Predictors of modern contraceptive use among adolescent girls and young women in sub-Saharan Africa: a mixed effects multilevel analysis of data from 29 demographic and health surveys.

BackgroundThe use of modern contraceptives among adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) remains an issue that needs urgent attention. This present study assesses the individual and contextual factors associated with modern contraceptive use among AGYW in SSA.MethodsData for this study was obtained from the latest Demographic and Health Surveys (DHS) conducted between January 2010 and December 2018 across 29 countries in SSA. Data were analysed with Stata version 14.2 by employing both Pearson's chi-square test of independence and a multilevel binary logistic regression. The selection of variables for the multilevel models was based on their statistical significance at the chi-square test at a p ResultsIt was found that 24.7% of AGYW in SSA use modern contraceptives. In terms of the individual level factors, the study showed that AGYW aged 15-19 [aOR = 0.86, CI = 0.83-0.90], those who were married [aOR = 0.83, CI = 0.79-0.87], Muslims [aOR = 0.59, CI = 0.57-0.62], working [aOR = 0.92, CI = 0.89-0.95], those who had no child [aOR = 0.44, CI = 0.42-0.47], those who had no exposure to newspaper/magazine [aOR = 0.44, CI = 0.63-0.71] and radio [aOR = 0.82, CI = 0.78-0.86] had lower odds of using modern contraceptives. Conversely, the use of modern contraceptives was high among AGYW whose age at first sex was 15-19 years [aOR = 1.20, CI = 1.12-1.28]. With the contextual factors, the odds of using modern contraceptives was low among AGYW who lived in rural areas [aOR = 0.89, CI = 0.85-0.93] and in communities with low literacy level [aOR = 0.73, CI = 0.70-0.77] and low socio-economic status [aOR = 0.69, CI = 0.65-0.73].ConclusionSeveral individual and contextual factors are associated with modern contraceptive use among AGYW in SSA. Therefore, Governments in the various countries considered in this study should intensify mass education on the use of modern contraceptives. This education should be more centered on AGYW who are in socio-economically disadvantaged communities, those who are not married, Muslims, those with high parity and high fertility preferences and those who are working

Maternal age at first childbirth and under-five morbidity in sub-Saharan Africa: analysis of cross-sectional data of 32 countries.

Background The prevalence of childhood morbidity remains high in low-and middle-income countries, including sub-Saharan Africa (SSA). In this study, the association between maternal age at first childbirth and under-five morbidity in SSA was examined. Methods This was a cross-sectional study involving nationally-representative data from the most recent Demographic and Health Surveys conducted in 32 countries in SSA from 2010 to 2019. A sample size of 311,603 mothers of children under-five was considered. The outcome variable for this study was under-five morbidity. This variable was derived from the experience of fever, cough, and diarrhoea among children under-five. Both multilevel and binary logistic regression models were used to test the hypothesis that adolescent childbirth is associated with under-five morbidity. The results were presented as crude odds ratios (cORs) and adjusted odds ratios (aORs), with 95 % confidence intervals (CIs). Results Children born to mothers whose first childbirth occurred at < 20 years were 16 % times more likely to suffer from under-five morbidity, compared to those whose mothers’ first childbirth occurred at age ≥ 20 years [cOR = 1.16; CI = 1.13–1.19], and this persisted but with reduced odds after controlling for covariates [aOR = 1.10; CI = 1.07–1.12]. At the country level, children born to mothers whose first childbirth occurred at < 20 years were more likely to suffer from under-five morbidity, compared to those whose mothers’ first childbirth occurred at age ≥ 20 years in Angola, Burundi, Congo DR, Guinea, Kenya, and Uganda. Conclusions In this study, an association between adolescent childbirth and morbidity in children under five in SSA has been established. The study concludes that under-five morbidity is higher among children born to mothers whose first childbirth occurred before 20 years compared to those whose mothers’ first childbirth occurred at 20 years and above. The findings indicate that in order to reduce under-five morbidity, there is the need to deal with adolescent childbearing through cultural and social change, coupled with engagement of adolescents and stakeholders in adolescent sexual and reproductive health programmes

Polygyny and intimate partner violence in sub-Saharan Africa: Evidence from 16 cross-sectional demographic and health surveys

In sub-Saharan Africa, where intimate partner violence has been found to be predominant, several scholars have made efforts to understand its predictors. Socio-culturally, polygyny has been considered as a key determinant of intimate partner violence. This study aimed to examine the association between polygyny and intimate partner violence in 16 sub-Saharan African countries. Binary logistic regression models were used in testing the association and the results were presented as crude and adjusted odds ratios at 95% confidence interval. The proportion of women in polygamous marriages in the 16 countries was 20.2%, ranging from as high as 40% in Chad to as low as 1.6% in South Africa. The prevalence of IPV was 30.7% in the 16 countries, ranging from as high as 44% in Uganda to as low as 12.7% in South Africa. The odds of IPV were higher among women in polygamous marriages in Angola, Burundi, Ethiopia, Uganda, Malawi, Mozambique, Zambia and Zimbabwe but was lower among women in polygamous marriages in Cameroon [COR = 0.54, 95% CI = 0.44–0.66] and Nigeria [COR = 0.61, 95% CI = 0.55–0.67], and this persisted after controlling for level of education, place of residence, wealth quintile, media exposure, and justification of violence. This study has found a significant association between polygyny and intimate partner violence. The practice of intimate partner violence in sub-Saharan Africa is fused into the socio-cultural norms and religious traditions of most countries in the sub-Saharan African region. The findings imply that family structures expose women to intimate partner violence. Therefore, global efforts in dealing with intimate partner violence through the Sustainable Development Goals should be done with attention on the socio-cultural norms and traditions around marriage and family structures

Under-5 mortality in sub-Saharan Africa: is maternal age at first childbirth below 20 years a risk factor?

Objectives This study aimed at examining the association between young maternal age at first childbirth and under-5 mortality in sub-Saharan Africa (SSA). Design and setting This cross-sectional study pooled nationally-representative data from the most recent Demographic and Health Surveys conducted in 30 countries in SSA from 2010 to 2019. Participants 116 379 mothers of children under 5. Results The prevalence of adolescent childbirth and death in children under 5 in SSA were 57.36% (95% CI 53.73% to 60.99%) and 4.10% (95% CI 3.65% to 4.54%), respectively. Children born to mothers whose first childbirth occurred at <20 years were 11% more likely to die before the age of 5 compared with those whose mothers’ first childbirth occurred at age ≥20 years (adjusted odds ratio (aOR) 1.11; 95% CI 1.05 to 1.18). In terms of the covariates, the likelihood of under-5 mortality was higher among children born to single (aOR 1.54; 95% CI 1.41 to 1.67) and cohabiting mothers (aOR 1.10; 95% CI 1.01 to 1.21) compared with married mothers. Children born to mothers who were obese were more likely to die before the age of 5 compared with those born to mothers with normal body weight (aOR 1.17; 95% CI 1.09 to 1.26). The odds of under-5 mortality were higher among children whose weight at birth was <2500 g compared with those whose weight was ≥2500 g at birth (aOR 1.83; 95% CI 1.64 to 2.03). Conclusions The findings call for the need to enhance policies aimed at reducing under-5 mortality in SSA by reducing adolescent pregnancy and childbirth through family planning, comprehensive sexuality education, and the elimination of child marriage. Again, Since under-5 mortality among adolescent mothers is linked with their poor socio-economic status, there is the need for government and non-governmental organisations in SSA to introduce poverty alleviation programmes and improve access to both formal and informal education as a way of enhancing the socioeconomic status of adolescent mothers. Public health education, through continuous advocacy programmes should be done to encourage adolescent mothers to access antenatal care and health facility deliveries as a way of enhancing the survival status of their children. These interventions should be implemented, taking into consideration other characteristics of mothers such marital status and BMI and child’s characteristics such as child’s weight, which were found to be associated with high under-5 mortality

Intimate partner violence against adolescent girls and young women and its association with miscarriages, stillbirths and induced abortions in sub-Saharan Africa: Evidence from demographic and health surveys

Intimate partner violence has been associated with numerous consequences for women, including pregnancy termination. This study aimed to examine the association between intimate partner violence and pregnancy termination among adolescent girls and young women in 25 sub-Saharan African countries. Data for this study was obtained from the demographic and health surveys of 25 countries in sub-Saharan Africa, published between 2010 and 2019. A total of 60,563 adolescent girls and young women were included in this study. Binary logistic regression models were used in analyzing the data and the results were presented as crude odds ratios (CORs) and adjusted odds ratios (AORs) at 95% confidence interval (CI). The prevalence of intimate partner violence and pregnancy termination among adolescent girls and young women in the 25 countries in sub-Saharan Africa were 19% and 10.1% respectively. In all these countries, the odds of pregnancy termination was higher among adolescent girls and young women who had ever experienced intimate partner violence, compared to those who had never experienced intimate partner violence [COR = 1.60, 95% CI = 1.51–1.71], and this persisted after controlling for confounders [AOR = 1.58, 95% CI = 1.48–1.68]. However, across countries, intimate partner violence had significant association with pregnancy termination among adolescent girls and young women in Angola, Chad, Congo DR and Gabon (Central Africa); Benin, Burkina Faso, Cote D'lvoire, Gambia and Mali (West Africa); Comoros, Rwanda and Uganda (East Africa); and Malawi and Zambia (Southern Africa). The findings imply that reducing pregnancy termination among adolescent girls and young women in sub-Saharan Africa depends on the elimination of intimate partner violence. Thus, policies and programmes aimed at reducing pregnancy termination among adolescent girls and young women in sub-Saharan Africa, should pay particular attention to those who have history of intimate partner violence

Predictors of unmet need for contraception among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa: A multilevel mixed effects analysis.

IntroductionDespite the desire of adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) to use contraceptives, the majority of them have challenges with access to contraceptive services. This is more evident in high fertility countries in SSA. The purpose of this study was to examine the predictors of unmet need for contraception among AGYW in selected high fertility countries in SSA.Materials and methodsData from current Demographic and Health Surveys (DHS) carried out between 2010 and 2018 in 10 countries in SSA were analysed. A sample size of 24,898 AGYW who were either married or cohabiting was used. Unmet need for contraception was the outcome variable in this study. The explanatory variables were age, marital status, occupation, educational level, frequency of reading newspaper/magazine, frequency of listening to radio, frequency of watching television and parity (individual level variables) and wealth quintile, sex of household head, place of residence and decision-maker in healthcare (household/community level variables). Descriptive and multilevel logistic regression analyses were carried out. The results of the multilevel logistic regression analyses were reported using adjusted odds ratios at 95% confidence interval.ResultsThe prevalence of unmet need for contraception in all the countries considered in this study was 24.9%, with Angola, recording the highest prevalence of 42.6% while Niger had the lowest prevalence of 17.8%. In terms of the individual level predictors, the likelihood of unmet need for contraception was low among AGYW aged 20-24 [aOR = 0.82; 95% CI = 0.76-0.88], those with primary [aOR = 1.22; 95% CI = 1.13-1.31] and secondary/higher levels of formal education [aOR = 1.18; 95% CI = 1.08-1.28, p ConclusionThis study has identified disparities in unmet need for contraception among AGYW in high fertility countries in SSA, with AGYW in Angola having the highest prevalence. Both individual and household/community level factors predicted unmet need for contraception among AGYW in this study. However, based on the ICC values, household/community level factors prevailed the individual level factors. Enhancing access to contraception among poorer AGYW, those in female-headed households, those in urban areas and those who take healthcare decisions alone by both governmental and non-governmental organisations in high fertility countries is recommended

Non-utilization of health facility delivery and its correlates among childbearing women: a cross-sectional analysis of the 2018 Guinea demographic and health survey data.

BackgroundMany childbearing women in sub-Saharan African countries like Guinea still face challenges accessing and utilizing health facility delivery services and opt to deliver at home. This study examined the non-utilization of health facility delivery and its associated factors among childbearing women in Guinea.MethodsData from the 2018 Guinea Demographic and Health Survey was used in this study. Data of 5406 childbearing women were analysed using STATA version 14.2 by employing a multilevel logistic regression approach. The results were presented using adjusted odds ratios (aOR) at 95% confidence interval (CI).ResultsMore than three-quarters (47.6%) of childbearing women in Guinea did not deliver at health facilities. Women who had no formal education (aOR = 1.52, 95% CI = 1.09-2.12), those whose partners had no formal education (aOR = 1.25, 95% CI =1.01-1.56), those whose pregnancies were unintended (aOR = 1.40, 95% CI =1.13-1.74) and those who were Muslims (aOR = 2.87, 95% CI =1.17-7.08) were more likely to deliver at home. Furthermore, women with parity four or more (aOR = 1.78, 95% CI =1.34-2.37), those who listened to radio less than once a week (aOR = 5.05, 95% CI =1.83-13.89), those who never watched television (aOR = 1.46, 95% CI =1.12-1.91), those with poorest wealth quintile (aOR = 4.29, 95% CI =2.79-6.60), women in female-headed households (aOR = 1.38, 95% CI =1.08-1.78) and rural dwellers (aOR = 3.86, 95% CI =2.66-5.60) were more likely to deliver at home.ConclusionThis study has identified low socio-economic status, inadequate exposure to media, having an unplanned pregnancy and religious disparities as key predictors of home delivery among childbearing women in Guinea. The findings call for the need to enhance advocacy and educational strategies like focus group discussions, peer teaching, mentor-mentee programmes at both national and community levels for women to encourage health facility delivery. There is also the need to improve maternal healthcare services utilization policies to promote access to health facility delivery by reducing costs and making health facilities available in communities

Factors associated with female genital mutilation among women of reproductive age and girls aged 0–14 in Chad: a mixed-effects multilevel analysis of the 2014–2015 Chad demographic and health survey data

Background Chad is one of the African countries with high prevalence of female genital mutilation (FGM). The aim of this study was to examine the factors associated with FGM among women aged 15–49 and girls aged 0–14 in Chad. Methods Data for the study were obtained from the 2014–2015 Chad Demographic and Health Survey. FGM among women aged 15–49 and girls aged 0–14 were the outcome variables. The prevalence of FGM among women and girls were presented using percentages while a mixed-effects multilevel multivariable logistic regression analysis was carried out to assess the factors associated with FGM. The results were presented using adjusted odds ratio with associated 95% confidence intervals. Results The results indicate that more than half (50.2%) of the women and 12.9% of girls in Chad had been circumcised. Among women aged 15–49, level of education, employment status, ethnicity, religion, wealth quintile and community literacy level were significant predictors of FGM. Age, partner’s level of education, marital status, employment status, ethnicity, religion and mother’s FGM status were associated with FGM among girls aged 0–14. Conclusion This study has identified several individual and contextual factors as predictors of FGM among women and girls in Chad. The findings imply the need to adopt strategies aimed at addressing these factors in order to help eliminate the practice of FGM. Government and non-governmental organisations in Chad need to implement policies that enhance media advocacy and community dialogue to help deal with FGM in the country

Understanding tobacco use and socioeconomic inequalities among men in Ghana, and Lesotho.

BACKGROUND: Tobacco use is one of the leading causes of preventable deaths and has become a significant public health issue. Previous studies have paid less attention to tobacco use and socio-economic equalities among men in developing countries. This study examines the relationship between tobacco use and socio-economic inequalities among men in Ghana and Lesotho. METHODS: The study made use of data from the 2014 Demographic and Health Survey (DHS) from Ghana, and Lesotho. Binary logistic regression was employed to examine the associations between socio-economic inequality characteristics of respondents and tobacco use. RESULTS: The results showed that the prevalence of tobacco use was high in Lesotho (47.9%) as compared to that of Ghana (6.3%). Tobacco use was generally high across all age groups in Lesotho and in contrast, it was relatively low across all ages in Ghana. A statistically significant association was found between all the socio-economic variables and tobacco use in both countries. The prevalence of tobacco use was smaller in age group 15-24 years compared to the age groups 25-34 years and 35-59 years in both Ghana and Lesotho, although the association is stronger in Ghana. The AOR's in Ghana are respectively 5.3 (95% CI: 3.29-8.59) and 9.7 (95% CI: 6.20-15.06), compared to respectively 1.7 (95% CI: 1.32-2.11) and 1.7 (95% CI: 1.36-2.12). Smoking prevalence was smaller in men with higher level of education compared to men with no education in both Ghana and Lesotho, although the association was weaker in Ghana. The AOR in Ghana is 0.1 (95% CI: (0.02-0.11), compared to 0.2 (95% Cl: (0.17-0.30). The prevalence of tobacco use was smaller among men in urban areas compared to rural areas in both Ghana and Lesotho, although the association is stronger in Ghana. The AOR in Ghana is 2.1 (95% CI: 1.67-2.73), compared to 1.6 (95% CI: (1.31-1.95). In both countries, prevalence of tobacco use was higher in men who are traditionalist/spiritualists or who had no religion compared to Christians, although the association was stronger in Ghana. The AOR in Ghana is 6.2 (95% CI: (4.42-4.09) compared to 1.7 (95% CI: (1.21-2.47). The prevalence of tobacco use was low among men with richest wealth status compared to men with poorest wealth status in both Ghana and Lesotho, although the association is weaker in Ghana. The AOR in Ghana is 0.1 (95% Cl: (0.06-0.17) compared to 0.4 (95% CI: (0.51-1.12). In relation to occupation, prevalence of tobacco use was smaller among professional workers compared to men in the Agricultural sector in both Ghana and Lesotho, although the association is stronger in Ghana. The AOR in Ghana is 9.3 (95% Cl: (4.54-18.99), compared to 3.5 (95% CI: (2.27-5.52). Formerly married men in both countries were more likely to use tobacco compared to currently not married men, although the prevalence was higher in Ghana. The AOR in Ghana is 1.6 (95% CI: (0.99-2.28)], compared to 1.4 (95% CI: (0.89-2.28) in Lesotho. CONCLUSION: Although similar socio-economic inequality factors provided an understanding of tobacco use among men in Ghana and Lesotho, there were variations in relation to how each factor influences tobacco use

Socio-economic and demographic predictors of unmet need for contraception among young women in sub-Saharan Africa: evidence from cross-sectional surveys.

IntroductionGlobally, sub-Saharan Africa (SSA) bears the highest proportion of women with unmet need for contraception as nearly 25% of women of reproductive age in the sub-region have unmet need for contraception. Unmet need for contraception is predominant among young women. We examined the association between socio-economic and demographic factors and unmet need for contraception among young women in SSA.MethodsData for this study obtained from current Demographic and Health Surveys (DHS) conducted between January 1, 2010 and December 31, 2018 in 30 sub-Saharan African countries. The sample size consisted of young women (aged 15-24), who were either married or cohabiting and had complete cases on all the variables of interest (N = 59,864). Both bivariate and multivariable binary logistic regression analyses were performed using STATA version 14.0.ResultsThe overall prevalence of unmet need for contraception among young women was 26.90% [95% CI: 23.82-29.921], ranging from 11.30% [95% CI: 5.1-17.49] in Zimbabwe to 46.7% [95% CI: 36.92-56.48] in Comoros. Results on socio-economic status and unmet need for contraception showed that young women who had primary [aOR = 1.18; CI = 1.12-1.25, p ConclusionOur study has demonstrated that unmet need for contraception is relatively high among young women in SSA and this is associated with socio-economic status. Age, marital status, parity, occupation, sex of household head, and access to mass media (newspaper) are also associated with unmet need for contraception. It is therefore, prudent that organisations such as UNICEF and UNFPA and the Bill & Melinda Gates Foundation who have implemented policies and programmes on contraception meant towards reducing unmet need for contraception among women take these factors into consideration when designing interventions in sub-Saharan African countries to address the problem of high unmet need for contraception among young women