Joshua O. Akinyemi

The relation of female circumcision to sexual behavior in Kenya and Nigeria

ABSTRACT One of the reasons for the perpetuation of female circumcision is that it controls female sexuality. In this study, the authors examined the relationship between female circumcision and the sexual behavior of women in Kenya and Nigeria. Data on women who were aware of circumcision and were circumcised were extracted from the Kenya Demographic and Health Survey of 2008–09 as well as the Nigeria Demographic and Health Survey of 2008. The sample size was 7,344 for Kenya and 16,294 for Nigeria. The outcome variables were age at first intercourse and total lifetime number of sexual partners. The study hypothesis was that women who were circumcised were less likely to have initiated sex early and to have only one sex partner. Cox proportional hazards regression and Poisson regression were used to examine the relations of female circumcision and other selected variables to sexual behavior. No association was observed between female circumcision and the outcomes for sexual behavior of women in Kenya and Nigeria. The argument of sexual chastity is insufficient to sustain the perpetuation of female circumcision.

Independent and combined effects of maternal smoking and solid fuel on infant and child mortality in sub-Saharan Africa.

To estimate the independent and combined risks of infant and child mortality associated with maternal smoking and use of solid fuel in sub‐Saharan Africa.

‘I’m in love with an older man’: reasons for intergenerational sexual relationships among young women in South Africa

Abstract The literature on intergenerational sexual relationships in Africa focuses predominantly on economic motivations. This paper aims to identify the common reasons for older male sexual partners among young women in South Africa. Data for the study came from the Fourth South African National HIV, Behaviour and Health Survey 2012. A representative sample of 620 young women (15–24 years old) with older male sexual partners was extracted. A multiple logistic regression analysis was conducted to adjust for potential confounders. The authors found that more than a quarter of sexually active young women engaged in age-disparate relationships. The majority of the respondents did not see age as an important factor, while financial support ranked fourth in the list of reasons for having older partners. Women who were 20–24 years old (AOR 1.16, CI: 0.59287–1.87493), divorced, separated or widowed (AOR 1.38, CI: 0.65360–1.92105) and who were students or learners (AOR 1.85, CI: 0.41943–1.29402) were more likely to have an older partner for financial reasons. Thus, financial motivations are not the predominant reason for age-disparate relationships; instead, other reasons including age not being important and feeling secure were more cited. Not all young women in South Africa are seeking financial assistance from older sexual partners.

Extra mouths to feed: The odds of young mothers engaging in transactional sexual relationships in South Africa

Abstract Transactional sexual relationships (TSRs) are of concern because of the negative health outcomes associated with the practice. Lack of condom use and multiple concurrent partnerships increase the risk of HIV infection and unintended pregnancies. For these reasons, a multitude of studies have been done to better understand the determinants of these relationships, particularly among youth who engage in sex with wealthier and often older partners. While the economic motivations among youth are known, broader determinants, such as having at least one child are rarely investigated. The role of having children is important to consider, as this suggests an economic motive for these relationships related to childcare needs. The objective of this study is to determine the association between having a child and TSRs among young women in South Africa. Cross-sectional data of 331 young females who engage in this practice are analysed. Descriptive statistics and multivariate logistic regressions are fit to the data to determine the association. Results show that youth not living with parents (84.96%) and those who see more than one sexual partner as acceptable (66.01%) engage in TSRs. Further, having at least one child increases the odds (OR = 1.98 p-value 0.004) of engaging in TSRs. In conclusion, having at least one child, as an economic motivation underlying TSRs should be taken into policy and intervention considerations. Young mothers should be specifically targeted in socioeconomic policies to enable them to care for their offspring without needing to engage in TSRs.

Household environment and symptoms of childhood acute respiratory tract infections in Nigeria, 2003–2013: a decade of progress and stagnation

BackgroundAcute respiratory infections (ARIs) remains a disease of public health importance in Nigeria. Though, previous studies have identified factors associated with childhood ARI symptoms, the progress made in reducing the burden of this major childhood morbidity in the past decade in Nigeria has not been quantified. Therefore, this study describes the trends in the prevalence and factors associated with ARI symptoms among under-five (U5) children in Nigeria between years 2003 and 2013.MethodsA retrospective cross-sectional analysis of nationally representative data from the Nigeria Demographic and Health Surveys (NDHS) for years 2003, 2008 and 2013 was done. The study sample included women of reproductive age who had U5 children presenting with a cough accompanied with short rapid breaths in the last 2 weeks prior data collection. Data were analysed using complementary log regression model.ResultsPrevalence of ARI symptoms were 10.3, 4.6 and 3.8% for years 2003, 2008 and 2013 respectively. The use of unclean cooking fuel was not associated with ARI symptom in 2003 and 2008, but in 2013 (OR = 2.50, CI: 1.16–5.42). Living in houses built with poor quality materials was associated with higher risk of ARI symptoms in 2008 (OR = 1.34, CI: 1.11–1.61) and 2013 (OR = 1.59, CI: 1.32–1.93). Higher risk of ARI symptoms was also associated with younger child’s age, Northern regions and household wealth quintile between 2003 and 2013.ConclusionsThough there has been a significant progress in the reduction of the prevalence of ARI symptoms between 2003 and 2013, the same could not be said of household environmental risk factors. Interventions to reduce the contributory effects of these factors to the occurrence of ARI symptoms should be instituted by government and other relevant stakeholders.

Maternal Employment and Child Survival During the Era of Sustainable Development Goals: Insights from Proportional Hazards Modelling of Nigeria Birth History Data

Background: One of the targets for the third and fifth Sustainable Development Goals (SDGs) borders on children survival and women economic empowerment, respectively. A robust investigation of the relationship between maternal employment and childhood mortality will provide information useful for programs aimed at ensuring the complementarity of SDG 3 (healthy life for all) and SDG 5 (gender equality, girls and women empowerment). Objective: We addressed the following questions: (1) What is the independent relationship between maternal employment and infant (0–11 months) and child (12–59 months) mortality in Nigeria? (2) How does father’s occupation, type of residence, and geopolitical region modify the relationship? Methods: We retrospectively analysed cross-sectional data on weighted sample of 31,828 under-five children extracted from the birth history in the 2013 round of Nigeria Demographic and Health Survey, using Cox proportional hazards models. The outcomes of interest were infant (0–11 months) and child (12–59 months) mortality, and the main explanatory variables include maternal employment, involvement in decision making on work earnings, and father’s occupation. Other confounding variables were also controlled. Findings: Results showed that about two-third (68.7%) of under-five children had mothers who were working, with the majority engaged in self-employed occupations such as sales or small businesses, agriculture, and other manual labour. Infant mortality rate amongst children of employed mothers (65 per 1000 live births) was slightly less than the unemployed (70 per 1000 live births). A similar pattern was observed for child mortality. Hazards regression models revealed that the risk of both infant and child mortality was higher amongst unemployed women. Sales and agriculture/manual occupation constituted a higher risk for infant and child mortality. Analysis of interaction effects also revealed variations by father’s occupation, type of residence, and geopolitical region. Conclusion: The role of maternal employment in child survival is dynamic and depends on the type of occupation, family, and residential and regional context.

The effect of internal migration, individual and contextual characteristics on contraceptive use among Nigerian women

ABSTRACT We investigated the relation of internal migration to contraceptive use and adjusted for individual and contextual (community) characteristics. Multilevel logistic regression models were fitted to nationally representative data of 28,876 women from 884 communities in Nigeria. Only about one out of every 10 women (10.4%) currently used a contraceptive method. Contraceptive prevalence according to the migration status were rural–urban (12.5%), urban–rural (13.8%), rural nonmigrants (6.2%) and urban nonmigrants (17.1%). The relationship between internal migration and contraceptive use was fully explained by individual and community characteristics. Programs aimed at increasing contraceptive prevalence should address contextual challenges alongside socioeconomic factors.

Dynamics of maternal union dissolution and childhood mortality in sub-Saharan Africa

ABSTRACT The family setting has implications for child survival. In this study, the dynamics of maternal union dissolution and childhood mortality were investigated in sub-Saharan Africa (SSA). Birth history data of 235 454 children from the most recent Demographic and Health Survey conducted in 23 SSA countries were analysed using life table techniques and piecewise exponential hazards models. The results revealed that the childhood mortality rates were 35 vs 32 per 1000 live births (one month), 61 vs 54 per 1000 (11 months) and 95 vs 86 per 1000 (48 months) for children of women in marital dissolution compared with those with intact marriages. Despite controlling for background variables, the risk of under-five mortality was significantly higher among children of women in marital dissolution (relative risk = 1.35, confidence interval: 1.30–1.40). The effect of dissolution on childhood mortality has not changed since the 1990s. Marital stability is an important social structure for child survival.

Living alone among older persons in Uganda: Prevalence and associated factors

This study aimed at investigating the prevalence and factors associated with living alone among older persons in Uganda. A secondary analysis of the 2010 Uganda National Household Survey (UNHS) data was conducted. A complementary log-log regression model was used to estimate the association between living alone and demographic, socio-economic and health factors. Nearly one out of ten (9%) older persons lived alone in Uganda. Living alone was associated with being divorced / separated (OR 18.5, 95% CI: 10.3–33.3), being widowed (OR 8.8, 95% CI: 5.1–15.2), advanced age (OR 2.1, 95% CI: 1.4–3.2), residence in western region (OR 0.6, 95% CI: 0.3–0.93), poor wealth status (OR 0.3, 95% CI: 0.2–06), receiving remittances (OR 1.6, 95% CI: 1.1–2.3) and being disabled (OR 1.6, 95% CI: 1.2–2.1). Living alone among older persons did not vary by gender.