| 1. |
- Agardh, Charlotte, et al.
(author)
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Risk of poor mental health and experience of violence among a young adult population with same-sex sexuality : a cross-sectional study in southern Sweden
- 2022
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In: BMJ Open. - : BMJ. - 2044-6055. ; 12:2
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Journal article (peer-reviewed)abstract
- ObjectivesTo assess prevalence and correlates of same-sex sexuality and its relationship to poor mental health and experiences of violence among youth and young adults in Sweden. A secondary aim was to estimate the same-sex sexuality attributable fractions.DesignA population-based cross-sectional survey.SettingSouthern Sweden.Participants2968 respondents out of 7000 youth and young adults between 18 and 29 years old, resident in southern Sweden, selected randomly by the Swedish Central Population Registry (final sample=2931 respondents, 318 with same-sex sexuality and 2613 without).Outcome measuresThe outcome measures were self-reported poor mental health (depression and anxiety) and experience of violence (physical violence, sexual violence and sexual coercion).ResultsIncreased odd of high scores of depression (adjusted OR 1.8, 95% CI 1.39 to 2.26) and anxiety (adjusted OR 1.6, 95% CI 1.28 to 2.07) were observed among youth and young adults with same-sex sexuality. Similarly, increased odds of experience of physical violence (OR 1.8, 95% CI 1.23 to 2.51), sexual violence (OR 2.8, 95% CI 1.96 to 3.89) and sexual coercion (OR 2.5, 95% CI 1.95 to 3.30) were observed with same-sex sexuality. Within the entire young population, same-sex sexuality accounted for 4.7% and 4.1% of the self-reported experience of depression and anxiety, respectively. The estimated same-sex sexuality attributable fractions of violence within the entire population of young people were 4.5% for physical violence, 7.3% for sexual violence and 6.4% for sexual coercion.ConclusionsThis study findings suggest that same-sex sexuality is associated with poor self-rated mental health and experience of violence among youth and young adults in Sweden. Some differences were observed between males and females, indicating that the vulnerabilities and experiences vary between young males and females. Further research is needed in order to gain a deeper knowledge of the factors underlying these associations and the gender differences observed.
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| 2. |
- Anichukwu, Onyekachi Ibenelo, et al.
(author)
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The impact of maternal health care utilisation on routine immunisation coverage of children in Nigeria : A cross-sectional study
- 2019
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In: BMJ Open. - : BMJ. - 2044-6055. ; 9:6
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Journal article (peer-reviewed)abstract
- Objective To examine the impact of maternal healthcare (MHC) utilisation on routine immunisation coverage of children in Nigeria. Design Individual level cross-sectional study using bivariate and multivariable logistic regression analyses to examine the association between MHC utilisation and routine immunisation coverage of children. Setting Nigeria Demographic and Health Survey 2013. Participants 5506 women aged 15-49 years with children aged 12-23 months born in the 5 years preceding the survey. Primary outcome measures Fully immunised children and not fully immunised children. Results The percentage of children fully immunised with basic routine childhood vaccines by the age of 12 months was 25.8%. Antenatal care (ANC) attendance irrespective of the number of visits (adjusted OR (AOR) 1-3 visits 2.4, 95% CI 1.79 to 3.27; AOR 4-7 visits 3.2, 95% CI 2.52 to 4.13; AOR ≥ 8 visits 3.5, 95% CI 2.64 to 4.50), skilled birth attendance (SBA) (AOR 1.9, 95% CI 1.65 to 2.35); and maternal postnatal care (PNC) (AOR 1.7, 95% CI 1.46 to 2.06) had positive effects on the child being fully immunised after adjusting for covariates (except for each other, ie, ANC, SBA and PNC). Further analyses (adjusting stepwise for each MHC service) showed a mediation effect that led to the effect of PNC not being significant. Conclusions The percentage of fully immunised children in Nigeria was very low. ANC attendance, SBA and maternal PNC attendance had positive impact on the child being fully immunised. The findings suggest that strategies aimed at maximising MHC utilisation in Nigeria could be effective in achieving the national coverage target of at least 80% for routine immunisation of children.
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| 3. |
- Arunda, Malachi Ochieng, et al.
(author)
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Determinants of continued maternal care seeking during pregnancy, birth and postnatal and associated neonatal survival outcomes in Kenya and Uganda : analysis of cross-sectional, demographic and health surveys data
- 2021
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In: BMJ Open. - : BMJ. - 2044-6055. ; 11:12, s. 1-16
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To examine how maternal and sociodemographic factors determine continued care-seeking behaviour from pregnancy to postnatal period in Kenya and Uganda and to determine associated neonatal survival outcomes.DESIGN: A population-based analysis of cross-sectional data using multinomial and binary logistic regressions.SETTING: Countrywide, Kenya and Uganda.PARTICIPANTS: Most recent live births of 24 502 mothers within 1-59 months prior to the 2014-2016 Demographic and Health Surveys.OUTCOMES: Care-seeking continuum and neonatal mortality.RESULTS: Overall, 57% of the mothers had four or more antenatal care (ANC) contacts, of which 73% and 41% had facility births and postnatal care (PNC), respectively. Maternal/paternal education versus no education was associated with continued care seeking in majority of care-seeking classes; relative risk ratios (RRRs) ranged from 2.1 to 8.0 (95% CI 1.1 to 16.3). Similarly, exposure to mass media was generally associated with continued care seekin; RRRs ranged from 1.8 to 3.2 (95% CI 1.2 to 5.4). Care-seeking tendency reduced if a husband made major maternal care-seeking decisions. Transportation problems and living in rural versus urban were largely associated with lower continued care use; RRR ranged from 0.4 to 0.7 (95% CI 0.3 to 0.9). The two lowest care-seeking categories with no ANC and no PNC indicated the highest odds for neonatal mortality (adjusted OR 4.2, 95% CI 1.6 to 10.9). 23% neonatal deaths were attributable to inadequate maternal care attendance.CONCLUSION: Strategies such as mobile health specifically for promoting continued maternal care use up to postnatal could be integrated in the existing structures. Another strategy would be to develop and employ a brief standard questionnaire to determine a mother's continued care-seeking level during the first ANC visit and to use the information to close the care-seeking gaps. Strengthening the community health workers system to be an integral part of promoting continued care seeking could enhance care seeking as a stand-alone strategy or as a component of aforementioned suggested strategies.
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| 4. |
- Asamoah, Benedict Oppong, et al.
(author)
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Inequality trends in maternal health services for young Ghanaian women with childbirth history between 2003 and 2014
- 2017
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In: BMJ Open. - : BMJ. - 2044-6055. ; 7:2
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Journal article (peer-reviewed)abstract
- Objective: To achieve universal coverage of reproductive healthcare and drastic reduction in maternal mortality, adequate attention and resources should be given to young women. This study therefore aimed to examine the inequality trends in the use of antenatal care (ANC) services and skilled birth attendance (SBA) within a subgroup of Ghanaian women aged 15-24 years between 2003 and 2014. Design: This is a cross-sectional study that used data from the Ghana Demographic and Health Surveys (DHS) 2003, 2008 and 2014. We applied regression-based total attributable fraction (TAF) as an index for measuring multiple dimensions of inequality in the use of ANC and SBA. Setting: Ghana. Participants: Young women aged 15-24 years with at least one previous birth experience in the past 5 years prior to the surveys. Main outcome measures: ANC visits and skilled attendance at birth. Results: Urbanicity-related, education-related and wealth-related inequality in non-use of SBA declined between 2003 and 2008, but increased between 2008 and 2014. A consistent decline was observed in urbanicity-related inequality in non-use of four or more ANC visits from 2003 through 2008 to 2014. A similar reduction was observed for education-related inequality in relation to the same outcome. In contrast, wealth-related inequality in ANC usage increased over time. Conclusions: The rise in urbanicity-related, education-related and wealth-related inequality in the usage of SBA between 2008 and 2014 threatens the sustainability of the general progress made in the usage of maternal health services in Ghana within the same period.
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| 5. |
- Nakiganda, Lydia Jacenta, et al.
(author)
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Cross-sectional comparative study of risky sexual behaviours among HIV-infected persons initiated and waiting to start antiretroviral therapy in rural Rakai, Uganda
- 2017
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In: BMJ Open. - : BMJ. - 2044-6055. ; 7:9
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Journal article (peer-reviewed)abstract
- Objectives To compare risky sexual behaviours between HIV-positive persons initiated on antiretroviral therapy (ART) (ART-experienced) and persons waiting to start on ART (ART-naive) and assess predictors of risky sexual behaviours among HIV-infected patients in rural Rakai district, Uganda. Study design This is a cross-sectional study that used data from the Rakai Community Cohort Study (RCCS) database between 2013 and 2014. A structured questionnaire was used for data collection. We used stepwise logistic regression as an index to estimate the adjusted ORs for the association between risky sexual behaviours and ART treatment status. Study setting This study was conducted in Rakai district, located in south-western Uganda. The data for this study were extracted from the RCCS. RCCS is an open prospective cohort of approximately 15 000 consenting participants aged 15-49 years. Participants HIV-positive participants aged 18-49 years who had sex at least once a month with any partner prior to the start of the study. Main outcome measures Inconsistent/no condom use in the last 12 months, alcohol use at last sexual encounter, and two or more sexual partners. Results ART-naive participants were more likely to report inconsistent condom use (OR=1.74, 95% CI 1.11 to 2.73) and more likely to drink alcohol at last sexual encounter (OR=1.65, 95% CI 1.11 to 2.46), compared with ART-experienced patients. ART treatment status (p<0.001) was a significant predictor of risky sexual behaviours. Both marital status (p=0.016) and occupation level (p=0.009) were positively associated with inconsistent condom use, while sex (p<0.001) correlated with alcohol use at last sexual encounter. Conclusion ART-naive participants were more likely to exhibit risky sexual behaviours than the ART-experienced participants. The intensity of risk reduction counselling should be increased for HIV-positive persons waiting to start ART but already in HIV care.
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| 6. |
- Nakiganda, Lydia Jacenta, et al.
(author)
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Cross-sectional study on the prevalence and predictors of pregnancy among women living in HIV discordant relationships in a rural Rakai cohort, Uganda
- 2018
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In: BMJ Open. - : BMJ. - 2044-6055. ; 8:4
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Journal article (peer-reviewed)abstract
- Objectives: This study examines the prevalence of pregnancy in serodiscordant couples and identifies predictors associated with pregnancy in rural Rakai, Uganda. Study design A population-based cross-sectional study that used data from the Rakai Community Cohort Study (RCCS). Setting and participants: We used data from the RCCS survey round 17 (2015-2016), which included 488 women in serodiscordant relationships. This study was conducted in Rakai district, located in south-western Uganda. Primary outcomes: Pregnancy status. Statistical analysis Multivariable modified Poisson regression using stepwise selection was used to determine characteristics and behaviours associated with pregnancy status. Results: The prevalence of pregnancy was 12% in women among serodiscordant couples. HIV-negative women in serodiscordant couples had a slightly higher pregnancy prevalence rate (13.6%) compared with HIV-positive women in serodiscordant couples (11%). Factors significantly associated with higher prevalence of pregnancy were; younger age 15-24 years (prevalence risk ratio (PRR)=4.04; 95% CI 1.72 to 9.50), middle age 25-34 years (PRR=2.49; 95% CI 1.05 to 5.89), Christian religion (PRR=2.26; 95% CI 1.41 to 3.63) and inconsistent condom use in the last 12 months (PRR=4.38, 95% CI 1.09 to 17.53). Neither HIV status nor HIV status disclosure was significantly associated with risk of getting pregnant. Conclusion: Nearly 12% of women in serodiscordant relationships were pregnant, highlighting the need for integrated services to prevent unintended pregnancies and reduce conceptional related risks for those choosing to conceive. Association with younger age and inconsistent condom use suggests a role for early and continued couple-based conception counselling.
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