We investigated birth-interval dynamics in 24 African countries using data from 76 Demographic and Health Surveys conducted since 1986. Controlling for selection bias in the birth-history data using the Brass-Juárez method and regression models produced almost identical results. Birth intervals have lengthened in every country examined. This analysis uncovered a distinctive and previously undocumented pattern of childbearing that is prevalent across sub-Saharan Africa. After allowing for time trends in birth-interval length, the lengthening of birth intervals in almost every country varies little by women's age or parity. Moreover, in several countries, birth intervals are now too long to be explicable by birth spacing contingent on the age of women's youngest child. Rather, women are postponing births for other reasons. These findings offer empirical support for the idea that the fertility transition in sub-Saharan Africa is following a different pattern from that observed elsewhere.

BackgroundLow use of maternal health services, as well as poor quality care, contribute to the high maternal mortality in sub-Saharan Africa (SSA). In particular, poor person-centered maternity care (PCMC), which captures user experience, contributes both directly to pregnancy outcomes and indirectly through decreased demand for services. While many studies have examined disparities in use of maternal health services, few have examined disparities in quality of care, and none to our knowledge has empirically examined disparities in PCMC in SSA. The aim of this study is to examine factors associated with PCMC, particularly the role of household wealth, personal empowerment, and type of facility.MethodsData are from a survey conducted in western Kenya in 2016, with women aged 15 to 49 years who delivered in the 9 weeks preceding the survey (N = 877). PCMC is operationalized as a summative score based on responses to 30 items in the PCMC scale capturing dignity and respect, communication and autonomy, and supportive care.ResultsWe find that net of other factors; wealthier, employed, literate, and married women report higher PCMC than poorer, unemployed, illiterate, and unmarried women respectively. Also, women who have experienced domestic violence report lower PCMC than those who have never experienced domestic violence. In addition, women who delivered in health centers and private facilities reported higher PCMC than those who delivered in public hospitals. The effect of employment and facility type is conditional on wealth, and is strongest for the poorest women. Poor women who are unemployed and poor women who deliver in higher-level facilities receive the lowest quality PCMC.ConclusionsThe findings imply the most disadvantaged women receive the lowest quality PCMC, especially when they seek care in higher-level facilities. Interventions to reduce disparities in PCMC are essential to improve maternal outcomes among disadvantaged groups.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3183-x) contains supplementary material, which is available to authorized users.

In countries where child marriage remains widespread, concerted efforts are underway to eliminate it, but overall progress remains uneven and slow. One in three Zimbabwean girls marries by age 18. To inform the country’s efforts to reduce child marriage, data from 5,542 women aged 20 to 24 years in the 2005-2006, 2010-2011, and 2015 Zimbabwe Demographic and Health Surveys are used to examine individual-, household-, and cluster-level correlates. Cumulative incidence functions first document changes over time, and multilevel models are used to explore correlates. Although prevalence is high, younger cohorts were less likely to marry young. A woman’s education, wealth quintile, religion, and provincial residence correlated with marrying as a child. Cluster-level female schooling, number of children ever born, and proportions using contraceptives were also correlated with child marriage. Efforts should promote socioeconomic well-being and target cultural practices promoting the practice. Interventions targeting at-risk women should complement universal approaches to combating child marriage.

Background The Florida Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program delivers evidence-based home visiting services to over 1400 families each year. Home visitors are integral in providing resources for families to promote healthy pregnancy, child development, family wellness, and self-sufficiency. Due to the nature of this work, home visitors experience work-related pressures and stressors that can impact staff well-being and retention. Objectives The purpose of this study was to understand primary sources of work-related stress experienced by home visitors, subsequent effects on their engagement with program participants, and to learn of coping mechanisms used to manage stress. Methods In 2015, Florida MIECHV program evaluators conducted ten focus groups with 49 home visitors during which they ranked and discussed their top sources of work-related stress. Qualitative analysis was conducted to identify emergent themes in work-related stressors and coping/supports. Results Across all sites, the burden of paperwork and data entry were the highest ranked work-related stressors perceived as interfering with home visitors’ engagement with participants. The second-highest ranked stressors included caseload management, followed by a lack of resources for families, and dangerous environments. Home visitors reported gratification in their helping relationships families, and relied on coworkers or supervisors as primary sources of workplace support along with self-care (e.g. mini-vacations, recreation, and counseling). Conclusions for practice Florida MIECHV home visitors across all ten focus groups shared similar work-related stressors that they felt diminished engagement with program participants and could impact participant and staff retention. In response, Florida MIECHV increased resources to support home visitor compensation and reduce caseloads, and obtained a competitive award from HRSA to implement a mindfulness-based stress reduction training statewide.

Objective: High-quality scientific evidence underpins public health decision making. The Centers for Disease Control and Prevention (CDC) agency provides scientific data, including during public health emergencies. To understand CDC’s contributions to COVID-19 science, we conducted a bibliometric evaluation of publications authored by CDC scientists from January 20, 2020, through January 20, 2022, by using a quality improvement approach (SQUIRE 2.0). Methods: We catalogued COVID-19 articles with ≥1 CDC-affiliated author published in a scientific journal and indexed in the World Health Organization’s COVID-19 database. We identified priority topic areas from the agency’s COVID-19 Public Health Science Agenda by using keyword scripts in EndNote and then assessed the impact of the published articles by using Scopus and Altmetric. Results: During the first 2 years of the agency’s pandemic response, CDC authors contributed to 1044 unique COVID-19 scientific publications in 208 journals. Publication topics included testing (n = 853, 82%); prevention strategies (n = 658, 63%); natural history, transmission, breakthrough infections, and reinfections (n = 587, 56%); vaccines (n = 567, 54%); health equity (n = 308, 30%); variants (n = 232, 22%); and post–COVID-19 conditions (n = 44, 4%). Publications were cited 40 427 times and received 81 921 news reports and 1 058 893 social media impressions. As the pandemic evolved, CDC adapted to address new scientific questions, including vaccine effectiveness, safety, and access; viral variants, including Delta and Omicron; and health equity. Conclusion: The agency’s COVID-19 Public Health Science Agenda helped guide impactful scientific activities. CDC continues to evaluate COVID-19 priority topic areas and contribute to development of new scientific work. CDC is committed to monitoring emerging issues and addressing gaps in evidence needed to improve health.