scholarly journals Socio-economic and geographical inequalities in adolescent fertility rate in Ghana, 1993–2014

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Bright Opoku Ahinkorah ◽  
Eugene Budu ◽  
Henry Ofori Duah ◽  
Joshua Okyere ◽  
Abdul-Aziz Seidu
Keyword(s):  
Adolescent Girls ◽  
Population Attributable Risk ◽  
Population Attributable Fraction ◽  
Fertility Rate ◽  
Sub Saharan Africa ◽  
World Health ◽  
Demographic And Health Surveys ◽  
Fertility Rates ◽  
Adolescent Fertility ◽  
Sub Saharan

Abstract Background Despite public health interventions to control adolescent fertility, it remains high in sub-Saharan Africa. Ghana is one of the countries in sub-Saharan Africa with the highest adolescent fertility rates. We examined the trends and socio-economic and geographical patterns of disparities in adolescent fertility in Ghana from 1993 to 2014. Methods Using the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the 1993–2014 Ghana Demographic and Health surveys were analyzed. First, we disaggregated adolescent fertility rates (AFR) by four equity stratifiers: wealth index, education, residence and region. Second, we measured the inequality through summary measures, namely Difference (D), Population Attributable Risk (PAR), Ratio (R) and Population Attributable Fraction (PAF). A 95 % confidence interval was constructed for point estimates to measure statistical significance. Results We observed substantial absolute and relative wealth-driven inequality in AFR (PAR=-47.18, 95 % CI; -49.24, -45.13) and (PAF= -64.39, 95 % CI; -67.19, -61.59) respectively in favour of the economically advantaged subpopulations. We found significant absolute (D = 69.56, 95 % CI; 33.85, 105.27) and relative (R = 3.67, 95 % CI; 0.95, 6.39) education-based inequality in AFR, with higher burden of AFR among disadvantaged subpopulations (no formal education). The Ratio measure (R = 2.00, 95 % CI; 1.53, 2.47) indicates huge relative pro-urban disparities in AFR with over time increasing pattern. Our results also show absolute (D, PAR) and relative (R, PAF) inequality in AFR across subnational region, between 2003 and 2014. For example, in the 2014 survey, the PAR measure (D=-28.22, 95 % CI; -30.58, -25.86) and the PAF measure (PAF=-38.51, 95 % CI; -41.73, -35.29) indicate substantial absolute and relative regional inequality. Conclusions This study has indicated the existence of inequality in adolescent fertility rate in Ghana, with higher ferlitiy rates among adolescent girls who are poor, uneducated, rural residents and those living in regions such as Northern, Brong Ahafo, and Central region, with increasing disparity over the time period of the study. There is the need for policy interventions that target adolescent girls residing in the rural areas and those in the low socioeconomic subgroups to enable the country to avert the high maternal/newborn morbidity and mortality usually associated with adolescent childbearing.

scholarly journals Socio-demographic determinants of pregnancy termination among adolescent girls and young women in selected high fertility countries in sub-Saharan Africa

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Bright Opoku Ahinkorah
Keyword(s):  
Adolescent Girls ◽  
Young Women ◽  
Pregnancy Termination ◽  
Statistical Significance ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
High Fertility ◽  
Fertility Rates ◽  
Literacy Level ◽  
Sub Saharan

Abstract Background Most of the unintended pregnancies that occur among adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) end up in pregnancy termination. In this study, the socio-demographic determinants of pregnancy termination among AGYW (aged 15–24) in selected countries with high fertility rates in SSA were examined. Methods This was a cross-sectional analysis of data from the most recent Demographic and Health Surveys of nine countries in SSA. The countries included are Angola, Burkina Faso, Burundi, Chad, Gambia, Mali, Niger, Nigeria, and Uganda. A total of 62,747 AGYW constituted the sample size for the study. Fixed and random effects models were used to examine the determinants of pregnancy termination with statistical significance at p < 0.05. Results Higher odds of pregnancy termination were found among AGYW aged 20–24, those who were cohabiting and married, those who listened to radio and watched television at least once a week and those who lived in communities with high literacy level. Conversely, the odds of pregnancy termination were lower among AGYW with three or more births and those with secondary/higher education. Conclusion The socio-demographic determinants of pregnancy termination among AGYW in this study were age, level of education, marital status, exposure to radio and television, parity, and community literacy level. The findings provide the needed information for designing health interventions to reduce unwanted pregnancies and unsafe abortions in countries with high fertility rates in SSA. It is recommended that governments and non-governmental organisations in these countries should enhance sexuality education and regular sensitization of adolescent sexual and reproductive health programmes targeted at AGYW who are at risk of pregnancy termination.

scholarly journals Inequality in fertility rate among adolescents: evidence from Timor-Leste demographic and health surveys 2009–2016

2020 ◽  
Vol 78 (1) ◽  
Author(s):  
Sanni Yaya ◽  
Betregiorgis Zegeye ◽  
Bright Opoku Ahinkorah ◽  
Kelechi Elizabeth Oladimeji ◽  
Gebretsadik Shibre
Keyword(s):  
Adolescent Girls ◽  
Birth Rate ◽  
Population Attributable Risk ◽  
Population Attributable Fraction ◽  
Attributable Risk ◽  
Attributable Fraction ◽  
Demographic And Health Surveys ◽  
Timor Leste ◽  
Adolescent Fertility ◽  
Adolescent Birth

Abstract Background Despite a decline in global adolescent birth rate, many countries in South East Asia still experience a slower pace decline in adolescent birth rates. Timor-Leste is one of the countries in the region with the highest adolescent birth rate and huge disparities between socio-economic subgroups. Hence, this study assessed the magnitude and trends in adolescent fertility rates within different socio-demographic subgroups in Timor-Leste. Methods Using the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the Timor-Leste Demographic and Health surveys (TLDHS) were analyzed between 2009 and 2016. We approached the inequality analysis in two steps. First, we disaggregated adolescent fertility rates by four equity stratifiers: wealth index, education, residence and region. Second, we measured the inequality through summary measures, namely Difference, Population Attributable Risk, Ratio and Population Attributable Fraction. A 95% confidence interval was constructed for point estimates to measure statistical significance. Results We found large socio-economic and area-based inequalities over the last 7 years. Adolescent girls who were poor (Population Attributable Fraction: -54.87, 95% CI; − 57.73, − 52.02; Population Attributable Risk: -24.25, 95% CI; − 25.51, − 22.99), uneducated (Difference: 58.69, 95% CI; 31.19, 86.18; Population Attributable Fraction: -25.83, 95% CI; − 26.93, − 24.74), from rural areas (Ratio: 2.76, 95% CI; 1.91, 3.60; Population Attributable Risk: -23.10, 95% CI; − 24.12, − 22.09) and from the Oecussi region (Population Attributable Fraction: -53.37, 95% CI; − 56.07, − 50.67; Difference: 60.49, 95% CI; 29.57, 91.41) had higher chance of having more births than those who were rich, educated, urban residents and from the Dili region, respectively. Conclusions This study identified disproportionately higher burden of teenage birth among disadvantaged adolescents who are, poor, uneducated, rural residents and those living in regions such as Oecussi, Liquica and Manufahi, respectively. Policymakers should work to prevent child marriage and early fertility to ensure continuous education, reproductive health care and livelihood opportunities for adolescent girls. Specialized interventions should also be drawn to the subpopulation that had disproportionately higher adolescent childbirth.

scholarly journals Unequal treatment: challenging socioeconomic and living area disparities in oral rehydration therapy and continued feeding in 35 Sub-Saharan African countries

2020 ◽  
Author(s):  
Gebretsadik shibre woldemedhn ◽  
Betregiorigis Zegeye
Keyword(s):  
Population Attributable Risk ◽  
Oral Rehydration Therapy ◽  
Analysis Data ◽  
Sub Saharan Africa ◽  
World Health ◽  
Demographic And Health Surveys ◽  
African Countries ◽  
Oral Rehydration ◽  
Unequal Treatment ◽  
Sub Saharan

Abstract Background While the 2030 global goal has motivated proliferation of equity-oriented studies globally, we did not find sweeping studies on disparity in Oral Rehydration Theory (ORT) and continued feeding at the level of the Sub-Saharan Africa (SSA) region. Yet, exploring the within and between-country variations of the service could help synthesize useful policy lessons that can be applied to other settings within the region. We aimed to generate evidence on inequality in use of the service at the level of SSA in order to suggest the way forward to advance the momentum already gained in the region with respect to improving coverage of this lifesaving interventions. Method We applied the World Health Organization’s Health Equity Assessment Toolkit for the analysis. Data were obtained from Demographic and Health Surveys conducted between 2012 and 2016. Thirty-five countries were selected from different income categories in SSA. ORT and continued feeding disparity was analyzed with respect to five dimensions of inequality (wealth, education, sex, residence and subnational regions) through four measures of inequality: difference, ratio, population attributable risk and fraction. Results Disparity in use of ORT and continued feeding plagued SSA and consistently favored advantaged population subgroups. In 20 out of 35 countries, the service was disproportionately concentrated among children from well to do households. The inequality was strikingly pronounced in Angola, Guinea, Cameroon and Mali. We also recorded sizable variations with respect to residence and education in 23 and 11 countries. Interestingly, male and female children get the service almost equally in most countries, with only four countries (Niger, Kenya, Guinea-Bissau, and Senegal) suffered sex differentials, generally to the favor of male children. Conclusion In SSA, unjustified disparity around use of ORT and continued feeding is a pervasive problem that requires resolute policy response soon. Eliminating the disparity would set the region miles ahead to reaching the child health related global goals to be attained in 2030. The region might benefit from equitable economic and education policies.

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

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.

scholarly journals Observed magnitude and trends in socioeconomic and geographic area inequalities in obesity prevalence among non-pregnant women in Chad: evidence from three waves of Chad demographic and health surveys

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Gebretsadik Shibre ◽  
Betregiorgis Zegeye ◽  
Gashaw Garedew Woldeamanuiel ◽  
Wassie Negash ◽  
Gorems Lemma ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Health Surveys ◽  
Population Attributable Risk ◽  
Population Attributable Fraction ◽  
Overweight And Obesity ◽  
World Health ◽  
Demographic And Health Surveys ◽  
Obesity Prevalence ◽  
Place Of Residence ◽  
Urban Rural

Abstract Background While the prevalence of obesity is increasing worldwide, the growing rates of overweight and obesity in developing countries are disquieting. Obesity is widely recognized as a risk factor for non-communicable diseases (NCDs), including diabetes, cancer and cardiovascular diseases. Available evidence on whether obesity has been more prevalent among higher or lower socioeconomic groups, across regions and urban-rural women’s are inconsistent. This study examined magnitude of and trends in socioeconomic, urban-rural and sub-national region inequalities in obesity prevalence among non-pregnant women in Chad. Method Using cross-sectional data from Chad Demographic and Health Surveys (DHSs) conducted in 1996, 2004 and 2014; we used the World Health Organization (WHO) Health Equity Assessment Toolkit (HEAT) to analyze socio-economic, urban-rural and regional inequalities in obesity prevalence among non-pregnant women aged 15–49 years. Inequalities were assessed using four equity stratifiers namely wealth index, educational level, place of residence and subnational region. We presented inequalities using simple and complex as well as relative and absolute summary measures such as Difference (D), Population Attributable Risk (PAR), Population Attributable Fraction (PAF) and Ratio (R). Results Though constant pattern overtime, both wealth-driven and place of residence inequality were observed in all three surveys by Difference measure and in the first and last surveys by Ratio measure. Similarly, including the recent survey (D = -2.80, 95% CI:-4.15, − 1.45, R = 0.37, 95% CI: 0.23, 0.50) absolute (in 1996 & 2014 survey) and relative (in all three surveys) educational status inequality with constant pattern were observed. Substantial absolute (PAR = -2.2, 95% CI: − 3.21, − 1.34) and relative (PAF = − 91.9, 95% CI: − 129.58, − 54.29) regional inequality was observed with increasing and constant pattern by simple (D) and complex (PAR, PAF) measures. Conclusion The study showed socioeconomic and area-based obesity inequalities that disfavored women in higher socioeconomic status and residing in urban areas. Prevention of obesity prevalence should be government and stakeholders’ priority through organizing the evidence, health promotion and prevention interventions for at risk population and general population.

scholarly journals Trends and inequalities in the nutritional status of adolescent girls and adult women in sub-Saharan Africa since 2000: a cross-sectional series study

2020 ◽  
Vol 5 (10) ◽  
pp. e002948
Author(s):  
Safia S Jiwani ◽  
Giovanna Gatica-Domínguez ◽  
Inacio Crochemore-Silva ◽  
Abdoulaye Maïga ◽  
Shelley Walton ◽  
...  
Keyword(s):  
Nutritional Status ◽  
Adolescent Girls ◽  
Overweight And Obesity ◽  
Rate Of Change ◽  
Capital City ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Adult Women ◽  
Cross Sectional ◽  
Sub Saharan

IntroductionEvidence on the rate at which the double burden of malnutrition unfolds is limited. We quantified trends and inequalities in the nutritional status of adolescent girls and adult women in sub-Saharan Africa.MethodsWe analysed 102 Demographic and Health Surveys between 1993 and 2017 from 35 countries. We assessed regional trends through cross-sectional series analyses and ran multilevel linear regression models to estimate the average annual rate of change (AARC) in the prevalence of underweight, anaemia, anaemia during pregnancy, overweight and obesity among women by their age, residence, wealth and education levels. We quantified current absolute inequalities in these indicators and wealth-inequality trends.ResultsThere was a modest decline in underweight prevalence (AARC=−0.14 percentage points (pp), 95% CI −0.17 to -0.11). Anaemia declined fastest among adult women and the richest pregnant women with an AARC of −0.67 pp (95% CI −1.06 to -0.28) and −0.97 pp (95% CI −1.60 to -0.34), respectively, although it affects all women with no marked disparities. Overweight is increasing rapidly among adult women and women with no education. Capital city residents had a threefold more rapid rise in obesity (AARC=0.47 pp, 95% CI 0.39, 0.55), compared with their rural counterparts. Absolute inequalities suggest that Ethiopia and South Africa have the largest gap in underweight (15.4 pp) and obesity (28.5 pp) respectively, between adult and adolescent women. Regional wealth inequalities in obesity are widening by 0.34 pp annually.ConclusionUnderweight persists, while overweight and obesity are rising among adult women, the rich and capital city residents. Adolescent girls do not present adverse nutritional outcomes except anaemia, remaining high among all women. Multifaceted responses with an equity lens are needed to ensure no woman is left behind.

scholarly journals Sub-regional disparities in the use of antenatal care service in Mauritania: findings from nationally representative demographic and health surveys (2011–2015)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Gebretsadik Shibre ◽  
Betregiorgis Zegeye ◽  
Bright Opoku Ahinkorah ◽  
Dina Idriss-Wheeler ◽  
Mpho Keetile ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Maternal Mortality ◽  
Statistical Significance ◽  
Maternal Mortality Ratio ◽  
Population Attributable Risk ◽  
Population Attributable Fraction ◽  
Regional Disparities ◽  
World Health ◽  
Demographic And Health Surveys ◽  
Mortality Ratio

Abstract Background Skilled antenatal care (ANC) has been identified as a proven intervention to reducing maternal deaths. Despite improvements in maternal health outcomes globally, some countries are signaling increased disparities in ANC services among disadvantaged sub-groups. Mauritania is one of sub-Saharan countries in Africa with a high maternal mortality ratio. Little is known about the inequalities in the country’s antenatal care services. This study examined both the magnitude and change from 2011 to 2015 in socioeconomic and geographic-related disparities in the utilization of at least four antenatal care visits in Mauritania. Methods Using the World Health Organization’s Health Equity Assessment Toolkit (HEAT) software, data from the 2011 and 2015 Mauritania Multiple Indicator Cluster Surveys (MICS) were analyzed. The inequality analysis consisted of disaggregated rates of antenatal care utilization using four equity stratifiers (economic status, education, residence, and region) and four summary measures (Difference, Population attributable risk, Ratio and Population attributable fraction). A 95% Uncertainty Interval was constructed around point estimates to measure statistical significance. Results Substantial absolute and relative socioeconomic and geographic related disparities in attending four or more ANC visits (ANC4+ utilization) were observed favoring women who were richest/rich (PAR = 19.5, 95% UI; 16.53, 22.43), educated (PAF = 7.3 95% UI; 3.34, 11.26), urban residents (D = 19, 95% UI; 14.50, 23.51) and those living in regions such as Nouakchott (R = 2.1, 95% UI; 1.59, 2.56). While education-related disparities decreased, wealth-driven and regional disparities remained constant over the 4 years of the study period. Urban-rural inequalities were constant except with the PAR measure, which showed an increasing pattern. Conclusion A disproportionately lower ANC4+ utilization was observed among women who were poor, uneducated, living in rural areas and regions such as Guidimagha. As a result, policymakers need to design interventions that will enable disadvantaged subpopulations to benefit from ANC4+ utilization to meet the Sustainable Development Goal (SDG) of reducing the maternal mortality ratio (MMR) to 140/100, 000 live births by 2030.

Adolescent fertility rates in a rural community in north-western Zambia: a retrospective study

2018 ◽  
Vol 48 (3) ◽  
pp. 213-217 ◽  
Author(s):  
Mwansa Jere
Keyword(s):  
Retrospective Study ◽  
Adolescent Mothers ◽  
Rural Community ◽  
Sub Saharan Africa ◽  
Fertility Rates ◽  
National Data ◽  
Vulnerable Group ◽  
Adolescent Fertility ◽  
Sub Saharan ◽  
North Western

Adolescent fertility rate is defined as the number of births per 1000 in women aged 15–19 years. These rates are highest in sub-Saharan Africa. National data from Zambia suggest the rate has declined from 179.6 in 1960 to 87.9 in 2015. A retrospective study was performed at Chitokoloki Mission Hospital using the hospital delivery registers during January 2008 to December 2015. In this period, 945 (20.81%) births were to adolescent mothers. As morbidity is significant in this vulnerable group, strategies to reduce pregnancy rates among these young girls is much-needed.

scholarly journals Regional variations and socio-economic disparities in neonatal mortality in Angola: a cross-sectional study using demographic and health surveys

2020 ◽  
Vol 37 (6) ◽  
pp. 785-792
Author(s):  
Sanni Yaya ◽  
Betregiorgis Zegeye ◽  
Bright Opoku Ahinkorah ◽  
Olanrewaju Oladimeji ◽  
Gebretsadik Shibre
Keyword(s):  
Neonatal Mortality ◽  
Rural Areas ◽  
Formal Education ◽  
Statistical Significance ◽  
Population Attributable Risk ◽  
Population Attributable Fraction ◽  
World Health ◽  
Demographic And Health Surveys ◽  
Gender Inequalities ◽  
Cross Sectional

Abstract Background Inequalities in neonatal mortality rates (NMRs) in low- and middle-income countries show key disparities at the detriment of disadvantaged population subgroups. There is a lack of scholarly evidence on the extent and reasons for the inequalities in NMRs in Angola. Objective The aim of this study was to assess the socio-economic, place of residence, region and gender inequalities in the NMRs in Angola. Methods The World Health Organization Health Equity Assessment Toolkit software was used to analyse data from the 2015 Angola Demographic and Health Survey. Five equity stratifiers: subnational regions, education, wealth, residence and sex were used to disaggregate NMR inequality. Absolute and relative inequality measures, namely, difference, population attributable fraction (PAF), population attributable risk (PAR) and ratio, were calculated to provide a broader understanding of the inequalities in NMR. Statistical significance was calculated at corresponding 95% uncertainty intervals. Findings We found significant wealth-driven [PAR = −14.16, 95% corresponding interval (CI): −15.12, −13.19], education-related (PAF = −22.5%, 95% CI: −25.93, −19.23), urban–rural (PAF = −14.5%, 95% CI: −16.38, −12.74), sex-based (PAR = −5.6%, 95% CI: −6.17, −5.10) and subnational regional (PAF = −82.2%, 95% CI: −90.14, −74.41) disparities in NMRs, with higher burden among deprived population subgroups. Conclusions High NMRs were found among male neonates and those born to mothers with no formal education, poor mothers and those living in rural areas and the Benguela region. Interventions aimed at reducing NMRs, should be designed with specific focus on disadvantaged subpopulations.

Sign in / Sign up

Export Citation Format

Share Document