Management of hypertension at the community level in Sub-Saharan Africa (SSA): towards a rational use of available resources

Abstract Background In sub-Saharan African countries, neonatal mortality rates remain unacceptably high. Ethiopia is one of the countries in Sub-Saharan Africa with the highest death rates of newborn children. Therefore, this study aimed to identify the risk factors associated with neonatal mortality in Ethiopia at the individual and community level. Methods The 2016 Ethiopian Demographic and Health Survey data was accessed and used for the analysis. A total of 2449 newborn children were included in the analysis. The multilevel logistic regression model was used to identify the significant factor of neonatal mortality. Adjusted odds ratio with a 95% confidence interval and p-value < 0.05 in the multilevel model was reported. Results A total of 2449 newborn children were included in this study. Multiple birth type (AOR = 3.18; 95% CI 2.78, 3.63), birth order of ≥ 5 (AOR = 2.15; 95% CI 1.75, 2.64), pre-term birth (AOR = 5.97; 95% CI 4.96, 7.20), no antenatal care (ANC) visit during pregnancy (AOR = 2.33; 95% CI 2.09, 2.61), not received TT injection during pregnancy (AOR = 2.28; 95% CI 1.92, 2.71), delivered at home (AOR = 1.99; 95% CI 1.48, 2.69), less than 24 months of preceding birth interval (AOR = 1.51; 95% CI 1.35,1.68), smaller birth size (AOR = 1.58; 95% CI 1.46, 1.71), never breastfeeding (AOR = 2.43; 95% CI 2.17, 2.72), poor wealth index (AOR = 1.29; 95% CI 1.17,1.41), non-educated mothers (AOR = 1.58; 95% CI 1.46, 1.71), non-educated fathers (AOR = 1.32; 95% CI 1.12, 1.54), rural residence (AOR = 2.71; 95% CI 2.23, 3.29), unprotected water source (AOR = 1.35; 95% CI 1.16, 1.58), and have no latrine facility (AOR = 1.78; 95% CI 1.50, 2.12) were associated with a higher risk of neonatal mortality. Neonates living in Amhara, Oromia, Somali, Harari, and Dire Dawa had a higher risk of neonatal mortality compared to Tigray. Moreover, the random effects result showed that about 85.57% of the variation in neonatal mortality was explained by individual- and community-level factors. Conclusions The findings suggest that attention be paid to education-based programs for mothers that would highlight the benefits of delivery care services, such as ANC visits, TT injections, and facility births. Meanwhile, public health initiatives should focus on expanding access to quality sanitation facilities, especially for latrines and drinking water that could improve neonatal health at the community-level as a whole.

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Timely initiation of breastfeeding and associated factors among mothers having children less than two years of age in sub-Saharan Africa: A multilevel analysis using recent Demographic and Health Surveys data

PLoS ONE ◽

10.1371/journal.pone.0248976 ◽

2021 ◽

Vol 16 (3) ◽

pp. e0248976

Author(s):

Achamyeleh Birhanu Teshale ◽

Getayeneh Antehunegn Tesema

Keyword(s):

Health Facility ◽

Community Level ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Health Facility Delivery ◽

Timely Initiation ◽

Pooled Prevalence ◽

Sub Saharan ◽

Timely Initiation Of Breastfeeding ◽

Initiation Of Breastfeeding

Background Despite the significant advantages of timely initiation of breastfeeding (TIBF), many countries particularly low- and middle-income countries have failed to initiate breastfeeding on time for their newborns. Optimal breastfeeding is one of the key components of the SDG that may help to achieve reduction of under-five mortality to 25 deaths per 1000 live births. Objective To assess the pooled prevalence and associated factors of timely initiation of breastfeeding among mothers having children less than two years of age in sub-Saharan Africa. Methods We used pooled data from the 35 sub-Saharan Africa (SSA) Demographic and Health Surveys (DHS). We used a total weighted sample of 101,815 women who ever breastfeed and who had living children under 2 years of age. We conducted the multilevel logistic regression and variables with p<0.05, in the multivariable analysis, were declared significantly associated with TIBF. Results The pooled prevalence of TIBF in SSA was 58.3% [95%CI; 58.0–58.6%] with huge variation between countries, ranging from 24% in Chad to 86% in Burundi. Both individual and community level variables were associated with TIBF. Among individual-level factors; being older-aged mothers, having primary education, being from wealthier households, exposure to mass media, being multiparous, intended pregnancy, delivery at a health facility, vaginal delivery, single birth, and average size of the child at birth were associated with higher odds of TIBF. Of community-level factors, rural place of residence, higher community level of ANC utilization, and health facility delivery were associated with higher odds of TIBF. Conclusion In this study, the prevalence of TIBF in SSA was low. Both individual and community-level factors were associated with TIBF. The authors recommend interventions at both individual and community levels to increase ANC utilization as well as health facility delivery that are crucial for advertising optimal breastfeeding practices such as TIBF.

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Noncompliance with the WHO’s Recommended Eight Antenatal Care Visits among Pregnant Women in Sub-Saharan Africa: A Multilevel Analysis

BioMed Research International ◽

10.1155/2021/6696829 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

Emmanuel Kolawole Odusina ◽

Bright Opoku Ahinkorah ◽

Edward Kwabena Ameyaw ◽

Abdul-Aziz Seidu ◽

Eugene Budu ◽

...

Keyword(s):

Health Insurance ◽

Antenatal Care ◽

Pregnant Women ◽

Pregnancy Outcomes ◽

Economic Status ◽

Community Level ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Negatively Associated ◽

Sub Saharan

Background. In 2016, the World Health Organization (WHO) introduced a minimum of eight antenatal care (ANC) visits for positive pregnancy outcomes. This study examined the prevalence of noncompliance with 8+ ANCvisits and its associated factors in sub-Saharan Africa (SSA). Methods. We used data from the Demographic and Health Surveys of eight countries in SSA. A pooled sample of 63,266 pregnant women aged 15-49 years who had given birth to children within 5 years prior to the surveys was included in this study. To examine the factors associated with noncompliance with ANC 8+ visits, multilevel binary logistic regression analysis was conducted, and the results were reported using odds radios at 95% confidence interval (CI). Results. The pooled prevalence of noncompliance with ANC 8+ visits was 92.3% (95% CI: 91.1%-93.3%) with the highest and lowest prevalence in Zambia (98.7%, 95% CI: 98.3%-99.1%) and Libya (73.4%, 95% CI: 70.4%-76.2%), respectively. With the individual level factors, women’s age (44-49 years- aOR = 0.33 , 9% CI: 0.14-0.78), health insurance registration, (yes- aOR = 0.53 , 95% CI: 0.29-0.98), and economic status (richest- aOR = 0.16 , 95% CI: 0.05-0.49) were negatively associated with noncompliance with 8+ ANC visits, while parity (five or more children- aOR = 1.68 , 95% CI: 1.12-2.52) was positively associated with noncompliance with 8+ ANC visit. With the community level factors, community level literacy was negatively associated with noncompliance with 8+ ANC visit (high- aOR = 0.56 , 95% CI: 0.32-0.99). Conclusion. About eight out of ten pregnant women did not comply with the WHO’s recommended minimum of eight ANC visits for positive pregnancy outcomes in SSA. Empowering the economic status of women , enhancing health insurance and education coverage, and giving more attention to young pregnant women and those with more children are crucial for improving the coverage of ANC 8+ visits in the region.

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Understanding the Agricultural Input Landscape in Sub-Saharan Africa : Recent Plot, Household, and Community-Level Evidence

10.1596/1813-9450-7014 ◽

2014 ◽

Cited By ~ 44

Author(s):

Megan Sheahan ◽

Christopher B. Barrett

Keyword(s):

Community Level ◽

Sub Saharan Africa ◽

Sub Saharan ◽

Agricultural Input

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Individual and community level factors associated with use of iodized salt in sub-Saharan Africa: A multilevel analysis of demographic health surveys

PLoS ONE ◽

10.1371/journal.pone.0251854 ◽

2021 ◽

Vol 16 (5) ◽

pp. e0251854

Author(s):

Yigizie Yeshaw ◽

Alemneh Mekuriaw Liyew ◽

Achamyeleh Birhanu Teshale ◽

Tesfa Sewunet Alamneh ◽

Misganaw Gebrie Worku ◽

...

Keyword(s):

Community Education ◽

Media Exposure ◽

Wealth Index ◽

Education Level ◽

Iodized Salt ◽

Community Level ◽

Sub Saharan Africa ◽

Poverty Level ◽

Community Media ◽

Sub Saharan

Introduction Iodine deficiency disorder a common problem in sub-Saharan Africa (SSA). It affects not only the health of the affected individual but also the economic development of the country. However, to the best of our knowledge, there is a scarcity in literature about the associated factors of iodized salt utilization in sub-Saharan Africa. Therefore, this study aimed to identify both individual and community level determinants of iodized salt utilization in sub-Saharan Africa. Methods This study used the appended datasets of the most recent demographic and health survey from 31 sub-Saharan countries. A total weighted sample of 391,463 households was included in the study. Both bivariable and multivariable multilevel logistic regression were done to determine the associated factors of iodized salt utilization in SSA. P value ≤ 0.05 was used to declare statistically significant variables. Results Those households with primary (AOR = 1.53, 95% CI = 1.50–1.57), secondary (AOR = 1.81, 95% CI = 1.76–1.86) and higher education level (AOR = 2.28, 95% CI = 2.17–2.40) had higher odds of iodized salt utilization. Households with middle (AOR = 1.05, 95% CI = 1.02–1.08), richer (AOR = 1.13, 95% CI = 1.09–1.17) and richest wealth index (AOR = 1.23, 95% CI = 1.18–1.28) also had an increased chance of using iodized salt. Households from high community media exposure (AOR = 2.07, 95% CI = 1.71–2.51), high community education level (AOR = 3.78, 95% CI = 3.14–4.56), and low community poverty level (AOR = 1.29, CI = 1.07–1.56) had higher odds of using salt containing iodine. Conclusion Both individual and community level factors were found to be associated with use of salt containing iodine in sub-Saharan Africa. Education level, media exposure, community poverty level, wealth index, community education, and community media exposure were found to be associated with use of salt containing iodine in SSA. Therefore, to improve the use of iodized salt in the region, there is a need to increase access to media sources and develop the socioeconomic status of the community.

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Risk scores for predicting HIV incidence among the general population in sub-Saharan Africa: a systematic review and meta-analysis

10.1101/2021.09.28.21264246 ◽

2021 ◽

Author(s):

Katherine M. Jia ◽

Hallie Eilerts ◽

Olanrewaju Edun ◽

Kevin Lam ◽

Adam Howes ◽

...

Keyword(s):

General Population ◽

Hiv Infection ◽

Hiv Risk ◽

Meta Analysis ◽

Random Effect ◽

Community Level ◽

Sub Saharan Africa ◽

Risk Scores ◽

Younger Age ◽

Sub Saharan

AbstractIntroductionSeveral HIV ‘risk scores’ have been developed to identify individuals for prioritised HIV prevention in sub-Saharan Africa. We systematically reviewed HIV risk scores to: (i) identify factors that consistently predicted incident HIV infection, (ii) review inclusion of community-level HIV risk in predictive models, and (iii) examine predictive performance.MethodsWe systematically searched nine databases for studies developing and/or validating HIV risk scores among the general population in sub-Saharan Africa from database inception until February 15, 2021. Studies not prospectively observing seroconversion or recruiting only key populations were excluded. Record screening, data extraction, and critical appraisal were conducted in duplicate. We used random-effect meta-analysis to summarise hazard ratios and the area under the receiver-operating characteristic curve (AUC-ROC).ResultsFrom 1563 initial search records, we identified 14 risk scores in 13 studies. Seven studies were among sexually active women using contraception enrolled in randomised-controlled trials, three among adolescent girls and young women (AGYW), and three among cohorts enrolling both men and women. Consistently identified HIV prognostic factors among women were younger age (pooled adjusted hazard ratio: 1.62 [95% Confidence Interval: 1.17, 2.23], compared to above-25), single/not cohabiting with primary partners (2.33 [1.73, 3.13]) and having sexually transmitted infections (STIs) at baseline (HSV-2: 1.67 [1.34, 2.09]; curable STIs: 1.45 [1.17; 1.79]). Among AGYW only STIs were consistently associated with higher incidence, but studies were limited (n=3). Community-level HIV prevalence or unsuppressed viral load strongly predicted incidence but were only considered in three of 11 multi-site studies. The AUC-ROC ranged from 0.56 to 0.79 on the model development sets. Only the VOICE score was externally validated by multiple studies, with pooled AUC-ROC 0.626 [0.588, 0.663] (I2: 64.02%).ConclusionsYounger age, non-cohabiting, and recent STIs were consistently identified as predicting future HIV infection. Both community HIV burden and individual factors should be considered to quantify HIV risk. However, HIV risk scores had only low-to-moderate discriminatory ability and uncertain generalizability outside of the study populations. Further evidence on the relative value of specific factors and data outside high-risk populations will help inform optimal implementation of risk scoring algorithms in HIV programmes.PROSPERO NumberCRD42021236367

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