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Background: Insecticide-treated net (ITN) is a cost-effective means to control malaria and morbidity in under-five children. This study synthesizes the factors associated with using the ITN as a malaria prevention tool in sub-Saharan Africa.Methods: There was an advanced search of four electronic databases, including PubMed Central, CINAHL, EMBASE, and Google Scholar, and identified articles between 2016 to April 2021. Following the title, abstract and full-text reading, 13 articles were deemed appropriate for this review. All the researchers developed, discussed, and accepted a matrix to extract relevant information from the studies. A convergent synthesis was adopted and allowed for integrating qualitative, quantitative, and mixed-method studies and transforming them into qualitative findings.Results: Household and caregiver related factors that influenced utilization of the ITN were, Household heads having two or more sleeping places, a knowledge that ITN prevents malaria, the presence of hanging ITNs, high literacy, living female-headed households, birth spacing, unmarried mothers, and antenatal clinic attendance promoted utilization. Perceived malaria risk was a critical determinant of ITN ownership and utilization. Some factors that hindered the use of the ITN included hotness of the weather, absence of visible mosquitoes, cost, inadequate number, rooms designs, unaffordability, insufficient knowledge on causes of malaria, and poor attitude to use. Specific ITN factors that hindered use were color, chemicals use, odor, and shape.Conclusion: It is important to use integrated multi-sectoral and culturally appropriate interventions to encourage households to prioritize and utilize the ITN in under-5 children. [ABSTRACT FROM AUTHOR]

Background: Low birth weight (LBW) is one of the major determinants of perinatal survival, infant morbidity, and mortality, as well as the risk of developmental disabilities and illnesses in future lives. Though studies were conducted to assess the magnitude and associated factors of low birth weight, most of the studies were at a single center and little information on the regional level. Hence, this study assessed the prevalence and associated factors of low birth weight in Sub-Saharan countries. Method: This study was based on secondary data sources from 35 Sub-Saharan countries' Demography and Health Survey (DHS). For this study, we used the Kids Record (KR file) data set. In the KR file, all under-five children who were born in the last five years preceding the survey in the selected enumeration area who had birth weight data were included for the study. To identify determinants of low birth weight multivariable mixed-effect logistic regression model fitted. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value ≤0.05 in the multivariable model were used to declare significant factors associated with low birth weight at birth. Result: The pooled prevalence of newborn babies' low birth weight measured at birth in Sub-Saharan Africa was 9.76% with (95% CI: 9.63% to 9.89%). Female child, women not participated in healthcare decision making, and wider birth intervals, divorced/ separated women, and twin pregnancies associated with increased occurrences of low birth weight, while some level of woman and husband education, antenatal care visits, older maternal age, and multiparity associated with reduced occurrence low birth weight. Conclusion: This study revealed that the magnitude of low birth weight was high in sub-Saharan Africa countries. Therefore, the finding suggests that more emphasis is important for women with a lack of support, multiples, and healthcare decision-making problems. [ABSTRACT FROM AUTHOR]

Background: Institutional delivery is an important indicator in monitoring the progress towards Sustainable Development Goal 3.1 to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. Despite the international focus on reducing maternal mortality, progress has been low, particularly in Sub-Saharan Africa (SSA), with more than 295,000 mothers still dying during pregnancy and childbirth every year. Institutional delivery has been varied across and within the country. Therefore, this study aimed to investigate the individual and community level determinants, and spatial distribution of institutional delivery in Ethiopia. Methods: A secondary data analysis was done based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 11,022 women was included in this study. For spatial analysis, ArcGIS version 10.6 statistical software was used to explore the spatial distribution of institutional delivery, and SaTScan version 9.6 software was used to identify significant hotspot areas of institutional delivery. For the determinants, a multilevel binary logistic regression analysis was fitted to take to account the hierarchical nature of EDHS data. The Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV), and deviance (-2LL) were used for model comparison and for checking model fitness. Variables with p-values<0.2 in the bi-variable analysis were fitted in the multivariable multilevel model. Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) were used to declare significant determinant of institutional delivery. Results: The spatial analysis showed that the spatial distribution of institutional delivery was significantly varied across the country [global Moran's I = 0.04 (p<0.05)]. The SaTScan analysis identified significant hotspot areas of poor institutional delivery in Harari, south Oromia and most parts of Somali regions. In the multivariable multilevel analysis; having 2–4 births (AOR = 0.48; 95% CI: 0.34–0.68) and >4 births (AOR = 0.48; 95% CI: 0.32–0.74), preceding birth interval ≥ 48 months (AOR = 1.51; 95% CI: 1.03–2.20), being poorer (AOR = 1.59; 95% CI: 1.10–2.30) and richest wealth status (AOR = 2.44; 95% CI: 1.54–3.87), having primary education (AOR = 1.47; 95% CI: 1.16–1.87), secondary and higher education (AOR = 3.44; 95% CI: 2.19–5.42), having 1–3 ANC visits (AOR = 3.88; 95% CI: 2.77–5.43) and >4 ANC visits (AOR = 6.53; 95% CI: 4.69–9.10) were significant individual-level determinants of institutional delivery while being living in Addis Ababa city (AOR = 3.13; 95% CI: 1.77–5.55), higher community media exposure (AOR = 2.01; 95% CI: 1.44–2.79) and being living in urban area (AOR = 4.70; 95% CI: 2.70–8.01) were significant community-level determinants of institutional delivery. Conclusions: Institutional delivery was low in Ethiopia. The spatial distribution of institutional delivery was significantly varied across the country. Residence, region, maternal education, wealth status, ANC visit, preceding birth interval, and community media exposure were found to be significant determinants of institutional delivery. Therefore, public health interventions should be designed in the hotspot areas where institutional delivery was low to reduce maternal and newborn mortality by enhancing maternal education, ANC visit, and community media exposure. [ABSTRACT FROM AUTHOR]

Background: The issue of child marriage is a form of human rights violation among young women mainly in resource-constrained countries. Over the past decades, child marriage has gained attention as a threat to women's health and autonomy. This study explores the prevalence of child marriage among women aged 20–24 years in sub-Saharan Africa countries and examines the association between child marriage and fertility outcomes. Methods: Latest DHS data from 34 sub-Saharan African countries were used in this study. Sixty thousand two hundred and fifteen women aged 20–24 years were included from the surveys conducted 2008–2017. The outcome variables were childbirth within the first year of marriage (early fertility), first preceding birth interval less than 24 months (rapid repeat of childbirth), unintended pregnancy, lifetime pregnancy termination, the use of modern contraceptive methods, lifetime fertility and any childbirth. The main explanatory variable was child marriage (< 18 years) and the associations between child marriage and fertility outcomes were examined from the ever-married subsample to estimate odds ratios (ORs) and 95% CIs using binary logistic regression models. Results: In the study population, the overall prevalence of women who experience child marriage was 54.0% while results showed large disparities across sub-Saharan African countries ranging from 16.5 to 81.7%. The prominent countries in child marriage were; Niger (81.7%), Chad (77.9%), Guinea (72.8%), Mali (69.0%) and Nigeria (64.0%). Furthermore, women who experience child marriage were 8.00 times as likely to have ≥3 number of children ever born (lifetime fertility), compared to women married at ≥18 years (OR = 8.00; 95%CI: 7.52, 8.46). Women who experience child marriage were 1.13 times as likely to use modern contraceptive methods, compared to adult marriage women (OR = 1.13; 95%CI: 1.09, 1.19). Those who married before the legal age were 1.27 times as likely to have lifetime terminated pregnancy, compared to women married at ≥18 years (OR = 1.27; 95%CI: 1.20, 1.34). Also women married at < 18 years were more likely to experience childbirth, compared to women married later (OR = 5.83; 95%CI: 5.45, 6.24). However, women married at < 18 years had a reduction in early childbirth and a rapid repeat of childbirth respectively. Conclusion: Implementing policies and programmmes against child marriage would help to prevent adverse outcomes among women in sub-Saharan Africa. Also, social change programmes on child-marriage would help to reduce child marriage, encourage the use of modern contraceptive, which would minimize lifetime terminated pregnancy and also children ever born. [ABSTRACT FROM AUTHOR]

The article discusses the transition from high to low fertility in Sub-Saharan Africa. Particular focus is given to differences between reproductive patterns in African and non-African countries. According to the author, the pace of fertility decline in Africa is significantly slower than in Asia and Latin America at similar stages of demographic transition. Details on differences in birth intervals, ideal family size, and demand for contraception are also presented. It is suggested that family planning programs should be supported and promoted. Other topics include economic development and unintended pregnancies.

We investigated birth-interval dynamics in 24 African countries using data from 76 Demographic and Health Surveys conducted since 1986. Controlling for selection bias in the birth-history data using the Brass–Juárez method and regression models produced almost identical results. Birth intervals have lengthened in every country examined. This analysis uncovered a distinctive and previously undocumented pattern of childbearing that is prevalent across sub-Saharan Africa. After allowing for time trends in birth-interval length, the lengthening of birth intervals in almost every country varies little by women's age or parity. Moreover, in several countries, birth intervals are now too long to be explicable by birth spacing contingent on the age of women's youngest child. Rather, women are postponing births for other reasons. These findings offer empirical support for the idea that the fertility transition in sub-Saharan Africa is following a different pattern from that observed elsewhere. [ABSTRACT FROM PUBLISHER]

This study examines the relationship between women's family planning outcomes and primary school enrollment among their 8-11-year-old children. We analyze household- and wider-context-level data for 103,000 children in 30 sub-Saharan African countries. Negative associations with school enrollment are found for those who have short preceding or succeeding birth intervals, a young sibling, or a mother who is pregnant. These findings remain unchanged after controlling for socioeconomic and demographic characteristics. Analysis of interaction effects shows that many associations with family planning outcomes depend on the context in which the household is living, revealing the importance of a situation-specific approach. Findings indicate that helping families improve their pregnancy planning will increase children's schooling opportunities and lead to more effective use of household and community resources. [ABSTRACT FROM AUTHOR]

Background Anaemia is a global public health problem, which disproportionately affects women in sub-Saharan Africa (SSA). The causes of anaemia are multifactorial, and a short interbirth interval has been identified as a potentially modifiable risk factor. However, the current evidence for the association between interbirth interval and maternal anaemia remains inconclusive. Hence, this study aimed at examining the association between the interbirth interval and maternal anaemia in SSA. Methods We conducted a multinational cross-sectional study of interbirth interval (time between two singleton live births) and maternal anaemia for 21 SSA countries using the most recent nationally representative Demographic and Health Surveys, 2010-2017. Modified Poisson regression models were used to estimate the relative risk (RR) and 95% confidence intervals (CIs) after adjusting for confounding variables. Results There were 81,693 women included in the study (89.2% nonpregnant, 10.8% pregnant and 32.2% postpartum). Overall, 36.9% of women had anaemia (36.0% of non-pregnant, 44.3% pregnant, and 38.7% of postpartum women). Compared to a 24-35 months interbirth interval, maternal anaemia was not associated with short (<24 months) interbirth intervals (aRR 1.01, 95% CI; 0. 98, 1.04) or long (≥60 months) interbirth interval (aRR 1.00, 95% CI 0.96, 1. 04). Conclusions Our finding revealed insufficient evidence that both short and long birth intervals were associated with the risk of maternal anaemia in SSA. Key messages It is unlikely that the high prevalence of maternal anaemia in SSA can be reduced by avoiding short nor long interbirth intervals. [ABSTRACT FROM AUTHOR]

Much of the literature on fertility transition presumes that birth control is practiced either to limit family size or to space births. This article argues that women also use birth control to postpone pregnancy. Postponement is not synonymous with spacing. It arises when women delay their next birth for indefinite periods for reasons unrelated to the age of their youngest child, but without deciding not to have any more children. Postponement has a distinctive impact on the shape of birth-interval distributions that differs from the impacts of family size limitation, birth spacing, or a mixture of the two behaviors. Some populations, such as that in South Africa, have developed fertility regimes characterized by birth intervals far longer than can be accounted for by birth spacing. Postponement of further childbearing that eventually becomes permanent may be an important driver of the transition to lower fertility in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Using Demographic and Health Survey data from 20 sub-Saharan African countries, this article compares the actual lengths of birth intervals to women's reported preferred lengths, and assesses the implications of the difference between the two for selected demographic and health indicators. The results show a clear pattern. In Comoros, Ghana, Kenya, Rwanda, and Zimbabwe, women prefer much longer birth intervals than those they actually have, compared with women in the other 15 countries studied. As a consequence, the potential effects of spacing preferences on the level of fertility and on the prevalences of short (less than 24 months) birth intervals and child malnutrition are greatest in the same five countries. The covariates of preferred birth-interval lengths are also examined. An explanation is offered for this pattern, based on the observed sharp decline in fertility recently experienced by these five "forerunners." In general, women who know, approve of, discuss, and use family planning prefer longer intervals than do their counterparts. The policy and program relevance of these results is discussed. [ABSTRACT FROM AUTHOR]