Factors associated with socio-demographic characteristics and antenatal care and iron supplement use in Ethiopia, Kenya, and Senegal

Determinants of iron-rich food deficiency among children under 5 years in sub-Saharan Africa: a comprehensive analysis of Demographic and Health Surveys

BACKGROUND

Iron deficiency is a major public health problem that affects the physical and cognitive development of children under 5 years of age (under-5 children) in sub-Saharan Africa (SSA). However, the factors associated with the limited consumption of iron-rich foods in the region are poorly understood.

OBJECTIVE

This study examined the prevalence and determinants of iron-rich food deficiency among under-5 children in 26 SSA countries.

DESIGN

This nationally representative quantitative study employed pooled data from Demographic and Health Surveys conducted between 2010 and 2019.

METHODS

Representative samples comprising 296 850 under-5 children from the various countries were used. Bivariate and multivariate logistic regression models were used to determine the associations between the lack of iron-rich food uptake and various sociodemographic factors.

RESULT

The overall prevalence of iron-rich food deficiency among the children in the entire sample was 56.75%. The prevalence of iron-rich food deficiency varied widely across the 26 countries, ranging from 42.76% in Congo Democratic Republic to 77.50% in Guinea. Maternal education, particularly primary education (OR 0.62, 95% CI 0.57 to 0.68) and higher education (OR 0.58, 95% CI 0.52 to 0.64), demonstrated a reduced likelihood of iron-rich food deficiency in the sample. Likewise, paternal education, with both primary education (OR 0.69, 95% CI 0.63 to 0.75) and higher education (OR 0.66, 95% CI 0.60 to 0.73) showed decreased odds of iron-rich food deficiency. Postnatal visits contributed significantly to reducing the odds of iron-rich food deficiency (OR 0.90, 95% CI 0.83 to 0.95), along with antenatal visits, which also had a positive impact (OR 0.84, 95% CI 0.74 to 0.95). Finally, residents in rural areas showed slightly higher odds of iron-rich food deficiency (OR 1.12, 95% CI 1.10 to 1.28).

CONCLUSION

Based on the findings, interventions targeting iron-food deficiency in the SSA region should take into strong consideration the key determinants highlighted in this study.

Pooled prevalence and determinants of antenatal care visits in countries with high maternal mortality: A multi-country analysis

Background

Complications during pregnancy and childbirth are the leading causes of maternal and child deaths and disabilities, particularly in low- and middle-income countries. Timely and frequent antenatal care prevents these burdens by promoting existing disease treatments, vaccination, iron supplementation, and HIV counseling and testing during pregnancy. Many factors could contribute to optimal ANC utilization remaining below targets in countries with high maternal mortality. This study aimed to assess the prevalence and determinants of optimal ANC utilization by using nationally representative surveys of countries with high maternal mortality.

Methods

Secondary data analysis was done using recent Demographic and Health Surveys (DHS) data of 27 countries with high maternal mortality. The multilevel binary logistic regression model was fitted to identify significantly associated factors. Variables were extracted from the individual record (IR) files of from each of the 27 countries. Adjusted odds ratios (AOR) with a 95% confidence interval (CI) and p-value of ≤0.05 in the multivariable model were used to declare significant factors associated with optimal ANC utilization.

Result

The pooled prevalence of optimal ANC utilization in countries with high maternal mortality was 55.66% (95% CI: 47.48-63.85). Several determinants at the individual and community level were significantly associated with optimal ANC utilization. Mothers aged 25-34 years, mothers aged 35-49 years, mothers who had formal education, working mothers, women who are married, had media access, households of middle-wealth quintile, richest household, history of pregnancy termination, female household head, and high community education were positively associated with optimal ANC visits in countries with high maternal mortality, whereas being rural residents, unwanted pregnancy, having birth order 2-5, and birth order >5 were negatively associated.

Conclusion and recommendations

Optimal ANC utilization in countries with high maternal mortality was relatively low. Both individual-level factors and community-level factors were significantly associated with ANC utilization. Policymakers, stakeholders, and health professionals should give special attention and intervene by targeting rural residents, uneducated mothers, economically poor women, and other significant factors this study revealed.

Determinants of recommended antenatal care visits among pregnant women in Ethiopia: a generalized linear mixed-effects modeling

BACKGROUND

Although antenatal care has the potential role to reduce maternal and child morbidity and mortality, utilization of a recommended number of antenatal care visits is still low in Ethiopia. Therefore, this study aimed to assess the determinants of recommended antenatal care visits in Ethiopia.

METHOD

Data from the 2019 mini-Ethiopian demographic and health survey (MEDHS) was used for this study. A total of 3916 women who gave birth 5 years preceding the MEDHS were included. A generalized linear mixed-effects (mixed-effects logistic regression) model was used to identify the determinants of recommended antenatal care service utilization. Finally, the adjusted odds ratio with a 95% confidence interval and random effects were reported.

RESULTS

In the generalized linear mixed-effects model, women with primary education (AOR = 1.55, 95%CI 1.22-2.01), secondary and above education (AOR = 5.12, 95%CI 2.80-8.16), women from the middle (AOR = 1.25, 95%CI 1.01-1.71) and rich wealth index (AOR = 1.54, 95%CI 1.12-2.25), women who were exposed to media (AOR = 1.23,95%CI 1.01-1.57) and who use contraception (AOR = 1.45 95%CI 1.25-2.03), had higher odds of recommended antenatal care service utilization.

CONCLUSION

In this study, factors like maternal educational status, media exposure, wealth index and history of contraceptive utilization were significantly associated with recommended ANC visits in Ethiopia. Therefore, encouraging women for contraceptive service utilization, consulting women to be exposed to media and improving women's wealth status will help to have recommended number of ANC visits by pregnant women in Ethiopia.

Health literacy in dietary supplement use among working-age groups: systematic review and meta-analysis

Background

Globally, dietary supplement use (DSU) is very popular against COVID19. This study aims to investigate the characteristics of research on health literacy (HL) in DSU and compare HL among working-age groups by reviewing related research between 2011 and 2021 in PubMed, SCOPUS, ClinicalKey, Google Scholar and ThaiJO.

Methods

Twenty-five articles that met the inclusion criteria were selected for study and analyzed using Cohen's d.

Results

The results showed that HL affected dietary supplement (DS) consumption behavior among working-age groups with an average effect size of 0.423 (95% CI = 0.249-0.598), followed by disclosure of DSU with an average effect size of 0.220 (95% CI = 0.087-0.353). No effect was found on awareness of dietary supplement advertisements.

Conclusion

The discovery of such knowledge is a significant contribution to public health, leading to the development of interventions and policies for enhancing HL in DSU e.g. organizing knowledge-sharing workshops on DSU and building support networks across all sectors.

Radio Communications on Family Planning: Case of West Africa

Sub-Saharan Africa will accommodate more population this century by having a multitude of births across the continent. Family planning methods provide women with techniques to manage their health and wellbeing. This study investigated how radio communications in family planning changed the perception of Ghanaian, Liberian, and Senegalese mothers toward having fewer children. Univariate and multivariate linear regression results after coarsened exact matching (CEM) with selected covariates for 15- to 49-year-old mothers from demographic and health survey (DHS) data implied the effectiveness of radio communications. This effort supports the need for further research on tailored communication methods for West African mothers over time.

Individual and community-level factors associated with early initiation of antenatal care: Multilevel modelling of 2018 Cameroon Demographic and Health Survey

Background

Early initiation of antenatal care (ANC) provided by skilled personnel is essential as it enables pregnant women to receive comprehensive reproductive health services. Early ANC utilisation could prevent complications related to pregnancy and improve maternal and neonatal health outcomes. Regardless of this, only forty-one in every hundred women in Cameroon seek early ANC services. Studies on the uptake of antenatal care in Cameroon have not focused on individual and community-level factors that influence early initiation of ANC. This study aimed at investigating the association between individual and community-level factors and early ANC uptake in Cameroon.

Methods

This study was a cross-sectional survey design. Data was extracted from the women’s file of the 2018 Cameroon Demographic and Health Survey (CDHS). A sample of 4,183 women aged 15–49 who had complete information on variables of interest to the study was used. The outcome variable was early ANC (i.e. women whose first ANC occurred between 0–3 months of pregnancy). Eighteen explanatory variables consisting of fifteen individual-level variables and three community-level variables were selected for the study. At 95% confidence interval (95% CI), two-level multilevel models were built. The results for the fixed effects were presented in adjusted odds ratio (aOR) and the random effects were expressed in terms of Intra-Class Correlation (ICC) and Primary Sampling Units (PSUs) variance.

Results

Descriptively, 46% [CI = 45.0–48.0] of the women aged 15–49 attended ANC earlier. The median age at which women started utilising early ANC was 28 (15 to 48) years. For the fixed effects results, it was found that the odds of seeking early ANC increased among those aged 35–39 [aOR = 1.78, CI = 1.24–2.57], the richest [aOR = 2.43, CI = 1.63–3.64] and those with secondary/higher education [aOR = 1.38, CI = 1.05–1.82]. Muslims [aOR = 0.73, CI = 0.60–0.88] and women at parity four or more had lesser odds to seek early ANC [aOR = 0.63, CI = 0.49–0.82]. The study found that primary sampling unit (community/cluster) [σ² = 0.53, CI = 0.40–0.72] and individual [σ² = 0.16, CI = 0.09–0.29] level variations exist in early initiation of ANC. About 14% (intra-class correlation (ICC) = 0.14) and 5% (ICC = 0.05) variability in early initiation of ANC were attributable to variations in the primary sampling unit (community/cluster) and individual-level factors, respectively.

Conclusion

Individual-level factors (maternal age, wealth status, educational attainment and religious affiliation) were associated with early initiation of ANC whereas variations in cluster/community characteristics contributed to the variations in early initiation of ANC seeking. The Departments of Health Promotion, Health Information Center and eHealth under the Ministry of Public Health, Cameroon, have to strengthen mass sensitisation programs on early ANC uptake and such programs should consider individual differences such as age, wealth status, education, and religious affiliation in its program design.

Utilization and Determinants of Antenatal Care Visits in East African Countries: A Multicountry Analysis of Demographic and Health Surveys

Background. The health care a woman receives during pregnancy is important for her survival and baby, both at the time of delivery and shortly after that. In the context of high maternal morbidity and mortality in sub-Saharan Africa, fewer than 80% of pregnant women receive antenatal care visit services. Receiving antenatal care visits at least four times increases the likelihood of receiving effective maternal health interventions through the antenatal period. This study aimed to identify the utilization and determinants of attending at least four visits in 12 East African countries. Methods. The study used the demographic and health survey data from 12 East African countries from 2008 to 2018. The DHS program adopts standardized methods involving uniform questionnaires, manuals, and field procedures to gather information comparable across countries globally. A multivariable logistic regression model was fitted to identify the determinants of completing at least four antenatal care services. With their 95% CI obtained from the adjusted multilevel logistic regression model, the adjusted odds ratio was presented to show the magnitude of the relationship between the independent variable and completing antenatal care visits. Results. The pooled utilization of attending at least four antenatal care visit in the East African region was 52.44% (95% CI: 52.13, 52.74), with the highest attending at least four or more antenatal care visit visits in Zimbabwe (75.72%) and the lowest attending at least four or more antenatal care visit visits in Ethiopia (31.82%). The significant determinants of completing at least four ANC visits were age category (24–34 (AOR = 1.24, 95% CI: 1.18, 1.31) and 35–49 (AOR = 1.42, 95% CI: 1.32, 1.53)); being married women (AOR = 1.11, 95% CI: 1.1.05, 1.16); education levels of primary education (AOR = 1.20, 95% CI: 1.13, 1.27), secondary education (AOR = 1.24, 95% CI: 1.24, 1.47), and higher education (AOR = 1.91, 95% CI: 1.62, 2.14); birth order (2–4 (AOR = 0.75, 95% CI: 0.70, 0.79) and 5+ (AOR = 0.63, 95% CI: 0.58, 0.68)); planned pregnancy (AOR = 0.81, 95% CI: 0.75, 0.86); contraceptive utilization (AOR = 1.36, 95% CI: 1.29, 1.43); wealth status of middle (AOR = 1.11, 95% CI: 1.05, 1.17) and rich (AOR = 1.25, 95% CI: 1.18, 1.32); having no problem accessing health care (AOR = 1.0.95, 95% CI: 0.89, 0.97); and living countries. Conclusions. The coverage of completing the recommended antenatal care visit was low in the region. Age, marital status, mother’s and partner’s education, women’s occupation, birth order, planned pregnancy, contraceptive utilization, wealth status, healthcare accessibility, and living countries were the major determinants of completing recommended antenatal care visits. Therefore, intersectoral collaboration to promote female education and empowerment, improve geographical access to health care, and strengthen implementation of antenatal care policies with active community participation is recommended. In addition, creating a conducive environment in entrepreneurial activities for poor women is needed.

Determinants of antenatal care utilisation in sub-Saharan Africa: a systematic review

OBJECTIVES

To identify the determinants of antenatal care (ANC) utilisation in sub-Saharan Africa.

DESIGN

Systematic review.

DATA SOURCES

Databases searched were PubMed, OVID, EMBASE, CINAHL and Web of Science.

ELIGIBILITY CRITERIA

Primary studies reporting on determinants of ANC utilisation following multivariate analysis, conducted in sub-Saharan Africa and published in English language between 2008 and 2018.

DATA EXTRACTION AND SYNTHESIS

A data extraction form was used to extract the following information: name of first author, year of publication, study location, study design, study subjects, sample size and determinants. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist for reporting a systematic review or meta-analysis protocol was used to guide the screening and eligibility of the studies. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the quality of the studies while the Andersen framework was used to report findings.

RESULTS

74 studies that met the inclusion criteria were fully assessed. Most studies identified socioeconomic status, urban residence, older/increasing age, low parity, being educated and having an educated partner, being employed, being married and Christian religion as predictors of ANC attendance and timeliness. Awareness of danger signs, timing and adequate number of antenatal visits, exposure to mass media and good attitude towards ANC utilisation made attendance and initiation of ANC in first trimester more likely. Having an unplanned pregnancy, previous pregnancy complications, poor autonomy, lack of husband's support, increased distance to health facility, not having health insurance and high cost of services negatively impacted the overall uptake, timing and frequency of antenatal visits.

CONCLUSION

A variety of predisposing, enabling and need factors affect ANC utilisation in sub-Saharan Africa. Intersectoral collaboration to promote female education and empowerment, improve geographical access and strengthened implementation of ANC policies with active community participation are recommended.

Factors associated with socio-demographic characteristics and antenatal care and iron supplement use in Ethiopia, Kenya, and Senegal

Antenatal care (ANC) offers remarkable opportunities to reach a large number of women with effective nutrition and health interventions, including iron (Fe) supplementation. However, all women do not equally seek nor benefit from ANC. We aimed to identify characteristics associated with ANC and Fe use among women in hard-to-reach areas in Afar, Ethiopia; Sedhiou and Kolda, Senegal; and Kakamega, Kenya. Women who gave birth within 1 year preceding the survey (n = 4,575) from 15 different sub-regions were randomly selected and surveyed. Multivariable logistic regression was used to identify associations of socio-demographic characteristics with ANC and Fe use. Factors that showed positive associations with ANC uptake included education, income, possession of a mobile phone, and the occupation of the mother or another household member. Beginning ANC in the first trimester associated positively with achievement of 4 or more ANC visits, and having any ANC visits related positively with Fe intake. Distance to the nearest health facility was negatively associated, and type of nearest facility and counselling and health education were positively associated with some outcomes. The results from these surveys demonstrate the need to ensure access of services across all population groups and can help identify ANC programming needs.