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Ibitoye M, Sandfort TGM, Bingenheimer JB, Sommer M. The sexual and reproductive health covariates of early menarche among adolescent girls. J Adolesc 2024; 96:789-802. [PMID: 38297495 DOI: 10.1002/jad.12298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 01/09/2024] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
INTRODUCTION Research suggests that girls who reach menarche at an early age are at greater risk for negative sexual and reproductive health (SRH) outcomes than their later-maturing counterparts, but very little research has examined this issue in sub-Saharan Africa, especially in West Africa. The goal of the current study was to determine whether early menarche was associated with any SRH outcomes in a sample of Ghanaian girls. METHODS The study data were drawn from the baseline assessment of a longitudinal study involving two age cohorts (13-14 and 18-19 years) of 700 adolescent girls from Ghana. Logistic regressions were used to assess the association between early menarche (before age 13) and seven SRH outcomes (adolescent sexual activity, early sexual initiation, inconsistent condom use, transactional sex, sexual violence, multiple sexual partners, and adolescent pregnancy). RESULTS Early menarche was significantly associated with adolescent sexual activity (odds ratio [OR] = 6.4; 95% confidence interval [CI] 2.1-19.7), and sexual violence (OR = 3.2; 95% CI 1.6-6.2) in the younger cohort and early sexual initiation (OR = 3.2; 95% CI 1.19-8.61) and multiple sexual partners (OR = 3.7; 95% CI 1.39-9.87) in the older cohort. Early menarche was also associated with transactional sex and teen pregnancy in the full sample. CONCLUSIONS These findings suggest the need for special attention to the needs of early-maturing girls in SRH programming. Interventions are needed to delay adolescent sexual activity in girls with early menarche. Efforts to prevent sexual violence among adolescent girls in Ghana may benefit from targeting and addressing the specific needs of early-maturing girls.
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Affiliation(s)
- Mobolaji Ibitoye
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Theo G M Sandfort
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
- Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | - Jeffrey B Bingenheimer
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington DC, USA
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
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Ibitoye M, Sommer M, Davidson LL, Sandfort TGM. Exploring the effect of early menarche on sexual violence among adolescent girls and young women in southeastern Ghana: a longitudinal mediation analysis. Sex Reprod Health Matters 2023; 31:2244271. [PMID: 37656485 PMCID: PMC10478596 DOI: 10.1080/26410397.2023.2244271] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Abstract
Research from several high-income countries links early menarche with an increased risk for sexual violence. However, the role of early menarche in adolescent girls' and young women's sexual violence risk in sub-Saharan Africa, where sexual violence rates are high, is not well understood. The current study explores the association between early menarche and sexual violence in Ghana with secondary analysis of data collected from 700 adolescent girls and young women followed over three years. Logistic regressions were used to assess the cross-sectional association between early menarche and sexual violence. Generalised estimating equations were used to assess whether the association between early menarche and sexual violence persisted over time. Inverse odds weighting was used to test potential mediators of the association between early menarche and sexual violence. Sexual violence was fairly common in the study sample, with 27% reporting having experienced sexual violence at baseline, and approximately 50% at year three. Early menarche was associated with 72% greater odds of having experienced sexual violence at baseline (95% confidence interval: 1.01-2.93). However, the odds ratio attenuated and lost significance over the three-year study period, with a lower risk of sexual violence among girls with early menarche at year three. Neither child marriage nor early sexual initiation significantly mediated the association between early menarche and sexual violence. The findings suggest that early-maturing girls may be particularly vulnerable to sexual violence in early adolescence, thus necessitating prevention interventions around the time of menarche to reduce the risk for sexual violence.
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Affiliation(s)
- Mobolaji Ibitoye
- Postdoctoral Scholar, Institute for Population Research, Ohio State University, Columbus, OH, USA
| | - Marni Sommer
- Professor of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Leslie L. Davidson
- Professor Emerita of Epidemiology and of Pediatrics, Columbia University Irving Medical Center, New York, NY, USA
| | - Theo G. M. Sandfort
- Professor of Clinical Sociomedical Sciences (in Psychiatry), Division of Gender, Sexuality and Health, New York State Psychiatric Institute and Columbia University, New York, NY, USA
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Compton SD, Darteh EKM, Seidu AA, Omolo T, Munro-Kramer ML. Danger and sexuality: exploring negotiations in romantic and sexual relationships among university students in Ghana. CULTURE, HEALTH & SEXUALITY 2023; 25:428-443. [PMID: 35311488 DOI: 10.1080/13691058.2022.2050425] [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: 07/08/2021] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
Gender inequalities and social mores normalise gender-based violence in many settings. The goal of this study was to gain a more in-depth understanding of romantic and sexual relationships, consent, and gender-based violence among university students in Ghana. We used focus group discussions to explore individual factors influencing romantic and sexual relationships among students enrolled at a university in the Central Region of the country to inform the development and tailoring of future interventions. During a series of four focus group discussions comprising students recruited via convenience and snowball sampling, participants were asked to reflect on the nature of their romantic and sexual relationships. Demographic data and experiences of gender-based violence were also collected. The focus groups discussions were recorded and transcribed verbatim and analysed thematically. Five themes were developed from the data: (1) traditional gender roles; (2) self-control; (3) relationship-based consent; (4) cheating; and (5) non-verbal communication. This study suggests negative health and social ramifications of violence will continue until there is a resolution of conflicting social norms that result in different expectations about how men and women can address their sexual needs. Future programming and interventions for gender-based violence prevention should reflect on their impact across all ecological levels.
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Affiliation(s)
- Sarah D Compton
- Department of OB/GYN, University of Michigan, Ann Arbor, MI, USA
| | - Eugene K M Darteh
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Services, James Cook University, Townsville, QLD, Australia
| | - Tanya Omolo
- School of Social Work & Public Policy, University of Michigan, Ann Arbor, MI, USA
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Amo-Adjei J, Deliege A, Nurzhynska A, Essuman R, Khan MR. A Vignettes-Based Exploration of Attitudes of Parents Toward Reporting of Child Sexual Abuse in Ghana. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:6138-6166. [PMID: 36213952 DOI: 10.1177/08862605221127215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Reporting child sexual abuse (CSA) to law enforcement institutions is the ideal child protection imperative. The role of parents in this process is unquestionably profound. Yet, there is limited evidence on parental perspectives on reporting CSA to law enforcement agencies in developing country contexts. We apply vignettes to describe the views of parents about reporting CSA perpetrated by "family members, schoolteachers, and strangers." Data was collected from 89 parents from four culturally diverse regions of Ghana. A systematic inductive approach was used to determine patterns and similarities in participants' attitudes toward reporting. We note that the attitudes of participants about reporting CSA varied considerably; these are influenced by the nature of social relationships between the victim and perpetrator. In a seeming order of severity, CSA perpetrated by a family member was viewed less seriously compared to victimization by a teacher or a stranger. The desire to preserve familial/kin ties and reputation and keeping to the cultural heritage of resolving "disputes and disagreements" amicably were primary norms against reporting CSA. However, attitudes toward reporting CSA by teachers were influenced by expectation of higher moral standards, which made reporting CSA by a teacher a reasonable cause of action. Positive attitudes toward reporting CSA by "strangers" were prevalent. Child protection programs must recognzse the segmented attitudes toward CSA and tackle the deep-seated cultural and social norms through social and behavioral change communication (SBCC).
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Azupogo F, Abizari AR, Osendarp SJM, Feskens EJ, Brouwer ID. Ten2Twenty-Ghana: Study Design and Methods for an Innovative Randomized Controlled Trial with Multiple-Micronutrient-Fortified Biscuits among Adolescent Girls in Northeastern Ghana. Curr Dev Nutr 2021; 5:nzaa184. [PMID: 33604499 PMCID: PMC7880270 DOI: 10.1093/cdn/nzaa184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/24/2020] [Accepted: 12/30/2020] [Indexed: 02/04/2023] Open
Abstract
Investing in adolescent girls' nutrition is vital for health and for breaking the intergenerational cycle of malnutrition and deprivation, but limited knowledge on the type, timing, and efficacy of interventions delays progress. We describe the design of a 26-wk randomized placebo-controlled trial with multiple-micronutrient-fortified biscuits (MMBs) among adolescent girls in northeastern Ghana. Apparently healthy, premenarche (n = 312) and postmenarche (n = 309) girls (10-17 y) were randomly assigned to receive the following for 5 d/wk: 1) MMBs (fortified with 11 vitamins and 7 minerals) or 2) unfortified biscuits. Data included plasma micronutrient status, anthropometry, body composition, cognitive function, psychosocial health, fertility, dietary intake, and sociodemographic and socioeconomic covariates, complemented with in-depth interviews (n = 30) and 4 focus group discussions. We hypothesized an increase in plasma ferritin and retinol-binding protein with a resultant increase in hemoglobin, cognition, vertical height, and psychosocial health. Our study seeks to investigate the efficacy and optimal timing of a multiple-micronutrient food intervention program for adolescent girls. The RCT was registered prospectively with the Netherlands Clinical Trials Register (NL7487).
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Affiliation(s)
- Fusta Azupogo
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
- Department of Family and Consumer Sciences, Faculty of Agriculture, Food, and Consumer Sciences, University for Development Studies, Tamale, Ghana
| | - Abdul-Razak Abizari
- Department of Nutritional Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Saskia J M Osendarp
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
- Micronutrient Forum, Washington, DC, USA
| | - Edith J Feskens
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
| | - Inge D Brouwer
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, The Netherlands
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Fawole OI, Okedare OO, Salawu MM, Kiene SM, Reed E. Relationship dynamics with male partners among girls in low-income communities of Ibadan, Nigeria: Risk for violence and health related consequences. J Adolesc 2021; 87:74-85. [PMID: 33508729 DOI: 10.1016/j.adolescence.2021.01.002] [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: 06/10/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This study explored the motivations for and relationship dynamics that may promote girls' vulnerability for intimate partner violence and sources of support reported in unhealthy relationships among girls residing in low-income communities in Ibadan, Nigeria. METHODS Focus group discussions (n = 14; 122 girls) were conducted among girls aged 15-19 years, who reported having been in a relationship lasting at least 3 months. Girls were recruited from schools and worksites where partner violence has been reported in high proportions. Data were analysed using conceptual content analyses and independently coded by two researchers. RESULTS Adolescent girls reported keeping their relationships secret from their parents. While girls reported that sometimes relationships were out of love, relationships were also often motivated by girls' financial need. The financial and secretive nature of these relationships appeared to place girls at risk for intimate partner violence, with sexual coercion, resulting in multiple adverse social and health outcomes, including sexually transmitted infections and unintended pregnancy. Girls reported that leaving an abusive relationship is especially difficult when girls rely financially, were sexually involved, pregnant, or have had a child with the male partner. Friends/peers, rather than girls' family, were often the source of support for intimate partner violence. CONCLUSION Early identification of unhealthy relationships and supporting girls to be financially independent appear to be critical to reduce vulnerability to violence. Peer-based interventions may be most appropriate, given that girls' friends, rather than parents, were most often the source of support for intimate partner violence and other relationship challenges.
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Affiliation(s)
- Olufunmilayo I Fawole
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Omowumi O Okedare
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Mobolaji M Salawu
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Susan M Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, USA.
| | - Elizabeth Reed
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, USA; Center on Gender Equity and Health, University of California San Diego, Division of Infectious Disease and Global Public Health, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
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Malnutrition, Hypertension Risk, and Correlates: An Analysis of the 2014 Ghana Demographic and Health Survey Data for 15-19 Years Adolescent Boys and Girls. Nutrients 2020; 12:nu12092737. [PMID: 32911770 PMCID: PMC7551149 DOI: 10.3390/nu12092737] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 12/23/2022] Open
Abstract
The sex differences in malnutrition and hypertension during adolescence is largely inconclusive. There is also a paucity of data on the sex-specific correlates of malnutrition and hypertension for adolescents. Hence, this study aimed to assess the association between malnutrition, pre-hypertension/hypertension (PHH) and sex among adolescents. The study also aimed to determine and contrast the factors associated with these risks in Ghana. We analysed data of non-pregnant adolescent girls (n = 857) and adolescent boys (n = 870) aged 15–19 years from the 2014 Ghana Demographic and Health Survey (DHS). We modelled the prevalence risk ratio (PRR) of malnutrition and PHH using Cox proportional hazard models. Compared to adolescent girls, boys were more than twice likely to be stunted (PRR = 2.58, 95% C.I (1.77, 3.76)) and underweight (PRR = 2.67, 95% C.I (1.41, 5.09)) but less likely to be overweight/obese (PRR = 0.85, 95% C.I (0.08, 0.29)). Boys were also about twice likely to have PHH (PRR = 1.96, 95% C.I (1.47, 2.59)) compared to their female peers. Girls were more at risk of the detrimental effects of poor education on stunting and PHH. Empowerment index while protective of stunting for girls (PRR = 0.82, 95% C.I (0.67, 0.99)) also increased their risk of overweight/obesity (PRR = 1.31, 95% C.I (1.02, 1.68)). A higher household wealth index (HWI) increased the risk of overweight/obesity for adolescent girls but was protective of stunting and PHH for adolescent boys. Improvement in household water, hygiene, and sanitation (WASH) reduced the risk of stunting by 15% for adolescent boys. Overall, our findings suggest a double-burden of malnutrition with an up-coming non-communicable disease burden for adolescents in Ghana. Our findings may also be highlighting the need to target adolescent boys alongside girls in nutrition and health intervention programmes.
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Prinsloo J, da Costa G. Exploring the personal and social context of female youth sex offenders. JOURNAL OF PSYCHOLOGY IN AFRICA 2017. [DOI: 10.1080/14330237.2017.1379658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Johan Prinsloo
- Department of Criminology & Security Science, University of South Africa, Pretoria, South Africa
| | - Gloria da Costa
- Department of Criminology & Security Science, University of South Africa, Pretoria, South Africa
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Gust DA, Gvetadze R, Furtado M, Makanga M, Akelo V, Ondenge K, Nyagol B, McLellan-Lemal E. Factors associated with psychological distress among young women in Kisumu, Kenya. Int J Womens Health 2017; 9:255-264. [PMID: 28496366 PMCID: PMC5422460 DOI: 10.2147/ijwh.s125133] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Attention to mental health issues is growing globally. In many countries, including Kenya, however, assessment of psychological distress, especially in rural areas, is limited. METHODS We analyzed data from young women screened for a longitudinal contraceptive ring study in Kisumu, Kenya. Multivariable regression analysis was used to assess factors associated with recent moderate and high psychological distress, as measured by the Kessler (K-6) psychological distress scale. RESULTS Among the 461 women screened, most (58.4%) were categorized as having moderate psychological distress, 20.8% were categorized as having low or no psychological distress, and 20.8% were categorized as having high psychological distress. Moderate psychological distress (vs low/no) was significantly more likely among women who reported a history of forced sex and were concerned about recent food insecurity. High (vs low/no) psychological distress was significantly more likely among women who reported a history of forced sex, who were concerned about recent food insecurity, and who self-reported a sexually transmitted infection. CONCLUSION To reduce psychological distress, a focus on prevention as well as care methods is needed. Girls need a path toward a healthy and productive adulthood with a focus on education, which would help them gain skills to avoid forced sex. Women would benefit from easy access to social services and supports that would help them with basic needs like food security among other things. A holistic or ecological approach to services that would address mental, educational, social, health, and economic issues may have the highest chance of having a long-term positive impact on public health.
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Affiliation(s)
- Deborah A Gust
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | - Roman Gvetadze
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention
| | | | - Mumbi Makanga
- HIV Research Branch, Kenya Medical Research Institute, Kisumu, Kenya
| | - Victor Akelo
- HIV Research Branch, Kenya Medical Research Institute, Kisumu, Kenya
| | - Kenneth Ondenge
- HIV Research Branch, Kenya Medical Research Institute, Kisumu, Kenya
| | - Beatrice Nyagol
- HIV Research Branch, Kenya Medical Research Institute, Kisumu, Kenya
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Ohene SA, Johnson K, Atunah-Jay S, Owusu A, Borowsky IW. Sexual and physical violence victimization among senior high school students in Ghana: Risk and protective factors. Soc Sci Med 2015; 146:266-75. [DOI: 10.1016/j.socscimed.2015.10.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 10/07/2015] [Accepted: 10/08/2015] [Indexed: 11/24/2022]
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Kamndaya M, Kazembe LN, Vearey J, Kabiru CW, Thomas L. Material deprivation and unemployment affect coercive sex among young people in the urban slums of Blantyre, Malawi: A multi-level approach. Health Place 2015; 33:90-100. [PMID: 25814337 PMCID: PMC4415138 DOI: 10.1016/j.healthplace.2015.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 02/18/2015] [Accepted: 03/02/2015] [Indexed: 11/05/2022]
Abstract
We explore relations among material deprivation (measured by insufficient housing, food insecurity and poor healthcare access), socio-economic status (employment, income and education) and coercive sex. A binary logistic multi-level model is used in the estimation of data from a survey of 1071 young people aged 18–23 years, undertaken between June and July 2013, in the urban slums of Blantyre, Malawi. For young men, unemployment was associated with coercive sex (odds ratio [OR]=1.77, 95% confidence interval [CI]: 1.09–3.21) while material deprivation (OR=1.34, 95% CI: 0.75–2.39) was not. Young women in materially deprived households were more likely to report coercive sex (OR=1.37, 95% CI: 1.07–2.22) than in non-materially deprived households. Analysis of local indicators of deprivation is critical to inform the development of effective strategies to reduce coercive sex in urban slums in Malawi. Local measures were used for an analysis of association between deprivation and coercive sex. Unemployment was associated with coercive sex among young men. Material deprivation was associated with coercive sex among young women.
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Affiliation(s)
- Mphatso Kamndaya
- School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown, 2193 Johannesburg, South Africa.
| | - Lawrence N Kazembe
- Department of Statistics & Population Studies, University of Namibia, Windhoek, Namibia.
| | - Jo Vearey
- African Centre for Migration and Society, School of Social Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Caroline W Kabiru
- Population Dynamics and Reproductive Health Research Program, African Population and Health Research Center, Nairobi, Kenya.
| | - Liz Thomas
- School of Public Health, University of the Witwatersrand, 27 St Andrews Road, Parktown, 2193 Johannesburg, South Africa.
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