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Background: There is a strong evidence showing that women who start menstruation early are at a greater risk of developing breast cancer. Recognizing that women will seek breast cancer screening when they have a high perceived risk, we hypothesized that women who experienced early menarche will be more likely to utilize clinical breast examination (CBE). Hence, we aimed to investigate the association between age at first menstruation and women's utilization of CBE in Côte d'Ivoire., Methods: We used data from the 2021 Côte d'Ivoire demographic and health survey. A sample of 14,685 women was used for the analysis. A descriptive analysis, as well as bivariate and multivariate logistic regression models were computed in STATA version 18. Adjusted odds ratio (AOR) and a 95% confidence interval was used to present the result., Results: CBE utilization was 17.4%. Women who had their first menstruation before attaining 15 years were significantly less likely to utilize CBE services [AOR = 0.89; 95% CI 0.81-0.99]. A significantly higher utilization of CBE was found among those with primary [AOR = 1.48, 95% CI 1.29-1.70], secondary [AOR = 2.96, 95% CI 2.59-3.38], and higher education [AOR = 4.35, 95% CI 3.50-5.40] compared to those with no formal education. Increasing likelihood of CBE utilization was observed as age increased. Rural residence was associated with lower odds of CBE utilization (AOR = 0.84, 95% CI 0.74-0.95]. Increasing wealth status was associated with higher odds of CBE utilization with those in the richest households having the highest odds compared to women in the poorest household [AOR = 2.11, 95% CI 1.69-2.64]., Conclusion: Utilization of CBE is low among women of reproductive age in Côte d'Ivoire. We conclude that even though existing literature has established early age at first menstruation as a strong risk factor for breast cancer, CBE utilization is significantly low among those who had early menarche. Going forward, it is necessary for Côte d'Ivoire's health Ministry to intensify breast cancer awareness in the country. Such awareness campaigns must emphasize age at menarche as a risk factor so as to motivate women with a history of early menstruation to utilize CBE., Competing Interests: Declarations. Ethical approval and consent to participate: We did not need to seek ethical clearance because the DHS dataset we used is publicly available. We obtained the datasets from the DHS Program after completing the necessary registration and getting approval for their use. We followed all the ethical guidelines that pertain to using secondary datasets in research publications. You can find detailed information about how we used the DHS data and the ethical standards we followed at this link: http://goo.gl/ny8T6X . Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Kenya has ratified and enacted several frameworks and laws in a bid to reduce the incidence of IPV and improve disclosure of violence experience. With these legal and structural mechanisms in place, women's disclosure of IPV is expected to show a positive trend over the years. We examined the trends and factors associated with disclosure of IPV among women in Kenya., Methods: The 2008, 2014 and 2022 Kenya demographic and health survey data was used, with a weighted sample of 6,093 women aged 15-49 years. The sample size for 2008, 2014 and 2022 were 1350, 1165, and 3578, respectively. Violence disclosure was the outcome variable. A logistic regression model was fitted to estimate the predicted probabilities (margins) of reporting violence for each year. Additionally, a multivariable logistic regression was performed to assess factors associated with violence disclosure using a backward stepwise approach., Results: We found a statistically significant increase in the odds of disclosing violence by 65% from 2008 to 2022 [OR = 1.65; 95%CI: 1.41-1.94, p < 0.001]. The odds of disclosing violence increased significantly by 35% from 2008 to 2014 (OR = 1.35, p = 0.003), and further declined by 23% from 2014 to 2022 (OR = 1.23, p = 0.012). Violence disclosure significantly increased with age. Women in the richest wealth index (AOR = 1.78, 95% CI: 1.46-2.16), those currently working (AOR = 1.23, 95% CI: 1.08-1.41), had witnessed parental violence (AOR = 1.14, 95% CI: 1.01-1.29), or had partners who drank alcohol (AOR = 1.41, 95% CI: 1.24-1.59) were also more likely to disclose violence., Conclusion: The findings from this study indicate that violence disclosure among women in Kenya has significantly increased over the years. Women in higher wealth quintile, currently employed, and those exposed to violence in their parental homes were more likely to disclose violence, highlighting the importance of economic empowerment and addressing intergenerational transmission of violence in increasing disclosure rates., Competing Interests: Declarations. Ethical approval and consent to participate: We did not need to seek ethical clearance because the KDHS dataset we used is publicly available. We obtained the datasets from the KDHS Program after completing the necessary registration and getting approval for their use. We followed all the ethical guidelines that pertain to using secondary datasets in research publications. Details of KDHS data and ethical standards followed can be found here: http://goo.gl/ny8T6X . Consent for publication: None declared. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Implementation strategies are key to enhancing the translation of new innovations but there is a need to systematically design and tailor strategies to match the targeted implementation context and address determinants. There are increasing methods to inform the development and tailoring of implementation strategies to maximize their usability, feasibility, and appropriateness in new settings such as the Cognitive Walkthrough for Implementation Strategies (CWIS) approach. The aim of the current project is to apply the CWIS approach to inform the redesign of a multifaceted selection-quality implementation toolkit entitled Adoption of Curricular supports Toolkit: Systematic Measurement of Appropriateness and Readiness for Translation in Schools (ACT SMARTS) for use in middle and high schools., Methods: We systematically applied CWIS as the second part of a community-partnered iterative redesign of ACT SMARTS for schools to evaluate the usability and inform further toolkit redesign areas. We conducted three CWIS user testing sessions with key end users of school district administrators (n = 3), school principals (n = 6), and educators (n = 6)., Results: Our CWIS application revealed that end users found ACT SMARTS acceptable and relevant but anticipate usability issues engaging in the ACT SMARTS process. Results informed the identification of eleven usability issues and corresponding redesign solutions to enhance the usability of ACT SMARTS for use in middle and high schools., Conclusions: Results indicated the utility of CWIS in assessing implementation strategy usability in service of informing strategy modification as part of our broader redesign to improve alignment with end user, end recipient, and setting needs. Recommendations regarding the use of this participatory approach are discussed., (© 2024. The Author(s).)

Background: This study examined the spatial distribution and factors associated with health insurance subscription among women in Ghana., Methods: We analysed a representative sample of 9380 women aged 15-49 y from the 2014 Ghana Demographic and Health Survey. Descriptive and multilevel regression analyses were performed. The study also employed spatial analysis techniques, including spatial autocorrelation, hotspot analysis, cluster and outlier analysis, as well as geographically weighted regression to explore the geographic distribution and predictors of non-subscription to health insurance., Results: The analysis revealed a moderately high prevalence of health insurance subscription among women in Ghana (62.4%). The spatial analyses indicated substantial variations in health insurance subscription across different regions in Ghana. The coastal and middle zones reported higher rates of non-subscription compared with the northern zone. We observed that young women (aged 20-24 y) had a lower likelihood of subscribing compared with adolescent girls (aged 15-19 y). Also, higher educational attainment, listening to the radio, being in a marital union and higher wealth status were positively associated with health insurance subscription., Conclusions: The study calls for targeted interventions and policies to promote equitable access to healthcare services, focusing on improving health infrastructure in coastal and middle zones, educational campaigns for individuals with lower education levels, leveraging media platforms for health insurance awareness and implementing equitable and affordable processes for individuals in poorer households., (© The Author(s) 2023. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Women who experience intimate partner violence (IPV) face increased risks of reproductive health issues and psychological distress. There is also a growing scholarly interest in its effect on cardiovascular health. About 30% of Kenyan women experience emotional violence, and 9.37% are hypertensive. Yet, there is the absence of localized studies on the role of emotional violence on hypertension risk. This study aims to address this gap by investigating the association between emotional violence and hypertension risk among women of reproductive age in Kenya. Using data from the 2022 Kenya demographic and health survey, we analysed the data of 5,109 women. The outcome and exposure were hypertension status and emotional violence, respectively. Descriptive analysis and binary logistic regression models were computed in STATA version 18. Results were presented in tables, showing the frequency, percentage, and adjusted odds ratio (AOR) at a 95% confidence interval (CI). The prevalence of hypertension was 9.78% [95% CI 8.73-10.94]. Women who had experienced emotional violence had 69% higher odds of hypertension [AOR 1.69; 95% CI 1.39-2.06]. After adjusting for covariates (i.e., age, place of residence, wealth status, exposure to media, and educational level), individuals who reported experiencing emotional violence exhibited a 51% higher odds of hypertension compared to those who did not [AOR 1.51; 95% CI 1.23-1.85]. There is a significant association between emotional violence and hypertension. The findings underscore a need for policy makers in Kenya to address emotional violence against women not only as a social issue but as a serious health risk factor. As such, the experience of emotional violence should be considered as part of the criteria to enhance hypertension screening among women., (© 2024. The Author(s).)

Background: In resource-constrained settings, availability and access to mammography is a challenge. As such, the World Health Organization (WHO) recommends clinical breast examination (CBE) for women in such settings. Yet, CBE uptake remains low. We, therefore, aimed to contribute to the discourse on factors that influence women's screening practice by investigating the association between the frequency of internet use and women's uptake of CBE in Ghana., Methods: This study was based on data from 15,013 women who participated in the 2022 Ghana demographic and health survey. We performed descriptive analysis, computed Pearson's chi-square test, and fitted multivariable logistic regression models. The findings from the regression model were presented in adjusted odds ratio (AOR) at a 95% confidence interval., Results: Only 18.39% of women 15-49 years had their breasts examined by a healthcare provider. About 38.22% of the total sample often used the internet. Compared to women who did not use the internet at all, those who often used it had twice the odds of getting screened (COR = 2.86; 95%CI: 2.62-3.13). The odds of CBE uptake remained significantly higher among those who often used the internet (AOR = 1.26; 95%CI: 1.12-1.43) even after adjusting for the covariates., Conclusion: We conclude that CBE uptake is significantly high among women who frequently use the internet. This association persists even when considering other influential factors such as age, education level, marital status, and socioeconomic status. As such, it is imperative for the Ministry of Health in collaboration with the Ghana Health Service to recognize the potential of digital health interventions, including online health education campaigns and telehealth services, in reaching and engaging women to get their breast examined by a healthcare provider., (© 2024. The Author(s).)

Background: Cervical cancer ranks third in terms of cancer incidence and mortality in Cape Verde. Understanding the factors associated with the age of cervical cancer screening (CCS) is essential because it helps identify populations at risk of delayed screening, enabling targeted interventions to ensure timely detection and treatment, ultimately reducing the burden of cervical cancer. We examined the factors associated with age at first screening for cervical cancer among adult Cape Verdean women., Methods: Data from the 2020 WHO STEPs survey were used. We analyzed data from 1,082 women aged 30-69 years who had ever screened for cervical cancer. Bivariable and multivariable logistic regression models were computed in STATA version 18., Results: Overall, 30.6% of women in the study had their first CCS before or at age 30. Except for visits to the health facility within the last 12 months, all variables significantly predicted women's first age for CCS in the crude model. In the adjusted model, women with tertiary education showed greater odds [AORs = 9.85; 95% CI: 4.12-23.54] compared to those with no formal education. Compared to those who were never married, previously married women had significantly lower odds of screening at an early age [AOR = 0.63; 95% CI: 0.39-0.99]. Women without hypertension had higher odds [AOR = 1.66; 95% CI: 1.18-2.34] of early screening compared to those with hypertension. Also, women who were currently working had significantly higher odds of early screening than those unemployed [AOR = 1.49; 95% CI: 1.09-2.04]., Conclusion: In conclusion, implementing targeted educational campaigns, addressing socio-economic barriers, and integrating cervical cancer screening into routine healthcare services can increase the early screening uptake among Cape Verdean women. There is a need to integrate CCS in the routine healthcare services of women living with hypertension. Also, the positive association between formal education and age at first screening, it is imperative for the Cape Verdean public health departments to implement comprehensive education programs within schools to promote awareness about CCS., (© 2024. The Author(s).)

Background: Despite global, regional, and national efforts to address intimate partner violence (IPV), physical IPV persists as a significant challenge in Kenya. This study employs geospatial analysis to examine the spatial distribution and determinants of physical intimate partner violence among women, aiming to inform targeted interventions and policies., Methods: The study used a secondary analysis of a cross-sectional study design based on the 2022 Kenya demographic and health survey. Analyses were conducted using Stata version 17.0 and ArcMap version 10.8. Spatial autocorrelation and hotspot assessment were conducted in the geospatial analysis, while a multilevel logistic regression model was used to examine determinants of physical violence among reproductive-aged women., Results: The study found 28.8% (10,477) of the surveyed women reported experiencing physical intimate partner violence. The spatial analysis identified significant clusters in the southwest and central regions, with women in sub-counties like Chepaluugu, Konion, Sotik, Bumula, and Metayos among others experiencing more violence. Conversely, women in areas in the North East and South East corners such as Kisauni, Tarabaj, Waijir North, Lafey, and Mandera North and South among others showed little or no physical intimate partner violence. Multivariable logistic regression identified age, education, wealth index, partner domineering indicators, and justification of wife beating to be associated with physical intimate partner violence. Higher education and wealth were associated with lower violence odds, while partner domineering indicators and justification of wife beating increased odds., Conclusion: Spatial variations in intimate partner violence risk for women in Kenya underscore the need for targeted government interventions. Focusing on hotspot regions, especially among women with the poorest wealth index, no formal education, and older age, is crucial. Implementing behavior change campaigns addressing violence justification and partner dominance is vital. Active involvement of male partners in programs aiming to eliminate intimate partner violence is essential for comprehensive impact., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Okyere et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Intimate partner violence (IPV) is a significant public health issue, predominantly among women in sub-Saharan Africa, including Ghana. Existing evidence indicates high rates of IPV perpetration and its associated adverse health outcomes. Despite previous studies, reliance on old data underscores the need for current, nationally representative data to inform policy-making and interventions. Therefore, this study utilizes the 2022 Ghana Demographic and Health Survey (GDHS) to examine IPV experiences and associated factors, aiming to provide updated insights for effective IPV mitigation strategies in Ghana., Methods: This is a cross-sectional study of a weighted sample of 3,741 women between the ages of 15-49 years old from the 2022 GDHS. Binary logistic regression analysis was used in predicting the outcome., Results: The study found that 36.4 percent of women in Ghana had experienced some form of IPV, primarily emotional violence (31.5%), physical violence (17.3%), and sexual violence (7.6%). Women with higher levels of education had a significantly reduced risk of 60% of experiencing some form of IPV than those with no formal education. Partner domineering behaviours, such as women whose partners often get jealous for seeing them talk with other men [adjusted OR:1.76, 95%CI:1.25,2.48], accusing them of unfaithfulness [adjusted OR:2.59, 95%CI:1.03,2.46], not permitting them to meet female friends [adjusted OR:1.1.59, 95%CI:1.03,2.46], and limiting their contact with family [adjusted OR:5.75, 95%CI:2.27,13.42], were more likely to experience at least one form of IPV. Similarly, women who justified or endorsed wife beating had a higher likelihood [aOR = 1.57, 95%CI = 1.22,2.02] of experiencing at least one form of IPV than those who did not endorse such behaviour., Conclusion: Identifying educational attainment, partner dominance, and violence endorsement as IPV predictors underscore targeted interventions. Promoting women's education bolsters empowerment and IPV prevention. Addressing dominance through education, counselling, and legal frameworks is crucial for fostering safer relationships and challenging violence normalization., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Dickson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Child abuse is a dominant public health concern that permeates race, varied social contexts and culture. Child abuse comprises any act of omission or commission perpetrated by a child's parent, caregiver, or other adult leading to harm, potential for, or any threat of harm to a child (below age 18), either intentional or unintentional. This subject has usually been explored by focusing on men. This study investigated the prevalence and social correlates of child abuse across seven countries in sub-Saharan Africa., Methods and Materials: Data was obtained from Demographic and Health Surveys (DHS) conducted in seven countries in sub-Saharan Africa between 2013 and 2020. The outcome variable employed for this study was acts of child abuse (including shouting, striking, and slapping). Descriptive and inferential analyses were carried out. The descriptive analysis focused on the bivariate analysis between the country variable and the outcome variables. Multivariate analysis was, however, utilized to determine the relationship between the outcome variables and the respondents' explanatory variables, using a binary logistic regression model. The adjusted odds ratios for each variable were calculated using a 95% confidence range., Results: The proportion of women shouting at children was 72 percent. This ranged from 49.2 percent in Chad to 84.2 percent in Benin. The proportion of women striking children was 52.5 percent and this ranged from 37.1 percent in Chad to 63.8 percent in Benin. The odds of women striking their children was higher for those with children aged 10-14 (aOR = 1.18, CI = 1.03, 1.34), women with primary education (aOR = 1.25, CI = 1.17, 1.33), cohabiting women (aOR = 1.17, CI = 1.10, 1.25) and women who had experienced intimate partner violence (aOR = 1.06, CI = 1.00, 1.12). The odds of women shouting at their children was higher for those aged 30-34 years (aOR = 1.31, CI = 1.11, 1.55) and for working women (aOR = 1.43, 1.33, 1.56). The odds of women slapping their children was higher for those who justify wife-beating (aOR = 1.10, CI = 1.03, 1.16) and for women with richest wealth status (aOR = 1.25, CI = 1.17, 1.33)., Conclusions: The findings show that it is imperative for the governments of the countries studied, especially those with high prevalence like Benin, to consider parent-friendly and culturally acceptable non-formal educational initiatives that will dissuade parents and guardians from abusing children. Possibly, legal reforms that sanction harsher punishments to perpetrators of child abuse may help make child abuse less attractive to parents and guardians., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Dickson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To examine the burden of non-communicable diseases (NCDs) among women of reproductive age in Kenya, highlighting the prevalence and risk factors., Design: Cross-sectional design based on the 2022 Kenya Demographic and Health Survey., Setting: Kenya., Primary Outcomes: Predict the burden of hypertension, diabetes, heart disease, lung disease, arthritis, depression, anxiety, breast and cervical cancer., Results: Overall, 15.9% of Kenyan women aged 15-49 years were living with at least one NCD. The most prevalent NCD among this cohort was hypertension (8.7%) followed by arthritis (2.9%) and depression (2.8%). Our findings revealed that increasing age, increasing wealth, being married or formerly married, being overweight or obese, consuming alcohol and some occupations were risk factors of NCDs among women of reproductive age in Kenya., Conclusion: We conclude that hypertension is the most prevalent NCD among women of reproductive age in Kenya. The findings underscore the multifaceted nature of NCD risk factors in Kenya, emphasising the importance of targeted interventions that consider age, economic status, education, marital status, occupation and lifestyle factors., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In 2021, Madagascar had approximately 13,919 people living with diabetes, with 66.1% of cases being undiagnosed. The implication is that this population are at high risk of developing diabetes complications which will affect their quality of life. However, promoting the uptake of screening practices such as the blood glucose test among the asymptomatic population would offer a chance to reduce the prevalence of undiagnosed diabetes in the country. This study examined the association between place of residence and blood sugar testing practices among men in Madagascar., Methods: Secondary data from the men recode file of the 2021 Madagascar Demographic and Health Survey (MDHS) was used. A sample of 9,035 were used for the analysis. Descriptive and multivariate analyses were performed in STATA version 14. The results are presented in adjusted odds ratio (AOR) with the corresponding 95% confidence interval., Results: Only 5.83% reported to have ever had their blood glucose/sugar tested by a health professional. Residing in rural areas was associated in lower likelihood of undergoing a test to check one's blood sugar level [AOR = 0.23; 95%CI = 0.19-0.28] compared to those in urban areas. This association remained consistent even after adjusting for the effects of covariates [AOR = 0.67; 95%CI = 0.52-0.86]., Conclusion: We conclude that place of residence plays a significant role in influencing men's decision to test their blood glucose level. It is, therefore, imperative for the Madagascar Public Health Department to liaise with the government to bridge the rural-urban disparities in terms of accessibility to blood glucose testing services. Practically, this can be achieved by instituting community-based health services centers in the rural areas of Madagascar to mitigate the rural-urban disparities. Also, health education campaigns to raise men's awareness about the need to test their blood glucose level must necessarily target older men, those without formal education, those without health insurance, and men who have been diagnosed with hypertension., (© 2024. The Author(s).)

Objectives: Given the well-established link between hormonal contraceptives and hypertension risk, and the paucity of research on hormonal contraceptive use dynamics in this particular demographic, we hypothesize that there is a likelihood of low utilization of high-risk hormonal contraceptives among women living with hypertension in SSA. This study investigates the prevalence and factors associated with hormonal contraceptive use among women living with hypertension in the SSA., Results: Only 18.5% of women living with hypertension used hormonal contraceptives. Hormonal contraceptive use was high among women with a higher level of education (aOR = 2.33; 95%CI: 1.73-3.14), those currently working (aOR = 1.38; 95%CI: 1.20-1.59), those who have heard about family planning on the radio (aOR = 1.27, 95%CI: 1.09-1.47), listened to the radio at least once a week (aOR = 1.29, 95%CI: 1.10-1.51), and those residing in rural areas (aOR = 1.32; 95%CI: 1.14-1.54). Conversely, women aged 45-49 exhibited a substantial decrease in the odds of hormonal contraceptive use (aOR = 0.23, 95%CI: 0.14-0.38) compared to younger women (15-19 years). Likewise, the odds of HCU were low among cohabiting (aOR = 0.66; 95%CI: 0.48-0.89) and previously married women (aOR = 0.67; 95%CI: 0.50-0.91) than never married women., (© 2024. The Author(s).)

Background: Nearly one-third of the world's population (2.4 billion people) rely on unclean cooking fuel sources. The study assessed the association of the type of cooking fuel and hypertension risk in sub-Saharan Africa (SSA)., Methods: The study analysed pooled data from 97 942 individuals in the Demographic and Health Survey (DHS) between 2014 and 2021 in 10 SSA countries. Univariate, bivariate and multivariate analyses were performed, including basic descriptive statistics and binary logistic regression. The independent variable of interest was the type of cooking fuel, while hypertension served as the outcome variable., Results: Women using unclean cooking fuel were 1.21 times more likely to be hypertensive compared with those using clean cooking fuel (adjusted odds ratio [aOR] 1.21 [95% confidence interval {CI} 1.11 to 1.31]). Older age (aOR 5.78 [95% CI 5.04 to 6.62]), higher education (aOR 1.14 [95% CI 1.05 to 1.23]), being married (aOR 1.64 [95% CI 1.49 to 1.80]), working in sales and services occupations (aOR 1.34 [95% CI 1.24 to 1.44]), frequent health facility visits (aOR 1.59 [95% CI 1.51 to 1.68]), higher wealth index and exposure to media were significantly associated with hypertension risk., Conclusions: Efforts to reduce reliance on unclean cooking fuel at both the household and population levels need to be intensified in SSA countries. Promoting the use of clean cooking technologies and fuels and implementing supportive policies for transitioning from unclean cooking fuels are crucial. Targeted interventions to reduce hypertension risk in SSA should focus on women using unclean cooking fuel, older women, individuals from wealthier households and those with higher education levels., (© The Author(s) 2023. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

The critical role of executive functioning in autism as well as the co-occurring mental health challenges common among autistic youth support to the immense value of interventions targeting executive functioning for enhancing mental health services for autistic children. The goal of the present study was to conduct a randomized feasibility trial of Unstuck and On Target, an executive functioning intervention, adapted for delivery in children's community mental health setting. Mental health therapists (n = 26) enrolled with participating autistic clients (n = 32) were randomized to receive training in and deliver the adapted Unstuck intervention or to deliver care as usual. We completed masked observational measures of Unstuck strategy use (fidelity) during recorded sessions of participating therapist-client dyads and collected measures of acceptability from participating clients and their caregivers. We also collected measures of pre-post changes in executive functioning and mental health symptoms. Therapists trained in Unstuck demonstrated significantly higher use of Unstuck strategies compared to usual care therapists. Caregivers and autistic clients perceive adapted Unstuck as highly acceptability and helpful. Autistic clients whose therapists were trained in adapted Unstuck demonstrated larger pre-post changes in executive functioning compared to usual care. Across all participating clients, changes in executive functioning were significantly related to changes in mental health symptoms. Finally, clients of therapists trained in adapted Unstuck demonstrated moderate improvements in overall mental health symptoms. The current study provides preliminary evidence of the feasibility and impact of Unstuck and On Target for children's community mental health settings., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: The aim of this study is to examine cervical cancer screening (CCS) uptake among women living with hypertension and HIV in Tanzania., Methods: We used the recently released 2022 Tanzania Demographic and Health Survey. The outcome variable assessed in the study was CCS, whereas chronic morbidities constituted the main explanatory variable. Data analysis was based on observations from 6,298 women aged 30-49 years. Multivariable logistic regression models were used to determine the association between hypertension and HIV status, and CCS uptake. The analyses were computed in STATA 18., Results: Out of the 6,298 respondents, only 805 (12.8%) had undergone CCS with higher screening uptake among those living with either one of the disease (28.5%) than among those living with neither hypertension or HIV. The highest proportion was found among those who had ever been diagnosed with hypertension (24.1%) and among women with positive HIV test results (36.7%). There was a significantly higher likelihood of undergoing screening for cervical cancer among women living with at least one of the diseases [AOR = 2.4; 95% CI: 1.4-2.8], compared to those without these conditions. Women diagnosed with hypertension showed increased likelihood of undergoing CCS [AOR = 1.4; 95%CI: 1.1-1.7]. Similarly, women with a positive HIV test result demonstrated higher odds of screening uptake [AOR = 5.2; 95%CI: 4.0-6.7]., Conclusion: The study found a positive association between comorbidities and CCS uptake in Tanzanian women. Our findings emphasize the critical importance of ensuring accessibility and adherence to essential screenings for individuals with chronic morbid conditions. Future efforts should focus on strengthening existing integrated services and identifying potential barriers to accessing CCS within these healthcare settings to optimize cervical cancer prevention efforts for individuals with chronic morbidities., (© 2024. The Author(s).)

Background: Despite the widespread prevalence of adolescent smoking in Gambia, a West African country, there is limited research exploring the relationships between exposure to pro-tobacco and anti-tobacco media messages and events and smoking behaviour among young people. This study investigates the interplay of these exposures and smoking behaviour among 11-17-year-old adolescents in Gambia., Methods: Secondary data analysis was conducted using the 2017 Gambia Global Youth and Tobacco Survey (GYTS), which included a total of 9,127 respondents. Descriptive and inferential analyses, including proportions, Pearson's chi-squared tests, and multivariable logistic regression models, were employed to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI)., Results: The final model revealed significant associations between exposure to anti-tobacco media messages and events and smoking behaviour. Adolescents exposed to anti-tobacco media messages had a 29% increased odds of smoking (aOR 1.29,CI = 1.08,1.53) compared to those unexposed, while exposure to anti-tobacco media events showed a 31% increased odds (aOR 1.31,CI = 1.09,1.59) compared to those unexposed. Exposure to pro-tobacco messages, such as witnessing tobacco use on TV (aOR 1.41, CI = 1.17,1.69) and owning objects with tobacco brand logos (aOR 1.49,CI = 1.19,1.86), was associated with higher odds of smoking. Covariates, including sex, age, and exposure to smoking behaviour by significant others, also demonstrated associations with smoking behaviour. Notably, male respondents showed significantly higher odds of smoking (aOR = 4.01,CI = 3.28,4.89) compared to females. Respondents aged 15 years and older had increased odds of smoking (aOR = 1.47,CI = 1.22,1.76) compared to those below 15 years old. Those whose fathers smoke displayed higher odds of smoking (aOR = 1.35, CI = 1.04,1.76) compared to individuals with non-smoking parents. Additionally, those whose closest friends smoke showed remarkably higher odds of smoking (aOR = 2.87,CI = 2.37, 3.48) compared to those without such influence., Conclusion: This study underscores the significant impact of exposure to both anti-tobacco and pro-tobacco media messages and events on smoking behaviour among adolescents in Gambia. However, pro-tobacco messages had a greater influence on smoking prevalence than anti-tobacco messages and events. Understanding these associations is crucial for devising effective public health interventions aimed at reducing tobacco use in this population., (© 2024. The Author(s).)

Introduction: Cervical cancer is the second dominant type of cancer among Ivorian women with an estimated age-standardised incidence and mortality rate of 31.2 cases and 22.8 deaths per 100,000 women in 2020, respectively. The Ivorian government through its Ministry of Health implemented the National Cancer Control Programme (NCCP) in 2003 with the aim of improving the prevention, early detection and treatment of cancers in Côte d'Ivoire. Yet, there is a low uptake of CCS (1.2%). Thus, making CCS uptake an important public health concern in the country. Understanding of the extent to which reproductive factors predict CCS uptake is limited in literature. This study aimed to investigate reproductive factors as a predictor of women's uptake of CCS in Côte d'Ivoire., Methods: Data from the 2021 Côte d'Ivoire Demographic and Health Survey. A sample of 9,078 women aged 25-49 years were analyzed. The outcome variable was CCS uptake while other variables considered included age at menarche, history of STI, sexual debut, parity, age, educational level, wealth index, health insurance, place of residence, and media exposure. A multivariable logistic regression model was fitted to examine the association between the outcome of interest and predictors at 95% confidence interval., Results: Approximately, 7.52% of women aged 25-49 years had ever undergone testing for cervical cancer by a healthcare provider. Early menarche was associated with lower odds of CCS uptake [AOR = 0.78; CI = 0.65-0.95]. Compared to those who had no STI, women with a history of STI were more likely to screen for cervical cancer [AOR = 2.63; CI = 2.02-3.42]. Increasing age, higher educational attainment, having health insurance, and being exposed to media were significantly associated with CCS uptake., Conclusion: In Cote d'Ivoire, age at menarche and STI history constitute reproductive factors that were significantly associated with women's uptake of CCS. It is imperative for public policy to focus on increasing CCS in these higher-risk women (i.e., women who experienced early menarche, women with early sexual debut and higher parity) through increased sensitization on cervical cancer risk factors., (© 2024. The Author(s).)

A core feature of autism is deficits in executive functioning (EF), including difficulty with planning, cognitive flexibility, and working memory. Despite a growing need for evidence-based assessments of EF for autism populations, statistical models of many commonly used measures of EF, including the Delis-Kaplan Executive Function System (D-KEFS), have not been investigated for a sample of autistic participants. The purpose of this study was to address a gap in the literature regarding the latent structure of the D-KEFS in a sample of autistic individuals. The D-KEFS is one of the most widely used clinical assessments of executive function, but its factor structure has not been examined in a sample of autistic participants. Reliability analyses were performed for sample subgroups based on participants' clinical and demographic characteristics, including IQ, autism severity, age, and race/ethnicity. Verbal Fluency (VF) was found to consistently decrease or not affect the overall reliability score. Additionally, one- and two-factor structure models were tested for the D-KEFS with a sample of autistic participants. The one-factor model was not found to be a good fit for the data. However, the two-factor model, with Cognitive Flexibility and Abstraction latent factors, was found to fit the data relatively well. This two-factor model was reexamined excluding the VF observed variable, resulting in a better overall model fit. Communication deficits are a common feature of autism, which explains why the VF task, that requires participants to produce novel words, may not be an adequate measure of executive function for autism populations., (© 2024 International Society for Autism Research and Wiley Periodicals LLC.)

Federally Qualified Health Centers are charged with providing comprehensive health care in traditionally underserved areas, underscoring their importance in caring for and promoting health equity for the large portion of historically marginalized communities in this setting. There is a significant need to ensure Federally Qualified Health Centers are equipped to appropriately address the immense behavioral health needs common among patients served. Care coordination is an evidence-based model that is increasingly utilized in Federally Qualified Health Centers to improve care equity and outcomes. Addressing and supporting behavioral health needs is a key aspect of such care coordination models. Context-specific considerations and programmatic supports, particularly those that address the needs of care coordinators and the complex patients they serve, are needed to ensure such models can appropriately meet and address the behavioral health concerns of the diverse populations served. The goal of this study was to present a mixed-methods case study that systematically applies implementation frameworks to conduct a needs and context assessment to inform the development and testing of evidence-based practice strategies and implementation support as part of a care coordination program within a partnered Federally Qualified Health Center.

Background: Intimate partner violence (IPV) is a major public health concern that mostly impacts women's health and social well-being. This study explored how the various types of IPV (physical, sexual, and emotional) including women's experience of childhood violence influence their help-seeking behavior in sub-Saharan Africa (SSA)., Methods: We analyzed data from the most recent Demographic and Health Surveys (DHS), carried out between 2018 and 2021. The outcome variable was help-seeking behavior. Descriptive and inferential analyses were carried out. The descriptive analysis looked at the bivariate analysis between the country and outcome variables. Using a binary logistic regression model, a multivariate analysis was utilized to determine the association between the outcome variable and the explanatory variables. Binary logistic regression modelling was used based on the dichotomous nature of the outcome variable. The results were sample-weighted to account for any under- or over-sampling in the sample., Results: The proportion of women who sought help for intimate partner violence was 36.1 percent. This ranged from 19.2 percent in Mali to 49.6 percent in Rwanda. Women who experienced violence in childhood (OR = 0.75, CI = 0.69, 0.82) have a lower likelihood of seeking help compared to those who did not experience violence in their childhood. Women who had experienced emotional violence (OR = 1.94, CI = 1.80, 2.08), and physical violence (OR = 1.37, CI = 1.26, 1.48) have a higher likelihood of seeking help compared to those who have not. Women with secondary educational levels (aOR = 1.13, CI = = 1.02, 1.24) have a higher likelihood of seeking help compared to those with no education. Cohabiting women have a higher likelihood (aOR = 1.22, CI = 1.10, 1.35) of seeking help compared to married women., Conclusion: The study highlights the importance of early identification of IPV and fit-for-purpose interventions to demystify IPV normalization to enhance women's willingness to seek help. The study's findings suggest that education is crucial for increasing women's awareness of the legalities surrounding IPV and available structures and institutions for seeking help., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Ayebeng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Diabetes prevalence appears to be increasing in low- and middle-income countries, yet little is known about how hypertension status mediates the association between household wealth and diabetes. This study examined the mediation effects of hypertension in associations between household wealth and diabetes in eight sub-Saharan African (SSA) countries., Methods: This is a cross-sectional study of 71 577 women from recent Demographic and Health Surveys for eight SSA countries. Sample-weighted logistic regression and causal mediation analyses were conducted., Results: Of the 71 577 women, 1.1% (782) reported ever being diagnosed with diabetes. Women with diabetes were more likely to have hypertension compared with those without diabetes (54.9% vs 9.9%). The odds of diabetes were significantly higher among women with hypertension (adjusted odds ratio [OR] 5.71 [95% confidence interval {CI} 4.62 to 7.05]) and women from rich households (adjusted OR 1.65 [95% CI 1.23 to 2.22]) compared with their respective counterparts. Hypertension status mediated 27.4% of the association between household wealth and diabetes status., Conclusions: Hypertension status partly contributes to the associations between household wealth disparities and diabetes status among women in the selected countries. Further research and targeted interventions are needed to explore specific mechanisms and confounding factors related to household wealth disparities, hypertension status and diabetes prevalence in this population., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Introduction: Before 2020 and the advent of the COVID-19 pandemic, mental disorders, including anxiety and mood disorders, were considered the leading causes of the global disease burden. There is evidence from multiple countries and social contexts that suggest the high risk of anxiety and mood disorders among students. Yet, there is a knowledge gap concerning understanding the association between the experience of discrimination and the risk of anxiety and mood disorders. We examined the association between the experience of discrimination and the risk of anxiety and mood disorders among university students., Methods: This study is a cross-sectional survey among university students in Ghana. A quota sampling technique was used to recruit 1,601 students. Data were collected using structured questionnaires. All data were analyzed using Stata. Binary logistic regression model was used to examine the significant association between the outcome variable and the explanatory variables., Results: The prevalence of anxiety disorder among the respondents was 67 per cent. Students who had experienced discrimination or had any member of their family experienced discrimination had higher odds (OR = 4.59, Cl = 2.64, 7.96) of anxiety and mood disorder compared to those who had not experienced any form of discrimination. Respondents aged 20-24 years had higher odds (OR = 1.47, Cl = 1.16, 1.85) of anxiety and mood disorder than those aged 15-19. Students with a high perceived risk of contracting COVID-19 had a higher odd (OR = 1.52, CI = 1.10, 2.10) compared to those with a low perceived risk., Conclusion: The findings underscore a need for university authorities to lay out clear initiatives that will reinforce and meet the mental health needs of university students during and after periods of crisis, such as returning from COVID-19 lockdown. There must be a conscious effort to advocate and raise students' awareness of anxiety disorders. Also, it is imperative to create support groups within the university set up to address the mental health needs of all students. Younger students should be the primary focus of these interventions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Darteh, Ninnoni, Okyere, Darteh, John-Langba and Dickson.)

Background: There is an interest in the extent to which the wealth status of women predicts their risk of being pre-hypertensive. This understanding is lacking in the current body of empirical literature, particularly within the context of Benin. Thus, indicating a knowledge gap that must be filled. To this end, the present study aimed to assess the association between wealth status and the risk of prehypertension among women aged 30-49 years in Benin., Methods: This study used a secondary data from the recent (2018) Demographic and Health Survey of Benin. Bivariate and multivariate logistic regression models were computed to examine the association between wealth index and the risks of prehypertension using Stata version 14. Findings were presented in adjusted odds ratio at 95% confidence level., Results: Women in the richest wealth index were significantly more likely to have prehypertension than those in the poorest wealth index [AOR = 1.4; 95%CI: 1.26-2.26]. Women aged 45-49 years were more likely to have prehypertension [AOR = 1.5; 95%CI: 1.15-1.98] compared to younger women. Women who used unclean cooking fuel were less likely to have prehypertension compared to those using clean cooking fuel [AOR = 0.6; 95%CI: 0.37,0.87]., Conclusion: The study concludes that wealth status is a significant predictor of prehypertension among women in Benin. Therefore, the Ministry of Health in Benin should prioritize health education and prehypertension awareness campaigns specifically targeting women in affluent communities and households. These campaigns should focus on promoting healthy dietary choices and encouraging physical activity to mitigate the elevated risk associated with wealth status. Recognizing the influence of age on prehypertension risk, it is imperative for older-middle aged women to be targeted as primary beneficiaries of health education programs and prehypertension screening programs., (© 2023. The Author(s).)

Aims: Addressing sexual and gender-based violence (SGBV) in educational settings across the globe, particularly in institutions of higher education, requires strong institutional framework and policy guidelines. Most research about university SGBV policies has focused on high-income countries with little or no recourse to universities in low- and middle-income countries. This policy analysis aims to analyze existing policies related to SGBV from select sub-Saharan African universities to provide guidance on best practices toward addressing SGBV at universities in Africa., Methods: Seven university policies and six national policies from six countries across sub-Saharan Africa (Ghana, Liberia, Nigeria, Rwanda, South Africa, and Zimbabwe) were reviewed using a standardized data extraction form. The policy analysis identified eight key elements of policies related to SGBV for sub-Saharan African universities, which were verified using a nominal group technique with five international experts in the field., Results: Overall, policies varied significantly in accessibility, terminology, definitions, format, and inclusivity across the sites. Some of the policies were not readily accessible, and there was limited evidence provided in some of the policy documents., Conclusions: Policies for universities in sub-Saharan Africa should (a) be evidence based, (b) be readily available in multiple formats, (c) define key terms broadly with gendered signifiers, (d) be succinct and concise, (e) incorporate broad definitions for all university stakeholders, (f) identify who created the policy and when, (g) address prevention, and (h) address response. Evidence-based policies addressing SGBV prevention, response, and justice are sorely needed at universities across the globe., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 International Association of Forensic Nurses.)

Objective: This study aimed to examine the association between fruit and vegetable consumption (FVC) and the risk of hypertension among women in Ghana., Design: Data from the 2014 Ghana Demographic and Health Survey were used. Bivariate and multivariate logistic regression analyses were performed using Stata version 14. The study reports the adjusted OR (AOR) and CI., Setting: Ghana., Participants: A total sample of 4168 women was used in the analysis., Results: Among women who met the WHO's recommended intake of FVC, 13·1 % had hypertension. The intake of the recommended servings of fruit and vegetables was not significantly associated with hypertension. However, the likelihood of being hypertensive was significantly associated with increasing age (AOR = 6·1; 95 % CI = 4·29, 8·73), being married (AOR = 1·7; 95 % CI = 1·14, 2·57) or formerly married (AOR = 2·3; 95 % CI = 1·44, 3·70), and being overweight (AOR = 1·6; 95 % CI = 1·24, 2·07) or obese (AOR = 2·4; 95 % CI = 1·82, 3·20)., Conclusion: The study concludes that there is no significant association between FVC and hypertension risk among women in Ghana. While this study did not find a significant association between FVC and hypertension risk among women in Ghana, it underscores the point that other multifaceted factors influence hypertension risk. As such, public health campaigns should emphasise a balanced and holistic approach to promoting cardiovascular health, including factors beyond FVC. The findings also highlight the need to target high-risk populations (i.e. older women, married and formerly married women, and overweight or obese women) with hypertension prevention education and related interventions.

Competing Interests: The authors report no financial relationships with commercial interests.

Background: Globally, the burden of disease is shifting towards non-communicable diseases (NCDs), including diabetes. Sub-Saharan Africa (SSA) faces an increasing prevalence of diabetes, hindering the achievement of global health goals. This study investigates the determinants of non-use of diabetes medication, specifically exploring potential sex differences in four SSA countries., Methods: This cross-sectional study analyzed recent Demographic and Health Survey (DHS) data (2017-2021) from four SSA countries (Benin, Cameroon, Madagascar, and Mauritania). Samples included 23,695 women and 25,339 men, focusing on individuals with diabetes not using medication (248 women, 162 men). Descriptive and inferential analyses, including chi-square tests and binary logistic regression models, were conducted using Stata version 14. Odds ratios were calculated with a 95% confidence interval to determine the associations., Results: This study found that a larger proportion of female patients with diabetes (64.1%) were not using diabetes medication compared to their male counterparts (59.4%). Age influenced medication non-use in males, with older individuals exhibiting lower odds of non-usage. Higher wealth status was associated with lower odds of non-use of diabetes medications. The presence of heart disease was associated with a lower likelihood of medication non-use among females., Conclusions: This study demonstrates sex disparities, age differences, wealth status, heart disease, and country-specific variations in medication non-use. Tailored interventions for different age groups, as well as socioeconomic support, are critical, as is integrated cardiovascular and diabetes care. These actions can improve medication use and adherence, quality of life, and long-term diabetes management outcomes., (© 2023. The Author(s).)

Background: Anaemia has become a major public health concern among women in Sub-Saharan Africa (SSA). However, little is known about the spatial disparities in anaemia prevalence and their associated factors among pregnant women in the region. This study analysed the spatial disparities in anaemia and their associated factors among pregnant women in rural and urban settings in SSA., Methods: This is a secondary analysis of the most recent demographic and health surveys of 26 countries in SSA. Spatial autocorrelation and hotspot assessment were conducted, while a multivariate logistic regression model was used to identify demographic factors associated with anaemia., Results: Anaemia was reported among ~50% of pregnant women in urban and rural areas of SSA. The hotspot analysis identified the West African sub-region as having a higher concentration of anaemia cases in rural settings. In urban areas, the odds of anaemia were significantly higher among pregnant women in their second trimester (Adjusted OR = 2.39, CI = 1.99, 2.76). On the other hand, pregnant women in their third trimester (Adjusted OR = 1.98, CI = 1.77, 2.22) and those who had taken intestinal parasite drugs (Adjusted OR = 1.12 CI = 1.02, 1.23) had a higher likelihood of having anaemia in rural areas. Pregnant women aged 35-39 years (Adjusted OR = 0.52, CI = 0.33, 0.81) and those aged 40-44 years (Adjusted OR = 0.69, CI = 0.50, 0.95) had a lesser likelihood of having anaemia compared to women aged 15-19 years in urban and rural areas respectively. Compared to Congo DR, Benin (OR = 2.22, CI = 1.51, 3.28) and Mali (OR = 3.71, CI = 2.73, 5.05) had higher odds of anaemia in urban and rural areas respectively., Conclusions: Spatial disparities in anaemia persist among pregnant women in rural and urban settings in SSA. Prevailing spatial variations in anaemia may be addressed by specialised interventions considering the contextual residential settings and socio-economic factors highlighted in this study., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Prostate cancer (PCa) screening is a cost-effective strategy to promote early detection and treatment. Understanding the determinants of PCa screening uptake would help policy makers to identify high-risk populations and ensure the cost-effectiveness of health promotion interventions. This study aims to estimate the prevalence of PCa screening uptake and assess its associated factors among Kenyan men., Methods: The study relied on data from the 2014 Kenya Demographic and Health Survey. Both descriptive and inferential analyses were performed. Firth logistic regression was employed using the "firthlogit" command in STATA. The adjusted odds ratio and 95% confidence interval were presented., Results: Overall, the prevalence of PCa screening uptake was 4.4%. The odds of PCa screening uptake were high among men aged 50-54 [aOR= 2.08; CI= 1.23, 3.52], those who had health insurance coverage [aOR= 1.69; CI= 1.28, 2.23], those who read at least once in a week [aOR= 1.52; CI= 1.10, 2.10], and among those who watched TV at least once in a week [aOR= 1.73; CI= 1.18, 2.52]. Men who resided in the Eastern [aOR= 2.23; CI= 1.39, 3.60], Nyanza [aOR= 2.13; CI= 1.29, 3.53], and Nairobi [aOR= 1.97; CI= 1.01, 3.86] had a higher likelihood of getting screened for PCa., Conclusion: In conclusion, the uptake of PCa screening in Kenya is low. To ensure the cost-effectiveness of health-promoting interventions that aim to improve PCa screening uptake in Kenya, men without health insurance coverage should be targeted and prioritized. Increasing literacy rate, sensitization via television, and increasing the insurance coverage in the country would significantly contribute to a higher uptake of PCa screening., Policy Summary: To improve the uptake of PCa screening, there would be a need to implement a national advocacy campaign that will sensitize Kenyan men about the need to undergo PCa screening. This national advocacy campaign to increase the uptake of PCa screening in Kenya must leverage mass media platforms., Competing Interests: Declaration of Competing Interest We declare no conflict of interest., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: The World Health Organization (WHO) has cited domestic violence as an urgent global maternal and child health priority. Gender differences in the acceptance of wife-beating have not been explored at the multi-country level in sub-Saharan Africa (SSA) where the occurrence of wife-beating (36%) is greater than the global average (30%). It is against this backdrop that we examine the gender differences in the acceptance of wife beating in SSA., Methods: We used Demographic and Health Survey data from 30 SSA countries. Acceptance of wife beating among women and men was the principal outcome variable of interest. We employed Multiple correspondence analysis and logistic regression model as the primary estimation methods for this study. The descriptive statistics show that women had a higher acceptance rate (44%) of wife beating than men (25%). For the women sample, Mali, Democratic Republic of Congo, Chad, and Guinea had higher rates of acceptance of the wife beating (80.6%, 78.4%, 77.1% and 70.3% respectively) For the men, only Guinea had an acceptance rate above 50 percent., Results: We found that all else equal, women's acceptance of wife beating is higher for male-headed households than for female-headed households. Women without formal education were 3.1 times more likely to accept wife beating than those with higher education. Men with no formal education were 2.3 times more likely to accept wife beating than men with higher education. We found that polygamous women were comparable to polygamous men. Polygamous women were 1.2 times more likely to accept wife beating than those in monogamous marriages. Women were 1.2 times more likely to accept wives beating if they had extramarital relationships. Contrarily, men who engaged in extramarital affairs were 1.5 times more likely to justify wife beating. We also found that women's acceptance of wife beating decreases as they age. Men who decide on major household purchases and spending decisions on their earnings are more likely to accept wife beating. Corollary, women with similar gender and employment roles also accept wife beating. Finally, exposure to mass media is significantly associated with lower acceptance of wife beating for women and men., Conclusion: We conclude that women have a higher acceptance rate of wife beating than men in SSA. Acceptance of wife beating differs significantly by country. Given the same level of education, women are more likely to accept wife beating than men. If women and men have similar levels of employment and gender roles, acceptance of wife beating is higher when men make major household purchasing decisions and and it is still higher even when the woman makes these decisions. Acceptance of wife beating is higher among young women and men, the uneducated, those in polygamous marriages, women, and men who engage in extra marital affairs, poor households and in rural areas. The findings indicate the need for policies and programs by SSA countries to truncate the high acceptance rate of wife beating, especially among women., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Evidence shows that intimate partner violence (IPV) occurs more frequently in sub-Saharan Africa (SSA) than in other regions of the world. However, limited empirical studies exist on the help-seeking behaviour of women who had experienced IPV in SSA. This study aimed to examine the help-seeking behaviour of women who had experienced IPV in SSA and the factors associated with their inability to seek help after experiencing IPV., Methods: This is a quantitative study based on data from the latest demographic and health surveys (DHS) of 24 SSA countries. A sample of 53,446 women aged 15-49 years was included in the study. Associations between women's background characteristics and their help-seeking behaviour after experiencing IPV were examined using proportions and multivariate logistic regression models., Results: Overall, 60.7% of the sample did not seek help after experiencing IPV. Women's inability to seek help for IPV was highest in Mali (80.4%) and lowest in Tanzania (43.1%). Women's level of education, wealth status, marital status, age, occupation, and country of residence had significant associations with 'not seeking help' for any type of IPV. Those who experienced generational violence (AOR = 1.26, CI = 1.19, 1.33) and those who justified wife-beating (AOR = 1.09, CI = 1.07, 1.15) had higher odds of not seeking help for any type of IPV compared to those who did not experience generational violence or did not justify wife beating. Women who experienced emotional violence (AOR = 0.53, CI = 0.51, 0.55) and physical violence (AOR = 0.74, CI = 0.70, 0.76) had lower odds of not seeking help for any type of IPV compared to their counterparts who did not experience these types of violence., Conclusion: Women's inability to seek help for IPV is common in many SSA countries. This study shows that several socio-demographic factors, such as women's age, educational levels, wealth status, and marital status are associated with their inability to seek help for IPV. Additionally, women's justification of wife beating and experience of generational abuse are strongly associated with their inability to seek help for IPV. These factors need to be considered critically in IPV interventions in SSA., (© 2023. The Author(s).)

Background: Within the African region, there are an estimated 8 million people living with HIV (PLHIV) in South Africa. Seeking healthcare services from traditional healers (TH) is one of the alternative and complementary approaches to HIV/AIDS treatment. Identifying the associated factors of TH utilisation among older PLHIV is crucial in developing healthcare interventions that cater to the unique needs of this vulnerable group. This study investigated the factors associated with TH utilisation among older PLHIV., Methods: We studied 516 older PLHIV using data from the WHO SAGE Well-Being of Older People Study (2011-2013). Chi-square, bivariate and multivariate logistic regression were computed in STATA Version 14. The results were presented with both crude and adjusted odds ratio (AOR) and at 95% confidence interval (CI)., Results: Of the 516 participants, 15.89% utilised TH. The major reason for TH utilisation among older PLHIV was the perception of receiving better healthcare services from TH (51.2%) and the flexibility to pay with goods instead of money (14.6%). The factors associated with TH utilisation were age [AOR = 0.05; CI  0.01, 0.37], being hypertensive [AOR = 2.07; CI  1.04, 4.11], and having more than four servings of fruits [AOR = 10.64; CI  2.95, 38.34]. TH utilisation was significantly lower among those who visited the clinic once or twice [AOR = 0.17; CI  0.05, 0.63], three to six times [AOR = 0.16; CI  0.05, 0.56], and more than 6 times [AOR = 0.09; CI  0.03, 0.34] compared to those who had no clinic visits., Conclusion: In conclusion, a low proportion of TH utilisation was reported among older PLHIV in South Africa. TH utilisation is associated with age, hypertension status, frequency of clinic visits and fruit servings consumed. Our study suggests that being hypertensive was a motivating factor for older PLHIV to utilise TH. Therefore, it is imperative for the South African health department to integrate the services of TH into the mainstream health system to manage non-communicable diseases, particularly hypertension, among older PLHIV., (© 2023. The Author(s).)

Background: The World Health Organisation recommends that all mothers seek postnatal care (PNC) within the first two months after childbirth. This study examined PNC utilisation for babies within the first two months after childbirth., Methods: We used data from the most recent Demographic and Health Surveys (DHS) (2018-2020) of eleven countries in SSA. Descriptive and a multivariate analysis were carried out, and presented in adjusted odds ratios. The explanatory variables included: age, place of residence, level of formal education, wealth quintile, antenatal care visits, marital status, frequency of watching TV, listening to radio and reading newspaper, getting permission to go medical help for self, getting money needed for treatment, and distance to facility., Results: PNC utilisation was 37.5% and 33% in urban and rural residences, respectively. Higher level of education (Urban: AOR = 1.39, CI = 1.25, 1.56; Rural: AOR = 1.31, CI = 1.10, 1.58), 4 or more ANC visits (Urban: AOR = 1.32, CI = 1.23, 1.40; Rural: AOR = 1.49, CI = 1.43, 1.56 0.86), requiring permission to go to the health facility (Urban: AOR = 0.67, CI = 0.61, 0.74; Rural: AOR = 0.86, CI = 0.81, 0.91), listening to the radio at least once a week (Urban: AOR = 1.32, CI = 1.23, 1.41; Rural: AOR = 0.86, CI = 0.77, 0.95), and watching television at least once a week (Urban: AOR = 1.11, CI = 1.03, 1.21; Rural: AOR = 1.15, CI = 1.07, 1.24) were significantly associated with PNC service utilisation in both rural and urban areas. However, belonging to a richer wealth status (AOR = 1.11, CI = 1.02, 1.20) and having a problem with distance (AOR = 1.13, CI = 1.07, 1.18) were significant in only rural areas, while having a problem with money for treatment was significant only in urban areas (AOR = 1.15, CI = 1.08, 1.23)., Conclusion: In this study, we conclude that the PNC service utilisation within the first 2 months after delivery was low across rural and urban residences. There is, therefore, a need for SSA countries to develop population tailored interventions such as advocacy and health education targeted at women with no formal education in both rural and urban areas. Our study also suggests that SSA countries must intensify radio programs and advertisements on the health benefits of PNC to improve maternal and child health., (© 2023. The Author(s).)

AbstractPsychiatric disorders usually do not have characteristic physical exam findings, imaging, or lab values. Psychiatrists therefore diagnose and treat patients largely based on reported or observed behavior, which makes collateral information from a patient's close contacts especially pertinent to an accurate diagnosis. The American Psychiatric Association considers communication with patients' supports a best practice when the patient provides informed consent or does not object to the communication. However, situations arise in which a patient's objection to such communication is the product of impaired decision-making and the benefits of obtaining collateral information represent best practice. In this article a framework for addressing these situations is proposed using a full decisional capacity evaluation, followed by an alternate decision-making process by concurrence from a second physician. It is recommended that a patient's refusal to allow the gathering of collateral information should be addressed exactly like refusals for other diagnostic or treatment interventions.

Background: Regular breast screening is one of the most effective ways to detect early signs of breast cancer but travel distance to cancer-diagnostic facilities can affect breast screening attendance. Yet, limited studies have examined the impact of distance to cancer-diagnostic facilities on clinical breast screening behaviour among women in sub-Saharan Africa (SSA). This study examined the influence of travel distance to a health facility on clinical breast screening behaviour in five SSA countries: Namibia, Burkina Faso, Cote D'Ivoire, Kenya, and Lesotho. The study further assessed variations in clinical breast screening behaviour across diverse socio-demographic characteristics of women., Methods: A sample of 45,945 women was drawn from the most recent Demographic and Health Surveys (DHS) for the included countries. The DHS uses 2-stage stratified cluster sampling to select nationally representative samples of women (15-49) and men (15-64) via a cross-sectional design. Proportions and binary logistic regression were used to examine associations between the women's socio-demographic characteristics and breast screening attendance., Results: The overall proportion of survey participants who underwent clinical breast cancer screening was 16.3%. Travel distance to a health facility had a significant (p < 0.001) impact on clinical breast screening behaviour as 18.5% of participants who self-reported distance as "not a big problem" attended clinical breast screening compared to 10.8% who self-reported distance as "a big problem". The study further found that various socio-demographic factors were significantly associated with breast cancer screening uptake, including age, education level, media exposure, wealth status, parity, contraceptive use, health insurance coverage, and marital status. The multivariate analysis controlling for other factors confirmed the strong association between distance to health facilities and screening uptake., Conclusions: The study found that travel distance is a significant factor affecting clinical breast screening attendance among women in the selected SSA countries. Furthermore, the likelihood of breast screening attendance varied depending on different women's characteristics. It is crucial to prioritise breast screening interventions, particularly among the disadvantaged women identified in this study, to achieve maximum public health benefits., (© 2023. The Author(s).)

Background and Aims: Early initiation of breastfeeding (EIB) remains one of the promising interventions for preventing neonatal and child deaths. EIB is positively associated with healthcare delivery or childbirth. Meanwhile, no study in sub-Saharan Africa (SSA) appears to have investigated the relationship between health facility delivery and EIB; thus, we assessed the correlation between health facility delivery and EIB., Methods: We used data from the Demographic and Health Survey (DHS) of 64,506 women from 11 SSA countries. The outcome variable was whether the respondent had early breastfeeding or not. Two logistic regression models were used in the inferential analysis. With a 95% confidence interval (CI), the adjusted odds ratios (aORs) for each variable were calculated. The data set was stored, managed, and analyzed using Stata version 13., Results: The overall percentage of women who initiated early breastfeeding was 59.22%. Rwanda recorded the highest percentage of early initiation of breastfeeding (86.34%), while Gambia recorded the lowest (39.44%). The adjusted model revealed a significant association between health facility delivery and EIB (aOR = 1.80, CI = 1.73-1.87). Compared with urban women, rural women had higher likelihood of initiating early breastfeeding (aOR = 1.22, CI = 1.16-1.27). Women with a primary education (aOR = 1.26, CI = 1.20-1.32), secondary education (aOR = 1.12, CI = 1.06-1.17), and higher (aOR = 1.13, CI = 1.02-1.25), all had higher odds of initiating early breastfeeding. Women with the richest wealth status had the highest odds of initiating early breastfeeding as compared to the poorest women (aOR = 1.33, CI = 1.23-1.43)., Conclusion: Based on our findings, we strongly advocate for the integration of EIB policies and initiatives with healthcare delivery advocacy. Integration of these efforts can result in drastic reduction in infant and child mortality. Essentially, Gambia and other countries with a lower proclivity for EIB must reconsider their current breastfeeding interventions and conduct the necessary reviews and modifications that can lead to an increase in EIB., Competing Interests: The authors declare there is no conflict of interest. All authors have read and approved the final version of the manuscript. Sanni Yaya had full access to all of the data in this study and took complete responsibility for the integrity of the data and the accuracy of the data analysis., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Introduction: Evidence shows that most women in Ghana do not meet the minimum 8-contact model for antenatal care as recommended by WHO with only 31.2%-41.9% of them meeting the recommendation. To the best of our knowledge, no study in Ghana has examined women's noncompliance with the WHO's recommended 8-contact model for antenatal care using geospatial analysis, as this study sets out to do., Methods: We sourced data from the recent version of the Ghana Maternal Health Survey which was executed in 2017. A sample of 10,077 women with complete data participated in this study. The link between the explanatory variables and the outcome variable was investigated using binary and multivariate logistic regression models and Spatial analyses such as spatial autocorrelation (Moran's I), hotspot, cluster and outlier analysis, and geographically weighted regression were conducted using ArcMap version 10.7., Results: Districts found in the north-eastern and south-western parts of the country were more likely to experience noncompliance with ANC. Women staying within the middle belt without health insurance were more likely (17-29%) to be noncompliant with ANC. Women with low community socioeconomic status were found to be more likely (17-34%) to be noncompliant with ANC in the eastern parts of Ghana., Conclusion: The study has shown that in order to achieve targets one and three of Sustainable Development Goal 3, the government of Ghana, the Ministry of Health, together with the Ghana Health Service may have to intensify health education in the identified areas to highlight the importance of adherence to the WHO recommendations on ANC 8-contact model., (© 2023. The Author(s).)

Background: Several studies have shown that unskilled birth attendance is associated with maternal and neonatal morbidity, disability, and death in sub-Saharan Africa (SSA). However, little evidence exists on prevailing geospatial variations and the factors underscoring the patterns of unskilled birth attendance in the region. This study analysed the geospatial disparities and factors associated with unskilled birth attendance in SSA., Methods: The study is based on data from thirty (30) SSA countries captured in the latest (2010-2019) demographic and health surveys (DHS). A total of 200,736 women aged between 15-49 years were included in the study. Geospatial methods including spatial autocorrelation and hot spot analysis as well as logistic regression models were used to analyse the data., Results: There were random spatial variations in unskilled birth attendance in SSA, with the main hotspot located in Chad, whereas South Africa and the Democratic Republic of Congo showed coldspots. Residence (urban or rural), wealth status, education, maternal age at the time of the survey and age at birth, desire for birth, occupation, media exposure, distance to a health facility, antenatal care visits, and deaths of under-five children showed significant associations with unskilled birth attendance., Conclusion: Random geospatial disparities in unskilled birth attendance exist in SSA, coupled with various associated socio-demographic determinants. Specific geospatial hotspots of unskilled birth attendance in SSA can be targeted for specialised interventions to alleviate the prevailing disparities., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Addo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Cervical cancer significantly affects women in Sub-Saharan Africa (SSA). However, limited studies have concentrated on cervical screening behaviour among women in SSA. This study aimed to assess the interplay of distance to health facilities and socio-demographic factors with cervical screening behaviour among women in five SSA countries., Methods: The study was based on pooled data of 40,555 women included in Demographic and Health Surveys (DHS) conducted between 2013 to 2021. Proportions and logistic regression models were used in assessing the interplay of distance to health facilities and socio-demographic factors with cervical screening behaviour., Results: Approximately, 7.9% of women that saw the distance to a health facility as a big problem, tested for cervical cancer compared to 13.5% who indicated that distance to a health facility is not a big problem. More women in urban areas, with a higher level of education, of richest wealth index, aged 40-44 years and using contraceptives who also indicated that distance to a health facility was a big problem tested for cervical cancer compared to those in rural areas with no education, of poorest wealth index, aged 15-19 years and not using contraceptives. Education, age, contraceptive use, frequent exposure to mass media and Sexual Transmitted Infections (STI) had a significant relationship with testing for cervical cancer., Conclusion: The prevalence of cervical cancer screening was low in the five SSA countries largely due to distance barriers and was also significantly influenced by education, age, contraceptive use, frequent exposure to mass media, and STI status. To improve the screening for cervical cancer and its associated benefits in the five SSA countries, there is a need for policymakers, clinicians and public health workers to channel more commitment and efforts to addressing the barriers identified in this study., (© 2023. The Author(s).)

Introduction: Reduction of maternal mortality remains a global priority as highlighted by the third Sustainable Development Goal (SDG). This is critical in the case of Sierra Leone as the country is one of three (3) countries with the highest maternal mortality ratio globally, thus 1,120 per 100,000 live births. The approximate lifetime risk of maternal mortality in the country is 1 in 17, relative to 1 in 3,300 in high-income countries. These raise doubt about the quality of the continuum of maternal healthcare in the country, particularly antenatal care and as a result, the objective of the present study is to investigate the association between socio-economic disadvantage and quality antenatal care service utilisation as well as associated correlates in Sierra Leone., Materials and Methods: The study used data from the most recent Demographic and Health Survey (DHS) of Sierra Leone. Only women who had given birth in the five years preceding the survey were included, which is 6,028. Quality antenatal care was defined as receipt of recommended ANC services including uptake of recommended pregnancy drugs (e.g. Fansidar and iron supplement); injections (e.g. tetanus injection) and having some samples (e.g. blood and urine sample) and health status indicators (e.g. blood pressure) taken. An index was created from these indicators with scores ranging from 0 to 6. The scores 0 to 5 were labelled as "incomplete" and 6 was labelled as "complete" and this was used to create a dummy variable. In analysing the data, descriptive analysis was done using chi-square test as well as an inferential analysis using bivariate and multivariate models., Results: Socio-economic disadvantaged [1.46 (1.09, 1.95), place of residence [2.29 (1.43, 3.67)], frequency of listening to radio [1.58 (1.20, 2.09)], health insurance coverage [3.48 (1.40, 8.64)], getting medical help for self: permission to go [0.53(0.42, 0.69) were seen to have significant relationship with quality of ANC utilized by women during pregnancy. Also, women Mende ethnicity are more likely to utilise quality ANC compared to women from the Temne ethnicity [2.58 (1.79, 3.72)]., Conclusion: Policy makers could consider measures to boost patronage of quality ANC in Sierra Leone by targeting the socio-economically disadvantaged women. Targeting these sub-groups with pro- maternal and child health (MCH) interventions would help Sierra Leone achieve Goal 3 of the SDGs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Dickson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Executive functioning is considered a key transdiagnostic factor underlying multiple mental health conditions. Evidence-based interventions targeting executive functioning skills exist and there are ongoing efforts to implement these interventions in routine community-based care. However, there is limited research characterizing therapist perspectives regarding addressing executive functioning within community-based mental health services. The current mixed-methods study aims to characterize mental health therapist perspectives regarding the role of executive functioning in youth clinical presentation and the psychotherapy process and outcomes as well as their experience and training related to executive functioning. Forty-three therapists completed a survey about their perspectives about executive functioning and 14 participated in subsequent focus groups to expand survey results. Results indicated that therapists perceive executive functioning challenges as impacting a large portion of children on their caseload, present across multiple mental health conditions, and that executive functioning is frequently a focus of psychotherapy. Therapists also identified executive functioning challenges as a barrier to therapy engagement and effectiveness. However, therapists reported limited knowledge and training as well as significant motivation for executive functioning training, including executive functioning interventions. Findings confirm the significant role of executive functioning in youth presenting for mental health services and the psychotherapy process and outcomes. Findings also highlight the need for further translation of evidence-based interventions and tools. Challenges as well as potential solutions to inform ongoing and future work seeking to translate and implement evidence-based executive functioning interventions in community mental health services are discussed., Competing Interests: Conflicts of Interest: The authors declare no conflicts of interest

Background: With a population of about 1.1 billion, sub-Saharan Africa is projected to overtake Eastern, Southern and Central Asia to become the most populous region by 2060. One effective approach for slowing this rapid population growth is the use of modern contraception and this may be short-acting or long acting. Previous studies have explored the association between women empowerment indicators contraception use, however, there is limited evidence on how women empowerment indicators associate with type of contraception. Hence the present study investigated the association between women empowerment indicators and type of contraception used by women in 11 sub-Saharan African countries., Methods: We utilised Demographic and Health Survey data of 22,637 women from 11 countries, collected between 2018 and 2021. The outcome variable was type of contraception used. Descriptive and inferential analyses were executed. The descriptive analysis reflected women empowerment indicators and the proportion of women using contraceptives. Multinomial logistic regression was considered for the inferential analysis. The results for the multinomial logistic regression were presented as adjusted odds ratios (aORs) along with the respective 95% confidence intervals (CIs) signifying precision. The sample weight (wt) was used to account for the complex survey (svy) design. All the analyses were done with Stata version 13 and SPSS version 25., Results: The study showed that on the average, 15.95% of the women do not use modern contraceptives, whilst 30.67% and 53.38% use long-acting and short-acting contraceptives respectively. The adjusted models showed that women who were working had higher odds of using long-acting (aOR = 1.44, CI 1.28-1.62) and short-acting (aOR = 2.00, CI 1.79-2.24) methods compared with those who were not working. The analysis revealed higher likelihood of long-acting method use among women with high decision-making capacity (aOR = 1.27, CI 1.09-1.47) compared with women with low decision-making capacity. Women with medium knowledge level had a higher likelihood (aOR = 1.54, 1.09-2.17) of using long-acting methods than their counterparts with low knowledge level., Conclusion: Our findings show that most women in the 11 countries use modern contraceptives, however, different empowerment indicators align with different contraceptive type. It therefore behoves governments of the studied countries to review current interventions and embrace new ones that are more responsive to the peculiar contraception needs of empowered and non-empowered women., (© 2022. The Author(s).)

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., (© 2022. The Author(s).)

Background: Globally, there has been an increase in the percentage of women in their reproductive ages who need modern contraceptives for family planning. However, in Chad, use of modern contraceptive is still low (with prevalence of 7.7%) and this may be attributable to the annual increase in growth rate by 3.5%. Social, cultural, and religious norms have been identified to influence the decision-making abilities of women in sub-Saharan Africa concerning the use of modern contraceptives. The main aim of the study is to assess the association between the health decision-making capacities of women in Chad and the use of modern contraceptives., Methods: The 2014-2015 Chad Demographic and Health Survey data involving women aged 15-49 were used for this study. A total of 4,113 women who were in sexual union with information on decision making, contraceptive use and other sociodemographic factors like age, education level, employment status, place of residence, wealth index, marital status, age at first sex, and parity were included in the study. Descriptive analysis and logistic regression were performed using STATA version 13., Results: The prevalence of modern contraceptive use was 5.7%. Women who take health decisions with someone are more likely to use modern contraceptives than those who do not (aOR = 2.71; 95% CI = 1.41, 5.21). Education, ability to refuse sex and employment status were found to be associated with the use of modern contraceptives. Whereas those who reside in rural settings are less likely to use modern contraceptives, those who have at least primary education are more likely to use modern contraceptives. Neither age, marital status, nor first age at sex was found to be associated with the use of modern contraceptives., Conclusion: Education of Chad women in reproductive age on the importance of the use of contraceptives will go a long way to foster the use of these. This is because the study has shown that when women make decisions with others, they are more likely to opt for the use of modern contraceptives and so a well-informed society will most likely have increased prevalence of modern contraceptive use. The use of modern contraceptives remains a pragmatic and cost-effective public health intervention for reducing maternal mortality, averting unintended pregnancy and controlling of rapid population growth, especially in developing countries. Although there has been an increase in the utilization of modern contraceptives globally, it is still low in Chad with a prevalence rate of 7.7%. This study assessed the association between the health decision-making capacities of women in Chad and the use of modern contraceptives. We used data from the 2014 - 2015 Chad Demographic and Health Survey. Our study involved 4,113 women who were in sexual union and with complete data on all variables of interest. We found the prevalence of modern contraceptive utilization at 5.7%. Level of education of women, women who can refuse sex and employment status were found to be significantly associated with the use of modern contraceptives. Whereas those who reside in rural settings are less likely to use modern contraceptives, those who have at least primary education are more likely to use modern contraceptives. Our study contributes to the efforts being made to increase the utilisation of modern contraceptives. There is a need to step up contraceptive education and improve adherence among Chad women in their reproductive years. In the development of interventions aiming at promoting contraceptive use, significant others such as partners and persons who make health decisions with or on behalf of women must be targeted as well., (© 2022. The Author(s).)

Objective: To examine differences in caregiver and youth reported mental health symptoms for youth initiating mental health treatment through phases of the Coronavirus Disease (COVID-19) pandemic, compared with symptomology reported the prior year., Study Design: This retrospective study analyzes group differences in mental health symptoms (Pediatric Symptom Checklist; PSC-35) based on 7874 youth seeking treatment in publicly funded mental health treatment programs during California's Stay-At-Home order (March-May, 2020) and the prolonged pandemic (May-December, 2020) phases of the COVID-19 pandemic as compared with matching groups in 2019., Results: Youth entering mental health treatment services, and their caregivers, reported significantly increased internalizing, externalizing, and attention-related symptoms during the prolonged pandemic phase, but not during the acute stay-at-home phase of the COVID-19 pandemic, and with small effect sizes. Group comparison analyses did not detect a significantly larger effect for Sexual and Gender Diverse (SGD) youth who identify as lesbian, gay, bisexual, asexual, transgender, Two-Spirit, queer, and/or intersex, and Black, Indigenous, People of Color (BIPOC)., Conclusions: A large-scale comparison of youth mental health symptoms before and during the COVID-19 pandemic suggests that mental health was disrupted for youth seeking treatment as the pandemic prolonged throughout 2020., (© 2022. The Author(s).)

Background: People living with HIV (PLHIV) are experiencing increased life expectancy mostly due to the success of anti-retroviral therapy. Consequently, they face the threat of chronic diseases attributed to ageing including hypertension. The risk of hypertension among PLHIV requires research attention particularly in South Africa where the prevalence of HIV is highest in Africa. We therefore examined the prevalence and factors associated with hypertension among older people living with HIV in South Africa., Methods: We analysed cross-sectional data on 514 older PLHIV. Data were extracted from the WHO SAGE Well-Being of Older People Study (WOPS) (2011-2013). The outcome variable was hypertension status. Data was analysed using STATA Version 14. Chi-square and binary logistic regression were performed. The results were presented in odds ratio with its corresponding confidence interval., Results: The prevalence of hypertension among PLHIV was 50.1%. Compared to PLHIV aged 50-59, those aged 60-69 [OR = 2.2; CI = 1.30,3.84], 70-79 years [OR = 2.8; CI = 1.37,5.82], and 80 + [OR = 4.9; CI = 1.68,14.05] had higher risk of hypertension. Females were more likely [OR = 5.5; CI = 2.67,11.12] than males to have hypertension. Persons ever diagnosed with stroke were more likely [OR = 3.3; CI = 1.04,10.65] to have hypertension when compared to their counterparts who have never been diagnosed with stroke. Compared to PLHIV who had no clinic visits, those who visited the clinic three to six times [OR = 5.3; CI = 1.35,21.01], or more than six times [OR = 5.5; CI = 1.41,21.41] were more likely to have hypertension., Conclusion: More than half of South African older PLHIV are hypertensive. The factors associated with hypertension among older PLHIV are age, sex, ever diagnosed with stroke and number of times visited the clinic. Integration of hypertension management and advocacy in HIV care is urgently needed in South Africa in order to accelerate reductions in the prevalence of hypertension among older PLHIV, as well as enhance South Africa's capacity to attain the Sustainable Development Goal target 3.3., (© 2022. The Author(s).)

Background: Unskilled birth attendance is a major public health concern in Sub-Saharan Africa (SSA). Existing studies are hardly focused on the socio-demographic correlates and geospatial distribution of unskilled birth attendance in Chad (a country in SSA), although the country has consistently been identified as having one of the highest prevalence of maternal and neonatal deaths in the world. This study aimed to analyse the socio-demographic correlates and geospatial distribution of unskilled birth attendance in Chad., Methods: The study is based on the latest Demographic and Health Survey (DHS) data for Chad. A total of 10,745 women aged between 15 and 49 years were included in this study. A multilevel analysis based on logistic regression was conducted to estimate associations of respondents' socio-demographic characteristics with unskilled birth attendance. Geographic Information System (GIS) mapping tools, including Getis-Ord Gi hotspot analysis tool and geographically weighted regression (GWR) tool, were used to explore areas in Chad with a high prevalence of unskilled birth attendance., Results: The findings show that unskilled birth attendance was spatially clustered in four Chad departments: Mourtcha, Dar-Tama, Assoungha, and Kimiti, with educational level, occupation, birth desire, birth order, antenatal care, and community literacy identified as the spatial predictors of unskilled birth attendance. Higher educational attainment, higher wealth status, cohabitation, lowest birth order, access to media, not desiring more births, and higher antenatal care visits were associated with lower odds of unskilled birth attendance at the individual level. On the other hand, low community literacy level was associated with higher odds of unskilled birth attendance in Chad whereas the opposite was true for urban residency., Conclusions: Unskilled birth attendance is spatially clustered in some parts of Chad, and it is associated with various disadvantaged individual and community level factors. When developing interventions for unskilled birth attendance in Chad, concerned international bodies, the Chad government, maternal health advocates, and private stakeholders should consider targeting the high-risk local areas identified in this study., (© 2022. The Author(s).)

Background: Hypertension, coupled with prehypertension and other hazards such as high blood pressure, is responsible for 8·5 million deaths from stroke, ischaemic heart disease, other vascular diseases, and renal disease worldwide. Hypertension is the fifth commonest cause of outpatient morbidity in Ghana. Some evidence have illustrated geographical variation in hypertension and it seems to have a heavy toll on women in southern Ghana compared to the north. This study seeks to determine the prevalence and associatedfactors of hypertension among women in southern Ghana using the most recent demographic and health survey (DHS) data set., Materials and Methods: This study used data of 5,662 women from the current DHS data from Ghana that was conducted in 2014. Data were extracted from the women's file of the 2014 Ghana DHS. The outcome variable of this current study was hypertension and it was measured by blood pressure, according to guidelines of the Joint National Committee Seven (JNC7). Multivariable binary logistic regression analyses were performed to establish the factors associated with hypertension at the individual and community levels., Results: Prevalence of hypertension among women in southern Ghana was 16%. Women aged 40-44 years (aOR = 8.04, CI = 4.88-13.25) and 45-49 years (aOR = 13.20, CI = 7.96-21.89] had the highest odds of hypertension relative to women aged 15-19 years. Women with two births (aOR = 1.45, CI = 1.01-2.07) and those with three births (aOR = 1.47, CI = 1.01-2.15) had a higher likelihood of being hypertensive. Greater Accra women had higher odds (aOR = 1.35, CI = 1.02-1.79) of being hypertensive relative to the reference category, women from the Western region. Women of Guan ethnicity had a lesser likelihood (aOR = 0.54, CI = 0.29-0.98) of being hypertensive. Women who engaged in agriculture had the least likelihood (aOR = 0.72, CI = 0.52-0.99) of being classified hypertensive compared to unemployed women., Conclusion: This study has revealed the prevalence of hypertension among women in southern Ghana. The associated factors include age, parity, region, and occupation. As a result, existing interventions need to be appraised in the light of these factors. Of essence is the need for Ghana Health Service to implement wide-embracing health promotion initiatives that accommodate the nutritional, exercise, and lifestyle needs of women in southern Ghana. Having more children is associated with higher propensity of hypertension and consequently, women need to limit childbearing to reduce their chances of being hypertensive. It will also be advisable for women in the Greater Accra region to have frequent hypertension screening, as women in the region exhibited higher hypertension prospects., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Cyprian Issahaku Dorgbetor et al.)