Utilization of health care facilities for child delivery is associated with improved maternal and neonatal outcomes, but less than half of mothers use these for child delivery in Nigeria. This study investigated the factors associated with facility delivery in Nigeria, and their variation between the Northern and Southern parts of the country – two regions with distinct socio-cultural make-ups. The study included 33,924 mothers aged 15–49 who had given birth in the last 5 years preceding the 2018 Nigeria Demographic and Health Survey. Overall, higher age, being educated, being a Christian, being an urban resident, being exposed to mass media, making joint decisions with partner on health care, beginning antenatal visits in the first trimester and attending antenatal clinics frequently were found to be associated with improved use of a health care facility for child delivery. An average mother in Northern Nigeria had a 38% chance of having a facility-based delivery, whereas the likelihood in the South was 76%. When other factors were adjusted for, age and listening to the radio were significant predictors of facility-based delivery in the South but not in the North. In the North, Christians were more likely than Muslims to have a facility-based delivery, but the reverse was true in the South. Rural women in the South had a 16% greater chance of having a facility-based delivery than urban women in the North. The study results suggest that there is inequality in access to health care facilities in Nigeria, and the differences in the socio-cultural make-up of the two regions suggest that uniform intervention programmes may not yield similar results across the regions. The findings give credence to, and expand on, the Cosmopolitan-Success and Conservative-Failure Hypothesis.

In 2005 and again in 2011, the Government of India launched schemes to encourage institutional delivery among poor women, with the aim of improving maternal and newborn health outcomes. Partly as a result of these initiatives, the proportion of children born in a health facility rose steeply from 42% in 2000–2005 to 81% a decade later. In this context, the objective of this paper was to determine the association between place of delivery (public sector, private sector, home) and early neonatal mortality, defined as death in the first 7 days after birth. The focus was on early neonatal mortality because over half of all under-five deaths occur in his period and because the protective effect of an institutional place of birth should be strongest in those few early days. Both bivariate methods and multivariate logistic regression analysis were applied to data from the fourth round of the National Family Health Survey conducted in 2015–16. For the country as a whole, it was found that the adjusted odds of death in the early neonatal period were lower for deliveries in public health facilities than for home deliveries (OR 0.833 p<0.01), but no significant difference was found between deliveries in private health facilities and at home. Adjusted odds of death were higher for deliveries in private than public sector facilities (OR 1.41 p<0.01). On further investigation, for the poor in Bihar and Uttar Pradesh, it was found that the risks of dying in the early neonatal period were even higher for babies delivered in private health facilities than for home deliveries with adjusted odds of over 2.0. These results raise serious questions about quality of care in the private sector in India. In the context of increased emphasis on public–private partnerships in health services provision in the country, it becomes imperative to enforce better inspection, licensing and quality control of private sector facilities, especially in the states of Bihar and Uttar Pradesh.

Early initiation of breastfeeding (EIBF) is considered one of the most cost-effective interventions for infant survival and well-being. This study aimed to examine the variations in, and determinants of, early initiation of breastfeeding among women in high and low neonatal mortality rate (NMR) settings in India using data from the fourth round of the National Family Health Survey conducted in 2015–16. At 35%, EIBF was found to be disproportionately low in the high NMR group of states compared with 52% in the low NMR group, with the national average being 44%. The chance of EIBF significantly increased if childbirth was vaginal, delivery took place in a health institution, the mother received breastfeeding advice and the birth was a planned one in both high and low NMR settings. In the high NMR group of states, the probability of initiating breastfeeding immediately after birth improved to a great extent if childbirth was assisted by a trained person and if the mother was exposed to any type of mass media. There is an urgent need to increase the access of mothers to breastfeeding advice during pregnancy and to increase their exposure to mass media, particularly in high NMR states. In addition, achieving universal access to institutional deliveries and deliveries assisted by a skilled birth attendant, especially in high NMR settings, and promoting early breastfeeding, especially in the case of Caesarean deliveries, would further improve the level of EIBF in the country as a whole. These interventions can potentially increase the prevalence of early initiation of breastfeeding and help India attain the neonatal mortality rate target of Sustainable Development Goal 3.

This study aimed to assess completeness of antenatal care coverage following implementation of a voucher scheme for maternal health in Bangladesh. The investigation used interview data from a survey conducted in Bangladesh in 2017 of 2400 randomly selected women aged 15–49 with children aged 0–23 months in four geographical areas where voucher scheme implementation was underway. Of these women, 1944 had attended at least one antenatal clinic visit so were included in the analysis. A ‘completeness index’ for antenatal visits was constructed as an outcome variable based on recall of thirteen elements of care. Bivariate analysis against independent variables of interest was carried out and multivariate linear regression models developed to examine the influence of voucher scheme participation on completeness of antenatal care adjusting for socio-demographic characteristics. Voucher scheme membership was associated with higher ‘completeness index’ scores, with a mean score of 185.2±101.0 for voucher recipients and 139.6 ± 93.3 for non-recipients (p<0.001). Scheme membership reduced the differentials associated with health facility type and socioeconomic status. Women from the lowest socioeconomic group who were voucher recipients received substantially more components of antenatal care (mean score: 159.6±82.1) compared with non-recipients (mean score: 115.7±83.0). This favourable effect of voucher scheme membership on the most vulnerable socioeconomic group remained significant after adjusting for educational status. The Bangladesh voucher scheme model has the potential to maximize gains in maternal and newborn health through enhancing the completeness of service provision.

Spousal violence against women is a serious public health problem that is prevalent in all societies, with one in three women around the world experiencing violence in their lifetime. This study examined the prevalence of spousal violence, and its determinants, in Afghanistan using data from the 2015 Afghanistan Demographic and Health Survey. Univariate, bivariate and logistic regression statistical techniques were used to assess the association of socioeconomic variables with spousal violence. The study sample comprised 20,827 currently married women aged 15–49. Fifty-two per cent of women reported experiencing some form of violence by their husband. A significant association was found between women’s justification of violence, women’s participation in decision-making in their household (COR=0.476; CI=0.446–0.509) and lower risk of experiencing spousal violence. After adjustment for demographic and socioeconomic factors, women’s participation in all of four household decisions, either alone or jointly, was found to be associated with a lower risk of experiencing spousal violence (AOR=0.472; CI=0.431–0.516). In both the crude and adjusted models, the risk of experiencing spousal violence was high if the husband’s desire for children was different from that of his wife. In the case of inequality in property ownership, the risk of spousal violence was significantly higher (COR=1.263; CI=1.178–1.353; AOR=1.159; CI=1.051–1.278) when women were joint owners of property compared with when they did not own any property. The findings point to an immediate need for legal and social interventions to prevent spousal violence against women, or at least reduce its prevalence, in Afghanistan.

Basic vaccination is important to protect children from infectious diseases and illnesses. Adequate levels of vaccination coverage reduce the morbidity and mortality burden among children and promote their physical and mental development. This study aimed to assess the association between basic childhood vaccination and the cognitive and learning ability of school children in India. Nationally representative follow-up data on 6183 children from the Indian Human Development Surveys conducted in 2004–05 and 2011–12 (IHDS I & II) were analysed. Children aged 8–10 years who had received all basic vaccines by the age 12 months performed better in a maths test than partially vaccinated or unvaccinated children (OR: 1.87, 95% CI: 1.48, 2.35). Similarly, fully vaccinated children performed better in writing tasks than partially vaccinated or unvaccinated children (OR: 1.77, 95% CI: 1.44, 2.18). Likewise, fully vaccinated children had better reading skills than fully unvaccinated children (OR: 1.60, 95% CI: 1.23, 2.09). The results suggest that enhancing child vaccination coverage can have significant benefits beyond health and can potentially improve the long-term educational outcomes of children.

The termination of unwanted pregnancies is a growing health-related issue around the world. This study used the 2017 Ghana Maternal Health Survey to examine the factors associated with the prevalence of induced abortion in Ghana. The study sample included 18,116 women of reproductive age who had a pregnancy in the 5 years preceding the survey. A multivariate logistic regression technique was applied. The prevalence of induced abortion was higher among women aged 25–34 years, those who had secondary-level education, those living in urban areas and in the Ashanti region, those of Akan ethnicity and those belonging to non-Catholic Christian denominations. Moreover, the prevalence was higher among single women, those who had no children, those who started sexual intercourse before the age of 18, those who were currently using a contraceptive, those exposed to media and those who knew about the legality of abortion. The multivariate analysis found that education, place and region of residence, marital status, ethnicity, current contraceptive use, religion, age at sexual debut, media exposure and knowledge about abortion legality were all significant predictors of induced abortion among women in Ghana. The study findings support a call for action to strengthen family planning services and educational programmes on induced abortion in Ghana to reach the target groups identified.

Malaria is a major public health concern in Malawi. This study explored the patterns and correlates of ownership and utilization of ITNs for malaria control among women of reproductive age in Malawi. Data were derived from the multi-stage cross-sectional Malaria Indicator Survey (MIS) conducted in 2017, which followed ITN distribution in 2012 and 2015. Of the 3860 sampled women aged 15–49 years, 88% (3398/3860) and 64% (2473/3860) reported that they owned and utilized ITNs, respectively. Adjusted multivariate logistic regression analysis showed that the odds of ownership of ITNs were significantly low among women with no education (AOR = 0.36, CI = 0.18–0.72), those with primary education (AOR = 0.50, CI = 0.27–0.94) and poor women (AOR = 0.70, CI = 0.51–0.97). Similarly, the odds of utilization of ITNs were significantly low among women with no education, (AOR = 0.40, CI = 0.26–0.63), primary education (AOR = 0.53, CI = 0.36–0.78) and poor women (AOR = 0.70, CI = 0.51–0.97). Furthermore, the odds of utilization of ITNs were significantly low among women living in households without a radio (AOR = 0.79, CI = 0.67–0.93) and those who have not seen or heard a malaria message in the last 6 months (AOR = 0.74, CI = 0.64–0.87). In order to prevent malaria morbidity and mortality among women of reproductive age, especially those from poor households, the Malawi government and relevant stakeholders need to continue the free distribution of ITNs to the poor and encourage social behaviours that promote the ownership and utilization of ITNs.

With the onset of the demographic transition in sub-Saharan Africa, couples’ desired number of children and the sex composition of offspring may become conflicted, with potential effects on future fertility. While intuitively expected, this effect has not been observed in studies in sub-Saharan Africa, where the level of fertility is higher than in other African regions. In this study, the hypothesis of a conflicted situation was examined by assessing the effect of sex composition of offspring on women’s intentions regarding additional children and their use of modern contraceptives. A mixed-method analysis was performed using quantitative data regarding 2567 women aged 35–49 years drawn from a 2012 Demtrend retrospective longitudinal population survey, supplemented by qualitative data collected through 23 in-depth interviews of men and women in Ouagadougou. Results showed that the absence of one sex (boy or girl) in the existing offspring was associated with additional demand for children and lower contraceptive use. These results suggest that a desire for a combination of both girls and boys may be the driving factor contributing to larger family size; that is, continued fertility may not be determined by son preference, but rather by overall composition of offspring, when existing children are all girls or all boys. This could explain the stalling of the fertility decline observed in recent years in Ouagadougou.

In Cameroon, two-fifths of the population is between the age of 15 and 24. Adolescents and youths are an important social group for the development of the country and the realization of the demographic dividend. The promotion of sexual and reproductive health will enable youth to transform their potential into development. This study aimed to identify the determinants of condom use at last sexual intercourse among single youths, highlight gender differences in the factors associated with condom use and identify the characteristics of youths who were less likely to use condoms. Data were taken from the 2018 Cameroon Demographic and Health Survey. The study sample comprised 1464 single females and 989 single males age 15–24. Multivariate logistic regression analysis was used to test the study hypotheses. Overall, 51% of the female and 66% of the male youths reported using condoms at last sexual intercourse. For both sexes, the protective factor was not having children. Among the females, belonging to the Bamileke or Mbo ethnic groups and delaying first sexual intercourse were also protective, while working in the modern or service sectors was the main risk factor. Among male youths, residing in households whose heads had a higher educational level was protective and household poverty was the main risk factor. These findings support Cameroon’s multi-sectoral approach to HIV/AIDS prevention among youths, and emphasize the importance of involving parents, teachers and youths in prevention strategies.

Utilization of antenatal care (ANC) services, as part of reproductive health care, presents a lifesaving chance for health promotion and the early diagnosis and treatment of illnesses throughout pregnancy. This study examines the factors associated with the number and timing of ANC visits among married women in Cameroon using data from the 2018 Cameroon Demographic and Health Survey. The outcome variables were number of ANC visits, categorized as <8 visits or ≥8 visits, and the timing of first ANC visit, categorized as ≤3 months (early) or >3 months (late) (as per the new 2016 WHO recommendations). Descriptive statistics and binary logistic regression were used to analyse the data. Crude odds ratios (cOR) and adjusted odds ratios (aOR) and p-values with significance at <0.05 were used to interpret the results. The proportions of women who had ≥8 ANC visits and first ANC visit at ≤3 months gestation were 6.3% and 35.6% respectively. Women aged 35–39 at childbirth (aOR=3.99, 95% CI=1.30–12.23), middle wealth quintile women (aOR=3.22, 95% CI=1.01–10.27), women whose husbands had secondary (aOR=7.00, 95% CI=2.26–21.71) or higher (aOR=16.93, 95% CI=4.91–58.34) education were more likely to have ≥8 ANC visits. Early timing of first ANC visit was low among women with birth order 3–4 (aOR=0.63, 95% CI=0.46–0.85). Conversely, the likelihood of having early ANC visits was high among women whose pregnancies were intended (aOR=1.32, 95% CI=1.01–1.74), the richest women (aOR=3.89, 95% CI=2.30–6.57) and women whose husbands had secondary (aOR=2.41, 95% CI=1.70–3.64) or higher (aOR=3.12, 95% CI=2.40–7.46) education. The study highlights that age at childbirth, wealth, husband’s educational attainment, birth order and pregnancy intention could influence the utilization of ANC services among married women in Cameroon. Hence, to improve attendance and early initiation of ANC, interventions should be targeted at empowering women financially and removing all financial barriers associated with accessing ANC, improving ANC education among women and encouraging male involvement in ANC education.

In the light of changes in the living conditions of populations, excess adiposity is currently a serious public health problem worldwide. The aim of this study was to assess the changes in the body fat ratio among preschool children aged 3–7 years from Kraków, Poland, between 2008 and 2018. The study group consisted of children examined in two cross-sectional studies. Analysed characteristics included triceps, calf, subscapular, abdominal and suprailiac skinfold thicknesses, and adiposity calculated according to Slaughter’s equations. The trunk adiposity index and limbs-to-trunk fat ratio were also calculated. Statistical significance was obtained using two-way ANOVA and Tukey’s tests. Lower-limb adiposity was largest in the 2008 cohort and trunk adiposity was greater in the 2018 cohort. The mean values of the trunk adiposity index and limbs-to-trunk fat ratio were lower in the 2018 cohort than in the 2008 cohort. The 2018 cohort was also characterized by a lower overall adiposity. Regardless of the lower body adiposity percentage, in 2018 there was a tendency towards the central allocation of fat tissue. This is a negative phenomenon because, especially when co-existing with reduced lower-limb adiposity, it is associated with an increased risk of metabolic and cardiovascular diseases, even in young children.

The aim of this paper was to evaluate the socioeconomic differences in adult anthropometric parameters of young women in Poland. The study was cross-sectional and conducted in the years 2015 to 2018 among 1257 women aged 19–24 years. The heights, weights, wrist widths and waist, hip and chest circumferences of the subjects were measured. Body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), waist-to-chest ratio (WCR) and chest-to-height ratio (CHtR) were calculated. A survey was conducted to collect data on the women’s socioeconomic characteristics. The application of the Generalized Linear Model (GLM) including all socioeconomic indicators (urbanization level of place of residence in childhood, parental education, number of siblings, material conditions) revealed no significant association of these with any of the analysed anthropometric traits. The results of the logistic regression showed no significant differences in the risk of underweight, too low abdominal adiposity or too high abdominal adiposity. However, the risk of overweight and obesity was significantly affected by the degree of urbanization of the women’s place of residence in childhood and by their number of siblings. The results show that the socioeconomic factors that once had a significant influence on anthropometric traits currently do not play such an important role. This change can be explained by the equalization of living conditions and lifestyles of individual social groups in Poland.