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Background: Equity is a guiding principle of the Global Strategy for Women, Children and Adolescents' Health (2016–2030) aimed at improving adolescent health and responding more effectively to adolescents' needs. We investigated the socioeconomic differentials in having multiple sexual partners and condom use among unmarried adolescents who reported ever having had sex aged 15–19 years in 14 sub-Saharan countries. Methods: Using the most recent publicly available Demographic and Health Surveys conducted between 2011 and 2018, we calculated survey- and sex-specific proportions of two or more partners and condomless sex, both overall and by selected socioeconomic characteristics and we fitted logistic regression models to estimate the survey- and sex-specific adjusted odds ratios. The pooled adjusted odds ratios were estimated using multilevel logistic regression. Results: In most countries, higher percentages of male adolescents than female adolescents reported having more than one partner in the last 12 months. Conversely, a lower percentage of young male reported having condomless sex when compared to young female: from 19.8% in Gabon to 84.5% in Sierra Leone among male adolescents and from 32.6% in Gabon to 93.2% in Sierra Leone among female adolescents. In the multilevel analyses, condomless sex was associated with place of residence, wealth and schooling for both female and male adolescents, while among male adolescents multiple partnerships was significantly associated with place of residence. Conclusion: Our findings on disparities in condomless sex associated with socioeconomic characteristics might reflect constraint choice and decision making. Results also suggest the need for educational programming and services and better access to barrier methods. [ABSTRACT FROM AUTHOR]

Millennium Development Goal 5 has not been universally achieved, particularly in sub-Saharan Africa. Understanding whether maternal deaths occur during pregnancy, childbirth, or puerperium is important to effectively plan maternal health programs and allocate resources. Our main research objectives are to (1) describe the proportions and rates of mortality for the antepartum, intrapartum, and postpartum periods; (2) document how these trends vary by sub-region; and (3) investigate ecological correlations between these rates and maternal care interventions. We used data from the Demographic and Health Survey program, which comprises 84 surveys from 34 sub-Saharan African countries conducted between 1990 and 2014. We calculated age-standardized maternal mortality rates and time-specific maternal mortality rates and proportions, and we assessed correlations with maternal care coverage. We found high levels of maternal mortality in all three periods. Time-specific maternal mortality rates varied by country and region, with some showing an orderly decline in all three periods and others exhibiting alarming increases in antepartum and postpartum mortality. Ecological analysis showed that antenatal care coverage was significantly associated with low antepartum mortality, whereas the presence of a skilled attendant at childbirth was significantly associated with low postpartum mortality. In sub-Saharan Africa, maternal deaths occur at high rates in all three risk periods, and vary substantially by country and region. The provision of maternal care is a predictor of time-specific maternal mortality. These results confirm the need for country-specific interventions during the continuum of care to achieve the global commitment to eliminating preventable maternal mortality. [ABSTRACT FROM AUTHOR]

Childhood malaria is a risk factor for disseminated infections with non-typhoidal Salmonella (NTS) in sub-Saharan Africa. While hemolytic anemia and an altered cytokine environment have been implicated in increased susceptibility to NTS, it is not known whether malaria affects resistance to intestinal colonization with NTS. To address this question, we utilized a murine model of co-infection. Infection of mice with Plasmodium yoelii elicited infiltration of inflammatory macrophages and T cells into the intestinal mucosa and increased expression of inflammatory cytokines. These mucosal responses were also observed in germ-free mice, showing that they are independent of the resident microbiota. Remarkably, P. yoelii infection reduced colonization resistance of mice against S. enterica serotype Typhimurium. Further, 16S rRNA sequence analysis of the intestinal microbiota revealed marked changes in the community structure. Shifts in the microbiota increased susceptibility to intestinal colonization by S. Typhimurium, as demonstrated by microbiota reconstitution of germ- free mice. These results show that P. yoelii infection, via alterations to the microbial community in the intestine, decreases resistance to intestinal colonization with NTS. Further they raise the possibility that decreased colonization resistance may synergize with effects of malaria on systemic immunity to increase susceptibility to disseminated NTS infections. [ABSTRACT FROM AUTHOR]