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Double burden of malnutrition and associated factors among women of reproductive age in sub-Saharan Africa: a multilevel multinomial logistic regression analysis

Por: Seifu · B. L. · Mare · K. U. · Legesse · B. T. · Tebeje · T. M.
Background

Globally, malnutrition among women of reproductive age is on the rise and significantly contributing to non-communicable disease, deaths and disability. Even though the double burden of malnutrition (DBM) is a common problem among women in sub-Saharan Africa (SSA), there are limited studies examining the factors contributing to underweight, overweight, and obesity at the SSA level.

Objective

To determine the factors associated with the DBM, and their relative magnitude, among women of reproductive age in SSA.

Design

Cross-sectional study design.

Setting

33 SSA countries.

Participants

240 414 women of reproductive age.

Primary and secondary outcome measures

A multilevel multinomial logistic regression model was applied to identify factors associated with malnutrition. The adjusted relative risk ratio with 95% CI was used to declare the statistical significance of the association.

Results

The pooled prevalence of underweight, overweight and obesity among women in SSA were 8.87%, 16.47% and 6.10%, respectively. Women who are from rural residence and smoke cigarettes were more likely to be underweight. Conversely, women between the age of 24–34 and 35–49, who have higher education, belong to a middle and rich household, are ever married, have high parity, use contraceptives, have media exposure and smoke cigarettes were more likely to be overweight and/or obese.

Conclusion

The findings of our study suggest that certain factors such as residence, education status, wealth, marital status, occupation, cigarette smoking, and contraceptive use have a significant assocation with malnutrition among women. Therefore, it is important for public health programs aimed at preventing the double burden of malnutrition to focus on these factors through comprehensive public awareness and cost-effective operational health interventions.

Uptake of community health care provision by community health entrepreneurs for febrile illness and diarrhoea: a cross-sectional survey in rural communities in Bunyangabu district, Uganda

Por: van der Hoeven · M. · van Lettow · M. · Boonstra · P. · Hoekstra · T. · Rutebemberwa · E. · Tweheyo · R. · Kok · M. O.
Objective

To assess the uptake of services provided by community health workers who were trained as community health entrepreneurs (CHEs) for febrile illness and diarrhoea.

Design

A cross-sectional survey among households combined with mapping of all providers of basic medicine and primary health services in the study area.

Participants

1265 randomly selected households in 15 rural villages with active CHEs.

Setting

Bunyangabu district, Uganda.

Outcome measures

We describe the occurrence and care sought for fever and diarrhoea in the last 3 months by age group in the households. Care provider options included: CHE, health centre or clinic (public or private), pharmacy, drug shop and other. Geographic Information Ssystem (GIS)-based geographical measures were used to map all care providers around the active CHEs.

Results

Fever and diarrhoea in the last 3 months occurred most frequently in children under 5; 68% and 41.9%, respectively. For those who sought care, CHE services were used for fever among children under 5, children 5–17 and adults over 18 years of age in 34.7%, 29.9% and 25.1%, respectively. For diarrhoea among children under 5, children 5–17 and adults over 18 years of age, CHE services were used in 22.1%, 19.5% and 7.0%, respectively. For those who did not seek care from a CHE (only), drug shops were most frequently used services for both fever and diarrhoea, followed by health centres or private clinics. Many households used a combination of services, which was possible given the high density and diversity of providers found in the study area.

Conclusions

CHEs play a considerable role in providing care in rural areas where they are active. The high density of informal drug shops and private clinics highlights the need for clarity on the de facto roles played by different providers in both the public and private sector to improve primary healthcare.

The development of physical characteristics in adolescent team sport athletes: A systematic review

by Lars M. Tingelstad, Truls Raastad, Kevin Till, Live S. Luteberget

Background

Physical development during adolescence is crucial for athletes in team sports, as it prepares them for the high sport demands at the senior level. While physical development in non-athletes are well-documented, a comprehensive understanding of adolescent athletes’ development, including the potential effects of team sports participation and training load, is lacking.

Objectives

The study aimed to investigate the development of physical characteristics in team sport athletes during adolescence (12–20 years) and explore the impact of training load.

Methods

A systematic search of the databases PubMed, SPORTDiscus and Web of Science were conducted combining keywords related to physical characteristics, youth athletes, team sport and study design. Criteria for inclusion were: (1) team sport athletes aged 12–20 years, (2) cross-sectional or longitudinal designs investigating physical characteristics, (3) comparisons across different age groups, (4) peer-reviewed original article, (5) written in English, and (6) available results from physical testing. Results were normalized and weighted based on sample size.

Results

176 eligible articles were identified. The results showed consistent annual improvement in most physical characteristics from 12 to 16 years for both sexes (e.g., boys: lower body strength 14.3%; intermittent endurance 11%; countermovement jump height 6.7%; change of direction 2.8%; 30 m sprint 3.6%, and girls: lower body strength 9.4%; intermittent endurance 12.1%; countermovement jump 4.7%; change of direction 3.3%; 30 m sprint 1.9%). Only 4 studies investigated the effect of training load on physical development.

Conclusions

Although both sexes consistently improved through adolescence, girls tended to have less pronounced physical development compared to boys, likely due to lower increase in lean mass and limb length. The existing evidence do not definitively establish whether team sports participation, compared to studies examining non-athletes, or training load have an additive effect on physical development during this period.

Determinants of anemia level among reproductive-age women in 29 Sub-Saharan African countries: A multilevel mixed-effects modelling with ordered logistic regression analysis

by Kusse Urmale Mare, Setognal Birara Aychiluhm, Kebede Gemeda Sabo, Abay Woday Tadesse, Bizunesh Fentahun Kase, Oumer Abdulkadir Ebrahim, Tsion Mulat Tebeje, Getahun Fentaw Mulaw, Beminate Lemma Seifu

Background

Despite the implementation of different nutritional and non-nutritional interventions, 43% of reproductive-age women in Africa suffer from anemia. Recent evidence also shows that none of the Sub-Saharan African (SSA) countries are on the track to achieve the nutrition target of 50% anemia reduction by 2030. To date, information on the level of anemia and its determinants among reproductive-age women at the SSA level is limited. Thus, this study aimed to estimate the pooled prevalence of anemia level and its determinants in SSA countries.

Methods

We used a pooled data of 205,627 reproductive-age women from the recent demographic and health surveys of 29 SSA countries that were conducted between 2010–2021. A multilevel mixed-effects analysis with an ordered logistic regression model was fitted to identify determinants of anemia level and the deviance value was used to select the best-fitted model. First, bivariable ordinal logistic regression analysis was done and the proportional odds assumption was checked for each explanatory variable using a Brant test. Finally, in a multivariable multilevel ordinal logistic regression model, a p-value Results

The pooled prevalence of anemia among women of reproductive age in SSA was 40.5% [95% CI = 40.2%-40.7%], where 24.8% [95% CI: 24.6%-25.0%], 11.1% [95% CI = 10.9%-11.2%], and 0.8% [95% CI = 0.7%-0.8%] had mild, moderate, and severe anemia, respectively. The prevalence significantly varied from the lowest of 13% in Rwanda to the highest of 62% in Mali, and anemia was found as a severe public health problem (prevalence of ≥ 40%) in 18 countries. The regression result revealed that polygamous marriage, women and husband illiteracy, poor household wealth, shorter birth interval, non-attendance of antenatal care, underweight, unimproved toilet and water facilities, and low community-level women literacy were positively linked with high anemia level. Additionally, the likelihood of anemia was lower in women who were overweight and used modern contraception.

Conclusions

Overall results showed that anemia among women of reproductive age is a severe public health problem in SSA countries, affecting more than four in ten women. Thus, enhancing access to maternal health services (antenatal care and contraception) and improved sanitation facilities would supplement the existing interventions targeted to reduce anemia. Moreover, strengthening women’s education and policies regulating the prohibition of polygamous marriage are important to address the operational constraints.

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