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BACKGROUND: Quality and adequate antenatal care (ANC) are key strategies necessary to achieve Sustainable Development Goal 3.1. However, in sub-Saharan Africa (SSA), there is a paucity of evidence on the role women's empowerment and socio-economic status play in ANC attendance. This study aimed to examine whether women's empowerment and socio-economic status predict the adequacy of ANC in SSA. METHODS: Data from the recent Demographic and Health Surveys (DHSs) of 10 countries in SSA were used for the study. We included countries with a survey dataset compiled between 2018 and 2020. We included 57 265 women with complete observations on variables of interest in the study. Frequencies and percentages were used to summarize the results of the coverage of adequate ANC services across the 10 countries. A multivariable binary multilevel regression analysis was employed to examine the association between women's empowerment and socio-economic status indicators and the adequacy of ANC. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were used to present the findings of the regression analysis. RESULTS: The average prevalence of adequate ANC in SSA was 10.4%. This ranged from 0.2% in Rwanda to 24.5% in Liberia. Women with medium (aOR 1.24 [CI 1.10 to 1.40]) and high (aOR 1.24 [CI 1.07 to 1.43]) decision-making power had higher odds of adequate ANC compared to those with low decision-making power. Women with higher levels of education (aOR 1.63 [CI 1.36 to 1.95]) as well as partners with higher education levels (aOR 1.34 [CI 1.14 to 1.56]) had the highest odds of adequate ANC compared to those with no formal education. Additionally, those working (aOR 1.35 [95% CI 1.23 to 1.49]) and those in the richest wealth category (aOR 2.29 [CI 1.90 to 2.76]) had higher odds of adequate ANC compared to those who are not working and those in the poorest wealth category. Those with high justification of violence against women (aOR 0.84 [CI 0.73 to 0.97]) had lower odds of a

BACKGROUND: Family planning is essential in promoting the well-being of women and their families and communities and ensuring quality of care in contraceptive use. This study sought to assess the trend and inequalities in the demand for family planning satisfied (DFPS) in Ghana from 1993 to 2014. METHODS: The World Health Organization's Health Equity Assessment Toolkit was employed to analyse the data. We disaggregated DFPS by five equity stratifiers: age, economic status, education, residence and region. Inequality was measured using difference (D), population attributable risk (PAR), ratio (R) and population attributable fraction (PAF). RESULTS: The study showed an increment in DFPS from 17.8% to 38.7% between 1993 and 2014. With respect to age, we noted substantial inequality in 2003 (D=21.9 [95% confidence interval {CI} 15.2 to 28.7]), 1993 (D=4.8 [95% CI -1.8 to 11.4]) and 2014 (D=15 [95% CI 3 to 26.9]). The greatest economic inequality occurred in 1993 (PAF=69.7 [95% CI 50.8 to 88.6]; D=20.1 [95% CI 14.8 to 25.4]). Regarding education, significant inequality existed in 1993 (PAF=112 [95% CI 100.8 to 123.2]; D=29.7 [95% CI 21.9 to 37.4]). Ashanti and the Upper West regions reported significant inequalities (PAF=55.6 [95% CI 33.1 to 78.2]; D=16.1 [95% CI 8.9 to 23.3]). CONCLUSIONS: There are age-, education-, wealth-, residence- and region-related inequalities with respect to DFPS. Policymakers will have to prioritize the needs of women with no formal or low educational attainment in order to improve DFPS coverage. Special attention needs to be given to adolescent girls since they suffer greater inequalities than adult women.

BACKGROUND: This study assessed the prevalence and predictors of minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) in sub-Saharan Africa (SSA). METHODS: A sample of 87 672 mother-child pairs from the 2010-2020 Demographic and Health Surveys of 32 countries in SSA was used. Multilevel binary logistic regression analysis was carried out to examine the predictors of MDD, MMF, and MAD. Percentages and adjusted odds ratios (aORs) with a 95% confidence interval (CI) were used to present the findings. RESULTS: The prevalence of MDD, MMF, and MAD in SSA were 25.3% (95% CI 21.7 to 28.9), 41.2% (95% CI 38.8 to 43.6), and 13.3% (95% CI 11.6 to 15.0), respectively. Children aged 18-23 months were more likely to have MDD and MAD but less likely to have MMF. Children of mothers with higher education levels were more likely to have MDD, MMF, and MAD. Children who were delivered in a health facility were more likely to have MDD and MAD but less likely to have MMF. CONCLUSIONS: Following the poor state of complementary feeding practices for infants and young children, the study recommends that regional and national policies on food and nutrition security and maternal and child nutrition and health should follow the internationally recommended guidelines in promoting, protecting, and supporting age-appropriate complementary foods and feeding practices for infants and young children.

BACKGROUND: Adolescent girls and young women are vulnerable populations who are at risk of several adverse sexual and reproductive health outcomes, including unintended pregnancies, sexually transmitted infections, unsafe abortions, and death from pregnancy-related complications. In this study, we examined the correlates of repeat pregnancies among adolescent girls and young women in sub-Saharan Africa (SSA). METHODS: We extracted data from the most recent Demographic and Health Surveys (DHS) of 31 countries in SSA. Countries whose surveys were conducted from 2010 to 2020 were included in the study. A total of 108,572 adolescent girls and young women (15-24 years) were included in the study. We used a multilevel mixed-effect binary logistic regression analysis to examine the correlates of repeat pregnancies among adolescent girls and young women in SSA. RESULTS: We found that adolescent girls and young women aged 20-24 [aOR = 2.36; 95%CI = 2.22, 2.51], those married [aOR = 7.52; 95%CI = 6.81, 8.30], living with a partner [aOR = 7.51; 95%CI = 6.87, 8.21], and those who had sexual intercourse before age 20 [aOR = 1.41; 95%CI = 1.33, 1.51] had higher odds of experiencing repeat pregnancies compared to those aged 15-19, those never in a union, those whose first sexual intercourse occurred at age 20 and above, respectively. Respondents exposed to listening to radio [aOR = 1.12; 95%CI = 1.06, 1.18] and those who justified intimate partner violence [aOR=1.13; 95%CI = 1.07, 1.19] had higher odds of experiencing repeat pregnancies compared to those who never listened to radio and those who did not justify intimate partner violence, respectively. Young women who had attained secondary or higher educational level [aOR = 0.83; 95%CI = 0.78, 0.90], those exposed to reading newspaper or magazine [aOR = 0.90; 95%CI = 0.82, 0.98], those residing in rural areas [aOR = 0.92; 95%CI = 0.86, 0.98], and those belonging to the richer [aOR = 0.87; 95%CI = 0.80, 0.95] and richest [aOR = 0.6

IntroductionPremarital sexual intercourse PSI without adequate information and or appropriate application of the relevant knowledge about sex before marriage potentially has adverse effects on the sexual and reproductive health outcomes of vulnerable young women in sub Saharan Africa SSA This study sought to examine the prevalence and predictors of PSI among young women aged 15 24 in SSA MethodsNationally representative cross sectional data from 29 countries in SSA were extracted for the study A weighted sample size of 87 924 never married young women was used to estimate the prevalence of PSI in each country A multilevel binary logistic regression modelling approach was used to examine the predictors of PSI at p 0 05 ResultsThe prevalence of PSI among young women in SSA was 39 4 Young women aged 20 24 aOR 4 49 95 CI 4 34 4 65 and those who had secondary higher educational level aOR 1 63 95 CI 1 54 1 72 were more likely to engage in PSI compared to those aged 15 19 and those with no formal education However young women who belonged to the Islamic religion aOR 0 66 95 CI 0 56 0 78 those who were working aOR 0 75 95 CI 0 73 0 78 belonged to the richest wealth index aOR 0 55 95 CI 0 52 0 58 were not exposed to radio at all aOR 0 90 95 CI 0 81 0 99 were not exposed to television at all aOR 0 50 95 CI 0 46 0 53 resided in rural areas aOR 0 73 95 CI 0 70 0 76 and those who were living in the East African sub region aOR 0 32 95 CI 0 29 0 35 were less likely to engage in PSI compared to those who were traditionalist unemployed belonged to the poorest wealth index exposed to radio frequently exposed to television frequently resided in urban areas and lived in the Southern Africa sub region respectively ConclusionSub regional variations in the prevalence of PSI exist amidst multiple risk factors among young women in SSA Concerted efforts are required to empower young women financially including education on sexual and reproductive health behaviors such as the detrimental effe

BackgroundContraceptive use is crucial to achieving Sustainable Development Goal 3 Evidence of socioeconomic inequality in the use of modern contraceptives is essential to address the developing inequality in its utilisation given the low prevalence of contraceptive use among women in Benin This study examined the socioeconomic inequalities in modern contraceptive use among women in Benin MethodsWe performed a cross sectional analysis of the 2017 18 Benin Demographic and Health Survey data A weighted sample of 7 360 sexually active women of reproductive age was included in the study We used a concentration curve to plot the cumulative proportion of women using modern contraception Decomposition analysis was conducted to determine factors accounting for the socioeconomic disparities in modern contraceptive use ResultsWe noted that the richest women had higher odds of modern contraceptive use adjusted odds ratio aOR 1 67 CI 1 22 2 30 compared to the poorest women Other factors that showed significant associations with modern contraception use were age marital status religious affiliation employment status parity women s educational level and ethnicity We found that modern contraceptive use is highly concentrated among the rich with rich women having a higher propensity of using modern contraception relative to the poor Also the disadvantaged to modern contraceptive use included the poor those aged 45 49 married women those working those with four or more live births rural residents and women of Bariba and related ethnicity Conversely favourable concentration in modern contraceptive use was found among the rich women aged 20 24 the divorced women with two live births the highly educated those with media exposure and women of Yoruba and related ethnicity ConclusionThe study has shown that wealthy women are more likely to utilize contraceptives than the poor This is because wealthy women could afford both the service itself and the travel costs to the health facility hen

BACKGROUND AND AIMS: Childhood vaccination remains a cost-effective strategy that has expedited the control and elimination of numerous diseases. Although coverage of new vaccines in low- and middle-income countries increased exponentially in the last two decades, progress on expanding routine vaccination services to reach all children remains low, and coverage levels in many countries remains inadequate. This study aimed to examine the pattern of wealth and residence-based related inequality in vaccination coverage through an equity lens. METHODS: We used data from the 2017-2018 Benin Demographic and Health Survey. Statistical and econometrics modeling were used to investigate factors associated with childhood vaccination. The Wagstaff decomposition analysis was used to disentangle the concentration index. RESULTS: A total of 1993 children were included, with 17% in the wealthiest quintile and 63% were living in rural areas. Findings showed that wealth is positively and significantly associated with vaccination coverage, particularly, for middle-wealth households. A secondary or higher education level of women and partners increased the odds of vaccination compared to no education (p < 0.05). Women with more antenatal care visits, with multiple births, attending postnatal care and delivery in a health facility had increased vaccination coverage (p < 0.01). Inequalities in vaccination coverage are more prominent in rural areas; and are explained by wealth, education, and antenatal care visits. CONCLUSION: Inequality in child vaccination varies according to socioeconomic and sociodemographic characteristics and is of interest to health policy. To mitigate inequalities in child vaccination coverage, policymakers should strengthen the availability and accessibility of vaccination and implement educational programs dedicated to vulnerable groups in rural areas.

Background Diarrhoea stools contain infectious agents and pose a public health threat to children and members of the entire family when exposed to them Therefore their hygienic disposal is essential Empirical data are needed to stir the needed public health interventions to encourage or enforce proper disposal practices to curb associated clinical issues This study assessed the prevalence and correlates of hygienic stool disposal practices by mothers of children with diarrhoea in sub Saharan Africa SSA Methods The Demographic and Health Surveys DHS data of 16 sub Saharan African countries from 2015 to 2021 involving 22 590 mother child pairs were analysed Multilevel binary logistic analysis was conducted to assess the individual and household level factors associated with the hygienic disposal of stool practices by mothers of children with diarrhoea The results were presented using adjusted odds ratios AOR and 95 confidence intervals CI at a statistical significance of i P i lt 05 Results The overall prevalence of hygienic disposal of children s stools among women of children with diarrhoea was 49 01 95 CI 48 40 49 62 and ranged from 15 70 in Liberia to 86 6 in Rwanda The practice of hygienic disposal of stools of children with diarrhoea was likely to increase among mothers who are working AOR 1 19 95 CI 1 09 1 30 those with partners with primary level of education AOR 1 18 95 CI 1 06 1 31 Muslims AOR 1 69 95 CI 1 49 1 91 and widowed divorced AOR 8 94 95 CI 3 55 22 53 Again mothers in the richer AOR 1 23 95 CI 1 08 1 39 wealth index had increased odds of disposing of stools hygienically compared to those in the poorest wealth index Women who were 20 years and above to who belonged to Traditional Religions AOR 0 57 95 CI 0 43 0 74 and those with unimproved sources of water AOR 0 89 95 CI 0 82 0 98 and toilet facilities AOR 0 63 95 CI 0 58 0 69 were less likely to dispose of child s diarrhoea stool hygienically than their counterparts Conclusion The study reveals that

BACKGROUND Anaemia among women has been reported to be a significant contributor to hemorrhage exacerbated risk of stillbirths miscarriages and maternal mortalities Hence understanding the factors associated with anaemia is imperative to develop preventive strategies We examined the association between history of hormonal contraceptive use and risk of anaemia among women in sub Saharan Africa METHODS We analyzed data from the recent Demographic and Health Surveys DHS of sixteen countries in sub Saharan Africa Countries with recent DHSs conducted from 2015 to 2020 were included in the study A total of 88 474 women of reproductive age were included We used percentages to summarize the prevalence of hormonal contraceptives and anaemia among women of reproductive age We used multilevel binary logistic regression analysis to examine the association between hormonal contraceptives and anaemia We presented the results using crude odds ratio cOR and adjusted odds ratios aOR with their respective 95 percent confidence intervals 95 CIs RESULTS On the average 16 2 of women are using hormonal contraceptives and this ranged from 7 2 in Burundi to 37 7 in Zimbabwe The pooled prevalence of anaemia was 41 ranging from 13 5 in Rwanda to 58 0 in Benin Women who used hormonal contraceptives were less likely to be anaemic compared to those who were not using hormonal contraceptives aOR 0 56 95 CI 0 53 0 59 At the country level hormonal contraceptive use was associated with a reduced likelihood of anaemia in 14 countries except for Cameroon and Guinea CONCLUSION The study underscores the importance of promoting the use of hormonal contraceptives in communities and regions that have a high burden of anaemia among women Specifically health promotion interventions aimed at promoting the use of hormonal contraceptives among women must be tailored to meet the needs of adolescents multiparous women those in the poorest wealth index and women in union as these sub populations were at significa

BACKGROUND: Contraceptives afford individuals the opportunity to meet their reproductive needs and reduce maternal mortality. We aimed at assessing the trend and inequalities of contraceptive use in Ghana based on the 1993-2014 Ghana Demographic and Health Surveys. METHODS: We used the World Health Organization's Health Equity Assessment Toolkit (HEAT) software in analysing the data. We adopted two approaches for the analysis. First, we disaggregated inequalities in contraceptive use using four equity stratifiers: wealth index, education, residence, and region. Second, summary measures (D), (PAR), (R), and (PAF) were also employed. A 95% uncertainty interval (UI) was constructed for point estimates to measure statistical significance. RESULTS: Contraceptive prevalence increased from 20.3% in 1993 to 26.7% in 2014. The contraceptive prevalence among women aged 20-49 increased from 20.6% [95% UI = 19.1, 22.3] in 1993 to 26.8% [95% UI = 24.9, 28.9] in 2014 and this exceeded the increase that was recorded among those aged 15-19 (from 13% [95 UI = 8.7, 19] to 18% [95% UI = 11.5, 28.6]), in the same period. It was evident that substantial inequality existed with respect to contraceptive use, from 1993 to 2014, with widest inequality occurring in 2003 (PAF = 2.7, 95% UI = -16.6-21.9; D = 17.4, 95% UI = 12.7-22.1). In terms of wealth index, the least inequality was observed in 2014 (PAR = 1.3, 95% UI = -1-3.6; D = 5.9, 95% UI = -0.1-12). Regarding education, the widest inequality occurred in 1993 (PAF = 138.6, UI = 132.1-145.1; D = 40.1, 95% UI = 34.4-45.9). With place of residence, the widest gap in inequality occurred in 1993 (PAF = 51.2, 95% UI = 46.2-56.3; D = 15.3, 95% UI = 11.8-18.7). There was inequality in contraceptive use with respect to sub-national regions. In 2014, the Difference (D = 21, 95% UI = 14.6-27.4) and the PAF (PAF = 20.9, 95% UI = 11.2 - 30.5) measures revealed substantial absolute and relative regional inequality between the regions. CONCLUSION: The

BACKGROUND: Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) remains one of the most significant public health challenges globally, particularly in sub-Saharan Africa (SSA). Although HIV testing is a vital step for both prevention and treatment, its uptake is still low in SSA. We therefore examined HIV testing in SSA and its individual/household and community factors among women of reproductive age groups (15-49 y). METHODS: Demographic and Health Survey data collected between 2010 and 2020 from 28 SSA countries were used for this analysis. We analysed the coverage of HIV testing and individual/household and community factors on 384 416 women in the reproductive age groups (15-49 y). Bivariate and multivariable multilevel binary logistic regression analysis were conducted to select candidate variables and to identify significant explanatory variables associated with HIV testing and the results were presented using adjusted odd ratios (AORs) at 95% confidence intervals (CIs). RESULTS: The pooled prevalence of HIV testing among women of reproductive age in SSA was 56.1% (95% CI 53.7 to 58.4), with the highest coverage found in Zambia (86.9%) and the lowest in Chad (6.1%). Age (45-49 y; AOR 0.30 [95% CI 0.15 to 0.62]), women's education level (secondary; AOR 1.97 [95% CI 1.36 to 2.84]) and economic status (richest; AOR 2.78 [95% CI 1.40 to 5.51]) were some of the individual/household factors associated with HIV testing. Similarly, religion (no religion; AOR 0.58 [95% CI 0.34 to 0.97]), marital status (married; AOR 0.69 [95% CI 0.50 to 0.95]) and comprehensive knowledge of HIV (yes; AOR 2.01 [95% CI 1.53 to 2.64]) were significantly associated individual/household factors for HIV testing. Meanwhile, place of residence (rural; AOR 0.65 [95% CI 0.45 to 0.94]) was found to be a significant community-level factor. CONCLUSION: More than half of married women in SSA have been tested for HIV, with between-country variations. Both individual/househol

BackgroundContraceptive continuation is an important factor that has significant implications on total fertility rates and reproductive health outcomes like unintended pregnancies Therefore it is imperative to understand the factors that influence women s decision to continue the use of contraceptives The present study examined the determinants of contraceptive continuation among women in sub Saharan Africa SSA MethodsData for the study were extracted from the most recent Demographic and Health Surveys DHS of twenty four 24 countries in SSA Descriptive and multivariable binary logistic regression analysis were conducted Frequencies percentanges and an adjusted odds ratio with 95 confidence intervals were used to present the results ResultsCompared to adolescents adult women aged 45 49 years aOR 1 24 CI 1 13 1 37 had higher odds of contraceptive continuation The odds of contraceptive continuation were lower among those working aOR 0 96 CI 0 93 0 98 compared to those not working Also the study shows that the likelihood of contraceptive continuation was lower among those exposed to family planning messages compared to those not exposed aOR 0 91 CI 0 88 0 93 Compared to women who used LARCs women who used pills aOR 0 34 CI 0 33 0 36 injectable aOR 0 42 CI 0 40 0 43 other modern contraceptives aOR 0 72 CI 0 68 0 75 or traditional methods aOR 0 50 CI 0 478 0 523 were less likely to continue with their contraception Women with one birth aOR 0 86 CI 0 83 0 90 and those with 2 births in the last five years aOR 0 54 CI 0 512 0 56 reported lower odds of contraceptive continuation as compared to those with no births Compared to women with no children living those with 4 children living had lower odds of contraceptive continuation aOR 0 62 CI 0 57 0 67 The study also found that the likelihood of contraceptive continuation was higher among those with secondary education aOR 1 08 CI 1 04 1 12 as compared to those with no formal education Contraceptive continuation was also higher

OBJECTIVE The study examined high risk fertility behaviour and its association with under five undernutrition in sub Saharan Africa SSA DESIGN We conducted a cross sectional analysis of data from 32 sub Saharan African countries Demographic and Health Surveys A weighted sample of 110 522 mother child pairs was included in final analysis Multilevel binary logistic regression was used to examine the association between high risk fertility behaviour and undernutrition The results were presented using adjusted odds ratio aOR with their respective 95 confidence intervals CIs SETTING Thirty two countries in SSA OUTCOME MEASURE Stunting wasting and underweight RESULTS The pooled prevalence of stunting was 31 3 ranging from 15 0 in Gabon to 51 7 in Burundi Wasting was highest among children from Burkina Faso 19 1 and lowest among those from South Africa 1 6 The overall prevalence of wasting was 8 1 The prevalence of underweight was 17 0 with the highest among children in Niger 37 1 and lowest in South Africa 4 8 Mothers who gave birth at the age less than 18 years and those with short birth interval were more likely to have their children being stunted wasted and underweight The odds of stunting and wasting were high among children born to women with high parity However maternal age at birth more than 34 was associated with lower odds of childhood underweight as against those with age at birth less than 34 CONCLUSION Countries in SSA are encouraged to address the issue of maternal age at birth less than 18 high parity and shorter birth intervals in order to meet the Global Nutrition targets which aim to achieve a 40 reduction in the number of stunted children under the age of 5 and to reduce and maintain childhood wasting to less than 5 by 2025

BACKGROUND Marital dissolution which refers to being divorced or separated is considered one of the most dramatic demographic events that significantly disrupt families Unearthing the factors predicting marital dissolution would support actions to reduce the incidence of this phenomenon The present study sought to examine the association between sex preference for children and marital dissolution segregated by place of residence METHODS Data for the study were extracted from the most recent Demographic and Health Surveys DHS of 25 countries in sub Saharan Africa Percentages were used to summarise the proportion of marital dissolution among women in sub Saharan Africa Binary logistic regression models were fitted to examine the association between sex preference for children and marital dissolution per place of residence Results of the regression analysis were presented using adjusted odds ratios aOR with their respective 95 confidence interval CI RESULTS The overall prevalence of marital dissolution was 5 92 95 CI 5 83 6 00 and this ranged from 1 63 95 CI 1 41 1 85 in Burkina Faso to 15 62 95 CI 14 70 16 54 in Mozambique In urban sub Saharan Africa the overall prevalence of marital dissolution was 8 88 95 CI 8 78 8 99 with the lowest prevalence in Mali 3 30 95 CI 2 91 3 69 and the highest in Uganda 18 60 95 CI 17 95 19 25 For rural sub Saharan Africa the pooled prevalence was 4 11 95 CI 4 03 4 18 with the lowest 0 80 95 CI 0 65 0 95 and highest 14 40 95 CI 13 51 15 29 prevalences in Burkina Faso and Mozambique respectively Compared to women with no sex preference the preference for boys was less likely to result in marital dissolution aOR 0 87 95 CI 0 83 0 90 in both urban and rural areas whereas the preference for girls was more likely to result in marital dissolution aOR 1 06 95 CI 1 02 1 10 When the results were disaggregated by place of residence in both urban aOR 0 87 95 CI 0 80 0 95 and rural areas aOR 0 87 95 CI 0 82 0 92 women who preferred boys were less li

Understanding the factors associated with women s autonomy to refuse risky sex is imperative to inform the development of policies and interventions to reduce the risk of unintended pregnancies sexually transmitted infections unsafe abortion and maternal mortality This study sought to examine the prevalence and factors associated with women s autonomy to refuse risky sex in sub Saharan Africa SSA Data for the study were extracted from the most recent Demographic and Health Surveys DHS of thirty countries in SSA conducted from 2010 to 2020 We included a weighted sample of 260 025 women who were married or cohabiting in the final analysis Percentages were used to present the results of the prevalence of women s ability to refuse risky sex We used a multilevel logistic regression analysis to examine the factors associated with women s ability to refuse risky sex Stata software version 16 0 was used for the analysis We found that 61 69 95 confidence interval CI 56 22 67 15 of the women were autonomous to refuse sex if their partners have other women and this was highest in Namibia 91 44 95 CI 90 77 92 18 and lowest in Mali 22 25 95 CI 21 24 23 26 The odds of autonomy in refusing risky sex was higher among women with higher education adjusted odds ratio aOR 1 88 95 CI 1 78 1 46 compared to those with no formal education Employment status was also a significant predictor with working women having higher odds of sex refusal compared to non working women aOR 1 16 95 CI 1 13 1 18 Advocacy to improve women s autonomy to refuse risky sex must leverage the mass media as it emerged as a significant factor Policies and intervention to enhance women s autonomy must also target high risk sub populations which constitutes adolescent girls those with no formal education and those without employment

Background Birth registration is a crucial aspect of ensuring that children have access to their rights and benefits including health care education and citizenship In sub Saharan Africa SSA birth registration rates remain low with millions of children going unregistered each year Understanding the predictors of birth registration among children in this sub region is important for developing targeted interventions to improve registration rates The study examines the predictors of birth registration among children in SSA Methods We performed a cross sectional analysis of secondary data pooled from the Demographic and Health Survey of 17 countries conducted from 2015 to 2021 A weighted sample of 162 500 children was included in the final analysis We summarized the proportion of birth registration among children in SSA using a forest plot We utilized a multilevel binary logistic regression analysis to examine the predictors of birth registration The results were presented using adjusted odds ratios aOR with 95 confidence intervals CIs Results We found that 48 32 48 15 48 49 of births in SSA were registered The lowest and highest prevalence of birth registration were found in Ethiopia 2 70 2 38 3 02 and Sierra Leone 92 93 92 36 93 50 respectively Increasing child s age was found to be significantly associated with a higher likelihood of birth registrations with those aged 4 years aOR 1 55 CI 1 49 1 62 having the highest odds of birth registration compared to those aged below 1 year Children born to mothers with primary aOR 1 17 CI 1 11 1 24 secondary aOR 1 44 CI 1 34 1 54 and higher education aOR 1 71 CI 1 48 1 99 were more likely to be registered than those born to mothers who had no formal education Also children born in health facilities were more likely to be registered aOR 1 60 CI 1 48 1 74 than those born at home The odds of birth registration were significantly higher among children whose mothers received assistance during delivery aOR 1 88 CI 1 72 2 04 those in

OBJECTIVE The study assessed the prevalence of physical violence against pregnant women and its associated factors in sub Saharan Africa SSA DESIGN We analysed cross sectional data of 108971 women in sexual unions from the most recent Demographic and Health Surveys of 26 countries in SSA The predictors of physical violence were examined using a multilevel binary logistic regression All the results were presented as adjusted odds ratios aORs with their corresponding 95 confidence intervals CIs SETTING Twenty six countries in SSA PARTICIPANTS 108 971 women who had ever been pregnant OUTCOME MEASURE Physical violence during pregnancy RESULTS Physical violence was identified in 6 0 of pregnant women in SSA The highest prevalence 14 0 was reported in South Africa while Burkina Faso recorded the lowest 2 1 Women who had primary aOR 1 26 95 CI 1 15 1 38 and secondary education aOR 1 15 95 CI 1 01 1 32 those who were cohabiting aOR 1 21 95 CI 1 11 1 32 those who were working aOR 1 17 95 CI 1 08 1 28 and those whose partners had primary aOR 1 15 95 CI 1 04 1 28 and secondary education aOR 1 14 95 CI 1 01 1 28 were more likely to experience physical violence during pregnancy compared with those who had no formal education those who were married those who were not working and those whose partners had no formal education respectively Moreover women whose partners consumed alcohol aOR 2 37 95 CI 2 20 2 56 those who had parity of four or more aOR 2 06 95 CI 1 57 2 72 and those who perceived intimate partner violence IPV as a culturally accepted norm aOR 1 55 95 CI 1 44 1 67 had higher odds of experiencing physical violence during pregnancy compared to those whose partners did not consume alcohol those with parity zero and those who did not perceive IPV as culturally accepted respectively On the contrary women who were aged 35 39 those who were of the richest wealth index and those in rural areas had reduced odds of experiencing physical violence during pregnancy CONCLUSION Based

BACKGROUND: Type of occupation has been linked to early antenatal care visits whereby women in different occupation categories tend to have different timing for antenatal care visits. Different occupations require varying levels of commitment, remuneration and energy requirements. This study, therefore, sought to investigate the association between the type of occupation and early antenatal care visits in sub-Saharan Africa. METHODS: This is a secondary analysis of Demographic and Health Survey data from 29 countries in sub-Saharan Africa conducted between 2010 and 2018. The study included 131,912 working women. We employed binary logistic regression models to assess the association between type of occupation and timely initiation of antenatal care visits. RESULTS: The overall prevalence of early initiation of antenatal care visits was 39.9%. Early antenatal care visit was high in Liberia (70.1%) but low in DR Congo (18.6%). We noted that compared to managerial workers, women in all other work categories had lower odds of early antenatal care visit and this was prominent among agricultural workers [aOR = 0.74, CI = 0.69, 0.79]. Women from Liberia [aOR = 3.14, CI = 2.84, 3.48] and Senegal [aOR = 2.55, CI = 2.31, 2.81] had higher tendency of early antenatal care visits compared with those from Angola. CONCLUSION: The findings bring to bear some essential elements worth considering to enhance early antenatal care visits within sub-Saharan Africa irrespective of the type of occupation. Women in the agricultural industry need much attention in order to bridge the early antenatal care visit gap between them and workers of other sectors. A critical review of the maternal health service delivery in DR Congo is needed considering the low rate of early antenatal care visits.

BACKGROUND: We examined the inequalities in the prevalence of full immunization coverage among one-year-olds in Ghana using nationally representative data from the 1993-2014 Ghana Demographic and Health Surveys (GDHSs). METHODS: Using the World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the 1993-2014 GDHSs were analyzed. We disaggregated full immunization by five equity stratifiers: wealth quintile, education, sex, residence, and region. Second, we measured the inequality through summary measures, namely Difference, Population Attributable Risk, Ratio, and Population Attributable Fraction. Statistical significance was pegged at 95% Uncertainty Interval. RESULTS: From 1993 to 2014, full immunization was higher among children born to mothers of the richest wealth index compared with those born to mothers of the poorest wealth index. Children with highly educated mothers dominated in full immunization coverage from 1993 (86.67%; UI = 70.38, 94.68] to 2014 (79.90%; UI = 73.94, 84.78). Within the same period, children of women without education recorded the least prevalence. Full immunization coverage was high among urban children in 1993 (71.07%; UI = 63.20, 77.84) but favoured rural children in 2008 (80.09%; UI = 74.30, 84.84) and 2014 (79.50%; UI = 74.00, 84.09) compared to urban children. More females were fully immunized in 1993 (56.68%; UI = 50.32, 62.82). In 2003, 2008 and 2014, Volta region (82.29%; UI = 70.32, 90.11), Brong Ahafo (93.94%; UI = 82.00, 98.14) and Upper East (95.27%; UI = 87.35, 98.32) regions dominated in full immunization coverage respectively. CONCLUSION: The inequality estimates revealed significant socio-economic inequality in full immunization coverage between 1993 and 2014 in Ghana. Similarly, urban children and children of women with secondary or higher education were predominantly fully immunized. To accelerate full immunization, policy makers should consider these disparities in the implementat

INTRODUCTION: Poor health seeking behaviour continues to be major challenge in accessing healthcare in sub-Saharan Africa despite the availability of effective treatment for most childhood illnesses. The current study investigated the barriers to healthcare access and health seeking for childhood illnesses in Burundi. METHODS: The study utilized data from the 2016-17 Burundi Demographic and Health Survey (BDHS). A total of 2173 children under five of childbearing women were included in our study. The outcome variable for the study was healthcare seeking for childhood illnesses (diarrhea and fever/cough). Barriers to healthcare access were the explanatory variables and maternal and child factors were the control variables. Chi-square test of independence and a binary logistic regression modelling were carried out to generate the results. RESULTS: Overall, less than 50% of children in Burundi who were ill two weeks before the survey obtained healthcare. We found that children of mothers who perceived getting money for medical care for self as a big problem [aOR = 0.75; CI = 0.60-0.93] and considered going for medical care alone as a big problem [aOR = 0.71; CI = 0.55-0.91] had lower odds of getting healthcare, compared to those of mothers who considered these indicators as not a big problem. The results also showed that children of mothers who had three [aOR = 1.48; 1.02-2.15] and four [aOR = 1.62; 1.10-2.39], children were more likely to get healthcare for childhood illnesses compared to those whose mothers had one child. Children of mothers with single birth children were less likely to get healthcare compared to those whose mothers had multiple births. CONCLUSION: Findings of the low prevalence of healthcare for childhood illnesses in Burundi suggest the need for government and non-governmental health organizations to strengthen women's healthcare accessibility for child healthcare services and health seeking behaviours. The Burundian government through multi-secto

BACKGROUND: Previous studies on child marriage have revealed its association with adverse health behaviors and outcomes, such as increased fertility, reduced modern family planning, less safe delivery, mental health disorders, suicidal attempt, and ideation, poor socio-economic status, morbidity, and mortality of children under- five. In this study, we investigate the association between child marriage and the utilization of maternal healthcare services in sub-Saharan Africa. METHODS: We utilized data from 29 sub-Saharan African countries' Demographic and Health Surveys conducted between 2010 and 2018. A total of 36,215 childbearing young women between the ages of 20-24 years constituted our sample size. A multilevel binary logistic regression analysis was carried out to examine the association between child marriage and the utilization of maternal healthcare services, and the results were presented as crude and adjusted odds ratios at 95% confidence interval. RESULTS: Young women who experienced child marriage were less likely to have ≥4 antenatal care visits during pregnancy [cOR = 0.60, CI = 0.57-0.63] compared to those who did not experience child marriage, and this was persistent after controlling for individual and community-level factors [aOR = 0.88, CI = 0.84-0.93]. Young women who experienced child marriage were less likely to use skilled birth attendance during delivery [cOR = 0.45, CI = 0.43-0.48] compared to those who did not experience child marriage, and this was persistent after controlling for individual and community-level factors [aOR = 0.87, CI = 0.82-0.93]. Young women who experienced child marriage were less likely to use postnatal care services [cOR = 0.79, CI = 0.75-0.82] compared to those who did not experience child marriage, but this was insignificant after controlling for individual and community-level factors. CONCLUSION: Our study found child marriage to be a major contributor to the low use of maternal healthcare services, including an

BACKGROUND: Today, an estimated 7.3% (50 million) of all children <5 y of age suffer from wasting, with more burden in African countries including Guinea. Investigating inequalities in childhood wasting is essential for designing efficient programs and interventions, but no related evidence exists in Guinea. This study aimed to examine the trends in the prevalence of childhood wasting and the extent of sex, socio-economic and geographic-based disparities in Guinea. METHODS: Data from the 1999, 2005 and 2012 Guinea Demographic and Health Surveys and the 2016 Guinea Multiple Indicator Cluster Survey, with a total of 16 137 children <5 y of age were included for analysis. For inequality analysis, we used the 2019 updated World Health Organization Health Equity Assessment Toolkit (HEAT) software. Inequality was measured using four summary measures (difference [D], population attributable risk [PAR], ratio [R] and population attributable fraction [PAF]) for five equity stratifiers (economic status, education, place of residence, sex and subnational region). We computed 95% confidence intervals (CIs) around the points estimates to measure statistical significance. RESULTS: The findings revealed a pro-rich (R=1.68 [95% CI 1.11 to 2.24]), pro-urban (PAR=-1.04 [95% CI -1.90 to -0.18]) and subnational region (D=8.11 [95% CI 4.85 to 11.36]) inequalities in childhood wasting across all surveys. Except in 2005, education-based disparities (PAF=-18.2 [95% CI -36.10 to -0.26]) were observed across all survey years, but not sex-based disparities. An approximately constant inequality pattern was seen across all dimensions. CONCLUSIONS: This study showed inequalities in childhood wasting in Guinea with a disproportionately higher risk of wasting among children from disadvantaged subpopulations/mothers, including uneducated, poorest/poor, rural residents and regions. Policies that target disadvantaged populations need to be considered in order to ensure social protection, access to a

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<0.05. The overall prevalences of safer sex negotiation and high parity among women in sub-Saharan Africa were 82.7% and 52.1%, respectively. The prevalence of high parity ranged from 32.3% in Chad to 72.1% in Lesotho. The lowest prevalence of safer sex negotiation was in Chad (16.8%) while the highest prevalence was recorded in Rwanda (99.7%). Women who had the capacity to negotiate for safer sex were less likely to have high parity compared with those who had no capacity to negotiate for safer sex (aOR = 0.78, CI: 0.75-0.81). Other factors that were associated with high parity were age, educational level, marital status, exposure to media, contraceptive use, religion, wealth quintile, sex of household head, and place of residence. The study identified significant association between safer sex negotiation and high parity among women of reproductive age in sub-Saharan Africa. It is worth noting that women's ability to negotiate for safer sex could reduce high parity among women in sub-Saharan Africa. Therefore, policies and programmes aimed at birth control or reducing high parity among women could be targeted at improving their capacity to negotiate for safer sex through education.

This study investigated the association between comprehensive HIV/AIDS knowledge and HIV testing among men in sub-Saharan Africa (SSA). Data were taken from the most recent (2010-2019) Demographic and Health Survey men's recode files of 29 countries in SSA. A total of 104,398 men who had complete information on all the variables of interest were included in the study. The outcome variable was HIV testing. A multilevel logistic regression analysis was conducted to determine the association between comprehensive HIV/AIDS knowledge and HIV testing. The results of the fixed effects model were presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). The average prevalences of HIV testing and comprehensive HIV/AIDS knowledge among men in SSA were 53.5% and 50.8% respectively. Rwanda and Niger recorded the highest (93.6%) and lowest prevalences (9.8%) respectively. The prevalence of comprehensive HIV/AIDS knowledge among men in the 29 countries was 50.8%, with the highest in Rwanda (76.4%) and the lowest in Benin (31.1%). Men who had no comprehensive HIV/AIDS knowledge were less likely to test for HIV compared with those who had comprehensive HIV/AIDS knowledge (AOR=0.59, CI: 0.57-0.60). Men who were older than 20 years, married or cohabiting, with at least secondary education, in the richest wealth quintile, exposed to mass media, used condoms and with multiple sexual partners were more likely to test for HIV. To improve HIV testing among men in SSA, this study recommends that policymakers and stakeholders step up comprehensive HIV/AIDS knowledge sensitization and education using effective tools such as mass media.

BACKGROUND: Caesarean section (CS) is an intervention to reduce maternal and perinatal mortality, for complicated pregnancy and labour. We analysed trends in the prevalence of birth by CS in Ghana from 1998 to 2014. METHODS: Using the World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the 1998-2014 Ghana Demographic and Health Surveys (GDHS) were analysed with respect of inequality in birth by CS. First, we disaggregated birth by CS by four equity stratifiers: wealth index, education, residence, and region. Second, we measured inequality through simple unweighted measures (Difference (D) and Ratio (R)) and complex weighted measures (Population Attributable Risk (PAR) and Population Attributable Fraction (PAF)). A 95% confidence interval was constructed for point estimates to measure statistical significance. RESULTS: The proportion of women who underwent CS increased significantly between 1998 (4.0%) and 2014 (12.8%). Throughout the 16-year period, the proportion of women who gave birth by CS was positively skewed towards women in the highest wealth quintile (i.e poorest vs richest: 1.5% vs 13.0% in 1998 and 4.0% vs 27.9% in 2014), those with secondary education (no education vs secondary education: 1.8% vs 6.5% in 1998 and 5.7% vs 17.2% in 2014) and women in urban areas (rural vs urban 2.5% vs 8.5% in 1998 and 7.9% vs 18.8% in 2014). These disparities were evident in both complex weighted measures of inequality (PAF, PAR) and simple unweighted measures (D and R), although some uneven trends were observed. There were also regional disparities in birth by CS to the advantage of women in the Greater Accra Region over the years (PAR 7.72; 95% CI 5.86 to 9.58 in 1998 and PAR 10.07; 95% CI 8.87 to 11.27 in 2014). CONCLUSION: Ghana experienced disparities in the prevalence of births by CS, which increased over time between 1998 and 2014. Our findings indicate that more work needs to be done to ensure that all subpopulations that

BACKGROUND: The death of children under-five years is one of the critical issues in public health and improving child survival continues to be a matter of urgent concern. In this paper, we assessed the proximate and socio-economics determinants of child mortality in Guinea. METHODS: Using the 2018 Guinea Demographic and Health Survey (GDHS), we extracted demographic and mortality data of 4,400 children under-five years. Both descriptive and multivariable logistic regression analyses were conducted. RESULTS: Under-five mortality was 111 deaths per 1,000 live births in Guinea. The likelihood of death was higher among children born to mothers who belong to other religions compared to Christians (aOR = 2.86, 95% CI: 1.10-7.41), smaller than average children compared to larger than average children (aOR = 1.97, 95% CI: 1.28-3.04) and those whose mothers had no postnatal check-up visits after delivery (aOR = 1.72, 95% CI: 1.13-2.63). Conversely, the odds of death in children with 2-3 birth rank & >2 years of birth interval compared to ≥4 birth rank and ≤2 years of birth interval were low (aOR = 0.53, 95% CI: 0.34-0.83). CONCLUSION: We found that household/individual-level socioeconomic and proximate factors predict under-five mortality in Guinea. With just about a decade left to the 2030 deadline of the Sustainable Development Goals (SDGs), concerted efforts across all key stakeholders, including government and development partners, need to be geared towards implementing interventions that target these predictors.

BACKGROUND: Maternal mortality remains high in sub-Saharan African countries, including Guinea. Skilled birth attendance (SBA) is one of the crucial interventions to avert preventable obstetric complications and related maternal deaths. However, within-country inequalities prevent a large proportion of women from receiving skilled birth attendance. Scarcity of evidence related to this exists in Guinea. Hence, this study investigated the magnitude and trends in socioeconomic and geographic-related inequalities in SBA in Guinea from 1999 to 2016 and neonatal mortality rate (NMR) between 1999 and 2012. METHODS: We derived data from three Guinea Demographic and Health Surveys (1999, 2005 and 2012) and one Guinea Multiple Indicator Cluster Survey (2016). For analysis, we used the 2019 updated WHO Health Equity Assessment Toolkit (HEAT). We analyzed inequalities in SBA and NMR using Population Attributable Risk (PAR), Population Attributable Fraction (PAF), Difference (D) and Ratio (R). These summary measures were computed for four equity stratifiers: wealth, education, place of residence and subnational region. We computed 95% Uncertainty Intervals (UI) for each point estimate to show whether or not observed SBA inequalities and NMR are statistically significant and whether or not disparities changed significantly over time. RESULTS: A total of 14,402 for SBA and 39,348 participants for NMR were involved. Profound socioeconomic- and geographic-related inequalities in SBA were found favoring the rich (PAR = 33.27; 95% UI: 29.85-36.68), educated (PAR = 48.38; 95% UI: 46.49-50.28), urban residents (D = 47.03; 95% UI: 42.33-51.72) and regions such as Conakry (R = 3.16; 95% UI: 2.31-4.00). Moreover, wealth-driven (PAF = -21.4; 95% UI: -26.1, -16.7), education-related (PAR = -16.7; 95% UI: -19.2, -14.3), urban-rural (PAF = -11.3; 95% UI: -14.8, -7.9), subnational region (R = 2.0, 95% UI: 1.2, 2.9) and sex-based (D = 12.1, 95% UI; 3.2, 20.9) inequalities in NMR were observed be

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

OBJECTIVE: This study sought to examine the association between high-risk fertility behaviour and childhood anaemia in sub-Saharan Africa . DESIGN: An analytical study was conducted using cross-sectional data from mothers with children under age 5 (n=64 512) from 28 sub-Saharan African countries. Multilevel logistic regression models were fitted to examine the association between high-risk fertility behaviour and childhood anaemia. The results were presented using adjusted odds ratios (aORs) with 95% confidence interval (CI). SETTING: Twenty-eight sub-Saharan African countries. OUTCOME MEASURE: Childhood anaemia. RESULTS: The percentage of children with anaemia in the 28 countries was 66.7%. We found that age more than 34 at delivery and short birth interval had significant associations with childhood anaemia. Children of mothers whose most recent delivery occurred after 34 years were less likely to be anaemic compared with those whose most recent delivery occurred before age 34 (aOR=0.89; 95% CI 0.83 to 0.95). We found that children born to mothers with short birth intervals were more likely to be anaemic, compared with those with long birth intervals (aOR=1.08; 95% CI 1.01 to 1.16). CONCLUSIONS: We, therefore, draw the attention of policy makers and programme implementers to invest in policies and programmes aimed at combating childhood anaemia in sub-Saharan Africa to focus on the population at risk, that is, women whose most recent delivery occurred at younger ages and those with short birth intervals. Encouraging contraceptive use and creating awareness about the importance of birth spacing among reproductive-age women would be more helpful.

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.

BACKGROUND: Sexually transmitted infections (STIs) are major public health challenges worldwide. Despite the importance of sexual autonomy in the prevention and control of sexual and reproductive health disorders such as STIs, there are limited studies on the possible relationship between women's sexual autonomy and self-reported STIs, especially in sub-Saharan Africa (SSA). This study, therefore, examined the association between sexual autonomy and self-reported STIs among women in sexual unions in SSA. METHODS: Data from the Demographic and Health Survey (DHS) of 31 countries in SSA conducted between 2010 and 2019 were analysed. A total of 234,310 women in sexual unions were included in the study. Data were analysed using binary logistic regression models and the results were presented as crude odds ratios (cORs) and adjusted odds ratios (aORs) at 95% confidence interval (CI). RESULTS: The prevalence of self-reported STIs among women in sexual unions in SSA was 5.8%. Approximately 83.0% of the women surveyed had sexual autonomy. Women who had no sexual autonomy were less likely to have self-reported STIs (cOR=0.52, CI: 0.46-0.54), compared to those who had sexual autonomy. Additionally, higher odds of self-reported STIs were found among women aged 25-29, compared to those aged 15-19 (aOR= 1.21, CI: 1.09-1.35); those who reside in urban areas, compared to those who reside in rural areas (aOR= 1.51, CI: 1.37-1.66) and those who were cohabiting, compared to those who were married (aOR= 1.65, CI: 1.52-1.79). On the other hand, lower odds of self-reported STIs were found among women who were exposed to newspapers (aOR= 0.89, CI: 0.82-0.95), those whose partners had primary education (aOR= 0.84, CI: 0.78-0.91), those who were not exposed to radio (aOR= 0.84, CI: 0.79-0.89), and working women (aOR= 0.86, CI: 0.80-0.93). CONCLUSIONS: Findings from this study suggest that sexual autonomy is a significant predictor of self-reported STIs among women in sexual unions in SSA.

Female genital mutilation (FGM) is very pervasive in Africa, with significant regional variations in the prevalence of this traditional practice. This study examined the linkages between FGM and multiple sexual partnership in Mali and Sierra Leone - two African countries with a high prevalence of FGM. Data were from the 2018 Mali and 2013 Sierra Leone Demographic and Health Surveys, and the study sample comprised 4750 women from Mali and 16,614 from Sierra Leone. Multilevel logistic regression was used for the data analysis, with reported adjusted odds ratios (aOR) and associated 95% confidence intervals. In Mali, women who had not undergone FGM were less likely to have multiple sexual partners (aOR=0.60, CI=0.38-0.96) compared with those who had undergone FGM. In Sierra Leone, women who had undergone FGM (aOR=1.15, CI=1.02-1.30) were more likely to have multiple sexual partners compared with those who had not undergone FGM. Age, level of education, wealth quintile, sex of household head, community socioeconomic status, mass media exposure, and community literacy level were found to be associated with the likelihood of multiple sexual partnership among women in Mali and Sierra Leone. Comprehensive, age-group-based risk-reduction strategies, such as abstinence education and decision-making skills (assertiveness) training, are needed to reduce girls' and young women's engagement in multiple sexual partnerships. Policy interventions, such as anti-FGM legislation and initiatives like the 'Schooling for the Female Child' initiative aimed at reducing social inequality among girls and women, might help decrease FGM and the likelihood of health-compromising behaviours like multiple sexual partnership.

Two commonly linked harmful practices that negatively impact the health of girls and women in sub-Saharan Africa, and threaten their development and quality of life, are female genital mutilation and girl-child marriage. The central focus of the study was to investigate the association between female genital mutilation and girl-child marriage in sub-Saharan Africa. Data from the most recent Demographic and Health Surveys of twelve sub-Sahara African countries were pooled. A total of 14,748 women aged 20-24 were included in the study. A multilevel logistic regression analysis was employed, with reported adjusted odds ratios (aORs) and associated 95% confidence intervals (CIs). The overall prevalence of FGM in the twelve countries was 52.19%, with the highest prevalence in Guinea (97.17%). The overall prevalence of girl-child marriage in the twelve countries was 57.96%, with the highest prevalence in Chad (78.06%). Women who had never experienced female genital mutilation were less likely to experience girl-child marriage (aOR=0.76, CI=0.71-0.82) compared with those who had ever experienced female genital mutilation. Age 24 (aOR=0.47, CI=0.43-0.52), secondary/higher level of education (aOR=0.31, CI=0.28-0.35), richest wealth quintile (aOR=0.56, CI=0.47-0.66), exposure to mass media (aOR=0.81, CI=0.74-0.88) medium community literacy level (aOR=0.63, CI=0.57-0.69) and low community socioeconomic status (aOR=0.67, CI=0.49-0.92) were found to be protective against girl-child marriage. The findings reveal that female genital mutilation is associated with girl-child marriage in sub-Saharan Africa. The continued practice will adversely affect the reproductive health outcomes of girls in the sub-region. Policies aimed at eliminating female genital mutilation and girl-child marriage should focus on compulsory basic education, poverty alleviation and increasing access to mass media. Further, campaigns should cover more communities with lower literacy levels and medium socioecon