An exploratory spatial analysis of geographical inequalities of birth intervals among young women in the Democratic Republic of Congo (DRC): a cross-sectional study

Determinants of short birth interval in Ethiopia: A multilevel analysis based on EDHS 2019, Ethiopia, 2023

INTRODUCTION

According to the World Health Organization and Ethiopian Demographic and Health Survey on birth spacing, there should be at least a two-year gap between conception and the first of two children born in quick succession. In poor nations like Ethiopia, resource issues were complex, making it difficult to get statistics for the entire country. However, by examining Ethiopian mini demographic and health survey data, we were able to provide data at the national level.

METHOD

The cross-sectional survey-based study was conducted in several of Ethiopia's administrative cities and nine regions. In the analysis, sampling weight was used to correct the survey's non-proportional sample distribution to strata and areas throughout the survey process and restore representative data. The study's household population was presented and described using descriptive statistics such as weighted frequencies and percentages. The statistically significant factors linked to frequent short birth intervals were found using a multivariable, multilevel logistic regression analysis.

RESULT

Overall, 4306 weighted multigravida mothers nested within 305 enumeration areas were included in the analysis. The respondents' mean (standard deviation) of the birth interval was 42.027(26.69). Higher-educated women had 12% lower odds of having a shorter pregnancy (AOR = 0.88; 95% CI: 0.35, 0.98) than women without higher education. The odds of a short birth interval were 3.04 times greater among women in the age category of 40-49 years at first marriage (AOR = 3.04; 95% CI: 1.08, 8.46) than among women in the age category of 15-19 years. This indicates that older women were most likely to have short birth intervals.

CONCLUSION

In the multilevel logistic regression model, maternal age, maternal educational status, the wealth quintile index, use of contraceptives, duration of breastfeeding, and contextual regions were significantly associated with short birth intervals in Ethiopia.

Prevalence and factors associated with short birth interval in the semi-rural community of Kaya, Burkina Faso: results of a community-based survey

BACKGROUND

A short birth interval adversely affects the health of mothers and children. This study aimed to measure the prevalence of short birth intervals and identify their associated factors in a semi-urban setting in Burkina Faso.

METHODS

We conducted a cross-sectional study in which data were collected in households between May and October 2022. The dependent variable was the short birth interval (SBI), defined by the World Health Organization as the time between two live births. We performed a multilevel mixed-effects Poisson regression with robust variance to determine the factors associated with the SBI by reporting adjusted prevalence ratios (aPR) with a 95% confidence interval (CI).

RESULTS

A total of 5544 birth intervals were recorded from 4067 women. A short birth interval was found in 1503 cases out of 5544, i.e., a frequency of 27.1%. The prevalence of short birth interval (time between two live births less than 33 months) was higher in never users of modern contraceptive users (aPR = 1.24; 95% CI [1.14-1.34] vs. previous users), in younger ages with aPR of 4.21 (95% CI [3.30-5.37]), 2.47 (95% CI [1.96-3.11]), and 1.45 (95% CI [1.16-1.81]), respectively for under 18, 18-24 years old, and 25-34 years old, compared to 35 and over. Childbirths occurring before the implementation of the maternal and infant free health care policy (aPR = 2.13; 95% CI [1.98-2.30]) and also before the free family planning policy (aPR = 1.53; 95% CI [1.28-1.81]) were more likely to have SBI. Women with low socio-economic positions were also more likely to have SBI.

CONCLUSION

This study found a high SBI in Burkina Faso (more than one woman out of four). Our results have programmatic implications, as some factors, such as contraceptive practice and socioeconomic status, are modifiable. These factors need particular attention to lengthen birth intervals and, in turn, improve mother-child couple health by reducing short birth interval consequences.

Wealth-based disparities in the prevalence of short birth interval in India: insights from NFHS-5

BACKGROUND

Short birth interval (SBI) has profound implications for the health of both mothers and children, yet there remains a notable dearth of studies addressing wealth-based inequality in SBI and its associated factors in India. This study aims to address this gap by investigating wealth-based disparities in SBI and identifying the underlying factors associated with SBI in India.

METHODS

We used information on 109,439 women of reproductive age (15-49 years) from the fifth round of the National Family Health Survey (2019-21). We assessed wealth-based inequality in SBI for India and its states using the Erreygers Normalised Concentration Index (ECI). Additionally, we used a multilevel binary logistic regression to assess the factors associated with SBI in India.

RESULTS

In India, the prevalence of SBI was 47.8% [95% CI: 47.4, 48.3] during 2019-21, with significant variation across states. Bihar reported the highest prevalence of SBI at 61.2%, while Sikkim the lowest at 18.1%. SBI prevalence was higher among poorer mothers compared to richer ones (Richest: 33.8% vs. Poorest: 52.9%). This wealth-based inequality was visible in the ECI as well (ECI= -0.13, p < 0.001). However, ECI varied considerably across the states. Gujarat, Punjab, and Manipur exhibited the highest levels of wealth-based inequality (ECI= -0.28, p < 0.001), whereas Kerala showed minimal wealth-based inequality (ECI= -0.01, p = 0.643). Multilevel logistic regression analysis identified several factors associated with SBI. Mothers aged 15-24 (OR: 12.01, p < 0.001) and 25-34 (2.92, < 0.001) were more likely to experience SBI. Women who married after age 25 (3.17, < 0.001) and those belonging to Scheduled Caste (1.18, < 0.001), Scheduled Tribes (1.14, < 0.001), and Other Backward Classes (1.12, < 0.001) also had higher odds of SBI. Additionally, the odds of SBI were higher among mothers in the poorest (1.97, < 0.001), poorer (1.73, < 0.001), middle (1.62, < 0.001), and richer (1.39, < 0.001) quintiles compared to the richest quintile. Women whose last child had passed away were also significantly more likely to have SBI (2.35, < 0.001). Furthermore, mothers from communities with lower average schooling levels (1.18, < 0.001) were more likely to have SBI. Geographically, mothers from eastern (0.67, < 0.001) and northeastern (0.44, < 0.001) regions of India were less likely to have SBI.

CONCLUSION

The significant wealth-based inequality in SBI in India highlights the need for targeted interventions focusing on economically disadvantaged women, particularly in states with high SBI prevalence. Special attention should be given to younger mothers and those from socially disadvantaged groups to enhance maternal and child health outcomes across the country.

Short birth interval prevalence, determinants and effects on maternal and child health outcomes in Asia-Pacific region: a systematic review and meta-analysis protocol

BACKGROUND

Short birth interval (SBI) has been linked to an increased risk of adverse maternal, perinatal, infant and child health outcomes. However, the prevalence and maternal and child health impacts of SBI in the Asia-Pacific region have not been well understood. This study aims to identify and summarise the existing evidence on SBI including its definition, measurement prevalence, determinants and association with adverse maternal and child health outcomes in the Asia-Pacific region.

METHODS

Five databases (MEDLINE, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Maternity and Infant Care, and Web of Science (WoS)) will be systematically searched from September 2000 up to May 2023. Data will be extracted, charted, synthesised and summarised based on the outcomes measured, and where appropriate, meta-analysis will be performed. The risk of bias will be assessed using Joanna Briggs Institute quality appraisal. Grading of Recommendation Assessment, Development and Evaluation framework will be used to evaluate the quality of cumulative evidence from the included studies.

ETHICS AND DISSEMINATION

This review does not require ethics approval. Findings will be disseminated through peer-reviewed publications, policy briefs and conference presentations.

PROSPERO REGISTRATION NUMBER

A protocol will be registered on PROSPERO for each separate outcome before performing the review.Cite Now.

Factors affecting birth interval among mothers in Dabat district, Amhara Regional state, Northwest Ethiopia: A community-based cross-sectional study, 2022

Introduction

Birth interval is the time period from live birth to a successive pregnancy or successive live birth which is the recommended to be at least 2 years or at least 33 months respectively. Both short and long birth intervals are associated with poor health outcomes for both mothers and babies. Therefore, the main objective of this study is to assess the length of birth intervals and its predictors among reproductive-age women in Dabat district.Methods: community-based cross-sectional survey conducted from December 10/2020 to January 10/2021. This study was done on 1262 multi para women. Five days training was given for the data collectors and supervisors. Bivariable and multivariable ordinal logistic regression analysis were done. Those variables which had P-value less than 0.25 in the bi variable analysis were entered to multivariable ordinal logistic regression analysis. An adjusted odds ratio with a 95% confidence interval and P-value less than 0.05 was used to determine significant determinants of birth interval.

Result

This study revealed that the magnitude of short and long birth interval was 30.59% and 22.82% respectively. Wealth status (poor: AOR = 0.72, CI: 0.53, 0.97), maternal education (Diploma and above: AOR = 2.79, CI: 1.18, 6.56), ANC follow up (having ante natal care: AOR = 2.15, CI: 1.72, 2.69), husband occupation (Employed: AOR = 1.77, CI: 1.03, 3.01) and history of abortion (abortion: AOR = 2.48, CI: 1.08, 5.66) were statistically significant factors.

Conclusion

Higher percentage of mothers have either short or long birth interval. Birth interval is affected by socio demographic characteristics of mothers and husbands.

Spatial distribution of short birth interval and associated factors among reproductive age women in Ethiopia: spatial and multilevel analysis of 2019 Ethiopian mini demographic and health survey

BACKGROUND

Short Birth Interval negatively affects the health of both mothers and children in developing countries. Studies conducted in Ethiopia on the spatial variation and determinants of individual and community-level factors about short birth intervals were limited. Thus, this study was intended to assess the spatial variation of the short birth interval and its determinants in Ethiopia.

METHODS

This study is a secondary analysis of the Ethiopian Demographic and Health Survey (mini EDHS 2019). A total of 1784 reproductive-age women were included in the analysis. The global spatial autocorrelation (Global Moran's I) and the Getis-Ord statistics tool were used to detect the presence of clustering and the high/low hotspot areas of SBI respectively. Ordinary kriging was used to interpolate short birth intervals, and spatial scan statistics were employed to identify spatial clusters with high and low SBI. A multilevel multivariable model was used to identify predictors of a short birth interval.

RESULTS

The prevalence of SBI was 62.89% (95%CI: 59.3, 69.7) in Ethiopia. High clustering of SBI was observed in all parts of Somali, in Afar (zones 1, 3, 4, &5), Oromia (Guje, Bale, & West Harerge), and northern Tigray. The most likely significant primary cluster was observed in the Somali region. Women who lived in the primary cluster were 24% more likely to have a short birth interval than those who lived outside the window. In the multilevel mixed-effect analysis age 25-34 [(AOR = 0.40, 95% CI: 0.35, 0.45)], 35-49 [(AOR = 0.44, 95% CI: 0.38, 0.51)], Muslim religion follower [(AOR = 3.5, 95% CI: 2.7, 4.69)], no formal education [(AOR = 0.5, 95% CI: 0.37, 0.70)], primary education[(AOR = 0.4, 95%CI: 0.28, 0.53)], and secondary education [(AOR = 0.3, 95% CI: 0.24, 0.48)], middle [(AOR: 1.3, 95% CI: 1.2, 1.52)], rich wealth status [(AOR: 1.4, 95% CI: 1.3, 1.68)], female sex children [(AOR: 1.2, 95% CI: 1.09, 1.42)], and two or fewer ideal number of children [(AOR = 0.2, 95% CI: 0.25, 0.32)] were found to be significant predictors of SBI.

CONCLUSION

Overall, SBI was high and significantly clustered across the region of Ethiopia. Age, religion, education, wealth status, the sex of the indexed child, and the ideal number of children were found to be significantly associated with short birth intervals. Hence, the government should design a health promotion strategy and public health awareness in the identified hotspot areas of SBI and should scale up family planning and the wealth status of reproductive-age women.

Spatio-temporal pattern of short birth interval and associated factors on women in Ethiopia: Using Ethiopian demographic and health surveys 2000–2016

Background

A short birth interval is a critical factor that contributes to a large number of maternal and infant mortality in low- and middle-income countries. It is the major cause of maternal and child mortality in Ethiopia. This study aimed to explore the spatiotemporal distribution of short birth intervals in Ethiopia using data from four (2000, 2005, 2011, and 2016) consecutive demographic and health surveys.

Methods

A total of 34,930 women were included in four consecutive Ethiopian Demographic and Health Surveys (EDHS). Thus, spatial autocorrelation, hotspot analysis, cluster analysis, and spatial interpolation were carried out for each survey separately to show the geographical and temporal pattern of at-risk areas for short birth intervals in Ethiopia. Finally, the highest proportion of short birth interval risk areas in each survey period was mapped. Geospatial analysis was conducted by using ArcGIS V.10.8 and R version 4.2.

Results

The results of the study indicated that the overall proportion of short birth intervals of women in Ethiopia was highest in 2000 (47.5%), 2005 (46.4%), 2011 (44.7%), and the lowest in 2016 (44.0%). The values for Global Moran’s I (MI = 0.177665 p = 0.0016, MI = 0.2024, p = 0.001, MI = 0.10023, p = 0.002, and MI = 0.764, p = 0.008) showed that the presence of significant short birth interval clustering in Ethiopian administrative zones in 2000, 2005, 2011, and 2016, respectively. The hotspot areas for short birth intervals were consistently observed in the zones in the Somali Region and the zones in the Harari Region for all the EDHS years. In addition, the survival status of the index child, residence, breastfeeding practice, religion, and the spatial variable (Si) were significantly associated with the short birth interval of women in all the EDHS years.

Conclusion

Spatial distribution of short birth intervals differs across Ethiopian administrative zones. Survival status of the index child being dead, rural residential, and no breastfeeding practice are the risk factors for short birth intervals of women that increase the risk of a short birth interval among women in all the EDHS years. Therefore, the hotspot areas and indicators need interventions to decrease the short birth interval of women.

Short birth interval and its predictors among reproductive age women in high fertility countries in sub-Saharan Africa: a multilevel analysis of recent Demographic and Health Surveys

BACKGROUND

In developing countries, short birth interval is one of the major public health issues. It is one of the leading cause's adverse birth outcomes in the worldwide. Despite the fact that ending maternal and perinatal morbidity and mortality is one of the Sustainable Development Goals (SDG), the burden of the problem continues to be a huge concern in developing countries, including high fertility countries. Thus, this study aimed to determine the short birth interval and its predictors in ten high fertile sub-Saharan African countries.

METHODS

Data for this study was obtained from the most recent Demographic and Health Surveys (DHS). A total of weighted sample of 303,979 women of childbearing age group (15- 49) who had at least two alive consecutive children was included. A multilevel mixed-effect binary logistic regression model was fitted to identify the associated factors of short birth interval. As a final step, the Adjusted Odds Ratio (AOR) was used with a confidence interval of 95% in determining statistical significance.

RESULTS

Overall prevalence of short birth interval in high fertile sub Saharan Africa was 58.74% (52.32%, 65.17%).The factors significantly associated with the short birth interval were women's educational status; primary education (AOR = 0.88; 95% CI: 0.86,0 .91), secondary and higher (AOR = 0.10; 95% CI: 0.09, 0.11), working (AOR = 0.91; 95% CI: 0.88, 0 .93), classified as rich wealth index level (AOR = 0.90; 95% CI: 0.88, 0.93),having six and above ideal number of children (AOR = 2.25; 95% CI: 2.22, 2.30), preferred waiting time two years and above to give birth (AOR = 0.83; 95% CI: 0.76, 0.89), contraceptive non users (AOR = 3.01; 95% CI: 2.93, 3.07), community level education (AOR = 1.97; 95% CI: 1.54, 2.08), rural residency (AOR = 2.17; 95% CI: 2.13, 2.22), and country Chad (AOR = 1.37; 95% CI: 1.22, 1.54).

CONCLUSION

The prevalence of short birth interval in the top ten high fertile sub Saharan African countries is still optimally high. Therefore, the government of each country should work on the access to family planning and education in rural parts of the countries.

Effects of short birth interval on different forms of child mortality in Bangladesh: Application of propensity score matching technique with inverse probability of treatment weighting

BACKGROUND

The prevalence of Short Birth Interval (SBI) is higher in Low- and Middle-Income countries (LMICs), including Bangladesh. Previous studies in LMICs have estimated the effects of SBI on child mortality by comparing two unequal groups of mothers based on their socio-economic status. This approach may lead to overestimation or underestimation of the true effect of birth interval on child mortality, particularly when sample sizes are relatively small.

OBJECTIVE

We determined the effects of SBI on several forms of child mortality in Bangladesh by comparing two equal groups created by applying the propensity score matching technique.

METHODS

This study analyzed data from 5,941 mothers and 1,594 health facilities extracted from the 2017/18 Bangladesh Demographic and Health Survey and the 2017 Bangladesh Health Facility Survey. The exposure variable was SBI (defined as the interval between two subsequent births <33 months: yes, no), while the outcome variables were neonatal mortality (defined as mortality within 28 days of birth: yes, no), infant mortality (defined as mortality within 1 year of birth: yes, no), and under-five mortality (defined as mortality within 5 years of birth: yes, no). Multilevel Poisson regression based on inverse probability treatment weights was used to determine the association between exposure and outcome variables.

RESULTS

The prevalence rates of neonatal, infant, and under-five mortality were 48.8, 30.8, and 23.1 per 1000 live births, respectively. Newborns of SBI mothers were found to have a 63% higher likelihood of neonatal mortality (aPR, 1.63; 95% CI, 1.08-2.46) compared to newborns of non-SBI mothers. Furthermore, the prevalence of infant mortality and under-five mortality was 1.45 times higher (aPR, 1.45; 95% CI, 1.01-2.08) and 2.82 times higher (aPR, 2.82; 95% CI, 2.16-3.70), respectively, among babies born in a short interval of their immediately preceding sibling as compared to babies born in a normal interval of their immediately preceding sibling.

CONCLUSIONS

Findings of this study indicate that SBI is an important predictor of child mortality. Consequently, around 1 million children born in a short interval every year in Bangladesh are at risk of dying before reaching their fifth birthday. This indicates a challenge for Bangladesh to achieve the SDG 3 target to reduce neonatal and under-five mortality to 12 and 25 deaths per 1000 live births, respectively. Hence, awareness-building programs about the adverse effects of SBI and strengthening existing healthcare facilities are important.

Exploring hot spots of short birth intervals and associated factors using a nationally representative survey in Bangladesh

Short Birth Interval (SBI, defined as < 33 months interval between the two most recent births or < 24 months between one live birth to the next pregnancy) is a public health problem in most low- and lower-middle-income countries. Understanding geographic variations in SBI, particularly SBI hot spots and associated factors, may help intervene with tailored programs. This study identified the geographical hot spots of SBI in Bangladesh and the factors associated with them. We analyzed women's data extracted from the 2017/18 Bangladesh Demographic and Health Survey and the healthcare facility data extracted from the 2017 Service Provision Assessment. SBI was the outcome variable, and it was defined as an interval between consecutive births of 33 months or less, as recommended by the World Health Organization. The characteristics of mothers and their partners were the explanatory variables. Moran's I was used to examine the spatial variation of SBI in Bangladesh whereas the Getis-Ord [Formula: see text](d) was used to determine the hot spots of SBI. The Geographical Weighted Regression (GWR) was used to assess the predictors of SBI at the enumeration areas' level. The variables included in the GWR were selected using the exploratory regression and ordinary least square regression model. Data of 5941 women were included in the analyses. Around 26% of the total births in Bangladesh had occurred in short intervals. A majority of the SBI hot spots were found in the Sylhet division, and almost all SBI cold spots were in the Rajshahi and Khulna divisions. No engagement with formal income-generating activities, high maternal parity, and history of experiencing the death of a child were significantly associated with SBI in the Sylhet division. Women's age of 34 years or less at the first birth was a protective factor of SBI in the Rajshahi and Khulna divisions. The prevalence of SBI in Bangladesh is highly clustered in the Sylhet division. We recommend introducing tailored reproductive health care services in the hot spots instead of the existing uniform approach across the country.

Socio-economic inequalities in children's nutritional status in Democratic Republic of the Congo in 2017-2018: an analysis of data from a nationally representative survey

OBJECTIVE

The Democratic Republic of the Congo (DRC) has one of the highest levels of child undernutrition globally; however, little information exists on the underlying socio-economic inequalities resulting in undernutrition. This study aims to examine the differences in the nutritional statuses of children across different wealth quintiles and explores the association between malnutrition in children and related factors.

DESIGN

We utilised the 2018 Multiple Indicator Cluster Survey data. We estimated the prevalence of malnutrition across all twenty-six provinces. The study used the WHO 2006 child growth standards to measure stunting, underweight and wasting. We employed a mixed-effect linear model to analyse the association between nutritional status and healthcare accessibility, domestic sanitation, and socio-demographic factors.

SETTING

Twenty-six provinces in the DRC.

PARTICIPANTS

21 477 children under 5 years of age and 21 828 women of childbearing age in the DRC.

RESULTS

The national prevalence of underweight, stunting and wasting was found to be 23·33 %, 42·05 % and 5·66 %, respectively. Household wealth and mother's education level were significantly positively associated with the nutritional statuses of children. Among households in the lowest wealth quintile, residence in urban areas was a protective factor against undernutrition.

CONCLUSION

The findings of this study indicate considerable socio-economic inequalities in the nutritional statuses of children under 5 years of age in the DRC, highlighting the need for nutrition promotion as part of maternal and child healthcare. Interventions and policies should include improving nutrition education for less-educated mothers, in particular, in the central provinces of the DRC.

Can women's 3E index impede short birth interval? evidence from Bangladesh Demographic and Health Survey, 2017-18

BACKGROUND

Women's empowerment, education, and economic status are jointly introduced as women's 3E. A number of studies found the significant association of these three variables with maternal health outcomes, but no studies, to the best of knowledge, have been found to justify the joint influence of women's 3E on the birth interval. As several studies have revealed that the short birth interval increases the risk of adverse maternal, perinatal, and infant outcomes and it is also responsible for increasing the country's population size, more research is needed on the birth interval. Therefore, the present study aimed to investigate the influence of women's 3E on the short birth interval after controlling the other selected covariates.

METHODS

Data from the Bangladesh Demographic and Health Survey (BDHS), 2017-18 have been used to serve the purpose of the study. To measure the birth interval, at least two live births for non-pregnant mothers and at least one live birth for currently pregnant mothers born in the 5 years before the survey were included in the study. The Chi-Square test was applied to know the unadjusted association of the selected covariates including women's 3E with the short birth interval. In order to find out the adjusted association of women's 3E with the short birth interval, sequential binary logistic regression models have been used.

RESULTS

The study found that about 23% of births in Bangladesh were born in a short birth interval. The likelihood of subsequent births of women decreases with an increase in the score of women's 3E before or after controlling the characteristics of women, child, and households. The results of the final model show that mothers with the coverage of 50% - 75%, 75% - 100%, and full coverage (100%) in 3E have a 23%, 41%, and 42% lower odds of having short birth interval compared to mothers with coverage of below 50% in 3E, respectively.

CONCLUSION AND RECOMMENDATION

Bangladesh still lags behind in meeting the minimum requirements for inter-birth intervals set by the World Health Organization. The study has shown that the 3E in women can contribute in prolonging the duration of subsequent births in Bangladesh. Policy-making interventions are needed to raise awareness among uneducated, under-empowered and economically poor reproductive women through family planning and fertility control programs so that the country can achieve the desired fertility rate.

Relationship between women's decision-making power over their own health care and use of modern contraception in the Democratic Republic of the Congo: a cross-sectional secondary data analysis

BACKGROUND

In sub-Saharan Africa, the use of modern contraception (MC) is a critical intervention aimed at reducing mortality rates associated with unintended, high-risk pregnancies. However, among Congolese women aged 15-49, the prevalence of MC use is low. Research suggests that women's general participation in decision-making is important in increasing MC use. However, little is known about the specific role of women's decision-making power over their own health care and how it relates to MC use. Thus, this study aimed to investigate the relationship between women's decision-making power over their own health care and use of MC.

METHODS

A cross-sectional secondary data analysis was conducted using the most recent data from the 2013-2014 Democratic Republic of the Congo (DRC) Demographic and Health Survey. Women who were considered in need of contraception based on their family planning preferences were included in the study population (N = 6422). Multivariate logistic regression was used to determine whether women's decision-making power over their own health care was associated with the use of MC.

RESULTS

Only one in ten women reported using a modern method of contraception. Logistic regression showed that women who made decisions alone regarding their own health care were more likely to use MC than women who had no say in these decisions, even after controlling for important covariates (OR 1.48; 95% CI 1.00, 2.17).

CONCLUSION

The results of this study lend further support that promoting women's autonomy and right to independently make decisions regarding their own health may be important in increasing the use of MC in the DRC. However, in order to effectively empower women to negotiate for the use of MC, qualitative research is needed to further assess the relationship between decision-making power and MC use.

Determinants of short birth interval among women in South Gondar, Ethiopia: community-based unmatched case-control study

BACKGROUND

The effect of short birth interval on socio-economic, negative maternal and child health outcomes remains common in developing countries. This study aimed to assess determinants of short birth interval among reproductive age women, who gave birth in health institution for last six-month in South Gondar, Ethiopia 2019.

METHODS

Community-based unmatched case control study design was conducted from February 1 to March 30, 2019. Sample size of 150 was included by simple random sampling technique. The data was collected by semi-structured and pre-tested face to face interviewer-administered questionnaire from selected respondent. The collected data was entered with Epi-Data version 3.1 and analyzed by using SPSS version 23 software. Bivariate and multivariable analyses were used to examine the association. Odds ratio, 95% CI and P-value < 0.05 were used to determine the statistical association.

RESULT

The mean age of the respondents was 32.42 (SD ± 5.14) and 35.12 (SD ± 5.86) for cases and controls, respectively. Mothers not used contraceptives (AOR = 6.29, 95% CI (1.95, 20.24)), participants who had ≤2 alive children (AOR = 5.57, 95% CI (1.47, 21.13)), mothers who breast fed less than 24 months (AOR = 3.42, 95% CI (1.38, 8.46)), husband decision on contraceptives utilization (AOR = 2.69,95% CI (1.05,6.88)) and mothers who did not have history of antenatal care follow up (AOR = 3.52, 95% CI (1.27, 9.75)) were associated with short birth interval.

CONCLUSION

The optimum birth spacing plays a vital role in decreasing fertility and the morbidity and mortality of mothers and children. Thus, providing health information on the benefit of breast feeding, follow-up of antenatal care during pregnancy, use of contraceptives after delivery and encouraging mothers to make decisions about their own health and use of contraceptives to optimize birth spacing for rural communities.

A multilevel analysis of short birth interval and its determinants among reproductive age women in developing regions of Ethiopia

BACKGROUND

Short Birth Interval negatively affects the health of both mothers and children in developing nations, like, Ethiopia. However, studies conducted to date in Ethiopia upon short birth interval were inconclusive and they did not show the extent and determinants of short birth interval in developing (Afar, Somali, Gambella, and Benishangul-Gumuz) regions of the country. Thus, this study was intended to assess the short birth interval and its determinants in the four developing regions of the country.

METHODS

Data were retrieved from the Demographic and Health Survey program official database website (http://dhsprogram.com). A sample of 2683 women of childbearing age group (15-49) who had at least two alive consecutive children in the four developing regions of Ethiopia was included in this study. A multilevel multivariable logistic regression model was fitted to identify the independent predictors of short birth interval and Akaike's Information Criterion (AIC) was used during the model selection procedure.

RESULTS

In this study, the prevalence of short birth interval was 46% [95% CI; 43.7%, 47.9%]. The multilevel multivariable logistic regression model showed women living in rural area [AOR = 1.52, CI: 1.12, 2.05], women attended secondary education and above level [AOR = 0.27, CI: 0.05, 0.54], have no media exposure [AOR = 1.35, CI: 1.18, 1.56], female sex of the index child [AOR = 1.13, CI:1.07,1.20], breastfeeding duration [AOR = 0.79, CI: 0.77, 0.82], having six and more ideal number of children [AOR = 1.14, CI: 1.09, 1.20] and having preferred waiting time to birth two years and above [AOR = 0.86, CI: 0.78, 0.95] were the predictors of short birth interval.

CONCLUSIONS

The prevalence of short birth intervals in the developing regions of Ethiopia is still high. Therefore, the government of Ethiopia should work on the access of family planning and education in rural parts of the developing regions where more than 90% of the population in these regions is pastoral.

Application of geographically weighted regression analysis to assess predictors of short birth interval hot spots in Ethiopia

Background

Birth interval duration is an important and modifiable risk factor for adverse child and maternal health outcomes. Understanding the spatial distribution of short birth interval, an inter-birth interval of less than 33 months, and its predictors are vital to prioritize and facilitate targeted interventions. However, the spatial variation of short birth interval and its underlying factors have not been investigated in Ethiopia.

Objective

This study aimed to assess the predictors of short birth interval hot spots in Ethiopia.

Methods

The study used data from the 2016 Ethiopia Demographic and Health Survey and included 8,448 women in the analysis. The spatial variation of short birth interval was first examined using hot spot analysis (Local Getis-Ord Gi* statistic). Ordinary least squares regression was used to identify factors explaining the geographic variation of short birth interval. Geographically weighted regression was used to explore the spatial variability of relationships between short birth interval and selected predictors.

Results

Statistically significant hot spots of short birth interval were found in Somali Region, Oromia Region, Southern Nations, Nationalities, and Peoples’ Region and some parts of Afar Region. Women with no education or with primary education, having a husband with higher education (above secondary education), and coming from a household with a poorer wealth quintile or middle wealth quintile were predictors of the spatial variation of short birth interval. The predictive strength of these factors varied across the study area. The geographically weighted regression model explained about 64% of the variation in short birth interval occurrence.

Conclusion

Residing in a geographic area where a high proportion of women had either no education or only primary education, had a husband with higher education, or were from a household in the poorer or middle wealth quintile increased the risk of experiencing short birth interval. Our detailed maps of short birth interval hot spots and its predictors will assist decision makers in implementing precision public health.

A Scoping Review of Spatial Analysis Approaches Using Health Survey Data in Sub-Saharan Africa

Spatial analysis has become an increasingly used analytic approach to describe and analyze spatial characteristics of disease burden, but the depth and coverage of its usage for health surveys data in Sub-Saharan Africa are not well known. The objective of this scoping review was to conduct an evaluation of studies using spatial statistics approaches for national health survey data in the SSA region. An organized literature search for studies related to spatial statistics and national health surveys was conducted through PMC, PubMed/Medline, Scopus, NLM Catalog, and Science Direct electronic databases. Of the 4,193 unique articles identified, 153 were included in the final review. Spatial smoothing and prediction methods were predominant (n = 108), followed by spatial description aggregation (n = 25), and spatial autocorrelation and clustering (n = 19). Bayesian statistics methods and lattice data modelling were predominant (n = 108). Most studies focused on malaria and fever (n = 47) followed by health services coverage (n = 38). Only fifteen studies employed nonstandard spatial analyses (e.g., spatial model assessment, joint spatial modelling, accounting for survey design). We recommend that for future spatial analysis using health survey data in the SSA region, there must be an improve recognition and awareness of the potential dangers of a naïve application of spatial statistical methods. We also recommend a wide range of applications using big health data and the future of data science for health systems to monitor and evaluate impacts that are not well understood at local levels.

Holliday E, Loxton D. Individual and community level determinants of short birth interval in Ethiopia: A multilevel analysis

Background

The World Health Organization recommends a minimum of 33 months between two consecutive live births to reduce the risk of adverse maternal and child health outcomes. However, determinants of short birth interval have not been well understood in Ethiopia.

Objective

The aim of this study was to assess individual- and community-level determinants of short birth interval among women in Ethiopia.

Methods

A detailed analysis of the 2016 Ethiopian Demographic and Health Survey data was performed. A total of 8,448 women were included in the analysis. A two-level multilevel logistic regression analysis was used to identify associated individual- and community-level factors and estimate between-community variance.

Results

At the individual-level, women aged between 20 and 24 years at first marriage (AOR = 1.37; 95% CI: 1.18–1.60), women aged between 25 and 29 years at first marriage (AOR = 1.65; 95% CI: 1.20–2.25), having a husband who attended higher education (AOR = 1.32; 95% CI: 1.01–1.73), being unemployed (AOR = 1.16; 95% CI: 1.03–1.31), having an unemployed husband (AOR = 1.23; 95% CI: 1.04–1.45), being in the poorest wealth quintile (AOR = 1.82; 95% CI: 1.39–2.39), being in the poorer wealth quintile (AOR = 1.58; 95% CI: 1.21–2.06), being in the middle wealth quintile (AOR = 1.61; 95% CI: 1.24–2.10), being in the richer wealth quintile (AOR = 1.54; 95% CI: 1.19–2.00), increased total number of children born before the index child (AOR = 1.07; 95% CI: 1.03–1.10) and death of the preceding child (AOR = 1.97; 95% CI: 1.59–2.45) were associated with increased odds of short birth interval. At the community-level, living in a pastoralist region (AOR = 2.01; 95% CI: 1.68–2.39), being a city dweller (AOR = 1.75; 95% CI: 1.38–2.22), high community-level female illiteracy (AOR = 1.23; 95% CI: 1.05–1.45) and increased distance to health facilities (AOR = 1.32; 95% CI: 1.11–1.56) were associated with higher odds of experiencing short birth interval. Random effects showed significant variation in short birth interval between communities.

Conclusion

Determinants of short birth interval are varied and complex. Multifaceted intervention approaches supported by policy initiatives are required to prevent short birth interval.

Birth Intervals and Associated Factors among Women Attending Young Child Clinic in Yumbe Hospital, Uganda

INTRODUCTION

Evidence suggests that both short and long birth intervals are associated with poor maternal and child health outcomes. However, current studies suggest that a number of births still occur at short intervals. The aim of this study was to document birth intervals and associated factors among women of reproductive age in rural Uganda.

MATERIALS AND METHODS

This was a cross-sectional study conducted among 296 women aged 15-49 years attending young child clinic at Yumbe Hospital who had at least two successive live births. Data was collected using interviewer-administered questionnaire. Birth interval was categorized according to the WHO-recommended birth interval of ≥24 months and <24 months.

RESULTS

Of the 296 participants, 86.6% desired a birth interval ≥ 24 months with a desired median birth interval of 36 months. The actual median birth interval was 22 months. Slightly more than half of the women (52.4%) had short birth intervals. Factors which were likely to be associated with short birth intervals included being younger (15-24 years) (AOR = 4.39, 95%CI = 1.49-12.93, P = 0.007), not planning to have another pregnancy (AOR = 0.33, 95%CI = 0.18-0.58, P = 0.001), not deciding together with husband when to have the next child (AOR = 3.10, 95%CI = 1.53-6.28, P = 0.002), not always using contraceptives before the next pregnancy (AOR = 0.28, 95%CI = 0.12-0.64, P = 0.003), and lack of influence of husband on when to have the next child (AOR = 2.59, 95%CI = 1.44-4.64, P = 0.001).

CONCLUSION

Prevalence of short birth intervals is still high in rural Uganda (52.4%), although majority (86.6%) of the women desire optimal birth intervals. Factors which were likely to be associated with short birth intervals included young maternal age, not using contraceptives, and lack of male involvement in child spacing activities. Therefore, to optimize birth intervals, focused child spacing strategies targeting young women and men are needed.

Service environment link and false discovery rate correction: Methodological considerations in population and health facility surveys

Background

Geospatial data are important in monitoring many aspects of healthcare development. Geographically linking health facility data with population data is an important area of public health research. Examining healthcare problems spatially and hierarchically assists with efficient resource allocation and the monitoring and evaluation of service efficacy at different levels. This paper explored methodological issues associated with geographic data linkage, and the spatial and multilevel analyses that could be considered in analysing maternal health service data.

Methods

The 2016 Ethiopia Demographic and Health Survey and the 2014 Ethiopia Service Provision Assessment data were used. Two geographic data linking methods were used to link these two datasets. Administrative boundary link was used to link a sample of health facilities data with population survey data for analysing three areas of maternal health service use. Euclidean buffer link was used for a census of hospitals to analyse caesarean delivery use in Ethiopia. The Global Moran’s I and the Getis-Ord Gi* statistics need to be carried out for identifying hot spots of maternal health service use in ArcGIS software. In addition to this, since the two datasets contain hierarchical data, a multilevel analysis was carried out to identify key determinants of maternal health service use in Ethiopia.

Results

Administrative boundary link gave more types of health facilities and more maternal health services as compared to the Euclidean buffer link. Administrative boundary link is the method of choice in case of sampled health facilities. However, for a census of health facilities, the Euclidean buffer link is the appropriate choice as this provides cluster level service environment estimates, which the administrative boundary link does not. Applying a False Discovery Rate correction enables the identification of true spatial clusters of maternal health service use.

Conclusions

A service environment link minimizes the methodological issues associated with geographic data linkage. A False Discovery Rate correction needs to be used to account for multiple and dependent testing while carrying out local spatial statistics. Examining maternal health service use both spatially and hierarchically has tremendous importance for identifying geographic areas that need special emphasis and for intervention purposes.

Short birth interval and associated factors among women of child bearing age in northern Ethiopia, 2016

Background

Short birth interval is known to have a negative effect on perinatal, neonatal and child health outcomes. In Ethiopia, 29% of births are short birth intervals at less than 24 months. Even though optimum birth spacing is considered as an essential factor for the health of women and their children, to the best of the authors’ knowledge studies conducted on short birth interval are insufficient to inform policy makers. Therefore, the aim of this study was to assess short birth interval and associated factors among women of child bearing age in Tigray, Ethiopia.

Methods

A community based cross-sectional study was conducted in Tselemti district among women of child bearing age from January 28 to February 28, 2016. Systematic sampling technique was used to select participants. Data were collected through face to face interviews and analyzed using SPSS version 20.0. Odds ratio along with 95% CI was computed to ascertain association between the outcome and predictor variables. A p-value of < 0.05 was considered as cut off point to assess significance of associations in the multivariable analysis.

Results

The overall prevalence of short birth interval among women of child bearing age was 187 (23.3%). Sub-optimum breastfeeding (AOR = 7.01; 95% CI: 3.64, 13.46), non-use of contraceptive (AOR = 2.44; 95% CI: 1.55, 3.82), being Muslim (AOR = 2.02; 95% CI: 1.20, 3.40) and not having desire to had the last child (AOR = 3.63; 95% CI: 2.23, 5.91) were factors associated with short birth interval.

Conclusion

Even though currently coverage of family planning use has increased, this study showed that short birth interval is still a concern for Ethiopian women due to factors such as: religion, suboptimum breastfeeding, unwanted pregnancy and non-use of contraceptives. Improving the accessibility and coverage of contraceptive use and involvement of religious leaders in family planning programs are essential strategies to be considered.

Electronic supplementary material

The online version of this article (10.1186/s12905-019-0776-4) contains supplementary material, which is available to authorized users.

Effect of Family Planning Counseling After Delivery on Contraceptive Use at 24 Weeks Postpartum in Kinshasa, Democratic Republic of Congo

Introduction Unintended pregnancy during the postpartum period is common. The aim of this study was to describe contraceptive use among postpartum women and assess whether family planning counseling offered by health care providers during well-baby clinic visits increased use of modern contraceptive methods at 6 months following delivery. Methods Data comes from a cohort of women enrolled in a breastfeeding promotion trial in Kinshasa, Democratic Republic of Congo who reported being sexually active at 24-weeks post-partum. Modern contraceptive methods included intrauterine devices, injectables, implants, and contraception pills. Logistic regression models were used to estimate odd ratios (OR) and 95% confidence intervals (CI) for the impact of nurse counseling on use of modern birth control methods. Results Of 522 participants who reported being sexually active, 251 (48.0%) reported doing at least one thing to avoid pregnancy and were included in this analysis. Of these 251, 14.3% were using a modern contraceptive method, despite availability at the clinic. Discussion with a nurse about family planning was associated with increased odds of using modern birth control relative to other methods (OR 4.0, 95% CI 1.9, 8.6). Discussion Discussion of family planning with a nurse increased the odds of using a modern contraceptive among postpartum women. Integration of family planning counseling into postpartum services offers a potential avenue to increase modern contraceptive use among women with access.