Women's position in the household as a determinant of neonatal mortality in sub-Saharan Africa

Background. The burden of under-five mortality in sub-Saharan Africa (SSA) is highest during the neonatal period, with over 40% of cases occurring during the first month of life. There is a paucity of evidence on the influence of women's household position on neonatal survival in SSA.Objective. To assess the influence of women's householposition on neonatal survival in SSA.Methods. We analysed pooled data (N=191 514) from the demographic and health surveys of 18 countries in SSA. Cox proportional hazards regression analysis was used to explore statistically significant relationships.Results. Findings support the hypothesis that a low position of a woman in the household is significantly associated with high neonatal mortality, as children of women who experienced a high position in the household had a significantly lower risk of neonatal mortality (hazard ratio 0.85, confidence interval 0.76 - 0.95; p<0.05) than those whose mothers experienced a low household position.Conclusion. This study concludes that improving women's household position through enhanced socioeconomic status could substantially contribute to reducing neonatal mortality in SSA

HIV and adolescents' educational attainment in South Africa: disentangling the effect of infection in children and household members

Background. Many empirical studies have assessed the effect of adults' HIV infection on their livelihood. However, the effect of children's HIV status on their educational outcomes during adolescence has not been adequately investigated. Objectives. The study aims to evaluate the effect of household members' HIV infection and that of children on their educational outcomes (school enrolment and progression) during adolescence. Methods. Waves 1 to 4 of the South African National Income Dynamics Study panel data collected between 2008 and 2015 were used.Analytical samples contained data for 8 835 adolescents aged 10-19 years. Analysis involved the use of descriptive statistics, logistic and linear regression as well as Oaxaca and Ransom decomposition methods. Results. Of the study sample, 7 176 were currently in school and 636 were not. HIV infection had no effect on adolescent school enrolment. Adolescent HIV infection significantly reduced their school progress index by about 8.41. The explanter variables explained 18% of the adolescents' school progress gap associated with HIV infection. The unexplained gap might have been attributable to stigmatisation and/or unobserved morbidity associated with adolescents' HIV infection. Conclusion. Adolescent HIV infection affects their school progression. Education support should be targeted directly at HIV-infected children instead of targeting families with infected parents only

Individual versus community-level measures of women decision-making involvement and child survival in Nigeria

Background. Although decision-making authority is associated with maternal healthcare utilisation, the evidence on the relative importance of individual-level v. community-level decision-making participation for child survival in sub-Saharan Africa is limited. Objectives. To assess the net effects of individual- and community-level measures of decision-making involvement (DMI) on under-5 mortality in Nigeria. Methods. Data on a nationally representative sample of 31 482 children in the 2013 Nigeria Demographic and Health Survey were analysed. Mothers who reported involvement in decision-making on own healthcare, major household purchases and visits to friends and relatives were categorised as having high DMI. Community-level measures of DMI were derived by aggregating the individual measures at the cluster level. Kaplan-Meier estimates of childhood mortality rates were computed. Multilevel discrete-time hazard models were employed to investigate the net effect of individual- and community-level DMI on childhood mortality. Results. Childhood mortality, at 59 months, was higher among children of women with low DMI (120 per 1 000) compared with those with high DMI (84 per 1 000). The full multilevel model showed that there was no difference in the risk of childhood death between children whose mothers had high v. low DMI (hazard ratio (HR) 1.01, CI 0.90 - 1.12). However, mortality risk was found to be lower among children in communities with medium DMI (HR 0.84, CI 0.74 - 0.96). Maternal age at child's birth, education, household wealth index and preceding birth interval were significantly associated with under-five mortality. Conclusion. Besides socioeconomic and biodemographic characteristics, community- and not individual-level DMI was associated with under-5 mortality. Women's empowerment programmes targeting maternal and child health outcomes should also focus on communities

Molluscum contagiosum virus infection amongst PLWHA in Ibadan, Nigeria

Background: Molluscum contagiosum (MC) infection is caused by a pox virus and the virus is probably passed on by direct skin-to-skin contact which may affect any part of the body. There is anecdotal evidence associating facial lesions with HIV-related immunodeficiency. This study was aimed to determine the prevalence and associated risk factors of Molluscum contagiosum infection among PLWHAs attending ART clinic at the University College Hospital, Ibadan, Nigeria. Methods: This is a descriptive cross-sectional survey of 5,207 patients (3519 female and 1688 males) attending ART clinic between January 2006 and December 2007. Physicians performed complete physical and pelvic examinations. Diagnosis of Molluscum Contagiosum infection was based on the clinical findings of typical lesions on the external genitalia, perianal, trunk, abdominal and facial regions. Results: The mean age of the patients was 34.67 yrs. ± 9.16). About 10% (542) had various sexually transmitted infections (STIs). The male to female ratio was 1: 4.2. One hundred and twenty seven subjects (23.4%) had no formal or primary education with 247 (45.6 %) beingtreatment naïve while 295 (54.4 %) were treatment experienced. Of the 542 PLWHAs with STIs, 3.3 % had undetectable viral load (< 200 copies/ ml) while 272 (50.1 %) had low CD4 count (< 200 cells / mm3.) and The Mean log10 viral load was 5.02 + 0.94. Molluscum Contagiosum infection was diagnosed in 13 patients (0.024%; 8 females and 5 males). Vaginal Candidiasis was the commonest genital infection diagnosed in 223 (41.1%) of the patients with STIs. MC patients had higher viral load, lower CD4 count and more likely to be treatment experienced".Conclusions: Molluscum Contagiosum infection is not uncommon among the HIV-infected patients, but underreported. Awareness of this cutaneous manifestation should be known to Physicians in AIDS care