1
|
Sokol NA, Sawadogo N, Bullington BW, Tumlinson K, Langer A, Soura A, Zabre P, Sie A, Johnson JA, Senderowicz L. Perceptions of access to long-acting reversible contraception removal among women in Burkina Faso. Contraception 2024; 129:110302. [PMID: 37802461 DOI: 10.1016/j.contraception.2023.110302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES Long-acting reversible contraception (LARC) initiation has been well-studied and intervened upon. Because LARC requires provider intervention for initiation and removal, it is critical to measure informed choice at the time of desired discontinuation as well. We examined perceptions of access to LARC discontinuation among women at two sites in Burkina Faso, where LARC is the dominant method in the contraceptive mix. STUDY DESIGN We analyzed data from a 2017-2018 population-based, cross-sectional survey of 281 implant users and 55 intrauterine device users at two sites in Burkina Faso. We measured perceptions of access to LARC discontinuation through survey items assessing whether participants (1) were informed on how to discontinue the method, (2) believed they could have LARC removed without a lot of difficulty, (3) believed cost would be a barrier to discontinuation, (4) had ever attempted to have a provider remove LARC, and (5) successfully had LARC removed. The distribution of these measures was examined in the population and for differences by gravida, parity, domestic partnership, fertility desires, and recency of last childbirth. RESULTS Thirty-eight (11%) of current LARC users reported that they were not informed on how to discontinue, 56 (17%) believed having their device removed would be difficult, and 54 (16%) believed cost would be a barrier to removal. Of women who attempted removal, providers did not immediately remove LARC on request for 10 (28%). CONCLUSIONS Findings indicate that LARC uptake is an insufficient measure of reproductive access or choice. Future studies should include patient-centered measures that span the full duration of contraceptive use. IMPLICATIONS This paper finds that a sizable proportion of LARC users lack information about method discontinuation and perceive or experience barriers to method removal. These findings call for a reconsideration of free and informed contraceptive choice to include the entire duration of contraceptive use, not only the time of method provision.
Collapse
Affiliation(s)
- Natasha A Sokol
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, United States; Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, United States.
| | - Nathalie Sawadogo
- Institut Supérieur des Sciences de la Population, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Brooke W Bullington
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
| | - Katherine Tumlinson
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States; Department of Health Policy and Management, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States
| | - Ana Langer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Abdramane Soura
- Institut Supérieur des Sciences de la Population, Université Joseph KI-ZERBO, Ouagadougou, Burkina Faso
| | - Pascal Zabre
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Ali Sie
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Janet A Johnson
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, Rhode Island, United States
| | - Leigh Senderowicz
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States; Department of Gender and Women's Studies, University of Wisconsin-Madison, Madison, Wisconsin, United States; Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, Wisconsin, United States
| |
Collapse
|
2
|
Bullington BW, Sawadogo N, Tumlinson K, Langer A, Soura A, Zabre P, Sie A, Senderowicz L. Prevalence of non-preferred family planning methods among reproductive-aged women in Burkina Faso: results from a cross-sectional, population-based study. Sex Reprod Health Matters 2023; 31:2174244. [PMID: 37195714 PMCID: PMC10193871 DOI: 10.1080/26410397.2023.2174244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
Family planning researchers have traditionally focused efforts on understanding contraceptive non-use and promoting contraceptive uptake. Recently, however, more scholars have been exploring method dissatisfaction, questioning the assumption that contraceptive users necessarily have their needs met. Here, we introduce the concept of "non-preferred method use", which we define as the use of one contraceptive method while having the desire to use a different method. Non-preferred method use reflects barriers to contraceptive autonomy and may contribute to method discontinuation. We use survey data collected from 2017 to 2018 to better understand non-preferred contraceptive method use among 1210 reproductive-aged family planning users in Burkina Faso. We operationalise non-preferred method use as both (1) use of a method that was not the user's original preference and (2) use of a method while reporting preference for another method. Using these two approaches, we describe the prevalence of non-preferred method use, reasons for using non-preferred methods, and patterns in non-preferred method use by current and preferred methods. We find that 7% of respondents reported using a method they did not desire at the time of adoption, 33% would use a different method if they could and 37% report at least one form of non-preferred method use. Many women cite facility-level barriers, such as providers refusing to give them their preferred method, as reasons for non-preferred method use. The high prevalence of non-preferred method use reflects the obstacles that women face when attempting to fulfil their contraceptive desires. Further research on reasons for use of non-preferred methods is necessary to promote contraceptive autonomy.
Collapse
Affiliation(s)
- Brooke W. Bullington
- PhD Student, Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
- Predoctoral Trainee, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Nathalie Sawadogo
- Senior Lecturer, Institut Supérieur des Sciences de la Population, Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso
| | - Katherine Tumlinson
- Faculty Fellow, Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Assistant Professor, Department of Maternal Child Health, University of North Carolina Gillings School of Global Public Health, Chapel Hill, USA
| | - Ana Langer
- Professor of the Practice of Public Health, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, BostonMA, USA
| | - Abdramane Soura
- Director, Institut Supérieur des Sciences de la Population, Université Joseph Ki-ZERBO, Ouagadougou, Burkina Faso
| | - Pascal Zabre
- Demographer, Head of HDSS, Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Ali Sie
- Director, Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Leigh Senderowicz
- Alumna, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, BostonMA, USA
- Assistant Professor, Department of Gender and Women’s Studies, University of Wisconsin–Madison, MadisonWI, USA
- Assistant Professor, Department of Obstetrics and Gynecology, University of Wisconsin–Madison, MadisonWI, USA
| |
Collapse
|
3
|
Ismail A, Madzorera I, Apraku EA, Tinkasimile A, Dasmane D, Zabre P, Ourohire M, Assefa N, Chukwu A, Workneh F, Mapendo F, Lankoande B, Hemler E, Wang D, Abubakari SW, Asante KP, Baernighausen T, Killewo J, Oduola A, Sie A, Soura A, Vuai S, Smith E, Berhane Y, Fawzi WW. The COVID-19 pandemic and its impacts on diet quality and food prices in sub-Saharan Africa. PLoS One 2023; 18:e0279610. [PMID: 37384715 PMCID: PMC10309633 DOI: 10.1371/journal.pone.0279610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 06/09/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Sub-Saharan Africa faces prolonged COVID-19 related impacts on economic activity, livelihoods and nutrition, with recovery slowed down by lagging vaccination progress. OBJECTIVE This study investigated the economic impacts of COVID-19 on food prices, consumption and dietary quality in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania. METHODS We conducted a repeated cross-sectional study using a mobile platform to collect data from July-December, 2021 (round 2). We assessed participants' dietary intake of 20 food groups over the previous seven days and computed the primary outcome, the Prime Diet Quality Score (PDQS), and Dietary Diversity Score (DDS), with higher scores indicating better quality diets. We used generalized estimating equation (GEE) linear regression models to assess factors associated with diet quality during COVID-19. RESULTS Most of the respondents were male and the mean age was 42.4 (±12.5) years. Mean PDQS (±SD) was low at 19.4(±3.8), out of a maximum score of 40 in this study. Respondents (80%) reported higher than expected prices for all food groups. Secondary education or higher (estimate: 0.73, 95% CI: 0.32, 1.15), medium wealth status (estimate: 0.48, 95% CI: 0.14, 0.81), and older age were associated with higher PDQS. Farmers and casual laborers (estimate: -0.60, 95% CI: -1.11, -0.09), lower crop production (estimate: -0.87, 95% CI: -1.28, -0.46) and not engaged in farming (estimate: -1.38, 95% CI: -1.74, -1.02) were associated with lower PDQS. CONCLUSION Higher food prices and lower diet quality persisted during the COVID-19 pandemic. Economic and social vulnerability and reliance on markets (and lower agriculture production) were negatively associated with diet quality. Although recovery was evident, consumption of healthy diets remained low. Systematic efforts to address the underlying causes of poor diet quality through transforming food system value chains, and mitigation measures, including social protection programs and national policies are critical.
Collapse
Affiliation(s)
- Abbas Ismail
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Isabel Madzorera
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, CA, United States of America
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
| | - Edward A. Apraku
- Kintampo Health Research Center, Research and Development Division, Ghana Health Service, Kintampo, Bono East Region, Ghana
| | | | - Dielbeogo Dasmane
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Pascal Zabre
- Nouna Health Research Center, Nouna, Burkina Faso
| | | | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Angela Chukwu
- Department of Statistics, University of Ibadan, Ibadan, Nigeria
| | | | - Frank Mapendo
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Bruno Lankoande
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Elena Hemler
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Dongqing Wang
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Sulemana W. Abubakari
- Kintampo Health Research Center, Research and Development Division, Ghana Health Service, Kintampo, Bono East Region, Ghana
| | - Kwaku P. Asante
- Kintampo Health Research Center, Research and Development Division, Ghana Health Service, Kintampo, Bono East Region, Ghana
| | - Till Baernighausen
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ayoade Oduola
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
| | - Ali Sie
- Nouna Health Research Center, Nouna, Burkina Faso
| | | | - Said Vuai
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Emily Smith
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
- Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Wafaie W. Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
| |
Collapse
|
4
|
Bullington BW, Sawadogo N, Tumlinson K, Langer A, Soura A, Zabre P, Sié A, Senderowicz L. Exploring Upward and Downward Provider Biases in Family Planning: The Case of Parity. Glob Health Sci Pract 2023; 11:e2200470. [PMID: 37348946 PMCID: PMC10285731 DOI: 10.9745/ghsp-d-22-00470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/24/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION Provider bias has become an important topic of family planning research over the past several decades. Much existing research on provider bias has focused on the ways providers restrict access to contraception. Here, we propose a distinction between the classical "downward" provider bias that discourages contraceptive use and a new conception of "upward" provider bias that occurs when providers pressure or encourage clients to adopt contraception. METHODS Using cross-sectional data from reproductive-aged women in Burkina Faso, we describe lifetime prevalence of experiencing provider encouragement to use contraception due to provider perceptions of high parity (a type of upward provider bias) and provider discouragement from using contraception due to provider perceptions of low parity (a type of downward provider bias). We also examine associations between sociodemographic characteristics and experiences of provider encouragement to use contraception due to perceptions of high parity. RESULTS Sixteen percent of participants reported that a provider had encouraged them to use contraception due to provider perceptions of high parity, and 1% of participants reported that a provider had discouraged them from using contraception because of provider perceptions of low parity. Being married, being from the rural site, having higher parity, and having attended the 45th-day postpartum check-up were associated with increased odds of being encouraged to use contraception due to provider perceptions of high parity. CONCLUSION We find that experiences of upward provider bias linked to provider perceptions of high parity were considerably more common in this setting than downward provider bias linked to perceptions of low parity. Research into the mechanisms through which upward provider bias operates and how it may be mitigated is imperative to promote contraceptive autonomy.
Collapse
Affiliation(s)
- Brooke W Bullington
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nathalie Sawadogo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-ZERBO, Ouagadougo, Burkina Faso
| | - Katherine Tumlinson
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Maternal Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ana Langer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Abdramane Soura
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-ZERBO, Ouagadougo, Burkina Faso
| | - Pascal Zabre
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Leigh Senderowicz
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Department of Gender and Women's Studies, University of Wisconsin-Madison, Madison, WI, USA
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
5
|
Arisco NJ, Sewe MO, Bärnighausen T, Sié A, Zabre P, Bunker A. The effect of extreme temperature and precipitation on cause-specific deaths in rural Burkina Faso: a longitudinal study. Lancet Planet Health 2023; 7:e478-e489. [PMID: 37286245 DOI: 10.1016/s2542-5196(23)00027-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Extreme weather is becoming more common due to climate change and threatens human health through climate-sensitive diseases, with very uneven effects around the globe. Low-income, rural populations in the Sahel region of west Africa are projected to be severely affected by climate change. Climate-sensitive disease burdens have been linked to weather conditions in areas of the Sahel, although comprehensive, disease-specific empirical evidence on these relationships is scarce. In this study, we aim to provide an analysis of the associations between weather conditions and cause-specific deaths over a 16-year period in Nouna, Burkina Faso. METHODS In this longitudinal study, we used de-identified, daily cause-of-death data from the Health and Demographic Surveillance System led by the Centre de Recherche en Santé de Nouna (CRSN) in the National Institute of Public Health of Burkina Faso, to assess temporal associations between daily and weekly weather conditions (maximum temperature and total precipitation) and deaths attributed to specific climate-sensitive diseases. We implemented distributed-lag zero-inflated Poisson models for 13 disease-age groups at daily and weekly time lags. We included all deaths from climate-sensitive diseases in the CRSN demographic surveillance area from Jan 1, 2000 to Dec 31, 2015 in the analysis. We report the exposure-response relationships at percentiles representative of the exposure distributions of temperature and precipitation in the study area. FINDINGS Of 8256 total deaths in the CRSN demographic surveillance area over the observation period, 6185 (74·9%) were caused by climate-sensitive diseases. Deaths from communicable diseases were most common. Heightened risk of death from all climate-sensitive communicable diseases, and malaria (both across all ages and in children younger than 5 years), was associated with 14-day lagged daily maximum temperatures at or above 41·1°C, the 90th percentile of daily maximum temperatures, compared with 36·4°C, the median (all communicable diseases: 41·9°C relative risk [RR] 1·38 [95% CI 1·08-1·77], 42·8°C 1·57 [1·13-2·18]; malaria all ages: 41·1°C 1·47 [1·05-2·05], 41·9°C 1·78 [1·21-2·61], 42·8°C 2·35 [1·37-4·03]; malaria younger than 5 years: 41·9°C 1·67 [1·02-2·73]). Heightened risk of death from communicable diseases was also associated with 14-day lagged total daily precipitation at or below 0·1 cm, the 49th percentile of total daily precipitation, compared with 1·4 cm, the median (all communicable diseases: 0·0 cm 1·04 [1·02-1·07], 0·1 cm 1·01 [1·006-1·02]; malaria all ages: 0·0 cm 1·04 [1·01-1·08], 0·1 cm 1·02 [1·00-1·03]; malaria younger than 5 years: 0·0 cm 1·05 [1·01-1·10], 0·1 cm 1·02 [1·00-1·04]). The only significant association with a non-communicable disease outcome was a heightened risk of death from climate-sensitive cardiovascular diseases in individuals aged 65 years and older associated with 7-day lagged daily maximum temperatures at or above 41·9°C (41·9°C 2·25 [1·06-4·81], 42·8°C 3·68 [1·46-9·25]). Over 8 cumulative weeks, we found that the risk of death from communicable diseases was heightened at all ages from temperatures at or above 41·1°C (41·1°C 1·23 [1·05-1·43], 41·9°C 1·30 [1·08-1·56], 42·8°C 1·35 [1·09-1·66]) and risk of death from malaria was heightened by precipitation at or above 45·3 cm (all ages: 45·3 cm 1·68 [1·31-2·14], 61·6 cm 1·72 [1·27-2·31], 87·7 cm 1·72 [1·16-2·55]; children younger than 5 years: 45·3 cm 1·81 [1·36-2·41], 61·6 cm 1·82 [1·29-2·56], 87·7 cm 1·93 [1·24-3·00]). INTERPRETATION Our results indicate a high burden of death related to extreme weather in the Sahel region of west Africa. This burden is likely to increase with climate change. Climate preparedness programmes-such as extreme weather alerts, passive cooling architecture, and rainwater drainage-should be tested and implemented to prevent deaths from climate-sensitive diseases in vulnerable communities in Burkina Faso and the wider Sahel region. FUNDING Deutsche Forschungsgemeinschaft and the Alexander von Humboldt Foundation.
Collapse
Affiliation(s)
- Nicholas J Arisco
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Maquins O Sewe
- Department of Public Health and Clinical Medicine, Sustainable Health Section, Umeå University, Umeå, Sweden
| | - Till Bärnighausen
- Center for Population and Development Studies, Harvard University, Cambridge, MA, USA; Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany; Africa Health Research Institute (AHRI), Somkhele, KwaZulu-Natal, South Africa; Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ali Sié
- Centre de Recherche en Santé de Nouna, Institut National de Santé Publique, Nouna, Burkina Faso
| | - Pascal Zabre
- Centre de Recherche en Santé de Nouna, Institut National de Santé Publique, Nouna, Burkina Faso
| | - Aditi Bunker
- Center for Climate, Health and the Global Environment, Harvard T H Chan School of Public Health, Boston, MA, USA; Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany.
| |
Collapse
|
6
|
Wang D, Adedokun OA, Millogo O, Madzorera I, Hemler EC, Workneh F, Mapendo F, Lankoande B, Ismail A, Chukwu A, Assefa N, Abubakari SW, Lyatuu I, Okpara D, Abdullahi YY, Zabre P, Vuai S, Soura AB, Smith ER, Sie A, Oduola AMJ, Killewo J, Berhane Y, Baernighausen T, Asante KP, Raji T, Mwanyika-Sando M, Fawzi WW. The Continued Impacts of the COVID-19 Pandemic on Education and Mental Health Among Sub-Saharan African Adolescents. J Adolesc Health 2023; 72:535-543. [PMID: 36635187 PMCID: PMC9701646 DOI: 10.1016/j.jadohealth.2022.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/20/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE This multicountry survey assessed the levels and the determinants of the impacts of the pandemic on education and mental health among adolescents in sub-Saharan Africa and the potential factors that may exacerbate these adverse impacts. METHODS A phone survey was conducted among adolescents in nine diverse areas in Burkina Faso, Ethiopia, Ghana, Nigeria, and Tanzania between July and December 2021. Approximately 300 adolescents per area and 2,803 adolescents in total were included. The survey collected information on adolescents' sociodemographic characteristics, current COVID-19 preventive measures, and the impacts of the pandemic on daily activities, education, and mental health. Log-binomial models were used to calculate the adjusted prevalence ratios (aPRs) for determinants of education and mental health outcomes. RESULTS Overall, 17% of the adolescents were not receiving any education. Compared to boys, girls were 15% more likely than boys to lack fully in-person education (aPR: 1.15; 95% confidence interval [CI]: 1.02, 1.30). Rural residence was associated with 2.7 times the prevalence of not currently receiving any education (aPR: 2.68; 95% CI: 2.23, 3.22). Self-reported experience of the current impacts of the pandemic on daily activities was associated with a higher prevalence of possible psychological distress (aPR: 1.86; 95% CI: 1.55, 2.24), high anxiety level (aPR: 3.37; 95% CI: 2.25, 5.06), and high depression level (aPR: 3.01; 95% CI: 2.05, 4.41). DISCUSSION The COVID-19 pandemic presents continued challenges to adolescents' education and mental health. Multisectoral efforts are needed to ensure that adolescents in sub-Saharan Africa do not fall further behind due to the pandemic.
Collapse
Affiliation(s)
- Dongqing Wang
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, Virginia.
| | | | | | - Isabel Madzorera
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Elena C Hemler
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | | | - Frank Mapendo
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Bruno Lankoande
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Abbas Ismail
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Angela Chukwu
- Department of Statistics, University of Ibadan, Ibadan, Nigeria
| | - Nega Assefa
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Sulemana Watara Abubakari
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
| | - Isaac Lyatuu
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Daniel Okpara
- University of Ibadan Research Foundation, Ibadan, Nigeria
| | | | - Pascal Zabre
- Nouna Health Research Center, Nouna, Burkina Faso
| | - Said Vuai
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Abdramane Bassiahi Soura
- Institut Supérieur des Sciences de la Population, University of Ouagadougou, Ouagadougou, Burkina Faso
| | - Emily R Smith
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, D.C.; Department of Exercise and Nutrition Sciences, Milken Institute School of Public Health, George Washington University, Washington, D.C
| | - Ali Sie
- Nouna Health Research Center, Nouna, Burkina Faso
| | | | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Till Baernighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany; Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana Health Service, Kintampo, Ghana
| | - Tajudeen Raji
- Division of Public Health Institutes and Research, Africa Centres for Disease Control and Prevention, Addis Ababa, Ethiopia
| | | | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
| |
Collapse
|
7
|
Senderowicz L, Bullington BW, Sawadogo N, Tumlinson K, Langer A, Soura A, Zabre P, Sie A. Assessing the Suitability of Unmet Need as a Proxy for Access to Contraception and Desire to Use It. Stud Fam Plann 2023; 54:231-250. [PMID: 36841972 PMCID: PMC10257191 DOI: 10.1111/sifp.12233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
Unmet need for contraception is a widely used but frequently misunderstood indicator. Although calculated from measures of pregnancy intention and current contraceptive use, unmet need is commonly used as a proxy measure for (1) lack of access to contraception and (2) desire to use it. Using data from a survey in Burkina Faso, we examine the extent to which unmet need corresponds with and diverges from these two concepts, calculating sensitivity, specificity, and positive/negative predictive values. Among women assigned conventional unmet need, 67 percent report no desire to use contraception and 61 percent report access to a broad range of affordable contraceptives. Results show unmet need has low sensitivity and specificity in differentiating those who lack access and/or who desire to use a method from those who do not. These findings suggest that unmet need is of limited utility to inform family planning programs and may be leading stakeholders to overestimate the proportion of women in need of expanded family planning services. We conclude that more direct measures are feasible at the population level, rendering the proxy measure of unmet need unnecessary. Where access to and/or desire for contraception are the true outcomes of interest, more direct measures should be used.
Collapse
Affiliation(s)
- Leigh Senderowicz
- Department of Gender and Women’s Studies, University of Wisconsin-Madison, USA
- Department of Obstetrics and Gynecology, University of Wisconsin-Madison, USA
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, USA
| | - Brooke W. Bullington
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, USA
| | - Nathalie Sawadogo
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-ZERBO, Burkina Faso
| | - Katherine Tumlinson
- Carolina Population Center, University of North Carolina at Chapel Hill, USA
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA
| | - Ana Langer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, USA
| | - Abdramane Soura
- Institut Supérieur des Sciences de la Population, Université Joseph Ki-ZERBO, Burkina Faso
| | - Pascal Zabre
- Centre de Recherche en Santé de Nouna, Burkina Faso
| | - Ali Sie
- Centre de Recherche en Santé de Nouna, Burkina Faso
| |
Collapse
|
8
|
Clauss A, Sie A, Zabre P, Schmoll J, Sauerborn R, Listl S. Population-Based Prevalence of Oral Conditions as a Basis for Planning Community-Based Interventions: An Epidemiological Study From Rural Burkina Faso. Front Public Health 2021; 9:697498. [PMID: 34277555 PMCID: PMC8280293 DOI: 10.3389/fpubh.2021.697498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/28/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: The purpose of the present study was to: (i) provide timely data on dental caries and periodontal conditions in rural Burkina Faso; (ii) identify the oral health practices carried out in this population, and (iii) to prioritize evidence-based interventions at the community level. Methods: Leaning on WHO recommendations for oral health epidemiological studies, clinical examinations and questionnaire-based surveys were conducted in two different age groups (adolescents: 15-19 years old; adults: 35-44 years old) in the health district of Nouna, Burkina Faso. Caries and tooth status were assessed according to the DMFT Index. The periodontal status was assessed by a modified Community Periodontal Index on all teeth present and measuring the level of attachment-loss of six index teeth. Questionnaire items specifically included utilization of oral health care and oral health behaviors. Results: The prevalence of untreated caries was 38% in adolescents and 73% in adults. In terms of periodontal health, 21% of adolescents and 61% of adults had an attachment loss ≥4 mm. Ninety seven percent of adolescents had not attended a dentist in the previous year and 78% of adults had never seen a dentist in their life. About one third of adolescents and adults cleaned their teeth less often than once per day with equal proportions of toothbrushes and traditional chewing sticks made of tree branches. Fluoride toothpaste was used by <10% of study participants. Almost half of the examined people reported to drink a sugar-sweetened beverage at least once a day. Conclusions: Dental caries and periodontitis are highly prevalent in rural Burkina Faso. These findings highlight the key relevance of epidemiological data for identifying people's oral health needs as basis for developing, testing, and implementing oral health interventions and programs. Special emphasis should be put on the design and evaluation of community-based interventions.
Collapse
Affiliation(s)
- Alexandra Clauss
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Ali Sie
- Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | - Pascal Zabre
- Institut National de Santé Publique, Ouagadougou, Burkina Faso
| | - Jörg Schmoll
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Rainer Sauerborn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
| | - Stefan Listl
- Radboud Institute for Health Sciences, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.,Section for Translational Health Economics, Heidelberg University Hospital, Department of Conservative Dentistry, Heidelberg, Germany
| |
Collapse
|
9
|
Rossier C, Schoumaker B, Delaunay V, Beguy D, Jain A, Bangha M, Aregay A, Beck B, Derra K, Millogo M, Dube AN, Siaka K, Wamukoya M, Zabre P. Adolescent Fertility Is Lower than Expected in Rural Areas: Results from 10 African HDSS. Stud Fam Plann 2020; 51:177-192. [PMID: 32529644 DOI: 10.1111/sifp.12116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The adolescent birth rate (ABR) is an important indicator of maternal health, adolescent sexual health, and gender equity; it remains high in sub-Saharan Africa. While Demographic and Health Surveys (DHS) are the main source of ABR estimates, Health and Demographic Surveillance Systems (HDSS) also produce ABRs. Studies are lacking, however, to assess the ease of access and accuracy of HDSS ABR measures. In this paper, we use birth and exposure data from 10 HDSS in six African countries to compute local ABRs and compare these rates to DHS regional rates where the HDSS sites are located, standardizing by education and place of residence. In rural HDSS sites, the ABR measure is on average 44 percent lower than the DHS measure, after controlling for education and place of residence. Strong temporary migration of childless young women out of rural areas and different capacities in capturing temporarily absent women in the DHS and HDSS could explain this discrepancy. Further comparisons based on more strictly similar populations and measures seem warranted.
Collapse
|
10
|
Sié A, Bountogo M, Ouattara M, Zabre P, Bagagnan C, Zakane A, Brogdon J, Lebas E, Lin Y, Godwin WW, Bärnighausen T, Lietman TM, Oldenburg CE. Insecticide-treated bed net access and use among preschool children in Nouna District, Burkina Faso. Int Health 2020; 12:164-169. [PMID: 32118266 PMCID: PMC7320422 DOI: 10.1093/inthealth/ihaa003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 01/02/2020] [Accepted: 01/08/2020] [Indexed: 11/16/2022] Open
Abstract
Background We evaluated universal insecticide-treated bed net access and use in children <5 y of age in a rural area of Burkina Faso. Methods A door-to-door enumerative census was conducted in Nouna District, Burkina Faso in December 2018 through April 2019. The most recent mass bed net distribution campaign occurred in June 2016. Heads of households were interviewed about household bed net ownership and use by children <5 y of age. We evaluated the relationship between demographic and socio-economic factors and household universal bed net access and use by children. Results In 23 610 households with at least one child <5 y of age, 71 329 bed nets were reported (94.5% insecticide-treated). One-third (35.2%) of households had universal access and two-thirds (67.0%) of children slept under an insecticide-treated net the previous night. Children in households with universal access more often slept under a net the previous night (adjusted odds ratio 4.81 [95% confidence interval 4.39–5.26]). Conclusions Bed net coverage was substantially less than the 80% World Health Organization target for universal coverage in Nouna District. Insecticide-treated nets were used preferentially for children, but important gaps remain in consistent bed net use in this population. Structural and behavioural interventions are needed to close these gaps.
Collapse
Affiliation(s)
- Ali Sié
- Centre de Recherche en Santé de Nouna, Rue Namory Kéita, Nouna, Burkina Faso
| | - Mamadou Bountogo
- Centre de Recherche en Santé de Nouna, Rue Namory Kéita, Nouna, Burkina Faso
| | - Mamadou Ouattara
- Centre de Recherche en Santé de Nouna, Rue Namory Kéita, Nouna, Burkina Faso
| | - Pascal Zabre
- Centre de Recherche en Santé de Nouna, Rue Namory Kéita, Nouna, Burkina Faso
| | - Cheik Bagagnan
- Centre de Recherche en Santé de Nouna, Rue Namory Kéita, Nouna, Burkina Faso
| | - Alphonse Zakane
- Centre de Recherche en Santé de Nouna, Rue Namory Kéita, Nouna, Burkina Faso
| | - Jessica Brogdon
- Francis I. Proctor Foundation, University of California, 513 Parnassus Ave, San Francisco, San Francisco, CA, USA, 94143
| | - Elodie Lebas
- Francis I. Proctor Foundation, University of California, 513 Parnassus Ave, San Francisco, San Francisco, CA, USA, 94143
| | - Ying Lin
- Francis I. Proctor Foundation, University of California, 513 Parnassus Ave, San Francisco, San Francisco, CA, USA, 94143
| | - William W Godwin
- Francis I. Proctor Foundation, University of California, 513 Parnassus Ave, San Francisco, San Francisco, CA, USA, 94143
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, University of Heidelberg, Im Neuenheimer Feld 130/3, 69120 Heidelberg, Germany.,Africa Health Research Institute, Somkhele, South Africa.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Thomas M Lietman
- Francis I. Proctor Foundation, University of California, 513 Parnassus Ave, San Francisco, San Francisco, CA, USA, 94143.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine E Oldenburg
- Francis I. Proctor Foundation, University of California, 513 Parnassus Ave, San Francisco, San Francisco, CA, USA, 94143.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | | |
Collapse
|
11
|
Sie A, Bountogo M, Nebie E, Ouattara M, Coulibaly B, Bagagnan C, Zabre P, Lebas E, Brogdon J, Godwin WW, Lin Y, Porco T, Doan T, Lietman TM, Oldenburg CE. Neonatal azithromycin administration to prevent infant mortality: study protocol for a randomised controlled trial. BMJ Open 2019; 9:e031162. [PMID: 31488494 PMCID: PMC6731835 DOI: 10.1136/bmjopen-2019-031162] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Biannual mass azithromycin distribution to children aged 1-59 months has been shown to reduce all-cause mortality. Children under 28 days of age were not treated in studies evaluating mass azithromycin distribution for child mortality due to concerns related to infantile hypertrophic pyloric stenosis (IHPS). Here, we report the design of a randomised controlled trial to evaluate the efficacy and safety of administration of a single dose of oral azithromycin during the neonatal period. METHODS AND ANALYSIS The Nouveaux-nés et Azithromycine: une Innovation dans le Traitement des Enfants (NAITRE) study is a double-masked randomised placebo-controlled trial designed to evaluate the efficacy of a single dose of azithromycin (20 mg/kg) for the prevention of child mortality. Newborns (n=21 712) aged 8-27 days weighing at least 2500 g are 1:1 randomised to a single, directly observed, oral dose of azithromycin or matching placebo. Participants are followed weekly for 3 weeks after treatment to screen for adverse events, including IHPS. The primary outcome is all-cause mortality at the 6-month study visit. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Boards at the University of California, San Francisco in San Francisco, USA (Protocol #18-25027) and the Comité National d'Ethique pour la Recherche in Ouagadougou, Burkina Faso (Protocol #2018-10-123). The findings of this trial will be presented at local, regional and international meetings and published in open access peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03682653; Pre-results.
Collapse
Affiliation(s)
- Ali Sie
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | | | - Eric Nebie
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | | | | | - Cheik Bagagnan
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | - Pascal Zabre
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | - Elodie Lebas
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
| | - Jessica Brogdon
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
| | - William W Godwin
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
| | - Ying Lin
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
| | - Travis Porco
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States
| | - Thuy Doan
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
| | - Thomas M Lietman
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States
| |
Collapse
|
12
|
Dennis EG, Sie A, Ouermi L, Dah C, Tapsoba C, Zabre P, Bärnighausen T, O'Brien KS, Lebas E, Keenan JD, Oldenburg CE. Short-term weight gain among preschool children in rural Burkina Faso: a secondary analysis of a randomised controlled trial. BMJ Open 2019; 9:e029634. [PMID: 31362969 PMCID: PMC6677972 DOI: 10.1136/bmjopen-2019-029634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Nutrition has profound effects on children's health outcomes and is linked to weight gain and cognitive development. We used data from a randomised controlled trial to evaluate the prospective associations between dietary, socioeconomic and demographic factors and short-term weight gain during the lean season in a rural area of Burkina Faso. DESIGN Prospective cohort data arising from a randomised controlled trial of the effect of antibiotic distribution on child growth and intestinal microbial diversity. SETTING Two rural communities in Nouna District, Burkina Faso. PARTICIPANTS 246 children aged 6-59 months living in the study communities were enrolled in the study. PRIMARY AND SECONDARY OUTCOME MEASURES Anthropometric measurements, including weight and height, were obtained at baseline and 1 month. RESULTS Of 246 children, the median weight for wasted children at baseline (weight-for-height z-score <-2) was 9.7 kg (IQR 8.65-10.8) and the weight of non-wasted children was 12.8 kg (IQR 10.9-14.75). Food insecurity was significantly associated with decreased weight gain velocity (mean difference -0.03 g/kg/day, 95% CI -0.06 to -0.006, p=0.04). CONCLUSION Experiences of household food insecurity before the beginning of the lean season were associated with decreased weight gain in children in rural Burkina Faso during the lean season, although the mean difference was small. Understanding the relationship between timing of food insecurity and anthropometric outcomes may help to develop policies and health programme that address both of these issues. TRIAL REGISTRATION NUMBER NCT03187834.
Collapse
Affiliation(s)
- Elena G Dennis
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
| | - Ali Sie
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | | | - Clarisse Dah
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | | | - Pascal Zabre
- Centre de Recherche en Sante de Nouna, Nouna, Burkina Faso
| | - Till Bärnighausen
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
- Africa Health Research Institute, Somkhele, South Africa
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
| | - Kieran S O'Brien
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
| | - Elodie Lebas
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
| | - Jeremy D Keenan
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, United States
| | - Catherine E Oldenburg
- Francis I Proctor Foundation, University of California, San Francisco, California, USA
- Department of Ophthalmology, University of California, San Francisco, California, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States
| |
Collapse
|
13
|
Sié A, Tapsoba C, Dah C, Ouermi L, Zabre P, Bärnighausen T, Arzika AM, Lebas E, Snyder BM, Moe C, Keenan JD, Oldenburg CE. Dietary diversity and nutritional status among children in rural Burkina Faso. Int Health 2019; 10:157-162. [PMID: 29579204 DOI: 10.1093/inthealth/ihy016] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/15/2018] [Indexed: 01/21/2023] Open
Abstract
Background Burkina Faso has a seasonal malnutrition pattern, with higher malnutrition prevalence during the rainy season when crop yields are low. We investigated the association between dietary diversity and nutritional status among children aged 6-59 mo during the low crop yield season in rural Burkina Faso to assess the role of dietary diversity during the lean season on childhood nutritional status. Methods Caregivers reported the dietary diversity of the past 7 d, consisting of 11 food groups, summed into a scale. Anthropometric measurements were taken from all children. Height-for-age (HAZ), weight-for-height (WHZ) and weight-for-age (WAZ) z-scores were calculated based on 2006 WHO standards. Stunting, wasting and underweight were defined as HAZ, WHZ and WAZ <-2 SD, respectively. Multivariable regression models adjusting for potential confounders including household food insecurity and animal ownership were used to assess the relationship between anthropometric indices and dietary diversity. Results Of 251 children enrolled in the study, 20.6% were stunted, 10.0% wasted and 13.9% underweight. Greater dietary diversity was associated with greater HAZ (SD 0.14, 95% CI 0.04 to 0.25) among all children. There was no association between dietary diversity and wasting or mid-upper arm circumference in this study. Conclusions Increasing dietary diversity may be an approach to reduce the burden of stunting and chronic malnutrition among young children in regions with seasonal food insecurity.
Collapse
Affiliation(s)
- Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Clarisse Dah
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | - Pascal Zabre
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Till Bärnighausen
- Heidelberg Institute of Public Health, University of Heidelberg, Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Elodie Lebas
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Blake M Snyder
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA
| | - Caitlin Moe
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Jeremy D Keenan
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine E Oldenburg
- Francis I. Proctor Foundation, University of California, San Francisco, San Francisco, CA, USA.,Department of Ophthalmology, University of California, San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
14
|
Sié A, Dah C, Ouermi L, Tapsoba C, Zabre P, Bärnighausen T, Lebas E, Arzika AM, Snyder BM, Porco TC, Lietman TM, Keenan JD, Oldenburg CE. Effect of Antibiotics on Short-Term Growth among Children in Burkina Faso: A Randomized Trial. Am J Trop Med Hyg 2018; 99:789-796. [PMID: 30014828 DOI: 10.4269/ajtmh.18-0342] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Antibiotics improve both weight and height gain in randomized trials of preschool children with preexisting morbidity. Here, we assess the effect of a short course of three different antibiotics (amoxicillin, azithromycin, and cotrimoxazole) on short-term linear and ponderal growth in a population-based sample of preschool children in rural Burkina Faso. We randomized households with at least two children in the Nouna district, Burkina Faso, to a 5-day course of amoxicillin, azithromycin, cotrimoxazole, or placebo. Within each antibiotic-randomized household, one child was randomly assigned to receive the antibiotic and the other to receive the placebo. Weight and height measurements were taken at baseline and 30 days following the last study medication dose. Weight-for-height Z (WHZ), height-for-age Z (HAZ), and weight-for-age Z (WAZ) scoreswere calculated based on the 2006 World Health Organization standards. Of the 124 households and 248 children enrolled, 229 had anthropometry measurements at 1 month and were analyzed. Children randomized to amoxicillin gained significantly more weight compared with both the placebo household (mean difference 317 g, 95% confidence interval [CI]: 115-519 g) and placebo sibling (mean difference 315 g, 95% CI: 147-482 g) controls. Growth velocity in g/kg/day, and WHZ and WAZ scores were higher in amoxicillin-treated children compared with placebo households and siblings. There were no differences in weight gain in children randomized to azithromycin or cotrimoxazole compared with placebo households or placebo siblings. There were no differences in height gain or HAZ across any of the study arms. Amoxicillin may have short-term growth-promoting effects in healthy children.
Collapse
Affiliation(s)
- Ali Sié
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Clarisse Dah
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | | | - Pascal Zabre
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | - Till Bärnighausen
- Africa Health Research Institute, KwaZulu-Natal, South Africa.,Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.,Heidelberg Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Elodie Lebas
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | | | - Blake M Snyder
- Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Travis C Porco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.,Department of Ophthalmology, University of California, San Francisco, San Francisco, California.,Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Thomas M Lietman
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.,Department of Ophthalmology, University of California, San Francisco, San Francisco, California.,Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Jeremy D Keenan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.,Department of Ophthalmology, University of California, San Francisco, San Francisco, California.,Francis I. Proctor Foundation, University of California, San Francisco, California
| | - Catherine E Oldenburg
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California.,Department of Ophthalmology, University of California, San Francisco, San Francisco, California.,Francis I. Proctor Foundation, University of California, San Francisco, California
| |
Collapse
|