Patterns of Physical Activity and Self-rated Health Among Adult Populations in South Asia

Introduction: Although South Asians are considered to be at high risk for cardiovascular diseases, research evidence on the health impacts of physical activity (PA) remains very limited. In this study we aimed to explore the patterns of PA and to investigate whether engaging in regular PA is associated with better Self-Rated Health (SRH) among South Asians.Methods: Cross-sectional data on population health were drawn from the World Health Survey of WHO. Subjects were 28,020 male and female South Asians (from Bangladesh, India, Nepal, and Sri Lanka) aged 18 years and above. Data were analysed using descriptive and multivariable logistic regression analyses.Results: The proportion of the sample population reported good SRH was 44.3%, 58.7%, 37.7%, and 73.7% in Bangladeshis, Indians, Nepalese, and Sri Lankans, respectively. Regular engagement in moderate PA was highest in Nepal (69.7%) and lowest in Bangladesh (37.4%). Vigorous PA was highest in India (29.9%) and lowest in Bangladesh (17.9%). In  Bangladesh, compared to those never engaged in MPA, those who engaged for 1-2, 3-4, 5-6, or 7 days a week were 30% [AOR=1.306; 95%CI 1.085-1.572], 33% [AOR=1.326; 95%CI 1.093-1.609], 39% [AOR=1.389; 95%CI 1.125-1.716], and 46% [AOR=1.459; 95%CI 1.249-1.705] more likely to report being in good health, respectively.Conclusions: We found that self-reported engagement in physical activities varies in South Asian countries. Since engaging in PA may help improve subjective and objective health status, health policy makers need to focus on designing exercise-friendly neighbourhoods in an attempt to promote population health

What does women’s empowerment have to do with malnutrition in Sub-Saharan Africa? Evidence from demographic and health surveys from 30 countries

Background: The reduction of childhood malnutrition has been identified as a priority for health and development in sub Saharan African countries. The association between women’s empowerment and children’s nutritional status is of policy interest due to its effect on human development, labour supply, productivity, economic growth and development. This study aimed to determine the association between women’s empowerment and childhood nutritional status in sub Saharan African countries. Methods: The study utilized secondary datasets of women in their child bearing age (15–49 years) from the latest Demographic and Health Survey (DHS) conducted in 2011–2017 across 30 sub Saharan Africa countries. The outcome variable of the study was childhood nutritional status while the exposure variable was women’s empowerment indicators such as decision making and attitude towards violence. Analyses were performed at bivariate level with the use of chi square to determine association between outcome and exposure variables and at multivariate level with the use of regression models to examine the effect of women’s empowerment on childhood nutritional status. Results: Women’s socio-demographic and other selected characteristics were statistically significantly associated with childhood nutritional status (stunted and underweight) at p < 0.001. These characteristics were also statistically significantly associated with empowerment status of women (Decision-making, Violence attitudes and Experience of violence) at p < 0.001 except for child age and sex. The association between childhood nutritional statuses and women’s empowerment (all three empowerment measures) was significant after controlling for other covariates that could also influence childhood nutrition statuses at p < 001. Two of the empowerment measures (attitudes towards violence and experience of violence) showed positive association with childhood nutritional statuses while the third (decision-making) showed negative association. Conclusion: There is an independent relationship between childhood nutrition status and women’s empowerment in sub Saharan African countries. Women’s empowerment was found to be related to childhood nutritional status. Policies and programmes aiming at reducing childhood malnutrition should include interventions designed to empower women in Sub-Saharan Africa

Le droit de l'OHADA face au commerce électronique

Le droit de l’OHADA face au commerce électronique est une réflexion épistémologique sur les questions juridiques que posent les transactions électroniques au sein des pays de l’Organisation pour l’Harmonisation en Afrique du Droit des Affaires (OHADA). Plus précisément, cette réflexion est une prospective sur l’encadrement juridique du commerce électronique par l’OHADA à partir des expériences menées notamment en Amérique du Nord (Canada-Québec) et en Europe. Les nouvelles technologies de l’information posent en Afrique comme elles l’ont fait ailleurs des défis au droit. Plusieurs initiatives régionales et nationales ont vu le jour au cours des dernières années pour relever ces défis. Seulement, le caractère hétérogène des législations mises en place est à même d’altérer la sécurité juridique régionale tant recherchée par l’organisation. Prenant appui sur la théorie de la circulation des modèles juridiques, cette thèse propose une véritable harmonisation dans le cadre de l’OHADA. Harmonisation qui veillera à prendre en compte les « spécificités africaines » tout en faisant de la Cour commune de Justice et d’Arbitrage (CCJA) d’Abidjan la plus haute juridiction communautaire en matière de commerce électronique.Le droit de l’OHADA face au commerce électronique (OHADA law pertaining to e-commerce) is an epistemological reflection on the legal issues raised by e-trade conducted among members of the Organisation for the Harmonisation of Business Law in Africa (OHADA). This forward looking analysis of the organization’s legal framework governing e commerce draws upon relevant experiments carried out notably in North America (Canada-Québec) and Europe. In Africa, as elsewhere, the new information technologies pose certain legal challenges. During the past several years, various regional and national initiatives have addressed these challenges. However, the heterogeneous nature of the different laws implemented impairs the regional-level legal security sought by OHADA. Building on legal transplant, this dissertation proposes, within the context of OHADA, a true harmonization that will ensure that “African specificities” are taken into account while making the Common Court of Justice and Arbitration (CCJA) in Abidjan the highest community jurisdiction in matters of e-commerce

Le coopératisme : Un atout pour le développement de l'Afrique rurale subsaharienne à l'ère de la mondialisation ?

Cette recherche exploratoire et qualitative a pour objectif d'analyser et de présenter à travers une étude socio-économique, les réponses que les coopératives peuvent apporter au mieux-être des communautés de l'Afrique rurale subsaharienne. Plusieurs variables relevées dans la littérature sur le coopératisme et le développement rural en Afrique sont intégrées dans un cadre original dont l'axe principal tourne autour des alternatives et des solutions capables de permettre aux communautés rurales africaines de sortir de l'impasse multiséculaire dans laquelle elles se trouvent longtemps engourdies. Notre recherche repose sur la prémisse suivante: l'entreprise coopérative est l'un des mécanismes de développement les plus appropriés dans l'économie de marché actuelle, car elle établit un équilibre unique entre les impératifs de développement économique et social. Cette nouvelle réalité émergente, qui prévaut dans nombre de pays industrialisés est aussi valable pour les pays en voie de développement en général, et ceux de l'Afrique en particulier. Nous nous attendons donc tout particulièrement à ce que cette recherche offre des outils et élabore des stratégies à mettre en avant pour permettre aux coopératives d'accentuer leurs contributions sociales et économiques dans la lutte contre la pauvreté. Les résultats de cette recherche devront donc enrichir la réflexion sur l'atteinte, par les coopératives, d'objectifs reliés au développement socio-économique des communautés rurales africaines afin de rejoindre les plus pauvres du continent. Les investigations permettront ainsi de préciser les rôles que pourraient jouer les coopératives dans une optique de développement plus durable et plus équitable. La méthode utilisée est celle de l'étude exploratoire et qualitative, particulièrement appropriée pour rendre compte des spécificités des pays en voie de développement. Des entrevues, enquêtes, des analyses de contenus de textes, des rapports et de documents législatifs seront menées, de même qu'un traitement analytique des données statistiques, quantitatives et qualitatives. Le terrain est celui de l'Afrique rurale subsaharienne, situé en Afrique occidentale, dans la zone intertropicale entre l'équateur et le tropique du cancer. Cette partie de l'Afrique qui regroupe essentiellement près de deux poignées de pays a été choisie dans le but de présenter un aperçu global et une vision panoramique de la réalité coopérative en Afrique rurale subsaharienne. Il est clair que ces divers pays ont chacun leur spécificité ; ce fait est indéniable. Toutefois, il est important de souligner qu'ils ont pour l'immense majorité d'entre eux subi les mêmes transformations et influences tant sur les plans politique, idéologique que socio-économique depuis les indépendances africaines. Par ailleurs, d'un point de vue macroscopique, l'économie et la structure sociale de ces pays présentent les mêmes caractéristiques à quelques exceptions près. En définitive, lorsqu'il est question de coopératives et de ruralité, de mondialisation et de développement en Afrique, la secousse est, partout, la même, qu'il s'agisse du Bénin, du Mali, du Burkina, de la Côte d'Ivoire ou de tous ces autres pays qui s'inscrivent dans la même dynamique

Determinants of community health workers effectiveness for delivery of maternal and child health in Sub Saharan Africa: A Systematic review protocol

Background: Countries in sub-Sahara African continue to have the highest maternal and under- five child death occurrences in the world and this has become a key health challenge in the region and persists as global public health agenda. Although Community Health Workers (CHWs) are increasingly being acknowledged as crucial members of the healthcare workforce in reducing health disparity, evidence is limited on perspective of community health workers. The objective of this protocol is to outline the methodological process of a systematic review that will gather qualitative data to examine determinants of community health workers effectiveness for delivery of maternal and child health in Sub Saharan Africa. Synthesizing the perspectives of community health workers’ perceived experience is crucial to inform decision makers, policy makers, and practitioners to address barriers to and scaleup facilitators of CHWs program to ensure maternal and child health equity and a resilience community health system. Methods: The protocol has been registered in the PROSPERO (CRD42020206874). We will systematically conduct a literature search from inception in MEDLINE complete, EMBASE, CINAHL complete and Global Health for relevant studies. Eligible studies will be reports of original research, peer reviewed articles having a qualitative component (i.e., qualitative, mixed, or multi-method studies) on empowerment of CHWs associated with maternal and child health in the sub-Saharan Africa. Eligibility will be restricted to studies published in English. Two reviewers will independently screen all included abstracts and full-text articles. The primary outcome will be CHWs’ perceived barriers to and facilitators of effectiveness of community health workers in maternal and child health in sub-Saharan Africa. Study methodological quality (or bias) will be appraised using appropriate tools. Narrative analysis will be conducted, and narrative summary of findings will be presented. We will use the ‘best fit’ framework method as a systematic approach to analyzing the qualitative data. Discussion: This study will systematically and comprehensively search literature and integrate evidence on perceived barriers to and facilitators of effectiveness of community health workers led maternal and child health program in sub-Saharan Africa. Our findings will inform policy and practice on maternal and child health equity and a resilient communities health system. The resulting manuscript will be disseminated in a peer-reviewed journal and at international and national conferences

Sex differences in HIV testing among elders in Sub-Saharan Africa: a systematic review protocol

Background: Elders (age 50+) HIV demographic (age and sex) data are essential to better understand their HIV service utilization and develop appropriate evidence-based responses and policies. Despite a significant prevalence rate of HIV and growing numbers of this population group, data are still scarce, and studies have neglected them in Sub-Saharan Africa. The aim of this protocol is to outline the methodological process of a systematic review that will gather qualitative and quantitative data to critically examine sex differences in HIV testing among elders (age 50+) in Sub-Saharan Africa. Methods: This protocol adheres to the PRISMA-P reporting guidelines. We will conduct a systematic database search to retrieve all observational and qualitative studies. Electronic search strategies will be developed for MEDLINE, EMBASE, Web of Science, Global Health, and CINAHL for studies reporting HIV data. Two reviewers will independently screen all citations, full-text articles, and abstract data. The search strategy will consist of free-text and Medical Subject Headings (MeSH) terms. Search terms for elders (50+) will include the following: “elders”, “older adults”, “aged”, “geriatric” and “seniors”. The primary outcome of interest is sex differences in the uptake of HIV counselling and testing (HCT). The study methodological quality (or bias) will be appraised using appropriate tools. Screening, data extraction, and assessments of risk of bias will be performed independently by two reviewers. Narrative synthesis will be conducted with studies that are compatible based on population and outcome. As it will be a systematic review, without human participants’ involvement, there will be no requirement for ethical approval. Discussion: The systematic review will present key evidence on sex differences in HIV testing among elders in Sub-Saharan Africa. The findings will be used to inform program developers, policymakers, and other stakeholders to enhance sex disaggregated HIV data to improve access to HIV counselling and testing service for elders in Sub-Saharan Africa. The final manuscript will be disseminated through a peer-reviewed journal and scientific conferences

There is life beyond the statistical significance

This article challenges the “tyranny of P-value” and promote more valuable and applicable interpretations of the results of research on health care delivery. We provide here solid arguments to retire statistical significance as the unique way to interpret results, after presenting the current state of the debate inside the scientific community. Instead, we promote reporting the much more informative confidence intervals and eventually adding exact P-values. We also provide some clues to integrate statistical and clinical significance by referring to minimal important differences and integrating the effect size of an intervention and the certainty of evidence ideally using the GRADE approach. We have argued against interpreting or reporting results as statistically significant or statistically non-significant. We recommend showing important clinical benefits with their confidence intervals in cases of point estimates compatible with results benefits and even important harms. It seems fair to report the point estimate and the more likely values along with a very clear statement of the implications of extremes of the intervals. We recommend drawing conclusions, considering the multiple factors besides P-values such as certainty of the evidence for each outcome, net benefit, economic considerations and values and preferences. We use several examples and figures to illustrate different scenarios and further suggest a wording to standardize the reporting. Several statistical measures have a role in the scientific communication of studies, but it is time to understand that there is life beyond the statistical significance. There is a great opportunity for improvement towards a more complete interpretation and to a more standardized reporting.Fil: Ciapponi, Agustín. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Belizan, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; ArgentinaFil: Piaggio, Gilda. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Yaya, Sanni. Imperial College London; Reino Unido. University of Ottawa; Canad

Fruit and vegetable consumption among adults in Namibia: analysis of a nationally representative population

Background: Prevalence of F&V consumption in Namibia is not known. In this study we aimed to address this gap by using nationally representative data with the objectives of measuring the prevalence of adequate F&V consumption among adult men and women and their socio demographic determinants.Methods: This study is based on data from Namibia Demographic and Health Survey (NDHS2013). Sample population were 14 185 men and women aged between 15 and 49 years.Amount of fruit and vegetable consumption was measured by self-reported frequencies and was defined as adequate (at least 5 servings/day) according to World Health Organization (WHO)guidelines.Results: Overall, only 4.3% (3.8-4.9%) of the men and women reported consuming at least 5 servings of F&V a day, with the percentage being slightly higher among women (4.8%,95% CI=3.7-6.2) compared with men (4.2%, 95% CI=3.6-4.8). In the multivariable analysis,education level and household wealth status appeared to be the only factors associated with adequate F&V intake. Men and women who had primary level education had higher odds of eating at least 5 servings of F&V a day compared with those who had no education. Regarding wealth status, men and women from non-poor households had respectively 2.13 times(OR=2.13, 95% CI=1.01-4.48) and 2.2 times (OR=2.19, 95% CI=1.56-3.38) higher odds of eating at least 5 servings of F&V a day.Conclusion: Only a small proportion of the men and women consumed adequate amount of F&V on daily basis. Having primary level education and non-poor household wealth status were positively associated with adequate amount of F&V intake

Age at First Sexual Intercourse and Multiple Sexual Partnerships Among Women in Nigeria: A Cross-Sectional Analysis

Background: Little is known about sexual behavior such as first sexual intercourse and number of sexual partnerships among women in Nigeria. Early sexual debut is a widely recognized public health issue due to its influence on higher lifetime sexual partners which in turn is associated with increased vulnerability to pregnancy complications, HIV/AIDS and other and sexually-transmitted diseases. In the present study, we attempted to explore the patterns of age of sexual debut and multiple sexual partnerships among women of reproductive age in Nigeria.Methods: Women who responded to the questions about the age at first sex and number of lifetime sex partners were selected from two latest rounds Nigeria Demographic and Health Survey (DHS). In total 60,611 women aged between 15 and 49 years were selected for this analysis. Age at sexual debut was used as the predictor of multiple sexual partnerships which was assessed by multinomial regression models with logit link function in complex sample analysis mode.Results: The median age at first sex was 16 years (Interquartile range 16–24). Age at first sexual intercourse below the age of 19 years was reported by 30.8% of the women. Respectively 45.4% (95%CI = 42.9–47.9) 49.8% (95%CI = 47.8–51.7) of the women reported experiencing first intercourse before reaching 15 and 17 years, whereas 46.9% (95%CI = 45.2–48.7) of the women reported being monogamous and 47.2% (95%CI = 45.6–48.8) and 47.6% (95%CI = 43.8–51.3) had 2–3 and &gt;3 lifetime sexual partners. In multivariable analysis after adjusting for confounding factors, women having sexual debut below 18 years were found to be significantly more likely to have 2–3 and more than 3 lifetime sexual partner.Conclusion: The study concludes that an increasing proportion of Nigerian women are experiencing sexual debut before reaching 15 years. The findings suggest that early sexual debut is associated with multiple sexual partnerships which may increase the risk of STIs. Stakeholders in health care system need to be aware that early sexual debut can be associated with successive unsafe sexual practices which can lead to adverse health outcomes including HIV infection and STIs, early marriage, unwanted pregnancy, and abortion. Therefore, it is important to design effective interventions to encourage women delay sexual debut to help prevent unintended pregnancies and decrease the disproportionate burden of adverse health outcomes

Authorship in studies conducted in low-and-middle income countries and published by Reproductive Health: advancing equitable global health research collaborations

Reproductive Health has an interest in reproductivehealth status globally, but it has particular interest inphenomena affecting disadvantaged populations. This isthe reason why this journal encourages submissionsfrom researchers conducting studies in low- and middleincome countries (LMICs).Fil: Pingray, Verónica. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Ortega, Vanesa. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Yaya, Sanni. University of Oxford; Reino UnidoFil: Belizan, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. Centro de Investigaciones en Epidemiología y Salud Pública. Instituto de Efectividad Clínica y Sanitaria. Centro de Investigaciones en Epidemiología y Salud Pública; Argentin