Not just numbers: beyond counting caesarean deliveries to understanding their determinants in Ghana using a population based cross-sectional study.

BACKGROUND:The increasing rate of caesarean deliveries (CD) has become a serious concern for public health experts globally. Despite this health concern, research on factors associated CD in many low- and -middle countries like Ghana is sparse. This study, therefore, assessed the prevalence and determinants of CD among child-bearing women aged 15-49  in Ghana. METHODS:The study used data from the 2014 Ghana Demographic and Health Survey. The analysis was limited to mothers (n = 2742) aged 15-49 , who had given birth in health facilities 5 years preceding the survey. Association between CD and its determinants was assessed by calculating adjusted odds ratios (AOR) with their respective 95% confidence intervals using a binary logistic regression. RESULTS:The percentage of mothers who delivered their babies through caesarean section (CS) was 18.5%. Using multivariable logistic regression, the results showed that women aged 45-49 (AOR = 10.5; 95% CI: 3.0-37.4), and women from a household that are headed by a female (AOR = 1.3; 95% CI = 1.1-1.7) had higher odds to deliver through CS. Women from the Upper East (AOR =0.4; 95% CI = 0.2-0.7) and Upper West (AOR = 0.4; 95% CI = 0.2-0.8) regions had lower odds to deliver their children through CS. Women with parity 4 or more (AOR = 0.3; 95% CI = 0.2-0.5) had lower odds of CD compared to those with parity 1. Women with female babies had lower odds (AOR = 0.8; CI = 0.7-0.9) of delivering them through CS compared to those with male children. CONCLUSION:The percentage of women delivering babies through the CS in Ghana is high. The high rates of CD noted do not essentially indicate good quality care or services. Hence, health facilities offering this medical protocol need to adopt comprehensive and strict measures to ensure detailed medical justifications by doctors for performing these caesarean surgeries

What has women's reproductive health decision-making capacity and other factors got to do with pregnancy termination in sub-Saharan Africa? evidence from 27 cross-sectional surveys.

INTRODUCTION:Pregnancy termination is one of the key issues that require urgent attention in achieving the third Sustainable Development Goal (SDG) of ensuring healthy lives and promoting well-being for all at all ages. The reproductive health decision-making (RHDM) capacity of women plays a key role in their reproductive health outcomes, including pregnancy termination. Based on this premise, we examined RHDM capacity and pregnancy termination among women of reproductive age in sub-Saharan Africa (SSA). MATERIALS AND METHODS:We pooled data from the women's files of the most recent Demographic and Health Surveys (DHS) of 27 countries in SSA, which are part of the DHS programme. The total sample was 240,489 women aged 15 to 49. We calculated the overall prevalence of pregnancy termination in the 27 countries as well as the prevalence in each individual country. We also examined the association between RHDM capacity, socio-demographic characteristics and pregnancy termination. RHDM was generated from two variables: decision-making on sexual intercourse and decision-making on condom use. Binary logistic regression analysis was conducted and presented as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) with their corresponding 95% confidence intervals (CI). Statistical significance was declared p<0.05. RESULTS:The prevalence of pregnancy termination ranged from 7.5% in Benin to 39.5% in Gabon with an average of 16.5%. Women who were capable of taking reproductive health decisions had higher odds of terminating a pregnancy than those who were incapable (AOR = 1.20, 95% CI = 1.17-1.24). We also found that women aged 45-49 (AOR = 5.54, 95% CI = 5.11-6.01), women with primary level of education (AOR = 1.14, 95% CI = 1.20-1.17), those cohabiting (AOR = 1.08, 95% CI = 1.04-1.11), those in the richest wealth quintile (AOR = 1.06, 95% CI = 1.02-1.11) and women employed in the services sector (AOR = 1.35, 95% CI = 1.27-1.44) were more likely to terminate pregnancies. Relatedly, women who did not intend to use contraceptive (AOR = 1.47, 95% CI = 1.39-1.56), those who knew only folkloric contraceptive method (AOR = 1.25, 95% CI = 1.18-1.32), women who watched television almost every day (AOR = 1.16, 95% CI = 1.20-1.24) and those who listened to radio almost every day (AOR = 1.11, 95% CI = 1.04-1.18) had higher odds of terminating a pregnancy. However, women with four or more children had the lowest odds (AOR = 0.5, 95% CI = 0.54-0.60) of terminating a pregnancy. CONCLUSION:We found that women who are capable of taking reproductive health decisions are more likely to terminate pregnancies. Our findings also suggest that age, level of education, contraceptive use and intention, place of residence, and parity are associated with pregnancy termination. Our findings call for the implementation of policies or the strengthening of existing ones to empower women about RHDM capacity. Such empowerment could have a positive impact on their uptake of safe abortions. Achieving this will not only accelerate progress towards the achievement of maternal health-related SDGs but would also immensely reduce the number of women who die as a result of pregnancy termination in SSA

Psychosocial distress among in-school adolescents in Mozambique: a cross-sectional study using the Global School-Based Health Survey data.

BackgroundPoor mental health remains the leading cause of disability, with considerable negative impacts in low- and middle-income countries. In this study, we examined the prevalence and correlates of psychosocial distress among in-school adolescents in Mozambique.MethodsThis was a cross-sectional study of 1918 in-school adolescents, using data from the 2015 Mozambique Global School-Based Health Survey. Descriptive and inferential statistics were adopted in analysing the data. Statistical significance was set at p ResultsThe prevalence of psychosocial distress was 21.2% (24.1% females and 18.5% males). Older adolescents [AOR = 1.681, 95% CI = 1.233-2.292] had higher odds of experiencing psychosocial distress, compared with younger adolescents. In terms of sex, males [AOR = 0.755, 95% CI 0.601-0.950] had lower odds of experiencing psychosocial distress, compared with females. Adolescents who were bullied [AOR = 1.451, 95% CI 1.150-1.831], physically attacked [AOR = 1.802, 95% CI 1.404-2.313], and engaged in a physical fight [AOR = 1.376, 95% CI 1.070-1.769] were respectively more likely to experience psychosocial distress than those who did not. Conversely, adolescents who had close friends [AOR = 0.503, 95% CI 0.372-0.681] had lower odds of being psychosocially distressed than those who did not have close friends.ConclusionThe prevalence of psychosocial distress among in-school adolescents in Mozambique is relatively high. The country may not be able to meet the Sustainable Development Goal 3.4 target of promoting mental health and wellbeing of all by the year 2030 if current rates of psychosocial distress persist among in-school adolescents. Mental health education and counselling as well as social support from friends should be intensified to reduce mental health problems and enable adolescents to effectively deal with the psychosocial challenges encountered in their transition from childhood to adulthood

Reproductive health decision-making capacity and pregnancy termination among Ghanaian women: Analysis of the 2014 Ghana demographic and health survey

© 2019, Springer-Verlag GmbH Germany, part of Springer Nature. Aims: This study sought to assess the association between reproductive health decision-making (RDM) capacity and pregnancy termination among women in Ghana. Methods: Using data from the 2014 Ghana Demographic and Health Survey, the study sample inluded 5437 women of reproductive age. Data were extracted and analysed using STATA version 14.2. Both bivariate and multivariate analyses were done to establish the association between the explanatory and outcome variable. Results: The prevalence of pregnancy termination was 30.4%. Twenty-eight percent (27.7%) of those who had the capacity to make a reproductive health decision had ever terminated a pregnancy. In the multivariate analysis, women who were capable of taking reproductive health decisions, women aged 45–49 (AOR = 7.3, 95% CI = 3.772, 14.24) years, women from the Ashanti region (AOR = 1.414, 95% CI = 1.095, 1.827), women who were using traditional methods of contraception (AOR = 1.636, 95% CI = 1.168, 2.290) and women who watched TV at least once a week (AOR = 1.332, 95% CI = 1.111, 1.596) had higher odds of terminating a pregnancy. On the other hand, women who had a higher level of education (AOR = 0.682, 95% CI = 0.467, 0.946) and women with 4+ (AOR = 0.441, 95% CI = 0.323, 0.602) children had lower odds of terminating pregnancies. Conclusion: RDM capacity, region, contraceptive use and intention, media exposure, level of education and parity are associated with pregnancy termination among Ghanaian women. To reduce pregnancy termination, regular integrated community-based outreach programmes targeted at generating community awareness of the effectiveness of modern contraception in prevention of unintended pregnancy are needed. Such efforts will go a long way toward reducing unintended pregnancy and subsequently bringing about reductions in induced abortion

Women's autonomy in household decision-making and safer sex negotiation in sub-Saharan Africa: An analysis of data from 27 Demographic and Health Surveys

Women's ability to negotiate the conditions and timing of sex is key to several reproductive health outcomes including family planning and prevention of sexually transmitted infections. We investigated the association between women's autonomy in household decision-making and safer sex negotiation (SSN) in sub-Saharan Africa (SSA). This was a cross-sectional analysis of data from the Demographic and Health Survey (DHS) of 27 countries in SSA. Data were analyzed using Stata version 16.0 using descriptive statistics, chi square test, and logistic regression models. Statistical significance was set at p < 0.05 at 95% confidence interval. The pooled prevalence of SSN in the 27 countries was 77.1%. Compared to women with low autonomy in household decision-making, those with medium (aOR = 1.30; CI = 1.23–1.37) and high levels of autonomy in household decision-making (aOR = 1.28; CI = 1.17–1.40) were more likely to have greater SSN. Those with primary (aOR = 1.35; CI = 1.28–1.41) and secondary/higher education level of education (aOR = 1.68; CI = 1.58–1.79) had higher odds of SSN, compared to those with no formal education. Women who were working had higher odds of SSN (aOR = 1.44; CI = 1.37–1.51) than those who were not working. Women in the middle (aOR = 0.93; CI = 0.87–0.99) and richer (aOR = 0.92; CI = 0.85–0.98) wealth status had lower odds of SSN, compared to those in the poorest wealth status. Women's autonomy in household decision-making is a significant predictor of SSN. Women autonomy in household decision-making programs and interventions should be intensified to achieve Sustainable Development Goals 3.7 and 5 which seek to achieve universal access to sexual and reproductive health services and ensure gender equality and empower all women and girls by 2030

Factors influencing the uptake of intermittent preventive treatment among pregnant women in sub-Saharan Africa: a multilevel analysis.

Intermittent Preventive Treatment (IPT) of malaria in pregnancy is a full therapeutic course of antimalarial sulfadoxine-pyrimethamine (SP) medicine given to pregnant women in their second trimester at routine antenatal care visits, regardless of whether the recipient is infected with malaria. Given the negative consequences of malaria in pregnancy, studies on Intermittent Preventive Therapy with Sulfadoxine-Pyrimethamine (IPTp-SP) are important benchmarks for understanding the extent of malaria control and prevention during pregnancy. We, therefore, examined the factors associated with the uptake of IPTp-SP among pregnant women in sub-Saharan Africa. We used data from the current versions of the Malaria Indicators Survey of 12 countries in sub-Saharan Africa. Women aged 15-49 years participated in the surveys. The analyses were carried out using Stata version 14.2. Descriptive (frequencies and percentages) and multilevel regression analyses were carried out. The results of the multilevel regression analysis were presented as adjusted odds ratios (aOR) with 95% confidence intervals (CIs).  RESULTS: The average prevalence of uptake of IPTp-SP among pregnant women in the studied sub-Saharan African countries was 30.69%, with the highest and lowest prevalences in Ghana (59.64%) and Madagascar (10.08%), respectively. Women aged 40-44 compared to those aged 15-19 (aOR = 1.147, 95%CI = [1.02,1.30) had higher odds of receiving 3 or more doses of IPTp-SP. Women with a secondary/higher level of education compared to those with no formal education (aOR = 1.12, 95%CI = 1.04,1.20] also had higher odds of receiving 3 or more doses of IPTp-SP. Women who were exposed to malaria messages on the radio (aOR = 1.07, 95%CI = 1.02,1.12] and television (aOR = 1.13,95%CI = [1.05,1.21]) had higher odds of receiving 3 or more doses of IPTp-SP compared to those who were not exposed. Our study indicates that the uptake of IPTp-SP is relatively low among the countries included in this study, with significant inter-country variations. Higher educational level, exposure to media, low parity, and higher age group were associated with higher odds of optimal IPTp-SP uptake. National policies, programs, guidance services such as information service and counselling and other interventions aimed at improving the coverage and uptake of IPTp-SP must be targeted at women with low level of education, non-exposure to media, high parity, and younger age group to attain the desired outcome

Loneliness and its Associated Risk Factors Among in-School Adolescents in Tanzania: Cross-Sectional Analyses of the Global School-Based Health Survey Data

Though considered a normal part of adolescent development, loneliness is a mental state that can result in considerable psychological distress. We examined the prevalence and risk factors for loneliness among in-school adolescents in Tanzania. This was a descriptive cross-sectional study of 2,449 in-school adolescents from Tanzania using data from the 2017 Global School-Based Health Survey. Frequencies, percentages, Chi-square, and binary logistic regression were used in analysing the data. The prevalence of loneliness was 17.4%. Adolescents in forms 1 and 2 were more likely to be lonely than those in grade 6–7. Adolescents who experienced hunger and anxiety, used tobacco, were truant, and engaged in a physical fight had higher risks of being lonely. The prevalence of loneliness among in-school adolescents in Tanzania is quite high. As a mental state, the drastic long-term effects of loneliness on its victims make it imperative for stakeholders in Tanzania’s health industry to plan and implement pragmatic innovative social support programmes and counselling support units in schools. This can ensure the attainment of the Sustainable Development Goal 3.4 target of improving mental health by the year 2030

Skilled antenatal care services utilisation in sub-Saharan Africa: a pooled analysis of demographic and health surveys from 32 countries.

BACKGROUND: Each day, an estimated 800 women die from preventable pregnancy and childbirth related complications, where 99% of these avoidable deaths happen in low-and middle-income countries. Skilled attendance during antenatal care (ANC) plays a role in reducing maternal and child mortality. However, the factors that predict the utilisation of skilled ANC services in sub-Saharan Africa (SSA) remains sparsely investigated. Therefore, we examined women's utilisation of skilled ANC services in SSA. METHODS: The research used pooled data from the most recent Demographic and Health Surveys conducted in 32 countries in SSA between January 1, 2010, and December 31, 2019. Binary logistic regression was used to examine the predictors of skilled ANC services utilisation. The results are presented as crude and adjusted odds ratios (aOR) with 95% confidence interval (CI). RESULTS: The prevalence of skilled ANC services utilisation in SSA was 76.0%, with the highest and lowest prevalence in Gambia (99.2%) and Burundi (8.4%), respectively. Lower odds of ANC from skilled providers was found among women aged 45-49 compared to those aged 20-24 (aOR = 0.86, CI = 0.79-0.94); widowed women compared to married women (aOR = 0.84, CI = 0.72-0.99); women who consider getting permission to visit the health facility as a big problem compared to those who consider that as not a big problem (aOR = 0.74, CI = 0.71-0.77); women who consider getting money needed for treatment as not a big problem compared to those who consider that as a big problem (aOR = 0.84, CI = 0.72-0.99); and women who consider distance to the health facility as a big problem compared to those who consider that as not a big problem (aOR = 0.75, CI = 0.72-0.77). CONCLUSION: SSA has relatively high prevalence of skilled ANC services utilisation, however, there are substantial country-level disparities that need to be prioritised. Increasing maternal reproductive age being widowed and far distance to health facility were factors that predicted lower likelihood of skilled ANC services utilisation. There is, therefore, the need to intensify female formal education, invest in community-based healthcare facilities in rural areas and leverage on the media in advocating for skilled ANC services utilisation