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Time trends in and factors associated with repeat adolescent birth in Uganda: Analysis of six demographic and health surveys.

ABSTRACT: BACKGROUND:Information on repeat adolescent birth remains scarce in sub-Sahara Africa. We investigated the prevalence and time trends in repeat adolescent birth in Uganda, and associated factors. METHODS:We analyzed Uganda Demographic and Health Survey data of women age 20-24 years collected on 6 surveys (1988/89-2016) to estimate repeat adolescent birth (first live birth <18 years of age followed by another live birth(s) <20 years). Further, we estimated the wantedness of the second order birth and the prevalence of short birth intervals birth (<13 months) between the first and second such birth. On the 2016 survey, we examined factors associated with repeat adolescent birth using bivariate and multivariate modified Poisson regression. RESULTS:At the 1988/89 survey, 58.9% of women with first birth <18 years reported a repeat adolescent birth. This percentage increased to 66.8% in 2006 (+7.9 percentage points [pp], p = 0.010) and thereafter declined to 55.6% by 2016 (-11.2 pp, p<0.001), nevertheless, no change occurred between 1988/89 and 2016 (-3.3pp, p = 0.251). Among women with repeat adolescent births, the mean number of live births by exact age 20 years (2.2 births) and prevalence of short birth intervals (3.5% in 1988/89, 5.4% in 2016) (+1.9pp, p = 0.245) did not change. Increasingly more women with repeat adolescent births preferred to have had the second child later, 22.5% in 1995 and 43.1% in 2016 (+20.6pp, p = <0.001). On the 2016 survey, women from poorer households and those of younger age at first birth were significantly more likely to report repeat adolescent birth. CONCLUSION:Following a first birth <18 years, more than half of the women report a repeat adolescent birth (<20 years), with no decline observed in 30 years. Increasingly more women wanted the second adolescent pregnancy later, highlighting the need to support adolescents with improved family planning services at each contact.

SUBMITTER: Amongin D

PROVIDER: S-EPMC7156070 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Time trends in and factors associated with repeat adolescent birth in Uganda: Analysis of six demographic and health surveys.

Amongin Dinah D Nakimuli Annettee A Hanson Claudia C Nakafeero Mary M Kaharuza Frank F Atuyambe Lynn L Benova Lenka L

PloS one 20200414 4

<h4>Background</h4>Information on repeat adolescent birth remains scarce in sub-Sahara Africa. We investigated the prevalence and time trends in repeat adolescent birth in Uganda, and associated factors.<h4>Methods</h4>We analyzed Uganda Demographic and Health Survey data of women age 20-24 years collected on 6 surveys (1988/89-2016) to estimate repeat adolescent birth (first live birth <18 years of age followed by another live birth(s) <20 years). Further, we estimated the wantedness of the sec ...[more]

PMID: 32287303

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Project description:BACKGROUND:Globally, 15 million infants are born preterm each year, and 1 million die due to complications of prematurity. Over 60% of preterm births occur in Sub-Saharan Africa and south Asia. Care at birth for premature infants may be critical for survival and long term outcome. We conducted a prospective audit to assess whether women giving birth preterm could be identified, and to describe cord clamping and neonatal care at hospitals in Africa and south Asia. METHODS:This prospective audit of livebirths was conducted at six hospitals in Uganda, Kenya, India and Pakistan. Births were considered preterm if between 28+?0 and 33+?6 weeks gestation and/or the birthweight was 1.00 to 1.99?kg. A pre-specified audit plan was agreed with each hospital. Livebirths before 28?weeks gestation with birthweight less than 1.0?kg were excluded. Data were collected on estimated and actual gestation and birthweight, cord clamping, and neonatal care. RESULTS:Of 4149 women who gave birth during the audit, data were available for 3687 (90%). As 107 were multiple births, 3781 livebirths were included, of which 257 (7%) were preterm. Antenatal assessment correctly identified 148 infants as 'preterm' and 3429 as 'term', giving a positive predictive value of 72% and negative predictive value of 97%. For term births, cord clamping was usually later at the two Ugandan hospitals, median time to clamping 50 and 76?s, compared with 23 at Kenyatta (Kenya), 7 at CMC (India) and 12 at FBH/LNH (Pakistan). At the latter two, timing was similar between term and preterm births, and between vaginal and Caesarean births. For all the hospitals, the cord was clamped quickly at Caesarean births, with Mbale (Uganda) having the highest median time to clamping (15?s 'term', 19 'preterm'). For preterm infants temperature on admission to the neonatal unit was below 35.5?°C for 50%, and 59 (23%) died before hospital discharge. CONCLUSIONS:Antenatal identification of preterm birth was good. Timing of cord clamping varied between hospitals, although at each there was no difference between 'term' and 'preterm' births. For premature infants hypothermia was common, and mortality before hospital discharge was high.

Project description:BackgroundSkilled birth attendants (SBAs) play a crucial role in reducing infant and maternal mortality. Although the ratio of skilled assistance at birth has increased in Bangladesh, factors associated with SBA use are unknown. The main goal of our study was to reveal the individual- and community-level factors associated with SBA use during childbirth in Bangladesh. We also showed the prevalence and trend of SBA use and related independent variables in Bangladesh over the past decade.MethodsThis study utilized the Bangladesh Health and Demographic Survey (BDHS) 2017-2018, a cross-sectional study. We used binary logistic regression to examine the extent of variation in SBA use attributable to the individual- and community-level variables.ResultsOverall, 53.35% of women received assistance from SBAs during childbirth. The average annual rate of increase (AARI) in the number of SBA-assisted births over the past 10 years was 8.88%. Respondents who gave birth at or above 19 years had 1.40 times (AOR = 1.40; 95% CI: 1.21-1.62) greater odds of having skilled delivery assistance than respondents aged 18 years old or less. Women and their husband's education levels were significantly associated with using skilled assistance during delivery, with odds of 1.60 (AOR = 1.60; 95% CI: 1.45-2.01) and 1.41 (AOR = 1.41; 95% CI: 1.21-1.66), respectively compared to those with education up to primary level. Women from rich families and those receiving better antenatal care (ANC) visits were more likely to have professional delivery assistance. Community-level factors also showed significance towards having professional assistance while giving birth. Women from urban communities and those who utilized more than four ANC visits and had completed secondary or higher education showed a greater tendency to use an SBA during childbirth than their counterparts.ConclusionThe use of SBAs during delivery was significantly associated with some individual- and community-level factors. To reduce maternal and child mortality, there is a need to focus on rural and uneducated people who are less likely to access these facilities. Special programs could increase awareness and help the poor community obtain the minimum facility in maternal care.

Project description:BACKGROUND:Uganda halved its maternal mortality to 343/100,000 live births between 1990 and 2015, but did not meet the Millennium Development Goal 5. Skilled, timely and good quality antenatal (ANC) and delivery care can prevent the majority of maternal/newborn deaths and stillbirths. We examine coverage, equity, sector of provision and content of ANC and delivery care between 1991 and 2011. METHODS:We conducted a repeated cross-sectional study using four Uganda Demographic and Health Surveys (1995, 2000, 2006 and 2011).Using the most recent live birth and adjusting for survey sampling, we estimated percentage and absolute number of births with ANC (any and 4+ visits), facility delivery, caesarean sections and complete maternal care. We assessed socio-economic differentials in these indicators by wealth, education, urban/rural residence, and geographic zone on the 1995 and 2011 surveys. We estimated the proportions of ANC and delivery care provided by the public and private (for-profit and not-for-profit) sectors, and compared content of ANC and delivery care between sectors. Statistical significance of differences were evaluated using chi-square tests. RESULTS:Coverage with any ANC remained high over the study period (>?90% since 2001) but was of insufficient frequency; <?50% of women who received any ANC reported 4+ visits. Facility-based delivery care increased slowly, reaching 58% in 2011. While significant inequalities in coverage by wealth, education, residence and geographic zone remained, coverage improved for all indicators among the lowest socio-economic groups of women over time. The private sector market share declined over time to 14% of ANC and 25% of delivery care in 2011. Only 10% of women with 4+ ANC visits and 13% of women delivering in facilities received all measured care components. CONCLUSIONS:The Ugandan health system had to cope with more than 30,000 additional births annually between 1991 and 2011. The majority of women in Uganda accessed ANC, but this contact did not result in care of sufficient frequency, content, and continuum of care (facility delivery). Providers in both sectors require quality improvements. Achieving universal health coverage and maternal/newborn SDGs in Uganda requires prioritising poor, less educated and rural women despite competing priorities for financial and human resources.

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Time trends in and factors associated with repeat adolescent birth in Uganda: Analysis of six demographic and health surveys.

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Time trends in and factors associated with repeat adolescent birth in Uganda: Analysis of six demographic and health surveys.

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