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

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.

Download Full-text

Utilization of deworming medication and its associated factors among pregnant married women in 26 sub-Saharan African countries: a multi-country analysis

Tropical Medicine and Health ◽

10.1186/s41182-021-00343-x ◽

2021 ◽

Vol 49 (1) ◽

Author(s):

Betregiorgis Zegeye ◽

Mpho Keetile ◽

Bright Opoku Ahinkorah ◽

Edward Kwabena Ameyaw ◽

Abdul-Aziz Seidu ◽

...

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Married Women ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

African Countries ◽

Related Factors ◽

Factors Associated ◽

Software Analysis ◽

Sub Saharan

Abstract Background Deworming is one of the strategies to reduce the burden of anemia among pregnant women. Globally, pregnant women in sub-Saharan Africa are more affected by anemia. Therefore, this study examined both the coverage and demographic, socioeconomic, and women empowerment-related factors associated with the utilization of deworming medication among pregnant married women in sub-Saharan Africa. Methods We used data from the most recent Demographic and Health Surveys of 26 countries in sub-Saharan Africa conducted between 2010 and 2019. Using Stata version-14 software, analysis was done on 168,910 pregnant married women. Bivariate and multivariable logistic regression analyses were conducted to examine the factors associated with the utilization of deworming medication. The results were presented using adjusted odds ratios (aORs) at 95% confidence intervals (CIs). Results The pooled results showed that about 50.7% (95% CI 48.2–53.3%) of pregnant married women in the studied countries took deworming medications, and this varied from as high as 84.1% in Sierra Leone to as low as 2% in Angola. Regarding sub-regional coverage, the highest and lowest coverages were seen in East Africa (67.6%, 95% CI 66.0–69.1%) and West Africa (24.3%, 95% CI 22.4–26.4%) respectively. We found higher odds of utilization of deworming medication among older pregnant married women (aOR=1.93, 95% CI 1.32–2.84), women with educated husbands (aOR=1.40, 95% CI 1.11–1.77), wealthier women (aOR=3.12, 95% CI 1.95–4.99), women exposed to media (aOR=1.46, 95% CI 1.18–1.80), and those who had four or more antenatal care visits (aOR=1.51, 95% CI 1.24–1.83). Conclusions Enhancing women’s education, disseminating information about maternal healthcare services through mass media, and ensuring that women from economically disadvantaged households benefit from national economic growth can be considered as deworming medication improvement strategies in sub-Saharan Africa. Moreover, providing more attention to adolescents or young pregnant women and increasing the number of antenatal care visits could be considered to increase deworming uptake among pregnant married women.

Download Full-text

Is improvement in indicators of women’s empowerment associated with uptake of WHO recommended IPTp-SP levels in sub-Saharan Africa? A multilevel approach

BMJ Open ◽

10.1136/bmjopen-2020-047606 ◽

2021 ◽

Vol 11 (10) ◽

pp. e047606

Author(s):

Edward Kwabena Ameyaw ◽

Carolyne Njue ◽

Roberta Mensima Amoah ◽

Francis Appiah ◽

Linus Baatiema ◽

...

Keyword(s):

Pregnant Women ◽

Low Income ◽

Community Level ◽

Sub Saharan Africa ◽

Outcome Variable ◽

Demographic And Health Surveys ◽

Major Public Health Problem ◽

Country Level ◽

Sub Saharan ◽

Ssa Countries

ObjectivesThe global burden of malaria has reduced considerably; however, malaria in pregnancy remains a major public health problem in sub-Saharan Africa (SSA), where about 32 million pregnant women are at risk of acquiring malaria. The WHO has recommended that pregnant women in high malaria transmission locations, including SSA, have intermittent preventive treatment of malaria during pregnancy with at least three doses of sulphadoxine-pyrimethamine (IPTp-SP). Therefore, we investigated the prevalence of IPTp-SP uptake and associated individual-level, community-level and country-level predictors in SSA.DesignA cross-sectional survey was conducted using recent Demographic and Health Surveys datasets of 20 SSA countries. A total of 96 765 women were included. Optimum uptake of IPTp-SP at most recent pregnancy was the outcome variable. We fitted three-level multilevel models: individual, community and country parameters at 95% credible interval.ResultsIn all, 29.2% of the women had optimal IPTp-SP uptake ranging from 55.1% (in Zambia) to 6.9% (in Gambia). The study revealed a high likelihood of optimum IPTp-SP uptake among women with high knowledge (aOR=1.298, Crl 1.206 to 1.398) relative to women with low knowledge. Women in upper-middle-income countries were more than three times likely to have at least three IPTp-SP doses compared with those in low-income countries (aOR=3.268, Crl 2.392 to 4.098). We found that community (σ2=1.999, Crl 1.088 to 2.231) and country (σ2=1.853, Crl 1.213 to 2.831) level variations exist in optimal uptake of IPTp-SP. According to the intracluster correlation, 53.9% and 25.9% of the variation in optimum IPTp-SP uptake are correspondingly attributable to community-level and country-level factors.ConclusionsThe outcome of our study suggests that low-income SSA countries should increase budgetary allocation to maternal health, particularly for IPTp-SP interventions. IPTp-SP advocacy behavioural change communication strategies must focus on women with low knowledge, rural dwellers, married women and those who do not meet the minimum of eight antenatal care visits.

Download Full-text

Prevalence and Correlates of Pregnancy Self-Testing Among Pregnant Women Attending Antenatal Care in Western Kenya

10.21203/rs.3.rs-78174/v1 ◽

2020 ◽

Author(s):

Nina Njeri Nganga ◽

Julia Dettinger ◽

John Kinuthia ◽

Jared Baeten ◽

Grace John-Stewart ◽

...

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Sub Saharan Africa ◽

Future Research ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Western Kenya ◽

Self Testing ◽

Sub Saharan ◽

Exposure Prophylaxis

Abstract In sub-Saharan Africa little is known about how often women use pregnancy self-tests or characteristics of these women despite evidence that pregnancy self-testing is associated with early antenatal care (ANC) attendance. Understanding the characteristics of women who use pregnancy self-tests may facilitate early access to ANC and preventive interventions in pregnancy. We conducted a cross-sectional survey on an ongoing pre-exposure prophylaxis (PrEP) implementation study which enrolled pregnant women to determine the prevalence and factors associated with pregnancy self-testing among women in western Kenya. Overall in our study population, the prevalence of pregnancy self-testing was 22% and higher among women who were employed, currently in school, had previous pregnancy complications, received services from urban health facilities, and had partners who had at least attended secondary school. The most reported reasons for non-use of pregnancy self-tests included not thinking it was necessary, lack of knowledge, and lack of money to pay for the test. Future research should focus on understanding the knowledge and attitudes of women toward pregnancy self-testing.

Download Full-text

Adherence to Iron Supplementation in 22 Sub-Saharan African Countries and Associated Factors among Pregnant Women: A Large Population-Based Study

Current Developments in Nutrition ◽

10.1093/cdn/nzz120 ◽

2019 ◽

Vol 3 (12) ◽

Cited By ~ 5

Author(s):

Djibril M Ba ◽

Paddy Ssentongo ◽

Kristen H Kjerulff ◽

Muzi Na ◽

Guodong Liu ◽

...

Keyword(s):

Pregnant Women ◽

Iron Supplementation ◽

Population Based ◽

Sub Saharan Africa ◽

Deficiency Anemia ◽

Demographic And Health Surveys ◽

Factors Associated ◽

Sub Saharan ◽

Ssa Countries ◽

Antenatal Visits

ABSTRACT Background Iron deficiency anemia during pregnancy is a significant public health problem in sub-Saharan Africa (SSA) and is associated with serious adverse health outcomes. Although it is recommended that all women receive iron supplementation during pregnancy, little research has been conducted to measure overall compliance with this recommendation or variation across SSA countries. Objectives To assess prevalence and sociodemographic-economic factors associated with adherence to iron supplementation among pregnant women in SSA. Methods This was a weighted population-based cross-sectional study of 148,528 pregnant women aged 15–49 y in 22 SSA countries that participated in the Demographic and Health Surveys (DHS) in 2013–2018 and measured iron supplementation during pregnancy. Adherence to iron supplementation was defined as using iron supplementation for ≥90 d during pregnancy of the most recent birth. Results The overall prevalence of adherence to ≥90 d of iron supplementation during pregnancy was 28.7%, ranging from 1.4% in Burundi to 73.0% in Senegal. Factors associated with adherence included receiving ≥4 antenatal care visits [adjusted Prevalence Ratio (aPR): 25.73; 95% CI: 22.36, 29.60] compared with no antenatal visits; secondary or higher education (aPR: 1.17; 95% CI: 1.14, 1.19) compared with no education; wealthy (aPR: 1.13; 95% CI: 1.10, 1.16) compared with poor; and older women aged 35–49 y (aPR: 1.07; 95% CI: 1.05, 1.10) compared with younger women aged 15–24 y. Conclusions Adherence to iron supplementation during pregnancy in SSA is low and varies substantially across countries and in relation to factors such as number of antenatal visits, education, and level of family wealth. These results underscore the need for increased efforts to improve the uptake of iron supplementation for pregnant women in SSA.

Download Full-text

Prenatal care coverage and correlates of HIV testing in sub-Saharan Africa: Insight from demographic and health surveys of 16 countries

PLoS ONE ◽

10.1371/journal.pone.0242001 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242001

Author(s):

Oluwafemi Emmanuel Awopegba ◽

Amarachi Kalu ◽

Bright Opoku Ahinkorah ◽

Abdul-Aziz Seidu ◽

Anthony Idowu Ajayi

Keyword(s):

Prenatal Care ◽

Pregnant Women ◽

Hiv Testing ◽

Health Surveys ◽

Central Africa ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

West And Central Africa ◽

Sub Saharan ◽

Ssa Countries

Background Prenatal screening of pregnant women for HIV is central to eliminating mother-to-child-transmission (MTCT) of HIV. While some countries in sub-Saharan Africa (SSA) have scaled up their prevention of MTCT programmes, ensuring a near-universal prenatal care HIV testing, and recording a significant reduction in new infection among children, several others have poor outcomes due to inadequate testing. We conducted a multi-country analysis of demographic and health surveys (DHS) to assess the coverage of HIV testing during pregnancy and also examine the factors associated with uptake. Methods We analysed data of 64,933 women from 16 SSA countries with recent DHS datasets (2015–2018) using Stata version 16. Adjusted and unadjusted logistic regression models were used to examine correlates of prenatal care uptake of HIV testing. Statistical significance was set at p<0.05. Results Progress in scaling up of prenatal care HIV testing was uneven across SSA, with only 6.1% of pregnant women tested in Chad compared to 98.1% in Rwanda. While inequality in access to HIV testing among pregnant women is pervasive in most SSA countries and particularly in West and Central Africa sub-regions, a few countries, including Rwanda, South Africa, Zimbabwe, Malawi and Zambia have managed to eliminate wealth and rural-urban inequalities in access to prenatal care HIV testing. Conclusion Our findings highlight the between countries and sub-regional disparities in prenatal care uptake of HIV testing in SSA. Even though no country has universal coverage of prenatal care HIV testing, East and Southern African regions have made remarkable progress towards ensuring no pregnant woman is left untested. However, the West and Central Africa regions had low coverage of prenatal care testing, with the rich and well educated having better access to testing, while the poor rarely tested. Addressing the inequitable access and coverage of HIV testing among pregnant women is vital in these sub-regions.

Download Full-text

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

BioMed Research International ◽

10.1155/2021/6516202 ◽

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.

Download Full-text

Examining the level and inequality in health insurance coverage in 36 sub-Saharan African countries

BMJ Global Health ◽

10.1136/bmjgh-2020-004712 ◽

2021 ◽

Vol 6 (4) ◽

pp. e004712

Author(s):

Edwine Barasa ◽

Jacob Kazungu ◽

Peter Nguhiu ◽

Nirmala Ravishankar

Keyword(s):

Health Insurance ◽

Concentration Index ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Population Coverage ◽

Financial Barriers ◽

Inequality In Health ◽

Sub Saharan

IntroductionLow/middle-income countries (LMICs) in sub-Saharan Africa (SSA) are increasingly turning to public contributory health insurance as a mechanism for removing financial barriers to access and extending financial risk protection to the population. Against this backdrop, we assessed the level and inequality of population coverage of existing health insurance schemes in 36 SSA countries.MethodsUsing secondary data from the most recent Demographic and Health Surveys, we computed mean population coverage for any type of health insurance, and for specific forms of health insurance schemes, by country. We developed concentration curves, computed concentration indices, and rich–poor differences and ratios to examine inequality in health insurance coverage. We decomposed the concentration index using a generalised linear model to examine the contribution of household and individual-level factors to the inequality in health insurance coverage.ResultsOnly four countries had coverage levels with any type of health insurance of above 20% (Rwanda—78.7% (95% CI 77.5% to 79.9%), Ghana—58.2% (95% CI 56.2% to 60.1%), Gabon—40.8% (95% CI 38.2% to 43.5%), and Burundi 22.0% (95% CI 20.7% to 23.2%)). Overall, health insurance coverage was low (7.9% (95% CI 7.8% to 7.9%)) and pro-rich; concentration index=0.4 (95% CI 0.3 to 0.4, p<0.001). Exposure to media made the greatest contribution to the pro-rich distribution of health insurance coverage (50.3%), followed by socioeconomic status (44.3%) and the level of education (41.6%).ConclusionCoverage of health insurance in SSA is low and pro-rich. The four countries that had health insurance coverage levels greater than 20% were all characterised by substantial funding from tax revenues. The other study countries featured predominantly voluntary mechanisms. In a context of high informality of labour markets, SSA and other LMICs should rethink the role of voluntary contributory health insurance and instead embrace tax funding as a sustainable and feasible mechanism for mobilising resources for the health sector.

Download Full-text

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.

Download Full-text

Under-5 mortality in sub-Saharan Africa: is maternal age at first childbirth below 20 years a risk factor?

BMJ Open ◽

10.1136/bmjopen-2021-049337 ◽

2021 ◽

Vol 11 (9) ◽

pp. e049337

Author(s):

Bright Opoku Ahinkorah

Keyword(s):

Adolescent Mothers ◽

Informal Education ◽

Maternal Age ◽

Economic Status ◽

Public Health Education ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Cross Sectional ◽

Sub Saharan ◽

Children Under 5

ObjectivesThis study aimed at examining the association between young maternal age at first childbirth and under-5 mortality in sub-Saharan Africa (SSA).Design and settingThis cross-sectional study pooled nationally-representative data from the most recent Demographic and Health Surveys conducted in 30 countries in SSA from 2010 to 2019.Participants116 379 mothers of children under 5.ResultsThe prevalence of adolescent childbirth and death in children under 5 in SSA were 57.36% (95% CI 53.73% to 60.99%) and 4.10% (95% CI 3.65% to 4.54%), respectively. Children born to mothers whose first childbirth occurred at <20 years were 11% more likely to die before the age of 5 compared with those whose mothers’ first childbirth occurred at age ≥20 years (adjusted odds ratio (aOR) 1.11; 95% CI 1.05 to 1.18). In terms of the covariates, the likelihood of under-5 mortality was higher among children born to single (aOR 1.54; 95% CI 1.41 to 1.67) and cohabiting mothers (aOR 1.10; 95% CI 1.01 to 1.21) compared with married mothers. Children born to mothers who were obese were more likely to die before the age of 5 compared with those born to mothers with normal body weight (aOR 1.17; 95% CI 1.09 to 1.26). The odds of under-5 mortality were higher among children whose weight at birth was <2500 g compared with those whose weight was ≥2500 g at birth (aOR 1.83; 95% CI 1.64 to 2.03).ConclusionsThe findings call for the need to enhance policies aimed at reducing under-5 mortality in SSA by reducing adolescent pregnancy and childbirth through family planning, comprehensive sexuality education, and the elimination of child marriage. Again, Since under-5 mortality among adolescent mothers is linked with their poor socio-economic status, there is the need for government and non-governmental organisations in SSA to introduce poverty alleviation programmes and improve access to both formal and informal education as a way of enhancing the socioeconomic status of adolescent mothers. Public health education, through continuous advocacy programmes should be done to encourage adolescent mothers to access antenatal care and health facility deliveries as a way of enhancing the survival status of their children. These interventions should be implemented, taking into consideration other characteristics of mothers such marital status and BMI and child’s characteristics such as child’s weight, which were found to be associated with high under-5 mortality.

Download Full-text

Evaluation of Urinary Iodine Concentration for Predicting Iodine Deficiency in Sub-Saharan Africa: First Population Based Study From the Demographic and Health Surveys Data (P10-089-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz034.p10-089-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Djibril Ba ◽

Paddy Ssentongo ◽

Guodong Liu ◽

Ping Du ◽

Xiang Gao

Keyword(s):

Pregnant Women ◽

Iodine Deficiency ◽

Urinary Iodine ◽

Iodine Concentration ◽

Reproductive Age ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Urinary Iodine Concentration ◽

Factors Associated ◽

Sub Saharan

Abstract Objectives Approximately 2 billion individuals suffer from an insufficient iodine intake, and sub-Saharan Africa is particularly the most affected. We thus conducted a cross-sectional study to assess iodine deficiency status, among women of reproductive age 20–49 years in Tanzania and examine the factors associated with iodine deficiency. Methods The current analysis was based on 3057 women aged 20–49 y who participated the Tanzania Demographic and Health Surveys 2015–2016. Iodine status was assessed using urinary iodine concentration (UIC). Iodine deficiency was defined if UIC was less than 100ug/L. A stepwise multivariable logistic regression to identify the factors associated with iodine deficiency. Potential predicators included age, education level, married status, wealth index, having a prenatal doctor and prenatal nurse, currently pregnant, currently breastfeeding, place of residence, employment status, and history of terminated pregnancy. Results The median UIC among pregnant women (median: 129 μg/L; 25th and 75th percentile: 57.8–240), uneducated women (99.0 μg/L; 48.2–201 μg/L), and poor women (92 μg/L; 43.1 -191 μg/L) were below the recommended ranges (≥150 μg/L for pregnant women and ≥100 μg/L for non-pregnant women) by the World Health Organization. Multivariable logistic stepwise regression showed that women were more likely to be iodine deficient if they were pregnant (aOR 1.55 [95% CI 1.11, 2.15], currently breastfeeding (aOR 1.56 [95% CI 1.28, 1.92], poor (aOR 1.75 [95% CI 1.35, 2.26], uneducated (aOR 1.77 [95% CI 1.26, 2.48], and living in the rural area (aOR 1.79 [95% CI 1.37, 2.34]. Unexpectedly, currently employed women also had significantly higher odds of iodine deficient (aOR 1.41 [95% CI 1.10, 1.80], relative to those without employment. Conclusions There is disparity in UIC among of women of reproductive age 20–49 in Tanzania. Poverty and lack of education appeared to be the driving factors for iodine deficiency. High risk of iodine deficient among pregnant and breastfeeding women appeal for action to implement and enforce universal salt iodization among this vulnerable population in Tanzania. Funding Sources There was no external or internal funding to support this study.

Download Full-text