Individual and contextual socioeconomic determinants of knowledge of the ABC approach of preventing the sexual transmission of HIV in Nigeria: a multilevel analysis

Sexual Health ◽  
2013 ◽  
Vol 10 (6) ◽  
pp. 522 ◽  
Author(s):  
Olalekan A. Uthman ◽  
Gbenga A. Kayode ◽  
Victor.T. Adekanmbi
Keyword(s):  
Sexual Transmission ◽  
Wealth Index ◽  
Community Level ◽  
People Living With Hiv ◽  
Linear Regression Models ◽  
Individual Level ◽  
Sexual Transmission Of Hiv ◽  
The Individual ◽  
Multilevel Linear Regression ◽  
Hiv Aids

Background Nigeria has the highest number of people living with HIV/AIDS in the world after India and South Africa. HIV/AIDS places a considerable burden on society’s resources, and its prevention is a cost-beneficial solution to address these consequences. To the best of our knowledge, there has been no multilevel study performed to date that examined the separate and independent associations of individual and community socioeconomic status (SES) with HIV prevention knowledge in Nigeria. Methods: Multilevel linear regression models were applied to the 2008 Nigeria Demographic and Health Survey on 48 871 respondents (Level 1) nested within 886 communities (Level 2) from 37 districts (Level 3). Results: Approximately one-fifth (20%) of respondents were not aware of any of the Abstinence, Being faithful and Condom use (ABC) approach of preventing the sexual transmission of HIV. However, the likelihood of being aware of the ABC approach of preventing the sexual transmission of HIV increased with older age, male gender, greater education attainment, a higher wealth index, living in an urban area and being from least socioeconomically disadvantaged communities. There were significant community and district variations in respondents’ knowledge of the ABC approach of preventing the sexual transmission of HIV. Conclusion: The present study provides evidence that both individual- and community-level SES factors are important predictors of knowledge of the ABC approach of preventing the sexual transmission of HIV in Nigeria. The findings underscore the need to implement public health prevention strategies not only at the individual level, but also at the community level.

scholarly journals Individual and community-level factors influencing optimal breastfeeding: A multilevel analysis from a national survey study in Ethiopia

2019 ◽  
Author(s):  
Amanuel Hagos ◽  
Mache Tsadik ◽  
Abate Bekele ◽  
Afewerki Tesfahunegn
Keyword(s):  
Child Death ◽  
Random Effect ◽  
Wealth Index ◽  
Community Level ◽  
Survey Study ◽  
Hierarchical Level ◽  
Individual Level ◽  
Explanatory Variables ◽  
Variation Explained ◽  
The Individual

Abstract Background Optimal breastfeeding is critical for healthy growth. Despite this about 820,000 children and 20,000 women lost due to inappropriate breastfeeding each year globally. In Ethiopia, about 50,000 children lost related to malnutrition. Of these, about 18% of child death is contributed by poor breastfeeding habit. Many studies reported the individual-level factors; however, little is known about the determinants of breastfeeding at the hierarchical level. Therefore, this study aimed to identify factors associated with optimal breastfeeding among children age 0-5 month in Ethiopia using multilevel analysis.Methods A five-year representative survey study was conducted to assess the determinants of optimal breastfeeding among 1,087 children aged 0-5 months using the 2016 Ethiopian Demographic and Health Survey data (EDHS). Both bivariate and multivariable multilevel logistic regression analysis were done to identify significant explanatory variables. Fixed effect and random effect were done to estimate the association between the dependent and explanatory variable and to measure the variation explained by the higher level respectively.Results Among the total of 1,087 children, only 45.4% of optimally breastfed. Children aged 4-5 months (AOR =0.19; 95%CI: 0.12-0.27), children from richest wealth index (AOR=2.87; 95% CI: 1.53- 5.43), children born through cesarean section and residing in Afar region were found significantly associated with optimal breastfeeding. The random-effects showed that the variation between communities was statistically significant.Conclusion Both individual and community level factors play a significant role in shaping optimal breastfeeding. Future strategies and health interventions should target individual and community level factors that enhance optimal breastfeeding.

scholarly journals Development and Validation of a Multivariable Prediction Model for Missed HIV Healthcare Provider Visits in a Large United States Clinical Cohort

2021 ◽  
Author(s):  
April C Pettit ◽  
Aihua Bian ◽  
Cassandra O Schember ◽  
Peter F Rebeiro ◽  
Jeanne C Keruly ◽  
...  
Keyword(s):  
Prediction Models ◽  
Community Level ◽  
Research Network ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Individual Level ◽  
Visit Adherence ◽  
Level Data ◽  
Missed Visits ◽  
The Individual

Abstract Background Identifying individuals at high risk of missing HIV care provider visits could support proactive intervention. Previous prediction models for missed visits have not incorporated data beyond the individual-level. Methods We developed prediction models for missed visits among people living with HIV (PLWH) with ≥1 follow-up visit in the Center for AIDS Research Network of Integrated Clinical Systems from 2010-2016. Individual-level (medical record data and patient-reported outcomes), community-level (American Community Survey), HIV care site-level (standardized clinic leadership survey), and structural-level (HIV criminalization laws, Medicaid expansion, and state AIDS Drug Assistance Program budget) predictors were included. Models were developed using random forests with 10-fold cross-validation; candidate models with highest area under the curve (AUC) were identified. Results Data from 382,432 visits among 20,807 PLWH followed for a median of 3.8 years were included; median age was 44 years, 81% were male, 37% were Black, 15% reported injection drug use, and 57% reported male-to-male sexual contact. The highest AUC was 0.76 and strongest predictors were at the individual-level (prior visit adherence, age, CD4+ count) and community-level (proportion living in poverty, unemployed, and of Black race). A simplified model, including readily accessible variables available in a web-based calculator, had a slightly lower AUC of 0.700. Conclusions Prediction models validated using multi-level data had a similar AUC to previous models developed using only individual-level data. Strongest predictors were individual-level variables, particularly prior visit adherence, though community-level variables were also predictive. Absent additional data, PLWH with previous missed visits should be prioritized by interventions to improve visit adherence.

scholarly journals Exploring the determinants of exclusive breastfeeding among infants under-six months in Ethiopia using multilevel analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245034
Author(s):  
Shambel Aychew Tsegaw ◽  
Yeshimebet Ali Dawed ◽  
Erkihun Tadesse Amsalu
Keyword(s):  
Logistic Regression ◽  
Exclusive Breastfeeding ◽  
Odds Ratio ◽  
Maternal Employment ◽  
Wealth Index ◽  
Household Wealth ◽  
Community Level ◽  
Multilevel Logistic Regression ◽  
Individual Level ◽  
The Individual

Introduction Exclusive breastfeeding (EBF) is the safest and healthiest option of feeding among infants in the first 6 months throughout the world. Thus, the promotion of EBF is essential to prevent complex infant health problems even at the adulthood level. But the majority of previous studies focused on individual- level determinants of EBF by using basic regression models in localized areas. This study aimed to identify the determinants of EBF at the individual and community level which would be helpful to design appropriate strategies for improving the practice of EBF. Methods It is a secondary data analysis using the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total of 1185 infants under 6 months of age were included in the analysis. A Multilevel logistic regression model was employed to investigate factors significantly associated with EBF among under-six infants in Ethiopia. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to measure the association of variables whereas Intracluster correlation (ICC), median odds ratio (MOR), and proportional change in variance (PCV) were used to measure random effects (variation). Result In multilevel logistic regression; 4–5 months age infant (AOR = 0.04, 95%CI:0.02–0.07), female infants (AOR = 2.51, 95%CI:1.61–3.91), infant comorbidities (AOR = 0.35, 95%CI: 0.21–0.57), richest household wealth index (AOR = 10.34, 95%CI: 3.14–34.03) and antenatal care (AOR = 2.25, 95%CI:1.32–3.82) were individual- level determinants significantly associated with exclusive breastfeeding. Whereas, contextual region (AOR = 0.30, 95%CI: 0.10–0.87), community- level of postnatal visit (AOR = 2.77, 95%CI: 1.26–6.58) and community -level of maternal employment (AOR = 2.8, 95%CI: 1.21–6.47) were community level determinants significantly associated with EBF. The full model showed that46.8% of the variation of exclusive breastfeeding was explained by the combined factors at the individual and community levels. Similarly, it showed that the variation in exclusive breastfeeding across communities remained statistically significant (ICC = 8.77% and variance = 0.32 with P<0.001). Conclusion and recommendation Our study showed that both individual and community level determinants were significantly associated with EBF practice among under 6 infants. Based on our findings, it is recommended to promote and enhance antenatal and postnatal care services utilization of mothers to improve exclusive breastfeeding practice and more emphasis should be given to infants with comorbid conditions and those who were living in the pastoralist regions.

scholarly journals Predictors of Discrimination Towards People Living With HIV/ AIDS Among People Aged 15–49 Years in Ethiopia: A Multilevel Analysis

2020 ◽  
Author(s):  
Mastewal Arefaynie ◽  
Yitayish Damtie ◽  
Bereket Kefale ◽  
Melaku Yalew
Keyword(s):  
Statistical Significance ◽  
Wealth Index ◽  
Community Level ◽  
P Value ◽  
People Living With Hiv ◽  
Cross Sectional ◽  
Mixed Effect ◽  
Hiv Test ◽  
Living With Hiv ◽  
Hiv Aids

Abstract BackgroundThere is limited national representative evidence on determinants of discrimination towards people living with HIV/AIDS especially, community level factors are not investigated in Ethiopia. Thus, this study aimed to assess individual and community level factors associated with discrimination towards people living with HIV/AIDS among 15 to 49 age people in Ethiopia.MethodA secondary data analysis was done on the 2016 Ethiopian Demographic and Health Survey dataset which were collected cross-sectional. A total of 25,927 15 to 49 age people were included in the analysis. Multi-level mixed-effect logistic regression analysis was done by STATA version 14.0 to identify individual and community-level factors. Adjusted odds ratio with 95% confidence interval was used to show the strength and direction of association and statistical significance was declared at P value less than 0.05.Resultfrom individual variables, female [AOR=1.47, 95% CI= (1.18, 1.83)], rural dwellers [AOR=1.65, 95% CI= ( 1.23, 2.21)], not attend education[AOR=5.88,95% CI= (4.50, 7.67)], attending primary education [AOR=3.03, 95% CI= (2.40, 3.81)] and attending secondary education [AOR=1.48, 95% CI= ( 1.19, 1.82)] have discrimination attitude towards people living with HIV/AIDS. From community level factors, live in low proportion of educated communities [AOR=1.33, 95% CI= (1.01, 1.65)], live in low proportion of HIV tested communities [AOR=1.61, 95% CI= (1.33, 1.93)] were significantly associated with people living with HIV/AIDS.Conclusionsex of the respondent, religion, educational status, house hold wealth index, marital status, media exposure, internet use, HIV test status, region, residence, community level of education and community level of HIV test status have significant association with HIV related stigma in Ethiopia. Improving educational coverage, improving community level HIV/AIDS test coverage are important interventions to reduce discrimination towards people living with HIV/AIDS in the country.

scholarly journals Less than one-fifth of the mothers practised exclusive breastfeeding in the emerging regions of Ethiopia: a multilevel analysis of the 2016 Ethiopian demographic and health survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tsegaye Gebremedhin ◽  
Demiss Mulatu Geberu ◽  
Asmamaw Atnafu
Keyword(s):  
Health Survey ◽  
Exclusive Breastfeeding ◽  
Household Wealth ◽  
Community Level ◽  
Wealth Status ◽  
Individual Level ◽  
Factors Associated ◽  
Breastfeeding Practices ◽  
The Individual ◽  
Low Coverage

Abstract Background The burden of low coverage of exclusive breastfeeding (EBF) has a significant impact on the health of a newborn and also on the family and social economy in the long term. Even though the prevalence of EBF practices in Ethiopia is low, the practices in the pastoral communities, in particular, are significantly low and affected by individual and community-level factors. Besides, its adverse outcomes are mostly unrecognised. Therefore, this study aimed to assess the individual and community-level factors of low coverage of EBF practices in the emerging regions of Ethiopia. Methods In this analysis, data from 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A two-stage stratified sampling technique was used to identify 1406 children aged 0 to 23 months in the emerging regions of Ethiopia. A multilevel mixed-effect binary logistic regression analysis was used to determine the individual and community level factors associated with exclusive breastfeeding practices. In the final model, variables with a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were found to be statistically significant factors that affect exclusive breastfeeding practices. Results Overall, 17.6% (95% CI: 15.6–19.6) of the children aged 0 to 23 months have received exclusive breastfeeding. Employed mothers (AOR: 0.33, 95% CI: 0.21–0.53), richer household wealth status (AOR: 0.39, 95% CI: 0.16–0.96), mothers undecided to have more children (AOR: 2.29, 95% CI: 1.21–4.29), a child with a history of diarrhoea (AOR: 0.31, 95% CI: 0.16–0.61) were the individual-level factors, whereas Benishangul region (AOR: 2.63, 95% CI: 1.44–4.82) was the community-level factors associated with the exclusive breastfeeding practices. Conclusions Less than one-fifth of the mothers have practised exclusive breastfeeding in the emerging regions of Ethiopia. The individual-level factors such as mother’s employment status, household wealth status, desire for more children, presence of diarrhoea and community-level factors such as region have contributed to the low coverage of exclusive breastfeeding. Therefore, the federal and regional health bureaus and other implementers should emphasise to those emerging regions by creating awareness and strengthening the existing community-based health extension program to enhance exclusive breastfeeding practices.

Risk and vulnerability of key populations to HIV infection in Iran; knowledge, attitude and practises of female sex workers, prison inmates and people who inject drugs

Sexual Health ◽  
2014 ◽  
Vol 11 (6) ◽  
pp. 568 ◽  
Author(s):  
Razieh Khajehkazemi ◽  
AliAkbar Haghdoost ◽  
Soodabeh Navadeh ◽  
Hamidreza Setayesh ◽  
Leily Sajadi ◽  
...  
Keyword(s):  
Sex Workers ◽  
Female Sex Workers ◽  
People Who Inject Drugs ◽  
Sexual Transmission ◽  
Study Data ◽  
Prison Inmates ◽  
Female Sex ◽  
Comprehensive Knowledge ◽  
Sexual Transmission Of Hiv ◽  
Hiv Aids

Background In this study data of three national surveys conducted among female sex workers (FSW), prison inmates and people who inject drugs (PWID) were presented and compared in relation to knowledge, attitude, and practises. Methods: The surveys were conducted in 2009 and 2010 and included 2546 PWID, 872 FSW and 5530 prison inmates. Knowledge, attitude and practises towards HIV were measured through similar questions for each category. Results: Over 90% of all participants had ever heard of HIV/AIDS, although only approximately half of them perceived themselves at risk of contracting HIV. More than 80% were able to correctly identify the ways of preventing the sexual transmission of HIV; while more than two-thirds did not use condom in their last sexual contact. Approximately 20% of prisoners and FSW had a history of injecting drugs. Among all participants who have injected drugs, prisoners had the highest unsafe injecting behaviour at the last injection (61%), followed by FSW (11%) and PWID (3%). Conclusions: Despite major efforts to control the HIV epidemic in Iran, the level of risk and vulnerability among prisoners, FSW and PWID is still high. The level of comprehensive knowledge about HIV/AIDS is relatively good; however, their risk perception of contracting HIV is low and high-risk behaviours are prevalent. Therefore, HIV prevention programs should be redesigned in a more comprehensive way to identify the best venues to reach the largest number of people at a higher risk of contracting HIV and decrease their risk overlaps and vulnerability factors.

scholarly journals WHETHER INDIVIDUALISM MAKES PEOPLE FROM THE “WEST” HAPPIER AND COLLECTIVISM MAKES PEOPLE FROM THE “EAST” MORE SATISFIED IN LIFE: AN INDIVIDUAL-LEVEL ANALYSIS

2019 ◽  
Vol 128 (6B) ◽  
pp. 57
Author(s):  
Nguyễn Hữu An ◽  
Lê Duy Mai Phương
Keyword(s):  
Interpersonal Relationships ◽  
Well Being ◽  
Cultural Dimension ◽  
Subjective Well Being ◽  
Linear Regression Models ◽  
The West ◽  
Individual Level ◽  
Collectivistic Cultures ◽  
The Individual ◽  
Level Of Analysis

Determinants of the variation of happiness have long been discussed in social sciences. Recent studies have focused on investigating cultural factors contributing to the level of individual happiness, in which the cultural dimension of individualism (IND) and collectivism (COL) has been drawing the attention of a large number of scholars. At the cultural level of analysis, happiness is associated with personal achievements as well as personal egoism in individualistic cultures, while it is related to interpersonal relationships in collectivistic cultures. Empirical research yields unconventional results at the individual level of analysis, that is, individuals in collectivistic cultures favor IND to be happy, in contrast, people in individualistic cultures emphasize COL be satisfied in life. Using data from the fifth wave of the World Values Survey (WVS), this study takes the cultural dimension of IND and COL at the individual level of analysis to detect its effects on happiness (conceptualized as subjective well-being – SWB) in the comparison between the two cultures. Multiple linear regression models reveal results that individuals from the “West” experience greater happiness when they expose themselves less individualist, while, individuals from the “East” feel more satisfied and happier in their life when they emphasize more on IND or being more autonomous.

“Do I need to use condoms if I’m taking my meds?”

HIV ◽  
2020 ◽  
pp. 45-54
Author(s):  
Robert K. Bolan
Keyword(s):  
Viral Load ◽  
Sexual Transmission ◽  
Hiv Treatment ◽  
Load Testing ◽  
Hiv Replication ◽  
Viral Load Testing ◽  
Sexual Transmission Of Hiv ◽  
The Individual ◽  
Exposure Prophylaxis ◽  
Living With Hiv

It has been conclusively proven that sexual transmission of HIV does not occur if the individual living with HIV is adherent to antiretroviral therapy and HIV replication is consistently maintained below a plasma level of 200 copies/mL. What remains to be defined is the frequency of viral load testing to provide assurance that HIV is suppressed and how long must it remain so until suppression can be considered durable. This is required in order to provide guidance for HIV pre-exposure prophylaxis (PrEP) use by a sexual partner who is not living with HIV. Based on currently published studies and until more data are presented, it seems prudent to recommend that sexual partners of individuals living with HIV who are highly adherent to treatment use PrEP for 6 months to 1 year following initiation of HIV treatment and that viral load testing be performed quarterly for at least the first 2 years in the partner living with HIV.

scholarly journals Individual-level and community-level factors associated with the family planning use among pastoralist community of Ethiopia: a community-based cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036519 ◽  
Author(s):  
Mussie Alemayehu ◽  
Araya Abrha Medhanyie ◽  
Elizabeth Reed ◽  
Afework Mulugeta
Keyword(s):  
Family Planning ◽  
Cross Sectional Study ◽  
Married Women ◽  
Community Level ◽  
Sectional Study ◽  
Community Based ◽  
Cross Sectional ◽  
Individual Level ◽  
Pastoralist Community ◽  
The Individual

ObjectiveThe study aimed to identify the effects of the individual-level and community-level factors on the use of family planning (FP) among married women in the pastoralist community of Ethiopia.DesignA community-based cross-sectional study was conducted in September 2018. Data were analysed using R software. To determine the fixed effect of individual-level and community-level factors of FP use, a two-level mixed-effects logistic regression was used. The result was described using the Adjusted OR (AOR), and the variance partition coefficient.Setting and participantsAfar, Ethiopia (2018; n=891) married women of reproductive age (15–49) years.Primary outcome measuresFP use or non-use.ResultsThe current use of FP was 18.7% (16.31%–21.43%). Women who need to walk 1 hour and more to the nearest health facility (AOR 0.14, 95% CI 0.05 to 0.3), have ANC visit of 4 and above (AOR 6.02, 95% CI 1.74 to 20.8), had their last birth at a health facility (AOR 2.71 95% CI 1.27 to 5.81), have five and more children (AOR 4.71, 95% CI 1.86 to 11.9), have high knowledge on FP (AOR 2.74, 95% CI 1.11 to 6.74) and had high intentions to use FP (AOR 10.3, 95% CI 3.85 to 27.6) were more likely to report FP use. The magnitude of the effect of for FP use was smaller than that of 9 of the 13 individual factors. Apart from this 19.4% of the total variance in the odds of using FP attributed to between community difference (intraclass correlation coefficient=0.194). Regarding the community-level characteristics, clusters of having higher electronic media possession (AOR 2.84, 95% CI 1.2 to 6.72) and higher women decision making on FP (AOR 8.35, 95% CI 2.7 to 27.1) were significantly associated with increased FP use compared with clusters with lower reports of these aspects.ConclusionFP use among the pastoralist community is influenced by both individual cluster/community-level characteristics or factors. Even though the effect of clustering in FP use was large in comparison with the unexplained between-cluster variation, it was lower than the individual-level factors.Trail registrtion numberNCT03450564

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