ZACHARIE TSALA DIMBUENE - Academia.edu (original) (raw)

Papers by ZACHARIE TSALA DIMBUENE

The Lancet Global Health, 2020

IntechOpen eBooks, Mar 7, 2024

BMJ Open, Dec 1, 2022

Objective To investigate inequalities of health insurance coverage (outcome) at subnational level... more Objective To investigate inequalities of health insurance coverage (outcome) at subnational level, and the effects of education and poverty on the outcome. Design Secondary analysis of Demographic and Health Surveys. The outcome variable was health insurance ownership. Setting The Democratic Republic of the Congo. Subjects Women aged 15-49 years (n=18 827). Results Findings indicated significant spatial variations of the health insurance ownership which ranged from 1.2% in Bandundu and Kasaï Oriental to 15.5% in Kinshasa the Capital City. Furthermore, findings showed that an additional year of women education increased by 10% the chance of health insurance ownership (adjusted OR, AOR 1.098; 95% CI 1.065 to 1.132). Finally, living in better-off households increased by 150% the chance of owing a health insurance (AOR 2.501; 95% CI 1.620 to 3.860) compared with women living in poor households. Conclusions Given the low levels of health insurance coverage, the Democratic Republic of the Congo will not reach the Sustainable Development Goal 3, aimed at improving maternal and child health unless a serious programmatic health shift is undertaken in the country to tackle inequalities among poor and uneducated women via universal health coverage.

IntechOpen eBooks, Sep 13, 2022

Sub-Saharan Africa (SSA) continues to face adverse maternal and child health (MCH) outcomes compa... more Sub-Saharan Africa (SSA) continues to face adverse maternal and child health (MCH) outcomes compared to other regions of the world. Previous research showed that SSA countries did not reach Millennium Development Goals (MDG)-4 and MDG-5. To further our understanding of levels and correlates of MCH outcomes, numerous studies have focused on socioeconomic factors, both at individual, household, and community levels. This chapter adopted a different approach and emphasized the role of leadership at regional, national, and local levels to improve MCH outcomes in SSA countries. Overall, the chapter demonstrated that without an enlightened leadership, SSA countries will be lagging behind SDG-3 targets. Additionally, evidence to guide policymaking in most countries is lacking mainly due to lack of sound data to specifically meet the needs of policymakers. There is an urgent need to focus on Research and Development (R&D) and Innovation. To achieve this goal, a crucial shift in leadership is compulsory.

UNAIDS proposed a set of core indicators for monitoring changes in the worldwide AIDS epidemic. T... more UNAIDS proposed a set of core indicators for monitoring changes in the worldwide AIDS epidemic. This paper explores the validity and effectiveness of the ‘multiple sexual partners ’ core indicator, which is only partially captured with current available data. The paper also suggests an innovative approach for collecting more informative data that can be used to provide an accurate measure of the UNAIDS’s ‘multiple sexual partners ’ core indicator. Specifically, the paper addresses three major limitations associated with the indicator when it is measured with respondents ’ sexual behaviors. First, the indicator assumes that a person’s risk of contracting HIV/AIDS/STIs is merely a function of his/her own sexual behavior. Second, the indicator does not account for a partner’s sexual history, which is very important in assessing an individual’s risk level. Finally, the 12-month period used to define a person’s risks can be misleading, especially because HIV/AIDS theoretically has a peri...

environment and peers matter?

PLOS ONE

Background High-risk fertility behaviour remains a major public health in the Democratic Republic... more Background High-risk fertility behaviour remains a major public health in the Democratic Republic of the Congo, like other sub-Saharan Africa countries, especially because Total Fertility Rate (TFR) is very high in the country, estimated at 6.6 children. Despite the commendable progress in reducing maternal deaths in the region, sub-Saharan Africa is still lagging very behind compared with other regions. Yet, high-risk fertility behaviours are pivotal to improve maternal and child health. This study aims to assess geographical variations of, and to identify risk factors associated with high-risk fertility behaviours among married women in the Democratic Republic of the Congo using the 2013–14 Demographic and Health Survey. Methods Overall, 11,497 married women were selected from a nationally representative using a two-stage sampling design. Standard logistic regressions were performed to identify individual- and household/community-level factors associated with high-risk fertility b...

Lancet (London, England), Jan 8, 2016

Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, fina... more Established in 2000, Millennium Development Goal 4 (MDG4) catalysed extraordinary political, financial, and social commitments to reduce under-5 mortality by two-thirds between 1990 and 2015. At the country level, the pace of progress in improving child survival has varied markedly, highlighting a crucial need to further examine potential drivers of accelerated or slowed decreases in child mortality. The Global Burden of Disease 2015 Study (GBD 2015) provides an analytical framework to comprehensively assess these trends for under-5 mortality, age-specific and cause-specific mortality among children under 5 years, and stillbirths by geography over time. Drawing from analytical approaches developed and refined in previous iterations of the GBD study, we generated updated estimates of child mortality by age group (neonatal, post-neonatal, ages 1-4 years, and under 5) for 195 countries and territories and selected subnational geographies, from 1980-2015. We also estimated numbers and r...

Journal of Biosocial Science, 2014

SummaryWorldwide, there is a consensus that parents must be involved in children's HIV/AIDS e... more SummaryWorldwide, there is a consensus that parents must be involved in children's HIV/AIDS education. However, there is little evidence that speaks to this advocacy for improving adolescent health. This study developed and tested four hypotheses about (i) the relationship between parents' and adolescents' knowledge of HIV/AIDS transmission routes and prevention strategies conditional upon (ii) parents' gender, (iii) communication about sexuality, and (iv) the parent–adolescent education gap. The sample consisted of 306 parent–adolescent dyads from the 2002 Cameroon Family and Health Survey. Adolescents were aged 12–19 years. Overall, fifteen items about HIV/AIDS transmission routes and prevention strategies were analysed. Descriptive results showed that parents fared better than adolescents regardless of the AIDS fact considered. An exception was the correct use of condoms (parents 57% vs adolescents 61%). The generation gap probably explains this result: parents ar...

PLOS global public health, Jan 24, 2023

Obesity is a major global public health problem. It is spreading very fast in low-and middleincom... more Obesity is a major global public health problem. It is spreading very fast in low-and middleincome countries and has reached world record levels in some of them. In Ghana, it has increased by over 65% among urban women in the past three decades. This study investigated the effects of social determinants of health on obesity among women in urban Ghana. The study analyzed the Ghana demographic and health survey data. These are nationally representative data collective every five years across low-and middle-income countries. A total of 1,204 urban women were included in the analysis. Body mass index was the outcome variable of interest. We used logistic regression to model the effects of the various social determinants of health on obesity. The results showed that 40% (95% confidence interval (CI) = 25.4, 57.0) and 36.7% (95% CI = 25.6, 49.3) of women who had higher education and those whose partners had higher education suffered from obesity, respectively. Women living in rich households had a five times higher prevalence of obesity than those in poor households (28.8% vs 5.7%). Further, 33.4% (95% CI = 18.5, 19.3) of women who occupied managerial positions were obese. The results from the multivariable logistic regression analysis suggested that compared to women in poor households, those in rich households were 3.4 times (95% CI = 1.31, 8.97) more likely to suffer from obesity. Women whose main occupation was agriculture were 81% (aOR = 0.19; 95% CI = 0.034, 0.99) less likely to suffer from obesity compared to those with no occupation. The results suggest that the various social determinants of health (SDH) included in the analysis significantly influence obesity outcomes. Women and partner education levels, occupying a managerial position, and living in rich households increase the risk of obesity. Interventions to address the rising obesity in urban Ghana should have specific packages targeted at these subgroups .

Scientific Reports

Childhood malnutrition is a significant public health problem confronting countries across the gl... more Childhood malnutrition is a significant public health problem confronting countries across the globe. Although there is evidence of a downward trend in undernutrition globally, sub-Saharan Africa did not experience significant improvement in the past decades. This study investigated the basic determinants of linear growth among children living in poor households. We analysed a nationally representative sample of children aged 0–59 months (N = 24,264). The study countries were Ghana, Kenya, the Democratic Republic of Congo (DRC), Nigeria, and Mozambique. The child’s height-for-age Z-scores (HAZ), categorised into HAZ > − 2 standard deviations (SD) (not stunted) and HAZ < − 2 SD (stunted) was the outcome variable of interest. We used logistic regression as our analytical strategy. In DRC, Ghana, Kenya and Nigeria, maternal years of schooling was associated with positive linear growth among children living in poor households. In Ghana and DRC, four antenatal visits had a positive...

Objectives: To examine the sociodemographic correlates associated with better linear growth among... more Objectives: To examine the sociodemographic correlates associated with better linear growth among children under 5 years living in poor households Design: Cross-sectional Setting: Ghana, Kenya, Democratic Republic of Congo (DRC), Nigeria and Mozambique Participants: Singleton children aged 0 to 59 months, born to mothers aged 15 to 49 years. Information on children was obtained through face-to-face interviews with mothers. Primary outcome measure: Child height-for-age Z-scores (HAZ), categorised into HAZ≥-2 standard deviations (SD) (better growth/not stunted) and HAZ≤-2 SD (stunted/poor growth). Results: A unit change in maternal years of education was associated with increased odds of better growth among children living in poor households in DRC [adjusted odds ratio (aOR)= 1.03, 95% CI=1.01,1.07)], Ghana (aOR=1.06, 95% CI=1.01,1.11), Kenya (aOR=1.03, 95% CI= 1.01, 1.05) and Nigeria (aOR=1.08, 95%=1.06,1.10). Maternal antenatal attendance of at least four visits was associated posit...

BMJ Open, 2017

ObjectiveTo examine the prevalence and trends in overweight and obesity among non-pregnant urban ... more ObjectiveTo examine the prevalence and trends in overweight and obesity among non-pregnant urban women in Africa over the past two and a half decades.DesignCross-sectional surveys conducted between 1991 and 2014.SettingsDemographic and Health Surveys (DHS), repeated cross-sectional data collected in 24 African countries.ParticipantsAdult non-pregnant women aged 15–49 years. The earlier DHS collected anthropometric data on only those women who had children aged 0–5 years. The main analyses were limited to this subgroup. The participants were classified as overweight (25.0–29.9 kg/m2) and obese (≥30.0 kg/m2).ResultsThe prevalence of overweight and obesity among women increased in all the 24 countries. Trends were statistically significant in 17 of the 24 countries in the case of obesity and 13 of the 24 for overweight. In Ghana, overweight almost doubled (p=0.001) while obesity tripled (p=0.001) between 1993 and 2014. Egypt has the highest levels of overweight and obesity at 44% (95% ...

Public Health Nutrition, 2017

ObjectiveTo investigate the differential effects of dietary diversity (DD) and maternal character... more ObjectiveTo investigate the differential effects of dietary diversity (DD) and maternal characteristics on child linear growth at different points of the conditional distribution of height-for-ageZ-score (HAZ) in sub-Saharan Africa.DesignSecondary analysis of data from nationally representative cross-sectional samples of singleton children aged 0–59 months, born to mothers aged 15–49 years. The outcome variable was child HAZ. Quantile regression was used to perform the multivariate analysis.SettingThe most recent Demographic and Health Surveys from Ghana, Nigeria, Kenya, Mozambique and Democratic Republic of Congo (DRC).SubjectsThe present analysis was restricted to children aged 6–59 months (n31 604).ResultsDD was associated positively with HAZ in the first four quantiles (5th, 10th, 25th and 50th) and the highest quantile (90th) in Nigeria. The largest effect occurred at the very bottom (5th quantile) and the very top (90th quantile) of the conditional HAZ distribution. In DRC, DD...

Lancet (London, England), Oct 8, 2016

In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it... more In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality a...

Lancet (London, England), Jan 19, 2016

In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs).... more In September, 2015, the UN General Assembly established the Sustainable Development Goals (SDGs). The SDGs specify 17 universal goals, 169 targets, and 230 indicators leading up to 2030. We provide an analysis of 33 health-related SDG indicators based on the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015). We applied statistical methods to systematically compiled data to estimate the performance of 33 health-related SDG indicators for 188 countries from 1990 to 2015. We rescaled each indicator on a scale from 0 (worst observed value between 1990 and 2015) to 100 (best observed). Indices representing all 33 health-related SDG indicators (health-related SDG index), health-related SDG indicators included in the Millennium Development Goals (MDG index), and health-related indicators not included in the MDGs (non-MDG index) were computed as the geometric mean of the rescaled indicators by SDG target. We used spline regressions to examine the relations between ...

Lancet (London, England), Jan 7, 2015

Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and year... more Up-to-date evidence about levels and trends in disease and injury incidence, prevalence, and years lived with disability (YLDs) is an essential input into global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013), we estimated these quantities for acute and chronic diseases and injuries for 188 countries between 1990 and 2013. Estimates were calculated for disease and injury incidence, prevalence, and YLDs using GBD 2010 methods with some important refinements. Results for incidence of acute disorders and prevalence of chronic disorders are new additions to the analysis. Key improvements include expansion to the cause and sequelae list, updated systematic reviews, use of detailed injury codes, improvements to the Bayesian meta-regression method (DisMod-MR), and use of severity splits for various causes. An index of data representativeness, showing data availability, was calculated for each cause and impairment during three periods globally...

Excess male mortality at early ages is an important source of child inequality in most societies.... more Excess male mortality at early ages is an important source of child inequality in most societies. We examine how improvement in the quality of political institutions affects the male survival disadvantage. Using data on twins in combination with a natural experiment on the development of African institutions, we quantify the distinct effects of biology and preconception environment on the infant mortality sex gap and find that these effects are important only in poor institutions. The analysis implies that improved institutions constrain genetic expression and mitigate preconception influences on excess male infant mortality, which is an optimistic finding with pragmatic implications.