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Introduction For several decades, the rate of caesarean section (CS) has been increasing in the world. In some countries, the CS rate is below the WHO recommended range (10–15%), while in other countries, it is significantly higher. The aim of this paper was to identify individual and community-level factors associated with CS in Haiti. Methods Secondary data analysis was conducted on nationally representative cross-sectional survey data from the 2016–2017 Haitian Demographic and Health Survey (HDHS). The analysis was restricted to 6303 children born in 5 years prior the survey (of the interviewed women). The study population’ characteristics, and the prevalence of CS were analysed using descriptive analysis (univariate/bivariate). In addition, multilevel binary logistic regression analysis was performed to identify factors associated with CS. Both descriptive and multivariate analysis were conducted using STATA 16.0 software (Stata Corp, Tex, USA). Statistical significance was declared at p  < 0.05. Results The overall prevalence of CS delivery was estimated at 5.4% (95% CI 4.8–6.0) in Haiti. Results also revealed that mothers aged 35 and above (aOR = 1.38; 95% CI 1.00–1.96); who attended secondary (aOR = 1.95; 95% CI 1.39–2.76) and higher education level (aOR = 3.25; 95% CI 1.92–5.49); who were covered by health insurance (aOR = 2.57; 95% CI 1.57–4.19); with less than 3 children (aOR = 4.13; 95% CI 2.18–7.85) or 3–4 children (aOR = 2.07; 95% CI 1.09–3.94); who received 9 or more antenatal visits (aOR = 2.21; 95% CI 1.40–3.50) were significantly more likely to deliver by CS. Children in communities with high preponderance of private health facilities had greater odds to be delivered through CS (aOR = 1.90; 95% CI 1.25–2.85). Furthermore, children with an average birth weight (aOR = 0.66; 95% CI 0.48–0.91) were less likely to be delivered through CS than their counterparts with high birth weight. Conclusions While the CS prevalence was low in Haiti, it masks significant geographic, social and economic disparities. To better develop and implement maternal and child health programs that address CS deliveries, the government authorities and NGOs operating in the field of women’s health in Haiti should take these disparities into account.

ObjectiveThis study aimed to assess the magnitude and identify associated factors with intimate partner violence (IPV) in Togo.DesignCross-sectional study.SettingTogo.ParticipantsWomen of reproductive age (15–49 years).Primary outcomeIntimate partner violence.MethodsThis study used data from the 2013 Togolese Demographic and Health Survey. A total of 4910 married or partnered women were included. A Generalised Structural Equation Model (GSEM) was performed to identify significant factors associated with IPV. Results of the GSEM were reported as adjusted ORs (aOR) with their corresponding 95% CIs.ResultsThe pooled prevalence of IPV was 35.5% (95% CI: 34.2% to 36.8%). Emotional violence and physical violence were the most reported forms of IPV (29.7% and 20.2%, respectively), while sexual violence was the least common, with a prevalence of 7.5%. Additionally, the results indicated that the following factors related to women, men and households were significantly associated with IPV in Togo: ethnicity, region, religion, wealth index, working status, age at the first union, having attitudes toward wife-beating, participation in household decision-making, education level, alcohol use and controlling behaviour.ConclusionIPV is a complex and multifactorial phenomenon in Togo. The Togo government as well as women’s human rights organisations should consider these factors when designing IPV programmes.

Introduction In Haiti, childhood diarrhea is one of the leading causes of serious illness and death among children. Factors associated with medical treatment-seeking behaviours for diarrhea illnesses are poorly documented even though diarrhea treatment is key to reduce diarrhea-related child morbidity and mortality. To fill this gap, this study aimed to determine prevalence and identify factors associated with medical treatment-seeking behaviour for childhood diarrhea among Haitian mothers. Methods The study was based on secondary data, collected from the fifth round of the Haitian Demographic and Health Survey (HDHS 2016–2017). Medical treatment-seeking behaviour for childhood diarrhea was the outcome variable. Various demographic and socio-economic variables were considered as explanatory variables. Descriptive statistics (univariate and bivariate percentage distribution, Pearson’s Chi-square test) and multilevel logistic regression were employed to draw inferences from the data. Results 1,245 children constituted our study population. The prevalence of children who suffered from diarrhea and received treatment (either oral rehydration solution (ORS) or recommended home fluids (RHF)) within two weeks period before the survey was 42.9% (95% CI 40.2–45.6). The results also revealed that children from the “Aire Métropolitaine de Port-au-Prince” region (Ref.), aged 12–23 months (aOR = 1.79; 95% CI: 1.26–2.55), whose mothers were aged 35 and above (aOR = 1.75; 95% CI: 1.15–2.67), whose mothers had secondary and higher levels (aOR = 1.63; 95% CI: 1.02–2.60), whose mothers were in a union (aOR = 2.18; 95% CI: 1.23–3.85), whose mothers did not consider the distance to the health facility a big problem (aOR = 1.35; 95% CI: 1.01–1.84), and children from communities with high access to improved toilet facilities (Ref.) were significantly more likely to receive diarrhea treatment. Conclusion To increase the uptake of diarrhea treatment in Haiti, policymakers and stakeholders must give due consideration to those factors. They should educate the population on the causes of childhood diarrhea, its consequences, and the importance of ORS and RHF. The socio-economic vulnerability of some Haitian communities, especially those with low access to improved toilet facilities, could be a major barrier to the use of diarrhea treatments. Consequently, the Haitian government needs to subsidize these products so that they are freely available in public health facilities and pharmacies in these communities.

Introduction In the Latin America and Caribbean region, Haiti is one of the countries with the highest rates of HIV. Therefore, this study examined the factors associated with HIV testing among women in Haiti and trends in HIV testing in 2006, 2012, and 2016/17. Methods Data from the last three Haitian Demographic and Health Surveys (2006, 2012, and 2016/17) were used. The analysis was restricted to women aged of 15–49 years who made their sexual debut. STATA/SE 16.0 was employed to analyze the data by computing descriptive statistics, Chi‑square, and multilevel regression model to describe the trends and identify factors associated with HIV testing in Haiti. P -value less than 0.05 was taken as a significant association. Results HIV testing prevalence increased more than twofold from 2006 (8.8%) to 2017 (21.3%); however, it decreased by 11.6% between 2012 and 2016/17. Additionally, the results indicated that age, place of residence, region, education level, wealth index, mass media exposure, marital status, health insurance, age at first sex and number of sexual partners were significantly associated with HIV testing. Conclusions To significantly increase HIV testing prevalence among women, the Haitian government must invest much more in their health education while targeting vulnerable groups (youth, women in union, and women with low economic status).

Introduction Although tobacco has harmful effects on the physical and mental health of individuals, its use remains significant, according to the World Health Organization. To understand this phenomenon, studies have been carried out in many countries around the world, while in Haiti where more than 5,000 people die each year due to tobacco use, little is known about the use of this substance. The aim of this study was to examine the prevalence and the factors associated with tobacco use in Haiti. Methods We used data from the 2016/17 Haitian Demographic Health Survey. Both descriptive and multivariate analyses were conducted using STATA 16.0 software to assess the prevalence and identify factors associated with tobacco use. Results were reported as adjusted odds ratios with 95% confidence intervals. Statistical significance was declared at p  < 0.05. Results The prevalence of tobacco use was estimated at 9.8% (95% CI: 9.2–10.4) among men and 1.7% (95% CI: 1.5–1.9) among women. Although the prevalence of tobacco use was low among young people, it increased with age. Respondents aged 35 and above, with no formal education, non-Christians, divorced/separated/widowed, from poorest households, rural areas, “Aire Métropolitaine de Port-au-Prince” region, with high media exposure had a higher likelihood of tobacco use. Conclusion The low prevalence of tobacco use among Haitian women and youth represents a public policy opportunity to prevent these vulnerable groups from starting smoking. Adult male smokers should also be targeted by appropriate policy to reduce the different health burdens associated with tobacco, both for the smokers and other people they may expose to passive smoking. Government and health sector stakeholders, along with community leaders, should create and enforce awareness strategies and rules to control advertisements that encourage irresponsible and health-risky consumption behaviors.

Background Despite many efforts to provide children with legal existence over the last decades, 1 in 4 children under the age of 5 (166 million) do not officially exist, with limited possibility to enjoy their human rights. In Latin America and the Caribbean, Haiti has one of the highest rates of undocumented births. This study aimed to analyze the prevalence and the determinant factors of undocumented childhood in Haiti. Methods For analysis of undocumented childhood and related socioeconomic determinants, data from the 2016/17 Haiti demographic and health survey were used. The prevalence and the associated factors were analyzed using descriptive statistics and the binary logistic regression model. Results The prevalence of undocumented childhood in Haiti was 23% (95% CI: 21.9–24.0) among children under-five. Among the drivers of undocumented births, mothers with no formal education (aOR = 3.88; 95% CI 2.21–6.81), children aged less than 1 year (aOR = 20.47; 95% CI 16.83–24.89), children adopted or in foster care (aOR = 2.66; 95% CI 1.67–4.24), children from the poorest regions like “Artibonite” (aOR = 2.19; 95% CI 1.63–2.94) or “Centre” (aOR = 1.51; 95% CI 1.09–2.10) or “Nord-Ouest” (aOR = 1.61; 95% CI 1.11–2.34), children from poorest households (aOR = 6.25; 95% CI 4.37–8.93), and children whose mothers were dead (aOR = 2.45; 95% CI 1.33–4.49) had higher odds to be undocumented. Conclusion According to our findings, there is an institutional necessity to bring birth documentation to underprivileged households, particularly those in the poorest regions where socioeconomic development programs are also needed. Interventions should focus on uneducated mothers who are reknown for giving birth outside of medical facilities. Therefore, an awareness campaign should be implemented to influence the children late-registering behavior.

ObjectiveThis study estimated the proportion of children aged 12–23 months who were fully vaccinated in sub-Saharan Africa (SSA), explored geographical disparities across subregions and countries, and identified country-level factors associated with full vaccination (FV).DesignCross-sectional study.SettingSSA.ParticipantsChildren aged 12–23 months.Primary outcomeFV.MethodsData for this study were extracted from the most recent Demographic and Health Survey (DHS) conducted in 34 SSA countries between 2012 and 2023. The study included a total weighted sample of 69 218 children. Univariate analyses were performed to describe the socio-demographic profile of the participants and estimate the proportion of FV and the proportion for each of the eight vaccines (BCG, DTP1, DTP2, DPT3, Polio1, Polio2, Polio3, Measles1) at regional level. Bivariate and spatial analyses were produced to examine existing disparities at regional, subregional and countries’ income levels. A multivariate logistic regression analysis was fitted for identifying country-level factors associated with FV.Results54.1% (95% CI 53.7% to 54.5%) children aged 12–23 months in SSA were fully vaccinated. In addition, substantial inequalities emerged in FV coverage across countries ranging from 23.9% in Guinea to a high of 95.5% in Rwanda. The same pattern was observed for the eight vaccines. Findings also showed that children of birth order 3 and above, who were delivered at home, had received less than four antenatal visits, from poor households and households with more than 5 members, whose mothers were under 25, had primary education level and below, and had no income-generating activities were less likely to be fully vaccinated.ConclusionTo achieve WHO’s global vaccination coverage target of 90% by 2030 in SSA, vaccination programmes must take account of regional, subregional and national inequities. Our findings also underline the need for interventions tailored to each SSA country’s socio-cultural context.Ethical considerationEthical approval was not required as this is a secondary analysis of publicly available data.

This article assesses the individual vulnerability of 550 farming households, 430 in Haiti and 120 in the Dominican Republic, on the Caribbean island of Hispaniola to the impacts of climate change. This assessment is based on an integrated approach, using socio-economic and biophysical variables. The variables collected for each farm household were grouped into three categories: adaptive capacity, sensitivity, and exposure. Multiple correspondence analysis (MCA) was used to develop a vulnerability index for each farm household, enabling them to be classified according to their level of vulnerability to the impacts of climate change. A logistic regression model was then used to identify the main factors influencing their vulnerability. The results revealed that on the island of Hispaniola, 33.91%, 32.09%, and 34% of farming households were classified as very vulnerable, vulnerable, and less vulnerable. In Haiti, these proportions were 36.74%, 36.51%, and 26.75%, while in the Dominican Republic, they were 20%, 20%, and 60%. Agricultural households with highly accessible credit (OR = 0.16, p < 0.001) and university education (OR = 0.05, p < 0.001) were relatively less vulnerable to climate change impacts compared to their counterparts.

Our study examines the progress made by ECOWAS member countries in creating a single currency. It therefore analyses what the last few years have taught us about the convergence and optimality of the ECOWAS zone based on a Mixture Model approach to classification. The variables used come from the theory of optimal currency zones and convergence criteria. Two periods were considered: 2000-2013 and 2014-2018. Our results show remarkable progress in the convergence of ECOWAS countries. The results for the 2014-2018 period show very little heterogeneity in the ECOWAS countries compared to the results of the previous period. Indeed, the number of classes resulting from this analysis is nine for the first period and two for the second period. The results therefore suggest that a monetary union is possible for ECOWAS countries except Liberia and Nigeria.