1
|
Kong Y, Chen S, Ma N, Chen Z, Karoli P, Niyi JL, Fan P, Fink G, Kwete XJ, Wehrmeister FC, Cheng F, Wang D, Zemene MA, Gatimu SM, Khan N, Rahman A, Fekadu L, Shibre G, Rahmartani LD, Aheto JMK, Geldsetzer P, Li Z. Association between concurrence of multiple risk factors and under-5 mortality: a pooled analysis of data from Demographic and Health Survey in 61 low-and-middle-income countries. EClinicalMedicine 2024; 71:102583. [PMID: 38618201 PMCID: PMC11015335 DOI: 10.1016/j.eclinm.2024.102583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/13/2024] [Accepted: 03/19/2024] [Indexed: 04/16/2024] Open
Abstract
Background Exposure to multiple risk factors is prevalent in low-and middle-income countries (LMICs), challenging one-directional strategies to address preventable under-5 mortality (U5M). This study aims to assess the associations between concurrence of multiple risk factors and U5M in LMICs. Methods We extracted data from the Demographic and Health Surveys conducted between 2010 and 2021 across 61 LMICs. Our primary outcome was U5M, defined as deaths from birth to 59 months. Binary logistic regression model was applied to ascertain the association between U5M and a total of 20 critical risk factors. Upon identifying the risk factors demonstrating the strongest associations, we investigated the simultaneous presence of multiple risk factors in each individual and assessed their combined effects on U5M with logistic regression models. Findings Of the 604,372 under-5 children, 18,166 (3.0%) died at the time of the survey. Unsatisfied family planning needs was the strongest risk factor for U5M (odds ratio [OR]: 2.0, 95% confidence interval [CI]: 1.9-2.1), followed by short birth interval (<18 months; OR: 2.0, 95% CI: 1.9-2.1), small birth size (OR: 2.0, 95% CI: 1.8-2.1), never breastfed or delayed breastfeeding (OR: 2.0, 95% CI: 1.9-2.0), and low maternal education (OR: 1.6, 95% CI: 1.4-1.8). 66.7% (66.6%-66.8%) of the children had 2 or more leading risk factors simultaneously. Simultaneous presence of multiple leading risk factors was significantly associated with elevated risk of U5M and children presenting with all 5 leading risk factors exhibited an exceedingly high risk of U5M (OR: 5.2, 95% CI: 4.3-6.3); a dose-response relationship between the number of risk factors and U5M was also observed-with the increment of numbers of leading risk factors, the U5M showed an increasing trend (p-trend < 0.001). Interpretation Exposure to multiple risk factors is very common in LMICs and underscores the necessity of developing multisectoral and integrated approaches to accelerate progress in reducing U5M in line with the SDG 3.2. Funding This research is funded by Research Fund, Vanke School of Public Health, Tsinghua University.
Collapse
Affiliation(s)
- Yuhao Kong
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Shaoru Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Ning Ma
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Zekun Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Peter Karoli
- National Institute for Medical Research, Dar es salaam, Tanzania
| | - John Lapah Niyi
- Ghana Health Service, Gushegu Municipal Health Directorate, Gushegu, Ghana
| | - Pengyang Fan
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Günther Fink
- Swiss TPH and University of Basel, Basel, Switzerland
| | | | - Fernando C. Wehrmeister
- Department of Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Institute for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Feng Cheng
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, 100084, Beijing, China
| | - Dongqing Wang
- Department of Global and Community Health, College of Public Health, George Mason University, Fairfax, VA, USA, 22030
| | - Melkamu Aderajew Zemene
- Department of Public Health, College of Health sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Nuruzzaman Khan
- Centre for Women's Health Research, Faculty of Health and Medicine, University of Newcastle, Australia
| | - Ashfikur Rahman
- Development Studies Discipline, Social Science School, Khulna University, Bangladesh
| | - Lelisa Fekadu
- Health Economist, Health Economics and Financing Program, Africa CDC, Addis Ababa, Ethiopia
| | - Gebretsadik Shibre
- Department of Reproductive, Family, and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lhuri Dwianti Rahmartani
- Faculty of Public Health, Department of Epidemiology, Universitas Indonesia, Depok, Jawa Barat, Indonesia
| | - Justice Moses K. Aheto
- Department of Biostatistics, School of Public Health, University of Ghana, Ghana
- WorldPop, School of Geography and Environmental Science, University of Southampton, United Kingdom
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- Chan Zuckerberg Biohub – San Francisco, CA, USA
| | - Zhihui Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Institute for Healthy China, Tsinghua University, 100084, Beijing, China
| |
Collapse
|
2
|
Endriyas M, Kassa M, Chisha Y, Mekonnen E, Misganaw T, Loha E, Astatkie A. Low long-lasting insecticidal net use in malaria elimination areas in Southern Ethiopia: results from community based cross-sectional study. Malar J 2024; 23:94. [PMID: 38575937 PMCID: PMC10996104 DOI: 10.1186/s12936-024-04909-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/13/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Despite remarkable progress in malaria burden reduction, malaria continues to be a major public health problem globally. Ethiopia has been distributing long-lasting insecticidal nets (LLINs) for free and nationwide distribution was completed in 2016. However, evidence suggests that the utilization of LLINs varies from setting to setting and from time to time due to different factors, and up-to-date evidence is required for LLIN related decision-making. Hence, this study was designed to assess LLIN utilization and its determinants in the Southern Nations, Nationalities, and People's Region (SNNPR) of Ethiopia. METHODS A community-based cross-sectional study was conducted in Southern Ethiopia in 2019. Using multi-stage sampling, a total of 2466 households were included. The region was stratified based on the annual malaria index as high, moderate, low, and free strata. Cluster sampling was then applied to select households from high, moderate, and low strata. Data on LLIN ownership, utilization and different determinant factors were collected using household questionnaire. SurveyCTO was used to collect data and data was managed using Stata 15. Descriptive statistics and multilevel mixed-effects logistic regression were performed to identify the determinants of utilization of LLINs. Effect measures were reported using adjusted odds ratio (AOR) with 95% CI. RESULTS From a total of 2466 households, 48.7% of households had at least one LLIN. LLIN adequacy based on family size was 23% while it was15.7% based on universal access and 29.2% based on sleeping space. From 1202 households that possessed LLIN(s), 66.0% of households reported that they slept under LLIN the night preceding the survey. However, when the total population in all surveyed households were considered, only 22.9% of household members slept under LLIN the night preceding the survey. Malaria endemicity, educational status, wealth status, and knowledge about malaria were associated with LLINs utilization. In addition, reasons for non-use included perceived absence of malaria, side effects of LLIN, conditions of LLINs, inconvenient space and low awareness. CONCLUSION Low LLIN coverage and low utilization were noted. A low level of utilization was associated with malaria endemicity, wealth status and level of awareness. Distribution of LLIN and continuous follow-up with community awareness creation activities are vital to improve coverage and utilization of LLINs, and to ensure the country's malaria elimination goal.
Collapse
Affiliation(s)
| | - Mekidim Kassa
- College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia
| | - Yilma Chisha
- College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia
| | | | | | - Eskindir Loha
- Centre for International Health, University of Bergen, Bergen, Norway
- Chr. Michelsen Institute, Bergen, Norway
| | - Ayalew Astatkie
- School of Public Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| |
Collapse
|
3
|
Kawuki J, Donkor E, Gatasi G, Nuwabaine L. Mosquito bed net use and associated factors among pregnant women in Rwanda: a nationwide survey. BMC Pregnancy Childbirth 2023; 23:419. [PMID: 37280560 DOI: 10.1186/s12884-023-05583-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/07/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND In malaria-endemic countries such as Rwanda, the appropriate use of mosquito bed nets is an effective intervention for malaria prevention. Despite being one of the demographics most impacted by malaria, there is a dearth of literature on the usage of mosquito bed nets by pregnant women in Rwanda. The study aimed to assess the prevalence and associated factors for mosquito bed net use among pregnant women in Rwanda. METHODS We used weighted data from the 2020 Rwanda Demographic and Health Survey of 870 pregnant women, and multistage stratified sampling was used to select participants. Multivariable logistic regression was conducted to determine the factors associated with mosquito bed net use, using SPSS (version 26). RESULTS Of the 870 pregnant women, 57.9% (95%CI: 54.6-61.1) used mosquito bed nets. However, 16.7% did not use bed nets among those owning bed nets. On one hand, older age (AOR = 1.59, 95%CI: 1.04-2.44), primary education (AOR = 1.18, 95%CI: 1.07-2.23), being married (AOR = 2.17, 95%CI: 1.43-3.20), being from Kigali region (AOR = 1.97, 95%CI: 1.19-3.91), partner's education (AOR = 1.22, 95%CI: 1.13-3.41), having recently visited a health facility (AOR = 2.07, 95%CI: 1.35-3.18), and being in the third pregnancy trimester (AOR = 2.14, 95%CI: 1.44-3.18) were positively associated with mosquito bed net use. On the other hand, low wealth index (AOR = 0.13, 95%CI: 0.07-0.24), and being from Eastern region (AOR = 0.42, 95% CI: 0.26-0.66) had a negative association. CONCLUSIONS About half of the pregnant women in Rwanda used mosquito bed nets and the usage was associated with various socio-demographics. There is a need for appropriate risk communication and continuous sensitisation to improve mosquito net use among pregnant women. Early antenatal care attendance and partner engagement in malaria prevention and mosquito net use, as well as consideration of household dynamics, are also crucial in improving not only mosquito net coverage but also utilization.
Collapse
Affiliation(s)
- Joseph Kawuki
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Elorm Donkor
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Ghislaine Gatasi
- Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Nanjing, Jiangsu Province, 210009, China
| | - Lilian Nuwabaine
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda
| |
Collapse
|