Search

Access to clean and safe drinking water is a fundamental human right. Despite global efforts, including the UN's "Water for Life" program, a significant portion of the population in developing countries, including Somaliland, continues to rely on unimproved water sources. These unimproved sources contribute to poor health outcomes, particularly for children. This study aimed to investigate the factors associated with the use of unimproved drinking water sources in Somaliland by employing supervised machine learning models to predict patterns and determinants based on data from the 2020 Somaliland Demographic and Health Survey (SHDS). Secondary data from SHDS 2020 were used, encompassing 8384 households across Somaliland. A multilevel logistic regression model was applied to analyze the individual- and community-level factors influencing the use of unimproved water sources. In addition, machine learning models, including logistic regression, decision tree, random forest, support vector machine (SVM), and K-nearest neighbor (KNN), were compared in terms of accuracy, sensitivity, specificity, and other metrics using cross-validation techniques. This study uses supervised machine learning models to analyze unimproved drinking water sources in Somaliland, providing data-driven insights into the complex determinants of water access. This enhances predictive accuracy and informs targeted interventions, offering a robust framework for addressing water-related public health issues in Somaliland. The analysis identified key determinants of unimproved water source usage, including socioeconomic status, education, region, and household characteristics. The random forest model performed the best with an accuracy of 93.57% and an area under the curve (AUC) score of 98%. Decision tree and KNN also exhibited strong performance, while SVM had the lowest predictive accuracy. This study highlights the role of socioeconomic and community factors in determining access to clean drinking water in Somali Land. Factors such as age, education, gender, household wealth, media access, urban or rural residence, poverty level, and literacy level significantly influenced access. Local policies and resource availability also contribute to variations in access. These findings suggest that targeted interventions aimed at improving education, infrastructure, and community water management practices can significantly reduce reliance on unimproved water sources and improve the overall public health. [ABSTRACT FROM AUTHOR]

Micronutrient deficiencies, known as "hidden hunger" or "hidden malnutrition," pose a significant health risk to pregnant women, particularly in low-income countries like the East Africa region. This study employed eight advanced machine learning algorithms to predict the status of micronutrient supplementation among pregnant women in 12 East African countries, using recent demographic health survey (DHS) data. The analysis involved 138,426 study samples, and algorithm performance was evaluated using accuracy, area under the ROC curve (AUC), specificity, precision, recall, and F1-score. Among the algorithms tested, the random forest classifier emerged as the top performer in predicting micronutrient supplementation status, exhibiting excellent evaluation scores (AUC = 0.892 and accuracy = 94.0%). By analyzing mean SHAP values and performing association rule mining, we gained valuable insights into the importance of different variables and their combined impact, revealing hidden patterns within the data. Key predictors of micronutrient supplementation were the mother's education level, employment status, number of antenatal care (ANC) visits, access to media, number of children, and religion. By harnessing the power of machine learning algorithms, policymakers and healthcare providers can develop targeted strategies to improve the uptake of micronutrient supplementation. Key intervention components involve enhancing education, strengthening ANC services, and implementing comprehensive media campaigns that emphasize the importance of micronutrient supplementation. It is also crucial to consider cultural and religious sensitivities when designing interventions to ensure their effectiveness and acceptance within the specific population. Furthermore, researchers are encouraged to explore and experiment with various techniques to optimize algorithm performance, leading to the identification of the most effective predictors and enhanced accuracy in predicting micronutrient supplementation status. [ABSTRACT FROM AUTHOR]

Background: Historically, family planning discussions have predominantly centred on women, overlooking the crucial role men play in contraception. This is particularly concerning in regions like Sub-Saharan Africa (SSA), where reproductive health challenges are pronounced. South Africa, a key country within SSA, continues to grapple with issues such as high unintended pregnancy rates and increasing pregnancy-related mortality. Understanding the factors that deter male contraceptive use is essential for achieving universal access to sexual and reproductive health (SRH) services. This study investigates the socioeconomic disparities influencing male contraceptive use in South Africa, drawing on data from the 2016 South Africa Demographic Health Survey. Methods: The study utilised data from the 2016 South African Demographic and Health Survey, which employed a stratified, two-stage sampling design across all provinces based on the 2011 Census. The survey focused on men aged 15–59 using the "Man's Questionnaire." Various socio-demographic and attitudinal variables were analysed using STATA 17. The analysis included multinomial logistic regression to identify determinants of male contraceptive use and the Erreygers Normalized Concentration Index to assess socioeconomic inequalities in contraceptive uptake. Results: Among the surveyed men, 47% reported not using any contraception, 40% used male methods, and 13% relied on their partners' contraceptive use. A majority began sexual activity between the ages of 14–17 (54%), resided in urban areas (56%), were unmarried (67%), and had attained secondary education (70%). Notably, 78% disagreed that contraception is solely a woman's responsibility, and 64% expressed positive attitudes toward contraception. Age, marital status, and education level emerged as significant factors influencing contraceptive use. The study revealed a slight pro-rich inequality in male contraception use, with socioeconomic status (SES) being the most significant contributor to this disparity (223.22%). This suggests that higher SES is associated with increased inequality in the adoption of modern male contraceptive methods. Conclusion: These findings highlight the impact of socioeconomic disparities and entrenched cultural beliefs on male contraceptive use in South Africa. To address these challenges, comprehensive strategies that prioritise education, expand family planning media campaigns and ensure equitable access to contraception are urgently needed. [ABSTRACT FROM AUTHOR]

Pakistan is one of those nations that is suffering from the complications of higher fertility and lower levels of education and struggling to improve these demographic factors. In any country, education is considered the reason to control fertility levels. To shed some light on the importance of this fact, education attainment and total children ever born have been considered by taking micro-level data from the Pakistan Demographic Health Survey (PDHS) of 2017–2018 to examine the relationship of education with fertility for women. Due to the nature of the response variable, children ever born, which is a count variable, Poisson regression was used. The results provide evidence that women with secondary and higher education have a negative and significant association with fertility and thus support the hypothesis that educated women have lower fertility. Women with secondary and higher education have fewer children compared to women with no education, while female education at the primary level did not significantly affect fertility in the research. Furthermore, the age of first cohabitation, age at first birth, and wealth index were revealed to be significant determinants of fertility. It interprets that the increase in education is related to greater opportunities and facilitates the participation of women in other activities of the economy. [ABSTRACT FROM AUTHOR]

Background: Breast cancer is the second most commonly diagnosed cancer worldwide, with a high mortality rate in developing countries, including sub-Saharan Africa. Screening is one way to ensure early detection and management of breast cancer, and it is influenced by several factors. Education and socio-economic status may also affect the utilization of breast cancer screening services as these impact decision-making. This study aimed to investigate women's empowerment and its influence on the uptake of breast cancer screening among women in Tanzania. Methods: This study utilized the 2022 Tanzania Demographic and Health Survey data, and included 4216 women aged 20 to 49 years. Women empowerment variables used include social independence, decision-making, ownership of assets, and attitude towards violence. Statistical Package for Social Sciences version 26 was used for data cleaning and analysis. Descriptive statistics and bivariate analysis were done, including a multivariate logistic regression to assess the level of association between independent variables with breast cancer screening. Results: Findings indicate that the prevalence of breast cancer screening is 5.2%. Age, education level, literacy, ownership of assets, attitude towards violence, and decision making are associated with ever going for breast cancer screening. Women aged 45 to 49 years (AOR = 6.28, 95% CI = 6.27–6.28), those with secondary or higher education (AOR 1.1, 95% CI = 1.05–1.06), literate women (AOR = 1.13, 95% CI = 1.13–1.13), those who own a house (AOR = 3.08, 95% CI = 3.08–3.09), who jointly decide on their healthcare with partners on healthcare (AOR = 1.18, 95% CI = 1.18–1.19) had significantly higher odds of going for breast cancer screening. Conclusion: Women's empowerment is significantly associated with the likelihood of engaging in breast cancer screening. Empowered women are more likely to undergo screening. Focus should be on empowering women through education, businesses, and community involvement. Country-specific interventions and breast cancer screening awareness campaigns should include empowerment initiatives to promote screening uptake. [ABSTRACT FROM AUTHOR]

Abstract Background Globally, access to sexual and reproductive health is a significant public health issue for women of the reproductive age group. Senegal is a low-income country with limited access to reproductive health services, such as in the prevention and treatment of STIs. The prevention and treatment of STIs is one of the goals set by the government to decrease reproductive health-related morbidity and mortality among women. So, the main objective of this research was to evaluate the prevalence’s and determinant of self-reported sexually transmitted infections among reproductive-age women. Methods Data from the 2023 Senegal Demographic and Health Survey datasets were used for secondary data analysis. A total of 16,583 women of reproductive age participated in the study. Bivariate analysis was employed in order to select the factors for multivariate analysis. In the multivariate analysis, variables with p

Abstract Micronutrient deficiencies, known as “hidden hunger” or “hidden malnutrition,” pose a significant health risk to pregnant women, particularly in low-income countries like the East Africa region. This study employed eight advanced machine learning algorithms to predict the status of micronutrient supplementation among pregnant women in 12 East African countries, using recent demographic health survey (DHS) data. The analysis involved 138,426 study samples, and algorithm performance was evaluated using accuracy, area under the ROC curve (AUC), specificity, precision, recall, and F1-score. Among the algorithms tested, the random forest classifier emerged as the top performer in predicting micronutrient supplementation status, exhibiting excellent evaluation scores (AUC = 0.892 and accuracy = 94.0%). By analyzing mean SHAP values and performing association rule mining, we gained valuable insights into the importance of different variables and their combined impact, revealing hidden patterns within the data. Key predictors of micronutrient supplementation were the mother’s education level, employment status, number of antenatal care (ANC) visits, access to media, number of children, and religion. By harnessing the power of machine learning algorithms, policymakers and healthcare providers can develop targeted strategies to improve the uptake of micronutrient supplementation. Key intervention components involve enhancing education, strengthening ANC services, and implementing comprehensive media campaigns that emphasize the importance of micronutrient supplementation. It is also crucial to consider cultural and religious sensitivities when designing interventions to ensure their effectiveness and acceptance within the specific population. Furthermore, researchers are encouraged to explore and experiment with various techniques to optimize algorithm performance, leading to the identification of the most effective predictors and enhanced accuracy in predicting micronutrient supplementation status.

Abstract Background Historically, family planning discussions have predominantly centred on women, overlooking the crucial role men play in contraception. This is particularly concerning in regions like Sub-Saharan Africa (SSA), where reproductive health challenges are pronounced. South Africa, a key country within SSA, continues to grapple with issues such as high unintended pregnancy rates and increasing pregnancy-related mortality. Understanding the factors that deter male contraceptive use is essential for achieving universal access to sexual and reproductive health (SRH) services. This study investigates the socioeconomic disparities influencing male contraceptive use in South Africa, drawing on data from the 2016 South Africa Demographic Health Survey. Methods The study utilised data from the 2016 South African Demographic and Health Survey, which employed a stratified, two-stage sampling design across all provinces based on the 2011 Census. The survey focused on men aged 15–59 using the “Man’s Questionnaire.” Various socio-demographic and attitudinal variables were analysed using STATA 17. The analysis included multinomial logistic regression to identify determinants of male contraceptive use and the Erreygers Normalized Concentration Index to assess socioeconomic inequalities in contraceptive uptake. Results Among the surveyed men, 47% reported not using any contraception, 40% used male methods, and 13% relied on their partners’ contraceptive use. A majority began sexual activity between the ages of 14–17 (54%), resided in urban areas (56%), were unmarried (67%), and had attained secondary education (70%). Notably, 78% disagreed that contraception is solely a woman’s responsibility, and 64% expressed positive attitudes toward contraception. Age, marital status, and education level emerged as significant factors influencing contraceptive use. The study revealed a slight pro-rich inequality in male contraception use, with socioeconomic status (SES) being the most significant contributor to this disparity (223.22%). This suggests that higher SES is associated with increased inequality in the adoption of modern male contraceptive methods. Conclusion These findings highlight the impact of socioeconomic disparities and entrenched cultural beliefs on male contraceptive use in South Africa. To address these challenges, comprehensive strategies that prioritise education, expand family planning media campaigns and ensure equitable access to contraception are urgently needed.

Abstract Background Breast cancer is the second most commonly diagnosed cancer worldwide, with a high mortality rate in developing countries, including sub-Saharan Africa. Screening is one way to ensure early detection and management of breast cancer, and it is influenced by several factors. Education and socio-economic status may also affect the utilization of breast cancer screening services as these impact decision-making. This study aimed to investigate women’s empowerment and its influence on the uptake of breast cancer screening among women in Tanzania. Methods This study utilized the 2022 Tanzania Demographic and Health Survey data, and included 4216 women aged 20 to 49 years. Women empowerment variables used include social independence, decision-making, ownership of assets, and attitude towards violence. Statistical Package for Social Sciences version 26 was used for data cleaning and analysis. Descriptive statistics and bivariate analysis were done, including a multivariate logistic regression to assess the level of association between independent variables with breast cancer screening. Results Findings indicate that the prevalence of breast cancer screening is 5.2%. Age, education level, literacy, ownership of assets, attitude towards violence, and decision making are associated with ever going for breast cancer screening. Women aged 45 to 49 years (AOR = 6.28, 95% CI = 6.27–6.28), those with secondary or higher education (AOR 1.1, 95% CI = 1.05–1.06), literate women (AOR = 1.13, 95% CI = 1.13–1.13), those who own a house (AOR = 3.08, 95% CI = 3.08–3.09), who jointly decide on their healthcare with partners on healthcare (AOR = 1.18, 95% CI = 1.18–1.19) had significantly higher odds of going for breast cancer screening. Conclusion Women’s empowerment is significantly associated with the likelihood of engaging in breast cancer screening. Empowered women are more likely to undergo screening. Focus should be on empowering women through education, businesses, and community involvement. Country-specific interventions and breast cancer screening awareness campaigns should include empowerment initiatives to promote screening uptake.

Abstract Background Working mothers are in a situation where they have to manage both their job and maternal roles simultaneously. We aim to show the relationship between mothers' breastfeeding behavior and working status, as well as the effect of their working conditions on the continuation of breastfeeding. Methods This study examined 3557 (weighted 3490) child-mother pairs from Turkey's Demographic Health Survey data in 2008, 2013, and 2018 with a complex sample multiple logistic regression analysis to explore the relationship between breastfeeding and maternal employment. Results In our study, 35.5% of the mothers had never worked, 18.6% were still working, and 45.9% had worked in the past but were not currently working. When breastfeeding percentages were examined based on maternal working status, mothers who worked in 2008 had significantly lower breastfeeding percentages than those who had never worked or had worked previously but not currently. In both 2013 and 2018, after legal regulations, maternal employment didn't affect breastfeeding. After adjusting for confounding factors, maternal employment in the industry sector had lower breastfeeding percentages [AOR:0.06 (95% CI: 0.01–0.48)] than those working in agriculture. Conclusion It seems that adhering to legal regulations such as paid maternity leave and lactation leave can promote breastfeeding. It is necessary to raise awareness of mothers working in the industry about the continuation of breastfeeding and to monitor their legal rights.

Abstract Symptoms of Acute Respiratory infections (ARIs) among under-five children are a global health challenge. We aimed to train and evaluate ten machine learning (ML) classification approaches in predicting symptoms of ARIs reported by mothers among children younger than 5 years in sub-Saharan African (sSA) countries. We used the most recent (2012–2022) nationally representative Demographic and Health Surveys data of 33 sSA countries. The air pollution covariates such as global annual surface particulate matter (PM 2.5) and the nitrogen dioxide available in the form of raster images were obtained from the National Aeronautics and Space Administration (NASA). The MLA was used for predicting the symptoms of ARIs among under-five children. We randomly split the dataset into two, 80% was used to train the model, and the remaining 20% was used to test the trained model. Model performance was evaluated using sensitivity, specificity, accuracy, and the area under the receiver operating characteristic curve. A total of 327,507 under-five children were included in the study. About 7.10, 4.19, 20.61, and 21.02% of children reported symptoms of ARI, Severe ARI, cough, and fever in the 2 weeks preceding the survey years respectively. The prevalence of ARI was highest in Mozambique (15.3%), Uganda (15.05%), Togo (14.27%), and Namibia (13.65%,), whereas Uganda (40.10%), Burundi (38.18%), Zimbabwe (36.95%), and Namibia (31.2%) had the highest prevalence of cough. The results of the random forest plot revealed that spatial locations (longitude, latitude), particulate matter, land surface temperature, nitrogen dioxide, and the number of cattle in the houses are the most important features in predicting the diagnosis of symptoms of ARIs among under-five children in sSA. The RF algorithm was selected as the best ML model (AUC = 0.77, Accuracy = 0.72) to predict the symptoms of ARIs among children under five. The MLA performed well in predicting the symptoms of ARIs and associated predictors among under-five children across the sSA countries. Random forest MLA was identified as the best classifier to be employed for the prediction of the symptoms of ARI among under-five children.

Abstract Globally one-third of global population are victims of anemia, significantly impacting maternal and infant health and linked to poor cognition, productivity, and mortality risks. We used randomly selected 4040 lactating mothers’ record from nationally representative survey. Descriptive statistics were weighted, and the standard hemoglobin cutoff point (below 12 g/dl) was used. Bivariable and multivariable multilevel binary logistic regression model considering the individual and community-level factors associated with anemia was employed. Crude and adjusted odds ratios with a 95% confidence interval were reported. In Ethiopia, 32.3% (95% CI 30.9–33.7%) of lactating women were anemic, with 23.4% having mild, 7.3% moderate, and 1.2% severe anemia. Pastoral regions (Afar, Somalia, and Oromia region) had higher burden of anemia than the others. The advanced age of the mother above 45 years (AOR = 1.43 (1.11–1.82), unemployment (AOR = 1.19; 95% CI 1.08–1.32), household wealth index (AOR = 0.56; 95% CI 0.50–0.63), extended family size (AOR = 1.20; 95% CI 1.04–1.46), and not using family planning (AOR = 1.70; 95% CI 1.49–1.93) were significant factors associated with anemia. Anemia is a moderate public health problem and associated with location and other factors to be addressed via effective interventions.

Background: Working mothers are in a situation where they have to manage both their job and maternal roles simultaneously. We aim to show the relationship between mothers' breastfeeding behavior and working status, as well as the effect of their working conditions on the continuation of breastfeeding. Methods: This study examined 3557 (weighted 3490) child-mother pairs from Turkey's Demographic Health Survey data in 2008, 2013, and 2018 with a complex sample multiple logistic regression analysis to explore the relationship between breastfeeding and maternal employment. Results: In our study, 35.5% of the mothers had never worked, 18.6% were still working, and 45.9% had worked in the past but were not currently working. When breastfeeding percentages were examined based on maternal working status, mothers who worked in 2008 had significantly lower breastfeeding percentages than those who had never worked or had worked previously but not currently. In both 2013 and 2018, after legal regulations, maternal employment didn't affect breastfeeding. After adjusting for confounding factors, maternal employment in the industry sector had lower breastfeeding percentages [AOR:0.06 (95% CI: 0.01–0.48)] than those working in agriculture. Conclusion: It seems that adhering to legal regulations such as paid maternity leave and lactation leave can promote breastfeeding. It is necessary to raise awareness of mothers working in the industry about the continuation of breastfeeding and to monitor their legal rights. [ABSTRACT FROM AUTHOR]

Globally one-third of global population are victims of anemia, significantly impacting maternal and infant health and linked to poor cognition, productivity, and mortality risks. We used randomly selected 4040 lactating mothers' record from nationally representative survey. Descriptive statistics were weighted, and the standard hemoglobin cutoff point (below 12 g/dl) was used. Bivariable and multivariable multilevel binary logistic regression model considering the individual and community-level factors associated with anemia was employed. Crude and adjusted odds ratios with a 95% confidence interval were reported. In Ethiopia, 32.3% (95% CI 30.9–33.7%) of lactating women were anemic, with 23.4% having mild, 7.3% moderate, and 1.2% severe anemia. Pastoral regions (Afar, Somalia, and Oromia region) had higher burden of anemia than the others. The advanced age of the mother above 45 years (AOR = 1.43 (1.11–1.82), unemployment (AOR = 1.19; 95% CI 1.08–1.32), household wealth index (AOR = 0.56; 95% CI 0.50–0.63), extended family size (AOR = 1.20; 95% CI 1.04–1.46), and not using family planning (AOR = 1.70; 95% CI 1.49–1.93) were significant factors associated with anemia. Anemia is a moderate public health problem and associated with location and other factors to be addressed via effective interventions. [ABSTRACT FROM AUTHOR]

In 1960s Pakistan, every woman was giving birth to more than 6 children on average. In 2021, Pakistan still has the second-highest fertility rate in South Asia with every woman giving birth to 3.4 children on average. This paper uses four waves of Demographic and Health Survey data to empirically analyze trends in fertility in Pakistan between 1990 and 2018; accounting for wealth, education and locational differences, this paper looks at three additional pathways for reducing fertility: (i) electrification, (ii) access to TV and (iii) family planning commercials broadcast on television. Results show that electricity does not reduce fertility whereas access to television has a significant effect in reducing fertility rates. The content and evolution of Pakistani soap-operas are also discussed, and it is argued that the role models, the types of households and the messages conveyed by these soap-operas may represent strong pathways for the fertility decline. [ABSTRACT FROM AUTHOR]

Globally, there has been little growth in vaccination coverage, with countries in the Horn of Africa having the lowest vaccination rates. This study investigated factors associated with vaccination status among children under five years old in Somaliland. The 2020 Somaliland Demographic and Health Survey surveyed women aged 15–49 years from randomly selected households. This multilevel analysis included 2673 primary caregivers of children under five. Only 34% of children were ever vaccinated. Childhood vaccination coverage was positively associated with high-budget regions, high healthcare facility density, and children older than 23 months. Vaccination coverage was greater for urban and rural residents than for nomadic people. Children whose mothers could read part of one sentence or one complete sentence were more likely to be vaccinated than illiterate mothers. Children whose mothers received antenatal care (ANC) once, two to three times, or four times or more were more likely to be vaccinated than those whose mothers received no ANC. Childhood vaccination coverage in Somaliland is low. Promoting maternal ANC visits and increasing women's literacy may enhance vaccination coverage. Funds should be allocated to areas with low resources, particularly for nomadic people, to boost vaccination uptake. [ABSTRACT FROM AUTHOR]

Abstract Background A substantial number of children in the world are regularly subjected to physical punishment by their parents as a method of upbringing. Evidence suggests that it has negative effects on the development of brain function. However, evidence regarding its association with verbal communication is limited and heterogeneous. It is also unknown whether the effects are the same in both boys and girls; especially in the contexts of developing countries, where the highest rates of physical punishment are found. Objective This investigation aimed at analyzing the association between physical punishment administered by both fathers and mothers and effective verbal communication among children aged 9–36 months according to sex. Methods A secondary analytical cross-sectional study was conducted based on the 2018–2019 Peruvian Demographic and Family Health Survey. Physical punishment, based on the mother’s report of the use of hitting and/or slapping, was considered as a method to correct children by the father and/or mother. Effective verbal communication (EVC) was measured using the Battle scale which consists of age-appropriate questions included in the early childhood development module. A generalized linear model of the family and Log Poisson link option was used to identify the association between them, using the crude, general adjusted, and sex-stratified models. Results Of all the children, 16.31% received physical punishment from their father and/or mother, wherein 16.65% were boys and 15.97% were girls. Moreover, 36.48% exhibited EVC, wherein 32.55% were boys and 40.50% were girls. Adjusting for socioeconomic level, witnessing violence, mother’s marital status, age, occupation, education level, language, number of children, and moderate-to-severe depressive symptoms, it was found that boys who received physical punishment from their father and/or mother have a 31% lower probability of EVC (adjusted prevalence ratio (aPR) 0.69, 95% confidence interval (CI) 0.58–0.83, p

Access to clean and safe drinking water is a fundamental human right. Despite global efforts, including the UN’s “Water for Life” program, a significant portion of the population in developing countries, including Somaliland, continues to rely on unimproved water sources. These unimproved sources contribute to poor health outcomes, particularly for children. This study aimed to investigate the factors associated with the use of unimproved drinking water sources in Somaliland by employing supervised machine learning models to predict patterns and determinants based on data from the 2020 Somaliland Demographic and Health Survey (SHDS). Secondary data from SHDS 2020 were used, encompassing 8384 households across Somaliland. A multilevel logistic regression model was applied to analyze the individual- and community-level factors influencing the use of unimproved water sources. In addition, machine learning models, including logistic regression, decision tree, random forest, support vector machine (SVM), and K-nearest neighbor (KNN), were compared in terms of accuracy, sensitivity, specificity, and other metrics using cross-validation techniques. This study uses supervised machine learning models to analyze unimproved drinking water sources in Somaliland, providing data-driven insights into the complex determinants of water access. This enhances predictive accuracy and informs targeted interventions, offering a robust framework for addressing water-related public health issues in Somaliland. The analysis identified key determinants of unimproved water source usage, including socioeconomic status, education, region, and household characteristics. The random forest model performed the best with an accuracy of 93.57% and an area under the curve (AUC) score of 98%. Decision tree and KNN also exhibited strong performance, while SVM had the lowest predictive accuracy. This study highlights the role of socioeconomic and community factors in determining access to clean drinking water in Somali Land. Factors such as age, education, gender, household wealth, media access, urban or rural residence, poverty level, and literacy level significantly influenced access. Local policies and resource availability also contribute to variations in access. These findings suggest that targeted interventions aimed at improving education, infrastructure, and community water management practices can significantly reduce reliance on unimproved water sources and improve the overall public health.

Pakistan is one of those nations that is suffering from the complications of higher fertility and lower levels of education and struggling to improve these demographic factors. In any country, education is considered the reason to control fertility levels. To shed some light on the importance of this fact, education attainment and total children ever born have been considered by taking micro-level data from the Pakistan Demographic Health Survey (PDHS) of 2017–2018 to examine the relationship of education with fertility for women. Due to the nature of the response variable, children ever born, which is a count variable, Poisson regression was used. The results provide evidence that women with secondary and higher education have a negative and significant association with fertility and thus support the hypothesis that educated women have lower fertility. Women with secondary and higher education have fewer children compared to women with no education, while female education at the primary level did not significantly affect fertility in the research. Furthermore, the age of first cohabitation, age at first birth, and wealth index were revealed to be significant determinants of fertility. It interprets that the increase in education is related to greater opportunities and facilitates the participation of women in other activities of the economy.

Background: A substantial number of children in the world are regularly subjected to physical punishment by their parents as a method of upbringing. Evidence suggests that it has negative effects on the development of brain function. However, evidence regarding its association with verbal communication is limited and heterogeneous. It is also unknown whether the effects are the same in both boys and girls; especially in the contexts of developing countries, where the highest rates of physical punishment are found. Objective: This investigation aimed at analyzing the association between physical punishment administered by both fathers and mothers and effective verbal communication among children aged 9–36 months according to sex. Methods: A secondary analytical cross-sectional study was conducted based on the 2018–2019 Peruvian Demographic and Family Health Survey. Physical punishment, based on the mother's report of the use of hitting and/or slapping, was considered as a method to correct children by the father and/or mother. Effective verbal communication (EVC) was measured using the Battle scale which consists of age-appropriate questions included in the early childhood development module. A generalized linear model of the family and Log Poisson link option was used to identify the association between them, using the crude, general adjusted, and sex-stratified models. Results: Of all the children, 16.31% received physical punishment from their father and/or mother, wherein 16.65% were boys and 15.97% were girls. Moreover, 36.48% exhibited EVC, wherein 32.55% were boys and 40.50% were girls. Adjusting for socioeconomic level, witnessing violence, mother's marital status, age, occupation, education level, language, number of children, and moderate-to-severe depressive symptoms, it was found that boys who received physical punishment from their father and/or mother have a 31% lower probability of EVC (adjusted prevalence ratio (aPR) 0.69, 95% confidence interval (CI) 0.58–0.83, p < 0.001), whereas no association was found in girls who received physical punishment from their father and/or mother and EVC (aPR 0.93, 95% CI 0.81–1.06, p = 0.278). Conclusions: An association was found between physical punishment administered by father and/or mother and reduced EVC among boys, whereas no such association was found among girls. It is possible that even though a significant impact has not been observed in girls during this early stage, they may experience consequences in later stages of life, further research is needed. [ABSTRACT FROM AUTHOR]

Abstract Introduction Despite its numerous benefits, exclusive breastfeeding (EBF) remains an underutilized practice. Enhancing EBF uptake necessitates a focused approach targeting regions where its adoption is suboptimal. This study aimed to investigate regional disparities in EBF practices and identify determinants of EBF among infants aged 0–1, 2–3, and 4–5 months in Tanzania. Methods This cross-sectional study utilized data from the 2015/16 Tanzania Demographic and Health Survey. A total of 1,015 infants aged 0–5 met the inclusion criteria, comprising 378 aged 0–1 month, 334 at 2–3 months, and 303 at 4–5 months. EBF practices were assessed using a 24-hour recall method. A generalized linear mixed model, with fixed covariates encompassing infant and maternal attributes and clusters for enumeration areas (EAs) and regions, was employed to estimate EBF proportions. Results Regional disparities in EBF were evident among infants aged 0–1, 2–3, and 4–5 months, with decline in EBF proportions as an infant’s age increases. This pattern was observed nationwide. Regional and EA factors influenced the EBF practices at 0–1 and 2–3 months, accounting for 17–40% of the variability at the regional level and 40–63% at the EA level. Literacy level among mothers had a significant impact on EBF practices at 2–3 months (e.g., women who could read whole sentences; AOR = 3.2, 95% CI 1.1,8.8). Conclusion Regional disparities in EBF proportions exist in Tanzania, and further studies are needed to understand their underlying causes. Targeted interventions should prioritize regions with lower EBF proportions. This study highlights the clustering of EBF practices at 0–1 and 2–3 months on both regional and EA levels. Conducting studies in smaller geographical areas may enhance our understanding of the enablers and barriers to EBF and guide interventions to promote recommended EBF practices.

Child mortality, particularly among infants below 5 years, is a significant community well-being concern worldwide. The health sector’s top priority in emerging states is to minimize children’s death and enhance infant health. Despite a substantial decrease in worldwide deaths of children below 5 years, it remains a significant community well-being concern. Children under five years of age died at 37 per 1,000 live birth globally in 2020. However, in underdeveloped countries such as Pakistan and Ethiopia, the fatality rate of children per 1,000 live birth is 65.2 and 48.7, respectively, making it challenging to reduce. Predictive analytics approaches have become well-known for predicting future trends based on previous data and extracting meaningful patterns and connections between parameters in the healthcare industry. As a result, the objective of this study was to use data mining techniques to categorize and highlight the important causes of infant death. Datasets from the Pakistan Demographic Health Survey and the Ethiopian Demographic Health Survey revealed key characteristics in terms of factors that influence child mortality. A total of 12,654 and 12,869 records from both datasets were examined using the Bayesian network, tree (J-48), rule induction (PART), random forest, and multi-level perceptron techniques. On both datasets, various techniques were evaluated with the aforementioned classifiers. The best average accuracy of 97.8% was achieved by the best model, which forecasts the frequency of child deaths. This model can therefore estimate the mortality rates of children under five years in Ethiopia and Pakistan. Therefore, an online model to forecast child death based on our research is urgently needed and will be a useful intervention in healthcare.

Abstract Objectives: the first five years of life are critical for children’s physical and intellectual development. However, the under-five mortality rate in South Asia and ASEAN is relatively high, caused by complex etiologies. This paper identifies maternal high-risk fertility behaviors and healthcare services utilization and examines predictors of under-five mortality (U5M) in 7 Asian (South Asia - ASEAN) developing countries (Indonesia, Myanmar, Cambodia, Philippines, Bangladesh, Nepal, and Pakistan). Methods: a multivariate logistic regression model with a complex survey was used to examine predictors of U5M on the frequency of U5M adjusted for comorbidities. Results: according to multivariate models (model 2), U5M was 2.99 times higher in mothers with low weight at birth infants than in mothers without low weight at birth infants (aOR= 2.99; CI95%=2.49-3.58); Mothers without antenatal care contacts were 3.37 times more likely (aOR= 3.37; CI95%=2.83-4.00) to have a U5M than mothers with eight or more antenatal care contacts; U5M in Indonesia was 2.34 times higher (aOR= 2.34; CI95%= 1.89-2.89). It is investigated that antenatal care serves as a predictor in decreasing U5MR. Conclusions: in order to achieve significant U5MR reduction, intervention programs that encourage antenatal care consultations should be implemented.

Introduction: Despite its numerous benefits, exclusive breastfeeding (EBF) remains an underutilized practice. Enhancing EBF uptake necessitates a focused approach targeting regions where its adoption is suboptimal. This study aimed to investigate regional disparities in EBF practices and identify determinants of EBF among infants aged 0–1, 2–3, and 4–5 months in Tanzania. Methods: This cross-sectional study utilized data from the 2015/16 Tanzania Demographic and Health Survey. A total of 1,015 infants aged 0–5 met the inclusion criteria, comprising 378 aged 0–1 month, 334 at 2–3 months, and 303 at 4–5 months. EBF practices were assessed using a 24-hour recall method. A generalized linear mixed model, with fixed covariates encompassing infant and maternal attributes and clusters for enumeration areas (EAs) and regions, was employed to estimate EBF proportions. Results: Regional disparities in EBF were evident among infants aged 0–1, 2–3, and 4–5 months, with decline in EBF proportions as an infant's age increases. This pattern was observed nationwide. Regional and EA factors influenced the EBF practices at 0–1 and 2–3 months, accounting for 17–40% of the variability at the regional level and 40–63% at the EA level. Literacy level among mothers had a significant impact on EBF practices at 2–3 months (e.g., women who could read whole sentences; AOR = 3.2, 95% CI 1.1,8.8). Conclusion: Regional disparities in EBF proportions exist in Tanzania, and further studies are needed to understand their underlying causes. Targeted interventions should prioritize regions with lower EBF proportions. This study highlights the clustering of EBF practices at 0–1 and 2–3 months on both regional and EA levels. Conducting studies in smaller geographical areas may enhance our understanding of the enablers and barriers to EBF and guide interventions to promote recommended EBF practices. [ABSTRACT FROM AUTHOR]

Background: Female genital mutilation (FGM) is a harmful traditional practice involving the partial or total removal of external genitalia for non-medical reasons. Despite efforts to eliminate it, more than 200 million women and girls have undergone FGM, and 3 million more undergo this practice annually. Tracking the prevalence of FGM and identifying associated factors are crucial to eliminating the practice. This study aimed to determine the prevalence of FGM and associated factors among daughters aged 0--14 years. Methods: The most recent Demographic Health Survey Data (DHS) datasets from sub-Saharan African countries were used for analysis. A multilevel modified Poisson regression analysis model was applied to identify factors associated with FGM. Data management and analysis were performed using STATA-17 software, and the pooled prevalence and adjusted odds ratio (AOR) with a 95% confidence interval (CI) were reported. Statistical significance was set at p ≤ 0.05. Results: The study included a weighted sample of 123,362 participants. The pooled prevalence of FGM among daughters aged 0--14 years in sub-Saharan Africa was found to be 22.9% (95% CI: 16.2--29.6). The daughter's place of birth (AOR = 0.54, 95% CI: 0.48--0.62), mother's age (AOR= 1.72, 95% CI: 1.4--2.11), father's education (AOR = 0.92, 95% CI: 0.87--0.98), mother's perception about FGM (AOR= 0.42, 95% CI: 0.35--0.48), FGM as a religious requirement (AOR= 1.23, 95% CI: 1.12--1.35), mother's age at circumcision (AOR= 1.11, 95% CI: 1.01--1.23), residing in rural areas (AOR= 1.12, 95% CI: 1.05--1.19), and community literacy level (AOR = 0.90, 95% CI: 0.83--0.98) were factors associated with FGM. Conclusion: The high prevalence of FGM among daughters aged 0--14 years in sub-Saharan Africa indicates the need for intensified efforts to curb this practice. Addressing the associated factors identified in this study through targeted interventions and policy implementation is crucial to eradicate FGM and protect the rights and well-being of girls. [ABSTRACT FROM AUTHOR]

Abstract Background Low birth weight (LBW) is associated with infant mortality and postpartum health complications. In previous studies, overall LBW has been found to be significantly associated with several sociodemographic factors, including ethnicity, maternal age, and family income. Few studies have evaluated the association between environmental risk factors and LBW rates. This study investigated the effect of pre-birth water, sanitation, and hygiene (WASH) and housing conditions on self-reported low birth weight. Methods The Ethiopian Demographic and Health Survey, which covered all administrative regions of Ethiopia from January to June 2016, provided data for this study. STATA version 16 was used to analyze 12,125 participants across weighted samples. Multivariable multilevel mixed-effect logistic regression analysis was conducted to determine the effects of each factor on the outcome while accounting for data clustering. The adjusted odds ratios and corresponding 95% confidence intervals were used to determine the statistical significance of the independent variables. Results One thousand five hundred and seventeen newborns, or 12.59% [95% CI (10.2- 15.3)], had low birth weights. When other factors were taken into account, the following factors were significantly associated with low birth weight: not using small-scale water treatment technology before using water [AOR (95% CI) 1.36 (1.08–2.23)], burning solid fuels for energy [AOR (95% CI) 1.99 (1.60–2.21)], living in homes with natural wall coverings [AOR (95% CI) 1.81 (1.47–2.21)], using a shared latrine within a woman's housing complex or compound [AOR (95% CI) 1.63(1.06–2.25)], and living in peripheral, isolated regions [AOR (95% CI) 1.38 (1.06–2.21)]. Conclusion A little more than one out of every ten deliveries in Ethiopia was under normal (recommended) weight. This study shows that poor housing conditions and lack of household WASH infrastructure are independent predictors of poor birth outcomes among Ethiopian women, adding to the limited evidence that environmental factors within the domicile contribute to low birth weight. Interventions to address these issues may help lower the prevalence of LBW.

Globally, there has been little growth in vaccination coverage, with countries in the Horn of Africa having the lowest vaccination rates. This study investigated factors associated with vaccination status among children under five years old in Somaliland. The 2020 Somaliland Demographic and Health Survey surveyed women aged 15–49 years from randomly selected households. This multilevel analysis included 2673 primary caregivers of children under five. Only 34% of children were ever vaccinated. Childhood vaccination coverage was positively associated with high-budget regions, high healthcare facility density, and children older than 23 months. Vaccination coverage was greater for urban and rural residents than for nomadic people. Children whose mothers could read part of one sentence or one complete sentence were more likely to be vaccinated than illiterate mothers. Children whose mothers received antenatal care (ANC) once, two to three times, or four times or more were more likely to be vaccinated than those whose mothers received no ANC. Childhood vaccination coverage in Somaliland is low. Promoting maternal ANC visits and increasing women’s literacy may enhance vaccination coverage. Funds should be allocated to areas with low resources, particularly for nomadic people, to boost vaccination uptake.

A study was conducted to investigate the district-level patterns of incidence of the human immunodeficiency virus (HIV) in Zimbabwe in the period 2005-2015 and explore variations in the relationship between covariates and HIV incidence across different districts. Demographic health survey data were analysed using hotspot analysis, spatial autocorrelation, and multi-scale geographically weighted regression (MGWR) techniques. The analysis revealed hotspots of the HIV epidemic in the southern and western regions of Zimbabwe in contrast to the eastern and northern regions. Specific districts in Matabeleland South and Matabeleland North provinces showed clusters of HIV incidence in 2005-2006, 2010-2011 and 2015. Variables studied were multiple sex partners and sexually transmitted infections (STI) condom use and being married. Recommendations include implementing targeted HIV prevention programmes in identified hotspots, prioritising interventions addressing the factors mentioned above as well as enhancing access to HIV testing and treatment services in high-risk areas, strengthening surveillance systems, and conducting further research to tailor interventions based on contextual factors. The study also emphasizes the need for regular monitoring and evaluation at the district level to inform effective responses to the HIV epidemic over time. By addressing the unique challenges and risk factors in different districts, significant progress can be made in reducing HIV transmission and improving health outcomes in Zimbabwe. These findings should be valuable for policymakers in resource allocation and designing evidence-based interventions.

BackgroundFemale genital mutilation (FGM) is a harmful traditional practice involving the partial or total removal of external genitalia for non-medical reasons. Despite efforts to eliminate it, more than 200 million women and girls have undergone FGM, and 3 million more undergo this practice annually. Tracking the prevalence of FGM and identifying associated factors are crucial to eliminating the practice. This study aimed to determine the prevalence of FGM and associated factors among daughters aged 0–14 years.MethodsThe most recent Demographic Health Survey Data (DHS) datasets from sub-Saharan African countries were used for analysis. A multilevel modified Poisson regression analysis model was applied to identify factors associated with FGM. Data management and analysis were performed using STATA-17 software, and the pooled prevalence and adjusted odds ratio (AOR) with a 95% confidence interval (CI) were reported. Statistical significance was set at p ≤ 0.05.ResultsThe study included a weighted sample of 123,362 participants. The pooled prevalence of FGM among daughters aged 0–14 years in sub-Saharan Africa was found to be 22.9% (95% CI: 16.2–29.6). The daughter's place of birth (AOR = 0.54, 95% CI: 0.48–0.62), mother's age (AOR = 1.72, 95% CI: 1.4–2.11), father's education (AOR = 0.92, 95% CI: 0.87–0.98), mother's perception about FGM (AOR = 0.42, 95% CI: 0.35–0.48), FGM as a religious requirement (AOR = 1.23, 95% CI: 1.12–1.35), mother's age at circumcision (AOR = 1.11, 95% CI: 1.01–1.23), residing in rural areas (AOR = 1.12, 95% CI: 1.05–1.19), and community literacy level (AOR = 0.90, 95% CI: 0.83–0.98) were factors associated with FGM.ConclusionThe high prevalence of FGM among daughters aged 0–14 years in sub-Saharan Africa indicates the need for intensified efforts to curb this practice. Addressing the associated factors identified in this study through targeted interventions and policy implementation is crucial to eradicate FGM and protect the rights and well-being of girls.

Background: Cardiovascular disease (CVD) is increasing in Sub-Saharan Africa (SSA). Overweight/obesity and tobacco use are modifiable CVD risk factors, however literature about the spatiotemporal dynamics of these risk factors in the region at subnational or local scales is lacking. We describe the spatiotemporal trends of overweight/obesity and tobacco use at subnational levels over a 13-year period (2003 to 2016) in five East African nations. Methods: Cross-sectional, nationally representative Demographic and Health Surveys (DHS) were used to explore the subnational spatiotemporal patterns of overweight/obesity and tobacco use in Burundi, Kenya, Rwanda, Tanzania, and Uganda, five East African Community (EAC) nations with unique cultural landscapes influencing CVD risk factors. Adaptive kernel density estimation and logistic regression were used to determine the spatial distribution and change over time of CVD risk factors on a subnational and subpopulation (rural/urban) scale. Results: Subnational analysis shows that regional and national level analysis masks important trends in CVD risk factor prevalence. Overweight/obesity and tobacco use trends were not similar: overweight/obesity prevalence increased across most nations included in the study and the inverse was true for tobacco use prevalence. Urban populations in each nation were more likely to be overweight/obese than rural populations, but the magnitude of difference varied widely between nations. Spatial analysis revealed that although the prevalence of overweight/obesity increased over time in both urban and rural populations, the rate of change differed between urban and rural areas. Rural populations were more likely to use tobacco than urban populations, though the likelihood of use varied substantially between nations. Additionally, spatial analysis showed that tobacco use was not evenly distributed across the landscape: tobacco use increased in and around major cities and urban centers but declined in rural areas. Conclusions: We highlight the importance of de-homogenizing CVD risk factor research in SSA. Studies of national or regional prevalence trends mask important information about subpopulation and place-specific behavior and drivers of risk factor prevalence. Spatially explicit studies should be considered as a vital tool to understand local drivers of health, disease, and associated risk factor trends, especially in highly diverse yet low-resourced, marginalized, and often homogenized regions. [ABSTRACT FROM AUTHOR]

Abstract Background Sustained motivation is essential for effective use of contraceptive methods by women in low- and middle-income countries as many women are likely to abandon contraceptives, especially when they continually experience episodes of failure. We aimed to determine the prevalence of discontinuation of contraceptives due to failure and its associated factors among Ugandan women aged 14–49 years. Methods A cross sectional study was conducted using the UDHS 2016 data. Multi stage stratified sampling was used to select participants. All eligible women aged 15 to 49 years at the time of the survey were enrolled. Bivariable and Multivariable logistic regression analysis were used to determine the factors associated with contraceptive failure. All analysis were done using Stata version 13. Contraceptive failure (getting pregnant while on contraceptives) within five years preceding the survey was the dependent variable. Results A total of 9061 women were included in the study. The overall prevalence of contraceptive failure was 5.6% [n = 506, 95% CI: 5.1–6.1] and was higher (6.2%) among women aged 20–29 years or had completed secondary education (6.1%). Having informed choice on contraceptives [aOR = 0.59, 95% CI: 0.49 – 0.72] and older age [aOR = 0.46, 95% CI: 0.24–0.89] were associated with lower odds of contraceptive failure. Conclusion The burden of contraceptive failure among women of reproductive age in Uganda is substantial and significantly varied by women's age, level of education, exposure to the internet, mass media, and informed choice. These findings highlight the need for improved counseling services and contraceptive quality to help women and couples use methods correctly and consistently.

Abstract Background Modern contraceptive use effectively prevents unwanted pregnancies, promoting maternal and child health and improving the socio-economic well-being of women and their families. Women’s autonomy has been shown to increase the uptake of modern contraception use. This research aimed to investigate the relationship between measures of women’s autonomy and modern contraception use among partnered women in Zambia. Methods This cross-sectional survey study used data from the health census, the 2018 Zambia Demographic Health Survey. We measured women’s autonomy using three indices: women’s participation in decision-making, women’s attitude towards wife-beating and women’s household status. Information from 6727 women in a relationship, not pregnant, not planning pregnancy and aged between 15 and 49 years old were analyzed using descriptive statistics and adjusted odds ratios (AOR). Results The mean age of respondents was 32 years. Most women lived in rural areas (65%), and 81% were protestant. Current modern contraception use among partnered women was 8.8%. Women’s autonomy was significantly associated with modern contraception use. Women with moderate autonomy (AOR = 1.054, P value = 0.004, 95% CI 1.048–1.312) and high autonomy (AOR = 1.031, P value = 0.001, 95% CI 1.013–1.562) had higher odds of using modern contraception compared to those with low autonomy. Other factors related to modern contraception use included a higher level of education (AOR = 1.181, P value = 0.012, 95% CI 1.091–1.783), increased wealth index (AOR = 1.230, P value = 0.006, 95% CI 1.105–1.766) and age, 15–24 (AOR = 1.266, P value = 0.007, 95% CI 1.182–2.113,) and 25–34 (AOR = 1.163, P value = 0.002, 95% CI 1.052–1.273). Conclusion This study argues that increasing women’s assertiveness to make independent decisions within the household is cardinal to enhancing the uptake of modern contraception in Zambia and other low-and-middle-income countries. Governments and other stakeholders must therefore consider rolling out programs to boost women’s autonomy, which in turn would support gender equality and reproductive health.

Background: Low birth weight (LBW) is associated with infant mortality and postpartum health complications. In previous studies, overall LBW has been found to be significantly associated with several sociodemographic factors, including ethnicity, maternal age, and family income. Few studies have evaluated the association between environmental risk factors and LBW rates. This study investigated the effect of pre-birth water, sanitation, and hygiene (WASH) and housing conditions on self-reported low birth weight. Methods: The Ethiopian Demographic and Health Survey, which covered all administrative regions of Ethiopia from January to June 2016, provided data for this study. STATA version 16 was used to analyze 12,125 participants across weighted samples. Multivariable multilevel mixed-effect logistic regression analysis was conducted to determine the effects of each factor on the outcome while accounting for data clustering. The adjusted odds ratios and corresponding 95% confidence intervals were used to determine the statistical significance of the independent variables. Results: One thousand five hundred and seventeen newborns, or 12.59% [95% CI (10.2- 15.3)], had low birth weights. When other factors were taken into account, the following factors were significantly associated with low birth weight: not using small-scale water treatment technology before using water [AOR (95% CI) 1.36 (1.08–2.23)], burning solid fuels for energy [AOR (95% CI) 1.99 (1.60–2.21)], living in homes with natural wall coverings [AOR (95% CI) 1.81 (1.47–2.21)], using a shared latrine within a woman's housing complex or compound [AOR (95% CI) 1.63(1.06–2.25)], and living in peripheral, isolated regions [AOR (95% CI) 1.38 (1.06–2.21)]. Conclusion: A little more than one out of every ten deliveries in Ethiopia was under normal (recommended) weight. This study shows that poor housing conditions and lack of household WASH infrastructure are independent predictors of poor birth outcomes among Ethiopian women, adding to the limited evidence that environmental factors within the domicile contribute to low birth weight. Interventions to address these issues may help lower the prevalence of LBW. [ABSTRACT FROM AUTHOR]

ObjectivesBangladesh has one of the highest adolescent childbearing rates in South Asia, which prevent women from realizing their full potential in life. This study aimed to compare the prevalence and determinants of adolescent childbearing in Bangladesh using data from the 2014 and 2017–18 Bangladesh Demographic and Health Survey (BDHS).MethodsNationally representative surveys of respondents were selected using a two-stage sampling process. The study recruited 2,023 and 1,951 ever-married women aged 15–19 from 2014 and 2017–18 BDHS surveys, respectively, from rural and urban settings from all eight geographic divisions of Bangladesh. Univariate and multivariate logistic regression models were fit to determine the factors associated with adolescent childbearing.ResultThe adolescent childbearing prevalence rate was 30.8% in 2014 BDHS and 27.6% in 2017–18 BDHS. Marriage at age 13 years or less also reduced significantly in 2017–18 compared to 2014 (12.7% vs. 17.4%, respectively). Significantly higher odds of adolescent childbearing were found in 2014 among women in the Sylhet Division (adjusted odds ratio (AOR) = 3.0; 95% confidence interval (CI): 1.6–6.1) and the Chittagong Division (AOR = 1.8; 95% CI: 1.8–2.7) compared to the Barisal Region; however, in 2017, there were no significant differences was found across the geographic Divisions. Compared to women in the lowest wealth quintile, women in all other quintiles had lower odds of adolescent childbearing, with the lowest odds found among women in the wealthiest quintile (AOR = 0.3; 95% CI: 0.2–0.6). Women who married at age 14–17 had 60% lower odds of adolescent childbearing compared to the women who married at age 10–13.ConclusionNearly one-third of married adolescents in Bangladesh were pregnant or had at least one child in 2014, and it was reduced only marginally in 2017–18. Marriage at an early age and income inequalities among families were significant predictors of adolescent childbearing in Bangladesh. This study highlighted change in the magnitude and determinants of adolescent childbearing in Bangladesh taken data from two nationally representative surveys conducted 4 years apart.

BackgroundChildhood malnutrition contributes to nearly half (45%) of all deaths among children under 5 globally. The United Nations’ Sustainable Development Goals (SDGs) aims to end all forms of malnutrition by 2030; however, measuring progress towards these goals is challenging, particularly in countries with emerging economies where nationally-representative data are limited. The primary objective of this study was to estimate the overall burden of childhood malnutrition in Ghana at national and regional levels using 3 data sources. MethodsUsing data from the long-standing Ghana Demographic and Health Surveys (GDHS), Ghana Multiple Indicator Cluster Survey (GMICS), and the emerging Ghana Socioeconomic Panel Survey (GSPS), we compared the prevalence of malnutrition using the extended composite index of anthropometric failure (eCIAF) for the period 2008-2011. This study included data for children aged 6-59 months and calculated all anthropometric z-scores based on the World Health Organization (WHO) Growth Standards. We tested for differences in malnutrition subtypes using two-group configural frequency analysis (CFA). ResultsOf the 10 281 children (6532 from GMICS, 2141 from GDHS and 1608 from GSPS) included in the study, the only demographic difference observed was the children included in the GSPS were slightly older than those included in the GDHS and GMICS (median age of 36 vs 30 vs 33 months, P < .001). Based on the eCIAF, the overall prevalence of malnutrition at the national level was higher among children in the GSPS (57.3%, 95% CI: 53.9%–60.6%), followed by the GDHS (39.7%, 95% CI: 37.0%–42.5%), and then those in the GMICS (31.2%, 95% CI: 29.3%–33.1%). The two-group CFA showed that the 3 data sources also estimated different prevalence rates for most of the malnutrition subtypes included in the eCIAF. ConclusionDepending on the data source adopted, our estimates of eCIAF showed that between one-third and half of all Ghanaian children aged 6-59 months had at least one form of malnutrition over the period 2008-2011. These eCIAF estimates should complement the commonly reported measures such as stunting and wasting when interpreting the severity of malnutrition in the country to inform policy decisions.

Objectives: the first five years of life are critical for children's physical and intellectual development. However, the under-five mortality rate in South Asia and ASEAN is relatively high, caused by complex etiologies. This paper identifies maternal high-risk fertility behaviors and healthcare services utilization and examines predictors of under-five mortality (U5M) in 7 Asian (South Asia - ASEAN) developing countries (Indonesia, Myanmar, Cambodia, Philippines, Bangladesh, Nepal, and Pakistan). Methods: a multivariate logistic regression model with a complex survey was used to examine predictors of U5M on the frequency of U5M adjusted for comorbidities. Results: according to multivariate models (model 2), U5M was 2.99 times higher in mothers with low weight at birth infants than in mothers without low weight at birth infants (aOR= 2.99; CI95%=2.49-3.58); Mothers without antenatal care contacts were 3.37 times more likely (aOR= 3.37; CI95%=2.83-4.00) to have a U5M than mothers with eight or more antenatal care contacts; U5M in Indonesia was 2.34 times higher (aOR= 2.34; CI95%= 1.89-2.89). It is investigated that antenatal care serves as a predictor in decreasing U5MR. Conclusions: in order to achieve significant U5MR reduction, intervention programs that encourage antenatal care consultations should be implemented. [ABSTRACT FROM AUTHOR]

Introduction: antenatal care (ANC) delivers services to prevent pregnancy complications and provides counseling for birth, and emergency preparedness. Having ANC on time has life-saving potential for the child and mother. Despite improvements in health infrastructure, human resources, and health insurance, hindrances to early ANC visits still exist in Rwanda. This study aimed to investigate the burden and factors associated with delayed ANC visits in Rwanda so that policymakers can develop strategies to promote early ANC visits. Methods: this is a crosssectional study using Rwanda demographic health survey (RDHS) 2019-2020 that included 6,039 women that had had a pregnancy in the 5 years preceding the survey. Descriptive analysis was used to determine the prevalence and a multivariable logistic regression model using manual backward stepwise regression was used to identify risk factors for delayed ANC in Rwanda. STATA 16 statistical software was used for all the analyses. Results: the prevalence of delayed ANC in Rwanda was 41% and the risk factors include: the number of children 4-6 (AOR = 1.4, 95% CI: 1.2-1.6) and 7 or more children (AOR = 1.5, 95% CI: 1.5-2.1) versus less than 3 children, unwanted pregnancy (AOR = 1.7, 95% CI: 1.5-2.0), not covered by health insurance (AOR = 14, 95% CI: 1.2-1.6), woman's education level: no education (AOR 2.6, 95% CI: 1.6-4.1), primary education (AOR 2.5, 95% CI: 1.6-3.7), secondary education (AOR 2.2, 95% CI: 1.5-3.2), woman's occupation: informal (AOR 2.3 95% CI: 1.5-3.7) and unemployment (AOR 2.3. 95% CI: 1.4-3.7). Conclusion: based on the findings from our study, family planning services should be made available to all women of childbearing age to prevent unwanted pregnancies; female education should be considered a priority, promotion of health insurance coverage and community-based education about reproductive health to encourage the early seeking of care among women of childbearing age. [ABSTRACT FROM AUTHOR]

Background: Modern contraceptive use effectively prevents unwanted pregnancies, promoting maternal and child health and improving the socio-economic well-being of women and their families. Women's autonomy has been shown to increase the uptake of modern contraception use. This research aimed to investigate the relationship between measures of women's autonomy and modern contraception use among partnered women in Zambia. Methods: This cross-sectional survey study used data from the health census, the 2018 Zambia Demographic Health Survey. We measured women's autonomy using three indices: women's participation in decision-making, women's attitude towards wife-beating and women's household status. Information from 6727 women in a relationship, not pregnant, not planning pregnancy and aged between 15 and 49 years old were analyzed using descriptive statistics and adjusted odds ratios (AOR). Results: The mean age of respondents was 32 years. Most women lived in rural areas (65%), and 81% were protestant. Current modern contraception use among partnered women was 8.8%. Women's autonomy was significantly associated with modern contraception use. Women with moderate autonomy (AOR = 1.054, P value = 0.004, 95% CI 1.048–1.312) and high autonomy (AOR = 1.031, P value = 0.001, 95% CI 1.013–1.562) had higher odds of using modern contraception compared to those with low autonomy. Other factors related to modern contraception use included a higher level of education (AOR = 1.181, P value = 0.012, 95% CI 1.091–1.783), increased wealth index (AOR = 1.230, P value = 0.006, 95% CI 1.105–1.766) and age, 15–24 (AOR = 1.266, P value = 0.007, 95% CI 1.182–2.113,) and 25–34 (AOR = 1.163, P value = 0.002, 95% CI 1.052–1.273). Conclusion: This study argues that increasing women's assertiveness to make independent decisions within the household is cardinal to enhancing the uptake of modern contraception in Zambia and other low-and-middle-income countries. Governments and other stakeholders must therefore consider rolling out programs to boost women's autonomy, which in turn would support gender equality and reproductive health. [ABSTRACT FROM AUTHOR]

Background: Anaemia disproportionately affects women of reproductive age in sub-Saharan Africa including Nigeria. Yet, community-based studies on the prevalence and determinants of anaemia among women of reproductive age are scarce in Nigeria. Design: A cross-sectional community-based survey using a nationally representative sample. Objectives: This study described anaemia prevalence and its associated factors among women of reproductive age, pregnant women, and non-pregnant women in Nigeria. Methods: We analysed data from the 2018 Nigeria Demographic and Health Survey. Pregnant women with a haemoglobin level less than 11 g/dL and non-pregnant women with a haemoglobin level less than 12 g/dL were considered anaemic. Anaemia was also categorized as mild, moderate, and severe. Pearson's chi-square test was used to evaluate the association between anaemia status and independent variables. All variables with ρ ⩽ 0.25 in bivariate analyses were further analysed using complex sample logistic regression. Results: Anaemia prevalence was 57.8%, 57.4%, and 61.1% for women of reproductive age, non-pregnant women, and pregnant women, respectively. The prevalence of severe anaemia was 1.6%, 1.5%, and 2.3% for overall women of reproductive age, non-pregnant women, and pregnant women, correspondingly. The southern regions, rural residence, low education, unemployment, low wealth index, and non-use of modern contraceptives significantly increased the likelihood of anaemia and severe anaemia among women of reproductive age and non-pregnant women. The likelihood of being anaemic was significantly increased by large family size among women of reproductive age and by being underweight among non-pregnant women. The South-East region, rural residence, low education, and unemployment were significantly associated with anaemia among pregnant women. The South-South region and unemployment increased the likelihood of severe anaemia among pregnant women. Short stature significantly reduced the odds of being anaemic and severely anaemic among pregnant women. Conclusions: Anaemia prevalence among all categories of women of reproductive age is high in Nigeria. Predictors of anaemia prevalence and severity should be considered in policies intended to reduce anaemia among women of reproductive age in Nigeria. [ABSTRACT FROM AUTHOR]

Background: Utilisation of continuum of maternal health care services is crucial for a healthy pregnancy and childbirth and plays an important role in attaining Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs) related to maternal and child health. This paper aims to assess the percentage of dropouts across various stages of utilization of continuum of maternal health services (CMHS) in India and also investigates the factors hindering the utilization of these services.Methods: We used recent data from National Family Health Survey(NFHS) encompassing a total sample of 1,70,937 pregnant women for the period 2015-16. The percentage of women dropping out while seeking maternal health care is measured using descriptive statistics. While, the factors impeding the utilization of maternal health services is estimated using a Multinomial Logistic Regression Model, where dependent variable (CMHS) is defined as complete care, incomplete care and no care.Results: Only17% of pregnant women availed the utilisation of complete care and 83% either did not seek any care or dropped after seeking one or two services. For instance, it is found that 79% of women who registered for antenatal care services (ANC) did not avail the same adequately. An empirical investigation of determinants of inadequate utilization of CMHS revealed that factors like individual characteristics, for instance- access to media (RRR: 2.06) and mother's education play (RRR: 3.61) a vital role in the uptake of CMHS. It is also found that the interaction between wealth index and place of residence plays a pivotal role in seeking complete care. Lastly, the results revealed that male participation (RRR: 2.69) and contacting multi-purpose worker (MPW) (RRR: 2.33) are also at play.Conclusion: The study suggests that the major determinants of utilisation of CMHS are access to media, mother's education, affordability barriers and male participation. Hence, policy recommendations should be oriented towards strengthening these dimensions and the utilisation of adequate ANC has to be considered as the need of the hour. [ABSTRACT FROM AUTHOR]

Abstract Background Utilisation of continuum of maternal health care services is crucial for a healthy pregnancy and childbirth and plays an important role in attaining Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs) related to maternal and child health. This paper aims to assess the percentage of dropouts across various stages of utilization of continuum of maternal health services (CMHS) in India and also investigates the factors hindering the utilization of these services. Methods We used recent data from National Family Health Survey(NFHS) encompassing a total sample of 1,70,937 pregnant women for the period 2015–16. The percentage of women dropping out while seeking maternal health care is measured using descriptive statistics. While, the factors impeding the utilization of maternal health services is estimated using a Multinomial Logistic Regression Model, where dependent variable (CMHS) is defined as complete care, incomplete care and no care. Results Only17% of pregnant women availed the utilisation of complete care and 83% either did not seek any care or dropped after seeking one or two services. For instance, it is found that 79% of women who registered for antenatal care services (ANC) did not avail the same adequately. An empirical investigation of determinants of inadequate utilization of CMHS revealed that factors like individual characteristics, for instance- access to media (RRR: 2.06) and mother’s education play (RRR: 3.61) a vital role in the uptake of CMHS. It is also found that the interaction between wealth index and place of residence plays a pivotal role in seeking complete care. Lastly, the results revealed that male participation (RRR: 2.69) and contacting multi-purpose worker (MPW) (RRR: 2.33) are also at play. Conclusion The study suggests that the major determinants of utilisation of CMHS are access to media, mother’s education, affordability barriers and male participation. Hence, policy recommendations should be oriented towards strengthening these dimensions and the utilisation of adequate ANC has to be considered as the need of the hour.

One in three Haitian women, and two in three Haitian children, experience physical abuse. This study aims to assess characteristics of abused Haitian women and identify effective sources of support. This cross-sectional study used multiple logistic regression models to analyze sociodemographic characteristics of Haitian women, associations with abuse-exposure from a parent/intimate partner (IPV)/any perpetrator, and impacts of seeking help for abuse, from police/doctors/family. About 9.1% experienced abuse by a parent, 8.6% from IPV. Women abused by a parent were less likely to be employed (OR = 0.74, [95% CI = 0.59–0.93]) and more likely to have an often-drunk partner (2.10, [1.54–2.87]). IPV-exposed women were more likely to have primary education (1.56, [1.12–2.16]), an often-drunk partner (3.07, [2.24–4.22]) and less likely to live rurally (0.65, [0.47–0.89]). Seeking help from own family for IPV exposure was strongly associated with having a job (2.00, [1.04–3.89]) (P for interaction = 0.039) and seeking help from partner’s family for IPV was strongly associated with having an often-drunk husband (8.80, [3.07–25.23]) (p for interaction

Background/Aims: Young women in Indonesia who experience an unwanted pregnancy may not have the necessary support to make an informed decision about whether to continue with or terminate the pregnancy. The aim of this study was to determine factors that influence the decision to terminate or continue with an unwanted pregnancy among women aged 15–24 years old in Indonesia. Methods: Data from the 2017 Indonesian demographic and health survey were used. These data included 9218 women aged 15–24 years from eight regions in Indonesia. Chi-squared tests and binary and multivariable logistic regression were used to analyse the data. Results: Almost 20% of women in Indonesia decided to terminate an unwanted pregnancy, and 25% experienced physical partner violence. Respondents who lived in Sulawesi, had primary education, lived in a rural area or had experienced physical partner violence were more likely terminate an unwanted pregnancy. Respondents who had a higher economic status were less likely terminate. Conclusions: The decision to terminate a pregnancy may be more likely to be made by women under certain circumstances. Programmes for pregnant women involving counselling should be initiated via cross-collaboration with government, parents and healthcare workers, to provide support for decision making in the case of an unwanted pregnancy. [ABSTRACT FROM AUTHOR]

To describe the prevalence and the correlation between individual, environmental and household, health behavior, and source of information factors with diarrhea among under-five children in five Southeast Asian countries based on the National Health Survey. Cross-sectional design conducted in five countries in Southeast Asia. Datasets from Demographic and Health Surveys and Multiple Indicator Cluster Surveys in five countries were analyzed. A total of 12,447 children under 5 years of age from five countries in Southeast Asia (Indonesia 1807, Cambodia 2650, Myanmar 1717, the Philippines 3669, and Timor-Leste 2614) were included in this study. Binary logistic regression was performed to analyze the data. A total of 12,447 under-five children were included in the study. Overall, in five Southeast Asian countries, the prevalence of diarrhea is known from 8.39% in the Philippines to 18.21% in Indonesia. Several factors related to diarrhea are individual; environmental and household; health behavior such as stool disposal, breastfeeding mothers, and children's food history; and source of information factors. The findings of this study indicate that diarrhea is a serious public health problem in the Southeast Asian region that must be addressed using preventive and curative approaches. The results indicate the need for cross-collaboration among nurses, medical doctor, and sanitarian is needed to tackle the childhood diarrhea and minimize the severity based on those determinants. • Diarrhea is the leading cause of children's mortality and morbidity in the Southeast Asian. • Children have suboptimal access to essential health services. • Children face multifactorial risk factors for diarrhea. • Multisectoral collaboration is needed to develop the prevention program for diarrhea. [ABSTRACT FROM AUTHOR]

Background: Road traffic crashes (RTCs) are a global public health burden whose resulting morbidity and mortality disproportionately impact low‐ and middle‐income countries with stressed health systems. There is a paucity of published studies that evaluate the sociodemographic distribution of RTCs using nationally representative samples from the African region. Aim: To examine population‐wide associations between sociodemographic factors and involvement in RTCs in Kenya. Methods: Data were obtained from the 2014 Kenyan Demographic Health Survey, representing all 47 counties in Kenya, from May to October of 2014. We estimated the prevalence of RTCs and utilized logistic regression for bivariate and multivariable analyses to determine the sociodemographic factors associated with RTCs. Study variables included age, place of residence, household wealth index, educational attainment, and history of alcohol consumption. We computed odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). Results: A higher prevalence was reported among men (8.76%) versus women (3.22%). The risk factors among men included being 20−34 years of age, living in a rural area (OR 1.38, 95% CI 1.09, 1.74), drinking alcohol (OR 1.33, 95% CI 1.11, 1.59), and having not higher than a primary (OR 1.90, 95% CI 1.19, 3.03) or secondary (OR 1.68, 95% CI 1.04, 2.71) education. The strongest risk factors for women included the being aged 45−49 (OR 2.30, 95% CI 1.44, 3.67) and 20−24 years (OR 1.81, 95% 1.17, 2.79) as well as being in the fourth wealth quintile (OR 1.83, 95% CI 1.15, 2.91). Conclusion: Men and the most economically productive age groups were more likely to report being involved in RTCs. Strategies to reduce the occurrences of RTCs should prioritize the most vulnerable sociodemographic groups. [ABSTRACT FROM AUTHOR]

Background: The National Health Insurance (NHI) program is the Indonesian government's national health program. However, health insurance coverage has not been maximized. This study aims to analyze the factors associated with health insurance coverage in Indonesia. Methods: Retrospective cross-sectional data were obtained from the Indonesian Demographic and Health Survey 2017. A total of 39,580 respondents were selected using two-stage stratified cluster sampling. The data come from the DHS Questionnaire Phase 7. In this study, we explored age, education level, wealth quintiles, residence, the number of children who are alive, marital status, current employment status, earnings, and health insurance status in relation to health insurance coverage. Then, we analyzed the data using chi-squared and binary logistic analyses. Results: The prevalence of health insurance coverage in the Indonesian population is 62.3%. Respondent aged 15-24 years [AOR=0.88; 95% CI=0.77-1.00], secondary education level [AOR=0.44; 95% CI=0.41-0.47], poorer wealth index [AOR=0.76; 95% CI=0.71-0.82], live in rural area [AOR=0.78; 95% CI=0.75-0.82], divorced [AOR=0.72; 95% CI=0.63-0.83] were less likelihood to have health insurance. Conversely, the respondent who received earnings [AOR=1.25; 95% CI=1.18-1.32] was more likely to have health insurance. Conclusion: This finding pointed to education level, economic status, and demographic area such as respondents who lived in rural areas should more pay attention to NHI. Intervention through the provision of appropriate information about NHI should be promoted.