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BACKGROUND: Vitamin A deficiency is considered a public health issue, particularly among children under 5 years. Vitamin A supplementation is among the ten key essential nutrition actions put in place to tackle malnutrition in children and helps to reduce under-five mortality by almost a quarter in Vitamin A deficient areas. We, therefore, examined inequalities in Vitamin A uptake among children 6-59 months in Ghana. METHODS: We used data from the 2003, 2008, and 2014 Ghana Demographic and Health Surveys. The WHO's HEAT version 3.1 software was used for all the analyses. We adopted six equity stratifiers (maternal age, economic status, level of education, place of residence, sex of the child, and region) to disaggregate Vitamin A supplementation among children 6-59 months. Four measures were used to compute inequality, namely, Difference (D), Population Attributable Risk (PAR), Population Attributable Fraction (PAF) and Ratio (R). RESULTS: Over the 11-year period, the proportion of children who received Vitamin A supplementation declined from 78.6% to 65.2%. There were inequalities by maternal age, particularly in 2003 (D = 13.1, CI: 2.3, 23.9; PAF = 0.5, CI: - 12.3, 13.2). The widest inequality in Vitamin A supplementation by economic status was noted in 2003 (D = 8.8, CI: 3.3-14.2; PAF = 8.3, CI: 5, 11.5). In terms of sex, the indices revealed mild inequality in Vitamin A supplementation throughout the period studied. For education, the highest inequality was observed in 2014 (D = 11.6, CI: 6.0, 17.1), while the highest inequality in terms of place of residence was observed in 2003 (D = 4.0, CI: - 0.1-8.4). In the case of region, substantial inequality was noted in 2014 (D = 34.7, CI: 22.6, 46.8; PAF = 21.1, CI: 15.3, 27). CONCLUSIONS: We conclude that there is a need for the government of Ghana to deploy targeted interventions to enhance the uptake of Vitamin A supplementation among the most disadvantaged subpopulations. Interventions targeted at these disadvantaged populations should be pro-poor in nature. In addition, the inequalities in the dimension of place of residence were mixed, favoring both rural and urban children at different points. This calls for a comprehensive and all-inclusive approach that enhances Vitamin A supplementation uptake in an equitable manner in both areas of residence. Empowerment of women through formal education could be an important step toward improving Vitamin A supplementation among children in Ghana.

OBJECTIVE: To examine the factors associated with intention to use contraceptives among married and cohabiting women in sub-Saharan Africa (SSA). DESIGN: Data for the study were extracted from the most recent Demographic and Health Surveys of 29 countries in SSA conducted from 2010 to 2020. We included a total of 180 682 women who were married or cohabiting. Multilevel regression analysis was carried out and the results were presented as adjusted odds ratio (AOR), with 95% confidence interval (CI). SETTING: 29 countries in SSA. PARTICIPANTS: Women aged 15-49 years in sexual unions. OUTCOME MEASURE: Intention to use contraceptives. RESULTS: The pooled prevalence of intention to use contraceptives among married and cohabiting women in the 29 countries was 41.46%. The prevalence ranged from 18.28% in Comoros to 71.39% in Rwanda. Intention to use contraceptives was lower among women aged 45-49 (AOR=0.06, 95% CI= 0.05 to 0.07), those with no education (AOR=0.60, 95% CI= 0.58 to 0.61), and primary education (AOR=0.90, 95% CI 0.88 to 0.93), married women (AOR=0.81, 95% CI= 0.79 to 0.84), those of the poorest wealth quintile (AOR=0.78, 95% CI= 0.75 to 0.82), and women who were not exposed to mass media (AOR=0.87, 95% CI= 0.86 to 0.90). Women with four or more births (AOR=2.09, 95% CI= 1.99 to 2.19) had greater likelihood of contraceptive use intention compared to those with no birth. Women in rural settings were found to have greater likelihood of intention to use contraceptives compared to those in urban settings (AOR=1.10, 95% CI= 1.07 to 1.14). CONCLUSION: There is a low prevalence of contraceptive use intention among married and cohabiting women in SSA with differences between countries. It is imperative for policymakers to consider these factors when developing and executing contraceptive programmes or policies to enhance contraceptive intents and use among married and cohabiting women. To resolve discrepancies and increase contraceptive intention among women, policymakers and other key stakeholders should expand public health education programmes.

BACKGROUND: Utilization of contraceptives remains low in several countries in sub-Saharan Africa despite evidence of its benefits. Several factors are associated with contraceptive use. However, little is known about the association between women's decision-making capacity and the utilization of contraceptives in Mali. This study sought to determine the effect of women's household decision-making power on contraceptive use in Mali. METHODS: This study involved a cross-sectional analysis of data from the 2018 Mali Demographic and Health Survey. A total of 7893 married women were included in the final analysis. A binary logistic regression analysis was conducted with statistical significance set at p

BACKGROUND: Pregnant women and children are the most vulnerable group of people usually affected by malaria. The use of insecticide-treated nets is one of the proven interventions for mitigating malaria and its associated deaths in endemic regions, including Ghana. Meanwhile, there is limited evidence on the extent of inequality in insecticide-treated nets use by pregnant women in Ghana. This study assessed the inequalities in insecticide-treated nets use by pregnant women in Ghana. METHODS: Data from the 2011 and 2017 versions of the Ghana Multiple Indicator Cluster Surveys were used. The 2019 updated World Health Organization (WHO) HEAT software (version 3.1) was used for all analyses. Four equity stratifiers were employed to disaggregate insecticide-treated nets use by pregnant women in Ghana. These are economic status, level of education, place of residence, and sub-national region. Four measures were used to compute inequality namely Difference (D), Population Attributable risk (PAR), Population Attributable Fraction (PAF) and Ratio (R). RESULTS: The analyses indicated a rise in pregnant women's insecticide-treated nets use from 32.6% in 2011 to 49.7% in 2017. Except sub-national region, all the factors showed mild inequality in insecticide-treated nets use. For instance, with respect to the economic status of pregnant women, only a slight inequality was exhibited by one of the simple measures in both 2011 (R = 0.3; 95% UI = 0.2-0.6) and 2017 (R = 0.5; 95% UI = 0.3-0.7). Marginal inequality in insecticide-treated nets use was noted in 2011 (R = 0.6; 95% UI = 0.5-0.9) and 2017 (R = 0.8; 95% UI = 0.6-0.9) for level of education. In the same vein, slight inequality was realized with respect to place of residence in 2011 (R = 0.4; 95% UI = 0.3-0.6) and 2017 (R = 0.6; 95% UI = 0.5-0.7). For sub-national region, both simple (D = 50.5; 95% UI = 30.7-70.4) and complex (PAF = 91.3; 95% UI = 72.3-110.3) measures demonstrated substantial inequality in 2011. In the case of 2017, considerable inequality in insecticide-treated nets use occurred (D = 58; 95% UI = 42.2-73.8, PAF = 51.9; 95% UI = 36.2-67.6). CONCLUSION: In conclusion, insecticide-treated nets utilization by pregnant Ghanaian women increased between 2011 and 2017. The findings show that Ghana's Ministry of Health in collaboration with anti-malarial non-governmental organizations must review patterns of insecticide-treated nets distribution and intensify advocacy among educated pregnant women, those in urban settings and the rich, to assuage the magnitude of inequality.

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.

BACKGROUND: Given the intricate relationship between mothers and their children with the continuum of care, it is quintessential for their healthcare and interventions to be enhanced through a continuum of care approach. We examined the factors associated with the continuum of care for maternal, newborn, and child health in sub-Saharan Africa. METHODS: Data for the study were pooled from the Demographic and Health Surveys of 17 countries in sub-Saharan Africa. We extracted the data from the women's files in all 17 countries. We included 15,359 married and cohabiting women with the most recent children aged 12-23 months at the time of the survey in the study. Multivariable multilevel logistic regression analysis was performed to examine the factors associated with continuum of care. Results were presented as adjusted odds ratios (aORs) with their 95% confidence interval. RESULTS: Women whose partners had secondary or higher level of education [aOR = 1.52; 95%CI = 1.07, 2.16], those with health insurance [aOR = 1.64; 95%CI = 1.18, 2.30], those who decide alone on their healthcare [aOR = 1.38; 95%CI = 1.01, 1.89], those with joint healthcare decision [aOR = 1.33; 95%CI = 1.02, 1.74], those exposed to radio [aOR = 1.38; 95%CI = 1.06, 1.79], those who started antenatal care early [aOR = 1.88; 95%CI = 1.50, 2.36] and those in southern Africa [aOR = 7.02; 95%CI = 3.23, 15.27] had higher odds of completing the continuum of care. CONCLUSION: We found that only 3.4% of women across the 17 sub-Saharan African countries included in this study completed all of the 11 maternal, newborn, and child health care interventions along the continuum of care. The factors that are associated with the maternal, newborn, and child health continuum of care include women's autonomy in decision-making, partners' level of education, health insurance coverage, early initiation of antenatal care, exposure to radio, and residing in Southern Africa. Problem with the distance to the facility lowered women's odds of completing the continuum of care. Governments and departments of health services across sub-Saharan African countries must leverage the radio to disseminate critical messages about the need to complete the continuum of care. Much commitment must be made toward advancing the autonomy of women. Health insurance coverage would have to be extended to reach all women to facilitate the completion of the continuum of care.

Globally, HIV/AIDS remains a public health issue, especially in sub-Saharan Africa (SSA). Despite the increased advocacy and dissemination of comprehensive HIV/AIDS information in SSA, it appears that little progress has been made to reduce the incidence of HIV/AIDS in the sub-region. This study, therefore, examined the association between comprehensive HIV/AIDS knowledge and safer sex negotiation among adolescent girls and young women in SSA. Data were taken from the Demographic and Health Surveys conducted between 2010 and 2019 in 30 countries in SSA. The study sample comprised 37,364 adolescent girls and young women aged 15-24. A multivariable binary logistic regression analysis was done to test the hypothesis that there is a positive association between comprehensive HIV/AIDS knowledge and safer sex negotiation. Adolescent girls and young women who had comprehensive knowledge on HIV/AIDS were more likely to negotiate for safer sex compared with those who had no comprehensive knowledge on HIV/AIDS (AOR=1.31, 95% CI: 1.22-1.41). At the country level, the positive association between comprehensive knowledge on HIV/AIDS and safer sex negotiation was significant in Chad, Congo DR, Gambia, Guinea, Liberia, Ethiopia and Malawi. On the other hand, in Togo, adolescent girls and young women who had comprehensive HIV/AIDS knowledge were less likely to negotiate for safer sex. These findings can inform policies and programmes on the crucial role of comprehensive HIV/AIDS education and knowledge in increasing safer sex negotiation among adolescent girls and young women in SSA. The study recommends that Togo needs to address certain practices such as intimate partner violence against adolescent girls and young women, which prevent them from negotiating for safer sex, despite their higher knowledge on comprehensive HIV/AIDS. Lessons can be learnt from Chad, Congo DR, Gambia, Guinea, Liberia, Ethiopia and Malawi about the scale-up of programmes and interventions targeted at young women.

INTRODUCTION: Globally, the rate of caesarean deliveries increased from approximately 16.0 million in 2000 to 29.7 million in 2015. In this study, we decomposed the rural-urban disparities in caesarean deliveries in sub-Saharan Africa. METHODS: Data for the study were extracted from the most recent Demographic and Health Surveys of twenty-eight countries in sub-Saharan Africa. We included 160,502 women who had delivered in health facilities within the five years preceding the survey. A multivariate non-linear decomposition model was employed to decompose the rural-urban disparities in caesarean deliveries. The results were presented using coefficients and percentages. RESULTS: The pooled prevalence of caesarean deliveries in the 28 countries considered in the study was 6.04% (95% CI = 5.21-6.88). Caesarean deliveries' prevalence was highest in Namibia (16.05%; 95% CI = 14.06-18.04) and lowest in Chad (1.32%; 95% CI = 0.91-1.73). For rural-urban disparities in caesarean delivery, the pooled prevalence of caesarean delivery was higher in urban areas (10.37%; 95% CI = 8.99-11.75) than rural areas (3.78%; 95% CI = 3.17-4.39) across the 28 countries. Approximately 81% of the rural-urban disparities in caesarean deliveries were attributable to the differences in child and maternal characteristics. Hence, if the child and maternal characteristics were levelled, more than half of the rural-urban inequality in caesarean deliveries would be reduced. Wealth index (39.2%), antenatal care attendance (13.4%), parity (12.8%), mother's educational level (3.5%), and health insurance subscription (3.1%) explained approximately 72% of the rural-urban disparities in caesarean deliveries. CONCLUSION: This study shows significant rural-urban disparities in caesarean deliveries, with the disparities being attributable to the differences in child and maternal characteristics: wealth index, parity, antenatal care attendance, mother's educational level, and health insurance subscription. Policymakers in the included countries could focus and work on improving the socioeconomic status of rural-dwelling women as well as encouraging antenatal care attendance, women's education, health insurance subscription, and family planning, particularly in rural areas.

BACKGROUND: Awareness about obstetric fistula and its concomitant factors is central to efforts to eliminate obstetric fistula in sub-Saharan Africa. We, therefore, assessed the magnitude of obstetric fistula awareness and its associated factors among women of reproductive age in sub-Saharan Africa. METHODS: Data for the study were extracted from the most recent Demographic and Health Surveys of 14 countries in sub-Saharan Africa. We included 185,388 women aged 15-49 years in this study. Percentages were used to summarise the prevalence of obstetric fistula awareness across the 14 countries studied. We adopted a multivariable multilevel binary logistic regression to examine the factors associated with obstetric fistula awareness in sub-Saharan Africa. We presented the results of the regression analysis using adjusted odds ratios with their 95% confidence intervals. Statistical significance was set at p

BACKGROUND: Intimate partner violence remains a major public health problem, especially in countries in sub-Saharan Africa. We examined the factors associated with married women's attitudes towards wife-beating in sub-Saharan Africa. METHODS: We used Demographic and Health Survey data of 28 sub-Saharan African countries that had surveys conducted between 2010 and 2019. A sample of 253,782 married women was considered for the analysis. Bivariate and multivariate logistic regression analyses were carried out, and the results were presented using crude odds ratio (cOR) and adjusted odds ratio (aOR) at 95% confidence interval. RESULTS: The pooled result showed about 71.4% of married women in the 28 countries in this study did not justify wife-beating. However, the prevalence of non-justification of wife-beating varied from 83.4% in Malawi to 17.7% in Mali. Women's age (40-44 years-aOR = 1.61, 95% CI 1.16-2.24), women's educational level (secondary school-aOR = 1.47, 95% CI 1.13-1.91), husband's educational level (higher-aOR = 0.55, 95% CI 0.31-0.95), women's occupation type (professional, technical or managerial-aOR = 1.66, 95% CI 1.06-2.62), wealth index (richest-aOR = 5.52, 95% CI 3.46-8.80) and women's decision-making power (yes-aOR = 1.39, 95% CI 1.19-1.62) were significantly associated with attitude towards wife-beating. CONCLUSION: Overall, less than three-fourth of married women in the 28 sub-Saharan African countries disagreed with wife-beating but marked differences were observed across socio-economic, decision making and women empowerment factors. Enhancing women's socioeconomic status, decision making power, and creating employment opportunities for women should be considered to increase women's intolerance of wife-beating practices, especially among countries with low prevalence rates such as Mali.

BACKGROUND: Globally, Human Immunodeficiency Virus (HIV) that causes Acquired Immunodeficiency Syndrome (AIDS) remains a public health problem with a higher burden in sub-Saharan African countries. Though the coverage is low in sub-Saharan Africa (SSA), comprehensive knowledge about HIV is vital for preventing and controlling the transmission of the virus. Women's decision-making power is significantly linked with the knowledge and use of healthcare services. However, there is no available evidence on women's decision-making capacity and comprehensive knowledge of HIV. Therefore, this study investigated the association between women's decision-making capacity within households and comprehensive knowledge of HIV/AIDS in SSA. METHODS: We derived data from the 2010 to 2020 Demographic and Health Surveys of 23 sub-Saharan African countries for the analysis. Using Stata version 14, both bivariate logistic regression and multivariate multilevel logistic regression analyses were used to examine the association between women's decision-making capacity and comprehensive knowledge of HIV/AIDS at p ≤ 0.05. Results were reported using adjusted odds ratios (aOR) with their respective 95% confidence interval (CI). RESULTS: The pooled results show that comprehensive HIV/AIDS knowledge among married women in the studied countries was 35.5%, from 18.3% in Chad to 77.1% in Rwanda. Regarding sub-regional distribution, comprehensive knowledge of HIV/AIDS in Southern Africa was 73.2%, followed by East Africa (52.4%), West Africa (43.6%), and Central Africa (35.5%). The study showed higher odds of comprehensive knowledge of HIV/AIDS among married women who had decision making power (yes-aOR = 1.20, 95% CI; 1.16-1.25) compared to those who had no decision-making power. Age, women and partner's level of education, place of residence, exposure to media, HIV testing status, community socio-economic status, parity, religion, and distance to health facilities also had significant association with comprehensive HIV/AIDS knowledge. CONCLUSIONS: Comprehensive knowledge of HIV/AIDS in SSA is low but varies per country. Married women with decision-making capacity were more likely to have comprehensive knowledge of HIV compared to those with no decision-making capacity. Therefore, comprehensive knowledge of HIV/AIDS can be increased through enhancing women's decision-making capacities, strengthening employment opportunities, socioeconomic capacities and creating awareness through media. Moreover, improving access to health care facilities working closely with religious leaders, can be considered to increase coverage of comprehensive knowledge of HIV among married women in SSA.

Utilization of antenatal care (ANC) services, as part of reproductive health care, presents a lifesaving chance for health promotion and the early diagnosis and treatment of illnesses throughout pregnancy. This study examines the factors associated with the number and timing of ANC visits among married women in Cameroon using data from the 2018 Cameroon Demographic and Health Survey. The outcome variables were number of ANC visits, categorized as 3 months (late) (as per the new 2016 WHO recommendations). Descriptive statistics and binary logistic regression were used to analyse the data. Crude odds ratios (cOR) and adjusted odds ratios (aOR) and p-values with significance at

BACKGROUND: Today, an estimated 7.3% (50 million) of all children

Women's ability to negotiate for safer sex has effects on their sexual and reproductive health. This study investigated the association between safer sex negotiation and parity among women in sub-Saharan Africa. The data were sourced from the Demographic and Health Surveys of 28 sub-Saharan African countries conducted from 2010 to 2019. A total of 215,397 women aged 15-49 were included in the study. Multilevel logistic analysis was conducted to examine the association between safer sex negotiation and parity among women in sub-Saharan Africa. The results were presented as adjusted odds ratios (aOR) and the significance level set at p

BACKGROUND: The Sustainable Development Goal (SDG) 3 aims at reducing neonatal and under-5 mortality to below 12 per 1000 and 25 per 1000 live births, respectively, globally by 2030. Studies have found that initiation of breastfeeding within one hour of birth and continuous breastfeeding for over 12 months can positively impact neonatal and infant health. However, there is evidence that the sex of a child may influence the breastfeeding practices of a mother. Thus, we examined sex inequality in early breastfeeding initiation in sub-Saharan Africa. MATERIALS AND METHODS: Data from Demographic and Health Surveys conducted in 24 sub-Saharan African countries between January 2010 and December 2019 were pooled and analysed. A total of 137,677 women of reproductive age (15-49 years) were considered in this study. Bivariate and multivariable regression analyses were performed, and the results were presented using crude odds ratio (cOR) and adjusted odds ratio (aOR) with statistical significance at a p-value less than 0.05. RESULTS: The highest inequality in early initiation of breastfeeding was reported in Togo with a difference of 5.21% between the female and male children, while the lowest inequality was reported in Guinea with 0.48% difference between the female and male children. A higher odds of breastfeeding within 1 hour was observed among female children [cOR = 1.05; 95%(CI = 1.02-1.09)] compared to male children, and this persisted after controlling for the confounders included in this study [aOR = 1.05; 95%(CI = 1.02-1.08)]. CONCLUSION: We found higher odds for early breastfeeding initiation of female children compared to male children in sub-Saharan Africa. To reduce breastfeeding initiation inequalities, programmes that educate and encourage early initiation of breastfeeding irrespective of the child sex should be promoted among mothers.

Objectives: There is a dearth of evidence on inequalities in vitamin A supplementation in Ethiopia. The goal of this study was to assess the magnitude and overtime changes of inequalities in vitamin A supplementation among children aged 6-59 months in Ethiopia. Methods: We extracted data from four waves of the Ethiopia Demographic and Health Surveys (2000, 2005, 2011, and 2016). The analysis was carried out using the 2019 updated World Health Organization's Health Equity Assessment Toolkit software that facilitates the use of stored data from World Health Organization's Health Equity Monitor Database. We conducted analysis of inequality in vitamin A supplementation by five equity stratifiers: household economic status, educational status, place of residence, child's sex, and subnational region. Four summary measures-population attributable fraction, ratio, difference, and population attributable risk-were assessed. We computed 95% uncertainty intervals for each point estimate to ascertain statistical significance of the observed vitamin A supplementation inequalities and overtime disparities. Results: The findings suggest marked absolute and relative pro-rich (population attributable fraction = 29.51, 95% uncertainty interval; 25.49-33.53, population attributable risk = 13.18, 95% uncertainty intervals; 11.38-14.98) and pro-urban (difference = 16.55, 95% uncertainty intervals; 11.23-21.87, population attributable fraction = 32.95, 95% uncertainty intervals; 32.12-33.78) inequalities. In addition, we found education-related (population attributable risk = 18.95, 95% uncertainty intervals; 18.22-19.67, ratio = 1.54, 95% uncertainty intervals; 1.37-1.71), and subnational regional (difference = 38.56, 95% uncertainty intervals; 29.57-47.54, ratio = 2.10, 95% uncertainty intervals; 1.66-2.54) inequalities that favored children from educated subgroups and those living in some regions such as Tigray. However, no sex-based inequalities were observed. While constant pattern was observed in subnational regional disparities, mixed but increasing patterns of socioeconomic and urban-rural inequalities were observed in the most recent surveys (2011-2016). Conclusion: In this study, we found extensive socioeconomic and geographic-based disparities that favored children from advantaged subgroups such as those whose mothers were educated, lived in the richest/richer households, resided in urban areas, and from regions like Tigray. Government policies and programs should prioritize underprivileged subpopulations and empower women as a means to increase national coverage and achieve universal accessibility of vitamin A supplementation.

Background and Objective: Access to health care services is a major challenge to women and children in many developing countries such as Ethiopia. In this study, we investigated the individual- and community-level factors associated with barriers to accessing health care services among married women in Ethiopia. Methods: Data from the 2016 Ethiopia demographic and health survey on 9,824 married women of reproductive age (15-49 years) were analyzed. Multilevel logistic regression models were used to assess individual- and community-level factors associated with barriers to access health care services. Regression analysis results revealed adjusted odds ratios at 95% confidence intervals. Results: Over two-thirds (71.8%) of married women in Ethiopia reported barriers to accessing health care services. Some of the individual-level factors that were associated with lower odds of reporting barriers to access health care services include: having secondary education (aOR=0.49, 95% CI: 0.32-0.77), being in the richest quintile (aOR=0.34, 95% CI: 0.22-0.54), and indicating wife-beating as unjustified (aOR=0.66, 95% CI:0.55-0.81). Among the community-level factors, high community-level literacy (aOR=0.56, 95% CI: 0.34-0.92) and moderate community socioeconomic status (aOR=0.62, 95% CI: 0.45-0.85) were significantly associated with lower odds of reporting barriers to access health care services. Conclusion and Implications for Translation: The findings revealed high barriers to access health care services, and both individual- and community-level factors were significant contributing predictors. Therefore, it is important to consider multidimensional strategies and interventions to facilitate access to health care services in Ethiopia. Copyright © Zegeye et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

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

Background and Aims Discriminatory attitude towards people living with human immunodeficiency virus (HIV) remains a major problem in the prevention and treatment of HIV in sub-Sahara Africa (SSA). Understanding the multiple factors linked to discriminatory attitude towards people living with HIV/AIDS (PLWHA) in SSA is necessary for developing appropriate interventions. This study aimed at investigating the individual, household, and community-level factors associated with pregnant married women's discriminatory attitude towards people living with HIV/AIDS. Methods We used data from the Demographic and Health Surveys of 12 sub-Saharan African countries conducted between 2015 and 2019. Data on 17 065 pregnant married women were analyzed. Bivariate (chi-squared test) and multivariable multilevel logistic regression analyses were applied to investigate the factors associated with discriminatory attitude towards PLWHA. The results were reported as adjusted odds ratio (aOR) at 95% confidence interval (CI). Results The mean age of participants was 31.2 ± 8.5. The prevalence of discriminatory attitude towards PLWHA was 36.2% (95% CI: 33.4%-39.1%). Individual/household-level factors associated with discriminatory attitude towards PLWHA were women's educational level (secondary school-aOR = 0.49, 95% CI: 0.26-0.93), husband's educational level (higher education-aOR = 0.35, 95% CI: 0.16-0.76), decision-making power (yes-aOR = 0.51, 95% CI: 0.38-0.69), wife-beating attitude (disagreement with wife beating-aOR = 0.58, 95% CI: 0.43-0.79), and religion (Muslim-aOR = 1.92, 95% CI: 1.22-3.04). Community socioeconomic status (medium-aOR = 0.61, 95% CI: 0.41-0.93) was the only community-level factor associated with discriminatory attitude towards PLWHA. Conclusion More than one-third of pregnant married women in SSA had discriminatory attitude towards PLWHA. Women's educational level, husband's educational level, decision-making power, wife-beating attitude, religion, and community socio-economic status were associated with discriminatory attitude towards PLWHA. To lessen the prevalence of discriminatory attitude towards PLWHA, considering these significant factors is needed. Therefore, governments and other stakeholders in the respective countries need to increase education coverage. Moreover, empowering women through education and economy is crucial. Finally, working with religious leaders to increase awareness about HIV and discriminatory attitude towards PLWHA should also be a priority in SSA.

BackgroundEarly initiation of breastfeeding (EIB) is an inexpensive practice but has a substantial potential to reduce neonatal morbidity. Therefore, this study investigated the maternal and child-related factors associated with EIB and makes recommendations that could help improve the practice in Chad.MethodsWe used data from the children's recode file of the 2014-2015 Chad Demographic and Health Survey. A total of 3991 women ages 15-49 y who had last-born children in the 2 y preceding the survey were included in our study. The outcome variable for the study was EIB. Both descriptive (frequencies and percentages) and inferential (binary logistic regression) analyses were carried out. All results of the binary logistic analyses are presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs).ResultsWe found the prevalence of EIB in Chad to be 23.8%. In terms of maternal factors, the likelihood of EIB was high among non-working women (aOR 1.37 [95% CI 1.18 to 1.59]), the richest wealth quintile women (aOR 1.37 [95% CI 1.04 to 1.79]) and non-media-exposed women (aOR 1.58 [95% CI 1.24 to 2.02]) compared with working women, the poorest wealth quintile women and media-exposed women, respectively. EIB was lower among children whose mothers had one to three antenatal care visits (ANC; aOR 0.73 [95% CI 0.61 to 0.87]) and four or more ANC visits (aOR 0.80 [95% CI 0.66 to 0.97]) compared with those who had no ANC visits. With the child factors, EIB was higher among mothers of children who were smaller than average size at birth compared with those of larger than average birth size (aOR 1.47 [95% CI 1.24 to 1.74]). Mothers of children of fifth-order or more births compared with those of first-order births (aOR 1.51 [95% CI 1.07 to 2.12]) and those who were delivered through vaginal birth compared with those delivered through caesarean section (aOR 4.71 [95% CI 1.36 to 16.24]) were more likely to practice EIB.ConclusionsMaternal and child-related factors play roles in EIB in Chad. Hence, it is important to consider these factors in maternal and neonatal health interventions. Such initiatives, including training of outreach health workers, health education, counselling sessions and awareness-raising activities on breastfeeding geared towards EIB should be undertaken. These should take into consideration the employment status, wealth quintile, exposure to mass media, size of the baby at birth, ANC visits, parity and delivery method.

BackgroundIn this article we report the prevalence and determinants of intended or wanted pregnancies among young women 15-24 y of age in selected sub-Saharan African countries.MethodsThis cross-sectional study used pooled data from current Demographic and Health Surveys conducted between 1 January 2010 and 31 December 2019 in 29 countries in sub-Saharan Africa (SSA). The sample size comprised 14 257 young women (15-24 y of age). Multivariable binary logistic regression models were used to present the results as adjusted odds ratios.ResultsThe prevalence of intended pregnancies was 67.7%, with the highest and lowest prevalence in Gambia (89.9%) and Namibia (37.7%), respectively. Intended pregnancy was lower among young women who had knowledge of modern contraceptives, those with a secondary/higher education and those with four or more births. Lower odds of intended pregnancy were observed among young women in the richer wealth quintile and those who lived in southern Africa.ConclusionsTo reduce intended pregnancies in sub-Saharan African countries such as Gambia, Burkina Faso and Nigeria, there is a need for government and non-governmental organisations to recalibrate current and past interventions such as investment in increasing formal education for women and poverty alleviation programmes, as well as augmenting job creation, including skill-building. These interventions have to be sensitive to the cultural realities of each setting, especially with regards to early marriages and womanhood.

AimThis study examined trends in absolute and relative socio-economic, gender and geographical inequalities in the coverage of polio immunisation in Guinea, West Africa, from 1999 to 2016.MethodsData from the 1999, 2005 and 2012 Guinea Demographic and Health Survey and the 2016 Guinea Multiple Indicator Cluster Survey were analysed using the World Health Organization's health equity assessment toolkit. We disaggregated polio immunisation coverage using five equity stratifiers: household economic status, maternal educational level, place of residence, child's gender and region. The four summary measures used were the difference, ratio, population attributable risk and population attributable fraction. A 95% confidence interval (CI) was constructed around point estimates to measure statistical significance.ResultsA total of 4778 1-year-old children were included. Polio immunisation coverage in 1999, 2005, 2012 and 2016 were 43.4%, 50.7%, 51.2% and 38.6%, respectively. Socio-economic and geographical inequalities in polio immunisation favoured children with educated mothers who came from richer families living in urban areas. There were also differences in the eight regions over the 1999-2016 study period.ConclusionTargeting children from disadvantaged subgroups must be prioritised to ensure equitable immunisation services that help to eradicate polio in Guinea.

Background The probability of not breastfeeding within the first hour after delivery (timely initiation of breastfeeding) is particularly pronounced in sub-Saharan Africa. In this study, we examined the maternal and child factors associated with timely initiation of breastfeeding in sub-Saharan Africa. Methods We pooled data from 29 sub-Saharan African countries’ Demographic and Health Surveys conducted from 2010 to 2018. A total of 60,038 childbearing women were included. Frequencies, percentages, and binary logistic regression analyses were carried out. Binary logistic regression was used to examine the maternal and child factors associated with timely initiation of breastfeeding and the results were presented as adjusted odds ratios (aOR) at 95% confidence interval (CI). Results We found a prevalence of 55.81% of timely initiation of breastfeeding in the sub-region. The country with the highest prevalence of timely initiation of breastfeeding was Burundi (86.19%), whereas Guinea had the lowest prevalence (15.17%). The likelihood of timely initiation of breastfeeding was lower among married women, compared to never married women (aOR 0.91; 95% CI 0.85, 0.98); working women compared to non-working women (aOR 0.90; 95% CI 0.87, 0.93); women who watched television at least once a week, compared to those who never watched television (aOR 0.74; 95% CI 0.70, 0.78); women who delivered through caesarean section, compared to vaginal birth (aOR 0.30; 95% CI 0.27, 0.32); and those with multiple births, compared to those with single births (aOR 0.67; 95% CI 0.59, 0.76). Women who lived in Central Africa were less likely to initiate breastfeeding timely compared to those who lived in West Africa (aOR 0.80; 95% CI 0.75, 0.84). Conclusions The findings call for the need for a behavioural change communication programmes, targeted at timely initiation of breastfeeding, to reverse and close the timely initiation of breastfeeding gaps stratified by the maternal and child factors. Prioritising policies to enhance timely initiation of breastfeeding is needed, particularly among Cental African countries where timely initiation of breastfeeding remains a challenge. Sufficient supportive care, especially for mothers with multiple births and those who undergo caesarean section, is needed to resolve timely initiation of breastfeeding inequalities.

People living with undiagnosed HIV are big contributors to the transmission of the virus. Although measures have been made to scale up HIV prevention and voluntary counselling and testing in sub-Saharan Africa, testing coverage remains low in many sub-Saharan African countries, including Mozambique and Kenya, where most people live with HIV/AIDS. Studies have shown that, in most countries in sub-Saharan Africa, men are less likely to test for HIV compared with women. This study examined the relationship between comprehensive HIV/AIDS knowledge and HIV testing among men in Kenya and Mozambique. Data were from the men's re-code file of the Demographic and Health Surveys of Mozambique and Kenya. Binary logistic regression models were generated and the results presented as crude odds ratios (cOR) and adjusted odds ratios (aOR). The prevalences of HIV testing in Kenya and Mozambique were 80.1% and 46.7%, respectively. Men in Mozambique who had comprehensive HIV/AIDS knowledge (aOR=1.26, CI: 1.07-1.47) were more likely to test for HIV compared with their counterparts who had no comprehensive HIV/AIDS knowledge. In Kenya, men who had comprehensive HIV/AIDS knowledge (aOR=1.23, CI: 1.09-1.39) were more likely to test for HIV compared with their counterparts who had no comprehensive HIV/AIDS knowledge. This study found a statistically strong significant association between comprehensive HIV/AIDS knowledge and HIV testing among men in Kenya and Mozambique. To improve HIV testing rate among men, it is important that interventions are geared towards improving men's comprehensive HIV/AIDS knowledge, perhaps by expanding HIV/AIDS education programmes and campaigns. This could improve HIV testing rates and ensure the realization of the global HIV/AIDS target of 95-95-95 by the year 2030.

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

BackgroundThe sustainable development goal 3, target 2, seeks to reduce under-five mortality to as low as 25 deaths per 1000 live births by 2030. As such, seeking child health services has become a priority concern for all countries, particularly those in sub-Saharan Africa (SSA). Evidence suggests that empowered women are more likely to seek child health services. Hence, this study examined the association between women empowerment indicators and uptake of child health services in SSA.MethodsThe study used data from the Demographic and Health Surveys of 26 SSA countries, which were conducted between 2010 and 2019. Two different samples were considered in the study: a total of 12 961 children within the vaccination age of 12-23, and 9489 children under age 5 with diarrhoea symptoms in the last 2 weeks before the survey. Women empowerment indicators comprised disagreement with reasons to justify wife beating, decision-making power and knowledge level, while child health services constituted complete vaccination uptake and seeking diarrhoea treatment. Frequencies, percentages and multivariable, multilevel binary logistic regression models were employed.ResultsThe study shows that women with high decision-making power [adjusted odds ratio (AOR) = 1.20, 95% confidence interval (CI) = 1.07, 1.35] had higher odds of seeking treatment for childhood diarrhoea compared to those with low decision-making power. It was also observed that among children aged 12-23 months [AOR = 1.28, 95% CI = 1.14, 1.43], mothers had higher odds of seeking diarrhoea treatment for them compared to those who were aged less than 12 months. Children whose mothers had medium decision-making power [AOR = 1.30, 95% CI = 1.19, 1.41] were more likely to seek complete immunization for their children compared to those with low decision-making power. Also, those with medium [AOR = 1.19, 95% CI = 1.07, 1.31] and high knowledge [AOR = 1.25, 95% CI = 1.10, 1.42] had higher odds of completing immunization for their children compared to those with low knowledge. Women with medium acceptance had lower odds [AOR = 0.76, 95% CI = 0.67, 0.83] of completing immunization for their children compared with those with low acceptance of wife beating.ConclusionsThis study has demonstrated a strong association between women empowerment indicators and the uptake of child health services. Therefore, efforts should be made to seek policy tools to empower women to help improve the well-being of women and the children they care for.

Background In sub-Saharan Africa, the majority of women of reproductive age who want to avoid pregnancy do not use any method of contraception. This study sought to determine the factors associated with modern contraceptive use among women with no fertility intention in sub-Saharan Africa. Methods This study used data from the Demographic and Health Surveys of 29 countries in sub-Saharan Africa. A total of 87,554 women aged 15–49 with no fertility intention and who had completed information on all the variables of interest were considered in this study. Using a multilevel logistic regression analysis, four models were used to examine the individual and contextual factors associated with modern contraceptive use. The results were presented as adjusted odds ratios (aOR), with their respective confidence intervals (CIs). Statistical significance was set at p< 0.05. Results The prevalence of modern contraceptive use was 29.6%. With the individual-level factors, women aged 45–49 had lower odds of using modern contraceptives (aOR = 0.33, 95% CI = 0.28, 0.39). Women who had their first sex at age 15–19 (aOR = 1.12, 95% CI = 1.07, 1.17), those with higher education (aOR = 1.93, 95% CI = 1.75, 2.13), and women who were exposed to newspaper (aOR = 1.15, 95% CI = 1.10, 1.20) and radio (aOR = 1.21, 95% CI = 1.17, 1.26) had higher odds of modern contraceptive use. In terms of the contextual factors, women living in urban areas (aOR = 1.06, 95% CI = 1.02, 1.11), women in the richest wealth quintile (aOR = 1.55, 95% CI = 1.43, 1.67), and those in communities with medium literacy level (aOR = 1.11, 95% CI = 1.06, 1.16) and medium community socio-economic status (aOR = 1.17, 95% CI = 1.10, 1.23) had higher odds of modern contraceptive use. Across the geographic regions in sub-Saharan Africa, women in Southern Africa had higher odds of modern contraceptive use (aOR = 5.29, 95% CI = 4.86, 5.76). Conclusion There is a relatively low prevalence of modern contraceptive use among women with no fertility intention in sub-Saharan Africa, with cross-country variations. Women’s age, age at first sex, level of education, mass media exposure, place of residence, community literacy level and community socio-economic status were found to be associated with modern contraceptive use. It is, therefore, important for policy makers to consider these factors when designing and implementing programmes or policies to increase contraceptive use among women who have no intention to give birth. Also, policymakers and other key stakeholders should intensify mass education programmes to address disparities in modern contraceptive use among women.

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

Introduction: Psychosocial distress has emerged as one of the world’s major public health problems, especially among adolescents in both low- and middle-income countries. This study used data from the 2015 version of the Global School-Based Health Survey to determine the risk and protective factors for psychosocial distress among in-school adolescents in Tanzania. Materials and methods: Chi-square and logistic regression analyses were used to estimate the magnitude of associations. A total of 2936 students participated in the study, of which 52.3% were female. Results: Psychosocial distress was found in 16.9% of the students at similar rates for both males and females. The risk factors associated with psychosocial distress were hunger (OR = 1.57, p < 0.001), being bullied (OR = 1.92, p < 0.001), being attacked (OR = 1.31, p < 0.05), engaging in physical activity (OR = 1.33, p < 0.05), truancy (OR = 1.28, p < 0.05) and tobacco use (OR = 2.40, p < 0.01). However, the protective factors were grade (OR = 0.55, p < 0.01) and having one or two (OR = 0.56, p < 0.01) and three or more close friends (OR = 0.57, p < 0.01). Conclusions: The prevalence of psychosocial distress among adolescents in Tanzania is relatively high and appears to be common among both sexes. To reduce psychosocial distress among in-school adolescents, more attention needs to be paid to the risk factors whiles encouraging healthy relationships among adolescents and their close friends.

Background Over the past few years, there has been growing public and research interest in adolescents’ experiences with various forms of bullying victimisation because of their psychological, emotional, and/ or physical consequences. The present study examined the prevalence of bullying victimisation and its associated factors among in-school adolescents in sub-Saharan Africa. Methods Using data from the Global School-based Health Survey (GSHS) from 2010 to 2017 of eleven sub-Saharan African countries, a sample of 25,454 in-school adolescents was used for analysis. Statistical analyses included frequencies, percentages, Pearson chi-square and multivariable logistic regression. Results were presented as adjusted odds ratios (aOR) at 95% confidence intervals (CIs). Results The overall prevalence of bullying victimisation among the respondents was 38.8%. The prevalence was lowest in Mauritius (22.2%) and highest in Sierra Leone (54.6%). Adolescents who felt lonely [aOR = 1.66, 95% CI = 1.53, 1.80], had history of anxiety [aOR = 1.53, 95% CI = 1.41, 1.66], suicidal ideation [aOR = 1.28, 95% CI = 1.17, 1.39], suicidal attempt [aOR = 1.86, 95% CI = 1.72, 2.02], current users of marijuana [aOR = 1.59, 95% CI = 1.38, 1.84], and truants at [aOR = 1.43, 95% CI = 1.34, 1.52] were more likely to be victims of bullying. Conversely, adolescents who had peer support were less likely to be victims of bullying [aOR = 0.78, 95% CI = 0.73, 0.82]. Adolescents aged 15 years or older had lower odds of experiencing bullying victimization compared to their counterparts aged 14 years or younger [aOR = 0.74, 95% CI = 0.69, 0.78]. Conclusion Our findings suggest that age, loneliness, anxiety, suicidal ideation, suicidal attempt, and current use of marijuana are associated with increased risk of bullying victimisation. School-wide preventative interventions (e.g., positive behavioural strategies- Rational Emotive Behavioral Education, [REBE], peer educator network systems, face-face counseling sessions, substance use cessation therapy) are essential in promoting a positive school climate and reduce students’ bullying victimisation behaviours. Supplementary Information The online version contains supplementary material available at 10.1186/s12888-021-03337-5.

Although insights on bride price and domestic violence have been explored in Ghana, very little is known about payment of bride price and the justification of sexual violence. We investigated the payment of bride price and justification of sexual violence among women (N = 4,222) in Ghana, dwelling on the 2014 Ghana Demographic and Health Survey. Two binary logistic regression models were fitted. We adjusted for significant sociodemographic variables. The findings revealed that women whose partners had paid their bride price had higher odds [OR = 1.54; CI = 1.174, 2.00] of justifying sexual violence, compared to those whose partners had not paid. We found that women with primary [AOR = 0.55; CI = 0.44-0.71] and secondary/higher [AOR = 0.47; CI = 0.36-0.60] levels of education had lower odds of accepting sexual violence. Women in the rich wealth quintile [AOR = 0.32; CI = 0.22, 0.46] had lower odds of justifying sexual violence. Our study has illustrated the need for women to appreciate that payment of bride price does not imply that their fundamental human rights have been bought by men, but they rather become partners. This information can form part of premarriage counselling and human rights initiatives by the Ministry of Gender and Social Protection. That is, the content of marriage counselling may be expanded to include issues on IPV, its implications, and legal consequences. Such information can develop personal realization and urge women to report any violent advances to the police and appropriate authorities for the required legal action to be taken. This may deter others to desist from violence perpetration against women. At the community level, chiefs and other leaders of high repute can be made anti-IPV ambassadors. The Ministry of Health and other nongovernmental anti-violence organizations can also collaborate to strengthen education on anti-sexual violence programs by using the mass media.

BACKGROUND:Global commitment to stop Human Immunodeficiency Virus (HIV) and ensure access to HIV treatment calls for women empowerment, as these efforts play major roles in mother-to-child transmission. We examined the association between women's healthcare decision-making capacity and uptake of HIV testing in sub-Saharan Africa. METHODS:We used data from the current Demographic and Health Surveys (DHS) of 28 countries in sub-Saharan Africa, conducted between January 1, 2010 and December 31, 2018. At the descriptive level, we calculated the prevalence of HIV testing in each of the countries. This was followed by the distribution of HIV testing across the socio-demographic characteristics of women. Finally, we used binary logistic regression assess the likelihood of HIV testing uptake by women's health care decision-making capacity and socio-demographic characteristics. The results were presented as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) with their corresponding 95% confidence intervals signifying precision. Statistical significance was set at p-value

Introduction:Sexual violence plays a key role in women's pregnancy intention. We investigated the influence of sexual violence on planned, mistimed, and unwanted pregnancies in sub-Saharan Africa (SSA). Materials and methods:Data from the Demographic and Health Survey (DHS) of 22 countries in SSA were used in this study. Both descriptive and inferential analyses were conducted. We carried out a multinomial logistic regression analysis to examine the effect of sexual violence on planned, mistimed, and unwanted pregnancies. STATA version 14.2 was used to carry out all analyses. Statistical significance was declared at p

INTRODUCTION:Contraception plays a significant role in fertility regulation and determines the reproductive health rights of women. Studies in other parts of the world have found that sexual violence has negative effects on unmet need for contraception. There has not been any study on the association between these two phenomena in sub-Saharan Africa using current nationally-representative survey data. We investigated the association between sexual violence and unmet need for contraception among married and cohabiting women in sub-Saharan Africa. MATERIALS AND METHODS:This study was based on secondary datasets from 26 sub-Saharan African countries' Demographic and Health Surveys conducted between 2010 and 2018. A sample of 101,968 women in sexual unions (married and cohabiting) with complete information on sexual violence and all the variables of interest were included in the analyses. Both bivariate and multilevel logistic regression analyses were carried out to examine the association between sexual violence and unmet need for contraception. Other individual and contextual level socio-economic and demographic variables were considered as covariates. Crude odds ratios [cOR] and adjusted odds ratios [aOR] with their corresponding 95% confidence intervals [CI], signifying precision, were presented. Level of statistical significance was declared at p

INTRODUCTION:Physical activity (PA) has both short- and long-term importance. In this study we sought to assess the prevalence and correlates of PA among 1,542 Senior High School (SHS) students. METHODS:A cross-sectional study was conducted in Ghana among SHS students using the 2012 version of the Ghana Global School-based Student Health Survey (GSHS) data, which utilised two-stage cluster sampling technique. The population for the study comprised SHS students. The outcome variable was physical activity. The data were analysed using STATA version 14.2 for Mac OS. Both bivariate and multivariate analyses were employed. At the bivariate level, Pearson chi-square test between each independent variable and PA was conducted and the level of statistical significance was set at 5%. All the significant variables from the chi-square test were selected for the multivariate analysis. In the multivariate analysis, Poisson regression with robust variance was performed to estimate crude and adjusted prevalence ratios (APR). RESULTS:It was found that 25.0% (29.0% males and 21.9% females) of SHS students were physically active. Female students (APR = 0.78, 95% CI = 0.65, 0.94), students in SHS 2 (APR = 0.76, 95% CI = 0.577, 0.941) and SHS3 (APR = 0.79, 95% CI = 0.63, 0.93), and those who went hungry (APR = 0.77, 95% CI = 0.65, 0.92) were less likely to be physically active compared to males, those in SHS1 and those who did not go hungry respectively. On the other hand, students who actively commuted to school (APR = 2.40, 95% CI = 1.72, 2.42) and got support from their peers were more likely to be physically active (APR = 1.62, 95% CI = 1.09-2.41). CONCLUSION:Only a quarter of SHS students who participated in the 2012 version of the GSHS met the WHO's recommended level of physical activity. Sex, grade/form and experience of hunger are associated with physical activity. Physical activity is a major component of any health promotion program. Policies and programmes targeting improvement in physical activity among SHS students should take these associated factors into consideration.

INTRODUCTION:Pregnancy termination is one of the key issues that require urgent attention in achieving the third Sustainable Development Goal (SDG) of ensuring healthy lives and promoting well-being for all at all ages. The reproductive health decision-making (RHDM) capacity of women plays a key role in their reproductive health outcomes, including pregnancy termination. Based on this premise, we examined RHDM capacity and pregnancy termination among women of reproductive age in sub-Saharan Africa (SSA). MATERIALS AND METHODS:We pooled data from the women's files of the most recent Demographic and Health Surveys (DHS) of 27 countries in SSA, which are part of the DHS programme. The total sample was 240,489 women aged 15 to 49. We calculated the overall prevalence of pregnancy termination in the 27 countries as well as the prevalence in each individual country. We also examined the association between RHDM capacity, socio-demographic characteristics and pregnancy termination. RHDM was generated from two variables: decision-making on sexual intercourse and decision-making on condom use. Binary logistic regression analysis was conducted and presented as Crude Odds Ratios (COR) and Adjusted Odds Ratios (AOR) with their corresponding 95% confidence intervals (CI). Statistical significance was declared p

BackgroundUnintended pregnancy constitutes a significant public health challenge in sub-Saharan Africa and particularly among young people, who are more likely to closely space births and experience adverse obstetric outcomes. Studies on modern contraceptive use have mostly focused on women of reproductive age in general with limited attention to factors associated with modern contraceptive use among adolescents and young women (aged 15-24) in Mali. We examined the individual and community-level factors associated with modern contraceptive use among this age cohort using the 2018 Mali demographic and health survey data.MethodsWe analyzed data from 2639 adolescent girls and young women, and our outcome of interest was current use of modern contraceptives. We performed descriptive analysis using frequencies and percentages and inferential analysis using mixed-effects multilevel logistic regression. The results of the mixed-effects multilevel logistic regression were presented as adjusted odds ratios with their corresponding 95% confidence intervals.ResultsThe prevalence of modern contraceptive use among adolescent girls and young women in Mali was 17.1% [95% CI, 15-19%]. Adolescent girls and young women who were married [aOR = 0.20, CI = 0.09-0.41], had no formal education [aOR = 0.43, CI = 0.32-0.59], in the poorest wealth quintile [aOR = 0.38, CI = 0.19-0.79] and had no children [aOR = 0.38, CI = 0.27-0.53] were less likely to use modern contraceptives. Similarly, those who had low knowledge of modern contraception [aOR = 0.60, CI = 0.42-0.85] and whose ideal number of children was six or more [aOR = 0.66, CI = 0.43-0.99] were less likely to use modern contraceptives. However, those with four or more births were more likely to use modern contraceptives [aOR = 1.85, CI = 1.24-2.77].ConclusionModern contraceptive use among adolescent girls and young women in Mali has improved slightly relative to the prevalence of 2012, though the prevalence is still low, compared to the prevalence in other sub-Saharan African countries and the prevalence globally. Individual-level factors such as marital status, educational level, wealth quintile, parity, ethnicity and ideal number of children were associated with the use of modern contraceptive among adolescent girls and young women in Mali. Community knowledge of modern contraceptives was found as a community-level factor associated with modern contraceptive use among adolescent girls and young women. Therefore, Mali's Ministry of Health and Public Hygiene's Health Promotion and Education unit should prioritise and intensify contraceptive education to increase coverage of modern contraceptive use and address disparities in the use of modern contraceptives. Such education should be done, taking into consideration factors at the individual and community-level of the target population.

IntroductionWorldwide, 25 million unsafe abortions (45% of all abortions) occurred every year between 2010 and 2014 and 97%, occurred in low-and-middle income countries. Abortion among adolescent girls and young women (15-24 years) is a major public health issue, especially in low-and middle-income countries, including Ghana. Using data from the 2017 Maternal Health Survey, we sought to examine the association between mass media exposure and adolescent girls and young women's self-efficacy in abortion decision making.Materials and methodsA sample of 5,664 adolescent girls and young women in Ghana was considered in this study. Both descriptive and inferential analytical approaches were employed to analyse the data. The descriptive analytical approach involved the use of proportions to illustrate the proportion of adolescent girls and young women who had self-efficacy in abortion decision-making. Self-efficacy in abortion decision-making was derived from the question 'Could you decide on your own to get an abortion?' Respondents who answered "Yes" to this question were considered as having self-efficacy in abortion decision making. At the inferential level, a chi-square test and bivariate and multivariable logistic regression models were employed with statistical significance pegged at p-value ResultsLess than a quarter of adolescent girls and young women (24%) in Ghana had self-efficacy in abortion decision-making. We further found that adolescent girls and young women who were exposed to mass media had higher odds in self-efficacy in abortion decision-making compared to those who were not exposed to the mass media [AOR = 1.55, CI = 1.14-2.11]. It was also found that adolescent girls and young women aged 20-24 [AOR = 1.45, CI = 1.25-1.68], those who were cohabiting [AOR = 1.40, CI = 1.02-1.93], and those from the Ashanti region [AOR = 2.39, CI = 1.85-3.07] had higher odds on self-efficacy in abortion decision-making. On the other hand, adolescent girls and young women from the Eastern Region [AOR = 0.52, CI = 0.36-0.73] and those belonging to the Ga-Adangbe ethnic group [AOR = 0.70, CI = 0.50-0.99] had lower odds in self-efficacy in abortion decision-making.ConclusionLess than a quarter of adolescent girls and young women in Ghana have self-efficacy in abortion decision-making which can affect adolescent girls and young women's future abortion seeking behaviours. Exposure to mass media was strongly associated with self-efficacy in abortion decision making. We recommend that policy makers should promote mass media campaigns scheduled on regular intervals in order to inform the target audience about safe abortions in Ghana. This could go a long way to ensure that cases of unsafe abortions are reduced to the starkest minimum.

INTRODUCTION:Receiving results for Human Immunodeficiency Virus (HIV) testing and counselling during antenatal care (ANC) is critical for eliminating mother-to-child transmission. We investigated the educational attainment of women and receiving results for HIV testing and counselling (HTC) during ANC in Ghana. MATERIALS AND METHODS:We extracted data from the women's files of the 2008 and 2014 Ghana Demographic and Health Surveys. The study sampled 2,660 women aged 15-49 with complete data on receiving HIV testing results during ANC. We computed the highest educational attainment and receipt of HTC results for each of the surveys and presented it with a dot plot. Two Binary Logistic Regression Models were fitted to determine the likelihood of receiving HTC results by the educational attainment of the women. RESULTS:We found that receiving HTC results was highest among women with secondary or higher education (87.4% in 2008 and 89.5% in 2014) and least among those with no education (69.9% in 2008 and 76.8 in 2014). From the regression analysis, women with secondary or higher level of education [AOR = 1.535; CI = 1.044, 2.258], richest women [AOR = 5.565; CI = 2.560, 12.10], and women aged 30-34 years [AOR = 1.693; CI = 1.171, 2.952], were more likely to receive HTC results. However, those who did not know that a healthy-looking person can have HIV or not [AOR = 0.322; CI = 0.161, 0.646] were less likely to receive HTC results. CONCLUSION:Despite the relatively high receipt of HTC results at ANC observed between 2008 and 2014, our findings revealed disparities driven by educational attainment, wealth status, age, ANC visits and residence. This indicates that women with no education, those from rural areas, younger and poor women are missing out on the full continuum of HTC service at ANC. The Health Promotion Unit of Ghana Health Service through Community Health Nurses and the Community-Based Health Planning and Services, should intensify their education programs on HIV and make full utilisation of HIV testing and counselling service appealing to women during ANC. This is particularly to be prioritised among the least educated, younger women and rural dwellers.

INTRODUCTION: Women's reproductive health decision-making is indispensable for improving their reproductive health and achieving Sustainable Development Goal three. This study explored the association between reproductive health decision-making capacity and unintended pregnancy among women in Ghana. MATERIALS AND METHODS: We used data from the 2014 version of the Ghana Demographic and Health Survey. The unit of analysis for this study was pregnant women at the time of the survey (679). Bivariate and multivariable analyses were conducted using Pearson chi-square tests and binary logistic regression respectively. RESULTS: We found that women who had the capacity to make reproductive health decision [AOR = 0.61; CI = 0.51-0.89] were less likely to experience unintended pregnancies, compared to those who did not have the capacity. Age was found to have a statistically significant influence on unintended pregnancy, with women aged 25-29 years [AOR = 0.29; CI = 0.13-0.63], 30-34 years [AOR = 0.18; CI = 0.08-0.45], and 35-39 years [AOR = 0.26; CI = 0.10-0.68] being less likely to experience unintended pregnancy compared to those aged 15-19 years. Women with primary level of education were more likely to have unintended pregnancies, compared to those with no education [AOR = 2.07; CI = 1.12-3.84]. CONCLUSION: This study has filled the gap in the already existing literature on the association between reproductive health decision making capacity and unintended pregnancy in Ghana and has created a room for specific interventions geared towards reducing unintended pregnancies, especially among women who are not capable of making reproductive health decisions, women aged 15-19 years, those with primary education, Traditionalists and unmarried women.