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Tebeje TM, Seifu BL, Seboka BT, Mare KU, Chekol YM, Tesfie TK, Gelaw NB, Abebe M. Trends, spatiotemporal variation and decomposition analysis of pregnancy termination among women of reproductive age in Ethiopia: Evidence from the Ethiopian demographic and health survey, from 2000 to 2016. Heliyon 2024; 10:e34633. [PMID: 39130402 PMCID: PMC11315203 DOI: 10.1016/j.heliyon.2024.e34633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/08/2024] [Accepted: 07/12/2024] [Indexed: 08/13/2024] Open
Abstract
Background Pregnancy termination is a major public health problem, and complications of unsafe abortion are among the proximate and major causes of maternal mortality. Mapping the trend and spatiotemporal variation and identifying factors that are responsible for the changes in pregnancy termination help achieve the sustainable development goal of reducing maternal mortality in Ethiopia by understanding the epidemiology and regional variations. Methods Data from the 2000-2016 Ethiopian Demographic and Health Survey were analyzed with a total weighted sample of 40,983 women of reproductive age. Variables with a p-value <0.05 in a logit multivariable decomposition analysis were considered significant predictors of the decline in pregnancy termination over time. Spatial analysis was used separately for each survey to show the changes in regional disparities in pregnancy termination in Ethiopia. Results The magnitude of pregnancy termination among women of reproductive age decreased by 39.5 %, from 17.7 % in 2000 to 10.7 % in 2016. The difference in the effects of literacy, working status, marital status, age at first intercourse, age at first cohabitation, knowledge about contraceptives, and knowledge of the ovulatory cycle were the significant predictors that contributed to the change in pregnancy termination over time. Significant clusters of pregnancy terminations were observed in central and northern Ethiopia (Addis Ababa, eastern Amhara, and Tigray regions). Conclusions Despite the substantial decrease in terminated pregnancies over time in Ethiopia, the magnitude is still high. The government should focus on promoting education for girls and women, providing reproductive health education, including access to contraceptives, and raising the minimum age for girls to engage in sexual activities or marriage by implementing policies.
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Affiliation(s)
- Tsion Mulat Tebeje
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Beminate Lemma Seifu
- Department of Public Health, College of Medicine and Health Science, Samara University, Afar, Ethiopia
| | - Binyam Tariku Seboka
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Afar, Ethiopia
| | - Yazachew Moges Chekol
- Department of Health Information Technology, Mizan Aman College of Health Science, Mizan Aman, Southwest Ethiopia, Ethiopia
| | - Tigabu Kidie Tesfie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Negalgn Byadgie Gelaw
- Department of Public Health, Mizan Aman College of Health Science, Mizan Aman, Southwest Ethiopia, Ethiopia
| | - Mesfin Abebe
- Department of Midwifery, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
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Kassa RN, Kaburu EW, Andrew-Bassey U, Abdiwali SA, Nahayo B, Samuel N, Akinyemi JO. Factors associated with pregnancy termination in six sub-Saharan African countries. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002280. [PMID: 38722942 PMCID: PMC11081391 DOI: 10.1371/journal.pgph.0002280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024]
Abstract
Pregnancy termination continues to be a leading cause of maternal morbidity and mortality among young women in Africa. The sub-Saharan Africa region has the highest rate of abortion-related deaths in the world, at 185 maternal deaths per 100,000 abortions. The aim of this study is to investigate the factors associated with pregnancy termination among women aged 15 to 29 years in six sub-Saharan African countries. We used secondary data from the most recent Demographic and Health Survey of six sub-Saharan African countries: Kenya, Tanzania, Ethiopia, Burundi, Nigeria, and Rwanda. A total weighted sample of 74,652 women aged 15-29 were analyzed. A multivariable logistic regression model was used to identify the factors associated with pregnancy termination at a p-value < 0.05. Results were presented using adjusted odds ratios (AOR) with 95% confidence interval. The study showed that 6.3% of women aged 15-29 reported pregnancy termination with a higher prevalence rate in Tanzania (8.8%) and lowest in Ethiopia (4%). Highest odds of pregnancy termination occurred among women aged 20-24 as compared to women aged 15-19 in Rwanda (AOR: 4.04, 95%CI 2.05, 7.97) followed by Nigeria (AOR: 2.62, 95% CI 1.99, 3.43), Kenya (AOR: 2.33, 95%CI 1.48, 3.66), Burundi (AOR: 1.99 95%CI 1.48, 2.85), Tanzania (AOR: 1.71 95%CI 1.29, 2.27), and Ethiopia (AOR: 1.69, 95% CI 1.19, 2.42). Women with no education had 4 times higher odds of pregnancy termination compared to women with higher education in Tanzania (AOR: 4.03 95%CI 1.00, 16.13) while women with no education and primary level education were 1.58 times (AOR: 1.58 95% CI 1.17, 2.13) and 1.78 times (AOR: 1.78 95% CI 1.34, 2.37) as likely to terminate pregnancy in Ethiopia. In Tanzania, the likelihood of a pregnancy termination was associated with a relationship to the household head; head (AOR: 3.66, 95% CI (2.32, 5.78), wife (AOR: 3.68, 95% CI 2.60, 5.12), and in-law (AOR:2.62, 1.71, 4.03). This study revealed that a significant number of women had pregnancy termination. Being in the age group of 20-24 & 25-29, having a lower level of education, being a domestic employee and professional, being single/never-in-union, being in the poorest and richer wealth quantile category, and being head, wife, daughter, and in-law to the household head were the significantly associated with pregnancy termination. Taking these socio-economic factors into consideration by stakeholders and specific sexual education targeted to women aged 15 to 29 would help tackle the problem.
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Affiliation(s)
- Rahel Nega Kassa
- Department of Obstetrics and Gynecology, College of Medicine, Pan African University Life and Earth Sciences Institute, University of Ibadan, Ibadan, Oyo State, Nigeria
- Department of Medical-surgical Nursing, School of Nursing, Saint Paul’s Millennium Medical College, Addis Ababa, Ethiopia
| | - Emily Wanja Kaburu
- Department of Obstetrics and Gynecology, College of Medicine, Pan African University Life and Earth Sciences Institute, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Uduak Andrew-Bassey
- Department of Obstetrics and Gynecology, College of Medicine, Pan African University Life and Earth Sciences Institute, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Saad Ahmed Abdiwali
- Department of Obstetrics and Gynecology, College of Medicine, Pan African University Life and Earth Sciences Institute, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Bonfils Nahayo
- Department of Obstetrics and Gynecology, College of Medicine, Pan African University Life and Earth Sciences Institute, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Ndayishimye Samuel
- Department of Obstetrics and Gynecology, College of Medicine, Pan African University Life and Earth Sciences Institute, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - Joshua Odunayo Akinyemi
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Das M, Patidar H, Singh M. Understanding trimester-specific miscarriage risk in Indian women: insights from the calendar data of National Family Health Survey (NFHS-5) 2019-21. BMC Womens Health 2024; 24:63. [PMID: 38263129 PMCID: PMC10804530 DOI: 10.1186/s12905-023-02838-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 12/09/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND The primary public health issue, especially in low- and middle-income countries, is early pregnancy loss driven by miscarriage. Understanding early pregnancy losses and the characteristics of mothers who have miscarriages is essential to creating effective reproductive health strategies. Thus, this study's primary goal is to delve into the factors which impact miscarriages that take place prior to and following the first 12 weeks of gestation. METHODS The bivariate analysis was employed to determine the frequency of miscarriages. The factors associated with miscarriages in the first (≤12 weeks) and second & above (> 12 weeks) trimesters of pregnancy were then examined using a generalised linear regression model, with 95% confidence intervals. Finally, we use ArcGIS to illustrate the prevalence of miscarriage in the districts of India. RESULTS Our result shows that miscarriages occur often in India (4.9%), with 23% of cases occurring in the first trimester (≤12 weeks). In our bivariate analysis, we identified several factors associated with a higher prevalence of miscarriages in India. It was found that mothers aged thirty years or older, residing in urban areas, with less than ten years of education, belonging to the richest wealth quantile, expressing a desire for more children, having no demand for contraception, and possessing no parity experienced a higher prevalence of miscarriage in total pregnancies in India. On the other hand, the generalised linear model's findings show that mothers who are thirty years of age or older, practise other religions, live in urban areas, are members of other castes, want more children, marry before the age of eighteen, and meet their contraceptive needs are more likely to have miscarriages in total pregnancy. However, there is a larger likelihood of miscarriage in the first trimester (≤12 weeks) for mothers who follow other religions, live in urban areas, are from Other Backward Class (OBC), get married before the age of eighteen, and fall into the middle and upper wealth quantiles. A mother is more likely to miscarriage in the second & above (> 12 weeks) trimesters if she is older than thirty, from other castes, wants more children, has moderate media exposure, marries before turning eighteen, meets her contraceptive needs, and does not feel the need for contraception. After accounting for socioeconomic characteristics, all results were statistically significant. CONCLUSIONS Given the substantial number of miscarriages in India, police need to improve planning and guidance in order to lower pregnancy loss due to miscarriage. Miscarriage rates may be significantly decreased by enhancing the availability and quality of reproductive health care infrastructure, particularly in rural areas.
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Affiliation(s)
- Milan Das
- International Institute for Population Sciences, Mumbai, India
| | | | - Mayank Singh
- International Institute for Population Sciences, Mumbai, India.
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Ba DM, Zhang Y, Pasha-Razzak O, Khunsriraksakul C, Maiga M, Chinchilli VM, Ssentongo P. Factors associated with pregnancy termination in women of childbearing age in 36 low-and middle-income countries. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001509. [PMID: 36963033 PMCID: PMC10021843 DOI: 10.1371/journal.pgph.0001509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/31/2022] [Indexed: 03/06/2023]
Abstract
Lack of access to safe, affordable, timely and adequate pregnancy termination care, and the stigma associated with abortion in low-middle income countries (LMICs), pose a serious risk to women's physical and mental well-being throughout the lifespan. Factors associated with pregnancy termination and their heterogeneity across countries in LMICs previously have not been thoroughly investigated. We aim to determine the relative significance of factors associated with pregnancy termination in LMICs and its variation across countries. Analysis of cross-sectional nationally representative household surveys carried out in 36 LMICs from 2010 through 2018. The weighted population-based sample consisted of 1,236,330 women of childbearing aged 15-49 years from the Demographic and Health Surveys. The outcome of interest was self-report of having ever had a pregnancy terminated. We used multivariable logistic regression models to identify factors associated with pregnancy termination. The average pooled weighted prevalence of pregnancy termination in the present study was 13.3% (95% CI: 13.2%-13.4%), ranging from a low of 7.8 (95% CI: 7.2, 8.4%) in Namibia to 33.4% (95% CI: 32.0, 34.7%) in Pakistan. Being married showed the strongest association with pregnancy termination (adjusted OR, 2.94; 95% CI, 2.84-3.05; P < 0.001) compared to unmarried women. Women who had more than four children had higher odds of pregnancy termination (adjusted OR, 2.45; 95% CI, 2.33-2.56; P < 0.001). Moreover, increased age and having primary and secondary levels of education were associated with higher odds of pregnancy termination compared to no education. In this study, married women, having one or more living children, those of older age, and those with at least primary level of education were associated with pregnancy termination in these 36 LMICs. The findings highlighted the need of targeted public health intervention to reduce unintended pregnancies and unsafe abortions.
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Affiliation(s)
- Djibril M Ba
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - Yue Zhang
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - Omrana Pasha-Razzak
- Department of Medicine, Division of Hospital Medicine, Penn State Health Medical Center, Hershey, Pennsylvania, United States of America
| | - Chachrit Khunsriraksakul
- The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - Mamoudou Maiga
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, United States of America
| | - Vernon M Chinchilli
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States of America
| | - Paddy Ssentongo
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania, United States of America
- Department of Medicine, Penn State Health Medical Center, Hershey, Pennsylvania, United States of America
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Hailegebreal S, Enyew EB, Simegn AE, Seboka BT, Gilano G, Kassa R, Ahmed MH, Haile Y, Haile F. Pooled prevalence and associated factors of pregnancy termination among youth aged 15-24 year women in East Africa: Multilevel level analysis. PLoS One 2022; 17:e0275349. [PMID: 36548267 PMCID: PMC9778526 DOI: 10.1371/journal.pone.0275349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 09/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Most of unwanted pregnancies among adolescent girls and young women (AGYW) in Africa result in pregnancy termination. Despite attempts to enhance maternal health care service utilization, unsafe abortion remains the leading cause of maternal death in Sub-Saharan Africa (SSA), there is still a study gap, notably in East Africa, where community-level issues are not studied. Therefore, this study aimed to assess pooled prevalence pregnancy termination and associated factors among youth (15-24 year-old) women in the East Africa. METHODS The study was conducted based on the most recent Demographic and Health Surveys (DHS) in the 12 East African countries. A total weighted sample of 44,846 youth (15-24) age group women was included in this study. To detect the existence of a substantial clustering effect, the Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), and Likelihood Ratio (LR)-test were used. Furthermore, because the models were nested, deviance (-2LLR) was used for model comparison. In the multilevel logistic model, significant factors related to pregnancy termination were declared using Adjusted Odds Ratios (AOR) with a 95%Confidence Interval (CI) and p-value of 0.05. RESULT The pooled prevalence of pregnancy termination in East African countries was 7.79% (95% CI: 7.54, 8.04) with the highest prevalence in Uganda 12.51% (95% CI: 11.56, 13.41) and lowest was observed in Zambia 5.64% ((95% CI: 4.86, 6.41). In multilevel multivariable logistic regression result, age 20-24 [AOR = 1.93; 95% CI: 1.71, 2.16], media exposure [AOR = 1.22; 95% CI: 1.12, 1.34], married [AOR = 1.32, 95% CI: 1.21, 1.43], had working [AOR = 1.13; 95% CI: 1.04, 1.23],no education[AOR = 3.98, 95% CI: 2.32, 6.81], primary education [AOR = 4.05, 95% CI: 2.38, 6.88], secondary education [AOR = 2.96, 95% CI: 1.74, 5.03], multiparous [AOR = 0.85; 95%CI: 0.79, 0.93], sexual initiation greater or equal to 15 [AOR = 0.82; 95%CI: 0.74, 0.99] were significantly associated with pregnancy termination. CONCLUSION The pooled prevalence of pregnancy termination in East Africa was high in this study. Maternal age, marital status, education status, parity, age at first sex, media exposure, working status and living countries were significantly associated with pregnancy termination. The finding provides critical information for developing health interventions to decrease unplanned pregnancies and illegal pregnancy termination.
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Affiliation(s)
- Samuel Hailegebreal
- Department of Health Informatics, College of Medicine and Health Science, School of Public Health, Arba Minch University, Arba Minch, Ethiopia
- * E-mail:
| | - Ermias Bekele Enyew
- Department of Health Informatics, Institute of Public Health, Mettu University, Metu, Ethiopia
| | - Atsedu Endale Simegn
- Department of Anesthesia, College of Medicine and Health Science, Wachemo University, Hosaena, Ethiopia
| | - Binyam Tariku Seboka
- Department of Health Informatics, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Girma Gilano
- Department of Health Informatics, College of Medicine and Health Science, School of Public Health, Arba Minch University, Arba Minch, Ethiopia
| | - Reta Kassa
- School of public health, Dilla University, Dilla, Ethiopia
| | | | - Yosef Haile
- Arba Minch University, College of Medicine and Health Sciences, School of Public Health, Arba Minch, Ethiopia
| | - Firehiwot Haile
- Arba Minch University, College of Medicine and Health Sciences, School of Public Health, Arba Minch, Ethiopia
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