A predictive model and socioeconomic and demographic determinants of under-five mortality in Sierra Leone.

Sierra Leone is among the countries that recorded high under-five child mortality rate in the world. To design and implement policies that can address this public health challenge, the present study developed a predictive model of factors that explained under-five mortality in Sierra Leone using the 2008 and 2013 Sierra Leone Demographic and Health Survey (SDHS) datasets. LASSO regression technique was used to select the predictors to build the under-five predictive single-level logit and multilevel logit models. Statistical analyses were performed in the R freeware version 3.6.1. About 588 (10.4%) and 1320 (11.1%) children under five were reported dead in 2008 and 2013, respectively. The significant predictors of under-five mortality in Sierra Leone were the total number of children ever born, number of children under five in the household, mother's birth in the last five years, mother's number of living children, and number of household members, household wealth, maternal contraceptive use and intention, number of eligible women in the household, type of toilet facility, sex of the child, and weight of the child at birth. The study identified certain predictors that deserve policy attention and interventions to strengthen the efforts of creating child welfare and survival atmosphere in Sierra Leone

Household Food Security and Child Diet in Northern Regions of Ghana: Evidence from the 2012 Ghana Feed the Future Population Baseline Survey

Background and Objectives: There is dearth of literature on the link between household food security and child feeding practices in sub-Saharan Africa. Therefore, this study investigated the relationship between level of household food security and achievement of recommended child feeding practices (minimum meal frequency, minimum dietary diversity, and minimum acceptable diet) in northern regions of Ghana. Also, the study investigated the relationship between socio-demographic characteristics and achievement of recommended complementary feeding practices. Conceptual Framework: The Model of Childcare was used as both the conceptual and analytical framework of the study. The model posits that childcare resources (food security resources, maternal resources, and infrastructure resources) exert influence on child health and development through childcare. Also, happenstances and genes in the childcare model directly influences child health and development. Context in the Model of Childcare either directly exert influence on child health and childcare or indirectly through childcare resources. Methods: Using child data from the 2012 Feed the Future baseline survey (n = 871), logistic regression was performed to assess the impact of household food security factors, maternal characteristics and contextual factors on the likelihood of 6-23 month old infants and children receiving recommended minimum meal frequency, minimum dietary diversity, and minimum acceptable diet. Results: About 36% of children were in food insecure households, and 64% of the children were in food secure households. Chi-Square test of independence indicated inadequate and adequate recommended feeding of children in both food secure and food insecure households. Children in food secure households were significantly more likely than children in food insecure households to achieve recommendations for minimum dietary diversity [O.R= 0.62; 95% CI: 0.43, 0.91] and minimum acceptable diet [O.R= 0.62; 95% CI: 0.40, 0.97]. There was no significant association between household food security status and minimum meal frequency. Compared to infants (6-11 months), children in the age groups 12-17 months [O.R=0.32; 95% CI: 0.21, 0.48] and 18-23 months [O.R= 0.18; 95% CI: 0.12, 0.29] were significantly more likely to achieve to achieve minimum dietary diversity. Also, compared to infants (6-11 months), children in the age groups 12-17 months [O.R=0.34; 95% CI: 0.21, 0.55] and 18-23 months [O.R= 0.42; 95% CI: 0.24, 0.71] were significantly more likely to achieve minimum acceptable diet. Region of residence, household size, and maternal dietary diversity were significant predictors of complementary feeding practices in the northern regions of Ghana. Discussion and Conclusions: There was a decent amount of variance accounted for in the analysis of minimum dietary diversity (.20-.30), modest for minimum acceptable diet (.09-.15) and almost nothing for minimum meal frequency (.02-.03). For minimum dietary diversity and minimum acceptable diet, the models are about the same, and household food security status has importance even accounting for every predictor variable in the models, including a powerful effect of child age. The rejoinder is that how one operationalizes child nutrition care is important; certain aspects of child feeding are significantly related to household food security status (minimum dietary diversity and minimum acceptable diet) and others are not (minimum meal frequency). While household food security was related to two measures of child feeding adequacy, there were instances of underfed children in food secure households and of well-fed children in food insecure households in northern Ghana. Also, child age is related to two measures of child feeding adequacy (minimum dietary diversity and minimum acceptable diet). Although children within the youngest age group (6-11 months) were at risk of being underfed, there were instances of inadequate and adequate recommended feeding of children across the three age groups (6-11 months, 12-17 months, and 18-23 months). The further study of these groups may shed light on how caregivers can be assisted to achieve adequate child feeding, irrespective of the household’s food security situation and the age of the child.Master of Philosophy in Health PromotionHEPRO350MPHEPR

Household food security and adequacy of child diet in the food insecure region north in Ghana

Background and objectives Adequate diet is of crucial importance for healthy child development. In food insecure areas of the world, the provision of adequate child diet is threatened in the many households that sometimes experience having no food at all to eat (household food insecurity). In the context of food insecure northern Ghana, this study investigated the relationship between level of household food security and achievement of recommended child diet as measured by WHO Infant and Young Child Feeding Indicators. Methods: Using data from households and 6–23 month old children in the 2012 Feed the Future baseline survey (n = 871), descriptive analyses assessed the prevalence of minimum meal frequency; minimum dietary diversity, and minimum acceptable diet. Logistic regression analysis was used to examine the association of minimum acceptable diet with household food security, while accounting for the effects of child sex and age, maternal -age, -dietary diversity, -literacy and -education, household size, region, and urban-rural setting. Household food security was assessed with the Household Hunger Scale developed by USAID’s Food and Nutrition Technical Assistance Project. Results: Forty-nine percent of children received minimum recommended meal frequency, 31% received minimum dietary diversity, and 17% of the children received minimum acceptable diet. Sixty-four percent of the children lived in food secure households, and they were significantly more likely than children in food insecure households to receive recommended minimum acceptable diet [O.R = 0.53; 95% CI: 0.35, 0.82]. However, in 80% of food secure households, children did not receive a minimal acceptable diet by WHO standards. Conclusions Children living in food secure households were more likely than others to receive a minimum acceptable diet. Yet living in a food secure household was no guarantee of child dietary adequacy, since eight of 10 children in food secure households received less than a minimum acceptable diet. The results call for research into factors besides household food security in the search for determinants of child diet adequacy. In this study at least, household food security was a very weak marker of child diet adequacy. This finding is of significance to public health practice, since it calls into question any assumption that having enough food in a household necessarily results in adequately fed children.publishedVersio

Cervical cancer screening prevalence and its correlates in Cameroon: secondary data analysis of the 2018 demographic and health surveys

BackgroundCervical cancer, although preventable, is the fourth most common cancer among women globally, and the second most common and deadliest gynaecological cancer in low-and-middle-income countries. Screening is key to the prevention and early detection of the disease for treatment. A few studies estimated the prevalence of cervical cancer screening and its correlates in Cameroon but relied on data that were limited to certain regions of the country. Therefore, this study sought to examine the prevalence and correlates of cervical cancer screening among Cameroonian women using current data that is nationally representative of reproductive-age women.MethodsWe used secondary data from the 2018 Cameroon Demographic and Health Survey. Summary statistics were used for the sample description. We employed the Firth logistic regression using the "firthlogit" command in STATA-14 to perform the bivariate analyses between the outcome variable and each of the explanatory variables. Given that all the explanatory variables were statistically significant correlates, they were all adjusted for in a multivariable analysis. All analyses were performed in STATA version 14.ResultsThe proportion of Cameroonian women who have ever screened for cervical cancer continue to remain low at approximately 4%. In the adjusted model, women with the following sociodemographic characteristics have a higher likelihood of undergoing cervical cancer screening: ever undergone HIV screening (AOR = 4.446, 95% CI: 2.475, 7.986), being 24-34 years (AOR = 2.233, 95% CI: 1.606, 3.103) or 35-44 years (AOR = 4.008, 95% CI: 2.840, 5.657) or at least 45 years old (AOR = 5.895, 95% CI: 3.957, 8.784), having attained a post-secondary education (AOR = 1.849, 95% CI: 1.032, 3.315), currently (AOR = 1.551, 95% CI: 1.177, 2.043) or previously married (AOR = 1.572, 95% CI: 1.073, 2.302), dwelling in the richest household (AOR = 4.139, 95% CI: 1.769, 9.682), and residing in an urban area (AOR = 1.403, 95% CI: 1.004,1.960). Except for the North-West region, residing in some five regions, compared to Yaounde, was negatively associated with cervical cancer screening.ConclusionCervical cancer screening programs and policies should target Cameroonian women who are younger, less educated, and those in poor households and rural areas

Covariates and Spatial Interpolation of HIV Screening in Mozambique:Insight from the 2015 AIDS Indicator Survey

We examined the factors associated with human immunodeficiency virus (HIV) screening and developed a HIV screening prevalence surface map using spatial interpolation techniques to identify the geographical areas with the highest and lowest rates of HIV screening in Mozambique. We analyzed the cross-sectional 2015 Mozambique AIDS Indicator Surveys with an analytic sample of 12,995 participants. Analyses were conducted on SPSS-21, STATA-14, and R freeware 3.5.3. We adjusted for the sample design and population weights. Results indicated that 52.5% of Mozambicans had undergone HIV screening. Mozambicans with these characteristics have a higher probability of undergoing HIV screening: females, those with a primary education or higher, urban dwellers, residents of wealthy households, having at least one lifetime sexual partner, and dwelling in these provinces—Niassa, Tete, Manica, Sofala, Inhambane, Gaza, Maputo Provincia, and Maputo Cidade. The spatial map revealed that the national and regional estimates mask sub-regional level estimates. Generally, zones with the highest HIV screening prevalence are found in southern provinces while the lowest prevalence was found in the northern provinces. The map further revealed intraregional differences in HIV screening estimates. We recommend that HIV screening be expanded, with equitable screening resource allocations that target more nuanced areas within provinces which have a low HIV screening prevalence

Prevalence and sociodemographic factors associated with vision difficulties in Ghana, Gambia, and Togo: a multi-country analysis of recent multiple Indicator cluster surveys

Background: The sense of sight is one of the important human sensory abilities that is required for independent functioning and survival. The highest burden of sight-related problems is recorded in low-and middle-income countries, especially in sub-Saharan Africa. Despite the burden, nationally representative analyses to understand the prevalence and determinants of vision difficulties are hard to find. Therefore, this study addressed this knowledge gap by estimating the prevalence of vision difficulties and its correlates in gender-stratified models in three West African countries: Ghana, Gambia, and Togo. Methods: The study used the most recent Multiple Indicator Cluster Surveys of Ghana (2017–2018), Gambia (2018), and Togo (2017). Summary statistics were used to describe the participants and logistic regression was used to perform the bivariate and multivariate analyses. The analyses were performed using Stata version 14 and the complex survey design of the datasets was accounted for using the ‘svyset’ command. Results: Gendered differences were observed for vision difficulties. More women than men reported vision difficulties in Ghana (men: 14.67% vs women: 23.45%) and Togo (men: 14.86% vs women: 23.61%), but more men than women reported vision difficulties in Gambia (men: 11.64% vs women: 9.76%). We also observed gender differences in how age, education, marital status, and region of residence were significantly associated with reported vision difficulties. The direction and magnitude of these relationships were different among men and women across the survey data in Ghana, Gambia, and Togo. Conclusion: The findings imply the need to tackle the existing gender inequities that are associated with vision difficulties to promote the quality of life of individuals, especially among older adults

Assessing Child Maintenance Cases in Ghana: What Do Social Workers Consider?

While one of the key responsibilities of social services in Ghana is to conduct maintenance arrangements so that the nonresident parent is committed to making financial contributions to the well-being of the child, little is known about what informs social workers’ assessments in child maintenance cases. The aim of this study was to determine what social workers consider when undertaking child maintenance assessments. A qualitative practice research study was conducted with 13 social workers and 12 parents involved in a child maintenance case with three agencies of the Department of Social Welfare and Community Development in Ghana. The study showed that corroborating the existence of nonpayment for maintenance in the family is the first step in assessing other factors, such as the parent’s income, occupational status and maintenance amount. Even after the maintenance amount was decided upon, social workers were often unable to follow-up on nonresident parents to ensure that they complied with the maintenance arrangements. Given that no assessment instrument exists in Ghana for addressing child maintenance cases, the study’s findings can provide useful information that can aid in the development of an instrument or framework to assist social workers in their assessments

Access heterogeneities and collection time inequalities of drinking water sources in Ghana: implications for water and development policy

Time poverty remains a critical issue for water access across the globe. However, research on the time spent for water collection and the factors associated with collection time inequalities and access heterogeneities is limited, especially in sub-Saharan Africa. Drawing on the 2014 Ghana’s Demographic and Health Survey (DHS) data, and statistical and spatial analysis, we apply the concept of “everydayness” of water collection time poverty to examine the factors associated with water collection time inequalities and access heterogeneities of drinking water sources in Ghana. Our analysis shows that 8.6% of households face drinking water collection time poverty and this is prevalent and significant across different socio-economic groups and geographies. The observed geographical heterogeneity and collection time inequality in drinking water sources in this paper adds to the literature in terms of variation in household water insecurity across time and space. The water policy implications of these findings are discussed, and we highlight strategies to rethink drinking water security in the Global South

Access heterogeneities and collection time inequalities of drinking water sources in Ghana : implications for water and development policy

Time poverty remains a critical issue for water access across the globe. However, research on the time spent for water collection and the factors associated with collection time inequalities and access heterogeneities is limited, especially in sub-Saharan Africa. Drawing on the 2014 Ghana’s Demographic and Health Survey (DHS) data, and statistical and spatial analysis, we apply the concept of “everydayness” of water collection time poverty to examine the factors associated with water collection time inequalities and access heterogeneities of drinking water sources in Ghana. Our analysis shows that 8.6% of households face drinking water collection time poverty and this is prevalent and significant across different socio-economic groups and geographies. The observed geographical heterogeneity and collection time inequality in drinking water sources in this paper adds to the literature in terms of variation in household water insecurity across time and space. The water policy implications of these findings are discussed, and we highlight strategies to rethink drinking water security in the Global South.https://www.tandfonline.com/journals/cloehj2024SociologySDG-06:Clean water and sanitatio

Rural-urban variation in exclusion from social activities due to menstruation among adolescent girls and young women in Ghana

Menstruation among adolescent girls and young women (AGYW) can be marked by several challenges that often result in exclusion from social activities. Information regarding this subject matter is however sparse in Ghana. This study examined the rural-urban differences in prevalence and correlates of exclusion from social activities due to menstruation among AGYW in Ghana. The study used cross-sectional data drawn from the women dataset of 2017/2018 Ghana Multiple Indicator Cluster Survey Six (GMICS 6). Data of adolescents (n = 2927; age 15-19) and young women (n = 2194; age 20-24) was analyzed in Stata version 14. About 21.65% of the respondents indicated that they excluded themselves from activities during menstruation with slightly higher rates for rural AGYW (22.2%) compared to their urban counterparts (21.11%). Multivariable Poisson regression models showed that compared with nonattainment of formal education, urban AGYW who attained a primary level education were more likely to exclude themselves from social activities due to menstruation [APR = 2.76, 95% CI:1.11, 6.90]. Also, currently married urban AGYW were less likely to exclude themselves from social activities due to menstruation [APR = 0.63, 95% CI:0.44, 0.91]. AGYW residing in the second-lowest wealth household in rural areas had a higher likelihood of exclusion from social activities due to menstruation [APR = 1.34, 95% CI:1.03, 1.75]. Region of residence was a significant correlate in both rural and urban samples but with an observed rural-urban variation. Given the prevalence of AGYW who exclude themselves from social activities, the government and non-governmental organizations that seek to improve menstrual hygiene and empower young women to participate in social activities regardless of their monthly menstrual flow should take into consideration the urban-rural differentials in the associated factors identified in this study