Impact of high-risk fertility behaviours on underfive mortality in Asia and Africa: evidence from Demographic and Health Surveys

Individual, household, and community-level factors associated with high-risk fertility behaviour among Nigerian women: secondary analysis of the 2018 demographic and health survey data

BACKGROUND

High-risk fertility behaviour (HRFB) remains a significant public health concern in Nigeria, contributing to increase in maternal and child morbidity and mortality. The existence of HRFB presents significant barrier to accomplishing the Sustainable Development Goals. The objective of this study was to examine the prevalence and contextual factors of HRFB among Nigerian women.

METHODS

In this study, cross-sectional data with national representativeness from the 2018 Nigeria demographic and health survey (NDHS) were used. The sample was made up of 21,792 women aged 15-49 years selected from 1389 enumeration areas. A multilevel multivariable binary logistic regression model was utilised to examine the factors associated with HRFB.

RESULTS

The weighted prevalence of HRFB was 64% (95% CI 62-65%). Women having at least a secondary education had 14% (aOR = 0.86; 95% CI 0.77-0.98) reduction in the odds of HRFB when compared with women with at most a primary education. Muslim women had 20% (aOR = 1.20; 95% CI 1.06-1.36) increase in the odds of HRFB, when compared with the Christian women. Those who had 3-4 living children had 3.97 times higher odds of HRFB, when compared with women with no child (aOR = 3.97; 95% CI 2.92-5.40). Women aged 25-34 and 35-49 years had higher odds of HRFB when compared with women aged 15-24 years respectively. Women exposed to media use had 12% (aOR = 0.88; 95% CI 0.80-0.97) reduction in the odds of HRFB when compared with women not exposed to media use. The non-poor women had 12% (aOR = 0.88; 95% CI 0.79-0.99) reduction in the odds of HRFB when compared with poor women. Respondents from female-headed households had 21% reduction in the odds of HRFB when compared with those from households with male head (aOR = 0.79; 95% CI 0.69-0.92). The geographical region was significantly associated with HRFB among women.

CONCLUSION

The high prevalence of HRFB among Nigerian women underscores the need for policies and programmes targeted to address the issue. Addressing socioeconomic factors, improving education and healthcare access, and promoting family planning could significantly reduce HRFB.

Socioeconomic inequalities in high-risk fertility behaviors over time in Ethiopia

INTRODUCTION

High-risk fertility behaviors (HRFB), including short birth intervals, early or late childbearing age, and high parity, are associated with adverse pregnancy outcomes. Understanding the importance of socioeconomic disparity in HRFB and the factors influencing this disparity is essential to improve maternal and child survival, Accordingly, this study investigated socioeconomic inequalities in HRFB over time and its contributing factors.

METHODS

We included a total weighted sample of 11,163 and 5,527 women aged 15 to 49 years from the 2005 and 2019 Ethiopia Demographic and Health Surveys, respectively. Erreygers Concentration index (ECI) and curve, along with Erreygers normalized decomposition analysis, were used to examine socioeconomic-related inequalities in HFRB and identify contributing factors to these inequalities.

RESULTS

The study showed that the concentration curve for HFRB remained above the equality line over time, indicating a disproportionate concentration among socioeconomically disadvantaged individuals. In 2005, the pro-poor ECI was -0.0682; in 2019, it was -0.2634, indicating that pro-poor inequality has widened. Educational status (10% in 2005 and 28% in 2019), place of birth (7% in 2005 and 28% in 2019), religion (16% in 2005 and 4% in 2019), and region (9% in 2005 and 3% in 2019) contributed to the observed pro-poor inequality. In 2019, contraceptive use (12%) and wealth index (15%) emerged as additional factors explaining HRFB inequality.

CONCLUSION

Our findings revealed the disproportional concentration of HRFB among socioeconomically disadvantaged women in Ethiopia, with a widening disparity between 2005 and 2019. Future interventions to address the effect of socioeconomic disadvantage on HRFB should prioritize women with low or no formal education, those who give birth at home, and those who do not use contraceptives.

Barriers and facilitators to accessing and utilising sexual and reproductive health services during the COVID-19 pandemic in Africa: a systematic review and meta-analysis

BACKGROUND

Ensuring uninterrupted access and utilisation of sexual and reproductive health (SRH) services remains crucial for preventing adverse SRH outcomes. However, the unprecedented emergence of the 2019 coronavirus disease (COVID-19) significantly disrupted most of these services in Africa. Thus, we systematically reviewed and examined barriers and facilitators to accessing and utilising SRH services during the COVID-19 pandemic in Africa.

METHODS

We systematically searched five databases for relevant articles published between January 2020 to December 2022, and the articles were screened following the JBI and PRISMA guidelines. Meta-synthesis of barriers and facilitators to accessing and utilising SRH services during the COVID-19 pandemic were reported, while a meta-analysis of the pooled prevalence of barriers to accessing and utilising SRH services during the COVID-19 pandemic in Africa was analysed using R.

RESULTS

The pooled prevalence of barriers to accessing and utilising SRH services during the COVID-19 pandemic in Africa was 26%. Seven themes were developed for the identified barriers (disruption of healthcare services, fear and misinformation, limited availability of resources, place & region of residence, healthcare staff attitude/manpower, limited access to transportation, and stigma and discrimination), whilst six themes were developed for the identified facilitators (support for vulnerable populations, socio-demographic characteristics, community outreach programs, policy adaptations, telemedicine and digital health, and change in choice of sexual and reproductive commodities).

CONCLUSION

This study found that the COVID-19 pandemic significantly impacted SRH service access and utilisation in Africa. We recommend that future research consider a longitudinal examination of the pandemic on African SRH services.

TRIAL REGISTRATION

PROSPERO registration number: CRD42022373335.

Socioeconomic inequalities in high-risk fertility behaviour among Nigerian women: A non-experimental population-based study

BACKGROUND

High-risk fertility behaviour (HRFB) has adverse health, social and economic effects on women. An understanding of socioeconomic inequalities is needed to design effective interventions targeted to lower maternal morbidity and mortality due to HRFB.

OBJECTIVES

The objective was to quantify socioeconomic inequalities in HRFB among Nigerian women.

DESIGN

This was a cross-section study that used population-based data.

METHODS

A sample of 21,792 Nigerian women aged 15-49 years from the 2018 Nigeria Demographic Health Survey was analyzed. Percentage was employed in univariate analysis. In addition, concentration index was used to assess the extent of inequalities in HRFB. This was further decomposed to ascertain the explanatory components' relative contributions to the socioeconomic inequalities in HRFB.

RESULTS

The weighted prevalence of HRFB (63.5%; 95% CI: 62.6-64.4%), included <18 years at childbirth (4.9%; 95% CI:4.5-5.3%), >34 years at childbirth (18.3%; 95% CI: 17.6-19.0%), >3 children birth order (49.6%; 95% CI: 48.7-50.5%) and <24 months at preceding birth interval (17.0% 95% CI: 16.3-17.6%) were estimated. Education (Contri: 50.3997%, Ec: 0.2771), wealth (Contri: 27.2811%, Ec: 0.2665), socioeconomic disadvantaged (Contri: 14.9163%, Ec: -0.0996), religion (Contri: 13.8636%, Ec: -0.0496), region (Contri: 11.1724%, Ec: 0.0711), partner education (Contri: 7.1351%, Ec: 0.2138), media use (Contri: 4.5064%, Ec: 0.1449) and family motility (Contri: 3.7890%, Ec: -0.0281) were positive contributors to HRFBs among Nigerian women. However, age (Contri: -14.6237, Ec: 0.0089) and history of contraceptive use (Contri: -8.7723, Ec: -0.2094) were negative contributors to HRFBs among women of reproductive age in Nigeria.

CONCLUSION

Women who have low socioeconomic level reported higher prevalence of HRFB. Targeted interventions are required to lower HRFB among Nigerian women from poor households and with no formal education. Women should get counselling and assistance from healthcare and educational institutions to help them adopt healthy sexual and reproductive practices.

Air pollution and under-5 child mortality: linking satellite and IPUMS-DHS data across 41 countries in South Asia and Sub-Saharan Africa

BACKGROUND

Despite progress, under-five mortality remains high, especially in Sub-Saharan Africa and South Asia, where around 13,400 children die daily. Environmental pollutants, including PM2.5 from outdoor air and household air pollution, significantly contribute to these preventable deaths.

METHODS

This cross-country study combined satellite data with 113 surveys from the IPUMS-DHS dataset (1998-2019) to examine under-five child mortality in 41 developing countries. The integration of Global Annual Particulate Matter with a diameter of 2.5 micrometres or less (PM2.5) Grids from Socioeconomic Data and Applications Center (SEDAC) and geospatial data from the DHS Program enabled a focused analysis of the association between indoor and outdoor air pollution, particularly PM2.5, and child mortality rates using both logistic and multilevel logistic regression models, as well as estimating Population Attributable Fractions (PAF) to quantify the mortality burden attributable to these pollutants.

RESULTS

Outdoor air pollution, measured by a one standard deviation increase in PM2.5, significantly increased the risk of child mortality (Odds Ratio [OR]: 1.14; 95% Confidence Interval [CI]: 1.10-1.18; p < 0.001). Moderate and high household air pollution exposure also heightened this risk, with increases of 37% (OR: 1.37; 95% CI: 1.24-1.53; p < 0.001) and 40% (OR: 1.40; 95% CI: 1.26-1.56; p < 0.001), respectively, compared to no exposure. Multilevel models (Models 5a and 10a) produced similar estimates to standard logistic regression, indicating robust associations. Additionally, Population Attributable Fraction analysis revealed that approximately 11.9% of under-five mortality could be prevented by reducing ambient PM2.5 exposure and 12.0% by mitigating household air pollution. The interaction between indoor and outdoor pollution revealed complex dynamics, with moderate and high household exposure associated with a reduction in mortality risk when combined with PM2.5. Geographical disparities were observed, with stronger correlations between outdoor air pollution and child mortality in Africa compared to Asia, and more pronounced impacts in low-income countries. However, household air pollution had stronger association with child mortality in Africa and lower- and middle-income countries.

CONCLUSIONS

Our findings could serve as a guide for policy development aimed at reducing under-five mortality, ultimately contributing to the attainment of the Sustainable Development Goal (SDGs).

High-risk fertility behaviors and associated factors among married reproductive-age women in sub-Saharan Africa: A multilevel mixed-effect analysis of nationally representative data from 35 countries

BACKGROUND

Although high-risk fertility behaviors are linked with poor maternal and child health outcomes, their prevalence remains higher in resource-limited countries and varies significantly by context. Evidence on the recent estimates of these fertility risks at the sub-Saharan Africa level is limited. Therefore, this study aimed to examine the pooled prevalence of high-risk fertility behaviors and associated factors among married women in this region.

METHODS

Data from DHS of 35 sub-Saharan African countries were used and a weighted sample of 243,657 married reproductive-age women were included in the analysis. A multilevel binary logistic regression models were fitted and the final model was selected based on the log-likelihood and deviance values. A p-value less than 0.05 and an adjusted odds ratio with a corresponding 95% confidence interval were used to identify the factors associated with high-risk fertility behaviors.

RESULTS

The pooled prevalence of high-risk fertility behaviors among women in sub-Saharan Africa was 77.7% [95% CI = 77.6%-77.9], where 43.1% [95% CI: 42.9%-43.3%], and 31.4% [95% CI = 31.2%-31.6%] had a single risk and combination of two or three fertility risks, respectively. The highest level of single-risk fertility pattern was observed in Burundi (53.4%) and Chad had the highest prevalence of both at least one (89.9%) and multiple (53.6%) fertility risks. Early and polygamous marriages, low maternal and husband education, poor wealth index, unmet need for contraception, couple's fertility discordance, rural residence, high community-level early marriage practice, and low community-level women empowerment were associated with risky fertility behaviors.

CONCLUSIONS

More than three-quarters of married women in SSA were engaged in high-risk fertility behaviors, with significant variations across the included countries. Therefore, addressing the modifiable risk factors like improving access to need-based contraceptive methods and empowering couples through education for a better understanding of their reproductive health with particular attention to rural settings are important in reducing these fertility risks. The results also suggest the need to strengthen the policies regulating the prohibition of early and polygamous marriages.

Association between high-risk fertility behaviors and neonatal mortality in Ethiopia: A multilevel mixed-effects logit models from 2019 Ethiopian mini demographic and health survey

Objectives

This study aimed to explore the association between high-risk fertility behaviors and neonatal mortality in Ethiopia.

Study design

A community-based cross-sectional study was conducted using data from the 2019 Ethiopian Mini-Demographic and Health Survey.

Methods

Mixed-effects logit regression models were fitted to 5527 children nested within 305 clusters. The definition of high-risk fertility behavior was adopted from the 2019 EMDHS. The fixed effects (the association between the outcome variable and the explanatory variables) were expressed as adjusted odds ratios (ORs) with 95 % confidence intervals and measures of variation explained by intra-class correlation coefficients, median odds ratio, and proportional change invariance.

Results

The presence of births with any multiple high-risk fertility behaviors was associated with a 70 % higher risk of neonatal mortality (AOR = 1.7, (95 % CI: 1.2, 2.3) than those with no high-risk fertility behavior. From the combined risks of high-risk fertility behaviors, the combination of preceding birth interval <24 months and birth order four or higher had an 80 % increased risk of neonatal mortality (AOR = 1.8, (95 % CI, 1.2, 2.7) as compared to those who did not have either of the two. The 3-way risks (combination of preceding birth interval <24 months, birth order 4+, and mother's age at birth 34+) were associated with approximately four times increased odds of neonatal mortality (AOR (95 % CI:3.9 (2.1, 7.4)].

Conclusions

High-risk fertility behavior is a critical predictor of neonatal mortality in Ethiopia, with three-way high-risk fertility behaviors increasing the risk of neonatal mortality fourfold. In addition, antenatal follow-up was the only non-high fertility behavioral factor significantly associated with the risk of neonatal mortality in Ethiopia.

Multilevel bivariate analysis of the association between high-risk fertility behaviors of birth and stunting with associated risk factors in Ethiopia

Introduction

Currently, the linkage between high-risk fertility behavior of birth and the occurrence of stunting among children under the age of 5 continues to be a significant public health problem in developing countries, including Ethiopia. This issue poses a threat to the health and overall wellbeing of under-five children. Thus, the main objective of this study was to examine the association between high-risk fertility behavior of birth and the stunting status of children and associated factors.

Methods

The data used for this study were extracted from the recent Ethiopian Mini Demographic and Health Survey data in 2019. A total weighted sample of 4,969 under-five children was included in this study, and the relevant data were extracted from those samples. The multilevel bivariate analysis was used to assess the association between high-risk fertility behavior of birth and the stunting status of under-five children in Ethiopia.

Results

It was found that, out of 4,997 under-five children, 24% of under-five children experienced stunting as a result of high-risk fertility behavior of birth. Our study also revealed an intra-class correlation of 0.2, indicating that 20% of the variability in both high-risk fertility behaviors of birth and stunting can be attributed to differences between communities. Furthermore, there was a statistically significant association between high-risk fertility behavior of birth and the stunting status of children under the age of 5 years [AOR = 8.5, 95% CI: (5.58, 18.70)]. Similarly, the stunting status of birth among boys was 1.36 times greater than the estimated odds of the stunting status of birth among girls [AOR = 1.36, 95% CI: (1.19, 1.55)].

Conclusion

This study found that there was a significant statistical association between high-risk fertility behavior of birth and stunting status of under-five children. Specifically, children born to mothers under 18 years and in households with high parity were identified as the main risk factors for child stunting. Furthermore, health-related education, improved access to maternal healthcare, and training interventions were associated with high-risk fertility behavior during birth and child stunting. The study suggests that regular health assessments and early interventions for infants born to mothers with high-risk reproductive characteristics are crucial to reducing the impact of child stunting under 5 years of age.

The effect of dietary diversity on anemia levels among children 6-23 months in sub-Saharan Africa: A multilevel ordinal logistic regression model

BACKGROUND

Anemia is the most common hematologic disorder of children worldwide. Since dietary diversity is a main requirement of children is to get all the essential nutrients, it can thus use as one of the basic indicator when assessing the child's anemia. Although dietary diversity plays a major role in anemia among children in sub-Saharan Africa, there is little evidence of an association between the dietary diversity and anemia level to identified potential strategies for prevention of anemia level in sub-Saharan Africa.

OBJECTIVE

To examine the association between dietary diversity and anemia levels among children aged 6-23 months in sub-Saharan Africa.

METHODS

The most recent Demographic and Health Surveys from 32 countries in SSA were considered for this study, which used pooled data from those surveys. In this study, a total weighted sample of 52,180 children aged 6-23 months was included. The diversity of the diet given to children was assessed using the minimum dietary diversity (MDD), which considers only four of the seven food groups. A multilevel ordinal logistic regression model was applied due to the DHS data's hierarchical structure and the ordinal nature of anemia. With a p-value of 0.08, the Brant test found that the proportional odds assumption was satisfied. In addition, model comparisons were done using deviance. In the bi-variable analysis, variables having a p-value ≤0.2 were taken into account for multivariable analysis. The Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was presented for potential determinants of levels of anemia in the multivariable multilevel proportional odds model.

RESULTS

The overall prevalence of minimum dietary diversity and anemia among children aged 6-23 months were 43% [95% CI: 42.6%, 43.4%] and 72.0% [95% CI: 70.9%, 72.9%] respectively. Of which, 26.2% had mild anemia, 43.4% had moderate anemia, and 2.4% had severe anemia. MDD, being female child, being 18-23 months age, born from mothers aged ≥25, taking drugs for the intestinal parasite, higher level of maternal education, number of ANC visits, middle and richer household wealth status, distance of health facility and being born in Central and Southern Africa were significantly associated with the lower odds of levels of anemia. Contrarily, being 9-11- and 12-17-months age, size of child, having fever and diarrhea in the last two weeks, higher birth order, stunting, wasting, and underweight and being in West Africa were significantly associated with higher odds of levels of anemia.

CONCLUSION

Anemia was a significant public health issue among children aged 6-23 months in sub-Saharan Africa. Minimum dietary diversity intake is associated with reduced anemia in children aged 6 to 23 months in sub-Saharan Africa. Children should be fed a variety of foods to improve their anemia status. Reducing anemia in children aged 6-23 months can be achieved by raising mother education levels, treating febrile illnesses, and improve the family's financial situation. Finally, iron fortification or vitamin supplementation could help to better reduce the risk of anemia and raise children's hemoglobin levels in order to treat anemia.

Maternal High-Risk Fertility Behavior and Its Associated Factors in Hadiya Zone, Southern Ethiopia: A Facility-Based Cross-Sectional Study

Background

The fertility behavior of women is characterized by maternal age, birth spacing and order, and it impacts the health of women and children. Evidence on the factors associated with maternal high-risk fertility behavior is scant in Ethiopia. Thus, the aim of this study was to identify the factors associated with maternal high-risk fertility behavior in Hadiya Zone, Southern Ethiopia.

Methods

A facility-based cross-sectional study was conducted. Three hundred women of reproductive age admissions to public hospitals in the Hadiya Zone who gave birth in the five years preceding this study were selected using systematic random sampling. Face-to-face interviews were held to gather data using interviewer-administered questionnaires. Descriptive statistics and binary logistic regression models were used to analyze data. Statistical significance was assessed using odds ratios and 95% confidence intervals and declared at a p-value of less than 0.05.

Results

The overall proportion of maternal high-risk fertility behavior was 60.3%. Mother, who lived in rural areas (AOR = 4.85; 95% CI: 2.56, 9.19), had early marriage (AOR = 3.39; 95% CI: 1.87, 6.14) and had unplanned last pregnancy (AOR = 2.62; 95% CI: 1.28, 5.39) were more likely engaged in high-risk fertility patterns.

Conclusions

In the study area, there was a high overall proportion of married women engaging in high-risk fertility behavior. Mothers with early marriages, unplanned pregnancies, and rural residence were more likely engaged in high-risk fertility behaviors. Plans for interventions aimed at preventing maternal high-risk fertility behavior should center on expanding access to family planning services and ending the practice of early marriage by giving rural women extra care and attention.

Association between sexual violence and multiple high-risk fertility behaviours among women of reproductive age in sub-Saharan Africa

BACKGROUND

Intimate partner violence has adverse outcomes on the sexual and reproductive health of women. In this study, we examined the association between sexual violence and multiple high-risk fertility behaviours (MHRFB) among women in sub-Saharan Africa (SSA).

METHODS

We conducted a cross-sectional analysis of data pooled from the most recent Demographic and Health Surveys of 20 countries in SSA. We included countries with most recent datasets conducted from 2015 to 2021 and had data on all variables included in the study. A weighted sample of 88,011 was included in the study. We used a multilevel binary logistic regression to examine the association between sexual violence and MHRFB, controlling for other covariates. The regression results were presented using adjusted odds ratio (aOR) with 95% confidence interval (CI). Statistical significance was set at p < 0.05.

RESULTS

The overall prevalence of MHRFB was 22.53% (95% CI: 22.26-22.81), which ranged from 9.94% in South Africa to 30.38% in Chad. For sexual violence, the pooled prevalence was 7.02% (95% CI: 6.86-7.19). Burundi (20.58%) and the Gambia (2.88%) reported the highest and lowest proportions, respectively. Women who experienced sexual violence were more likely to engage in MHRFB compared to those who did not experience sexual violence [aOR = 1.11, 95% CI: 1.02, 1.21].

CONCLUSION

There is a positive association between sexual violence and the risk of MHRFB. Our findings underscore a need for sub-Saharan African countries to strengthen their efforts to reduce the occurrence of sexual violence in intimate partner relationships. To augment efforts and accelerate social change, sub-Saharan African countries can introduce pro-poor policies and interventions to improve the wealth status of women. Also, empowering women through the encouragement of attaining higher education would be a useful step in lowering the risk of MHRFB in SSA.

Determinants of high-risk fertility behavior among women of reproductive age in Kenya: a multilevel analysis based on 2022 Kenyan demographic and health survey

BACKGROUND

Women's high-risk fertility behavior (HRFB), which is characterized by narrow birth intervals, high birth order, and younger maternal age at birth, have been scientifically reported to have detrimental effects on the mother and child's health. To date, there has been limited research into the underlying factors contributing to high-risk fertility behavior in Kenya. Thus, the aim of this study is to identify the factors associated with high-risk fertility behavior among women of reproductive age in Kenya.

METHOD

The 2022 Kenyan Demography and Health Survey data was used for the current study. This study included 15,483 women of reproductive age. To account for the clustering effects of DHS data and the binary nature of the outcome variable, a multilevel binary logistic regression model was applied. An adjusted odds ratio with a 95% confidence interval was reported to declare the statistical significance. In addition, the model that had the lowest deviance was the one that best fit the data.

RESULTS

The overall prevalence of HRFB among Kenyan women were 70.86% (95%CI = 69.96, 71.40). Women with primary, secondary, and higher educational levels, Protestant and Muslim religion followers, women whose husbands/partners had secondary and higher educational levels, a high household wealth index, ever had a terminated pregnancy, and rural residence, all of these factors were found to be strongly associated with high-risk fertility behavior.

CONCLUSION

As per the findings of our study, in Kenya a significant proportion of women has experienced HRFB. This is a matter of concern as it poses a significant challenge to the healthcare system. The high prevalence of HRFB indicates that there is an urgent need to take appropriate measures in order to mitigate its impact. The situation calls for a comprehensive and coordinated approach involving all stakeholders to address this issue effectively. It would benefit policymakers to create programs that consider factors like education, wealth, and residence that make women more susceptible to HRFB. Targeting women living in high HRFB-prevalence areas could help address the root causes of the issue. This approach can alleviate negative impacts and ensure effective and sustainable solutions.

Multiple high-risk fertility behaviours and children under five mortality survivors among ever-married women of reproductive age in Nigeria

BACKGROUND

Multiple high-risk fertility behaviours (MHRFBs), including maternal age < 18 or > 34 years old, a birth order 4+, and birth spacing < 24 months, can directly or indirectly affect survival outcomes among under-five children. There is a dearth of available information and data about these two phenomena in Nigeria. Thus, this study evaluates the prevalence of MHRFBs and examines the association between MHRFBs and under-five mortality survival (U5M) outcomes among ever-married women of reproductive age in Nigeria.

METHODS

This study used the recent secondary datasets from the Nigerian Demographic Health Surveys conducted in 2018, with a total sample size of 10,304 women of reproductive age. The outcome variable was MHRFBs. Multivariable logistic regression analysis was employed to examine the association between U5M and MHRFBs. Odds ratios with a p-value of less than 0.05 were considered significant.

RESULTS

It was found that among women who had MHRFBs, U5M was prevalent, particularly in young maternal age (< 18 years) and within short birth intervals (< 24 months). The adjusted odds ratio of the association between MHRFBs and U5M shows the experience of MHRFBs, in addition to other factors such as household wealth index, type of marriage, and sex of child, to be significant predictors for U5M. The odds were higher for U5M to occur among women who had experienced MHRFBs compared to those who have not had an experience of MHRFBs [aOR = 1.48; 95%CI: 1.02-2.17 ]. Similarly, the odds of U5M occurrence among women in polygamous marriages are higher compared to those in monogamous unions [aOR = 1.35; 95% CI: 1.10-1.65]. While under-five children born in the richest households (wealth quintiles) are less likely to die compared to those born in the poorest households [aOR = 0.64; 95% CI: 0.41-1.01].

CONCLUSION

This study concludes that women in Nigeria who engaged in MHRFBs, particularly maternal ages < 18 years and short birth intervals (< 24 months), were more likely to experience U5M. Furthermore, children born to women who received post-natal care after delivery were more likely to survive U5M, as were children born to women with educated partners. We recommend strengthening educational opportunities and creating adaptive reproductive health education programs for ever-married women of reproductive age in Nigeria.

Safer sex negotiation and parity among women in sub-Saharan Africa

Women's ability to negotiate for safer sex has effects on their sexual and reproductive health. This study investigated the association between safer sex negotiation and parity among women in sub-Saharan Africa. The data were sourced from the Demographic and Health Surveys of 28 sub-Saharan African countries conducted from 2010 to 2019. A total of 215,397 women aged 15-49 were included in the study. Multilevel logistic analysis was conducted to examine the association between safer sex negotiation and parity among women in sub-Saharan Africa. The results were presented as adjusted odds ratios (aOR) and the significance level set at p<0.05. The overall prevalences of safer sex negotiation and high parity among women in sub-Saharan Africa were 82.7% and 52.1%, respectively. The prevalence of high parity ranged from 32.3% in Chad to 72.1% in Lesotho. The lowest prevalence of safer sex negotiation was in Chad (16.8%) while the highest prevalence was recorded in Rwanda (99.7%). Women who had the capacity to negotiate for safer sex were less likely to have high parity compared with those who had no capacity to negotiate for safer sex (aOR = 0.78, CI: 0.75-0.81). Other factors that were associated with high parity were age, educational level, marital status, exposure to media, contraceptive use, religion, wealth quintile, sex of household head, and place of residence. The study identified significant association between safer sex negotiation and high parity among women of reproductive age in sub-Saharan Africa. It is worth noting that women's ability to negotiate for safer sex could reduce high parity among women in sub-Saharan Africa. Therefore, policies and programmes aimed at birth control or reducing high parity among women could be targeted at improving their capacity to negotiate for safer sex through education.

High-risk fertility behaviours among women of reproductive ages in the Democratic Republic of the Congo: Prevalence, correlates, and spatial distribution

BACKGROUND

High-risk fertility behaviour remains a major public health in the Democratic Republic of the Congo, like other sub-Saharan Africa countries, especially because Total Fertility Rate (TFR) is very high in the country, estimated at 6.6 children. Despite the commendable progress in reducing maternal deaths in the region, sub-Saharan Africa is still lagging very behind compared with other regions. Yet, high-risk fertility behaviours are pivotal to improve maternal and child health. This study aims to assess geographical variations of, and to identify risk factors associated with high-risk fertility behaviours among married women in the Democratic Republic of the Congo using the 2013-14 Demographic and Health Survey.

METHODS

Overall, 11,497 married women were selected from a nationally representative using a two-stage sampling design. Standard logistic regressions were performed to identify individual- and household/community-level factors associated with high-risk fertility behaviours. Additionally, interactions between women's age and education, and urban residence were tested. Bernoulli based spatial scan statistics were used to identify the presence of high-risk fertility behaviours spatial clusters using Kulldorff's SaTScan version 9.6 software. ArcGIS 10.7 was used to visualize the spatial variations of high-risk fertility behaviours. Geographically weighted regression (GWR) analysis was employed using Multiscale GWR version 2.0 software.

RESULTS

Findings indicated that more than two-third of married women exhibited high-risk fertility behaviours in the Democratic Republic of the Congo. Multivariate logistic regression showed that education was negatively and significantly associated with the odds of high-risk fertility behaviours. In contrast, women's age significantly increased the odds of high-risk fertility behaviours. Interactions between urban residence and women's education and age confirmed the urban advantage identified from previous studies. Finally, high-risk fertility behaviours were highly clustered in the Northeastern provinces of the country.

CONCLUSION

The study showed that there were significant geographical variations of high-risk fertility behaviours across provinces in the Democratic Republic of the Congo. The paper also identified significant-high hot spots of high-risk fertility behaviours in the Northeastern provinces of the country. To reduce high-risk fertility behaviours, and ultimately improve maternal and child outcomes in the country, policymakers and health planners need to strategically address these inequalities. Finally, this paper highlighted the persistent needs of country-specific studies due to differences across sub-Saharan African countries in terms of social development and cultures.

Individual-and community-level factors associated with anemia among children aged 6–23 months in sub-Saharan Africa: evidence from 32 sub-Saharan African countries

Background

Anemia among children aged 6–23 months is a major public health problem worldwide specifically in sub-Saharan Africa (SSA). Anemia during the childhood period causes significant short-and long-term health consequences. However, there is a paucity of evidence on Anemia among children aged 6–23 months in SSA. Therefore, this study examined the individual- and community-level factors associated with anemia among children aged 6–23 months in sub-Saharan Africa.

Methods

A secondary data analysis was done based on the most recent Demographic and Health Survey (DHS) of 32 sub-Saharan African countries. A total weighted sample of 51,044 children aged 6–23 months was included for analysis. We have used a multilevel proportional odds model to identify predictors of severity levels of anemia. Variables with p < 0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable multilevel proportional odds model, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) was reported to declare the statistical significance and strength of the association.

Results

In this study, about 76.6% (95% CI: 76.2%, 76.9%) of children aged 6–23 months in sub-Saharan Africa were anemic. In the multivariable multilevel proportional odds model, being female, being aged 18–23 months, higher level of maternal education, being larger size at birth, belonging to a wealthier household, getting four ANC visits and above, advanced maternal age, and belonging to a community with high maternal education were significantly associated with lower odds of higher levels of anemia. On the other hand, being twin birth, being smaller size at birth, being of a higher order of birth, having fever in the last two weeks, and distance to a health facility were significantly associated with higher odds of higher levels of anemia.

Conclusion

The study found that more than three-fourths of children aged 6–23 months in sub-Saharan Africa were anemic. This finding proved that the severity levels of anemia among children in sub-Saharan Africa remain a serious public health concern. Therefore, to curve this problem enhancing maternal education, promoting maternal health service utilization, and improving health care access is crucial. In addition, health care providers better give special emphasis to twin births, higher-order birth, and those belonging to poor households to reduce the incidence of anemia among children aged 6–23 months in SSA.

Determinants associated with high-risk fertility behaviours among reproductive aged women in Bangladesh: a cross-sectional study

BACKGROUND

We aimed to determine the factors that increase the risk of HRFB in Bangladeshi women of reproductive age 15-49 years.

METHODS

The study utilised the latest Bangladesh Demographic and Health Survey (BDHS) 2017-18 dataset. The Pearson's chi-square test was performed to determine the relationships between the outcome and the independent variables, while multivariate logistic regression analysis was used to identify the potential determinants associated with HRFB.

RESULTS

Overall 67.7% women had HRFB among them 45.6% were at single risk and 22.1% were at multiple high-risks. Women's age (35-49 years: AOR = 6.42 95% CI 3.95-10.42), who were Muslims(AOR = 5.52, 95% CI 2.25-13.52), having normal childbirth (AOR = 1.47, 95% CI 1.22-1.69), having unwanted pregnancy (AOR = 10.79, 95% CI 5.67-18.64) and not using any contraceptive methods  (AOR = 1.37, 95% CI 1.24-1.81) were significantly associated with increasing risk of having HRFB. Alternatively, women and their partners' higher education were associated with reducing HRFB.

CONCLUSION

A significant proportion of Bangladeshi women had high-risk fertility behaviour which is quite alarming. Therefore, the public health policy makers in Bangladesh should emphasis on this issue and design appropriate interventions to reduce the maternal HRFB.