Not just numbers: beyond counting caesarean deliveries to understanding their determinants in Ghana using a population based cross-sectional study.

BACKGROUND:The increasing rate of caesarean deliveries (CD) has become a serious concern for public health experts globally. Despite this health concern, research on factors associated CD in many low- and -middle countries like Ghana is sparse. This study, therefore, assessed the prevalence and determinants of CD among child-bearing women aged 15-49  in Ghana. METHODS:The study used data from the 2014 Ghana Demographic and Health Survey. The analysis was limited to mothers (n = 2742) aged 15-49 , who had given birth in health facilities 5 years preceding the survey. Association between CD and its determinants was assessed by calculating adjusted odds ratios (AOR) with their respective 95% confidence intervals using a binary logistic regression. RESULTS:The percentage of mothers who delivered their babies through caesarean section (CS) was 18.5%. Using multivariable logistic regression, the results showed that women aged 45-49 (AOR = 10.5; 95% CI: 3.0-37.4), and women from a household that are headed by a female (AOR = 1.3; 95% CI = 1.1-1.7) had higher odds to deliver through CS. Women from the Upper East (AOR =0.4; 95% CI = 0.2-0.7) and Upper West (AOR = 0.4; 95% CI = 0.2-0.8) regions had lower odds to deliver their children through CS. Women with parity 4 or more (AOR = 0.3; 95% CI = 0.2-0.5) had lower odds of CD compared to those with parity 1. Women with female babies had lower odds (AOR = 0.8; CI = 0.7-0.9) of delivering them through CS compared to those with male children. CONCLUSION:The percentage of women delivering babies through the CS in Ghana is high. The high rates of CD noted do not essentially indicate good quality care or services. Hence, health facilities offering this medical protocol need to adopt comprehensive and strict measures to ensure detailed medical justifications by doctors for performing these caesarean surgeries

What has women's reproductive health decision-making capacity and other factors got to do with pregnancy termination in sub-Saharan Africa? evidence from 27 cross-sectional surveys.

INTRODUCTION:Pregnancy termination is one of the key issues that require urgent attention in achieving the third Sustainable Development Goal (SDG) of ensuring healthy lives and promoting well-being for all at all ages. The reproductive health decision-making (RHDM) capacity of women plays a key role in their reproductive health outcomes, including pregnancy termination. Based on this premise, we examined RHDM capacity and pregnancy termination among women of reproductive age in sub-Saharan Africa (SSA). MATERIALS AND METHODS:We pooled data from the women's files of the most recent Demographic and Health Surveys (DHS) of 27 countries in SSA, which are part of the DHS programme. The total sample was 240,489 women aged 15 to 49. We calculated the overall prevalence of pregnancy termination in the 27 countries as well as the prevalence in each individual country. We also examined the association between RHDM capacity, socio-demographic characteristics and pregnancy termination. RHDM was generated from two variables: decision-making on sexual intercourse and decision-making on condom use. Binary logistic regression analysis was conducted and presented as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) with their corresponding 95% confidence intervals (CI). Statistical significance was declared p<0.05. RESULTS:The prevalence of pregnancy termination ranged from 7.5% in Benin to 39.5% in Gabon with an average of 16.5%. Women who were capable of taking reproductive health decisions had higher odds of terminating a pregnancy than those who were incapable (AOR = 1.20, 95% CI = 1.17-1.24). We also found that women aged 45-49 (AOR = 5.54, 95% CI = 5.11-6.01), women with primary level of education (AOR = 1.14, 95% CI = 1.20-1.17), those cohabiting (AOR = 1.08, 95% CI = 1.04-1.11), those in the richest wealth quintile (AOR = 1.06, 95% CI = 1.02-1.11) and women employed in the services sector (AOR = 1.35, 95% CI = 1.27-1.44) were more likely to terminate pregnancies. Relatedly, women who did not intend to use contraceptive (AOR = 1.47, 95% CI = 1.39-1.56), those who knew only folkloric contraceptive method (AOR = 1.25, 95% CI = 1.18-1.32), women who watched television almost every day (AOR = 1.16, 95% CI = 1.20-1.24) and those who listened to radio almost every day (AOR = 1.11, 95% CI = 1.04-1.18) had higher odds of terminating a pregnancy. However, women with four or more children had the lowest odds (AOR = 0.5, 95% CI = 0.54-0.60) of terminating a pregnancy. CONCLUSION:We found that women who are capable of taking reproductive health decisions are more likely to terminate pregnancies. Our findings also suggest that age, level of education, contraceptive use and intention, place of residence, and parity are associated with pregnancy termination. Our findings call for the implementation of policies or the strengthening of existing ones to empower women about RHDM capacity. Such empowerment could have a positive impact on their uptake of safe abortions. Achieving this will not only accelerate progress towards the achievement of maternal health-related SDGs but would also immensely reduce the number of women who die as a result of pregnancy termination in SSA

Women's autonomy in household decision-making and safer sex negotiation in sub-Saharan Africa: An analysis of data from 27 Demographic and Health Surveys

Women's ability to negotiate the conditions and timing of sex is key to several reproductive health outcomes including family planning and prevention of sexually transmitted infections. We investigated the association between women's autonomy in household decision-making and safer sex negotiation (SSN) in sub-Saharan Africa (SSA). This was a cross-sectional analysis of data from the Demographic and Health Survey (DHS) of 27 countries in SSA. Data were analyzed using Stata version 16.0 using descriptive statistics, chi square test, and logistic regression models. Statistical significance was set at p < 0.05 at 95% confidence interval. The pooled prevalence of SSN in the 27 countries was 77.1%. Compared to women with low autonomy in household decision-making, those with medium (aOR = 1.30; CI = 1.23–1.37) and high levels of autonomy in household decision-making (aOR = 1.28; CI = 1.17–1.40) were more likely to have greater SSN. Those with primary (aOR = 1.35; CI = 1.28–1.41) and secondary/higher education level of education (aOR = 1.68; CI = 1.58–1.79) had higher odds of SSN, compared to those with no formal education. Women who were working had higher odds of SSN (aOR = 1.44; CI = 1.37–1.51) than those who were not working. Women in the middle (aOR = 0.93; CI = 0.87–0.99) and richer (aOR = 0.92; CI = 0.85–0.98) wealth status had lower odds of SSN, compared to those in the poorest wealth status. Women's autonomy in household decision-making is a significant predictor of SSN. Women autonomy in household decision-making programs and interventions should be intensified to achieve Sustainable Development Goals 3.7 and 5 which seek to achieve universal access to sexual and reproductive health services and ensure gender equality and empower all women and girls by 2030

Loneliness and its Associated Risk Factors Among in-School Adolescents in Tanzania: Cross-Sectional Analyses of the Global School-Based Health Survey Data

Though considered a normal part of adolescent development, loneliness is a mental state that can result in considerable psychological distress. We examined the prevalence and risk factors for loneliness among in-school adolescents in Tanzania. This was a descriptive cross-sectional study of 2,449 in-school adolescents from Tanzania using data from the 2017 Global School-Based Health Survey. Frequencies, percentages, Chi-square, and binary logistic regression were used in analysing the data. The prevalence of loneliness was 17.4%. Adolescents in forms 1 and 2 were more likely to be lonely than those in grade 6–7. Adolescents who experienced hunger and anxiety, used tobacco, were truant, and engaged in a physical fight had higher risks of being lonely. The prevalence of loneliness among in-school adolescents in Tanzania is quite high. As a mental state, the drastic long-term effects of loneliness on its victims make it imperative for stakeholders in Tanzania’s health industry to plan and implement pragmatic innovative social support programmes and counselling support units in schools. This can ensure the attainment of the Sustainable Development Goal 3.4 target of improving mental health by the year 2030