Socioeconomic inequalities in the use of caesarean section delivery in Ghana: a cross-sectional study using nationally representative data

Abstract Background Inappropriate use of Caesarean Section (CS) delivery is partly to blame for Ghana’s high maternal mortality rate. However, previous research offered mixed findings about factors associated with CS use. The goal of this study is to examine use of CS in Ghana and the socioeconomic factors associated with it. Methods Data from the nationally representative 2014 Ghana Demographic and Health Survey (GDHS) was used after permission from the Monitoring and Evaluation to Assess and Use Results (MEASURE) Demographic and Health Survey (DHS) program. Univariable and multivariable logistic regression models were fitted to examine the socioeconomic inequalities in CS use. The independent variables included maternal age, marital status, religion, ethnicity, education, place of residence, wealth quintile, and working status. Concentration index (CI) and rate-ratios were computed to ascertain the level of CS inequalities. Results Out of the 4294 women, 11.4% had CS delivery. However, the percentage of CS delivery ranged from 5% of women in the poorest quintile to 27.5% of women in the richest qunitle. Significant associations were detected between CS delivery and maternal age, parity, education, and wealth quintile . Conclusions This study revealed that first, even though Ghana has achieved an aggregate CS rate consistent with WHO recommendations, it still suffers from inequities in the use of CS. Second, both underuse of CS among poorer women in Ghana and overuse among rich and educated women are public health concerns that need to be addressed. Third, the results show in spite of Ghana’s free maternal care services policies, wealth status of women continues to be strongly and signtificantly associated with CS delivery, indicating that there are indirect health care costs and other reasons preventing poorer women from having access to CS which should be understood better and addressed with appropriate policies.

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Prevalence of diabetes and prediabetes among Bangladeshi adults and associated factors: Evidence from the Demographic and Health Survey, 2017-18

10.1101/2021.01.26.21250519 ◽

2021 ◽

Author(s):

Rakibul M. Islam ◽

Md. Nuruzzaman Khan ◽

John C. Oldroyd ◽

Juwel Rana ◽

Dianna J. Magliago ◽

...

Keyword(s):

Health Survey ◽

Adult Population ◽

Fasting Blood Glucose ◽

Wealth Quintile ◽

Normal Weight ◽

Demographic And Health Survey ◽

Control Measures ◽

Effective Prevention ◽

Factors Associated ◽

Nationally Representative

AbstractAimTo estimate the age-standardised prevalence of diabetes and prediabetes, and to identify factors associated with these conditions at individual, household, and community levels.MethodsData from 11, 952 Bangladeshi adults aged 18+ available from the most recent nationally representative Bangladesh Demographic and Health Survey 2017-18 were used. Anthropometric measurements and fasting blood glucose samples were taken as part of the survey. Prevalence estimates of diabetes and prediabetes were age-standardised with direct standarisation, and risk factors were identified using multilevel mix-effects Poisson regression models with robust variance.ResultsThe overall age-standardised prevalence of diabetes was 12.8% (95%CI 11.2-14.3) (men: 12.8%, women: 12.7%), and prediabetes was 14.0% (95%CI 12.6-15.4) (men: 12.1%, women: 16.5%). Among people with diabetes, 61.5% were unaware that they had the condition. 35.2% were taking treatment regularly and only 30.4% of them had controlled diabetes. Factors associated with an increased prevalence of having diabetes were increasing age, male, overweight/obesity, hypertension, being in the highest wealth quintile and living in the Dhaka division. Compared with normal weight and currently unemployed, individuals who were underweight or currently employed were less likely to develop diabetes.ConclusionDiabetes and prediabetes affect a substantial proportion (over one-quarter) of the Bangladeshi adult population. Continuing surveillance and effective prevention and control measures, with a particular focus on obesity reduction and hypertension management, are urgently needed.

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Individual and contextual factors associated with barriers to accessing healthcare among women in Papua New Guinea: insights from a nationwide demographic and health survey

International Health ◽

10.1093/inthealth/ihaa097 ◽

2020 ◽

Author(s):

Abdul-Aziz Seidu ◽

Ebenezer Agbaglo ◽

Louis Kobina Dadzie ◽

Bright Opoku Ahinkorah ◽

Edward Kwabena Ameyaw ◽

...

Keyword(s):

Papua New Guinea ◽

Health Survey ◽

Rural Areas ◽

Contextual Factors ◽

Statistical Significance ◽

New Guinea ◽

Wealth Quintile ◽

Demographic And Health Survey ◽

Outcome Variable ◽

Factors Associated

Abstract Background This study sought to assess the individual and contextual factors associated with barriers to accessing healthcare among women in Papua New Guinea. Methods The study was conducted among 14 653 women aged 15–49 y using data from the 2016–2018 Papua New Guinea Demographic and Health Survey. The outcome variable was barriers to accessing healthcare. Descriptive and multilevel logistic regression analyses were conducted. Statistical significance was declared at P < 0.05. Results Women aged 15–19 y were more likely to experience at least one barrier compared with those aged 40–49 y (adjusted OR [AOR]=1.48; 95% CI 1.18 to 1.86). Women with secondary/higher education (AOR=0.68; 95% CI 0.57 to 0.81), women in the richest wealth quintile (AOR=0.36; 95% CI 0.28 to 0.46) and those in the least disadvantaged socioeconomic status (AOR=0.46; 95% CI 0.33 to 0.64) had lower odds of having challenges with at least one barrier to healthcare. However, living in rural areas increased the odds of facing at least one barrier to healthcare (AOR=1.87; 95% CI 1.27 to 2.77). Conclusions This study has demonstrated that both individual and contextual factors are associated with barriers to healthcare accessibility among women in Papua New Guinea. To enhance the achievement of the Sustainable Development Goals 3.1, 3.7 and 3.8, it is critical to deem these factors necessary and reinforce prevailing policies to tackle barriers to accessing healthcare among women in Papua New Guinea.

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Predictors of home births among rural women in Ghana: analysis of data from the 2014 Ghana Demographic and Health Survey

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03211-4 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Eugene Budu

Keyword(s):

Maternal Health ◽

Health Survey ◽

Rural Women ◽

Rural Areas ◽

Statistical Significance ◽

Northern Region ◽

Demographic And Health Survey ◽

Wealth Status ◽

Home Births ◽

Factors Associated

Abstract Background Home births is one of the factors associated with maternal mortality. This study examined the predictors of home births among rural women in Ghana. Methods Data for this study was obtained from the 2014 Demographic and Health Survey (DHS) of Ghana. For the purpose of this study, a sample size of 2,101 women in the rural areas who had given birth within five years prior to the survey and had responses on variables was considered. Data processing, management and analysis were carried out using STATA version 14.0. This study carried out bivariate and multivariate analyses and results were tested at 95% confidence interval. The Adjusted odds ratios were used to present the results and the level of statistical significance was assessed using 95% confidence intervals. Results Home births was found to be high among women who resided in the Northern region compared to those in the Western region [AOR, 1.81 CI = 1.10–2.98]. Similarly, the likelihood of home birth was high among women with four or more births [AOR, 1.46 CI = 1.03–2.05] and Traditionalists [AOR, 2.50 CI = 1.54–4.06]. Conversely, giving birth at home was low among women with higher level of education [AOR = 0.58, CI = 0.43–0.78], those with rich wealth status [AOR = 0.19, CI = 0.10–0.38], those with four or more ANC visits [AOR = 0.11, CI = 0.15–0.23] and those who were covered by NHIS [AOR = 0.58, CI = 0.46–0.72]. Conclusions Over the years, there have been efforts by governments in Ghana to make maternal health services free in the country. However, a substantial proportion of women still undergo home births. To reduce the utilization of home births in Ghana, it is essential that government and non-governmental organisations make the cost of delivery services part of the free maternal health care policy and take into consideration the factors associated with the high rates of home births among rural women in Ghana.

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Factors associated with low birth weight in Afghanistan: a cross-sectional analysis of the demographic and health survey 2015

BMJ Open ◽

10.1136/bmjopen-2018-025715 ◽

2019 ◽

Vol 9 (5) ◽

pp. e025715 ◽

Cited By ~ 1

Author(s):

Rajat Das Gupta ◽

Krystal Swasey ◽

Vanessa Burrowes ◽

Mohammad Rashidul Hashan ◽

Gulam Muhammed Al Kibria

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Health Survey ◽

Urban Areas ◽

Maternal Education ◽

Multivariable Analysis ◽

Demographic And Health Survey ◽

Secondary Outcome ◽

Cross Sectional ◽

Factors Associated

ObjectivesThis study aimed to investigate the factors associated with low birth weight (LBW) in Afghanistan.DesignCross-sectional study.SettingThis study used data collected from the Afghanistan Demographic and Health Survey 2015.ParticipantsFacility-based data from 2773 weighted live-born children enrolled by a two-stage sampling strategy were included in our analysis.Primary and secondary outcome measuresThe primary outcome was LBW, defined as birth weight <2.5kg.ResultsOut of 2773 newborns, 15.5% (n=431) had LBW. Most of these newborns were females (58.3%, n=251), had a mother with no formal schooling (70.5%, n=304), lived in urban areas (63.4%, n=274) or lived in the Central region of Afghanistan (59.7%, n=257). In multivariable analysis, residence in Central (adjusted OR (AOR): 3.4; 95% CI 1.7 to 6.7), Central Western (AOR: 3.0; 95% CI 1.5 to 5.8) and Southern Western (AOR: 4.0; 95% CI 1.7 to 9.1) regions had positive association with LBW. On the other hand, male children (AOR: 0.5; 95% CI 0.4 to 0.8), newborns with primary maternal education (AOR: 0.5; 95% CI 0.3 to 0.8), birth interval ≥48 months (AOR: 0.4; 95% CI 0.1 to 0.8), belonging to the richest wealth quintile (AOR: 0.2; 95% CI 0.1 to 0.6) and rural residence (AOR: 0.3; 95% CI 0.2 to 0.6) had decreased odds of LBW.ConclusionsMultiple factors had association with LBW in Afghanistan. Maternal, Neonatal and Child Health programmes should focus on enhancing maternal education and promoting birth spacing to prevent LBW. To reduce the overall burden of LBW, women of the poorest wealth quintiles, and residents of Central, Central Western and South Western regions should also be prioritised. Further exploration is needed to understand why urban areas are associated with higher likelihood of LBW. In addition, research using nationally representative samples are required.

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What influences home delivery among women who live in urban areas? Analysis of 2014 Ghana Demographic and Health Survey data

PLoS ONE ◽

10.1371/journal.pone.0244811 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244811

Author(s):

Bright Opoku Ahinkorah ◽

Abdul-Aziz Seidu ◽

Eugene Budu ◽

Ebenezer Agbaglo ◽

Francis Appiah ◽

...

Keyword(s):

Antenatal Care ◽

Health Survey ◽

Rural Areas ◽

Urban Areas ◽

Wealth Quintile ◽

Home Delivery ◽

Northern Region ◽

Demographic And Health Survey ◽

Factors Associated ◽

At Home

Background In Ghana, home delivery among women in urban areas is relatively low compared to rural areas. However, the few women who deliver at home in urban areas still face enormous risk of infections and death, just like those in rural areas. The present study investigated the factors associated with home delivery among women who live in urban areas in Ghana. Materials and methods Data for this study was obtained from the 2014 Ghana Demographic and Health Survey. We used data of 1,441 women who gave birth in the 5 years preceding the survey and were dwelling in urban areas. By the use of Stata version 14.2, we conducted both descriptive and multivariable logistic regression analyses. Results We found that 7.9% of women in urban areas in Ghana delivered at home. The study revealed that, compared to women who lived in the Northern region, women who lived in the Brong Ahafo region [AOR = 0.38, CI = 0.17–0.84] were less likely to deliver at home. The likelihood of home delivery was high among women in the poorest wealth quintile [AOR = 2.02, CI = 1.06–3.86], women who professed other religions [AOR = 3.45; CI = 1.53–7.81], and those who had no antenatal care visits [AOR = 7.17; 1.64–31.3]. Conversely, the likelihood of home delivery was lower among women who had attained secondary/higher education [AOR = 0.30; 0.17–0.53], compared to those with no formal education. Conclusion The study identified region of residence, wealth quintile, religion, antenatal care visits, and level of education as factors associated with home delivery among urban residents in Ghana. Therefore, health promotion programs targeted at home delivery need to focus on these factors. We also recommend that a qualitative study should be conducted to investigate the factors responsible for the differences in home delivery in terms of region, as the present study could not do so.

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Determinants of caesarean section in Bangladesh: Cross-sectional analysis of Bangladesh Demographic and Health Survey 2014 Data

PLoS ONE ◽

10.1371/journal.pone.0202879 ◽

2018 ◽

Vol 13 (9) ◽

pp. e0202879 ◽

Cited By ~ 9

Author(s):

Mohammad Masudur Rahman ◽

Mohammad Rifat Haider ◽

Md. Moinuddin ◽

Ahmed Ehsanur Rahman ◽

Shakil Ahmed ◽

...

Keyword(s):

Caesarean Section ◽

Health Survey ◽

Demographic And Health Survey ◽

Cross Sectional ◽

Cross Sectional Analysis ◽

Sectional Analysis

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Coverage and factors associated with full immunisation among children aged 12–59 months in Bangladesh: insights from the nationwide cross-sectional demographic and health survey

BMJ Open ◽

10.1136/bmjopen-2018-028020 ◽

2019 ◽

Vol 9 (7) ◽

pp. e028020 ◽

Cited By ~ 1

Author(s):

Abdur Razzaque Sarker ◽

Raisul Akram ◽

Nausad Ali ◽

Marufa Sultana

Keyword(s):

Health Survey ◽

Urban Areas ◽

Coverage Rate ◽

Demographic And Health Survey ◽

Medium Size ◽

Immunisation Coverage ◽

Cross Sectional ◽

Factors Associated ◽

Full Immunisation ◽

Socioeconomic And Demographic Factors

ObjectiveTo estimate the coverage and factors associated with full immunisation coverage among children aged 12–59 months in Bangladesh.Study designThe study is cross sectional in design. Secondary dataset from Bangladesh Demographic and Health Survey was used for this analysis. Immunisation status was categorised as ‘fully immunised’ if the children had received all the eight recommended vaccine doses otherwise ‘partially/unimmunised’.SettingsBangladesh.ParticipantChildren aged 12–59 months were the study participants. Participants were randomly selected through a two-stage stratified sampling design. A total of 6230 children were eligible for the analysis.ResultsAbout 86% of the children (5356 out of 6230) were fully immunised. BCG has the highest coverage rate (97.1%) followed by oral polio vaccine 1 (97%) and pentavalent 1 (96.6%), where the coverage rate was the lowest for measles vaccine (88%). Coverage was higher in urban areas (88.5%) when compared with rural ones (85.1%). Full immunisation coverage was significantly higher among children who lived in the Rangpur division (adjusted OR (AOR)=3.46; 95% CI 2.45 to 4.88, p<0.001), were 48–59 months old (AOR=1.32; 95% CI 1.06 to 1.64, p=0.013), lived in a medium size family (AOR=1.56; 95% CI 1.32 to 1.86, p<0.001), had parents with a higher level of education (AOR=1.96; 95% CI 1.21 to 3.17, p=0.006 and AOR=1.55; 95% CI 1.05 to 2.29, p=0.026) and belonged to the richest families (AOR=2.2; 95% CI 1.5 to 3.21, p<0.001). The likelihood of being partially or unimmunised was higher among children who had the father as their sole healthcare decision-maker (AOR=0.69; 95% CI 0.51 to 0.92, p<0.012).ConclusionsThere were significant variations of child immunisation coverage across socioeconomic and demographic factors. These findings will inform innovative approaches for immunisation programmes, and the introduction of relevant policies, including regular monitoring and evaluation of immunisation coverage—particularly for low-performing regions, so that the broader benefit of immunisation programmes can be achieved in all strata of the society.

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HIV screening in men and women in Senegal: coverage and associated factors; analysis of the 2017 demographic and health survey

BMC Infectious Diseases ◽

10.1186/s12879-019-4717-5 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 11

Author(s):

Ndeye Aïssatou Lakhe ◽

Khardiata Diallo Mbaye ◽

Khadime Sylla ◽

Cheikh Tidiane Ndour

Keyword(s):

Mobile Phone ◽

Hiv Testing ◽

Health Survey ◽

Age Groups ◽

Wealth Quintile ◽

Household Wealth ◽

Demographic And Health Survey ◽

Sexually Active ◽

Level Of Education ◽

Factors Associated

Abstract Background Despite the adoption of the provider-initiated HIV testing strategy, the rate of HIV testing is still very low in sub-Saharan Africa. The aim of this study was to assess the factors associated with HIV testing among sexually active women and men in Senegal. Knowledge of HIV status is the gateway to antiretroviral treatment. Methods A secondary analysis of the 2017 Senegal Demographic and Health Survey (DHS) was performed, using data on sexually active women aged 15–49 and men aged 15–59. The outcome variable was the proportion of women and men who reported ever being tested for HIV in the last 12 months before the survey. Descriptive, bivariate, and multivariable logistic regression analyses were performed to identify the socio-demographic, HIV-knowledge, media exposure, and behavioral factors associated with HIV testing in Senegal. Results The study found that 61.1% (95%CI: 59.2–62.9) of women and 26.2% (95%CI: 24.2–28.3) of men were tested for HIV at the last 12 months. In multivariate analysis, among men the factors independently associated with being tested for HIV were: age groups 20–24 to 40–44 and age group 50–54; a higher level of education; being in the richest household wealth quintile; being married; knowing about the efficacy of HAART during pregnancy; having 2 or more lifetime sex partners and owning a mobile phone. Among women factors independently associated with HIV testing were: being in any age groups versus 15–19; a higher level of education; being in the richest household wealth quintile; being married; knowing about the efficacy of HAART during pregnancy; having any STI in last 12 months; fearing stigma; owning a mobile phone; and having any number of ANC visits, versus none. Conclusion Although HIV remains a public health threat, HIV testing’s prevalence is still low in Senegal, making it difficult to interrupt the transmission chain within the community and to reach the UNAIDS goal for 2020 of “90–90-90”. Innovative community-based strategies are needed to address barriers and improve access to HIV testing in Senegal, particularly for men and for the youngest and poorest populations.

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Prevalence, awareness, treatment, and control of hypertension in Bangladesh: Findings from National Demographic and Health Survey, 2017-18

10.1101/2021.04.09.21255237 ◽

2021 ◽

Author(s):

Md. Nuruzzaman Khan ◽

John C. Oldroyd ◽

Enayet K. Chowdhury ◽

Mohammad Bellal Hossain ◽

Juwel Rana ◽

...

Keyword(s):

Blood Pressure ◽

Health Survey ◽

Demographic And Health Survey ◽

Hypertension Control ◽

Control Blood Pressure ◽

Factors Associated ◽

Robust Variance ◽

Control Programmes ◽

Nationally Representative ◽

And Control

AbstractObjectiveTo estimate the age-standardised prevalence, awareness, treatment and control of hypertension; and to identify their risk factors in Bangladeshi adults 18 years and above using the Bangladesh Demographic and Health Survey (BDHS) 2017-18 data.MethodsData from 12, 904 Bangladeshi adults aged 18 years and older available from the most recent nationally representative BDHS 2017-18 were used. Hypertension was defined as having systolic blood pressure ≥140 mmHg and/or a diastolic blood pressure ≥90 mmHg, and/or taking anti-hypertensive drugs to control blood pressure. Age-standardised prevalence of hypertension and control were estimated with direct standardisation, and a multilevel mixed-effects Poisson regression model with a robust variance was used to identify factors associated with hypertension and its awareness, treatment, and control.ResultsThe overall age-standardised prevalence of hypertension was 40.0% (95% CI, 38.9-42.2); (men: 37.1%, women: 42.0%). Among those with hypertension (n=3531), 44.3% were aware that they had the condition and 39.1% were taking anti-hypertensive medication. Among those treated for hypertension (n=1306), only 41% had controlled hypertension. Factors independently associated with hypertension were increasing age, higher body mass index, being women, having diabetes, and residing in selected administrative divisions. A declining trend of hypertension control was observed with increasing age and those not being educated.ConclusionHypertension is highly prevalent (4 out of 10) in Bangladeshi adults, while awareness, treatment, and control are low. Irrespective of risks associated with hypertension and its management, awareness and control programmes should be given high priority in reducing hypertension, and improving hypertension control in Bangladesh.

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Factors associated with HIV testing and counselling services among women and men in Nepal: a cross-sectional study using data from a nationally representative survey

BMJ Open ◽

10.1136/bmjopen-2021-049415 ◽

2021 ◽

Vol 11 (12) ◽

pp. e049415

Author(s):

Navaraj Bhattarai ◽

Kiran Bam ◽

Kiran Acharya ◽

Rajshree Thapa ◽

Bhagawan Shrestha

Keyword(s):

Hiv Testing ◽

Primary Outcome ◽

Multivariable Analysis ◽

Age Groups ◽

Media Exposure ◽

Wealth Quintile ◽

Cross Sectional Study ◽

Cross Sectional ◽

Factors Associated ◽

Nationally Representative

ObjectivesThis study is set up to explore the factors associated with Human Immunodeficiency Virus (HIV) testing among women and men in Nepal.Study designNepal Demographic and Health Survey, 2016 adopts a cross-sectional design.SettingNepal.ParticipantsWomen and men of age 15–49 years.Primary outcome measuresOur primary outcome was ever tested for HIV. We used multivariable analysis at a 95% level of significance to measure the effect in outcome variables.ResultsAbout one in 10 women (10.8%) and one in five men (20.5%) ever tested for HIV. Women who had media exposure at least once a week ((adjusted odds ratio (aOR)=2.8; 95% CI: 1.4 to 5.3) were more likely to get tested for HIV compared with those who had no media exposure at all. Similarly, those who had their recent delivery in the health facility (aOR=3.9; 95% CI: 2.4 to 6.3) were more likely to get tests for HIV compared with those delivered elsewhere. Likewise, among men, compared with adolescents (15–19 years), those from older age groups were more likely to get tested for HIV. Compared with no education, secondary (aOR=2.3; 95% CI: 1.4 to 3.6) and higher education (aOR=1.7; 95% CI: 1.0 to 2.8) had higher odds of getting tested for HIV. Similarly, wealth quintiles in richer and richest groups were more likely to get tested for HIV compared with the poorest quintile. Other characteristics like media exposure, paid sex and 2+ sexual partners were positively associated with being tested for HIV.ConclusionsHIV testing is not widespread and more men than women are accessing HIV services. More than two-thirds of women who delivered at health facilities never tested for HIV. It is imperative to reach out to people engaging in risky sexual behaviour, people with lower educational attainment, and those in the lower wealth quintile for achieving 95–95–95 targets by 2030.

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