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Background Logistic regression is a useful statistical technique commonly used in many fields like healthcare, marketing, or finance to generate insights from binary outcomes (e.g., sick vs. not sick). However, when applying logistic regression to complex survey data, which includes complex sampling designs, specific methodological issues are often overlooked. Methods The systematic review extensively searched the PubMed and ScienceDirect databases from January 2015 to December 2021, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, focusing primarily on the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS). 810 articles met the inclusion criteria and were included in the analysis. When discussing logistic regression, the review considered multiple methodological problems such as the model adequacy assessment, handling dependence of observations, utilization of complex survey design, dealing with missing values, outliers, and more. Results Among the selected articles, the DHS database was used the most (96%), with MICS accounting for only 3%, and both DHS and MICS accounting for 1%. Of these, it was found that only 19.7% of the studies employed multilevel mixed-effects logistic regression to account for data dependencies. Model validation techniques were not reported in 94.8% of the studies with limited uses of the bootstrap, jackknife, and other resampling methods. Moreover, sample weights, PSUs, and strata variables were used together in 40.4% of the articles, and 41.7% of the studies did not use any of these variables, which could have produced biased results. Goodness-of-fit assessments were not mentioned in 75.3% of the articles, and the Hosmer–Lemeshow and likelihood ratio test were the most common among those reported. Furthermore, 95.8% of studies did not mention outliers, and only 41.0% of studies corrected for missing information, while only 2.7% applied imputation techniques. Conclusions This systematic review highlights important gaps in the use of logistic regression with complex survey data, such as overlooking data dependencies, survey design, and proper validation techniques, along with neglecting outliers, missing data, and goodness-of-fit assessments, all of which point to the need for clearer methodological standards and more thorough reporting to improve the reliability of results. Future research should focus on consistently following these standards to ensure stronger and more dependable findings.

Background: This study investigates the association between intimate partner violence (IPV) against women and its impact on child morbidity in the south Asian region. Methods: The analysis uses logistic regression models with cross sectional nationally representative data from three countries - Bangladesh, India and Nepal. The data have been pooled from 'Demographic and Health Surveys' (DHS) of Bangladesh, Nepal and 'National Family and Health Survey' (NFHS) of India. Results: The study revealed that after controlling for potential confounders, children of mothers experiencing physical violence, sexual violence or both were more likely to have Acute Respiratory Infection (ARI) (ORadj 1.57; 95 % CI 1.48-1.67), fever (ORadj 1.44; 95 % CI 1.35-1.54) and diarrhea (ORadj 1.56; 95 % CI 1.44-1.69). Conclusions: The results highlight that IPV can influence childhood morbidity and support the need to address IPV with a greater focus within current child nutrition and health programs and policies.

BACKGROUND: Accurate and harmonized estimates of education-specific fertility rates are crucial for understanding the past and projecting the future human population. Yet fertility estimates derived from demographic surveys that collect detailed fertility histories often do not align with the reliable and widely used United Nations (UN) World Population Prospects. This inconsistency means that the choice of data source can affect research outcomes on fertility trends. OBJECTIVE: We combine the patchy Demographic and Health Surveys (DHS) data and the UN total fertility rate (TFR) estimates to create three harmonized datasets of education-specific TFRs for 36 sub-Saharan African countries, with different degrees of consistency with the UN TFR. METHODS: We develop a flexible Bayesian hierarchical model that reconstructs education-specific fertility rates by combining the DHS data and the UN TFR estimates. RESULTS: We provide time series of education-specific TFR quinquennial estimates between 1980 and 2014 for 36 sub-Saharan African countries. We present three model specifications that provide the users with fertility estimates that differ in their degree of consistency with the UN TFR. CONCLUSIONS: The model estimates show significant variation across countries, leading to divergent fertility trends from 1980 to 2014, mainly in levels but sometimes also in direction. CONTRIBUTION: Our flexible modelling framework offers model specifications that suit different conditions and can obtain results consistent with stakeholder needs: consistent with but not identical to the UN, fully consistent (nearly identical) with the UN, and consistent with the DHS. Further, our estimates of education-specific TFR can be used to analyse and forecast fertility trends and their contribution to population change in 36 sub-Saharan African countries.

Background The suspension and/or termination of many programmes funded through the United States Agency for International Development (USAID) by the new US administration has severe short- and long-term negative impacts on the health of people worldwide. We draw attention to the termination of the Demographic and Health Surveys (DHS) Program, which includes nationally representative surveys of households, DHS, Malaria Indicator Surveys [MIS]) and health facilities (Service Provision Assessments [SPA]) in over 90 low- and middle-income countries. USAID co-funding and provision of technical support for these surveys has been shut down. Main body The impact of these disruptions will reverberate across local, regional, national, and global levels and severely impact the ability to understand the levels and changes in population health outcomes and behaviours. We highlight three key impacts on (1) ongoing data collection and data processing activities; (2) future data collection and consequent lack of population-level health indicators; and (3) access to existing data and lack of support for its use. Conclusions We call for immediate action on multiple fronts. In the short term, universal access to existing data and survey materials should be restored, and surveys which were planned or in progress should be completed. In the long term, this crisis should serve as a tipping point for transforming these vital surveys. We call on national governments, regional organisations, and international partners to develop sustainable alternatives that preserve the principles (standardised questionnaires, backward compatibility, open access data with rigorous documentation) which made the DHS Program an invaluable global health resource.

Pasteurized yogurt is a healthy yogurt that can be stored in ambient temperature conditions. Dynamic headspace sampling (DHS) combined with gas chromatography-olfactory mass spectrometry (GC-O-MS), sensory evaluation, electronic nose (E-nose), and partial least squares discriminant analysis (PLS-DA) were used to analyze the flavor changes of pasteurized yogurt with different process combinations before and after aging. The results of odor profiles showed that the sensory descriptors of fermented, sweet, and sour were greatly affected by different process combinations. The results of odor-active compounds and relative odor activity value (r-OAV) showed that the combination of the production process affected the overall odor profile of pasteurized yogurt, which was consistent with the sensory evaluation results. A total of 15 odor-active compounds of 38 volatile compounds were detected in pasteurized yogurt samples. r-OAV results revealed that hexanal, (E)-2-octenal, 2-heptanone, and butanoic acid may be important odor-active compounds responsible for off-odor in aged, pasteurized yogurt samples. PLS-DA and variable importance of projection (VIP) results showed that butanoic acid, hexanal, acetoin, decanoic acid, 1-pentanol, 1-nonanal, and hexanoic acid were differential compounds that distinguish pasteurized yogurt before and after aging.

Background Over the last decade, progress in reducing maternal mortality in Rwanda has been slow, from 210 deaths per 100,000 live births in 2015 to 203 deaths per 100,000 live births in 2020. Access to quality antenatal care (ANC) can substantially reduce maternal and newborn mortality. Several studies have investigated factors that influence the use of ANC, but information on its quality is limited. Therefore, this study aimed to identify the determinants of quality antenatal care among pregnant women in Rwanda using a nationally representative sample. Methods We analyzed secondary data of 6,302 women aged 15–49 years who had given birth five years prior the survey from the Rwanda Demographic and Health Survey (RDHS) of 2020 data. Multistage sampling was used to select RDHS participants. Good quality was considered as having utilized all the ANC components. Multivariable logistic regression was conducted to explore the associated factors using SPSS version 25. Results Out of the 6,302 women, 825 (13.1%, 95% CI: 12.4–14.1) utilized all the ANC indicators of good quality ANC); 3,696 (60%, 95% CI: 58.6–61.1) initiated ANC within the first trimester, 2,975 (47.2%, 95% CI: 46.1–48.6) had 4 or more ANC contacts, 16 (0.3%, 95% CI: 0.1–0.4) had 8 or more ANC contacts. Exposure to newspapers/magazines at least once a week (aOR 1.48, 95% CI: 1.09–2.02), lower parity (para1: aOR 6.04, 95% CI: 3.82–9.57) and having been visited by a field worker (aOR 1.47, 95% CI: 1.23–1.76) were associated with more odds of receiving all ANC components. In addition, belonging to smaller households (aOR 1.34, 95% CI: 1.10–1.63), initiating ANC in the first trimester (aOR 1.45, 95% CI: 1.18–1.79) and having had 4 or more ANC contacts (aOR 1.52, 95% CI: 1.25–1.85) were associated with more odds of receiving all ANC components. Working women had lower odds of receiving all ANC components (aOR 0.79, 95% CI: 0.66–0.95). Conclusion The utilization of ANC components (13.1%) is low with components such as having at least two tetanus injections (33.6%) and receiving drugs for intestinal parasites (43%) being highly underutilized. Therefore, programs aimed at increasing utilization of ANC components need to prioritize high parity and working women residing in larger households. Promoting use of field health workers, timely initiation and increased frequency of ANC might enhance the quality of care.

Introduction Although cervical cancer screening is one of the most effective strategies to reduce the incidence and mortality of cervical cancer, the percentage of cervical cancer screening in low- and middle-income counties is low. In Kenya, the current nationwide prevalence and associated factors for the detection of cervical cancer is unknown. Therefore, this study aimed to assess the prevalence and associated factors for the detection of cervical cancer screening among women of reproductive age in Kenya using the Kenyan Demographic and Health Survey 2022. Methods This study used the most recent Kenyan Demographic and Health Survey data (2022) with a total weighted sample of 16,901 women. A mixed effects logistic regression analysis was performed and in the multivariable analysis, variables with a p -value below 0.05 were considered statistically significant. The strength of the association was evaluated using adjusted odds ratios along with their corresponding 95% confidence intervals. Results The prevalence of cervical cancer screening in Kenya was 16.81%(95% CI: 16.24, 17.38%). Having a history of abortion (AOR = 1.33, 95% CI: 1.171.50, 1.43), using modern contraceptive methods (AOR = 1.57, 95% CI: 1.25, 1.95), media exposure (AOR = 1.31, 95%CI: 1.03, 1.65), primary education (AOR = 1.56, 95%CI: 1.09, 2.22), secondary education (AOR = 21.99, 95% CI: 1.1.38, 2.87), higher education (AOR = 2..50, 95% CI: 1.71, 3.65), visiting health facility within the past 12 months (AOR = 1.61, 95%CI: 1.46, 1.79), positive HIV status (AOR: 3.50, 95% CI: 2.69, 4.57), being from a community with a higher proportion of educated individuals (AOR = 1.37, 95%CI: 1.13, 1.65) and being from a community with high proportion of poor individuals (AOR = 0.72, 9 5%CI: 0.60–0.87)) were significantly associated with cervical cancer screening. Conclusion In Kenya, the prevalence of cervical cancer screening was found to be low. A history of abortion, use of modern contraceptives, exposure to the media, visits to health facilities in the past 12 months, HIV status, level of education, community educational level, and community wealth were identified as significant associated factors for cervical cancer screening. Therefore, it is recommended to implement targeted public health interventions that focus on these identified factors to improve the adoption of cervical cancer screening in Kenya.

Background Women’s health remains a global public health concern, as enshrined in the Sustainable Development Goals. This study, therefore, sought to assess the individual and contextual factors associated with barriers to accessing healthcare among women in Ghana. Methods The study was conducted among 9370 women aged 15–49, using data from the 2014 Ghana Demographic and Health Survey. Barrier to healthcare, derived from four questions— whether a woman faced problems in getting money, distance, companionship, and permission to see a doctor—was the outcome variable. Descriptive and multilevel logistic regression analyses were carried out. The fixed effect results of the multilevel logistic regression analyses were reported using adjusted odds ratios at a 95% confidence interval. Results More than half (51%) of the women reported to have at least one form of barrier to accessing healthcare. Women aged 45–49 (AOR = 0.65, CI: 0.49–0.86), married women (AOR = 0.71, CI:0.58–0.87), those with a higher level of education (AOR = 0.51, CI: 0.37–0.69), those engaged in clerical or sales occupation (AOR = 0.855, CI: 0.74–0.99), and those who were covered by health insurance (AOR = 0.59, CI: 0.53–0.66) had lower odds of facing barriers in accessing healthcare. Similarly, those who listened to radio at least once in a week (AOR =0.77, CI: 0.66–0.90), those who watched television at least once a week (AOR = 0.75, CI: 0.64–0.87), and women in the richest wealth quintile (AOR = 0.47, CI: 0.35–0.63) had lower odds of facing barriers in accessing healthcare. However, women who were widowed (AOR = 1.47, CI: 1.03–2.10), those in the Volta Region (AOR 2.20, CI: I.38–3.53), and those in the Upper West Region (AOR =2.22, CI: 1.32–3.74) had the highest odds of facing barriers to healthcare accessibility. Conclusion This study shows that individual and contextual factors are significant in predicting barriers in healthcare access in Ghana. The factors identified include age, marital status, employment, health insurance coverage, frequency of listening to radio, frequency of watching television, wealth status, and region of residence. These findings highlight the need to pay critical attention to these factors in order to achieve the Sustainable Development Goals 3.1, 3.7, and 3.8. It is equally important to strengthen existing strategies to mitigate barriers to accessing healthcare among women in Ghana.

The aim of this study was to compare three different collection methods; purge and trap, solid phase micro extraction and automated dynamic headspace/thermal desorption, all followed by GC–MS analysis used for the measurements of concentrations of volatile oxidation products in three different food matrices, namely oil, emulsion and milk. The linearity ranges of calibration curves obtained by the three different methods were compared for oil samples. Overall, the results showed that the three collection methods were comparable, although there were large differences in the linearity range of the calibration curves depending on the collection method. However, some challenges were observed for solid phase micro extraction and automated dynamic headspace/thermal desorption, namely, competition problems and overestimation of concentration by calibration curves, respectively. Based on the results, we suggest mainly to apply solid phase micro extraction on simple matrices and to be cautious with more complex matrices such as enriched milk and highly oxidized oils. Thereby, the study confirmed some challenges observed by other authors regarding competition problems on the fiber when using solid phase micro extraction. Furthermore, we observed that purge and trap, and automated dynamic headspace/thermal desorption were excellent for extraction of volatile compounds in all three matrices. However, automated dynamic headspace/thermal desorption calibration curves did provide an overestimation for oil samples so results must be interpreted with caution.

Cross-sectional analyses have identified polygyny as a prevalent family form across sub-Saharan Africa, though it has been declining over time in most countries. Yet how the prevalence of young children in polygynous households has changed over time concurrent to changes in other demographic indicators is not well understood. Trends in polygynous living arrangements and selection into these households may have consequences for related disparities in health and mortality over time. We describe the proportion of young children residing in polygynous households over a 20-year period of significant social and demographic change. We analyze nationally representative household survey data from 83 Demographic and Health Surveys from 27 sub-Saharan African countries collected between 2000 and 2020. Among children under 5 years of age, we estimate the proportion residing in a polygynous household over time and compare it to the proportion of women of reproductive age in polygynous unions over time. We then disaggregate this change by maternal marital status and wife rank. Despite substantial variation between countries in the sample, the proportion of young children in polygynous households declined almost universally in sub-Saharan Africa from 2000 to 2020. The proportion of children in polygynous households declined more rapidly than the proportion of women of reproductive age in polygynous unions in almost all countries. Children in West Africa are increasingly living in monogamous households, while children in Central and Southern Africa are more likely to have a mother who is divorced, widowed, or never married.