Background: Within the continuum of reproductive health care, antenatal care (ANC) provides a platform for vital health care functions, such as disease prevention, health promotion, screening, and diagnosis. It has been widely confirmed that by implementing appropriate evidence-based practices, ANC can save lives. Previous studies investigated the utilization of ANC based on the four visits model. The new guidelines set by the World Health Organization 2016 recommended increasing contacts with health providers from four to eight contacts. The present study aims to determine the frequency, determinants, and socioeconomic inequalities of ANC utilization based on the eight or more contacts in Benin. This will provide information for policy makers to improve ANC utilization. Methods: We used a population-based cross-sectional data from Benin Demographic and Health Survey (BDHS)-2017-2018. The outcome variable considered for this study was coverage of ≥ 8 ANC contacts. About 1094 women of reproductive age who became pregnant after the new guideline of ≥ 8 ANC contacts was endorsed were included in this study. The determinants for ≥ 8 ANC contacts were measured using multivariable logistic regression. Concentration (Conc.) Index and Lorenz curves were used to estimate the socioeconomic inequalities of ≥ 8 ANC contacts. The level of significance was set at P < 0.05. Results: The coverage of ≥ 8 ANC contacts was 8.0%; 95%CI 6.5%, 9.7%. The results of timing of antenatal care initiation showed that women who had late booking (after 1st trimester) had 97% reduction in ≥ 8 ANC contacts compared with women who initiated ANC contacts within the first trimester (adjusted odds ratio (AOR) = 0.03; 95% CI 0.00, 0.21). In addition, women with medium or high enlightenment were 4.55 and 5.49 as more likely to have ≥ 8 ANC contacts, compared with women having low enlightenment (AOR = 4.55; 95% CI 1.41, 14.69 and AOR = 5.49; 95% CI 1.77, 17.00, respectively). Conc. Index for the household wealth-related factor was 0.33; p < 0.001 for urban women and 0.37; p < 0.001 for the total sample. Similarly, Conc. Index for maternal education was 0.18; p = 0.006 for urban women and 0.21; p < 0.001 for the total sample.

Background: Many underlying factors are assumed to contribute to the disparities in magnitude of childhood malnutrition. Notwithstanding, socioeconomic inequalities remain key measures to determine chronic and hidden hunger among under-five children. This study was undertaken to explore childhood malnutrition problems that are associated to household wealth-related and mother's educational attainment in sub-Saharan Africa (SSA). Methods: Secondary data from birth histories in 35 SSA countries was used. The Demographic and Health Survey (DHS) data of 384,747 births between 2008 and 2017 in 35 countries was analyzed. The outcome variables of interest were mainly indicators of malnutrition: stunting, underweight, wasting, overweight, anemia, and under-five children survival. Household wealth-related and mother's educational level were the measures of socioeconomic status. Concentration index and Lorenz curves were the main tools used to determine inequalities for nutritional outcomes. The statistical significance level was determined at 5%. Results: Based on the results, Burundi (54.6%) and Madagascar (48.4%) accounted for the highest prevalence of stunted children. Underweight children were 32.5% in Chad and 35.5% in Niger. Nigeria (16.6%) and Benin (16.4%) had the highest burdens of wasted children. Overall, overweight and under-five survival were significantly more in the higher household wealth, compared with the lower household wealth (Conc. Index = 0.0060; p < 0.001 and Conc. Index = 0.0041; p = 0.002 respectively). Conversely, stunting (Conc. Index = − 0.1032; p < 0.001), underweight (Conc. Index = − 0.1369; p < 0.001), wasting (Conc. Index = − 0.0711; p < 0.001), and anemia (Conc. Index = − 0.0402; p < 0.001) were significantly lower in the higher household wealth status, compared with the lower household wealth groups. Furthermore, under-five children survival was significantly more from mothers with higher educational attainment, compared with children from mothers with lower educational attainment (Conc. Index = 0.0064; p < 0.001). Conversely, stunting (Conc. Index = − 0.0990; p < 0.001), underweight (Conc. Index = − 0.1855; p < 0.001), wasting (Conc. Index = − 0.1657; p < 0.001), overweight (Conc. Index = − 0.0046; p < 0.001), and anemia (Conc. Index = 0.0560; p < 0.001) were significantly more among children from mothers with lower educational attainment. The test for differences between children from urban vs. rural was significant in stunted, underweight, overweight, and anemia for household wealth status. Also, the difference in prevalence between children from urban vs. rural was significant in stunted, underweight, and wasted for mother's educational attainment.

Background Skin-to-skin contact (SSC) between mother and the newborn brings many benefits including its potential to promote the survival of the newborn. Nevertheless, it is a practice that is underutilized in many resource-constrained settings including The Gambia where a high rate of maternal and child mortality has been reported. In this study, we examined the prevalence and determinants of mother and newborn SSC in The Gambia. Methods We used secondary data from The Gambia Multiple Indicator Cluster Survey (MICS)—2018. Data from 9205 women between 15-49 years who gave birth within 5 years of the survey was extracted for the analysis. Percentages and chi-square test were used for analyses. The significant variables from chi-square test were included in the multivariable binary logistic regression model to calculate the adjusted odds ratios (with corresponding 95% CI) of the factors associated with mother and newborn SSC. Results The results of this study showed that the national prevalence of mother and newborn SSC was 35.7%. Across local government areas; Mansakonko (47.8%) and Kerewan (44.2%) had the highest prevalence, while Basse (28.5%) and Brikama (26.5%) had the least prevalence of mother and newborn SSC in The Gambia. Based on results from the logit model, normal weight (at least 2.5 kg) children were 1.37 times as likely to have mother and newborn SSC, compared with the low birthweight (< 2.5 kg) children (OR = 1.37; 95% CI: 1.05, 1.78). In addition, there was 38% increase in the odds of rural women who reported mother and newborn SSC, compared with urban women (OR = 1.38; 95% CI: 1.06, 1.79). Women who delivered at health facility were 3.35 times as likely to have mother and newborn SSC, compared with women who delivered at home (OR = 3.35; 95% CI: 2.37, 4.75). Furthermore, women who initiated antenatal care (ANC) after the first trimester had 21% reduction in the odds of mother and newborn SSC, compared with women who initiated ANC within the first trimester (OR = 0.79; 95% CI: 0.68, 0.93). Conclusion The prevalence of mother and newborn SSC was low. In addition, geographical residence, birth weight, urban-rural residential status, place of delivery, and timing to ANC initiation were associated with mother and newborn SSC. There is a need to promote institutional based delivery using skilled birth attendance, promote early ANC initiation and healthy fetal growth.

Background: Child mortality has become a prominent public health issue in sub-Saharan Africa (SSA). The mortality rates can in part be translated to how communities meet the health needs of children and address key household and environmental risk factors. Though discussions on the trends and magnitude of child mortality continue as to strategize for a lasting solution, large gap exists specifically in family characteristics associated with child death. Moreover, household dynamics of child mortality in SSA is under researched despite the fact that mortality rates remain high. This study aimed to examine the influence of household structure on child mortality in SSA. Methods: Secondary data from birth histories in recent Demographic and Health Survey (DHS) in 35 SSA countries were used in this study. The total sample data of children born in the 5 years prior to the surveys were 384,747 births between 2008 and 2017. Unadjusted and adjusted Cox proportional hazard regression model was fitted to model infant and under-five mortality. The measure of association was hazard ratio (HR) with 95% confidence interval (CI). Statistical test was conducted at p < 0.05 level of significance. Results: Total infant mortality rates were highest in Sierra Leone (92 deaths per 1000 live births), Chad (72 deaths per 1000 live births) and Nigeria (69 deaths per 1000 live births), respectively. Furthermore, total rates of under-five mortality across 35 SSA countries were highest in Cameroon (184 deaths per 1000 live births), Sierra Leone (156 deaths per 1000 live births) and Chad (133 deaths per 1000 live births). The risk of infant mortality was higher in households of polygyny, compared with households of monogyny (HR = 1.23; CI 1.16, 1.29). Households with large number of children (3-5 and ≥ 6) had higher risk of infant mortality, compared with those with 1-2 number of children. Infants from mothers with history of multiple union had 16% increase in the risk of infant mortality, compared with those from mothers from only one union (HR = 1.16; CI 1.09, 1.24). Furthermore, under-five from female household headship had 10% significant reduction in the risk of mortality, compared with those from male household headship (HR = 0.90; CI 0.84, 0.96). The risk of under-five mortality was higher in households of polygyny, compared with monogyny (HR = 1.33; CI 1.28, 1.38). Households with large number of children (3-5 and ≥ 6) had higher risk of under-five mortality, compared with those with 1-2 number of children ever born. Under-five

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Background Cervical cancer is a prominently diagnosed form of cancer in several resource-constrained settings particularly within the sub-Saharan African region. Globally, Africa region has the highest incidence and mortality rates of cervical cancer. The high prevalence has been attributed to several factors including lack of awareness of the disease. The aim of this paper is to explore the prevalence and factors associated with awareness of cervical cancer among women of reproductive age in Republic of Benin and Zimbabwe, sub-Saharan Africa. Methods We used population-based cross-sectional data from Benin Demographic and Health Survey (BDHS) and Zimbabwe Demographic and Health Survey (ZDHS) respectively. BDHS 2017–18 and ZDHS - 2015 are the 5th and 6th rounds of the surveys respectively. About 15,928 and 9955 women aged 15–49 years were included in this study respectively. The awareness of cervical cancer among women of reproductive age in Benin and Zimbabwe was measured dichotomously; yes (if a woman heard of cervical cancer) vs. no (if a woman has not heard of cervical cancer). All significant variables from the bivariate analysis were included in the multivariable logistic regression model to calculate the adjusted odds ratios (AOR) with corresponding 95% confidence interval. Results While majority (79.2%) of women from Zimbabwe have heard about cervical cancer, only about one-tenth (10.2%) of their Beninese counterparts have heard about the disease. Advanced maternal age, having formal education, use of internet, having professional/technical/managerial occupation significantly increased the odds of awareness of cervical cancer after adjusting for other confounders. However, in Benin, women who resided in the rural area and those of Islamic belief had 20% (AOR = 0.80; 95%CI: 0.64, 0.99) and 35% (AOR = 0.65; 95%CI: 0.50, 0.86) reduction in the odds of awareness of cervical cancer respectively, when compared with women from urban residence and Christianity. Results from the predictive marginal effects showed that, assuming the distribution of all factors remained the same among women, but every woman is an urban dweller, we would expect 11.0 and 81.0% level of awareness of cervical cancer; If everywoman had higher education, we would expect 20.0 and 90% level of awareness of cervical cancer and if instead the distribution of other maternal factors were as observed and other covariates remained the same among women, but all women were in the richest household wealth quintile, we would expect about 11.0 and 83.0% level of awareness of cervical cancer, among women of reproductive age from Benin and Zimbabwe respectively. Conclusion The study has revealed that socio-demographical factors including geographical location and selected economic factors explained the inequality in distribution of women’s awareness on cervical cancer in both countries. Designing an effective population-based health education and promotion intervention programs on cervical cancer will be a great way forward to improving women’s awareness level on cervical cancer.

Background: Contraceptive use initiation and continuation is one of the major interventions for reducing maternal deaths worldwide. Nigeria aimed to achieve a 27% prevalence rate of modern contraceptive uptake by 2020, however, this seems to have remained unachieved. The objective of this study was to investigate when Nigerian women initiate contraceptive use and its associated factors, using nationally representative data. Methods: Data on 11,382 Nigerian women (aged 15-49 years) from the 2017 Performance Monitoring and Accountability 2020 (PMA2020) survey were used to determine the prevalence of lifetime contraceptive use. The Kaplan-Meier test was used to determine median time (years) to contraceptive uptake. In addition, the factors associated with contraceptive use were determined using multivariable logistic regression model. Statistical significance was determined at 5%. Results: The prevalence of modern contraceptive use was 14.2%. There were disparities in the timing (years) of contraceptive use initiation across several women's characteristics. Women from urban residence, highest household wealth index, nulliparous, unmarried, and highly educated women had the minimum median time (years) to contraceptive use initiation. The multivariable logistic model showed that rural women were 26% less likely to initiate contraceptive use, when compared with the urban dwellers (OR= 0.74; 95% CI: 0.65, 0.84). Furthermore, married women were 24% less likely to initiate contraceptive use, when compared with the unmarried (OR= 0.76; 95% CI: 0.63, 0.93). In addition, geographical region, wealth, television source, ever given birth, education, age, and religion were significantly associated with contraceptive use. Conclusion:The prevalence of contraceptive use is low in Nigeria. There were differences in contraceptive use initiation among women of reproductive age in Nigeria. There is a need to adopt sustainable strategies to improve contraceptive uptake and to re-iterate the benefits of contraception, including providing enlightenment programs among key populations such as the rural dwellers and low income earners.

Introduction: Tuberculosis remains a major public health issue in Nigeria with the country ranking seventh among the 30 high TB burden countries. Nigeria is among the three countries that account for half of the 4.3 million "missing" TB cases globally. One untreated TB case is able to infect about 10 -20 people annually. Hence, it is pertinent that TB is controlled effectively through the use of active case finding strategies to find the missing TB cases. Objective: This article highlights the best practices and key lessons learnt during the implementation of the active house to house TB case finding strategy in Nigeria. Lessons Learnt and Recommendations: Strategic community engagement, massive awareness creation using mass media and local means of communication, mapping of locations where registered TB cases live, to inform home visits for contact tracing and strengthening of laboratory systems, are viable mechanisms to improve TB case finding. Conclusion: Active TB case finding interventions should be implemented in the context of a strengthened diagnostics system, strategic community engagement and media involvement.