Browsing by Author "Agbi, Delight Mawufemor"

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    Differentiated effects of sources of malaria messages on mosquito bed net use among women of reproductive age in Uganda: a propensity score matched analysis
    (Springer Nature, 2026-01-25) Mwebesa, Edson; Agbi, Delight Mawufemor; Iha, Daniel Thoya; Kogei, Dan Kipkosgei; Agasa, Lameck Ondieki; Kerich, Gregory Kibet; Mwangi, Ann
    Introduction Malaria remains a significant public health challenge, particularly in high-burden settings such as Uganda. Social and Behaviour Change Communication (SBCC) interventions play a vital role in influencing knowledge, attitudes, and practices related to malaria prevention. However, despite the widespread promotion of mosquito bed net (MBN) use, there is limited evidence on the comparative effectiveness of different media platforms in encouraging their adoption. This study estimated the effect of exposure to malaria messages from different media platforms on MBN use among women of reproductive age in Uganda using propensity score–matched analysis. Methods We conducted a secondary analysis of nationally representative data from the 2018–2019 Uganda Malaria Indicator Survey (UMIS), restricted to 3488 women aged 15–49 years who reported exposure to at least one malaria message. The primary outcome was MBN use, and the key exposures were nine distinct SBCC platforms. One-to-one nearest neighbour propensity score matching was applied, adjusting for key socio-demographic characteristics including age, education level, household wealth index, place of residence, and region. Propensity score matching analysis (PSMA) was applied to estimate the average treatment effect on the treated (ATT) for each platform, with ATT chosen to quantify effects among women who were actually exposed to malaria-related messages, adjusting for relevant observed covariates. Data analysis was done in Stata V14.0. Results Of the 3488 women included in the study, 73.2% reported using MBN the previous night before the survey. Propensity score matched analysis revealed that exposure to malaria messages through community health workers (ATT = 0.322, 95% CI 0.111, 0.533), community events (ATT = 0.296, 95% CI 0.085, 0.507), and social mobilization (ATT = 0.185, 95% CI 0.008, 0.362) significantly increased MBN use. Other effective channels included social media, radio, interpersonal communication, and billboards. Television exposure (ATT = 0.051; 95% CI  − 0.062, 0.164) and exposure from other unspecified sources were not significantly associated with MBN use. Conclusion Among women exposed to malaria messages, exposure through community health workers and community events showed the strongest associations MBN use, followed by exposure through social mobilisation and other SBCC platforms. Exposure through television was not significantly associated with MBN use, suggesting that community-based and interpersonal communication channels may be more strongly associated with MBN utilisation than some mass media platforms.
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    Effect of exposure to malaria messages on insecticide-treated net use among women and under-five children in Uganda: a propensity score matched analysis
    (Springer Nature, 2025-11-10) Mwebesa, Edson; Agbi, Delight Mawufemor; Iha, Daniel Thoya; Agasa, Lameck Ondieki; Mwangi, Ann
    Background: Malaria remains a global public health issue, with almost 2.5 million cases and more than 0.6 million deaths each year, of which women and children remain disproportionately affected. Insecticide-treated nets (ITNs) are a cornerstone of malaria prevention in endemic malaria regions. Malaria messages (MM) are intended for positive and measurable social, attitude, and behavioural change towards malaria prevention uptake. However, their impact on insecticide-treated nets (ITNs) use has not been sufficiently investigated through rigorous statistical approaches. This study investigated the effect of MM on ITN use among women and children under five years in Uganda using Propensity Score Matched Analysis (PSMA). Methods: The study utilized the Uganda Malaria Indicator Survey (UMIS) 2018 -19 data. Women (n = 8868) and children (n = 6915) datasets were extracted from Individual Women’s and Children’s Data, respectively. The children’s dataset included data on interviewed women (caregivers), household indicators and under-five children’s data, while the women's dataset contains records of every eligible woman in selected households. Propensity score-matched analysis (PSMA) was utilized to identify the effect of the MM (intervention) on ITN use (outcome) among women of reproductive age and children under five in Uganda. Results: The results revealed that 69.3 [95% CI: 67.2, 71.2] of the women and 71.8 [95% CI: 69.1, 74.4] of the children under five years slept under a mosquito bed net the night preceding the survey. The results further revealed a significant and positive effect of exposure to malaria messages on ITN use among exposed women [Average Treatment Effect of the Treated (ATT) = 5.1%, 95% CI: 1.5–8.9%] and under-five children of exposed women [ATT = 4.3%, 95% CI: 1.0–7.6%]. Conclusion: Effective and relevant behavioural change communications, such as malaria messages, are an effective way of influencing the use of ITN. Such an intervention may reduce malaria endemicity, morbidity, and mortality in Uganda.
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    Effect of exposure to malaria messages on insecticide-treated net use among women and under-five children in Uganda: a propensity score matched analysis
    (Springer Nature, 2025-11-10) Mwebesa, Edson; Agbi, Delight Mawufemor; Iha, Daniel Thoya; Agasa, Lameck Ondieki; Mwangi, Ann
    Background Malaria remains a global public health issue, with almost 2.5 million cases and more than 0.6 million deaths each year, of which women and children remain disproportionately affected. Insecticide-treated nets (ITNs) are a cornerstone of malaria prevention in endemic malaria regions. Malaria messages (MM) are intended for positive and measurable social, attitude, and behavioural change towards malaria prevention uptake. However, their impact on insecticide-treated nets (ITNs) use has not been sufficiently investigated through rigorous statistical approaches. This study investigated the effect of MM on ITN use among women and children under five years in Uganda using Propensity Score Matched Analysis (PSMA). Methods The study utilized the Uganda Malaria Indicator Survey (UMIS) 2018 -19 data. Women (n = 8868) and children (n = 6915) datasets were extracted from Individual Women’s and Children’s Data, respectively. The children’s dataset included data on interviewed women (caregivers), household indicators and under-five children’s data, while the women's dataset contains records of every eligible woman in selected households. Propensity score-matched analysis (PSMA) was utilized to identify the effect of the MM (intervention) on ITN use (outcome) among women of reproductive age and children under five in Uganda. Results The results revealed that 69.3 [95% CI: 67.2, 71.2] of the women and 71.8 [95% CI: 69.1, 74.4] of the children under five years slept under a mosquito bed net the night preceding the survey. The results further revealed a significant and positive effect of exposure to malaria messages on ITN use among exposed women [Average Treatment Effect of the Treated (ATT) = 5.1%, 95% CI: 1.5–8.9%] and under-five children of exposed women [ATT = 4.3%, 95% CI: 1.0–7.6%]. Conclusion Effective and relevant behavioural change communications, such as malaria messages, are an effective way of influencing the use of ITN. Such an intervention may reduce malaria endemicity, morbidity, and mortality in Uganda.
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    Impact of eight or more antenatal care visits on intermittent preventive treatment of malaria uptake during pregnancy and facility-based delivery in Ghana: a propensity score matched analysis
    (Springer Nature, 2026-02-24) Agbi, Delight Mawufemor; Mwebesa, Edson; Jimmy, Abraham Isiaka; Valère, Salako Kolawolé; Kerich, Gregory Kibet
    Introduction Maternal and malaria-related morbidity remain major public health challenges in sub-Saharan Africa, particularly in Ghana. The World Health Organization (WHO) recommends eight or more antenatal care (ANC8+) contacts to enhance maternal and child health, but its effect on malaria prevention and delivery outcomes is not well established. This study examined the impact of ANC8 + visits on facility-based delivery and optimal uptake of intermittent preventive treatment for malaria during pregnancy (IPTp-SP). Methods Data were drawn from the 2022 Ghana Demographic and Health Survey, including women aged 15–49 years who had given birth within the three years preceding the survey. Propensity score matching was applied to estimate the effect of ANC8 + visits on facility-based delivery and uptake of at least three IPTp-SP doses. Results Only 38.7% of women met the ANC8 + threshold. Among all respondents, 85.4% delivered in a health facility, and 66.5% received three or more IPTp-SP doses. After matching, ANC8 + attendance increased the likelihood of facility delivery by 8.2% points (ATT = 8.2, 95% CI: 4.6–11.9) and optimal IPTp-SP uptake by 11.1% points (ATT = 11.1, 95% CI: 6.8–15.4). Conclusion Adherence to WHO’s ANC8 + recommendation significantly improves facility-based delivery and malaria prevention during pregnancy. Strengthening policies that enhance ANC attendance, particularly among socioeconomically and geographically disadvantaged groups, is essential for advancing maternal and child health in Ghana.
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    Women’s decision-making autonomy and early antenatal care initiation in Ghana: a propensity score-matched analysis
    (Springer Nature, 2026-03-03) Agbi, Delight Mawufemor; Nwankwo, Gideon Ikemdinachi; Mawuko, Courage Venunye; Iha, Daniel Thoya; Djossou, Josias Ounsinli; Mwebesa, Edson
    Introduction Women’s decision-making autonomy is widely recognized as an important determinant of maternal health behaviors such as the timing of antenatal care (ANC) initiation in low- and middle-income countries. However, empirical evidence from Ghana on this relationship, particularly using causal inference approaches, remains limited. This study investigates the effect of women’s decision-making autonomy on the early initiation of ANC visits in Ghana. Methods Data were sourced from the 2022 Ghana Demographic and Health Survey (GDHS), including 4,314 women aged 15–49 years with a birth in the preceding three years before the survey. Autonomy was measured as a composite index from household decision-making participation. Propensity Score Matching (PSM) was used to match women with High and None/Low autonomy, based on covariates like age, education, wealth, and residence. The average treatment effect on the treated (ATT) was estimated to assess the impact of high autonomy on early ANC initiation (within the first trimester), compared to the counterfactual scenario in which the same women lacked such autonomy. Results Among the women included in the study, 25.3% reported high decision-making autonomy, and 66.4% initiated ANC early. Women with high autonomy were more likely to be older (30–49 years), educated (secondary or higher), married, employed, Christian, insured, urban residents, and from wealthier households. After matching on socio-demographic covariates, no statistically significant effect of high autonomy on early ANC initiation was observed [-0.029; 95% CI: -0.081 to 0.022]. Conclusion Women’s decision-making autonomy, when measured through household decision-making participation and within the Ghanaian context, does not independently drive early ANC initiation, suggesting that broader structural and contextual barriers may constrain the translation of autonomy into early care-seeking.