Dataset Information

Sexual Relationship Power and Socio-demographic Factors Predicting Contraceptive Use, Antenatal Visits and Sick Child Health Service Use in Northern Togo.

ABSTRACT: INTRODUCTION:Implementation of community-based healthcare services offering effective contraception, antenatal care (ANC), and treatment for symptomatic children under five has reduced maternal and child mortality in Togo. However, understanding if women are utilizing these services differentially based on social or demographic factors is important. This study identifies whether sexual relationship and socio-demographic factors are associated with healthcare utilization in four health facility catchment areas. METHODS:We conducted a cross-sectional household survey of women aged 15-49 in four health facility catchment areas in 2016 (three rural sites, one urban site). We used multivariable Poisson regression to test whether socio-demographic factors and a validated sexual relationship power scale were associated with contraceptive use, ANC visits, and seeking treatment for symptomatic children under five. RESULTS:Among women not pregnant or desiring pregnancy, older age, lower education, and single relationship status were associated with lower use of effective contraception. Among women who gave birth in two years preceding survey, low relationship power and low wealth quintile were associated with being less likely to attend at least four ANC visits. Women in rural sites were slightly more likely than women in the urban site to report seeking treatment for child under five with malaria, pneumonia, and/or diarrhea symptoms in last 2 weeks. DISCUSSION:Interventions in low-resource settings should explore ways to reach women with low health-service utilization to improve contraceptive use, ANC visits, and treatment for sick children. Furthermore, age, education, marital status, wealth status and sexual relationship power must be considered when targeting maternal health behaviors. TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT03773913; Date of registration: 12 Dec. 2018.

SUBMITTER: Kaplowitz ET

PROVIDER: S-EPMC7340338 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Sexual Relationship Power and Socio-demographic Factors Predicting Contraceptive Use, Antenatal Visits and Sick Child Health Service Use in Northern Togo.

Kaplowitz Elianna T ET Fiori Kevin P KP Lauria Molly E ME Gbeleou Sesso S Miziou Agnés A Sowu Etonam E Schechter Jennifer J Jones Heidi E HE

Maternal and child health journal 20200701 7

<h4>Introduction</h4>Implementation of community-based healthcare services offering effective contraception, antenatal care (ANC), and treatment for symptomatic children under five has reduced maternal and child mortality in Togo. However, understanding if women are utilizing these services differentially based on social or demographic factors is important. This study identifies whether sexual relationship and socio-demographic factors are associated with healthcare utilization in four health fa ...[more]

PMID: 32347439

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Project description:BackgroundThe under-five child mortality rate is a widely accepted indicator of the development of a country as well as reflects the country's health care system and quality of life. Although the child mortality rate is decreasing over time in Bangladesh, the rate is still high among South Asian countries. The target of the Sustainable Development Goal-3.2 is to reduce the under-five mortality rate in all countries of the world to 25 or fewer per 1000 live births by 2030. The purpose of this study is to identify the socio-demographic factors which have an influence on under-five child mortality in Bangladesh as well as to examine whether contraceptive use has any effect on under-five mortality in Bangladesh. Finally, a comparison has been made between the results obtained from the Cox proportional Hazard Model and Weibull model to find out which model is more efficient for the study data.MethodsFor the study, data was extracted from Bangladesh Demographic Health Surveys 2017-2018 (BDHS 2017-2018). The Kaplan-Meier survival function has been used to demonstrate the survival probabilities of under-five children. While multivariate analyses of the Cox Proportional Hazard model and Weibull model are used to estimate the under-five mortality risks for various predictors.ResultsThe study results show consistently higher survival probabilities for children of mothers who used modern contraceptives during survival periods. Other significant predictors for under-five child mortality include mother's education level (higher education), mother's age (> 20), wealth index (rich), source of drinking water (tube well), and division (Chittagong, Khulna, Mymensingh). Weibull model has given more efficient results than the Cox Proportional Hazard model except for one covariate (water source).ConclusionContraceptives use significantly improves the survival chances of children under-five age. This underscores the importance of contraceptive use in the pursuit of a sustainable reduction in under-five mortality in Bangladesh. It also intensifies the need to address the present level of contraceptive use in the country. This may not be due to the use of contraceptives in itself but may be due to the substantial biological and socioeconomic benefits that are concomitant with contraceptive use which may promote both maternal and child health. So, Extra effort should be given by the policymakers to ensure the use of modern contraceptive methods to improve the under-five survival in Bangladesh.

Project description:BackgroundWidespread use of antibiotics has led to the development of antibiotic resistance. However, there are limited data describing antibiotic use in the community setting, and examining factors associated with greater use. Our study aimed to quantify antibiotic dispensing in older adults in the community according to socio-demographics and health services use.MethodsProspective analysis of a population-based cohort study of 239,981 adults aged ?45 years in Australia (the Sax Institute's 45 and Up Study). Data on socio-demographics and health from a questionnaire, were linked to 2015 antibiotic dispensing data from the Pharmaceutical Benefits Scheme (PBS), as well as other administrative health databases. We estimated the Defined Daily Dose (DDD) of systemic antibiotics dispensed, defined by an Anatomic Therapeutic Classification code beginning with J01, in 2015. We also conducted Poisson regression with robust standard errors to identify factors associated with antibiotic dispensing.ResultsOverall, 49.3% of 45 and Up Study participants had at least one systemic antibiotic dispensed in 2015 with a total of 392,856 prescriptions dispensed and an average of 36.5 DDDs/1000-persons/day in the study population. The quantity of antibiotics dispensed increased with increasing age (25.6 DDDs/1000/day in <60 years old versus 50.4 DDDs/1000/day in 80+ year old) and was higher comparing women to men (39.9 versus 32.4 DDDs/1000/day). Of factors examined, the greatest dispensing of antibiotics was among those who had been resident in an aged care facility and those with >15 general practitioner consultations in the last year (80.5 and 88.3 DDDs/1000/day, respectively). These factors remained strongly associated with greater antibiotic dispensing after adjusting for age, sex, education, income, area of residence and co-morbidities.ConclusionsResidence in aged care facilities and high GP visits are associated with greater antibiotic dispensing. This study provides important evidence regarding high use groups for antimicrobial stewardship.

Project description:BackgroundThis study explores how socio-demographic and health factors shape the relationship between multimorbidity and one-year acute care service use (i.e., hospital, emergency department visits) in older adults in Ontario, Canada.MethodsWe linked multiple cycles (2005-2006, 2007-2008, 2009-2010, 2011-2012) of the Canadian Community Health Survey (CCHS) to health administrative data to create a cohort of adults aged 65 and older. Administrative data were used to estimate one-year service use and to identify 12 chronic conditions used to measure multimorbidity. We examined the relationship between multimorbidity and service use stratified by a range of socio-demographic and health variables available from the CCHS. Logistic and Poisson regressions were used to explore the association between multimorbidity and service use and the role of socio-demographic factors in this relationship.ResultsOf the 28,361 members of the study sample, 60% were between the ages of 65 and 74 years, 57% were female, 72% were non-immigrant, and over 75% lived in an urban area. Emergency department visits and hospitalizations consistently increased with the level of multimorbidity. This study did not find strong evidence of moderator or interaction effects across a range of socio-demographic factors. Stratified analyses revealed further patterns, with many being similar for both services - e.g., the odds ratios were higher at all levels of multimorbidity for men, older age groups, and those with lower household income. Rurality and immigrant status influenced emergency department use (higher in rural residents and non-immigrants) but not hospitalizations. Multimorbidity and the range of socio-demographic variables remained significant predictors of service use in the regressions.ConclusionsStrong evidence links multimorbidity with increased acute care service use. This study showed that a range of factors did not modify this relationship. Nevertheless, the factors were independently associated with acute care service use, pointing to modifiable risk factors that can be the focus of resource allocation and intervention design to reduce service use in those with multimorbidity. The study's results suggest that optimizing acute care service use in older adults requires attention to both multimorbidity and social determinants, with programs that are multifactorial and integrated across the health and social service sectors.

Dataset Information

Sexual Relationship Power and Socio-demographic Factors Predicting Contraceptive Use, Antenatal Visits and Sick Child Health Service Use in Northern Togo.

Publications

Sexual Relationship Power and Socio-demographic Factors Predicting Contraceptive Use, Antenatal Visits and Sick Child Health Service Use in Northern Togo.

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