death from pregnancy-related complications. In this study, we examined the correlates of repeat pregnancies among adolescent girls and young women in sub-Saharan Africa (SSA). Methods: We extracted data from the most recent Demographic and Health Surveys (DHS) of 31 countries in SSA. Countries whose surveys were conducted from 2010 to 2020 were included in the study. A total of 108,572 adolescent girls and young women (15–24 years) were included in the study. We used a multilevel mixed-effect binary logistic regression analysis to examine the correlates of repeat pregnancies among adolescent girls and young women in SSA. Results: We found that adolescent girls and young women aged 20–24 [aOR = 2.36; 95%CI = 2.22, 2.51], those married [aOR = 7.52; 95%CI = 6.81, 8.30], living with a partner [aOR = 7.51; 95%CI = 6.87, 8.21], and those who had sexual intercourse before age 20 [aOR = 1.41; 95%CI = 1.33, 1.51] had higher odds of experiencing repeat pregnancies compared to those aged 15–19, those never in a union, those whose first sexual intercourse occurred at age 20 and above, respectively. Respondents exposed to listening to radio [aOR = 1.12; 95%CI = 1.06, 1.18] and those who justified intimate partner violence [aOR=1.13; 95%CI = 1.07, 1.19] had higher odds of experiencing repeat pregnancies compared to those who never listened to radio and those who did not justify intimate partner violence, respectively. Young women who had attained secondary or higher educational level [aOR = 0.83; 95%CI = 0.78, 0.90], those exposed to reading newspaper or magazine [aOR = 0.90; 95%CI = 0.82, 0.98], those residing in rural areas [aOR = 0.92; 95%CI = 0.86, 0.98], and those belonging to the richer [aOR = 0.87; 95%CI = 0.80, 0.95] and richest [aOR = 0.68; 95%CI = 0.61, 0.76] wealth quintile were less likely to experience repeat pregnancies. Conclusion: The correlates of repeat pregnancies include age, age at first sexual intercourse, marital status, exposure to media, justification of intimate partner violence, wealth index, educational attainment, and place of residence. The findings underscore the need for governments and policymakers in SSA to implement policies that target the most at-risk groups: those with no formal education, the poor, and adolescent girls. Our findings also highlight the need to strengthen advocacy against the justification of intimate partner violence and intensify girl-child education

Exposure to interparental violence and intimate partner violence among women in Papua New Guinea

Introduction: Evidence suggests that childhood exposure to interparental violence increases the risk of intimate partner violence (IPV) experience or perpetration in adolescence or adulthood. However, it is unclear if exposure to interparental violence increases the risk of IPV among women in Papua New Guinea. This study, therefore, seeks to fill this gap in the literature by examining the association between childhood exposure to interparental violence and IPV among women in Papua New Guinea. Methods: We used data from the most recent 2016–18 Papua New Guinea Demographic and Health Survey. We included 3,512 women in our analyses. Past-year experience of IPV was the outcome variable in this study. Exposure to interparental violence was the key explanatory variable. We used a multilevel binary logistic regression to examine the association between exposure to interparental violence and IPV. Results: We found a higher probability of experiencing IPV among women exposed to interparental violence [aOR = 1.45, 95% CI = 1.13, 1.86] relative to women who were not exposed. Furthermore, we found that women living in rural areas had a lower likelihood of IPV experience [aOR = O.50, 95% CI = 0.32, 0.80] compared to those in urban settings. Finally, a greater odd of IPV experience was found among women staying in the Highlands Region [aOR = 1.44, 95% CI = 1.06, 1.96] compared to those staying in the Southern Region. Conclusion: Exposure to interparental violence was found to be significantly associated with IPV among women in Papua New Guinea. The findings of this study suggest the need for proven operational strategies to reduce IPV, such as improving anti-IPV laws in Papua New Guinea. We recommend the development and implementation of intercession strategies to reduce the experience and justification of violence among women exposed to interparental violence. In addition, health professionals should implement counseling and health education initiatives to tackle the consequences of IPV on women's well-being

Mother–child dyads of overnutrition and undernutrition in sub-Saharan Africa

Background: Malnutrition remains one of the major public health concerns globally. To achieve the Sustainable Development Goal 2 which seeks to ensure that hunger and malnutrition are reduced by 2030, it is imperative to ascertain the factors influencing their occurrence. This study examined the prevalence and factors associated with mother–child dyads of overnutrition and undernutrition in sub-Saharan Africa. Methods: Demographic and Health Survey data from 25 sub-Saharan African countries were used for the study. The sample was made up of 125,280 mother–child dyads. Descriptive analysis was performed to determine the prevalence of overweight or obese mother (OWOBM) with a stunted child (OWOBM-SC), OWOBM with an underweight child (OWOBM-UC), OWOBM with a wasted child (OWOBM-WC), and OWOBM with any form of child’s undernutrition indicators (OWOBM-SUWC). Multilevel regression models were developed to examine the factors associated with these indicators. The results were presented using an adjusted odds ratio (AOR) with their respective 95% confidence interval (CI). Results: Higher likelihood of OWOBM-SUWC was found among women aged 45–49 [AOR 2.20, 95% CI 1.70, 2.85], those with primary [AOR 1.32, 95% CI 1.21, 1.44] or secondary education [AOR 1.21, 95% CI 1.09, 1.35], and divorced women [AOR 1.32, 95% CI 1.02, 1.73]. However, lower odds of OWOBM-SUWC were observed among women who were working [AOR 0.82, 95% CI 0.76, 0.89] and those breastfeeding [AOR 0.75, 95% CI 0.70, 0.82]. The odds of OWOBM-SUWC was lower among females compared to male children [AOR 0.85, 95% CI 0.80, 0.90]. Compared to children aged <1 year, children of all other age groups were more likely to have OWOBM-SUWC. Other child characteristics significantly associated with OWOBM-SUWC were low birth weight [AOR 1.50, 95% CI 1.32, 1.71], having diarrhea [AOR 1.13, 95% CI 1.04, 1.24], and higher birth order [AOR 1.37, 95% CI 1.13, 1.66]. Children whose mothers used unimproved toilet facilities [AOR 0.90, 95% CI 0.83, 0.98], those who lived in rural areas [AOR 0.79, 95% CI 0.71, 0.87], and children from the Central [AOR 0.55, 95% CI 0.46, 0.65], Eastern [AOR 0.44, 95% CI 0.38, 0.52] and Western [AOR 0.76, 95% CI 0.65, 0.89] sub-Saharan Africa were less likely to have OWOBM-SUWC. Conclusion: Combination of child, maternal, and contextual factors could explain mother–child dyads of overnutrition and undernutrition in sub-Saharan Africa. Addressing this situation requires multidimensional policies and interventions that empower women through education and economic engagement. The observed sub-regional differences in policies and commitments related to addressing malnutrition suggest the need for comprehensive and coordinated efforts to implement and strengthen multisectoral comprehensive nutrition plans across sub-Saharan Africa. Sharing best practices and lessons learned can help improve the effectiveness and comprehensiveness of nutrition interventions and contribute to reducing the prevalence of malnutrition

Unmet need for contraception and its associated factors among women in Papua New Guinea: analysis from the demographic and health survey

Background: Unmet need for contraception is highest in low-and middle-income countries. In Papua New Guinea, about 26% of married women and 65% of unmarried sexually active women have an unmet need for contraception. This study investigated the prevalence and correlates of unmet need for contraception among women in Papua New Guinea. Methods: Data for the study were extracted from the most recent 2016–18 Papua New Guinea Demographic and Health Survey. We included 7950 women with complete data on all variables of interest. Multilevel logistic regression analysis was conducted to examine the factors associated with unmet needs for contraception using four models. Adjusted odds ratios (AOR) and 95% confidence intervals (CIs) were used to present the results of the regression analysis. Results: We found that the overall unmet need for contraception was 32.2%. The odds of unmet needs for contraception was higher among cohabiting women [AOR = 1.25, 95% CI = 1.01, 1.56], women with 1–3 births [AOR = 1.57, 95% CI = 1.18, 2.08], and women with 4 or more births [AOR = 1.06, 95% CI = 1.13, 2.27]. Likewise, a higher probability of unmet need was found among women whose partners decided on their healthcare as compared to those who decided on their own healthcare [AOR = 1.35, 95% CI = 1.066, 1.71]. With regards to wealth, the likelihood of unmet contraceptive need decreased with an increase in wealth status. With region, it was found that women in the Mamose region had greater likelihood of unmet contraceptive need compared to those in Southern region [AOR = 1.33, 95% CI = 1.09, 1.63]. Conclusion: Our study contributes to the discussion on unmet need for contraception in the context of Papua New Guinea. We found the overall prevalence of unmet need for contraception to be relatively high among women in Papua New Guinea. Public health interventions aimed at addressing women's contraception needs should be encouraged so that women can make informed decisions about contraceptive use. These interventions should be implemented taking into consideration significant socio-demographic characteristics of women as identified in this study

Long-acting reversible contraceptives use among adolescent girls and young women in high fertility countries in sub-Saharan Africa

Background: Given the instrumental role long-acting reversible contraceptives (LARCs) play in reducing unintended pregnancies, there is a need to understand the factors that predict their use among adolescent girls and young women in high fertility countries. Our study examined the prevalence and predictors of LARCs use among adolescent girls and young women in high fertility countries in sub-Saharan Africa. Materials and methods: We pooled data from the women’s files of the most recent Demographic and Health Surveys (DHS) from 2010 to 2020 of the top ten high fertility countries in sub-Saharan Africa, which are part of the DHS programme. The total sample was 5854 sexually active adolescent girls and young women aged 15–24 who were using modern contraceptives at the time of the survey. Descriptive and multilevel logistic regression models were used in the analyses. The results were presented using percentages and adjusted odds ratio (AOR) with their respective 95% confidence intervals (CIs). Results: At the descriptive level, the overall prevalence of LARCs utilisation was 17.6% in the ten countries, with the lowest of 1.7% in Angola and the highest of 55.8% in Mali. Adolescent girls and young women who were married had a lower likelihood of LARCs utilisation than those who were never married [AOR = 0.63, 95% CI = 0.45, 0.88]. Adolescent girls and young women who wanted no more children had higher odds of LARCs use compared to those who wanted more children [AOR = 1.56, 95% CI = 1.09, 2.26]. Adolescent girls and young women with one to three births [AOR = 6.42, 95% CI = 4.27, 9.67], and those with four or more births [AOR = 7.02, 95% CI = 3.88, 12.67] were more likely to use LARCs compared to those who had no children. Countries in sub-Saharan Africa with lower probability of utilizing LARCs were Angola, Niger and Mozambique, whereas adolescent girls and young women in Mali had higher probability of utilizing LARCs. Conclusion: Our findings suggest that LARCs utilisation among adolescent girls and young women is low in high fertility countries in sub-Saharan Africa. To reduce the rates of unplanned pregnancies and induced abortions, it is imperative that adolescent girls and young women in sub-Saharan Africa are educated on the advantages of utilising LARCs. Additionally, governments, policymakers, and stakeholders in sub-Saharan Africa should raise awareness by executing health promotion measures to enhance the demand for LARCs among adolescent girls and young women. Achieving these would not only prevent unplanned pregnancies and induced abortions, but also help meet the United Nation’s health and well being for all as enshrined in Sustainable Development Goals 3 and 5

In-school adolescents’ loneliness, social support, and suicidal ideation in sub-Saharan Africa: Leveraging Global School Health data to advance mental health focus in the region

Introduction: Adolescent and youth mental health problems are increasingly becoming an area of concern in global health. Young people in sub-Saharan Africa experience significant adversities and systemic challenges despite technological advancements and demographic transition that the region is experiencing. We examined the nexus between experiences of loneliness, low social support, and presence of suicidal ideation among in-school adolescents in sub-Saharan Africa. Method: A total of 19,119 in-school adolescents from eight countries in sub-Saharan Africa were included in this study. Suicidal ideation was the main outcome variable and loneliness, and social support were the explanatory variables. Percentages were used to summarise the prevalence of suicidal ideation, loneliness, and social support among the in-school adolescents. A multivariable binary logistic regression analysis was later used to determine the association between suicidal ideation and the explanatory variables and covariates using Stata v16. Four models were tested using the regression analysis. We presented the regression results using adjusted odds ratios (aOR), with their respective 95% confidence intervals (CIs). Results: Overall, the past year prevalence of loneliness, peer support, one or more close friends, and suicidal ideation were 10%, 33.4%, 90.1%, and 14.5%, respectively. In-school adolescents who felt lonely (aOR = 1.88, 95% CI = 1.69, 2.09) were more likely to experience suicidal ideation. However, those who received peer support (aOR = 0.89, 95% CI = 0.82, 0.97) and had one or more close friends (aOR = 0.77, 95% CI = 0.68, 0.86) were less likely to experience suicidal ideation. Conclusion: These results point to the significant roles of loneliness, and lack of social support, in understanding suicidal ideations. Countries in sub-Saharan Africa need to improve child and adolescent mental health policies and programmes to respond to these risk factors and mental health challenges. Programmes with a differential focus on the needs of males and females, younger and older adolescents will be important in the future

Interpersonal violence among in-school adolescents in sub-Saharan Africa: Assessing the prevalence and predictors from the Global School-based health survey

Interpersonal violence in adolescents has over the years grown into a serious public health problem that merits a robust intervention. This study, therefore, assessed the prevalence and predictors of interpersonal violence among in-school adolescents in sub-Saharan Africa (SSA). The study involved a cross-sectional analysis of data from the Global School-based Health Survey conducted between 2012 and 2017 from eight sub-Saharan African countries. A total of 14,967 in-school adolescents aged 10-19 years were included in the pooled analysis. A multivariable binomial logistic regression was used to determine the predictors of interpersonal violence using the adjusted odds ratio (aOR) with their respective 95% confidence intervals (CIs). The overall prevalence of interpersonal violence among in-school adolescents in SSA was 53.7%. The odds of interpersonal violence were higher among adolescents who were bullied (aOR = 2.52, 95% CI = 2.23-2.85), had an injury (aOR = 2.42, 95% CI = 2.15-2.72), had suicidal attempts (aOR = 1.40, 95% CI = 1.16-1.70), were truant (aOR = 1.51, 95% CI = 1.33-1.72), used alcohol (aOR = 1.49, 95% CI = 1.06-2.11), and used tobacco (aOR = 1.46, 95% CI = 1.23-1.74). In-school adolescents with peer support, parents or guardians bonding, those whose parents or guardians respected their privacy, and those aged 15 years or older were less likely to experience interpersonal violence. These factors provide education directors and school heads/teachers with relevant information to guide the design of specific interventions such as parent-teacher meetings and programs, peer educator network system, face-to-face counseling sessions, Rational Emotive Behavioural Education (REBE) and substance use cessation therapy to prevent interpersonal violence, particularly physical fights and attacks in school settings. Also, students should be sensitized on the negative effects of interpersonal violence and those who have been exposed to it should be counselled. School rules should be strengthened and appropriate punishment given to students who engage in violence baheviours in schools in order to deter others from engaging in them