Adolescent childbearing experiences in Kenya: geographical and socioeconomic determinants

Sub-Saharan Africa has one of the highest level of teenage pregnancies in the world. Some studies on this topic highlight the presence of unmet reproductive health needs of adolescent in different regions. Improving maternal health has been established as a key development priority among the Millennium Development Goals, and upgrading reproductive and maternal health is usually associated with the eradication of inequality and poverty and with the presence of health care programs and services devoted to girls’ education. We attempt to investigate the geographical and socioeconomic determinants of both teenage pregnancies and maternal health behaviours among adolescent women in Kenya. We ascertain the influence of the availability of health care facilities mainly oriented to the specific needs of reproductive health. Main data are represented by 2003 Kenyan Demographic and Health Survey. In addition, the DHS data set collects Global Positioning System locators for each of the primary sampling units included in the samples that enable a deep geographical analysis. We perform a multivariate multilevel analysis to estimate the influence that individual, household, and community-level factors have on the risk of adolescent childbearing. Additionally, a spatial component allows for the presence and proximity of maternal health services. We expect that the availability of reproductive health facilities acts together with levels of socio-economic development, individual and household characteristics and community fertility norms, in influencing individual reproductive behavior at very young ages.Kenya, gravidanze adolescenziali, salute materna, strutture sanitarie, modelli multilivello Kenya, teenage pregnancy, maternal health, health facilities, multilevel modelling, millennium development goals

Adolescent childbearing experiences in Kenya : geographical and socioeconomic determinants

Sub-Saharan Africa has one of the highest level of teenage pregnancies in the world. Some studies on this topic highlight the presence of unmet reproductive health needs of adolescent in different regions. Improving maternal health has been established as a key development priority among the Millennium Development Goals, and upgrading reproductive and maternal health is usually associated with the eradication of inequality and poverty and with the presence of health care programs and services devoted to girls’ education. We attempt to investigate the geographical and socioeconomic determinants of both teenage pregnancies and maternal health behaviours among adolescent women in Kenya. We ascertain the influence of the availability of health care facilities mainly oriented to the specific needs of reproductive health. Main data are represented by 2003 Kenyan Demographic and Health Survey. In addition, the DHS data set collects Global Positioning System locators for each of the primary sampling units included in the samples that enable a deep geographical analysis. We perform a multivariate multilevel analysis to estimate the influence that individual, household, and community-level factors have on the risk of adolescent childbearing. Additionally, a spatial component allows for the presence and proximity of maternal health services. We expect that the availability of reproductive health facilities acts together with levels of socio-economic development, individual and household characteristics and community fertility norms, in influencing individual reproductive behavior at very young ages

Geospatial modeling of child mortality across 27 countries in Sub-Saharan Africa

Preventable mortality of children has been targeted as one of the UN’s Sustainable Development Goals for the 2015-30 period. Global decreases in child mortality (4q1) have been seen, although sub-Saharan Africa remains an area of concern, with child mortality rates remaining high relative to global averages or even increasing in some cases. Furthermore, the spatial distribution of child mortality in sub-Saharan Africa is highly heterogeneous. Thus, research that identifies primary risk factors and protective measures in the geographic context of sub-Saharan Africa is needed. In this study, household survey data collected by The Demographic and Health Surveys (DHS) Program aggregated at DHS sub-national area scale are used to evaluate the spatial distribution of child mortality (age 1 to 4) across 27 sub-Saharan Africa countries in relation to a number of demographic and health indicators collected in the DHS surveys. In addition, this report controls for spatial variation in potential environmental drivers of child mortality by modeling it against a suite of geospatial datasets. These datasets vary across the study area in an autoregressive spatial model that accounts for the spatial autocorrelation present in the data. This study shows that socio-demographic factors such as birth interval, stunting, access to health facilities and literacy, along with geospatial factors such as prevalence of Plasmodium falciparum malaria, variety of ethnic groups, mean temperature, and intensity of lights at night can explain up to 60% of the variance in child mortality across 255 DHS sub-national areas in the 27 countries. Additionally, three regions - Western, Central, and Eastern Africa - have markedly different mortality rates. By identifying the relative importance of policy-relevant socio-demographic and environmental factors, this study highlights priorities for research and programs targeting child mortality over the next decade. <br/

Reproduction and maternal health care among young women in Kenya: geographic and socio-economic determinants

Many factors influence the propensity of young women to seek appropriate maternal healthcare, and they need to be considered when analyzing these women’s reproductive behavior. This study aimed to contribute to the analysis concerning Kenyan young women’s determinants on maternal healthcare-seeking behavior for the 5 years preceding the 2008/9 Kenya Demographic and Health Survey. The specific objectives were to: investigate the individual and contextual variables that may explain maternal healthcare habits; measure the individual, household and community effect on maternal healthcare attitudes in young women; assess the link between young women’s characteristics and the use of facilities for maternal healthcare; find a relationship between young women’s behavior and the community where they live; examine how the role of the local presence of healthcare facilities influences reproductive behavior, and if the specificity of services offered by healthcare facilities affects their inclination to use healthcare facilities, and measure the geographic differences that influence the propensity to seek appropriate maternal healthcare. The analysis of factors associated with maternal healthcare-seeking behavior for young women in Kenya was investigated using multilevel models. We performed three major analyses, which concerned the individual and contextual determinants influencing antenatal care (discussed in Part 6), delivery care (Part 7), and postnatal care (Part 8). Our results show that there is a significant variation in antenatal, delivery and postnatal care between communities, even if the majority of variability is explained by individual characteristics. There are differences at the women’s level on the probability of receiving antenatal care and delivering in a healthcare facility instead of at home. Moreover, community factors and availability of healthcare facilities on the territory are also crucial in influencing young women’s behavior. Therefore, policies addressed to youth’s reproductive health should also consider geographic inequalities and different types of barriers in access to healthcare facilities

Mapping out-of-school adolescents and youths in low- and middle-income countries

Education is a human right and a driver of development, but, is still not accessible for a vast number of adolescents and school-age-youths. Out-of-school adolescents and youth rates (SDG 4.3.1) in lower and middle-income countries have been at a virtual halt for almost a decade. Thus, there is an increasing need to understand geographic variation on accessibility and school attendance to aid in reducing inequalities in education. Here, the aim was to estimate physical accessibility and secondary school non-attendance amongst adolescents and school-age youths in Tanzania, Cambodia, and the Dominican Republic. Community cluster survey data were triangulated with the spatial location of secondary schools, non-proprietary geospatial data and fine-scale population maps to estimate accessibility to all levels of secondary school education and the number of out-of-school. School attendance rates for the three countries were derived from nationally representative household survey data, and a Bayesian model-based geostatistical framework was used to estimate school attendance at high resolution. Results show a sub-national variation in accessibility and secondary school attendance rates for the three countries considered. Attendance was associated with distance to the nearest school (R2 &gt; 70%). These findings suggest increasing the number of secondary schools could reduce the long-distance commuted to school in low-income and middle-income countries. Future work could extend these findings to fine-scale optimisation models for school location, intervention planning, and understanding barriers associated with secondary school non-attendance at the household level

Treatment-seeking behaviour in low- and middle-income countries estimated using a Bayesian model

Background: Seeking treatment in formal healthcare for uncomplicated infections is vital to combating disease in low- and middle-income countries (LMICs). Healthcare treatment-seeking behaviour varies within and between communities and is modified by socio-economic, demographic, and physical factors. As a result, it remains a challenge to quantify healthcare treatment-seeking behaviour using a metric that is comparable across communities. Here, we present an application for transforming individual categorical responses (actions related to fever) to a continuous probabilistic estimate of fever treatment for one country in Sub-Saharan Africa (SSA).Methods: Using nationally representative household survey data from the 2013 Demographic and Health Survey (DHS) in Namibia, individual-level responses (n = 1138) were linked to theoretical estimates of travel time to the nearest public or private health facility. Bayesian Item Response Theory (IRT) models were fitted via Markov Chain Monte Carlo (MCMC) simulation to estimate parameters related to fever treatment and estimate probability of treatment for children under five years. Different models were implemented to evaluate computational needs and the effect of including predictor variables such as rurality. The mean treatment rates were then estimated at regional level.Results: Modelling results suggested probability of fever treatment was highest in regions with relatively high incidence of malaria historically. The minimum predicted threshold probability of seeking treatment was 0.3 (model 1: 0.340; 95% CI 0.155–0.597), suggesting that even in populations at large distances from facilities, there was still a 30% chance of an individual seeking treatment for fever. The agreement between correctly predicted probability of treatment at individual level based on a subset of data (n = 247) was high (AUC = 0.978), with a sensitivity of 96.7% and a specificity of 75.3%.Conclusion: We have shown how individual responses in national surveys can be transformed to probabilistic measures comparable at population level. Our analysis of household survey data on fever suggested a 30% baseline threshold for fever treatment in Namibia. However, this threshold level is likely to vary by country or endemicity. Although our focus was on fever treatment, the methodology outlined can be extended to multiple health seeking behaviours captured in routine national survey data and to other infectious diseases.<br/

Understanding factors associated with attending secondary school in Tanzania using household survey data

Background Sustainable Development Goal (SDG) 4 aims to ensure inclusive and equitable access for all by 2030, leaving no one behind. One indicator selected to measure progress towards achievement is the participation rate of youth in education (SDG 4.3.1). Here we aim to understand drivers of school attendance using one country in East Africa as an example. Methods Nationally representative household survey data (2015–16 Tanzania Demographic and Health Survey) were used to explore individual, household and contextual factors associated with secondary school attendance in Tanzania. These included, age, head of household’s levels of education, gender, household wealth index and total number of children under five. Contextual factors such as average pupil to qualified teacher ratio and geographic access to school were also tested at cluster level. A two-level random intercept logistic regression model was used in exploring association of these factors with attendance in a multi-level framework. Results Age of household head, educational attainments of either of the head of the household or parent, child characteristics such as gender, were important predictors of secondary school attendance. Being in a richer household and with fewer siblings of lower age (under the age of 5) were associated with increased odds of attendance (OR = 0.91, CI 95%: 0.86; 0.96). Contextual factors were less likely to be associated with secondary school attendance. Conclusions Individual and household level factors are likely to impact secondary school attendance rates more compared to contextual factors, suggesting an increased focus of interventions at these levels is needed. Future studies should explore the impact of interventions targeting these levels. Policies should ideally promote gender equality in accessing secondary school as well as support those families where the dependency ratio is high. Strategies to reduce poverty will also increase the likelihood of attending school.</p

Treatment-seeking behaviour in low- and middle-income countries estimated using a Bayesian model

Background Seeking treatment in formal healthcare for uncomplicated infections is vital to combating disease in low- and middle-income countries (LMICs). Healthcare treatment-seeking behaviour varies within and between communities and is modified by socio-economic, demographic, and physical factors. As a result, it remains a challenge to quantify healthcare treatment-seeking behaviour using a metric that is comparable across communities. Here, we present an application for transforming individual categorical responses (actions related to fever) to a continuous probabilistic estimate of fever treatment for one country in Sub-Saharan Africa (SSA). Methods Using nationally representative household survey data from the 2013 Demographic and Health Survey (DHS) in Namibia, individual-level responses (n = 1138) were linked to theoretical estimates of travel time to the nearest public or private health facility. Bayesian Item Response Theory (IRT) models were fitted via Markov Chain Monte Carlo (MCMC) simulation to estimate parameters related to fever treatment and estimate probability of treatment for children under five years. Different models were implemented to evaluate computational needs and the effect of including predictor variables such as rurality. The mean treatment rates were then estimated at regional level. Results Modelling results suggested probability of fever treatment was highest in regions with relatively high incidence of malaria historically. The minimum predicted threshold probability of seeking treatment was 0.3 (model 1: 0.340; 95% CI 0.155–0.597), suggesting that even in populations at large distances from facilities, there was still a 30% chance of an individual seeking treatment for fever. The agreement between correctly predicted probability of treatment at individual level based on a subset of data (n = 247) was high (AUC = 0.978), with a sensitivity of 96.7% and a specificity of 75.3%. Conclusion We have shown how individual responses in national surveys can be transformed to probabilistic measures comparable at population level. Our analysis of household survey data on fever suggested a 30% baseline threshold for fever treatment in Namibia. However, this threshold level is likely to vary by country or endemicity. Although our focus was on fever treatment, the methodology outlined can be extended to multiple health seeking behaviours captured in routine national survey data and to other infectious diseases

Reproductive, maternal, newborn, child, and adolescent health and development indicators at district level for 2015-16 India, version 1.0

Reproductive, maternal, newborn, child, and adolescent health and development indicators at district level for 2015-16 India. Version 1.0. </span

Geostatistical tools to map the interaction between development aid and indices of need

In order to meet and assess progress towards global sustainable development goals (SDGs), an improved understanding of geographic variation in population wellbeing indicators such as health status, wealth and access to resources is crucial, as the equitable and efficient allocation of international aid relies on knowing where funds are needed most. Unfortunately, in many low-income countries, detailed, reliable and timely information on the spatial distribution and characteristics of intended aid recipients are rarely available. Furthermore, lack of information on the past distribution of aid relative to need also hinders assessments of the impacts of aid. High-resolution data on key social and health indicators, as well as how aid distribution relates to these indicators are therefore fundamental for targeting limited resources and building on past efforts.In this study, we show how modern statistical approaches combined with a new geographic database of aid distribution can be used to map the distribution of indicators with a level of detail that can support geographically stratified decision-making. Based on geo-located survey data from Demographic and Health Surveys (DHS) in Nigeria (2008 - 2013) and Nepal (2006 - 2011), Bayesian geostatistical models and machine learning approaches were used in combination with a suite of spatial data layers to create high-resolution predictive maps for (i) the rates of stunting in children under the age of five and (ii) the household wealth index. An ensemble model was also exploited for aggregating different modelling results to improve the modelling prediction capacity in Nigeria (for stunting 2008). By combining these maps with information on the disbursement of aid for increasing food security and alleviating poverty (AidData database - http://aiddata.org/), we quantified both the reported spatial distribution of aid relative to stunting and poverty, as well as how changes in these indices overtime related to aid disbursement. While many cases of aid disbursement lacked detailed spatial information, the results here demonstrate the potential of this approach and highlight the value of spatially disaggregated data on the distribution of aid.<br/