Prevalence and determinants of termination of pregnancy among reproductive-age women who had a short preceding birth interval in Sub-Saharan Africa: a multilevel analysis.

Termination of pregnancy is one of the biggest five causes of maternal mortality in countries with low and middle incomes. Although termination of pregnancy is hazardous, its prevalence and determinates are not well studied in developing countries. Therefore, this study aims to assess the prevalence and determinants of termination of pregnancy among reproductive-age women who had a short preceding birth interval in Sub-Saharan Africa. Data from the most recent Demographic and Health Surveys, which covered 21 Sub-Saharan African countries from 2015 to 2022, were used for secondary data analysis. The study used a total of 283,785 women. Stata 14 was used to analyze the data. The determinants of termination of pregnancy were determined using a multilevel mixed-effects logistic regression model. Significant factors associated with termination of pregnancy were declared significant at p-values < 0.05. The result was interpreted using the confidence interval and adjusted odds ratio. The best-fit model was determined to be the one with the highest log likelihood ratio and the lowest deviance. In Sub-Saharan Africa, one in ten women with short birth intervals experienced pregnancy termination. Individual factors, including the sex of the preceding birth (AOR = 1.21, 95% CI: 1.05, 1.40), maternal age (AOR = 1.57, 95% CI: 1.27, 1.95), pregnancy complications (AOR = 1.28, 95% CI: 1.09, 1.49), No ANC visits (AOR = 2.29, 95% CI: 1.26, 4.14), previous cesarean section delivery (AOR = 1.74, 95% CI: 1.32, 2.30), <6 months of breastfeeding (AOR = 1.56, 95% CI: 1.35, 1.81), traditional contraception usage (AOR = 1.67, 95% CI: 1.13, 2.46), poor wealth status (AOR = 1.50, 95% CI: 1.22, 1.85), and community-level factors such as urban residence (AOR = 1.31, 95% CI: 1.06, 1.62) had higher odds of pregnancy termination. This study concludes that termination of pregnancy rates among women with short preceding birth interval is high. The study identified that both individual and community-level variables were determinants of termination of pregnancy. Therefore, the ministries of health in Sub-Saharan African countries should give attention to those women who underutilize antenatal care services and to women from urban areas while designing policies and strategies targeting reducing termination of pregnancy rates.

Zegeye AF ，Tamir TT ，Mekonen EG ，Techane MA ，Terefe B ，Workneh BS ... -  《-》

Early postnatal care uptake and its associated factors following childbirth in East Africa-a Bayesian hierarchical modeling approach.

The postnatal period is a critical period for both mothers and their newborns for their health. Lack of early postnatal care (PNC) services during a 2-day period is a life-threatening situation for both the mother and the babies. However, no data have been examined for PNCs in East Africa. Hence, using the more flexible Bayesian multilevel modeling approach, this study aims to investigate the pooled prevalence and potential factors for PNC utilization among women after delivery in East African countries. We retrieved secondary data from the Kids Record (KR) demographic and health surveys (DHS) data from 2015 to 2022 from 10 East African countries. A total of 77,052 weighted women were included in the study. We used R 4.3.2 software for analysis. We fitted Bayesian multilevel logistic regression models. Techniques such as Rhat, effective sample size, density, time series, autocorrelation plots, widely applicable information criterion (WAIC), deviance information criterion (DIC), and Markov Chain Monte-Carlo (MCMC) simulation were used to estimate the model parameters using Hamiltonian Monte-Carlo (HMC) and its extensions, No-U-Turn Sampler (NUTS) techniques. An adjusted odds ratio (AOR) with a 95% credible interval (CrI) in the multivariable model to select variables that have a significant association with PNC was used. The overall pooled prevalence of PNC within 48 hrs. of delivery was about 52% (95% CrI: 39, 66). A higher rate of PNC usage was observed among women aged 25-34 years (AOR = 1.21; 95% CrI: 1.15, 1.27) and 35-49-years (AOR = 1.61; 95% CrI: 1.5, 1.72) as compared to women aged 15-24 years; similarly, women who had achieved primary education (AOR = 1.96; 95% CrI: 1.88, 2.05) and secondary/higher education (AOR = 3.19; 95% CrI: 3.03, 3.36) as compared to uneducated women; divorced or widowed women (AOR = 0.83; 95% CrI: 0.77, 0.89); women who had currently working status (AOR = 0.9; 95% CrI: 0.87, 0.93); poorer women (AOR = 0.88; 95% CrI: 0.84, 0.92), middle-class women (AOR = 0.83; 95% CrI: 0.79, 0.87), richer women (AOR = 0.77; 95% CrI: 0.73, 0.81), and richest women (AOR = 0.59; 95% CrI: 0.55, 0.63) as compared to the poorest women; women who had media exposure (AOR = 1.32; 95% CrI: 1.27, 1.36), were having 3-5 children (AOR = 0.89; 95% CrI: 0.84, 0.94), had >5 children (AOR = 0.69; 95% CrI: 0.64, 0.75), had first birth at age < 20 years (AOR = 0.82; 95% CrI: 0.79, 0.84), had at least one ANC visit (AOR = 1.93; 95% CrI: 1.8, 2.08), delivered at health facilities (AOR = 2.57; 95% CrI: 2.46, 2.68), had average birth size (AOR = 0.94; 95% CrI: 0.91, 0.98) and small birth size child (AOR = 0.88; 95% CrI: 0.84, 0.92), had twin newborns (AOR = 1.15; 95% CrI: 1.02, 1.3), and fourth and above birth order (AOR = 0.88; 95% CrI: 0.82, 0.95) were individual-driven women who have been independently associated with PNC, respectively. Regarding community-level variables, rural women (AOR = 0.76; 95% CrI: 0.72, 0.79), high media exposure communities (AOR = 1.1; 95% CrI: 1.04, 1.18), communities with high wealth levels (AOR = 0.88 95% CrI: 0.83, 0.94), communities with high antenatal care (ANC) utilization (AOR = 1.13, 95% CrI: 1.07, 1.19), and long distance to health facilities (AOR = 1.5; 95% CrI: 1.38, 1.63) were among the community factors associated with PNC, respectively. One of the significant public health priorities in East Africa continues to be the underutilization of immediate PNC. The government ought to prioritize improving maternity and child health services, collaborating with interested parties in the area, reducing health disparities, educating mothers about child health, and other connected issues that are very beneficial.

Terefe B ，Asgedom DK ，Arage FG ，Aychiluhm SB ，Ayele TA ... -  《Frontiers in Public Health》

Number of tetanus toxoid injections before birth and associated factors among pregnant women in low and middle income countries: Negative binomial poisson regression.

Zegeye AF ，Tamir TT ，Mekonen EG ，Ali MS ，Gonete AT ，Techane MA ，Wassie M ，Kassie AT ，Ahmed MA ，Tsega SS ，Wassie YA ，Tekeba B ，Workneh BS ... -  《-》

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》

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 ... -  《-》