Time to first birth and its predictors among reproductive-age women in Ethiopia: inverse Weibull gamma shared frailty model

Predictors of adolescent childbearing among Ethiopian women with spatial effect adjustment

BACKGROUND

Childbearing under the age of 20 is referred to as teenage childbearing. Compared to high-income countries, it is significantly higher in low-income countries. Adolescent childbearing is influenced by a number of variables, including economic, demographic, and social factors, and these vary geographically. Thus, this study aimed to determine the predictors of adolescent childbearing among Ethiopian women with spatial effect adjustment.

METHODS

A total weighted sample of 4712 women aged 15 to 49 were included. The data were obtained from the 2019 Ethiopia Demographic and Health Survey. A generalized Geoadditive model which accounts for spatial effect and the non-linear effect of continuous variables was adopted to determine the associated factors of adolescent childbearing among Ethiopian women.

RESULTS

The spatial pattern of adolescent childbearing was non-random in Ethiopia with Moran's index statistics 1.731999 (P-value < 0.001). Based on the evidence of spatial variation in a model, the highest risk of adolescent childbearing was observed in Jijiga, Shinilie, Welwel and Walder, Afar (Zone1 and Zone 5), Assosa, Metekel, and Gambela (Zone1). We also noted that women not intending to use a contraceptive method, Muslim religion, living in a rural area, and large household family size were significantly associated with a high risk of adolescent childbearing. Furthermore, our model results also confirmed that higher educational levels, older household age, and good economic status significantly reduced the risk of adolescent childbearing.

CONCLUSIONS

This study revealed that adolescent childbearing distribution was significantly clustered in the Eastern and Southwestern parts of Ethiopia. Intervention programs aimed at the prevention of early marriage and raising awareness of sexual activity are essential to reducing adolescent childbearing.

Time to first birth and its predictors among reproductive-age women in Ethiopia: multilevel analysis using shared frailty model

OBJECTIVE

To determine the time to first birth and its predictors among reproductive-age women in Ethiopia.

DESIGN, SETTING AND PARTICIPANTS

Nationwide secondary data analysis using mini Ethiopian Demographic and Health Survey, 2019. A stratified, two-stage cluster sampling technique was used to select the sample. Among 9012 women of age 15-49 years, 8885 completed the interview yielding a response rate of 99%.

MAIN OUTCOMES MEASURED

Time to first birth was determined. Kaplan-Meier method was used to estimate the time to first birth. The lognormal inverse Gaussian shared frailty model was used to model the data at a 95% CI. CI and adjusted time ratio (ATR) were reported as effect size. Statistical significance was declared at p-value<0.05.

RESULTS

The overall median time to give first birth was 18 years (IQR: 15, 21). Age 20-29 (ATR=1.08; 95% CI, 1.05 to 1.12), Age>29 years (ATR=1.08; 95% CI, 1.05 to 1.11), northern regions (ATR=1.06; 95% CI, 1.03 to 1.08), rural residence (ATR=0.95; 95% CI, 0.93 to 0.98), never using contraceptive methods (ATR=0.98; 95% CI, 0.96 to 0.99), sex of household head (ATR=1.01; 95% CI, 1 to 1.03), poorest wealth index (ATR=1.04; 95% CI, 1.02 to 1.06) and richest wealth index (ATR=1.07; 95% CI, 1.04 to 1.1) were the significant predictors of time to first birth among reproductive-age women.

CONCLUSION

In Ethiopia, women often gave birth to their first child at a younger age than what is recommended. Explicitly, women aged 20-29 and over 29, living in the northern region, leading a household as females, and belonging to the poorest or wealthiest wealth index tended to have a slightly delayed first childbirth. On the other hand, women in rural areas and those who had never used contraception were more likely to have an early first birth. The findings indicated the necessity of implementing targeted measures for rural Ethiopian women, especially those lacking knowledge about contraception.

Investigating time to first birth among women of reproductive age in Bangladesh: a survival analysis of nationwide cross-sectional survey data

BACKGROUND

The birth of the first child is an important turning point in a woman's life as it is the starting point of the demanding responsibilities of motherhood and childcare. This study aimed to explore the waiting time and the significant indicators of time to the first birth of aged 15-49 years of ever-married women in Bangladesh.

METHODS

The study considered the most recent country-representative data collected from Bangladesh Demographic and Health Survey (BDHS) in 2017/18. The log-rank test was used to assess the statistical significance of the observed difference between waiting time to first birth and various socio-economic and demographic factors. The Cox proportional hazard model is applied to identify the influential factors for waiting time to first birth.

RESULTS

About 55% of the respondents' age at their first birth was less than 18 years. More than 21% of them were 20 years and above at their first birth. Findings revealed a higher mean age at first birth in urban areas than in rural areas. Also, in Dhaka and Sylhet region, women have a higher age at first than in other regions of Bangladesh. Results show that the place of residence, region, age at first marriage, age at first sex, respondent's education, employment status, contraceptive use, and mass media exposure were found to be statistically significant determinants of the age of respondents at the time of first birth. Findings also show that a woman from rural areas was likely to be 5% smaller in age at the time of first birth than their counterpart (aHR 1.05; 95% CI 1.01-1.10). The age at first birth of a woman in Chattogram was 24% shorter, while in Rangpur and Barishal, that age was increased by 14% and 8%, respectively. A woman with no education, primary, and secondary education had 28%, 38%, and 29%, respectively, shorter age at first birth than that of the higher educated women. Mass media unexposed women were shorter aged at first birth by 27% (aHR 1.27; 95% CI 1.10-1.47) compared to the women who were mass media exposed.

CONCLUSION

It is necessary to increase the age of mothers at first birth which may help to reduce the prevalence of child marriage in Bangladesh. The study findings will be helpful to the policymakers in identifying the gap and designing the programmes targeting the early timing of first birth to reduce child mortality as well as poor maternal outcomes which will be beneficial for achieving the Sustainable Development Goal-3 in Bangladesh.

Fertility Intentions, Parenting Attitudes, and Fear of Childbirth among College Students in China: A Cross-Sectional Study

STUDY OBJECTIVE

This study aimed to investigate the current situation regarding fertility intentions, parenting attitudes, and fear of childbirth among college students in mainland China and the factors related to these variables.

DESIGN

A cross-sectional study SETTING: Colleges across China PARTICIPANTS: Five hundred and eighty-three college students attending regular institutions of higher education MAIN OUTCOME MEASURES: Fertility intentions and fear of childbirth were measured using the Swedish Fertility Awareness Questionnaire and the Childbirth Fear Prior to Pregnancy scale.

RESULTS

Only 38.8% of participants expressed their willingness to have children, and there was a significant difference between male and female students (P < .02). Males regarded having children as more important (P < .01), and females were more concerned about the negative effects of becoming parents, including difficulties in the labor market, having less freedom, and having less money. When deciding whether to have children, factors such as work, economics, and childcare were more important to females. Students who did not want children had higher levels of fear of childbirth than those who wanted children or were unsure (P < .02).

CONCLUSIONS

The fertility intentions of college students were not optimistic. In addition to the 2-child Chinese fertility policy, interventions aimed at reducing the cost of raising children, eliminating gender inequality in the workplace, and normalizing childcare institutions might help alleviate conflict between work and childrearing.

Implementation of maternal guidelines for gravid teenagers with hypertensive disorders in KwaZulu-Natal

BACKGROUND

 The worldwide phenomenon of teenage pregnancy among 13-9-year-olds is complicated by obstetric conditions. Among the top three causes of maternal mortality, hypertension is the third in South Africa. Quality maternal care is assured by obstetric practitioners (OPs) implementing guidelines specific for management of hypertension in pregnancy.

OBJECTIVE

 The objective of this study was to investigate implementation of maternal guidelines for hypertension in pregnancy among teenagers.

METHODS

 As a retrospective quantitative research design was used, 173 maternal records of pregnant teenagers from 13 to 19 years were sampled from six district hospitals and Community Health Centres (CHCs) between 01 January 2017 and 31 December 2019 to undergo systematic random sampling. A pretested structured checklist was used to record data from sampled maternal records. Statistical Package for Social Sciences (SPSS) version 26 was used for data analysis, and results were presented using simple descriptive statistics.

RESULTS

 Research results indicated that teenagers who suffered from hypertension intrapartum and postpartum did not receive maternal care according to the guidelines for maternity care in South Africa. Blood pressure was not measured of six (3.47%) intrapartum and five (2.9%) postpartum teenagers. Seventeen (9.8%) hypertensive postpartum teenagers received their antihypertensives.

CONCLUSION

 Public health institutions (PHIs) compromised provision of quality maternal care among teenagers, evidenced by incomplete intrapartum and postpartum assessment, diagnosis and management of hypertensive disorders in pregnancy (HDP).Contribution: This study contributed to facilitating adherence to guidelines improving healthcare of teenagers in government facilities.

Timing of perinatal death; causes, circumstances, and regional variations among reviewed deaths in Ethiopia

INTRODUCTION

Ethiopia is one of the countries facing a very high burden of perinatal death in the world. Despite taking several measures to reduce the burden of stillbirth, the pace of decline was not that satisfactory. Although limited perinatal mortality studies were conducted at a national level, none of the studies stressed the timing of perinatal death. Thus, this study is aimed at determining the magnitude and risk factors that are associated with the timing of perinatal death in Ethiopia.

METHODS

National perinatal death surveillance data were used in the study. A total of 3814 reviewed perinatal deaths were included in the study. Multilevel multinomial analysis was employed to examine factors associated with the timing of perinatal death in Ethiopia. The final model was reported through the adjusted relative risk ratio with its 95% Confidence Interval, and variables with a p-value less than 0.05 were declared statistically significant predictors of the timing of perinatal death. Finally, a multi-group analysis was carried out to observe inter-regional variation among selected predictors.

RESULT

Among the reviewed perinatal deaths, 62.8% occurred during the neonatal period followed by intrapartum stillbirth, unknown time of stillbirth, and antepartum stillbirth, each contributing 17.5%,14.3%, and 5.4% of perinatal deaths, respectively. Maternal age, place of delivery, maternal health condition, antennal visit, maternal education, cause of death (infection and congenital and chromosomal abnormalities), and delay to decide to seek care were individual-level factors significantly associated with the timing of perinatal death. While delay reaching a health facility, delay to receive optimal care health facility, type of health facility and type region were provincial-level factors correlated with the timing of perinatal death. A statistically significant inter-regional variation was observed due to infection and congenital anomalies in determining the timing of perinatal death.

CONCLUSION

Six out of ten perinatal deaths occurred during the neonatal period, and the timing of perinatal death was determined by neonatal, maternal, and facility factors. As a way forward, a concerted effort is needed to improve the community awareness of institutional delivery and ANC visit. Moreover, strengthening the facility level readiness in availing quality service through all paths of the continuum of care with special attention to the lower-level facilities and selected poor-performing regions is mandatory.

Time to first birth and its predictors among reproductive age women in high fertility countries in Sub-Saharan Africa: Inverse Weibull gamma shared frailty model

BACKGROUND

Early initiation of childbearing leads to an increase in total fertility rate and population growth. It has been linked with both maternal and child morbidity and mortality. However, there is limited information on the timing of the first birth and its predictors in the area so far. Therefore, determining the time to first birth and its predictors will help to design strategies to improve fertility rate, maternal and child survival.

METHODS

The survey used recent (2010 - 2018) Demographic and Health data; a stratified, two-stage cluster sampling technique was used to select the sample. Inverse Weibull gamma shared frailty model was used to model the data at 95% confidence interval. Adjusted hazard ratio (AHR) and median hazard ratio (MHR) were reported as effect size. Statistical significance was declared at p value < 0.05.

RESULTS

The overall median age at first birth was found to be 19 years (IQR: 16, 21 years). Rural residency (AHR = 1.02, 95%, CI 1.00,1.04), agricultural employee (AHR = 1.14, 95%, CI 1.13, 1.17), and nonagricultural employee (AHR = 1.06, 95%, CI 1.05, 1.08), marriage below 15 years (AHR = 5.47, 95%, CI 5.37, 5.57) and 15-17 years (AHR = 3.27, 95%, CI 3.22, 3.32), had sex below 15 years (AHR =  = 1.57, 95%, CI 1.54, 1.61) and 15-17 years (AHR = 1.38, 95%, CI 1.38, 1.43), women who had unmet need for contraceptive (AHR = 1.39, 95%, CI 1.37, 1.42), and met need (AHR = 1.32, 95%, CI 1.30, 1.35), high spousal age gap (AHR = 1.17, 95%, CI 1.15, 1.19), not heard family planning message (AHR = 1.02, 95%, CI 1.01,1.04) were the higher hazard of early childbirth.

CONCLUSION

The median age at first birth was found to be 19 years. This is lower than the optimal age for giving first birth, which is between late 20 s and early 30 s years. Rural residences, occupation, hearing family planning massage in the media, early sexual intercourse, early age at first marriage, high spousal gap, and unmet need for family planning were predictors of first birth at an early age. Thus, governments and non-governmental organizations should strive to implement programs that aim to reduce early age at first birth by considering these factors.

Bayesian Shared Frailty Models for Time to First Birth of Married Women in Ethiopia: Using EDHS 2016

Introduction

The primary effect of the fertility process is the birth of the first child. The ages at which women establish marital union and give their first birth depend on and result in varying demographic features. This research demonstrates how to examine the effect of numerous factors on married women's delay to first birth in Ethiopia using Bayesian parametric models with gamma shared frailty distribution.

Methods

This study analyzed data from the 2016 EDHS on factors related to the time of married women to first birth. A sample of 8810 married women from all parts of Ethiopia participated in the study. The Akaike information criterion (AIC) and Bayesian information criterion (BIC) were used to compare several parametric models with gamma shared frailty distributions to find the best model (BIC). Finally, when the prior data was taken into account, the chosen model was proven to be accurate (Bayesian approach).

Results

The median survival time for the first birth after marriage is 24 years (95% CI; 23.4, 25.3). The result shows that the place of residence, the access to media, the level of education of the mother, the education level of the husband, the use of the head of the contraceptives, and the sex of the household are statistically associated with the time to first birth of married women. The Weibull-gamma shared frailty model under the Bayesian approach was found to be the best model that fit the time to first birth data in this study. The result also showed that there is heterogeneity between regions of married women.

Conclusion

To slow the increase in the Ethiopian population, families must be taught how to use contraception, and rural populations must be educated on the necessity of increasing the length of the first birth gap rather than encouraging early marriage. In general, attempts to reduce fertility by raising the age of the first marriage must consider the social and cultural settings in which marriage takes place. On the other hand, the campaign against early marriage should focus on the sociocultural, physiological, and psychological effects, as well as the reduction of reproduction.