scholarly journals A Multilevel Analysis of Risk and Protective Factors for Adolescent Childbearing in Malawi

2021 ◽  
Vol 10 (8) ◽  
pp. 303
Author(s):  
Jesman Chintsanya ◽  
Monica Magadi ◽  
Gloria Likupe
Keyword(s):  
Protective Factors ◽  
Teenage Pregnancy ◽  
Sexual Debut ◽  
Risk And Protective Factors ◽  
Sub Saharan Africa ◽  
Protective Effects ◽  
Teenage Childbearing ◽  
Never Married ◽  
Sub Saharan ◽  
Over Time

Although teenage pregnancy and childbearing has declined throughout sub-Saharan Africa, the recent increase in teenage pregnancy in countries such as Malawi has prompted interest from social researchers. Using Malawi Demographic and Health Survey (MDHS) data from 2004 to 2015, this study employs multilevel logistic regression to examine the magnitude of change over time in risk and protective factors for teenage childbearing. During this period, teenage childbearing declined from 36.1% (C.I.: 31.5–36.7) in 2004 to 25.6% (C.I.: 24.0–27.3) in 2010 before increasing to 29.0% (C.I.: 27.4–30.7) in 2015. Age and being married (compared to never married) were consistently significantly associated with increased odds of teenage childbearing. However, delaying sexual debut, attaining secondary education, belonging to the richest quintile and rural residence offered protective effects against early motherhood, while Muslim affiliation (compared to Christian denominations) was associated with increased likelihood of teenage childbearing among adolescents. Teenage childbearing remains high in the country, largely influenced by adolescents’ early sexual debut and child marriage—risk factors that have hardly changed over time. While individual socioeconomic predictors are useful in explaining the apparent high risk of adolescent fertility among specific subgroups in Malawi, sustained declines in teenage childbearing were not evident at district level.

scholarly journals Understanding Mental Health in the Context of Adolescent Pregnancy and HIV in Sub-Saharan Africa: A Systematic Review Identifying a Critical Evidence Gap

2021 ◽  
Author(s):  
Kathryn J. Roberts ◽  
Colette Smith ◽  
Lucie Cluver ◽  
Elona Toska ◽  
Lorraine Sherr
Keyword(s):  
Mental Health ◽  
Systematic Review ◽  
Mental Disorder ◽  
Protective Factors ◽  
Adolescent Pregnancy ◽  
Common Mental Disorder ◽  
Risk And Protective Factors ◽  
Sub Saharan Africa ◽  
Sub Saharan ◽  
Living With Hiv

AbstractAdolescent (10–19 years) mental health remains an overlooked global health issue. Rates of adolescent pregnancy within sub-Saharan Africa are some of the highest in the world and occur at the epicentre of the global HIV epidemic. Both experiencing adolescent pregnancy and living with HIV have been found to be associated with adverse mental health outcomes, when investigated separately. Poor mental health may have implications for both parent and child. The literature regarding mental health within groups experiencing both HIV and adolescent pregnancy is yet to be summarised. This systematic review sought to identify (1) the prevalence/occurrence of common mental disorder amongst adolescents who are living with HIV and have experienced pregnancy, (inclusive of adolescent fathers) in sub-Saharan Africa (2) risk and protective factors for common mental disorder among this group, and (3) interventions (prevention/treatment) for common mental disorder among this group. A systematic search of electronic databases using pre-defined search terms, supplemented by hand-searching, was undertaken in September 2020. One author and an independent researcher completed a title and abstract screening of results from the search. A full-text search of all seemingly relevant manuscripts (both quantitative and qualitative) was undertaken and data extracted using pre-determined criteria. A narrative synthesis of included studies is provided. Quality and risk of bias within included studies was assessed using the Newcastle-Ottawa scale. A systematic keyword search of databases and follow-up hand searching identified 2287 unique records. Of these, thirty-eight full-text quantitative records and seven full-text qualitative records were assessed for eligibility. No qualitative records met the eligibility criteria for inclusion within the review. One quantitative record was identified for inclusion. This study reported on depressive symptomology amongst 14 pregnant adolescents living with HIV in Kenya, identifying a prevalence of 92.9%. This included study did not meet the high methodological quality of this review. No studies were identified reporting on risk and protective factors for common mental disorder, and no studies were found identifying any specific interventions for common mental disorder for this group, either for prevention or for treatment. The limited data identified within this review provides no good quality evidence relating to the prevalence of common mental disorder among adolescents living with HIV who have experienced pregnancy in sub-Saharan Africa. No data was available relating to risk and protective factors or interventions for psychological distress amongst this group. This systematic review identifies a need for rigorous evidence regarding the mental health of pregnant and parenting adolescents living with HIV, and calls for granular interrogation of existing data to further our understanding of the needs of this group. The absence of research on this topic (both quantitative and qualitative) is a critical evidence gap, limiting evidence-based policy and programming responses, as well as regional development opportunities.

scholarly journals Trends and country-level variation in age at first sex in sub-Saharan Africa among birth cohorts entering adulthood between 1985 and 2020

2021 ◽  
Author(s):  
Van Kinh Nguyen ◽  
Jeffrey W Eaton
Keyword(s):  
Gender Gap ◽  
Sexual Debut ◽  
Random Effect Model ◽  
Sub Saharan Africa ◽  
Logistic Distribution ◽  
Birth Cohorts ◽  
First Sex ◽  
Sub Saharan ◽  
Ssa Countries ◽  
Over Time

Background: Debuting sexual intercourse is a life course event marking exposure to pregnancy or fatherhood, and sexually transmitted infections (STIs), including HIV. We systematically analysed the timing, distribution, and trends in age at first sex (AFS) in 42 sub-Saharan Africa (SSA) countries. Methods: We collated individual-level AFS data from nationally representative household surveys across SSA. We used a log-skew-logistic distribution to model the distribution of AFS in a Bayesian spatio-temporal hierarchical random-effect model to estimate national trends of AFS over time and space, adjusting for age at report biases. Findings: Small changes in AFS are observed between the birth cohorts entering adulthood between 1985 and 2020, ranging 0.79 years [-0.01-1.51] and 0.48 [-0.03-1.92] for female and male, respectively. Northern SSA countries show appreciable increase in AFS but its gender gap remains the widest compared with minimal gender gap in the southern countries. The gender gap shows little evidence of change over time in most of the countries. Female's AFS approach to a similar age across SSA while male's AFS varies between regions. Proportion ever had sex under fifteen and eighteen are as high 34% and 83%, respectively. AFS distribution is typically asymmetric with most of sexual debut events occur in a span of 3.9 [3.4-5.0] years. Female teen often reports higher AFS compare to their late twenties while male teen report lower AFS; both sexes tend to recall a higher AFS in older ages compared to their thirties. Interpretation: Women debut sexually earlier and in a shorter span of age than men. Northern and southern SSA gender gap are distinctively different. Since the ratifying of HIV/AIDS intervention programs in SSA, a stagnant trend in AFS had remained in the countries most affected by the epidemic.

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 Contrasting Monetary and Multidimensional Poverty Measures in a Low-Income Sub-Saharan African Country

2020 ◽  
Vol 151 (2) ◽  
pp. 547-574 ◽  
Author(s):  
Lukas Salecker ◽  
Anar K. Ahmadov ◽  
Leyla Karimli
Keyword(s):  
Risk Factors ◽  
Low Income ◽  
Multidimensional Poverty ◽  
Poverty Measurement ◽  
Sub Saharan Africa ◽  
Analytical Strategy ◽  
Poverty Risk ◽  
Two Measures ◽  
Sub Saharan ◽  
Over Time

AbstractDespite significant progress in poverty measurement, few studies have undertaken an in-depth comparison of monetary and multidimensional measures in the context of low-income countries and fewer still in Sub-Saharan Africa. Yet the differences can be particularly consequential in these settings. We address this gap by applying a distinct analytical strategy to the case of Rwanda. Using data from two waves of the Rwandan Integrated Household Living Conditions Survey, we combine comparing poverty rates cross-sectionally and over time, examining the overlaps and differences in the two measures, investigating poverty rates within population sub-groups, and estimating several statistical models to assess the differences between the two measures in identifying poverty risk factors. We find that using a monetary measure alone does not capture high incidence of multidimensional poverty in both waves, that it is possible to be multidimensional poor without being monetary poor, and that using a monetary measure alone overlooks significant change in multidimensional poverty over time. The two measures also differ in which poverty risk factors they put emphasis on. Relying only on monetary measures in low-income sub-Saharan Africa can send inaccurate signals to policymakers regarding the optimal design of social policies as well as monitoring their effectiveness.

scholarly journals The relative importance and stability of disease burden causes over time: summarizing regional trends on disease burden for 290 causes over 28 years

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Henry Dyson ◽  
Raf Van Gestel ◽  
Eddy van Doorslaer
Keyword(s):  
Disease Burden ◽  
Respiratory Infections ◽  
Sub Saharan Africa ◽  
Regional Trends ◽  
Disability Adjusted Life ◽  
Life Years ◽  
Causes Of Disease ◽  
Sub Saharan ◽  
Disease Study ◽  
Over Time

Abstract Background Since the Global Burden of Disease study (GBD) has become more comprehensive, data for hundreds of causes of disease burden, measured using Disability Adjusted Life Years (DALYs), have become increasingly available for almost every part of the world. However, undergoing any systematic comparative analysis of the trends can be challenging given the quantity of data that must be presented. Methods We use the GBD data to describe trends in cause-specific DALY rates for eight regions. We quantify the extent to which the importance of ‘major’ DALY causes changes relative to ‘minor’ DALY causes over time by decomposing changes in the Gini coefficient into ‘proportionality’ and ‘reranking’ indices. Results The fall in regional DALY rates since 1990 has been accompanied by generally positive proportionality indices and reranking indices of negligible magnitude. However, the rate at which DALY rates have been falling has slowed and, at the same time, proportionality indices have tended towards zero. These findings are clearest where the focus is exclusively upon non-communicable diseases. Notably, large and positive proportionality indices are recorded for sub-Saharan Africa over the last decade. Conclusion The positive proportionality indices show that disease burden has become less concentrated around the leading causes over time, and this trend has become less prominent as the DALY rate decline has slowed. The recent decline in disease burden in sub-Saharan Africa is disproportionally driven by improvements in DALY rates for HIV/AIDS, as well as for malaria, diarrheal diseases, and lower respiratory infections.

Countering Violent Extremism in Sub-Saharan Africa: What Policy Makers Need to Know

World Affairs ◽  
2019 ◽  
Vol 182 (3) ◽  
pp. 256-272 ◽  
Author(s):  
Robin A. Hardy
Keyword(s):  
Financial Support ◽  
Muslim World ◽  
Sub Saharan Africa ◽  
Risk Assessments ◽  
Boko Haram ◽  
Policy Makers ◽  
Counter Terrorism ◽  
Violent Extremism ◽  
Sub Saharan ◽  
Over Time

This essay addresses recurring and growing inaccurate reports from political officials as well as counter-terrorism analysts and journalists that the Sahara-Sahel group Boko Haram is a defeated entity. Notwithstanding concerted efforts to rout the movement, Boko Haram and its network of jihadists have expanded. Crucial misunderstandings surrounding what fostered and sustains the phenomenon—as well as a general naivety regarding the organization’s flexibility to adapt to attract combatants, financial support, and weaponry beyond Nigeria’s borders—have made performing basic adequate risk assessments overwhelmingly challenging. Policy makers and CVE (Countering Violent Extremism) practitioners would be wise to recognize that not only has Boko Haram morphed but its growing affiliates also terrorize increased territory. The threat of militant Islam in the Sahara-Sahel, therefore, has not been contained as some would have us believe. Rather, Muslim extremism has become entangled and more complex not only in Africa but across the Muslim world. When jihadists in one territory have taken a beating, surviving fighters have simply relocated to other geographies accompanied by connections for capital and munitions. In this way, Boko Haram—the fulcrum of violent Islam in the Sahara-Sahel—has become, over time, an international jihadist actor.

scholarly journals Investigating persistent measles dynamics in Niger and associations with rainfall

2020 ◽  
Vol 17 (169) ◽  
pp. 20200480
Author(s):  
Alexandre Blake ◽  
Ali Djibo ◽  
Ousmane Guindo ◽  
Nita Bharti
Keyword(s):  
Spatial Clustering ◽  
Vaccine Coverage ◽  
Sub Saharan Africa ◽  
Environmental Drivers ◽  
Transmission Mechanisms ◽  
Immunization Strategies ◽  
Annual Periodicity ◽  
Sub Saharan ◽  
Low Coverage ◽  
Over Time

Measles is a major cause of child mortality in sub-Saharan Africa. Current immunization strategies achieve low coverage in areas where transmission drivers differ substantially from those in high-income countries. A better understanding of measles transmission in areas with measles persistence will increase vaccination coverage and reduce ongoing transmission. We analysed weekly reported measles cases at the district level in Niger from 1995 to 2004 to identify underlying transmission mechanisms. We identified dominant periodicities and the associated spatial clustering patterns. We also investigated associations between reported measles cases and environmental drivers associated with human activities, particularly rainfall. The annual and 2–3-year periodicities dominated the reporting data spectrum. The annual periodicity was strong with contiguous spatial clustering, consistent with the latitudinal gradient of population density, and stable over time. The 2–3-year periodicities were weaker, unstable over time and had spatially fragmented clustering. The rainy season was associated with a lower risk of measles case reporting. The annual periodicity likely reflects seasonal agricultural labour migration, whereas the 2–3-year periodicity potentially results from multiple mechanisms such as reintroductions and vaccine coverage heterogeneity. Our findings suggest that improving vaccine coverage in seasonally mobile populations could reduce strong measles seasonality in Niger and across similar settings.

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