Indirect Estimation of the Timing of First Union Dissolution With Incomplete Marriage Histories.

The lack of nationally representative data with detailed marriage histories in low- and middle-income countries (LMICs) impedes a comprehensive understanding of essential aspects of union dissolution, such as the timing of first union dissolution, in these countries. We propose a method for estimating quantum-adjusted measures of the timing of first union dissolution from incomplete marriage histories. This method, indirect life table of first union dissolution (ILTUD), estimates the first union survival function from a simple tabulation of ever-married women by duration since first union, classified by union dissolution status (intact vs. dissolved first union). It then uses the relationships between life table functions to generate the distribution of marriages ending each year (θt) for a given marriage cohort. Using this distribution, ILTUD generates quantum-adjusted first union survival rates from which the percentiles of first union dissolution are calculated. ILTUD estimates are consistent with estimates produced using traditional statistical methods, such as the Kaplan-Meier estimator. In addition, ILTUD is simple to implement and has minimal data requirements, which are available in most nationally representative surveys. Thus, the ILTUD method has the potential to broaden our understanding of union dissolution dynamics in LMICs.

Meeting demand-Obstetric hemorrhage and blood availability in Malawi, a qualitative study.

BACKGROUND: Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in Malawi. Despite the presence of a centralized institution supplying blood and blood products for hospitals across the country, a lack of timely blood transfusion has been identified as a critical barrier to successful PPH management. This study aims to understand the factors that affect the blood delivery pipeline and adequate access to blood products for postpartum haemorrhage patients. METHODS: Qualitative data were collected through in-depth interviews with key stakeholders across the blood delivery pipeline. Interviews were conducted from July 2020 to January 2021 at Queen Elizabeth Central Hospital and Mulanje District Hospital, a referral and district hospital respectively, as well as the Malawi Blood Transfusion Service. Line by line, open coding was used to perform a thematic analysis of the data using Nvivo and Atlas.ti software. RESULTS: Five key themes were identified: 1) Lack of blood availability due to an inadequate donor pool, 2) Transportation of blood products and PPH patients is impeded by distance to target sites and competing interests for blood delivery vehicles, 3) The Malawi Blood Transfusion Service has difficulty meeting demand for blood products due to inadequate funding and difficulty retaining blood donors, 4) Current PPH management protocols and practices lead to delays due to inconsistent guidelines on delivery and analysis of patient samples, and 5) Communication between health cadres is inconsistent and affected by a lack of adequate resources. CONCLUSIONS: Barriers to timely blood transfusion for PPH patients exist across the blood delivery pipeline. While an investment of infrastructure would alleviate many obstacles, several solutions identified in this study can be implemented without additional resources, such as establishing joint department meetings to improve communication between health cadres. Ultimately, given a resource limited setting, it may be worth considering de-centralizing the blood supply.

Fertility decline in sub-Saharan Africa: Does remarriage matter?

The interplay between remarriage and fertility is among the most poorly documented subjects in sub-Saharan Africa (SSA), despite remarriage being one of the fundamental aspects of marriage dynamics in this region. We use Demographic and Health Survey data from 34 countries in SSA to document the association between remarriage and fertility during the reproductive years and over the fertility transition. The findings show that in 29 countries, remarried women end up having fewer children than women in intact unions, despite attaining similar or higher levels of fertility at early reproductive ages. However, remarriage is found to have a positive effect on fertility in Sierra Leone. The effects of remarriage on fertility diminish as fertility declines, with smaller effects generally observed in countries that are relatively advanced in their fertility transition and larger effects found elsewhere. These findings shed light on the role that remarriage might play in country-level fertility declines.