Differentials in prevalence and correlates on uptake of tetanus toxoid and intermittent preventive treatment with sulfadoxine-pyrimethamine during pregnancy: A community-based cross-sectional study in The Gambia.

OBJECTIVES: The study examined the differentials in prevalence and correlates on the uptake of tetanus toxoid and intermittent preventive treatment of malaria among pregnant women in The Gambia. METHODS: The 2018 data from The Gambia Multiple Indicators Cluster Survey were analyzed. Data from 6143 women of reproductive age who have given birth were extracted for the analysis. Percentages and Chi-square tests were used. In addition, a multivariable logistic regression model was used to calculate the adjusted odds ratios (with a corresponding 95% confidence interval). The level of significance was set at p < 0.05. RESULTS: The prevalence of tetanus toxoid uptake among women in The Gambia was 88.2%, while that of the adequate tetanus toxoid doses was 34.8%. The prevalence of intermittent preventive treatment with sulfadoxine-pyrimethamine uptake among maternal women in The Gambia was 98.6%, while that of the adequate intermittent preventive treatment with sulfadoxine-pyrimethamine doses taken was 34.3%. The identified statistically significant covariates of tetanus toxoid immunization and intermittent preventive treatment with sulfadoxine-pyrimethamine uptake includes women's age, local government areas, parity, use of radio, use of newspaper, and antenatal care visits. CONCLUSION: The current utilization rate for adequate intermittent preventive treatment with sulfadoxine-pyrimethamine and tetanus toxoid immunization during pregnancy in The Gambia is very low and even below universal levels. The country needs to strengthen more and effective mass media advocacy programs that would target both rural and urban populace, and motivate maternal women to ensure adequate vaccination against malaria and tetanus.

Prevalence and factors associated with unplanned pregnancy in The Gambia: findings from 2018 population-based survey.

BACKGROUND: Unplanned pregnancy is a public health issue that has detrimental implications for the mother and baby alike. However, few studies have been conducted in The Gambia on this subject. As a result, the prevalence of unplanned pregnancy among women of reproductive age in The Gambia was investigated, as well as the factors associated with it. METHODS: The Gambia's Multiple Indicators Cluster Survey (MICS) was used to evaluate the 2018 results. Data was obtained from 3790 women aged 15 to 49 who had also given birth. The univariate analysis was conducted using percentage. The adjusted odds ratios (AOR) were determined using a multivariable logistic regression model (with corresponding 95% confidence interval (CI)). The degree of statistical significance was set at 5%. RESULTS: Approximately 25.3% (95% CI: 23.1%-27.6%) of the women reported unplanned pregnancy. Women aged 30-34 years had 45% reduction in unplanned pregnancy, when compared with those aged 15-19 years (AOR = 0.55; 95% CI: 0.32-0.94). The Fula and non-Gambian women had 30% and 45% reduction in unplanned pregnancy respectively, when compared with Mandinka women. Those who had no functional difficulties had 47% reduction in unplanned pregnancy, when compared with women who had functional difficulties (AOR = 0.53; 95% CI: 0.30, 0.91). Respondents who had given births to 3-4 and 5 + children were 1.79 and 3.02 times as likely to have unplanned pregnancy, when compared with women who had given birth to 1-2 children. Single/unmarried women were 11.38 times as likely to have unplanned pregnancy, when compared with women currently married/in union (AOR = 11.38; 95% CI: 6.38, 20.29). Local Government Area of residence was significantly associated with unplanned pregnancy. Furthermore, women who were neither happy nor unhappy and 18 + at sexual debut were 1.39 and 1.34 times as likely to have unplanned pregnancy, when compared with the very happy women and those < 18 at sexual debut respectively. CONCLUSION: The rate of unintended pregnancies was large (25.3%). Several causes have been linked to unplanned pregnancies. These results suggest that further efforts are required to enhance women's sex education, expand access to family planning services, and provide affordable health care to high-risk women in order to minimize unintended pregnancies.

Predictors of Postnatal Care Service Utilization Among Women of Childbearing Age in The Gambia: Analysis of Multiple Indicators Cluster Survey.

BACKGROUND: Despite the importance of postnatal care (PNC) in maternal and newborn health, however, such services have been underutilized in many resource-constrained settings including The Gambia. The objective of this study was to determine the coverage and factors of PNC in The Gambia. METHODS: The 2018 data from The Gambia Multiple Indicators Cluster Survey (MICS) were analyzed. Data from 9205 women with ages 15-49 years, who also have given birth, were extracted for the analysis. Percentages and Chi-square tests were used. In addition, multivariable logistic regression model was used to calculate the adjusted odds ratios (with corresponding 95% CI). The level of significance was set at p< 0.05. RESULTS: The prevalence of PNC was 22.4% and 26.7% for women and children, respectively. Local government area (LGA) was associated with PNC for women and children alike. Furthermore, ethnicity was associated with PNC among women in The Gambia. Women who listened to radio almost every day had 1.51 increase in the odds of PNC (OR= 1.51; 95% CI: 1.15, 1.98) and 1.30 increase in the odds of PNC for children (OR= 1.30; 95% CI: 1.01, 1.67), respectively, when compared with women who do not listen to radio. Women who initiated antenatal care (ANC) at second or third trimester (late booking) had a 22% reduction in the odds of PNC (OR= 0.78; 95% CI: 0.64, 0.94), when compared with women who booked at first trimester. CONCLUSION: The findings showed that geographical locations, ethnicity, use of radio, and timing to antenatal care initiation were associated with PNC. Women's enlightenment and early ANC programs can be designed to improve PNC coverage.

Prevalence and Factors Associated with Institutional-based Delivery in The Gambia: Further Analysis of Population-based Cross- Sectional Data.

Institutional-based delivery could be the major strategy to avoid most maternal deaths occurring from preventable obstetric complications. The study examines the prevalence and factors associated with institutional-based delivery in The Gambia. The secondary data, from The Gambia Multiple Indicator Cluster Survey (MICS) - 2018 for 3,791 women aged 15-49 years who had given birth, were extracted for the analysis. Chi-square analysis and multivariable logistic regression model were used to determine factors associated with institutional-based delivery with statistical significance set at p < 0.05. About three-quarters (78.1%) of Gambian women had institutional-based delivery. The study identified that women from richer (AOR= 2.38; 95%CI: 1.49, 3.79) and richest households (4.14; 95%CI: 2.06, 8.33) were more likely to have institutional-based delivery when compared with women from poorest households. Furthermore, women with secondary or higher education (AOR= 1.66; 95%CI: 1.28, 2.16) were more likely to have institutional-based delivery, when compared with women without formal education. Conversely, rural dwellers (AOR= 0.63; 95%CI: 0.47, 0.84), women with high parity and advanced age had significant reduction in the odds of institutional-based delivery in The Gambia. There is a need for concerted efforts to improve skilled birth attendance among women of low socioeconomic status, those living in hard-to-reach communities and the multiparous women in The Gambia.