Socio-demographic risk factors for unintended pregnancy among unmarried adolescent Nigerian girls

BACKGROUND : Globally, unintended births among unmarried adolescent girls are a major contributor to maternal and childhood mortality, the vicious cycle of ill-health, poverty, and truncated educational opportunities. Nigeria has the highest rates of adolescent fertility in sub-Saharan Africa. Over 900 000 births to adolescents occur annually and 150 out of every 1000 women who give birth in Nigeria are 19 years old or under. OBJECTIVE : To document and investigate socio-demographic risk factors for unintended pregnancy among unmarried adolescent Nigerian girls. METHODS : Data for this study were drawn from the 2008 Nigeria Demographic and Health Survey. Univariate and multivariate statistical analyses were used to assess the relationship between adolescent pregnancy and socio-demographic contextual factors focusing on sex and age of household head, adolescent girls’ age, and educational attainment, place of residence, religious affiliation, and household wealth index. All data were analysed using STATA Version 11. RESULTS : Non-pregnant adolescents had older household heads; such households were wealthy, and parents of such households had higher educational standing. Female-headed households were less likely to experience unwanted adolescent pregnancy compared to those of the reference group category (OR = 0.56, 95% CI = 0.3920–0.8073). CONCLUSION : There is a significant relationship between age and sex of household head and risk of unintended adolescent pregnancy among unmarried adolescent girls. Adolescent girls from households headed by young adults are more likely to experience adolescent pregnancy compared to adolescent girls from households headed by older adults.http://medpharm.tandfonline.com/loi/ojfp20am201

Single motherhood and neonatal and infant mortality in Sierra Leone, Burkina Faso and Burundi

BACKGROUND : Childhood mortality is a stubborn problem and remains highest in Sub-Saharan Africa (SSA). Existing research on childhood mortality in SSA indicate that most of the childhood deaths are from preventable causes such as diarrhoea, pneumonia, measles, malaria, HIV and underlying malnutrition, acute respiratory infections, whooping cough, tuberculosis, bronchopneumonia, dirty feeding bottles and utensils, inadequate disposal of household refuse and poor storage of drinking water. However, insufficient attention has been given to maternal marital status and childhood mortality relationships. Understanding the implications of maternal marital status for childhood mortality can add to our knowledge of the correlates of neonatal and infant mortality and furnish insights to support the design and delivery of interventions to address the problem. OBJECTIVE : To document and examine the extent to which the association between neonatal and infant mortality varies between single and ever-married mothers in Sierra Leone, Burkina Faso, and Burundi. A single mother is defined in this study as a woman who has either lived with a partner, married before, widowed, separated during the survey periods and has given at least one life birth. Ever-married woman is woman who has been married at least once in their lives although their current marital status may not be married. STUDY DESIGN : Data for this study were drawn from the latest Demographic and Health Surveys (DHS) in Burkina Faso, Sierra Leone and Burundi. The selected datasets came from 2010 Burkina Faso DHS (BFDHS), 2008 Sierra Leone DHS (SLDHS) and 2010 Burundi DHS (EDSB II). METHODS : The relevant data for this study (women age 15-49 years who had at least one live birth within the five years preceding the survey) were extracted from the whole dataset of each country (Burkinabe (n = 17,087), Sierra Leonean (n = 7374) and Burundian (n = 9389). Univariate and multivariate statistical analyses were used to assess the association between neonatal and infant mortality and maternal marital status. All data were analysed using STATA Version 11. RESULTS : The multivariate logistic regression analyses yielded significantly increased risk of neonatal and infant mortality among single mothers. CONCLUSIONS : Neonates and infants of single mothers are at increased risk of neonatal and infant mortality compared to those of ever-married women.http://www.elsevier.com/puhe2017-06-30hb2016Sociolog

The Shifting Roles of Men in Collective Action on SGBV in Kenya: Report of a Movement and Influence Mapping Workshop, Nairobi, 3–5 July 2013

Over a decade and a half on from the landmark declarations of the Cairo International Conference on Population and Development (UN 1994) and the Fourth World Conference on Women in Beijing (UN 1995), there is now a growing consensus on the importance of engaging men and boys in efforts to stop violence against women and girls. Kenya’s 2008/09 Demographic and Health Survey indicated that 45 per cent of women aged 15–49 had experienced either physical or sexual violence — mostly committed by their husbands or partners. Some of the causes behind the prevalence of sexual and gender-based violence (SGBV) in Kenya include traditional gender norms that support male superiority and entitlement, social norms that tolerate or justify violence against women, and weak community sanctions against perpetrators. While SGBV has been a feature of all societies throughout history, in Kenya women and girls suffered increased incidences of sexual violence in 2007-08 following accusations that the government manipulated the election process. This plunged the country into turmoil, with Kenya spiralling into a political, economic and humanitarian crisis that resulted in the death of 1,300 people and the displacement of around 300,000 people (Muhula 2009). In order to improve our understanding and knowledge of shifting roles of men in movements to address SGBV through collective action in Kenya, Men for Gender Equality Now (MEGEN), the African Population and Health Research Center (APHRC) and the Institute of Development Studies (IDS) joined together to engage with multiple actors in Kenya for collective learning through this workshop.UK Department for International Developmen

Building capacity for public and population health research in Africa : the consortium for advanced research training in Africa (CARTA) model

Background: Globally, sub-Saharan Africa bears the greatest burden of disease. Strengthened research capacity to understand the social determinants of health among different African populations is key to addressing the drivers of poor health and developing interventions to improve health outcomes and health systems in the region. Yet, the continent clearly lacks centers of research excellence that can generate a strong evidence base to address the region’s socio-economic and health problems. Objective and program overview: We describe the recently launched Consortium for Advanced Research Training in Africa (CARTA), which brings together a network of nine academic and four research institutions from West, East, Central, and Southern Africa, and select northern universities and training institutes. CARTA’s program of activities comprises two primary, interrelated, and mutually reinforcing objectives: to strengthen research infrastructure and capacity at African universities; and to support doctoral training through the creation of a collaborative doctoral training program in population and public health. The ultimate goal of CARTA is to build local research capacity to understand the determinants of population health and effectively intervene to improve health outcomes and health systems. Conclusions: CARTA’s focus on the local production of networked and high-skilled researchers committed to working in sub-Saharan Africa, and on the concomitant increase in local research and training capacity of African universities and research institutes addresses the inability of existing programs to create a critical mass of well-trained and networked researchers across the continent. The initiative’s goal of strengthening human resources and university-wide systems critical to the success and sustainability of research productivity in public and population health will rejuvenate institutional teaching, research, and administrative systems

Capacity development for health research in Africa: experiences managing the African Doctoral Dissertation Research Fellowship Program

Africa's progress depends on her capacity to generate, adapt, and use scientific knowledge to meet regional health and development needs. Yet, Africa's higher education institutions that are mandated to foster this capacity lack adequate resources to generate and apply knowledge, raising the need for innovative approaches to enhance research capacity. In this paper, we describe a newly-developed program to support PhD research in health and population sciences at African universities, the African Doctoral Dissertation Research Fellowship (ADDRF) Program. We also share our experiences implementing the program. As health research capacity-strengthening in Africa continues to attract attention and as the need for such programs to be African-led is emphasized, our experiences in developing and implementing the ADDRF offer invaluable lessons to other institutions undertaking similar initiatives

Gender-based violence and its association with mental health among Somali women in a Kenyan refugee camp: a latent class analysis

BACKGROUND: In conflict-affected settings, women and girls are vulnerable to gender-based violence (GBV). GBV is associated with poor long-term mental health such as anxiety, depression and post-traumatic stress disorder (PTSD). Understanding the interaction between current violence and past conflict-related violence with ongoing mental health is essential for improving mental health service provision in refugee camps. METHODS: Using data collected from 209 women attending GBV case management centres in the Dadaab refugee camps, Kenya, we grouped women by recent experience of GBV using latent class analysis and modelled the relationship between the groups and symptomatic scores for anxiety, depression and PTSD using linear regression. RESULTS: Women with past-year experience of intimate partner violence alone may have a higher risk of depression than women with past-year experience of non-partner violence alone (Coef. 1.68, 95% CI 0.25 to 3.11). Conflict-related violence was an important risk factor for poor mental health among women who accessed GBV services, despite time since occurrence (average time in camp was 11.5 years) and even for those with a past-year experience of GBV (Anxiety: 3.48, 1.85-5.10; Depression: 2.26, 0.51-4.02; PTSD: 6.83, 4.21-9.44). CONCLUSION: Refugee women who experienced past-year intimate partner violence or conflict-related violence may be at increased risk of depression, anxiety or PTSD. Service providers should be aware that compared to the general refugee population, women who have experienced violence may require additional psychological support and recognise the enduring impact of violence that occurred before, during and after periods of conflict and tailor outreach and treatment services accordingly

Gender-related power differences, beliefs and reactions towards people living with HIV/AIDS: an urban study in Nigeria

<p>Abstract</p> <p>Background</p> <p>Although there are an increasing number of studies on HIV-related stigma in Nigeria, very little research has focused on how power differences based on gender perpetuate the stigmatization of people living with HIV/AIDS (PLWHA) and how these gender differences affect the care that PLWHA receive in health care institutions. We explore gender-related beliefs and reactions of society, including health care professionals (HCPs), with regard to PLWHA, using Connell's theoretical framework of gender and power (1987). With Connell's structural theory of gender and power (financial inequality, authority and structure of social norms), we can describe gender differences in stigmatization of PLWHA.</p> <p>Method</p> <p>We conducted in-depth semi-structured interviews, lasting 60 to 90 minutes, with 100 persons (40 members of the general public, 40 HCPs and 20 PLWHA) in Port Harcourt, Nigeria. The interviews were tape-recorded and transcribed verbatim. The Nvivo 7 computer package was used to analyze the data.</p> <p>Results</p> <p>There are similarities and differences between the general public and HCPs towards PLWHA in gender-related beliefs and reactions. For instance, although association with promiscuity and power differences were commonly acknowledged in the different groups, there are differences in how these reactions are shown; such as HCPs asking the female PLWHA to inform their partners to ensure payment of hospital bills. Women with HIV/AIDS in particular are therefore in a disadvantaged position with regard to the care they receive.</p> <p>Conclusion</p> <p>Despite the fact that men and women with HIV/AIDS suffer the same illness, clear disparities are apparent in the negative reaction women and men living with HIV/AIDS experience in society. We show that women's generally low status in society contributes to the extreme negative reactions to which female PLWHA are subject. The government should create policies aimed at reducing the power differences in family, society and health care systems, which would be important to decrease the gender-related differences in stigma experienced by PLWHA. Interventions should be directed at the prevailing societal norms through appropriate legislation and advocacy at grassroots level with the support of men to counter laws that put women in a disadvantaged position. Furthermore, development of a policy that encourages equality in access to health care for all patients with HIV/AIDS by applying the same conditions to both men and women in health care institutions is recommended. There is a need to protect women's rights through implementing support policies, including paying attention to gender in the training of HCPs.</p

Maternal and neonatal factors associated with mode of delivery under a universal newborn hearing screening programme in Lagos, Nigeria

<p>Abstract</p> <p>Background</p> <p>Emerging evidence from a recent pilot universal newborn hearing screening (UNHS) programme suggests that the burden of obstetric complications associated with mode of delivery is not limited to maternal and perinatal mortality but may also include outcomes that undermine optimal early childhood development of the surviving newborns. However, the potential pathways for this association have not been reported particularly in the context of a resource-poor setting. This study therefore set out to establish the pattern of delivery and the associated neonatal outcomes under a UNHS programme.</p> <p>Methods</p> <p>A cross-sectional study in which all consenting mothers who delivered in an inner-city tertiary maternity hospital in Lagos, Nigeria from May 2005 to December 2007 were enrolled during the UNHS programme. Socio-demographic, obstetric and neonatal factors independently associated with vaginal, elective and emergency caesarean deliveries were determined using multinomial logistic regression analyses.</p> <p>Results</p> <p>Of the 4615 mothers enrolled, 2584 (56.0%) deliveries were vaginal, 1590 (34.4%) emergency caesarean and 441 (9.6%) elective caesarean section. Maternal age, parity, social class and all obstetric factors including lack of antenatal care, maternal HIV and multiple gestations were associated with increased risk of emergency caesarean delivery compared with vaginal delivery. Only parity, lack of antenatal care and prolonged/obstructed labour were associated with increased risk of emergency compared with elective caesarean delivery. Infants delivered by vaginal method or by emergency caesarean section were more likely to be associated with the risk of sensorineural hearing loss but less likely to be associated with hyperbilirubinaemia compared with infants delivered by elective caesarean section. Emergency caesarean delivery was also associated with male gender, low five-minute Apgar scores and admission into special care baby unit compared with vaginal or elective caesarean delivery.</p> <p>Conclusions</p> <p>The vast majority of caesarean delivery in this population occur as emergencies and are associated with socio-demographic factors as well as several obstetric complications. Mode of delivery is also associated with the risk of sensorineural hearing loss and other adverse birth outcomes that lie on the causal pathways for potential developmental deficits.</p