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Patterns and determinants of short and long birth intervals among women in selected sub-Saharan African countries.

ABSTRACT: Optimal birth spacing (defined as a birth spacing of 24-59 months) is incontrovertibly linked to better health outcomes for both mothers and babies. Using the most recent available Demographic and Health Survey data, we examined the patterns and determinants of short and long birth intervals among women in selected sub-Saharan African (SSA) countries.Reproductive health and sociodemographic data of 98,934 women from 8 SSA countries were analyzed. Unadjusted and adjusted multinomial logistic regression models were used to examine the net relationship between all the independent variables and short and long birth intervals.Overall, the majority of women in all the countries optimally spaced births. However, a significant proportion of women had short birth intervals in Chad (30.2%) and the Democratic Republic of Congo (Congo DRC) (27.1%). Long birth spacing was more common in Eastern and Southern African countries, with Zimbabwe having the highest rate of long term birth interval (27.0%). Women who were aged 35 years and above in Uganda (RRR?=?0.72, CI?=?0.60-0.87), Tanzania (RRR?=?0.62, CI?=?0.49-0.77), Zimbabwe (RRR?=?0.52, CI?=?0.31-0.85), Nigeria (RRR?=?0.82, CI?=?0.72-0.94) and Togo (RRR?=?0.67, CI?=?0.46-0.96) had significantly lower odds of having short birth intervals compared to women aged 15-24 years. Older women (above 34 years) had increased odds for long birth intervals in all countries studied (Chad (RRR?=?1.44, CI?=?1.18-1.76), Congo DRC (RRR?=?1.73, CI?=?1.33-2.15), Malawi (RRR?=?1.54, CI?=?1.23-1.94) Zimbabwe (RRR?=?1.95, CI?=?1.26-3.02), Nigeria (RRR?=?1.85 CI?=?1.56-2.20), Togo (RRR?=?2.12, CI?=?1.46-3.07), Uganda (RRR?=?1.48, CI?=?1.15-1.91), Tanzania RRR?=?2.12, CI?=?1.53-2.93).The analysis suggested that the determinants of long and birth intervals differ and varies from country to country. The pattern of birth spacing found in this study appears to mirror the contraceptive use and fertility rate in the selected SSA countries. Birth intervals intervention addressing short birth intervals should target younger women in SSA, especially in Chad and Congo DRC, while intervention for long birth spacing should prioritize older, educated and wealthy women.

SUBMITTER: Ajayi AI

PROVIDER: S-EPMC7440207 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Patterns and determinants of short and long birth intervals among women in selected sub-Saharan African countries.

Ajayi Anthony Idowu AI Somefun Oluwaseyi Dolapo OD

Medicine 20200501 19

Optimal birth spacing (defined as a birth spacing of 24-59 months) is incontrovertibly linked to better health outcomes for both mothers and babies. Using the most recent available Demographic and Health Survey data, we examined the patterns and determinants of short and long birth intervals among women in selected sub-Saharan African (SSA) countries.Reproductive health and sociodemographic data of 98,934 women from 8 SSA countries were analyzed. Unadjusted and adjusted multinomial logistic regr ...[more]

PMID: 32384488

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Project description:IntroductionBirth spacing is a critical pathway to improving reproductive health. WHO recommends a minimum of 33-month interval between two consecutive births to reduce maternal, perinatal, infant morbidity and mortality. Our study evaluated factors associated with short birth intervals (SBIs) of less than 33 months between two consecutive births, in Karachi, Pakistan.MethodsWe used data from a cross-sectional study among married women of reproductive age (MWRA) who had at least one live birth in the 6 years preceding the survey (N=2394). Information regarding their sociodemographic characteristics, reproductive history, fertility preferences, family planning history and a 6-year reproductive calendar were collected. To identify factors associated with SBIs, we fitted simple and multiple Cox proportional hazards models and computed HRs with their 95% CIs.ResultsThe median birth interval was 25 months (IQR: 14-39 months), with 22.9% (833) of births occurring within 33 months of the index birth. Women's increasing age (25-30 years (aHR 0.63 (0.53 to 0.75), 30+ years (aHR 0.29, 95% CI 0.22 to 0.39) compared with 20-24 years; secondary education (aHR 0.75, 95% CI 0.63 to 0.88), intermediate education (aHR 0.62, 95% CI 0.48 to 0.80), higher education (aHR 0.69, 95% CI 0.51 to 0.92) compared with no education, and a male child of the index birth (aHR 0.81, 95% CI 0.70 to 0.94) reduced the likelihood of SBIs. Women's younger age <20 years (aHR 1.24, 95% CI 1.05 to 1.24) compared with 20-24 years, and those who did not use contraception within 9 months of the index birth had a higher likelihood for SBIs for succeeding birth compared with those who used contraception (aHR 2.23, 95% CI 1.93 to 2.58).ConclusionStudy shows that birth intervals in the study population are lower than the national average. To optimise birth intervals, programmes should target child spacing strategies and counsel MWRA on the benefits of optimal birth spacing, family planning services and contraceptive utilisation.

Project description:ObjectivesThe burden and highest regional prevalence of anaemia is reported in sub-Saharan Africa (SSA). The study evaluated changes in anaemia prevalence across the Demographic Health Surveys (DHS) periods in SSA and reported factors influencing observed changes in the trend.MethodThe study was implemented by a two-stage cross-sectional stratified sampling approach. The study involved women of reproductive age (15-49 years) in sub-Saharan Africa countries (Ghana, Sierra Leone, Mali, and Benin) using two different periods of their demographic health surveys (DHS) data. The study adopted both descriptive and inferential statistical methods. The chi-square test was used to determine the existence of a statistically significant relationship between the outcome and predictor variables and test the observed changes in anaemia. Multivariable logistic regression analyses were conducted on each survey year and the pooled dataset for eligible study countries. Multivariate decomposition analysis was performed to explain how compositional changes and behavioural effects of women characteristics affected the changes in anaemia prevalence. The study reported frequencies, percentages and odds ratios along with their 95% confidence intervals (CI).ResultsGhana and Sierra Leone experienced 17.07% [95% CI: 14.76-19.37, p < 0.001] and 1% [95% CI: 1.0-2.9, p > 0.05] of anaemia decrease from period 1 to period 2, respectively, while Mali and Benin experienced 11% [95% CI: 9.14-12.90, p < 0.001] and 16.7% [95% CI: 14.99-18.5, p < 0.001] of increase in anaemia prevalence from period 1 to period 2, respectively. Behavioural effects explained the decrease in Ghana and the increase in Benin and Mali while endowments or compositional changes explained the decrease in Sierra Leone.ConclusionAnaemia continues to pose a significant challenge in sub-Saharan Africa. Therefore, there is an imperative need to scale up the implementation of nutrition-related programmes and advocacies to ensure optimum changes in women nutrition-related behaviours.

Project description:BackgroundGenito-urinary fistulas may occur as complications of obstetric surgery. Location and circumstances can indicate iatrogenic origin as opposed to pressure necrosis following prolonged, obstructed labor.MethodsThis retrospective review focuses on 787 women with iatrogenic genito-urinary fistulas among 2942 women who developed fistulas after cesarean birth between 1994 and 2017. They are a subset of 5469 women who sought obstetric fistula repair between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia, and Ethiopia. We compared genito-urinary fistula classifications following vaginal birth to classifications following cesarean birth. We assessed whether and how the proportion of iatrogenic genito-urinary fistula was changing over time among women with fistula, comparing women with iatrogenic fistulas to women with fistulas attributable to pressure necrosis. We used mixed effects logistic regression to model the rise in iatrogenic fistula among births resulting in fistula and specifically among cesarean births resulting in fistula.ResultsOver one-quarter of women with fistula following cesarean birth (26.8%, 787/2942) had an injury caused by surgery rather than pressure necrosis due to prolonged, obstructed labor. Controlling for age, parity, and previous abdominal surgery, the odds of iatrogenic origin nearly doubled over time among all births resulting in fistula (aOR 1.94; 95% CI 1.48-2.54) and rose by 37% among cesarean births resulting in fistula (aOR 1.37; 95% CI 1.02-1.83). In Kenya and Rwanda the rise of iatrogenic injury outpaced the increasing frequency of cesarean birth.ConclusionsDespite the strong association between obstetric fistula and prolonged, obstructed labor, more than a quarter of women with fistula after cesarean birth had injuries due to surgical complications rather than pressure necrosis. Risks of iatrogenic fistula during cesarean birth reinforce the importance of appropriate labor management and cesarean decision-making. Rising numbers of iatrogenic fistulas signal a quality crisis in emergency obstetric care. Unaddressed, the impact of this problem will grow as cesarean births become more common.

Project description:The aim of the study was to analyse trends in the relationship between mother's educational level and mortality of children under the year of five in Sub-Saharan Africa, from 1990 to 2015.Data used in this study came from different waves of Demographic and Health Surveys (DHS) of Sub-Saharan countries. Logistic regression and Buis's decomposition method were used to explore the effect of mother's educational level on the mortality of children under five years.Although the results of our study in the selected countries show that under-five mortality rates of children born to mothers without formal education are higher than the mortality rates of children of educated mothers, it appears that differences in mortality were reduced over the past two decades. In selected countries for our study, we noticed a significant decline in mortality among children of non-educated mothers compared to the decrease in mortality rates among children of educated mothers during the period of 1990-2010. The results show that the decline in mortality of children under five years was much higher among the children born to mothers who have never received formal education-112 points drop in Malawi, over 80 in Zambia and Zimbabwe, 65 points in Burkina Faso, 56 in Congo, 43 in Namibia, 27 in Guinea, Cameroon, and 22 to 15 in Niger. However, we noted a variation in results among the countries selected for the study-in Burkina Faso (OR = 0.7), in Cameroon (OR = 0.8), in Guinea (OR = 0.8) and Niger (OR = 0.8). It is normally observed that children of mothers with 0-6 years of education are about 20% more likely to survive until their fifth year compared to children of mothers who have not been to school. Conversely, the results did not reveal significant differences between the under-five deaths of children born to non-educated mothers and children of low-level educated mothers in Congo, Malawi and Namibia.The decline in under-five mortality rates, during last two decades, can be partly due to the government policies on women's education. It is evident that women's educational level has resulted in increased maternal awareness about infant health and hygiene, thereby bringing about a decline in the under-five mortality rates. This reduction is due to improved supply of health care programmes and health policies in reducing economic inequalities and increasing access to health care.

Project description:To assess the financial burden due to out of pocket (OOP) payments, two mutually exclusive approaches have been used: catastrophic health expenditure (CHE) and impoverishment. Sub-Saharan African (SSA) countries primarily rely on OOP and are thus challenged with providing financial protection to the populations. To understand the variations in CHE and impoverishment in SSA, and the underlying determinants of CHE, a scoping review of the existing evidence was conducted.This review is guided by Arksey and O'Malley scoping review framework. A search was conducted in several databases including PubMed, EBSCO (EconLit, PsychoInfo, CINAHL), Web of Science, Jstor and virtual libraries of the World Health Organizations (WHO) and the World Bank. The primary outcome of interest was catastrophic health expenditure/impoverishment, while the secondary outcome was the associated risk factors.Thirty-four (34) studies that met the inclusion criteria were fully assessed. CHE was higher amongst West African countries and amongst patients receiving treatment for HIV/ART, TB, malaria and chronic illnesses. Risk factors associated with CHE included household economic status, type of health provider, socio-demographic characteristics of household members, type of illness, social insurance schemes, geographical location and household size/composition. The proportion of households that are impoverished has increased over time across countries and also within the countries.This review demonstrated that CHE/impoverishment is pervasive in SSA, and the magnitude varies across and within countries and over time. Socio-economic factors are seen to drive CHE with the poor being the most affected, and they vary across countries. This calls for intensifying health policies and financing structures in SSA, to provide equitable access to all populations especially the most poor and vulnerable. There is a need to innovate and draw lessons from the 'informal' social networks/schemes as they are reported to be more effective in cushioning the financial burden.

Project description:ObjectivesBreast cancer is the most prevalent cancer and the second leading cause of cancer-related deaths among women after cervical cancer in much of sub-Saharan Africa. This study aims to examine the prevalence and sociodemographic-socioeconomic factors associated with breast cancer screening among women of reproductive age in sub-Saharan Africa.DesignA weighted population-based cross-sectional study using Demographic and Health Surveys (DHS) data. We used all available data on breast cancer screening from the DHS for four sub-Saharan African countries (Burkina Faso, Ivory Coast, Kenya and Namibia). Breast cancer screening was the outcome of interest for this study. Multivariable Poisson regression was used to identify independent factors associated with breast cancer screening.SettingFour countries participating in the DHS from 2010 to 2014 with data on breast cancer screening.ParticipantsWomen of reproductive age 15-49 years (N=39 646).ResultsThe overall prevalence of breast cancer screening was only 12.9% during the study period, ranging from 5.2% in Ivory Coast to 23.1% in Namibia. Factors associated with breast cancer screening were secondary/higher education with adjusted prevalence ratio (adjusted PR)=2.33 (95% CI: 2.05 to 2.66) compared with no education; older participants, 35-49 years (adjusted PR=1.73, 95% CI : 1.56 to 1.91) compared with younger participants 15-24 years; health insurance coverage (adjusted PR=1.57, 95% CI: 1.47 to 1.68) compared with those with no health insurance and highest socioeconomic status (adjusted PR=1.33, 95% CI : 1.19 to 1.49) compared with lowest socioeconomic status.ConclusionDespite high breast cancer mortality rates in sub-Saharan Africa, the prevalence of breast cancer screening is substantially low and varies gradually across countries and in relation to factors such as education, age, health insurance coverage and household wealth index level. These results highlight the need for increased efforts to improve the uptake of breast cancer screening in sub-Saharan Africa.

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Patterns and determinants of short and long birth intervals among women in selected sub-Saharan African countries.

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Patterns and determinants of short and long birth intervals among women in selected sub-Saharan African countries.

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