BackgroundGlobally postnatal care (PNC) of the newborn is being promoted as a strategy to reduce neonatal deaths, yet few studies have looked at associations between early PNC and neonatal outcomes in sub-Saharan Africa. In this study we look at the associations of PNC provided on day 1 and by day 7 of life by type of provider – skilled (doctor, midwife or nurse or unskilled (traditional birth attendant or community health worker) on neonatal death on days 2 to 7 and days 2 to 28.MethodsData from 10 African countries with recent (from 2009 onwards) Demographic and Health Surveys are pooled and used in a multilevel logistic regression analysis to study associations between the PNC variables with the mortality outcomes after controlling for relevant socioeconomic and maternal factors (including antenatal care, skilled delivery, tetanus immunization and ever breastfed).ResultsFindings indicate that PNC, whether provided by a skilled or unskilled provider, is protective against both neonatal death outcomes. Unskilled PNC on day 1was associated with a 32% decrease in the probability of death (compared to no PNC on day 1) during days 2 to 28 after controlling for other factors (OR: 0.68; 95% CI: 0.48, 0.97). Both skilled and unskilled PNC by day 7 were associated with reduced neonatal death during days 2 to 7 (Skilled: OR: 0.40; 95% CI 0.18, 0.88; Unskilled: OR 0.34; 95% CI 0.23, 0.52) and days 2 to 28 (Skilled: OR: 0.51; 95% CI 0.35, 0.75; Unskilled: OR 0.34; 95% CI 0.30, 0.38). There were also significant associations between four or more antenatal care visits and ever breastfed with both outcomes.ConclusionPNC is an important strategy to reduce neonatal death. While postnatal care by a skilled provider is a preferred strategy, PNC provided by unskilled providers can also serve as an intermediate implementation approach as countries strive to reach more newborns and save more lives.

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HIV disclosure is a gateway to HIV prevention - particularly among couples living in regions severely affected by the HIV epidemic. This cross-sectional study utilizes data collected from 862 people living with HIV across three countries (Ethiopia, Mozambique, and Uganda) in 2011 to determine the role of partner disclosure on self-reported health perceptions and changes in sexual risk behavior. The study's secondary aims are to understand whether or not internalized stigma mediates this relationship and if there is a different pattern of results by gender. The multivariate analysis reveals that the three key HIV-related independent variables, belonging to a support group, doing volunteer work, and disclosing to one's spouse or partner, were significantly associated with lower levels of internalized stigma. Internalized stigma was associated with self-perceptions of poorer health for both women and men, with women reporting higher levels of internalized stigma than men. Disclosure to spouse was positively associated with perceptions of better health for women but not for men. For men, doing HIV-related volunteer work and disclosing their status to their spouse were positively associated with self-reported changes in sexual risk behavior, although stigma was not found to mediate this relationship. Findings from this study suggest that disclosure and stigma have gender-specific effects on individual well-being and changes in sexual risk behaviors. As such, programs must address gender inequity in disclosure patterns and stigma to enhance prevention efforts.

Gender equality and education are being promoted as strategies to combat the HIV epidemic in Africa, but few studies have looked at the role of gender equality and education in the uptake of a vital service - HIV testing. This study looks at associations between education (a key input needed for gender equality) and key gender equality measures (financial decision-making and attitudes towards violence) with ever tested for HIV and tested for HIV in the past year. The study focused on currently married women ages 15–24 and 25–34 in three countries - Kenya, Zambia and Zimbabwe. The data came from the Demographic and Health Surveys (DHS). Logistic regression was used to study the role of gender equality and education on the HIV testing outcomes after controlling for both social and biological factors. Results indicated that education had a consistent positive relationship with testing for both age groups, and the associations were always significant for young women 15–24 (p<0.01). The belief that gender-based violence is unacceptable was positively associated with testing for women 25–34 in all three countries though the associations were only significant in Kenya (among women reporting ever being tested: OR 1.58, p<0.00; among women reporting being tested in the past year: OR 1.34, p<0.05) and Zambia (among women reporting ever being tested: OR 1.24, p<0.10; among women reporting being tested in the past year: OR 1.29, p< 0.05). High financial decision-making was associated with testing for women 25–34 in Zimbabwe only (among women reporting ever being tested: OR 1.66, p< 0.01). Overall the findings indicate that education and the promotion of gender equality are important strategies for increasing uptake of a vital HIV service, and thus are important tools for protecting girls and young women against HIV.

Not all depression scales are appropriate for use among adolescents given their unique developmental stage. An alternative cut point for depression classification could improve detection of depression among Zimbabwean adolescents.