Population-Modifiable Risk Factors Associated With Childhood Stunting in Sub-Saharan Africa

Importance

Identifying modifiable risk factors associated with childhood stunting in sub-Saharan Africa (SSA) is imperative for the development of evidence-based interventions and to achieve the Sustainable Development Goals.

Objective

To evaluate key modifiable risk factors associated with childhood stunting in SSA.

Design, Setting, and Participants

This cross-sectional study examined the most recent (2014-2021) Demographic and Health Surveys data for children younger than 5 years from 25 SSA countries.

Exposures

Modifiable risk factors included history of diarrhea within 2 weeks, consumption of dairy products, maternal body mass index, maternal educational level, antenatal care visits, place of birth, wealth index, type of toilet, and type of cooking fuel.

Main Outcomes and Measures

Stunting and severe stunting, measured using the height-for-age z score, were the main outcomes. Children who scored below -2.0 SDs or -3.0 SDs were classified as having stunted or severely stunted growth, respectively. Relative risks and 95% CIs were computed using generalized linear latent and mixed models and log-binomial link functions. Population-attributable fractions (PAFs) were calculated using adjusted relative risks and prevalence estimates for key modifiable risk factors.

Results

This study included 145 900 children from 25 SSA countries. The mean (SD) age of the children was 29.4 (17.3) months, and 50.6% were male. The highest PAFs of severe childhood stunting were observed for mothers lacking a formal education (PAF, 21.9%; 95% CI, 19.0%-24.8%), children lacking consumption of dairy products (PAF, 20.8%; 95% CI, 16.8%-24.9%), unclean cooking fuel (PAF, 9.5%; 95% CI, 2.6%-16.3%), home birth (PAF, 8.3%; 95% CI, 6.3%-10.0%), and low-income household (PAF, 5.8%; 95% CI, 3.4%-8.0%). These 5 modifiable risk factors were associated with 51.6% (95% CI, 40.5%-60.9%) of the severe childhood stunting in SSA.

Conclusions and Relevance

This cross-sectional study identified 5 modifiable risk factors that were associated with 51.6% of severe childhood stunting in SSA. These factors should be a priority for policy makers when considering future child health interventions to address chronic malnutrition in SSA.

Double burden of malnutrition and its associated factors among women in low and middle income countries: findings from 52 nationally representative data

BACKGROUND

Double burden of malnutrition (DBM) is an emerging global public health problem. The United Nations member states adopted eradicating all forms of malnutrition as an integral component of the global agenda. However, there is evidence of a high burden of undernutrition among women and rising rates of overweight and obesity, especially in low and middle income countries (LMICs). Therefore, this study aimed to investigate the prevalence and associated factors of underweight, overweight, and obesity among women of reproductive age in LMICs.

METHODS

Data for the study were drawn from a recent 52 Demographic and Health Surveys (DHS) conducted in LMICS. We included a sample of 1,099,187 women of reproductive age. A multilevel multinomial logistic regression model was used to identify factors associated with DBM. Adjusted relative risk ratio (RRR) with a 95% Confidence Interval (CI) was reported to show an association.

RESULTS

The prevalence of underweight, overweight, and obesity in LMICs among women of reproductive age was 15.2% (95% CI: 15.1-15.3), 19.0% (95% CI: 18.9- 19.1), and 9.1% (95% CI: 9.0-9.2), respectively. This study found that women aged 24-34 years, aged ≥ 35 years, with primary, secondary, and above educational level, from wealthy households, using modern contraceptives, exposed to media (radio and television), and with high parity (more than one birth) were more likely to have overweight and obesity and less likely to have underweight. Moreover, the risk of having obesity (RRR = 0.59; 95% CI = 0.58-0.60 and overweight (RRR = 0.78; 95% CI = 0.77-0.79) were lower among rural women, while the risk of being underweight was (RRR = 1.13; 95% CI = 1.11-1.15) higher among rural women compared to urban women.

CONCLUSION

The prevalence of underweight, overweight, and obesity was high among women of reproductive age in LMICs. Underweight, overweight, and obesity are influenced by sociodemographic, socioeconomic, and behavioral-related factors. This study shows that, in order to achieve Sustainable Development Goal 2, a multifaceted intervention approach should be considered to prevent both forms of malnutrition in women of reproductive age. This can be achieved by raising awareness and promoting healthy behaviors such as healthy eating and physical activity, especially among educated women, women from wealthy households, and women exposed to the media.

Estimating the impact of birth interval on under-five mortality in east african countries: a propensity score matching analysis

BACKGROUND

Under-five mortality remains a global public health concern, particularly in East African countries. Short birth interval is highly associated with under-five mortality, and birth spacing has a significant effect on a child's likelihood of survival. The association between short birth intervals and under-five mortality was demonstrated by numerous observational studies. However, the effect of short birth intervals on under-five mortality has not been investigated yet. Therefore, this study aimed to investigate the impact of short birth intervals on under-five mortality in East Africa using Propensity Matched Analysis.

METHODS

A secondary data analysis was conducted based on the most recent Demographic and Health Survey (DHS) data of 12 East African countries. A total weighted sample of 105,662 live births was considered for this study. A PSM analysis was carried out to evaluate the effect of short birth intervals on under-five mortality. Under-five mortality was the outcome variable, while the short birth interval was considered a treatment variable. To determine the Average Treatment Effect on the population (ATE), Average Treatment Effect on the treated (ATT), and Average Treatment Effect on the untreated (ATU), we performed PSM analysis with a logit-based model using the psmatch2 ate STATA function. The quality of matching was assessed statistically and graphically. The common support assumption was checked and fulfilled. We have employed Mantel-Haenszel bounds to examine whether the result would be free from hidden bias or not.

RESULTS

The prevalence of short birth intervals in East Africa was 44%. The under-five mortality rate among mothers who had optimal birth intervals was 39.9 (95% CI: 38.3, 41.5) per 1000 live births while it was 60.6 (95% CI: 58.5, 62.8) per 1000 live births among mothers who had a short birth intervals. Propensity score matching split births from mothers into treatment and control groups based on the preceding birth interval. In the PSM analysis, the ATT values in the treated and control groups were 6.09% and 3.97%, respectively, showed under-five mortality among births to mothers with short birth intervals was 2.17% higher than births to mothers who had an optimal birth interval. The ATU values in the intervention and control groups were 3.90% and 6.06%, respectively, indicating that for births from women who had an optimal birth interval, the chance of dying within five years would increase by 2.17% if they were born to mother with short birth interval. The final ATE estimate was 2.14% among the population. After matching, there was no significant difference in baseline characteristics between the treated and control groups (p-value > 0.05), which indicates the quality of matching was good.

CONCLUSIONS

We conclude that enhancing mothers to have optimal birth spacing is likely to be an effective approach to reducing the incidence of under-five mortality. Our findings suggest that births to mothers with short birth intervals have an increased risk of death in the first five years of life than births to mothers who had an optimal birth interval. Therefore, public health programs should enhance interventions targeting improving birth spacing to reduce the incidence of under-five mortality in low-and middle-income countries like East African countries. Moreover, to achieve a significant reduction in the under-five mortality rate, interventions that encourage birth spacing should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets in East African countries.

Determinants of anemia severity levels among children aged 6-59 months in Ethiopia: Multilevel Bayesian statistical approach

Anemia is a widespread public health problem that affects all stages of life particularly preschool children and pregnant mothers. Anemia among children had significant impact on their growth, development, school performance and mortality. Different strategies like deworming of young children, vitamin A supplementation for children aged 6-59 months, and ferrous sulphate supplementation and provision of insecticide treated bed net for pregnant women were designed to control and prevent anemia. Also, previous studies on anemia factors were conducted but they were not considering the ordered nature of anemia. Therefore, this study aimed to identify the factors of anemia severity levels among children aged 6-59 months in Ethiopia by using ordinal analysis based on Bayesian hierarchical statistical approach. A secondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Survey data. A total of 8483 weighted children were included. Due to the ordered nature of the anemia and nested nature of DHS data, ordinal logistic regression model based on hierarchical Bayesian statistical approach was employed to identify the determinants of anemia severity levels. In this study, moderate anemia level was found to be the commonest type which accounts around 29.4%. Female children, poorer, middle, and richest wealth index, primary maternal education and having ANC visit had lower risk of having higher order of anemia. Moderate maternal anemia and stunted children had higher chance of having higher order of anemia. Children age had significant different effect on mild and moderate anemia. Meanwhile, multiple birth/s and deworming had effect on moderate anemia. In addition, normal birth weight had also significant and different effect on mild and severe anemia and history of feverlike illness on mild anemia. The prevalence of anemia among children aged 6-59 months anemia was found to be a severe public health problem. Children age, sex, maternal education, child stunting, history of fever, multiple birth, birth weight, provision of deworming and maternal anemia was found to be the most important factors for child anemia severity levels. Therefore, intervention efforts to control and prevent anemia in Ethiopia requires targeting of these hindering factors.

Appropriate feeding practice and associated factors among under-five children with diarrheal disease in sub-Saharan Africa: a multi-country analysis

BACKGROUND

Diarrheal disease is one of the leading causes of child mortality and morbidity in low-income countries. Although the provision of more fluid and solid foods during diarrhea are important to treat the diseases, in Africa, food and fluid restrictions are common during diarrheal illness. Therefore, the aim of this study was to determine appropriate feeding practice and associated factors among under-five children with diarrheal disease in sub-Saharan Africa (SSA).

METHODS

We have used the appended most recent demographic and health survey (DHS) datasets of 35 sub-Saharan countries conducted from 2010 to 2020. A total weighted sample of 42,882 living children with diarrhea were included in the analyses. Multivariable multilevel binary logistic regression was used to identify factors associated with appropriate child feeding practice in SSA. A p value of ≤ 0.05 was used as a cut of point to declare statistically significant variables.

RESULTS

The overall prevalence of appropriate child feeding practice in this study was 10.45% (95% CI 10.17-10.74). The odds of having appropriate child feeding practice was higher among women with primary (AOR = 1.27: 1.17-1.37), secondary (AOR = 1.38: 1.25-1.52), and higher education level (AOR = 1.52: 1.21-1.90), media exposure (AOR = 1.11: 1.11-1.29), richer (AOR = 1.23:1.01-1.26) and richest (AOR = 1.19:1.05-1.35) wealth index, and currently working (AOR = 1.12: 1.04-1.19).

CONCLUSION

The prevalence of appropriate child feeding practice in this study was found to be very low. It advisable to reduce diarrhea-related child mortality through enhancing diarrhea management practice especially by working on the after mentioned factors.

The prevalence and determinant factors of substance use among the youth in Ethiopia: A multilevel analysis of Ethiopian Demographic and Health Survey

Background

In Ethiopia, the youth are more exposed to substances such as alcohol, Khat, and tobacco than other populations. Despite the seriousness of the situation, low- and middle-income nations, particularly Ethiopia, have intervention gaps. Service providers must be made more aware of relevant evidence to combat these problems. This research focused on finding out how common substance abuse is among teenagers and the factors that influence it.

Methods

The 2016 Ethiopian Demographic and Health Survey data were used for secondary data analysis. This survey includes all young people aged 15 to 24 years. The total sample size was 10,594 people. Due to the hierarchical nature of the survey data, a multilevel logistic regression model was employed to uncover the individual- and community-level characteristics related to substances.

Results

In Ethiopia, the overall current prevalence of occasional or daily substance use 30 days prior to the survey was 46.74%. Of the participants, 36.34, 12.56, and 0.95% were drinking alcohol, chewing Khat, and smoking cigarettes/any tobacco products, respectively. Male sex, 20-24 years of age, exposure to media, having a job, and living in large central and metropolitan regions were the factors associated with the problem.

Conclusion

According to the 2016 EDHS, substance use among young people is widespread in Ethiopia. To lower the prevalence of substance use among youth, policymakers must increase the implementation of official rules, such as restricting alcohol, Khat, and tobacco product marketing to minors, prohibiting smoking in public places, and banning mass-media alcohol advertising. Specific interventions targeting at-risk populations, such as youth, are mainly required in prominent central and metropolitan locations.

Spatial distribution and determinants of alcohol consumption among pregnant women in Ethiopia: Spatial and multilevel analysis

BACKGROUND

Alcohol consumption during pregnancy is a known contributor to teratogen and causes a range of effects on pregnancy and birth outcomes. This study aimed to investigate the spatial variation and determinants of alcohol consumption among pregnant women in Ethiopia.

METHODS

A secondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Survey data. A total of 1,135 pregnant women were included in the analysis. ArcGIS version 10.7 software was used to explore the spatial distribution of alcohol consumption, and SaTScan version 9.6 was employed to identify the significant spatial clusters of alcohol consumption. A mixed multi-level logistic regression analysis was employed to identify the determinant factors of alcohol consumption during pregnancy.

RESULTS

The result showed that the prevalence of alcohol consumption during pregnancy was 22.49% (with a 95% CI: 18.18 to 26.17). The spatial analysis showed that the spatial distribution of alcohol consumption significantly varied across the country [Global Moran's I value = 0.30 (P<0.001)]. The SaTScan analysis identified two most likely clusters with high rates of alcohol consumption such as northwest Ethiopia (Log-Likelihood Ratio (LLR) = 155.56, p<0.001) and central Ethiopia (LLR = 19.27, p<0.01). Never in union, divorced and/ widowed [Adjusted odds ratio (AOR) = 2.56; 95% CI: 1.07, 10.14], attended primary school [AOR = 0.45; 95% CI: 0.27, 0.95], having two or more lifetime sexual partners [AOR = 2.59; 95% CI: 1.11, 6.18], living in rural [AOR = 1.52; 95% CI: 1.12, 2.93] and higher community media exposure [AOR = 0.54; 95% CI: 0.28, 0.97] were the factors associated with alcohol consumption.

CONCLUSION

Alcohol consumption during pregnancy in Ethiopia was high. The spatial distribution of alcohol consumption was significantly varied across the country. Therefore, public health interventions targeting areas with high alcohol consumption are needed for drinking cessation and to prevent poor pregnancy outcomes related to alcohol use.

Prevalence and factors associated with unintended pregnancy among adolescent girls and young women in sub-Saharan Africa, a multilevel analysis

BACKGROUND

Unintended pregnancy predisposes women to unsafe abortion, malnutrition, mental illness, and even death. Though adolescent girls and young women are at higher risk of unintended pregnancy, there is a paucity of evidence in its burden and associated factors in sub-Saharan Africa. Therefore, this study aimed to assess the prevalence and factors associated with unintended pregnancy among adolescent girls and young women in sub-Saharan Africa.

METHOD

This study was a secondary data analysis of 36 sub-Saharan African countries with a total weighted sample of 17,797 adolescent girls and young women. A multilevel logistic regression model was fitted and, the Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was reported to assess the association between the independent variables and unintended pregnancy in Sub-Saharan Africa.

RESULT

The pooled prevalence of unintended pregnancy in sub-Saharan Africa was 30.01 with 95% CI (29.38-30.74). In multivariable multilevel logistic regression analysis, adolescent girls, and young women with higher education (AOR = 0.71 95%CI 0.52-0.97), those who know modern contraceptive methods (AOR = 0.86 95%CI 0.75-0.98), and traditional contraceptive methods (AOR = 0.90, 95%CI 0.59-0.95), married (AOR = 0.80, 95%CI 0.73-0.88), those from female-headed households (AOR = 0.86,95%CI 0.78-0.94), had lower odds of unintended pregnancy. Whereas adolescent girls and young women from Central Africa (AOR = 2.09,95%CI 1.23-3.55), southern Africa (AOR = 5.23, 95%CI 2.71-10.09), and Eastern Africa (AOR = 1.07,95%CI 1.07-2.66) had higher odds of unintended pregnancy.

CONCLUSION

Prevalence of unintended pregnancy in Sub-Saharan Africa is high. Therefore, educating adolescent girls and young women, and improving their knowledge about family planning services is vital. It is also better for the government of countries in sub-Saharan Africa and other global and local stakeholders to work hard to ensure universal access to sexual and reproductive healthcare services, including family planning, education, and the integration of reproductive health into national strategies and programs to reduce unintended pregnancy.

Understanding the rural-urban disparity in acute respiratory infection symptoms among under-five children in Sub-Saharan Africa: a multivariate decomposition analysis

Background

Acute Respiratory Infections (ARIs) account for more than 6% of the worldwide disease burden in children under the age of five, with the majority occurring in Sub-Saharan Africa. Rural children are more vulnerable to and disproportionately affected by ARIs. As a result, we examined the rural–urban disparity in the prevalence of ARI symptoms and associated factors among children under the age of five in Sub-Saharan Africa.

Methods

We used the most recent Demographic and Health Survey (DHS) data from 36 countries in Sub-Saharan Africa. The study included 199,130 weighted samples in total. To identify variables associated with ARIs symptoms, a multilevel binary logistic regression model was fitted. The Adjusted Odds Ratio (AOR) with a 95% CI was used to determine the statistical significance and strength of the association. To explain the rural–urban disparity in ARI prevalence, a logit-based multivariate decomposition analysis was used.

Results

Being female, ever breastfeeding, belonging to a poorer, better wealth status, and having better maternal educational status were significantly associated with lower odds of ARIs among under-five children. Whereas, small size or large size at birth, not taking vitamin A supplementation, being severely underweight, having diarrhea, didn’t have media exposure, never had the vaccination, being aged 36–47 months, and being aged 48–59 months were significantly associated with higher odds of ARIs among under-five children. The multivariate decomposition analysis revealed that the difference in characteristics (endowment) across residences explained 64.7% of the overall rural–urban difference in the prevalence of ARIs, while the difference in the effect of characteristics (change in coefficient) explained 35.3%.

Conclusion

This study found that rural children were highly affected by ARIs in SSA. To reduce the excess ARIs in rural children, public health interventions aimed at impoverished households, home births, and unvaccinated and malnourished children are crucial.

Pooled prevalence of stunting and associated factors among children aged 6-59 months in Sub-Saharan Africa countries: A Bayesian multilevel approach

Background

Over 155 million children under five suffer from stunting, and it is responsible for over one million deaths and 54.9 million Disability Adjusted Life Years (DALYS) of under-five children worldwide. These predominantly occurred in low-and middle-income countries like sub-Saharan Africa. Stunted children begin their lives at a marked disadvantage. Some of these are; poor cognition and educational performance, low adult wages, lost productivity and, when accompanied by excessive weight gain later in childhood, an increased risk of nutrition-related chronic diseases in adult life and the devastating effects of stunting can last a lifetime and even affect the next generation. Despite this, its magnitude rises in the past 25 years in sub-Saharan Africa. Studies that capture the pooled prevalence and associated factors of stunting among children aged 6–59 months in sub-Saharan Africa are limited. Therefore, this study was carried out on the basis of the Bayesian approach to determine the pooled prevalence and predictors of stunting among children aged 6–59 months in Sub-Saharan Africa.

Objective

To assess the pooled prevalence of stunting and associated factors among children aged 6–59 months in Sub-Saharan Africa

Methods

For this study a total of 173,483 weighted samples from the demography and health survey data set of 35 sub-Saharan African countries from 2008 to 2020 were used. After checking Variation between cluster by computing Intraclass Correlation Coefficient, binary logistic regression model was conducted based on hierarchical Bayesian statistical approach to account the hierarchical nature of demography and health survey data and to get reliable estimates by using additional information from the prior distribution. Adjusted odds ratio with 95% credible interval of the best fitted model was used to ascertain the predictors.

Results

The pooled prevalence of stunting in Sub-Saharan Africa was about 35% (95%CI: 34.87, 35.31). Of the sub-regions, the highest prevalence of stunting was in East Africa, 37% (95%, CI: 36.96, 37.63) followed by Central Africa, 35% (95%CI: (34.93, 35.94). Being male (AOR = 1.27, 95% CrI 1.25, 1.30), small birth size (AOR = 1.29, CrI 1.25, 1.32), home delivery (AOR = 1.17, CrI 1.14, 1.20), and no education of mothers (AOR = 3.07, CrI 2.79, 3.39) were some of the significant predictors of stunting of children.

Conclusion and recommendation

The prevalence of stunting of children in sub-Saharan Africa is among the highest in the world. Predictors such as being male, being small at birth, a child delivered at home, and, low level of maternal education were some of the predictors of childhood stunting. Stakeholders and non-governmental organizations should consider those contributing factors of stunting when they plan and design nutritional improvement programs.

Effect of COVID-19 pandemic on missed medical appointment among adults with chronic disease conditions in Northwest Ethiopia

BACKGROUND

COVID-19 had affected the health-care-seeking behavior of people with chronic medical conditions. The impact is even worse in resource-limited settings like Ethiopia. Therefore, this study was aimed to assess the extent and correlates of missed appointments among adults with chronic disease conditions before and during the COVID-19 pandemic in the Northwest Ethiopia.

METHODS

A retrospective chart review and cross-sectional survey were conducted from December 2020 to February 2021. A total of 1833 patients with common chronic disease were included by using a stratified systematic random sampling technique. Web-based data collection was done using Kobo collect. The data were explored using descriptive statistical techniques, the rate of missed appointments s before and during the COVID-19 pandemic was determined. A negative binomial regression model was fitted to identify the factors of missed appointment. An incidence rate ratio with its 95% confidence interval (CI) and p-value of the final model were reported.

RESULTS

The rate of missed appointments was 12.5% (95% CI: 11.13%, 14.20%) before the pandemic, increased to 26.8% (95% CI: 24.73%, 28.82%) during the pandemic (p-value < 0.001). Fear of COVID-19 infection and lack of transport was the most common reasons for missing appointments. Older patients (Adjusted Incidence Rate Ratio (AIRR) = 1.01, 95% CI: 1.001; 1.015), having treatment follow up more than 5 years (AIRR = 1.36, 95%CI: 1.103; 1.69), shorter frequency of follow-up (AIRR = 2.22, 95% CI: 1.63; 2.49), covering expense out of pocket (AIRR = 2.26, 95%CI: 1.41; 2.95), having a sedentary lifestyle (AIRR = 1.36, 95%CI: 1.12; 1.71), and history of missed appointments before COVID-19 pandemic (AIRR = 4.27, 95%CI: 3.35; 5.43) were positively associated with the incidence of missed appointments.

CONCLUSION

The rate of missed appointment increased significantly during the COVID-19 pandemic. Older age, longer duration of follow up, more frequent follow-up, out-of-pocket expenditure for health service, history of poor follow-up, and sedentary lifestyle had positive relationship with missed appointments during the pandemic. Therefore, it is important to give special emphasis to individuals with these risk factors while designing and implementing policies and strategies for peoples with chronic diseases to ensure the continuity of care and to avoid the long-term impact on their health.

Spatial variation and factors associated with home delivery after ANC visit in Ethiopia; spatial and multilevel analysis

Introduction

Institutional delivery is crucial to reduce maternal and neonatal mortality as well as serious morbidities. However, in Ethiopia, home delivery (attended by an unskilled birth attendant) after antenatal care (ANC) visit is highly in practice. Therefore, this study aimed to assess the spatial variation and determinants of home delivery after antenatal care visits in Ethiopia.

Method

A secondary data analysis was conducted using the 2019 mini Ethiopian demographic and health survey. A total of 2,923 women who had ANC visits were included. Spatial analysis was done by using GIS 10.7 and SaTscan 9.6. The risk areas for home delivery from GIS and spatial scan statistics results were reported. A multi-level logistic regression model was fitted using Stata14 to identify individual and community-level factors associated with home delivery after ANC visit. Finally, AOR with 95% CI and random effects were reported.

Result

Home delivery after ANC visit was spatially clustered in Ethiopia(Moran’s index = 0.52, p-value <0.01). The primary clusters were detected in Oromia and SNNP region (LLR = 37.48, p < 0.001 and RR = 2.30) and secondary clusters were located in Benishangul Gumuz, Amhara, Tigray and Afar (LLR = 29.45, p<0.001 and RR = 1.54). Being rural resident (AOR = 2.52; 95%CI 1.09–5.78), having no formal education (AOR = 3.19;95% CI 1.11–9.16), being in the poor (AOR = 2.20;95%CI 1.51–3.22) and middle wealth index (AOR = 2.07;95% CI 1.44–2.98), having one ANC visit (AOR = 2.64; 95% CI 1.41–4.94), and living in the agrarian region (AOR = 3.63; 95%CI 1.03–12.77) had increased the odds of home delivery after ANC visit.

Conclusion and recommendation

Home delivery after ANC visit was spatially clustered in Ethiopia. Factors like maternal education, wealth index, number of ANC visits, residency and region were significantly associated with home delivery after ANC visit. Therefore, it is better to increase the number of ANC contact by giving health education, especially for women with low levels of education and better to improve the wealth status of women. A special strategy is also vital to reduce home delivery after ANC visit in those high-risk regions.

Coverage and factors associated with completion of continuum of care for maternal health in sub-Saharan Africa: a multicountry analysis

Background

Many maternal and neonatal deaths are largely preventable by expanding the continuum of care (at least four antenatal visits, skilled birth attendance and postnatal care). Even though ensuring the Continuum of Care (CoC) has advantages over separate services, evidence from the globe suggests that completion of the CoC for maternal health is very low. From our search of the literature, there is limited evidence on the completion of the entire CoC and its associated factors in sub-Saharan Africa (sSA). Therefore, this study aimed to assess coverage and associated factors of completion of the CoC for maternal health in sSA.

Methods

Data for the study were drawn from a recent nationally representative survey of 32 Demographic and Health Surveys (DHS). A total weighted sample of 225,135 women of reproductive-age, who gave birth in the two preceding years were included. Due to the hierarchical nature of DHS data, a multilevel logistic regression model was applied to investigate individual and community-level factors that may influence completion of CoC. Adjusted Odds Ratios (aORs) with 95% Confidence Interval (CI) were reported and variables with 95% CI not including 1 were considered as significant factors of the completion of CoC.

Results

Only, 56,172 (25.0%; 95% CI, 20.5%, 29.4%) of the women in sSA utilized the CoC for maternal health which varied from 11,908 (17.9.0%) in East Africa to 7,418 (51.5% in Southern Africa. Factors associated with higher odds of CoC were women aged 24–34 years (aOR 1.22, 95% CI: 1.17, 1.25), aged ≥ 35 years (aOR 1.40, 95% CI: 1.35, 1.47), attending primary education (aOR 1.44, 95% CI: 1.41, 1.49), secondary education (aOR 1.95, 95% CI: 1.89, 2.03), higher education (aOR 2.15, 95% CI: 2.01, 2.25), having mass media exposure (aOR 1.35, 95% CI: 1.28, 1.39), women from female-headed households (aOR 1.18, 95% CI: 1.15, 1.21) and women from communities with high maternal education (aOR 1.12, 95% CI: 1.09, 1.16). However, perceiving distance from the health facility as a big problem (aOR 0.88, 95% CI: 0.85, 0.91), residing in rural areas (aOR 0.78, 95% CI: 0.75, 0.81), delayed ANC initiation (aOR 0.43, 95% CI: 0.41, 0.47) and unintended pregnancy (aOR 0.87, 95% CI: 0.84, 0.91) were associated with lower odds of CoC.

Conclusion

This study showed a low proportion of women, who utilized the CoC in sSA. Both individual and community-level factors were associated with CoC completion rates among women in sSA. Therefore, policymakers in sSA must consider both individual and community-level factors and undertake multi-sectorial approaches to address barriers of CoC at different levels.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04757-1.

The effect of COVID-19 on poor treatment control among ambulatory Hypertensive and/or Diabetic patients in Northwest Ethiopia

Background

Diabetes and hypertension have emerged as important clinical and public health problems in Ethiopia. The need to have long-term sustainable healthcare services for patients with diabetes and hypertension is essential to enhance good treatment control among those patients and subsequently delay or prevent complications. A collective shift towards acute care for COVID-19 patients combined with different measures to contain the pandemic had disrupted ambulatory care. Hence, it is expected to have a significant impact on treatment control of hypertensive and diabetic patients. However, there is limited evidence on the effect of the pandemic on treatment control and its determinants. Therefore, this study aimed to assess the effect of COVID-19 pandemic on treatment control of ambulatory Hypertensive and Diabetic patients and identify the factors for poor treatment control in North West Ethiopia.

Methods

A retrospective chart review and cross-sectional survey design were conducted between December 2020 and February 2021. Using a stratified systematic random sampling technique, 836 diabetic and/or hypertensive patients were included in the study. Web-based data collection was done using Kobo collect. The changes in the proportion of poor treatment control among ambulatory Hypertensive and/or Diabetic patients during the COVID-19 pandemic period were assessed. A multivariable binary logistic regression mixed model was fitted to identify the determinants of poor treatment control. The odds ratios were reported in both crude and adjusted form, together with their 95% confidence intervals and p-values.

Result

Poor treatment control increased significantly from 24.81% (21.95, 27.92) prior to the COVID-19 pandemic to 30.33% (27.01, 33.88), 35.66% (32.26, 39.20), 36.69% (33.40, 40.12), and 34.18% (3102, 37.49) in the first, second, third, and fourth months following the date of the first COVID-19 case detection in Ethiopia, respectively. Marital status (AOR = 0.56, 95%CI; 0.41, 0.74), regimen of medication administration (AOR = 1.30, 95%CI; 1.02, 166), daily (AOR = 0.12, 95%CI; 0.08, 0.20), twice (AOR = 0.42, 95%CI; 0.30. 0.59), and three times (AOR = 0.31, 95%CI; 0.21, 0.47) frequency of medication, number medications taken per day (AOR = 0.79, 95%CI;0.73, 0.87), patients habits like hazardous alcohol use (AOR = 1.29, 95%CI; 1.02, 1.65) and sedentary lifestyle (AOR = 1.72,95%CI;1.46, 2.02), missed appointment during the COVID-19 pandemic (AOR = 2.09, 95%CI; 1.79, 2.45), and presence of disease related complication (AOR = 1.11, 95%CI; 0.93, 1.34) were significantly associated with poor treatment control among Diabetic and/or hypertensive patients during the COVID-19 pandemic.

Conclusion

The COVID-19 pandemic had a substantial impact on ambulatory Diabetic and/or Hypertensive patients’ treatment control. Being married, as well as the frequency and types of medicines taken per day were all found to be negatively associated with poor treatment control. During the COVID -19 pandemic, patients’ habits such as hazardous alcohol use and sedentary lifestyle, longer follow-up time, having disease-related complication (s), patients taking injectable medication, number of medications per day, and missed appointments were positively associated with poor treatment control in ambulatory diabetic and hypertensive patients. Therefore, it is better to consider the risk factors of poor treatment control while designing and implementing policies and strategies for chronic disease control.

Multilevel analysis of determinants of anemia among young women (15-24) in sub-Sahara Africa

Background

Anemia is a disorder by which the body’s red blood cells are inadequate to fulfill The physiological needs of the body. The World Health Organization (WHO) defines anemia as having a hemoglobin (Hb) level of less than 120 g/l for nonpregnant women and 110 g/l for pregnant women. It has serious implications for human health as well as negative social and economic consequences like decreased workforce, impaired learning, and stunted child development. As these women are highly vulnerable to different micro and macro-nutritive deficiency associated with rapid physical, mental and psychological development, particular attention should be given to a young woman (15–24). Therefore this study assesses the magnitude and determinants of anemia among young women in sub-Saharan Africa (SSA).

Methods

This was a secondary data analysis based on the Demographic and Health Surveys (DHS) data conducted in sub-Saharan Africa. We pooled the most recent DHS surveys done in 31 sub-Sahara Africa and a total weighted sample of 88, 832 young women (15–24 years) were included. At bivariable analysis, variables with a p-value of ≤0.2 were selected for multivariable analysis, and at the multivariable analysis variables with a p-value of ≤0.05 were considered as a significant factor associated with anemia among young women (15–24 years).

Results

The pooled prevalence of anemia among young women (15–24) in sub-Sahara Africa was 42.17% [95%CI: 41.85, 42.50]. Young women of aged 20–24 years [AOR = 0.92, 95%CI: 0.89–0.95], women from rich household [AOR = 0.83, 95%CI: 0.80–0.87], young women with primary [AOR = 0.7, 95%CI: 0.67–0.72], secondary [AOR = 0.72, 95%CI: 0.69–0.75] and higher educational status [AOR = 0.58, 95%CI: 0.53–0.64], married women [AOR = 1.12, 95%CI: 1.08–1.17], divorced/separated/widowed women [AOR = 1.16, 95%CI: 1.08–1.25], women who use modern contraceptive [AOR = 0.65, 95%CI: 0.62–0.67], young women who ever had terminated pregnancy [AOR = 1.22, 95%CI: 1.14–1.29], overweight young woman [AOR = 0.79, 95%CI: 0.76–0.82] and young women from female-headed household [AOR = 0.94, 95%CI: 0.91–0.97] were the individual-level factors that significantly associated with anemia of young women. Meanwhile, being a rural dweller [AOR = 0.82, 95%CI: 0.79–0.85] and high community educational level [AOR = 0.87, 95%CI: 0.70–0.97] were the community level determinant of anemia. Interclass correlation coefficient (ICC), Median Odds Ratio (MOR) and Percentage change in variance (PCV) were done for the assessment of the random effect model of the multilevel analysis. The ICC value in the null model was 0.05, which indicates that 5% of the variation in anemia among young women in sub-Saharan Africa was attributed to community-level factors.

Conclusion

The prevalence of anemia among young women in this study was higher compared with reports from the previous studies. Divorced/separated/widowed women, married women and women with ever terminated pregnancy, young women with primary, secondary and higher educational achievement, being rural dwellers, young women aged 20–24 years, being from rich households and women who used modern contraceptives were factors that significantly associated with anemia among young women. Therefore, particular attention should be given to those higher-risk women including, young women with a history of a terminated pregnancy, those from rural areas and young women aged 15–19 years to reduce the burden of anemia among these young women as the continuity of the future generation depends on the health of young women.

Minimum acceptable diet feeding practice and associated factors among children aged 6-23 months in east Africa: a multilevel binary logistic regression analysis of 2008-2018 demographic health survey data

BACKGROUND

Despite the proportion of receiving a minimum acceptable diet (minimum meal frequency and minimum dietary diversity) is lower in east Africa, there is limited evidence on minimum acceptable diet. Therefore, this study aimed to investigate the minimum acceptable diet and associated factors among children aged 6-23 months in east Africa.

METHODS

A secondary data analysis of the most recent Demographic and Health Survey (DHS) data of 12 east African countries was done. A total weighted sample of 34, 097 children aged 6-23 months were included. A multilevel binary logistic regression model was applied. The Intra-class Correlation Coefficient (ICC) and Median Odds Ratio (MOR) were calculated to assess the clustering effect. Besides, deviance was used for model comparison as the models are nested models. Both crude and adjusted Odds Ratio (OR) with a 95% Confidence Interval (CI) were reported as potential predictors of minimum acceptable diet feeding practice.

RESULTS

The prevalence of minimum acceptable diet feeding practice among children in east Africa was 11.56%; [95%CI; 11.22%, 11.90%]. In the multilevel analysis; child age of 12-17 month (AOR = 1.33: 95%CI; 1.20, 1.48), maternal primary (AOR = 1.21: 95%CI; 1.08, 1.35), secondary (AOR = 1.63: 95%CI; 1.44, 1.86) higher (AOR = 2.97: 95%CI; 2.30, 3.38) education level, media exposure (AOR = 1.38, 95%CI; 1.26, 1.51), household wealth statues (AOR = 1.28, 95%CI; 1.15, 1.42 for middle and AOR = 1.50: 95%CI; 1.42, 1.71 foe rich), employed mother (AOR = 1.27: 95%CI; 1.17, 1.37), maternal age 25-34 (AOR = 1.20: 95%CI; 1.09, 1.32) and 35-49 (AOR = 1.22: 95%; 1.06, 1.40) years, delivery in health facility (AOR = 1.43: 95%CI; 1.29, 1.59) and high community education level (AOR = 1.05: 95%CI; 1.01, 1.17) were positively associated with minimum acceptable diet child feeding practice. Meanwhile, the use of wood (AOR = 0.72: 95%CI; 0.61, 0.86) and animal dug (AOR = 0.34: 95%CI; 0.12, 0.95) as a source of cooking fuel and being from female-headed households (AOR = 0.88: 95%CI; 0.81, 0.96) were negatively associated with minimum acceptable diet feeding practice.

CONCLUSION

Child age, mother's educational level, source of cooking fuel, exposure to media, sex of household head, household wealth status, mother working status, age of the mother, place of delivery and community-level education were the significant determinants of minimum acceptable diet feeding practices. Therefore, designing public health interventions targeting higher-risk children such as those from the poorest household and strengthening mothers' education on acceptable child feed practices are recommended.

Barriers for health care access affects maternal continuum of care utilization in Ethiopia; spatial analysis and generalized estimating equation

BACKGROUND

Although Ethiopia had made a significant change in maternal morbidity and mortality over the past decades, it remains a major public health concern. World Health Organization designed maternal continuum of care to reduce maternal morbidity and mortality. However, majority of the mothers didn't utilize the maternal continuum of care. Therefore, this study aimed to assess the spatial distribution of incomplete utilization of maternal continuum of care and its associated factors in Ethiopia.

METHODS

This study was based on 2016 Demographic and Health Survey data of Ethiopia. A total weighted sample of 4,772 reproductive aged women were included. The study used ArcGIS and SaTScan software to explore the spatial distribution of incomplete utilization of maternal continuum of care. Besides, multivariable Generalized Estimating Equation was fitted to identify the associated factors of incomplete utilization of maternal continuum of care using STATA software. Model comparison was made based on Quasi Information Criteria. An adjusted odds ratio with 95% confidence interval of the selected model was reported to identify significantly associated factors of incomplete utilization of maternal continuum of care.

RESULTS

The spatial analysis revealed that incomplete utilization of maternal continuum of care had significant spatial variation across the country. Primary clusters were detected at Somali, North-Eastern part of Oromia, and East part of Southern Nation Nationalities while secondary clusters were detected in the Central Amhara region. In multivariate GEE, rural residency, secondary education, higher education, Protestant religious follower's, Muslim religious follower's, poorer wealth index, richer wealth index, richest wealth index, currently working, having barriers for accessing health care, and exposure for mass media were significantly associated with incomplete utilization maternal continuum of care.

CONCLUSION

Incomplete utilization of maternal continuum of care had significant spatial variations in Ethiopia. Residence, wealth index, education, religion, and barriers for health care access, mass media exposure, and currently working were significantly associated with incomplete utilization of maternal continuum of care. Therefore, public health interventions targeted to enhance maternal service utilization and women empowerment in hotspot areas of incomplete utilization of maternal continuum of care are crucial for reducing maternal morbidity and mortality.

Individual and community-level factors of treatment-seeking behaviour among caregivers with febrile children in Ethiopia: A multilevel analysis

Background

Early diagnosis and treatment of childhood fever are essential for controlling disease progression and death. However, the Treatment-seeking behaviour of caregivers is still a significant challenge in rural parts of the African region. This study aimed to assess individual and community-level factors associated with treatment-seeking behaviours among caregivers of febrile under-five age children in Ethiopia.

Method

The recent Ethiopian Demographic and Health Survey data (EDHS 2016) was used for the study. The survey collected information among 1,354 under-five children who had a fever within two weeks before the survey. The data were extracted, cleaned, and recoded using STATA version 14. Multilevel logistic regressions were used to determine the magnitude and associated factors of treatment-seeking behaviour among caregivers with febrile children in Ethiopia. Four models were built to estimate both fixed and random effects of individual and community-level factors between cluster variations on treatment-seeking behaviour. The Adjusted Odds Ratios with 95% Confidence Intervals (CI) of the best-fitted model were reported at p<0.05.

Result

This study revealed that 491 (36.26%) caregivers seek treatment for their febrile children. Living in metropolitan and small peripheral regions, delivery at health institutions, being poorer, middle and richer wealth quintiles, having a child with diarrhoea, cough, short rapid breathing, and wasting were positively associated with treatment-seeking behaviour of caregivers.

Conclusion

The caregivers had poor treatment-seeking behaviour for their febrile children in Ethiopia. Health education programmers should emphasise the importance of seeking early treatment, taking action on childhood febrile illness signs.

Comprehensive knowledge about HIV/AIDS and associated factors among women of reproductive age in sub-Saharan Africa: a multilevel analysis using the most recent demographic and health survey of each country

Background

Women of reproductive age in sub-Saharan African (SSA) share the greatest burden of the HIV/AIDS epidemic. Comprehensive knowledge about HIV is seen as pivotal in combating the epidemic. Therefore, this study aimed to assess comprehensive knowledge about HIV/AIDS and associated factors among women of reproductive age in sub-Saharan Africa.

Objective

To examine comprehensive knowledge about HIV/AIDS and associated factors among women of reproductive age in sub-Saharan Africa.

Methods

We used the most recent SSA countries Demographic and Health Surveys (DHS) data. To assess comprehensive knowledge, a composite score of six separate questions (can get HIV by witchcraft or supernatural means, can reduce risk of getting HIV by using condoms during sex, reduce the risk of getting HIV by having one sex partner only, can get HIV from mosquito bites, can get HIV by sharing food with a person who has HIV/AIDS, and a healthy-looking person can have HIV) was used. Those who answered all six questions correctly were considered to have comprehensive knowledge. To assess the factors associated with comprehensive knowledge of HIV/AIDS, we used a multilevel binary logistic regression model since the data had hierarchical nature.

Results

In this study, the comprehensive knowledge about HIV/AIDS was 38.56% (95% CI: 38.32, 38.75). Both individual and community-level factors were associated with comprehensive knowledge about HIV/AIDS. Among individual-level factors, older age, having primary and above educational level, being from wealthy households, contraceptive use, listening to the radio, and reading newspaper were associated with higher odds of comprehensive knowledge about HIV/AIDS. Being from urban areas and the Eastern African region were the community-level factors that were associated with higher odds of comprehensive knowledge about HIV/AIDS.

Conclusion

The study found that comprehensive knowledge of HIV/AIDS is low. Individual and community-level factors were associated with comprehensive knowledge of HIV/AIDS. Therefore, giving special attention to those young women, women who had no formal education, those from poor socioeconomic status, and those who are from remote areas could decrease the epidemics of HIV/AIDS by increasing the comprehensive knowledge about HIV/AIDS. Besides, it is better to strengthen media campaigns regarding HIV/AIDS to increase comprehensive knowledge about HIV/AIDS.

Determinants of accessing healthcare in Sub-Saharan Africa: a mixed-effect analysis of recent Demographic and Health Surveys from 36 countries

OBJECTIVE

This study aimed to assess the determinants of accessing healthcare among reproductive-age women in Sub-Saharan Africa (SSA).

DESIGN, SETTING AND ANALYSIS

Cross-sectional data were sourced from recent Demographic and Health Surveys in 36 SSA countries. We employed mixed-effect analysis to identify the determinants of accessing healthcare in SSA. OR and its 95% CI were reported for determinants associated with accessing healthcare.

OUTCOME

The outcome for this study was whether accessing healthcare was a 'big problem' or 'not a big problem'. Responses to these questions were categorised as a big problem and not a big problem.

PARTICIPANTS

A total weighted sample of 500 439 reproductive-age (15-49 years) women from each country's recent Demographic and Health Surveys from 2006 to 2018 were included in this study.

RESULTS

The pooled prevalence of healthcare access among reproductive-age women in SSA was 42.56% (95% CI 42.43% to 42.69%). The results of the mixed-effect analysis revealed that the determinants of accessing healthcare were urban residence (adjusted OR (AOR)=1.25, 95% CI 1.34 to 1.73), ability to read and write (AOR=1.15, 95% CI 1.22 to 1.28), primary education (AOR=1.08, 95% CI 1.07 to 1.12), secondary education and above (AOR=1.12, 95% CI 1.10 to 1.14), husband with primary education (AOR=1.06, 95% CI 1.07 to 1.1.12), husband with secondary education and above (AOR=1.22, 95% CI 1.18 to 1.27), middle wealth index (AOR=1.43, 95% CI 1.40 to 1.47), rich wealth index (AOR=2.19, 95% CI 2.13 to 2.24) and wanted pregnancy (AOR=1.27, 95% CI 1.19 to 1.29).

CONCLUSION

Healthcare access in SSA was found at 42.56%, which is very low even if Sustainable Development Goal 3.8 targeted universal health coverage for everyone so they can obtain the health services they need. The major determinants of healthcare access among reproductive-age women in SSA were urban residence, higher educational level, higher wealth index and wanted pregnancy. The findings of this study suggest and recommend strengthening and improving healthcare access for women who reside in the countryside, women with low level of education and women of low socioeconomic status.

Timely initiation of antenatal care and its associated factors among pregnant women in sub-Saharan Africa: A multicountry analysis of Demographic and Health Surveys

BACKGROUND

Timely initiation of antenatal care (ANC) is an important component of ANC services that improve the health of the mother and the newborn. Mothers who begin attending ANC in a timely manner, can fully benefit from preventive and curative services. However, evidence in sub-Saharan Africa (sSA) indicated that the majority of pregnant mothers did not start their first visit timely. As our search concerned, there is no study that incorporates a large number of sub-Saharan Africa countries. Thus, the objective of this study was to assess the prevalence of timely initiation of ANC and its associated factors in 36 sSA countries.

METHODS

The Demographic and Health Survey (DHS) of 36 sSA countries were used for the analysis. The total weighted sample of 233,349 women aged 15-49 years who gave birth in the five years preceding the survey and who had ANC visit for their last child were included. A multi-level logistic regression model was used to examine the individual and community-level factors that influence the timely initiation of ANC. Results were presented using adjusted odds ratio (AOR) with 95% confidence interval (CI).

RESULTS

In this study, overall timely initiation of ANC visit was 38.0% (95% CI: 37.8-38.2), ranging from 14.5% in Mozambique to 68.6% in Liberia. In the final multilevel logistic regression model:- women with secondary education (AOR = 1.08; 95% CI: 1.06, 1.11), higher education (AOR = 1.43; 95% CI: 1.36, 1.51), women aged 25-34 years (AOR = 1.20; 95% CI: 1.17, 1.23), ≥35 years (AOR = 1.30; 95% CI: 1.26, 1.35), women from richest household (AOR = 1.19; 95% CI: 1.14, 1.22), women perceiving distance from the health facility as not a big problem (AOR = 1.05; 95%CI: 1.03, 1.07), women exposed to media (AOR = 1.29; 95%CI: 1.26, 1.32), women living in communities with medium percentage of literacy (AOR = 1.51; 95%CI: 1.40, 1.63), and women living in communities with high percentage of literacy (AOR = 1.56; 95%CI: 1.38, 1.76) were more likely to initiate ANC timely. However, women who wanted their pregnancy later (AOR = 0.84; 95%CI: 0.82, 0.86), wanted no more pregnancy (AOR = 0.80; 95%CI: 0.77, 0.83), and women residing in the rural area (AOR = 0.90; 95%CI: 0.87, 0.92) were less likely to initiate ANC timely.

CONCLUSION

Even though the WHO recommends all women initiate ANC within 12 weeks of gestation, sSA recorded a low overall prevalence of timely initiation of ANC. Maternal education, pregnancy intention, residence, age, wealth status, media exposure, distance from health facility, and community-level literacy were significantly associated with timely initiation of ANC. Therefore, intervention efforts should focus on the identified factors in order to improve timely initiation of ANC in sSA. This can be done through the providing information and education to the community on the timing and importance of attending antenatal care and family planning to prevent unwanted pregnancy, especially in rural settings.

Preterm birth and its associated factors among reproductive aged women in sub-Saharan Africa: evidence from the recent demographic and health surveys of sub-Sharan African countries

BACKGROUND

Globally, preterm birth is the leading cause of neonatal and under-five children mortality. Sub-Saharan African (SSA) accounts for the majority of preterm birth and death following its complications. Despite this, there is limited evidence about the pooled prevalence and associated factors of preterm birth at SSA level using nation-wide representative large dataset. Therefore, this study aimed to determine the pooled prevalence and associated factors of preterm birth among reproductive aged women.

METHODS

The recent Demographic and Health Surveys (DHSs) data of 36 SSA countries were used. We included a total weighted sample of 172,774 reproductive-aged women who were giving birth within five years preceding the most recent survey of SSA countries were included in the analysis. We used a multilevel logistic regression model to identify the associated factors of preterm birth in SSA. We considered a statistical significance at a p-value less than 0.05.

RESULTS

In this study, 5.33% (95% CI: 5.23, 5.44%) of respondents in SSA had delivered preterm baby. Being form eastern Africa, southern Africa, rural area, being educated, substance use, having multiple pregnancy, currently working history, having history of terminated pregnancy, and previous cesarean section delivery, primi-parity, and short birth interval were associated with higher odds of preterm birth among reproductive aged women. However, having better wealth index, being married, wanted pregnancy, and having four or more antenatal care visit were associated with lower odds for a preterm birth among reproductive aged women.

CONCLUSION

The prevalence of preterm birth among reproductive-aged women remains a major public health problem in SSA. Preterm birth was affected by various socio-economic and obstetrical factors. Therefore, it is better to consider the high-risk groups during intervention to prevent the short-term and long-term consequences of preterm birth.

A multilevel analysis of determinants of PMTCT service utilisation among women during the antepartum, intrapartum and postpartum period in Ethiopia

Background

Mother-to-child transmission (MTCT) is the largest source of HIV infection in children below the age of 15 years, and more than 90% of pediatric HIV are infected through mother to child transmission. Without treatment, one-half of those infected children will die before the age of 2 years. Despite this, there is limited evidence on PMTCT and its determinants. Therefore, this study aimed to determine the factors affecting the PMTCT service utilisation in Ethiopia.

Methods

A two-stage stratified sampling technique was used to identify 4081 women from 2016 Ethiopian Demographic and Health Survey (EDHS). A multilevel mixed-effect binary logistic regression analysis was used to identify the individual and community level factors associated with PMTCT services utilisation. In the final model, a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) were used to declare statistically significant factors with the utilisation.

Results

Overall, 21.9% (95% CI, 20.6–23.2) of the women were utilized PMTCT services. Educational status; primary (AOR: 1.65, 95% CI: 1.27–2.13), secondary (AOR: 1.52, 95% CI: 1.03–2.24) and higher school (AOR: 2.48, 95% CI: 1.45–4.22), poorer (AOR: 1.62, 95% CI: 1.12–2.37), middle (AOR: 1.82, 95% CI: 1.10–3.02), richer (AOR: 2.44, 95% CI: 1.42–4.21) and richest (AOR: 4.45, 95% CI: 2.43–8.14) wealth status and orthodox religion follower (AOR: 1.62, 95% CI: 1.22–2.16) were the individual level factors. Moreover, having basic (AOR: 1.66, 95% CI: 1.34–2.06) and comprehensive (AOR: 1.73, 95% CI: 1.38–2.18) knowledge on HIV prevention methods, having knowledge on MTCT of HIV (AOR: 2.69, 95% CI: 2.16–3.36) were also factors at individual level. Whereas, rural residence (AOR: 0.52, 95% CI: 0.32–0.85) was the community level factors that affects the utilization.

Conclusions

Less than one-fourth of the mothers had utilised the PMTCT services in Ethiopia. To increase the utilisation of the services, the health care providers should give emphases on counselling, awareness creation, and strengthen the existing frontline integrated health care services in the country.

Health-Related Quality of Life Among Myocardial Infarction Survivors: Structural Equation Modeling Approach

BACKGROUND

Myocardial infarction is the fifth leading causes of disability-adjusted life years in low-income countries including Ethiopia. The aim of this study was to construct a hypothetical model to determine the factors affecting the health-related quality of life of myocardial infarction survivors at the cardiac center Ethiopia.

METHODS

A cross-sectional study design was employed, and 421 myocardial infarction patients were enrolled through consecutive sampling technique from the outpatient clinic at the cardiac center of Ethiopia. The World Health Organization Quality of Life-BREF-26 tool was used to assess the problem. It consists of four domains such as physical, psychological, social relationships, and environmental health domains. The structural equation modeling (SEM) analysis was employed using STATA-14 software to examine the relationship between various exogenous and endogenous or mediating variables with overall quality of life.

RESULTS

Psychological, physical, environmental health domains and sex had significant association with health-related quality of life (β=0.708, p<0.001, β= 0.237, p=0.046, β=0.242, p=0.020, and β=0.189, p=0.017, respectively), whereas age had direct, negative association with health-related quality of life (β=-0.007, p=0.026). Residence and level of education were not directly associated with health-related quality of life. Residence indirectly, negatively influenced health-related quality of life (β= -0.379, p<0.001). On the other hand, level of education indirectly, positively affects health-related quality of life (β=i0.133, p<0.001).

CONCLUSION

Psychological health factors had the most substantial causal effect on health-related quality of life, which was larger than the causal effects of physical and environmental health-related factors. Developing and providing comprehensive interventions are necessary to assess and manage psychological, physical, and environmental health factors and to improve the quality of life in myocardial infarction patients.

Knowledge about mother to child transmission of HIV/AIDS, its prevention and associated factors among reproductive-age women in sub-Saharan Africa: Evidence from 33 countries recent Demographic and Health Surveys

BACKGROUND

In sub-Saharan Africa (SSA) 90 percent of babies acquired HIV/AIDS from infected mothers. Maternal knowledge about mother to child transmission (MTCT) of HIV/AIDS and its prevention is a cornerstone for elimination of MTCT of HIV/AIDS. Despite this, there is limited evidence about knowledge about MTCT of HIV/AIDS and its prevention and associated factors in SSA. Therefore, this study aimed to assess knowledge of MTCT of HIV/AIDS, its prevention (PMTCT) and, associated factors among reproductive-age women in sub-Saharan Africa.

OBJECTIVE

To assess Knowledge about mother to child transmission of HIV/AIDS and its prevention and associated factors among reproductive-age women in Sub-Saharan Africa.

METHODS

The recent SSA countries' Demographic and Health Surveys (DHS), which were conducted from 2008/09 to 2018/19, was our data source. We appended 33 countries' DHS data for our analysis. For our study, a total weighted sample of 350,888 reproductive-age women was used. Due to the hierarchical nature of the DHS data, we conducted a multilevel analysis. Finally, the adjusted odds ratio with its 95% confidence interval was reported, and variables with p-value≤0.05 were considered as significant predictors of knowledge of MTCT of HIV/AIDS and its prevention.

RESULTS

In this study, 56.21% (95% CI: 56.05-56.38) of respondents had correct knowledge about MTCT of HIV/AIDS and its prevention among reproductive-age women in SSA. In the multilevel logistic regression analysis: being in the older age group, better education level, being from a rich household, having mass media exposure, having parity of one and above were associated with higher odds of knowledge about MTCT of HIV/AIDS and its prevention. However, being perceiving distance from the health facility as a big problem was associated with lower odds of knowledge about MTCT of HIV/AIDS and its prevention.

CONCLUSION

Knowledge about MTCT of HIV/AIDS and its prevention among reproductive-age women in SSA was low. Therefore, it is better to consider the high-risk groups during the intervention to increase awareness about this essential public health issue and to tackle its devastating outcome.

Individual and community level factors associated with use of iodized salt in sub-Saharan Africa: A multilevel analysis of demographic health surveys

Introduction

Iodine deficiency disorder a common problem in sub-Saharan Africa (SSA). It affects not only the health of the affected individual but also the economic development of the country. However, to the best of our knowledge, there is a scarcity in literature about the associated factors of iodized salt utilization in sub-Saharan Africa. Therefore, this study aimed to identify both individual and community level determinants of iodized salt utilization in sub-Saharan Africa.

Methods

This study used the appended datasets of the most recent demographic and health survey from 31 sub-Saharan countries. A total weighted sample of 391,463 households was included in the study. Both bivariable and multivariable multilevel logistic regression were done to determine the associated factors of iodized salt utilization in SSA. P value ≤ 0.05 was used to declare statistically significant variables.

Results

Those households with primary (AOR  =  1.53, 95% CI  =  1.50–1.57), secondary (AOR  = 1.81, 95% CI  =  1.76–1.86) and higher education level (AOR  =  2.28, 95% CI  =  2.17–2.40) had higher odds of iodized salt utilization. Households with middle (AOR  =  1.05, 95% CI  =  1.02–1.08), richer (AOR  = 1.13, 95% CI  =  1.09–1.17) and richest wealth index (AOR  =  1.23, 95% CI  =  1.18–1.28) also had an increased chance of using iodized salt. Households from high community media exposure (AOR  =  2.07, 95% CI  =  1.71–2.51), high community education level (AOR  =  3.78, 95% CI  =  3.14–4.56), and low community poverty level (AOR = 1.29, CI  =  1.07–1.56) had higher odds of using salt containing iodine.

Conclusion

Both individual and community level factors were found to be associated with use of salt containing iodine in sub-Saharan Africa. Education level, media exposure, community poverty level, wealth index, community education, and community media exposure were found to be associated with use of salt containing iodine in SSA. Therefore, to improve the use of iodized salt in the region, there is a need to increase access to media sources and develop the socioeconomic status of the community.

Prevalence and determinants of anemia among pregnant women in East Africa; A multi-level analysis of recent Demographic and Health Surveys

Introduction

Anemia during pregnancy is a public health problem that leads to different life-threatening complications and poor pregnancy outcomes. So far, the evidence is scarce on pooled prevalence and determinants of anemia during pregnancy in East Africa for integrated intervention. Therefore, this study aimed to assess the prevalence and determinants of anemia among pregnant women in eastern Africa using recent Demographic and Health Surveys.

Method

Secondary data analysis was conducted using data from recent Demographic and Health Survey datasets from 10 East African countries. A total of 8583 (weighted sample) pregnant women were included in the analysis. The multi-level mixed-effects generalized linear model (Poisson regression with robust error variance) was fitted to identify determinants of anemia. Finally, the adjusted prevalence ratio (aPR) with 95% CI and random effects for the multilevel generalized linear mixed-effects model was reported.

Results

In this study, the overall prevalence of anemia among pregnant women was 41.82% (95% CI: 40.78, 42.87) with a large difference between specific countries which ranged from 23.36% in Rwanda to 57.10% in Tanzania. In the multi-level analysis, teenage pregnant women (aPR = 1.22;95%CI:1.02, 1.40), unmarried women (aPR = 1.14; 95% CI;1.02,1.28), pregnant women who had unimproved toilet facility (aPR = 1.17;95%CI:1.06,1.27), and those women from countries with high illiteracy level (aPR = 1.12;95%CI; 1.07,1.18) had a higher prevalence of anemia during pregnancy.

Conclusion

Anemia is still a public health problem in East Africa. Therefore, enabling the households to have improved toilet facilities by strengthening the existing health extension program, reducing teenage pregnancy, and improving the community literacy level is vital to reduce the prevalence of anemia during pregnancy in East Africa.

Prevalence and determinants of severity levels of anemia among children aged 6-59 months in sub-Saharan Africa: A multilevel ordinal logistic regression analysis

BACKGROUND

Anemia is a major public health problem affecting more than half of children under the age of five globally. It has serious short- and long-term consequences including growth retardation, impaired motor and cognitive development, and increased morbidity and mortality. Despite anemia is the leading cause of child mortality in sub-Saharan Africa, there is limited evidence on the prevalence and determinants of anemia among under-five children in sub-Saharan Africa. Therefore, this study aimed to investigate the prevalence and determinants of severity levels of anemia among children aged 6-59 months in sub-Saharan Africa.

METHODS

This study was based on the most recent Demographic and Health Survey (DHS) data of 32 sub-Saharan African countries. A total weighted sample of 135,619 children aged 6-59 months was included in the study. Considering the hierarchical nature of DHS data and the ordinal nature of anemia, a multilevel ordinal logistic regression model was applied. Proportional odds assumption was tested by Brant test and it was satisfied (p-value = 0.091). Besides, deviance was used for model comparison. Variables with a p-value ≤0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable multilevel proportional odds model, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported for potential determinant factors of severity levels of anemia.

RESULTS

The overall prevalence of anemia among children aged 6-59 months in sub-Saharan Africa was 64.1% [95% CI: 63.9%, 64.4%]. Of which, 26.2% were mildly anemic, 34.9% moderately anemic and 3% severely anemic. Poor maternal education, lower household wealth status, large family size, being male child, multiple births, having fever in the last two weeks, having diarrhea in the last two weeks, higher-order birth, maternal anemia, underweight, wasted, and stunted were significantly associated with increased odds of higher levels of anemia. Whereas, being 24-59 months age, taking drugs for an intestinal parasite, and born from mothers aged ≥ 20 years were significantly associated with lower odds of higher levels of anemia.

CONCLUSION

Severity levels of anemia among children aged 6-59 months in sub-Saharan Africa was a major public health problem. Enhancing maternal education, providing drugs for an intestinal parasite, designing interventions that address maternal anemia, febrile illness, and diarrheal disease, and strengthening the economic status of the family are recommended to reduce childhood anemia. Furthermore, it is better to strengthen the strategies of early detection and management of stunted, wasted, and underweight children to decrease childhood anemia.

Delayed breast feeding initiation increases the odds of colostrum avoidance among mothers in Northwest Ethiopia: a community-based cross-sectional study

BACKGROUND

Colostrum is a yellowish and sticky breast milk produced in late pregnancy. Annually, 60% of 10.9 million under-five deaths globally are due to malnutrition. Of these, over two-thirds of the deaths are accounted by sub-optimal feeding practices in the first year of life, including colostrum discarding. However, evidence on the magnitude of colostrum avoidance and its associated factors at the community level is very limited in Ethiopia, particularly in the study area. Thus, this study aimed to assess the magnitude of colostrum avoidance and associated factors among mothers who gave birth in the last six months in Gozamen district, northwest Ethiopia, 2019.

METHODS

A community-based cross-sectional study was conducted among 741 (741) mothers who gave birth in the last six months in Gozamen district from August 1 to September 12, 2019. A stratified cluster sampling technique was used to select the study participants. Data were collected by face-to-face interviewer-administered, pretested, and semi-structured questionnaire. Binary logistic regressions (bi-variable and multivariable) were fitted to identify statistically significant variables. Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was used to declare statistically significant variables on the basis of p-value < 0.05 in the multivariable binary logistic regression.

RESULTS

This study indicated that the magnitude of colostrum avoidance was 22.1% (95% CI, 19.0, 25.2%). Mothers who did not get counseling on timely initiation of breast feeding (AOR = 3.91[95% CI, 1.98, 7.72]), not participate in pregnant woman forum (AOR = 2.59[95% CI, 1.30, 5.14]), initiate breast-feeding lately (more than 1 h) (AOR 2.27[95% CI, 1.18, 4.34]), and those having unfavorable attitude towards colostrum feeding (AOR = 7.35[95% CI, 3.89, 13.91]) were factors associated with the increased likelihood of colostrum avoidance. However, institutional delivery (AOR; 0.06[95% CI, 0.02, 0.19]) and prelacteal feeding (AOR; 0.10[95% CI, 0.05, 0.21]) were predictors associated with reduced likelihood of colostrum avoidance.

CONCLUSION

Colostrum avoidance is a common practice in the study area. Therefore, in order to reduce this practice, strengthening infant feeding counseling, promoting institutional delivery, timely initiation of breastfeeding, health education, and community advocating are recommended interventions. In addition, creating awareness on the benefits of colostrum feeding is very instrumental to tackle the practice of colostrum avoidance.