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Colbourn T, Janoušková E, Li Lin I, Collins J, Connolly E, Graham M, Jewel B, Kachale F, Mangal T, Manthalu G, Mfutso‐Bengo J, Mnjowe E, Mohan S, Molaro M, Ng'ambi W, Nkhoma D, Revill P, She B, Manning Smith R, Twea P, Tamuri A, Phillips A, Hallett TB. Modeling Contraception and Pregnancy in Malawi: A Thanzi La Onse Mathematical Modeling Study. Stud Fam Plann 2023; 54:585-607. [PMID: 38129327 PMCID: PMC10941698 DOI: 10.1111/sifp.12255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Malawi has high unmet need for contraception with a costed national plan to increase contraception use. Estimating how such investments might impact future population size in Malawi can help policymakers understand effects and value of policies to increase contraception uptake. We developed a new model of contraception and pregnancy using individual-level data capturing complexities of contraception initiation, switching, discontinuation, and failure by contraception method, accounting for differences by individual characteristics. We modeled contraception scale-up via a population campaign to increase initiation of contraception (Pop) and a postpartum family planning intervention (PPFP). We calibrated the model without new interventions to the UN World Population Prospects 2019 medium variant projection of births for Malawi. Without interventions Malawi's population passes 60 million in 2084; with Pop and PPFP interventions. it peaks below 35 million by 2100. We compare contraception coverage and costs, by method, with and without interventions, from 2023 to 2050. We estimate investments in contraception scale-up correspond to only 0.9 percent of total health expenditure per capita though could result in dramatic reductions of current pressures of very rapid population growth on health services, schools, land, and society, helping Malawi achieve national and global health and development goals.
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Mohamed S, Chipeta MG, Kamninga T, Nthakomwa L, Chifungo C, Mzembe T, Vellemu R, Chikwapulo V, Peterson M, Abdullahi L, Musau K, Wazny K, Zulu E, Madise N. Interventions to prevent unintended pregnancies among adolescents: a rapid overview of systematic reviews. Syst Rev 2023; 12:198. [PMID: 37858208 PMCID: PMC10585784 DOI: 10.1186/s13643-023-02361-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
Risks associated with unintended pregnancy include unsafe abortions, poor maternal health-seeking behaviour, poor mental health, and potentially, maternal and infant deaths. Adolescent girls with unintended pregnancies are particularly vulnerable as they are at higher risk of eclampsia, premature onset of labour, and increased neonatal morbidity and mortality. Unintended pregnancy, with the right combination of interventions, can be avoided. Evidence-based decision-making and the need for a robust appraisal of the evidence have resulted in many systematic reviews. This review of systematic reviews focuses on adolescent pregnancy prevention and will seek to facilitate evidence-based decision-making. Two review authors independently extracted data and assessed the methodological quality of each review according to the AMSTAR 2 criteria. We identified three systematic reviews from low- and middle-income countries and high-income counties and included all socioeconomic groups. We used vote counting and individual narrative review summaries to present the results. Overall, skill-building, peer-led and abstinence programmes were generally effective. Interventions focused on information only, counselling and interactive sessions provided mixed results.In contrast, exposure to parenting and delaying sexual debut interventions were generally ineffective. Adolescent pregnancy prevention interventions that deploy school-based primary prevention strategies, i.e. strategies that prevent unintended pregnancies in the first place, may effectively reduce teenage pregnancy rates, improve contraceptive use, attitudes and knowledge, and delay sexual debut. However, the included studies have methodological issues, and our ability to generalise the result is limited.
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Affiliation(s)
- Sahra Mohamed
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Michael G Chipeta
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi.
| | | | - Lomuthando Nthakomwa
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Chimwemwe Chifungo
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Themba Mzembe
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Ruth Vellemu
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Victor Chikwapulo
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Maame Peterson
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Leyla Abdullahi
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Kelvin Musau
- The Children's Investment Fund Foundation, Nairobi, Kenya
| | - Kerri Wazny
- The Children's Investment Fund Foundation, London, UK
| | - Eliya Zulu
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Nyovani Madise
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
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Chen X, Prata Menezes N, Rusatira JC, Cardona C, Odeku M, Kioko D, Castro J, Ibeawuchi C, Lincoln JS, Ng'wanansabi D, Macha J, Msemo A, Yusuph N, Rimon JG. Demographic dividend-favorable policy environment in two pre-dividend African nations: review of national policies and prospects for policy amendments in Nigeria and Tanzania. BMC Public Health 2023; 23:1070. [PMID: 37277812 DOI: 10.1186/s12889-023-15690-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 04/16/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND In collaboration with local partners, we reviewed 18 national policy documents across two sub-Saharan African countries identified as pre-dividend nations by the World Bank in 2017: Nigeria and Tanzania. Our aim was to assess national policies in pre-dividend countries and to determine whether national strategies were primed to capitalize on changing demographic structures, maximally attain the demographic dividend, and augment socio-economic growth. METHODS We conducted policy reviews by focusing on five key sectors of the Gates Institute Demographic Dividend Framework: Family Planning, Maternal and Child Health, Education, Women's Empowerment, and Labor Market. This framework was developed as a tool for countries to apply targeted policies for accelerating the demographic dividend based on their demographic structure. For each component we used a comprehensive list of indicators, defined via a systematic literature review, through which we assessed national policies aimed at maximizing the demographic dividend. RESULTS Between the two countries, we observed persistent gaps in policies targeting family planning. Although more comprehensive, policies addressing maternal and child health, education, women's empowerment, and labor market still lagged in their specificity and measurability. We identified specific policy amendments and alternatives that Nigeria and Tanzania could consider to mitigate these gaps. We also stress the importance of designing measurable policy initiatives across sectors. CONCLUSIONS Based on these recommendations, as Nigeria, Tanzania, and other pre-dividend nations start experiencing rapid demographic changes, they may consider implementing routine policy reviews to strengthen policies across the five key sectors and harness the benefits of a demographic dividend.
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Affiliation(s)
- Xiaomeng Chen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neia Prata Menezes
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA.
| | | | - Carolina Cardona
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mojisola Odeku
- Centre for Communication Programs Nigeria, Lagos, Nigeria
| | - Deanna Kioko
- Centre for Communication Programs Nigeria, Lagos, Nigeria
| | - Jessica Castro
- Centre for Communication Programs Nigeria, Lagos, Nigeria
| | | | | | - Deo Ng'wanansabi
- Tanzania Communication and Development Center, Dar Es-Salaam, Tanzania
| | - Jacob Macha
- Tanzania Communication and Development Center, Dar Es-Salaam, Tanzania
| | - Abubakar Msemo
- Tanzania Communication and Development Center, Dar Es-Salaam, Tanzania
| | - Nazir Yusuph
- Tanzania Communication and Development Center, Dar Es-Salaam, Tanzania
| | - Jose G Rimon
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Rusatira JC, Cardona C, Martinez-Baack M, Rimon JG, Ahmed S. Development of the Demographic Dividend Effort Index, a novel tool to measure existing efforts to create a favourable environment to harness a demographic dividend: results from an experts' survey from six sub-Saharan African countries. BMJ Open 2023; 13:e059937. [PMID: 36958778 PMCID: PMC10040031 DOI: 10.1136/bmjopen-2021-059937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
OBJECTIVE This study aimed to develop a tool to measure the extent of national efforts in policies, services, research and programmes implemented to cultivate and harness the benefits of a potential demographic dividend in six sub-Saharan African countries. DESIGN The survey was self-administered online using the SurveyMonkey platform. The survey questionnaire covered six key sectors: family planning, maternal and child health, education, women's empowerment, labour market, and governance and economic institution. Each sector-specific questionnaire was structured around five practice domains: policymaking, services and programmes, advocacy, research and civil society. Each item was scored from 1 to 10. Factor analysis was used to select the items to be retained for final score estimation. Simple averages were computed to estimate sectoral and domain scores and overall country scores were estimated using weighted country mean scores. Internal consistency, construct validity and reliability were examined using factor analysis and Cronbach's alpha. SETTING Sub-Saharan Africa. PARTICIPANTS A total of 440 knowledgeable informants from six countries; namely, Ethiopia (73), Kenya (69), Nigeria (67), Rwanda (54), Senegal (81) and Tanzania (96). RESULTS Based on the results from factor analysis, 38 items were dropped from the analysis and Cronbach's alpha results ranged from 0.84 to 0.98 across domains. The overall demographic dividend effort index (DDEI) scores ranged between 5.4 (95% CI 5.1 to 5.8) in Ethiopia to 7.7 (95% CI 7.5 to 8.0) in Rwanda. In most countries, the disaggregated scores by sector revealed low scores in the labour market and women's empowerment. CONCLUSION The DDEI scores highlight important gaps in key health and development sectors. The DDEI proved to be a reliable and internally consistent tool for effort measurement in key demographic dividend sectors. The DDEI can serve as a self-evaluation tool for local actors and may complement existing quantitative tools such as the Global Gender Gap and the Human Capital Index.
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Affiliation(s)
- Jean Christophe Rusatira
- Population Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Carolina Cardona
- Population Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Michelle Martinez-Baack
- Population Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jose G Rimon
- Population Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Saifuddin Ahmed
- Population Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Mkwananzi S. Gender differentials of contraceptive knowledge and use among youth – evidence from demographic and health survey data in selected African countries. Front Glob Womens Health 2022; 3:880056. [DOI: 10.3389/fgwh.2022.880056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022] Open
Abstract
Improving family planning demand and uptake has both social and economic benefits, including increasing education attainment, reducing poverty and increased participation in the labour force. Also, contraceptive use remains a key driver in Africa to facilitate demographic transition and the demographic dividend. However, numerous challenges have prevented the take-up of contraception across the continent. This is more so the case among African youth that present the lowest levels of contraceptive use in sub-Saharan Africa. Therefore, the objective of this research was to examine gender differences in contraceptive use and knowledge of sexually active young people (15–24 years) in sub-Saharan African countries. This study used data from nine countries in sub-Saharan Africa through the Demographic and Health Surveys (DHSs) of Benin, Democratic Republic of Congo, Lesotho, Namibia, Niger, Rwanda, Senegal, South Africa and Zimbabwe. Data analysis entailed frequency distributions and cross-tabulations to describe the gender-differentiated levels of contraceptive use and knowledge among youth. Additionally, logistic regression showed the gender-specific predictors of contraceptive use for African youth. Our findings present the gender-specific predictors of contraceptive use and will contribute to policy and programme formulation for African countries and organisations that promote contraceptive use.
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