Female genital mutilation/cutting in Sierra Leone: are educated women intending to circumcise their daughters?

BACKGROUND:Female genital mutilation/cutting (FGM/C) has been recognized as a gross violation of human rights of girls and women. This is well established in numerous international legal instruments. It forms part of the initiation ceremony that confers womanhood in Sierra Leone. Girls and women who are subjected to this practice are considered to be ready for marriage by their parents and communities and are rewarded with celebrations, gifts, and public recognition. Following this, we examined the relationship between education and women's FGM/C intention for their daughters in Sierra Leone. METHODS:We used cross-sectional data from the women's file of the 2013 Sierra Leone Demographic and Health Survey (SLDHS) to explore the influence of education on FGM/C intention among women in the reproductive age (15-49). A sample of 6543 women were included in the study. Our analysis involved descriptive computation of education and FGM/C intention. This was followed by a two-level multilevel analysis. Fixed effect results were reported as Odds Ratios and Adjusted Odds Ratios with their respective credible intervals (CrIs) whilst results of the random effects were presented as variance partition coefficients and median odds ratios. RESULTS:Our findings showed that women who had no formal education were more likely to intend to circumcise their daughters [aOR = 4.3, CrI = 2.4-8.0]. Among the covariates, women aged 20-24 [aOR = 2.3, CrI = 1.5-3.4] were more likely to intend to circumcise their daughters compared to women between 45 and 49 years old. Poorest women were more likely to report intention of circumcising their daughters in the future compared with the richest [aOR = 2.1, CrI = 1.3-3.2]. We noted that, 63.3% of FGM/C intention in Sierra Leone is attributable to contextual factors. CONCLUSION:FGM/C intention is more common among women with no education, younger women as well as women in the lowest wealth category. We recommend segmented female-child educational and pro-poor policies that target uneducated women in Sierra Leone. The study further suggests that interventions to end FGM/C need to focus on broader contextual and social norms in Sierra Leone

Drivers of desire for more children among childbearing women in sub-Saharan Africa: implications for fertility control.

BackgroundDespite the extensive research on fertility desires among women the world over, there is a relative dearth of literature on the desire for more children in sub-Saharan Africa (SSA). This study, therefore, examined the desire for more children and its predictors among childbearing women in SSA.MethodsWe pooled data from 32 sub-Saharan African countries' Demographic and Health Surveys. A total of 232,784 married and cohabiting women with birth history, who had complete information on desire for more children made up the sample for the study. The outcome variable for the study was desire for more children. Multilevel logistic regression analysis was conducted. Results were presented using adjusted odds ratios (aOR), with their corresponding 95% confidence intervals (CI).ResultsThe overall prevalence of the desire for more children was 64.95%, ranging from 34.9% in South Africa to 89.43% in Niger. Results of the individual level predictors showed that women aged 45-49 [AOR = 0.04, CI = 0.03-0.05], those with higher education [AOR = 0.80, CI = 0.74-0.87], those whose partners had higher education [AOR = 0.88; CI = 0.83-0.94], women with four or more births [AOR = 0.10, CI = 0.09-0.11], those who were using contraceptives [AOR = 0.68, CI = 0.66-0.70] and those who had four or more living children [AOR = 0.09 CI = 0.07-0.12] were less likely to desire for more children. On the other hand, the odds of desire for more children was high among women who considered six or more children as the ideal number of children [AOR = 16.74, CI = 16.06-17.45] and women who did not take decisions alone [AOR = 1.58, CI = 1.51-1.65]. With the contextual factors, the odds of desire for more children was high among women who lived in rural areas compared to urban areas [AOR = 1.07, CI = 1.04-1.13].ConclusionsThis study found relatively high prevalence of women desiring more children. The factors associated with desire for more children are age, educational level, partners' education, parity, current contraceptive use, ideal number of children, decision-making capacity, number of living children and place of residence. Specific public health interventions on fertility control and those aiming to design and/or strengthen existing fertility programs in SSA ought to critically consider these factors

Maternal healthcare utilsation and complete childhood vaccination in sub-Saharan Africa: a cross-sectional study of 29 nationally representative surveys

Objective The objective of the study was to examine the association between maternal healthcare utilisation and complete childhood vaccination in sub-Saharan Africa. Design Our study was a cross-sectional study that used pooled data from 29 countries in sub-Saharan Africa. Participants A total of 60 964 mothers of children aged 11–23 months were included in the study. Outcome variables The main outcome variable was complete childhood vaccination. The explanatory variables were number of antenatal care (ANC) visits, assistance during delivery and postnatal care (PNC). Results The average prevalence of complete childhood vaccination was 85.6%, ranging from 67.0% in Ethiopia to 98.5% in Namibia. Our adjusted model, children whose mothers had a maximum of three ANC visits were 56% less likely to have complete vaccination, compared with those who had at least four ANC visits (adjusted OR (aOR)=0.44, 95% CI 0.42 to 0.46). Children whose mothers were assisted by traditional birth attendant/other (aOR=0.43, 95% CI 0.41 to 0.56) had lower odds of complete vaccination. The odds of complete vaccination were lower among children whose mothers did not attend PNC clinics (aOR=0.26, 95% CI 0.24 to 0.29) as against those whose mothers attended. Conclusion The study found significant variations in complete childhood vaccination across countries in sub-Saharan Africa. Maternal healthcare utilisation (ANC visits, skilled birth delivery, PNC attendance) had significant association with complete childhood vaccination. These findings suggest that programmes, interventions and strategies aimed at improving vaccination should incorporate interventions that can enhance maternal healthcare utilisation. Such interventions can include education and sensitisation, reducing cost of maternal healthcare and encouraging male involvement in maternal healthcare service utilisation

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

Women's autonomy in healthcare decision-making and healthcare seeking behaviour for childhood illness in Ghana: Analysis of data from the 2014 Ghana Demographic and Health Survey.

IntroductionThe capacity of women to decide on their healthcare plays a key role in their health. In this study, we examined the association between women's healthcare decision-making capacity and their healthcare seeking behaviour for childhood illnesses in Ghana.Materials and methodsWe used data from the 2014 Ghana Demographic and Health Survey. A total sample of 2,900 women with children less than 5 years was used for the analysis. Data were processed and analysed using STATA version 14.0. Chi-square test of independence and binary logistic regression were carried out to generate the results. Statistical significance was pegged at 95% confidence intervals (CIs). We relied on the 'Strengthening the Reporting of Observational Studies in Epidemiology' (STROBE) statement in writing the manuscript.ResultsOut of the 2,900 women, approximately 25.7% could take healthcare decisions alone and 89.7% sought healthcare for childhood illnesses. Women who decided alone on personal healthcare had 30% reduced odds of seeking healthcare for childhood illnesses compared to those who did not decide alone [AOR = 0.70, CI = 0.51-0.97]. With age, women aged 45-49 had 69% reduced odds of seeking healthcare for childhood illnesses compared to those aged 25-29 [AOR = 0.31, CI = 0.14-0.70]. Women from the Northern and Upper West regions had 72% [AOR: 0.28, CI: 0.11-0.70] and 77% [AOR: 0.23, CI: 0.09-0.58] reduced odds of seeking healthcare for childhood illnesses respectively, compared to those from the Western region.ConclusionGhanaian women with autonomy in healthcare decision-making, those who were older and those from the Northern and Upper West regions were less likely to seek healthcare for childhood illness. To reduce childhood mortalities and morbidities in Ghana, we recommend educating women such as those who take healthcare decisions alone, older women and women from deprived regions like the Northern and Upper West regions on the need to seek healthcare for childhood illnesses

The impact of providing rapid diagnostic malaria tests on fever management in the private retail sector in Ghana: a cluster randomized trial

Objective: To examine the impact of providing rapid diagnostic tests for malaria on fever management in private drug retail shops where most poor rural people with fever present, with the aim of reducing current massive overdiagnosis and overtreatment of malaria. Design: Cluster randomized trial of 24 clusters of shops. Setting: Dangme West, a poor rural district of Ghana. Participants: Shops and their clients, both adults and children. Interventions: Providing rapid diagnostic tests with realistic training. Main outcome measures: The primary outcome was the proportion of clients testing negative for malaria by a double-read research blood slide who received an artemisinin combination therapy or other antimalarial. Secondary outcomes were use of antibiotics and antipyretics, and safety. Results: Of 4603 clients, 3424 (74.4%) tested negative by double-read research slides. The proportion of slide-negative clients who received any antimalarial was 590/1854 (32%) in the intervention arm and 1378/1570 (88%) in the control arm (adjusted risk ratio 0.41 (95% CI 0.29 to 0.58), P<0.0001). Treatment was in high agreement with rapid diagnostic test result. Of those who were slide-positive, 690/787 (87.8%) in the intervention arm and 347/392 (88.5%) in the control arm received an artemisinin combination therapy (adjusted risk ratio 0.96 (0.84 to 1.09)). There was no evidence of antibiotics being substituted for antimalarials. Overall, 1954/2641 (74%) clients in the intervention arm and 539/1962 (27%) in the control arm received appropriate treatment (adjusted risk ratio 2.39 (1.69 to 3.39), P<0.0001). No safety concerns were identified. Conclusions: Most patients with fever in Africa present to the private sector. In this trial, providing rapid diagnostic tests for malaria in the private drug retail sector significantly reduced dispensing of antimalarials to patients without malaria, did not reduce prescribing of antimalarials to true malaria cases, and appeared safe. Rapid diagnostic tests should be considered for the informal private drug retail sector

Proximate, intermediate, and distal predictors of under-five mortality in Chad: analysis of the 2014-15 Chad demographic and health survey data.

BackgroundUnder-five mortality in Chad reached a minimum value of 119 deaths per 1000 live births in 2018, compared with a maximum of 250 in 1972. Despite this decline in the  mortality trend, for every six children in Chad, one dies before the age of five. This study, therefore, investigated the proximate, intermediate, and distal determinants of under-five mortality in Chad.MethodsWe used data from the 2014-15 Chad's Demographic and Health Survey. Data of 7782 children below 5 years were used for the study. Both descriptive and multivariable hierarchical logistic regression analyses were performed. Statistical significance was declared at p ResultsUnder-five mortality was found to be 130 deaths per 1000 live births in Chad, with variations across the various population sub-groups. For distal predictors, the likelihood of death was higher in children born in the FChari Baguirmi region (AOR = 3.83, 95% CI: 1.81-8.14). Children whose mothers belonged to the Baguirmi/Barma ethnic group (AOR = 8.04, 95% CI: 1.75-36.99) were more likely to die before the age of five. On the contrary, the likelihood of under-five mortality was low among children born in rural areas (AOR = 0.73, 95% CI: 0.55-0.97). With the intermediate predictors, the likelihood of under-five deaths was higher among children whose mothers had no formal education (AOR = 1.72, 95% CI: 1.06-2.77). Regarding the proximate predictors, the odds of under-five deaths was higher among male children (AOR = 1.03, 95% CI: 1.05-1.63) and first rank children (AOR = 1.58, 95% CI: 1.13-2.21).ConclusionThe study found that the determinants of under-five mortality in Chad are region of residence, place of residence, ethnicity, education, sex of child, and birth rank. These findings show that both socio-economic and proximate factors explain the disparities in under-five mortality in Chad. The identification of these factors can be pivotal towards the design of evidence-based interventions intended to improve child survival. Therefore, improving maternal education while refocusing and re-packaging existing strategies to target selected sub-regional populations with high under-five mortality is urgently required

Maternal healthcare utilization and full immunization coverage among 12–23 months children in Benin: a cross sectional study using population-based data

Background Maternal and child health are important issues for global health policy, and the past three decades have seen a significant progress in maternal and child healthcare worldwide. Immunization is a critical, efficient, and cost-effective public health intervention for newborns. However, studies on these health-promoting indicators in low-income and middle-income countries, especially in sub-Sahara Africa are sparse. We investigated the association between maternal healthcare utilization and complete vaccination in the Republic of Benin. Methods We analysed data from the 2018 Benin Demographic and Health Survey (BDHS). Specifically, the children’s recode file was used for the study. The outcome variable used was complete vaccination. Number of antenatal care visits, assistance during delivery, and postnatal check-up visits were the key explanatory variables. Bivariate and multilevel logistic regression analyses were carried out. The results were presented as unadjusted odds ratios (uOR) and adjusted odds ratios (aOR), with their corresponding 95% confidence intervals (CIs) signifying their level of precision. Statistical significance was declared at p < 0.05. Results The prevalence of full immunization coverage in Benin was 85.4%. The likelihood of full immunization was lower among children whose mothers had no antenatal care visits, compared to those whose mothers had 1–3 visits [aOR = 0.11, 95% CI: 0.08–0.15], those who got assistance from Traditional Birth Attendants/other during delivery, compared to those who had assistance from Skilled Birth Attendants/health professionals [aOR = 0.55, 95% CI: 0.40–0.77], and mothers who had no postnatal care check-up visit, compared to those who had postnatal care check-up < 24 h after delivery [aOR = 0.49, 95% CI: 0.36–0.67]. With the covariates, religion, partner’s level of education, parity, wealth quintile, and place of residence also showed significant associations with full immunization. Conclusion The study has demonstrated strong association between full immunization and antenatal care, skilled attendance at birth, and postnatal care check-up visit. We found that full immunization decreases among women with no antenatal care visits, those who receive assistance from Traditional Birth Attendants during delivery, and those who do not go for postnatal care visits. To help achieve full immunization, it is prudent that the government of Benin collaborates with international organisations such as WHO and UNICEF to provide education to pregnant women on the importance of immunization after delivery. Such education can be embedded in the antenatal care, delivery and postnatal care services offered to pregnant women during pregnancy, delivery, and after delivery

Factors Associated with Utilization of Postnatal Care Services in Mali, West Africa

Background and Objective: Postnatal care is recognized as one of the most effective ways of preventing and managing physical and mental disabilities that occur during the postpartum period. Despite the importance of postnatal care, its utilization is low in Mali. The present study investigates factors associated with utilization of postnatal care services in Mali. Methods: A total of 5,778 women who had complete information on all the variables of interest were included in our study. The data were analyzed with Stata version 14.2 by employing a multilevel logistic regression approach. The results were presented using adjusted odds ratios (aOR) at 95% confidence interval (CI). Results: We found that 25.18% of childbearing women in Mali utilized postnatal care. Women with no education (aOR=1.28, 95% CI=1.02-1.62) and those with primary level of education (OR=1.38, 95% CI=1.06- 1.81) had higher odds of postnatal care uptake, compared to those with secondary/higher education. On the contrary, postnatal care service utilization was lower among women who were not covered by health insurance (aOR=0.63, 95% CI=0.46-0.88), those who were not working (aOR=0.82, 95% CI=0.70-0.96), and those who were not exposed to mass media (aOR=0.80, 95% CI=0.70-0.93). Similarly, compared to women in the Mopti region, women in all other regions were less likely to utilize postnatal care services. Postnatal care service utilization was lower among women in communities with low educational level (aOR = 0.42, 95% CI=0.27-0.66) and medium socio-economic status (aOR=0.59, 95% CI=0.36-0.99). Conclusion and Implications for Translation: The study revealed several individual, household and community level factors as predictors of utilization of postnatal care services in Mali. Public health interventions intended to improve postnatal care services uptake in Mali should pay attention to these factors. This will help achieve the Sustainable Development Goal 3.1 which focuses on reducing the global maternal mortality ratio to less than 70 per 100 000 live births by 2030.   Copyright © 2021 Ahinkorah et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.</jats:p

The malaria testing and treatment landscape in mainland Tanzania, 2016

Abstract Background Understanding the key characteristics of malaria testing and treatment is essential to the control of a disease that continues to pose a major risk of morbidity and mortality in mainland Tanzania, with evidence of a resurgence of the disease in recent years. The introduction of artemisinin combination therapy (ACT) as the first-line treatment for malaria, alongside policies to promote rational case management following testing, highlights the need for evidence of anti-malarial and testing markets in the country. The results of the most recent mainland Tanzania ACTwatch outlet survey are presented here, including data on the availability, market share and price of anti-malarials and malaria diagnosis in 2016. Methods A nationally-representative malaria outlet survey was conducted between 18th May and 2nd July, 2016. A census of public and private outlets with potential to distribute malaria testing and/or treatment was conducted among a representative sample of administrative units. An audit was completed for all anti-malarials, malaria rapid (RDT) diagnostic tests and microscopy. Results A total of 5867 outlets were included in the nationally representative survey, across both public and private sectors. In the public sector, availability of malaria testing was 92.3% and quality-assured (QA) ACT was 89.1% among all screened outlets. Sulfadoxine–pyrimethamine (SP) was stocked by 51.8% of the public sector and injectable artesunate was found in 71.4% of all screened public health facilities. Among anti-malarial private-sector stockists, availability of testing was 15.7, and 65.1% had QA ACT available. The public sector accounted for 83.4% of the total market share for malaria diagnostics. The private sector accounted for 63.9% of the total anti-malarial market, and anti-malarials were most commonly distributed through accredited drug dispensing outlets (ADDOs) (39.0%), duka la dawa baridi (DLDBs) (13.3%) and pharmacies (6.7%). QA ACT comprised 33.1% of the national market share (12.2% public sector and 20.9% private sector). SP accounted for 53.3% of the total market for anti-malarials across both private and public sectors (31.3 and 22.0% of the total market, respectively). The median price per adult equivalent treatment dose (AETD) of QA ACT in the private sector was $1.40, almost 1.5 times more expensive than the median price per AETD of SP ($1.05). In the private sector, 79.3% of providers perceived ACT to be the most effective treatment for uncomplicated malaria for adults and 88.4% perceived this for children. Conclusions While public sector preparedness for appropriate malaria testing and case management is showing encouraging signs, QA ACT availability and market share in the private sector continues to be sub-optimal for most outlet types. Furthermore, it is concerning that SP continues to predominate in the anti-malarial market. The reasons for this remain unclear, but are likely to be in part related to price, availability and provider knowledge or preferences. Continued efforts to implement government policy around malaria diagnosis and case management should be encouraged