Peter Austin Morton Ntenda

Factors associated with contraceptive use and intention to use contraceptives among married women in Ethiopia

ABSTRACT Family planning has improved the well-being of families by preventing high-risk pregnancies and abortions and reducing unplanned pregnancies. However, the effectiveness of family planning efforts has not been consistent across countries. This study examined factors associated with contraceptive use among married women in Ethiopia. Data were from the 2011 Ethiopian Demographic and Health Survey. The sample comprised 10,204 married women (aged 15–49 years). Logistic regression models were used to analyze the data. Among married women in Ethiopia, 29.2% used contraceptive methods. About 44.1% of women who were not current users of contraceptives reported that they intended to use contraceptives in the future. Age at first marriage, being educated, number of living children, exposure to mass media, being employed, having educated partners, and having been informed about contraceptive use at health facilities were positively associated with current contraceptive use. By contrast, older age, a rural resident, or Muslim; belonging to the Afar or Somali ethnic groups; desiring numerous children; having husbands who desired additional children; and abortion experience were negatively associated with current contraceptive use. Our findings indicated that improving education, providing employment opportunities for women, and providing training to family planning providers are essential to increasing contraceptive use.

Analysis of the effects of individual and community level factors on childhood immunization in Malawi

BACKGROUND Empirical evidence regarding the relationship between childhood immunization and individual- and community-level factors in low-income countries has received little attention. We compared the trends and the effects of a wide range of individual- and community-level socioeconomic factors on the likelihood of a child being immunized between 2004 and 2010 in Malawi. METHODS We used data from the 2004 and 2010 Malawi Demographic and Health Survey and applied generalized estimating logistic regression equation to analyze data respectively on 2042 and 3496 children aged 12-23months. We compared the relationship between individual- and community-level socioeconomic factors and a childs vaccination status for four basic vaccines recommended by the World Health Organization: bacillus Calmette-Guérin (BCG) vaccine, diphtheria-tetanus-pertussis (DPT3) vaccine, oral polio vaccine (OPV3), and measles-containing vaccine 1 (MCV1). RESULTS The trends of vaccination had a similar pattern in 2004 and 2010. The coverage of the four vaccinations was highest for BCG and lowest for OPV3 and complete immunization was higher in 2010. The multivariate analyses show that mothers low education, having one or none antenatal visits, having no immunization card, having immunization card but not seen, residing in poor households, and living in central region were the most significant factors associated with decreased odds of achieving vaccination coverage and complete vaccination in both 2004 and 2010. However, maternal education was more likely to be associated with childrens immunization in 2010, while the geographical region was more likely to be associated with childrens immunization in 2004. CONCLUSIONS There were marked improvements in the national immunization coverage from 2004 to 2010. In order to achieve complete immunization, to further enhance the national immunization coverage as well as to lessen the gaps and disparities in childhood vaccination in Malawi, policy makers should design interventions based on the factors addressed in this study.

Analysis of individual-level and community-level effects on childhood undernutrition in Malawi

BACKGROUND Undernutrition is a major global public health problem among children under the age of 5 years. We aimed to untangle the effects of a wide range of individual- and community-level socioeconomic factors on the risks of childhood undernutrition in Malawi. METHODS We analyzed 6384 women-infant pairs from the 2004 and 2010 Malawi Demographic and Health Surveys (MDHSs). The undernutrition status was assessed by three domains of stunted (height-for-age), wasted (weight-for-height), and underweight (weight-for-age). We constructed generalized estimating equation logistic models to analyze associations of individual- and community-level characteristics with childhood undernutrition. RESULTS About 48.4% of the children were stunted, 4.5% were wasted, and 14.4% were underweight. At the individual level, the risk of childhood undernutrition was significantly higher in males, children with a small birth size, children with a diarrheal episode in the last 2 weeks, children that were a product of multiple births, children born to mothers with either a low socioeconomic status, or a poor education, or who were underweight, and children born in the year 2004. At community level, children born in communities with low and medium wealth, and in communities with low and medium female educational attainment were more likely to be undernourished. Unexpectedly, the maternal HIV status was not associated with childhood undernutrition at either the individual or community level. CONCLUSION This study provides evidence of the importance of both individual- and community-level factors in determining childhood undernutrition. Interventions against childhood undernutrition should consider the various predictors discussed in this study in order to reduce undernutrition in children and contribute to their well-being.

Predictors of uptake of newly introduced vaccines in Malawi – monovalent human rotavirus and pneumococcal conjugate vaccines: Evidence from the 2015–16 Malawi demographic and health survey

OBJECTIVES The purpose of this study was to examine the uptake and predictors of monovalent human rotavirus and pneumococcal conjugate vaccines among children of age 12-35 months in Malawi. METHODS This study used cross-sectional data obtained from the 2015-16 Malawi Demographic and Health Survey. Multivariate logistic regression was used to identify the factors related to uptake of pneumococcal and rotavirus vaccination. RESULTS The uptake of rotavirus and pneumococcal vaccines was 90.96% and 88.84%, respectively. The multivariate logistic results showed that children whose mothers had no formal education, who did not attend postnatal care for the baby within 2 months and had no vaccination card or had lost it were less likely to achieve vaccination uptake. Furthermore, children from northern region had increased odds of achieving vaccination uptake. CONCLUSIONS Strategies aimed at increasing further uptake of rotavirus and pneumococcal vaccines should target uneducation women to improve health knowledge on vaccination.

Multilevel Analysis of the Effects of Individual- and Community-Level Factors on Childhood Anemia, Severe Anemia, and Hemoglobin Concentration in Malawi

Background The purpose of this article was to examine individual- and community-level factors associated with childhood anemia, severe anemia, and hemoglobin (Hb) concentration in Malawi. Methods Using data from the 2010 Malawi demographic and health survey (MDHS), the multilevel regression models were constructed to analyze 2597 children aged 6-59 months living in 849 communities. Results The results showed that both childhood anemia and severe anemia were negatively associated with childs age, no fever in the previous 2 weeks and height-for-age, and positively associated with residing in poor household. Childhood anemia was negatively associated with community female education. Childs age, no fever in the previous 2 weeks and maternal Hb levels were positively associated with child Hb concentration, while residing in poorest households was negatively associated with childrens Hb concentration. Conclusion Comprehensive public health strategies aimed at reducing childhood anemia need to focus more on the significant characteristics addressed in this study.

High Maternal Body Mass Index Is Associated with an Early-Onset of Overweight/Obesity in Pre-School-Aged Children in Malawi. A Multilevel Analysis of the 2015-16 Malawi Demographic and Health Survey

BACKGROUND Overweight/obesity in young children is one of the most serious public health issues globally. We examined whether individual- and community-level maternal nutritional status is associated with an early onset of overweight/obesity in pre-school-aged children in Malawi. DESIGN Data were obtained from the 2015-16 Malawi Demographic and Health Survey (MDHS). The maternal nutritional status as body mass index and childhood overweight/obesity status was assessed by using the World Health Organization (WHO) recommendations. To examine whether the maternal nutritional status is associated with overweight/obesity in pre-school-aged children, two-level multilevel logistic regression models were constructed on 4023 children of age less than five years dwelling in 850 different communities. RESULTS The multilevel regression analysis showed that children born to overweight/obese mothers had increased odds of being overweight/obese [adjusted odds ratio (aOR) = 3.11; 95% confidence interval (CI): 1.13-8.54]. At the community level, children born to mothers from the middle (aOR: 1.68; 95% CI: 1.02-2.78) and high (aOR: 1.69; 95% CI: 1.00-2.90) percentage of overweight/obese women had increased odds of being overweight/obese. In addition, there were significant variations in the odds of childhood overweight/obesity in the communities. CONCLUSIONS Strategies aimed at reducing childhood overweight/obesity in Malawi should address not only women and their children but also their communities. Appropriate choices of nutrition, diet and physical activity patterns should be emphasized upon in overweight/obese women of childbearing age throughout pregnancy and beyond.

Factors associated with complementary feeding practices among children aged 6–23 mo in Malawi: an analysis of the Demographic and Health Survey 2015–2016

Background Optimal child complementary feeding practices are crucial for nutritional status, growth, development and health, and ultimately affect child survival. This is the first population-based study in Malawi that aimed to examine factors associated with complementary feeding practices among children aged 6-23 mo. Methods Utilizing data from the 2015-16 Malawi Demographic and Health Survey (MDHS), 4732 children aged 6-23 mo and their mothers were analysed. The MDHS produced a nationally representative sample using a multistage cluster sampling design that included sampling weights. The impact of child, maternal, household, community and health service utilization factors on complementary feeding practices was examined using the generalized estimating equation logistic regression. Results After controlling for a wide range of covariates, children from mothers with secondary or post-secondary education and from mothers working in agriculture and living in the central region were significantly more likely to have timely introduction to solid, semi-solid or soft food. Surprisingly, being >1 y of age was associated with reduced odds of achieving minimum meal frequency. In addition, children >1 y of age from mothers older than 24 y and from mothers with primary, secondary and post-secondary education were significantly more likely to achieve minimum dietary diversity. Children from rich households were more likely to achieve both minimum dietary diversity and minimum acceptable diet. Finally, exposure to mass media was significantly associated with increased odds of achieving minimum meal frequency, minimum dietary diversity and minimum acceptable diet. Conclusions Public health strategies aimed at reducing childhood undernutrition should focus on children from poor households whose mothers have no formal education and are unemployed. In addition, exposure to mass media had a positive impact on the three complementary feeding indicators. Therefore behaviour change communication messages through mass media aimed at promoting child nutrition are necessary to achieve optimal child complementary feeding practices.

Unwanted pregnancy, pregnancy loss, and other risk factors for intimate partner violence in the Democratic Republic of the Congo

ABSTRACT The Democratic Republic of the Congo (DRC) has one of the highest rates of violence against women in the world; however, few studies have focused on this issue. In this study, we assessed the interrelationship among intimate partner violence (IPV), unintended pregnancy, pregnancy loss, and other sociodemographic factors in the DRC. Our analyses were based on data from the DRC demographic and health survey, conducted from November 2013 to February 2014. We constructed generalized estimating equation models to analyze the data from a sample of 5,120 married women. Our results showed that having a husband or partner who exhibited controlling behaviors, women who justified wife-beating, having a mother who had experienced IPV, and having a husband or partner who consumed alcohol were positively associated with IPV, whereas decision-making autonomy among women was negatively associated with IPV. In the community, the proportion of women who had experienced IPV and that of those who had completed secondary or higher education were positively and negatively associated with any IPV type, respectively. In addition, emotional IPV and any IPV type were positively associated with pregnancy loss. Our results indicate the necessity of implementing programs targeting gender equality at both individual and community levels.