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Purpose: We examined the association between iron deficiency anemia (IDA) and severe maternal morbidity (SMM) during delivery and up to 1-year postpartum., Methods: In a retrospective cohort study across 3 states, we computed adjusted relative risks (aRR) for SMM comparing individuals with IDA versus those without, using modified Poisson regression models., Results: Among 2459,106 individuals, 10.3 % (n = 252,240) had IDA. Individuals with IDA experienced higher rates of blood transfusion and non-transfusion SMM (329 and 122 per 10,000 deliveries, respectively) than those without IDA (33 and 46 per 10,000 deliveries, respectively). The risk of blood transfusion (aRR: 8.2; 95 % CI 7.9-8.5) and non-transfusion SMM (aRR: 1.9; 95 % CI: 1.8-2.0) were higher among individuals with IDA. The attributable risk per 10,000 deliveries due to IDA for blood transfusion and non-transfusion SMM during delivery were 29.5 (95 % CI: 28.9-30.0) and 5.7 (95 % CI: 5.3-6.2), respectively. Within 1-year postpartum, the relative risk of non-transfusion SMM (aRR:1.3; 95 % CI: 1.2-1.3) was 30 % higher among individuals with IDA., Conclusion: IDA is associated with increased SMM risk. Addressing IDA in pregnant individuals may reduce SMM rates., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Nansi Boghossian reports financial support was provided by National Institute on Minority Health and Health Disparities. Samuel Nyarko reports financial support was provided by National Institute on Minority Health and Health Disparities. Lucy Greenberg reports financial support was provided by National Institute on Minority Health and Health Disparities. Molly Passarella reports financial support was provided by National Institute on Minority Health and Health Disparities. Scott Lorch reports financial support was provided by National Institute on Minority Health and Health Disparities. Ciaran Phibbs reports financial support was provided by National Institute on Minority Health and Health Disparities. George Saade reports financial support was provided by National Institute on Minority Health and Health Disparities. Jeff Buzas reports financial support was provided by National Institute on Minority Health and Health Disparities. None If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Despite the widespread prevalence of adolescent smoking in Gambia, a West African country, there is limited research exploring the relationships between exposure to pro-tobacco and anti-tobacco media messages and events and smoking behaviour among young people. This study investigates the interplay of these exposures and smoking behaviour among 11-17-year-old adolescents in Gambia., Methods: Secondary data analysis was conducted using the 2017 Gambia Global Youth and Tobacco Survey (GYTS), which included a total of 9,127 respondents. Descriptive and inferential analyses, including proportions, Pearson's chi-squared tests, and multivariable logistic regression models, were employed to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI)., Results: The final model revealed significant associations between exposure to anti-tobacco media messages and events and smoking behaviour. Adolescents exposed to anti-tobacco media messages had a 29% increased odds of smoking (aOR 1.29,CI = 1.08,1.53) compared to those unexposed, while exposure to anti-tobacco media events showed a 31% increased odds (aOR 1.31,CI = 1.09,1.59) compared to those unexposed. Exposure to pro-tobacco messages, such as witnessing tobacco use on TV (aOR 1.41, CI = 1.17,1.69) and owning objects with tobacco brand logos (aOR 1.49,CI = 1.19,1.86), was associated with higher odds of smoking. Covariates, including sex, age, and exposure to smoking behaviour by significant others, also demonstrated associations with smoking behaviour. Notably, male respondents showed significantly higher odds of smoking (aOR = 4.01,CI = 3.28,4.89) compared to females. Respondents aged 15 years and older had increased odds of smoking (aOR = 1.47,CI = 1.22,1.76) compared to those below 15 years old. Those whose fathers smoke displayed higher odds of smoking (aOR = 1.35, CI = 1.04,1.76) compared to individuals with non-smoking parents. Additionally, those whose closest friends smoke showed remarkably higher odds of smoking (aOR = 2.87,CI = 2.37, 3.48) compared to those without such influence., Conclusion: This study underscores the significant impact of exposure to both anti-tobacco and pro-tobacco media messages and events on smoking behaviour among adolescents in Gambia. However, pro-tobacco messages had a greater influence on smoking prevalence than anti-tobacco messages and events. Understanding these associations is crucial for devising effective public health interventions aimed at reducing tobacco use in this population., (© 2024. The Author(s).)

While light at night (LAN) and noise levels have been linked to suboptimal sleep outcomes, little is known about the link between these factors and long-term suboptimal sleep trajectories. The current study examined the association of neighborhood LAN and nighttime noise with long-term sleep trajectories in a cohort of Black individuals and White individuals predominantly from low-income communities. We used data from the Southern Community Cohort Study (N = 28,759 Black individuals and 16,276 White individuals). Sleep duration was self-reported at baseline and after an average of five years of follow-up, based on which we constructed nine sleep trajectories: normal-normal (optimal, reference), short-short, long-long, short-long, long-short, normal-short, normal-long, short-normal, and long-normal. LAN and nighttime noise were derived from satellite imagery and model-based estimates, respectively. Multinomial logistic regression was used to determine the relationship between LAN and noise exposures and sleep trajectories. Higher exposures to LAN and nighttime noise were associated with multiple suboptimal long-term sleep trajectories. In the total sample, higher LAN was associated with higher odds of long-long (OR Q5 vs. Q1 = 1.23 (CI = 1.02, 1.48)) and long-short (OR = 1.35 (CI = 1.06, 1.72)) trajectories, while higher nighttime noise was associated with short-short (1.19 (1.07, 1.31)), long-short (1.31 (1.05, 1.64)), and normal-song (1.16 (1.01, 1.34)) trajectories. Black and White individual-specific results showed qualitatively similar patterns between Black individuals and White individuals, although we also observed suggestive evidence for Black-White individual differences. In conclusion, elevated LAN and nighttime noise levels were associated with various suboptimal long-term sleep trajectories. However, it is noteworthy that the light and noise measures in our study may not accurately reflect individual-level exposures, and residual confounding from other factors is a concern. Future studies should use more accurate exposure measurements, collect information on and control for a wider range of factors, and examine whether reductions in neighborhood light and noise levels may contribute to improved long-term sleep health.

Background: Severe maternal morbidity has been increasing in the past few decades. Few studies have examined the risk of severe maternal morbidity among individuals with stillbirths vs individuals with live-birth deliveries., Objective: This study aimed to examine the prevalence and risk of severe maternal morbidity among individuals with stillbirths vs individuals with live-birth deliveries during delivery hospitalization as a primary outcome and during the postpartum period as a secondary outcome., Study Design: This was a retrospective cohort study using birth and fetal death certificate data linked to hospital discharge records from California (2008-2018), Michigan (2008-2020), Missouri (2008-2014), Pennsylvania (2008-2014), and South Carolina (2008-2020). Relative risk regression analysis was used to examine the crude and adjusted relative risks of severe maternal morbidity along with 95% confidence intervals among individuals with stillbirths vs individuals with live-birth deliveries, adjusting for birth year, state of residence, maternal sociodemographic characteristics, and the obstetric comorbidity index., Results: Of the 8,694,912 deliveries, 35,012 (0.40%) were stillbirths. Compared with individuals with live-birth deliveries, those with stillbirths were more likely to be non-Hispanic Black (10.8% vs 20.5%); have Medicaid (46.5% vs 52.0%); have pregnancy complications, including preexisting diabetes mellitus (1.1% vs 4.3%), preexisting hypertension (2.3% vs 6.2%), and preeclampsia (4.4% vs 8.4%); have multiple pregnancies (1.6% vs 6.2%); and reside in South Carolina (7.4% vs 11.6%). During delivery hospitalization, the prevalence rates of severe maternal morbidity were 791 cases per 10,000 deliveries for stillbirths and 154 cases per 10,000 deliveries for live-birth deliveries, whereas the prevalence rates for nontransfusion severe maternal morbidity were 502 cases per 10,000 deliveries for stillbirths and 68 cases per 10,000 deliveries for live-birth deliveries. The crude relative risk for severe maternal morbidity was 5.1 (95% confidence interval, 4.9-5.3), whereas the adjusted relative risk was 1.6 (95% confidence interval, 1.5-1.8). For nontransfusion severe maternal morbidity among stillbirths vs live-birth deliveries, the crude relative risk was 7.4 (95% confidence interval, 7.0-7.7), whereas the adjusted relative risk was 2.0 (95% confidence interval, 1.8-2.3). This risk was not only elevated among individuals with stillbirth during the delivery hospitalization but also through 1 year after delivery (severe maternal morbidity adjusted relative risk, 1.3; 95% confidence interval, 1.1-1.4; nontransfusion severe maternal morbidity adjusted relative risk, 1.2; 95% confidence interval, 1.1-1.3)., Conclusion: Stillbirth was found to be an important contributor to severe maternal morbidity., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Diabetes prevalence appears to be increasing in low- and middle-income countries, yet little is known about how hypertension status mediates the association between household wealth and diabetes. This study examined the mediation effects of hypertension in associations between household wealth and diabetes in eight sub-Saharan African (SSA) countries., Methods: This is a cross-sectional study of 71 577 women from recent Demographic and Health Surveys for eight SSA countries. Sample-weighted logistic regression and causal mediation analyses were conducted., Results: Of the 71 577 women, 1.1% (782) reported ever being diagnosed with diabetes. Women with diabetes were more likely to have hypertension compared with those without diabetes (54.9% vs 9.9%). The odds of diabetes were significantly higher among women with hypertension (adjusted odds ratio [OR] 5.71 [95% confidence interval {CI} 4.62 to 7.05]) and women from rich households (adjusted OR 1.65 [95% CI 1.23 to 2.22]) compared with their respective counterparts. Hypertension status mediated 27.4% of the association between household wealth and diabetes status., Conclusions: Hypertension status partly contributes to the associations between household wealth disparities and diabetes status among women in the selected countries. Further research and targeted interventions are needed to explore specific mechanisms and confounding factors related to household wealth disparities, hypertension status and diabetes prevalence in this population., (© The Author(s) 2024. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.)

Background: Anaemia has become a major public health concern among women in Sub-Saharan Africa (SSA). However, little is known about the spatial disparities in anaemia prevalence and their associated factors among pregnant women in the region. This study analysed the spatial disparities in anaemia and their associated factors among pregnant women in rural and urban settings in SSA., Methods: This is a secondary analysis of the most recent demographic and health surveys of 26 countries in SSA. Spatial autocorrelation and hotspot assessment were conducted, while a multivariate logistic regression model was used to identify demographic factors associated with anaemia., Results: Anaemia was reported among ~50% of pregnant women in urban and rural areas of SSA. The hotspot analysis identified the West African sub-region as having a higher concentration of anaemia cases in rural settings. In urban areas, the odds of anaemia were significantly higher among pregnant women in their second trimester (Adjusted OR = 2.39, CI = 1.99, 2.76). On the other hand, pregnant women in their third trimester (Adjusted OR = 1.98, CI = 1.77, 2.22) and those who had taken intestinal parasite drugs (Adjusted OR = 1.12 CI = 1.02, 1.23) had a higher likelihood of having anaemia in rural areas. Pregnant women aged 35-39 years (Adjusted OR = 0.52, CI = 0.33, 0.81) and those aged 40-44 years (Adjusted OR = 0.69, CI = 0.50, 0.95) had a lesser likelihood of having anaemia compared to women aged 15-19 years in urban and rural areas respectively. Compared to Congo DR, Benin (OR = 2.22, CI = 1.51, 3.28) and Mali (OR = 3.71, CI = 2.73, 5.05) had higher odds of anaemia in urban and rural areas respectively., Conclusions: Spatial disparities in anaemia persist among pregnant women in rural and urban settings in SSA. Prevailing spatial variations in anaemia may be addressed by specialised interventions considering the contextual residential settings and socio-economic factors highlighted in this study., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Evidence shows that intimate partner violence (IPV) occurs more frequently in sub-Saharan Africa (SSA) than in other regions of the world. However, limited empirical studies exist on the help-seeking behaviour of women who had experienced IPV in SSA. This study aimed to examine the help-seeking behaviour of women who had experienced IPV in SSA and the factors associated with their inability to seek help after experiencing IPV., Methods: This is a quantitative study based on data from the latest demographic and health surveys (DHS) of 24 SSA countries. A sample of 53,446 women aged 15-49 years was included in the study. Associations between women's background characteristics and their help-seeking behaviour after experiencing IPV were examined using proportions and multivariate logistic regression models., Results: Overall, 60.7% of the sample did not seek help after experiencing IPV. Women's inability to seek help for IPV was highest in Mali (80.4%) and lowest in Tanzania (43.1%). Women's level of education, wealth status, marital status, age, occupation, and country of residence had significant associations with 'not seeking help' for any type of IPV. Those who experienced generational violence (AOR = 1.26, CI = 1.19, 1.33) and those who justified wife-beating (AOR = 1.09, CI = 1.07, 1.15) had higher odds of not seeking help for any type of IPV compared to those who did not experience generational violence or did not justify wife beating. Women who experienced emotional violence (AOR = 0.53, CI = 0.51, 0.55) and physical violence (AOR = 0.74, CI = 0.70, 0.76) had lower odds of not seeking help for any type of IPV compared to their counterparts who did not experience these types of violence., Conclusion: Women's inability to seek help for IPV is common in many SSA countries. This study shows that several socio-demographic factors, such as women's age, educational levels, wealth status, and marital status are associated with their inability to seek help for IPV. Additionally, women's justification of wife beating and experience of generational abuse are strongly associated with their inability to seek help for IPV. These factors need to be considered critically in IPV interventions in SSA., (© 2023. The Author(s).)

Objective: To examine the association of neighborhood socioeconomic status (SES) with sleep duration among a large cohort of Black and white men and women in the United States., Methods: We used data from the Southern Community Cohort Study (SCCS, N = 75,248). Neighborhood SES was based on census data and sleep duration was measured by self-report. Multinomial logistic regression analysis was performed to assess the association between neighborhood SES and short (<7 hours) and long (≥9 hours) sleep in the overall sample and according to race-sex subgroups., Results: In the total sample, when compared with the highest quintile of neighborhood SES, the lowest quintile was associated with higher odds of both short (adjusted OR Q5 vs. Q1 [95% CI], 1.10 [1.03, 1.17]) and long sleep (1.37 [1.24, 1.52]). In race-sex specific analysis, the association between lower neighborhood SES and short sleep was only observed among white women (1.21 [1.05, 1.40]), but not in other subgroups. On the other hand, the association between lower neighborhood SES and long sleep duration was primarily observed among Black women (1.31 [1.06, 1.60])., Conclusions: The association between neighborhood SES and sleep duration varied among race-and-sex subgroups. These findings provide new evidence on the importance of considering individual sociodemographic characteristics in understanding the potential effects of neighborhood socioeconomic context on sleep health., (Copyright © 2023 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Stunting has been a major concern in sub-Saharan Africa. However, little evidence exists on the spatiotemporal variations in under-five stunting within a national context., Objective: This paper examines the spatiotemporal variations in under-five stunting and determinants using data from the Ethiopia Demographic and Health Surveys (2000-2016)., Methods: Spatial autocorrelation and multilevel logistic regression models were used to conduct the analyses., Results: The stunting prevalence has decreased from 51% to 37%, while the prevalence of severe stunting has decreased by more than half (from 28% to 12%). Wide regional variations in stunting have been consistently observed over the years, which exhibited a higher level of stunting in Tigray (48%), Afar (42%), and Amhara (42%). The results show considerable local and regional variations in under-five stunting levels with diverse patterns of improvements in regional stunting levels over time. Stunting levels were associated with child-level factors such as the sex of a child, birth size, age of a child, birth order, preceding birth interval, and place of birth. Maternal educational attainment, nutritional status, household wealth, toilet facility type, and place of residence were linked to under-five stunting. The regional-level infant mortality rate was associated with under-five stunting., Conclusions: Specially tailored policies and interventions should be devised to address persistent spatial inequalities in stunting by focusing on higher risk populations.

Background: Several studies have shown that unskilled birth attendance is associated with maternal and neonatal morbidity, disability, and death in sub-Saharan Africa (SSA). However, little evidence exists on prevailing geospatial variations and the factors underscoring the patterns of unskilled birth attendance in the region. This study analysed the geospatial disparities and factors associated with unskilled birth attendance in SSA., Methods: The study is based on data from thirty (30) SSA countries captured in the latest (2010-2019) demographic and health surveys (DHS). A total of 200,736 women aged between 15-49 years were included in the study. Geospatial methods including spatial autocorrelation and hot spot analysis as well as logistic regression models were used to analyse the data., Results: There were random spatial variations in unskilled birth attendance in SSA, with the main hotspot located in Chad, whereas South Africa and the Democratic Republic of Congo showed coldspots. Residence (urban or rural), wealth status, education, maternal age at the time of the survey and age at birth, desire for birth, occupation, media exposure, distance to a health facility, antenatal care visits, and deaths of under-five children showed significant associations with unskilled birth attendance., Conclusion: Random geospatial disparities in unskilled birth attendance exist in SSA, coupled with various associated socio-demographic determinants. Specific geospatial hotspots of unskilled birth attendance in SSA can be targeted for specialised interventions to alleviate the prevailing disparities., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Addo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Study Objectives: Sleep duration can change over the life course; however, previous studies rarely investigated the association between socioeconomic status (SES) and individual sleep trajectories over time. We examined the association between baseline socioeconomic characteristics and long-term sleep trajectories among Black and White adults., Methods: This study used data from the Southern Community Cohort Study (N = 45 035). Diverse trajectories of sleep duration were constructed using self-reported sleep duration at baseline and after ~10 years of follow-up. The associations between baseline socioeconomic characteristics and sleep trajectories were examined using multinomial logistic regression., Results: Both Black and White participants experienced similar long-term individual sleep trajectories for baseline educational attainment and employment status albeit the associations appeared stronger among White participants. Lower education and unemployment were associated with higher odds of various suboptimal sleep trajectories suggesting worsening long-term sleep patterns among both racial groups. However, there were some racial differences in the experience of long-term sleep trajectories for household income and neighborhood SES. Household income was notably more important among White than Black individuals; lower household income was associated with higher odds of more suboptimal long-term sleep trajectories for White than Black individuals. Also, neighborhood SES was slightly more important among White than Black individuals; lower neighborhood SES was associated with higher odds of a few suboptimal long-term sleep trajectories for both racial groups., Conclusions: Lower socioeconomic characteristics were associated with various suboptimal long-term sleep trajectories among Black and White participants. Substantial improvements in socio-economic characteristics may contribute to improved sleep patterns., (© The Author(s) 2022. Published by Oxford University Press on behalf of Sleep Research Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Unskilled birth attendance is a major public health concern in Sub-Saharan Africa (SSA). Existing studies are hardly focused on the socio-demographic correlates and geospatial distribution of unskilled birth attendance in Chad (a country in SSA), although the country has consistently been identified as having one of the highest prevalence of maternal and neonatal deaths in the world. This study aimed to analyse the socio-demographic correlates and geospatial distribution of unskilled birth attendance in Chad., Methods: The study is based on the latest Demographic and Health Survey (DHS) data for Chad. A total of 10,745 women aged between 15 and 49 years were included in this study. A multilevel analysis based on logistic regression was conducted to estimate associations of respondents' socio-demographic characteristics with unskilled birth attendance. Geographic Information System (GIS) mapping tools, including Getis-Ord Gi hotspot analysis tool and geographically weighted regression (GWR) tool, were used to explore areas in Chad with a high prevalence of unskilled birth attendance., Results: The findings show that unskilled birth attendance was spatially clustered in four Chad departments: Mourtcha, Dar-Tama, Assoungha, and Kimiti, with educational level, occupation, birth desire, birth order, antenatal care, and community literacy identified as the spatial predictors of unskilled birth attendance. Higher educational attainment, higher wealth status, cohabitation, lowest birth order, access to media, not desiring more births, and higher antenatal care visits were associated with lower odds of unskilled birth attendance at the individual level. On the other hand, low community literacy level was associated with higher odds of unskilled birth attendance in Chad whereas the opposite was true for urban residency., Conclusions: Unskilled birth attendance is spatially clustered in some parts of Chad, and it is associated with various disadvantaged individual and community level factors. When developing interventions for unskilled birth attendance in Chad, concerned international bodies, the Chad government, maternal health advocates, and private stakeholders should consider targeting the high-risk local areas identified in this study., (© 2022. The Author(s).)

Background: Although prior studies have established the association of asthma with smoking and obesity, literature on difference-in-differences analyses involving sexual identity is sparse. Therefore, this study aimed to examine the between and within sexual identity-group differences in asthma prevalence among individuals who smoke and are obese., Methods: We aggregated the 2017-2019 National Survey on Drug Use and Health data on adults ( N = 128,319) to perform weighted multivariable logistic regression analysis and marginal estimates and marginsplot to determine asthma prevalence by sexual identity and the status of smoking and obesity., Results: About 66% of the study population reported having asthma. Among the individuals with asthma, 42% were obese, 10% were daily cigarette smokers, and 6% identified as bisexual persons. Lesbian/gay daily smokers (86%) or former smokers (75%) had a higher probability of having asthma than bisexual (daily smokers = 78% vs former smokers = 72%) and heterosexual (daily smokers = 68% vs former smokers = 65%) persons. Within each sexual identity subgroup, daily smokers (68-86%) had the highest probability of asthma. Obese bisexual (73%) or lesbian/gay (72%) persons had higher probabilities of having asthma than heterosexual persons (69%). Obese (73%) or overweight (72%) bisexual (compared to normal weight = 70% or underweight = 51%) and obese (69%) or overweight (65%) heterosexual (compared to normal weight = 62% or underweight = 57%) persons had the highest probabilities of having asthma within their groups, whereas overweight persons (overweight = 81% vs underweight = 79%, normal weight = 78%, and obese = 72%) had the highest probabilities within lesbian/gay persons., Conclusions: Smoking and obesity show heightened odds for asthma, with significant odds for sexual minorities in asthma diagnosis relative to heterosexuals. These findings provide formative information for future longitudinal and experimental studies to explore these mechanisms of asthma risks among sexual and gender minorities., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2022 by Daedalus Enterprises.)

Objective: Child undernutrition is a global public health problem with serious implications. In this study, we estimate predictive algorithms for the determinants of childhood stunting by using various machine learning (ML) algorithms., Design: This study draws on data from the Ethiopian Demographic and Health Survey of 2016. Five ML algorithms including eXtreme gradient boosting, k-nearest neighbours (k-NN), random forest, neural network and the generalised linear models were considered to predict the socio-demographic risk factors for undernutrition in Ethiopia., Setting: Households in Ethiopia., Participants: A total of 9471 children below 5 years of age participated in this study., Results: The descriptive results show substantial regional variations in child stunting, wasting and underweight in Ethiopia. Also, among the five ML algorithms, xgbTree algorithm shows a better prediction ability than the generalised linear mixed algorithm. The best predicting algorithm (xgbTree) shows diverse important predictors of undernutrition across the three outcomes which include time to water source, anaemia history, child age greater than 30 months, small birth size and maternal underweight, among others., Conclusions: The xgbTree algorithm was a reasonably superior ML algorithm for predicting childhood undernutrition in Ethiopia compared to other ML algorithms considered in this study. The findings support improvement in access to water supply, food security and fertility regulation, among others, in the quest to considerably improve childhood nutrition in Ethiopia.

The pace of decline in fertility rates in sub-Saharan Africa appears to have slowed or stalled in the last few decades. This study examines the socioeconomic associated with cumulative fertility in Ghana. Negative binomial regression models were used to estimate determinants of cumulative fertility using data from the Ghana Demographic and Health Surveys of 2003, 2008, and 2014. The composition of children ever born by women did not change considerably over the study periods. Socioeconomic disparities in educational attainment, household wealth, employment, and employer status are significantly associated with cumulative fertility risks in Ghana. The current age of women, age at sexual debut, and marital status, among others, are also linked to cumulative fertility levels. Place and region of residence are also linked to fertility in Ghana. Cumulative fertility levels in Ghana are underscored by considerable socioeconomic disparities among women of reproductive age. Fertility regulation policies should hinge on improving the socio-economic wellbeing of women in Ghana., Competing Interests: The author has declared that no competing interests exist.

Childbirth outside marriage has several negative implications for the well-being of children, women, and families globally. In sub-Saharan Africa, however, the phenomenon appears to be under-studied. In this study, we examine the levels and socioeconomic correlates of nonmarital fertility in Ghana. Using pooled data from the 2003, 2008, and the 2014 Ghana Demographic and Health Surveys, logistic regression models were used in determining significantly predictive factors of nonmarital fertility. The results show that nonmarital fertility levels have been on the rise over time without any sign of reduction (24.0%, 33.0%, and 40.0% for 2003, 2008, and 2014, respectively). Some socioeconomic characteristics are linked to nonmarital fertility levels with women without formal education, women from poor households, and self-employed women having significantly higher nonmarital fertility risks. Also, older unmarried women, women who have an early sexual debut, cohabiters, women with unmet need for family planning are all associated with considerably higher risks of nonmarital childbearing. A few significant regional disparities also exist, with the Central Region having higher whereas the Upper West Region has lower risks of nonmarital fertility compared to the Greater Accra Region. Childbirth outside marriage is a social concern among women in Ghana. The findings have possible implications for bridging socioeconomic disparities among unmarried women., Competing Interests: The authors have declared that no competing interests exist.

There is a dearth of information on induced abortion in Ghana, possibly owing to the sensitive nature of the subject. In this study, we examine the effect of socioeconomic and contextual factors on induced abortion in Ghana. This study draws on data from the 2017 Ghana Maternal Health Survey. The study used a Bayesian multilevel logistic regression analysis to estimate both individual- and contextual-level factors affecting induced abortion levels in Ghana. The results show a total induced abortion prevalence of 19.6% coupled with considerable district-level disparities. Induced abortion is significantly associated with socioeconomic factors such as educational attainment, wealth status, and marital status at the individual-level. The risk of induced abortion is considerably higher among the educated, wealthy, and cohabiting women. The current age of women, age at first sex, religious affiliation, parity, and type of residence are the demographic factors having an association with induced abortion levels. At the contextual-level, district health insurance coverage and poverty rate have a significant association with induced abortion. Induced abortion appears to be prevalent in Ghana and is underpinned by both individual-level socioeconomic and aggregate-level factors. Addressing induced abortion levels in Ghana may require policies that take a multilevel approach by focusing on the socioeconomic status of women and district-level contextual factors., Competing Interests: The authors have declared that no competing interests exist

The literature on spatial patterns and contextual factors affecting modern contraceptive use is not well-documented in Ghana. This study describes the spatial variations and estimates the socioeconomic determinants of modern contraception among women in reproductive age in Ghana. Using data from the 2014 Ghana Demographic and Health Survey, both global and local Moran's I test were performed to show spatial autocorrelation and Bayesian multilevel models estimated to determine socioeconomic factors affecting modern contraceptive use. The results show evidence of low prevalence and spatial clustering of modern contraception use across the country. There were also notable regional disparities in contraceptive use that favour mostly the southern regions. Modern contraceptive use is significantly associated with socioeconomic factors such as educational attainment, work status, and marital status, as well as age, religious affiliation, and parity. Contextual factors such as the convenient location of health facility and family planning messages exposure also have a considerable positive effect on modern contraceptive use. Uneducated, unemployed and never-married women are considerably disadvantaged in the utilisation of modern contraception in Ghana. Socioeconomic and contextual factors play a key role in modern contraceptive use in Ghana., Competing Interests: The authors have declared that no competing interests exist

The uptake of HIV testing has always been found to be lower among men compared with women in many developing countries. The aim of this study was to ascertain the level and determinants of HIV testing uptake among men aged 15 to 59 in Ghana. This article was based on data from the 2003, 2008 and 2014 Ghana Demographic and Health Surveys. A bivariate statistical method was used to calculate the levels of uptake while three logit models were fitted to estimate the determinants of HIV uptake among the respondents. The total levels of the uptake of HIV testing among the respondents were 9.1%, 14.7% and 22.7% for 2003, 2008 and 2014, respectively; 15% overall. These were significantly determined by age, educational attainment, religious affiliation, wealth and work status, region of residence and media exposure. HIV testing uptake is very low among men in Ghana, albeit it has seen consistent improvements over the past years. Specially tailored HIV education and prevention programmes should be targeted at men in areas of low uptake, based on their different characteristics, in order to increase uptake.

Men have a critical role to play in reducing cervical cancer burden. Yet, there is little information on male involvement in the cervical cancer screening and treatment process in Ghana. In this study, we explore male knowledge and support during cervical cancer screening and treatment in a rural setting in Ghana. In-depth interviews and focus group discussions were conducted among a total of 41 respondents to collect qualitative data from cervical cancer patients, their male partners and other married men in the North Tongu District, Ghana. A thematic approach was used for data analysis and presentation of the results. The results show that male partners have little or no knowledge about cervical cancer. Some men provide various forms of support-financial, social, material and emotional-to their partners during the screening and treatment stages of the disease. Some men, however, abandoned their partners during the screening and treatment process of the disease. Men whose partners did not have cervical cancer said they were willing to provide financial, social, emotional and material support to their partners if they should contract the disease. Some men said they were willing to support their female partners but lacked education on the disease. This study underscores the need for cervical cancer education programmes to target Ghanaian men. The education should focus on the causes of the disease, screening and treatment methods of the disease, and, ultimately, promote spousal support during the screening and treatment processes., Competing Interests: The authors have declared that no competing interests exist.

Background: This study sought to explore the barriers to the uptake of cervical cancer screening and treatment in the North Tongu district of Ghana., Methods: Twenty-five in-depth interviews were conducted, while three focus group discussions were held among respondents. The data were analysed with the R package for qualitative data analysis using a thematic analytical approach., Results: Low level of knowledge about the disease and screening services, personal or psychological convictions, and cost of screening and treatment coupled with a low level of income were the barriers at the individual level. Perceived health personnel attitude, perceived lack of privacy, and misdiagnosis were the barriers at the institutional level while the sociocultural belief system of the communities about the etiology of the disease was the barrier at the community level. Inadequate education about the disease, lack of funding and access to screening facilities also constrained screening and treatment at the policy level., Conclusions: Cervical cancer screening and treatment are constrained at multiple levels in rural Ghana. This study underscores the need to address the low uptake of cervical cancer screening and treatment at the individual, community, institutional, and policy levels simultaneously., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper., (Copyright © 2019 Charity Binka et al.)

Objective: High under-five mortality has been identified as a major problem in many developing countries including Ethiopia. The main purpose of this study is to examine the effect of modern contraceptive use on under-five mortality in Ethiopia., Methods: The study draws on data from the 2011 and 2016 Ethiopia Demographic and Health Surveys. The Kaplan-Meier survival function was used to demonstrate the survival probabilities of children while a multivariate analysis using the Cox proportional hazards model was used to estimate the under-five mortality risks for various predictors., Results: The results show consistently higher survival probabilities for children of mothers who use modern contraceptives for all survival periods. Significant predictors of under-five mortality include modern contraceptive use, tetanus vaccinations, mother's age, child's sex, parity, postnatal checkup, marital status, and source of drinking water., Conclusion: Modern contraceptive use has a notable implication for the chances of under-five survival in Ethiopia. This underscores the importance of modern contraceptive use in the pursuit of a substantial reduction in under-five mortality in the country.

Background: Women's satisfaction with maternal healthcare services is vital in quality healthcare delivery. However, the dearth of in-depth information on the issue is a challenge in Ghana. In this study, we explore women's satisfaction with maternal care services at a health facility in the Ketu South Municipality, Ghana., Methods: This is a qualitative study that used a purposive sampling technique to select 15 women who attended a child welfare clinic at the facility for in-depth interviews. The interviews were tape-recorded, and the results presented in quotes in accordance with the themes that emerged., Results: The study found that respondents were generally satisfied with the quality of maternal healthcare services provided to them. However, they were dissatisfied with drug administration procedures at the facility. Respondents generally reported poor attitudes on the part of healthcare providers at the health facility. Some logistics were also reported to be in unfavorable condition. Nonetheless, respondents generally had positive perceptions about maternal care services provided to them by the healthcare facility., Conclusions: Drug administration procedures and attitude of healthcare providers toward clients as well as logistics need to be improved to enhance satisfaction with services at the health facility, particularly among pregnant women and mothers.

Background: Unintended pregnancy is seen as the key concept for better understanding the fertility and the unmet need for family planning of populations. It is seen as a major challenge among women in many developing countries including Ghana. However, there is scarcely nationally representative information on its prevalence and predictors in Ghana., Methods: In a cross-sectional study design, data for this study were extracted from the 2014 Ghana Demographic and Health Survey. The prevalence of unintended pregnancies was computed, and logit regression models were fitted to predict the factors influencing unintended pregnancies in the country., Results: The total prevalence of unintended pregnancies among pregnant women in Ghana was found to be 40%. Background characteristics such as age (OR=4.85, CI=1.48-15.84), level of education (OR=0.50, CI=0.26-1.01), marital status (OR=3.83, CI=1.67-8.75), parity (OR=0.13, CI=0.05-0.32), and region of residence (OR=0.11, CI=0.03-0.31) were the significant predictors of unintended pregnancy, net of unmet need for contraception. However, unmet need for contraception (OR=7.13, CI=1.57-8.91) serves as an independently significant predictor of unintended pregnancy regardless of the background characteristics of respondents., Conclusions: The study findings strongly underscore the need for significant improvement in the access to contraception methods and family planning information in the quest to considerably reduce unintended pregnancies in the entire country.

Background: The kaya business is known to pose significant health-related risks to female migrants. This study sought to explore the health-related concerns of female head porters in the Mallam Atta market, Accra, Ghana., Methods: A qualitative study was conducted in which twenty female head porters at the Mallam Atta market in Accra were interviewed. A thematic analysis was performed and the emerging themes were presented and supported with quotations from the respondents., Results: Poor accommodation and eating habits, harsh working conditions, and lack of knowledge about health conditions exposed the respondents to several health-related concerns like neck pains, skin rashes, malaria, cholera, and stomach ache among other infections. The popular means of seeking health care was through purchasing drugs from pharmacies or drug peddlers instead of health facilities. Financial constraints, lack of faith in the National Health Insurance Scheme, and long waiting periods at the health facilities militated against seeking appropriate health care at the hospitals and clinics., Conclusion: Political willpower needs to be strengthened for poverty reduction strategies such as training of hairdressing, dress and soap making, and shea butter processing for women from the Northern regions in order to ameliorate their livelihoods and/or reduce migration to the south.

Background: Cervical cancer is a very common disease among women in Ghana and in the world as a whole. However, there is a dearth of information on the mechanisms cervical cancer patients adopt to cope with the condition in Ghana. This study sought to explore the strategies adopted by cervical cancer patients in rural Ghana to cope with the disease., Methods: In-depth interviews were conducted to collect qualitative data from cervical cancer patients in a health facility in the Volta Region of Ghana. Data processing was done using the R software package for Qualitative Data Analysis (RQDA) and a thematic approach was used to analyse and present the results., Results: The results show that cervical cancer patients adopted personal and psychological strategies such as sexual abstinence, personal hygiene, and disease denial to cope with the condition. Respondents also described social, financial and non-material support services they received from family members and the church as critical resources, which helped them to manage the conditions of the disease. Respondents also reported that faith healing, herbal and orthodox medicines helped them to manage the symptoms of the disease., Conclusions: Cervical cancer patients used a variety of coping strategies to manage the disease. Yet, it will be essential for interventions to focus on strengthening knowledge about the disease. This study underscores the need for financial, social and material support as well as an encouragement of the use of health services among cervical cancer patients.

Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common disorders in early childhood. However, not many studies have been conducted on the prevalence and effect of ADHD on school performance in Ghana. This study sought to ascertain the prevalence of ADHD and its effect on school performance among primary school pupils in the Hohoe municipality of Ghana., Methods: This is a cross-sectional descriptive study that included 400 primary school pupils in the Hohoe Municipality of Ghana. The study adopted the disruptive behaviour disorder rating scale which includes the three subtypes of ADHD among pupils in the form of a close-ended questionnaire for data collection., Results: The results revealed the overall prevalence of ADHD to be 12.8%. The males had a higher prevalence (14.4%) compared to the females (10.5%). For the subtypes, the prevalence was 8.0% for attention-deficit disorder, 8.5% for hyperactivity disorder and 3.8% for the combined subtype. In terms of school performance, the results showed that there was a significant difference in the school performance between ADHD-positive pupils and the negative status pupils among the various core subjects., Conclusions: Attention-deficit/hyperactivity disorder was quite prevalent among primary school pupils in the Hohoe Municipality, and has impacted negatively on their school performance. Screening of pupils for ADHD should be integrated into the school health services to enable early detection and management.

Background: Preparedness of health care professionals for emergency situations is quite indispensable in quality health care; yet, information barely exists on the preparedness of health care professionals for emergency cases in health facilities in Ghana. This study sought to assess the preparedness of health professionals in preventing maternal mortality cases at a public health facility in Ghana., Methods: This is a qualitative study that used purposive and convenient sampling techniques to recruit 12 health care professionals for in-depth interviews. The interviews were tape-recorded, transcribed and the results presented in themes verbatim., Results: The results show that health care professionals at the hospital were ill-equipped to effectively handle maternal mortality cases in the municipality. As such, inadequate staff size and dearth of essential logistics militate against the preparedness of health care professionals in curbing maternal mortality., Conclusions: More health care professionals and essential logistics should, therefore, be provided by the Ghana Health Service to augment the existing ones.

Cervical cancer is becoming a leading cause of death among women in developing countries. Nevertheless, little is known regarding knowledge and perception of cervical cancer and screening behaviour particularly among female tertiary students in Ghana. This study sought to examine the knowledge and perceptions of cervical cancer and screening behaviour among female students in the University of Cape Coast and Ghana Institute of Management and Public Administration in Ghana. A cross-sectional survey design was adopted for the study. Systematic and stratified random sampling techniques were used to select 410 participants for the study. The study found that the participants lacked knowledge on specific risk factors and symptoms of cervical cancer. Also, even though the participants had a fair perception of cervical cancer, they had a poor cervical cancer screening behaviour. Awareness of cervical cancer was significantly influenced by religious affiliation while cervical cancer screening was significantly determined by the working status of the participants. Specific knowledge on cervical cancer and its risk factors as well as regular screening behaviour is paramount to the prevention of cervical cancer. Consequently, the University Health Services should focus on promoting regular cervical cancer awareness campaigns and screening among the students particularly, females.

Background: There is dearth of information on contraceptive use among women in reproductive age in Ghana over time. This study sought to examine the trends in contraceptive practices among women in reproductive age in a health facility in Ghana in terms of acceptor rates, age at first reporting and couple-years of protection., Methods: The contraceptive data of women were extracted from the registry of a health facility for a three-year period from 2011 to 2013. Graphs and tables were used to present the trends in the use of various contraceptive methods for the study period., Results: Depot Medroxyprogesterone Acetate (Depo-Provera) was the most accepted contraceptive method as well as the most protective method against unwanted pregnancies for the three-year period. However, male condom, estradiol valerate/norethindrone enanthate (Norigynon) and pills were the lowest among all the contraceptives used by women for the study period in terms of acceptance, while intra-uterine device had the lowest couple-years of protection., Conclusions: Some contraceptive methods have been consistently under-utilised by women in the catchment area and needed to be promoted to improve upon the contraceptive use rate.

Background. Hypertension is a global health problem. Yet, studies on hypertension rarely focus on women in Ghana. The purpose of this study is to ascertain the prevalence and sociodemographic determinants of hypertension history among Ghanaian women in reproductive age. Methods. This study used data from the 2014 Ghana Demographic and Health Survey. Bivariate and logistic regression analyses were carried out to ascertain the prevalence and determinants of hypertension history among the respondents. Results. The study found that the overall prevalence of hypertension history among the respondents was 7.5%; however, there were vast variations within most of the sociodemographic categories. Age, level of education, marital status, work status, and wealth status had a significant relationship with hypertension history among the respondents. Women in advanced age groups, highly educated, married, and widowed/divorced/separated, nonworking women, and women from wealthy households were at higher risk of having hypertension history. Conclusion. Myriads of sociodemographic factors determine the hypertension history of women in Ghana. It is therefore essential to target medical and psychosocial hypertension interventions at Ghanaian women in the higher risk groups.

Background: Adolescence is a critical stage in the life course and evidence suggests that even though contraceptive use has been steadily increasing among women in Ghana over the past years, contraceptive prevalence and determinants among female adolescents is quite lacking. This paper examines the prevalence and correlates of contraceptive use among female adolescents in Ghana., Methods: The paper used data from the 2008 Ghana Demographic and Health survey. Bivariate analysis was carried out to determine the contraceptive prevalence among female adolescents while logistic regression analysis was applied to examine the correlates of female adolescent contraceptive use., Results: The study founded that female adolescent contraceptive use was significantly determined by age of adolescent, education, work status, knowledge of ovulatory cycle, visit of health facility and marital status., Conclusions: This has implications for adolescent sexual and reproductive health programmes in Ghana. It is therefore essential to intensify girl child education and strengthen the provision of family planning information and services for female adolescents in the country.

Background: There is little empirical literature on the effects of infertility on marital relationships in Ghana. This study sought to examine the effects of infertility on marital relationship among fertility clients at a Public Hospital in Accra, Ghana., Results: The study revealed that infertility negatively affected the sexual life of participants as they generally reported that even though they still had regular sexual intercourse with their partners after realising they were infertile (61.6 %), sex was only for the purpose of reproduction and not for mutual sexual satisfaction (68.8 %). Sexual intercourse was reported to be unfulfilling as well as unenjoyable (64.3 %). The psychological well-being of participants (87.5 %) and stability within marital unions were also negatively affected by infertility, resulting in quarrels (72.3 %)., Conclusions: Infertility has numerous negative implications for marital relationship. Thus, infertile persons should not be only physically examined and treated for infertility, but should also be given counselling to lessen the psychological trauma attached to infertility.

Background. Malaria is an entrenched global health challenge particularly in the sub-Saharan African countries. However, in Ghana, little is known about the determinants of malaria prevalence among under-five children. As such, this study sought to examine the sociodemographic factors that determine malaria among under-five children in Ghana. Methods. This paper used secondary data drawn from the 2008 Ghana Demographic and Health Survey. Bivariate analysis and complementary log-log regression models were used to examine the determinants of malaria prevalence among under-five children in Ghana for the study period. Results. The results therefore revealed that region of residence, age of child, and ownership of mosquito net were the key predictors of malaria cases among under-five children in Ghana for the five-year period preceding the survey. Conclusion. It is therefore imperative that special education on prevention of malaria should be intensified by the National Malaria Control Programme in all the regions in order to reduce malaria prevalence particularly among under-five children in Ghana.