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Kawuki J, Nuwabaine L, Namulema A, Asiimwe JB, Sserwanja Q, Gatasi G, Donkor E. Prevalence of risk factors for human immunodeficiency virus among sexually active women in Rwanda: a nationwide survey. BMC Public Health 2023; 23:2222. [PMID: 37950175 PMCID: PMC10638791 DOI: 10.1186/s12889-023-17148-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND The Human Immunodeficiency Virus (HIV) remains a global health burden, and despite the advancements in antiretroviral therapy and various strategies employed to curb HIV infections, the incidence of HIV remains disproportionately high among women. Therefore, this study aimed to determine the prevalence of the risk factors for the acquisition of HIV among sexually active women in Rwanda. METHODS Secondary data from the 2020 Rwanda Demographic Health Survey, comprising 10,684 sexually active women, was used. Multistage stratified sampling was employed to select the study participants. Multivariable logistic regression was conducted to determine the associated risk factors using the SPSS (version 25). RESULTS Of the 10,684 sexually active women, 28.7% (95% confidence interval (CI): 27.5-29.4) had at least one risk factor for HIV acquisition. Having no education (AOR = 3.65, 95%CI: 2.16-6.16), being unmarried (AOR = 4.50, 95%CI: 2.47-8.21), being from female-headed households (AOR = 1.75, 95%CI: 1.42-2.15), not having health insurance (AOR = 1.34, 95%CI: 1.09-1.65), no HIV test history (AOR = 1.44, 95%CI: 1.01-2.08), being from the poorest wealth quintile (AOR = 1.61, 95%CI: 1.14-2.27) and lack of exposure to mass media (AOR = 1.30, 95%CI: 1.07-1.58) were associated with higher odds of exposure to at least one HIV acquisition risk factor. In contrast, age groups of 25-34 (AOR = 0.56, 95%CI: 0.44-0.71) and 35-44 years (AOR = 0.62, 95%CI: 0.48-0.80), rural residence (AOR = 0.63, 95%CI: 0.49-0.81) and being from the western region (AOR = 0.67, 95%CI: 0.48-0.94) were associated with less odds of exposure to at least one HIV acquisition risk factor. CONCLUSION More than a quarter of sexually active women in Rwanda had exposure to at least one risk factor for HIV acquisition. There is a need to maximize the use of mass media in disseminating HIV prevention and behavioral change messages. Engagement of religious leaders and promotion of HIV testing, especially among the never-testers, may be vital strategies in successful HIV prevention programs.
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Affiliation(s)
- Joseph Kawuki
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Lilian Nuwabaine
- School of Nursing and Midwifery, Aga Khan University, Kampala, Uganda.
| | | | | | | | - Ghislaine Gatasi
- Key Laboratory of Environmental Medicine Engineering, School of Public Health, Southeast University, Nanjing, 210009, Jiangsu Province, China
| | - Elorm Donkor
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Mapping HIV prevalence in Nigeria using small area estimates to develop a targeted HIV intervention strategy. PLoS One 2022; 17:e0268892. [PMID: 35675346 PMCID: PMC9176772 DOI: 10.1371/journal.pone.0268892] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 05/10/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Although geographically specific data can help target HIV prevention and treatment strategies, Nigeria relies on national- and state-level estimates for policymaking and intervention planning. We calculated sub-state estimates along the HIV continuum of care in Nigeria. Design Using data from the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) (July–December 2018), we conducted a geospatial analysis estimating three key programmatic indicators: prevalence of HIV infection among adults (aged 15–64 years); antiretroviral therapy (ART) coverage among adults living with HIV; and viral load suppression (VLS) rate among adults living with HIV. Methods We used an ensemble modeling method called stacked generalization to analyze available covariates and a geostatistical model to incorporate the output from stacking as well as spatial autocorrelation in the modeled outcomes. Separate models were fitted for each indicator. Finally, we produced raster estimates of each indicator on an approximately 5×5-km grid and estimates at the sub-state/local government area (LGA) and state level. Results Estimates for all three indicators varied both within and between states. While state-level HIV prevalence ranged from 0.3% (95% uncertainty interval [UI]: 0.3%–0.5%]) to 4.3% (95% UI: 3.7%–4.9%), LGA prevalence ranged from 0.2% (95% UI: 0.1%–0.5%) to 8.5% (95% UI: 5.8%–12.2%). Although the range in ART coverage did not substantially differ at state level (25.6%–76.9%) and LGA level (21.9%–81.9%), the mean absolute difference in ART coverage between LGAs within states was 16.7 percentage points (range, 3.5–38.5 percentage points). States with large differences in ART coverage between LGAs also showed large differences in VLS—regardless of level of effective treatment coverage—indicating that state-level geographic targeting may be insufficient to address coverage gaps. Conclusion Geospatial analysis across the HIV continuum of care can effectively highlight sub-state variation and identify areas that require further attention in order to achieve epidemic control. By generating local estimates, governments, donors, and other implementing partners will be better positioned to conduct targeted interventions and prioritize resource distribution.
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Mweemba C, Hangoma P, Fwemba I, Mutale W, Masiye F. Estimating district HIV prevalence in Zambia using small-area estimation methods (SAE). Popul Health Metr 2022; 20:8. [PMID: 35183216 PMCID: PMC8858531 DOI: 10.1186/s12963-022-00286-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 02/08/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The HIV/AIDS pandemic has had a very devastating impact at a global level, with the Eastern and Southern African region being the hardest hit. The considerable geographical variation in the pandemic means varying impact of the disease in different settings, requiring differentiated interventions. While information on the prevalence of HIV at regional and national levels is readily available, the burden of the disease at smaller area levels, where health services are organized and delivered, is not well documented. This affects the targeting of HIV resources. There is need, therefore, for studies to estimate HIV prevalence at appropriate levels to improve HIV-related planning and resource allocation.
Methods
We estimated the district-level prevalence of HIV using Small-Area Estimation (SAE) technique by utilizing the 2016 Zambia Population-Based HIV Impact Assessment Survey (ZAMPHIA) data and auxiliary data from the 2010 Zambian Census of Population and Housing and the HIV sentinel surveillance data from selected antenatal care clinics (ANC). SAE models were fitted in R Programming to ascertain the best HIV predicting model. We then used the Fay–Herriot (FH) model to obtain weighted, more precise and reliable HIV prevalence for all the districts.
Results
The results revealed variations in the district HIV prevalence in Zambia, with the prevalence ranging from as low as 4.2% to as high as 23.5%. Approximately 32% of the districts (n = 24) had HIV prevalence above the national average, with one district having almost twice as much prevalence as the national level. Some rural districts have very high HIV prevalence rates.
Conclusions
HIV prevalence in Zambian is highest in districts located near international borders, along the main transit routes and adjacent to other districts with very high prevalence. The variations in the burden of HIV across districts in Zambia point to the need for a differentiated approach in HIV programming within the country. HIV resources need to be prioritized toward districts with high population mobility.
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Niragire F, Ndikumana C, Nyirahabimana MG, Uwizeye D. Prevalence and factors associated with fertility desire among HIV-positive women in Rwanda in the context of improved life expectancy. Arch Public Health 2021; 79:209. [PMID: 34819164 PMCID: PMC8613943 DOI: 10.1186/s13690-021-00742-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 11/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background The knowledge of the key factors associated with fertility desire among people living with HIV/AIDS is crucial for the efficient planning of maternal and child health care programs. Fertility desire has generally increased among women of reproductive age in Rwanda. However, its level and determinants among women living with HIV/AIDS (WLHA) are currently not well known in the context of Rwanda. The present study aimed to fill in this knowledge gap. Methods Data were extracted from the 2015 Rwanda demographic and health survey (RDHS) for 243 HIV-positive women of reproductive age. Univariate and multivariable logistic regression analyses were conducted in order to identify the most influential factors. Results The prevalence of desire to have another child in HIV-positive women was found to be as high as 40.7%. Multivariable logistic regression analyses showed that the woman’s age of 35–49 years (AOR = 0.051, 95% CI: 0.013–0.204), woman’s parity of 3 children or above (AOR = 0.177, 95% CI: 0.037–0.837), being employed (AOR = 0.298, 95% CI: 0.113–0.782) and currently using contraceptives (AOR = 0.146; 95% CI: 0.057–0.375) were significantly associated with low odds of fertility desire among HIV- positive women in Rwanda. Women younger than 25 years, with no living child, or who were unemployed or who were not using any contraceptive were significantly associated with greater odds of desire to have another child than did other HIV- positive women. A woman whose partner's desire for children is different from hers was associated with about four times higher odds (AOR = 3.752; 95% CI: 1.203–11.702) of desire for more children than women who desire the same as their partners. Conclusion Fertility desire in WLHA is currently high in Rwanda. It is significantly influenced by demographic and socioeconomic factors. The Rwanda’s health care system should be prepared to intensify the required services for the prevention of the vertical transmission of HIV, the delivery of maternal and child health care services, and the support to WLHA in planning their fertility. Interventions should target low-parity young women, with a particular focus on meeting their contraceptive needs.
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Affiliation(s)
- François Niragire
- Department of Applied Statistics, University of Rwanda, Kigali, Rwanda.
| | - Celestin Ndikumana
- Department of Governance and Public Administration, University of Rwanda, Kigali, Rwanda
| | | | - Dieudonne Uwizeye
- Department of Development Studies, University of Rwanda, Kigali, Rwanda
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Ayalew KA, Manda S, Cai B. A Comparison of Bayesian Spatial Models for HIV Mapping in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111215. [PMID: 34769735 PMCID: PMC8582764 DOI: 10.3390/ijerph182111215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/08/2021] [Accepted: 10/09/2021] [Indexed: 11/16/2022]
Abstract
Despite making significant progress in tackling its HIV epidemic, South Africa, with 7.7 million people living with HIV, still has the biggest HIV epidemic in the world. The Government, in collaboration with developmental partners and agencies, has been strengthening its responses to the HIV epidemic to better target the delivery of HIV care, treatment strategies and prevention services. Population-based household HIV surveys have, over time, contributed to the country’s efforts in monitoring and understanding the magnitude and heterogeneity of the HIV epidemic. Local-level monitoring of progress made against HIV and AIDS is increasingly needed for decision making. Previous studies have provided evidence of substantial subnational variation in the HIV epidemic. Using HIV prevalence data from the 2016 South African Demographic and Health Survey, we compare three spatial smoothing models, namely, the intrinsically conditionally autoregressive normal, Laplace and skew-t (ICAR-normal, ICAR-Laplace and ICAR-skew-t) in the estimation of the HIV prevalence across 52 districts in South Africa. The parameters of the resulting models are estimated using Bayesian approaches. The skewness parameter for the ICAR-skew-t model was not statistically significant, suggesting the absence of skewness in the HIV prevalence data. Based on the deviance information criterion (DIC) model selection, the ICAR-normal and ICAR-Laplace had DIC values of 291.3 and 315, respectively, which were lower than that of the ICAR-skewed t (348.1). However, based on the model adequacy criterion using the conditional predictive ordinates (CPO), the ICAR-skew-t distribution had the lowest CPO value. Thus, the ICAR-skew-t was the best spatial smoothing model for the estimation of HIV prevalence in our study.
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Affiliation(s)
- Kassahun Abere Ayalew
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg 3209, South Africa;
- Correspondence:
| | - Samuel Manda
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg 3209, South Africa;
- Biostatistics Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Statistics, University of Pretoria, Pretoria 0028, South Africa
| | - Bo Cai
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
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Munakampe MN, Fwemba I, Zulu JM, Michelo C. Association between socioeconomic status and fertility among adolescents aged 15 to 19: an analysis of the 2013/2014 Zambia Demographic Health Survey (ZDHS). Reprod Health 2021; 18:182. [PMID: 34507589 PMCID: PMC8431886 DOI: 10.1186/s12978-021-01230-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 08/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Adolescents face significant barriers to access and utilization of sexual and reproductive health services in many low-income settings, which in turn may be associated with adverse consequences such as early pregnancy, sexually transmitted infections, unsafe abortion and mortality. There is evidence suggesting that limited access to sexual and reproductive health information and services among adolescents contributes to these outcomes. We aimed to find out the factors that affect the fertility of adolescents aged 15 to 19 years in Zambia and to identify possible drivers of adolescents’ fertility. Methods Secondary analysis of the ZDHS 2013/14 data was carried out to find out the factors that affect the fertility rate of adolescents aged 15 to 19 years using multivariate logistic regression (n = 3666). Results Overall, 23.1% of adolescents had given birth at least once in the 5 years leading to the survey (n = 3666, 99.4% response), and 49.8% were rural-based while 50.2% were urban-based. The median number of schooling was 8 years (IQR 6–10). About 52% of the adolescents were in the poorer, poor and medium wealth quintiles while the other 48% were in the rich and richer quintiles. Factors found to affect fertility include residence, wealth status, educational attainment, marriage and abortion. An urban-based adolescent with a lower socioeconomic status was 2.4 times more likely to give birth compared to rural-based poorer adolescents (aOR = 2.4, 95% CI: 1.5, 3.7, p < 0.001). Although odds of giving birth were much higher among rural-based married adolescents (aOR = 8.0, 95% CI: 5.4, 11.9, p < 0.001) compared to urban married adolescents (aOR = 5.5, 95% CI: 8.3, 16.0, p < 0.001), and these relationships both statistically significant, higher educational attainment (aOR = 0.7, 95% CI: 0.6, 0.8 p < 0.001) and abortion (aOR = 0.3, 95% CI: 0.1, 0.8, p = 0.020) reduced these odds, particularly for rural-based adolescents. Conclusion Despite response aimed at reducing adolescent fertility, low wealth status, low educational attainment and early marriage remain significant drivers of adolescent fertility in Zambia. There is a need to address sexual and reproductive health needs of urban-based adolescents with a lower socioeconomic status. Adolescents go through serious challenges related to accessing and using sexual and reproductive health services in many low-income settings, and may also be related to negative consequences such as early pregnancy, sexually transmitted infections and unsafe abortion and death. Research has revealed that limited access to sexual and reproductive health information and services among young people contributes to these negative consequences. This analysis aimed to find out the factors that affect the fertility of 3666 adolescents aged 15 to 19 years in Zambia and to identify possible drivers of adolescents’ fertility, using the Zambia Demographic and Health Survey conducted in 2013/2014. A little over a quarter of the adolescents had given birth at least once in the five years leading to the survey. About half of the young people were rural-basedwhile the other half were urban-based, with an average of about 8 years in school. The rural-based adolescents had slightly lower average years in school compared to the urban-based; 7 years and 9 years respectively. Living in a rural area, residing in a home with a low wealth status and being married were all linked to higher chances of giving birth, while terminating a pregnancy and having more years of education were linked to lower chances of giving birth among the adolescents. Urban-based adolescents with lower wealth status were also linked to higher chances of giving birth compared to urban-based adolescents with higher wealth status. These results suggest that while residing in rural areas and being married increase the chances of higher fertility, the adolescents in urban areas but with lower wealth status also need interventions aimed at reducing their fertility.
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Affiliation(s)
- Margarate Nzala Munakampe
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia. .,Department of Epidemiology & Biostatistics, School of Public Health, University of Zambia, Strategic Centre for Health Systems Metrics & Evaluations (SCHEME), Lusaka, Zambia.
| | - Isaac Fwemba
- Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia.,Department of Biostatistics, School of Public Health, University of Ghana, Accra, Ghana
| | - Joseph Mumba Zulu
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Charles Michelo
- Department of Epidemiology & Biostatistics, School of Public Health, University of Zambia, Strategic Centre for Health Systems Metrics & Evaluations (SCHEME), Lusaka, Zambia.,Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia
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Manda S, Haushona N, Bergquist R. A Scoping Review of Spatial Analysis Approaches Using Health Survey Data in Sub-Saharan Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E3070. [PMID: 32354095 PMCID: PMC7246597 DOI: 10.3390/ijerph17093070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/01/2020] [Accepted: 04/03/2020] [Indexed: 01/03/2023]
Abstract
Spatial analysis has become an increasingly used analytic approach to describe and analyze spatial characteristics of disease burden, but the depth and coverage of its usage for health surveys data in Sub-Saharan Africa are not well known. The objective of this scoping review was to conduct an evaluation of studies using spatial statistics approaches for national health survey data in the SSA region. An organized literature search for studies related to spatial statistics and national health surveys was conducted through PMC, PubMed/Medline, Scopus, NLM Catalog, and Science Direct electronic databases. Of the 4,193 unique articles identified, 153 were included in the final review. Spatial smoothing and prediction methods were predominant (n = 108), followed by spatial description aggregation (n = 25), and spatial autocorrelation and clustering (n = 19). Bayesian statistics methods and lattice data modelling were predominant (n = 108). Most studies focused on malaria and fever (n = 47) followed by health services coverage (n = 38). Only fifteen studies employed nonstandard spatial analyses (e.g., spatial model assessment, joint spatial modelling, accounting for survey design). We recommend that for future spatial analysis using health survey data in the SSA region, there must be an improve recognition and awareness of the potential dangers of a naïve application of spatial statistical methods. We also recommend a wide range of applications using big health data and the future of data science for health systems to monitor and evaluate impacts that are not well understood at local levels.
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Affiliation(s)
- Samuel Manda
- Biostatistics Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Department of Statistics, University of Pretoria, Pretoria 0002, South Africa
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg 3209, South Africa
| | - Ndamonaonghenda Haushona
- Biostatistics Research Unit, South African Medical Research Council, Pretoria 0001, South Africa
- Division of Epidemiology and Biostatistics, University of Stellenbosch, Cape Town 8000, South Africa
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Neal S, Ruktanonchai CW, Chandra-Mouli V, Harvey C, Matthews Z, Raina N, Tatem A. Using geospatial modelling to estimate the prevalence of adolescent first births in Nepal. BMJ Glob Health 2019; 4:e000763. [PMID: 31321088 PMCID: PMC6606082 DOI: 10.1136/bmjgh-2018-000763] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Adolescent pregnancy is associated with significant risks and disadvantages for young women and girls and their children. A clear understanding of population subgroups with particularly high prevalence of first births in adolescence is vital if appropriate national responses are to be developed. This paper aims to provide detailed data on socioeconomic and geographic inequities in first births to adolescents in Nepal, including wealth quintile, education, rural/urban residence and geographic region. A key element is the use of geospatial modelling to develop estimates for the prevalence of adolescent births at the district level. METHODS The study uses data from the 2011 Nepal Demographic and Health Survey. Initial cross-tabulations present disaggregated data by socioeconomic status and basic geographic region. Estimates of prevalence of adolescent first births at the district level are creating by regression modelling using the Integrated Nested Laplace Approximation package in R software. RESULTS Our findings show that 40% of women had given birth before the age of 20 years, with 5% giving birth before 16 years. First births to adolescents remain common among poorer, less educated and rural women. Geographic disparities are striking, with estimates for the percentage of women giving birth before 20 years ranging from 35% to 53% by region. District level estimates showed even more marked differentials (26%-67% had given birth by 20 years), with marked heterogeneity even within regions. In some districts, estimates for the prevalence of first birth among the youngest age groups (<16 years) are high. CONCLUSION Important geographic and socioeconomic inequities exist in adolescent first births. In some districts and within some subgroups, there remain high levels of adolescent first births, including births to very young adolescents. The use of Bayesian geospatial modelling techniques can be used by policymakers to target resources.
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Affiliation(s)
- Sarah Neal
- Social Statistics and Demography Department, University of Southampton, Southampton, UK
| | | | - Venkatraman Chandra-Mouli
- Department of Reproductive Health and Research, World Health Organization/Human Reproduction Programme, World Health Organization, Geneva, Switzerland
| | - Chloe Harvey
- Social Statistics and Demography Department, University of Southampton, Southampton, UK
| | - Zoe Matthews
- Social Statistics and Demography Department, University of Southampton, Southampton, UK
| | - Neena Raina
- Regional Office for South-East Asia (SEARO), World Health Organisation, New Delhi, India
| | - Andrew Tatem
- WorldPop, Department of Geography and Environmental Science, University of Southampton, Southampton, UK
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Joshi RK, Mehendale SM. Determinants of consistently high HIV prevalence in Indian Districts: A multi-level analysis. PLoS One 2019; 14:e0216321. [PMID: 31063471 PMCID: PMC6504102 DOI: 10.1371/journal.pone.0216321] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/19/2019] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Factors associated with persistently high Human Immunodeficiency Virus (HIV) prevalence levels in several districts of India are not well understood. This study was undertaken to determine the association of socio-demographic characteristics, economic factors, awareness about HIV and Sexually Transmitted Infections (STIs), and condom use with consistently high HIV prevalence in the Indian districts and to ascertain whether these associations differed across various regions of India. METHODS This study was carried out including all 640 districts of India. Secondary analysis of data obtained from the Census of India-2011, HIV Sentinel Surveillance in India and District Level Household Survey-III was done. Population profile, socio-economic characteristics, levels of HIV/STI/condom awareness and condom use, were compared between the districts with and without consistently high HIV prevalence. Due to the presence of collinearity among predictor variables, we used principal component analysis and the principal component scores were included as covariates for further analysis. Considering the districts at level 1 and the regions at level 2, multi-level analysis was done by generalised linear mixed models. Variance partition coefficient and median odds ratio were also calculated. RESULTS Sixty-three districts with consistently high HIV prevalence were found clustered in the South and the North-east regions of India. Population size, density and urbanisation were found to be positively associated with consistently high HIV prevalence in these districts. Higher levels of literacy, better socio-economic status, higher proportion of population in reproductive age group and late marriages were positively associated with consistently high HIV prevalence in all regions of India except in the Southern region. Higher levels of knowledge about the role of condoms in HIV prevention and condom use were associated with low HIV prevalence at the district level. CONCLUSIONS Considerable heterogeneity among factors associated with consistently high HIV prevalence at the district level in different regions of India necessitates special region-specific strategies for HIV control. Increasing awareness about HIV alone is not sufficient for controlling the HIV epidemic and there is a need to raise knowledge levels about preventive measures against HIV and promote the use of condoms amongst population.
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Affiliation(s)
- Rajneesh Kumar Joshi
- Symbiosis International University, Pune, India
- National AIDS Research Institute (ICMR), Pune, India
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Gutreuter S, Igumbor E, Wabiri N, Desai M, Durand L. Improving estimates of district HIV prevalence and burden in South Africa using small area estimation techniques. PLoS One 2019; 14:e0212445. [PMID: 30794619 PMCID: PMC6386240 DOI: 10.1371/journal.pone.0212445] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/01/2019] [Indexed: 11/18/2022] Open
Abstract
Many countries, including South Africa, have implemented population-based household surveys to estimate HIV prevalence and the burden of HIV infection. Most household HIV surveys are designed to provide reliable estimates down to only the first subnational geopolitical level which, in South Africa, is composed of nine provinces. However HIV prevalence estimates are needed down to at least the second subnational level in order to better target the delivery of HIV care, treatment and prevention services. The second subnational level in South Africa is composed of 52 districts. Achieving adequate precision at the second subnational level therefore requires either a substantial increase in survey sample size or use of model-based estimation capable of incorporating other pre-existing data. Our purpose is demonstration of the efficacy of relatively simple small-area estimation of HIV prevalence in the 52 districts of South Africa using data from the South African National HIV Prevalence, Incidence and Behavior Survey, 2012, district-level HIV prevalence estimates obtained from testing of pregnant women who attended antenatal care (ANC) clinics in 2012, and 2012 demographic data. The best-fitting model included only ANC prevalence and dependency ratio as out-of-survey predictors. Our key finding is that ANC prevalence was the superior auxiliary covariate, and provided substantially improved precision in many district-level estimates of HIV prevalence in the general population. Inclusion of a district-level spatial simultaneously autoregressive covariance structure did not result in improved estimation.
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Affiliation(s)
- Steve Gutreuter
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Ehimario Igumbor
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Pretoria, Republic of South Africa
- School of Public Health, University of the Western Cape, Bellville, Cape Town, Republic of South Africa
| | - Njeri Wabiri
- Division of Epidemiology and Strategic Information, Human Sciences Research Council, Pretoria, Republic of South Africa
| | - Mitesh Desai
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Lizette Durand
- Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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Ruktanonchai CW, Nilsen K, Alegana VA, Bosco C, Ayiko R, Seven Kajeguka AC, Matthews Z, Tatem AJ. Temporal trends in spatial inequalities of maternal and newborn health services among four east African countries, 1999-2015. BMC Public Health 2018; 18:1339. [PMID: 30514269 PMCID: PMC6278077 DOI: 10.1186/s12889-018-6241-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 11/21/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sub-Saharan Africa continues to account for the highest regional maternal mortality ratio (MMR) in the world, at just under 550 maternal deaths per 100,000 live births in 2015, compared to a global rate of 216 deaths. Spatial inequalities in access to life-saving maternal and newborn health (MNH) services persist within sub-Saharan Africa, however, with varied improvement over the past two decades. While previous research within the East African Community (EAC) region has examined utilisation of MNH care as an emergent property of geographic accessibility, no research has examined how these spatial inequalities have evolved over time at similar spatial scales. METHODS Here, we analysed temporal trends of spatial inequalities in utilisation of antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC) among four East African countries. Specifically, we used Bayesian spatial statistics to generate district-level estimates of these services for several time points using Demographic and Health Surveys data in Kenya, Tanzania, Rwanda, and Uganda. We examined temporal trends of both absolute and relative indices over time, including the absolute difference between estimates, as well as change in performance ratios of the best-to-worst performing districts per country. RESULTS Across all countries, we found the greatest spatial equality in ANC, while SBA and PNC tended to have greater spatial variability. In particular, Rwanda represented the only country to consistently increase coverage and reduce spatial inequalities across all services. Conversely, Tanzania had noticeable reductions in ANC coverage throughout most of the country, with some areas experiencing as much as a 55% reduction. Encouragingly, however, we found that performance gaps between districts have generally decreased or remained stably low across all countries, suggesting countries are making improvements to reduce spatial inequalities in these services. CONCLUSIONS We found that while the region is generally making progress in reducing spatial gaps across districts, improvement in PNC coverage has stagnated, and should be monitored closely over the coming decades. This study is the first to report temporal trends in district-level estimates in MNH services across the EAC region, and these findings establish an important baseline of evidence for the Sustainable Development Goal era.
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Affiliation(s)
- Corrine W. Ruktanonchai
- WorldPop, Geography and Environmental Science, University of Southampton, Southampton, UK
- Flowminder Foundation, Roslagsgatan 17, SE-11355 Stockholm, Sweden
| | - Kristine Nilsen
- WorldPop, Geography and Environmental Science, University of Southampton, Southampton, UK
- Flowminder Foundation, Roslagsgatan 17, SE-11355 Stockholm, Sweden
| | - Victor A. Alegana
- Population Health Theme, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Geography and Environmental Science, University of Southampton, Southampton, SO17 1BJ UK
| | - Claudio Bosco
- WorldPop, Geography and Environmental Science, University of Southampton, Southampton, UK
- Flowminder Foundation, Roslagsgatan 17, SE-11355 Stockholm, Sweden
| | - Rogers Ayiko
- Open Health Initiative, East African Community Secretariat, Arusha, Tanzania
| | - Andrew C. Seven Kajeguka
- EAC Integrated Health Programme (EIHP), Health Department, East African Community (EAC) Secretariat, Arusha, United Republic of Tanzania
| | - Zöe Matthews
- Division of Social Statistics and Demography & Centre for Global Health, Population, Poverty and Policy, University of Southampton, Southampton, UK
| | - Andrew J. Tatem
- WorldPop, Geography and Environmental Science, University of Southampton, Southampton, UK
- Flowminder Foundation, Roslagsgatan 17, SE-11355 Stockholm, Sweden
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Targeting the right interventions to the right people and places: the role of geospatial analysis in HIV program planning. AIDS 2018; 32:957-963. [PMID: 29547437 PMCID: PMC5965918 DOI: 10.1097/qad.0000000000001792] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Wen YH, Wu SS, Lin CHR, Tsai JH, Yang P, Chang YP, Tseng KH. A Bayesian Approach to Identifying New Risk Factors for Dementia: A Nationwide Population-Based Study. Medicine (Baltimore) 2016; 95:e3658. [PMID: 27227925 PMCID: PMC4902349 DOI: 10.1097/md.0000000000003658] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Dementia is one of the most disabling and burdensome health conditions worldwide. In this study, we identified new potential risk factors for dementia from nationwide longitudinal population-based data by using Bayesian statistics.We first tested the consistency of the results obtained using Bayesian statistics with those obtained using classical frequentist probability for 4 recognized risk factors for dementia, namely severe head injury, depression, diabetes mellitus, and vascular diseases. Then, we used Bayesian statistics to verify 2 new potential risk factors for dementia, namely hearing loss and senile cataract, determined from the Taiwan's National Health Insurance Research Database.We included a total of 6546 (6.0%) patients diagnosed with dementia. We observed older age, female sex, and lower income as independent risk factors for dementia. Moreover, we verified the 4 recognized risk factors for dementia in the older Taiwanese population; their odds ratios (ORs) ranged from 3.469 to 1.207. Furthermore, we observed that hearing loss (OR = 1.577) and senile cataract (OR = 1.549) were associated with an increased risk of dementia.We found that the results obtained using Bayesian statistics for assessing risk factors for dementia, such as head injury, depression, DM, and vascular diseases, were consistent with those obtained using classical frequentist probability. Moreover, hearing loss and senile cataract were found to be potential risk factors for dementia in the older Taiwanese population. Bayesian statistics could help clinicians explore other potential risk factors for dementia and for developing appropriate treatment strategies for these patients.
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Affiliation(s)
- Yen-Hsia Wen
- From the School of Pharmacy, College of Pharmacy, Kaohsiung Medical University (Y-HW, S-SW); Department of Psychiatry (J-HT) and Department of Neurology (Y-PC), Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung Medical University (PY); and Department of Computer Science and Engineering, National Sun Yat-sen University (C-HRL, K-HT), Kaohsiung, Taiwan
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Barankanira E, Molinari N, Niyongabo T, Laurent C. Spatial analysis of HIV infection and associated individual characteristics in Burundi: indications for effective prevention. BMC Public Health 2016; 16:118. [PMID: 26847711 PMCID: PMC4743168 DOI: 10.1186/s12889-016-2760-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 01/20/2016] [Indexed: 11/10/2022] Open
Abstract
Background Adequate resource allocation is critical in the battle against HIV/AIDS, especially in Africa. The determination of the location and nature of HIV services to implement must comply with the geographic, social and behavioral characteristics of patients. We therefore investigated the spatial heterogeneity of HIV prevalence in Burundi and then assessed the association of social and behavioral characteristics with HIV infection accounting for the spatial heterogeneity. Methods We used data from the 2010 Demographic and Health Survey. We analyzed these data with a geostatistical approach (which takes into account spatial autocorrelation) by i) interpolating HIV data using the kernel density estimation, ii) identifying the spatial clusters with high and low HIV prevalence using the Kulldorff spatial scan statistics, and then iii) performing a multivariate spatial logistic regression. Results Overall HIV prevalence was 1.4 %. The interpolated data showed the great spatial heterogeneity of HIV prevalence (from 0 to 10 %), independently of administrative boundaries. A cluster with high HIV prevalence was found in the capital city and adjacent areas (3.9 %; relative risk 3.7, p < 0.001) whereas a cluster with low prevalence straddled two southern provinces (0 %; p = 0.02). By multivariate spatial analysis, HIV infection was significantly associated with the female sex (posterior odds ratio [POR] 1.36, 95 % credible interval [CrI] 1.13-1.64), an older age (POR 1.97, 95 % CrI 1.26-3.08), the level of education (POR 1.50, 95 % CrI 1.22-1.84), the marital status (POR 1.86, 95 % CrI 1.23-2.80), a higher wealth index (POR 2.11, 95 % CrI 1.77-2.51), the sexual activity (POR 1.76, 95 % CrI 1.04-2.96), and a history of sexually transmitted infection (POR 2.03, 95 % CrI 1.56-2.64). Conclusions Our study, which shows where and towards which populations HIV resources should be allocated, could help national health policy makers develop an effective HIV intervention in Burundi. Our findings support the strategy of the Joint United Nations Programme on HIV/AIDS (UNAIDS) for country-specific, in-depth analyses of HIV epidemics to tailor national prevention responses.
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Affiliation(s)
- Emmanuel Barankanira
- Département des Sciences Naturelles, Ecole Normale Supérieure, Bujumbura, Burundi. .,TransVIHMI, IRD UMI 233 / INSERM U 1175 / Université de Montpellier, Montpellier, France. .,Institut de Recherche pour le Développement (UMI 233), 911 avenue Agropolis, BP 64501, Montpellier, 34394 cedex 5, France.
| | - Nicolas Molinari
- IMAG, UMR 519 / Centre Hospitalier Régional Universitaire de Montpellier / Université de Montpellier, Montpellier, France
| | | | - Christian Laurent
- TransVIHMI, IRD UMI 233 / INSERM U 1175 / Université de Montpellier, Montpellier, France
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