Environmental and nutritional determinants of diarrhoea disease among children under five years in Rwanda: A secondary data analysis of the Rwanda demographic and health survey 2014-15

Background Diarrhoea remains one of the leading of causes of deaths in children under five years old globally. Children under five years are more vulnerable to diarrhea especially those from low and middle countries. The aim of this study was to explore the environmental and nuttitional factors associated with diarrhea among children underfive years in Rwanda. Methods A secondary data analysis of the Rwanda Demographic and Heralth Survey 2014-2015 (RDHS 2014-2015) was used. A total sample of 7,558 children under five years old was included. The data were analysed using Stata 13. Bivariate with Chi-square test and multivariable logistic regression analysis were performed to assess the relashionship of factors associsted with diarreha. A 95% confidence interval and a significance level of 0.05 were set. Results Two environmental factors (Source of drinking water and shared toilets facilities with other households) were associated with child diarrhea. Pvalues: 0.029, OR:1.79, CI [1.06-3.01]; 0.019, OR:1.26, CI: [1.04-1.53] respectively. None of the selected nutritional factors was associated with childhood diarrhea. Conclusion Based on the findings, drinking borehole water and shared toilet facilities were associated with diarrhea. The study therefore recommends the provision of potable water and supporting/enabling the households to own toilets.

Risk factors for under-five mortality in Ethiopia: Evidence from the 2016 Ethiopian Demographic and Health Survey

Background. The under-five child mortality (U5CM) rate is the most important sensitive indicator of the socioeconomic and health status of a community, and the overall development of a nation. Despite the world having made substantial progress in reducing child mortality since 1990, the global U5CM rate was 41 per 1 000 in 2016. The rate is higher in Ethiopia than in several other low- and middle-income countries. Objectives. To estimate the effects of socioeconomic and demographic factors on U5CM in Ethiopia. Methods. A community-based cross-sectional study was conducted on 10 641 under-five children. The 2016 Ethiopian Demographic and Health Survey data were used for this research. Binary logistic regression was employed to identify factors affecting the U5CM rate. Results. The U5CM rate was 60 deaths per 1 000 live births. Children who were delivered at home (adjusted odds ratio (aOR) 1.30; 95% CI 1.04 - 1.63) and male (aOR 1.36; 95% CI 1.15 - 1.60) were at an increased risk of death. Children whose family size was between 1 and 3 (aOR 5.54; 95% CI 4.08 - 7.54), and 4 and 6 (aOR 1.94; 95% CI 1.55 - 2.43) were more likely to die before age 5 than those whose family size was ≥6. First-born (aOR 0.49; 95% CI 0.36 - 0.67), second- or third-born (aOR 0.51; 95% CI 0.39 - 0.67) and fourth- or fifth-born (aOR 0.71; 95% CI 0.56 - 0.91) children were less likely to die than those who were sixth-born and above. Similarly, singleton children (aOR 0.20; 95% CI 0.15 - 0.28), children residing in urban communities (aOR 0.55; 95% CI 0.40 - 0.76) and children whose families had protected sources of water (aOR 0.84; 95% CI 0.71 - 0.99) had reduced risks of death compared with their respective counterparts. Conclusions. The present study identified risk factors for under-five mortality in Ethiopia. Programmes to reduce under-five mortality in Ethiopia must focus on the place of delivery, households with unprotected sources of drinking water and families residing in rural areas

Individual and socioeconomic factors associated with childhood immunization coverage in Nigeria

Introduction: immunization is the world most successful and cost-effective public health interventions as it prevents over 2 million deaths annually. However, over 2 million deaths still occur yearly from Vaccine preventable diseases, the majority of which occur in sub-Saharan Africa. Nigeria is a major contributor of global childhood deaths from VPDs. Till date, Nigeria still has wild polio virus in circulation. The objective of this study was to identify the individual and socioeconomic factors associated with immunization coverage in Nigeria through a secondary dataset analysis of Nigeria Demographic and Health Survey (NDHS), 2013.Methods: a quantitative analysis of the 2013 NDHS dataset was performed. Ethical approvals were obtained from Walden University IRB and the National Health Research Ethics Committee of Nigeria. The dataset was downloaded, validated for completeness and analyzed using univariate, bivariate and multivariate statistics.Results: of 27,571 children aged 0 to 59 months, 22.1% had full vaccination, and 29% never received any vaccination. Immunization coverage was significantly associated with childbirth order, delivery place, child number, and presence or absence of a child health card. Maternal age, geographical location, education, religion, literacy, wealth index, marital status, and occupation were significantly associated with immunization coverage. Paternal education, occupation, and age were also significantly associated with coverage. Respondent's age, educational attainment and wealth index remained significantly related to immunization coverage at 95% confidence interval in multivariate analysis.Conclusion: the study highlights child, parental and socioeconomic barriers to successful immunization programs in Nigeria. These findings need urgent attention, given the re-emergence of wild poliovirus in Nigeria. An effective, efficient, sustainable, accessible, and acceptable immunization program for children should be designed, developed and undertaken in Nigeria with adequate strategies put in place to implement them

Comparison of statistical models used for assessing factors associated with infant mortality in Nigeria

Background: Infant mortality is a public health concern especially in developing countries, particularly Nigeria. Different models had been used independently to identify factors associated with infant mortality. Some of the used models sometimes violate the underlying assumption for the models. This study was designed to compare the models that have been previously used and identify the appropriate model using standard model selection criteria to analyse risk factors for infant mortality in Nigeria.Methods: The study utilised 2008 Nigeria Demographic and Health Survey (NDHS) data with a sample size of 7107. The NDHS was a stratified two-stage cluster design where a questionnaire was used to collect data on the birth history of women aged 15-49 years. The models employed for this study were: Logit, Probit and Clog-log. The model selection criteria were Akaike Information Criterion (AIC), Residual Deviance and Vuong test. The model with the smallest criteria was considered to be the best fit.Results: The results showed that Infant Mortality in Nigeria can be appropriately modelled by Clog-log model. The models and corresponding AIC values were: Logit (6171.1), Probit (6212.6) and Clog-log (6126.6). The residual deviance included: Logit (6135.1), Probit (6176.6) and Clog-log (6090.6). Clog-log had the smallest AIC and residual deviance values; hence, it was of the best fit. Home delivery and delivery by professionals had negative significant associations with infant mortality while women's education (primary/no education) and birth order had positive significant association, (p < 0.05). Conclusion: The best model for infant mortality evaluation in Nigeria was Clog-log. Generally, improved women's education would significantly reduce Infant Mortality in Nigeria

Prevalence and Determinants of Unintended Pregnancies in Malawi

Available statistics indicate high levels of unintended pregnancies in Africa. This study examines the prevalence and determinants of unintended pregnancies in Malawi based on 2;144 pregnant women extracted from the 2010 Malawi Demographic and Health Survey. Data were analyzed using univariate; bivariate and multinomial logistic regression models. Nearly 43 of the pregnancies were unintended of which 25 were mistimed. Multivariate analysis indicated that mistimed pregnancies are significantly influenced by the age of the respondent; fertility preference and number of children ever born. Among the variables that significantly increased the likelihood of unwanted pregnancies are age of respondent; wealth status; fertility preference; and region of residence even though potential confounding factors were used as control. The study recommends the strengthening of family planning services in order to reduce the level of unintended pregnancies. Focus should be on couples in Central Region and those having large number of children

Breaking bad news in clinical setting - health professionals' experience and perceived competence in Southwestern Nigeria: A Cross Sectional Study

Background: Communication skills are vital in clinical settings because the manner in which bad news is delivered could be a huge determinant of responses to such news; as well as compliance with beneficial treatment option. Information on training; institutional guidelines and protocols for breaking bad news (BBN) is scarce in Nigeria. We assessed the training; experience and perceived competence of BBN among medical personnel in southwestern Nigeria. Materials and Methods: The study was a cross-sectional descriptive study conducted out among doctors and nurses in two healthcare institutions in southwestern Nigeria using an anonymous questionnaire (adapted from the survey by Horwitz et al.); which focused on the respondents training; awareness of protocols in BBN; and perceived competence (using a Five-Point Likert Scale) in five clinical scenarios. We equally asked the respondents about an instance of BBN they have recently witnessed. Results: A total of 113 of 130 selected (response rate 86.9) respondents were studied. Eight (7.1) of the respondents knew of the guidelines on BBN in the hospital in which they work. Twenty-three (20.3) respondents claimed knowledge of a protocol. The median perceived competence rating was 4 out of 5 in all the clinical scenarios. Twenty-five (22.1) respondents have had a formal training in BBN and they generally had significant higher perceived competence rating (P = 0.003-0.021). There is poor support from fellow workers during instances of BBN. Conclusion: It appears that the large proportion of the respondents in this study were unconsciously incompetent in BBN in view of the low level of training and little or no knowledge of well known protocols for BBN even though self-rated competence is high. Continuous medical education in communication skills among health personnel in Nigeria is advocated

Health Survey of Primary School Children: Outcome and Implication for Strengthening School Health Inspection in Abraka; Delta State; Nigeria

Background: Health inspection involves physical observation of the general appearance; mouth and teeth; nose and throat; skin; ears; eyes; scalp and hair; and behavior of children at play. The objective of this study was therefore to conduct a health survey of primary school children with a view to providing relevant information with policy implication for strengthening school health inspection in Abraka; Delta State; Nigeria. Method: This is a school based cross-sectional descriptive study conducted from September 2009 to February 2010 among primary school children in Abraka selected by multistage sampling technique. The studyinstrument was a pro-forma with twenty items subdivided into two sections.Results : The outcome of health inspection of the children revealed that over half (57.1) of them had dirty nails; while 45.0; 29.8; 21.2; 18.6and 1.8of them had dirty uniform; dental caries; skin infections; dirty hair and ear discharge respectively. The association between the occurrence of dirty nails; dirty uniform; dirty hair and dental caries with the type of primary school (private or public) were statistically significant (P0.05); while the association between the occurrence of ear discharge and skin infection with the type of primary school were not statistically significant (P0.05). Conclusion: This study has revealed the poor state of affairs as regards school health inspection of primary school children in Abraka

Abortion Incidence and Postabortion Care in Rwanda

Abortion is illegal in Rwanda except when necessary to protect a woman's physical health or to save her life. Many women in Rwanda obtain unsafe abortions; and some experience health complications as a result. To estimate the incidence of induced abortion; we conducted a national sample survey of health facilities that provide postabortion care and a purposive sample survey of key informants knowledgeable about abortion conditions. We found that more than 16;700 women received care for complications resulting from induced abortion in Rwanda in 2009; or 7 per 1;000 women aged 15-44. Approximately 40 percent of abortions are estimated to lead to complications requiring treatment; but about a third of those who experienced a complication did not obtain treatment. Nationally; the estimated induced abortion rate is 25 abortions per 1;000 women aged 15-44; or approximately 60;000 abortions annually. An urgent need exists in Rwanda to address unmet need for contraception; to strengthen family planning services; to broaden access to legal abortion; and to improve postabortion care. (StudieS in Family Planning 2012; 43[1]: 11-20)

A Five-year Survey of Caesarean Delivery at a Nigerian Tertiary Hospital

Background: The rising global rate in caesarean delivery has been a source of concern to obstetricians worldwide. In spite of remarkable improvement in the safety of anaesthesia and surgical techniques; caesarean section has higher risks of maternal death when compared with normal vaginal delivery. Thus; the current emphasis is to limit the rising rate of caesarean section to as much as possible. Objective: To determine the rate of caesarean section; pregnancy out-come; major indications and complications of caesarean section. Methods: A five year (January 1st 2005 to December 31st 2009) retrospective analysis of clinical data from the ward admissions and discharge books; patients' folders and the operating theatre record books at the University of Nigeria Teaching Hospital; Ituku Ozalla; Enugu. Results: Out of the 3;554 deliveries during the study period; 980 cases were by caesarean section; giving a rate of 27.6. Most cases 918 (93.7) were by emergency caesarean sections; with elective procedure accounting only for 6.3of the cases. The age range of the women was between 16-48yrs. Four hundred and seven (41.5) were primigravidae; 503(51.4) were between para one and para four; while 70 (7.1) were grand-multipara. The rate of caesarean section was higher amongst the booked patients; 563 (57.5) than the unbooked patients 355 (36.2). Two previous caesarean section was the commonest indication for caesarean section 211(21.5); followed by cephalopelvic disproportion 198 (20.2); and foetal distress188 (19.2). A total of 1009 babies were delivered through caesarean section by the 980 women; 955 cases of singleton gestations and 25 cases of multiple gestations (21 twins and 4 triplets). Majority of the babies 918 (91) were delivered by emergency procedure. More than half of the babies 582(57.7) had birth asphyxia and there were 39 (3.9) perinatal deaths. All the cases of perinatal deaths and 549 (94.3) of birth asphyxia were following emergency procedure. Anaemia was the commonest postpartum morbidity and the maternal case fatality rate was 0.7. Conclusion: There is now a further rise in rate of caesarean section after a slight drop that followed the initial high 1.5fold rise from previous studies. The perinatal outcome is poor especially following emergency caesarean section. Reducing primary caesarean section rate and more encouragement of vaginal delivery after one previous caesarean section may reduce the prevalence of two previous caesarean sections which is the leading indication for caesarean section in the hospital

Are some Women More at Risk of Obstetric Fistula in Uganda? Evidence from the Uganda Demographic and Health Survey

With only four years left for the Millennium Development Goal's 2015 deadline for reducing poor maternal health outcomes; developing countries are still bearing a huge burden of maternal morbidity worldwide. Estimates show that over 2 million women worldwide are suffering from obstetric fistula; the majority of which live in sub-Saharan Africa; Southeast Asia; and the Arab region. The purpose of this study is to shed a light on obstetric fistula by examining risk factors associated with this morbidity in Uganda. Descriptive and multivariate analyses were conducted using data from the 2006 Uganda Demographic and Health Survey. Older age at first sexual intercourse was significantly associated with a lower risk of obstetric fistula (OR=0.302) compared to younger age at first intercourse (7-14 years). Lack of autonomy was negatively associated with the risk of obstetric fistula; women who have problems securing permission from their husband to go seek care (OR=1.658) were more likely to suffer from this morbidity. Significant differentials in obstetric fistula have also been observed based on the region of residence: women living in Central (OR=4.923); East Central (OR=3.603); West Nile (OR=2.049); and Southwest (1.846) more likely to suffer from obstetric fistula than women living in North Central. Findings demonstrate the importance of improving geographical accessibility to maternal health care services; and emphasize the need to reinforce intervention programs; which seek to address gender inequalities

Male circumcision and its association with HIV infection and sexually transmitted diseases: evidence from 18 demographic and health surveys in sub-Saharan Africa

The study aimed to assess the association between male circumcision and HIV infection and STDs. The issue is controversial as various studies reported conflicting findings. A cross-sectional comparative study based on the secondary data of 18 Demographic Health Surveys (DHS); carried out in Sub-Saharan Africa starting from 2003; was conducted. From all surveys; information on 70 554 males aged 15 - 59 years was extracted. The association between male circumcision and HIV infection and STD symptoms (genital discharge or genital ulcer/sore) was assessed using binary logistic regression. Adjustment was made for sexual history and basic socio-demographic variables. The weighted prevalence of HIV among men 15 - 59 years was 3.1. In the bivariate analysis uncircumcised status was significantly associated with risk of HIV; with odds ratio (OR) of 4.12 (95 CI: 3.85 - 4.42). The association was even more significant (4.95 (95 CI: 4.57-5.36)) after adjustment for number of lifetime sexual partners and socio-demographic variables. The risk associated with uncircumcised status is significantly lower among younger men aged 15 - 29 years than those in 30 - 59-year age category. About 5.5 of the study subjects reported either genital discharge or genital sore/ulcer in the preceding 12 months of the surveys. Circumcision status was not significantly associated with either of the symptoms; with adjusted OR of 1.07 (95 CI: 0.99 - 1.15). The study concludes that there is a strong association between uncircumcised status and HIV infection. Hence; male circumcision can be considered as a possible way of reducing the spread of HIV infection in areas where the practice is rare. A comprehensive study to assess the association between circumcision and different types of STDs is recommended

Declining child mortality in northern Malawi despite high rates of infection with HIV

Objective:To determine whether routine surveys; such as the Demographic and Health Surveys (DHS); have underestimated child mortality in Malawi : Methods :Rates and causes of child mortality were obtained from a continuous-registration demographic surveillance system (DSS) in Malawi for a population of 32 000. After initial census; births and deaths were reported by village informants and updated monthly by project enumerators. Cause of death was established by verbal autopsy whenever possible. The likely impact of human immunodeficiency virus (HIV) infection on child mortality was also estimated from antenatal clinic surveillance data. Overall and age-specific mortality rates were compared with those from the 2004 Malawi DHS. Findings:Between August 2002 and February 2006; 38 617 person-years of observation were recorded for 20 388 children aged 15 years. There were 342 deaths. Re-census data; follow-up visits at 12 months of age and the ratio of stillbirths to neonatal deaths suggested that death registration by the DSS was nearly complete. Infant mortality was 52.7 per 1000 live births; under-5 mortality was 84.8 per 1000 and under-15 mortality was 99.1 per 1000. One-fifth of deaths by age 15 were attributable to HIV infection. Child mortality rates estimated with the DSS were approximately 30 lower than those from national estimates as determined by routine surveys Conclusion: The fact that child mortality rates based on the DSS were relatively low in the study population is encouraging and suggests that the low mortality rates estimated nationally are an accurate reflection of decreasing rates

HIV infection in older adults in Sub-Saharan Africa: extrapolating prevalence from existing data

Objective:To quantify the number of cases and prevalence of human immunodeficiency virus (HIV) infection among older adults in sub-Saharan Africa. Methods We reviewed data from Demographic and Health Surveys (DHS). Although in these surveys all female respondents are 50 years of age; 18 of the surveys contained data on HIV infection among men aged . 50 years. To estimate the percentage of older adults (i.e. people . 50 years of age) who were positive for HIV (HIV+); we extrapolated from data from the Joint United Nations Programme on HIV/AIDS on the estimated number of people living with HIV and on HIV infection prevalence among adults aged 15.49 years. Findings In 2007; approximately 3 million people aged . 50 years were living with HIV in sub-Saharan Africa. The prevalence of HIV infection in this group was 4.0; compared with 5.0among those aged 15.49 years. Of the approximately 21 million people in sub-Saharan Africa aged. 15 years that were HIV+; 14.3were . 50 years old. Conclusion To better reflect the longer survival of people living with HIV and the ageing of the HIV+ population; indicators of the prevalence of HIV infection should be expanded to include people 49 years of age. Little is known about comorbidity and sexual behaviour among HIV+ older adults or about the biological and cultural factors that increase the risk of transmission. HIV services need to be better targeted to respond to the growing needs of older adults living with HIV

Assessment of the protective effect of male circumcision from HIV infection and sexually transmitted diseases: evidence from 18 demographic and health surveys in Sub-Saharan Africa

A cross-sectional study based on the secondary data of 18 Demographic Health Surveys carried out in Sub-Saharan Africa was conducted to assess the protective effect of male circumcision from HIV infection and STDs. Information on 70,554 males aged 15-59 years was extracted. The association between circumcision and HIV infection and STD symptoms (Genital discharge or ulcer/sore) was assessed using logistic regression. Un-circumcision was significantly associated with risk of HIV with odds ratio of 4.12 (95%CI: 3.85-4.42). The association was even more significant, 4.95 (95%CI: 4.57-5.36), after adjustment was made for number lifetime sexual partners and socio-demographic variables. The risk associated with un-circumcision is significantly lower among younger men aged 15-29 years than older age categories. However, circumcision found to have no association with the symptoms of STDs. The study concluded that male circumcision can be considered as a way of reducing the spread of HIV infection (Afr. J. Reprod. Health 2010; 14[2]: 105-113)

Hepatitis B infection is highly endemic in Uganda: findings from a national serosurvey

Background: Infant immunization against hepatitis B began in Uganda in 2002. Objective: To determine the baseline prevalence of hepatitis B virus (HBV) infection and explore risk factors. Methods: A hepatitis B prevalence study was nested in the 2005 national HIV/AIDS serobehavioural survey. Demographic characteristics and risk factors were explored by questionnaire. One third of blood specimens (n=5875) from adults aged 15 to 59 years were tested for hepatitis B core antibodies (HBcAb); positive specimens were tested for hepatitis B surface antigen (HBsAg). Results: HBcAb was present in 52.3(95CI: 51.0-53.6) of adults; and HBsAg in 10.3(9.5-11.1). By 15-19 years of age; 40.0had been infected with HBV. Prevalence of both markers was significantly higher across northern Uganda; in rural areas; among the poor and least educated; and in uncircumcised men. Other independent predictors of infection were age; ethnic group; occupation; number of sex partners; and HIV and HSV-2 status. Conclusion: Hepatitis B virus infection is highly endemic in Uganda; with transmission occurring in childhood and adulthood. More than 1.4 million adults are chronically infected and some communities disproportionately affected. The hepatitis B infant immunization programme should be sustained and catch-up vaccination considered for older children

Age at sexual debut in South Africa

It is important to understand the age at which sexual relations start in designing HIV prevention strategies. Most studies on age of sexual activity of young people provide estimated percentages of those that are sexually active in specific age groups; and tend either to not provide data for age at sexual debut; or to overlook the complexities of analysing data concerning sexual debut. This study considers the rate of entry into sexual relations in South Africa by providing the median age of women at time of first sexual relations as well as other percentiles; and analyses the hypothesis that age at sexual debut has been falling. The analysis uses data from the 1998 South African Demographic and Health Survey; including a nationally representative sample of 11 735 women; aged 15 to 49; interviewed in 1998. The analysis uses life-table techniques and multivariate analysis. About 8 of the respondents had had sex by age 15. The median age at time of first sex was approximately 18 years; and virtually all the women had had sex by age 23. There is evidence that the peak of the rate of entry into sexual relations occurs at age 18 and that younger cohorts of women are entering sexual relations at a younger age. The rate of entry into sexual relations is 14 to 20 faster for the younger cohorts; based on information given by the older respondents concerning their own behaviour at the same age. Age of entry into sexual relations of the women who participated in this study is compared to findings of demographic and health surveys in Tanzania and Zimbabwe; and rates of entry into marriage are also presented. The lag between entry into sexual relations and rate of entry into marriage is compared across countries. It appears that; whereas South Africans tend to enter into sexual relations later than Tanzanian counterparts and more or less at the same stage as Zimbabweans; their rates of entry into marriage are hugely delayed. The consequences for HIV infection control are discussed

Birth Intervals and Child Survival in Kenya

This paper examines the effect of birth intervals on child survival in Kenya; using the data drawn from the 1988/89 Kenya Demographic and Health Survey. Logistic regression is used as the major method of data analysis. The results show that the birth intervals have strong negative effects on infant and child mortality. Their effects remain strong even after a large number of other explanatory variables are taken into account This paper provides empirical evidence that birth intervals of at least two years enhance the prospects of child survival in Kenya