Timely initiation of antenatal care and its associated factors among pregnant women in sub-Saharan Africa: A multicountry analysis of Demographic and Health Surveys

Background Timely initiation of antenatal care (ANC) is an important component of ANC services that improve the health of the mother and the newborn. Mothers who begin attending ANC in a timely manner, can fully benefit from preventive and curative services. However, evidence in sub-Saharan Africa (sSA) indicated that the majority of pregnant mothers did not start their first visit timely. As our search concerned, there is no study that incorporates a large number of sub-Saharan Africa countries. Thus, the objective of this study was to assess the prevalence of timely initiation of ANC and its associated factors in 36 sSA countries. Methods The Demographic and Health Survey (DHS) of 36 sSA countries were used for the analysis. The total weighted sample of 233,349 women aged 15–49 years who gave birth in the five years preceding the survey and who had ANC visit for their last child were included. A multi-level logistic regression model was used to examine the individual and community-level factors that influence the timely initiation of ANC. Results were presented using adjusted odds ratio (AOR) with 95% confidence interval (CI). Results In this study, overall timely initiation of ANC visit was 38.0% (95% CI: 37.8–38.2), ranging from 14.5% in Mozambique to 68.6% in Liberia. In the final multilevel logistic regression model:- women with secondary education (AOR = 1.08; 95% CI: 1.06, 1.11), higher education (AOR = 1.43; 95% CI: 1.36, 1.51), women aged 25–34 years (AOR = 1.20; 95% CI: 1.17, 1.23), ≥35 years (AOR = 1.30; 95% CI: 1.26, 1.35), women from richest household (AOR = 1.19; 95% CI: 1.14, 1.22), women perceiving distance from the health facility as not a big problem (AOR = 1.05; 95%CI: 1.03, 1.07), women exposed to media (AOR = 1.29; 95%CI: 1.26, 1.32), women living in communities with medium percentage of literacy (AOR = 1.51; 95%CI: 1.40, 1.63), and women living in communities with high percentage of literacy (AOR = 1.56; 95%CI: 1.38, 1.76) were more likely to initiate ANC timely. However, women who wanted their pregnancy later (AOR = 0.84; 95%CI: 0.82, 0.86), wanted no more pregnancy (AOR = 0.80; 95%CI: 0.77, 0.83), and women residing in the rural area (AOR = 0.90; 95%CI: 0.87, 0.92) were less likely to initiate ANC timely. Conclusion Even though the WHO recommends all women initiate ANC within 12 weeks of gestation, sSA recorded a low overall prevalence of timely initiation of ANC. Maternal education, pregnancy intention, residence, age, wealth status, media exposure, distance from health facility, and community-level literacy were significantly associated with timely initiation of ANC. Therefore, intervention efforts should focus on the identified factors in order to improve timely initiation of ANC in sSA. This can be done through the providing information and education to the community on the timing and importance of attending antenatal care and family planning to prevent unwanted pregnancy, especially in rural settings.

A growing disadvantage of being born in an urban area? Analysing urban–rural disparities in neonatal mortality in 21 African countries with a focus on Tanzania

IntroductionNeonatal mortality rate (NMR) has been declining in sub-Saharan African (SSA) countries, where historically rural areas had higher NMR compared with urban. The 2015–2016 Demographic and Health Survey (DHS) in Tanzania showed an exacerbation of an existing pattern with significantly higher NMR in urban areas. The objective of this study is to understand this disparity in SSA countries and examine the specific factors potentially underlying this association in Tanzania.MethodsWe assessed urban–rural NMR disparities among 21 SSA countries with four or more DHS, at least one of which was before 2000, using the DHS StatCompiler. For Tanzania DHS 2015–2016, descriptive statistics were carried out disaggregated by urban and rural areas, followed by bivariate and multivariable logistic regression modelling the association between urban/rural residence and neonatal mortality, adjusting for other risk factors.ResultsAmong 21 countries analysed, Tanzania was the only SSA country where urban NMR (38 per 1000 live births) was significantly higher than rural (20 per 1,000), with largest difference during first week of life. We analysed NMR on the 2015–2016 Tanzania DHS, including live births to 9736 women aged between 15 and 49 years. Several factors were significantly associated with higher NMR, including multiplicity of pregnancy, being the first child, higher maternal education, and male child sex. However, their inclusion did not attenuate the effect of urban–rural differences in NMR. In multivariable models, urban residence remained associated with double the odds of neonatal mortality compared with rural.ConclusionThere is an urgent need to understand the role of quality of facility-based care, including role of infections, and health-seeking behaviour in case of neonatal illness at home. However, additional factors might also be implicated and higher NMR within urban areas of Tanzania may signal a shift in the pattern of neonatal mortality across several other SSA countries.

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

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.

The role of healt-hcare supply chain management in the wake of COVID-19 pandemic: hot off the press

Purpose The study aims to examine the role of health-care supply chain management during the COVID-19 pandemic in a cross-section of 42 selected sub-Saharan African (SSA) countries. Design/methodology/approach The study used cross-sectional robust least square regression for parameter estimates. Findings The results confirmed the N-shaped relationship between the health-care logistics performance index (HLPI) and COVID-19 cases. It implies that initially HLPI increases along with an increase in COVID-19 cases. Later down, it decreases COVID-19 cases by providing continued access to medical devices and personal protective equipment. Again, it increases due to resuming economic activities across countries. Practical implications The continuing health-care supply chain is crucial to minimize COVID-19 cases. The international support from the developed world in providing health-care equipment, debt resettlement and resolving regional conflicts is deemed desirable to escape the SSA countries from the COVID-19 pandemic. Originality/value The importance of the health-care supply chain during the COVID-19 pandemic is evident in the forecasting estimates, which shows that from August 2021 to April 2022, increasing the health-care supply chain at their third-degree level would reduce coronavirus registered cases. The results conclude that SSA countries required more efforts to contain coronavirus cases by thrice increasing their health-care logistics supply chain.

Factors affecting willingness to comply with public health measures during the pandemic among sub-Sahara Africans

Background: The unprecedented outbreak of coronavirus disease (COVID-19) drastically spread worldwide, resulting in extraordinary measures put in place in various countries including Sub Saharan Africa (SSA) countries. Objective: To assess the factors associated with compliance with the public health measures imposed by various SSA countries. Method: Cross sectional study using self-administered surveys distributed on social media platforms between April 18th and May 16th, 2020, corresponding with the mandatory lockdown period in most SSA countries. Multivariate analysis examined theassociated factors. Results: The prevalence of hand hygiene, quarantine, self isolation practices, wearing of face mask and attending large gatherings during COVID-19 were 94%, 39%, 31%, 64% and 14%, respectively. In multivariate models, older age 49+ years: adjusted OR2.13, 95%CI 1.22,3.71), females (OR 1.41,95%CI 1.03,1.93), Central African countries (OR 3.73,95%CI 2.02,6.87) were associated with wearing face mask. Living alone (aOR 1.52,95%CI 1.04,2.24) during the lockdown was associated with avoiding large gatherings including religious events. Female respondents (aOR 1.61, 95%CI 1.30, 2.00), married (aOR 1.71,95%CI 1.33,2.21) and unemployed (aOR 1.62,95%CI 1.25,2.09) SSAs were more likely to practice self-quarantine measures. Conclusion: The low prevalence of mitigation practices suggest the need for targeted education campaign programs to sensitise the population. Keywords: Facemask; Handwashing; Self-isolation; Mitigation; Survey monkey; Pandemic; Lockdown; West Africa; Eastern Africa; South Africa; Nigeria.

The development of telemedicine programs in Sub-Saharan Africa: Progress and associated challenges

Monitoring the progress of telemedicine use in Sub-Saharan Africa (SSA) countries has received a considerable attention from many health organizations and governmental agencies. This study reviewed the current progress and challenges in relation to the development of telemedicine programs in SSA. The results from reviewing 66 empirical studies revealed an unbalanced progress across SSA countries. Further, technological, organisational, legal and regulatory, individual, financial, and cultural aspects were identified as the major barriers to the success of telemedicine development in SSA. This study reported the current trends in telemedicine application, as well as highlighting critical barriers for consideration by healthcare decision makers. The outcomes from this study offer a number of recommendations to support wider implementation and sustainable usage of telemedicine in SSA.

Health System Productivity In Sub-Saharan Africa: Tuberculosis Control In High Burden Countries

Background: 21 of the 30 countries with a high tuberculosis (TB) burden are in Sub-Saharan Africa (SSA). SSA is also home to 74% of all HIV-positive TB patients reported worldwide in 2014. This paper analyses the productivity changes of TB programs and decompose this productivity down into technological change and technical efficiency. Method: this study was carried out in 16 SSA countries where TB is highly endemic and covers the period 2009-2016. The data is taken from the annual reports of global TB Program. We used the Hicks-Moorsteen index to compute and decompose total factor productivity (TFP), and the β-convergence and σ-convergence tests to check for convergence patterns among SSA countries. Results: The largest increase in the TFP (35.7%) in 2016 with respect to the base year corresponds to the cutbacks in inputs (9.1%) and a positive change in outputs (0.9%). We found that technological change has been the main driver of the TFP growth, and that increasing technical efficiency may be the first objective in efforts to improve the TFP of TB programs. Our findings support the hypothesis of convergence among SSA countries in the fight against TB. Moreover, corruption was considered as one of the most important determinants of tuberculosis control in SSA countries.Conclusion: the findings suggest that improving the technical efficiency of TB programs mainly calls for better resource allocation, capacity building in governance and management of programs, improved training of the health providers and stronger prevention policies. An efficient use of funds will arguably reduce the number of tuberculosis cases and TB burden. The Global Fund must closely monitor all the grants in its portfolio and respond decisively and urgently to any instances of corruption.

Preterm birth and its associated factors among reproductive aged women in sub-Saharan Africa: evidence from the recent demographic and health surveys of sub-Sharan African countries

Background Globally, preterm birth is the leading cause of neonatal and under-five children mortality. Sub-Saharan African (SSA) accounts for the majority of preterm birth and death following its complications. Despite this, there is limited evidence about the pooled prevalence and associated factors of preterm birth at SSA level using nation-wide representative large dataset. Therefore, this study aimed to determine the pooled prevalence and associated factors of preterm birth among reproductive aged women. Methods The recent Demographic and Health Surveys (DHSs) data of 36 SSA countries were used. We included a total weighted sample of 172,774 reproductive-aged women who were giving birth within five years preceding the most recent survey of SSA countries were included in the analysis. We used a multilevel logistic regression model to identify the associated factors of preterm birth in SSA. We considered a statistical significance at a p-value less than 0.05. Results In this study, 5.33% (95% CI: 5.23, 5.44%) of respondents in SSA had delivered preterm baby. Being form eastern Africa, southern Africa, rural area, being educated, substance use, having multiple pregnancy, currently working history, having history of terminated pregnancy, and previous cesarean section delivery, primi-parity, and short birth interval were associated with higher odds of preterm birth among reproductive aged women. However, having better wealth index, being married, wanted pregnancy, and having four or more antenatal care visit were associated with lower odds for a preterm birth among reproductive aged women. Conclusion The prevalence of preterm birth among reproductive-aged women remains a major public health problem in SSA. Preterm birth was affected by various socio-economic and obstetrical factors. Therefore, it is better to consider the high-risk groups during intervention to prevent the short-term and long-term consequences of preterm birth.

Impacts of Covid-19 on Migration Dynamics and Remittances in Sub-Saharan Africa (SSA)

The paper therefore x-rays the impacts of the COVID-19 pandemic on migration dynamics by analyzing types and trends dynamics of migrants’ movement, demographic dynamics of migration as related to the inflow of remittances (both cash and in-kind) to SSA countries prior to the pandemic. Also discusses the constraints of transferring cash remittances and subsequent decline posed by the COVID-19 outbreak during and beyond the pandemics. Secondary evidence from Somali and Nigeria were analyzed on the constraints of remitting cash, while in-kind remittance from the Republic of Chad was evaluated. The importance of remittances to the home communities was established. Measures to safeguard SSA migrants’ mobility and their remittances, citing some selected countries of destination, were exploited. The paper concludes that COVID-19 impacts on migration should be opportunities for policymakers (both home and destination countries) to reset their efforts towards protecting migrants and their future activities.