Dataset Information

Determinants of accessing healthcare in Sub-Saharan Africa: a mixed-effect analysis of recent Demographic and Health Surveys from 36 countries.

ABSTRACT:

Objective

This study aimed to assess the determinants of accessing healthcare among reproductive-age women in Sub-Saharan Africa (SSA).

Design, setting and analysis

Cross-sectional data were sourced from recent Demographic and Health Surveys in 36 SSA countries. We employed mixed-effect analysis to identify the determinants of accessing healthcare in SSA. OR and its 95% CI were reported for determinants associated with accessing healthcare.

Outcome

The outcome for this study was whether accessing healthcare was a 'big problem' or 'not a big problem'. Responses to these questions were categorised as a big problem and not a big problem.

Participants

A total weighted sample of 500 439 reproductive-age (15-49 years) women from each country's recent Demographic and Health Surveys from 2006 to 2018 were included in this study.

Results

The pooled prevalence of healthcare access among reproductive-age women in SSA was 42.56% (95% CI 42.43% to 42.69%). The results of the mixed-effect analysis revealed that the determinants of accessing healthcare were urban residence (adjusted OR (AOR)=1.25, 95% CI 1.34 to 1.73), ability to read and write (AOR=1.15, 95% CI 1.22 to 1.28), primary education (AOR=1.08, 95% CI 1.07 to 1.12), secondary education and above (AOR=1.12, 95% CI 1.10 to 1.14), husband with primary education (AOR=1.06, 95% CI 1.07 to 1.1.12), husband with secondary education and above (AOR=1.22, 95% CI 1.18 to 1.27), middle wealth index (AOR=1.43, 95% CI 1.40 to 1.47), rich wealth index (AOR=2.19, 95% CI 2.13 to 2.24) and wanted pregnancy (AOR=1.27, 95% CI 1.19 to 1.29).

Conclusion

Healthcare access in SSA was found at 42.56%, which is very low even if Sustainable Development Goal 3.8 targeted universal health coverage for everyone so they can obtain the health services they need. The major determinants of healthcare access among reproductive-age women in SSA were urban residence, higher educational level, higher wealth index and wanted pregnancy. The findings of this study suggest and recommend strengthening and improving healthcare access for women who reside in the countryside, women with low level of education and women of low socioeconomic status.

SUBMITTER: Tessema ZT

PROVIDER: S-EPMC8804632 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

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Publications

Determinants of accessing healthcare in Sub-Saharan Africa: a mixed-effect analysis of recent Demographic and Health Surveys from 36 countries.

Tessema Zemenu Tadesse ZT Worku Misganaw Gebrie MG Tesema Getayeneh Antehunegn GA Alamneh Tesfa Sewunet TS Teshale Achamyeleh Birhanu AB Yeshaw Yigizie Y Alem Adugnaw Zeleke AZ Ayalew Hiwotie Getaneh HG Liyew Alemneh Mekuriaw AM

BMJ open 20220131 1

<h4>Objective</h4>This study aimed to assess the determinants of accessing healthcare among reproductive-age women in Sub-Saharan Africa (SSA).<h4>Design, setting and analysis</h4>Cross-sectional data were sourced from recent Demographic and Health Surveys in 36 SSA countries. We employed mixed-effect analysis to identify the determinants of accessing healthcare in SSA. OR and its 95% CI were reported for determinants associated with accessing healthcare.<h4>Outcome</h4>The outcome for this stud ...[more]

PMID: 35105635

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Project description:BackgroundMore than 75% of neonatal deaths occurred in the first weeks of life as a result of adverse birth outcomes. Low birth weight, preterm births are associated with a variety of acute and long-term complications. In Sub-Saharan Africa, there is insufficient evidence of adverse birth outcomes. Hence, this study aimed to determine the pooled prevalence and determinants of adverse birth outcomes in Sub-Saharan Africa.MethodData of this study were obtained from a cross-sectional survey of the most recent Demographic and Health Surveys (DHS) of ten Sub-African (SSA) countries. A total of 76,853 children born five years preceding the survey were included in the final analysis. A Generalized Linear Mixed Models (GLMM) were fitted and an adjusted odds ratio (AOR) with a 95% Confidence Interval (CI) was computed to declare statistically significant determinants of adverse birth outcomes.ResultThe pooled prevalence of adverse birth outcomes were 29.7% (95% CI: 29.4 to 30.03). Female child (AOR = 0.94, 95%CI: 0.91 0.97), women attended secondary level of education (AOR = 0.87, 95%CI: 0.82 0.92), middle (AOR = 0.94,95%CI: 0.90 0.98) and rich socioeconomic status (AOR = 0.94, 95%CI: 0.90 0.99), intimate-partner physical violence (beating) (AOR = 1.18, 95%CI: 1.14 1.22), big problems of long-distance travel (AOR = 1.08, 95%CI: 1.04 1.11), antenatal care follow-ups (AOR = 0.86, 95%CI: 0.83 0.86), multiparty (AOR = 0.88, 95%CI: 0.84 0.91), twin births (AOR = 2.89, 95%CI: 2.67 3.14), and lack of women involvement in healthcare decision-making process (AOR = 1.10, 95%CI: 1.06 1.13) were determinants of adverse birth outcomes.ConclusionThis study showed that the magnitude of adverse birth outcomes was high, abnormal baby size and preterm births were the most common adverse birth outcomes. This finding suggests that encouraging antenatal care follow-ups and socio-economic conditions of women are essential. Moreover, special attention should be given to multiple pregnancies, improving healthcare accessibilities to rural areas, and women's involvement in healthcare decision-making.

Project description:BackgroundIn developing countries, most women want to avoid pregnancy for two years after giving birth. However, 70% do not use contraceptives during this time. Unintended pregnancies may occur for couples who delay contraceptive use during the postpartum period. The most effective form of contraceptive methods for postpartum women is long-acting reversible contraceptive (LARC). Therefore, this study aimed to assess long-acting reversible contraceptive use and associated factors among postpartum women in Sub-Saharan Africa.MethodsSecondary data analysis was performed using the recent Demographic and Health Surveys (DHS). Stata version 14 was used to analyze the data. A multilevel mixed-effect logistic regression model was used to identify factors associated with long-acting reversible contraceptive use. Variables with a p-value < 0.05 in the multilevel mixed-effect logistic regression model were declared significant factors associated with long-acting reversible contraceptives.ResultsThe magnitude of long-acting reversible contraceptive use among postpartum women was 12.6% (95% CI: 12.3, 12.8). Women primary (aOR = 1.51; 95% CI: 1.41, 1.63) and secondary education (aOR = 1.62; 95% CI: 1.32, 1.71), media exposure (aOR = 1.73; 95% CI: 1.51, 1.85), place of delivery (aOR = 1.54; 95% CI: 1.43, 1.67), number of ANC visit; 1-3 (aOR = 2.62; 95% CI: 2.31, 2.83) and ≥4 (aOR = 3.22; 95% CI: 2.93, 3.57), received PNC (aOR = 1.34; 95%CI: 1.13, 1.58), and income level; low middle income (aOR = 2.41; 95% CI: 2.11, 2.88) and upper middle income (aOR = 1.83; 95% CI: 1.56, 1.24) were significantly associated with long-acting reversible contractive use.ConclusionNearly one in 10 postpartum women used long-acting reversible contraceptives. Hence, we suggest that the concerned bodies should promote family planning messages in mass media and give the well-documented benefits of postpartum long-acting contraceptive use. Promote the integration of postpartum LARC methods into maternal health care services and give better attention to postpartum women living in low-income countries and uneducated women.

Project description:BackgroundPrenatal screening of pregnant women for HIV is central to eliminating mother-to-child-transmission (MTCT) of HIV. While some countries in sub-Saharan Africa (SSA) have scaled up their prevention of MTCT programmes, ensuring a near-universal prenatal care HIV testing, and recording a significant reduction in new infection among children, several others have poor outcomes due to inadequate testing. We conducted a multi-country analysis of demographic and health surveys (DHS) to assess the coverage of HIV testing during pregnancy and also examine the factors associated with uptake.MethodsWe analysed data of 64,933 women from 16 SSA countries with recent DHS datasets (2015-2018) using Stata version 16. Adjusted and unadjusted logistic regression models were used to examine correlates of prenatal care uptake of HIV testing. Statistical significance was set at p<0.05.ResultsProgress in scaling up of prenatal care HIV testing was uneven across SSA, with only 6.1% of pregnant women tested in Chad compared to 98.1% in Rwanda. While inequality in access to HIV testing among pregnant women is pervasive in most SSA countries and particularly in West and Central Africa sub-regions, a few countries, including Rwanda, South Africa, Zimbabwe, Malawi and Zambia have managed to eliminate wealth and rural-urban inequalities in access to prenatal care HIV testing.ConclusionOur findings highlight the between countries and sub-regional disparities in prenatal care uptake of HIV testing in SSA. Even though no country has universal coverage of prenatal care HIV testing, East and Southern African regions have made remarkable progress towards ensuring no pregnant woman is left untested. However, the West and Central Africa regions had low coverage of prenatal care testing, with the rich and well educated having better access to testing, while the poor rarely tested. Addressing the inequitable access and coverage of HIV testing among pregnant women is vital in these sub-regions.

Project description:BackgroundVitamin A one of the important micronutrients that it cannot be made in the human body and must be taken from outside the body through the diet. Ensuring that vitamin A is available in any form in sufficient quantities remains a challenge, especially in regions where access to vitamin A-containing foods and healthcare interventions is limited. As a result, vitamin A deficiency (VAD) becomes a common form of micronutrient deficiency. To the best of our knowledge, there is limited evidence on determinants of good Vitamin A consumption in East African countries. Therefore, this study aimed to assess the magnitude and determinants of good vitamin A consumption in East African countries.MethodsA recent Demographic and Health Survey (DHS) of twelve East African countries were included to determine the magnitude and determinants of good vitamin A consumption. A total of 32,275 study participants were included in this study. A multilevel logistic regression model was used to estimate the association between the likelihood of good vitamin A-rich food consumption. Both community and individual levels were used as independent variables. Adjusted odds ratio and its 95% confidence interval were used to see the strength of the association.ResultThe pooled magnitude of good vitamin A consumption was 62.91% with a 95% CI of 62.3 to 63.43. The higher proportion of good vitamin A consumption 80.84% was recorded in Burundi and the smallest good vitamin A consumption 34.12% was recorded in Kenya. From the multilevel logistic regression model, women's age, marital status, maternal education, wealth index, maternal occupation, children's age in a month, media exposure, literacy rate, and parity were significantly associated with good vitamin A consumption in East Africa.ConclusionThe magnitude of good vitamin A consumption in twelve East African countries is low. To increase good vitamin A consumption health education through the mass media and enhancing the economic status of women is recommended. Planners and implementers should give attention and priority to identified determinants to enhance good vitamin A consumption.

Project description:BackgroundSub-Saharan Africa (SSA) has the highest burden of neonatal mortality in the world. Identifying the most critical modifiable risk factors is imperative for reducing neonatal mortality rates. This study is the first to calculate population-attributable fractions (PAFs) for modifiable risk factors of neonatal mortality in SSA.MethodsWe analysed the most recent Demographic and Health Surveys data sets from 35 SSA countries conducted between 2010 and 2022. Generalized linear latent and mixed models were used to estimate odds ratios (ORs) along with 95% confidence intervals (CIs). PAFs adjusted for communality were calculated using ORs and prevalence estimates for key modifiable risk factors. Subregional analyses were conducted to examine variations in modifiable risk factors for neonatal mortality across Central, Eastern, Southern, and Western SSA regions.FindingsIn this study, we included 255,891 live births in the five years before the survey. The highest PAFs of neonatal mortality among singleton children were attributed to delayed initiation of breastfeeding (>1 h after birth: PAF = 23.88%; 95% CI: 15.91, 24.86), uncleaned cooking fuel (PAF = 5.27%; 95% CI: 1.41, 8.73), mother's lacking formal education (PAF = 4.34%; 95% CI: 1.15, 6.31), mother's lacking tetanus vaccination (PAF = 3.54%; 95% CI: 1.55, 4.92), and infrequent antenatal care (ANC) visits (PAF = 2.45; 95% CI: 0.76, 3.63). Together, these five modifiable risk factors were associated with 39.49% (95% CI: 21.13, 48.44) of neonatal deaths among singleton children in SSA. Our subregional analyses revealed some variations in modifiable risk factors for neonatal mortality. Notably, delayed initiation of breastfeeding consistently contributed to the highest PAFs of neonatal mortality across all four regions of SSA: Central, Eastern, Southern, and Western SSA.InterpretationThe PAF estimates in the present study indicate that a considerable proportion of neonatal deaths in SSA are preventable. We identified five modifiable risk factors that accounted for approximately 40% of neonatal deaths in SSA. The findings have policy implications.FundingNone.

Project description:BackgroundAccording to the 2017 estimate, around 214 million reproductive-age women in developing regions who want to avoid pregnancy do not use a modern contraceptive method. Although there are studies done on factors associated with modern contraceptive utilization in individual East African countries, as to our search of the literature, there is limited evidence on the pooled prevalence and determinants of modern contraceptive utilization in the East African region. Therefore, this study aimed to estimate the pooled prevalence and determinants of modern contraceptive utilization in the East African region.MethodsThe pooled prevalence of modern contraceptive utilization and the strength of determinants were estimated using STATA version 14. Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV), and deviance were used for model fitness and comparison. The multilevel logistic regression model was fitted to identify determinants of modern contraceptive use in the region. Adjusted Odds Ratio with its 95% Confidence Interval was presented, and variables with a p-value ≤of 0.05 were declared significant determinants of modern contraceptive utilization.ResultsOverall, about 20.68% (95%CI:-20.46.,20.91)of women used modern contraceptive, ranging from 9.08% in Mozambique to 61.49% in Comoros. In the multilevel logistic regression model; maternal age group 25-34 (AOR: 0.79, 95%CI:0.76,0.82) and 35-49 (AOR:0.49, 95%CI:0.46,0.51). Being married (AOR:0.85, 95%CI:0.82,0.88), mothers with primary education (AOR:1.48, 95%CI:1.43,1.54) and secondary and above education level (AOR:1.60, 95%CI:1.52,1.69), husbands with primary education (AOR:2.43, 95%CI:2.35,2.51) and secondary and above education level (AOR:2.92, 95%CI:2.76,3.05). The mothers who had occupation (AOR:2.11, 95%CI:1.23,1.33), mothers from households with middle wealth index (AOR:1.23, 95%CI:1.19,1.28) and rich wealth index (AOR:1.28, 95%CI:1.23,1.33) were found to be significant determinants of modern contraceptive use.ConclusionWe found that modern contraceptive utilization in the 12 East Africa countries was low compared to SDG target 2030(75%). The governmental and non-governmental organizations should scale up their public health programs to the poor and marginalized communities to scale up modern contraceptive utilization uptake in the region. In addition, reforming the health system and reproductive health education through mass media to create awareness of modern contraceptive use benefits are effective strategies to improve modern contraceptive use among East Africa women.

Dataset Information

Determinants of accessing healthcare in Sub-Saharan Africa: a mixed-effect analysis of recent Demographic and Health Surveys from 36 countries.

Objective

Design, setting and analysis

Outcome

Participants

Results

Conclusion

Publications

Determinants of accessing healthcare in Sub-Saharan Africa: a mixed-effect analysis of recent Demographic and Health Surveys from 36 countries.

Similar Datasets

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