Rural-urban variation in insecticide-treated net utilization among pregnant women:evidence from 2018 Nigeria Demographic and Health Survey

Background: In 2018, Nigeria accounted for the highest prevalence of malaria worldwide. Pregnant women and children under five years bear the highest risk of malaria. Geographical factors affect utilization of insecticide-treated nets (ITN), yet existing literature have paid little attention to the rural-urban dimension of ITN utilization in Nigeria. This study aimed at investigating the rural-urban variation in ITN utilization among pregnant women in Nigeria using data from the 2018 Demographic and Health Survey.Methods: A total of 2909 pregnant women were included in the study. The prevalence of ITN utilization for rural and urban pregnant women of Nigeria were presented with descriptive statistics. Chi-square test was employed to assess the association between residence, socio-demographic characteristics and ITN utilization at 95% level of significance. Subsequently, binary logistic regression was used to assess the influence of residence on ITN utilization.Results: Eight out of ten of the rural residents utilized ITN (86.1%) compared with 74.1% among urban residents. Relative to urban pregnant women, those in rural Nigeria had higher odds of utilizing ITNs both in the crude [cOR = 2.17, CI = 1.66-2.84] and adjusted models [aOR = 1.18, CI = 1.05-1.24]. Pregnant women aged 40-44 had lower odds of ITN utilization compared to those aged 15-19 [aOR = 0.63, CI = 0.44-0.92]. Poorer pregnant women had higher odds of ITN utilization compared with poorest pregnant women [aOR = 1.09, CI = 1.04-1.32]. Across regions, those in the south [aOR = 0.26, CI = 0.14-0.49] and south-west [aOR = 0.29, CI = 0.16-0.54] had lower odds of ITN use compared to their counterparts in the north-west region.Conclusion: The high use of ITNs among pregnant women in Nigeria may be due to the prioritization of rural communities by previous interventions. This is a dimension worth considering to enhance the attainment of the national anti-malarial initiatives. Since possession of ITN is not a guarantee for utilization, women in urban locations need constant reminder of ITN use through messages delivered at ANC and radio advertisements. Moreover, subsequent mass ITN campaigns ought to take cognizance of variations ITN use across regions and pragmatic steps be taken to increase the availability of ITN in households since there is a moderately high use in households with at least one ITN in Nigeria.</p

What Influences Where They Give Birth? Determinants of Place of Delivery among Women in Rural Ghana

Background. There is a paucity of empirical literature in Ghana on rural areas and their utilisation of health facilities. The study examined the effects of the sociodemographics of rural women on place of delivery in the country. Methods. The paper made use of data from the 2014 Ghana Demographic and Health Survey. Women from rural areas who had given birth within five years prior to the survey were included in the analysis. Descriptive analyses and binary logistic regression were used to analyse the data. Results. Wealth, maternal education, ecological zone, getting money for treatment, ethnicity, partner’s education, parity, and distance to a health facility were found as the determinants of place of delivery among women in rural Ghana. Women in the richest wealth quintile were three times (OR = 3.04, 95% CI = 0.35–26.4) more likely to deliver at a health facility than the poorest women. Conclusions. It behoves the relevant stakeholders including the Ghana Health Service and the Ministry of Health to pay attention to the wealth status, maternal education, ecological zone, ethnicity, partner’s education, parity, and distance in their planning regarding delivery care in rural Ghana

Prevalence and determinants of the place of delivery among reproductive age women in sub-Saharan Africa.

IntroductionMaternal mortality is an issue of global public health concern with over 300,000 women dying globally each year. In sub-Saharan Africa (SSA), these deaths mainly occur around childbirth and the first 24hours after delivery. The place of delivery is, therefore, important in reducing maternal deaths and accelerating progress towards attaining the 2030 sustainable development goals (SDGs) related to maternal health. In this study, we examined the prevalence and determinants of the place of delivery among reproductive age women in SSA.Materials and methodsThis was a cross-sectional study among women in their reproductive age using data from the most recent demographic and health surveys of 28 SSA countries. Frequency, percentage, chi-square, and logistic regression were used in analysing the data. All analyses were done using STATA.ResultsThe overall prevalence of health facility delivery was 66%. This ranged from 23% in Chad to 94% in Gabon. More than half of the countries recorded a less than 70% prevalence of health facility delivery. The adjusted odds of health facility delivery were lowest in Chad. The probability of giving birth at a health facility also declined with increasing age but increased with the level of education and wealth status. Women from rural areas had a lower likelihood (AOR = 0.59, 95%CI = 0.57-0.61) of delivering at a health facility compared with urban women.ConclusionsOur findings point to the inability of many SSA countries to meet the SDG targets concerning reductions in maternal mortality and improving the health of reproductive age women. The findings thus justify the need for peer learning among SSA countries for the adaption and integration into local contexts, of interventions that have proven to be successful in improving health facility delivery among reproductive age women

Socio – economic determinants of abortion among women in Mozambique and Ghana: evidence from demographic and health survey

Abstract Background Despite the variances in abortion laws accounting for differences in incidence of abortion among African countries, it appears there is absence of literature on other factors that may also account for the differences in incidence of abortion. Specifically, there is paucity of information on how socio-demographic factors account for the disparities in prevalence of pregnancy termination among women of reproductive age in sub-Saharan Africa. In view of this, this paper examined how socio-demographic factors influence pregnancy termination among women in reproductive age in Mozambique and Ghana. Methods The study made use of data from the 2014 Ghana and 2011 Mozambique Demographic and Health Survey for the study. For the purpose of this study a sample of 9375 and 13,660 made up of women in their reproductive ages (15–49) in Ghana and Mozambique respectively was used. The results on the analysis of the association between socio-demographic factors and pregnancy termination are presented as odds ratio (OR) with 95% confidence intervals (CI). Results The results revealed that about 25% of the respondents in Ghana and 9% of the respondents in Mozambique reported ever had a pregnancy terminated. In both countries, the odds of pregnancy termination were high among women with primary education, those in the older age groups, women who were Christians and women who were employed. Similarly, higher odds of pregnancy termination were found among ever married women, those who less than four births or more and those who have had access to social media (radio and television). Conclusion To reduce unintended pregnancies that could lead to pregnancy termination, there is a need for regular integrated community-based outreach programs targeted at generating community responsiveness of effective contraception and prevention of unintended pregnancy

Responsiveness of Health Professionals to Postabortion Care at a Regional Level Hospital in Ghana: A Qualitative Study of Patients’ Self-Reports

Background. The responsiveness of health professionals to patients in the provision of abortion services is essential to influencing patients’ perceptions and expectations regarding the quality of medical care to be received and their general satisfaction. This, in turn, determines if patients will revisit a particular health facility to access abortion services. In this study, we examine the responsiveness of health professionals in providing postabortion care at a regional level health facility in Ghana. Methods. Qualitative data collected from 20 female patients who assessed abortion services at a regional level health facility in Ghana were used. The sample was achieved through saturation while a systematic qualitative orientated text analysis was adopted in analysing the data. Results. Health professionals were responsive to postabortion care at the facility. Most women who sought postabortion care at the facility were referred from other health facilities which could not handle such cases. Other reasons include satisfaction with services received on previous visits to the hospital. We also realized, however, that postabortion services were not covered by the National Health Insurance Scheme. Conclusions. All hospitals across the country should be equipped with the basic equipment and personnel to conduct and manage abortions. This would reduce not only referrals but also possible maternal deaths. Abortion services should also be added to the services covered by the country’s National Health Insurance Scheme

Gender differences in the acceptance of wife-beating: evidence from 30 countries in Sub-Saharan Africa

Abstract Background The World Health Organization (WHO) has cited domestic violence as an urgent global maternal and child health priority. Gender differences in the acceptance of wife-beating have not been explored at the multi-country level in sub-Saharan Africa (SSA) where the occurrence of wife-beating (36%) is greater than the global average (30%). It is against this backdrop that we examine the gender differences in the acceptance of wife beating in SSA. Methods We used Demographic and Health Survey data from 30 SSA countries. Acceptance of wife beating among women and men was the principal outcome variable of interest. We employed Multiple correspondence analysis and logistic regression model as the primary estimation methods for this study. The descriptive statistics show that women had a higher acceptance rate (44%) of wife beating than men (25%). For the women sample, Mali, Democratic Republic of Congo, Chad, and Guinea had higher rates of acceptance of the wife beating (80.6%, 78.4%, 77.1% and 70.3% respectively) For the men, only Guinea had an acceptance rate above 50 percent. Results We found that all else equal, women’s acceptance of wife beating is higher for male-headed households than for female-headed households. Women without formal education were 3.1 times more likely to accept wife beating than those with higher education. Men with no formal education were 2.3 times more likely to accept wife beating than men with higher education. We found that polygamous women were comparable to polygamous men. Polygamous women were 1.2 times more likely to accept wife beating than those in monogamous marriages. Women were 1.2 times more likely to accept wives beating if they had extramarital relationships. Contrarily, men who engaged in extramarital affairs were 1.5 times more likely to justify wife beating. We also found that women’s acceptance of wife beating decreases as they age. Men who decide on major household purchases and spending decisions on their earnings are more likely to accept wife beating. Corollary, women with similar gender and employment roles also accept wife beating. Finally, exposure to mass media is significantly associated with lower acceptance of wife beating for women and men. Conclusion We conclude that women have a higher acceptance rate of wife beating than men in SSA. Acceptance of wife beating differs significantly by country. Given the same level of education, women are more likely to accept wife beating than men. If women and men have similar levels of employment and gender roles, acceptance of wife beating is higher when men make major household purchasing decisions and and it is still higher even when the woman makes these decisions. Acceptance of wife beating is higher among young women and men, the uneducated, those in polygamous marriages, women, and men who engage in extra marital affairs, poor households and in rural areas. The findings indicate the need for policies and programs by SSA countries to truncate the high acceptance rate of wife beating, especially among women

Socio-economic disadvantage and quality Antenatal Care (ANC) in Sierra Leone: Evidence from Demographic and Health Survey

Introduction Reduction of maternal mortality remains a global priority as highlighted by the third Sustainable Development Goal (SDG). This is critical in the case of Sierra Leone as the country is one of three (3) countries with the highest maternal mortality ratio globally, thus 1,120 per 100,000 live births. The approximate lifetime risk of maternal mortality in the country is 1 in 17, relative to 1 in 3,300 in high-income countries. These raise doubt about the quality of the continuum of maternal healthcare in the country, particularly antenatal care and as a result, the objective of the present study is to investigate the association between socio-economic disadvantage and quality antenatal care service utilisation as well as associated correlates in Sierra Leone. Materials and methods The study used data from the most recent Demographic and Health Survey (DHS) of Sierra Leone. Only women who had given birth in the five years preceding the survey were included, which is 6,028. Quality antenatal care was defined as receipt of recommended ANC services including uptake of recommended pregnancy drugs (e.g. Fansidar and iron supplement); injections (e.g. tetanus injection) and having some samples (e.g. blood and urine sample) and health status indicators (e.g. blood pressure) taken. An index was created from these indicators with scores ranging from 0 to 6. The scores 0 to 5 were labelled as “incomplete” and 6 was labelled as “complete” and this was used to create a dummy variable. In analysing the data, descriptive analysis was done using chi-square test as well as an inferential analysis using bivariate and multivariate models. Results Socio-economic disadvantaged [1.46 (1.09, 1.95), place of residence [2.29 (1.43, 3.67)], frequency of listening to radio [1.58 (1.20, 2.09)], health insurance coverage [3.48 (1.40, 8.64)], getting medical help for self: permission to go [0.53(0.42, 0.69) were seen to have significant relationship with quality of ANC utilized by women during pregnancy. Also, women Mende ethnicity are more likely to utilise quality ANC compared to women from the Temne ethnicity [2.58 (1.79, 3.72)]. Conclusion Policy makers could consider measures to boost patronage of quality ANC in Sierra Leone by targeting the socio-economically disadvantaged women. Targeting these sub-groups with pro- maternal and child health (MCH) interventions would help Sierra Leone achieve Goal 3 of the SDGs

Socio-economic disadvantage and quality Antenatal Care (ANC) in Sierra Leone: Evidence from Demographic and Health Survey.

IntroductionReduction of maternal mortality remains a global priority as highlighted by the third Sustainable Development Goal (SDG). This is critical in the case of Sierra Leone as the country is one of three (3) countries with the highest maternal mortality ratio globally, thus 1,120 per 100,000 live births. The approximate lifetime risk of maternal mortality in the country is 1 in 17, relative to 1 in 3,300 in high-income countries. These raise doubt about the quality of the continuum of maternal healthcare in the country, particularly antenatal care and as a result, the objective of the present study is to investigate the association between socio-economic disadvantage and quality antenatal care service utilisation as well as associated correlates in Sierra Leone.Materials and methodsThe study used data from the most recent Demographic and Health Survey (DHS) of Sierra Leone. Only women who had given birth in the five years preceding the survey were included, which is 6,028. Quality antenatal care was defined as receipt of recommended ANC services including uptake of recommended pregnancy drugs (e.g. Fansidar and iron supplement); injections (e.g. tetanus injection) and having some samples (e.g. blood and urine sample) and health status indicators (e.g. blood pressure) taken. An index was created from these indicators with scores ranging from 0 to 6. The scores 0 to 5 were labelled as "incomplete" and 6 was labelled as "complete" and this was used to create a dummy variable. In analysing the data, descriptive analysis was done using chi-square test as well as an inferential analysis using bivariate and multivariate models.ResultsSocio-economic disadvantaged [1.46 (1.09, 1.95), place of residence [2.29 (1.43, 3.67)], frequency of listening to radio [1.58 (1.20, 2.09)], health insurance coverage [3.48 (1.40, 8.64)], getting medical help for self: permission to go [0.53(0.42, 0.69) were seen to have significant relationship with quality of ANC utilized by women during pregnancy. Also, women Mende ethnicity are more likely to utilise quality ANC compared to women from the Temne ethnicity [2.58 (1.79, 3.72)].ConclusionPolicy makers could consider measures to boost patronage of quality ANC in Sierra Leone by targeting the socio-economically disadvantaged women. Targeting these sub-groups with pro- maternal and child health (MCH) interventions would help Sierra Leone achieve Goal 3 of the SDGs

Maternal and child factors associated with late neonatal bathing practices in Nigeria: evidence from a national survey

Abstract Background Twohundred and seventy out of every thousand live births died in Nigeria in 2019. These deaths were attributable to infections, complications of preterm birth, and intrapartum-related conditions. The World Health Organization recommends withholding bathing of neonates until 24 h after birth or until their vital signs become stable to prevent hypothermia. Despite the link between neonatal bathing and thermal control, the subject is understudied in Nigeria. This study aimed at investigating the factors associated with late neonatal bathing practices in Nigeria. Methods The study adopted a cross-sectional design and extracted data from the women’s file of the 2018 Nigerian Demographic and Health Survey. The unit of analysis was limited to 12,972 women who had complete data for the study. We applied chi-square test of independence to ascertain the association between the outcome variable and explanatory variables. At 95% confidence interval, two logistic regression models were built with Model I consisting of only maternal factors whilst Model II contained both maternal and child factors, and results were presented in adjusted odds ratio. Results Descriptively, 12% (CI = 0.122–0.134) of the women bathed their neonates after 24 h of delivery. Inferentially, women with secondary/higher education [AOR = 1.30, CI = 1.05–1.61], the rich [AOR = 1.24, CI = 1.03–1.50], those with access to mass media [AOR = 131, CI = 1.15–1.50], women that professed other religions [AOR = 9.28, CI = 4.24–17.56], those who delivered in a health facility [AOR = 1.93, CI = 1.66–2.25], whose child was small in size at birth [AOR = 1.46, CI = 1.21–1.77] and delivered by caesarean section [AOR = 2.50, CI = 1.97–3.18] had higher odds of bathing their neonates 24 h after birth. Conclusions The proportion of women who practised late neonatal bathing was generally low. To improve the practice of late neonatal bathing, much-concerted effort should be directed to women’s education and approaches to increasing receptivity of late neonatal bathing among pregnant women through the media. The Nigerian Ministry of Health should incorporate routine counselling on the risks of bathing newborns prematurely into antenatal and postnatal care services