Chasing the Youth Dividend in Nigeria, Malawi and South Africa: What Is the Role of Poverty in Determining the Health and Health Seeking Behaviour of Young Women?

Africa's new source of hope lies in harnessing Demographic Dividend, which may create a window of economic opportunity as fertility levels decrease if the correct policies and programmes are put in place. It has been shown that the health status of young people should be optimal for the realisation of the demographic dividend. This study examined the association between poverty and the health status and health seeking behaviour of young women (15-25), using the Demographic Health surveys of Nigeria 2013, Malawi 2015-2016, and South Africa 2015-2016. Interest variables were household and community-levels of poverty, while the outcomes were pregnancy and HIV testing and health services seeking. Results showed that in Malawi only household poverty was associated with a higher likelihood of pregnancy, while in South Africa household- and community-levels of poverty were associated with a higher likelihood of pregnancy. In Nigeria, household- and community-levels of poverty were not significantly linked to pregnancy but were associated with a lower likelihood of HIV testing and health seeking behaviour. The study shows empirical evidence of the construction of negative health outcomes in poor households and communities in Nigeria, Malawi, and South Africa. Therefore, if the demographic dividend is to be a reality in the near future, it is imperative to ensure that poverty-alleviation urgently occurs.

Gender differentials of contraceptive knowledge and use among youth - evidence from demographic and health survey data in selected African countries.

Improving family planning demand and uptake has both social and economic benefits, including increasing education attainment, reducing poverty and increased participation in the labour force. Also, contraceptive use remains a key driver in Africa to facilitate demographic transition and the demographic dividend. However, numerous challenges have prevented the take-up of contraception across the continent. This is more so the case among African youth that present the lowest levels of contraceptive use in sub-Saharan Africa. Therefore, the objective of this research was to examine gender differences in contraceptive use and knowledge of sexually active young people (15-24 years) in sub-Saharan African countries. This study used data from nine countries in sub-Saharan Africa through the Demographic and Health Surveys (DHSs) of Benin, Democratic Republic of Congo, Lesotho, Namibia, Niger, Rwanda, Senegal, South Africa and Zimbabwe. Data analysis entailed frequency distributions and cross-tabulations to describe the gender-differentiated levels of contraceptive use and knowledge among youth. Additionally, logistic regression showed the gender-specific predictors of contraceptive use for African youth. Our findings present the gender-specific predictors of contraceptive use and will contribute to policy and programme formulation for African countries and organisations that promote contraceptive use.

Provincial differentials of the effect of internal migration on teenage fertility in South Africa.

This study investigated the association between internal migration and teenage fertility in South Africa. Data were from the 2007 and 2016 South African community surveys, N2007= 89800 and N2016=239733, age range 12 to 19, black teenagers= 81.5% and 89.4%, respectively. Results showed that between 2007 and 2016 internal migration levels decreased by 2% nationally, but increased for Gauteng, Western Cape and KwaZulu Natal provinces. Teenage fertility levels decreased in all provinces except the Northern Cape in the study period. In both years teenage fertility was observed at higher levels among girls that were older, heads of households, and who were in secondary schooling. Random-intercept multilevel binary logistic regression revealed that the risk of teenage fertility differed between more rural and urban provinces. In provinces that were predominantly rural the risk of teenage pregnancy increased as community-levels of internal migration increased while the risk decreased as internal migration increased in provinces that were predominantly urban. Findings suggest that the effects of internal migration on teenage pregnancy are largely dependent on the local context making it necessary to create interventions that are context-specific at sub-national levels.

Provincial differentials of the effect of internal migration on teenage fertility in South Africa

This study investigated the association between internal migration and teenage fertility in South Africa. Data were from the 2007 and 2016 South African community surveys, N2007= 89800 and N2016=239733, age range 12 to 19, black teenagers= 81.5% and 89.4%, respectively. Results showed that between 2007 and 2016 internal migration levels decreased by 2% nationally, but increased for Gauteng, Western Cape and KwaZulu Natal provinces. Teenage fertility levels decreased in all provinces except the Northern Cape in the study period. In both years teenage fertility was observed at higher levels among girls that were older, heads of households, and who were in secondary schooling. Random-intercept multilevel binary logistic regression revealed that the risk of teenage fertility differed between more rural and urban provinces. In provinces that were predominantly rural the risk of teenage pregnancy increased as community-levels of internal migration increased while the risk decreased as internal migration increased in provinces that were predominantly urban. Findings suggest that the effects of internal migration on teenage pregnancy are largely dependent on the local context making it necessary to create interventions that are context-specific at sub-national levels.

Association between type of birth attendants and neonatal mortality: Evidence from a National survey.

Background: Although Lesotho has one of the highest childhood mortality levels in Southern Africa, there has been limited research on the link between type of birth attendant and neonatal mortality in Lesotho. This study examined the relationship between type of birth attendant and neonatal mortality while controlling for socio-demographic characteristics of mothers in Lesotho. Methods: The study used data from the children's file of 2014 Lesotho Demographic and Health Survey data. Kaplan-Meier method was used to estimate neonatal mortality rate and Cox proportional hazard regression model was used to assess the association between type of birth attendant and neonatal mortality. Results: Result shows that 5.3% of all births attended to by non-SBAs resulted into neonatal mortality compared to 2.8% of those attended to by SBA. Result further shows that regardless of socio-demographic characteristics, the risks of neonatal mortality were significantly higher with non-SBAs compared to SBA in Lesotho (HR: 2.00, CI: 1.31-3.06). Conclusion: The risk of neonatal mortality is two times higher among children delivered by Non-SBA. Scale-up in access and uptake of SBA is recommended in Lesotho. Thus, Policy on scale-up access to SBA at delivery at no costs need to be put in place.

Teenage pregnancy among unmarried teenagers in Malawi: Does sex of the household head matter?

The role of parents, especially the household head, is very crucial in the sexual values and behaviour of teenagers. This study used the Malawi Demographic and Health Survey (MDHS) data of 2015-16 to examine the impact of sex of the household head on pregnancy outcomes among unmarried teenagers in Malawi. Using STATA 14, the data was analysed using univariate, bivariate and multivariate level of analysis. The multivariate logistic regression analysis was employed to examine the association between sex of the household head and teenage pregnancy. Results showed that teenage pregnancy was higher among unmarried females living in female-headed households (OR 2.54; CI: 1.01-6.43) compared to females from male-headed households. The study also found that unmarried teenagers with secondary and higher education had lower risk of teenage pregnancy (OR 0.53; CI: 0.40-0.72) compared to those with no education and primary education. The study concludes that teenage pregnancy is higher in female-headed households, a finding which suggests that parenting styles differ between male and female heads of households. Policy interventions in regard to sex education should be specific to the sex of the household heads in which teenage girls reside, while unmet need for contraceptives among teenagers should also be addressed.

Factors Associated with Teen Pregnancy in sub-Saharan Africa: A Multi-Country Cross-Sectional Study.

This study aimed to assess the contextual factors associated with teenage pregnancy in sub-Saharan Africa. Using DHS data we modelled females aged 15-19 with multilevel logistic regression to establish the independent influence of social disadvantage on teenage pregnancy in West, East and Southern Africa with aid of the MLwiN programme. Results showed teenage pregnancy decreased in East Africa, plateaued in West Africa and increased slightly in Southern Africa between 1992 and 2011. Multilevel multivariate regression revealed teenage pregnancy was associated with family disruption (0.39; 0.40: P<0.05), community-levels of female unemployment (1.01; 0.99: P<0.05) and community poverty (1.01; 1.02: P<0.05) in Southern and East Africa, while only community poverty (1.01; P<0.05) independently predicted the outcome in West Africa. Our findings emphasise the necessity of creating regional-specific interventions and prevention campaigns to address multilevel factors such as family disruption as well as the need for governments to address issues of unemployment, poverty and inequality.