The Influence of Contextual Factors on Maternal Healthcare Utilization in sub-Saharan Africa: A Scoping Review of Multilevel Models

Simona, Simona; Lumamba, Casildah; Moyo, Felicitas; Ng’andu, Emily; Phiri, Million

doi:10.1101/2022.03.15.22272437

Cited by 16 publications

(15 citation statements)

References 68 publications

(216 reference statements)

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“…This could also be the reason for high prevalent rates of teenage pregnancy and teenage marriages in sub-Saharan Africa where almost one third of teenagers are out of school [40]. Literate women are expected to have better access to sexual education and be better informed about sexual, health and reproductive rights that help them to avoid early and risky behaviours [41][42][43][44].…”

Section: Discussionmentioning

confidence: 99%

A multilevel analysis of trends and predictors associated with teenage pregnancy in Zambia (2001–2018)

et al. 2023

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Background Teenage pregnancy remains a major social and public health challenge in developing countries especially sub-Saharan Africa (SSA) where prevalence rates are still increasing. Even if considerable effort has been made over the years to study determining factors of teenage pregnancy in SSA, few studies have looked at the trends and associated factors over a longer period. Furthermore, no known study has focussed on both individual and contextual factors influencing teenage pregnancy in Zambia. This study, thus sought to fill this gap in knowledge by simultaneously investigating trends of teenage pregnancy as well as its individual and contextual determining factors. Methods A total pooled weighted sample of 10,010 teenagers (in the age group 15–19) from four waves of the Zambia Demographic and Health Surveys were extracted. Using bivariate analysis, we investigated the trends of teenage pregnancy between 2001 and 2018. Separate multilevel logistic regression models were fitted on pooled teenage pregnancy data in relation to several individual and contextual level factors. Both fixed and random effects were produced. Bayesian parameter estimates were produced using lme4 package in R statistical programming environment. Results Results of the trends of teenage pregnancy in Zambia have shown an overall decrease of 2% between 2001 and 2018. Almost all the socioeconomic and demographic variables were consistently associated with teenage pregnancy (p < 0.001) in a bivariate analysis across the four survey. In multilevel analysis, the odds of being pregnant were higher for teenagers who were employed (aOR = 1.21, 95% CI: 1.02–1.42), married (aOR = 7.71, 95% CI: 6.31–9.52) and those with knowledge of ovulation period (aOR = 1.58, 95% CI: 1.34–1.90). On the other hand, belonging to households in high wealth quintiles, being literate, exposure to mass-media family planning messages and delayed sexual debut were associated with decreased odds of teenage pregnancy. Conclusion The study shows that teenage pregnancy remains a social and public health challenge in Zambia as the country has seen little decrease in the prevalence over the years under consideration. Factors associated with teenage pregnancy include marital status, and employment, knowledge of ovulation period, wealth quintile, sexual debut and exposure to mass-media family planning messaging. Concerted effort must be made to improve literacy levels, reduce poverty and enhance sexual health promotion through the mass media in view of cultural norms, which may prevent parents and children from discussion sexual education topics thus exacerbate the vice.

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Section: Discussionmentioning

confidence: 99%

A multilevel analysis of trends and predictors associated with teenage pregnancy in Zambia (2001–2018)

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“…Cultural dimension of empowerment has to do with access to symbolic and information resources to be used as the basis for action and this may include but limited to educational attainment (Dyson and Moore, 1983). Some of the dimensions of empowerment have been used to examine the influence of various structural, social, economic and demographic factors on maternal health care health care in sub-Saharan Africa (Simona et al, 2022). This study extends existing literature by distinguishing the conceptualisation of women empowerment from gender relations and examining the relationship between both concepts and maternal health care utilisation.…”

Section: Women Empowerment and Maternal Healthcare Utilisationmentioning

confidence: 99%

“…Some of the dimensions of empowerment have been used to examine the influence of various structural, social, economic and demographic factors on maternal health care health care in sub-Saharan Africa (Simona et al, 2022). This study extends existing literature by distinguishing the conceptualisation of women empowerment from gender relations and examining the relationship between both concepts and maternal health care utilisation.…”

Section: Introductionmentioning

confidence: 99%

Gender Relations, Women Empowerment and Maternal Health Care in sub-Saharan Africa: A Bayesian Multilevel Analysis

Simona

2022

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Maternal health care utilization still remains crucial in ensuring good pregnancy outcomes and a reduction in maternal and child mortality especially in developing countries. Although several studies have been conducted to investigate determinants of maternal health care utilization, the innfluence of gender relations and women empowerment on maternal healthcare in cross-national context has received little attention. This paper sought out to examine the influence of gender relations and women empowerment on maternal healthcare utilization in sub-Saharan Africa. The analysis pools sample data of 245,955 respondents from the most recent Demographic and Health Surveys (DHS) and World Development Indicators of 35 sub-Saharan African countries. Separate Bayesian multilevel logistic regression models are fitted for adequate antenatal care and institutional delivery in relation to several factors indicating gender relations and women empowerment at three levels. Several components of gender relations and women empowerment were significantly associated with maternal health care after adjusting for covariates. In addition, significant between country and between community variations in the odds of maternal health care utilisation were observed. These results underscore the importance of prioritising contextual gender equity and women empowerment to achieve better utilisation of maternal healthcare services and subsequently, a reduction in maternal mortality in sub-Saharan Africa.

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“…In 2013, 31.4% of women aged 20–24 reported to have been married before age 18 [ 1 , 9 , 10 ]. The prevalence is significantly higher in rural areas than in urban areas [ 9 , 36 , 37 ]. We therefore conducted this study to investigate individual and community-factors associated with child marriage in Zambia.…”

Section: Introductionmentioning

confidence: 99%

Individual and Community-level factors associated with early marriage in Zambia: a mixed effect analysis

et al. 2023

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Background Child marriage has long been a public health concern around the world, because it has the potential to deprive adolescent girls of their sexual reproductive health rights and limits their ability to reach their full potential in life. The prevalence of child marriage has been consistently higher in sub-Saharan Africa than elsewhere. However, fewer studies have explored the influence of both individual and community-level influences on early marriage in sub-Saharan Africa. This study, therefore, examined individual and community-level factors associated with child marriages in Zambia. Methods Data came from the Zambia Demographic and Health Surveys (ZDHS) conducted in 2007, 2013–14 and 2018. A pooled weighted sample of 9990 women aged 20–29 years was used in the analysis. Stata software version 17 was used to perform statistical analysis, taking into account complex survey design. The association between individual- and community- level factors and early marital behavior was assessed using multilevel logistic regression models. Results The prevalence of child marriage among women aged 20–29 was 44.4 percent (95% CI: 42.1, 46.7) in 2018, declining from 51.5 percent (95% CI: 48.9, 54.0) in 2007. Women with secondary or higher level of education [aOR = 0.36, 95% CI = 0.26–0.49] and [aOR = 0.07, 95% CI = 0.03–0.18] and those whose age at first birth was (15–19 year) or (20–29 years) were associated with less likelihood of experiencing child marriage. Communities with a high percentage of women who gave birth at a young age [aOR = 1.36, 95% CI = 1.15–1.62] were more likely to experience child marriage. Individual and community-level characteristics accounted for 35% of the overall variations in communities' likelihood of experiencing early marriage. Even after controlling for both individual and community-level influences, the intra-class correlation revealed that around 4.5 percent of the overall variations remained unexplained. Conclusion Prevalence of child marriage has reduced over the years but is still high in Zambia. Both individual and community- level factors influenced child marriage in Zambia. There is a need to strengthen strategies that keep girls in school to delay their exposure to early sexual debut and child marriage. Designing of reproductive health interventions in the country should consider integration of community factors such as economic insecurity and access to reproductive health information.

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The Influence of Contextual Factors on Maternal Healthcare Utilization in sub-Saharan Africa: A Scoping Review of Multilevel Models

Cited by 16 publications

References 68 publications

A multilevel analysis of trends and predictors associated with teenage pregnancy in Zambia (2001–2018)

A multilevel analysis of trends and predictors associated with teenage pregnancy in Zambia (2001–2018)

Gender Relations, Women Empowerment and Maternal Health Care in sub-Saharan Africa: A Bayesian Multilevel Analysis

Individual and Community-level factors associated with early marriage in Zambia: a mixed effect analysis

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