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In the context of a couples cohort established to evaluate an optimised couples-focused behavioural intervention in rural South Africa, we examined: (1) Is couples' relationship quality (RQ) associated with couples HIV testing and counselling (CHTC) uptake? (2) Does CHTC uptake or the intervention components uptake improve subsequent RQ? Enrolled couples, (n = 218), previously naïve to couples HIV testing, were invited to two group sessions and offered four couples counselling sessions (CS1-CS4), as part of the intervention and administered a questionnaire individually at baseline, four weeks, and four months, which included item-scales to measure RQ: satisfaction, intimacy, dyadic trust, conflict, and mutual constructive communication. Logistic models indicated that no baseline RQ measures were significantly associated with CHTC uptake. Linear regression models showed that CHTC uptake before four weeks assessment significantly improved couples' satisfaction and trust at four weeks, and intimacy at four months. Attending at least one CS was associated with increased satisfaction, intimacy, and decreased conflict within couples at four weeks; the improvement in intimacy was sustained at four months. Consistent with the theoretical interdependence model, our findings suggest that CHTC and CS seemed to strengthen aspects of relationship quality, possibly leading to further collaboration in managing lifestyle changes and treatment adherence. [ABSTRACT FROM AUTHOR]

Objectives: To identify and synthesise prevailing definitions and indices of vulnerability in maternal, new-born and child health (MNCH) research and health programs in low- and middle-income countries. Design and setting: Scoping review using Arksey and O'Malley's framework and a Delphi survey for consensus building. Participants: Mothers, new-borns, and children living in low- and middle-income countries were selected as participants. Outcomes: Vulnerability as defined by the authors was deduced from the studies. Results: A total of 61 studies were included in this scoping review. Of this, 22 were publications on vulnerability in the context of maternal health and 40 were on new-born and child health. Definitions used in included studies can be broadly categorised into three domains: biological, socioeconomic, and environmental. Eleven studies defined vulnerability in the context of maternal health, five reported on the scales used to measure vulnerability in maternal health and only one study used a validated scale. Of the 40 included studies on vulnerability in child health, 19 defined vulnerability in the context of new-born and/or child health, 15 reported on the scales used to measure vulnerability in child health and nine reported on childhood vulnerability indices. As it was difficult to synthesise the definitions, their keywords were extracted to generate new candidate definitions for vulnerability in MNCH. Conclusion: Included studies paid greater attention to new-born/ child vulnerability than maternal vulnerability, with authors defining the terms differently. A definition which helps in improving the description of vulnerability in MNCH across various programs and researchers was arrived at. This will further help in streamlining research and interventions which can influence the design of high impact MNCH programs. Scoping review registration: The protocol for this review was registered in the open science framework at the registered address (https://osf.io/jt6nr). [ABSTRACT FROM AUTHOR]

Studies have linked the timing of sexual debut to unplanned pregnancies and sexually transmissible infections, including HIV. Current understandings of sexual debut among Nigerian adolescents focused on the roles of individual and familial characteristics. We leveraged the 2018 Nigeria Demographic and Health Survey data to examine how community features like affluence, ethnic diversity, and women empowerment may be associated with the timing of sexual debut among adolescent girls. The sample comprised 7449 adolescent girls who were usual residents in 6,505 households and 1,352 clusters or communities. Statistical associations between community characteristics and the onset of sexual debut were assessed using a two-level mixed-effects parametric survival model with Weibull distribution. We found that community affluence [aHR:0.43, 95%CI: 0.30–0.62] and community ethnic diversity [aHR: 0.63, 95%CI: 0.42–0.94] are associated with a lower hazard of sexual debut among adolescent girls. We also observed that women that married within the observation period had an earlier sexual initiation than those who were unmarried. The results disaggregated by marital status further shows that higher community level of women's employment [aHR: 2.45, 95%CI: 1.38–4.38] and women's education [aHR:1.85, 95%CI: 1.03–3.33] were associated with a higher hazard of sexual debut among unmarried adolescent girls but not married adolescent girls. Higher community affluence [aHR:0.40, 95%CI: 0.27–0.60] was also associated with a lower hazard of sexual debut among unmarried adolescent girls but not married adolescent girls. Our results illuminate the associated factors of the timing of sexual debut among adolescent girls that moves beyond individual characteristics to community characteristics. [ABSTRACT FROM AUTHOR]

Multiple studies have successfully used Facebook's advertising platform to recruit study participants. However, very limited methodological discussion exists regarding the magnitude of low effort responses from participants recruited via Facebook and African samples. This study describes a quasi-random study that identified and enrolled young adults in Kenya, Nigeria, and South Africa between 22 May and 6 June 2020, based on an advertisement budget of 9,000.00 ZAR (US $521.44). The advertisements attracted over 900,000 views, 11,711‬ unique clicks, 1190 survey responses, and a total of 978 completed responses from young adults in the three countries during the period. Competition rates on key demographic characteristics ranged from 82% among those who attempted the survey to about 94% among eligible participants. The average cost of the advertisements was 7.56 ZAR (US $0.43) per survey participant, 8.68 ZAR (US $0.50) per eligible response, and 9.20 ZAR (US $0.53) per complete response. The passage rate on the attention checks varied from about 50% on the first question to as high as 76% on the third attention check question. About 59% of the sample passed all the attention checks, while 30% passed none of the attention checks. Results from a truncated Poisson regression model suggest that passage of attention checks was significantly associated with demographically relevant characteristics such as age and sex. Overall, the findings contribute to the growing body of literature describing the strengths and limitations of online sample frames, especially in developing countries. [ABSTRACT FROM AUTHOR]

For primary prevention of spousal violence which is highly prevalent in sub-Saharan Africa (SSA), an important empirical question is "how early in a marital relationship does spousal violence commence? In this study, we employed descriptive statistics, Kaplan-Meier method and accelerated failure time models to estimate prevalence of parental history of spousal violence; estimate the timing of onset of spousal violence for sub-regions of SSA and assess the associated factors. We analyzed a weighted sample of 62,274 women aged 15–49 years from the domestic violence module of Demographic and Health Surveys conducted in 14 SSA countries between 2015 and 2018. Prevalence of spousal violence among ever married women ranged from 20.5% in Nigeria to 45.9%% in Burundi. The median time to first spousal violence after marriage in Western, Middle, Eastern, and Southern Africa was 2 years. Results from accelerated failure time models showed that age at marriage, educational attainment, and parental history of spousal violence were independently associated with early onset of spousal violence in all SSA subregions (West: TR = 0.21, CI 0.19–0.24; Middle: TR = 0.38, CI 0.34–0.43; East: TR = 0.46, CI 0.44–0.49; South: TR = 0.50, CI 0.46–0.54). Adolescents, youth, and older adults should be targeted for preventive and corrective interventions for spousal violence. [ABSTRACT FROM AUTHOR]

Background: Risky sexual behaviours are not uncommon among young adults particularly those in the higher levels of education. It is known that higher self-efficacy could contribute to better sexual and reproductive health outcomes including the use of condoms. However, there is limited research on the role of socio-demographic, behavioural and parental factors as predictors of condom-use self-efficacy. As a result, this exploratory study was designed to assess the predictors of self-efficacy for condom use among university students in Nigeria Methods: A cross-sectional survey was conducted with 755 university students in Nigeria from February to April 2018. Self-efficacy for condom use was assessed by combining responses to 11-items measures of condom self-efficacy drawn from the work of Barkley and colleagues. We fitted a structural equation model to identify the pathways through which socio-demographic, behavioural and parental factors predict two constructs of condom-use self-efficacy (self-efficacy for condom purchase and use and partner communication self-efficacy) in the sample. Results: Demographic factors such as age (β = -0.29, p<0.05) and sex (β = 0.42, p<0.05), as well as ratings on religious importance (β = -0.08, p<0.05) were directly associated with self-efficacy for condom purchase and use. These factors showed significantly mediated effects through sexual experience which also had a direct positive relationship (β = 0.73, p<0.05) with self-efficacy for condom purchase and use. The receipt of parental support, on the other hand, was directly associated with higher partner communication efficacy for condom use (β = 0.07, p<0.05). We found no evidence that the level of partner communication efficacy was directly associated with any of the behavioural, demographic or parental factors. Conclusion: The findings of this study affirm that sex, or age or having higher ratings on religious importance alone does not increases self-efficacy but also exposure to sexual activity through which these factors affect self-efficacy for condom purchase and use. These findings also highlight the need to address and strengthen condom use self-efficacy among young adults, particularly the sexually inexperienced, highly religious and young adults with limited support from their parent. [ABSTRACT FROM AUTHOR]

Despite laws against child marriage, the practice remains widespread in sub-Sahara Africa (SSA), partly because of poverty, inequality, and cultural norms. W e examined the levels of child marriage as well as its implications for the sexual and reproductive health of girls and infant survival in SSA. Data was drawn from the recent DHS of 18 countries in SSA. Results show that women who married earlier than I8years were less likely to use a modern method of contraception [OR:0.92, CI:0.869-0.982], more likely to experience sexual violence [OR:1.33, Cl:1.188-1.487], had fewer antenatal visits [IRR:0.94, Ck0.926-0.950] and less likely to deliver at a health facility [OR:0.53, 0:0.495-0.560]. They were also less likely to be assisted by a skilled birth attendant [OR:0.65, 0:0.609-0.685] and their first births were less likely to survive infancy [HR:0.84, 0:0.814-0.869], These findings highlight the negative implications of child marriage and the need for heightened efforts to reduce its practice. [ABSTRACT FROM AUTHOR]

Despite efforts aimed at improving the nutritional status of children under-five years, only a slow progress has been made in Sub-Saharan Africa (SSA). Using data from the latest Demographic and Health Surveys of 17 countries in SSA, we illuminate the association between living arrangement and the nutritional status of 144,765 children under five years. Results showed that living with only the father compared to both parents was associated with a higher risk of malnutrition in SSA [OR: 1.18, Cl: 1.03-1.30] while not living with both parents was associated with a higher risk of malnutrition in West Africa [OR: 1.25, Cl: 1.02-1.54], Lower risk of malnutrition was observed among children residing in households headed by their mother compared to those headed by their father in West Africa [OR:0.76, CI:0.66-0.87] and SSA [OR:0.83, 0:0.77-0.90], These results suggest that with whom and where children live as well as biological relationships are vital in improving children's nutritional status in SSA. [ABSTRACT FROM AUTHOR]

Despite efforts aimed at improving child health status globally, marasmus remains a health burden in sub-Sahara Africa (SSA) and an important risk factor for illnesses and death, especially among young children. Using pooled data from the latest (2010-2014) demographic and health surveys of 21-SSA countries, we examined the relationship between single motherhood and marasmus among under-fives in SSA. Multivariate logistic regression was fitted on a representative sample of 59,013 under-fives who were either marasmic or physically healthy. Contrary to some studies, we found no evidence that single-motherhood was associated with the risk of marasmus in SSA and its sub-regions regions. Results from the regression analysis revealed that the risk of marasmus was lower for under-fives of single mothers in West Africa (OR=0.72 CI:0.508-I.0I6), East Africa (OR=0.55 Cl:0.230-1.299), Central Africa (OR=0.88 Cl:0.522-I.487) and SSA (OR=0.87 Cl:0.699-1.070) but higher in Southern Africa (OR= 1.32 Cl:0.899-1.946) all compared to under-fives of married mothers. [ABSTRACT FROM AUTHOR]

High fertility in developing countries often strains socio-economic resources and impedes the achievements of national policies and individual goals. In this study, we investigated the effect of partner age difference on fertility in Uganda, a high fertility country in Sub-Sahara Africa. Data was drawn from the 2011 Uganda Demographic and Health Survey. Poisson regression model was used to isolate the effect partner age difference on fertility. Our findings from both unadjusted and adjusted regression models suggested that partner age difference had no effect on fertility in Uganda. However, the observed direction of flow was that; women with younger partners had slightly lower fertility (IRR:0.97 CI:0.8446-1.1159) while those with older partners by 1-5years had slightly higher fertility (IRR:1.05 CI:0.9532-1.1652) relative to women whose age was not different from their partners'. [ABSTRACT FROM AUTHOR]

The global health crisis of antibacterial resistance (ABR) poses a particular threat in low-resource settings like East Africa. Interventions for ABR typically target antibiotic use, overlooking the wider set of factors which drive vulnerability and behaviours. In this cross-sectional study, we investigated the joint contribution of behavioural, environmental, socioeconomic, and demographic factors associated with higher risk of multi-drug resistant urinary tract infections (MDR UTIs) in Kenya, Tanzania, and Uganda. We sampled outpatients with UTI symptoms in healthcare facilities and linked their microbiology data with patient, household and community level data. Using bivariate statistics and Bayesian profile regression on a sample of 1610 individuals, we show that individuals with higher risk of MDR UTIs were more likely to have compound and interrelated social and environmental disadvantages: they were on average older, with lower education, had more chronic illness, lived in resource-deprived households, more likely to have contact with animals, and human or animal waste. This suggests that interventions to tackle ABR need to take account of intersectional socio-environmental disadvantage as a priority., (© 2024. The Author(s).)

Background: There is still little empirical evidence on how the outbreak of coronavirus disease 2019 (COVID-19) and associated regulations may have disrupted care-seeking for non-COVID-19 conditions or affected antibiotic behaviours in low- and middle-income countries (LMICs). We aimed to investigate the differences in treatment-seeking behaviours and antibiotic use for urinary tract infection (UTI)-like symptoms before and during the pandemic at recruitment sites in two East African countries with different COVID-19 control policies: Mbarara, Uganda and Mwanza, Tanzania., Methods: In this repeated cross-sectional study, we used data from outpatients (pregnant adolescents aged >14 and adults aged >18) with UTI-like symptoms who visited health facilities in Mwanza, Tanzania and Mbarara, Uganda. We assessed the prevalence of self-reported behaviours (delays in care-seeking, providers visited, antibiotics taken) at three different time points, labelled as 'pre-COVID-19 phase' (February 2019 to February 2020), 'COVID-19 phase 1' (March 2020 to April 2020), and 'COVID-19 phase 2' (July 2021 to February 2022)., Results: In both study sites, delays in care-seeking were less common during the pandemic than they were in the pre-COVID phase. Patients in Mwanza, Tanzania had shorter care-seeking pathways during the pandemic compared to before it, but this difference was not observed in Mbarara, Uganda. Health centres were the dominant sources of antibiotics in both settings. Over time, reported antibiotic use for UTI-like symptoms became more common in both settings. During the COVID-19 phases, there was a significant increase in self-reported use of antibiotics like metronidazole (<30% in the pre-COVID-19 phase to 40% in COVID phase 2) and doxycycline (30% in the pre-COVID-19 phase to 55% in COVID phase 2) that were not recommended for treating UTI-like symptoms in the National Treatment Guidelines in Mbarara, Uganda., Conclusions: There was no clear evidence that patients with UTI-like symptoms attending health care facilities had longer or more complex treatment pathways despite strict government-led interventions related to COVID-19. However, antibiotic use increased over time, including some antibiotics not recommended for treating UTI, which has implications for future antimicrobial resistance., Competing Interests: Disclosure of interest: The authors completed the ICMJE Disclosure of Interest Form (available upon request from the corresponding author) and disclose no relevant interests., (Copyright © 2024 by the Journal of Global Health. All rights reserved.)

Introduction: Gender lens application is pertinent in addressing inequities that underlie morbidity and mortality in vulnerable populations, including mothers and children. While gender inequities may result in greater vulnerabilities for mothers and children, synthesising evidence on the constraints and opportunities is a step in accelerating reduction in poor outcomes and building resilience in individuals and across communities and health systems., Methods: We conducted a scoping review that examined vulnerability and resilience in maternal, newborn and child health (MNCH) through a gender lens to characterise gender roles, relationships and differences in maternal and child health. We conducted a comprehensive search of peer-reviewed and grey literature in popular scholarly databases, including PubMed, ScienceDirect, EBSCOhost and Google Scholar. We identified and analysed 17 published studies that met the inclusion criteria for key gendered themes in maternal and child health vulnerability and resilience in low-income and middle-income countries., Results: Six key gendered dimensions of vulnerability and resilience emerged from our analysis: (1) restricted maternal access to financial and economic resources; (2) limited economic contribution of women as a result of motherhood; (3) social norms, ideologies, beliefs and perceptions inhibiting women's access to maternal healthcare services; (4) restricted maternal agency and contribution to reproductive decisions; (5) power dynamics and experience of intimate partner violence contributing to adverse health for women, children and their families; (6) partner emotional or affective support being crucial for maternal health and well-being prenatal and postnatal., Conclusion: This review highlights six domains that merit attention in addressing maternal and child health vulnerabilities. Recognising and understanding the gendered dynamics of vulnerability and resilience can help develop meaningful strategies that will guide the design and implementation of MNCH programmes in low-income and middle-income countries., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)