Background: The objective of this study was to model the predictors of HIV prevalence in Malawi through a complex sample logistic regression and spatial mapping approach using the national Demographic and Health Survey datasets. Methods: We conducted a secondary data analysis using the 2015-2016 Malawi Demographic and Health Survey and AIDS Indicator Survey. The analysis was performed in three stages while incorporating population survey sampling weights to: i) interpolate HIV data, ii) identify the spatial clusters with the high prevalence of HIV infection, and iii) perform a multivariate complex sample logistic regression. Results: In all, 14,779 participants were included in the analysis with an overall HIV prevalence of 9% (7.0% in males and 10.8% in females). The highest prevalence was found in the southern region of Malawi (13.2%), and the spatial interpolation revealed that the HIV epidemic is worse at the southeastern part of Malawi. The districts in the high HIV prevalent zone of Malawi are Thyolo, Zomba, Mulanje, Phalombe and Blantyre. In central and northern region, the district HIV prevalence map identified Lilongwe in the central region and Karonga in the northern region as districts that equally deserve attention. People residing in urban areas had a 2.2 times greater risk of being HIVpositive compared to their counterparts in the rural areas (AOR = 2.16; 95%CI = 1.57-2.97). Other independent predictors of HIV prevalence were gender, age, marital status, number of lifetime sexual partners, extramarital partners, the region of residence, condom use, history of STI in the last 12 months, and household wealth index. Disaggregated analysis showed in-depth sociodemographic regional variations in HIV prevalence. Conclusion: These findings identify high-risk populations and regions to be targeted for Pre-Exposure Prophylaxis (PrEP) campaigns, HIV testing, treatment and education to decrease incidence, morbidity, and mortality related to HIV infection in Malawi.

Study Design. Retrospective review of prospective cohort. Objective. We sought to examine the role of halo gravity traction (HGT) in reducing preoperative surgical risk. Summary of Background Data. The impact of HGT on procedure choice, preoperative risk factors, and surgical complications has not been previously described. Methods. Patients treated with HGT before primary surgery were included. The FOCOS Score (FS) was used to quantify operative risk. FS was calculated using patient-factors (ASIA, body mass index, etiology), procedure-factors (PcF; osteotomy planned, number of levels fused, etc.), and curve magnitude (CM). Scores ranged from 0 to 100 with higher scores indicating increased risk. FS was calculated before and after HGT to see how changes in FS affected complication rates. Results. A total of 96 patients were included. Halo-related complications occurred in 34% of patients but revision was required in only 8.3%. Average FS improved by 18 points after HGT. CM, PcF, and patient-factors all improved (P < 0.05). The greatest changes were in CM and PcF. The planned rate of three-column osteotomies dropped from 91% to 38% after HGT. FS (area under the curve [AUC]: 0.68, P = 0.023) and change in FS (AUC: 0.781, P < 0.001) was successfully able to predict the rate of surgical complications. A preoperative FS of 74 was identified as a cut-off for a higher rate of surgical complications (sensitivity 58.8%, specificity 74.7%). Patients with a reduction in FS <  = 10pts were five times more likely to have a complication (relative risk 5.2, 95% confidence interval: 1.9–14.6, P < 0.001). A multivariate regression showed that change in FS was an independent predictor of complication rates (P < 0.05). Conclusion. FS can successfully predict surgical risk in pediatric patients with complex spinal deformity. Preoperative HGT can reduce FS and surgical risk by improving CM, lowering three-column osteotomies use, and improving body mass index. A reduction in FS after HGT predicts a lower rate of surgical complications. Level of Evidence: 3

Background Early initiation of breastfeeding (EIBF) is a key strategy in averting neonatal deaths. However, studies on the facilitators and risk factors for EIBF are rare in Ghana. We examined trends in EIBF and its major facilitators and risk factors in Ghana using data from Demographic and Health Surveys from 1998 to 2014. Methods We used complete weighted data of 3194, 3639, 2909 and 5695 pairs of mothers ages 15–49 y and their children ages 0–5 y in the 1998, 2003, 2008 and 2014 surveys, respectively. We accounted for the complex sampling used in the surveys for both descriptive statistics and multiple variable risk ratio analysis. Results The proportion of children who achieved EIBF increased by about 2.5 times from 1998 to 2003 and there was a marginal increase in the proportion of children who achieved EIBF between 2003 and 2014. Children born by caesarean section were at higher risk of being breastfed later than 1 h across all four surveys. Being born in the Upper East Region (compared with the Western Region) of Ghana facilitated EIBF in 2003 and 2008. Conclusions The study revealed that the current estimate of the proportion of children achieving EIBF in Ghana was 55.1%, and delivery by caesarean section and region of residence consistently predicted the practice of EIBF in Ghana.

The important role of women's health care decision making autonomy in enhancing the well-being of women and their families cannot be undervalued. As such, this study sought to examine the determinants of health care decision making autonomy among mothers of children less than five years in Ghana using the 2014 Ghana Demographic and Health Survey dataset. A total of 5076 women were included in the analysis. Results showed that 75% of the Ghanaian women reported exercising health care decision making autonomy either alone (22%) or jointly with their partners (53%). Multivariate logistic regression analysis revealed that independent determinants of women's health care decision making autonomy were women's attainment of primary education (OR=1.52, 95%CI 1.1574 to 1.9861), secondary education (OR=1.46, 95% CI 1.1338 to 1.8784) or higher than secondary education (OR=2.20, 95%CI 1.2322 to 3.9547), women's ability to make decisions about their earnings alone (OR=2.42, 95% CI 1.7570 to 3.3391) or jointly with their partners (OR=9.85, 95% CI 6.7215 to 14.4364), and having a partner who has attained primary education (OR=1.5,95%CI 1.0876 to 2.0641) or secondary education (OR=1.5,95%CI 1.1740 to 1.9247). Therefore, encouraging women to pursue education, improving their earnings autonomy whiles promoting education of partners remains a comprehensive way of enhancing women's autonomy in health decision making in order to promote reproductive, maternal and child health. Keywords: Healthcare, decision making, autonomy, women, Ghana © 2017 Adisah-Atta et al; licensee Herbert Publications Ltd. This is an Open Access article distributed under the terms of Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0). This permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. IntroductionFemale healthcare decision-making autonomy is an area that has received attention by researchers due to its growing importance from both human rights and healthcare outcomes perspectives. Generally, autonomy can be defined as having the ability to acquire information and arrive at decisions regarding one's own personal problems [1]. Health decision making autonomy is very critical for the health of women. For example, Alemayehu and Meskele [2] noted that the ability of a woman to visit health care facilities and receive treatment is somewhat dependent on their ability to take personal decisions. However, societal norms, culture, gender roles, gender inequality, religious norms and other socio-cultural factors influence the way women live their lives in developing countries [3].Existing studies from developing countries have shown that women's autonomy in health care decisions is related to child's health, women's health, utilization of healthcare services and empowerment amongst others [4][5][6][7][8][9].Similarly, higher risk of malnutrition has been observed from households where women had little or no autonomy in making household decisions [10]. The abili...

Level IV-case series.