scholarly journals The changing temporal association between caesarean birth and neonatal death in Ethiopia: secondary analysis of nationally representative surveys

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e027235
Author(s):  
Engida Yisma ◽  
Ben W Mol ◽  
John W Lynch ◽  
Lisa G Smithers
Keyword(s):  
Caesarean Section ◽  
Rural Women ◽  
Neonatal Death ◽  
Secondary Analysis ◽  
Household Wealth ◽  
Temporal Association ◽  
Demographic And Health Surveys ◽  
Neonatal Deaths ◽  
Caesarean Birth ◽  
Nationally Representative

ObjectiveTo examine the changing temporal association between caesarean birth and neonatal death within the context of Ethiopia from 2000 to 2016.DesignSecondary analysis of Ethiopian Demographic and Health Surveys.SettingAll administrative regions of Ethiopia with surveys conducted in 2000, 2005, 2011 and 2016.ParticipantsWomen aged 15–49 years with a live birth during the 5 years preceding the survey.Main outcome measuresWe analysed the association between caesarean birth and neonatal death using log-Poisson regression models for each survey adjusted for potential confounders. We then applied the ‘Three Delays Model’ to 2016 survey to provide an interpretation of the association between caesarean birth and neonatal death in Ethiopia.ResultsThe adjusted prevalence ratios (aPR) for neonatal death among neonates born via caesarean section versus vaginal birth increased over time, from 0.95 (95% CI: 0.29 to 3.19) in 2000 to 2.81 (95% CI: 1.11 to 7.13) in 2016. The association between caesarean birth and neonatal death was stronger among rural women (aPR (95% CI) 3.43 (1.22 to 9.67)) and among women from the lowest quintile of household wealth (aPR (95% CI) 7.01 (0.92 to 53.36)) in 2016. Aggregate-level analysis revealed that an increased caesarean section rates were correlated with a decreased proportion of neonatal deaths.ConclusionsA naïve interpretation of the changing temporal association between caesarean birth and neonatal death from 2000 to 2016 is that caesarean section is increasingly associated with neonatal death. However, the changing temporal association reflects improvements in health service coverage and secular shifts in the characteristics of Ethiopian women undergoing caesarean section after complicated labour or severe foetal compromise.

scholarly journals Geospatial analysis of determinants of neonatal mortality in Ghana

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Duah Dwomoh
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Mortality ◽  
Neonatal Death ◽  
Reproductive Age ◽  
Multiple Births ◽  
Demographic And Health Surveys ◽  
Neonatal Deaths ◽  
The Impact

Abstract Background Ghana did not meet the Millennium Development Goal 4 of reducing child mortality by two-thirds and may not meet SDG (2030). There is a need to direct scarce resources to mitigate the impact of the most important risk factors influencing high neonatal deaths. This study applied both spatial and non-spatial regression models to explore the differential impact of environmental, maternal, and child associated risk factors on neonatal deaths in Ghana. Methods The study relied on data from the Ghana Demographic and Health Surveys (GDHS) and the Ghana Maternal Health Survey (GMHS) conducted between 1998 and 2017 among 49,908 women of reproductive age and 31,367 children under five (GDHS-1998 = 3298, GDHS-2003 = 3844, GDHS-2008 = 2992, GDHS-2014 = 5884, GMHS-2017 = 15,349). Spatial Autoregressive Models that account for spatial autocorrelation in the data at the cluster-level and non-spatial statistical models with appropriate sampling weight adjustment were used to study factors associated with neonatal deaths, and a p-value less than 0.05 was considered statistically significant. Results Population density, multiple births, smaller household sizes, high parity, and low birth weight significantly increased the risk of neonatal deaths over the years. Among mothers who had multiple births, the risk of having neonatal deaths was approximately four times as high as the risk of neonatal deaths among mothers who had only single birth [aRR = 3.42, 95% CI: 1.63–7.17, p < 0.05]. Neonates who were perceived by their mothers to be small were at a higher risk of neonatal death compared to very large neonates [aRR = 2.08, 95% CI: 1.19–3.63, p < 0.05]. A unit increase in the number of children born to a woman of reproductive age was associated with a 49% increased risk in neonatal deaths [aRR = 1.49, 95% CI: 1.30–1.69, p < 0.05]. Conclusion Neonatal mortality in Ghana remains relatively high, and the factors that predisposed children to neonatal death were birth size that were perceived to be small, low birth weight, higher parity, and multiple births. Improving pregnant women’s nutritional patterns and providing special support to women who have multiple deliveries will reduce neonatal mortality in Ghana.

scholarly journals Birth weight and childhood obesity: effect modification by residence and household wealth

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Helen Andriani
Keyword(s):  
Birth Weight ◽  
Childhood Obesity ◽  
Rural Area ◽  
Low Income ◽  
Secondary Analysis ◽  
Household Wealth ◽  
Z Score ◽  
Cross Sectional ◽  
Effective Prevention ◽  
Nationally Representative

Abstract Background There are both genetic and environmental factors which contribute to a child’s chances of being obese. When low birth weight (LBW) has been specifically evaluated relative to its association with childhood obesity, the results have produced conflicting findings. This study aims to describe the relationship between birth weight and childhood obesity and investigate the influence that residence and household wealth has on this relationship. Methods I performed a secondary analysis on the 2013 Riskesdas (or Basic Health Research), a cross-sectional, nationally representative survey of the Indonesian population. Height, weight, information regarding child’s birth weight, and basic characteristics of the study population were collected from parents with children aged 0 to 5 years (n = 63,237) in 2013. The exposure was child’s birth weight and the outcomes were child’s current weight, BMI z-score, and obesity. Data were analyzed by using multiple linear regression and multiple logistic regression. Results I found a significant increase in the weight, BMI z-score, and risk of childhood obesity to be associated with LBW. LBW children in rural area were associated with higher BMI z-score (mean ± standard error: 1.44 ± 0.02) and higher odds (odds ratio (95% confidence interval): 7.46 (6.77–8.23)) of obesity than those in urban area. LBW children from low class families were associated with higher BMI z-score (1.79 ± 0.04) and had higher odds (14.79 (12.47–17.54)) of obesity than those from middle class and wealthy families. Conclusions Effective prevention and intervention to childhood obesity as early as possible are imperative. As far as this study was concerned, efforts, policies, and targets are required to reduce the prevalence of LBW. Children born of LBW, who live in a rural area and from low income families, should be emphatically intervened as early as possible.

scholarly journals Sociodemographic Inequalities in Health Insurance Ownership among Women in Selected Francophone Countries in Sub-Saharan Africa

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Yiting Wang ◽  
Xuhui Wang ◽  
Lu Ji ◽  
Rui Huang
Keyword(s):  
Health Insurance ◽  
Rural Women ◽  
Rural Areas ◽  
Household Wealth ◽  
Access To Healthcare ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Universal Healthcare ◽  
Explanatory Factors ◽  
Sub Saharan

In sub-Saharan Africa, improving equitable access to healthcare remains a major challenge for public health systems. Health policymakers encourage the adoption of health insurance schemes to promote universal healthcare. Nonetheless, progress towards this goal remains suboptimal due to inequalities health insurance ownership especially among women. In this study, we aimed to explore the sociodemographic factors contributing to health insurance ownership among women in selected francophone countries in sub-Saharan Africa. Methods. This study is based on cross-sectional data obtained from Demographic and Health Surveys on five countries including Benin ( n = 13,407 ), Madagascar ( n = 12,448 ), Mali ( n = 10,326 ), Niger ( n = 12,558 ), and Togo ( n = 6,979 ). The explanatory factors included participant age, marital status, type of residency, education, household wealth quantile, employment stats, and access to electronic media. Associations between health insurance ownership and the explanatory factors were analyzed using multivariate regression analysis, and effect sizes were reported in terms in average marginal effects (AMEs). Results. The highest percentage of insurance ownership was observed for Togo (3.31%), followed by Madagascar (2.23%) and Mali (2.2%). After stratifying by place of residency, the percentages were found to be significantly lower in the rural areas for all countries, with the most noticeable difference observed for Niger (7.73% in urban vs. 0.54% in rural women). Higher levels of education and wealth quantile were positively associated with insurance ownership in all five countries. In the pooled sample, women in the higher education category had higher likelihood of having an insurance: Benin ( AME = 1.18 ; 95% CI = 1.10 , 1.27), Madagascar ( AME = 1.10 ; 95% CI = 1.05 , 1.15), Mali ( AME = 1.14 ; 95% CI = 1.04 , 1.24), Niger ( AME = 1.13 ; 95% CI = 1.07 , 1.21), and Togo ( AME = 1.17 ; 95% CI = 1.09 , 1.26). Regarding wealth status, women from the households in the highest wealth quantile had 4% higher likelihood of having insurance in Benin and Mali and 6% higher likelihood in Madagascar and Togo. Conclusions. Percentage of women who reported having health insurance was noticeably low in all five countries. As indicated by the multivariate analyses, the actual situation is likely to be even worse due to significant socioeconomic inequalities in the distribution of women having an insurance plan. Increasing women’s access to healthcare is an urgent priority for population health promotion in these countries, and therefore, addressing the entrenched sociodemographic disparities should be given urgent policy attention in an effort to strengthen universal healthcare-related goals.

The Gender System and Class Mobility

2021 ◽  
pp. 1-45
Author(s):  
Ieva Zumbyte
Keyword(s):  
Rural Women ◽  
Fixed Effects ◽  
Driving Forces ◽  
Household Wealth ◽  
Social Force ◽  
Women’S Autonomy ◽  
Women's Autonomy ◽  
Class Mobility ◽  
Nationally Representative ◽  
Gender System

It is often assumed that improvements in household wealth are associated with greater gender equality, including greater women’s autonomy and decision-making power inside the home. Yet, evidence often shows the opposite: greater household wealth often curtails women’s autonomy. Research has yet to reveal the driving forces behind this surprising finding. This paper focuses on one important social force, the community gender system, to show how it shapes the relationship between changing household wealth and women’s autonomy. Drawing on a nationally representative panel of rural women in India and fixed effects models, I find that the prevalence of women’s veiling at the village level, a notable marker of an exclusionary gender system, moderates the effects of increasing household wealth on women’s autonomy. In villages with less veiling, increases in wealth have the perverse effect of suppressing women’s autonomy. The study suggests that in these places, households curtail women’s mobility because such behavior signals rising social status. In contrast, in villages with more veiling increasing household wealth does not reduce women’s autonomy because most households across the class spectrum are already conforming to the norms of seclusion. The findings demonstrate how new wealth interacts with a community gender system which is anchored in gendered notions of family honor to reproduce structures of gender inequality.

scholarly journals Consistency of the determinants of early initiation of breastfeeding in Ghana: insights from four Demographic and Health Survey datasets

2020 ◽  
Author(s):  
Precious A Duodu ◽  
Henry O Duah ◽  
Veronica M Dzomeku ◽  
Adwoa B Boamah Mensah ◽  
Josephine Aboagye Mensah ◽  
...  
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Early Initiation ◽  
Demographic And Health Surveys ◽  
Current Estimate ◽  
Neonatal Deaths ◽  
Early Initiation Of Breastfeeding ◽  
Multiple Variable ◽  
Using Data ◽  
Initiation Of Breastfeeding

Abstract Background Early initiation of breastfeeding (EIBF) is a key strategy in averting neonatal deaths. However, studies on the facilitators and risk factors for EIBF are rare in Ghana. We examined trends in EIBF and its major facilitators and risk factors in Ghana using data from Demographic and Health Surveys from 1998 to 2014. Methods We used complete weighted data of 3194, 3639, 2909 and 5695 pairs of mothers ages 15–49 y and their children ages 0–5 y in the 1998, 2003, 2008 and 2014 surveys, respectively. We accounted for the complex sampling used in the surveys for both descriptive statistics and multiple variable risk ratio analysis. Results The proportion of children who achieved EIBF increased by about 2.5 times from 1998 to 2003 and there was a marginal increase in the proportion of children who achieved EIBF between 2003 and 2014. Children born by caesarean section were at higher risk of being breastfed later than 1 h across all four surveys. Being born in the Upper East Region (compared with the Western Region) of Ghana facilitated EIBF in 2003 and 2008. Conclusions The study revealed that the current estimate of the proportion of children achieving EIBF in Ghana was 55.1%, and delivery by caesarean section and region of residence consistently predicted the practice of EIBF in Ghana.

scholarly journals Service utilization patterns for childbirth and neonatal mortality in the occupied Palestinian territory during conflict

2020 ◽  
Vol 30 (5) ◽  
pp. 856-860
Author(s):  
Zeina Ali Siam ◽  
Tiziana Leone
Keyword(s):  
Neonatal Mortality ◽  
Policy Implications ◽  
Demographic And Health Surveys ◽  
Childbearing Age ◽  
Neonatal Deaths ◽  
Occupied Palestinian Territory ◽  
Utilization Patterns ◽  
Nationally Representative ◽  
Palestinian Territory ◽  
Conflict Intensity

Abstract Background The global incidence of man-made crises has increased in the last decade. Evidence on deviations in service uptake during conflict is needed to better understand the link between conflict and adverse neonatal outcomes. We assessed the association between conflict intensity in the occupied Palestinian territory (oPt) at time of birth and (i) utilization patterns for childbirth across different providers; and (ii) neonatal mortality. Methods We combined data on conflict intensity with four demographic and health surveys (2004, 2006, 2010 and 2014) that included nationally representative samples of women of childbearing age. Our exposure variable was casualties per 100 000 population in defined sub-regions of the oPt. Our outcome specifications were a binary variable for neonatal deaths and a categorical variable for childbirth location. We used multivariate logistic and multinomial regressions to assess the associations. Results High conflict intensity was associated with fewer childbirths in the private sector (RR=0.97, P=0.04), and non-governmental organizations (RR=0.95, P=0.03) compared to public facilities. Conflict intensity was not associated with higher neonatal mortality beyond 2004. Conclusions Policy implications include better preparedness in the public sector for childbirth during conflict and exploring reasons for the slow decline in neonatal mortality in the territory beyond conflict at time of birth.

scholarly journals Trends and factors associated with the nutritional status of adolescent girls in Ghana: a secondary analysis of the 2003–2014 Ghana demographic and health survey (GDHS) data

2021 ◽  
pp. 1-16
Author(s):  
Fusta Azupogo ◽  
Abdul-Razak Abizari ◽  
Elisabetta Aurino ◽  
Aulo Gelli ◽  
Saskia JM Osendarp ◽  
...  
Keyword(s):  
Adolescent Girls ◽  
Urban Areas ◽  
Secondary Analysis ◽  
Prevalence Ratio ◽  
Household Wealth ◽  
Demographic And Health Surveys ◽  
Clear Trend ◽  
Cross Sectional ◽  
Factors Associated ◽  
Pregnant Adolescent

Abstract Objective: We examined the trends over time and the factors associated with malnutrition among adolescent girls in Ghana. Design: Cross-sectional analysis from 3 nationwide Ghana Demographic and Health Surveys conducted in 2003 (n 983), 2008 (n 955) and 2014 (n 857). We used Cox proportional hazard models with sample weighting to model the prevalence ratio (PR) of malnutrition. Setting: Countrywide, covering rural and urban areas in Ghana. Participants: Non-pregnant adolescent girls aged 15–19 years. Results: Compared with 2003, thinness declined marginally (PR 0·88 (95 % CI 0·45, 1·73)) in 2008 and in 2014 (PR 0·71 (95 % CI 0·38, 1·56)). Stunting declined marginally by 19 % in 2008 (PR 0·81 (95 % CI 0·59, 1·12)), flattening out in 2014 (PR 0·81 (95 % CI 0·57, 1·17)). We found an increasing trend of overweight/obesity with the PR peaking in 2014 (PR 1·39 (95 % CI 1·02, 1·88)) compared to 2003. The anaemia prevalence remained severe without a clear trend. A low level of education of the adolescent girl was positively associated with stunting. Increasing age was positively associated with stunting but inversely associated with thinness and anaemia. Girls who ever bore a child were more likely to be anaemic compared to those who never did. A lower level of household wealth and a unit increase in household size was negatively associated with overweight/obesity. Urban dwelling girls were less likely to be stunted. Conclusions: The stagnant burden of under-nutrition and rising over-nutrition emphasise the need for double-duty actions to tackle malnutrition in all its forms in Ghanaian adolescent girls.

scholarly journals Adverse infant outcomes associated with caesarean section delivery in India

2019 ◽  
Vol 12 (5) ◽  
pp. 411-416
Author(s):  
Tamala Gondwe ◽  
Kalpana Betha ◽  
G N Kusneniwar ◽  
Clareann H Bunker ◽  
Gong Tang ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Neonatal Death ◽  
Caesarean Delivery ◽  
Mode Of Delivery ◽  
Family Health ◽  
Cross Sectional ◽  
Infant Outcomes ◽  
Neonatal Deaths ◽  
Maternal Report ◽  
Caesarean Section Delivery

Abstract Background Caesarean section delivery is increasing worldwide and in India, yet little is known about the effect on infants. We examined the association between caesarean delivery and adverse infant outcomes in an Indian national survey, accounting for factors related to the mode of delivery. Methods Inverse probability weighted logistic regression analysis of the 2015–2016 India National Family Health Survey obtained adjusted ORs (aORs) and 95% CIs. Infant outcomes were maternal report of recent concomitant diarrhoea and acute respiratory infection (ARI) in infants age ≤6 mo and neonatal death. Results Of the 189 143 reported most recent singleton births, 15.4% were delivered by caesarean, 860 (3.2%) of all infants age ≤6 mo had concomitant diarrhoea and ARI and 3480 (1.8%) neonatal deaths were reported. In adjusted analysis, caesarean delivery was not associated with concomitant diarrhoea and ARI (aOR 0.96 [95% CI 0.71 to 1.32]) but was associated with neonatal death (aOR 1.19 [95% CI 1.02 to 1.39]). Conclusions Using nationally representative cross-sectional data for India, caesarean section delivery was found to be associated with neonatal death after accounting for factors associated with the mode of delivery. Prospective exploration of the relationship between caesarean delivery and adverse infant outcomes is warranted.

scholarly journals Vaginal or Caesarean Delivery? A Comparative Study of Factors Associated with the Choice Method of Childbirth Delivery in Kenya and Egypt

2020 ◽  
Vol 2 (6) ◽  
Author(s):  
Gilbert Omedi ◽  
Margaret Mwaila ◽  
Sarafina Wanja
Keyword(s):  
Caesarean Section ◽  
Antenatal Care ◽  
Descriptive Analysis ◽  
Household Wealth ◽  
Health Facilities ◽  
Demographic And Health Surveys ◽  
Related Factors ◽  
Egyptian Women ◽  
Kenyan Women ◽  
Choice Method

Background: Childbirth delivery today is becoming a complex process. There exist linkages between choice method of childbirth delivery, whether vaginal or caesarean section, and socioeconomic, maternal, and pregnancy-related factors. Study objectives: To compare the choice method of childbirth delivery among women of childbearing ages in Kenya and Egypt. Specifically, the study sought to (a) show patterns of caesarean section births in the two countries using women’s background characteristics, (b) estimate levels and differentials of caesarean births in the two countries and, (c) investigate the socio-economic, maternal and pregnancy-related factors that determine the choice of caesarean section deliveries in the two countries Data and methods: Data was derived from the 2014 Kenya and Egypt demographic and health surveys women-file. The data was fitted in the Statistical Package for Social Sciences in which descriptive and binary logistic regression analyses were conducted. Results: Majority of Egyptian women (53.5%) gave birth by caesarean section compared to Kenyan women (7.8%). At descriptive analysis level, all the study variables were significant at ρ<0.05 and less, save for marital status. At inferential level, there were higher odds of caesarean section delivery among Egyptian women in middle and rich households (1.318 and 1.701, respectively) compared to those from poor households. Among Kenyan women, those aged 25-34 and 35-49 were 1.335 and 1.690 more likely to delivery by caesarean section compared to their colleagues in the 15-24 age group. Pertaining to the number of antenatal care visits, Egyptian women who had no antenatal care visits were 0.761 less likely, while those with 5-8 and at least 9 antenatal care visits were 1.296 and 1.783, respectively, more likely to delivery by caesarean section compared to their colleagues with 3-4 antenatal care visits. Such a trend was observed among Kenyan women for 5-8 and 9+ antenatal care visits, at the odds of 1.234 and 2.053 respectively. Childbirth deliveries in private health facilities had the odds of 2.060 and 1.438 in Egypt and Kenya, respectively, compared to delivery in public health facilities. Conclusion: The results suggest that the main contributory factors behind the choice method of childbirth delivery are household wealth (Egypt), maternal age (Kenya), number of antenatal care visits (both Kenya and Egypt), and place of delivery (both Kenya and Egypt).

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