1
|
Mayanja Y, Kayesu I, Kamacooko O, Lunkuse JF, Muturi-Kioi V, Price M, Kosidou K, Ekström AM. Preference for novel biomedical HIV pre-exposure prophylaxis methods among adolescent girls and young women in Kampala, Uganda: a mixed methods study. Front Public Health 2024; 12:1369256. [PMID: 38846614 PMCID: PMC11153736 DOI: 10.3389/fpubh.2024.1369256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/30/2024] [Indexed: 06/09/2024] Open
Abstract
Background Novel HIV pre-exposure prophylaxis (PrEP) methods including a potential future HIV vaccine, will increase prevention options for adolescent girls and young women (AGYW) at high risk of HIV infection in Eastern and Southern Africa, yet data on AGYW's preferences for various PrEP methods is limited. We investigated preferences for five biomedical PrEP methods (oral, injectable, vaginal ring, implant, HIV vaccine) among 14-24-years-old AGYW in Kampala, Uganda. Methods From January to December 2019, we conducted a mixed methods study including 265 high-risk AGYW. After receiving two education sessions on the five PrEP methods, participants were asked about their "most preferred PrEP method." Multinomial logistic regression (oral PrEP as reference category) was used to determine participant characteristics associated with method preference. Results are presented as adjusted relative risk ratios (aRRR) with 95% confidence intervals (CI). In-depth interviews were conducted with 20 selected participants to examine reasons influencing PrEP preferences and suggestions for method improvements. Transcripts were analyzed thematically. Results Participants preferred methods were: HIV vaccine (34.7%), oral PrEP (25.7%), injectable PrEP (24.9%), PrEP implant (13.6%), and vaginal ring (1.1%). Preference for injectable PrEP increased with every year of age (aRRR 1.22; 95% CI 1.04-1.44) and among participants with chlamydia or gonorrhoea (aRRR 2.53; 95% CI 1.08-5.90), while it was lower among participants having sexual partner(s) living with HIV or of unknown HIV status (aRRR 0.30; 95% CI 0.10-0.91). Preference for PrEP implants also increased with age (aRRR 1.42; 95% CI 1.14-1.77) and was strong among participants having ≥10 sexual partners in the past 3 months (aRRR 3.14; 95% CI 1.16-8.55), while it was lower among those with sexual partner(s) living with HIV or of unknown HIV status (aRRR 0.25; 95% CI 0.07-0.92). PrEP method preference was influenced by product attributes and prior experiences with similar product forms commonly used in health care. Conclusion AGYW have varied preferences for biomedical PrEP method and those with higher sexual behavioral risk prefer long-acting methods. As we anticipate more available PrEP options, oral PrEP use should be supported among AGYW, especially for those with sexual partners living with HIV or of unknown HIV status.
Collapse
Affiliation(s)
- Yunia Mayanja
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ivy Kayesu
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Onesmus Kamacooko
- Child Health and Development Centre, School of Medicine, Makerere University, Kampala, Uganda
| | - Jane Frances Lunkuse
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | | | - Matt Price
- 4IAVI, New York, NY, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Kyriaki Kosidou
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases/Venhälsan, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|
2
|
Geta TG, Abdiwali SA, Farah MM, Assefa DZ, Arusi TT. Multilevel analysis on prevalence and associated factors of modern contraceptive uptake in Somaliland: based on The Somaliland Health and Demographic Survey 2020. Reprod Health 2024; 21:67. [PMID: 38773601 PMCID: PMC11110236 DOI: 10.1186/s12978-024-01786-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/03/2024] [Indexed: 05/24/2024] Open
Abstract
INTRODUCTION Contraception is the deliberate prevention of unwanted pregnancy through various contraceptive methods. Its uptake is low in Sub-Saharan African countries, particularly in east Africa. This might be linked to the high prevalence of unwanted pregnancies and the high fertility rate in the area. Although studies reporting the prevalence and associated factors of modern contraceptive uptake are available in other African countries, no study has been conducted in Somaliland. Therefore, the current study aimed to assess its prevalence and associated factors in Somaliland using Somaliland Health and Demographic Survey (SLHDS) data. METHODS AND MATERIALS The study used Somaliland Demographic Health Survey (SLDHS) 2020 data. The survey was a national-level survey using a cross-sectional study design. A total of 3656 reproductive-age women were included in the current study. To determine independent predictors of modern contraceptive uptake, a multi-level multivariable logistic regression analysis was done. Random effect analysis, standard error (SE) and intra-cluster correlation (ICC) were computed. RESULTS The proportion of modern contraceptive uptake among reproductive age groups in Somaliland is 1%. Modern contraceptive uptake is significantly associated with the residence, educational level and wealth index of participants. Women from nomadic communities had lower odds (AOR: 0.25; 95% CI: 0.10, 0.66) of modern contraceptive uptake compared to those from urban areas. Being in the highest wealth quintiles (AOR: 17.22; 95% CI: 1.99, 155.92) and having a tertiary educational level (AOR: 2.11; 95% CI: 1.29, 9.11) had higher odds of using the modern contractive method compared to those with the lowest wealth quintiles and non-formal education, respectively. CONCLUSION The prevalence of modern contraceptive uptake in Somaliland was very low. It is associated with the level of education, wealth index and residence of the women.
Collapse
Affiliation(s)
- Teshome Gensa Geta
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
- Department of Public Health, College of Health Science and Medicine, Gollis University, Hargeisa, Somaliland.
| | - Saad Ahmed Abdiwali
- Department of Public Health, College of Health Science and Medicine, Gollis University, Hargeisa, Somaliland
| | - Mustafa Mohamoud Farah
- Department of Public Health, College of Health Science and Medicine, Gollis University, Hargeisa, Somaliland
| | - Dereje Zewdu Assefa
- Department of Anaesthesia, College of Health Science and Medicine, Wolkite University, Wolkite, Ethiopia
| | - Temesgen Tantu Arusi
- Department of Obstetrics and Gynaecology, College of Health Science and Medicine, Wolkite University, Wolkite, Ethiopia
| |
Collapse
|
3
|
Mankelkl G, Kassaw AB, Kinfe B. Factors associated with modern contraceptive utilization among reproductive age women in Kenya; evidenced by the 2022 Kenyan demographic and health survey. Contracept Reprod Med 2024; 9:10. [PMID: 38491382 PMCID: PMC10941430 DOI: 10.1186/s40834-024-00271-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/25/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Globally, sexual and reproductive health is a significant public health issue for women of the reproductive age group. A modern contraceptive method enables individuals and families to manage fertility by reducing unintended pregnancies, abortions, pregnancy-related morbidity, and death. A modern contraceptive method is a drug or medical treatment that prevents sexual activity from leading to pregnancy. However, there is limited reliable and updated data on factors associated with modern contraceptive utilization among reproductive-age women at the national level in Kenya. So, the major goal of this study was to evaluate factors associated with modern contraceptive utilization among women of reproductive age in Kenya at the national level, as evidenced by the 2022 Kenyan demographic and health survey. METHODS The most recent datasets from the Kenyan Demographic and Health Survey were used for secondary data analysis. In all, 14,987 women of reproductive age participated in the investigation. Data for multivariable analysis on the factors influencing modern contraceptive utilization among Kenyan women of reproductive age can be obtained from the Kenyan Demographic and Health Survey. Finally, the odd ratio and percentages were presented along with their 95% confidence intervals. RESULT This study includes a total weighted sample of 14,987 reproductive-age women from the Kenyan demographic and health survey. Of the total contraceptive use, 90.1% of the study participants used modern contraceptives. Being married [AOR: 1.593, 95% CI (1.302, 1.948)], living in an urban area [AOR: 1.230, 95% CI (1.060, 1.428)], reading a magazine [1.002, 95% CI (0.921, 1.091)], listening to radio [AOR: 1.265, 95% CI (1.101, 1.454)], not breastfeeding [AOR: 1.296, 95% CI (1.114, 1.507), and having more than two children [AOR: 2.350, 95% CI (1.603, 3.445)] were the factors that promote modern contraceptive utilization. Conversely, having a history of terminated pregnancy [AOR: 0.767, 95% CI (0.657, 0.897), being Muslim [AOR: 0.566, 95% CI (0.418, 0.766)], and being in the 35-39 age range [AOR: 0.766, 95% CI (0.605, 0.971)] were all associated with a lower use of modern contraceptives. CONCLUSION Certain factors such as marriage, living in urban areas, having more than two children, having a female-led household, belonging to the middle class, reading magazines, listening to the radio, and not breastfeeding have a positive correlation with the use of modern contraceptives. Conversely, being a Muslim, aged between 35 and 39, and having a history of miscarriages are negatively correlated with the use of modern contraceptives. This indicates that addressing socioeconomic, geographic, and cultural barriers could improve the effectiveness of modern contraceptive.
Collapse
Affiliation(s)
- Gosa Mankelkl
- Department of Biomedical Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
| | - Altaseb Beyene Kassaw
- Department of Biomedical Sciences, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Beletu Kinfe
- Department of occupational Health and safety, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| |
Collapse
|
4
|
Chaka B, Osano AM, Wesley ON, Forbes PBC. Seasonal variation in pesticide residue occurrences in surface waters found in Narok and Bomet Counties, Kenya. ENVIRONMENTAL MONITORING AND ASSESSMENT 2023; 195:1050. [PMID: 37589911 DOI: 10.1007/s10661-023-11629-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/22/2023] [Indexed: 08/18/2023]
Abstract
Narok and Bomet are agricultural counties in Kenya which depend on flowing surface waters for farming activities. Agrochemicals have frequently been used to increase agricultural produce in this region. Occasionally, appropriate pesticide utilization measures are not followed. These surface waters are also consumed domestically by humans, livestock, and wild animals thus posing safety concerns to them. The current study sought to evaluate the levels and nature of pesticide residues found in surface waters in the dry and wet seasons of these counties. Eight water samples were collected in July (dry season) and October (wet season) at four different river sites in each of the two counties predetermined by the agricultural activity of its proximate environs. Pesticides extracted by solid phase extraction were analyzed by gas chromatography-mass spectrometry. At least 38 different pesticides were detected in the two counties with the highest concentration being recorded for chlorpyrifos and piperidine in Narok and Bomet counties, respectively. The pesticides chlorpyrifos, cypermethrin, cyfluthrin, and cyhalothrin were more prevalent in Narok County while triazine, semicarbazone, and epinephrine were more prevalent in Bomet County. There were significantly more pesticides detected during the wet season (P ≤ 0.05). Out of the nine prevalent pesticides detected, four of them posed serious ecotoxicology concerns with risk quotients above 1.0 (high risk); thus, there is a need for more government policy interventions in deterring farming near riparian lands and in training of famers regarding best practice for pesticide applications.
Collapse
Affiliation(s)
- Bakari Chaka
- Department of Mathematics and Physical Sciences, Maasai Mara University, P.O. Box 861-20500, Narok, Kenya
| | - Aloys M Osano
- Department of Mathematics and Physical Sciences, Maasai Mara University, P.O. Box 861-20500, Narok, Kenya.
| | - Omwoyo N Wesley
- Department of Mathematics and Physical Sciences, Maasai Mara University, P.O. Box 861-20500, Narok, Kenya
| | - Patricia B C Forbes
- Department of Chemistry, Faculty of Agriculture and Natural Sciences, University of Pretoria, Pretoria, 0002, South Africa
| |
Collapse
|
5
|
Kawuma R, Lunkuse JF, Ssembajjwe W, Kayesu I, Price MA, Brickley DB, Abaasa A, Mayanja Y. "I fear those things": non-uptake of contraceptives, and barriers to use among adolescent girls and young women at high risk of HIV infection in Kampala, Uganda. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1198672. [PMID: 37649966 PMCID: PMC10465063 DOI: 10.3389/frph.2023.1198672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Abstract
Background Adolescent girls and young women involved in risky behaviors are vulnerable to multiple health problems, yet sexual and reproductive health services remain underutilized. We evaluated factors associated with non-uptake of contraceptives and barriers to use among adolescent girls and young women (14-24 years old) at high risk of HIV infection in an environment where contraceptives were provided at no cost. Methods We conducted a mixed methods study, utilizing data from a baseline cross sectional survey and qualitative in-depth interviews. Survey participants tested negative for pregnancy and reported willingness to use contraception. Non-uptake of contraceptives was defined as not taking contraception at any study visit (baseline and throughout the study). Logistic regression model was used to assess factors associated with non-uptake of contraceptives. We purposively selected participants for interviews to discuss their knowledge and experiences with contraceptives and make suggestions to improve uptake. Qualitative data were analyzed thematically. Results All 285 participants were included in the analysis. Out of the 285 participants 127 were not using contraceptives and of the 127, 44 (34.6%) did not take up any method throughout the study while 43 of the 83 remaining participants (who took up a method) chose male condoms only. Non-uptake of contraceptives was less likely among older women (20-24 years) (aOR = 0.32, 95% CI 0.16-0.89) compared to younger women (less than 20 years). Qualitative data showed that concerns about future fertility, fear of associated side effects and influence from close relations contributed to non-uptake of contraception. Conclusion Non-uptake of contraceptives was common despite the promotion and provision of contraceptives in the context of a research study mainly because adolescents lack autonomy while making contraceptive decisions. Identifying and addressing their concerns and continued counselling on contraceptive use alongside condom promotion may improve uptake and utilization of contraceptives.
Collapse
Affiliation(s)
- Rachel Kawuma
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Jane Frances Lunkuse
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Wilber Ssembajjwe
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Ivy Kayesu
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| | - Matt A. Price
- Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA, United States
- IAVI, New York, NY, United States
| | - Debbie B. Brickley
- Institute for Global Health Sciences, University of California, San Francisco (UCSF), San Francisco, CA, United States
| | - Andrew Abaasa
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Yunia Mayanja
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine, Uganda Research Unit, Entebbe, Uganda
| |
Collapse
|
6
|
Kitaw TA, Haile RN. Time to first childbirth and its predictors among reproductive-age women in Ethiopia: survival analysis of recent evidence from the EDHS 2019. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1165204. [PMID: 37519340 PMCID: PMC10382129 DOI: 10.3389/frph.2023.1165204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/17/2023] [Indexed: 08/01/2023] Open
Abstract
Background Being a mother for the first time is the most significant event in a woman's life. "Age at first birth" refers to a mother's age in years when she gives birth to her first child. The age of first childbirth has physical, economic, and social implications. However, little is known about this issue in Ethiopia. Thus, this study sought to determine the time to first childbirth and its predictors at a national level. Methods Data were extracted from the 2019 Ethiopia Demographic and Health Survey using STATA version 17 software. A total of 8,885 weighted reproductive-age women (15-49 years) were included in this study. A Kaplan-Meier survivor curve was generated to estimate the time of first childbirth. A log-rank test was used to compare the difference in survival curves. Akaike information criteria and Bayesian information criteria were calculated to select the appropriate survival model for the data. The Weibull accelerated failure time model with no frailty distribution was used to identify significant predictors. Results The overall median survival time to first childbirth was 18 years. The significant predictors of time to first childbirth were the educational level of the mother [primary education (ϕ = 1.036, 95% CI: 1.011, 1.063), secondary and above education (ϕ = 1.154, 95% CI: 1.118, 1.191)], knowledge of any contraceptive method [know at least one (ϕ = 1.051, 95% CI: 1.006, 1.101)], and media exposure (ϕ = 1.048, 95% CI: 1.011, 1.086). Conclusion The median survival time to first childbirth was 18 years, which is lower than the optimal age for first childbirth (late 20 s and early 30 s). The timing of first childbirth in Ethiopia is mainly influenced by the educational level of women, knowledge of contraceptive methods, and exposure to media. Thus, exposing women to educational materials and other awareness-creation campaigns regarding the consequences of early first childbirth and strategies to improve women's knowledge of contraceptive methods is highly recommended.
Collapse
|
7
|
Essis EML, Yeo KJ, Amalaman D, Konan LL, Bamba I, Coulibaly KSA, Kpebo DOD, Orsot T, Delafosse J, Aka J. Libido-sexual disorders and abandonment of injectable contraceptives among users of the Ivorian Association for Family Well-Being in Korhogo, Côte d'Ivoire. Front Glob Womens Health 2023; 4:1026253. [PMID: 37275208 PMCID: PMC10235761 DOI: 10.3389/fgwh.2023.1026253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/19/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction The recent introduction of modern contraceptive methods in resource-limited countries is confronted with the occurrence of undesirable effects that hinder their use in the long term. This study conducted among the users of the Ivorian Association for Family Well-Being in Korhogo describes the libido-sexual problems associated with the discontinuation of injectable contraceptives in former users. The objective of the study was to identify the factors that led to the abandonment of injectable contraceptives among female users of the Ivorian Association for Family Well-Being in Korhogo between 2018 and 2019. Materials and methods Qualitative data were collected from 15 former users (24-38 years old) of injectable contraceptives duration of 2-3 months. Additional data were collected from five health workers aged 35-60 years. In-depth interviews were conducted to explore the experience with injectable contraceptives and reasons for discontinuation. Following data collection, audio-recorded data were transcribed, translated, and coded using thematic analysis through an inductive approach. Results Side effects identified as associated with injectable contraceptives include libido-sexual disorders, unusual bleeding, and weight gain. The most common reason for discontinuation were libido-sexual disorders, which impacted the households' intimacy and provoked their abandonment or the change of contraceptive methods among injectable contraceptive users. Conclusion Adverse events were dominated by libido-sexual disorders, unusual bleeding, and weight gain leading to the abandonment or change of the contraceptive. These results suggest points of intervention for increasing continuation among users. This intervention should include training of health workers to investigate and manage adverse events related to the use of injectable contraceptives and the improvement of communication between health workers and users on adverse events of injectable contraceptive use.
Collapse
Affiliation(s)
- Esme Marie-Laure Essis
- Center for Population and Health Policy and Systems Research, National Institute of Public Health, Abidjan, Côte d'Ivoire
- Reproductive Health Research Unit of Cote d'Ivoire, Abidjan, Côte d'Ivoire
| | - Katienin Jeanne Yeo
- Department of Sociology and Anthropology, Peleforo Gon COULIBALY University of Korhogo, Korhogo, Côte d'Ivoire
| | - Djedou Martin Amalaman
- Department of Sociology and Anthropology, Peleforo Gon COULIBALY University of Korhogo, Korhogo, Côte d'Ivoire
| | - Loukou Leandres Konan
- Center for Population and Health Policy and Systems Research, National Institute of Public Health, Abidjan, Côte d'Ivoire
| | - Iba Bamba
- Center for Population and Health Policy and Systems Research, National Institute of Public Health, Abidjan, Côte d'Ivoire
| | | | - D. Olga Denise Kpebo
- Reproductive Health Research Unit of Cote d'Ivoire, Abidjan, Côte d'Ivoire
- Department of Public Health and Biostatistics, Faculty of Medicine, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Tetchi Orsot
- Center for Population and Health Policy and Systems Research, National Institute of Public Health, Abidjan, Côte d'Ivoire
- Department of Public Health and Biostatistics, Faculty of Medicine, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Joseph Delafosse
- Department of Public Health and Biostatistics, Faculty of Medicine, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Joseph Aka
- Center for Population and Health Policy and Systems Research, National Institute of Public Health, Abidjan, Côte d'Ivoire
- Department of Public Health and Biostatistics, Faculty of Medicine, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
| |
Collapse
|
8
|
Namanda C, Atuyambe L, Ssali S, Mukose A, Tumwesigye NM, Makumbi FE, Tweheyo R, Gidudu A, Sekimpi C, Hashim CV, Nicholson M, Ddungu P. A qualitative study of influences on the uptake of contraceptive services among people of reproductive age in Uganda. BMC Womens Health 2023; 23:130. [PMID: 36964537 PMCID: PMC10039563 DOI: 10.1186/s12905-023-02274-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 03/09/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Uganda has registered an increased investment in family planning (FP) programs, which has contributed to improvement in knowledge of modern contraceptive methods being nearly universal. However, this has not matched the uptake of modern methods or the reduction in the unmet need for FP. This may be explained by the different influences which include health workers, family, and friends. Due to the limited uptake of contraceptive methods, a program on improving awareness, access to, and uptake of modern contraceptives is being implemented in selected regions in Uganda. We, therefore, conducted a formative study to determine the influences on contraceptive uptake at the onset of this program. METHODS Using a qualitative study design, we conducted thirty-two focus group discussions and twenty-one in-depth interviews involving men and women of reproductive age. We also carried out twenty-one key informant interviews with people involved in FP service delivery. Data was collected in four districts where implementation of the program was to take place. Audio recorders were used to collect data and tools were translated into local languages. A codebook was developed, and transcripts were coded in vivo using the computer software Atlas-ti version 7 before analysis. Ethical clearance was obtained from institutional review boards and informed consent was sought from all participants. RESULTS From the study, most married people mentioned health workers as their main influence while adolescents reported their peers and friends. Religious leaders and mothers-in-law were reported to mainly discourage people from taking up modern contraceptive methods. The cultural value attached to having many children influenced the contraceptive use decision among people in rural settings. Other influences included a person's experience and housing. CONCLUSIONS Health workers, religious leaders, and mothers determine the uptake of contraceptive services. The study recommends the consideration of the role of these influences in the design of FP program interventions as well as more involvement of health workers in sensitization of communities about contraceptive methods.
Collapse
Grants
- PO 7891 Foreign, Commonwealth and Development Office
- PO 7891 Foreign, Commonwealth and Development Office
- PO 7891 Foreign, Commonwealth and Development Office
- PO 7891 Foreign, Commonwealth and Development Office
- PO 7891 Foreign, Commonwealth and Development Office
- PO 7891 Foreign, Commonwealth and Development Office
- PO 7891 Foreign, Commonwealth and Development Office
- PO 7891 Foreign, Commonwealth and Development Office
- PO 7891 Foreign, Commonwealth and Development Office
- PO 7891 Foreign, Commonwealth and Development Office
- PO 7891 Foreign, Commonwealth and Development Office
- PO 7891 Foreign, Commonwealth and Development Office
Collapse
Affiliation(s)
- Cissie Namanda
- Makerere University School of Public Health New Mulago Hospital Complex, P.O. Box 7072, Mulago Hill Road, Kampala, Uganda.
| | - Lynn Atuyambe
- Makerere University School of Public Health New Mulago Hospital Complex, P.O. Box 7072, Mulago Hill Road, Kampala, Uganda
| | - Sarah Ssali
- Makerere University School of Gender and Women studies, P.O. Box 7062, Makerere Hill, Kampala, Uganda
| | - Aggrey Mukose
- Makerere University School of Public Health New Mulago Hospital Complex, P.O. Box 7072, Mulago Hill Road, Kampala, Uganda
| | - Nazarius Mbona Tumwesigye
- Makerere University School of Public Health New Mulago Hospital Complex, P.O. Box 7072, Mulago Hill Road, Kampala, Uganda
| | - Frederick E Makumbi
- Makerere University School of Public Health New Mulago Hospital Complex, P.O. Box 7072, Mulago Hill Road, Kampala, Uganda
| | - Ritah Tweheyo
- Marie Stopes Uganda, Plot 1020 Rose Lane, Kisugu-Muyenga, P.O Box 10431, Kampala, Uganda
| | - Andrew Gidudu
- Marie Stopes Uganda, Plot 1020 Rose Lane, Kisugu-Muyenga, P.O Box 10431, Kampala, Uganda
| | - Carole Sekimpi
- Marie Stopes Uganda, Plot 1020 Rose Lane, Kisugu-Muyenga, P.O Box 10431, Kampala, Uganda
| | | | - Martha Nicholson
- Marie Stopes International, 1 Conway Street, Fitzroy Square, W1T 6LP, London, UK
| | - Peter Ddungu
- Marie Stopes Uganda, Plot 1020 Rose Lane, Kisugu-Muyenga, P.O Box 10431, Kampala, Uganda
| |
Collapse
|
9
|
Mankelkl G, Kinfe B. Spatial variations and multilevel mixed effect analysis on determinants factors of modern contraceptive utilization among reproductive age women in Ethiopia; proven by Ethiopian mini demographic health survey 2019. BMC Womens Health 2023; 23:77. [PMID: 36814235 PMCID: PMC9948416 DOI: 10.1186/s12905-022-02030-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/26/2022] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Globally, in 2019, there are 1.9 billion women of reproductive age (15-49), of which 1.1 billion have a need for family planning. Of these, 842 million use contraceptives, and 270 million still have an unmet need for contraception. Ethiopia is a low-income country with inadequate access to family planning (FP), especially in the developing regions. The Ethiopian government was striving to increase the number of health facility in order to provide quality maternal care and services. Increasing the modern contraceptive prevalence rate is one of the goals of the government to reduce maternal and child mortality and morbidity. METHODS Secondary data analysis was conducted using data from mini-EDHS of 2019 demographic and health Survey datasets. The study comprised a total of 8885 reproductive-age women. Spatial variations and multilevel mixed effect analysis on determinants factors of modern contraceptive use among reproductive age women in Ethiopia; evidenced by mini-EDHS 2019. Finally, the percentage and odd ratio, its 95% confidence intervals, and the result of spatial analysis were reported. RESULT This study includes a total weighted sample of 8885 reproductive-age women from the 2019 mini-Ethiopian demographic and health survey. The prevalence of modern contraceptive use was 25.5% in Ethiopia. living in urban area [AOR = 2.13; 95% CI = (1.75, 2.61); P = 0.000], being married [AOR = 1.42; 95% CI = (1.19, 1.70); P = 0.000] were found positively associated with contraceptive use. In contrast to this, attending primary education [AOR = 0.91; 95% CI = (0.74, 1.12); P = 0.000]., being Muslim [AOR = 0.25; 95% CI = (0.22, 0.29); P = 0.000], being poorest [AOR = 0.54; 95% CI = (0.45, 0.66); P = 0.000] were found negatively associated with contraceptive use. CONCLUSION In this study Individual and community level factors were associated with modern contraceptive use and also there were spatial variations in modern contraceptive use across the region among reproductive-age women. Empowering women to have better educational status, improving the wealth index, promoting marriage, creating awareness among rural residences women and promoting education about modern contraceptives through religiously acceptable persons, and promoting modern contraceptive use in developing regions were the key factors to improve modern contraceptive use among reproductive age women in Ethiopia.
Collapse
Affiliation(s)
- Gosa Mankelkl
- College of Medicine and Health Science, Mizan-Tepi University, Mizan Teferi, Ethiopia.
| | - Beletu Kinfe
- College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| |
Collapse
|
10
|
Delie AM, Gezie LD, Gebeyehu AA, Tarekegn GE, Muche AA. Trend of adherence to iron supplementation during pregnancy among Ethiopian women based on Ethiopian demographic and health surveys: A Multivariable decomposition analysis. Front Nutr 2022; 9:955819. [PMID: 36590221 PMCID: PMC9800971 DOI: 10.3389/fnut.2022.955819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
Background Iron deficiency is one of the significant factors of anemia during pregnancy. Iron supplementation is the main method of prevention and control of iron deficiency anemia, and its effectiveness depends on adherence to the iron supplementation. Methods This study was based on a secondary analysis of 2005, 2011, and 2016 EDHS data. After the data was weighted using sampling weight, 696, 1,282, and 3,096 in 2005, 2011, and 2016 EDHS data, respectively, were used for the final analysis. The data were edited, cleaned, coded, managed, and analyzed using StataCorp version 16 software. A logit-based multivariable decomposition analysis was used to identify variables significantly associated with the change in the adherence level during pregnancy. Results Adherence levels increased from 1.1% (95% CI; 0.4, 2.7) in 2005 EDHS to 12.4% (95% CI; 10.9, 14.1) in 2016 EDHS. About 30.9% of the overall change in the adherence level to iron supplement use during pregnancy was due to the difference in women's sociodemographic-related variables. After adjusting for these compositional changes, ~69.1% of the change in the adherence level was because of the difference in the coefficients (behavior-related variables). Among the behavioral characteristics, women's age-group, rich wealth index, and secondary and above-secondary educational status of their husbands had a statistically significant effect on the positive change in the adherence level of pregnant mothers. Conclusion The adherence level to iron supplement use during pregnancy has increased significantly over the last decade in Ethiopia. Both the compositional and behavioral characteristics of women play a major role in the increasing trend of adherence levels.
Collapse
Affiliation(s)
- Amare Mebrat Delie
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Asaye Alamneh Gebeyehu
- Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gebrekidan Ewnetu Tarekegn
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia,*Correspondence: Gebrekidan Ewnetu Tarekegn
| | - Achenef Asmamaw Muche
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
11
|
Ba DM, Ssentongo P, Gao X, Chinchilli VM, Richie JP, Maiga M, Muscat JE. Prevalence and determinants of meeting minimum dietary diversity among children aged 6-23 months in three sub-Saharan African Countries: The Demographic and Health Surveys, 2019-2020. Front Public Health 2022; 10:846049. [PMID: 36081474 PMCID: PMC9445207 DOI: 10.3389/fpubh.2022.846049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 08/08/2022] [Indexed: 01/21/2023] Open
Abstract
Background Dietary diversity is an indicator of nutritional adequacy, which plays a significant role in child growth and development. Lack of adequate nutrition is associated with suboptimal brain development, lower school performance, and increased risk of mortality and chronic diseases. We aimed to determine the prevalence and determinants of meeting minimum dietary diversity (MDD), defined as consuming at least five out of eight basic food groups in the previous 24-h in three sub-Saharan African countries. Methods A weighted population-based cross-sectional study was conducted using the most recent Demographic and Health Surveys (DHS). MDD data were available between 2019 and 2020 for three sub-Saharan African countries (Gambia, Liberia, and Rwanda). The study population included 5,832 children aged 6-23 months. A multivariable logistic regression model was developed to identify independent factors associated with meeting MDD. Results Overall, the weighted prevalence of children who met the MDD was 23.2% (95% CI: 21.7-24.8%), ranging from 8.6% in Liberia to 34.4% in Rwanda. Independent factors associated with meeting MDD were: age of the child (OR) = 1.96, 95% CI: 1.61, 2.39 for 12-17 months vs. 6-11 months], mothers from highest households' wealth status (OR = 1.86, 95% CI: 1.45-2.39) compared with the lowest, and mothers with secondary/higher education (OR = 1.69, 95% CI: 1.35-2.12) compared with those with no education. Mothers who were employed, had access to a radio, and those who visited a healthcare facility in the last 12 months were more likely to meet the MDD. There was no significant association between the child's sex and the odds of fulfilling the MDD. Conclusions There is substantial heterogeneity in the prevalence of MDD in these three sub-Saharan African countries. Lack of food availability or affordability may play a significant role in the low prevalence of MDD. The present analysis suggests that policies that will effectively increase the prevalence of meeting MDD should target poor households with appropriate materials or financial assistance and mothers with lower literacy. Public health interventions working with sectors such as education and radio stations to promote health education about the benefits of diverse diets is a critical step toward improving MDD in sub-Saharan Africa and preventing undernutrition.
Collapse
Affiliation(s)
- Djibril M. Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States,*Correspondence: Djibril M. Ba
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Xiang Gao
- Department of Nutritional Sciences, Penn State University, State College, PA, United States,Department of Nutrition and Food Hygiene, School of Public Health, Fudan University, Shanghai, China
| | - Vernon M. Chinchilli
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - John P. Richie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| | - Mamoudou Maiga
- Northwestern University, Department of Biomedical Engineering, Evanston, IL, United States
| | - Joshua E. Muscat
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
| |
Collapse
|
12
|
Tetui M, Baroudi M, Ssekamatte T, Birabwa C, Kibira SP, Atuyambe L, Delamou A, Makumbi FE. Total Demand, Use and Unmet Need for Modern Contraceptives Among Women Living in Informal Settlements in Kira Municipality, Wakiso District, Uganda. Implications for Urban Health. Front Glob Womens Health 2021; 2:655413. [PMID: 34816210 PMCID: PMC8593938 DOI: 10.3389/fgwh.2021.655413] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Update and utilization of modern contraceptives has public health benefits including reduction of unintended pregnancies, unsafe abortions, and related maternal mortality. However, paucity of evidence on key indicators of family planning in the informal settlements abounds. Data are usually collapsed within the larger urban communities that tend to mask peculiarities of informal settlements. This study determined the proportion of women using modern contraceptives, the unmet need for modern contraceptives and the total demand in informal settlements of an urban municipality. Methods: A cross-sectional study conducted among 626 women in the reproductive age (15-49 years) in the informal settlements of Kira municipality (part of metropolitan Kampala). Multi-stage sampling was applied in the selection of the respondents. Descriptive and log-binomial regression analysis were conducted to determine percentage of women using modern contraceptives, unmet need, and total demand with their associated factors. All analyses were conducted using STATA version 15.0. Results: The total demand for modern contraceptives was 84.9%, modern contraceptive prevalence was 47.4% nearly meeting the national target of 50%, however the unmet need was 37.3%, which much higher than the national target of 10%. Lower total demand for contraceptives was associated with higher women's education status and preference to have another child, while higher total demand was associated with having at least one living child. Higher modern contraceptives use was associated with older age, having at least one living child and high decision-making power, while lower modern contraceptives use was associated with higher education and undetermined fertility preference. Lower unmet need for modern contraceptives was associated with older age (PR 0.68, 95% CI: 0.48-0.97) and high decision-making power (PR 0.64, 95% CI: 0.50-0.81), while higher unmet need was found among those who having at least one living child (PR 1.40, 95% CI: 1.01-1.93) and undetermined fertility preference (PR 1.70, 95% CI: 1.24-2.34). Conclusions: Total demand and contraceptive use were found to be higher in the informal settlements of Kira municipality, however, the unmet need was much higher among this population as compared to the national urban estimates. This indicates a much higher demand for contraceptives and the need to consider the diverse socio-demographic characteristics of urban spaces. Development of Interventions need to critically consider the diverse urban space, associated explanatory variables and a collaborative systems lens to achieve sustained improvements.
Collapse
Affiliation(s)
- Moses Tetui
- School of Pharmacy, Waterloo University, Waterloo, ON, Canada
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Mazen Baroudi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Tonny Ssekamatte
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Catherine Birabwa
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Simon Peter Kibira
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Lynn Atuyambe
- Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| | - Alexandre Delamou
- Africa Center of Excellence for Prevention and Control of Communicable Diseases (CEA-PCMT), Faculty of Science and Health Techniques, Gamal Abdel Nasser University of Conakry, Conakry, Guinea
- National Training and Research Center in Rural Health of Maferinyah, Forecariah, Guinea
| | - Fredrick Edward Makumbi
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, New Mulago Hospital Complex, Kampala, Uganda
| |
Collapse
|
13
|
Macharia PM, Joseph NK, Sartorius B, Snow RW, Okiro EA. Subnational estimates of factors associated with under-five mortality in Kenya: a spatio-temporal analysis, 1993-2014. BMJ Glob Health 2021; 6:e004544. [PMID: 33858833 PMCID: PMC8054106 DOI: 10.1136/bmjgh-2020-004544] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To improve child survival, it is necessary to describe and understand the spatial and temporal variation of factors associated with child survival beyond national aggregates, anchored at decentralised health planning units. Therefore, we aimed to provide subnational estimates of factors associated with child survival while elucidating areas of progress, stagnation and decline in Kenya. METHODS Twenty household surveys and three population censuses conducted since 1989 were assembled and spatially aligned to 47 subnational Kenyan county boundaries. Bayesian spatio-temporal Gaussian process regression models accounting for inadequate sample size and spatio-temporal relatedness were fitted for 43 factors at county level between 1993 and 2014. RESULTS Nationally, the coverage and prevalence were highly variable with 38 factors recording an improvement. The absolute percentage change (1993-2014) was heterogeneous ranging between 1% and 898%. At the county level, the estimates varied across space and over time with a majority showing improvements after 2008 which was preceded by a period of deterioration (late-1990 to early-2000). Counties in Northern Kenya were consistently observed to have lower coverage of interventions and remained disadvantaged in 2014 while areas around Central Kenya had and historically have had higher coverage across all intervention domains. Most factors in Western and South-East Kenya recorded moderate intervention coverage although having a high infection prevalence of both HIV and malaria. CONCLUSION The heterogeneous estimates necessitates prioritisation of the marginalised counties to achieve health equity and improve child survival uniformly across the country. Efforts are required to narrow the gap between counties across all the drivers of child survival. The generated estimates will facilitate improved benchmarking and establish a baseline for monitoring child development goals at subnational level.
Collapse
Affiliation(s)
- Peter M Macharia
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Noel K Joseph
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Benn Sartorius
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Robert W Snow
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Emelda A Okiro
- Population Health Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
14
|
Ba DM, Ssentongo P, Musa J, Agbese E, Diakite B, Traore CB, Wang S, Maiga M. Prevalence and determinants of cervical cancer screening in five sub-Saharan African countries: A population-based study. Cancer Epidemiol 2021; 72:101930. [PMID: 33756434 DOI: 10.1016/j.canep.2021.101930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/19/2021] [Accepted: 03/14/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cervical cancer is the fourth most common cancer among women worldwide, with an estimate of 570,000 new cases and about 311,000 deaths annually. Low-resource countries, including those in sub-Saharan Africa, have the highest-burden with an estimate of 84 % of all cervical cancers. This study examines the prevalence and socio-demographic-economic factors associated with cervical cancer screening in sub-Saharan Africa. METHODS A weighted population-based cross-sectional study using Demographic and Health Surveys data. We used available data on cervical cancer screening between 2011 and 2018 from the Demographic and Health Surveys for five sub-Saharan African countries (Benin, Ivory Coast, Kenya, Namibia, and Zimbabwe). The study population included women of childbearing age, 21-49 years (n = 28,976). We fit a multivariable Poisson regression model to identify independent factors associated with cervical cancer screening. RESULTS The overall weighted prevalence of cervical cancer screening was 19.0 % (95 % CI: 18.5 %-19.5 %) ranging from 0.7 % in Benin to 45.9 % in Namibia. Independent determinants of cervical cancer screening were: older age (40-49 years) adjusted prevalence ratio (aPR) = 1.77 (95 % CI: 1.64, 1.90) compared with younger age (21-29 years), secondary/higher education (aPR = 1.51, 95 CI: 1.28-1.79) compared with no education, health insurance (aPR = 1.53, 95 % CI: 1.44-1.61) compared with no insurance, and highest socioeconomic status (aPR = 1.39, 95 % CI: 1.26-1.52) compared with lowest. CONCLUSION The prevalence of cervical cancer screening is substantially low in sub-Saharan Africa countries and shows a high degree of between-country variation. Interventions aimed at increasing the uptake of cervical cancer screening in sub-Saharan Africa are critically needed.
Collapse
Affiliation(s)
- Djibril M Ba
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, United States.
| | - Paddy Ssentongo
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, United States
| | - Jonah Musa
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Nigeria; Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University, IL 60611, USA
| | - Edeanya Agbese
- Penn State College of Medicine, Department of Public Health Sciences, Hershey, PA, United States
| | - Brehima Diakite
- University of Sciences, Techniques, and Technologies of Bamako (USTTB), Faculty of Medicine and Odontostomatology, Bamako, Mali
| | - Cheick Bougadari Traore
- University of Sciences, Techniques, and Technologies of Bamako (USTTB), Faculty of Medicine and Odontostomatology, Bamako, Mali
| | - Steve Wang
- Mobile Imaging Innovations, Inc., Evanston, IL, United States
| | - Mamoudou Maiga
- University of Sciences, Techniques, and Technologies of Bamako (USTTB), Faculty of Medicine and Odontostomatology, Bamako, Mali; Northwestern University, Department of Biomedical Engineering, Evanston, IL, United States; Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Northwestern University, IL 60611, USA
| |
Collapse
|
15
|
Ba DM, Ssentongo P, Agbese E, Yang Y, Cisse R, Diakite B, Traore CB, Kamate B, Kassogue Y, Dolo G, Dembele E, Diallo H, Maiga M. Prevalence and determinants of breast cancer screening in four sub-Saharan African countries: a population-based study. BMJ Open 2020; 10:e039464. [PMID: 33046473 PMCID: PMC7552834 DOI: 10.1136/bmjopen-2020-039464] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Breast cancer is the most prevalent cancer and the second leading cause of cancer-related deaths among women after cervical cancer in much of sub-Saharan Africa. This study aims to examine the prevalence and sociodemographic-socioeconomic factors associated with breast cancer screening among women of reproductive age in sub-Saharan Africa. DESIGN A weighted population-based cross-sectional study using Demographic and Health Surveys (DHS) data. We used all available data on breast cancer screening from the DHS for four sub-Saharan African countries (Burkina Faso, Ivory Coast, Kenya and Namibia). Breast cancer screening was the outcome of interest for this study. Multivariable Poisson regression was used to identify independent factors associated with breast cancer screening. SETTING Four countries participating in the DHS from 2010 to 2014 with data on breast cancer screening. PARTICIPANTS Women of reproductive age 15-49 years (N=39 646). RESULTS The overall prevalence of breast cancer screening was only 12.9% during the study period, ranging from 5.2% in Ivory Coast to 23.1% in Namibia. Factors associated with breast cancer screening were secondary/higher education with adjusted prevalence ratio (adjusted PR)=2.33 (95% CI: 2.05 to 2.66) compared with no education; older participants, 35-49 years (adjusted PR=1.73, 95% CI : 1.56 to 1.91) compared with younger participants 15-24 years; health insurance coverage (adjusted PR=1.57, 95% CI: 1.47 to 1.68) compared with those with no health insurance and highest socioeconomic status (adjusted PR=1.33, 95% CI : 1.19 to 1.49) compared with lowest socioeconomic status. CONCLUSION Despite high breast cancer mortality rates in sub-Saharan Africa, the prevalence of breast cancer screening is substantially low and varies gradually across countries and in relation to factors such as education, age, health insurance coverage and household wealth index level. These results highlight the need for increased efforts to improve the uptake of breast cancer screening in sub-Saharan Africa.
Collapse
Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Edeanya Agbese
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Yanxu Yang
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Ramata Cisse
- Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Brehima Diakite
- Faculty of Medicine and Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Cheick Bougadari Traore
- Faculty of Medicine and Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Bakarou Kamate
- Faculty of Medicine and Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Yaya Kassogue
- Faculty of Medicine and Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Guimogo Dolo
- Faculty of Medicine and Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Etienne Dembele
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Hama Diallo
- Faculty of Medicine and Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Mamoudou Maiga
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| |
Collapse
|
16
|
Apanga PA, Kumbeni MT, Ayamga EA, Ulanja MB, Akparibo R. Prevalence and factors associated with modern contraceptive use among women of reproductive age in 20 African countries: a large population-based study. BMJ Open 2020; 10:e041103. [PMID: 32978208 PMCID: PMC7520862 DOI: 10.1136/bmjopen-2020-041103] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the prevalence and factors associated with modern contraceptive (CP) use among women of the reproductive age. DESIGN Cross-sectional study. SETTING We used data from the Multiple Indicator Cluster Surveys (MICSs) from 20 African countries collected between 2013 and 2018. PARTICIPANTS Data on 1 177 459 women aged 15-49 years old. METHODS Multivariable logistic regression was used to identify factors associated with modern CP use, while controlling simultaneously for independent variables, and accounting for clustering, stratification and sample weights from the complex sampling design. We used random effects meta-analysis to pool adjusted estimates across the 20 countries. RESULTS The overall prevalence of modern CP use was 26% and ranged from 6% in Guinea to 62% in Zimbabwe. Overall, injectable (32%) was the most preferred method of CP, followed by oral pill (27%) and implants (16%). Women were more likely to use a modern CP if they: had a primary (adjusted prevalence odds ratios (aPORs): 1.68, 95% CI: 1.47 to 1.91)) or secondary/higher education (aPOR: 2.16, 95% CI: 1.80 to 2.59) compared with women with no formal education; had no delivery in the last 2 years (aPOR: 3.89, 95% CI: 2.76 to 5.47) compared with women who delivered in the last 2 years; were aged 25-34 years (aPOR: 1.33, 95% CI: 1.20 to 1.47) compared with women aged 15-24 years; were of middle-income status (aPOR: 1.25, 95% CI: 1.11 to 1.39) or rich (aPOR: 1.53, 95% CI: 1.27 to 1.84) compared with poor women and had two or more antenatal care visits compared with women without a visit. Perceived domestic violence was not associated with modern CP use (aPOR: 0.98, 95% CI: 0.92 to 1.05). CONCLUSION Our findings are relevant in a global context, particularly in the African region, and improve our understanding on relevant factors essential to increasing modern CP use.
Collapse
Affiliation(s)
| | - Maxwell Tii Kumbeni
- Nabdam District Health Directorate, Ghana Health Service, Nangodi, Upper East Region, Ghana
| | - Emmanuel Awine Ayamga
- Nabdam District Health Directorate, Ghana Health Service, Nangodi, Upper East Region, Ghana
| | - Mark B Ulanja
- School of Medicine, University of Nevada, Reno, Nevada, USA
| | - Robert Akparibo
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| |
Collapse
|
17
|
Ba DM, Ssentongo P, Na M, Kjerulff KH, Liu G, Du P, Song W, Richie JP, Gao X. Factors Associated with Urinary Iodine Concentration among Women of Reproductive Age, 20-49 Years Old, in Tanzania: A Population-Based Cross-Sectional Study. Curr Dev Nutr 2020; 4:nzaa079. [PMID: 32462108 PMCID: PMC7236838 DOI: 10.1093/cdn/nzaa079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/14/2020] [Accepted: 04/25/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Universal salt iodization (USI) is the most feasible and cost-effective, and equitable, approach to prevent iodine deficiency. Severe maternal iodine deficiency during pregnancy is associated with serious adverse gestational and birth outcomes. OBJECTIVES The aim was to assess iodine status and identify independent factors associated with urinary iodine concentration (UIC) among women of reproductive age in Tanzania. METHODS This was a weighted, population-based, cross-sectional study in 2985 women of reproductive age (20-49 y) in Tanzania who participated in the Demographic and Health Surveys in 2015-2016 (DHS 2015-2016) and had measured UIC. Multivariable generalized linear regression was used to identify potential factors that were associated with UIC. RESULTS The median UICs among women consuming inadequately iodized salt (93.6 μg/L; 25th and 75th percentiles: 43.1, 197.9 μg/L) and women in the lowest socioeconomic status (92.3 μg/L; 45.6, 194.4 μg/L) were below the WHO-recommended ranges (≥150 μg/L for pregnant women and ≥100 μg/L for nonpregnant women). The results of multivariable models indicated that pregnant women had 1.21 μg/L lower UIC than nonpregnant women (β = -1.21; 95% CI: -3.42, -0.12), breastfeeding women had 1.02 μg/L lower UIC than nonbreastfeeding women (β = -1.02; 95% CI: -2.25, -0.27), and women with no education had a 1.88 μg/L lower UIC compared with those with secondary/highest education (β = -1.88; 95% CI: -4.58, -0.36). Women consuming inadequately iodized salt had 6.55 μg/L lower UIC than those consuming adequately iodized salt (β = -6.55; 95% CI: -9.24, -4.33). The median UIC varied substantially across geographic zones, ranging from 83.2 μg/L (45.9, 165.3) in the Western region to 347.8 μg/L (185.0, 479.8) in the Eastern region. CONCLUSIONS Our findings indicated a great heterogeneity in median UIC across regions of Tanzania among women of reproductive age. Poverty, consuming inadequately iodized salt, and lack of education appeared to be the driving factors for lower UIC in Tanzania.
Collapse
Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Muzi Na
- Department of Nutritional Sciences, Penn State University, State College, PA, USA
| | - Kristen H Kjerulff
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Ping Du
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Won Song
- Department of Food Science and Human Nutrition, Michigan State University, East Lansing, MI, USA
| | - John P Richie
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Xiang Gao
- Department of Nutritional Sciences, Penn State University, State College, PA, USA
| |
Collapse
|
18
|
Lee S, Begley CE, Morgan R, Chan W, Kim SY. Addition of mHealth (mobile health) for family planning support in Kenya: disparities in access to mobile phones and associations with contraceptive knowledge and use. Int Health 2020; 11:463-471. [PMID: 30576546 DOI: 10.1093/inthealth/ihy092] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/27/2018] [Accepted: 11/06/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recently mobile health (mHealth) has been implemented in Kenya to support family planning. Our objectives were to investigate disparities in mobile phone ownership and to examine the associations between exposure to family planning messages through mHealth (stand-alone or combined with other channels such as public forums, informational materials, health workers, social media and political/religious/community leaders' advocacy) and contraceptive knowledge and use. METHODS Logistic and Poisson regression models were used to analyze the 2014 Kenya Demographic and Health Survey. RESULTS Among 31 059 women, 86.7% had mobile phones and were more likely to have received higher education, have children ≤5 y of age and tended to be wealthier or married. Among 7397 women who were sexually active, owned a mobile phone and received family planning messages through at least one channel, 89.8% had no exposure to mHealth. mHealth alone was limited in improving contraceptive knowledge and use but led to intended outcomes when used together with four other channels compared with other channels only (knowledge: incidence rate ratio 1.084 [95% confidence interval {CI} 1.063-1.106]; use: odds ratio 1.429 [95% CI 1.026-1.989]). CONCLUSIONS Socio-economic disparities existed in mobile phone ownership, and mHealth alone did not improve contraceptive knowledge and use among Kenyan women. However, mHealth still has potential for family planning when used with existing channels.
Collapse
Affiliation(s)
- Seohyun Lee
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Charles E Begley
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Robert Morgan
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Wenyaw Chan
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sun-Young Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| |
Collapse
|
19
|
Non-iodized salt consumption among women of reproductive age in sub-Saharan Africa: a population-based study. Public Health Nutr 2020; 23:2759-2769. [PMID: 31915084 DOI: 10.1017/s1368980019003616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify countries in sub-Saharan Africa (SSA) that have not yet achieved at least 90 % universal salt iodization and factors associated with the consumption of non-iodized salt among women of reproductive age. DESIGN A cross-sectional study using data from Demographic and Health Surveys (DHS). The presence of iodine in household salt (iodized or non-iodized), which was tested during the survey process, was the study outcome. Multivariable logistic regression models were used to determine independent factors associated with the consumption of non-iodized salt among women of reproductive age. SETTING There were eleven countries in SSA that participated in the DHS since 2015 and measured the presence of iodine in household salt. PARTICIPANTS Women (n 108 318) aged 15-49 years. RESULTS Countries with the highest rate of non-iodized salt were Senegal (29·5 %) followed by Tanzania (21·3 %), Ethiopia (14·0 %), Malawi (11·6 %) and Angola (10·8 %). The rate of non-iodized salt was less than 1 % in Rwanda (0·3 %), Uganda (0·5 %) and Burundi (0·8 %). Stepwise multivariable logistic regression showed that women were more likely to be using non-iodized salt (adjusted OR; 95 % CI) if they were poor (1·62; 1·48, 1·78), pregnant (1·16; 1·04, 1·29), aged 15-24 years (v. older: 1·14; 1·04, 1·24) and were not literate (1·14; 1·06, 1·23). CONCLUSIONS The use of non-iodized salt varies among SSA countries. The higher level of use of non-iodized salt among poor, young women and pregnant women is particularly concerning.
Collapse
|
20
|
Ba DM, Ssentongo P, Sznajder KK. Prevalence, behavioral and socioeconomic factors associated with human immunodeficiency virus in Ghana: a population-based cross-sectional study. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
21
|
Ba DM, Ssentongo P, Kjerulff KH, Na M, Liu G, Gao X, Du P. Adherence to Iron Supplementation in 22 Sub-Saharan African Countries and Associated Factors among Pregnant Women: A Large Population-Based Study. Curr Dev Nutr 2019; 3:nzz120. [PMID: 31777771 PMCID: PMC6867960 DOI: 10.1093/cdn/nzz120] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/10/2019] [Accepted: 10/18/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Iron deficiency anemia during pregnancy is a significant public health problem in sub-Saharan Africa (SSA) and is associated with serious adverse health outcomes. Although it is recommended that all women receive iron supplementation during pregnancy, little research has been conducted to measure overall compliance with this recommendation or variation across SSA countries. OBJECTIVES To assess prevalence and sociodemographic-economic factors associated with adherence to iron supplementation among pregnant women in SSA. METHODS This was a weighted population-based cross-sectional study of 148,528 pregnant women aged 15-49 y in 22 SSA countries that participated in the Demographic and Health Surveys (DHS) in 2013-2018 and measured iron supplementation during pregnancy. Adherence to iron supplementation was defined as using iron supplementation for ≥90 d during pregnancy of the most recent birth. RESULTS The overall prevalence of adherence to ≥90 d of iron supplementation during pregnancy was 28.7%, ranging from 1.4% in Burundi to 73.0% in Senegal. Factors associated with adherence included receiving ≥4 antenatal care visits [adjusted Prevalence Ratio (aPR): 25.73; 95% CI: 22.36, 29.60] compared with no antenatal visits; secondary or higher education (aPR: 1.17; 95% CI: 1.14, 1.19) compared with no education; wealthy (aPR: 1.13; 95% CI: 1.10, 1.16) compared with poor; and older women aged 35-49 y (aPR: 1.07; 95% CI: 1.05, 1.10) compared with younger women aged 15-24 y. CONCLUSIONS Adherence to iron supplementation during pregnancy in SSA is low and varies substantially across countries and in relation to factors such as number of antenatal visits, education, and level of family wealth. These results underscore the need for increased efforts to improve the uptake of iron supplementation for pregnant women in SSA.
Collapse
Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
- Center for Neural Engineering, Department of Engineering, Science and Mechanics, The Pennsylvania State University, University Park, PA, USA
| | - Kristen H Kjerulff
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Muzi Na
- Department of Nutritional Sciences, Penn State University, State College, PA, USA
| | - Guodong Liu
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Xiang Gao
- Department of Nutritional Sciences, Penn State University, State College, PA, USA
| | - Ping Du
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| |
Collapse
|
22
|
Ba DM, Ssentongo P, Agbese E, Kjerulff KH. Prevalence and predictors of contraceptive use among women of reproductive age in 17 sub-Saharan African countries: A large population-based study. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 21:26-32. [PMID: 31395230 DOI: 10.1016/j.srhc.2019.06.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/03/2019] [Accepted: 06/08/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To measure the prevalence of contraceptive use among women of reproductive age in 17 sub-Saharan Africa countries and identify factors associated with contraceptive use in these countries. STUDY DESIGN We conducted a population-based cross-sectional study using data on contraceptive use from the Demographic and Health Surveys (DHS) for 17 sub-Saharan Africa countries (Angola, Benin, Burkina Faso, Burundi, Cameroon, Congo, Gambia, Ghana, Guinea, Ivory Coast, Liberia, Mali, Niger, Nigeria, Senegal, Togo, and Uganda). We restricted our sample to women aged 15-49 years and used generalized estimating equations to identify factors associated with contraceptive use while controlling for other covariates. RESULTS The overall prevalence of current contraceptive use among women of reproductive age was only 17%, with rates ranging from 7% in Gambia to 29% in Uganda. After adjusting for potential confounders, we found that women were more likely to use a method of contraception if they were sexually active (adjusted prevalence ratio (aPR) 2.17 [95% confidence interval (CI) 2.11, 2.24]); had 5-7 living children (aPR 2.19 [95% CI 1.89, 2.55] compared to no children); had secondary or higher education (aPR 1.71 [95% CI 1.63, 1.78] compared to no education); and were wealthy (aPR 1.34 [95% CI 1.29, 1.40] compared to poor). CONCLUSION The use of contraceptives is low in sub-Saharan Africa, but varies substantially across countries. Use of contraception is associated with both personal and socioeconomic factors.
Collapse
Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
| | - Paddy Ssentongo
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA; Center for Neural Engineering, Department of Engineering, Science and Mechanics, The Pennsylvania State University, University Park, PA, USA
| | - Edeanya Agbese
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Kristen H Kjerulff
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| |
Collapse
|