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Social network-based measurement of abortion incidence: promising findings from population-based surveys in Nigeria, Cote d'Ivoire, and Rajasthan, India.

ABSTRACT: BACKGROUND:Monitoring abortion rates is highly relevant for demographic and public health considerations, yet its reliable estimation is fraught with uncertainty due to lack of complete national health facility service statistics and bias in self-reported survey data. In this study, we aim to test the confidante methodology for estimating abortion incidence rates in Nigeria, Cote d'Ivoire, and Rajasthan, India, and develop methods to adjust for violations of assumptions. METHODS:In population-based surveys in each setting, female respondents of reproductive age reported separately on their two closest confidantes' experience with abortion, in addition to reporting about their own experiences. We used descriptive analyses and design-based F tests to test for violations of method assumptions. Using post hoc analytical techniques, we corrected for biases in the confidante sample to improve the validity and precision of the abortion incidence estimates produced from these data. RESULTS:Results indicate incomplete transmission of confidante abortion knowledge, a biased confidante sample, but reduced social desirability bias when reporting on confidantes' abortion incidences once adjust for assumption violations. The extent to which the assumptions were met differed across the three contexts. The respondent 1-year pregnancy removal rate was 18.7 (95% confidence interval (CI) 14.9-22.5) abortions per 1000 women of reproductive age in Nigeria, 18.8 (95% CI 11.8-25.8) in Cote d'Ivoire, and 7.0 (95% CI 4.6-9.5) in India. The 1-year adjusted abortion incidence rates for the first confidantes were 35.1 (95% CI 31.1-39.1) in Nigeria, 31.5 (95% CI 24.8-38.1) in Cote d'Ivoire, and 15.2 (95% CI 6.1-24.4) in Rajasthan, India. Confidante two's rates were closer to confidante one incidences than respondent incidences. The adjusted confidante one and two incidence estimates were significantly higher than respondent incidences in all three countries. CONCLUSIONS:Findings suggest that the confidante approach may present an opportunity to address some abortion-related data deficiencies but require modeling approaches to correct for biases due to violations of social network-based method assumptions. The performance of these methodologies varied based on geographical and social context, indicating that performance may be better in settings where abortion is legally and socially restricted.

SUBMITTER: Bell SO

PROVIDER: S-EPMC7574299 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Social network-based measurement of abortion incidence: promising findings from population-based surveys in Nigeria, Cote d'Ivoire, and Rajasthan, India.

Bell Suzanne O SO Shankar Mridula M Omoluabi Elizabeth E Khanna Anoop A Andoh Hyacinthe Kouakou HK OlaOlorun Funmilola F Ahmad Danish D Guiella Georges G Ahmed Saifuddin S Moreau Caroline C

Population health metrics 20201019 1

<h4>Background</h4>Monitoring abortion rates is highly relevant for demographic and public health considerations, yet its reliable estimation is fraught with uncertainty due to lack of complete national health facility service statistics and bias in self-reported survey data. In this study, we aim to test the confidante methodology for estimating abortion incidence rates in Nigeria, Cote d'Ivoire, and Rajasthan, India, and develop methods to adjust for violations of assumptions.<h4>Methods</h4>I ...[more]

PMID: 33076922

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Project description:ObjectiveAdvancing reproductive autonomy requires targeted strategies and interventions that address barriers to contraceptive use. The primary objective of this study is to investigate whether perceptions of low pregnancy likelihood are associated with lower likelihood of using contraception among presumably fecund, sexually active women.Study designWe used population-based survey data of reproductive age women at risk of pregnancy collected in 2018 from Côte d'Ivoire (N = 1447), Nigeria (N = 4110), and Rajasthan, India (N = 1994). To assess one's perceived biological likelihood of pregnancy, we used 2 measures: likelihood following a single act of sex without contraception and likelihood following 1 year of regular sex without contraception. Response options included: definitely yes, maybe yes, maybe no, definitely no, and do not know. We conducted multivariable logistic regression to assess the relationship between each perception measure with odds of contraceptive use separately by country.ResultsPerceived chance of definitely or maybe becoming pregnant after one act of sex without contraception ranged from 54.0% to 55.0% in Nigeria and Rajasthan to 80.0% in Côte d'Ivoire, while it was higher for regular sex without contraception (76.0%-85.1%). Multivariable results indicate that perceptions of pregnancy likelihood were associated with contraceptive use among presumably fecund women, with a stronger relationship observed in relation to cumulative likelihood (odds ratio 0.1-0.6) than likelihood after one act (odds ratio 0.4-0.8) and a dose-response pattern by strength of perceived chance.ConclusionsResults indicate that women's use of contraception in low-resource settings is associated with their perceived likelihood of becoming pregnant after unprotected sex.ImplicationsFindings suggest that understanding women's perceived likelihood of pregnancy may aid in the development of interventions to help women achieve their reproductive goals.

Project description:ObjectivesThe analysis aimed to assess the scale of interviewer effects on abortion survey responses, to compare interviewer effects between different question wordings and between direct and indirect approaches, and to identify interviewer and interview characteristics that explain interviewer effects on abortion reporting.Setting2018 Performance Monitoring for Action nationally representative household surveys from Côte d'Ivoire, Nigeria and Rajasthan, India.ParticipantsSurvey data from 20 016 interviews with reproductive age (15-49) women, selected using multistage stratified cluster sampling. Data from self-administered interviewer surveys and from a sample of health service delivery points that serve the female survey participants were also included.Primary outcome measuresOutcomes were the respondent's own experience of ever 'removing a pregnancy', their closest confidante's experience of pregnancy removal and the respondent's own experience of period regulation.ResultsSubstantial interviewer effects were observed, ranging from 7% in Côte d'Ivoire to 24% in Nigeria for pregnancy removal. Interviewer effects for survey questions that were designed to ask about abortion in a less stigmatising way were either similar to (9%-26% for confidante-reporting) or higher than (17%-32% for a question about period regulation) the pregnancy removal question. Interviewer and interview characteristics associated with abortion reporting included respondent-interviewer familiarity, the language of interview and the interviewer's comfort asking questions about abortion.ConclusionThis study highlights that questions designed to be less stigmatising may increase interviewer effects due to lower comprehension among respondents. Further work is needed to assess question wordings for different contexts. Selecting and training interviewers to ensure comfort asking questions about abortion is important for reproductive health surveys. Challenges for the use of 'insider' interviewers and the management of surveys in countries with high linguistic diversity are also identified.

Project description:BACKGROUND:In Côte d'Ivoire, induced abortion is legally restricted unless a pregnancy threatens a woman's life. Yet the limited available evidence suggests abortion is common and that unsafe abortion is contributing to the country's high maternal mortality. Our study aimed to estimate the one-year incidence of induced abortion in Côte d'Ivoire using both direct and indirect methodologies, determine the safety of reported abortions, and identify the women most likely to experience a recent induced abortion or an unsafe abortion. METHODS:In 2018, we conducted a nationally representative, population-based survey of women age 15 to 49 in Côte d'Ivoire. Women reported their own abortion experiences and those of their closest female confidante. We estimated the one-year incidence of induced abortion, and the safety of the abortions women experienced. Using bivariate and multivariate regression, we separately assessed sociodemographic characteristics associated with having had a recent abortion or an unsafe abortion. RESULTS:Overall, 2,738 women participated in the survey, approximately two-thirds of whom reported on the abortion experiences of their closest female friend. Based on respondent data, the one-year incidence of induced abortion was 27.9 (95% CI 18.6-37.1) per 1,000 women of reproductive age, while the confidante incidence was higher at 40.7 (95% CI 33.3-48.1) per 1,000. Among respondents, 62.4% of abortions were most unsafe, while 78.5% of confidante abortions were most unsafe. Adolescents, less educated women, and the poorest women had the most unsafe abortions. CONCLUSION:This study provides the first national estimates of induced abortion incidence and safety in Côte d'Ivoire, using a population-based approach to explore social determinants of abortion and unsafe abortion. Consistent with other research, our results suggest that legal restrictions on abortion in Côte d'Ivoire are not preventing women from having abortions, but rather pushing women to use unsafe, potentially dangerous abortion methods. Efforts to reduce the harms of unsafe abortion are urgently needed.

Project description:Cucurbita moschata varieties grown in Africa have very low yield. They have been neglected, and totally ignored in agricultural research programs. However, interest in their fruits, seeds, flowers and leaves is growing nowadays due to their nutritional and medicinal potentials. That growing interest has prompted plant breeders and agronomists to develop research programs for their improvement. A complete diallel cross analysis of four parental lines, Long, Zouan-H, Oval, and Soubre and their twelve F1 hybrids, was carried out in a farming environment at the University Nangui Abrogoua, Abidjan, Côte d'Ivoire. The four parental lines and the F1 hybrids were evaluated for their general performances, combining abilities, potency ratio and heterosis effects. The investigated traits included plant height, and eleven fruit- and seed-related characters. The analysis of variance showed significant differences for all traits studied. In addition, the diallel model yielded highly significant gca effects of the female parents. The gca effects of the male parents were significant for all traits except plant height, length of the fruit, width of the fruit and length of the seed. Highly significant sca effects were observed in the crosses for all the traits. Strong maternal effects were observed for the weight and diameter of the fruit, weight of the pulp, number of seeds per fruit, weight of the fresh seeds and 100-seed weight. The general predictive ratio approached the value 1 for all the traits except weight of the fresh seed and width of the dry seed. Most of the characters under this study are predominantly determined by the effects of additive genes. But, weight of the fresh seed and width of the dry seed may be controlled by non-additive genes. Mid-parent heterosis was significant for all measured traits in the crosses, except the length of the fruit. And better-parent heterosis was significant for all traits except plant height, number of fruits per plant and length of the fruit. Gene expression is described by a super-dominance for many traits, and partial dominance for some other traits in all twelve F1 hybrids. Classification of the parental lines based on the effects of their general combining ability grouped the Soubre lines as promising contributors to fruit yield. The parental lines Long and Oval formed another group likely on the basis of the small size of their fruits, the small pulps, the smaller number of fruits per plant and the large number of seeds per fruit. However, Long would be a candidate parent for the development of cultivars with longer vegetative growth. The parental line Zouan-H formed the third group and it was mostly characterized by its large number of seeds per fruit and relatively large fruits.

Project description:BackgroundKnowing the species composition and insecticide resistance status of the target vector population is important to guide malaria vector control. The aim of this study was to characterize the malaria vector population in terms of species composition, insecticide susceptibility status and potential underlying resistance mechanisms in Ellibou, southern Côte d'Ivoire.MethodsA 1-year longitudinal entomological survey was conducted using light traps and pyrethroid spray catches to sample adult mosquitoes in combination with larval sampling. The susceptibility status of Anopheles gambiae sensu lato (s.l.) to bendiocarb, deltamethrin, DDT and malathion was assessed using the World Health Organization insecticide susceptibility test. Additionally, An. gambiae specimens were screened for knockdown (kdr) and acetylcholineesterase (ace1) target site resistance alleles, and the expression levels of eight metabolic resistance genes, including seven cytochrome P450 monooxygenases (P450s) and one glutathione S-transferase (GST), measured with reverse transcription quantitative real-time polymerase chain reaction (qPCR).ResultsOverall, 2383 adult mosquitoes from 12 different taxa were collected with Culex quinquefasciatus and An. gambiae being the predominant taxa. Molecular identification of An. gambiae s.l. revealed the presence of Anopheles arabiensis, Anopheles coluzzii, An. gambiae sensu stricto (s.s.) and Anopheles coluzzii/An. gambiae s.s. hybrids. Anopheles gambiae mosquitoes were resistant to all insecticides except malathion. PCR diagnostics revealed the presence of ace1-G280S and the kdr L995F, L995S and N1570Y target-site mutations. Additionally, several genes were upregulated, including five P450s (i.e., CYP6P3, CYP6M2, CYP9K1, CYP6Z1, CYP6P1) and GSTE2.ConclusionThis is the first documented presence of An. arabiensis in Côte d'Ivoire. Its detection - together with a recent finding further north of the country - confirms its existence in the country, which is an early warning sign, as An. arabiensis shows a different biology than the currently documented malaria vectors. Because the local An. gambiae population was still susceptible to malathion, upregulation of P450s, conferring insecticide resistance to pyrethroids, together with the presence of ace1, suggest negative cross-resistance. Therefore, organophosphates could be an alternative insecticide class for indoor residual spraying in the Ellibou area, while additional tools against the outdoor biting An. arabiensis will have to be considered.

Dataset Information

Social network-based measurement of abortion incidence: promising findings from population-based surveys in Nigeria, Cote d'Ivoire, and Rajasthan, India.

Publications

Social network-based measurement of abortion incidence: promising findings from population-based surveys in Nigeria, Cote d'Ivoire, and Rajasthan, India.

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