Mixed effects analysis of factors associated with barriers to accessing healthcare among women in sub-Saharan Africa: insights from demographic and health surveys

Background: Access to healthcare is one of the key global concerns as treasured in the Sustainable Development Goals. This study, therefore, sought to assess the individual and contextual factors associated with barriers to accessing healthcare among women in sub-Saharan Africa (SSA). Materials and methods: Data for this study were obtained from the latest Demographic and Health Surveys (DHS) conducted between January 2010 and December 2018 across 24 countries in SSA. The sample comprised 307,611 women aged 15-49. Data were analysed with STATA version 14.2 using both descriptive and multilevel logistic regression modelling. Statistical significance was set at p<0.05. Results: It was found that 61.5% of women in SSA face barriers in accessing healthcare. The predominant barriers were getting money needed for treatment (50.1%) and distance to health facility (37.3%). Women aged 35-39 (AOR = 0.945, CI: 0.911-0.980), married women (AOR = 0.694, CI: 0.658-0.732), richest women (AOR = 0.457, CI:0.443-0.472), and those who read newspaper or magazine at least once a week (AOR = 0.893, CI:0.811-0.983) had lower odds of facing barriers in accessing healthcare. However, those with no formal education (AOR = 1.803, CI:1.718-1.891), those in manual occupations (AOR = 1.551, CI: 1.424- 1.689), those with parity 4 or more (AOR = 1.211, CI: 1.169-1.255), those who were not covered by health insurance (AOR = 1.284, CI: 1.248-1.322), and those in rural areas (AOR = 1.235, CI:1.209-1.26) had higher odds of facing barriers to healthcare access. Conclusion: Both individual and contextual factors are associated with barriers to healthcare accessibility in SSA. Particularly, age, marital status, employment, parity, health insurance coverage, exposure to mass media, wealth status and place of residence are associated with barriers to healthcare accessibility. These factors ought to be considered at the various countries in SSA to strengthen existing strategies and develop new interventions to help mitigate the barriers. Some of the SSA African countries can adopt successful programs in other parts of SSA to suit their context such as the National Health Insurance Scheme (NHIS) and the Community-based Health Planning and Services concepts in Ghana

Factors associated with early antenatal care attendance among women in Papua New Guinea: a population‐based cross‐sectional study

Background: Early initiation of antenatal care (ANC) is a key component of antenatal care, as suggested by the World Health Organisation (WHO). It helps in early identification and mitigation of adverse pregnancy-related complications. Despite this, a greater proportion of women worldwide still do not adhere to this recommendation. This study, therefore, sought to assess the prevalence and factors associated with early initiation of ANC among women in Papua New Guinea (PNG). Methods: A population-based cross-sectional study was conducted among 4,274 women using data from the 2016–2018 PNG Demographic and Health Survey (PDHS). The outcome variable was early initiation of ANC. Bivariate (chi-square) and multivariable logistic regression analyses were done and statistical significance was set at p < 0.05. Results: The prevalence of early ANC initiation was 23.0 % (CI = 20.8–24.6). The binary logistic regression analysis showed that working women had higher odds of early ANC attendance compared with those who were not working [AOR = 1.37, 95 %CI = 1.17 = 1.60]. The results also showed that women from Islands region had lower odds [AOR = 0.50, 95 %CI = 0.40–0.62] of early ANC attendance compared with those from Southern region. Finally, women with parity 3 had lower odds of early ANC attendance compared to those with parity 1[AOR = 0.64,95 % CI = 0.49–0.84]. Conclusions: This study found a relatively low prevalence of early ANC uptake among women in PNG. The factors associated with early ANC attendance were region of residence, parity, and working status of mothers. To increase early ANC uptake, these factors should be considered when designing new policies or reviewing policies and strategies on ANC uptake to help increase ANC attendance, which can help in the reduction of maternal mortality

A multinomial regression analysis of factors associated with antenatal care attendance among women in Papua New Guinea

Objectives: This study sought to assess the prevalence and factors associated with antenatal care (ANC) uptake among women in Papua New Guinea. Study design: This is a secondary data analysis of a nationally representative population based cross-sectional survey of households in Papua New Guinea conducted from 2016 to 2018. Methods: Descriptive statistics in the form of frequencies and percentages and multinomial logistic regression analysis were done to assess the factors associated with ANC uptake and statistical significance was set at p<0.05. Results: The prevalence of 4 or more ANC visits was 51.4%. The multinomial logistic regression analysis showed that women aged 35–39 [ARRR = 1.630, 95% CI = 1.016,2.615], those in the richest wealth quintile [2.361, 95% CI = 1.595,3.496], women who had secondary/higher level of education [ARRR = 3.644, 95% CI = 2.614,5.079], and those whose partners had secondary/higher education [ARRR = 1.706, 95% CI = 1.310,2.223] were more likely to attain 4 or more ANC visits. The likelihood of 4 or more ANC visits increased among women in Momase region [ARRR = 3.574, 95% CI = 2.683,4.762], those with parity 1 [ARRR = 2.065, 95% CI = 1.513,2.816], women who did not have a big problem with permission to go to the hospital for care [ARRR = 1.331, 95% CI = 1.110,1.597] and distance to health facility [ARRR = 1.970, 95% CI = 1.578,2.458]. However, women who were not working [ARRR = 0.756, 95% CI = 0.630,0.906], those in rural areas [ARRR = 0.712, 95% CI = 0.517,0.980] and those who do not take healthcare decisions alone [ARRR = 0.824, 95% CI = 0.683,0.994] were less likely to attain 4 or more ANC visits. Conclusion: It was found that 51.4% of women have attained 4 or more ANC visits. Age, wealth status, employment, maternal and partner's education, region and place of residence, parity, exposure to mass media, problem with distance and getting money needed for treatment and decision making on healthcare are associated with 4 or more ANC uptake among women in Papua New Guinea. To promote optimal number of ANC visits, there is the need for a multi-sectorial collaboration. For example, the various ministries such as the Ministry of Labour/Employment, Education, Development, Women affairs and Finance could collaborate with the Ministry of Health to achieve universal ANC coverage

Using Anderson's model of health service utilization to assess the use of HIV testing services by sexually active men in Ghana

Introduction: Globally, HIV testing and counseling is considered a key cost-effective component of HIV prevention and treatment. This study sought to use Anderson's model of health service utilization to assess the uptake of HIV testing services by sexually active men in Ghana. Materials and Methods: Data were from the 2014 Ghana Demographic and Health Survey. Both bivariate and multivariate analysis were conducted. The multivariate analysis results are presented as Adjusted Odds ratios (AORs) with 95% confidence intervals (CI). Statistical significance was declared at p < 0.05. Results: A total of 3,052 sexually active men aged 15–59 were included in the analysis. Of these, 25.4% tested for their HIV status. Men aged 30–39 (AOR = 2.715, CI = 1.458, 5.054), those with higher level of education (AOR = 3.566,CI = 2.309, 5.509), married (AOR = 1.50, CI = 1.167, 1.931), and men in Upper East (AOR = 2.625, CI = 1.608, 4.285) had higher odds of HIV testing uptake than their counter parts aged 15–19, those with no formal education unmarried and those in Western Region, respectively. However, men with no religion (AOR = 0.606, CI = 0.376, 0.975) and those who belong to the Mole-Dagbani ethnic group (AOR = 0.633, CI = 0.429, 0.934) had lower odds of HIV testing uptake compared to those who are Christians, and Akans, respectively. Men who have subscribed to health insurance (AOR = 1.896, 95% CI = 1.361, 2.643), those in the rich wealth quintile (AOR = 1.896, CI = 1.361, 2.643), those who read newspaper (AOR = 1.552, CI = 1.198, 2.012), listened to radio (AOR = 1.530, CI = 1.087, 2.153) at least once a week, and men who experienced discharge from their penis (AOR = 1.056, CI = 1.200, 1.515) had higher odds of HIV testing uptake. Conclusion: Uptake of HIV testing among Ghanaian men is relatively low. There is the need for a concerted effort by various stakeholders to strengthen current efforts to target younger and unmarried men, men with low level of education, those who do not profess any religious affiliation and men belonging to Mole-Dagbani ethnic group

Are children’s stools in Ghana disposed of safely? Evidence from the 2014 Ghana demographic and health survey

Background: Safe disposal of children’s faeces has always been one of the main challenges to good hygiene in Ghana. Although it has been proven that children’s faeces are more likely to spread diseases than adults’ faeces, people usually mistake them for harmlessness. This study, therefore, sought to determine the prevalence and factors associated with safe disposal of children’s faeces in Ghana. Methods: Data from the 2014 Ghana Demographic and Health Survey was used for the analysis. A sample size of 2228 mother-child pairs were used for the study. The outcome variable was disposal of children stools. Both bivariate and multivariable logistic regression analyses were performed to identify the factors with safe child stool disposal. Results: The prevalence of safe child stool disposal in Ghana was 24.5%. Women in the middle [Adjusted odds ratio (AOR) = 4.62; Confidence Interval (CI) = 3.00–7.10], Coastal Zone [AOR = 4.52; CI = 2.82–7.22], mothers whose children were aged 12–17 [AOR = 1.56; CI = 1.15–2.13] and 18–23 months [AOR = 1.75; CI = 1.29–2.39], and mothers whose household had improved type of toilet facility [AOR = 2.04; CI = 1.53–2.73] had higher odds of practicing safe children’s faeces disposal. However, women from households with access to improved source of drinking water [AOR = 0.62; CI = 0.45–2.7] had lower odds of practicing safe children’s faeces disposal. Conclusion: Approximately only about 25 out of 100 women practice safe disposal of their children’s faeces in Ghana. The age of the child, ecological zone, the type of toilet facilities, and the type of drinking water source are associated with the disposal of child faeces. These findings have proven that only improved sanitation (i.e. drinking water and toilet facilities) are not enough for women to safely dispose of their children’s faeces. Therefore, in addition to provision of toilet facilities especially in the northern zone of Ghana, there is also the need to motivate and educate mothers on safe disposal of children’s stools especially those with children below 12 months. More so, mothers without access to improved toilet facility should also be educated on the appropriate ways to bury their children’s stools safely

Socio-economic and demographic predictors of unmet need for contraception among young women in sub-Saharan Africa: evidence from cross-sectional surveys

© 2020, The Author(s). Introduction: Globally, sub-Saharan Africa (SSA) bears the highest proportion of women with unmet need for contraception as nearly 25% of women of reproductive age in the sub-region have unmet need for contraception. Unmet need for contraception is predominant among young women. We examined the association between socio-economic and demographic factors and unmet need for contraception among young women in SSA. Methods: Data for this study obtained from current Demographic and Health Surveys (DHS) conducted between January 1, 2010 and December 31, 2018 in 30 sub-Saharan African countries. The sample size consisted of young women (aged 15–24), who were either married or cohabiting and had complete cases on all the variables of interest (N = 59,864). Both bivariate and multivariable binary logistic regression analyses were performed using STATA version 14.0. Results: The overall prevalence of unmet need for contraception among young women was 26.90% [95% CI: 23.82–29.921], ranging from 11.30% [95% CI: 5.1–17.49] in Zimbabwe to 46.7% [95% CI: 36.92–56.48] in Comoros. Results on socio-economic status and unmet need for contraception showed that young women who had primary [aOR = 1.18; CI = 1.12–1.25, p < 0.001] and secondary/higher levels of formal education [aOR = 1.27; CI = 1.20–1.35, p < 0.001] had higher odds of unmet need for contraception compared to those with no formal education. With wealth status, young women in the richest wealth quintile had lower odds of unmet need for contraception compared with those in the poorest wealth quintile [aOR = 0.89; CI = 0.81–0.97, p < 0.01]. With the demographic factors, the odds of unmet need for contraception was lower among young women aged 20–24 [aOR = 0.74; CI = 0.70–0.77, p < 0.001], compared with 15–19 aged young women. Also, young women who were cohabiting had higher odds of unmet need for contraception compared to those who were married [aOR = 1.35; CI = 1.28–1.43, p < 0.001]. Conclusion: Our study has demonstrated that unmet need for contraception is relatively high among young women in SSA and this is associated with socio-economic status. Age, marital status, parity, occupation, sex of household head, and access to mass media (newspaper) are also associated with unmet need for contraception. It is therefore, prudent that organisations such as UNICEF and UNFPA and the Bill & Melinda Gates Foundation who have implemented policies and programmes on contraception meant towards reducing unmet need for contraception among women take these factors into consideration when designing interventions in sub-Saharan African countries to address the problem of high unmet need for contraception among young women

“I don't like to be seen by a male provider”: health workers’ strike, economic, and sociocultural reasons for home birth in settings with free maternal healthcare in Nigeria

Background: Ending maternal mortality has been a significant global health priority for decades. Many sub-Saharan African countries introduced user fee removal policies to attain this goal and ensure universal access to health facility delivery. However, many women in Nigeria continue to deliver at home. We examined the reasons for home birth in settings with free maternal healthcare in Southwestern and North Central Nigeria. Methods: We adopted a fully mixed, sequential, equal-status design. For the quantitative study, we drew data from 211 women who reported giving birth at home from a survey of 1227 women of reproductive age who gave birth in the 5 y before the survey. The qualitative study involved six focus group discussions and 68 in-depth interviews. Data generated through the interviews were coded and subjected to inductive thematic analysis, while descriptive statistics were used to analyse the quantitative data. Results: Women faced several barriers that limited their use of skilled birth attendants. These barriers operate at multiple levels and could be grouped as economic, sociocultural and health facility–related factors. Despite the user fee removal policy, lack of transportation, birth unpreparedness and lack of money pushed women to give birth at home. Also, sociocultural reasons such as hospital delivery not being deemed necessary in the community, women not wanting to be seen by male health workers, husbands not motivated and husbands’ disapproval hindered the use of health facilities for childbirth. Conclusions: This study has demonstrated that free healthcare does not guarantee universal access to healthcare. Interventions, especially in the Nasarawa state of Nigeria, should focus on the education of mothers on the importance of health facility–based delivery and birth preparedness

Age–sex differences in the global burden of lower respiratory infections and risk factors, 1990–2019: results from the Global Burden of Disease Study 2019

Background: The global burden of lower respiratory infections (LRIs) and corresponding risk factors in children older than 5 years and adults has not been studied as comprehensively as it has been in children younger than 5 years. We assessed the burden and trends of LRIs and risk factors across all age groups by sex, for 204 countries and territories. Methods: In this analysis of data for the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, we used clinician-diagnosed pneumonia or bronchiolitis as our case definition for LRIs. We included International Classification of Diseases 9th edition codes 079.6, 466–469, 470.0, 480–482.8, 483.0–483.9, 484.1–484.2, 484.6–484.7, and 487–489 and International Classification of Diseases 10th edition codes A48.1, A70, B97.4–B97.6, J09–J15.8, J16–J16.9, J20–J21.9, J91.0, P23.0–P23.4, and U04–U04.9. We used the Cause of Death Ensemble modelling strategy to analyse 23 109 site-years of vital registration data, 825 site-years of sample vital registration data, 1766 site-years of verbal autopsy data, and 681 site-years of mortality surveillance data. We used DisMod-MR 2.1, a Bayesian meta-regression tool, to analyse age–sex-specific incidence and prevalence data identified via systematic reviews of the literature, population-based survey data, and claims and inpatient data. Additionally, we estimated age–sex-specific LRI mortality that is attributable to the independent effects of 14 risk factors. Findings: Globally, in 2019, we estimated that there were 257 million (95% uncertainty interval [UI] 240–275) LRI incident episodes in males and 232 million (217–248) in females. In the same year, LRIs accounted for 1·30 million (95% UI 1·18–1·42) male deaths and 1·20 million (1·07–1·33) female deaths. Age-standardised incidence and mortality rates were 1·17 times (95% UI 1·16–1·18) and 1·31 times (95% UI 1·23–1·41) greater in males than in females in 2019. Between 1990 and 2019, LRI incidence and mortality rates declined at different rates across age groups and an increase in LRI episodes and deaths was estimated among all adult age groups, with males aged 70 years and older having the highest increase in LRI episodes (126·0% [95% UI 121·4–131·1]) and deaths (100·0% [83·4–115·9]). During the same period, LRI episodes and deaths in children younger than 15 years were estimated to have decreased, and the greatest decline was observed for LRI deaths in males younger than 5 years (–70·7% [–77·2 to –61·8]). The leading risk factors for LRI mortality varied across age groups and sex. More than half of global LRI deaths in children younger than 5 years were attributable to child wasting (population attributable fraction [PAF] 53·0% [95% UI 37·7–61·8] in males and 56·4% [40·7–65·1] in females), and more than a quarter of LRI deaths among those aged 5–14 years were attributable to household air pollution (PAF 26·0% [95% UI 16·6–35·5] for males and PAF 25·8% [16·3–35·4] for females). PAFs of male LRI deaths attributed to smoking were 20·4% (95% UI 15·4–25·2) in those aged 15–49 years, 30·5% (24·1–36·9) in those aged 50–69 years, and 21·9% (16·8–27·3) in those aged 70 years and older. PAFs of female LRI deaths attributed to household air pollution were 21·1% (95% UI 14·5–27·9) in those aged 15–49 years and 18·2% (12·5–24·5) in those aged 50–69 years. For females aged 70 years and older, the leading risk factor, ambient particulate matter, was responsible for 11·7% (95% UI 8·2–15·8) of LRI deaths. Interpretation: The patterns and progress in reducing the burden of LRIs and key risk factors for mortality varied across age groups and sexes. The progress seen in children younger than 5 years was clearly a result of targeted interventions, such as vaccination and reduction of exposure to risk factors. Similar interventions for other age groups could contribute to the achievement of multiple Sustainable Development Goals targets, including promoting wellbeing at all ages and reducing health inequalities. Interventions, including addressing risk factors such as child wasting, smoking, ambient particulate matter pollution, and household air pollution, would prevent deaths and reduce health disparities

Does knowledge of pregnancy complications influence health facility delivery? Analysis of 2014 Bangladesh Demographic and Health Survey

Introduction Only thirty-seven percent (37%) of deliveries occur in health facilities in Bangladesh despite the enormous benefits of health facility delivery. We investigated women’s recall of receiving counseling on pregnancy complications and how it affects health facility delivery in Bangladesh. Materials and methods Data from the 2014 Bangladesh Demographic and Health Survey was used for the study. After calculating the proportion of women who were informed about pregnancy complications during their last Antenatal Care (ANC) and the number of them who delivered in health facilities, Binary Logistic Regression was utilized in investigating chances of giving birth in health facilities among women who recalled they were told about pregnancy complications and those who were not told. The models were considered significant at 95%. Results A little above half of the women who were told about pregnancy complications during ANC delivered in health facilities (53.3%) and 43.6% of those who were not told delivered in health facilities. The findings revealed that women who were told about pregnancy complications during ANC were more likely to deliver at the health facility compared to those who were not told [COR = 1.56, CI = 1.31–1.87], and this persisted after controlling for the effect of covariates [AOR = 1.44, CI = 1.21–1.71]. Conclusion This study has stressed the importance of telling women about pregnancy complications during ANC by revealing that telling women about pregnancy complications during ANC is likely to result in health facility delivery. Health workers should intensify health education on pregnancy complications during ANC and motivate women to deliver in health facilities

Global, regional, and national burden of hepatitis B, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: Combating viral hepatitis is part of the UN Sustainable Development Goals (SDGs), and WHO has put forth hepatitis B elimination targets in its Global Health Sector Strategy on Viral Hepatitis (WHO-GHSS) and Interim Guidance for Country Validation of Viral Hepatitis Elimination (WHO Interim Guidance). We estimated the global, regional, and national prevalence of hepatitis B virus (HBV), as well as mortality and disability-adjusted life-years (DALYs) due to HBV, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. This included estimates for 194 WHO member states, for which we compared our estimates to WHO elimination targets