Multilevel multinomial regression analysis of factors associated with birth weight in sub-Saharan Africa.

Birth weight significantly determines newborns immediate and future health. Globally, the incidence of both low birth weight (LBW) and macrosomia have increased dramatically including sub-Saharan African (SSA) countries. However, there is limited study on the magnitude and associated factors of birth weight in SSA. Thus, thus study investigated factors associated factors of birth weight in SSA using multilevel multinomial logistic regression analysis. The latest demographic and health survey (DHS) data of 36 sub-Saharan African (SSA) countries was used for this study. A total of a weighted sample of 207,548 live births for whom birth weight data were available were used. Multilevel multinomial logistic regression model was fitted to identify factors associated with birth weight. Variables with p-value < 0.2 in the bivariable analysis were considered for the multivariable analysis. In the multivariable multilevel multinomial logistic regression analysis, the adjusted Relative Risk Ratio (aRRR) with the 95% confidence interval (CI) was reported to declare the statistical significance and strength of association. The prevalence of LBW and macrosomia in SSA were 10.44% (95% CI 10.31%, 10.57%) and 8.33% (95% CI 8.21%, 8.45%), respectively. Maternal education level, household wealth status, age, and the number of pregnancies were among the individual-level variables associated with both LBW and macrosomia in the final multilevel multinomial logistic regression analysis. The community-level factors that had a significant association with both macrosomia and LBW were the place of residence and the sub-Saharan African region. The study found a significant association between LBW and distance to the health facility, while macrosomia had a significant association with parity, marital status, and desired pregnancy. In SSA, macrosomia and LBW were found to be major public health issues. Maternal education, household wealth status, age, place of residence, number of pregnancies, distance to the health facility, and parity were found to be significant factors of LBW and macrosomia in this study. Reducing the double burden (low birth weight and macrosomia) and its related short- and long-term effects, therefore, calls for improving mothers' socioeconomic status and expanding access to and availability of health care.

Bezie MM ，Tesema GA ，Seifu BL 《Scientific Reports》

Prevalence and determinants of intimate partner sexual violence among pregnant women in sub-Saharan Africa: Evidence from the most recent DHS data 2015-2022.

Tekeba B ，Tamir TT ，Zeleke GA ，Zegeye AF ... -  《-》

Minimum meal frequency and associated factors among children aged 6-23 months in Sub-Saharan Africa: a multilevel analysis of the demographic and health survey data.

Worldwide, approximately half of all children are not provided the minimum meal frequency (MMF). Sub-Saharan Africa (SSA) had the lowest proportion of children aged 6-23 months who met the requirements of the complementary feeding indicators, including MMF. Ensuring adequate meal frequency poses a challenge in numerous developing countries, particularly in regions characterized by low household food security, such as SSA. Therefore, this study aimed to assess the pooled prevalence of MMF and its associated factors in SSA via the most recent demographic and health survey data. A total of 100,526 weighted samples from demographic and health survey datasets of 35 SSA countries were used. A multilevel Poisson regression model with robust variance was applied to identify factors associated with MMF, and the model with the lowest deviance was the best-fitted model. An adjusted prevalence ratio with a 95% confidence interval (CI) was reported, and variables with a p < 0.05 were considered statistically significant. The pooled prevalence of MMF among children aged 6-23 months in SSA was 38.47% (95% CI: 34.97-41.97), which ranged from 21.41% in Liberia to 63.98% in Madagascar. According to the subgroup analysis, the pooled magnitude of MMF in central, west, east, and southern Africa was 36.42, 35.46, 39.97, and 50.69%, respectively. Marital status, maternal education level, sex of household head, working status, wealth index, media exposure, age of the child, postnatal check-up, breastfeeding status, residence, and SSA regions were significantly associated with minimum meal frequency. Less than forty percent of infants and young children in SSA receive the minimum recommended meal frequency, which is relatively low. This presents a notable difficulty in efforts to prevent malnutrition and attain sustainable development goals related to health and nutrition on the continent. Therefore, priority should be given to empowering women, promoting breastfeeding and postnatal check-ups, targeting infants who just started complementary feeding, and spreading information through media.

Tebeje TM ，Abebe M ，Tesfaye SH ，Seboka BT ，Argaw GS ，Seifu BL ，Mare KU ，Aragaw FM ... -  《Frontiers in Public Health》

Determinants of non-testing for HIV among women during antenatal care follow up in sub-saharan Africa: a hierarchical analysis of recent Demographic and Health Survey datasets.

HIV/AIDS is a global public health concern that is closely related to other sociocultural problems. The prevention of mother to child transmission cascade often begins with and is integrated into antenatal care in order to ensure a high rate of case detection and optimal treatment coverage. Although guidelines suggest that all pregnant women should have HIV testing as part of their regular screening checks during antenatal care, a significant proportion of pregnant women were not tested for HIV during antenatal care follow-up in sub-Saharan Africa. Hence, this study was aimed at assessing the determinants of women not tested for HIV during antenatal care follow-up in sub-Saharan Africa. A cross-sectional study was conducted to assess the determinants of non-testing for HIV among women as part of antenatal care in sub-Saharan Africa, utilizing secondary data from the 2015-2022 Demographic and Health Surveys. The study included a weighted sample of 788,421 women who had antenatal care follow-up during their most recent pregnancy within five years preceding the survey. A multilevel mixed effect logistic regression analysis was employed to identify the determinants of non-testing for HIV among these women. The adjusted odds ratios with 95% confidence intervals were calculated to determine the associations between the outcome and explanatory variables. Statistical significance was determined using a p-value of less than 0.05. The hierarchical analysis of this study identified several significant factors associated with women not being tested for HIV during antenatal care in sub-Saharan Africa. These factors include young age, low or no education, not being in a union, unemployment, and low household wealth index. Additionally, limited media exposure, stigmatizing attitudes towards people living with HIV, male-headed households, and rural residence were significant at the individual and household levels. At the community level, low media exposure and high illiteracy rates were significant, while at the country level, high fertility rates and low literacy rates were also associated with lower rates of HIV testing during antenatal care. This study identified significant individual, community, and country-level factors associated with women not testing for HIV during antenatal care in sub-Saharan Africa. Key factors include young age, low education, unemployment, not being in a union, low household wealth, limited media exposure, stigmatizing attitudes towards people living with HIV, male household head, rural residence, low community media exposure, high community illiteracy, high fertility rates, and low literacy rates. These findings highlight the need for targeted, context-specific interventions to improve HIV testing rates and enhance maternal and child health outcomes in the region.

Tamir TT ，Zegeye AF ，Mekonen EG ，Liyew B ，Workneh BS ... -  《BMC HEALTH SERVICES RESEARCH》

Care-seeking for difficulties conceiving in sub-Saharan Africa: findings from population-based surveys in eight geographies.

What is the nature of women's care-seeking for difficulties conceiving in sub-Saharan Africa (SSA), including the correlates of seeking biomedical infertility care at a health facility? Care-seeking for difficulties getting pregnant was low, much of which involved traditional or religious sources of care, with evidence of sociodemographic disparities in receipt of biomedical care. Nearly all research on infertility care-seeking patterns in SSA is limited to clinic-based studies among the minority of people in these settings who obtain facility-based services. In the absence of population-based data on infertility care-seeking, we are unable to determine the demand for services and disparities in the use of more effective biomedical sources of care. We used cross-sectional, population-based data from the Performance Monitoring for Action (PMA) female survey in eight geographies in SSA, including nationally representative data from Burkina Faso, Côte d'Ivoire, Kenya, and Uganda and regionally representative data from two provinces in the Democratic Republic of the Congo (DRC) (Kinshasa and Kongo Central) and two states in Nigeria (Kano and Lagos). We employed a multi-stage cluster random sampling design with probability proportional to size selection of clusters within each geography to produce representative samples of women aged 15-49. Samples ranged from 1144 in Kano, Nigeria, to 9489 in Kenya. PMA collected these data between November 2021 and December 2022. We restricted the sample to women who had ever had sex, with analytic samples ranging from 854 in Kano to 8,059 in Kenya, then conducted descriptive and bivariable analyses to examine characteristics of those who sought care for difficulties getting pregnant. Among those who reported seeking care, we conducted bivariable and multivariable logistic regression analyses to determine factors associated with receipt of biomedical services from a health facility. All analyses were conducted separately by geography. Our study found low levels of care-seeking for difficulties getting pregnant among sexually active women in eight geographies in SSA, ranging from 3.7% (Kenya) to 15.3% (Côte d'Ivoire). Of this, 51.8% (Burkina Faso) to 86.7% (Kinshasa) involved receipt of biomedical services in health facilities. While many factors were consistently associated with infertility care-seeking from any source across geographies, factors associated with receipt of biomedical care specifically were less pronounced. This may be a result of the highly limited sources of infertility services in SSA; thus, even privileged groups may struggle to obtain effective treatment for difficulties getting pregnant. However, we did observe disparities in biomedical care-seeking in our bivariable results in several geographies, with the wealthiest women, those with more education, and those residing in urban areas generally more likely to have sought biomedical care for difficulties getting pregnant. Our data lacked details on the nature of the services received and outcomes, and we do not have information on reasons why women chose the sources they did. Small samples of women who sought care limited our power to detect significant differences in care-seeking by women's characteristics in several geographies. Infertility and access to appropriate treatment are issues of reproductive health and human rights. While our results do not indicate to what extent use of non-biomedical sources of care is driven by preferences, cost, or lack of accessible services, it is clear from our results and existing literature that more needs to be done to ensure access to affordable, quality, cost-effective infertility services in SSA. This study was supported by grants from the Bill & Melinda Gates Foundation (INV009639) and the National Institute of Child Health and Human Development (K01HD107172). The funders were not involved in the study design, analyses, manuscript writing, or the decision to publish. The authors have no conflicts of interest to declare. N/A.

Bell SO ，Larson E ，Bittle D ，Moreau C ，Omoluabi E ，OlaOlorun FM ，Akilimali P ，Kibira SPS ，Makumbi F ，Guiella G ，Mosso R ，Gichangi P ，Anglewicz P ... -  《-》