Educational Assortative Mating in Sub-Saharan Africa: Compositional Changes and Implications for Household Wealth Inequality

Educational Assortative Mating ◽

Abstract Sub-Saharan Africa (SSA) is undergoing rapid transformations in the realm of union formation in tandem with significant educational expansion and rising labor force participation rates. Concurrently, the region remains the least developed and most unequal along multiple dimensions of human and social development. In spite of this unique scenario, never has the social stratification literature examined patterns and implications of educational assortative mating for inequality in SSA. Using 126 Demographic and Health Surveys from 39 SSA countries between 1986 and 2016, this study is the first to document changing patterns of educational assortative mating by marriage cohort, subregion, and household location of residence and relate them to prevailing sociological theories on mating and development. Results show that net of shifts in educational distributions, mating has increased over marriage cohorts in all subregions except for Southern Africa, with increases driven mostly by rural areas. Trends in rural areas align with the status attainment hypothesis, whereas trends in urban areas are consistent with the inverted U-curve framework and the increasing applicability of the general openness hypothesis. The inequality analysis conducted through a combination of variance decomposition and counterfactual approaches reveals that mating accounts for a nonnegligible share (3% to 12%) of the cohort-specific inequality in household wealth, yet changes in mating over time hardly move time trends in wealth inequality, which is in line with findings from high-income societies.

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 ◽

Universal Healthcare ◽

Explanatory Factors ◽

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.

Recent Underweight and Overweight Trends by Rural–Urban Residence among Women in Low- and Middle-Income Countries

Journal of Nutrition ◽

10.3945/jn.114.203562 ◽

2014 ◽

Vol 145 (2) ◽

pp. 352-357 ◽

Cited By ~ 53

Author(s):

Lindsay M Jaacks ◽

Meghan M Slining ◽

Barry M Popkin

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Sub Saharan Africa ◽

Urban Residence ◽

African Countries ◽

Middle Income ◽

Rate Of Increase ◽

Nationally Representative ◽

AbstractBackground: Long-term trends mask critical recent dynamics in the prevalence of under- and overweight.Objective: The objective of this study was to compare annualized prevalence rates of both under- and overweight among nonpregnant women aged 19–49 y during the periods covering 1) the 1990s–the early 2000s and 2) the early 2000s–the late 2000s or early 2010s, by rural–urban residence.Methods: Data are from nationally representative surveys (29 Demographic and Health Surveys and 4 national surveys). Standardized protocols were used to measure weight and height. Underweight was defined as body mass index (BMI) < 18.5 kg/m2 and overweight as BMI ≥ 25 kg/m2.Results: From the 1990s to the early 2000s, most countries were making progress on decreasing the prevalence of underweight, especially in rural areas. Although many countries continued to make progress more recently, several countries in Sub-Saharan Africa that previously had a decreasing prevalence of underweight now have an increasing prevalence of underweight. For example, in rural areas of Senegal, the prevalence of underweight decreased 0.23% annually between 1992 and 2005, then increased 1.60% annually between 2005 and 2010. Meanwhile, the prevalence of overweight is increasing in nearly all countries, and in approximately half of all countries, the rate of increase is greater in rural areas than in urban areas. Although underweight persists as more prevalent than overweight in rural areas of many East Asian, South Asian, and Sub-Saharan African countries, the ratio of underweight to overweight in many countries has decreased over time, indicating that this trend is reversing.Conclusions: Select countries in Sub-Saharan Africa may be more susceptible to food crises and should be targets for intervention. At the same time, global health efforts need to focus on preventing overweight, particularly in rural areas, which are quickly catching up to their urban counterparts.

Decomposing the rural–urban gap in factors associated with childhood immunisation in sub-Saharan Africa: evidence from surveys in 23 countries

BMJ Global Health ◽

10.1136/bmjgh-2020-003773 ◽

2021 ◽

Vol 6 (1) ◽

pp. e003773

Author(s):

Edward Kwabena Ameyaw ◽

Yusuf Olushola Kareem ◽

Bright Opoku Ahinkorah ◽

Abdul-Aziz Seidu ◽

Sanni Yaya

Keyword(s):

Decomposition Analysis ◽

Household Wealth ◽

Sub Saharan Africa ◽

Childhood Immunisation ◽

Urban Settings ◽

Factors Associated ◽

Rural And Urban ◽

Full Immunisation ◽

BackgroundAbout 31 million children in sub-Saharan Africa (SSA) suffer from immunisation preventable diseases yearly and more than half a million children die because of lack of access to immunisation. Immunisation coverage has stagnated at 72% in SSA over the past 6 years. Due to evidence that full immunisation of children may be determined by place of residence, this study aimed at investigating the rural–urban differential in full childhood immunisation in SSA.MethodsThe data used for this study consisted of 26 241 children pooled from 23 Demographic and Health Surveys conducted between 2010 and 2018 in SSA. We performed a Poisson regression analysis with robust Standard Errors (SEs) to determine the factors associated with full immunisation status for rural and urban children. Likewise, a multivariate decomposition analysis for non-linear response model was used to examine the contribution of the covariates to the observed rural and urban differential in full childhood immunisation. All analyses were performed using Stata software V.15.0 and associations with a p<0.05 were considered statistically significant.ResultsMore than half of children in urban settings were fully immunised (52.8%) while 59.3% of rural residents were not fully immunised. In all, 76.5% of rural–urban variation in full immunisation was attributable to differences in child and maternal characteristics. Household wealth was an important component contributing to the rural–urban gap. Specifically, richest wealth status substantially accounted for immunisation disparity (35.7%). First and sixth birth orders contributed 7.3% and 14.9%, respectively, towards the disparity while 7.9% of the disparity was attributable to distance to health facility.ConclusionThis study has emphasised the rural–urban disparity in childhood immunisation, with children in the urban settings more likely to complete immunisation. Subregional, national and community-level interventions to obviate this disparity should target children in rural settings, those from poor households and women who have difficulties in accessing healthcare facilities due to distance.

Migration as a Risk Factor for HIV Infection among Youths in Sub-Saharan Africa

The Annals of the American Academy of Political and Social Science ◽

10.1177/0002716213482440 ◽

2013 ◽

Vol 648 (1) ◽

pp. 136-158 ◽

Cited By ~ 4

Author(s):

Monica A. Magadi

Keyword(s):

Risk Factor ◽

Hiv Infection ◽

Urban Areas ◽

Young Female ◽

Sub Saharan Africa ◽

Country Level ◽

Female Migrants ◽

Sub Saharan ◽

Living With Hiv

Of the estimated 10 million youths living with HIV worldwide, 63 percent live in sub-Saharan Africa. This article focuses on migration as a risk factor of HIV infection among the youths in sub-Saharan Africa. The study is based on multilevel modeling, applied to the youth sample of the Demographic and Health Surveys (DHS), conducted from 2003 to 2008 in nineteen countries. The analysis takes into account country-level and regional-level variations. The results suggest that across countries in sub-Saharan Africa, migrants have on average about 50 percent higher odds of HIV infection than nonmigrants. The higher risk among migrants is to a large extent explained by differences in demographic and socioeconomic factors. In particular, migrants are more likely to be older, to have been married, or to live in urban areas, all of which are associated with higher risks of HIV infection. The higher risk among youths who have been married is particularly pronounced among young female migrants.

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 ◽

African Countries ◽

Double Burden ◽

Double Burden Of Malnutrition ◽

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.

MIGRATION, TRANSLOCAL NETWORKS AND SOCIO-ECONOMIC STRATIFICATION IN NAMIBIA

Africa ◽

10.1017/s0001972011000477 ◽

2011 ◽

Vol 81 (4) ◽

pp. 606-627 ◽

Cited By ~ 22

Author(s):

Clemens Greiner

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Sub Saharan Africa ◽

Urban Migration ◽

Urban Networks ◽

Rural And Urban Areas ◽

Economic Stratification ◽

Rural And Urban ◽

Sub Saharan ◽

Price Differences

ABSTRACTRural–urban migration and networks are fundamental for many livelihoods in sub-Saharan Africa. Remittances in cash and kind provide additional income, enhance food security and offer access to viable resources in both rural and urban areas. Migration allows the involved households to benefit from price differences between rural and urban areas. In this contribution, I demonstrate that rural–urban networks not only contribute to poverty alleviation and security, but also further socio-economic stratification. This aspect has been ignored or neglected by most scholars and development planners. Using ethnographic data from Namibia, I have adopted a translocal perspective on migration and stratification, focusing on the resulting impact in rural areas where modern urban forms of stratification, induced by education and income from wage labour, are on the increase.

Sexual Autonomy and Self-reported Sexually Transmitted Infections Among Sub-saharan African Women in Sexual Unions

10.21203/rs.3.rs-639480/v1 ◽

2021 ◽

Author(s):

Collins Adu ◽

Aliu Mohammed ◽

Eugene Budu ◽

James Boadu Frimpong ◽

Justice Kannor Tetteh ◽

...

Keyword(s):

Sexually Transmitted Infections ◽

Rural Areas ◽

Urban Areas ◽

Study Data ◽

Sub Saharan Africa ◽

African Women ◽

Odds Ratios ◽

Sexual Autonomy ◽

Sexually Transmitted ◽

Abstract Background Sexually transmitted infections (STIs) remain a major public health challenge worldwide. Despite the importance of sexual autonomy in the prevention and control of sexual and reproductive health disorders such as STIs, there are limited studies on the possible relationship between women’s sexual autonomy and self-reported STIs, especially in sub-Saharan Africa (SSA). This study, therefore, examined the association between sexual autonomy and self-reported STIs among women in sexual unions in SSA.Methods Data from the Demographic and Health Survey (DHS) of 31 countries in SSA conducted between 2010 and 2019 were analysed. A total of 234,310 women in sexual unions were included in the study. Data were analysed using binary logistic regression models and the results were presented as crude odds ratios (cORs) and adjusted odds ratios (aORs) at 95% confidence interval (CI). Results The prevalence of self-reported STIs among women in sexual unions in SSA was 5.8%. Approximately 83.0% of the women surveyed had sexual autonomy. Women who had no sexual autonomy were less likely to have self-reported STIs (cOR=0.52, CI: 0.46-0.54), compared to those who had sexual autonomy. Additionally, higher odds of self-reported STIs were found among women aged 25-29, compared to those aged 15-19 (aOR= 1.21, CI: 1.09-1.35); those who reside in urban areas, compared to those who reside in rural areas (aOR= 1.51, CI: 1.37-1.66) and those who were cohabiting, compared to those who were married (aOR= 1.65, CI: 1.52-1.79). On the other hand, lower odds of self-reported STIs were found among women who were exposed to newspapers (aOR= 0.89, CI: 0.82-0.95), those whose partners had primary education (aOR= 0.84, CI: 0.78-0.91), those who were not exposed to radio (aOR= 0.84, CI: 0.79-0.89), and working women (aOR= 0.86, CI: 0.80-0.93). Conclusion Findings from this study suggest that sexual autonomy is a significant predictor of self-reported STIs among women in sexual unions in SSA. Thus, instituting policies and programs that empower women and improve their levels of sexual autonomy may result in increased self-reporting of symptoms associated with STIs which subsequently help in minimising STI-related complications. Also, policies aimed at enhancing women’s sexual autonomy may reduce the burden of STIs in SSA, especially among women in sexual unions.

Clinical Features of Rheumatoid Arthritis in a Sub-Saharan African Population: A 308 Study Cases in Senegal

Saudi Journal of Internal Medicine ◽

10.32790/sjim.2014.4.1.5 ◽

2014 ◽

Vol 4 (1) ◽

pp. 23-28

Author(s):

Souhaibou Ndongo ◽

Abdoulaye Pouye ◽

Emeric Azankpan ◽

Mourtalla M. Ka ◽

Thérèse Moreira Diop

Keyword(s):

Rheumatoid Arthritis ◽

Rural Areas ◽

Urban Areas ◽

Cross Sectional Study ◽

Sicca Syndrome ◽

Sub Saharan Africa ◽

Cross Sectional ◽

Early Management ◽

Delay In Diagnosis ◽

Background: Rheumatoid arthritis, formerly rare in sub-Saharan Africa, is becoming increasingly reported. The objective study determines the epidemiological, clinical and biological features of rheumatoid arthritis at diagnosis. Methods: A cross-sectional study conducted at the rheumatology outpatient department of Aristide Le Dantec Teaching Hospital of Dakar in Senegal. Results: Three hundred eight patients with rheumatoid arthritis according, to American College of Rheumatology 1987 criteria, were included: 273 women and 35 men (ratio of 7:8). Median age was 41 years (Q1: 31; Q3: 53 years); predominant age group was 30-40 years. Ninety-three percent resided in urban areas and 7% in rural areas. Family history of chronic inflammatory arthritis was reported by 35.1% of patients. Thirty-nine percent of patients initially consulted a traditional healer. On admission, the median Disease Activity Score 28 was 6.5 (Q1: 5.5; Q3: 7.3). Rheumatoid arthritis was very active in 81.1% and a positive factor in 84% of patients. Cyclic citrullinated peptide antibodies assessed in 116 patients; 95 reported positive (81.9%). Of 169 patients, at least one extra-articular manifestation was presented; the most common, anemia and sicca syndrome. Conclusion: Rheumatoid arthritis was characterized by an important delay in diagnosis, a polyarticular presentation, and a high positivity of immunological markers. Extra-articular manifestations included mainly anemia and sicca syndrome. Early management and a better understanding of rheumatoid arthritis in sub-Saharan Africa are required.

Understanding the Factors That Are Associated with Motorcycle Crash Severity in Rural and Urban Areas of Ghana

Journal of Advanced Transportation ◽

10.1155/2021/6336517 ◽

2021 ◽

Vol 2021 ◽

pp. 1-11

Author(s):

William Agyemang ◽

Emmanuel Kofi Adanu ◽

Steven Jones

Keyword(s):

Rural Areas ◽

Traffic Congestion ◽

Urban Areas ◽

Urban Traffic ◽

Sub Saharan Africa ◽

Crash Data ◽

Rural And Urban Areas ◽

Rural And Urban ◽

Run Off ◽

Like many countries in sub-Saharan Africa, Ghana has witnessed an increase in the use of motorcycles for both commercial transport and private transport of people and goods. The rapid rise in commercial motorcycle activities has been attributed to the problem of urban traffic congestion and the general lack of reliable and affordable public transport in rural areas. This study investigates and compares factors that are associated with motorcycle crash injury outcomes in rural and urban areas of Ghana. This comparison is particularly important because the commercial use of motorcycles and their rapid growth in urban areas are a new phenomenon, in contrast to rural areas where people have long relied on motorcycles for their transportation needs. Preliminary analysis of the crash data revealed that more of the rural area crashes occurred under dark and unlit roadway conditions, while urban areas recorded more intersection-related crashes. Additionally, it was found that more pedestrian collisions happened in urban areas, while head-on collisions happened more in rural areas. The model estimation results show that collisions with a pedestrian, run-off-road, and collisions that occur under dark and unlit roadway conditions were more likely to result in fatal injury. Findings from this study are expected to help in crafting and targeting appropriate countermeasures to effectively reduce the occurrence and severity of motorcycle crashes throughout the country and, indeed, sub-Saharan Africa.

Women empowerment and skilled birth attendance in sub-Saharan Africa: A multi-country analysis

PLoS ONE ◽

10.1371/journal.pone.0254281 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0254281

Author(s):

Kwamena Sekyi Dickson ◽

Kenneth Setorwu Adde ◽

Edward Kwabena Ameyaw

Keyword(s):

Urban Areas ◽

Working Women ◽

Skilled Birth Attendance ◽

Sub Saharan Africa ◽

Wife Beating ◽

Women Empowerment ◽

Maternal Deaths ◽

Birth Attendance ◽

Introduction In 2017, the highest global maternal deaths occurred in sub-Saharan Africa (SSA). The WHO advocates that maternal deaths can be mitigated with the assistance of skilled birth attendants (SBAs) at childbirth. Women empowerment is also acknowledged as an enabling factor to women’s functionality and healthcare utilisation including use of SBAs’ services. Consequently, this study investigated the association between women empowerment and skilled birth attendance in SSA. Materials and methods This study involved the analysis of secondary data from the Demographic and Health Surveys of 29 countries conducted between January 1, 2010, and December 3, 2018. For this study, only women who had given birth in the five years prior to the surveys were included, which is 166,022. At 95% confidence interval, Binary Logistic Regression analyses were conducted and findings were presented as adjusted odds ratios (aORs). Results The overall prevalence of skilled birth attendance was 63.0%, with the lowest prevalence in Tanzania (13.8%) and highest in Rwanda (91.2%). Women who were empowered with high level of knowledge (aOR = 1.60, 95% CI = 1.51, 1.71), high decision-making power (aOR = 1.19, 95% CI = 1.15, 1.23), and low acceptance of wife beating had higher likelihood of skill birth attendance after adjusting for socio-demographic characteristics. Women from rural areas had lesser likelihood (OR = 0.53, 95% CI = 0.51–0.55) of skilled birth attendance compared to women from urban areas. Working women had a lesser likelihood of skilled birth attendance (OR = 0.91, 95% CI = 0.88–0.94) as compared to those not working. Women with secondary (OR = 2.13, 95% CI = 2.03–2.22), or higher education (OR = 4.40, 95% CI = 3.81–5.07), and women in the richest wealth status (OR = 3.50, 95% CI = 3.29–3.73) had higher likelihood of skilled birth attendance. Conclusion These findings accentuate that going forward, successful skilled birth attendant interventions are the ones that can prioritise the empowerment of women.