Experience of Intimate Partner Violence among Women in Sexual Unions: Is Supportive Attitude of Women towards Intimate Partner Violence a Correlate?

Intimate partner violence (IPV) is predominant in sub-Saharan Africa (SSA), with nearly 40 percent of women reporting IPV at some point in time. In this study, we investigated whether a supportive attitude towards IPV is associated with past-year experience of IPV among women in sexual unions in SSA. This study involved a cross-sectional analysis of data from the Demographic and Health Survey (DHS) of 23 countries in SSA. Bivariate and multivariable binary logistic regression analyses were performed to determine the association between attitude towards IPV and past-year experience of IPV. The regression results were presented in a tabular form using crude odds ratio (cOR) and adjusted odds ratio (aOR) at 95% confidence intervals (CIs). In the pooled countries, we found that women who had supportive attitude towards IPV were more likely to experience IPV compared to those who rejected IPV (cOR = 1.72, 95% CI = 1.64, 1.79), and this persisted after controlling for maternal age, marital status, wealth, maternal education level, place of residence, and mass-media exposure (aOR = 1.72, 95% CI = 1.64, 1.79). The same trend and direction of association between attitude towards IPV and experience of IPV was also found in all the 23 studied countries. This study has demonstrated that women who accept IPV are more likely to experience IPV. Hence, we recommend that efforts to end IPV must focus primarily on changing the attitudes of women. This goal can be achieved by augmenting women’s empowerment, education, and employment interventions, as well as sensitizing women in relation to the deleterious ramifications of accepting IPV. Furthermore, reducing IPV is critical towards the achievement of Sustainable Development Goal

Intimate partner violence as a predictor of marital disruption in sub-Saharan Africa: A multilevel analysis of demographic and health surveys

Intimate partner violence has gained momentum as health, social, and human right issue across the globe. Women within sub-Saharan Africa often do not report any case of violence due to the acceptance of violence which is rooted in their socio-cultural beliefs and practices. With a high prevalence of marital disruption in sub-Saharan Africa, it is important that we understand the role intimate partner violence plays in this phenomenon. Hence, this present study assessed the association between intimate partner violence and marital disruption among women in sub-Saharan Africa. Methods This study involved a cross-sectional analysis of data from the Demographic and Health Survey of 25 countries in sub-Saharan Africa. Multilevel binary logistic regression analysis was carried out and the results were presented as adjusted odds ratios (aOR) at 95% Confidence Interval (CI). Results The prevalence of physical, emotional, and sexual violence in the 25 countries considered in this study were 29.3%, 28%, and 11.5%, respectively. The highest prevalence of physical violence was in Sierra Leone (50.0%) and the lowest prevalence was in Comoros (5.7%). For emotional violence, the highest prevalence was in Sierra Leone (45.9%) and the lowest prevalence was in Comoros (7.9%). The highest prevalence of sexual violence was in Burundi (25.5%) and the lowest prevalence was in Comoros (1.8%). The average prevalence of marital disruption was 7.7%. This ranged from 1.3% in Burkina Faso to 20.2% in Mozambique. We found that women who had ever experienced physical violence were more likely to experience marital disruptions compared to those who had never experienced physical violence [aOR = 1.42, 95% CI = 1.35–1.50]. Women who had ever experienced sexual violence were more likely to experience marital disruption compared to those who had never experienced sexual violence [aOR = 1.29, 95% CI = 1.21–1.37]. Finally, women who had ever experienced emotional violence were more likely to experience marital disruption compared to those who had never experienced emotional violence [aOR = 1.86, 95% CI = 1.76–1.96]. Conclusion Findings from this study call for proven effective intimate partner violence reduction interventions such as strengthening laws against intimate partner violence in sub-Saharan Africa. Again, marital counseling and health education interventions should be implemented to address the role of intimate partner violence on the wellbeing of women and the stability of couples in sub-Saharan Africa

Antenatal care attendance and low birth weight of institutional births in sub-Saharan Africa.

BACKGROUND: Low birth weight (LBW) remains a major health problem that affects newborns worldwide. However, there has been growing evidence that antenatal care (ANC) is associated with LBW. Yet, there is a dearth of research investigating the association between ANC attendance and LBW in sub-Saharan Africa (SSA). This study examined the association between the number of ANC visits and LBW using data from 10 sub-Saharan African countries. METHODS: This study pooled data from the recent Demographic and Health Survey (DHS) of 10 sub-Saharan African countries conducted from 2018 to 2020. A total of 33,585 women aged 15-49 who had live births in the five years preceding the survey were included in this study. Bivariable and multivariable multilevel regression models were fitted to show the association between the number of ANC visits and LBW. Crude odds ratio (cOR) and adjusted odds ratio (aOR) at 95% confidence intervals (CIs) were used in presenting the results of the regression analysis. RESULTS: The pooled prevalence of LBW was 5.7%. The highest prevalence of LBW was recorded in Gambia (7.2%) with the lowest found in Sierra Leone (2.9%). In terms of eight or more ANC visits, the overall prevalence was 14.5%. Nigeria had the highest prevalence of eight or more ANC visits (43.5%) with the lowest in Rwanda (0.2%). We found a statistically significant association between the number of ANC visits and LBW. Mothers who had eight or more ANC visits were less likely to have LBW children compared to mothers who had less than eight ANC visits [cOR = 0.66; CI = 0.55 - 0.79] and this persisted after controlling for the covariates [aOR = 0.68; CI = 0.56 - 0.82]. Covariates associated with LBW were maternal age, marital status, level of education, age of child, and wealth index. CONCLUSION: This study has shown a statistically significant association between ANC and LBW in SSA, with women who had eight or more ANC visits being at lower risks of giving birth to children with LBW. We found that eight or more ANC attendance was a protective factor against LBW in SSA. Therefore, it is important for sub-Saharan African countries with low prevalence of eight or more ANC attendance and high LBW prevalence to channel their efforts towards promoting more ANC attendance

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

Alcohol consumption among tertiary students in the Hohoe municipality, Ghana: analysis of prevalence, effects, and associated factors from a cross-sectional study.

Background:Alcohol consumption constitutes a major public health problem as it has negative consequences on the health, social, psychological, and economic outcomes of individuals. Tertiary education presents students with unique challenges and some students resort to the use of alcohol in dealing with their problems. This study, therefore, sought to determine alcohol use, its effects, and associated factors among tertiary students in the Hohoe Municipaility of Ghana. Methods: An institutional-based cross-sectional study was conducted among 418 tertiary students in the Hohoe Municipality of Ghana using a two-stage sampling technique. Data were collected using structured questionnaires. A binary logistic regression modelling was used to determine the strength of the association between alcohol consumption and the explanatory variables. The level of significance was set at p < 0.05. Stata version 16.0 was used to perform the analysis. Results: The lifetime prevalence of alcohol consumption was 39.5%. Out of them, 49.1% were still using alcohol, translating to an overall prevalence of 19.4% among the tertiary students. Self-reported perceived effects attributed to alcohol consumption were loss of valuable items (60.6%), excessive vomiting (53.9%), stomach pains/upset (46.1%), accident (40.0%), unprotected sex (35.1%), risk of liver infection (16.4%), depressive feelings (27.3%), diarrhoea (24.2%), debt (15.2%), and petty theft (22.4%). In terms of factors associated with alcohol consumption, students aged 26 years and above were more likely to have consumed alcohol [AOR = 4.4, 95%CI = 1.74, 11.14] than those in 16–20 years group. Muslim students had lower odds of alcohol consumption compared to Christians [AOR = 0.1, 95% CI = 0.02, 0.31]. It was also found that students who had peer influence [AOR = 3.7, 95%CI = 2.31, 5.82] and those who had academic adjustment problems [AOR = 3.6, 95% CI = 2.01, 6.46] were more likely to consume alcohol. Conclusion: Lifetime prevalence of alcohol consumption is high among tertiary students in the Hohoe Municipality of Ghana, with several physical, psychosocial and economic consequences. Alcohol-related education should be intensified in tertiary institutions and counseling units should be equipped with relevant assessment tools to assess and help students who are at risk and those who are already consuming alcohol

Exposure to interparental violence and justification of intimate partner violence among women in sexual unions in sub-Saharan Africa.

Background Justification of intimate partner violence (IPV) is one of the critical factors that account for the high prevalence of IPV among women. In this study, we examined the association between exposure to interparental violence and IPV justification among women in sexual unions in sub-Saharan Africa (SSA). Methods Data for this study were obtained from the most recent Demographic and Health Surveys (DHS) of 26 countries in SSA conducted between 2010 and 2020. A total of 112,953 women in sexual unions were included in this study. A multivariable binary logistic regression analysis was carried out. The results of the regression analysis were presented using crude odds ratios (cOR) and adjusted odds ratios (aOR) with their respective 95% confidence intervals (CIs). Results The prevalence of interparental violence in the countries considered in this study was 23.8%, with the highest (40.8%) and lowest (4.9%) in Burundi and Comoros, respectively. IPV justification was 45.8%, with the highest and lowest prevalence in Mali (80.9%) and South Africa (4.6%) respectively. Women who were exposed to interparental violence were more likely to justify IPV compared to those who were not exposed [aOR = 1.53, 95% CI = 1.47–1.59]. We found higher odds of justification of IPV among women who were exposed to interparental violence compared to those who were not exposed in all the countries, except Burkina Faso, Comoros, Gambia, and Rwanda. Conclusion The findings call for several strategies for addressing interparental violence. These may include empowerment services targeting both men and women, formation of stronger social networks to improve women’s self-confidence, and the provision of evidence-based information and resources at the community level. These interventions should pay critical attention to young people exposed to interparental violence. Public health education and messaging should emphasise on the negative health and social implications of interparental violence and IPV

Mass Media Exposure and Safer Sex Negotiation among Women in Sexual Unions in Sub-Saharan Africa: Analysis of Demographic and Health Survey Data.

(1) Background: Improving sexual autonomy among women in sexual unions comes with various benefits, including the reduction of sexually transmitted and blood-borne infections. We examined the relationship between mass media exposure and safer sex negotiation among women in sub-Saharan Africa (SSA). (2) Methods: The study involved a cross-sectional analysis of Demographic and Health Survey (DHS) data of 29 sub-Saharan African countries. A total of 224,647 women aged 15–49 were included in our analyses. We examined the association between mass media exposure and safer sex negotiation using binary logistic regression analysis. The results are presented using a crude odds ratio (cOR) and adjusted odds ratio (aOR), with their respective confidence intervals (CIs). Statistical significance was set at p < 0.05. (3) Results: The overall prevalence of safer sex negotiation among women in sexual unions in SSA was 71.6% (71.4–71.8). Women exposed to mass media had higher odds of negotiating for safer sex compared with those who had no exposure (aOR = 1.94; 95% CI = 1.86–2.02), and this persisted after controlling for covariates (maternal age, wealth index, maternal educational level, partner’s age, partner’s educational level, sex of household head, religion, place of residence, and marital status) (aOR = 1.40; 95% CI = 1.35–1.46). The disaggregated results showed higher odds of safer sex negotiation among women exposed to mass media in all the individual countries, except Ghana, Comoros, Rwanda, and Namibia. (4) Conclusions: The findings could inform policies (e.g., transformative mass media educational seminars) and interventions (e.g., face-to-face counselling; small group sensitization sessions) in SSA on the crucial role of mass media in increasing safer sex practice among women in sexual unions. To accelerate progress towards the achievement of the Sustainable Development Goal five’s targets on empowering all women and safeguarding their reproductive rights, the study recommends that countries such as Ghana, Comoros, Rwanda, and Namibia need to intensify their efforts (e.g., regular sensitization campaigns) in increasing safer sex negotiation among women to counter power imbalances in sexual behaviour

Health facility delivery among women of reproductive age in Nigeria: Does age at first birth matter?

BackgroundHigh maternal mortality ratio in sub-Saharan Africa (SSA) has been linked to inadequate medical care for pregnant women due to limited health facility delivery utilization. Thus, this study, examined the association between age at first childbirth and health facility delivery among women of reproductive age in Nigeria.MethodsThe study used the most recent secondary dataset from Nigeria's Demographic and Health Survey (NDHS) conducted in 2018. Only women aged15-49 were considered for the study (N = 34,193). Bi-variate and multivariable logistic regression models were used to examine the association between age at first birth and place of delivery. The results were presented as crude odds ratios and adjusted odds ratios (aOR) with corresponding 95% confidence intervals (CIs). Statistical significance was set at pResultsThe results showed that the prevalence of health facility deliveries was 41% in Nigeria. Women who had their first birth below age 20 [aOR = 0.82; 95%(CI = 0.74-0.90)] were less likely to give birth at health facilities compared to those who had their first birth at age 20 and above.ConclusionOur findings suggest the need to design interventions that will encourage women of reproductive age in Nigeria who are younger than 20 years to give birth in health facilities to avoid the risks of maternal complications associated with home delivery. Such interventions should include male involvement in antenatal care visits and the education of both partners and young women on the importance of health facility delivery

Maternal healthcare utilsation and complete childhood vaccination in sub-Saharan Africa: a cross-sectional study of 29 nationally representative surveys

Objective The objective of the study was to examine the association between maternal healthcare utilisation and complete childhood vaccination in sub-Saharan Africa. Design Our study was a cross-sectional study that used pooled data from 29 countries in sub-Saharan Africa. Participants A total of 60 964 mothers of children aged 11–23 months were included in the study. Outcome variables The main outcome variable was complete childhood vaccination. The explanatory variables were number of antenatal care (ANC) visits, assistance during delivery and postnatal care (PNC). Results The average prevalence of complete childhood vaccination was 85.6%, ranging from 67.0% in Ethiopia to 98.5% in Namibia. Our adjusted model, children whose mothers had a maximum of three ANC visits were 56% less likely to have complete vaccination, compared with those who had at least four ANC visits (adjusted OR (aOR)=0.44, 95% CI 0.42 to 0.46). Children whose mothers were assisted by traditional birth attendant/other (aOR=0.43, 95% CI 0.41 to 0.56) had lower odds of complete vaccination. The odds of complete vaccination were lower among children whose mothers did not attend PNC clinics (aOR=0.26, 95% CI 0.24 to 0.29) as against those whose mothers attended. Conclusion The study found significant variations in complete childhood vaccination across countries in sub-Saharan Africa. Maternal healthcare utilisation (ANC visits, skilled birth delivery, PNC attendance) had significant association with complete childhood vaccination. These findings suggest that programmes, interventions and strategies aimed at improving vaccination should incorporate interventions that can enhance maternal healthcare utilisation. Such interventions can include education and sensitisation, reducing cost of maternal healthcare and encouraging male involvement in maternal healthcare service utilisation

Risk factors associated with the coexistence of stunting, underweight, and wasting in children under 5 from 31 sub-Saharan African countries.

OBJECTIVE: This study investigated the risk factors associated with the coexistence of stunting, underweight, and wasting among children under age 5 in sub-Saharan Africa (SSA). DESIGN: Data of 127, 487 under-5 children from 31 countries in SSA were pooled from the Demographic and Health Surveys collected between 2010 and 2019. We examined the risk of coexistence of stunting, underweight, and wasting using multinomial logistic regression models. The results were presented using relative risk ratios (RRR) with corresponding confidence intervals (CIs). SETTING: Thirty-one sub-Saharan African countries. PARTICIPANTS: Children under age 5. OUTCOME MEASURES: The outcome variables were three child anthropometrics: stunting (height-for-age z-scores); underweight (weight-for-age z-scores) and wasting (weight-for-height z-scores). RESULTS: The prevalence of coexistence of stunting, underweight, and wasting varied across countries, with the highest (12.14%) and lowest (0.58%) prevalences of coexistence of stunting, underweight and wasting in Benin and Gambia respectively. The risk of coexistence of the three indicators of undernutrition was higher among children aged 1 year (RRR=3.714; 95% CI 3.319 to 4.156) compared with those aged 0. The risk of coexistence of the three dimensions was lower among female children (RRR=0.468 95% CI 0.420 to 0.51), but higher for those with small size at birth (RRR=3.818; CI 3.383 to 4.308), those whose mothers had no education (RRR=3.291; 95% CI 1.961 to 5.522), not working (RRR=1.195; 95% CI 1.086 to 1.314), had no antenatal visits during pregnancy (RRR=1.364; 95% CI 1.20 to 1.541), children delivered at home (RRR=1.372; CI 1.232 to 1.529), those from poor households (RRR=1.408; 95% CI 1.235 to 1.605), those whose mothers had no access to media (RRR=1.255; 95% CI 1.144 to 1.377) and living in households with an unimproved toilet facility (RRR=1.158; 95% CI 1.032 to 1.300). CONCLUSIONS: Findings suggest the urgent need for consideration of the coexistence of stunting, wasting and underweight among under-5 children in policy design and programming of interventions to eradicate child malnutrition in SSA. In the short-term, national-level policies and interventions need to be well tailored considering the compositional characteristics