Individual and contextual factors associated with abortion among reproductive age women in sub-Saharan Africa: Insights from 24 recent demographic and health surveys.

Despite the Sustainable Development Goal to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030, abortion remains one of the top five causes of maternal mortality in low and middle-income countries. However, there is a lack of comprehensive data on the pooled prevalence and determinants of abortion in sub-Saharan Africa (SSA). Therefore, this study aims to investigate the pooled prevalence and determinants of abortion among women of reproductive age in 24 SSA countries using the most recent Demographic and Health Surveys. The most recent Demographic and Health Survey (DHS) data from 24 Sub-Saharan African (SSA) countries were analyzed, using a weighted sample of 392,332 women of reproductive age. To address the clustering effects inherent in DHS data and the binary nature of the outcome variable, a multilevel binary logistic regression model was employed. The results were reported as adjusted odds ratios with 95% confidence intervals to indicate statistical significance. Additionally, the model with the lowest deviance was identified as the best fit for the data. The pooled prevalence of abortion in SSA were 6.93% (95%CI: 5.38, 8.48). Older age (AOR = 3.71; 95%CI: 3.46, 3.98), ever married (AOR = 3.87; 95%CI: 3.66, 4.10), being educated (AOR = 1.35; 95%CI: 1.28, 1.44), having formal employment (AOR = 1.19; 95%CI: 1.16, 1.23), traditional contraceptive use (AOR = 1.27; 95%CI: 1.19, 1.36) and media exposure (AOR = 1.37; 95%CI: 1.32, 1.41) found to be a predisposing factors for abortion. While high parity (AOR = 0.72; 95%CI: 0.68, 0.76), rural residence (AOR = 0.87; 95%CI: 0.85, 0.91), and rich (AOR = 0.96; 95%CI: 0.93, 0.99) wealth index were a protective factors. The study found that the pooled prevalence of abortion in Sub-Saharan Africa is 7%. Potential interventions include comprehensive sexual education to inform and empower women, increased access to modern contraceptives to reduce unintended pregnancies, improved healthcare services especially in rural areas, economic empowerment through education and employment opportunities, media campaigns to disseminate information and reduce stigma, and policy development to ensure safe and legal access to abortion services. These interventions aim to improve reproductive health outcomes and reduce unsafe abortions in SSA.

Seifu BL ，Tebeje TM ，Asgedom YS ，Asmare ZA ，Asebe HA ，Kase BF ，Shibeshi AH ，Lombebo AA ，Sabo KG ，Wubshet BZ ，Fente BM ，Mare KU ... -  《PLoS One》

Inequality in modern contraceptive use and unmet need for contraception among women of reproductive age in Zambia. A trend and decomposition analysis 2007-2018.

Access to contraception can be a transformational intervention towards advancement of education, health, and freedom of choice. Countries have committed to improving access to contraception enshrined in the sustainable development goals (SDGs), indicator 3.7.1. Our study seeks to investigate the level of inequality in current use of modern contraception and unmet need for contraception among sexually active women of reproductive age in Zambia during 2007, 2013/14 and 2018 to inform family planning policy. We use three rounds of Zambia demographic and health survey datasets for the years 2007, 2013/14 and 2018, which are nationally representative surveys. We included a total of 19,973 sexually active women of reproductive age from 15 to 49 years living in Zambia. The level of inequality was assessed using concentration curves, and indices. The concentration indices were decomposed to identify the causes of the inequality. Our analysis shows that there was inequality in the current use of modern contraception across the years 2007, 2013/14 and 2018. The concentration curves showed that current use of modern contraception was higher among the wealthy than the poor. This pro-rich trend was consistent throughout the study period. Erreygers concentration Index (EI) values were 0.2046 in 2007, 0.1816 in 2013/14, and 0.1124 in 2018. The inequality in current use of modern contraception was significantly influenced by having access to contraceptive counselling, education level and being in a union (living with a partner). In addition, there was inequality in unmet need for contraception with concentration curves showing that unmet need for modern contraception was experienced more among the poor compared to the wealthy. Unmet need was thus pro poor. The EI values were - 0.0484 in 2007, - 0.0940 in 2013/14 and - 0.0427 in 2018. This inequality was significantly influenced by education, employment status, being in a union, and having health insurance. Inequality in modern contraceptive use and unmet need for contraception exists and has persisted over the years in Zambia. Such inequality can be addressed through a multipronged approach that includes encouraging women to visit health facilities, access to contraceptive counselling, and promoting formal education.

Kazibwe J ，Masiye F ，Klingberg-Allvin M ，Ekman B ，Sundewall J ... -  《Reproductive Health》

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 ... -  《-》

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》

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》