No evidence, no problem? A critical interpretive synthesis of the vulnerabilities to and experiences of sexual violence among young migrants in Europe

BACKGROUND

Growing evidence indicates that young migrants are particularly vulnerable to sexual violence, however most research has focused on instances of sexual violence occurring in conflict zones and during transit. Much less attention has been given to the vulnerabilities to and experiences of sexual violence among young migrants in Europe.

OBJECTIVES

To understand the scientific evidence regarding the experiences of and vulnerabilities to sexual violence among young migrants (aged 11-30 years) in Europe.

METHODS

A search of three databases resulted in 1279 peer reviewed articles published between 2002 and 2022. Of these, 11 were included in this review. A critical interpretive synthesis methodology was applied.

RESULTS

Few studies investigate sexual violence among young migrants in Europe. The existing studies focus on very specific sub-groups of migrants, and as such, experiences of persons outside these groups are largely absent from the academic discourse. How sexual violence is understood varies across studies, often conflated with other forms of violence, hampering comparisons. However, the results of this review indicate that young migrants in Europe, both male and female, experience sexual violence and there are multiple sources of vulnerabilities at all levels of the socioecological model.

CONCLUSION

The scarcity of research regarding sexual violence among young migrants in Europe could give rise to the perception that no evidence means no problem, resulting in a continued lack of attention to this issue. There is a critical need to address this gap to inform prevention interventions, to identify victims, and to facilitate access to care.

Coming across a hidden problem in an excluded population in Sweden: professionals' experiences of young migrants' disclosures of sexual violence

Growing evidence suggests that young migrants are particularly vulnerable to sexual violence. As young migrants often lack family and social networks, professionals are often the recipients of disclosures of sexual violence. This study aimed to explore how professionals experience young migrants' disclosures of sexual violence. A qualitative design was used, based on 14 semi-structured interviews with a range of professionals from the public sector and civil society in southern Sweden. The data were analysed using qualitative content analysis. The overarching theme developed was 'coming across the hidden problem of sexual violence in an excluded population' supported by three sub-themes: 'linking structural marginalisation and vulnerability to sexual violence'; 'realising that sexual violence is one among many other concerns'; and 'taking pride in backing up young people betrayed by society'. Professionals expressed a strong sense of responsibility due to the complex vulnerabilities of young migrants and their lack of access to services. This, coupled with the lack of clarity about how to respond to disclosures of sexual violence, can lead to moral distress. There is a need to strengthen support for professionals, including recognition of ethical dilemmas and the establishment of formal connections between organisations making access more straightforward and predictable.

Enablers of sexual and reproductive health and rights interventions in low- and middle-income countries. Insights from capacity development projects implemented in 13 countries in Africa and Asia

Background

The global community has committed to achieving universal access to sexual and reproductive health and rights (SRHR) services, but how to do it remains a challenge in many low-income countries. Capacity development is listed as a means of implementation for Agenda 2030. Although it has been a major element in international development cooperation, including SRHR, its effectiveness and circumstances under which it succeeds or fails have limited evidence.

Objective

The study sought to examine whether improvement in team capacity of SRHR practitioners resulted in improved organisational effectiveness and/or improved SRHR outcomes in low-income countries.

Methods

The study involved 99 SRHR interventions implemented in 13 countries from Africa and Asia. Self-reported evaluation data from healthcare practitioners who participated in a capacity development international training programme in SRHR was used. The training was conducted by Lund University in Sweden between 2015 and 2019. Logistic regression models were used to examine the association between improved team capacity, improved organizational effectiveness and improved SRHR outcomes, for all the 99 interventions. Adoption of new SRHR approaches (guidelines and policies), media engagement, support from partner organisations and involvement of stakeholders were assessed as possible confounders.

Results

Improved team capacity, support from partner organisations and media engagement were positively associated with improved organisational effectiveness. Improved team capacity was the strongest predictor of organisational effectiveness even after controlling for other covariates at multivariate analysis. However, adopting new SRHR approaches significantly reduced organisational effectiveness. Furthermore, support from partner organisations was positively associated with increased awareness of and demand for SRHR services.

Conclusions

Successful implementation of capacity development interventions requires an enabling environment. In this study, an SRHR training programme aiming at improving team capacity resulted in an improvement in organisational effectiveness. Support from partner organisations and media engagement were key enablers of organisational effectiveness.

Survival patterns of neonates born to adolescent mothers and the effect of pregnancy intentions and marital status on newborn survival in Kenya, Uganda, and Tanzania, 2014-2016

Background

Adolescent pregnancy and associated neonatal mortality are major global health challenges. In low-income settings where 90% of the 21 million global adolescent pregnancies occur, half are unintended and a fifth experience unsafe abortion. In Kenya, Uganda, and Tanzania, the survival patterns of neonates born to adolescents are unclear.

Objectives

To assess survival patterns among neonates born to adolescents and the effect of pregnancy intentions and marital status on survival in Kenya, Uganda, and Tanzania.

Methods

Cross-sectional data from demographic and health surveys in Kenya, Uganda, and Tanzania 2014–2016 were used. Kaplan-Meier estimates investigated patterns of neonatal survival among adolescent mothers, aged 15–19 years, compared to mothers aged 20–29 years. Cox proportional hazards regression determined the hazard ratios (HR) for the predictors of neonatal survival.

Results

About 50% of adolescent pregnancies were unintended and neonatal death rate was twice as high than older mothers (26.6 versus 12.0 deaths/1000 live births). The median survival time was two days for adolescent-born babies and four days among older mothers. The hazard of death for all adolescent-born neonates was about twofold that of 20–29 years-old-mothers, HR 1.80 (95% CI 1.22–2.63). Among married adolescents with unintended newborn pregnancies, the HR was 4-folds higher than corresponding older mothers, HR 4.08 (95% CI 1.62–10.31). Among married, primiparous adolescents with unintended pregnancies, the HR was six times higher than corresponding older mothers.

Conclusion

Our findings reveal how unintended pregnancies and deaths of neonates born to adolescents contribute substantially to preventable neonatal deaths in East Africa. Full implementation of existing adolescent health policies and utilization of contraceptives should be ensured. Partnership with youths and novel efforts that address sociocultural norms to reduce adolescent pregnancies or marriage should be supported. Regulations requiring adolescents’ obstetric care conducted by only skilled personnel should be introduced and implemented.

Investigating pathways for predisposing, enabling and need factors in predicting the use of STI/HIV-testing services among Syrian and Iraqi migrants in Scania, Sweden - a cross-sectional study with directed acyclic graphs for modelling pathways to testing

BACKGROUND

Some groups of migrants have increased vulnerability to Sexually Transmitted Infections (STI) and Human Immunodeficiency Virus (HIV) transmission partly due to a lower uptake of disease preventive activities targeting the general population in receiving country. Limited access to economic and social resources and poor language skills may exacerbate exposure to sexual risks and utilization of health services.

AIM

To explore general and migrant specific predictors for STI/HIV-testing among Syrian and Iraqi migrants in Sweden and to investigate potential pathways that link predisposing, enabling and need- factors to STI/HIV-testing.

METHOD

Cross-sectional study design based on a migration specific framework for health care utilization. Directed acyclic graphs (DAGs) were used to model assumptions about factors associated with the uptake of STI/HIV-testing services. Bi-variable and multivariable logistic regression analyses assessed individual predictors while adjusting for covariates. The magnitude of the indirect effect of mediating variables were estimated with bootstrap analyses and a method for decomposing the total effect.

RESULT

The pathways between younger age, unmarried, and self-identifying as bi- or homosexual and testing were mainly indirect, mediated by experiences of sexual coercion and other risk behaviours. One third of the indirect mediating effect of the pathway between higher education and testing could be attributed to Swedish language skills.

CONCLUSION

Utilization of STI/HIV-testing services among Syrian and Iraqi migrants seemed to be motivated by sexual risk exposure and risk awareness. Interventions should focus on language-adapted information about available screening services and where to go for advice on sexual wellbeing and sexual rights. Such activities should be implemented within an integration promoting framework, addressing structures that increase STI/HIV risk exposure, specifically targeting vulnerable subgroups of migrants.

Facilitating an encounter with a new sexuality discourse: the role of civic communicators in building sexual health literacy among newly arrived migrants

Language and different sexual health discourses constitute barriers to the uptake of information on sexual and reproductive health and rights among migrants. Challenges remain with regards to the design and implementation of culturally appropriate programmes and interventions. This study explored the role of civic communicators in increasing access to sexual health information among migrants resettling in Sweden. Twenty in-depth interviews were conducted and analysed using qualitative content analysis. Findings illustrate the potential role of civic communicators in identifying sexual health needs, deconstructing misinformation and providing a space for reflective dialogue. Training in adult pedagogy, leadership, cultural competence and subject knowledge, and allocating sufficient time to cover themes that are culturally different, sensitive and politicised, are essential for good quality implementation and promoting rights-based sexual health.

Uptake of cervical cancer screening and its predictors among women of reproductive age in Gomma district, South West Ethiopia: a community-based cross-sectional study

BACKGROUND

Cervical cancer is a public health challenge despite the available free screening service in Ethiopia. Early screening for cervical cancer significantly improves the chances of successful treatment of pre-cancers and cancers among women of reproductive age. Therefore, this study aimed to assess the uptake of screening and identify the factors among women of reproductive age.

METHODS

A community-based cross-sectional study was conducted in Gomma Woreda, Jimma Zone, Ethiopia, from 1st to the 30th of August, 2019. The total sample size was 422. A systematic random sampling technique was employed. Data were collected using a structured questionnaire, entered in epidata, and exported and analyzed using SPSS version 20.0 software packages. Descriptive, bivariate and multivariable logistic regression analyses with 95% CI for odds ratio (OR) were performed to declare a significant predictors.

RESULT

A total of 382 study participants were involved with a response rate of 90.5%. The mean age of the study participants was 26.45 ± 4.76 SD. One hundred forty-eight (38.7%) of participants had been screened for CC. Marital status (AOR = 10.74, 95%, CI = 5.02-22.96), residence (AOR = 4.45, 95%, CI = 2.85-6.96), educational status (AOR = 1.95, 95% CI = 1.12-3.49), government employee (AOR = 2.61, 95%, CI = 1.33-5.15), birth experience (AOR = 8.92, 95% CI = 4.28-19.19), giving birth at health center and government hospitals (AOR = 10.31, 95% CI = 4.99-21.62; AOR = 5.54, 95% CI = 2.25-13.61); distance from health facility (AOR = 4.41, 95% CI = 2.53-9.41), health workers encouragement (AOR = 3.23, 95% CI = 1.57-6.63), awareness on cervical cancer (AOR = 0.37, 95% CI = 0.19-0.72), awareness about CC screening (AOR = 4.52, 95%, CI = 2.71-7.55) and number of health facility visit per year (AOR = 3.63, 95%, CI = 1.86-6.93) were the predictors for the uptake of cervical cancer screening.

CONCLUSION

The uptake of cervical cancer screening was low. Marital status, residence, occupation, perceived distance from screening health facility, health workers encouragement, number of health facility visits, birth experience, place of birth, and knowledge about cervical cancer screening were the predictors. There is a need to conduct further studies on continuous social and behavioral change communication.

Risk of poor mental health and experience of violence among a young adult population with same-sex sexuality: a cross-sectional study in southern Sweden

OBJECTIVES

To assess prevalence and correlates of same-sex sexuality and its relationship to poor mental health and experiences of violence among youth and young adults in Sweden. A secondary aim was to estimate the same-sex sexuality attributable fractions.

DESIGN

A population-based cross-sectional survey.

SETTING

Southern Sweden.

PARTICIPANTS

2968 respondents out of 7000 youth and young adults between 18 and 29 years old, resident in southern Sweden, selected randomly by the Swedish Central Population Registry (final sample=2931 respondents, 318 with same-sex sexuality and 2613 without).

OUTCOME MEASURES

The outcome measures were self-reported poor mental health (depression and anxiety) and experience of violence (physical violence, sexual violence and sexual coercion).

RESULTS

Increased odd of high scores of depression (adjusted OR 1.8, 95% CI 1.39 to 2.26) and anxiety (adjusted OR 1.6, 95% CI 1.28 to 2.07) were observed among youth and young adults with same-sex sexuality. Similarly, increased odds of experience of physical violence (OR 1.8, 95% CI 1.23 to 2.51), sexual violence (OR 2.8, 95% CI 1.96 to 3.89) and sexual coercion (OR 2.5, 95% CI 1.95 to 3.30) were observed with same-sex sexuality. Within the entire young population, same-sex sexuality accounted for 4.7% and 4.1% of the self-reported experience of depression and anxiety, respectively. The estimated same-sex sexuality attributable fractions of violence within the entire population of young people were 4.5% for physical violence, 7.3% for sexual violence and 6.4% for sexual coercion.

CONCLUSIONS

This study findings suggest that same-sex sexuality is associated with poor self-rated mental health and experience of violence among youth and young adults in Sweden. Some differences were observed between males and females, indicating that the vulnerabilities and experiences vary between young males and females. Further research is needed in order to gain a deeper knowledge of the factors underlying these associations and the gender differences observed.

Prevalence and antimicrobial susceptibility level of typhoid fever in Ethiopia: A systematic review and meta-analysis

Typhoid fever continues to be a health challenge in low-and middle-income countries where access to clean water and sanitation infrastructure is scarce. The non-confirmatory diagnostic method continues to hinder effective diagnosis and treatment, ensuring in a high antimicrobial resistance. This systematic review and meta-analysis aimed to estimate the pooled prevalence and antimicrobial susceptibility level of typhoid fever in Ethiopia. The review was designed based on the condition-context-population review approach. Fifteen eligible articles were identified from PubMed, Google Scholar, and Science Direct databases. Risk of bias and quality of studies were assessed using the Joanna Briggs Institute's appraisal criteria. Heterogeneity was assessed using Cochran's Q test and I2 statistics. The review protocol was registered in PROSPERO (registration number CRD42021224478). The estimated pooled prevalence of typhoid fever from blood and stool culture diagnosis was 3% (95% CI: 2%-4%, p < 0.01) (I2  = 82.25) and Widal test examination 33% (95% CI: 22%-44%) (I2  = 99.14). The sub-group analyses identified a lower detection of typhoid fever of 2% (95% CI: 1%-3%) among febrile patients compared to typhoid suspected cases of 6% (95% CI: 2%-9%). The stool culture test identified was twofold higher, value of 4% (95% CI: 2%-7%) salmonella S. Typhi infection than blood culture test of 2% (95% CI: 1%-4%). The antimicrobial susceptibility of salmonella S. Typhi for antibiotics was 94%, 80% and 65% for ceftriaxone, ciprofloxacin, and gentamycin respectively. Low susceptibility of salmonella S. Typhi isolates against nalidixic acid 22% (95% CI: 2%-46%) and chloramphenicol 11% (95% CI: 2%-20%) were observed. The diagnosis of typhoid fever was under or overestimated depending on the diagnostic modality. The Widal test which identified as nonreliable has long been used in Ethiopia for the diagnosis of salmonella S. Typhi causing high diagnosis uncertainties. Antimicrobial susceptibility of salmonella S. Typhi was low for most nationally recommended antibiotics. Ethiopian Food and Drug Authority must strengthen its continued monitoring and enhanced national antimicrobial surveillance system using the best available state-of-the-art technology and or tools to inform the rising resistance of salmonella S. Typhi towards the prescription of standard antibiotics. Finally, it is crucial to develop an evidence-based clinical decision-making support system for the diagnosis, empiric treatment and prevention of antimicrobial resistance.

Determinants of continued maternal care seeking during pregnancy, birth and postnatal and associated neonatal survival outcomes in Kenya and Uganda: analysis of cross-sectional, demographic and health surveys data

OBJECTIVES

To examine how maternal and sociodemographic factors determine continued care-seeking behaviour from pregnancy to postnatal period in Kenya and Uganda and to determine associated neonatal survival outcomes.

DESIGN

A population-based analysis of cross-sectional data using multinomial and binary logistic regressions.

SETTING

Countrywide, Kenya and Uganda.

PARTICIPANTS

Most recent live births of 24 502 mothers within 1-59 months prior to the 2014-2016 Demographic and Health Surveys.

OUTCOMES

Care-seeking continuum and neonatal mortality.

RESULTS

Overall, 57% of the mothers had four or more antenatal care (ANC) contacts, of which 73% and 41% had facility births and postnatal care (PNC), respectively. Maternal/paternal education versus no education was associated with continued care seeking in majority of care-seeking classes; relative risk ratios (RRRs) ranged from 2.1 to 8.0 (95% CI 1.1 to 16.3). Similarly, exposure to mass media was generally associated with continued care seekin; RRRs ranged from 1.8 to 3.2 (95% CI 1.2 to 5.4). Care-seeking tendency reduced if a husband made major maternal care-seeking decisions. Transportation problems and living in rural versus urban were largely associated with lower continued care use; RRR ranged from 0.4 to 0.7 (95% CI 0.3 to 0.9). The two lowest care-seeking categories with no ANC and no PNC indicated the highest odds for neonatal mortality (adjusted OR 4.2, 95% CI 1.6 to 10.9). 23% neonatal deaths were attributable to inadequate maternal care attendance.

CONCLUSION

Strategies such as mobile health specifically for promoting continued maternal care use up to postnatal could be integrated in the existing structures. Another strategy would be to develop and employ a brief standard questionnaire to determine a mother's continued care-seeking level during the first ANC visit and to use the information to close the care-seeking gaps. Strengthening the community health workers system to be an integral part of promoting continued care seeking could enhance care seeking as a stand-alone strategy or as a component of aforementioned suggested strategies.

Tuberculosis Treatment Outcome and Predictors in Africa: A Systematic Review and Meta-Analysis

This review aimed to summarize and estimate the TB treatment success rate and factors associated with unsuccessful TB treatment outcomes in Africa. Potentially eligible primary studies were retrieved from PubMed and Google Scholar. The risk of bias and quality of studies was assessed using The Joanna Briggs Institute's (JBI) appraisal criteria, while heterogeneity across studies was assessed using Cochran's Q test and I2 statistic. Publication bias was checked using the funnel plot and egger's test. The protocol was registered in PROSPERO, numbered CRD42019136986. A total of 26 eligible studies were considered. The overall pooled estimate of TB treatment success rate was found to be 79.0% (95% CI: 76-82%), ranging from 53% (95% CI: 47-58%) in Nigeria to 92% (95% CI: 90-93%) in Ethiopia. The majority of unsuccessful outcomes were attributed to 48% (95% CI: 40-57%) death and 47% (95% CI: 39-55%) of defaulter rate. HIV co-infection and retreatment were significantly associated with an increased risk of unsuccessful treatment outcomes compared to HIV negative and newly diagnosed TB patients with RR of 1.53 (95% CI: 1.36-1.71) and 1.48 (95% CI: 1.14-1.94), respectively. TB treatment success rate was 79% below the WHO defined threshold of 85% with significant variation across countries. Countries need to explore contextual underlining factors and more effort is required in providing TB preventive treatment, improve case screening and linkage for TB treatment among HIV high-risk groups and use confirmatory TB diagnostic modality. Countries in Africa need to strengthen counseling and follow-up, socio-economic support for patients at high risk of loss to follow-up and poor treatment success is also crucial for successful TB control programs.

Male partners' participation in birth preparedness and complication readiness in low- and middle-income countries: a systematic review and meta-analysis

BACKGROUND

Maternal and neonatal health outcomes remain a challenge in low- and middle-income countries (LMICs) despite priority given to involving male partners in birth preparedness and complication readiness (BPCR). Men in LMICs often determine women's access to and affordability of health services. This systematic review and meta-analysis determined the pooled magnitude of male partner's participation in birth preparedness and complication readiness in LMICs.

METHODS

Literature published in English language from 2004 to 2019 was retrieved from Google Scholar, PubMed, CINAHL, Scopus, and EMBASE databases. The Joanna Briggs Institute's critical appraisal tool for prevalence and incidence studies were used. A pooled statistical meta-analysis was conducted using STATA Version 14.0. The heterogeneity and publication bias were assessed using the I2 statistics and Egger's test. Duval and Tweedie's nonparametric trim and fill analysis using the random-effect analysis was carried out to validate publication bias and heterogeneity. The random effect model was used to estimate the summary prevalence and the corresponding 95% confidence interval (CI) of birth preparedness and complication readiness. The review protocol has been registered in PROSPERO number CRD42019140752. The PRISMA flow chart was used to show the number of articles identified, included, and excluded with justifications described.

RESULTS

Thirty-seven studies with a total of 17, 148 participants were included. The pooled results showed that 42.4% of male partners participated in BPCR. Among the study participants, 54% reported having saved money for delivery, whereas 44% identified skilled birth attendants. 45.8% of male partners arranged transportation and 57.2% of study participants identified health facility as a place of birth. Only 16.1% of the male partners identified potential blood donors.

CONCLUSIONS

A low proportion of male partners were identified to have participated in BPCR in LMICs. This calls countries in low- and middle-income setting for action to review their health care policies, to remove the barriers and promote facilitators to male partner's involvement in BPCR. Health systems in LMICs must design and innovate scalable strategies to improve male partner's arrangements for a potential blood donor and transportation for complications that could arise during delivery or postpartum haemorrhage.

Cesarean delivery and associated socioeconomic factors and neonatal survival outcome in Kenya and Tanzania: analysis of national survey data

Background: The increasing trends in cesarean delivery are globally acknowledged. However, in many low-resource countries, socioeconomic disparities have created a pattern of underuse and overuse among lower and higher socioeconomic groups. The impact of rising cesarean delivery rates on neonatal survival is also unclear.Objective: To examine cesarean delivery and its associated socioeconomic patterns and neonatal survival outcome in Kenya and Tanzania.Methods: We employed binary logistic regression to analyze cross-sectional demographic and health survey data on neonates born in health facilities in Kenya (2014) and Tanzania (2016).Results: Cesarean delivery rates ranged from 5% among uneducated, rural Tanzanian women to 26% among educated urban women in Kenya to 37.5% among managers in urban Tanzania. Overall findings indicated higher odds of cesarean delivery among mothers from richest households, adjusted odds ratio (aOR) 1.4 (95% CI 1.2-1.8), those insured, aOR 1.6 (95% CI 1.3-1.9), highly educated, aOR 1.6 (95% CI 1.2-2.0) and managers aOR 1.7 (95% CI 1.3-2.2), compared to middle class, no insurance, primary education and unemployed, respectively. Overall, compared to normal births and while adjusting for maternal risk factors, cesarean delivery was significantly associated with neonatal mortality in Kenya and Tanzania, overall aOR 1.7 (95% CI 1.2-2.7). However, statistical significance ceased when fetal risk factors and number of antenatal care visits were further controlled for, aOR 1.6 (95% CI 0.9-2.6).Conclusion: Disproportionate access to cesarean delivery has widened in Kenya and Tanzania. Higher risks of cesarean-related neonatal deaths exist. Medically indicated or not, the safety and/or choice of cesarean delivery is best addressed on individual basis at the health-facility level. However, policy initiatives to eliminate incentives, improve equitable access and accountability to reduce unnecessary cesarean deliveries through well-informed decisions are needed. Efforts to prevent unintended pregnancies among adolescents as well as training of health workers and continuous research to improve neonatal outcomes are vital.

The impact of maternal health care utilisation on routine immunisation coverage of children in Nigeria: a cross-sectional study

OBJECTIVE

To examine the impact of maternal healthcare (MHC) utilisation on routine immunisation coverage of children in Nigeria.

DESIGN

Individual level cross-sectional study using bivariate and multivariable logistic regression analyses to examine the association between MHC utilisation and routine immunisation coverage of children.

SETTING

Nigeria Demographic and Health Survey 2013.

PARTICIPANTS

5506 women aged 15-49 years with children aged 12-23 months born in the 5 years preceding the survey.

PRIMARY OUTCOME MEASURES

Fully immunised children and not fully immunised children.

RESULTS

The percentage of children fully immunised with basic routine childhood vaccines by the age of 12 months was 25.8%. Antenatal care (ANC) attendance irrespective of the number of visits (adjusted OR (AOR)_{1-3 visits} 2.4, 95% CI 1.79 to 3.27; AOR_{4-7 visits} 3.2, 95% CI 2.52 to 4.13; AOR_{≥ 8 visits} 3.5, 95% CI 2.64 to 4.50), skilled birth attendance (SBA) (AOR 1.9, 95% CI 1.65 to 2.35); and maternal postnatal care (PNC) (AOR 1.7, 95% CI 1.46 to 2.06) had positive effects on the child being fully immunised after adjusting for covariates (except for each other, ie, ANC, SBA and PNC). Further analyses (adjusting stepwise for each MHC service) showed a mediation effect that led to the effect of PNC not being significant.

CONCLUSIONS

The percentage of fully immunised children in Nigeria was very low. ANC attendance, SBA and maternal PNC attendance had positive impact on the child being fully immunised. The findings suggest that strategies aimed at maximising MHC utilisation in Nigeria could be effective in achieving the national coverage target of at least 80% for routine immunisation of children.

Stunting and anemia among children 6-23 months old in Damot Sore district, Southern Ethiopia

BACKGROUND

Stunting and anemia are long-standing public health challenges which adversely affects the cognitive development and physical wellbeing of children in low income settings. The aim of this study was to assess the prevalence and associated factors of stunting and anemia among 6-23 months old children in Damot Sore District, Southern Ethiopia.

METHODS

Cross-sectional survey was conducted among 477 children aged 6-23 months, which were living in Damot Sore District, in April 2017. A multistage sampling technique was used. Villages were randomly selected and systematic random sampling method was used to select study participants. Data on socio-demographic, anthropometric, dietary, blood samples for hemoglobin were collected. Data were entered into EPI Data V. 3.1 and exported into SPSS Version 21.0 for analysis. A principal component analysis (PCA) was done to generate wealth score of households. Binary logistic regression model was used to identify factors associated with the outcome variables (stunting and anemia) separately, those variables having less than a p-value of 0.25 were chosen as candidate for multivariable analyses and finally multivariable logistic regression model was used to identify independent variables of each outcomes, with statistical significance set at p < 0.05 (95% confidence interval (CI)).

RESULTS

Out of 477 children studied, 31.7% were stunted and 52% were anemic. In the multivariable analyses, the number of under five children within a household (AOR = 4.18, 95% CI: 2.65-6.57), drinking water from unsafe source (AOR = 4.08, 95% CI: 1.33-12.54) and anemia (AOR = 3.13, 95% CI 2.00-4.92) were factors significantly associated with stunting. On the other hand, independent variables of anemia were early initiation of complementary feeding (AOR = 2.96, 95% CI: 1.23-4.85), poor dietary diversity (AOR = 2.95, 95% CI: 1.78-4.91), poor breast feeding practice (AOR = 2.94, 95% CI: 1.63-5.32) and stunting (AOR = 3.65, 95% CI: 2.15-6.19).

CONCLUSION

This study revealed higher level of stunting and anemia among children aged 6-23 months than WHO (world health organization) criteria of public health importance. Sustainable promotion of diversified diet, optimal complementary feeding, optimal and complementary breast feeding practices, improving sanitation infrastructure are measures needed to tackle these severe public health challenges.

Effectiveness of antenatal care services in reducing neonatal mortality in Kenya: analysis of national survey data

BACKGROUND

Although global neonatal mortality declined by about 40 percent from 1990 to 2013, it still accounted for about 2.6 million deaths globally and constituted 42 percent of global under-five deaths. Most of these deaths occur in developing countries. Antenatal care (ANC) is a globally recommended strategy used to prevent neonatal deaths. In Kenya, over 90 percent of pregnant women attend at least one ANC visit during pregnancy. However, Kenya is currently among the 10 countries that contribute the most neonatal deaths globally.

OBJECTIVE

The aim of this study is to examine the effectiveness of ANC services in reducing neonatal mortality in Kenya.

METHODS

We used binary logistic regression to analyse cross-sectional data from the 2014 Kenya Demographic and Health Survey to investigate the effectiveness of ANC services in reducing neonatal mortality in Kenya. We determined the population attributable neonatal mortality fraction for the lack of selected antenatal interventions.

RESULTS

The highest odds of neonatal mortality were among neonates whose mothers did not attend any ANC visit (adjusted odds ratio [aOR] 4.0, 95% confidence interval [CI] 1.7-9.1) and whose mothers lacked skilled ANC attendance during pregnancy (aOR 3.0, 95% CI 1.4-6.1). Lack of tetanus injection relative to one tetanus injection was significantly associated with neonatal mortality (aOR 2.5, 95% CI 1.0-6.0). About 38 percent of all neonatal deaths in Kenya were attributable to lack of check-ups for pregnancy complications.

CONCLUSIONS

Lack of check-ups for pregnancy complications, unskilled ANC provision and lack of tetanus injection were associated with neonatal mortality in Kenya. Integrating community ANC outreach programmes in the national policy strategy and training geared towards early detection of complications can have positive implications for neonatal survival.

A generation at risk: a cross-sectional study on HIV/AIDS knowledge, exposure to mass media, and stigmatizing behaviors among young women aged 15-24 years in Ghana

HIV/AIDS stigmatizing behaviors are a huge barrier to early detection and treatment of individuals with the AIDS virus. HIV/AIDS stigma and related consequences are debilitating, especially for vulnerable populations. This study sought to assess whether young women's HIV/AIDS knowledge levels and exposure to mass media (television and radio) have an influence on their stigmatizing behaviors and role as agents of stigma towards individuals living with HIV and AIDS. The data used for this study originated from the Ghana Multiple Indicator Cluster Survey 2011. Binary and multiple (stepwise) logistic regression analyses were used to examine the associations between HIV/AIDS knowledge, frequency of exposure to mass media, and HIV/AIDS stigmatizing behaviors among young women aged 15-24 years in Ghana. Of the 3573 young women, 80% of 15-19-year-olds and 76% of 20-24-year-olds had at least one stigmatizing behavior towards persons living with HIV/AIDS (PLHA). Young women with increased knowledge regarding HIV/AIDS and frequent exposure to mass media (television and radio) had lesser tendency to stigmatize or act as agents of stigma towards PLHA (proportion with at least one stigmatizing behavior per subgroup - HIV/AIDS knowledge: those with highest knowledge score 579 [70.1%], those with lowest knowledge score 28 [90.3%]; mass media: those with daily exposure 562 [73.4%], those not exposed at all 249 [89.2%]). There was a graded negative 'exposure-response' association between the ranked variables: HIV/AIDS knowledge, mass media, and HIV/AIDS stigmatizing behaviors. The significant inverse association between HIV/AIDS knowledge, frequency of exposure to mass media, and HIV/AIDS stigmatizing behaviors persisted even after adjusting for all other covariates in the multiple logistic regression models. It is extremely important to increase HIV/AIDS-related knowledge and reduce stigma among young women in Ghana through targeted HIV/AIDS factual knowledge transfer. The use of mass media for communication of issues regarding HIV/AIDS, its mode of transmission, and associated stigma should be emphasized among women in Ghana.

Survival of low birthweight neonates in Uganda: analysis of progress between 1995 and 2011

Background

Although low birthweight (LBW) babies represent only 15.5% of global births, it is the leading underlying cause of deaths among newborns in countries where neonatal mortality rates are high. In Uganda, like many other sub-Saharan African countries, the progress of reducing neonatal mortality has been slow and the contribution of low birthweight to neonatal deaths over time is unclear. The aim of this study is to investigate the association between low birthweight and neonatal mortality and to determine the trends of neonatal deaths attributable to low birthweight in Uganda between 1995 and 2011.

Methods

Cross-sectional survey datasets from Uganda Demographic and Health Surveys between 1995 and 2011 were analyzed using binary logistic regression with 95% confidence interval (CI) and Kaplan-Meier survival analysis to examine associations and trends of neonatal mortalities with respect to LBW. A total of 5973 singleton last-born live births with measured birthweights were included in the study.

Results

The odds of mortality among low birthweight neonates relative to normal birthweight babies were; in 1995, 6.2 (95% CI 2.3 −17.0), in 2000–2001, 5.3 (95% CI 1.7 −16.1), in 2006, 4.3 (95% CI 1.3 − 14.2) and in 2011, 3.8 (95% CI 1.3 − 11.2). The proportion of neonatal deaths attributable to LBW in the entire population declined by more than half, from 33.6% in 1995 to 15.3% in 2011. Neonatal mortality among LBW newborns also declined from 83.8% to 73.7% during the same period.

Conclusion

Low birthweight contributes to a substantial proportion of neonatal deaths in Uganda. Although significant progress has been made to reduce newborn deaths, about three-quarters of all LBW neonates died in the neonatal period by 2011. This implies that the health system has been inadequate in its efforts to save LBW babies. A holistic strategy of community level interventions such as improved nutrition for pregnant mothers, prevention of teenage pregnancies, use of mosquito nets during pregnancy, antenatal care for all, adequate skilled care during birth to prevent birth asphyxia among LBW babies, and enhanced quality of postnatal care among others could effectively reduce the mortality numbers.

Self-Reported Discrimination in Health-Care Settings Based on Recognizability as Transgender: A Cross-Sectional Study Among Transgender U.S. Citizens

Discrimination has long been tied to health inequality. Rejected by families and communities because of their gender identity and gender-role behavior, transgender individuals are often socially marginalized. This study aimed to assess discrimination in health-care settings among persons self-identifying as transgender in the U.S. in relation to their recognizability as transgender, operationalized as how often they experienced that others recognized them as transgender. Data were obtained from the National Transgender Discrimination Survey (n = 6106 participants, assigned sex at birth = 3608 males, 2480 females, respectively). Binary logistic regressions were performed to examine associations between transgender recognizability and discrimination in health-care settings. Being recognized as transgender to any extent had a significant effect on perceived discrimination in health care. Always recognized as transgender showed significant associations with discrimination in a health-care setting (OR 1.48) and the following individualized health-care settings: social service settings (rape crisis and domestic violence centers, OR 5.22) and mental health settings (mental health clinic and drug treatment program, OR 1.87). Sex work and other street economy, which are known experiential factors affected by discrimination, were also significantly associated with discrimination in health-care settings. Discrimination in health-care settings is pervasive for transgender who are recognized as transgender. Public health efforts to improve access to equitable health care for transgender individuals may benefit from consideration of demographic, experiential, and medical risk factors to more fully understand the source of the seemingly excess risk of discrimination among persons recognized by others as being transgender.

Cross-sectional study on the prevalence and predictors of pregnancy among women living in HIV discordant relationships in a rural Rakai cohort, Uganda

OBJECTIVES

This study examines the prevalence of pregnancy in serodiscordant couples and identifies predictors associated with pregnancy in rural Rakai, Uganda.

STUDY DESIGN

A population-based cross-sectional study that used data from the Rakai Community Cohort Study (RCCS).

SETTING AND PARTICIPANTS

We used data from the RCCS survey round 17 (2015-2016), which included 488 women in serodiscordant relationships. This study was conducted in Rakai district, located in south-western Uganda.

PRIMARY OUTCOMES

Pregnancy status.

STATISTICAL ANALYSIS

Multivariable modified Poisson regression using stepwise selection was used to determine characteristics and behaviours associated with pregnancy status.

RESULTS

The prevalence of pregnancy was 12% in women among serodiscordant couples. HIV-negative women in serodiscordant couples had a slightly higher pregnancy prevalence rate (13.6%) compared with HIV-positive women in serodiscordant couples (11%). Factors significantly associated with higher prevalence of pregnancy were; younger age 15-24 years (prevalence risk ratio (PRR)=4.04; 95% CI 1.72 to 9.50), middle age 25-34 years (PRR=2.49; 95% CI 1.05 to 5.89), Christian religion (PRR=2.26; 95% CI 1.41 to 3.63) and inconsistent condom use in the last 12 months (PRR=4.38, 95% CI 1.09 to 17.53). Neither HIV status nor HIV status disclosure was significantly associated with risk of getting pregnant.

CONCLUSION

Nearly 12% of women in serodiscordant relationships were pregnant, highlighting the need for integrated services to prevent unintended pregnancies and reduce conceptional related risks for those choosing to conceive. Association with younger age and inconsistent condom use suggests a role for early and continued couple-based conception counselling.

Individual- and Family-Level Determinants of Risky Sexual Behavior Among Swedish- and Foreign-Born Young Adults 18-30 Years of Age, Residing in Skåne, Sweden

In Sweden, various public health interventions have been performed to reduce risky sexual behaviors among young people and promote safer and positive approaches to sexuality, while attempting to bridge the gap between the less privileged or more vulnerable young people and their more privileged peers. This study aimed to compare the individual- and familial-level determinants of risky sexual behavior among foreign-born and Swedish-born young adults 18-30 years of age residing in Skåne, the south of Sweden. This was a cross-sectional study that used a questionnaire to collect data from 2968 randomly selected respondents between 18 and 30 years between January and March 2013. The associations were analyzed using chi-square tests, and simple and multiple logistic regression analyses. Younger age, i.e., individual-level factor, and living with only one parent or another person while growing up, i.e., familial-level factor, increased the risk of engaging in sexual risk taking for both Swedish- and foreign-born youth. Male gender was related to a higher risk of engaging in sexual risk-taking behaviors among foreign-born youth but was not as important as influence on sexual risk taking among Swedish-born youth. Parental education level, on the other hand, was significantly associated with sexual intercourse on the "first night" and early sexual debut solely among Swedish-born youth. Condom use was not associated with any family-level factor among both Swedish-born and foreign-born youth. The design of sexual reproductive health and rights messages and interventions to target risky sexual behavior among Swedish youth should take into consideration immigration status (for example, being Swedish-born or foreign-born), individual- and family-level characteristics, as well as the type of behavioral change or outcome desired.

Cross-sectional comparative study of risky sexual behaviours among HIV-infected persons initiated and waiting to start antiretroviral therapy in rural Rakai, Uganda

OBJECTIVES

To compare risky sexual behaviours between HIV-positive persons initiated on antiretroviral therapy (ART) (ART-experienced) and persons waiting to start on ART (ART-naive) and assess predictors of risky sexual behaviours among HIV-infected patients in rural Rakai district, Uganda.

STUDY DESIGN

This is a cross-sectional study that used data from the Rakai Community Cohort Study (RCCS) database between 2013 and 2014. A structured questionnaire was used for data collection. We used stepwise logistic regression as an index to estimate the adjusted ORs for the association between risky sexual behaviours and ART treatment status.

STUDY SETTING

This study was conducted in Rakai district, located in south-western Uganda. The data for this study were extracted from the RCCS. RCCS is an open prospective cohort of approximately 15 000 consenting participants aged 15-49 years.

PARTICIPANTS

HIV-positive participants aged 18-49 years who had sex at least once a month with any partner prior to the start of the study.

MAIN OUTCOME MEASURES

Inconsistent/no condom use in the last 12 months, alcohol use at last sexual encounter, and two or more sexual partners.

RESULTS

ART-naive participants were more likely to report inconsistent condom use (OR=1.74, 95% CI 1.11 to 2.73) and more likely to drink alcohol at last sexual encounter (OR=1.65, 95% CI 1.11 to 2.46), compared with ART-experienced patients. ART treatment status (p<0.001) was a significant predictor of risky sexual behaviours. Both marital status (p=0.016) and occupation level (p=0.009) were positively associated with inconsistent condom use, while sex (p<0.001) correlated with alcohol use at last sexual encounter.

CONCLUSION

ART-naive participants were more likely to exhibit risky sexual behaviours than the ART-experienced participants. The intensity of risk reduction counselling should be increased for HIV-positive persons waiting to start ART but already in HIV care.

Inequality trends in maternal health services for young Ghanaian women with childbirth history between 2003 and 2014

OBJECTIVE

To achieve universal coverage of reproductive healthcare and drastic reduction in maternal mortality, adequate attention and resources should be given to young women. This study therefore aimed to examine the inequality trends in the use of antenatal care (ANC) services and skilled birth attendance (SBA) within a subgroup of Ghanaian women aged 15-24 years between 2003 and 2014.

DESIGN

This is a cross-sectional study that used data from the Ghana Demographic and Health Surveys (DHS) 2003, 2008 and 2014. We applied regression-based total attributable fraction (TAF) as an index for measuring multiple dimensions of inequality in the use of ANC and SBA.

SETTING

Ghana.

PARTICIPANTS

Young women aged 15-24 years with at least one previous birth experience in the past 5 years prior to the surveys.

MAIN OUTCOME MEASURES

ANC visits and skilled attendance at birth.

RESULTS

Urbanicity-related, education-related and wealth-related inequality in non-use of SBA declined between 2003 and 2008, but increased between 2008 and 2014. A consistent decline was observed in urbanicity-related inequality in non-use of four or more ANC visits from 2003 through 2008 to 2014. A similar reduction was observed for education-related inequality in relation to the same outcome. In contrast, wealth-related inequality in ANC usage increased over time.

CONCLUSIONS

The rise in urbanicity-related, education-related and wealth-related inequality in the usage of SBA between 2008 and 2014 threatens the sustainability of the general progress made in the usage of maternal health services in Ghana within the same period.

Under-five mortality and maternal HIV status in Tanzania: analysis of trends between 2003 and 2012 using AIDS Indicator Survey data

Background

Mortality among children under five remains a significant health challenge across sub-Saharan Africa. HIV/AIDS is one of the leading contributors to the relatively slow decline in under-five mortality in this region. In Tanzania, HIV prevalence among under-five children is high and 90% of all infections are due to mother-to-child transmission.

Objectives

The study aimed to examine the association between maternal HIV-positive status and under-five mortality in Tanzania. It also aimed to estimate the proportions and trends of under-five mortality attributable to maternal HIV/AIDS in Tanzania between 2003 and 2012.

Design

Binomial logistic regression was used to analyze cross-sectional survey data from the Tanzania AIDS Indicator Surveys to examine the association between maternal HIV positivity and under-five mortality between 2003 and 2012.

Results

After controlling for confounders, the adjusted odds ratios were 1.5 (95% CI 1.1–1.9) in 2003–2004, 4.6 (95% CI 2.7–7.8) in 2007–2008, and 2.4 (95% CI 1.2–4.6) in 2011–2012. The maternal HIV-attributable mortality risk percent of under-five children was 3.7 percent in 2003–2004, 11.3 percent in 2007–2008 and 5.6% in 2011–2012.

Conclusion

Maternal HIV positivity is associated with under-five mortality in Tanzania, making maternal HIV serostatus a relevant determinant of whether a child will survive up to five years of age or not. The impact of maternal HIV/AIDS attributable mortality risk has a significant contribution to the overall under-five mortality in Tanzania. The continued monitoring of HIV and mortality trends is important for policy development and design of interventions.

Unmet medical care and sexual health counseling needs-: a cross-sectional study among university students in Uganda

In 2010, unmet medical care and sexual health counseling needs were assessed among students at a Ugandan University. Unmet medical care need was associated with poor mental health, experience of sexual coercion, and poor self-rated health. Unmet sexual health counseling need was significantly associated with being female, coming from an urban area, low social participation, poor mental health status, experience of sexual coercion, poor self-rated health, inconsistent condom use, and having multiple sexual partners. Gender differences, poor mental health, sexual coercion, poor self-rated health, and risky sexual behavior must be considered when designing intervention models to reduce unmet health care needs among young people in this setting.

Spatial analysis of skilled birth attendant utilization in Ghana

BACKGROUND

Maternal mortality is a major health problem in most resource-poor settings, especially in sub-Saharan Africa. In Ghana, maternal mortality remains high and births attended by skilled health professionals are still low despite the introduction, in 2005, of free maternal health care for all women seeking care in public health facilities.

OBJECTIVES

This study aimed to explore geographical patterns in the risk of not utilizing a skilled birth attendant during childbirth in women of different socioeconomic backgrounds in Ghana.

METHODS

Global and Geographically Weighted Odds Ratios (GWORs) were used to examine the spatially varying relationships between low socioeconomic status (low education and low income) and non-utilization of skilled birth attendants based on data from the Ghana Demographic and Health Survey (GDHS) 2008.

RESULTS

Low education and low income were associated with non-use of skilled birth attendants. The GWORs revealed a north-south spatial variation in the magnitude of the association between non-use of skilled birth attendants and low education (Log GWOR ranged from 0.75 to 9.26) or low income (Log GWOR ranged from 1.11 to 6.34) with higher values in the north.

CONCLUSIONS

The relationship between low socioeconomic status and the non-use of skilled birth attendants in Ghana is geographically variable. Effective governmental and non-governmental interventions are needed to address these regional inequalities.