Utilization of deworming medication and its associated factors among pregnant married women in 26 sub-Saharan African countries: a multi-country analysis

A comprehensive assessment of deworming coverage among pregnant women in low- and middle-income countries, 2000-30

Background

Intestinal parasitic infections pose a significant global public health issue, particularly among pregnant women, who are generally more susceptible due to their elevated need for iron and nutrients. Deworming stands as a secure and efficacious public health intervention. The World Health Organization (WHO) set a target for the national deworming coverage rate among pregnant women at 75% by 2030. Nonetheless, the existing body of evidence on deworming among pregnant women in low- and middle-income countries (LMICs) remains limited.

Methods

Based on Demographic Health Survey (DHS) data from 56 LMICs (n = 924 277) between 2000 and 2022, we used Bayesian hierarchical models to estimate trends of deworming coverage up to 2030 and to analyse determinant factors of deworming.

Results

We found that, despite progress in deworming coverage estimates for most countries, only 11 (<20%) are on track to achieve the WHO target coverage at the national level. Inequality gaps were projected to increase in most LMICs. A multilevel model showed that increased numbers of antenatal care, access to safe water, and a higher wealth index were associated with higher odds of deworming.

Conclusions

The progress on deworming coverage and inequality in many countries remains insufficient for achieving the WHO target by 2030. Additional investments in the health sector towards the expansion of deworming programmes, along with integration with existing health services, are urgently required, as is the introduction of effective policies and strengthening programmes within the context of the 'Leave No One Behind' agenda.

Deworming coverage and its determinants among 12-59 months old children in East Africa: A population-based study

BACKGROUND

Intestinal parasitic infections are the world's largest public health issue, primarily in developing nations. The World Health Organization (WHO) recommends deworming as a preventative or therapeutic measure for all vulnerable people residing in endemic areas. Despite this issue, there is little data on the prevalence and associated factors of deworming drug use among children under five years of age in East Africa.

OBJECTIVE

This study aimed to evaluate the prevalence and contributing factors of deworming coverage among children under the age of five in East Africa using the most available national health survey data.

METHODS

Data from the Demographic and Health Survey, which included 103,865 weighted children between the ages of 12-59 months, were used in this investigation. Our outcome of interest was taking deworming medicine six months before the interview. A logistic regression model was then fitted. A cutoff P value of 0.2 was used in the binary logistic regression analysis. To identify significant variables, a 95% confidence interval and adjusted odds ratio (AOR) with a value < 0.05 were used.

RESULTS

The prevalence of deworming in East Africa was 54.13% (95% CI: 53.83%-54.43%). The maternal age group of 24-34 years, and from 35-49 years (AOR = 1.37, 95% CI, 1.32,1.42), and (AOR = 1.71, 95% CI, 1.62,1.79), employed women (AOR = 1.62, 95% CI, 1.58,1.67), being from rural(AOR = 1.11,95% CI,1.07,1.15), unmarried mothers (AOR = 1.12,95% CI,1.09,1.15), mothers from poorer, middle, richer, and richest households (AOR = 1.16,95% CI, 1.12,1.21), (AOR = 1.23, 95% CI, 1.18,1.28), (AOR = 1.22,95% CI, 1.16,1.27), and (AOR = 1.27, 95% CI, 1.21,1.34) having at least one antenatal care follow up(AOR = 2.90, 95% CI, 2.63,3.16), health facility delivery(AOR = 1.69, 95% CI,1.64,1.75), mass media exposure AOR = 1.32, 955 CI, 1.29,1.36), having of 3-5 children (AOR = 0.89, 95% CI, 0.86,0.93), more than five children (AOR = 0.79, 95% CI, 0.73,0.86), and parity of 2nd or 3rd birth order (AOR = 1.05, 95% CI, 1.01,1.09) as compared to primi mothers were associated with the deworming among under five children in east Africa respectively.

CONCLUSION

The under-five population in East Africa had a lower prevalence of deworming medication per the most recent DHS findings. Promoting mother and child health services (antenatal care, institutional delivery, family planning), as well as women's empowerment, should be prioritized.

Factors Associated with Deworming Medication Utilization among Pregnant Women in Benin: Evidence from the Demographic and Health Survey

Deworming medication utilization is a useful strategy to reduce the burden of anemia among pregnant women. Yet, we know very little about the prevalence and correlates of deworming medication utilization among pregnant women in sub-Saharan Africa, including Benin. To address this void in the literature, we used the 2017–2018 Benin Demographic and Health Survey and applied logistic regression analysis to explore the demographic, socioeconomic, and healthcare factors associated with deworming medication utilization in Benin. We found that deworming medication coverage was 65% at the national level. We observed that women aged 35–49 years were less likely to use deworming medication compared to those aged 15–24 years (OR = 0.79, p < 0.01). Compared to Christian women, Muslim women (OR = 0.70, p < 0.01) and women of other religions (OR = 0.51, p < 0.01) were also less likely to use deworming medication. Moreover, women with lower levels of education and household wealth, as well as unemployed women, were less likely to use deworming medication in comparison to their educated, richer, and employed counterparts. Women who visited ANC fewer than eight times were also less likely to use deworming medication compared to their counterparts who did so eight times or more (OR = 0.65, p < 0.001). Based on these findings, we discussed several implications for policymakers.

Deworming utilization among pregnant mothers with at least one antenatal care follow-up in Ethiopia, 2022:- A multilevel analysis

BACKGROUND

Soil-transmitted helminthes (STHs) are the major public health problems that affect the health of pregnant women and their incoming newborns. In Ethiopia, about 33.35% of pregnant women were affected by these infections. Utilization of deworming medication during pregnancy is the main strategy endorsed by the World Health Organization (WHO) to reduce the burden of STH-induced anemia and its related complications. However, information related to the coverage and its individual as well as community-level factors on the utilization of deworming medication among pregnant mothers with at least one antenatal care (ANC) visit is limited in Ethiopia.

METHODS

A nationwide population-based cross-sectional study was conducted from January 18 to June 27, 2016. The information was obtained from the 2016 Ethiopian Demographic Health Survey (EDHS 2016), which can be accessed at: https://www.dhsprogram.com. A weighted sample of 4690 pregnant women selected using a two-stage stratified cluster sampling technique was included in the final analysis. A Multi-variable multilevel binary logistic regression model was fitted to identify the determinants of the utilization of deworming medication during pregnancy. Log-likelihood ration (LLR), deviance and Akaike's Information Criterion (AIC) were used to select the best fitted model in the multilevel analysis. Statistical significance was declared at p-value <0.05.

RESULT

From a total of 4690 mothers included in the final analysis, only 365 (7.8%) of them utilized deworming medication in pregnancy. After controlling for confounding effects, having four or more Antenatal care (ANC) visits, having functional working status, intake of iron folic acid (IFA) tablets and coming from a community with a low poverty level increases the odds of utilization of deworming medication during pregnancy.

CONCLUSION AND RECOMMENDATION

In this study, less than one in ten pregnant mothers takes deworming medication. Mothers with less than four ANC visits, who did not receive IFA tablets, who came from a community with a high poverty level, and mothers with no good functional status were at the greatest risk of not receiving deworming medication during pregnancy. Sustained efforts need to be undertaken to increase the socioeconomic status of the community and to scale up the health care utilization behaviors of pregnant mothers.

Intestinal Parasitic Infections, Treatment and Associated Factors among Pregnant Women in Sao Tome and Principe: A Cross-Sectional Study

Background. Intestinal parasitic infections (IPIs) are a public health problem in developing countries such as Sao Tome and Principe (STP) although the pregnancy burden of IPIs is unknown in this endemic country. Thus, the aim of this study was to determine the prevalence of IPIs, prescribed anthelmintics, and associated factors among pregnant women admitted to Hospital Dr. Ayres de Menezes (HAM). Methods. A hospital-based cross-sectional study was conducted among pregnant women admitted to the HAM who had undergone antenatal copro-parasitological screening. Data were abstracted from antenatal care (ANC) cards regarding parasitological results and anthelmintic prescriptions. A structured questionnaire face-to-face interview was also applied. Pregnant women with an IPI (210) were compared to noninfected women (151). Data analysis was performed using SPSS version 25.0. Odds ratios (ORs) with 95% confidence intervals (CIs) for factors associated with IPIs were estimated using multiple logistic regression models. A $p$ value <0.05 was considered statistically significant. Results. A total of 361 participants (210 IPI and 151 no-IPI) with a mean age of 26.96 (SD: 7.00) were included. The overall prevalence of IPI was 58.2% (95% CI 52.9 to 63.3), mainly due to helminthiasis, with a 55.9% (95% CI 50.7–61.2%) rate. Ascaris lumbricoides (90.9%) was the most predominant parasite species identified followed by Trichuris trichiura (13.8%). Polyparasitism was observed in 25 cases (11.9%). Anthelmintics were prescribed to 23% of pregnant women. S intercalatum (11) and E histolytica (7) infections were not adequately treated. IPI was significantly associated with primary education (AOR 1.73 (95% CI: 1.10–2.71)), unemployment (AOR 1.94 (95% CI: 1.20–3.13)), and parity of five or above (AOR 3.82 (95% CI: 1.32–11.08)). Conclusion. This study highlights the IPI burden, associated factors, and missing treatment opportunities among pregnant women with STP. This study is a useful tool for policymakers in STP to enhance the health of women and their unborn babies.

Malaria and Helminthic Co-Infection during Pregnancy in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Malaria and helminthic co-infection during pregnancy causes fetomaternal haemorrhage and foetal growth retardation. This study determined the pooled burden of pregnancy malaria and helminthic co-infection in sub-Saharan Africa. CINAHL, EMBASE, Google Scholar, Scopus, PubMed, and Web of Science databases were used to retrieve data from the literature, without restricting language and publication year. The Joanna Briggs Institute’s critical appraisal tool for prevalence studies was used for quality assessment. STATA Version 14.0 was used to conduct the meta-analysis. The I² statistics and Egger’s test were used to test heterogeneity and publication bias. The random-effects model was used to estimate the pooled prevalence at a 95% confidence interval (CI). The review protocol has been registered in PROSPERO, with the number CRD42019144812. In total, 24 studies (n = 14,087 participants) were identified in this study. The pooled analysis revealed that 20% of pregnant women were co-infected by malaria and helminths in sub-Saharan Africa. The pooled prevalence of malaria and helminths were 33% and 35%, respectively. The most prevalent helminths were Hookworm (48%), Ascaris lumbricoides (37%), and Trichuris trichiura (15%). Significantly higher malaria and helminthic co-infection during pregnancy were observed. Health systems in sub-Saharan Africa must implement home-grown innovative solutions to underpin context-specific policies for the early initiation of effective intermittent preventive therapy.

Magnitude and Determinants of Under-Nutrition Among Late Adolescent Girls in East Africa: Evidence From Demographic and Health Surveys (2010-2016)

Background

Adolescent girls are vulnerable to undernutrition owing to their increased nutrition demand for growth and development, including sexual development and maturation. Despite its public health importance, undernutrition among late adolescent girls has received little attention in health and nutrition policies. Although undernutrition in adolescent girls has been investigated, most of the previous study reports were based on small sample sizes and limited geographic settings. Therefore, we aimed to estimate the prevalence and determinants of undernutrition among late adolescent girls in East Africa.

Methods

Secondary data analysis was conducted among 10 East African countries using the most recent Demographic and Health Survey (DHS) reports. A total of 21,779 adolescent girls aged 15-19 years were included in this study. Descriptive statistics were conducted to describe the study population. The binary logistic regression model was fitted to identify the determinants of undernutrition among late adolescent girls. Variables with a p-value of <0.05 in the multivariate analysis were identified as statistically significant determinants of undernutrition.

Results

The overall magnitude of undernutrition among late adolescent girls in East Africa was 16.50% (95% CI: 16.00-17.00), whereas the overall magnitude of obesity among late adolescent girls in East Africa was 2.41% (95% CI: 2.21-2.62). In the final model of the multivariate analysis, adolescent girls aged 18-19 years [adjusted odds ratio (AOR) = 0.55; 95% CI: 0.51-0.60], having secondary education (AOR = 0.79; 95% CI: 0.68-0.93), being from a rich wealth index family (AOR = 0.63; 95% CI: 0.56-0.69), and being from a medium wealth index family (AOR = 0.80; 95% CI: 0.72-0.89) were negatively and statistically associated with undernutrition. Likewise, having more than seven household members (AOR = 1.36; 95% CI: 1.10-1.67), walking more than 30 min to a water source (AOR = 1.10; 95% CI: 1.01-1.20), and living in Ethiopia (AOR = 1.75; 95% CI: 1.51-2.03) were positive determinants of undernutrition among late adolescent girls.

Conclusion

In this study, undernutrition in late adolescent girls remains a considerable public health problem in East Africa. Age group, educational status, marital status, family wealth index, family size, time taken to reach a water source, media exposure, and country of resident were significant determinants of undernutrition. Therefore, devising strategies that improve the socioeconomic status of households and/or adolescents would help to reduce the risks of undernutrition in late adolescents.