Teenage childbearing and child health in Eritrea

Data from the 2002 Eritrea Demographic and Health Survey (EDHS) are used to examine teenage childbearing and its health consequences. Bivariate analysis is used to calculate trends and differentials in teenage childbearing. Logistic and Cox hazard models are employed to examine the health impact of teenage childbearing on mothers and their children. Teenage childbearing is high in Eritrea, where around half of all women aged 19 have already been pregnant with their first child. Nearly all first births among teenagers occur within marriage. A decline in teenage childbearing is evident over the period 1995-2002. If the mother is a teenager when she gives birth, particularly if she is under 18, she can expect worse prenatal medical care, an increased risk of low birth weight and higher child mortality compared to an older mother. The effect of age of mothers is significant even when controlling for sociodemographic factors. Strategies designed to reduce the health effecs of teenage childbearing should address both maternal age and behavioral factors.

Women’s status and reproductive preferences in Eritrea

The importance of women’s decision-making autonomy has recently emerged as a key factor in influencing reproductive preferences and demand for family planning in developing countries. In this study, the effect of direct indicators of women’s decision-making autonomy on fertility preferences and ever-use of modern contraception is examined using logistic regression models with and without proxy indicators. The results provide evidence that different dimensions of women’s autonomy influence the outcome variables differently in terms of magnitude and statistical significance. Particularly, women’s final say in decisions regarding day-to-day household purchases and spousal communication about family planning are influential predictors of fertility preferences and ever-use of modern family planning methods. At the same time, results show that the effects of women’s education on fertility preferences are not always significant although it has significant roles in affecting women’s decision-making autonomy. Women’s household economic situation has always significant effects on women’s autonomy as well as on fertility preferences and ever use of contraception. Thus, a complete explanation of the relationship between women’s autonomy and reproductive preferences must recognize the effects of both proxy and direct indicators of women’s autonomy. Interventions are needed to improve women’s decision-making autonomy and strengthen their negotiating capacity for family planning use if an increased desire to limit fertility is to be attained.Eritrea, family planning, fertility, women's status

Evidence of recent fertility decline in Eritrea: an analysis of trends and determinants

This paper contributes to an improved understanding of the recent fertility decline in Eritrea and the possible factors underlying it. Based on data from the 2002 Eritrea Demographic and Health Survey (EDHS), it offers increased clarity as to whether the recent decline indicates the onset of a long-term fertility transition or if it is merely a short-term response to the border conflict with Ethiopia (mid-1998-2000). Various methods, including period trend analyses by age and parity, cohort fertility analysis, and multivariate statistical methods, are used to assess the extent of the decline and to identify major contributors to it. The evidence from this study indicates that fertility decline has started in Eritrea and that it has occurred in urban and rural areas, and in every region of the country. The decline is evident across all reproductive ages and birth orders, but is stronger among older mothers and for higher-order births. A prolonged spacing of births, cessation of further childbearing, and delayed age at marriage are the main contributors to the overall fertility decline. The study also reveals that the fertility decline started in the mid-1990s, well before the conflict, but it was faster during the peak years of the border conflict (1999-2000). This suggests that the reduction in fertility is not primarily an outcome of the border conflict (nor a temporary phenomenon), but that it might be the beginning of a long-term fertility transition, which was then accelerated by the border war and the associated social and economic crisis.Eritrea, fertility

Breastfeeding Practices of Immigrant Mothers in Canada: The Role of Immigration Status, Length of Residence, and Ethnic Minority

Previous studies have demonstrated a strong relationship between breastfeeding practices and immigration status, length of residence, and ethnic minority. However, it remains unclear to what extent differences in these factors can be explained by cultural influences or other socio-demographic factors. Using the 2005 Canadian Community Health Survey (CCHS) data, this study investigates whether immigration status, year of residence, and visible minority status are associated with initiation and duration of exclusive breastfeeding in the context of socio-demographic factors. The findings show that while the relationship between breastfeeding and immigration process is complex, some clear, broad patterns exist that may have important theoretical and policy implications. First, immigrant mothers are more likely than their Canadian-born counterparts to have higher breastfeeding initiation and exclusive breastfeeding rates. Second, increased years of residence in Canada was associated with decreased likelihood of breastfeeding after adjusting for the socio-demographic factors, with long-time immigrants having rates of exclusive breastfeeding as low as their Canadian-born counterparts. This suggests that a substantial part of the effect of residency is channeled through other factors. Efforts are needed to encourage and support immigrant women to maintain their cultural tradition of breastfeeding as they become more acculturated in Canada. Gebremariam Woldemicael is presently a visiting scholar at the Department of Sociology, University of Western Ontario, Canada; has over twenty years of professional work experiences in teaching and research at different Universities and institutions including Stockholm University in Sweden, the Max Planck Institute for Demographic Research in Germany, and the University of Asmara in Eritrea. With competent research and analytical skills, he has conducted extensive researches that have theoretical and policy implications in reproductive health, fertility, maternal and child health - central elements to achieving some of the Millennium Development Goals. He holds BSc in Mathematics, MSc and PhD in Demography with contact discipline in Statistics. Most of his recent research work and interests focus on: Fertility, health, and immigration; Maternal and child health; Women’s autonomy, reproductive health and preferences; and Demographic response to violent conflict

Demographic situation in Eritrea

This paper gives estimates of the following demographic indicators for Eritrea: population size, annual growth rate, age and sex composition, fertility, infant, and child mortality. Brief background sections place the demographic characteristics in a broader perspective. The data used in the analysis of fertility and mortality are taken from sample surveys conducted after independence. Other figures are obtained from government and non-government reports. Indirect techniques were employed to analyze the fertility and mortality rates. Results indicate that the total population of Eritrea in 1993 was roughly 3.5 million. The average annual rate of population growth is found to be about 3% . Children fourteen years old or younger are estimated to be about 46% of the total population. Only 4% of Eritreans are 65 years of age or older. The findings also reveal that fertility rates in Eritrea are high. Women have on average about 7.0 children. The findings further indicate an infant mortality of 112 and an under-five mortality of 208 deaths per 1,000 live births. Given the poor socioeconomic situation of the country, these rates, especially the infant mortality rate, are considered to be underestimates. Further research is therefore needed to ascertain the prevailing situation of Eritrea

Declining Fertility in Eritrea Since the Mid-1990s: A Demographic Response to Military Conflict

Between the mid-1990s and the early part of the new century, the total fertility rate in Eritrea declined by twenty one percent. Even more striking than the magnitude of this decline within a short period is that it occurred in the absence of any improvements in contraceptive use and without any evident reduction in desired family size. In this study, fertility decline and its underlying factors are examined using data from two waves of the Eritrea Demographic and Health Surveys. The central question is whether the recent decline is an outcome of the 1998-2000 border conflict, is related to changes in women's reproductive intentions, or is due to socio-economic transformations. The findings demonstrate that the fertility decline, especially for first births, is the result less of increased demand for family size limitation and more of the border conflict. Although the conflict seems to have played a role in accelerating the decline in higher-order births, the change seems to be a long-term transition that started before the conflict. These findings imply that military conflicts are unlikely to instigate sustainable fertility decline, but may prompt short-term fertility changes among certain groups or modify an ongoing decline

Fertility Behavior of Immigrants in Canada: Converging Trends

Using data from the 2002 Ethnic Diversity Survey (EDS), this paper compares fertility behavior across four groups of generations: recent and long-term immigrants of 1st generation, plus second and third generations. Several important findings emerge from this study: First, consistent with previous studies, we have documented higher current fertility among recent immigrants, but childbearing is lowest in the second generation. Second, although cumulative fertility tends to be significantly higher among long-term immigrants than recent immigrants, it becomes more similar to that of second and successive generations after adjusting for socio-demographic composition. This suggests that it is not generation per se, but compositional characteristics associated with generation groups that underlie fertility differentials. It can be argued that differences in the fertility patterns of long-term immigrants in Canada are likely to diminish as their socio-economic and cultural characteristics converge to those of the Canadian-born. This study also documents ethnic minority and age at arrival differences, suggesting higher fertility for those who are less acculturated or assimilated into the society

Diarrhoea, acute respiratory infection, and fever among children in the Democratic Republic of Congo

Several years of war have created a humanitarian crisis in the Democratic Republic of Congo (DRC) with extensive disruption of civil society, the economy and provision of basic services including health care. Health policy and planning in the DRC are constrained by a lack of reliable and accessible population data. Thus there is currently a need for primary research to guide programme and policy development for reconstruction and to measure attainment of the Millennium Development Goals (MDGs). This study uses the 2001 Multiple Indicators Cluster Survey to disentangle children's health inequalities by mapping the impact of geographical distribution of childhood morbidity stemming from diarrhoea, acute respiratory infection, and fever. We observe a low prevalence of childhood diarrhoea, acute respiratory infection and fever in the western provinces (Kinshasa, Bas-Congo and Bandundu), and a relatively higher prevalence in the south-eastern provinces (Sud-Kivu and Katanga). However, each disease has a distinct geographical pattern of variation. Among covariate factors, child age had a significant association with disease prevalence. The risk of the three ailments increased in the first 8–10 months after birth, with a gradual improvement thereafter. The effects of socioeconomic factors vary according to the disease. Accounting for the effects of the geographical location, our analysis was able to explain a significant share of the pronounced residual geographical effects. Using large scale household survey data, we have produced for the first time spatial residual maps in the DRC and in so doing we have undertaken a comprehensive analysis of geographical variation at province level of childhood diarrhoea, acute respiratory infection, and fever prevalence. Understanding these complex relationships through disease prevalence maps can facilitate design of targeted intervention programs for reconstruction and achievement of the MDGs

Understanding the relationship between access to care and facility‐based delivery through analysis of the 2008 Ghana Demographic Health Survey

ObjectiveTo determine the types of access to care most strongly associated with facility‐based delivery among women in Ghana.MethodsData relating to the “5 As of Access” framework were extracted from the 2008 Ghana Demographic Health Survey and analyzed using multivariate logistic regression.ResultsIn all, 55.5% of a weighted sample of 1102 women delivered in a healthcare facility, whereas 45.5% delivered at home. Affordability was the strongest access factor associated with delivery location, with health insurance coverage tripling the odds of facility delivery. Availability, accessibility (except urban residence), acceptability, and social access variables were not significant factors in the final models. Social access variables, including needing permission to seek healthcare and not being involved in decisions regarding healthcare, were associated with a reduced likelihood of facility‐based delivery when examined individually. Multivariate analysis suggested that these variables reflected maternal literacy, health insurance coverage, and household wealth, all of which attenuated the effects of social access.ConclusionAffordability was an important determinant of facility delivery in Ghana—even among women with health insurance—but social access variables had a mediating role.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/135213/1/ijgo224.pd

Hand washing promotion for preventing diarrhoea.

BACKGROUND: Diarrhoea accounts for 1.8 million deaths in children in low- and middle-income countries (LMICs). One of the identified strategies to prevent diarrhoea is hand washing. OBJECTIVES: To assess the effects of hand washing promotion interventions on diarrhoeal episodes in children and adults. SEARCH METHODS: We searched the Cochrane Infectious Diseases Group Specialized Register (27 May 2015); CENTRAL (published in the Cochrane Library 2015, Issue 5); MEDLINE (1966 to 27 May 2015); EMBASE (1974 to 27 May 2015); LILACS (1982 to 27 May 2015); PsycINFO (1967 to 27 May 2015); Science Citation Index and Social Science Citation Index (1981 to 27 May 2015); ERIC (1966 to 27 May 2015); SPECTR (2000 to 27 May 2015); Bibliomap (1990 to 27 May 2015); RoRe, The Grey Literature (2002 to 27 May 2015); World Health Organization (WHO) International Clinical Trial Registry Platform (ICTRP), metaRegister of Controlled Trials (mRCT), and reference lists of articles up to 27 May 2015. We also contacted researchers and organizations in the field. SELECTION CRITERIA: Individually randomized controlled trials (RCTs) and cluster-RCTs that compared the effects of hand washing interventions on diarrhoea episodes in children and adults with no intervention. DATA COLLECTION AND ANALYSIS: Three review authors independently assessed trial eligibility, extracted data, and assessed risk of bias. We stratified the analyses for child day-care centres or schools, community, and hospital-based settings. Where appropriate, incidence rate ratios (IRR) were pooled using the generic inverse variance method and random-effects model with 95% confidence intervals (CIs). We used the GRADE approach to assess the quality of evidence. MAIN RESULTS: We included 22 RCTs: 12 trials from child day-care centres or schools in mainly high-income countries (54,006 participants), nine community-based trials in LMICs (15,303 participants), and one hospital-based trial among people with acquired immune deficiency syndrome (AIDS) (148 participants).Hand washing promotion (education activities, sometimes with provision of soap) at child day-care facilities or schools prevents around one-third of diarrhoea episodes in high income countries (rate ratio 0.70; 95% CI 0.58 to 0.85; nine trials, 4664 participants, high quality evidence), and may prevent a similar proportion in LMICs but only two trials from urban Egypt and Kenya have evaluated this (rate ratio 0.66, 95% CI 0.43 to 0.99; two trials, 45,380 participants, low quality evidence). Only three trials reported measures of behaviour change and the methods of data collection were susceptible to bias. In one trial from the USA hand washing behaviour was reported to improve; and in the trial from Kenya that provided free soap, hand washing did not increase, but soap use did (data not pooled; three trials, 1845 participants, low quality evidence).Hand washing promotion among communities in LMICs probably prevents around one-quarter of diarrhoea episodes (rate ratio 0.72, 95% CI 0.62 to 0.83; eight trials, 14,726 participants, moderate quality evidence). However, six of these eight trials were from Asian settings, with only single trials from South America and sub-Saharan Africa. In six trials, soap was provided free alongside hand washing education, and the overall average effect size was larger than in the two trials which did not provide soap (soap provided: rate ratio 0.66, 95% CI 0.56 to 0.78; six trials, 11,422 participants; education only: rate ratio: 0.84, 95% CI 0.67 to 1.05; two trials, 3304 participants). There was increased hand washing at major prompts (before eating/cooking, after visiting the toilet or cleaning the baby's bottom), and increased compliance to hand hygiene procedure (behavioural outcome) in the intervention groups than the control in community trials (data not pooled: three trials, 3490 participants, high quality evidence).Hand washing promotion for the one trial conducted in a hospital among high-risk population showed significant reduction in mean episodes of diarrhoea (1.68 fewer) in the intervention group (Mean difference 1.68, 95% CI 1.93 to 1.43; one trial, 148 participants, moderate quality evidence). There was increase in hand washing frequency, seven times per day in the intervention group versus three times in the control in this hospital trial (one trial, 148 participants, moderate quality evidence).We found no trials evaluating or reporting the effects of hand washing promotions on diarrhoea-related deaths, all-cause-under five mortality, or costs. AUTHORS' CONCLUSIONS: Hand washing promotion probably reduces diarrhoea episodes in both child day-care centres in high-income countries and among communities living in LMICs by about 30%. However, less is known about how to help people maintain hand washing habits in the longer term