Condom Use for Preventing STI/HIV and Unintended Pregnancy Among Young Men in Sub-Saharan Africa

The condom is the only known method that provides simultaneous protection against unplanned pregnancy and some sexually transmitted infections (STIs), including HIV, among sexually active people. Using data from the Demographic and Health Surveys from 18 Sub-Saharan African countries, this study examined condom use and reasons for using the method at last intercourse among sexually active young men aged 15 to 29. Most young men were aware of the condom (73%-98%), but its use at last intercourse was quite variable, ranging from 6% in Madagascar to 74% in Namibia. In 10 countries, more young men reportedly used condoms for preventing STIs alone than they did for preventing pregnancy alone. In 6 countries, at least one third of the users used the method for both purposes. Use of the condom at last intercourse was associated with union status, education, residence, and exposure to television in at least two thirds of the countries.

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Wealth-related inequalities in demand for family planning satisfied among married and unmarried adolescent girls and young women in sub-Saharan Africa

Reproductive Health ◽

10.1186/s12978-021-01076-0 ◽

2021 ◽

Vol 18 (S1) ◽

Author(s):

Martin K. Mutua ◽

Yohannes D. Wado ◽

Monica Malata ◽

Caroline W. Kabiru ◽

Elsie Akwara ◽

...

Keyword(s):

Family Planning ◽

West Africa ◽

Adolescent Girls ◽

Young Women ◽

Rate Of Change ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Sexually Active ◽

Sub Saharan ◽

Over Time

Abstract Background The use of modern contraception has increased in much of sub-Saharan Africa (SSA). However, the extent to which changes have occurred across the wealth spectrum among adolescents is not well known. We examine poor-rich gaps in demand for family planning satisfied by modern methods (DFPSm) among sexually active adolescent girls and young women (AGYW) using data from national household surveys. Methods We used recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys to describe levels of wealth-related inequalities in DFPSm among sexually active AGYW using an asset index as an indicator of wealth. Further, we used data from countries with more than one survey conducted from 2000 to assess DFPSm trends. We fitted linear models to estimate annual average rate of change (AARC) by country. We fitted random effects regression models to estimate regional AARC in DFPSm. All analysis were stratified by marital status. Results Overall, there was significant wealth-related disparities in DFPSm in West Africa only (17.8 percentage points (pp)) among married AGYW. The disparities were significant in 5 out of 10 countries in Eastern, 2 out of 6 in Central, and 7 out of 12 in West among married AGYW and in 2 out of 6 in Central and 2 out of 9 in West Africa among unmarried AGYW. Overall, DFPSm among married AGYW increased over time in both poorest (AARC = 1.6%, p < 0.001) and richest (AARC = 1.4%, p < 0.001) households and among unmarried AGYW from poorest households (AARC = 0.8%, p = 0.045). DPFSm increased over time among married and unmarried AGYW from poorest households in Eastern (AARC = 2.4%, p < 0.001) and Southern sub-regions (AARC = 2.1%, p = 0.030) respectively. Rwanda and Liberia had the largest increases in DPFSm among married AGYW from poorest (AARC = 5.2%, p < 0.001) and richest (AARC = 5.3%, p < 0.001) households respectively. There were decreasing DFPSm trends among both married (AARC = − 1.7%, p < 0.001) and unmarried (AARC = − 4.7%, p < 0.001) AGYW from poorest households in Mozambique. Conclusion Despite rapid improvements in DFPSm among married AGYW from the poorest households in many SSA countries there have been only modest reductions in wealth-related inequalities. Significant inequalities remain, especially among married AGYW. DFPSm stalled in most sub-regions among unmarried AGYW.

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Willingness to Pay for Condoms among Men in Sub-Saharan Africa

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16010034 ◽

2018 ◽

Vol 16 (1) ◽

pp. 34 ◽

Cited By ~ 2

Author(s):

William Evans ◽

Kuyosh Kadirov ◽

Ibou Thior ◽

Ramakrishnan Ganesan ◽

Alec Ulasevich ◽

...

Keyword(s):

Public Health ◽

Willingness To Pay ◽

Condom Use ◽

Sub Saharan Africa ◽

Linear Regression Models ◽

African Countries ◽

Donor Funding ◽

Sub Saharan ◽

Tool Building ◽

Hiv Aids

HIV/AIDS and other sexually transmitted infections (STIs) continue to be among the greatest public health threats worldwide, especially in sub-Saharan Africa (SSA). Condom use remains an essential intervention to eradicate AIDS, and condom use is now higher than ever. However, free and subsidized condom funding is declining. Research on how to create healthy markets based on willingness to pay for condoms is critically important. This research has three primary aims: (1) willingness of free condom users in five African countries to pay for socially marketed condoms; (2) the relationship between specific population variables and condom brand marketing efforts and willingness to pay; and (3) potential opportunities to improve condom uptake. Nationally representative samples of at least 1200 respondents were collected in Kenya, Nigeria, South Africa, Zambia, and Zimbabwe. We collected data on a range of demographic factors, including condom use, sexual behavior, awareness of condom brands, and willingness to pay. We estimated multivariate linear regression models and found that free condom users are overwhelmingly willing to pay for condoms overall (over 90% in Nigeria) with variability by country. Free users were consistently less willing to pay for condoms if they had a positive identification with their free brand in Kenya and Zimbabwe, suggesting that condom branding is a critical strategy. Ability to pay was negatively correlated with willingness, but users who could not obtain free condoms were willing to pay for them in Kenya and Zimbabwe. In a landscape of declining donor funding, this research suggests opportunities to use scarce funds for important efforts such as campaigns to increase demand, branding of condoms, and coordination with commercial condom manufacturers to build a healthy total market approach for the product. Free condoms remain an important HIV/AIDS prevention tool. Building a robust market for paid condoms in SSA is a public health priority.

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Correlates of the double burden of malnutrition among women: an analysis of cross sectional survey data from sub-Saharan Africa

BMJ Open ◽

10.1136/bmjopen-2019-029545 ◽

2019 ◽

Vol 9 (7) ◽

pp. e029545 ◽

Cited By ~ 5

Author(s):

Dickson Abanimi Amugsi ◽

Zacharie Tsala Dimbuene ◽

Catherine Kyobutungi

Keyword(s):

Household Wealth ◽

Normal Weight ◽

Overweight And Obesity ◽

Sub Saharan Africa ◽

Outcome Variable ◽

Demographic And Health Surveys ◽

African Countries ◽

Double Burden ◽

Double Burden Of Malnutrition ◽

Sub Saharan

ObjectiveTo investigate the correlates of the double burden of malnutrition (DBM) among women in five sub-Saharan African countries.DesignSecondary analysis of Demographic and Health Surveys (DHS). The outcome variable was body mass index (BMI), a measure of DBM. The BMI was classified into underweight (BMI <18.50 kg/m2), normal weight (18.50–24.99 kg/m2), overweight (25.0–29.9 kg/m2) and obesity (≥30.0 kg/m2).SettingsGhana, Nigeria, Kenya, Mozambique and Democratic Republic of Congo (DRC).SubjectsWomen aged 15–49 years (n=64698).ResultsCompared with normal weight women, number of years of formal education was associated with the likelihood of being overweight and obese in Ghana, Mozambique and Nigeria, while associated with the likelihood of being underweight in Kenya and Nigeria. Older age was associated with the likelihood of being underweight, overweight and obese in all countries. Positive associations were also observed between living in better-off households and overweight and obesity, while a negative association was observed for underweight. Breastfeeding was associated with less likelihood of underweight in DRC and Nigeria, obesity in DRC and Ghana, overweight in Kenya and overweight and obesity in Mozambique and Nigeria relative to normal weight.ConclusionsOur analysis reveals that in all the countries, women who are breastfeeding are less likely to be underweight, overweight and obese. Education, age and household wealth index tend to associate with a higher likelihood of DBM among women. Interventions to address DBM should take into account the variations in the effects of these correlates.

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Ethnic inequality and coups in sub-Saharan Africa

Journal of Peace Research ◽

10.1177/0022343316685140 ◽

2017 ◽

Vol 54 (3) ◽

pp. 382-396 ◽

Cited By ~ 5

Author(s):

Christian Houle ◽

Cristina Bodea

Keyword(s):

Ethnic Group ◽

Ethnic Groups ◽

Strong Support ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Ethnic Inequality ◽

African Countries ◽

Sub Saharan ◽

Coups D'etat ◽

Group Inequality

Does ethnic inequality breed coups? The recent literature on civil war shows both that inequality between ethnic groups induces war and, importantly, that civil wars and coups, although fundamentally different, are related. The literature on coups d’état, however, has yet to theorize and test the effect of ethnic inequality on coups. The link is plausible because many coups are ‘ethnic coups’, which depend on the capacity of plotters to mobilize their co-ethnics. We argue that large income and wealth disparities between ethnic groups accompanied by within-group homogeneity increase the salience of ethnicity and solidify within-group preferences vis-à-vis the preferences of other ethnic groups, increasing the appeal and feasibility of a coup. We use group-level data for 32 sub-Saharan African countries and 141 ethnic groups between 1960 and 2005 and provide the first large-N test to date of the effect of ethnic inequality on coups. Between- and within-group inequality measures are constructed based on survey data from the Afrobarometer and the Demographic and Health Surveys. We find strong support for our hypothesis: between-ethnic-group inequality (BGI) increases the likelihood that an ethnic group stages a coup only when within-ethnic-group inequality (WGI) is low. Coups remain frequent in sub-Saharan Africa and coups are the main threat to democracy in the region, by harming democratic consolidation and economic development, and by provoking further political instability. Our work provides a novel rationale to be concerned about ethnic inequality, showing that when ethnic and income cleavages overlap, destabilizing coups d’état are more likely.

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Birth registration and child undernutrition in sub-Saharan Africa

Public Health Nutrition ◽

10.1017/s136898001500333x ◽

2015 ◽

Vol 19 (10) ◽

pp. 1757-1767 ◽

Cited By ~ 11

Author(s):

Ornella Comandini ◽

Stefano Cabras ◽

Elisabetta Marini

Keyword(s):

Nutritional Status ◽

Permutation Test ◽

Negative Relationship ◽

Wealth Quintile ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Birth Registration ◽

African Countries ◽

Cross Sectional ◽

Sub Saharan

AbstractObjectiveIn many countries of the world millions of people are not registered at birth. However, in order to assess children’s nutritional status it is necessary to have an exact knowledge of their age. In the present paper we discuss the effects of insufficient or imprecise age data on estimates of undernutrition prevalence.DesignBirth registration rates and levels of stunting, underweight and wasting were retrieved from Multiple Indicator Cluster Surveys and Demographic and Health Surveys of thirty-seven sub-Saharan African countries, considering the subdivision in wealth quintiles. The composition of the cross-sectional sample used for nutritional evaluation was analysed using a permutation test. Logistic regression was applied to analyse the relationship between birth registration and undernutrition. The 95 % probability intervals and Student’s t test were used to evaluate the effect of age bias and error.ResultsHeterogeneous sampling designs were detected among countries, with different percentages of children selected for anthropometry. Further, registered children were slightly more represented within samples used for nutritional analysis than in the total sample. A negative relationship between birth registration and undernutrition was recognized, with registered children showing a better nutritional status than unregistered ones, even within each wealth quintile. The over- or underestimation of undernutrition in the case of systematic over- or underestimation of age, respectively, the latter being more probable, was quantified up to 28 %. Age imprecision was shown to slightly overestimate undernutrition.ConclusionsSelection bias towards registered children and underestimation of children’s age can lead to an underestimation of the prevalence of undernutrition.

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Investigation of the Possible Moderators of Alcohol-Related Intimate Partner Violence in Sub-Saharan Africa

African Journal of Biology and Medical Research ◽

10.52589/ajbmr-oaebs2xl ◽

2021 ◽

Vol 4 (2) ◽

pp. 67-83

Author(s):

Ekpenyong M.S. ◽

Tawari E. P.2

Keyword(s):

Intimate Partner Violence ◽

Partner Violence ◽

Meta Analysis ◽

Intimate Partner ◽

Sub Saharan Africa ◽

Public Health Issue ◽

Demographic And Health Surveys ◽

African Countries ◽

Cross Sectional ◽

Sub Saharan

Alcohol-related intimate partner violence (IPV) is a serious public health issue which has attracted a lot of research and debates. While some studies have reported the relationship between alcohol and IPV to be linear, others have reported threshold effects. While some studies have found the link to be strong, others have reported it to be weak or to show no association. The aim of this study was to determine the possible moderators on the alcohol-IPV link in sub-Saharan Africa. For the quantitative study, secondary analysis and meta-analysis were used to analyze cross-sectional data from the demographic and health surveys of ten countries in sub-Saharan Africa (Burkina Faso, Ghana, Kenya, Liberia, Malawi, Nigeria, Sao Tome and Principe, Tanzania, Zambia, and Zimbabwe). Logistic regression analysis of possible moderators of the alcohol-IPV link was determined in ten sub-Saharan African countries. The nature of moderation was different among countries. The results of this study can be applied in planning country-specific and multi-faceted intervention programmes.

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Diarrhea and associated factors among under five children in sub-Saharan Africa: Evidence from demographic and health surveys of 34 sub-Saharan countries

PLoS ONE ◽

10.1371/journal.pone.0257522 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257522

Author(s):

Getu Debalkie Demissie ◽

Yigizie Yeshaw ◽

Wallelign Aleminew ◽

Yonas Akalu

Keyword(s):

Associated Factors ◽

Maternal Education ◽

Wealth Index ◽

Water Source ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

African Countries ◽

Under Five ◽

Under Five Children ◽

Sub Saharan

Introduction Diarrhea is responsible for the death of more than 90% of under-five children in low and lower-middle income countries. Regionally, South Asia and sub-Saharan Africa accounted for 88% of deaths with the same age group. Therefore, the aim of this study was to determine the prevalence and associated factors of diarrhea among children under-five years in sub-Saharan Africa. Methods The appended, most recent demographic and health survey datasets of 34 sub-Saharan African countries were used to determine the prevalence and associated factors of diarrhea among under-five children in the region. A total weighted sample of 330,866 under-five children were included in the study. Both bivariable and multivariable multilevel logistic regression were done to determine the associated factors of diarrhea among under five children in sub-Saharan Africa. The Odds Ratio (OR) with a 95% Confidence Interval (CI) was calculated for those potential factors included in the final model. Result The overall prevalence of diarrhea in this study was 15.3% (95% CI: 15.1–15.4). Those children of mothers aged 15–24 (AOR = 1.26; 95% CI: 1.23, 1.30) and 25–34 years (AOR = 1.15; 95%CI: 1.12, 1.18), those children of mothers with no education (AOR = 1.69; 95%CI: 1.57–1.82), primary education (AOR = 1.73; 95%CI: 1.61–1.86) and secondary education (AOR = 1.49; 95%CI: 1.38–1.59) had higher odds of having diarrhea. Those children from poorest (AOR = 1.14; 95%CI: 1.10, 1.19), poorer (AOR = 1.12; 95%CI: 1.08–1.17), middle (AOR = 1.06; 95%CI: 1.02, 1.10), and richer (AOR = 1.14; 95%CI: 1.04–1.12) households had higher chance of having diarrhea compared to their counterparts. Conclusion This study found that the prevalence of childhood diarrhea morbidity in sub-Saharan Africa was high. Maternal age, wealth index, maternal education, maternal occupation, age of child, time of initiation of breast feeding and time to get water source were significantly associated with diarrhea. Therefore, intervention through health education and health promotion for mothers/caretakers who are poor, less educated, and young should be designed to prevent diarrhea in the region.

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Clusters of sub-Saharan African countries based on sociobehavioural characteristics and associated HIV incidence

10.1101/620450 ◽

2019 ◽

Cited By ~ 2

Author(s):

Aziza Merzouki ◽

Janne Estill ◽

Erol Orel ◽

Kali Tal ◽

Olivia Keiser

Keyword(s):

National Level ◽

Principal Component ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

People Living With Hiv ◽

Hiv Incidence ◽

African Countries ◽

Aggregated Data ◽

Sub Saharan ◽

Ssa Countries

AbstractIntroductionHIV incidence varies widely between sub-Saharan African (SSA) countries. This variation coincides with a substantial sociobehavioural heterogeneity, which complicates the design of effective interventions. In this study, we investigated how sociobehavioural heterogeneity in sub-Saharan Africa could account for the variance of HIV incidence between countries.MethodsWe analysed aggregated data, at the national-level, from the most recent Demographic and Health Surveys of 29 SSA countries [2010-2017], which included 594’644 persons (183’310 men and 411’334 women). We preselected 48 demographic, socio-economic, behavioural and HIV-related attributes to describe each country. We used Principal Component Analysis to visualize sociobehavioural similarity between countries, and to identify the variables that accounted for most sociobehavioural variance in SSA. We used hierarchical clustering to identify groups of countries with similar sociobehavioural profiles, and we compared the distribution of HIV incidence (estimates from UNAIDS) and sociobehavioural variables within each cluster.ResultsThe most important characteristics, which explained 69% of sociobehavioural variance across SSA among the variables we assessed were: religion; male circumcision; number of sexual partners; literacy; uptake of HIV testing; women’s empowerment; accepting attitude toward people living with HIV/AIDS; rurality; ART coverage; and, knowledge about AIDS. Our model revealed three groups of countries, each with characteristic sociobehavioural profiles. HIV incidence was mostly similar within each cluster and different between clusters (median(IQR); 0.5/1000(0.6/1000), 1.8/1000(1.3/1000) and 5.0/1000(4.2/1000)).

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A multi-country cross-sectional study of self-reported sexually transmitted infections among sexually active men in sub-Saharan Africa

BMC Public Health ◽

10.1186/s12889-020-09996-5 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Abdul-Aziz Seidu ◽

Bright Opoku Ahinkorah ◽

Louis Kobina Dadzie ◽

Justice Kanor Tetteh ◽

Ebenezer Agbaglo ◽

...

Keyword(s):

Sexually Transmitted Infections ◽

Hiv And Aids ◽

Sub Saharan Africa ◽

Outcome Variable ◽

Sexually Active ◽

First Sex ◽

Sexually Transmitted ◽

Aids Knowledge ◽

Sub Saharan ◽

Hiv Aids

Abstract Background Despite the importance of self-reporting health in sexually transmitted infections (STIs) control, studies on self-reported sexually transmitted infections (SR-STIs) are scanty, especially in sub-Saharan Africa (SSA). This study assessed the prevalence and factors associated with SR-STIs among sexually active men (SAM) in SSA. Methods Analysis was done based on the current Demographic and Health Survey of 27 countries in SSA conducted between 2010 and 2018. A total of 130,916 SAM were included in the analysis. The outcome variable was SR-STI. Descriptive and inferential statistics were performed with a statistical significance set at p < 0.05. Results On the average, the prevalence of STIs among SAM in SSA was 3.8%, which ranged from 13.5% in Liberia to 0.4% in Niger. Sexually-active men aged 25–34 (AOR = 1.77, CI:1.6–1.95) were more likely to report STIs, compared to those aged 45 or more years. Respondents who were working (AOR = 1.24, CI: 1.12–1.38) and those who had their first sex at ages below 20 (AOR = 1.20, CI:1.11–1.29) were more likely to report STIs, compared to those who were not working and those who had their first sex when they were 20 years and above. Also, SAM who were not using condom had higher odds of STIs (AOR = 1.35, CI: 1.25–1.46), compared to those who were using condom. Further, SAM with no comprehensive HIV and AIDS knowledge had higher odds (AOR = 1.43, CI: 1.08–1.22) of STIs, compared to those who reported to have HIV/AIDS knowledge. Conversely, the odds of reporting STIs was lower among residents of rural areas (AOR = 0.93, CI: 0.88–0.99) compared to their counterparts in urban areas, respondents who had no other sexual partner (AOR = 0.32, CI: 0.29–0.35) compared to those who had 2 or more sexual partners excluding their spouses, those who reported not paying for sex (AOR = 0.55, CI: 0.51–0.59) compared to those who paid for sex, and those who did not read newspapers (AOR = 0.93, CI: 0.86–0.99) compared to those who read. Conclusion STIs prevalence across the selected countries in SSA showed distinct cross-country variations. Current findings suggest that STIs intervention priorities must be given across countries with high prevalence. Several socio-demographic factors predicted SR-STIs. To reduce the prevalence of STIs among SAM in SSA, it is prudent to take these factors (e.g., age, condom use, employment status, HIV/AIDS knowledge) into consideration when planning health education and STIs prevention strategies among SAM.

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USING COUPLES’ DISCORDANT REPORTS TO ESTIMATE FEMALE COVERT USE OF MODERN CONTRACEPTION IN SUB-SAHARAN AFRICA

Journal of Biosocial Science ◽

10.1017/s0021932017000256 ◽

2017 ◽

Vol 50 (3) ◽

pp. 326-346 ◽

Cited By ~ 6

Author(s):

Natalie C. Gasca ◽

Stan Becker

Keyword(s):

Contraceptive Use ◽

Modern Method ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Modern Contraceptive ◽

African Countries ◽

Couple Communication ◽

Significant Difference ◽

Contraceptive Prevalence ◽

Sub Saharan

SummarySubstantial numbers of married women use contraceptives without their partner’s knowledge in sub-Saharan Africa, but studies of female covert use across time are rare. This study investigates the levels, trends and correlates of covert use in nine countries and determines which contraceptive methods are more frequently used covertly by women. Data from monogamous couples in Demographic and Health Surveys were used from nine sub-Saharan African countries that had experienced an increase of 10 percentage points in current modern contraceptive use between an earlier (1991–2004) and later (2007–2011) survey. Covert use was indirectly estimated as the percentage of women who reported a female modern method whose husband did not report a modern method. The percentage of women using covertly increased in eight of the countries studied (significantly in three of them), yet when comparing across countries cross-sectionally, covert use was lower where contraceptive prevalence was higher. In general, women with more years of schooling and those with larger spousal schooling gaps had lower odds of covert use. There was no significant difference between covert and open injectable use, though more than half of both groups used this method in the later surveys. Encouraging couple communication about contraception, where the woman feels it is safe to do so, could be an important strategy to minimize covert use. Further research is needed to better identify the contraceptive prevalence and social context in which covert use declines within a country.

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