Contraception needs and pregnancy termination in sub-Saharan Africa: a multilevel analysis of demographic and health survey data

Background: Women in sub-Saharan Africa (SSA) have a higher risk of unintended pregnancies that are more likely to be terminated, most of which are unsafe with associated complications. Unmet need for contraception is highest in SSA and exceeds the global average. This study investigates the association between unmet/met need for contraception and pregnancy termination SSA. Methods: We used pooled data from Demographic and Health Surveys conducted from January 2010 to December 2018 in 32 countries in SSA. Our study involved 265,505 women with diverse contraception needs and with complete data on all variables of interest. Multilevel logistic regression at 95% CI was used to investigate the association between individual and community level factors and pregnancy termination. Results: We found an overall pregnancy termination rate of 16.27% ranging from 9.13% in Namibia to 38.68% in Gabon. Intriguingly, women with a met need for contraception were more likely to terminate a pregnancy [aOR = 1.11; 95% CI 1.07–1.96] than women with unmet needs. Women with secondary education were more likely to terminate a pregnancy as compared to those without education [aOR = 1.23; 95% CI 1.19–1.27]. With regards to age, we observed that every additional age increases the likelihood of terminating a pregnancy. At the contextual level, the women with female household heads were less likely to terminate a pregnancy [aOR = 0.95; 95% CI 0.92–0.97]. The least socio-economically disadvantaged women were less likely to terminate a pregnancy compared to the moderately and most socio-economically disadvantaged women. Conclusions: Our study contributes towards the discussion on unmet/met need for contraception and pregnancy termination across SSA. Women with met need for contraception have higher odds of terminating a pregnancy. The underlying cause of this we argued could be poor adherence to the protocols of contraceptives or the reluctance of women to utilise contraceptives after experiencing a failure. Governments of SSA and non-governmental organisations need to take pragmatic steps to increase met needs for contraception and also utilise mass media to encourage women to adhere to the prescription of contraceptives in order to reduce the incidence of unplanned pregnancies and unsafe abortions

The global burden of tuberculosis: results from the Global Burden of Disease Study 2015

Background: An understanding of the trends in tuberculosis incidence, prevalence, and mortality is crucial to tracking of the success of tuberculosis control programmes and identification of remaining challenges. We assessed trends in the fatal and non-fatal burden of tuberculosis over the past 25 years for 195 countries and territories. Methods: We analysed 10 691 site-years of vital registration data, 768 site-years of verbal autopsy data, and 361 site-years of mortality surveillance data using the Cause of Death Ensemble model to estimate tuberculosis mortality rates. We analysed all available age-specific and sex-specific data sources, including annual case notifications, prevalence surveys, and estimated cause-specific mortality, to generate internally consistent estimates of incidence, prevalence, and mortality using DisMod-MR 2.1, a Bayesian meta-regression tool. We assessed how observed tuberculosis incidence, prevalence, and mortality differed from expected trends as predicted by the Socio-demographic Index (SDI), a composite indicator based on income per capita, average years of schooling, and total fertility rate. We also estimated tuberculosis mortality and disability-adjusted life-years attributable to the independent effects of risk factors including smoking, alcohol use, and diabetes. Findings: Globally, in 2015, the number of tuberculosis incident cases (including new and relapse cases) was 10·2 million (95% uncertainty interval 9·2 million to 11·5 million), the number of prevalent cases was 10·1 million (9·2 million to 11·1 million), and the number of deaths was 1·3 million (1·1 million to 1·6 million). Among individuals who were HIV negative, the number of incident cases was 8·8 million (8·0 million to 9·9 million), the number of prevalent cases was 8·9 million (8·1 million to 9·7 million), and the number of deaths was 1·1 million (0·9 million to 1·4 million). Annualised rates of change from 2005 to 2015 showed a faster decline in mortality (–4·1% [–5·0 to –3·4]) than in incidence (–1·6% [–1·9 to –1·2]) and prevalence (–0·7% [–1·0 to –0·5]) among HIV-negative individuals. The SDI was inversely associated with HIV-negative mortality rates but did not show a clear gradient for incidence and prevalence. Most of Asia, eastern Europe, and sub-Saharan Africa had higher rates of HIV-negative tuberculosis burden than expected given their SDI. Alcohol use accounted for 11·4% (9·3–13·0) of global tuberculosis deaths among HIV-negative individuals in 2015, diabetes accounted for 10·6% (6·8–14·8), and smoking accounted for 7·8% (3·8–12·0). Interpretation: Despite a concerted global effort to reduce the burden of tuberculosis, it still causes a large disease burden globally. Strengthening of health systems for early detection of tuberculosis and improvement of the quality of tuberculosis care, including prompt and accurate diagnosis, early initiation of treatment, and regular follow-up, are priorities. Countries with higher than expected tuberculosis rates for their level of sociodemographic development should investigate the reasons for lagging behind and take remedial action. Efforts to prevent smoking, alcohol use, and diabetes could also substantially reduce the burden of tuberculosis

Age differences and protected first heterosexual intercourse in Ghana

Age differences between partners, where females are relatively younger than their male partners, can negatively affect power dynamics and subsequent negotiations for safe sex practices with implications on unplanned pregnancies and STIs transmission. This paper examines the effects of age differentials on condom use at first sex. Using a weighted sample of 925 women drawn from the fifth round of Ghana Demographic and Health Survey and applying complementary log-log model, the probability of first sex being protected vis-à-vis partner age differences are estimated. The results suggest that females’ being ten or more yearsyounger than their male partners at first sex was a significant indicator of non-protection while at age intervals 1-4 and 5-9 years, the probability of protected sex inflates significantly. The results demonstrate that large age disparities between partners pose a significant barrier to protection during first sex and strategies have to be developed to altering wrong perceptions associated with intergenerational sex, particularly, in settings such as Africa where gerontocratic tendencies pervade not only social relationshipsbut sexual as well. (Afr J Reprod Health 2012; 16[4]: 58-67)

Women's Health Decision-Making Autonomy and Skilled Birth Attendance in Ghana.

Delivering in health facility under the supervision of skilled birth attendant is an important way of mitigating impacts of delivery complications. Empirical evidence suggests that decision-making autonomy is aligned with holistic wellbeing especially in the aspect of maternal and child health. The objective of this paper was to examine the relationship between women's health decision-making autonomy and place of delivery in Ghana. We extracted data from the 2014 Ghana Demographic and Health Survey. Descriptive and logistic regression techniques were applied. The results indicated that women with health decision-making autonomy have higher tendency of health facility delivery as compared to those who are not autonomous [OR = 1.27, CI = 1.09-1.48]. However, those who have final say on household large purchases [OR = 0.71, CI = 0.59-0.84] and those having final say on visits [OR = 0.86, CI = 0.73-1.01] were less probable to deliver in health facility than those without such decision-making autonomy. Consistent with existing evidence, wealthier, urban, and highly educated women had higher inclination of health facility delivery. This study has stressed the need for interventions aimed at enhancing health facility delivery to target women without health decision-making autonomy and women with low education and wealth status, as this can play essential role in enhancing health facility delivery

Decision-Making for Induced Abortion in the Accra Metropolis, Ghana

AbstractDecision-making for induced abortion can be influenced by various circumstances including those surrounding onset of a pregnancy. There are various dimensions to induced abortion decision-making among women who had an elective induced abortion in a cosmopolitan urban setting in Ghana, which this paper examined. A cross-sectional mixed method study was conducted between January and December 2011 with 401 women who had undergone an abortion procedure in the preceding 12 months. Whereas the quantitative data were analysed with descriptive statistics, thematic analysis was applied to the qualitative data. The study found that women of various profiles have different reasons for undergoing abortion. Women considered the circumstances surrounding onset of pregnancy, person responsible for the pregnancy, gestational age at decision to terminate, and social, economic and medical considerations. Pressures from partners, career progression and reproductive intentions of women reinforced these reasons. First time pregnancies were mostly aborted regardless of gestational ages and partners’ consent. Policies and programmes targeted at safe abortion care are needed to guide informed decisions on induced abortions. Keywords: Induced abortion; decision-making; GhanaRésuméLa prise de décision pour l'avortement provoqué peut être influencée par diverses circonstances, y compris ceux qui entourent le début d'une grossesse. Cette étude a examine les différentes dimensions concernant la prise de décision sur l'avortement provoqué chez les femmes qui ont eu un avortement provoqué élective dans un milieu urbain cosmopolite au Ghana, ce qui fait l’objet d’étude dans cet article. Nous avons mené une étude transversale de méthode mixte entre janvier et décembre 2011 auprès de 401 femmes qui avaient subi un avortement au cours des 12 mois précédents. Considérant que les données quantitatives ont été analysées avec des statistiques chi-carré descriptives, l’analyse thématique a été appliquée aux données qualitatives. L'étude a révélé que les femmes de divers profils ont différentes raisons de subir un avortement. Les femmes ont considéré les circonstances qui entourent le debut de la grossesse, la personne responsable de la grossesse, l'âge gestationnel au moment de la prise de l’avorter, et les considérations sociales, économiques et médicales. Les pressions exercées par les partenaires, la progression de carrière et les intentions de procréation des femmes ont renforcé ces raisons. Les toutes premières grossesses étaient pour la plupart abandonnées sans tenir compte de l'âge gestationnel et le consentement des partenaires. Il faut des politiques et des programmes qui ont comme cibles les services d'avortement médicalisé pour guider des décisions éclairées sur les avortements provoqués.Mots-clés: avortement provoqué, prise de décision, Ghan