Department of Biological Sciences
Permanent URI for this collectionhttps://dspace.njala.edu.sl/handle/20.500.144402/136
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Item Provincial distribution and factors associated with high completed fertility among married and cohabiting women aged 40–49 years in Sierra Leone: a cross-sectional study(Oxford University Press, 2025-02-17) Osborne, AugustusBACKGROUND: High completed fertility among married and cohabiting women has significant implications, such as burden on resources, exacerbating healthcare issues and educational and gender disparities. This study examined the provincial distribution and factors associated with high completed fertility among married and cohabiting women aged 40-49 y in Sierra Leone. METHODS: Data for the study were sourced from the 2019 Sierra Leone Demographic and Health Survey. Our study comprised 2253 married and cohabiting women aged 40-49 y in Sierra Leone. Geographic variations in high fertility were presented using a spatial map. A mixed-effect multilevel binary logistic regression analysis was performed to identify the factors associated with high completed fertility. The findings were presented as adjusted ORs (aOR) with 95% confidence intervals (CIs). RESULTS: The national prevalence of high completed fertility among married and cohabiting women in Sierra Leone was 61.7% (58.9-64.5). Women whose partners had secondary/higher education (aOR=0.54, 95% CI 0.33 to 0.89) had lower odds of high completed fertility than those with no formal education. Women in the Northern province (aOR=0.39, 95% CI 0.17 to 0.87) had lower odds of high completed fertility than those in the Eastern province. Women who indicated ≥6 as their ideal number of children had a higher (aOR=8.10, 95% CI 4.58 to 14.35) likelihood of experiencing high completed fertility compared with those whose ideal number of children was 0-3. Those who were using contraceptives at the time of the survey had a higher (aOR=2.09, 95% CI 1.28 to 3.41) likelihood of having high completed fertility compared with those who were not using contraceptives. Women in the poorer (aOR=1.70, 95% CI 1.07 to 2.72) and middle wealth index quintiles (aOR=2.09, 95% CI 1.29 to 3.41) had higher odds of high completed fertility than those in the poorest wealth index quintile. CONCLUSIONS: A significant proportion (>60%) of married and cohabiting women aged 40-49 y in Sierra Leone have high completed fertility. Partner's education, province, ideal number of children, use of contraceptives and wealth index were the factors associated with high completed fertility among women in Sierra Leone. Policymakers in Sierra Leone should increase access to and education on family planning methods to empower women to make informed choices about their fertility. The government and policymakers should support educational opportunities, particularly for men, because they are usually the heads of households and can influence fertility decisions. In-depth interviews should be conducted with women who use contraception to understand their motivations and experiences.Item Determinants of poor access to health care among women of reproductive age in Sierra Leone: a cross-sectional study(BioMed Central, 2025-02-05) Osborne, AugustusBACKGROUND: Sierra Leone, like many developing countries, faces challenges in ensuring equitable access to healthcare, particularly for women of reproductive age. This women has specific healthcare needs related to sexual and reproductive health, maternal health, and family planning. Despite improvements in national healthcare coverage, disparities persist, with women of reproductive age, especially those in rural areas and lower socio-economic brackets, experiencing significant barriers to accessing essential services. The study examined the factors associated with poor access to healthcare among women in Sierra Leone. METHODS: The study utilised the cross-sectional 2019 Sierra Leone Demographic Health Survey. The study included 15,574 women of reproductive age (15-49 years) in Sierra Leone. A mixed-effect multilevel binary logistic regression analysis was conducted, determining the factors associated with poor access to healthcare using a four-modeled approach. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI). RESULTS: From our study the proportion of poor access to healthcare was 71.9% \[69.7,74.0\] in Sierra Leone. Previously married women(divorced, separated, or widowed) \[aOR = 1.74; 95% CI: 1.30, 2.34\] had higher odds of poor access to healthcare than those never in a union. Women living in rural areas \[aOR = 1.88; 95% CI: 1.30, 2.71\] had higher odds of poor access to healthcare than those living in urban areas. Women with secondary \[aOR = 0.74; 95% CI: 0.62, 0.89\] and higher education \[aOR = 0.48; 95% CI: 0.34, 0.68\] had lower odds of poor healthcare access than those without education. Women who watch television \[aOR = 0.70; 95% CI: 0.56, 0.86\] had lower odds of poor access to healthcare than those who did not. Richer \[aOR = 0.57; 95% CI: 0.42, 0.79\] and Richest quintile women \[aOR = 0.45; 95% CI: 0.32, 0.65\] have lower odds of poor access to healthcare than women in the poorest quintile. Women living in the Western region \[aOR = 0.38; 95% CI: 0.22, 0.65\] have lower odds of poor access to healthcare than those living in the Eastern region. CONCLUSION: Our study revealed that poor access to healthcare is a significant issue in Sierra Leone. Women who were previously married (divorced, separated, or widowed), lived in rural areas, or had lower education levels faced higher odds of poor healthcare access. Conversely, women with higher education, greater wealth, watch television, and those residing in the Western region had significantly lower odds of poor healthcare access. These findings underscore the need for targeted interventions addressing socioeconomic, educational, and provincial disparities to improve healthcare access for women in Sierra Leone.Item Determinants of healthcare access among women aged 15–49 years in tanzania: a population-based cross-sectional survey(BioMed Central, 2025-12-14) Luoga, PankrasBACKGROUND: Globally, access to healthcare among women of reproductive age is among top most health agenda. In line with the endeavor, the government of Tanzania strive to ensure healthcare is accessible to every community member particularly women of reproductive age (15-49 years). However, there are limited scientific evidence on the proportion of women aged 15-49 who can access and the determinants of healthcare services in Tanzania. This study intended to fill the gap. METHODS: In this study, we analysed secondary information of a weighted sample 15,254 women aged 15-49 years collected using cross-sectional design during the 2022 Tanzania Demographic and Health Survey(TDHS). The binary dependent variable was healthcare access status and independent variables were women's social demographical characteristics. Descriptive analysis and multivariable modified Poisson regression analysis were performed. The p-value < 0.05 at 95% was set to determine the significant determinant. RESULTS: The proportion of women with access to healthcare in Tanzania, stand at 50.2%. After controlling for other covariates, the modified Poisson regression showed that women with secondary and higher education level (Adjusted Prevalence Ratio (APR);1.21,95%CI:1.12,1.30), women who are covered by health insurance (APR;1.18,95%CI:1.11,1.26), belonging to richest households (APR;1.62,95%CI:1.45,1.80), residing in southern zone (APR;1.32,95%CI:1.22,1.42) and women living in union (APR;1.10,95%C:1.05,1.16); had higher prevalence ratio of healthcare access compared to their counter parts. "Conversely, negative determinants of healthcare access included being aged 35-49 years (APR; 0.92; 95% CI: 0.88, 0.97), living in households with 5-6 members, and residing in rural areas (APR; 0.78; 95% CI: 0.73, 0.83). These groups had a lower prevalence of healthcare access compared to their counterparts. CONCLUSION: Only half of Tanzanian women of reproductive age had adequate healthcare access. Its positive determinants included having secondary and above education level, being covered by health insurance, belonging to richest households, residing in southern and coast zones and living in union. Negative determinants included residing in rural, coming from poor households and having no formal education. As a motive toward universal health coverage in Tanzania, the government should design targeted health interventions focusing on poor women in rural areas with low levels of education to improve the healthcare access for all.Item Barriers to healthcare services utilisation among women in Ghana: evidence from the 2022 Ghana Demographic and Health Survey(BioMed Central, 2025-02-25) Wongnaah, Florence GyembuzieBACKGROUND: Access to healthcare is vital to women's health outcomes, as emphasised in the Sustainable Development Goals. This study aimed to assess the factors associated with barriers to healthcare utilisation among women aged 15-49 years in Ghana. METHODS: Data from the 2022 Ghana Demographic and Health Survey was used for the study. The study included 15,014 women. Regional variations in the proportion of respondents with healthcare access were visualised using a spatial map. A multivariable binary logistic regression analysis was conducted. The results were presented as adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS: In Ghana, 53.6% \[51.7, 55.5\] of women reported barriers to healthcare utilisation. Women aged 25-29 years \[aOR = 1.245; 95% CI: 1.01, 1.53\] and 45-49 years \[aOR = 1.377; 95% CI: 1.04, 1.82\] had higher odds of facing barriers in healthcare services utilisation than those aged 15-19 years. The odds for experiencing barriers to healthcare utilisation were higher among women with two \[aOR = 1.290; 95% CI: 1.06, 1.56\], three \[aOR = 1.478; 95% CI: 1.20, 1.82\], and four or more children \[aOR = 1.306; 95% CI: 1.05, 1.63\], women of Ewe \[aOR = 1.325; 95% CI: 1.07, 1.63\], or Mole Dagbani ethnicity \[aOR = 1.512; 95% CI: 1.22, 1.87\] compared to those with no children and Akan women respectively. Lower odds were observed among women with higher education \[aOR = 0.642; 95% CI: 0.49, 0.84\], married \[aOR = 0.555; 95% CI: 0.47, 0.66\] or cohabiting women \[aOR = 0.646; 95% CI: 0.55, 0.76\], Muslims \[aOR = 0.770; 95% CI: 0.64, 0.92\], who watched Television \[aOR = 0.776; 95% CI: 0.68, 0.88\], and internet users \[aOR = 0.765; 95% CI: 0.67, 0.87\]. Those in the poorer \[aOR = 0.666; 95% CI: 0.54, 0.82\], middle \[aOR = 0.453; 95% CI: 0.36, 0.58\], richer \[aOR = 0.368; 95% CI: 0.28, 0.48\] and richest \[aOR = 0.247; 95% CI: 0.18, 0.34\] wealth quintile were less likely to experience barriers to healthcare services utilisation compared to the poorest. Regionally, women in Volta \[aOR = 0.478; 95% CI: 0.33, 0.68\], Bono \[aOR = 0.488; 95% CI: 0.32, 0.76\], and Upper East \[aOR = 0.382; 95% CI: 0.21, 0.71\] regions had lower odds of experiencing barriers to healthcare utilisation than those living in the Western region. CONCLUSION: A higher proportion of women in Ghana experience barriers to healthcare utilisation. Older age, higher parity, higher educational attainment or level, access to media, religion, ethnicity, wealth index, marital status, and geographical region were factors identified to be associated with barriers to healthcare utilisation in Ghana. It is recommended that policymakers prioritise interventions aimed at addressing regional disparities in healthcare infrastructure, improving geographic accessibility to healthcare services, and tackling socioeconomic, cultural, and social determinants of health. Efforts should focus on strengthening community-based healthcare initiatives, strengthening health insurance coverage, and promoting health education and literacy programs. These interventions can enhance health outcomes and promote health equity nationwide.