Maternal age at first childbirth and under-five morbidity in sub-Saharan Africa: analysis of cross-sectional data of 32 countries

Infant mortality in Ghana: investing in health care infrastructure and systems

Child and infant mortality is a global problem. Almost half of deaths of children under age 5 years occur in the neonatal period, the first 28 days of life, with 2.4 million neonatal deaths globally in 2020. Sub-Saharan Africa has disproportionately high numbers of neonatal deaths. Ghana's neonatal mortality rate is 22.8 per 1000 live births and remains behind targets set by the United Nations Sustainable Development Goals. Quality antenatal care, postnatal monitoring, breastfeeding support, and postnatal family planning are important in preventing neonatal deaths. While Ghana has made progress in making care more financially accessible, it has not been matched with the improvements in the critical infrastructure required to ensure quality health care. The improvements have also not eliminated out-of-pocket costs for care, which have hindered progress in decreasing infant mortality. Policymakers should consider investments in health care infrastructure, including expanding public-private partnerships. Policies that improve workforce development programs, transportation infrastructure, and health insurance systems improvements are needed.

Time to first childbirth and its predictors among reproductive-age women in Ethiopia: survival analysis of recent evidence from the EDHS 2019

Background

Being a mother for the first time is the most significant event in a woman's life. "Age at first birth" refers to a mother's age in years when she gives birth to her first child. The age of first childbirth has physical, economic, and social implications. However, little is known about this issue in Ethiopia. Thus, this study sought to determine the time to first childbirth and its predictors at a national level.

Methods

Data were extracted from the 2019 Ethiopia Demographic and Health Survey using STATA version 17 software. A total of 8,885 weighted reproductive-age women (15-49 years) were included in this study. A Kaplan-Meier survivor curve was generated to estimate the time of first childbirth. A log-rank test was used to compare the difference in survival curves. Akaike information criteria and Bayesian information criteria were calculated to select the appropriate survival model for the data. The Weibull accelerated failure time model with no frailty distribution was used to identify significant predictors.

Results

The overall median survival time to first childbirth was 18 years. The significant predictors of time to first childbirth were the educational level of the mother [primary education (ϕ = 1.036, 95% CI: 1.011, 1.063), secondary and above education (ϕ = 1.154, 95% CI: 1.118, 1.191)], knowledge of any contraceptive method [know at least one (ϕ = 1.051, 95% CI: 1.006, 1.101)], and media exposure (ϕ = 1.048, 95% CI: 1.011, 1.086).

Conclusion

The median survival time to first childbirth was 18 years, which is lower than the optimal age for first childbirth (late 20 s and early 30 s). The timing of first childbirth in Ethiopia is mainly influenced by the educational level of women, knowledge of contraceptive methods, and exposure to media. Thus, exposing women to educational materials and other awareness-creation campaigns regarding the consequences of early first childbirth and strategies to improve women's knowledge of contraceptive methods is highly recommended.

Influence of maternal age on birth and infant outcomes at 6 months: a cohort study with quantitative bias analysis

BACKGROUND

Maternal age is increasingly recognized as a predictor of birth outcomes. Given the importance of birth and growth outcomes for children's development, wellbeing and survival, this study examined the effect of maternal age on infant birth and growth outcomes at 6 months and mortality. Additionally, we conducted quantitative bias analysis (QBA) to estimate the role of selection bias and unmeasured confounding on the effect of maternal age on infant mortality.

METHODS

We used data from randomized-controlled trials (RCTs) of 21 555 neonates in Burkina Faso conducted in 2019-2020. Newborns of mothers aged 13-19 years (adolescents) and 20-40 years (adults) were enrolled in the study 8-27 days after birth and followed for 6 months. Measurements of child's anthropometric measures were collected at baseline and 6 months. We used multivariable linear regression to compare child anthropometric measures at birth and 6 months, and logistic regression models to obtain the odds ratio (OR) of all-cause mortality. Using multidimensional deterministic analysis, we assessed scenarios in which the difference in selection probability of adolescent and adult mothers with infant mortality at 6 months increased from 0% to 5%, 10%, 15% and 20% if babies born to adolescent mothers more often died during the first week or were of lower weight and hence were not eligible to be included in the original RCT. Using probabilistic bias analysis, we assessed the role of unmeasured confounding by socio-economic status (SES).

RESULTS

Babies born to adolescent mothers on average had lower weight at birth, lower anthropometric measures at baseline, similar growth outcomes from enrolment to 6 months and higher odds of all-cause mortality by 6 months (adjusted OR = 2.17, 95% CI 1.35 to 3.47) compared with those born to adult mothers. In QBA, we found that differential selection of adolescent and adult mothers could bias the observed effect (OR = 2.24, 95% CI 1.41 to 3.57) towards the null [bias-corrected OR range: 2.37 (95% CI 1.49 to 3.77) to 2.84 (95% CI 1.79 to 4.52)], whereas unmeasured confounding by SES could bias the observed effect away from the null (bias-corrected OR: 2.06, 95% CI 1.31 to 2.64).

CONCLUSIONS

Our findings suggest that delaying the first birth from adolescence to adulthood may improve birth outcomes and reduce mortality of neonates. Babies born to younger mothers, who are smaller at birth, may experience catch-up growth, reducing some of the anthropometric disparities by 6 months of age.

Predictors of maternal knowledge on early childhood development in highly marginalized communities in Mexico: Implications for public policy

INTRODUCTION

Efforts to identify the predictors of maternal knowledge on Early Child Development (ECD) have proven inconclusive thus far, particularly with respect to socially deprived contexts in Low- and Middle-Income Countries (LMICs). We quantified the extent of ECD knowledge among mothers who were the primary caregivers of 0-38-month-old infants in marginalized communities in Mexico. We also explored the characteristics of the children, both individually and with regard to their households, given the influence of these factors on childhood development.

METHODS

We analyzed primary data obtained through a questionnaire administered to mothers who were the primary caregivers of 1045 girls and boys 0-38 months of age. The instrument was specifically designed for our study in order to explore the knowledge of participants about physical, neurological and psycho-affective development during childhood. We performed fractional regression analysis to assess the predictors of ECD knowledge.

RESULTS

The mean score of maternal ECD knowledge increased with their age and schooling as well as with their levels of cognitive ability and self-esteem. Irrespective of age at first birth, mean knowledge was relatively high for women with high school education and low for women with elementary or no formal education, a gradient with respect to age at fist birth was more marked among women with middle school education. ECD knowledge scores increased among mothers from households enjoying higher socioeconomic levels and from households with health insurance. Scores were lower for indigenous households regardless of their participation in social programs.

CONCLUSION

Public policies on ECD should promote programs that are not only adapted to specific contexts, but also designed to improve shared child-rearing, early childhood care and as well as psycho-emotional education skills as a pathway to healthier ECD. The participation of families and communities in sensitive childhood care should form part of multisectoral programs involving education, health and wellbeing.

Determinant factors of under-five mortality in rural Ethiopia

Background

Methods

Results

Conclusion

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Ethiopia's under-five mortality rate is still high in the nation's rural areas despite a slight drop.

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A total of 4414 weighted under-five children from the EMDHS 2019 dataset were included from nine geographical regions and two administrative cities of Ethiopia.

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Out of 4414 total under-five children, 267(6%) of them were dead before the age of five years.

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From the current study the researcher Conclude that under-five mortality was very high in rural Ethiopia.

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This research suggests that encouraging women to birth in health facilities and expanding possibilities for mothers' education for rural residents will assist to lessen the burden of under-five mortality.