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BackgroundThe remarkable growth of cell phone ownership in low- and middle-income countries has generated significant interest in using cell phones for conducting surveys through computer-assisted telephone interviews, live interviewer-administered surveys, or automated surveys (ie, interactive voice response). ObjectiveThis study aimed to compare, by mode, the sociodemographic characteristics of cell phone owners who completed a follow-up phone survey with those who did not complete the survey. MethodsThe study was based on a nationally representative sample of women aged 15 to 49 years who reported cell phone ownership during a household survey in Burkina Faso in 2016. Female cell phone owners were randomized to participate in a computer-assisted telephone interview or hybrid interactive voice response follow-up phone survey 11 months after baseline interviews. Completion of the phone survey was defined as participants responding to more than 50% of questions in the phone survey. We investigated sociodemographic characteristics associated with cell phone survey completion using multivariable logistic regression models, stratifying the analysis by survey mode and by directly comparing computer-assisted telephone interview and hybrid interactive voice response respondents. ResultsA total of 1766 women were called for the phone survey between November 5 and 17, 2017. In both the computer-assisted telephone interview and hybrid interactive voice response samples, women in urban communities and women with secondary education or higher were more likely to complete the survey than their rural and less-educated counterparts. Compared directly, women who completed the hybrid interactive voice response survey had higher odds of having a secondary education than those who completed computer-assisted telephone interviews (odds ratio 1.7, 95% CI 1.1-2.6). ConclusionsIn Burkina Faso, computer-assisted telephone interviews are the preferred method of conducting cell phone surveys owing to less sample distortion and a higher response rate compared with a hybrid interactive voice response survey.

A growing body of literature in low- and middle-income countries is challenging the long-held assumption that the respondent and interviewer should be strangers. We conducted a qualitative study in Burkina Faso comprised of in-depth interviews and focus group discussions to explore interviewers' experiences of collecting data on sexual and reproductive health indicators in their communities, and their perceptions of how familiarity with the respondents influences measurement error and nonresponse. We found that interviewers perceive familiarity to affect the process of collecting data but has minimal impact on responses obtained. Rather, interviewers perceived the personality of the respondent and her willingness to disclose personal information to be of greater influence. This study illustrates the complexities of interviewer--respondent exchange, provides context for the hiring practices of future surveys, and suggests specific variables to check when assessing data quality.

Background: Parkinson's disease (PD) leads to changes in verbal communications. The focus of most studies to date has been on speech impairment, which is specifically referred to as dysarthria. Although these studies are crucial to understanding the impact of PD on verbal communication, they do not focus on the features of dialogues between people with PD (PwPD) and other people in communicative contexts. Aims: To investigate whether PwPD produce less feedback than typical people during dialogue, thus potentially making it more difficult for them to reach mutual comprehension (i.e., common ground) with their conversational partner. Methods & Procedures: A matching task experiment was conducted during which an experimenter described abstract pictures to a participant, who was either a PwPD or a typical participant, so that he or she could organize these pictures in a grid. The participants could produce as much feedback as they liked. Outcomes & Results: PwPD were less likely to produce feedback than typical participants. This effect was mainly driven by two specific types of feedback: acknowledgment tokens and hesitations. Conclusions & Implications: The results suggest that PD impacts feedback production. This could decrease the communicative abilities of PwPD in interactive contexts by affecting grounding, that is, the ability to build common ground with others. This paper is one of the first to specifically document the production of feedback markers in PwPD. Future studies should examine the extent to which our results, which were obtained in a controlled dialogue task, may be generalized to daily-life conversions. From a clinical perspective, our study points to the necessity of assessing feedback production, and more generally abilities related to common ground construction and use, during PD progression.

Background: Knowledge of the conditions under which abortion is legal is important so that people can advocate for their right to abortion care. Yet minimal research has explored the association between women's knowledge of abortion legality and the induced abortion care they receive, particularly using population-based survey data. Methods: Using national survey data collected by Performance Monitoring for Action (PMA) in Côte d'Ivoire and Ghana, we aimed to compare the prevalence of accurate knowledge of abortion legality, factors associated with knowledge of the law, and the association between knowledge of abortion legality and the source of women's induced abortion care in these two settings. We ran bivariate and multivariable logistic regressions to assess the relationships of interest. Results: We found that awareness and knowledge of the abortion law were low in both Côte d'Ivoire and Ghana. In Cote d'Ivoire, women who were older, more educated, and with past abortion experience were more likely to be aware of the law. In Ghana, knowledge of the law did not vary significantly by demographic characteristics. However, in Ghana, knowledge of the law was correlated with women's use of the formal healthcare system for abortion care, with greater use of clinical sources in rural areas. Conclusions: It is possible that for populations with reduced access to abortion services, such as those in rural areas, knowledge of the law is advantageous for those seeking facility-based abortion care, particularly in settings where abortion is legal for a range of indications. Interventions seeking to improve access to facility-based abortion care in settings where abortion is legal on various grounds should incorporate education on the legal grounds for abortion. Plain language summary: Knowledge of the conditions under which abortion is legal is important for people to advocate for their right to abortion care, yet minimal research has explored the association between women's knowledge of abortion legality and the abortion care they receive, particularly using population-based survey data. Using national survey data collected by Performance Monitoring for Action (PMA) in Côte d'Ivoire and Ghana, we aimed to compare the prevalence of accurate knowledge of abortion legality, factors associated with knowledge of the law, and the association between knowledge of abortion legality and the source of women's abortion care in these two settings. We ran bivariate and multivariable logistic regressions to assess the relationships of interest. We found that awareness and knowledge of the abortion law were low in both Côte d'Ivoire and Ghana. In Côte d'Ivoire, knowledge was unequally distributed according to sociodemographic factors, while such inequities did not exist in Ghana. However, in Ghana, knowledge of the law was correlated with women's use of the formal healthcare system for abortion care, with greater use of clinical sources in rural areas. It is possible that for populations with reduced access to abortion services, such as those in rural areas, knowledge of the law is advantageous for those seeking facility-based abortion care, particularly in settings where abortion is legal for a range of indications. Interventions seeking to improve access to facility-based abortion care in settings where abortion is legal on various grounds should incorporate education on the legal grounds for abortion. [ABSTRACT FROM AUTHOR]

Background: Abortion has been legal for multiple indications in Ghana since 1985, and efforts have been made to expand the availability of safe abortion care in the years since. However clandestine, and potentially unsafe, abortions remain common, suggesting numerous barriers to access persist; one possible barrier is poor knowledge of the abortion law among those working in health facilities. Our study aimed to identify levels of legal knowledge among health facility staff across Ghana. Methods: Data for this paper are drawn from a nationally representative cross-sectional health facility survey conducted in 2018; our analytic sample includes 340 facilities that provide induced abortion and/or postabortion care (PAC). The survey collected data on provision of abortion and PAC, as well as knowledge of abortion legality and recommendations for reducing unsafe abortion. We used descriptive statistics to examine levels of knowledge and recommendations, and logistic regression to assess associations with individual and facility characteristics. Findings: Comprehensive knowledge of the legal indications for abortion was low among health facility staff; just 6% identified all legal indications, and the majority (83%) underestimated the number of conditions under which abortion is legal. Knowledge was higher for more restrictive indications, such as a woman's life being at risk, which was identified by 72% of respondents, than more broadly interpretable indications, such as mental health, identified by 29%. Respondents in facilities providing both induced abortion and PAC had better knowledge of several legal indications than those in facilities providing PAC only. Conclusions: Health facility staff have significant gaps in their knowledge of abortion legality. Knowledge of the law among this population is highly important for ensuring that abortion care is made available to the fullest extent of the law. Efforts are needed to improve knowledge of the law among providers and facility staff, particularly for indications with broad interpretability. [ABSTRACT FROM AUTHOR]

STUDY QUESTION What is the nature of women's care-seeking for difficulties conceiving in sub-Saharan Africa (SSA), including the correlates of seeking biomedical infertility care at a health facility? SUMMARY ANSWER Care-seeking for difficulties getting pregnant was low, much of which involved traditional or religious sources of care, with evidence of sociodemographic disparities in receipt of biomedical care. WHAT IS KNOWN ALREADY Nearly all research on infertility care-seeking patterns in SSA is limited to clinic-based studies among the minority of people in these settings who obtain facility-based services. In the absence of population-based data on infertility care-seeking, we are unable to determine the demand for services and disparities in the use of more effective biomedical sources of care. STUDY DESIGN, SIZE, DURATION We used cross-sectional, population-based data from the Performance Monitoring for Action (PMA) female survey in eight geographies in SSA, including nationally representative data from Burkina Faso, Côte d'Ivoire, Kenya, and Uganda and regionally representative data from two provinces in the Democratic Republic of the Congo (DRC) (Kinshasa and Kongo Central) and two states in Nigeria (Kano and Lagos). We employed a multi-stage cluster random sampling design with probability proportional to size selection of clusters within each geography to produce representative samples of women aged 15–49. Samples ranged from 1144 in Kano, Nigeria, to 9489 in Kenya. PMA collected these data between November 2021 and December 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS We restricted the sample to women who had ever had sex, with analytic samples ranging from 854 in Kano to 8,059 in Kenya, then conducted descriptive and bivariable analyses to examine characteristics of those who sought care for difficulties getting pregnant. Among those who reported seeking care, we conducted bivariable and multivariable logistic regression analyses to determine factors associated with receipt of biomedical services from a health facility. All analyses were conducted separately by geography. MAIN RESULTS AND THE ROLE OF CHANCE Our study found low levels of care-seeking for difficulties getting pregnant among sexually active women in eight geographies in SSA, ranging from 3.7% (Kenya) to 15.3% (Côte d'Ivoire). Of this, 51.8% (Burkina Faso) to 86.7% (Kinshasa) involved receipt of biomedical services in health facilities. While many factors were consistently associated with infertility care-seeking from any source across geographies, factors associated with receipt of biomedical care specifically were less pronounced. This may be a result of the highly limited sources of infertility services in SSA; thus, even privileged groups may struggle to obtain effective treatment for difficulties getting pregnant. However, we did observe disparities in biomedical care-seeking in our bivariable results in several geographies, with the wealthiest women, those with more education, and those residing in urban areas generally more likely to have sought biomedical care for difficulties getting pregnant. LIMITATIONS, REASONS FOR CAUTION Our data lacked details on the nature of the services received and outcomes, and we do not have information on reasons why women chose the sources they did. Small samples of women who sought care limited our power to detect significant differences in care-seeking by women's characteristics in several geographies. WIDER IMPLICATIONS OF THE FINDINGS Infertility and access to appropriate treatment are issues of reproductive health and human rights. While our results do not indicate to what extent use of non-biomedical sources of care is driven by preferences, cost, or lack of accessible services, it is clear from our results and existing literature that more needs to be done to ensure access to affordable, quality, cost-effective infertility services in SSA. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by grants from the Bill & Melinda Gates Foundation (INV009639) and the National Institute of Child Health and Human Development (K01HD107172). The funders were not involved in the study design, analyses, manuscript writing, or the decision to publish. The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

Recent evidence suggests that women in high‐income countries desired to delay or forgo childbearing due to COVID‐19, yet there remains insufficient evidence of COVID‐19's impact on fertility desires in low‐ and middle‐income countries, particularly in sub‐Saharan Africa (SSA). We examined how quantum and tempo of fertility intentions changed in the first year of COVID‐19 and assessed the impact of economic insecurity and sociodemographic characteristics on these changes in SSA. We used longitudinal data collected among 14,053 women from Kenya, Burkina Faso, two provinces in the Democratic Republic of Congo (Kinshasa and Kongo Central), and two states in Nigeria (Kano and Lagos). Descriptive analyses and logistic regression examined overall changes and economic and sociodemographic factors associated with quantum and tempo shifts. At the population‐level, most women remained stable in their fertility intentions throughout the first year of COVID‐19. Despite widespread income loss, few women reported that COVID‐19 influenced their near‐term childbearing intentions. However, among women who changed their intentions in Burkina Faso and Kenya, income loss was associated with transitions toward wanting to delay or limit childbearing, particularly among the poorest women. These findings underscore the importance of accounting for context when anticipating the consequences of public health emergencies on fertility. [ABSTRACT FROM AUTHOR]