African Journal of Reproductive Health <p><em>African Journal of Reproductive Health (AJRH)</em>&nbsp;is published by the Women’s Health and Action Research Centre (WHARC). It is a multidisciplinary and international journal that publishes original research, comprehensive review articles, short reports and commentaries on reproductive health in Africa. The journal strives to provide a forum for African authors, as well as others working in Africa, to share findings on all aspects of reproductive health, and to disseminate innovative, relevant and useful information on reproductive health throughout the continent.</p> <p><em>AJRH</em>&nbsp;is indexed and included in Index Medicus/MEDLINE. The abstracts and tables of contents are published online by INASP at while full text is published at&nbsp;<a title="" href="" target="_blank" rel="noopener"></a>&nbsp;and by Bioline International at&nbsp;<a title="http://www.bioline" href="" target="_blank" rel="noopener">http://www.bioline</a>. It is also abstracted in&nbsp;<em>Ulrich’s Periodical, Feminist Periodicals African Books Publishing Records.</em></p> <p>La Revue Africaine de santé de la Reproduction (RASR) est publiée par le Women’s Health and Action Research Centre (WHARC). C’est une revue à la fois pluridisciplinaire et internationale qui publie des articles de recherche originaux, des articles de revue détaillés, de brefs rapports et des commentaires sur la santé de la reproduction en Afrique. La Revue s’efforce de fournir un forum aussi bien à des auteurs africains qu'a des professionels qui travaillent en Afrique, afin qu'ils puissent partager leurs découvertes dans tous les aspects de la santé de reproduction et diffuser à travers le continent, des informations innovatrices, pertinentes et utiles dans ce domaine de santé de la reproduction.</p> <p>La R<em>ASR&nbsp;</em>est indexée et figure sur I’Index Medicus/MEDLINE. Les résumés et les tables des matières sont publiés en ligne par INASP sur le site web&nbsp;<a title="" href="" target="_blank" rel="noopener"><em>http:</em>//<em>ajol&nbsp;</em></a>tandis que le texte est publié à&nbsp;<a title="" href="" target="_blank" rel="noopener"></a>&nbsp;par Bioline International sur le site web&nbsp;<em><a title="" href="" target="_blank" rel="noopener"></a>.&nbsp;</em>Il est également résumé dans&nbsp;<em>Ulrich Periodical, feminist Periodical et African Books Publishing Records</em></p> Published by: Women’s Health and Action Research Centre (WHARC) en-US African Journal of Reproductive Health 1118-4841 <p>Copyright for articles published in this journal is retained by Women's Health and Action Research Centre (WHARC).</p> Human papilloma virus (HPV) vaccine and cervical cancer prevention in Africa <p>No abstract.</p> Friday Okonofua Lindsay Edouard Maradona Isikhuemen Copyright (c) 2024 2024-01-08 2024-01-08 27 12 9 14 10.4314/ajrh.v27i12. Determinants of option B+ treatment adherence among HIV-positive breastfeeding women in Zimbabwe <p>Zimbabwe is one of the countries in sub-Saharan Africa with the highest prevalence of HIV. Despite the launch of the Option B+ treatment approach in 2013 to eliminate mother-to-child transmission, the number of pregnant women and children living with HIV is still high due to non-adherence. This prompted this study with the aim to explore the determinants of adherence to Option B+ HIV treatment among HIV-positive breastfeeding women. This descriptive phenomenological study explored the lived experiences of 12 purposively recruited HIV-positive breastfeeding women in 2020 through in-depth interviews. The collected data were analysed using Colaizzi’s phenomenological data analysis framework. The study findings revealed that client-related factors such as food insecurity, travel, early infant diagnosis, and treatment-related factors such as the unavailability of drugs, the side effects of medications, and health institution-related factors are barriers to adherence among HIV-positive breastfeeding women. The findings also indicated that support from the family, health care workers, awareness of the benefits of the treatment plan, and positive role models are promoters of adherence. To improve breastfeeding women's adherence to Option B+ HIV treatment, the identified barriers to adherence should be addressed while optimising the motivators of adherence.</p> Patricia M. Dhlakama Ayobami P. Adekola Azwihangwisi H. Mavhandu-Mudzusi Copyright (c) 2024 2024-01-08 2024-01-08 27 12 15 26 10.4314/ajrh.v27i12. Gender disparity in access to education, under-5 mortality, and economic growth in sub-Saharan Africa <p>This paper empirically analyses the impact of gender disparity in access to education and under 5 mortality on economic growth in selected sub-Saharan African (SSA) countries from the period 2005 – 2020. The study engaged a panel data of 17 selected SSA countries sourced from the World Development Indicators (WDI) and the United Nations Institute for Statistics (UNIS) and applied the instrumental variable generalised method of moments analytical approach. The result shows that the interaction between gender parity in access to education and primary school enrolment has a significant impact on economic growth. The study concludes that policies to promote gender parity in access to education would be of paramount importance to increase economic growth towards the actualisation of sustainable development goal related to inclusive and equitable quality education and the promotion of lifelong learning opportunities (SDG4) in SSA countries.</p> Lin Wang Mya Nwabuoku Jin Zhang Romanus Osabohien Copyright (c) 2024 2024-01-08 2024-01-08 27 12 27 35 10.4314/ajrh.v27i12. Relationship between placental location and fetal gender using ultrasonography: A prospective study from the Maternity and Children’s Hospital, Najran, Saudi Arabia <p>The study was a prospective cross-sectional design and was carried out at the Maternity and Children’s Hospital in Najran, Saudi Arabia on 142 pregnant women. The objective of the study was to establish, utilising ultrasound scan, whether there is any link between the site of the placenta and the gender of the fetus<strong>. </strong>A higher percentage of female fetuses were identified. The majority of placentas (73, 51.4%) were found to be anterior, of which 66 (46.5%) and 7 (4.9%) were present in female and male fetuses, respectively. 58 (40.8%) placentas were noted to be posterior, i.e. females, 10 (7.0%); males, 48 (33.8%). 10 (7.0%) placentas were high, a position which was equally prevalent in both genders, i.e. females, 5 (3.5%); males 5 (3.5%), and 1 (0.7%), in a male fetus, was low-lying. A significant correlation between placental site and the gender of the fetus was revealed by the chi-squared test (p &lt; 0.05) the sensitivity of ultrasound in predication fetal gender was 95.1%. The outcome reveals a noteworthy association between the position of the placenta and the gender of the fetus.</p> Nagla H.M. Khalid Jihan I. Babiker Samia A. Fathelrahman Copyright (c) 2024 2024-01-08 2024-01-08 27 12 36 42 10.4314/ajrh.v27i12. Experiences of pressure to have children among mothers in Accra, Ghana <p>Pregnancy and childbirth are viewed as both an event and a marker of womanhood and a key reason for marriage in Ghana. Consequently, women often encounter substantial pressure to have a child, particularly within the context of marriage. Drawing on semi-structured interviews with thirteen women in Ghana, this study explores the pressure to have a child irrespective of fertility status. The study demonstrates that community members consistently scrutinize and assess the bodies of participants, remaining vigilant for any signs indicating pregnancy. Additionally, women experience both internal and external pressures to have children. Interestingly, not all participants desired immediate pregnancy after marriage, and some were not entirely content upon discovering their first pregnancy. The findings underscore the necessity for public education aimed at shifting the responsibility placed on women to bear children. There is a crucial need to educate individuals to refrain from intrusive behaviors such as questioning why a woman has not yet given birth.</p> Elizabeth Y. Odoi Copyright (c) 2024 2024-01-08 2024-01-08 27 12 43 50 10.4314/ajrh.v27i12. Political factors, entrepreneurship, and female employment vulnerability in sub-Saharan Africa <p>This study examines the relationship between political factors, entrepreneurship, and female employment vulnerability in sub-Saharan Africa. Using data from the World Development Indicators (WDI) and World Governance Indicators (WGI) of the World Bank for the period 2001 - 2022, the study employs the Generalised Method of Moments to control for endogeneity. The results show that there exists an elastic relationship between voice and accountability and female vulnerability to employment in these sub-regions. It implies that a percentage increase in voice and accountability will result in a 11.9%, 3.07%, 1.08% decrease in female vulnerability to employment in Central, East, West and Southern Africa, respectively. These findings suggest that improving political institutions and reducing corruption could help to promote female entrepreneurship and reduce vulnerability in Sub-Saharan Africa.</p> Chensheng Wu Ying Yan Copyright (c) 2024 2024-01-08 2024-01-08 27 12 51 62 10.4314/ajrh.v27i12. Political factors, household income, under five survival, and life expectancy in the Sahel region <p>In recent decades, the Sahel region has experienced ongoing health crises, including high fertility rates, declining life expectancy, and low under-five survival rates. As such, this study investigates the impact of political factors and household income on under-five survival and life expectancy in the Sahel region, using secondary data from seven countries in the area. The data for the study was extracted from the World Development Indicators, and a panel Autoregressive Distributed Lag model was applied for analysis. The findings reveal that individuals in the Sahel region have a life expectancy of approximately 57 years, with an alarming rate of approximately 102 children per 1,000 births not surviving beyond age five. Political factors significantly contribute to reduction of under-five survival and life expectancy in the region, as does household income. Therefore, addressing government effectiveness, political stability, and household income is crucial to improving health outcomes in the Sahel countries, ultimately enhancing under-five survival rates and life expectancy across the region.</p> Ying Tang Guanxiufeng Lan Copyright (c) 2024 2024-01-08 2024-01-08 27 12 63 71 10.4314/ajrh.v27i12. Saudi Arabian women's knowledge and attitudes towards premarital screening of genetic disorders <p>This study assessed the knowledge and attitudes of Saudi women regarding the premarital screening program (PMS) using a tailored questionnaire survey. Of the 185 participants, 176 (95.1%) were familiar with PMS, and 117 (63.2%) were aware of the diseases that the screening tests aim to detect. The majority of participants supported also including screenings for drug use and mental illness. When considering the situation of compatible partners with one being a carrier, a considerable proportion of respondents indicated they would not proceed with matrimony. Overall, the level of awareness and attitudes concerning the critical significance of PMS were deemed satisfactory. To mitigate the impact of diseases, it is imperative to continue disseminating information concerning the program, its importance, and the necessity of making well-informed decisions after the evaluations.</p> Mohammed Makkawi Copyright (c) 2024 2024-01-08 2024-01-08 27 12 72 78 10.4314/ajrh.v27i12. Screening and risk factors for cervical cancer among survivors of sexual violence in conflict settings, Eastern Democratic Republic of Congo <p>This study assesses the risk that rape survivors have of developing cervical cancer in the context of conflict. A cross-sectional and descriptive study conducted in Bunyakiri and Kavumu, a conflict region in the east of the Democratic Republic of the Congo during the period from September 1 to 10, 2022, including 47 women survivors of sexual violence, 41 of whom were selected on the basis of certain criteria with age ranging from 18 to 50 years. Speculum examination was performed with visual inspection with acetic acid (VIA). After collecting data, the latter were encoded in the Excel file and grouped in the form of tables then analyzed after calculating the percentage. Ages of 21-30 years was the most represented, i.e., 56%. Among them, 34.1% were married and 31.7% were abandoned. Majority was in secondary school (46.3%) and illiterates (34.1%). 36.5% complained of pelvic pain and 36.5% reported first sexual intercourse at the age range of 13-15 years, of which 25 cases, i.e., 61% were sexually active. 39% reported having had 3 sexual partners in their life. VIA was negative in 97.5% of cases. It should be mentioned in this study that the environment of conflict zone, the circumstances of rape and the risky sexual behavior of survivors are an ecosystem that predisposes them to cervical cancer.</p> Glorieux B. Kimoni Ravonna Martin Denis M. Mukengere Cathleen de Kerchove Sifa Naweza Ntamwenge Olivier N. Ngeleza Copyright (c) 2024 2024-01-08 2024-01-08 27 12 79 85 10.4314/ajrh.v27i12. Comparative analysis of population growth and women employment patterns in agriculture and service sectors: Evidence from China and India <p>This study uses a comparative approach to investigate population growth patterns and women employment in two strategic sectors of China and India from 2005 to 2021. Consequently, a descriptive statistic was used to estimate the performance of each of the variables of interest. The results showed that the average mean value of population growth rate in China is 0.52 % while that of India is 1.23%. The mean value of women employed in agriculture in India is higher comparing to the average percentage of women in agriculture in China. Moreover, Chinese service sector accounts for 45.27% of female workforce but its India counterpart engages 21.71% of women working population. This implies that the Chinese service sector engages a significant proportion of the female working population. In the light of this, policymakers in India should prioritise investment in human development of the female population in order to ensure gender balancing in the service sector of the country. Also, the policymakers in India need to embark on a proactive measure in controlling its increasing population in order to ensure that the country’s population growth rate does not overshoot the means of sustenance in the country.</p> Zezhen Gong Chenyu Ma Copyright (c) 2024 2024-01-08 2024-01-08 27 12 86 93 10.4314/ajrh.v27i12. Out-of-pocket expenditure and maternal mortality nexus in China: Implications for the Sustainable Development Goal 3 <p>The global maternal mortality rate has remained alarmingly high over the years. Meanwhile, socioeconomic factors such out-of-pocket expenditure, in contributing to maternal mortality remains a subject of interest. There is a scarcity of recent empirical studies that delve into the influence of out-of-pocket expenses on maternal mortality in China. Thus, this study examines the nexus between out-of-pocket expenditure and maternal mortality in China from 2000 to 2021. The data for the study was extracted from the World Development Indicators, and a Fully modified ordinary least squares was utilized to estimate the objective of the study with the following submissions; out-of-pocket expenditure and maternal mortality have a significant positive relationship in China. GDP per capita growth and maternal mortality have a significant negative relationship in China. Therefore, if the policymakers in China desire to meet the SDG 3 by reducing maternal mortality to 70 deaths per 100,000 live births, policies such as health insurance scheme should be implemented in the country for women of reproductive age. This would likely reduce the out-of-pocket expenditure and maternal mortality rate in the country.</p> Weina Ai Timothy Ayomitunde Aderemi Rowland Bassey Andaratu A. Khalid Copyright (c) 2024 2024-01-08 2024-01-08 27 12 94 100 10.4314/ajrh.v27i12. Women’s experiences providing kangaroo mother care in an academic hospital in Tshwane, Gauteng <p>Preterm birth can be stressful for mothers and have negative consequences for the natural establishment of the mother-infant relationship. A high-impact, economical, and potentially life-saving strategy for the care of preterm and low-birthweight babies is kangaroo mother care (KMC). The literature suggests challenges to and enablers of KMC implementation in low-resource environments. The aim was to explore and describe women's experiences of providing KMC to their preterm babies. A qualitative, exploratory and descriptive approach was adopted. An unstructured interview guide was used to collect data during a focus group interview with mothers who provided kangaroo care. Data were analyzed using Braun and Clarke’s method. Four main themes emerged from the analyzed data. The results reflected on participants’ positive experiences, parenting skills and challenges. The participants suggested measures to enhance their encounters while providing KMC. Nurses need to support mothers who provide KMC; continuous education and guidance can enhance the implementation of this evidence-based practice to improve health outcomes for both preterm babies and their mothers. There is a need for continued training and support for mothers practising KMC, along with the consideration for healthcare providers to offer postpartum services for the mothers.</p> Moreoagae B Randa Jacobeth M Malesela Copyright (c) 2024 2024-01-08 2024-01-08 27 12 101 105 10.4314/ajrh.v27i12. Self-sampling for human papilloma virus DNA as a strategy to increase access to cervical cancer screening: Patients’ and providers’ perspectives on facilitators and barriers to scale <p>Self-sampling represents a high accuracy approach to human papilloma virus DNA (HPV-DNA) testing that allows for privacy and autonomy. As part of a larger study to evaluate cervical cancer screening in Mozambique, we explored user-driven facilitators and barriers to, and provider perspectives on, self-sampling. Our study was conducted in 4 public health facilities in 2 districts in Mozambique. Women aged 30-49 were prospectively enrolled for HPV screening and were offered provider or self-collected sampling. We used enrolment data from 9014 participants to examine characteristics of women choosing self-sampling and conducted in depth interviews with 104 women and 15 providers to understand facilitators and barriers to self-sampling. 97.5% of participants chose self-sampling over provider sampling. Participant-reported barriers included fear about technique, discomfort and inadequate training. Facilitators to self-sampling included increased privacy and having been exposed to a peer who previously self-sampled. Providers expressed concern about their limited role in the screening process with a self-sampling technique. Self-sampling for HPV is an acceptable approach to cervical cancer screening but barriers such as fear of sampling incorrectly and discomfort with their bodies remain.</p> Eva Lathrop Marcos Chissano Guilhermina Tevir Yolanda Chongo Elvira Cambe Edson Chivambo Hannah Hoover Paul Bouanchaud Copyright (c) 2024 2024-01-08 2024-01-08 27 12 106 111 10.4314/ajrh.v27i12.