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Adjei NK, Samkange-Zeeb F, Boakye D, Saleem M, Christianson L, Kebede MM, Heise TL, Brand T, Esan OB, Taylor-Robinson DC, Agyemang C, Zeeb H. Ethnic differences in metabolic syndrome in high-income countries: A systematic review and meta-analysis. Rev Endocr Metab Disord 2024:10.1007/s11154-024-09879-9. [PMID: 38598068 DOI: 10.1007/s11154-024-09879-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/11/2024]
Abstract
This review aimed to systematically quantify the differences in Metabolic Syndrome (MetS) prevalence across various ethnic groups in high-income countries by sex, and to evaluate the overall prevalence trends from 1996 to 2022. We conducted a systematic literature review using MEDLINE, Web of Science Core Collection, CINAHL, and the Cochrane Library, focusing on studies about MetS prevalence among ethnic groups in high-income countries. We pooled 23 studies that used NCEP-ATP III criteria and included 147,756 healthy participants aged 18 and above. We calculated pooled prevalence estimates and 95% confidence intervals (CI) using both fixed-effect and random-effect intercept logistic regression models. Data were analysed for 3 periods: 1996-2005, 2006-2009, and 2010-2021. The pooled prevalence of MetS in high-income countries, based on the NCEP-ATP III criteria, was 27.4% over the studied period, showing an increase from 24.2% in 1996-2005 to 31.9% in 2010-2021, with men and women having similar rates. When stratified by ethnicity and sex, ethnic minority women experienced the highest prevalence at 31.7%, while ethnic majority women had the lowest at 22.7%. Notably, MetS was more prevalent in ethnic minority women than men. Among ethnic minorities, women had a higher prevalence of MetS than men, and the difference was highest in Asians (about 15 percentage points). Among women, the prevalence of MetS was highest in Asians (41.2%) and lowest in Blacks/Africans (26.7%). Among men, it was highest in indigenous minority groups (34.3%) and lowest among in Blacks/Africans (19.8%). MetS is increasing at an alarming rate in high-income countries, particularly among ethnic minority women. The burden of MetS could be effectively reduced by tailoring interventions according to ethnic variations and risk profiles.
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Affiliation(s)
- Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, L69 3GL, UK.
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
- Health Sciences Bremen, University of Bremen, Bremen, Germany.
| | | | - Daniel Boakye
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Maham Saleem
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Lara Christianson
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | | | - Thomas L Heise
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Tilman Brand
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Oluwaseun B Esan
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, L69 3GL, UK
| | - David C Taylor-Robinson
- Department of Public Health, Policy and Systems, University of Liverpool, Waterhouse Building 2nd Floor Block F, Liverpool, L69 3GL, UK
| | - Charles Agyemang
- Department of Public Health, Amsterdam Public Health Research Institute, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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Jonsson KR, Bailey CK, Corell M, Löfstedt P, Adjei NK. Associations between dietary behaviours and the mental and physical well-being of Swedish adolescents. Child Adolesc Psychiatry Ment Health 2024; 18:43. [PMID: 38555430 PMCID: PMC10981827 DOI: 10.1186/s13034-024-00733-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
AIMS This study aims to investigate the association between dietary behaviours, overweight/obesity, and mental health and well-being among Swedish adolescents. METHODS Data from the 2017/2018 Health Behaviour in School-aged Children (HBSC) survey of 3692 adolescents aged ≈11, ≈13, and ≈15 years was analysed. We evaluated the prevalence and association of dietary behaviours, characterised by daily intake of fruits and vegetables, consumption of sugar-sweetened beverages (SSBs) and sweets once per week, and daily consumption of family meals and breakfast, with socioeconomic and demographic factors. Multivariate logistic regression models (adjusted and unadjusted) were then used to examine the relationship between dietary behaviours, overweight/obesity, and mental health and well-being including psychosomatic complaints, life satisfaction, and school-related pressure. RESULTS Boys were more likely to eat breakfast and have meals together with their family than girls, but their fruit and vegetable intake was lower compared to girls. Adolescents with lower socioeconomic status (low family affluence, families perceived 'not well-off' and two unemployed parents), single-parent households and twoforeign born parents were more likely to engage in poorer dietary behaviours. Daily breakfast, family meals, fruit and vegetable intake were positively associated with mental health and well-being. Specifically, daily family meals were linked to higher life satisfaction, fewer psychosomatic complaints, and reduced school-related pressure. Breakfast emerged as a beneficial dietary habit, associated with higher life satisfaction, and a lower likelihood of psychosomatic complaints, school-related pressure, and overweight/obesity. Fruit and vegetable consumption was consistently associated with better mental health and well-being while associations between SSBs and sweets were mixed. CONCLUSIONS Improving mental health and well-being, along with tackling the rising rates of mental illness and challenges related to overweight/obesity in adolescents constitute key public health priorities. Implementing policies that promote the intake of fruits and vegetables, reducing the consumption of SSBs and sweets, and emphasizing the value of having breakfast and sharing family meals could offer a cost-effective public health intervention.
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Affiliation(s)
- Kenisha Russell Jonsson
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Box 463, Göteborg, 405 30, Sweden
| | | | - Maria Corell
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Box 463, Göteborg, 405 30, Sweden
| | - Petra Löfstedt
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Box 463, Göteborg, 405 30, Sweden
| | - Nicholas Kofi Adjei
- Department of Public Health and Policy, University of Liverpool, Waterhouse Building 2nd Floor, Block F, Liverpool, L69 3GL, UK.
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
- Health Sciences Bremen, University of Bremen, Bibliothekstrasse 1, 28359, Bremen, Germany.
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Adjei NK, Jonsson KR, Straatmann VS, Melis G, McGovern R, Kaner E, Wolfe I, Taylor-Robinson DC. Impact of poverty and adversity on perceived family support in adolescence: findings from the UK Millennium Cohort Study. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02389-8. [PMID: 38353677 DOI: 10.1007/s00787-024-02389-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/25/2024] [Indexed: 03/21/2024]
Abstract
Emotional support from family members may have an important effect on adolescent health outcomes, and has been identified as a target for policy to protect against the impacts of poverty and other early life adversities. However, few studies have assessed the extent to which poverty and adversity themselves influence the nature of emotional support that parents can provide to adolescents. We, therefore, aimed to investigate the impact of trajectories of income poverty and family adversities, including parental mental ill health, alcohol misuse and domestic violence across childhood developmental stages on young people's relationships with their families and perceived emotional support received. We analysed longitudinal data on 10,976 children from the nationally representative UK Millennium Cohort study. Exposure trajectories of poverty and family adversities were characterised using group-based multi-trajectory models (age 9 months-14 years). The outcomes were perceived emotional support and quality of family relationships, measured by the three-item Short Social Provisions Scale (SPS-3) and levels of parent-adolescent closeness and conflict, measured at age 14. ORs and 95% CIs were estimated using multivariable logistic regression models, adjusting for potential confounding factors. At age 14, the overall prevalence of low perceived emotional support was 13% (95% CI: 12, 14). Children of mothers with lower socioeconomic status (SES) were more likely to report low emotional support, with a clear social gradient (education-degree plus: 10.3% vs. no qualifications: 15.4%). Compared with children exposed to low levels of poverty and adversity, children in the persistent adversity trajectory groups experienced higher odds of low emotional support and low-quality parent-adolescent relationship; those exposed to both persistent poverty and poor parental mental health were particularly at increased risk of experiencing poor family relationships and low perceived emotional support (adjusted odds ratio 2·2; 95% CI 1·7-2·9). Low perceived emotional support and poor family relationships in adolescence are more prevalent among socially disadvantaged children and adolescents and those experiencing social adversity. Policies to improve levels of family support for UK adolescents should focus on improving modifiable determinants such as child poverty and family mental health.
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Affiliation(s)
- Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
| | - Kenisha Russell Jonsson
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Göteborg, Sweden
| | | | - Gabriella Melis
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Ingrid Wolfe
- Department of Women and Children's Health, King's College London, London, UK
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Adjei NK, Schlüter DK, Melis G, Straatmann VS, Fleming KM, Wickham S, Munford L, McGovern R, Howard LM, Kaner E, Wolfe I, Taylor-Robinson DC. Impact of Parental Mental Health and Poverty on the Health of the Next Generation: A Multi-Trajectory Analysis Using the UK Millennium Cohort Study. J Adolesc Health 2024; 74:60-70. [PMID: 37831048 DOI: 10.1016/j.jadohealth.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE Exposure to parental mental ill-health and poverty in childhood impact health across the lifecourse. Both maternal and paternal mental health may be important influences, but few studies have unpicked the complex interrelationships between these exposures and family poverty for later health. METHODS We used longitudinal data on 10,500 children from the nationally representative UK millennium cohort study. Trajectories of poverty, maternal mental health, and secondary caregiver mental health were constructed from child age of 9 months through to 14 years. We assessed the associations of these trajectories with mental health outcomes at the age of 17 years. Population-attributable fractions were calculated to quantify the contribution of caregivers' mental health problems and poverty to adverse outcomes at the country level. RESULTS We identified five distinct trajectories. Compared with children with low poverty and good parental mental health, those who experienced poverty and poor primary or secondary caregiver mental health (53%) had worse outcomes. Children exposed to both persistent poverty and poor caregiver mental health were at markedly increased risk of socioemotional behavioural problems (aOR 4.2; 95% CI 2.7-6.7), mental health problems (aOR 2.5; CI 1.6-3.9), and cognitive disability (aOR 1.7; CI 1.1-2.5). We estimate that 40% of socioemotional behavioural problems at the age of 17 were attributable to persistent parental caregivers' mental health problems and poverty. DISCUSSION More than half of children growing up in the UK are persistently exposed to either one or both of poor caregiver mental health and family poverty. The combination of these exposures is strongly associated with adverse health outcomes in the next generation.
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Affiliation(s)
- Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom.
| | - Daniela K Schlüter
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Gabriella Melis
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | | | - Kate M Fleming
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Sophie Wickham
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Luke Munford
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Louise M Howard
- Department of Health Service and Population Research, King's College London, London, United Kingdom
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Ingrid Wolfe
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | - David C Taylor-Robinson
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
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Black M, Adjei NK, Strong M, Barnes A, Jordan H, Taylor-Robinson D. Trajectories of Child Cognitive and Socioemotional Development and Associations with Adolescent Health in the UK Millennium Cohort Study. J Pediatr 2023; 263:113611. [PMID: 37468036 DOI: 10.1016/j.jpeds.2023.113611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 06/19/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE To identify and describe distinct trajectories of cognitive and socioemotional development during childhood and to examine their relationships with adolescent health. STUDY DESIGN We used group-based multitrajectory modeling applied to longitudinal data on 11 564 children up to age 14 years from the UK Millennium Cohort study to identify trajectories of cognitive and socioemotional development measured using validated instruments. We assessed associations between the derived trajectories and baseline socioeconomic, parental, and school factors using multinomial regression. Logistic regression was used to assess associations between trajectory groups and adolescent health at age 14 and 17 years. RESULTS Four child development trajectories were identified: "no problems" (76.5%); "late socio-emotional problems" (10.1%); "early cognitive and socioemotional problems" (8.6%); and "persistent cognitive and socioemotional problems" (4.8%). Those in the problem trajectories were more socioeconomically disadvantaged. Compared with the "no problem" trajectory, the "late socioemotional problems" trajectory had increased odds of overweight and mental ill-health at age 14 years of 1.50 (95% CI 1.24-1.81) and 2.51 (2.03-3.10), respectively. For the "persistent problems" group, the OR for overweight was 1.41 (1.04-1.91), and for mental ill-health, 3.01 (2.10-3.30). For both groups, the associations persisted to age 17 years. CONCLUSIONS In a representative UK cohort, groups of distinct trajectories of cognitive and socioemotional development were identified. Adverse development, if unresolved, can have a negative impact on weight and mental health in adolescence. Socioemotional development was the main driver of the impact on adolescent health and this requires emphasis in child health policy.
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Affiliation(s)
- Michelle Black
- School of Health and Related Research, The University of Sheffield, Regent Court, Sheffield, United Kingdom.
| | - Nicholas Kofi Adjei
- Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Mark Strong
- School of Health and Related Research, The University of Sheffield, Regent Court, Sheffield, United Kingdom
| | - Amy Barnes
- School of Health and Related Research, The University of Sheffield, Regent Court, Sheffield, United Kingdom
| | - Hannah Jordan
- School of Health and Related Research, The University of Sheffield, Regent Court, Sheffield, United Kingdom
| | - David Taylor-Robinson
- Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
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Bain LE, Mbouamba Yankam B, Kong JD, Claude Nkfusai N, Badru OA, Ebuenyi ID, Butali A, Adjei NK, Adeagbo O. Global Health Mentorship: Challenges and Opportunities for Equitable Partnership. BMJ Glob Health 2023; 8:e013751. [PMID: 37984896 PMCID: PMC10660828 DOI: 10.1136/bmjgh-2023-013751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/16/2023] [Indexed: 11/22/2023] Open
Affiliation(s)
- Luchuo Engelbert Bain
- Department of Psychology, University of Johannesburg, Auckland Park, South Africa
- IDRC, Ottawa, Ontario, Canada
| | - Brenda Mbouamba Yankam
- Department of Statistics, University of Nigeria, Nsukka, Nigeria
- Malaria Consortium, Buea, Cameroon
| | - Jude Dzevela Kong
- Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
| | - Ngwayu Claude Nkfusai
- Department of Publich Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Oluwaseun Abdulganiyu Badru
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, Iowa, USA
- Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Ikenna Desmond Ebuenyi
- Department of Rehabilitation Science & Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Azeez Butali
- Department of Oral Pathology, Radiology, and Medicine, College of Dentistry, University of Iowa, Iowa City, Iowa, USA
- Iowa Institute for Oral Health Research, University of Iowa, Iowa City, Iowa, USA
| | - Nicholas Kofi Adjei
- Department of Public Health, Policy, and Systems, University of Liverpool, Liverpool, UK
| | - Oluwafemi Adeagbo
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, Iowa, USA
- Department of Sociology, Faculty of Humanities, University of Johannesburg, Auckland Park, South Africa
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Zegeye B, Adjei NK, Ahinkorah BO, Tesema GA, Ameyaw EK, Budu E, Seidu AA, Yaya S. HIV testing among women of reproductive age in 28 sub-Saharan African countries: a multilevel modelling. Int Health 2023; 15:573-584. [PMID: 37099414 PMCID: PMC10472880 DOI: 10.1093/inthealth/ihad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 03/15/2023] [Accepted: 04/13/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) remains one of the most significant public health challenges globally, particularly in sub-Saharan Africa (SSA). Although HIV testing is a vital step for both prevention and treatment, its uptake is still low in SSA. We therefore examined HIV testing in SSA and its individual/household and community factors among women of reproductive age groups (15-49 y). METHODS Demographic and Health Survey data collected between 2010 and 2020 from 28 SSA countries were used for this analysis. We analysed the coverage of HIV testing and individual/household and community factors on 384 416 women in the reproductive age groups (15-49 y). Bivariate and multivariable multilevel binary logistic regression analysis were conducted to select candidate variables and to identify significant explanatory variables associated with HIV testing and the results were presented using adjusted odd ratios (AORs) at 95% confidence intervals (CIs). RESULTS The pooled prevalence of HIV testing among women of reproductive age in SSA was 56.1% (95% CI 53.7 to 58.4), with the highest coverage found in Zambia (86.9%) and the lowest in Chad (6.1%). Age (45-49 y; AOR 0.30 [95% CI 0.15 to 0.62]), women's education level (secondary; AOR 1.97 [95% CI 1.36 to 2.84]) and economic status (richest; AOR 2.78 [95% CI 1.40 to 5.51]) were some of the individual/household factors associated with HIV testing. Similarly, religion (no religion; AOR 0.58 [95% CI 0.34 to 0.97]), marital status (married; AOR 0.69 [95% CI 0.50 to 0.95]) and comprehensive knowledge of HIV (yes; AOR 2.01 [95% CI 1.53 to 2.64]) were significantly associated individual/household factors for HIV testing. Meanwhile, place of residence (rural; AOR 0.65 [95% CI 0.45 to 0.94]) was found to be a significant community-level factor. CONCLUSION More than half of married women in SSA have been tested for HIV, with between-country variations. Both individual/household factors were associated with HIV testing. Stakeholders should therefore consider all above-mentioned factors to plan an integrated approach to enhancing HIV testing through health education, sensitization, counselling and empowering older and married women, those with no formal education, those who do not have comprehensive HIV/AIDS knowledge and those in rural areas.
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Affiliation(s)
- Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Nicholas Kofi Adjei
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Hong Kong
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Estate Management, Takoradi Technical University, P.O. Box 256, Takoradi,Ghana
- Centre for Gender and Advocacy, Takoradi Technical University, P.O. Box 256, Takoradi,Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD 4811, Australia
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, 120 University Private, Ottawa, Ontario K1N 6N5, Canada
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Teshale AB, Wang VQ, Biney GK, Ameyaw EK, Adjei NK, Yaya S. Contraceptive use pattern based on the number and composition of children among married women in sub-Saharan Africa: a multilevel analysis. Contracept Reprod Med 2023; 8:39. [PMID: 37488658 PMCID: PMC10364431 DOI: 10.1186/s40834-023-00240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The relationship between composition of children and contraception use has received limited scholarly attention in sub-Saharan Africa. In this study, we examined the relationship between contraceptive methods, the number and composition of children in SSA. METHODS Data on 21 countries in sub-Saharan Africa (SSA) countries that had a Demographic and Health Survey on or before 2015 were analysed. We applied a multilevel multinomial logistic regression model to assess the influence of family composition on contraceptive use. Adjusted relative risk ratio (aRRR) and 95% CI were estimated. The significant level was set at p < 0.05. All the analyses were conducted using weighted data. RESULTS Women who had one son and two daughters (aRRR = 0.85, CI = 0.75, 0.95), two sons and one daughter (aRRR = 0.81 CI = 0.72, 0.92), one son and three daughters (aRRR = 0.66, CI = 0.54, 0.80), two sons and two daughters (aRRR = 0.59, CI = 0.50, 0.69), and three or more sons (aRRR = 0.75, CI = 0.63, 0.91) were less likely to use temporary modern contraceptive methods. Those with two sons and two daughters were less likely to use traditional methods (aRRR = 0.52, CI = 0.35, 0.78). Women in the older age group (35-49 years) were less likely to use temporary modern methods (aRRR = 0.60; 95%CI; 0.57, 0.63). However, this group of women were more likely to use permanent (sterilization) (aRRR = 1.71; 95%CI; 1.50, 1.91) and traditional methods (aRRR = 1.28; 95%CI; 1.14, 1.43). CONCLUSION These findings suggest that contraception needs of women vary based on the composition of their children, hence a common approach or intervention will not fit. As a result, contraception interventions ought to be streamlined to meet the needs of different categories of women. The findings can inform policymakers and public health professionals in developing effective strategies to improve contraceptive use in SSA.
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Affiliation(s)
- Achamyeleh Birhanu Teshale
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Vicky Qi Wang
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, Hong Kong
| | - Godness Kye Biney
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, USA
| | - Edward Kwabena Ameyaw
- Institute of Policy Studies and School of Graduate Studies, Lingnan University, Tuen Mun, Hong Kong
- L & E Research Consult Ltd, Upper West Region, Ghana
| | - Nicholas Kofi Adjei
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada.
- The George Institute for Global Health, Imperial College London, London, UK.
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Jonsson KR, Corell M, Löfstedt P, Adjei NK. The clustering of multiple health and lifestyle behaviors among Swedish adolescents: a person-oriented analysis. Front Public Health 2023; 11:1178353. [PMID: 37538263 PMCID: PMC10394625 DOI: 10.3389/fpubh.2023.1178353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/16/2023] [Indexed: 08/05/2023] Open
Abstract
Background Knowledge of the distribution, prevalence, and clustering of multiple health and lifestyle related behaviors (HLBs) among adolescents can inform the development of effective health-promoting policies and interventions. We assessed the clustering of multiple HLBs among 11, 13 and 15-year-old Swedish adolescents and examined the socioeconomic and demographic correlates for the identified clusters. Methods We used data from the 2017/2018 Swedish Health Behaviour in School-aged children (HBSC) study to conduct sex and age-stratified latent class analysis (LCA). The LCA was based on five HLBs: eating behavior and habits (EBH), physical activity (PA), tobacco usage (TU), alcohol consumption (AC) and sleeping habits and patterns (SHPs). Multinomial logistic regression models were used to assess the associations between the identified clusters and the socioeconomic and demographic characteristics of adolescents and their parents. Results Health behaviors varied by sex and age. Four distinct clusters were identified based on sex: cluster 1 (Mixed eating behaviors and habits, physical activity and low alcohol consumption), cluster 2 (Healthy lifestyle behaviors), cluster 3 (Unhealthy lifestyle behaviors), and cluster 4 (Breakfast, low alcohol consumption and tobacco usage). In the age-stratified analyzes, three clusters were identified: cluster 1 (Unhealthy lifestyle behaviors), cluster 2 (Moderately healthy lifestyle behaviors) and cluster 3 (Healthy lifestyle behaviors). The multinomial analysis showed that sex, age, family situation and perceived family wealth were strong predictors of health behaviors. Unhealthy behaviors were most commonly associated with socioeconomic disadvantage, having a migrant background, and living in reconstructed families or single-parent households. Conclusion Health behaviors vary significantly based on socioeconomic and demographic circumstances. Targeted policies and intervention programs are necessary to improve HLBs among vulnerable and at-risk adolescents.
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Affiliation(s)
- Kenisha Russell Jonsson
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Göteborg, Sweden
| | - Maria Corell
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Göteborg, Sweden
| | - Petra Löfstedt
- School of Public Health and Community Medicine, Institute of Medicine, Gothenburg University, Göteborg, Sweden
| | - Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
- Leibniz Institute for Prevention Research and Epidemiology–BIPS, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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Zegeye B, Idriss-Wheeler D, Ahinkorah BO, Ameyaw EK, Seidu AA, Adjei NK, Yaya S. Association between women's household decision-making autonomy and health insurance enrollment in sub-saharan Africa. BMC Public Health 2023; 23:610. [PMID: 36997885 PMCID: PMC10064715 DOI: 10.1186/s12889-023-15434-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 03/13/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Out of pocket payment for healthcare remains a barrier to accessing health care services in sub-Saharan Africa (SSA). Women's decision-making autonomy may be a strategy for healthcare access and utilization in the region. There is a dearth of evidence on the link between women's decision-making autonomy and health insurance enrollment. We, therefore, investigated the association between married women's household decision making autonomy and health insurance enrollment in SSA. METHODS Demographic and Health Survey data of 29 countries in SSA conducted between 2010 and 2020 were analyzed. Both bivariate and multilevel logistic regression analyses were carried out to investigate the relationship between women's household decision-making autonomy and health insurance enrollment among married women. The results were presented as an adjusted odds ratio (AOR) and the 95% confidence interval (CI). RESULTS The overall coverage of health insurance among married women was 21.3% (95% CI; 19.9-22.7%), with the highest and lowest coverage in Ghana (66.7%) and Burkina Faso (0.5%), respectively. The odds of health insurance enrollment was higher among women who had household decision-making autonomy (AOR = 1.33, 95% CI; 1.03-1.72) compared to women who had no household decision-making autonomy. Other covariates such as women's age, women's educational level, husband's educational level, wealth status, employment status, media exposure, and community socioeconomic status were found to be significantly associated with health insurance enrollment among married women. CONCLUSION Health insurance coverage is commonly low among married women in SSA. Women's household decision-making autonomy was found to be significantly associated with health insurance enrollment. Health-related policies to improve health insurance coverage should emphasize socioeconomic empowerment of married women in SSA.
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Affiliation(s)
- Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Dina Idriss-Wheeler
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | | | - Abdul-Aziz Seidu
- Centre for Gender and Advocacy, Takoradi Technical University, P.O.Box 256, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, QLD4811, Townsville, Queensland, Australia
| | - Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, 120 University Private, K1N 6N5, Ottawa, ON, Canada.
- The George Institute for Global Health, Imperial College London, London, UK.
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Adjei NK, Schlüter DK, Straatmann VS, Melis G, Fleming KM, McGovern R, Howard LM, Kaner E, Wolfe I, Taylor-Robinson DC. Quantifying the contribution of poverty and family adversity to adverse child outcomes in the UK: evidence from the UK Millennium Cohort Study. Lancet 2022; 400 Suppl 1:S16. [PMID: 36929958 DOI: 10.1016/s0140-6736(22)02226-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescent health is poor in the UK, with higher prevalence of adverse outcomes in adolescents exposed to family adversities that cluster with poverty from early life. However, little evidence exists to quantify the contribution of these exposures to poor child health in the UK to inform policy. The aim of this study was to estimate the proportion of child physical, mental, cognitive, and behavioural outcomes that could be prevented if exposure to poverty and family adversity during childhood were eliminated. METHODS We used nationally representative birth cohort data from the UK Millennium Cohort Study to calculate population attributable fractions. Exposure trajectories were characterised using previously developed group-based multi-trajectory models of childhood adversities up to age 14 years, including low poverty and family adversity, persistent poverty, persistent parental alcohol use, persistent domestic violence and abuse, and persistent poverty and poor parental mental health trajectory; and we assessed the effect of these trajectories on adolescent outcomes using regression models. These models were used to calculate population attributable fractions by contrasting a hypothetical scenario in which all children were in a low poverty and family adversity trajectory with the real-world scenario. FINDINGS The identified exposure trajectories contributed substantially to the burden of childhood developmental problems. Compared with the low poverty and family adversity trajectory, the overall percentage of socioemotional behavioural problems at age 14 years attributable to persistent poverty and family adversity trajectories was 54% (95% CI 45-60). A percentage of 36·1% (95% CI 21·8-46·2) was reported for drug experimentation, 32·6% (18·8-40·7) for cognitive disability, and 27·4% (12·9-34·9) for obesity (appendix). INTERPRETATION Poverty and family adversity contribute to a substantial burden of adverse child health and developmental outcomes in the UK population. FUNDING The National Institute for Health Research (NIHR) Policy Research Programme, NIHR Applied Research Collaboration South London at King's College Hospital NHS Foundation Trust, and the UK Medical Research Council.
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Affiliation(s)
- Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK.
| | - Daniela K Schlüter
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | | | - Gabriella Melis
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Kate M Fleming
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise M Howard
- Department of Health Service and Population Research, King's College London, London, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ingrid Wolfe
- Department of Women and Children's Health, King's College London, London, UK
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12
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Black M, Adjei NK. Longitudinal analysis of cognitive development across childhood and adolescence: evidence from the UK Millennium Cohort Study. Lancet 2022; 400 Suppl 1:S23. [PMID: 36929966 DOI: 10.1016/s0140-6736(22)02233-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Poor cognitive ability in childhood may lead to poor outcomes across the life course. Thus, isolating clusters of children who share similar trajectories of cognitive development across the childhood developmental stages will facilitate the development of more precise interventions. This study sought to identify trajectories of cognitive development across childhood and early-adolescence. We then aimed to assess associations of these trajectories with demographic factors, socioeconomic circumstances, parenting and school environment. METHOD We used data from the UK Millennium Cohort study on 11564 children aged between 3 and 14 years. Cognitive development was assessed through standard cognition tests administered individually to cohort members at ages 3, 5, 7, 11, and 14 years. The British Ability Scales II tests were used at ages 3-11 years and a word activity test at age 14 years. Standardised test scores were used to classify children into two groups to create a binary measure with children classified as having cognitive problems if they scored -1·25 SDs below the cohort mean. We used a group-based trajectory model to identify trajectories of cognitive development for children. Multinomial regression models were used to assess associations. FINDINGS Four trajectories were identified: early childhood cognitive problems (719 [6·2%] of sample), late childhood cognitive problems (1084 [9·4%]), persistent cognitive problems (498 [4·3%]) and low cognitive problems (9263 [80·1%]). In the multivariable regression analysis increasing deprivation, low maternal education and low parental involvement with school increased the risk of being in all of the problem groups compared with children with low cognitive problems. Males, being bullied and those of non-White ethnicity had an increased risk of being in the persistent problems group. Males, not being read to and those of non-White ethnicity had an increased risk of being in the early problems group. Females, being bullied and not enjoying school had an increased risk of being in the late problems group. INTERPRETATION Deprivation is associated with cognitive problems throughout childhood. Gender, ethnicity, the school environment, and aspects of parenting are associated with cognitive problems at different stages of childhood. These findings highlight possible targets for interventions. Using a contemporary nationally representative UK cohort, to identify characteristics of children with similar trajectories of cognitive development, strengthens generalisability of findings to inform UK policy. FUNDING UK National Institute for Health Research Doctoral Research Fellowship Programme.
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Affiliation(s)
- Michelle Black
- School of Health and Related Research, The University of Sheffield, Sheffield, UK.
| | - Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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Zegeye B, Adjei NK, Idriss-Wheeler D, Yaya S. Individual and community-level determinants of knowledge of ovulatory cycle among women of reproductive age in 29 African countries: a multilevel analysis. BMC Womens Health 2022; 22:394. [PMID: 36175854 PMCID: PMC9523965 DOI: 10.1186/s12905-022-01984-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Knowledge of the ovulatory cycle (KOC) can help reduce the chances of unwanted pregnancies and may improve a woman’s reproductive health. However, little is known about the factors associated with knowledge of the ovulatory cycle across Africa. Therefore, we aimed to investigate the individual/household and community level determinants of KOC among women of childbearing age in 29 African countries. Methods We used data from the Demographic and Health Surveys of 29 African countries conducted between 2010 and 2020. Bivariate and multivariate multilevel logistic regressions were used to examine the association between women’s correct knowledge of the ovulatory cycle and individual/household and community-level factors. The results were reported using adjusted odds ratios (AOR) with a 95% confidence interval (CI). Results The pooled results showed that correct KOC among women was 15.5% (95% CI 14.2–17.0%), varying from 11.5% in Liberia to 57.1% in the Democratic Republic of Congo. Regarding regional distribution, the highest prevalence of KOC was observed in West Africa (38.8%) followed by East Africa (21.3%) and was lowest in Southern Africa (15.6%) and Central Africa (15.5%). After adjusting for potential confounders, at the individual level, we found the odds of KOC to be higher among older women (40–44 years-aOR 3.57, 95% CI 1.90–6.67, 45–49 years-aOR 2.49, 95% CI 1.29–4.82), and women with higher educational level (aOR 2.58, 95% CI 1.40–4.75); at the community level, higher KOC was among women exposed to media (aOR 2.24, 95% CI 1.32–3.81). Conclusions Knowledge of ovulatory cycle among women of reproductive age was found to be low in the region and varied by country. Women’s age and educational level were the individual-level factors associated with increased knowledge of ovulatory cycle while community-level media exposure was found to be associated with increased knowledge of ovulatory cycle in this study. This finding highlights the need for appropriate strategies (possibly use of mass media) to increase knowledge of ovulatory cycle among women of reproductive age, especially among adolescents in Africa.
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Mukamana JI, Machakanja P, Zeeb H, Yaya S, Adjei NK. Investigating the associations between intimate partner violence and nutritional status of women in Zimbabwe. PLoS One 2022; 17:e0272038. [PMID: 35877657 PMCID: PMC9312962 DOI: 10.1371/journal.pone.0272038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Intimate partner violence (IPV) against women and poor nutritional status are growing health problems in low and middle-income countries (LMICs). Moreover, violence against women has been shown to be associated with poor nutrition. This study investigated the relationship between IPV and nutritional status (i.e., underweight, overweight, and obesity) among women of reproductive age (15–49 years) in Zimbabwe.
Methods
Pooled data from the 2005/2006, 2010/2011, and 2015 Zimbabwe Demographic Health Surveys (ZDHS) on 13,008 married/cohabiting women were analysed. Multinomial logistic regression models were used to examine the associations between the various forms of IPV and the nutritional status of women. We further estimated the prevalence of BMI ≥ 25.0 kg/m2 (overweight and obesity) by intimate partner violence type.
Results
The mean BMI of women was 24.3 kg/m2, more than one-fifth (24%) were overweight and about 12% were obese. Forty-three percent (43%) of women reported to have ever experienced at least one form of intimate partner violence. More than one-third (35%) of women who reported to have ever experienced at least one form of intimate partner violence had a BMI ≥ 25.0 kg/m2 (p< 0.01). Relative to normal weight, women who had ever experienced at least one form of IPV (i.e., physical, emotional, or sexual) were more likely to be obese (aOR = 2.59; 95% CI = 1.05–6.39). Women’s exposure to any form of intimate partner violence was not significantly associated with the likelihood of being underweight or overweight relative to normal weight.
Conclusions
The study findings show that women of reproductive age in Zimbabwe are at high risk of both IPV and excess weight. Moreover, we found a positive relationship between exposure to at least one form IPV and obesity. Public health interventions that target the well-being, empowerment and development of women are needed to address the complex issue of IPV and adverse health outcomes, including obesity.
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Affiliation(s)
| | - Pamela Machakanja
- Institute of Peace, Leadership and Governance, Africa University, Mutare, Zimbabwe
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Canada
| | - Nicholas Kofi Adjei
- Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
- * E-mail:
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15
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Zegeye B, Adjei NK, Olorunsaiye CZ, Ahinkorah BO, Ameyaw EK, Budu E, Seidu AA, Yaya S. Time trends in socio-economic and geographic-based inequalities in childhood wasting in Guinea over 2 decades: a cross-sectional study. Int Health 2022; 15:10-18. [PMID: 35106565 PMCID: PMC9808518 DOI: 10.1093/inthealth/ihac002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 12/09/2021] [Accepted: 01/12/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Today, an estimated 7.3% (50 million) of all children <5 y of age suffer from wasting, with more burden in African countries including Guinea. Investigating inequalities in childhood wasting is essential for designing efficient programs and interventions, but no related evidence exists in Guinea. This study aimed to examine the trends in the prevalence of childhood wasting and the extent of sex, socio-economic and geographic-based disparities in Guinea. METHODS Data from the 1999, 2005 and 2012 Guinea Demographic and Health Surveys and the 2016 Guinea Multiple Indicator Cluster Survey, with a total of 16 137 children <5 y of age were included for analysis. For inequality analysis, we used the 2019 updated World Health Organization Health Equity Assessment Toolkit (HEAT) software. Inequality was measured using four summary measures (difference [D], population attributable risk [PAR], ratio [R] and population attributable fraction [PAF]) for five equity stratifiers (economic status, education, place of residence, sex and subnational region). We computed 95% confidence intervals (CIs) around the points estimates to measure statistical significance. RESULTS The findings revealed a pro-rich (R=1.68 [95% CI 1.11 to 2.24]), pro-urban (PAR=-1.04 [95% CI -1.90 to -0.18]) and subnational region (D=8.11 [95% CI 4.85 to 11.36]) inequalities in childhood wasting across all surveys. Except in 2005, education-based disparities (PAF=-18.2 [95% CI -36.10 to -0.26]) were observed across all survey years, but not sex-based disparities. An approximately constant inequality pattern was seen across all dimensions. CONCLUSIONS This study showed inequalities in childhood wasting in Guinea with a disproportionately higher risk of wasting among children from disadvantaged subpopulations/mothers, including uneducated, poorest/poor, rural residents and regions. Policies that target disadvantaged populations need to be considered in order to ensure social protection, access to a wholesome diet and universal and quality health services.
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Affiliation(s)
- Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Nicholas Kofi Adjei
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Eugene Budu
- 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
| | - Sanni Yaya
- Corresponding author: Tel: +1-613-562-5800; E-mail:
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Russell Jonsson K, Taylor-Robinson DC, Schultz Straatmann V, Melis G, Adjei NK. Health behaviors and subsequent mental health problems during the COVID-19 pandemic: A longitudinal analysis of adults in the UK. Front Public Health 2022; 10:1064677. [PMID: 36711346 PMCID: PMC9877513 DOI: 10.3389/fpubh.2022.1064677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/23/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Public health mitigation policies aimed at slowing the spread of COVID-19 led to an increase in mental health problems (MHPs). This study examines the association between multiple pre-pandemic health behaviors and MHPs prior to, and during, the COVID-19 pandemic. Methods We analyzed a representative population sample of 11,256 adults (aged 20-65 years) from Understanding Society-The UK Household Longitudinal Study. Baseline data from participants interviewed in 2017/2019 (wave 9) were linked to web surveys conducted during the COVID-19 pandemic. We used latent class analysis (LCA) to identify mutually exclusive health behavior (physical activity, alcohol consumption, eating habits and smoking tobacco) clusters by gender, and examined the sociodemographic correlates of each cluster. We assessed how pre-pandemic latent classes of health behaviors were associated with changes in MHPs during the pandemic using fixed effects regression models. Results Three health behavior clusters were identified: positive (33%), moderate (24%), and high risk (43%), where similar behaviors clustered within individuals and sociodemographic circumstances. In particular, gender, age, migrant status and ethnicity were found to have strong associations with each cluster. Our results also demonstrated a clear association in MHPs with health behaviors both prior to, and during the pandemic. There were significant increases in MHPs between 2017/2019 and January 2021, with fluctuations coinciding with changes in public health mitigation policies. Assessments across the three clusters showed about 25.2%, 16.9%, and 0.7% increases in MHPs in the positive, moderate and high risk health behavior clusters, respectively. Discussion This study shows that pre-pandemic health behaviors were significantly associated with mental health before and during the pandemic. Holistic policy interventions and promotions targeting multiple health behaviors may be an effective strategy to improve mental health in the pandemic recovery period.
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Affiliation(s)
- Kenisha Russell Jonsson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Göteborg, Sweden
| | | | - Viviane Schultz Straatmann
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom.,Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Gabriella Melis
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
| | - Nicholas Kofi Adjei
- Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom.,Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
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Yaya S, Odusina EK, Adjei NK. Health care seeking behaviour for children with acute childhood illnesses and its relating factors in sub-Saharan Africa: evidence from 24 countries. Trop Med Health 2021; 49:95. [PMID: 34906263 PMCID: PMC8670049 DOI: 10.1186/s41182-021-00385-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood illnesses and mortality rates have declined over the past years in sub-Saharan African countries; however, under-five mortality is still high in the region. This study investigated the magnitude and factors associated with health care seeking behaviour for children with childhood illnesses in 24 sub-Saharan African countries. METHODS We used secondary data from Demographic and Health Surveys (DHSs) conducted between 2013 and 2018 across the 24 sub-Saharan African countries. Binary logistic regression models were applied to identify the factors associated with health care seeking behaviour for children with acute childhood illnesses. The results were presented using adjusted odds ratios (aOR) with 95% confidence intervals (CIs). RESULTS Overall, 45% of children under-5 years with acute childhood illnesses utilized health care facilities. The factors associated with health care seeking behaviour for children with acute illnesses were sex of child, number of living children, education, work status, wealth index, exposure to media and distance to a health facility. CONCLUSIONS Over half of mothers did not seek appropriate health care for under-five childhood illnesses. Effective health policy interventions are needed to enhance health care seeking behaviour of mothers for childhood illnesses in sub-Saharan African countries.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON Canada
- The George Institute for Global Health, Imperial College London, London, UK
| | - Emmanuel Kolawole Odusina
- Department of Demography and Social Statistics, Faculty of Social Sciences, Federal University, Oye, Ekiti Nigeria
| | - Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, L69 3BX UK
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18
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Zegeye B, Adjei NK, Olorunsaiye CZ, Ahinkorah BO, Ameyaw EK, Seidu AA, Yaya S. Pregnant women's decision-making capacity and adherence to iron supplementation in sub-Saharan Africa: a multi-country analysis of 25 countries. BMC Pregnancy Childbirth 2021; 21:822. [PMID: 34903198 PMCID: PMC8667357 DOI: 10.1186/s12884-021-04258-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anaemia and related complications during pregnancy is a global problem but more prevalent in sub-Sahara Africa (SSA). Women's decision-making power has significantly been linked with maternal health service utilization but there is inadequate evidence about adherence to iron supplementation. This study therefore assessed the association between household decision-making power and iron supplementation adherence among pregnant married women in 25 sub-Saharan African countries. METHODS We used data from the Demographic and Health Surveys (DHS) of 25 sub-Saharan African countries conducted between 2010 and 2019. Women's decision-making power was measured by three parameters; own health care, making large household purchases and visits to her family or relatives. The association between women's decision-making power and iron supplementation adherence was assessed using logistic regressions, adjusting for confounders. The results were presented as adjusted odds ratio (AOR) with 95% confidence intervals (CIs). RESULTS Approximately 65.4% of pregnant married women had made decisions either alone or with husband in all three decisions making parameters (i.e., own health care, making large household purchases, visits to her family or relatives). The rate of adherence to iron medication during pregnancy was 51.7% (95% CI; 48.5-54.9%). Adherence to iron supplementation was found to be higher among pregnant married women who had decision-making power (AOR = 1.46, 95% CI; 1.16-1.83), secondary education (AOR = 1.45, 95% CI; 1.05-2.00) and antenatal care visit (AOR = 2.77, 95% CI; 2.19-3.51). Wealth quintiles and religion were significantly associated with adherence to iron supplementation. CONCLUSIONS Adherence to iron supplementation is high among pregnant women in SSA. Decision making power, educational status and antenatal care visit were found to be significantly associated with adherence to these supplements. These findings highlight that there is a need to design interventions that enhance women's decision-making capacities, and empowering them through education to improve the coverage of antenatal iron supplementation.
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Affiliation(s)
- Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | | | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland Australia
| | - Sanni Yaya
- School of International Development and Global Studies, Faculty of Social Sciences, University of Ottawa, 120 University Private, Ottawa, ON K1N 6N5 Canada
- The George Institute for Global Health, Imperial College London, London, UK
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Zegeye B, Adjei NK, Ahinkorah BO, Ameyaw EK, Budu E, Seidu A, Yaya S. Individual-, household-, and community-level factors associated with pregnant married women's discriminatory attitude towards people living with HIV in sub-Saharan Africa: A multicountry cross-sectional study. Health Sci Rep 2021; 4:e430. [PMID: 34746443 PMCID: PMC8549109 DOI: 10.1002/hsr2.430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND AIMS Discriminatory attitude towards people living with human immunodeficiency virus (HIV) remains a major problem in the prevention and treatment of HIV in sub-Sahara Africa (SSA). Understanding the multiple factors linked to discriminatory attitude towards people living with HIV/AIDS (PLWHA) in SSA is necessary for developing appropriate interventions. This study aimed at investigating the individual, household, and community-level factors associated with pregnant married women's discriminatory attitude towards people living with HIV/AIDS. METHODS We used data from the Demographic and Health Surveys of 12 sub-Saharan African countries conducted between 2015 and 2019. Data on 17 065 pregnant married women were analyzed. Bivariate (chi-squared test) and multivariable multilevel logistic regression analyses were applied to investigate the factors associated with discriminatory attitude towards PLWHA. The results were reported as adjusted odds ratio (aOR) at 95% confidence interval (CI). RESULTS The mean age of participants was 31.2 ± 8.5. The prevalence of discriminatory attitude towards PLWHA was 36.2% (95% CI: 33.4%-39.1%). Individual/household-level factors associated with discriminatory attitude towards PLWHA were women's educational level (secondary school-aOR = 0.49, 95% CI: 0.26-0.93), husband's educational level (higher education-aOR = 0.35, 95% CI: 0.16-0.76), decision-making power (yes-aOR = 0.51, 95% CI: 0.38-0.69), wife-beating attitude (disagreement with wife beating-aOR = 0.58, 95% CI: 0.43-0.79), and religion (Muslim-aOR = 1.92, 95% CI: 1.22-3.04). Community socioeconomic status (medium-aOR = 0.61, 95% CI: 0.41-0.93) was the only community-level factor associated with discriminatory attitude towards PLWHA. CONCLUSION More than one-third of pregnant married women in SSA had discriminatory attitude towards PLWHA. Women's educational level, husband's educational level, decision-making power, wife-beating attitude, religion, and community socio-economic status were associated with discriminatory attitude towards PLWHA. To lessen the prevalence of discriminatory attitude towards PLWHA, considering these significant factors is needed. Therefore, governments and other stakeholders in the respective countries need to increase education coverage. Moreover, empowering women through education and economy is crucial. Finally, working with religious leaders to increase awareness about HIV and discriminatory attitude towards PLWHA should also be a priority in SSA.
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Affiliation(s)
- Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field OfficeShewarobitEthiopia
| | | | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of HealthUniversity of Technology SydneyUltimoNew South WalesAustralia
| | - Eugene Budu
- Department of Population and HealthUniversity of Cape CoastCape CoastGhana
| | - Abdul‐Aziz Seidu
- Department of Population and HealthUniversity of Cape CoastCape CoastGhana
- College of Public Health, Medical and Veterinary SciencesJames Cook UniversityTownsvilleQueenslandAustralia
| | - Sanni Yaya
- School of International Development and Global StudiesUniversity of OttawaOttawaOntarioCanada
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Adjei NK, Schlüter DK, Straatmann VS, Melis G, Fleming KM, McGovern R, Howard LM, Kaner E, Wolfe I, Taylor-Robinson DC. Impact of poverty and family adversity on adolescent health: a multi-trajectory analysis using the UK Millennium Cohort Study. Lancet Reg Health Eur 2021; 13:100279. [PMID: 35199082 PMCID: PMC8841277 DOI: 10.1016/j.lanepe.2021.100279] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool United Kingdom
- Correspondence to: Dr. Nicholas Kofi Adjei, Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom Waterhouse Building 2nd Floor Block F, L69 3GL, Liverpool United Kingdom.
| | - Daniela K. Schlüter
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool United Kingdom
| | | | - Gabriella Melis
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool United Kingdom
| | - Kate M. Fleming
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool United Kingdom
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle United Kingdom
| | - Louise M. Howard
- Department of Health Service and Population Research, King's College London, London, United Kingdom
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle United Kingdom
| | - Ingrid Wolfe
- Department of Women and Children's Health, King's College London, London, United Kingdom
| | - David C. Taylor-Robinson
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool United Kingdom
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Zegeye B, Adjei NK, Ahinkorah BO, Ameyaw EK, Seidu AA, Olorunsaiye CZ, Yaya S. Does attitude towards wife beating determine infant feeding practices during diarrheal illness in sub-Saharan Africa? Trop Med Health 2021; 49:80. [PMID: 34627410 PMCID: PMC8501539 DOI: 10.1186/s41182-021-00369-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 09/21/2021] [Indexed: 11/16/2022] Open
Abstract
Background Inappropriate feeding practices of children during illness remains a public health problem globally, particularly in sub-Saharan Africa (SSA). One strategy to improve child health outcomes is through women empowerment—measured by wife beating attitude. However, the role of attitude towards wife beating in child feeding practices has not been comprehensively studied. Therefore, we investigated the association between women's attitude towards wife beating and child feeding practices during childhood diarrhea in 28 countries in SSA. Methods We analyzed data from the Demographic and Health Survey on 40,720 children under 5 years. Bivariate and multivariate binary logistic regression analyses were applied to assess the association between women's attitude towards wife beating and child feeding practices. The results were presented using adjusted odds ratio (aOR) with 95% confidence intervals (CIs). Results The pooled results showed that appropriate feeding practices during diarrheal illness among under-five children was 9.3% in SSA, varying from 0.4% in Burkina Faso to 21.1% in Kenya. Regarding regional coverage, the highest coverage was observed in Central Africa (9.3%) followed by East Africa (5.5%), Southern Africa (4.8%), and West Africa (4.2%). Women who disagreed with wife-beating practices had higher odds of proper child feeding practices during childhood diarrhea compared to those who justified wife-beating practices (aOR = 2.02, 95% CI; 1.17–3.48). Conclusion The findings suggest that women’s disagreement with wife beating is strongly associated with proper child feeding practices during diarrheal illness in SSA. Proactive measures and interventions designed to change attitudes towards wife-beating practices are crucial to improving proper feeding practices in SSA.
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Affiliation(s)
- Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | | | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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22
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Yaya S, Odusina EK, Adjei NK, Uthman OA. Association between intimate partner violence during pregnancy and risk of preterm birth. BMC Public Health 2021; 21:1610. [PMID: 34479527 PMCID: PMC8414853 DOI: 10.1186/s12889-021-11625-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background Preterm birth is a risk factor for child survival in both the short and long term. In Zimbabwe, the prevalence of preterm birth is rising, and there are growing concerns about the adverse consequences. This study explored the association between intimate partner violence (IPV) during pregnancy and preterm birth in Zimbabwe. Methods Using data from the 2015 Zimbabwe Demographic and Health Survey, we applied propensity score matching to estimate the effect of IPV during pregnancy on preterm birth among women of reproductive age (15–49 years). A total of 4833 pregnant women who gave birth during the five years preceding the survey were analysed. Results We successfully matched 79 women who were exposed to IPV during pregnancy to 372 unexposed during pregnancy. Using the matched sample, the probability of preterm delivery was significantly higher among women who were exposed to IPV during pregnancy than those who were not exposed. The findings showed that 7 out of 79 (8.9%) of women exposed to IPV during pregnancy experienced preterm delivery, and 11 out of 372 (3.0%) of those who were not exposed to IPV during pregnancy experienced preterm delivery. In the urban areas, those exposed to IPV during pregnancy were almost five times more likely to experience preterm delivery (OR = 4.8, 95% CI 2.0–11.6), but the association was not significantly different among women in rural areas. Conclusion The findings showed that women exposed to IPV during pregnancy were at increased risk of preterm birth. Some of the risk factors associated with IPV were urban residence, low economic status and unemployment. Effective policies and programmes are required to address the issue of IPV in Zimbabwe.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
| | | | - Nicholas Kofi Adjei
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Olalekan A Uthman
- Warwick Centre for Applied Health Research and Delivery (WCAHRD), Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
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Yaya S, Zegeye B, Ahinkorah BO, Seidu AA, Ameyaw EK, Adjei NK, Shibre G. Predictors of skilled birth attendance among married women in Cameroon: further analysis of 2018 Cameroon Demographic and Health Survey. Reprod Health 2021; 18:70. [PMID: 33766075 PMCID: PMC7993505 DOI: 10.1186/s12978-021-01124-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/17/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND In Cameroon, maternal deaths remain high. The high maternal deaths in the country have been attributed to the low utilization of maternal healthcare services, including skilled birth attendance. This study examined the predictors of skilled birth services utilization among married women in Cameroon. METHODS Data from the 2018 Cameroon Demographic and Health Survey was analyzed on 7881 married women of reproductive age (15-49 years). Both bivariate and multivariable logistic regression analyses were carried out to determine the predictors of skilled childbirth services. The results were presented with crude odds ratio (cOR) and adjusted odds ratio (aOR) and 95% confidence interval (CI). RESULTS The coverage of skilled birth attendance among married women of reproductive age in Cameroon was 66.2%. After adjusting for potential confounders, media exposure (aOR = 1.46, 95% CI: 1.11-1.91), higher decision making (aOR = 1.88, 95% CI: 1.36-2.59), maternal education (aOR = 2.38, 95% CI; 1.65-3.42), place of residence (aOR = 0.50, 95% CI; 0.33-0.74), religion (aOR = 0.55, 95% CI; 0.35-0.87), economic status (aOR = 5.16, 95% CI; 2.58-10.30), wife beating attitude (aOR = 1.32, 95% CI; 1.05-1.65), parity (aOR = 0.62, 95% CI; 0.41-0.93) and skilled antenatal care (aOR = 14.46, 95% CI; 10.01-20.89) were found to be significant predictors of skilled birth attendance. CONCLUSIONS This study demonstrates that social, economic, regional, and cultural factors can act as barriers to skilled childbirth services utilization in Cameroon. Interventions that target women empowerment, antenatal care awareness and strengthening are needed, especially among the rural poor, to reduce barriers to care seeking. Maternal healthcare services utilization interventions and policies in Cameroon need to focus on specific equity gaps that relate to socio-economic status, maternal education, and the economic empowerment of women. Such policies and interventions should also aim at reducing geographical barriers to access to maternal healthcare services, including skilled birth attendance. Due to the presence of inequities in the use of skilled birth attendance services, programs aimed at social protection and empowerment of economically disadvantaged women are necessary for the achievement of the post-2015 targets and the Sustainable Development Goals. Globally, Cameroon is one of the countries with high maternal deaths. Low utilization of maternal healthcare services, including skilled birth attendance have been found to account for the high maternal deaths in the country. This study sought to examine the factors associated with skilled childbirth services utilization among married women in Cameroon. Using data from the 2018 Cameroon Demographic and Health Survey, we found that the coverage of skilled birth attendance among married women of reproductive age in Cameroon is high. Factors such as higher decision-making power, higher maternal education, place of residence, religion, higher economic status, wife beating attitude, parity and skilled antenatal care were found to be the significant predictors of skilled birth attendance. This study has shown that socio-economic, regional and cultural factors account for the utilization of skilled childbirth services utilization in Cameroon. Interventions aimed at enhancing the utilization of skilled childbirth services in Cameroon should target women empowerment, antenatal care awareness creation and sensitization, especially among the rural poor, to reduce barriers to care seeking. Maternal healthcare services utilization interventions and policies in Cameroon need to focus on specific equity gaps that relate to socio-economic status, maternal education, and the economic empowerment of women.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Canada
- The George Institute for Global Health, Imperial College London, London, UK
| | - Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW Australia
| | - Nicholas Kofi Adjei
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Heiligenhafen, Germany
| | - Gebretsadik Shibre
- Department of Reproductive, Family and Population Health, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Zegeye B, Ahinkorah BO, Idriss-Wheeler D, Olorunsaiye CZ, Adjei NK, Yaya S. Modern contraceptive utilization and its associated factors among married women in Senegal: a multilevel analysis. BMC Public Health 2021; 21:231. [PMID: 33509144 PMCID: PMC7845035 DOI: 10.1186/s12889-021-10252-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Utilization of modern contraceptives is still low in low-and middle-income countries, although fertility and population growth rates are high. In Senegal, modern contraceptive utilization is low, with few studies focusing on its associated factors. This study examined modern contraceptive use and its associated factors among married women in Senegal. Methods Data from the 2017 Continuous Demographic and Health Survey (C-DHS) on 11,394 married women was analysed. We examined the associations between the demographic and socioeconomic characteristics of women and their partners and modern contraceptive use using multilevel logistic regression models. Adjusted odds ratios with 95% confidence intervals (CI) were estimated. Results The utilization of modern contraceptives among married women was 26.3%. Individual level factors associated with modern contraceptive use were women’s age (45–49 years-aOR = 0.44, 0.30–0.63), women’s educational level (higher-aOR = 1.88, 1.28–2.76) husband’s educational level (higher-aOR = 1.43, 1.10–1.85)), number of living children (5 or more children-aOR = 33.14, 19.20–57.22), ideal number of children (2 children-aOR = 1.95, 1.13–3.35), desire to have more children (wants no more-aOR = 2.46, 2.06–2.94), ethnicity (Diola-aOR = 0.70, 0.50–0.99), media exposure (yes-aOR = 1.44, 1.16–1.79)), wealth index (richer-aOR = 1.31, 1.03–1.67) and decision making power of women (decision making two-aOR = 1.20, 1.02–1.41). Whereas, region (Matam-aOR = 0.35, 0.23–0.53), place of residence (rural-aOR = 0.76, 0.63–0.93), community literacy level (high-aOR = 1.31, 1.01–1.71) and community knowledge level of modern contraceptives (high-aOR = 1.37, 1.13–1.67) were found as significant community level factors. Conclusions The findings indicate that both individual and community level factors are significantly associated with modern contraceptive use among married women in Senegal. Interventions should focus on enhancing literacy levels of women, their husbands and communities. Furthermore, strengthening awareness and attitude towards family planning should be given priority, especially in rural areas and regions with low resources.
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Affiliation(s)
- Betregiorgis Zegeye
- HaSET Maternal and Child Health Research Program, Shewarobit Field Office, Shewarobit, Ethiopia
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Dina Idriss-Wheeler
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Nicholas Kofi Adjei
- Leibniz Institute for Prevention Research and Epidemiology, BIPS, Bremen, Germany
| | - Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, 120 University Private, Ottawa, ON, K1N 6N5, Canada. .,The George Institute for Global Health, Imperial College London, London, UK.
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Jonsson KR, Oberg G, Samkange-Zeeb F, Adjei NK. Determinants and impact of role-related time use allocation on self-reported health among married men and women: a cross-national comparative study. BMC Public Health 2020; 20:1204. [PMID: 32758207 PMCID: PMC7404928 DOI: 10.1186/s12889-020-09306-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 07/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Research on the effects of marriage on health maintains that there is a gender-specific gradient, with men deriving far greater benefits than women. One reason provided for this difference is the disproportionate amount of time spent by women on housework and childcare. However, this hypothesis has yet to be explicitly tested for these role-related time use activities. This study provides empirical evidence on the association between role-related time use activities (i.e. housework, childcare and paid work) and self-reported health among married men and women. Methods Data from the Multinational Time Use Study (MTUS) on 32,881 men and 26,915 women from Germany, Italy, Spain, the UK and the US were analyzed. Seemingly unrelated regression (SUR) models and multivariable logistic regression were used to estimate the association between role-related time use activities and self-reported health among married men and women. Results The findings showed that education, occupation and number of children under 18 years old in the household were the most consistent predictors of time allocation among married men and women. Significant gender differences were also found in time allocation, with women sacrificing paid working time or reducing time devoted to housework for childcare. Men, in contrast, were less likely to reduce paid working hours to increase time spent on childcare, but instead reduced time allocation to housework. Allocating more time to paid work and childcare was associated with good health, whereas time spent on housework was associated with poor health, especially among women. Conclusions Time allocation to role-related activities have differential associations on health, and the effects vary by gender and across countries. To reduce the gender health gap among married men and women, public policies need to take social and gender roles into account.
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Affiliation(s)
- Kenisha Russell Jonsson
- The Institute for Future Studies, Stockholm, Sweden.,Department of Sociology, University of Essex, Colchester, UK
| | - Gustav Oberg
- The Institute for Future Studies, Stockholm, Sweden
| | - Florence Samkange-Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Unit Social Epidemiology, Achterstrasse 30, 28359, Bremen, Germany
| | - Nicholas Kofi Adjei
- The Institute for Future Studies, Stockholm, Sweden. .,Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Unit Social Epidemiology, Achterstrasse 30, 28359, Bremen, Germany. .,Health Sciences Bremen, University of Bremen, Bremen, Germany.
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Yaya S, Ahinkorah BO, Ameyaw EK, Seidu AA, Darteh EKM, Adjei NK. Proximate and socio-economic determinants of under-five mortality in Benin, 2017/2018. BMJ Glob Health 2020; 5:e002761. [PMID: 32843572 PMCID: PMC7449341 DOI: 10.1136/bmjgh-2020-002761] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Globally, under-five mortality has declined significantly, but still remains a critical public health problem in sub-Saharan African countries such as Benin. Yet, there is no empirical information in the country using a nationally representative data to explain this phenomenon. The aim of this study was to examine how proximate and socio-economic factors are associated with mortality in under-five children in Benin. METHODS We analysed data of 5977 under-five children using the 2017 to 2018 Benin Demographic and Health Surveys. Multivariable hierarchical logistic regression modelling technique was applied to investigate the factors associated with under-five mortality. The fit of the models were assessed using variance inflation factor and Pseudo R2. Results were reported as adjusted odds ratios (aORs). All comparisons were considered to be statistically significant at p<0.05. RESULTS The study revealed an under-five mortality rate of 96 deaths per 1000 live births in Benin. Regarding the socio-economic determinants, the risk of death was found to be higher in children born in the Plateau region (aOR=3.05; 95% CI: 1.29 to 7.64), in rural areas (aOR=1.45; 95% CI: 1.07 to 1.98) and children with ≥4 birth rank and >2 years of birth interval (aOR=1.52; 95% CI: 1.07 to 2.17). Among the proximate determinants, we found the probability of death to be higher in children whose mothers had no postnatal check-up (PNC) visits after delivery (aOR=1.79; 95% CI: 1.22 to 2.63), but there was no significant association between individual-level/household-level factors and under-five mortality. CONCLUSION This study has established that socio-economic and proximate factors are important determinants of under-five mortality in Benin. Our findings have shown the need to implement both socio-economic and proximate interventions, particularly those related to PNC visits when planning on under-five mortality. To achieve this, a comprehensive, long-term public health interventions, which consider the disparity in the access and utilisation of healthcare services in Benin are key.
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Affiliation(s)
- Sanni Yaya
- School of International Development and Global Studies, University of Ottawa, Ottawa, Ontario, Canada
- The George Institute for Global Health, Imperial College London, London, UK
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Edward Kwabena Ameyaw
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Abdul-Aziz Seidu
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | | | - Nicholas Kofi Adjei
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Bremen, Germany
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Mensah A, Adjei NK. Work-life balance and self-reported health among working adults in Europe: a gender and welfare state regime comparative analysis. BMC Public Health 2020; 20:1052. [PMID: 32669103 PMCID: PMC7364652 DOI: 10.1186/s12889-020-09139-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 06/17/2020] [Indexed: 12/02/2022] Open
Abstract
Background The pressing demands of work over the years have had a significant constraint on the family and social life of working adults. Moreover, failure to achieve a ‘balance’ between these domains of life may have an adverse effect on their health. This study investigated the relationship between work-life conflict and self-reported health among working adults in contemporary welfare countries in Europe. Methods Data from the 6th European Working Conditions Survey 2015 on 32,275 working adults from 30 countries in Europe were analysed. Multivariate logistic regression models were used to examine the associations between work-life balance and self-reported health among men and women. We further used a 2 stage multi-level logistic regression to assess variations in self-reported health among welfare state regimes by gender. Results The results showed a strong association between work-life conflict and poor self-reported health among working adults in Europe (aOR = 2.07; 95% CI: 1.93–2.23). However, the magnitude of the effect differed slightly by gender (men: aOR = 1.97; 95% CI: 1.78–2.18 vs women: aOR = 2.23; 95% CI: 2.01–2.47). Furthermore, we found variations in the relationship between work-life conflict and poor self-reported health between welfare states regimes. The association was found to be weaker in the Nordic and Southern welfare states than the Liberal, Conservative, and Central Eastern European welfare states. Although the associations were more consistent among men than women in the Conservative welfare states regime, we found higher associations for women than men in the Southern, Nordic, Liberal, and Central Eastern European welfare states. Conclusions This study provides evidence of some variations in the association between work-life conflict and poor self-reported health among men and women across welfare states regimes in Europe. The results demonstrate the need for governments, organizations and policymakers to provide conducive working conditions and social policies for working adults to deal with competing demands from work and family activities.
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Affiliation(s)
- Aziz Mensah
- Bielefeld Graduate School in History and Sociology (BGHS), Bielefeld University, Universitätsstrasse 25, 33615, Bielefeld, Germany.
| | - Nicholas Kofi Adjei
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
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Adjei NK, Samkange-Zeeb F, Kebede M, Saleem M, Heise TL, Zeeb H. Racial/ethnic differences in the prevalence and incidence of metabolic syndrome in high-income countries: a protocol for a systematic review. Syst Rev 2020; 9:134. [PMID: 32513278 PMCID: PMC7282095 DOI: 10.1186/s13643-020-01400-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 05/27/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Metabolic syndrome is a constellation of various cardiovascular and type 2 diabetes risk factors, such as abdominal obesity, atherogenic dyslipidemia, high blood pressure, and high blood glucose, but its prevalence varies widely by geographical region, sex, and race/ethnicity. The objective of this study is to examine the prevalence and incidence of metabolic syndrome among adults of different racial/ethnic origins in high-income countries. METHODS We designed and registered a study protocol for a systematic review of descriptive epidemiological data. Observational studies (e.g., cross sectional and cohort studies) reporting morbidity data of metabolic syndrome and conducted in a wide range of adult people (e.g., different racial/ethnic origins, including migrants) will be included. The primary outcome will be the prevalence and incidence of metabolic syndrome. Secondary outcomes will be the prevalence and incidence of individual components of metabolic syndrome (e.g., abdominal obesity, dyslipidemia, high blood pressure, and high blood glucose). Literature searches will be conducted in several electronic databases (from inception onwards), including MEDLINE, Web of Science Core Collection (Science Citation Index and Social Science Citation Index), CINAHL, and Cochrane Library. Two investigators will independently screen all reference titles, abstracts, and full-text articles. The methodological quality (or potential bias) of selected studies will be appraised using an appropriate tool. Our results will be described narratively. Random-effects meta-analysis will be conducted, if feasible and appropriate. Additional analyses will be conducted to explore the potential sources of heterogeneity. CONCLUSION This systematic review will identify, evaluate, and integrate prevalence and incidence data of metabolic syndrome, with focus on racial/ethnic differences in high-income countries. We anticipate our findings may guide policy formulation and identify knowledge gaps in the literature that future research should address. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42020157189.
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Affiliation(s)
- Nicholas Kofi Adjei
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, D-28359, Bremen, Germany. .,Health Sciences Bremen, University of Bremen, Bremen, Germany.
| | - Florence Samkange-Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, D-28359, Bremen, Germany
| | - Mihiretu Kebede
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, D-28359, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Maham Saleem
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, D-28359, Bremen, Germany
| | - Thomas L Heise
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, D-28359, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstrasse 30, D-28359, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
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Jonsson KR, Busfield J, Södergren M, Karen M, Adjei NK. Social Capital, Deprivation and Psychological Well-Being among Young Adolescents: A Multilevel Study from England and Wales. Int J Environ Res Public Health 2020; 17:E3420. [PMID: 32422976 PMCID: PMC7277447 DOI: 10.3390/ijerph17103420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 11/25/2022]
Abstract
Examining the mechanisms influencing mental health and life satisfaction simultaneously allows for a better understanding of adolescents psychological well-being. Six indicators of neighbourhood social capital (NSC), neighbourhood socioeconomic deprivation (SecD) and their association with psychological well-being among young adolescents aged 10-15 from England and Wales were investigated. Using a random sample of 5201 adolescents (7253 observations) from the UK Household Longitudinal Study merged to aggregated local area census measures, we fitted a series of multilevel models. The findings showed that not being worried about crime and friendship networks mitigated the negative effects of deprivation on adolescent's psychological well-being. These findings suggest that some forms of NSC may have a buffering and protective function, with the strongest effects in deprived neighbourhoods. We further found that psychological well-being of adolescents is dependent on both individual vulnerabilities and neighbourhood context. However caution is required if, and when public health policies are formulated to address this issue, given significant variations (27-36%) in the inter- and intra-individual psychological well-being were found among this group over time. Thus, policies designed to improve psychological well-being among adolescents should take into account the role of social processes in transmitting deprivation's effects, as well as the various forms of social capital.
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Affiliation(s)
| | - Joan Busfield
- Department of Sociology, University of Essex, Colchester CO4 3SQ, UK;
| | - Marita Södergren
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels alle 23, 14183 Huddinge, Sweden;
| | - Miia Karen
- Unaffiliated Researcher, 16847 Broma, Sweden;
| | - Nicholas Kofi Adjei
- Leibniz Institute for Prevention Research & Epidemiology-BIPS, Achterstrasse 30, 28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bibliothekstrasse 1, 28359 Bremen, Germany
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Iman'ishimwe Mukamana J, Machakanja P, Adjei NK. Trends in prevalence and correlates of intimate partner violence against women in Zimbabwe, 2005-2015. BMC Int Health Hum Rights 2020; 20:2. [PMID: 31959182 PMCID: PMC6971918 DOI: 10.1186/s12914-019-0220-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/18/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Intimate partner violence (IPV) is a widespread problem affecting all cultures and socioeconomic groups. This study explored the trends in prevalence and risk factors associated with IPV among Zimbabwean women of reproductive age (15-49 years) from 2005 to 2015. METHODS Data from the 2005/2006, 2010/2011 and 2015 Zimbabwe Demographic and Health Survey (ZDHS) on 13,409 women (survey year: 2005/2006; n = 4081), (survey year: 2010/2011; n = 4411) and (survey year: 2015; n = 4917) were analyzed. Multiple logistic regressions and hierarchical modelling techniques were applied to examine the associations between demographic characteristics, socioeconomic status, media exposure and IPV against women. We further estimated IPV prevalence by type (physical, sexual and emotional) over time. RESULTS The prevalence of IPV decreased from 45.2% in 2005 to 40.9% in 2010, and then increased to 43.1% in 2015. Some of the risk factors associated with IPV were younger age, low economic status, cohabitation and rural residence. Educational attainment of women was however not significantly associated with IPV. CONCLUSIONS The findings indicate that women of reproductive age are at high and increasing risk of physical and emotional violence. There is thus an urgent need for an integrated policy approach to address the rise of IPV related physical and emotional violence against women in Zimbabwe.
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Affiliation(s)
- Jeanette Iman'ishimwe Mukamana
- Institute of Peace, Leadership and Governance, Africa University, Off Nyanga Road Fairview Road, P.O. Box 1320, Mutare, Zimbabwe.
| | - Pamela Machakanja
- College of Business, Peace, Leadership and Governance, Africa University, Mutare, Zimbabwe
| | - Nicholas Kofi Adjei
- Health Sciences Bremen, University of Bremen, Bremen, Germany.,Leibniz Institute for Prevention Research & Epidemiology -BIPS, Bremen, Germany
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Adjei NK, Jonsson KR, Brand T. Psychosocial determinants of health disparities among elderly women and men in Europe. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- N K Adjei
- University of Bremen, Bremen, Germany
| | | | - T Brand
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
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Adjei NK, Jonsson KR, Brand T. Time spent on work-related activities, social activities and time pressure as intermediary determinants of health disparities among elderly women and men in 5 European countries: a structural equation model. Int J Equity Health 2018; 17:121. [PMID: 30115073 PMCID: PMC6097401 DOI: 10.1186/s12939-018-0840-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/09/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Psychosocial factors shape the health of older adults through complex inter-relating pathways. Besides socioeconomic factors, time use activities may explain gender inequality in self-reported health. This study investigated the role of work-related and social time use activities as determinants of health in old age. Specifically, we analysed whether the impact of stress in terms of time pressure on health mediated the relationship between work-related time use activities (i.e. housework and paid work) on self-reported health. METHODS We applied structural equation models and a maximum-likelihood function to estimate the direct and indirect effects of psychosocial factors on health using pooled data from the Multinational Time Use Study on 11,168 men and 14,295 women aged 65+ from Italy, Spain, UK, France and the Netherlands. RESULTS The fit indices for the conceptual model indicated an acceptable fit for both men and women. The results showed that socioeconomic status (SES), demographic factors, stress and work-related time use activities after retirement had a significant direct influence on self-reported health among the elderly, but the magnitude of the effects varied by gender. Social activities had a positive impact on self-reported health but had no significant impact on stress among older men and women. The indirect standardized effects of work-related activities on self-reported health was statistically significant for housework (β = - 0.006; P < 0.001 among men and β = - 0.008; P < 0.001 among women) and paid work (β = 0.012; P < 0.01 among men and β = 0.000; P > 0.05 among women), which implied that the paths from paid work and housework on self-reported health via stress (mediator) was very weak because their indirect effects were close to zero. CONCLUSIONS Our findings suggest that although stress in terms of time pressure has a direct negative effect on health, it does not indirectly influence the positive effects of work-related time use activities on self-reported health among elderly men and women. The results support the time availability hypothesis that the elderly may not have the same time pressure as younger adults after retirement.
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Affiliation(s)
- Nicholas Kofi Adjei
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Unit Social Epidemiology, Achterstrasse 30, D-28359 Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
- Department of Health Sciences, Africa University, Mutare, Zimbabwe
| | | | - Tilman Brand
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Unit Social Epidemiology, Achterstrasse 30, D-28359 Bremen, Germany
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Adjei NK, Brand T. Investigating the associations between productive housework activities, sleep hours and self-reported health among elderly men and women in western industrialised countries. BMC Public Health 2018; 18:110. [PMID: 29320997 PMCID: PMC5763579 DOI: 10.1186/s12889-017-4979-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 12/05/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND After retirement, elderly men and women allocate more time to housework activities, compared to working-age adults. Nonetheless, sleep constitutes the lengthiest time use activity among the elderly, but there has not been any study on the associations between time spent on housework activities, sleep duration and self-reported health among the older population. This study not only examined individual associations between self-reported health and both housework activities and sleep duration, but it also explored self-reported health by the interaction effect between housework activities and sleep duration separately for men and women. METHODS Pooled data from the Multinational Time Use Study (MTUS) on 15,333 men and 20,907 women from Germany, Italy, Spain, UK, France, the Netherlands and the US were analysed. Multiple binary logistic regression models were used to examine the associations between three broad categories of housework activities ((1) cooking, cleaning and shopping, (2) gardening and maintenance; (3) childcare) and health. We further investigated the extent to which total housework hours and sleep duration were associated with self-reported health for men and women separately. RESULTS We found a positive association between time devoted to housework activities, total housework and health status among elderly men and women. Compared to those who spent 1 to 3 h on total productive housework, elderly people who spent >3 to 6 h/day had higher odds of reporting good health (OR = 1.25; 95% CI = 1.14-1.37 among men and OR = 1.10; 95% CI = 1.01-1.20 among women). Both short (<7 h) and long (>8 h) sleep duration were negatively associated with health for both genders. However, the interactive associations between total productive housework, sleep duration, and self-reported health varied among men and women. Among women, long hours of housework combined with either short or long sleep was negatively associated with health. CONCLUSIONS Although time allocation to housework activities may be beneficial to the health among both genders, elderly women have higher odds of reporting poor health when more time is devoted total housework combined with either short or long sleep duration.
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Affiliation(s)
- Nicholas Kofi Adjei
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Germany, Unit Social Epidemiology, Achterstrasse 30, D-28359, Bremen, Germany.
- Health Sciences Bremen, University of Bremen, Bremen, Germany.
| | - Tilman Brand
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Germany, Unit Social Epidemiology, Achterstrasse 30, D-28359, Bremen, Germany
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Adjei NK, Brand T, Zeeb H. Gender inequality in self-reported health among the elderly in contemporary welfare countries: A cross-country analysis of time use activities, socioeconomic positions and family characteristics. PLoS One 2017; 12:e0184676. [PMID: 28949984 PMCID: PMC5614435 DOI: 10.1371/journal.pone.0184676] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 08/29/2017] [Indexed: 11/19/2022] Open
Abstract
Background Paradoxically, despite their longer life expectancy, women report poorer health than men. Time devoted to differing social roles could be an explanation for the observed gender differences in health among the elderly. The objective of this study was to explain gender differences in self-reported health among the elderly by taking time use activities, socio-economic positions, family characteristics and cross-national differences into account. Methods Data from the Multinational Time Use Study (MTUS) on 13,223 men and 18,192 women from Germany, Italy, Spain, UK and the US were analyzed. Multiple binary logistic regression models were used to examine the association between social factors and health for men and women separately. We further identified the relative contribution of different factors to total gender inequality in health using the Blinder-Oaxaca decomposition method. Results Whereas time allocated to paid work, housework and active leisure activities were positively associated with health, time devoted to passive leisure and personal activities were negatively associated with health among both men and women, but the magnitude of the association varied by gender and country. We found significant gender differences in health in Germany, Italy and Spain, but not in the other countries. The decomposition showed that differences in the time allocated to active leisure and level of educational attainment accounted for the largest health gap. Conclusions Our study represents a first step in understanding cross-national differences in the association between health status and time devoted to role-related activities among elderly men and women. The results, therefore, demonstrate the need of using an integrated framework of social factors in analyzing and explaining the gender and cross-national differences in the health of the elderly population.
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Affiliation(s)
- Nicholas Kofi Adjei
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
- * E-mail:
| | - Tilman Brand
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Health Sciences Bremen, University of Bremen, Bremen, Germany
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