Economic burden of female genital mutilation in 27 high-prevalence countries

BACKGROUND

Female genital mutilation (FGM) is a traditional harmful practice affecting 200 million women and girls globally. Health complications of FGM occur immediately and over time, and are associated with healthcare costs that are poorly understood. Quantifying the global FGM-related burden is essential for supporting programmes and policies for prevention and mitigation.

METHODS

Health complications of FGM are derived from a meta-analysis and stratified by acute, uro-gynaecological, obstetric and psychological/sexual. Treatment costs are calculated from national cohort models of 27 high-burden countries over 30 years. Savings associated with full/partial abandonment are compared with a current incidence reference scenario, assuming no changes in FGM practices.

RESULTS

Our model projects an increasing burden of FGM due to population growth. As a reference scenario assuming no change in practices, prevalent cases in 27 countries will rise from 119.4 million (2018) to 205.8 million (2047). Full abandonment could reduce this to 80.0 million (2047), while partial abandonment is insufficient to reduce cases. Current incidence economic burden is US$1.4 billion/year, rising to US$2.1 billion/year in 2047. Full abandonment would reduce the future burden to US$0.8 billion/year by 2047.

CONCLUSION

FGM is a human rights violation, a public health issue and a substantial economic burden that can be avoided through effective prevention strategies. While decreasing trends are observed in some countries, these trends are variable and not consistently observed across settings. Additional resources are needed to prevent FGM to avoid human suffering and growing costs. The findings of this study warrant increased political commitment and investment in the abandonment of FGM.

Modeling the determinant of time to age at first marriage among women in Ethiopia using Cox models with mixed effects

Background

Time to age at first marriage of women is the duration of time until the age at which they started living with their first partner. Time to age at first marriage is widely considered a proxy indicator for the age at which women begin to be exposed to the risks inherent in sexual activity. The purpose is to model the determinant of time to age at first marriage among women in Ethiopia using Cox models with mixed effects.

Methods

The 2016 Ethiopian Demography and Health survey sample was selected using a two-stage cluster design. The data set in this study were obtained from the Demography and Health survey conducted in Ethiopia in 2016. In this study, we used Cox models with mixed effects.

Results

Of all 15,683 women aged 15–49 years, 11,405 (72.72%) were married with the median and mean age at first marriage 17 years and 18 years, respectively. Cox frailty survival model showed that residence, educational level, occupation, work status of women& head education level of households were the most significant factors whereas religion, access to media and wealth index of a household of women were not significant factors at 5% level of significance. The significant clustering effect showed that heterogeneity among the regions on age at first marriage was present.

Conclusions

The present study determined the duration of time until the age at first marriage and indicated relevant solutions for marriage-related problems of women aged 15–49 years in Ethiopia. Women residing in rural area of Ethiopia and had lower education level were married earlier. Therefore, programs to reduce the high rate of early marriage in Ethiopia should give attention to women education and women residing in rural area.

Time to age at first marriage of women is the duration of time until the age at which they started living with their first partner. African women are more likely to marry earlier than other continent women, which causes high fertility due to their long period of exposure to the risk of pregnancy. Even though Sub-Sahara Africa accounts for the highest rate of age at first marriage among countries in the Africa continent, comparably the case is very worse in Ethiopia. Furthermore, there is no study about the determinant of time to age at first marriage in Ethiopia using advanced models like Cox Model with Mixed effects. This model allows for the analysis of data with complex patterns of variability, with a focus on nested sources of variability. Very often it makes sense to use such a model to represent the variability within and between groups. For instance, in this study, our interest is not only knowing the significant effect of determinant factors on time to age at first marriage among women in Ethiopia but also the variability of time to age at first marriage within the region of Ethiopia and between regions of Ethiopia. We have used a dataset for this study from Ethiopia Demography and Health Survey which was conducted in 2016. The study helps to indicate relevant solutions for women's marriage-related problems (predominantly, women's reproductive health problems) in Ethiopia and it provides input for further studies in Ethiopia.

Associated factors of first-birth interval among women in reproductive age, addressing maternal and child health

Background

The first-birth interval directly influences family size and maternal and child mortality. The objective of this study is to investigate factors associated with the time of the first-birth after the first marriage among women in Iran.

Methods

In this cross-sectional study, the first birth history of 1350 women aged 15–49 years was collected in Kerman (southern Iran) in 2018. To assess the predictor variables of the first-birth interval and calculate the adjusted hazard ratios, multivariate Cox regression was used. The P-value < 0.05 was considered as significant. The statistical analysis of data was performed using SPSS version 22.

Results

The average of the first-birth interval was 2.5 ∓ 0.8 years. Woman’s age at marriage (HR 1.48, 95% CI 1.32–2.48), husband’s age at marriage (HR 1.88, 95% CI 1.62–2.03), age at the first menstruation (HR 1.53, 95% CI 1.24–2.53), being rural residents (HR 2.041, 95% CI 1.26–2.95), and having engagement period (HR 1.85, 95% CI 1.52–3.05) were associated with short first-birth interval, and woman’s BMI (HR 1.72, 95% CI 1.54–2.77), woman’s university educational level (HR 1.47, 95% CI 1.35–2.57), husband’ s university educational level (HR 1.39, 95% CI 1.32–2.51), contraception use (HR 2.28, 95% CI 1.12–2.86) and income sufficiency (HR 2.25, 95% CI 1.12–2.96) were associated with long first-birth interval.

Conclusions

Being a rural resident is the most influential predictor of short first-birth interval and income sufficiency is the most influential predictor of long first-birth interval.

Total Fertility Rate, which is the average number of live births that would be born to a woman over her reproductive life if she experiences the current age-specific fertility rates throughout her lifetime. The fertility pattern can be measured by several indicators such as the first-birth interval (FBI) after marriage. FBI is defined as the duration of time spent by married couples to have their first child since the first day of marriage. Some studies have demonstrated that the length of FBI subsequently influences spacing and childbearing pattern of a family. The aim of this study is first to determine the mean of FBI and second to explore the associated factors of FBI in Kerman, southern Iran. We analyzed data for 1350 women 15–49 years old. The outcome variable was the first-birth interval (FBI). Results showed that the average of FBI was 2.5 years. There is a positive association between FBI and age of wives at marriage, first menace age, wives’ BMI, wives and husbands’ educational level, contraception use, age of husbands at marriage, residence place, income sufficiency, and having engagement period. The women and men who got married at older ages were more likely to report short FBI. It was indicated that Educated women and men and women who experience menstruation at a younger age are more likely to report longer FBI. The knowledge about importance of FBI should be more announced for couples by health services in order to help them manage their child-spacing and fertility. The government also should pay attention on FBI as an important index in determining the average age of country population.

Exploration of service centres for older persons in the Eastern Cape province, South Africa

Background

Objective

Method

Results

Conclusion

Clinical implications

Sexual autonomy and self-reported sexually transmitted infections among women in sexual unions

BACKGROUND

Sexually transmitted infections (STIs) are major public health challenges worldwide. Despite the importance of sexual autonomy in the prevention and control of sexual and reproductive health disorders such as STIs, there are limited studies on the possible relationship between women's sexual autonomy and self-reported STIs, especially in sub-Saharan Africa (SSA). This study, therefore, examined the association between sexual autonomy and self-reported STIs among women in sexual unions in SSA.

METHODS

Data from the Demographic and Health Survey (DHS) of 31 countries in SSA conducted between 2010 and 2019 were analysed. A total of 234,310 women in sexual unions were included in the study. Data were analysed using binary logistic regression models and the results were presented as crude odds ratios (cORs) and adjusted odds ratios (aORs) at 95% confidence interval (CI).

RESULTS

The prevalence of self-reported STIs among women in sexual unions in SSA was 5.8%. Approximately 83.0% of the women surveyed had sexual autonomy. Women who had no sexual autonomy were less likely to have self-reported STIs (cOR=0.52, CI: 0.46-0.54), compared to those who had sexual autonomy. Additionally, higher odds of self-reported STIs were found among women aged 25-29, compared to those aged 15-19 (aOR= 1.21, CI: 1.09-1.35); those who reside in urban areas, compared to those who reside in rural areas (aOR= 1.51, CI: 1.37-1.66) and those who were cohabiting, compared to those who were married (aOR= 1.65, CI: 1.52-1.79). On the other hand, lower odds of self-reported STIs were found among women who were exposed to newspapers (aOR= 0.89, CI: 0.82-0.95), those whose partners had primary education (aOR= 0.84, CI: 0.78-0.91), those who were not exposed to radio (aOR= 0.84, CI: 0.79-0.89), and working women (aOR= 0.86, CI: 0.80-0.93).

CONCLUSIONS

Findings from this study suggest that sexual autonomy is a significant predictor of self-reported STIs among women in sexual unions in SSA. Thus, instituting policies and programs that empower women and improve their levels of sexual autonomy may result in increased self-reporting of symptoms associated with STIs which subsequently help in minimising STI-related complications. Also, policies aimed at enhancing women's sexual autonomy may reduce the burden of STIs in SSA, especially among women in sexual unions.

Magnitude and determinants of unmet need for family planning among reproductive age women in East Africa: multilevel analysis of recent demographic and health survey data

Introduction

Unmet need for family planning is the main obstacle to achieve healthy timing and desired number of children. Decreasing the unmet need for FP respects and protects human right and help to decrease the influence on biodiversity. Unmet need for family planning is the contributor and devastating issue of maternal health. Therefore, meeting the unmet need of contraceptive averts the maternal death and poverty. Therefore, determining the magnitude and its determinants is very important to intervene and design appropriate program umbrella.

Objective

To determine the magnitude and its determinants of unmet need for family planning among reproductive age women in East Africa.

Method

This study was analyzed secondary data from Demographic and Health Surveys (DHS) of which contained detailed family planning for all interviewed women aged 15 to 49 years. The data were weighted using sampling weight before any statistical analysis to account the sampling design. STATA version 15 was used for extracting, editing, recoding, and multilevel analysis. Median odds ratio (MOR), proportional change in Variance (PCV), Intraclass correlation coefficient (ICC), and Akaike Information Criteria (AIC) was analyzed. Four model was build and the best model was selected based on the smallest Akaike Information Criteria (AIC). Both bivariable and multivariable multilevel analysis was done. Variable with p-value< 0.25 were selected for multivariable multilevel logistic regression analysis. Variables with p-value ≤5% declared as statistical significant with outcome variable.

Results

The magnitude of unmet need for family planning was 24.66% (95%CI: 24.1–25.2). The identified determinants of unmet need for family planning was 30–39 years (AOR = 0.7; 95% CI 0.54–0.91), age of 40–49 (AOR = 0.76; 95% CI 0.58–0.99), rural residence (AOR = 1.17; 95% CI 1.02–1.34), female household head (AOR = 0.66; 95% CI 0.61–0.73), women having 4–6 child (AOR = 1.76; 95% CI 1.55–1.99), women having 7–9 child (AOR = 2.77; 95% CI 2.34–3.28) women having ≥10 child (AOR = 3.51; 95% CI 2.58–4.78), women who give their first birth 19-25 years (AOR = 1.1; 95% CI 1.0–1.26), 26–34 years (AOR = 1.4; 95% CI 1.19–1.83) ≥35 years (AOR = 2.1; 95% CI 1.1–4.27) and no fertility desire (AOR = 1.52; 95% CI 1.36–1.67) were the determinants of unmet need for family planning in east Africa.

Conclusion

Unmet need in east Africa is high as compare to other previous study. Maternal age, residence, sex of household head, number of children, age at first birth and fertility desire were the determinants identified in this study. Therefore, health interventions that reduce unmet need which enhance family planning service delivery among rural, male-headed household, women having more than three children and women who had no fertility desire needed in advance. Policies and programs of unmet need should be tailored the rural, young and no fertility desire women as well as male headed households.

Geographic Access and Maternal Health Services Utilization in Sélingué Health District, Mali

Introduction

Maternal mortality is one of the main causes of death for women of childbearing age in Mali, and improving this outcome is slow, even in regions with relatively good geographic access to care. Disparities in maternal health services utilization can constitute a major obstacle in the reduction of maternal mortality in Mali and indicates a lack of equity in the Malian health system. Literature on maternal health inequity has explored structural and individual factors influencing outcomes but has not examined inequities in health facility distribution within districts with moderate geographic access. The purpose of this article is to examine disparities in education and geographic distance and how they affect utilization of maternal care within the Sélingué health district, a district with moderate geographic access to care, near Bamako, Mali.

Methods

We conducted a cross sectional survey with cluster sampling in the Sélingué health district. Maternal health services characteristics and indicators were described. Association between dependent and independent variables was verified using Kendall’s tau-b correlation, Chi square, logistic regression with odds ratio and 95% confidence interval. Gini index and concentration curve were used to measure inequity.

Results

Most respondents were 20 to 24 years old. Over 31% of our sample had some education, 65% completed at least four ANC visits, and 60.8% delivered at a health facility. Despite this evidence of healthcare access in Sélingué, disparities within the health district contribute to inadequate utilization among approximately 40% of the women in our sample. The concentration index demonstrated the impact of inequity in geographic access,

comparing women residing near and far from the referral care facility.

Conclusion

Maternal health services underutilization, within a district with moderate geographic access, indicates that deliberate attention should be paid to addressing geographic access even in such a district.

Married women’s decision-making autonomy on contraceptive use and its associated factors in Ethiopia: A multilevel analysis of 2016 demographic and health survey

Introduction:

Women’s decision-making autonomy has a positive effect on the scale-up of contraceptive use. In Ethiopia, evidence regarding women’s decision-making autonomy on contraceptive use and associated factors is limited and inconclusive. Therefore, this study was intended to assess married women’s decision-making autonomy on contraceptive use and associated factors in Ethiopia using a multilevel logistic regression model.

Methods:

The study used data from the 2016 Ethiopia Demographic and Health Survey that comprised of a weighted sample of 3668 married reproductive age women (15–49 years) currently using contraceptives. A multilevel logistic regression model was fitted to identify factors affecting married women’s decision-making autonomy on contraceptive use. Akaike’s information criterion was used to select the best-fitted model.

Results:

Overall, 21.6% (95% confidence interval = 20.3%–22.9%) of women had decision-making autonomy on contraceptive use. Community exposure to family planning messages (adjusted odds ratio = 2.22, 95% confidence interval = 1.67–3.05), media exposure (adjusted odds ratio = 2.13, 95% confidence interval = 1.52–3.23), age from 35 to 49 years (adjusted odds ratio = 2.09, 95% confidence interval = 1.36–4.69), living in the richer households (adjusted odds ratio = 1.67, 95% confidence interval = 1.32–3.11), and visiting health facility (adjusted odds ratio = 2.01, 95% confidence interval = 1.34–3.87) were positively associated with women’s decision-making autonomy on contraceptive use. On the contrary, being Muslim (adjusted odds ratio = 0.53, 95% confidence interval = 0.29–0.95), being married before the age of 18 years (adjusted odds ratio = 0.33, 95% confidence interval = 0.12–0.92), and residing in rural residence (adjusted odds ratio = 0.48, 95% confidence interval = 0.23–0.87) were negatively associated with women’s independent decision on contraceptive use.

Conclusion:

Less than one-fourth of married reproductive age women in Ethiopia had the decision-making autonomy on contraceptive use. Media exposure, women’s age, household wealth, religion, age at marriage, visiting health facilities, community exposure to family planning messages, and residence were the factors associated with women’s decision-making autonomy on contraceptive use. The government should promote women’s autonomy on contraceptive use as an essential component of sexual and reproductive health rights through mass media, with particular attention for adolescent women, women living in households with poor wealth, and those residing in rural settings.

Coverage and determinants of modern contraceptive use in sub-Saharan Africa: further analysis of demographic and health surveys

Background

The use of modern contraceptives (MC) in most African countries has been low despite the high fertility rate and unmet need for family planning. This study sought to determine the coverage and determinants of modern contraceptive use among women of reproductive age (15-49 years) in sub-Saharan Africa (SSA).

Methods

Data for the study were obtained from the Demographic and Health Surveys (DHS) conducted between 1995–2020 across 37 SSA countries. Women of reproductive age (15–49 years) was the unit of analysis. Analysis of data was done using STATA version 16 for windows. A bivariate Rao Scott’s Chi-square test of independence was done to determine factors associated with the use of modern contraceptives. Factors that showed significance (p < 0.05) were included in a multilevel logistic regression to determine significant predictors of modern contraceptives. Clustering, stratification and sample weighting were accounted for in the analyses.

Results

The overall prevalence of the use of MC was found to be 22.0%. This ranged from 3.5% in the Central Africa Republic to 49.7% in Namibia. The most common type of MC used were injections (39.4%), condoms (17.5%) and implants (26.5%). Women were less likely to use modern contraceptive if they: had no education (aOR = 0.4, 95% CI 0.38–0.44), had no children (aOR = 0.27–0.42), not told of family planning at a health facility (aOR = 0.69, 95% CI 0.67–0.71), not heard of family planning in the media (aOR = 0.77, 95% CI 0.74–0.79) and being poor (aOR = 0.76, 95% CI 0.73–0.79). On the other hand, women were more likely to use modern contraceptive if they were between the age of 35–39 years (aOR = 1.69, 95% CI 0.73–0.79), married (aOR = 2.66, 95% CI 2.50–2.83), had seven or more children (aOR = 1.27, 95% CI 1.17–0.38), had knowledge of any method of contraceptives (aOR = 303.8, 95% CI 89.9–1027.5) and when field worker visited and talked about family planning (aOR = 1.53, 95% CI 1.39–0.68).

Conclusion

The study showed a low prevalence of modern contraceptive use in sub-Saharan Africa. Findings from the study highlight the need to provide education to women to increase uptake of modern contraceptive and also re-enforce contraceptive interventions to improve women’s health and well-being.

The use of modern contraceptives (MC) to protect against sexually transmitted diseases, unwanted pregnancy and mortality as a result of unsafe abortion is low in many African countries. This study sought to determine the coverage and factors associated with the use of MC among women of child-bearing age in sub-Saharan Africa (SSA). Data for the study were obtained from the Demographic and Health Surveys (DHS) conducted in 37 SSA countries. Interpretation of the data focussed on women of children bearing age (15–49 years). The overall prevalence of the use of MC was found to be 22.0%. This ranged from 3.5% in the Central Africa Republic to 49.7% in Namibia. The most common type of MC used were injections (39.4%), condoms (17.5%) and implants (26.5%). Women were less likely to use MC if they had no education, no children, were not told of family planning at a health facility, had not heard of family planning on the Television, radio, newspaper and were poor. On the other hand, women who were between 35–39 years, were married, had seven or more children, had knowledge of any method of contraceptives and had a field worker visited and talked about family planning were more likely to use modern contraceptives. The study showed a low prevalence of MC use in sub-Saharan Africa. The results from the study is important and emphasize the need to provide education to women of child-bearing age to increase uptake of MC to reduce mortality and improve on women’s health and well-being.

Understanding the impacts of child marriage on the health and well-being of adolescent girls and young women residing in urban areas in Egypt

BACKGROUND

Egypt has made progress in delaying age at marriage, but child marriage continues to be practiced in many places across the country. This study investigates the impacts of child marriage on the health and wellbeing of girls residing in urban Egypt using a multi-method approach.

METHODS

The quantitative component leveraged data from the 2014 Egypt Demographic and Health Survey and focused on (1) reproductive health, (2) maternal health and (3) social outcomes among a subsample of ever-married urban women ages 20-24 (N = 1041). Simple and multivariable logistic regressions were used to estimate prevalence odds ratios and 95% confidence intervals for associations between child marriage and the three sets of outcomes. The qualitative component drew from 11 focus groups, 23 in-depth interviews, and 13 key informant interviews conducted in three urban sites in Egypt. The data was thematically analyzed using a combination of inductive and deductive coding.

RESULTS

The prevalence of marriage under age 18 was 13.22%. Child marriage was significantly associated with ever use of contraception (Adjusted Odds Ratio (AOR) 2.95 95% CI 1.67-5.19), multiple births (AOR 12.93 95% CI 5.45-30.72), rapid repeat childbirth (AOR 2.20 95% CI 1.34-3.63), and pregnancy termination (AOR 1.89 95% CI 1.11-3.23). Many of these associations disappeared after adjusting for marriage duration. Girls married under age 18 had larger spousal age gaps (AOR 2.06; 95% CI 1.24-3.41) and higher odds of FGM (AOR 2.14; 95% CI 1.11-4.13). They were significantly more likely to report receiving no ANC care (AOR 0.39; 95% CI 0.19-0.80), and less likely to deliver through C-section (AOR: 0.53; 95% CI 0.34-0.83). Consequences emerging from the qualitative data centered around five themes: (1) Access to and use of sexual and reproductive health services; (2) exposure to FGM; (3) marriage and birth registration; (4) marital relations; and (5) relationship with in-laws.

CONCLUSION

Findings provide important insights into the practice of child marriage in urban areas in Egypt and illustrate a range of adverse consequences associated with the practice.

Sexual and reproductive health education and its association with ever use of contraception: a cross-sectional study among women in urban slums, Accra

Background

Sexual and reproductive health education among girls and women has several reproductive health benefits, including improved contraceptive knowledge, contraception use at first intercourse, increased chance of contraceptive use in a lifetime, and effective usage of contraceptives. It is however not clear whether women/girls in urban slums who have had sexual and reproductive health education would likely utilize contraception. This study sets out to test the hypothesis that Accra slum women who have had sex education have higher chances of ever using contraception.

Methods

A cross-sectional survey was conducted among reproductive aged women in two slums (i.e. Agbogbloshie and Old Fadama) in Accra, Ghana. A sample size of 691, made up of respondents who provided responses to the question on ever used contraception, sex education as well as those with complete information on all the other variables of interest was considered in this study. Binary logistic regression models were fitted to examine association between sexual and reproductive health education and ever use of contraception. Crude odds ratios (cOR) and adjusted odds ratios (aOR) at p-value less than 0.05 were used to assess the strength of the association between the outcome and independent variables.

Results

More than half (56.73%) of the women have never received sexual and reproductive health education. Most of the respondents (77.28%) had ever used contraceptives. Women who had no form of sexual and reproductive health education had lower odds of ever using contraception (OR = 0.641, 95% CI 0.443, 0.928) and this persisted after controlling for the effect of demographic factors (AOR = 0.652, 95% CI 0.436, 0.975] compared to those who have ever received any form of sex education. Non-married women as well as women who were exposed to media (newspapers/radio/television) were also more likely to use contraceptives in slums in Accra, Ghana.

Conclusion

The study revealed a relatively low prevalence of sex education among women in urban slums in Accra. However, sex education was found to increase the odds of ever use of contraception. These findings call for intensified sexual and reproductive health education among reproductive aged girls and women in urban slums in Accra using existing informal social networks and local media platforms.

Sexual and reproductive health education among girls and women has several reproductive health benefits, including improved contraceptive knowledge, contraception use at first intercourse, increased chance of contraceptive use in a lifetime, and effective usage of contraceptives. It is however not clear whether women/girls in urban slums who have had some form of sex education would likely utilize contraception more than those who have not. This study sets out to test the hypothesis that Accra slum women who have had sex education have higher chances of ever using contraception. A cross-sectional survey was conducted among reproductive aged women in two slums (i.e. Agbogbloshie and Old Fadama) in Accra, Ghana. A sample size of 691 girls/women aged 15–49 was considered. More than half (56.73%) of the women had never received some form of sex education. Most of the respondents (77.28%) had ever used contraceptives. Women who had no form of sex education had lower odds of ever using contraception and this persisted after controlling for the effect of demographic factors compared to those who have ever received any form of sex education. Non-married women as well as women who were exposed to media (newspapers/radio/television) were also more likely to use contraceptives in slums in Accra, Ghana. In sum, the study revealed that while prevalence of sex education was relatively low among urban slum women, sex education generally increased the chances of ever use of contraception. These findings call for more and targeted sexual and reproductive health education among reproductive aged girls and women in urban slums in Accra using existing informal social networks and local media platforms.

The development of adolescent agency and implications for reproductive choice among girls in Zambia

Background

A substantial proportion of adolescent girls in Zambia lack the ability to decide their reproductive future. We examined the role of agency in early and unwanted adolescent childbearing.

Methods

Using latent transition analysis, we characterized a multi-dimensional profile of adolescent agency annually over a four-year period. We investigated the influence of early life access to resources and time-varying predictors (school retention, violence, early marriage and unwanted/mistimed pregnancy and childbearing) on agency profile membership as well as transitions in agency status over time.

Results

Four agency profiles were identified, with differences by age cohort (10–14 years vs. 15–19 years). Three profiles identified in both age cohorts were: Low-moderate agency, Self-assured gender conformers, and High agency. Unique to younger girls was the Gender conscious, low belief in abilities status, while among older girls was the Self-assured selective gender conscious status. While younger girls were likely to transition to the highest agency status over time, high agency membership declined among older girls. Early life resources were associated with augmented agency while exposure to negative events, particularly early marriage, were associated with detraction from high agency status. Girls who expressed high self-efficacy but gender-conforming values were most at risk of early marriage and unwanted/mistimed pregnancy while High agency girls were at comparatively low risk.

Conclusions

Results show agency is dynamic but less mutable with increasing age. Early adolescent strategies which address inequitable gender norms and limit early marriage, may guard against losses to agency which contribute to unwanted fertility outcomes.

•

Findings support agency as a dynamic, multidimensional construct in adolescence.

•

In general, access to resources promoted agency across dimensions.

•

Time-varying events, particularly early marriage, detracted from agency status.

•

Agency dimensions combined in unique ways with distinct implications for early/unwanted fertility.

Prevalence and factors affecting the utilization of antenatal care in rural areas of Southwestern Ethiopia

BACKGROUND

Antenatal care (ANC) is a health care intervention intended to ensure the safety of pregnancy. According to the World Health Organization, at least four ANC visits are recommended for a healthy pregnancy. However, whether this recommended number of visits was followed or not in the rural areas of Southwestern Ethiopia is not known. Therefore, the study aimed to investigate the prevalence of, and the associated factors of ANC utilization by pregnant women in the rural areas of Southwestern Ethiopia.

METHODS

A community-based cross-sectional study design was used in three rural zones. The data were collected from n = 978 women through a structured questionnaire with face-to-face interview. The collected data were analyzed using descriptive statistics and a multiple binary logistic regression model.

RESULTS

The results showed that 56% of women made the recommended minimum number of ANC visits and the remaining 44% of them underutilized the ANC service. The multiple binary logistic regression model identified zone, marital status of the woman, educational level of the husband, occupation of the husband, knowledge of danger signs of pregnancy, birth interval, source of information, timely visits, and transportation problem to be statistically significant factors affecting the prevalence of ANC visit utilization of women. Bench Maji zone had smaller odds ratio of ANC visit prevalence as compared to Kaffa zone. Women who lived in the rural area of Sheko zone are 2.67 times less likely to utilize ANC visit than those who lived in the rural area of Kaffa zone keeping other variables constant.

CONCLUSION

The study results highlight the need to increase the number of ANC visits, and the importance of using an appropriate model to determine the important socio-demographic factors that ANC service providers shall focus on to improve the health of the unborn baby and the mother during pregnancy.

As long as (I think) my husband agrees…: role of perceived partner approval in contraceptive use among couples living in military camps in Kinshasa, DRC

BACKGROUND

Male partner's approval is a key determinant of contraceptive use for women living in Sub-Saharan Africa and improving men's support and couple communication is a cornerstone of family planning programs. However, approval is often only measured through the women's perception of their partner's opinion.

METHODS

This study conducted in Kinshasa compares contraceptive approval variables from matched male and female partners (n = 252 couples) to establish the frequency of (in)accurate perceptions by the woman, then test their association with modern contraceptive use. Additional regressions estimate individual and couple variables associated with (in)correct perceptions.

RESULTS

Results confirm women are poorly aware of their partner's opinion but indicate that perceived approval or disapproval by the woman is a much stronger determinant of modern contraceptive use than her partner's actual opinion. Higher educational achievement from the woman is the strongest driver of misunderstanding her partner's approval.

CONCLUSIONS

Women's perceptions of partner's approval are much stronger determinant of contraceptive use than the latter's actual opinion, and stereotyping men's opinion of family planning is a common error of appreciation. However, findings also suggest these misunderstandings might serve women's capacity to negotiate contraceptive use.

Women's empowerment and fertility preferences of married women: analysis of demographic and health survey'2016 in Timor-Leste

A recently independent state, Timor-Leste, is progressing towards socioeconomic development, prioritizing women empowerment while its increased fertility rate (4.1) could hinder the growth due to an uncontrolled population. Currently, limited evidence shows that indicators of women's empowerment are associated with fertility preferences and rates. The objective of this study was to assess the association between women empowerment and fertility preferences of married women aged 15 to 49 years in Timor-Leste using nationally representative survey data. The study was conducted using the data of the latest Timor-Leste Demographic and Health Survey 2016. The study included 4040 rural residents and 1810 urban residents of Timor-Leste. Multinomial logistic regression has been performed to assess the strength of association between the exposures indicating women's empowerment and outcome (fertility preference). After adjusting the selected covariates, the findings showed that exposures that indicate women empowerment in DHS, namely, the employment status of women, house and land ownership, ownership of the mobile phone, and independent bank account status, contraceptive use, and the attitude of women towards negotiating sexual relations are significantly associated with fertility preferences. The study shows higher the level of education, the less likely were the women to want more children, and unemployed women were with a higher number of children. Our study also found that the attitude of violence of spouses significantly influenced women's reproductive choice. However, employment had no significant correlation with decision-making opportunities and contraceptive selection due to a lack of substantial data. Also, no meaningful data was available regarding decision-making and fertility preferences. Our findings suggest that women's empowerment governs decision-making in fertility preferences, causing a decline in the fertility rate.

Satisfaction with the quality of nursing care among older adults during acute hospitalization in Ghana

Aim

This study assessed the level of satisfaction with the quality of nursing care among hospitalized older adults and the factors associated with it.

Design

This was a quantitative descriptive cross‐sectional survey.

Methods

We used a validated questionnaire to collect data from a convenience sample of 206 older adults from three government hospitals in Tamale, Ghana. Data were analysed using descriptive statistics, independent sample t test and one‐way ANOVA.

Results

Most of the participants (72.3%) reported moderate levels of satisfaction with the quality of nursing care, while 23.8% reported high levels of satisfaction. The association between gender, religion and level of satisfaction with nursing care was not statistically significant. However, patients differed on levels of satisfaction based on healthcare facility: patients at the Tamale Central Hospital were more satisfied with the quality of nursing care than those at the Tamale Teaching Hospital. There is a need for capacity building and sensitization workshops on the rudiments of geriatric care for nurses in the metropolis to serve as an impetus for improvement in the quality of care.

Consolidating and Upscaling Molecular Research Capacity in Nigeria: On Who's Account?

Molecular research and researchers engage in studies that seek to understand the structures, functions, and interactions of biomolecules as the basis for cellular and systemic effects in living organisms. This research approach was made possible by considerable technological advancements that equip researchers with tools to view biomolecules. Although molecular research holds great promises for improving lives and living, the technological requirements and equipment to undertake molecular research are quite expensive, often requiring a heavy start-up capital or investment. In developing countries such as Nigeria, where the majority of the population lives below the poverty line and research funding is abysmally low, such heavy investments into research that do not provide immediate solutions to societal problems are difficult. This is mostly due to limited resources available to tackle many urgent and pressing needs, and limited perspective and understanding of policymakers, leading to infrastructural and skilled personnel deficit to support molecular research. Despite all these, the field of molecular research continues to grow exponentially globally, hence, funding and investments into this critical life science research area have become imperative. With the rich biodiversity of humans, animals, and plants in Nigeria, and the huge burden of infectious diseases in the country or region, global advances in genomics and proteomics studies will be incomplete without adequate contribution from Nigeria and sub-Saharan Africa region. This paper examines the progression and challenges of undertaking molecular research in Nigeria, and how Nigerian molecular research scientists are tackling these issues, with recommendations for improved molecular research capacity and output in the country or region.

Factors Associated With the Utilisation and Unmet Need for Modern Contraceptives Among Urban Women in Kenya: A Cross-Sectional Study

Background: Family planning (FP) is a key intervention in improving maternal and child health. Hence, we assessed the factors associated with utilisation and unmet need for modern contraceptives among urban women in Kenya.

Methods: The study used pooled data on 10,474 women 15–49 years from the seven rounds of the performance monitoring for accountability surveys collected between 2014 and 2018. The surveys were conducted in 11 of the 47 counties of Kenya using a multistage cluster design. Sample characteristics were described using frequencies and percentages while factors associated with utilisation and unmet need for modern contraceptives were assessed using multivariable logistic regressions.

Results: The prevalence of modern contraceptives use and unmet need for FP among urban women in Kenya was 53.7% [95% confidence interval (CI) 52.1–55.3%] and 16.9% (15.8–18.1%), respectively. The use of modern contraceptive was associated with the county of residence, age, marital status, parity, education, household wealth quintile, exposure to media, and survey year. Teenagers, poorest urban women, women with no formal or primary level of education and those who seek services at a dispensary or health centres had higher odds of unmet need for FP while women who resided in Kitui and Nyamira counties had reduced odds of unmet need for FP. The odds of unmet need decreased with the survey year while that of modern contraceptive use had an inverse trend.

Conclusion: Overall modern contraceptive use in urban areas is lower than the national average while the unmet need for FP is higher than national average, highlighting a potential urban-rural disparity in FP indicators in Kenya. Individual sociodemographic and socioeconomic and contextual factors are associated with the use of modern contraceptive and unmet need for FP among urban women in Kenya. Urban family planning policies and programmes in Kenya need to focus on strengthening urban healthcare systems to provide equal and accessible FP services, especially targeted towards teenagers and young women and those of low socioeconomic status.

Experiences and practices of caregiving for older persons living with dementia in African countries: A qualitative scoping review

BACKGROUND

The increasing awareness and diagnosis of dementia in Africa necessitate documentation of caregiving practices to understand local patterns and improve the quality of care. Caregiving in African communities is rooted in informal-communal social organization. This scoping review analyses caregiver characteristics and experiences, and practices of caregiving for persons living with dementia in Africa.

METHODS

A total of 152 references were retrieved, with 64 references obtained from PubMed, 85 from AJOL, and three from Scopus. Based on the relevance of titles, 83 references were further retained from PubMed (64), AJOL (16), and Scopus (3). A rapid review of abstracts was done in Distiller SR, and finally, six relevant articles were content-analyzed using Atlas ti 8.4 qualitative analysis software.

RESULTS

All six included studies were published between 2003 and 2018. Four themes were identified: article characteristics, caregiver characteristics, caregiver in context, and caregiver potentialities (challenges and opportunities). Studies reported findings from research conducted in four African countries: three from Nigeria, and one each from South Africa, Egypt, and Tanzania. Caregivers of persons living with dementia typically had eight years or less of formal education, were unpaid, and spent a daily average of 13 hours in caregiving. Cultural thresholds and individual caregiver differences underlie the interpretation of stressors across cultures. Caregivers lack the right training and information as well as support systems to improve their role performance and reduce accumulated stress.

CONCLUSION

In African countries, informational and educational platforms are essential for improved individual dementia caregiving, vis-à-vis strengthened roles of governments, and religious/traditional leaders and organizations.

Effect of four or more antenatal care visits on facility delivery and early postnatal care services utilization in Uganda: a propensity score matched analysis

Introduction

Maternal mortality remains a global public health issue, more predominantly in developing countries, and is associated with poor maternal health services utilization. Antenatal care (ANC) visits are positively associated with facility delivery and postnatal care (PNC) utilization. However, ANC in itself may not lead to such association but due to differences that exist among users (women). The purpose of this study, therefore, is to examine the effect of four or more ANC visits on facility delivery and early PNC and also the effect of facility-based delivery on early PNC using Propensity Score Matched Analysis (PSMA).

Methods

The present study utilized the 2016 Uganda Demographic and Health Survey (UDHS) dataset. Women aged 15 – 49 years who had given birth three years preceding the survey were considered for this study. Propensity score-matched analysis was used to analyze the effect of four or more ANC visits on facility delivery and early PNC and also the effect of facility-based delivery on early PNC.

Results

The results revealed a significant and positive effect of four or more ANC visits on facility delivery [ATT (Average Treatment Effect of the Treated) = 0.118, 95% CI: 0.063 – 0.173] and early PNC [ATT = 0.099, 95% CI: 0.076 – 0.121]. It also found a positive and significant effect of facility-based delivery on early PNC [ATT = 0.518, 95% CI: 0.489 – 0.547].

Conclusion

Policies geared towards the provision of four or more ANC visits are an effective intervention towards improved facility-based delivery and early PNC utilisation in Uganda.

Association between socioeconomic factors and unmet need for modern contraception among the young married women: A comparative study across the low- and lower-middle-income countries of Asia and Sub-Saharan Africa

Modern contraceptive methods are effective tools for controlling fertility and reducing unwanted pregnancies. Yet, the unmet need for modern contraception (UNMC) remains high in most of the developing countries of the world. This study aimed to compare the coverage of modern contraceptive usage and the UNMC among the young married women of low- and lower-middle-income countries (LMICs) of Asia and Sub-Saharan Africa, and further examined the likelihood of UNMC across these regions. This cross-sectional study used Demographic and Health Survey (DHS) data on family planning from 32 LMICs of South Asia (SA), Southeast Asia (SEA), West-Central Africa (WCA), and Eastern-Southern Africa (ESA). Multilevel logistic regression models were used to investigate the relationship between UNMC and women's socioeconomic status. Out of 1,00,666 younger married women (15-24 years old), approximately 37% used modern contraceptives, and 24% experienced UNMC. Regionally, women from SA reported higher modern contraceptive usage (44.7%) and higher UNMC (24.6%). Socioeconomic factors like- higher education (in SA and WCA), unemployment (in SA and ESA), no media exposure (in SA and ESA), and higher decision-making autonomy (except SEA) showed positive and significant association with UNMC. Poorest households were positively associated with UNMC in SA and ESA, while negatively associated with UNMC in SEA. UNMC was highly reported among the SA young married women, followed by WCA, SEA, and ESA regions. Based on this study findings, versatile policies, couples counseling campaigns, and community-based outreach initiatives might be undertaken to minimize UNMC among young married women in LMICs.

Social Support, General Self-Efficacy, Fear of Falling, and Physical Activity Among Older Adults in a Middle-Income Country

Objectives: To investigate the levels and interrelationships between fear of falling (FOF), physical activity (PA), social support (SS), and general self-efficacy (GSE) among older adults in a Nigerian community. Methods: This was a cross-sectional survey involving 100 older adults (65.0% females; mean age = 74.25 ± 8.01 years) consecutively recruited from Nnewi community. Participants’ FOF, PA, GSE, and SS were assessed using standardized questionnaires. Data were analyzed using descriptive statistics, Spearman rank order correlation, and structural equation modeling at a 0.05 level of significance. Results: The participants’ mean FOF, PA, GSE, and SS scores were 15.22 ± 7.43 (fearful), 114.76 ± 90.18 (low), 21.64 ± 8.25 (low) and 5.72 ± 1.19 (high) respectively. There were significant correlations between each pair of FOF, PA, GSE, and SS scores of the participants (p < .05). FOF and GSE were significant predictors of PA while GSE and SS were significant predictors of FOF. Conclusion: FOF and SS were high while PA and GSE were low in this sample of Nigerian older adults. Significant correlations existed between FOF, SS, GSE, and PA, with FOF and GSE being predictors of PA while GSE and SS significantly predicted FOF. Measures should be geared towards reducing FOF and improving PA, GSE, and SS in this group.

Association between knowledge of Human Immunodeficiency Virus transmission and consistent condom use among sexually active men in Nigeria: An analysis of 2018 Nigeria Demographic Health Survey

An estimated 1.7 million people were living with HIV in Nigeria in 2020, with over 86,000 people newly infected. Although the global rates of HIV have remained consistent over time, Nigeria has the second-highest number of people living with HIV and contributes to 9% of the global burden of HIV/AIDS. This is due to several structural and individual-level factors that limit knowledge of HIV and condom utilization. In this context, this study examines the association between knowledge about HIV transmission and consistent condom use among sexually active men in Nigeria. The data utilised in this study was sourced from the latest Nigeria Demographic and Health Survey conducted in 2018. The sample included a total of 9,346 men between the ages of 15-59 years who were sexually active at the time of data collection. Frequency distribution, univariate and multivariable analyses were performed at 95% confidence interval and p-value less than 0.05 to determine the association between the key independent variables and covariates. The results showed that 85.03% of sexually active men who had no knowledge of HIV engaged in inconsistent condom use. The key independent variable showed that sexually active men who had knowledge of HIV had higher odds [AOR = 1.37; 95%(CI = 1.10-1.72)] of consistent condom use compared to those without knowledge of HIV. However, sexually active men who were previously married [AOR = 0.38; 95%(CI = 0.24-0.61)], and those residing in the South Eastern region of Nigeria [AOR = 0.62; 95%(CI = 0.44-0.96)] had lower odds of consistent condom use. This study established the association between HIV knowledge and consistent condom use among sexually active males in Nigeria even after controlling for confounders. Educational level, wealth index, and ethnicity are also associated with condom use. This calls for the consideration of social determinants of health, localised and cultural health promotion and targeted public health strategies at all governmental levels to combat the HIV/AIDS epidemic in Nigeria.

Trends of unmet need for family planning among currently married reproductive age women in Ethiopia: A multivariate decomposition analysis

INTRODUCTION

Despite decreasing the percentage of women with unmet needs, Ethiopian women still have a higher unmet need for family planning due to different factors. Therefore, addressing the unmet need for FP provides an opportunity for policymakers in all sectors to respond to the expressed fertility preferences of their population. This study aimed to analyze trends and determinants of changes in unmet needs over time among married women of reproductive age in Ethiopia.

METHODS

The study used data from three consecutive Demographic and Health Surveys conducted in Ethiopia (2005, 2011, and 2016). These nationally representative household surveys cover all Ethiopia region and city administrations with population health and other relevant indicators). The study included a total weighted sample of 8642 in 2005, 10204 in 2011, and 9824 in 2016 in the final analysis. Factors contributing to the change in unmet need rate were examined using logit-based multivariate decomposition analysis.

RESULTS

Among married women, unmet needs declined from 33.8% (95% confidence interval (CI):32.8,34.8) in 2005 to 21.0%(95%CI:20.2,21.9) in 2016. In decomposition analysis, the difference in coefficients was responsible for 90% of the overall change in the unmet need rate. In particular, being at the age of 25-49 years, rural place of residence, agrarian regions, and having more than four children were significant predictors of the increase in unmet need rate.

CONCLUSIONS

Unmet needs among women have shown a remarkable decline over the last decade in Ethiopia. Policy and program interventions better targeting younger, agrarian regions and rural dwellers would help to maintain a declining trend in unmet needs.

Marriage to first pregnancy interval and related factors among women in North Central Nigeria

Background

The age at which a woman gets married may affect the timing and occurrence of her first pregnancy as well as the total number of children she will have in her lifetime. Factors which affect the marriage to first pregnancy interval include the age at marriage of the woman, her educational level, and cultural and religious beliefs among others. This study seeks to find out the marriage to first pregnancy interval and factors that affect this interval as well as the average number of children of women in North Central Nigeria.

Materials and Methods

This was a cross-sectional community survey utilizing structured questionnaires. Information on marriage to first pregnancy interval as well as related factors was obtained from 300 currently or ever-married women in Abuja, North Central Nigeria.

Results

The women were aged 13-72 years (mean: 28.67 years); the mean age at first marriage was 21.57 years, and the mean age at first pregnancy was 22.48 years. Marriage to first pregnancy interval was <3 months in 68 (22.6%), 1 year in 86 (28.6%), and ≥2 years in 154 (51.3%). The mean number of children for 45 years and above was 4.5. Overall, women who are artisans were found to be more likely to have a pregnancy soon after marriage. Husband's place of residence, educational qualification of the woman, age at marriage, tribe, and religion did not significantly affect first marriage to first pregnancy interval.

Conclusion

Women in this part of Nigeria marry in early adulthood and are likely to want to have their first pregnancy soon after marriage. This has social implications for population dynamics and planning.

Continuum of maternal healthcare services utilization and its associated factors in Ethiopia: A systematic review and meta-analysis

The continuum of care throughout pregnancy, childbirth, and postnatal period is one of the vital strategies for improving maternal and neonatal health and preventing maternal and neonatal mortalities and morbidities. The level and determinants of the complete continuum of care for maternal health services reported by different studies were extremely varied in Ethiopia. Therefore, this meta-analysis aimed to estimate the overall prevalence of a complete continuum of maternal health care services utilization and its associated factors in Ethiopia. Databases such as PubMed/MEDLINE, Science Direct, DOJA, African journals online, Cochrane library, Google scholar, web of science, and Ethiopian universities’ institutional repository were used to search for relevant studies. A total of seven studies with 4854 study participants were involved in this study. Data were extracted by two reviewers and exported to STATA Version 11 for analysis. The I2 statistics and Egger’s test were used to assess heterogeneity and publication bias, respectively. The random-effects random effects model was used to estimate the level of complete continuum of care for maternal health services. The pooled prevalence of complete continuum of maternal healthcare services utilization was 25.51%. Employed mothers (OR = 3.16, 95%CI = 1.82, 5.47), first antenatal ante natal care visit before 16 weeks (OR = 7.53, 95% CI = 2.94, 19.29), birth preparedness and complication readiness plan (OR = 1.95, 95% CI = 1.12, 3.41), secondary and above educational status (OR = 2.97, 95% CI = 2.00, 4.41), planned pregnancy (OR = 6.86, 95% CI = 3.47, 13.58) and autonomy (OR = 3.73, 95% CI = 2.24–6.23) were significantly associated with continuum of maternal healthcare services utilization. In conclusion, the national level of complete continuum of maternal healthcare service utilization was low in Ethiopia. Being employed mothers, first ante natal care visit before 16 weeks, birth preparedness and complication readiness plan, secondary and above educational status, autonomy, and planned pregnancy were the major determinants of continuum of maternal healthcare services utilization.

Factors related to the incidence of unmet need in couples of reproductive age in the working area of Marawola Health Center

OBJECTIVE

This study aimed at determining factors associated with the incidence of unmet need for family planning among couples of reproductive age in the working area of Marawola Health Center, Sigi Regency.

METHOD

This research was an analytic observational study with a cross-sectional study design. The variables in this study included age, education, family planning history, husband's support and unmet need. Data were in the form of primary and secondary data. Data were collected using a questionnaire. The data were analyzed using univariate and bivariate analysis utilizing the Chi-Square test. Population in this study were 4715 couples of reproductive age in the working area of Marawola Health Center. By using Lemeshow's calculation technique and simple random sampling, a sample of 90 people was obtained.

RESULT

The results demonstrated a relationship between age and the incidence of unmet need with p value=0.004 (p-value ≤0.05); education and the incidence of unmet deed with p value=0.005 (p-value ≤0.05); family planning history and the incidence of unmet need with p value=0.002 (p-value ≤0.05); as well as husband's support and the incidence of unmet need with p value=0.001 (p-value ≤0.05).

CONCLUSION

This study concludes that there is a relationship between age, education, family planning history, and husband's support and the incidence of unmet need for family planning in the working area of Marawola Health Center, Sigi Regency. Therefore, health workers, local governments, and traditional institutions are expected to provide education about family planning to couples of reproductive age (husband and wife) as an attempt to reduce the number of unmet needs in the working area of Marawola Health Center.

In Pursuit of Development: Post-Migration Stressors among Kenyan Female Migrants in Austria

The emphasis on migration for development obscures its diverse challenges. The migration development nexus is paradoxical, problematic, and controversial. Remittances have long gained wide interest. Migrants’ subjective experiences are important in understanding overall migration outcomes. International African female migration has increased and it is underexplored. This paper investigates the psychosocial stressors of migration based on the lived experiences of Kenyan female migrants in Austria. A sample of 6 female migrants was selected. Narrative data were recorded and analysed using interpretative phenomenological analysis. The findings showed that migration resulted in troubled relationships within the core and extended families. The economic dependency of family members in Kenya caused conflicts in interracial marriages. Acculturation led to alienation, family separation and isolation. Achieving economic goals proved challenging due to unpredictable effects in Austria. Failed expectations driven by stereotypes about Europe resulted in disillusionment and high expenses. Routine racism and Black female body objectification affected the mental health of the participants. This article contributes to knowledge on international African migration and gender-specific issues concerning African female migrants. The results will inform policymakers, academia, future migrants and mental health providers. Further research on the effects of migration on African migrants is recommended.

Access to primary healthcare Services in Conflict-Affected Fragile States: a subnational descriptive analysis of educational and wealth disparities in Cameroon, Democratic Republic of Congo, Mali, and Nigeria

BACKGROUND

Measuring and improving equitable access to care is a necessity to achieve universal health coverage. Pre-pandemic estimates showed that most conflict-affected and fragile situations were off-track to meet the Sustainable Development Goals on health and equity by 2030. Yet, there is a paucity of studies examining health inequalities in these settings. This study addresses the literature gap by applying a conflict intensity lens to the analysis of disparities in access to essential Primary Health Care (PHC) services in four conflict-affected fragile states: Cameroon, Democratic Republic of Congo, Mali and Nigeria.

METHODS

For each studied country, disparities in geographic and financial access to care were compared across education and wealth strata in areas with differing levels of conflict intensity. The Demographic Health Survey (DHS) and the Uppsala Conflict Data Program were the main sources of information on access to PHC and conflict events, respectively. To define conflict intensity, household clusters were linked to conflict events within a 50-km distance. A cut-off of more than two conflict-related deaths per 100,000 population was used to differentiate medium or high intensity conflict from no or low intensity conflict. We utilized three measures to assess inequalities: an absolute difference, a concentration index, and a multivariate logistic regression coefficient. Each disparity measure was compared based on the intensity of conflict the year the DHS data was collected.

RESULTS

We found that PHC access varied across subnational regions in the four countries studied; with more prevalent financial than geographic barriers to care. The magnitude of both educational and wealth disparities in access to care was higher with geographic proximity to medium or high intensity conflict. A higher magnitude of wealth rather than educational disparities was also likely to be observed in the four studied contexts. Meanwhile, only Nigeria showed statistically significant interaction between conflict intensity and educational disparities in access to care.

CONCLUSION

Both educational and wealth disparities in access to PHC services can be exacerbated by geographic proximity to organized violence. This paper provides additional evidence that, despite limitations, household surveys can contribute to healthcare assessment in conflict-affected and fragile settings.

Resilient and Accelerated Scale-Up of Subcutaneously Administered Depot-Medroxyprogesterone Acetate in Nigeria (RASuDiN): A Mid-Line Study in COVID-19 Era

Background

Injectable contraceptives are fast becoming the method of choice among women in sub-Saharan Africa (SSA). Specifically, the subcutaneously administered depot–medroxyprogesterone acetate (DMPA-SC) is gaining traction as a convenient, private and effective method to address unmet need for family planning (FP). The objective of this study was to determine the trend in DMPA-SC use in Nigeria.

Methods

Data was extracted from the National Health Management Information System (NHMIS) FP register on DMPA-SC uptake in public health facilities and through community-oriented resource providers (CORPS) in 10 Nigerian states. The linear trend model was adopted in data analysis based on lowest measure of dispersion and/or highest adjusted coefficient of determination (R²). The statistical significance was determined at 5%.

Results

There was an upward trend in the use of DMPA-SC among clients who received the service through health providers, CORPS and self-injection in the 10 project states over a period of 12 months (August 2019–July 2020). In addition, the linear trend model showed that for every unit increase in months, the average number of women expected to use DMPA-SC through health providers, CORPS and self-injection will increase by 1308.3 (Yt = 3799.7 +1308.3*t), 756.73 (Yt = −1030.8 +756.73*t) and 77.864 (Yt = −159.7 +77.864*t) respectively. In all models, the adjusted coefficient of determination was 99.9% which showed good model fitness. The results also showed that the number of DMPA-SC clients varied across the project states with Niger (32,988) and Oyo (31,511) states reporting the highest number of clients over the period of 12 months.

Conclusion

There was an increasing use of DMPA-SC and self–injection among clients over time. Health facility and community-based FP programs should be strengthened to ensure improved access to FP services.

How Gender Is Recognised in Economic and Education Policy Programmes and Initiatives: An Analysis of Nigerian State Policy Discourse

Many African states are involved in the frontline discourse on the fight for gender equality through the adoption of public policies, aiming to improve the lives of women through social, economic, and political development. In Nigeria, despite the adoption of Article 42 of the Constitution of the Federal Republic of Nigeria 1999 adapted from the United Nations principles of gender equality, which provides for equality and elimination of all forms of discrimination against women, the Nigerian state still struggles with different forms of gendered marginalisation issues against women in various aspects of Nigerian society; these issues are mainly due to cultural, economic, and legislative challenges. Therefore, this article explores how gender is recognized through public policy programmes and initiatives using a qualitative content analysis of relevant policy documents. The documents were collected from various government ministries and cover policy areas that represent entrepreneurship and economic activities in Nigeria between 2000 and 2020. The analysis confirms the recognition of gender in public policies by subjective bias and mediating access to education for female gender advancement in Nigerian society. Some gender gaps were also recognized and discussed in the article.

Building a research agenda for mental health assessments in resolving legal dilemmas on adolescent sexual consent

The dilemma of adolescent consent confounds dispensation of justice in child sexual abuse and juvenile justice contexts, with legal personnel struggling to discern between consent and coercion in cases of adolescents who are sexually abused and those who are accused of alleged sexual offences. Given that capacities for consent also determine personal safety and mental health, there is an imperative to build a child mental health research agenda for developing methodologies that incorporate psychological knowledge on abuse dynamics, adolescent mental health and development, vulnerability and risk, to assess adolescent sexual consent and sexual decision-making processes.

Geospatial Distribution of Family Planning Services in Kira Municipality, Wakiso District, Uganda

Introduction: Access to family planning (FP) services remains a challenge, particularly in informal urban settlements. The unmet need for FP in these settings is high, with a correspondingly high prevalence of unintended pregnancies that may lead to unsafe abortions. However, there is a paucity of quality data on the distribution of FP services in such settings in Uganda. This paper described the geospatial distribution of FP services in Kira Municipality, Wakiso District, Uganda.

Methods: This was a cross-sectional study in which we determined the availability and distribution of FP services in Kira Municipality. Community mapping and analysis were conducted using ArcGIS (version 10.1) and ArcGIS Online. Stata version 13.1 was used for data analysis. Chi-square test was used to compare the contraceptive provision and availability among facilities from informal and formal settlements.

Results: Of the 176 healthcare facilities surveyed, only 42% (n = 74) offered contraceptives in informal settlements. The majority of the facilities were privately owned small clinics (95%). At least 80% of the facilities provided three or more modern contraceptive methods, with no difference (p = 0.107) between facilities in informal and formal settlements. Only 30.7% (p = 0.001) of the facilities provided at least one long-acting contraceptive. Similarly, 20 and 12% (p = 0.001) of the facilities had implants and intrauterine devices (IUDs) on the day of the survey. Almost 25% of the facilities did not offer contraceptive services (counseling and commodities) to unmarried adolescents.

Conclusions: Most facilities were small privately-owned clinics, offering at least three modern contraceptive methods. The unavailability of long-acting reversible methods in the informal settings may affect the quality of FP services due to limited choice. The inequity in service provision that disfavors the unmarried adolescent may increase unwanted/unintended pregnancies. We recommend that local governments and partners work toward filling the existing commodities gap and addressing the discrimination against unmarried adolescents in such settings.

Prevalence and inequalities in contraceptive use among adolescents and young women: data from a birth cohort in Brazil

Monitoring trends of contraceptive use and identifying the groups with less coverage are needed to guide public policies and make them more efficient. But, in Brazil, recent data about these aspects are limited. This study aimed to investigate the prevalence of contraceptive use and its inequalities during adolescence and early adulthood. Data from the 1993 Pelotas birth cohort, Rio Grande do Sul State, Brazil, were used. At 15, 18 and 22 years, respectively, 335, 1,458 and 1,711 women reported having started their sexual lives and were included in analysis. Prevalence and 95% confidence intervals were obtained to describe the most used contraceptive methods. Inequalities in modern contraceptive use were evaluated according to wealth index, scholastic backwardness and ethnicity. In all follow-ups, more than 80% of women used at least one modern method. The use of barrier methods decreased with age; at 22 this prevalence was 36.3%. Such use concomitant with other modern methods was lower than 50% in all follow-ups. We observed inequalities in the use of modern contraceptive methods, mainly in barrier methods used with other modern methods. These findings may contribute and improve the public policies in family planning.

Nutritional Status and Associated Risk Factors of Syrian Children's Residents in the Kingdom of Saudi Arabia

This study aimed to evaluate the nutritional status and associated risk factors of Syrian children living in Saudi Arabia. In this study, 55 boys and 55 girls ranging in age from 6 to 12 years were selected. Socioeconomic data of families were collected using a structured questionnaire. The participants' anthropometric measurements were calculated. The 24-h recall method was applied to calculate the daily food intake. Dietary nutrients' average daily intake of both boys and girls was significantly (p ≤ 0.01) lower than that of the dietary reference intake (DRI) with few exceptions. The sedentary lifestyles of both boys and girls had a negative impact on their food choices, and as a result, a large number of them were underweight and suffered from malnutrition and stunting. Spearman correlation coefficients revealed that most of the children's dependent variables were risk factors and strongly and negatively associated with their nutritional status proxies. The study concluded that both boys and girls had unbalanced nutritional status with high percentages of malnutrition and stunting because most dependent factors were adversely related to the independent ones.

Connection in Youth Development Key to the Mental Health Continuum in Ghana: A Structural Equation Model of Thriving and Flourishing Indicators

Practitioners from sub-Saharan Africa are working to provide evidence-based intervention programs to address the mental health of established adults in poor rural communities in Ghana. However, institutions in Ghana also pursue youth policy for training human capital that can contribute to national development as a strategy to leverage its heavy demographic makeup of adolescents and emerging adults. Positive Youth Development (PYD) is a framework for measuring indicators of thriving for such youthful populations. Studies have recently examined PYD in terms of developmental assets with mental illness, but less is known about their interaction with the continuum of mental health, which poses strength-based theoretical distinctions about the conditions of human flourishing. Investigating positive mental health in terms of well-being, along with developmental indicators from another conception of PYD with strong theoretical grounding known as the 5Cs, represents a salient cross-section of Ghana's current trajectory along these policies and evaluations of culturally attuned well-being toward youth-focused efforts. Thus, the aim of this study was to clarify whether developmental constructs could predict positive mental health outcomes for indications of adaptive regulation processes and cultural concepts of well-being. We used structural equation modeling of the PYD domains (i.e., the 5Cs) to provide novel insights into individual differences in factors of thriving with flourishing-languishing indicators from the mental health continuum (MHC; i.e., factors of Emotional, Social, and Psychological Well-being) for 710 youth and emerging adults (M age=19.97, SD=1.93) attending a university in Ghana. The results showed supported paths for Connection, which was associated with all three MHC well-being domains (βs=0.34-0.41), and Caring, which was associated with Psychological Well-being (β=0.27), as factors to consider for youth who are expected to underwrite Ghana's development under economically challenged conditions. These findings support evidence-based program outcomes and prior work that situates social relations as a key route to maintaining well-being, advancing research on the specificity of predictors for positive mental health factors among young people in an enterprising Ghana.

Health facility delivery among women of reproductive age in Nigeria: Does age at first birth matter?

BACKGROUND

High maternal mortality ratio in sub-Saharan Africa (SSA) has been linked to inadequate medical care for pregnant women due to limited health facility delivery utilization. Thus, this study, examined the association between age at first childbirth and health facility delivery among women of reproductive age in Nigeria.

METHODS

The study used the most recent secondary dataset from Nigeria's Demographic and Health Survey (NDHS) conducted in 2018. Only women aged15-49 were considered for the study (N = 34,193). Bi-variate and multivariable logistic regression models were used to examine the association between age at first birth and place of delivery. The results were presented as crude odds ratios and adjusted odds ratios (aOR) with corresponding 95% confidence intervals (CIs). Statistical significance was set at p<0.05.

RESULTS

The results showed that the prevalence of health facility deliveries was 41% in Nigeria. Women who had their first birth below age 20 [aOR = 0.82; 95%(CI = 0.74-0.90)] were less likely to give birth at health facilities compared to those who had their first birth at age 20 and above.

CONCLUSION

Our findings suggest the need to design interventions that will encourage women of reproductive age in Nigeria who are younger than 20 years to give birth in health facilities to avoid the risks of maternal complications associated with home delivery. Such interventions should include male involvement in antenatal care visits and the education of both partners and young women on the importance of health facility delivery.

Spatial Distribution and Determinants of Nonautonomy on Decision Regarding Contraceptive Utilization among Married Reproductive-Age Women in Ethiopia: Spatial and Bayesian Multilevel Analysis

BACKGROUND

Studies conducted to date in Ethiopia did not explore the spatial distribution, individual-level, and community-level factors affecting women's nonautonomy on decision to use contraceptives. Hence, this study aimed to assess the spatial distribution of women's nonautonomy on decision regarding contraceptive utilization and its determinants in Ethiopia.

METHODS

Data were accessed from the Demographic Health Survey program official database website (https://dhsprogram.com). A weighted sample of 3,668 married reproductive-age women currently using contraceptives was included in this analysis. Bayesian multilevel logistic regression models were fitted to identify the determinants of women's nonautonomy on contraceptive utilization. Adjusted odds ratio with 95% credible interval was used to select variables that have a significant effect on nonautonomy on contraceptive utilization.

RESULTS

A high proportion of women with nonautonomy on decision regarding contraceptive utilization was found in northern parts of Southern Nations, Nationalities, and People's Region, Southern parts of Oromia, and Benishangul-Gumuz regions of the country. Overall, 2876 (78.40% (95% CI: 77.0%, 79.7%)) women were nonautonomous on decision regarding contraceptive utilization. In the final model, age from 35-49 (AOR (95% CI) = 0.63 (0.54, 0.72)), living in the richer households (AOR (95% CI) = 0.12 (0.03, 0.26)), being married at 18 years or above (AOR (95% CI) = 0.33 (0.19, 0.57)), and residing in an rural areas (AOR (95% CI) = 1.34 (1.01, 1.71)) and metropolitan regions (AOR (95% CI) = 0.71(0.54, 0.91)) were associated with women's nonautonomy on decision regarding contraceptive utilization.

CONCLUSIONS

In Ethiopia, the spatial distribution of women's nonautonomy on decision about contraceptive utilization was nonrandom. More than three-fourths of married reproductive-age women in Ethiopia are nonautonomous on decision regarding contraceptive utilization. Region, residence, current age, age at marriage, and wealth index were statistically associated with women's nonautonomy on decision regarding contraceptive utilization.

A comparative analysis of determinants of low birth weight and stunting among under five children of adolescent and non-adolescent mothers using 2015/16 Tanzania Demographic and Health Survey (TDHS)

BACKGROUND

Tanzania is one of the Sub-Saharan African country with nearly 12 out of 60 million people being adolescent. The prevalence of child marriage is higher with one out of every three girls being married before reaching their 18th birthday, 5 % being married by the age of 15, and 31% by the age of 18 years. Literature shows early pregnancy is associated with Low Birth Weight (LBW) and stunting among children under 5 years. This paper explores variation and factors associated with low birth weight and stunting among children born by adolescent and non-adolescent mothers.

METHODS

Data from 13,266 women with children under 5 years collected as part of the 2015/2016 TDHS was re-analyzed using STATA version 14 software while accounting for survey design. A total of 6385 women (of which 7.2% were adolescent) and 8852 women (of which 6.7% were adolescent) were involved in the analysis of child birth weight and stunting respectively. Descriptive statistics stratified by maternal age was conducted with LBW and stunting as outcome variables followed by logistic regressions models controlling for confounding variables.

RESULTS

The proportion of obese or overweight adolescent and non-adolescent mothers was 11.8 and 36.5% respectively. Antenatal care (ANC) attendance, areas of residence and social economic status were very similar in the two maternal age groups. Non- adolescent mothers had reduced odds of giving birth to LBW babies compared to adolescent mothers (Adjusted Odds Ratio (AOR) = 0.34; 95% CI: 0.22-0.50). Maternal undernutrition (AOR = 2.29; 95% CI: 1.43-3.67), being divorced, separated or widowed (AOR = 1.76; 95% CI: 1.24-2.50) and having at least four ANC visits (AOR = 0.64; 95% CI: 0.49-0.83) were significantly associated with reduced odds of having a LBW. Child stunting was not associated with maternal age. Maternal high socioeconomic status (AOR = 0.69; 95% CI: 0.57-0.84) and maternal obesity or overweight (AOR = 0.77; 95% CI: 0.64-0.92) were negatively associated with stunting. Child birth weight, sex, and age were significantly associated with stunting.

CONCLUSION

Maternal age was a predictor of LBW but not stunting. ANC attendance and not living with a spouse increase the risk of LBW babies. Stunting was associated with low maternal body mass index (BMI), low socioeconomic status, child birth weight, gender, and age. A multi-sectoral approach is needed to address child nutrition problems with teenagers 'specific intervention that offer emotional support, and health education during pregnancies for improving immediate and later life child birth outcomes.

Social network and social normative characteristics of married female adolescents in Dosso, Niger: Associations with modern contraceptive use

In this study we analysed the social networks of a sample of married adolescent girls (ages 13-19 years) residing in Dosso, Niger (N = 322); data were collected for evaluation of a family planning (FP) intervention. Participants were asked to name individuals important in their lives (alters) using three name generating questions as part of a larger survey on reproductive health, social norms, and FP. One alter per girl was then recruited to be separately interviewed (N = 250). This provided us with two separate datasets: one with data from each respondent regarding each person that they nominated, and one with the interviewed alters matched with the respondent who nominated them. We found that married adolescent girls who were nulliparous were more likely to have no alters and that those in the intervention had the most alters. Alters of treatment participants were more likely to have used FP. Respondents were more likely to have used FP when their sisters or in-laws had, but there was no correlation with use by friends. Our results provide evidence of diffusion of the FP program to those close to intervention participants. Future research should study these dynamics, crucial to understanding intervention costing, impact, and normative change.

Do women with autonomy in the household experience less intimate partner violence in Malawi? Evidence from the 2015-16 Demographic and Health Survey

In Malawi, the prevalence of intimate partner violence (IPV), or closely related violence, is estimated at 42% according to the 2015-16 Malawi Demography and Health Survey (MDHS). This study investigated the association between women's autonomy in household decision-making participation as well as sexual autonomy and IPV among married and cohabiting women aged 15-49 years in Malawi. Secondary data were taken from the 2015-16 MDHS. Multivariate analysis was performed using a stepwise forward logistic (binary) regression model to assess the association of dimensions of women's autonomy in the household and selected control variables with IPV. No association was found between dimensions of women's autonomy in the household and IPV. However, other variables did have an association with some form of IPV, namely women justifying wife beating, having a jealous partner, being accused of unfaithfulness by their partner, having a partner who drinks alcohol and having a partner with another woman or more. In addition, religion, ethnicity, women education level and women's occupation were found to be associated with the risk of experiencing IPV. The study recommends policy interventions aimed at supporting youth, especially girls, to complete secondary education before they marry or cohabit; the development of accessible and affordable psycho-social counselling specialists and platforms for married and cohabiting couples; nationwide rigorous advocacy and civic education on IPV; and enforcement of Malawi's 2006 domestic violence law.

Health and demographic surveillance systems in low- and middle-income countries: history, state of the art and future prospects

Health and Demographic Surveillance Systems (HDSS) have been developed in several low- and middle-income countries (LMICs) in Africa and Asia. This paper reviews their history, state of the art and future potential and highlights substantial areas of contribution by the late Professor Peter Byass.Historically, HDSS appeared in the second half of the twentieth century, responding to a dearth of accurate population data in poorly resourced settings to contextualise the study of interventions to improve health and well-being. The progress of the development of this network is described starting with Pholela, and progressing through Gwembe, Balabgarh, Niakhar, Matlab, Navrongo, Agincourt, Farafenni, and Butajira, and the emergence of the INDEPTH Network in the early 1990'sThe paper describes the HDSS methodology, data, strengths, and limitations. The strengths are particularly their temporal coverage, detail, dense linkage, and the fact that they exist in chronically under-documented populations in LMICs where HDSS sites operate. The main limitations are generalisability to a national population and a potential Hawthorne effect, whereby the project itself may have changed characteristics of the population.The future will include advances in HDSS data harmonisation, accessibility, and protection. Key applications of the data are to validate and assess bias in other datasets. A strong collaboration between a national HDSS network and the national statistics office is modelled in South Africa and Sierra Leone, and it is possible that other low- to middle-income countries will see the benefit and take this approach.

Individual and Contextual Factors Associated with Malaria among Children 6-59 Months in Nigeria: A Multilevel Mixed Effect Logistic Model Approach

Background/Purpose: Over the last two decades, malaria has remained a major public health concern worldwide, especially in developing countries leading to high morbidity and mortality among children. Nigeria is the world most burdened malaria endemic nation, contributing more than a quarter of global malaria cases. This study determined the prevalence of malaria among children at 6–59 months in Nigeria, and the effects of individual and contextual factors. Methods: This study utilized data from 2018 Nigeria Demographic and Health Survey (NDHS) involving a weighted sample size of 10,185 children who were tested for malaria using rapid diagnostic test (RDT). Given the hierarchical structure of the data set, such that children at Level-1 were nested in communities at Level-2, and nested in states and Federal Capital Territory (FCT) at Level-3, multilevel mixed effect logistic regression models were used for the analysis. Results: The proportion of children 6–59 months of age in Nigeria that had malaria fever positive as assessed by RDTs was 35.5% (3418/10,185), (CI: 33.9–37.1). Kebbi State had 77.7%, (CI: 70.2–83.5), which was the highest proportion of 6–59 months who were malaria positive, next in line was Katsina State with 55.5%, (CI: 47.7–63.1). The Federal Capital Territory (FCT), Abuja had the proportion of 29.6%, (CI: 21.6–39.0), malaria positive children of 6–59 months of age. Children between the age of 48 and 59 months were 2.68 times more likely to have malaria fever than children of ages 6–11 months (AOR = 2.68, 95% CI: 2.03–3.54). In addition, children from the rural area (AOR = 2.12, 95% CI: 1.75–2.57), were more likely to suffer from malaria infection compared to children from urban area. Conclusion: The study identified some individual and contextual predictors of malaria among children in Nigeria. These factors identified in this study are potential areas that need to be considered for policy designs and implementations toward control and total elimination of malaria-related morbidity and mortality among children in Nigeria.

Urban Family Planning in Low- and Middle-Income Countries: A Critical Scoping Review

Health agendas for low- and middle-income countries (LMICs) should embrace and afford greater priority to urban family planning to help achieve a number of the global Sustainable Development Goals. The urgency of doing so is heightened by emerging evidence of urban fertility stalls and reversals in some sub-Saharan African contexts as well as the significance of natural increase over migration in driving rapid urban growth. Moreover, there is new evidence from evaluations of large programmatic interventions focused on urban family planning that suggest ways to inform future programmes and policies that are adapted to local contexts. We present the key dimensions and challenges of urban growth in LMICs, offer a critical scoping review of recent research findings on urban family planning and fertility dynamics, and highlight priorities for future research.

Migration and interbirth transition rate using Benin Demographic and Health Survey data: Does episode-splitting matter?

BACKGROUND

The relationship between migration and fertility has vexed demographers for years. One issue missing in the literature is the lack of careful temporal consideration of when women migrate and specifically, the extent to which they do either before or after live births.

OBJECTIVE

Here, we opt for a more appropriate methodological approach to help remedy the complexity of the temporal aspect of migration and childbirth processes: regression models using the episode-splitting method.

METHODS

This paper applies a rarely used methodological approach (episode-splitting) in the literature of migration-fertility relationship to investigate how internal in-migration is associated with inter-birth intervals among women in Cotonou, the largest city of Benin. Data comes from the 2017-2018 Benin Demographic and Health Survey (DHS) of women aged 15-49. Estimates from exponential regression models with episode-splitting were compared to estimates from exponential regression models without episode-splitting approach. Sensitivity analysis was also conducted to determine the robustness of the comparison between the two methods. Akaike Information Criteria (AIC) and Bayesian Information Criteria (BIC) were used to identify the method that provides models with best fit.

RESULTS

The results from (standard) exponential regression models without episode-splitting show that there is no significant association between migration and interbirth transition rate. However, significant associations between migration and interbirth transition rate emerge after applying the episode splitting method. The hazard ratios (HR) of the transition to the next live birth are higher among migrant women than among nonmigrant women. This trend is persistent even after 10 years spent in Cotonou by migrant women.

CONCLUSION

Exponential regression models with episode-splitting were of better fit than exponential regression models without episode-splitting. Sensitivity analysis conducted seems to confirm that models with episode-splitting produce estimates that are accurate, reliable and superior to models without episode-splitting. The results suggest a long-run process adaptation of migrants to lower fertility behaviours in Cotonou and are therefore consistent with the socialization hypothesis.

Spatial Patterns and Multilevel Analysis of Factors Associated with Antenatal Care Visits in Nigeria: Insight from the 2018 Nigeria Demographic Health Survey

Despite global progress towards antenatal care (ANC) uptake, ANC utilization in a number of countries in sub-Saharan Africa, such as Nigeria, is low. Although several studies have identified the determinants and factors associated with ANC services utilization in Nigeria, there is a gap in knowledge about the spatial patterns in ANC use. Therefore, this study aims to map the spatial distribution and factors associated with ANC visits in Nigeria. A cross-sectional dataset was obtained from the 2018 Nigeria Demographic and Health Survey. A total of 20,003 women aged 15-49 were considered in this study. Both spatial and multilevel analyses were carried out. The results were presented in spatial maps and adjusted odds ratios (aOR) at a 95% confidence interval (CI). Hot spot areas (high proportion of an incomplete ANC visit) were located in Sokoto, Kebbi, Zamfara, Katsina, Kano, Jigawa, Bauchi, Niger, Borno, Gombe, and Bayelsa. Regional disparities in incomplete ANC visits were found in this study. Maternal age, maternal education, partner's level of education, working status, ethnicity, parity, religion, exposure to media, place of residence, wealth index, region, and community literacy level were factors associated with incomplete ANC. There is a need to consider these factors in the design and strengthening of existing interventions (e.g., mini-clinics) aimed at increasing ANC visits to help attain maternal health-related Sustainable Development Goals by 2030. The regional disparities in incomplete ANC visits also need to be considered by encouraging pregnant women in hotspot areas to attend ANC visits.