Risk assessment for COVID-19 transmission at household level in sub-Saharan Africa: evidence from DHS.

Household habitat conditions matter for diseases transmission and control, especially in the case of the novel coronavirus (COVID-19). These conditions include availability and adequacy of sanitation facilities, and number of persons per room. Despite this, little attention is being paid to these conditions as a pathway to understanding the transmission and prevention of COVID-19, especially in Africa, where household habitat conditions are largely suboptimal. This study assesses household sanitation and isolation capacities to understand the COVID-19 transmission risk at household level across Africa. We conducted a secondary analysis of the Demographic and Health Surveys of 16 African countries implemented between 2015 and 2018 to understand the status of households for prevention of COVID-19 transmission in home. We assessed handwashing capacity and self-isolation capacity using multiple parameters, and identified households with elderly persons, who are most at risk of the disease. We fitted two-level random intercept logit models to explore independent relationships among the three indicators, while controlling for the selected explanatory variables. Handwashing capacity was highest in Tanzania (48.2%), and lowest in Chad (4.2%), varying by household location (urban or rural), as well as household wealth. Isolation capacity was highest in South Africa (77.4%), and lowest in Ethiopia (30.9%). Senegal had the largest proportion of households with an elderly person (42.1%), while Angola (16.4%) had the lowest. There were strong, independent relationships between handwashing and isolation capacities in a majority of countries. Also, strong associations were found between isolation capacity and presence of older persons in households. Household capacity for COVID-19 prevention varied significantly across countries, with those having elderly household members not necessarily having the best handwashing or isolation capacity. In view of the age risk factors of COVID-19 transmission, and its dependence on handwashing and isolation capacities of households, each country needs to use the extant information on its risk status to shape communication and intervention strategies that will help limit the impact of the disease in its population across Africa. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s41118-021-00130-w.

Women at risk: Gender inequality and maternal health.

Gender inequality has been documented as a key driver of negative health outcomes, especially among women. However, studies have not clearly examined the role of gender inequality in maternal health in an African setting. Therefore, the authors of this study examined the role of gender inequality, indicated by lack of female autonomy, in exposing women to maternal health risk. Data were obtained from the 2007 Zambia Demographic and Health Survey on a weighted sample of 3,906 married or partnered women aged 15-49 years. Multivariable analyses revealed that low autonomy in household decision power was associated with maternal health risk (Odds Ratio (OR) = 1.52, p < .001). Autonomy interacted with household wealth showed that respondents who were in the wealthier households and had low autonomy in household decision power (OR = 2.03, p < .05) were more likely to be exposed to maternal health risk than their counterparts who had more autonomy. Efforts to lower women's exposure to maternal mortality and morbidity in Zambia should involve interventions to alter prevailing gender norms that limit women's active participation in decisions about their own health during pregnancy and delivery.

Risky sexual behaviour among women: Does economic empowerment matter? Case of Gabon, Mozambique, Sierra-Leone and Zambia.

The link between economic empowerment and high risky sexual behaviour has been debated by different scholars in various settings. However, no consistently clear connection between poverty and lack of education has been found regarding engagement in risky sexual behaviour. Also, not much research has been done to examine the strength of these relationships for adolescents and women. The objectives of this study were to assess the relationship between female economic empowerment and risky sexual behaviour in Africa. Using the latest Demographic and Health Surveys Data (DHS 2011-2014) from Gabon, Mozambique, Sierra Leone and Zambia, univariate, bivariate and multivariate analysis was done on women aged 15 to 49 to examine the patterns of and differences in the association between women's economic empowerment and risky sexual behaviour. The findings both at community and individual level indicate that empowered women (higher education and wealth household) and adolescents aged 15 to 19 are highly significantly associated with engagement in high risky behaviour. The result of this study stresses the need to look further than individual factors in the quest to resolve risky sexual behaviour in Africa. The interrelations between female economic empowerment and engagement in risky sexual behaviour are more complicated and less straightforward than usually presumed.