Relationships between infant mortality, birth spacing and fertility in Matlab, Bangladesh

Net benefit of smaller human populations to environmental integrity and individual health and wellbeing

Introduction

The global human population is still growing such that our collective enterprise is driving environmental catastrophe. Despite a decline in average population growth rate, we are still experiencing the highest annual increase of global human population size in the history of our species-averaging an additional 84 million people per year since 1990. No review to date has accumulated the available evidence describing the associations between increasing population and environmental decline, nor solutions for mitigating the problems arising.

Methods

We summarize the available evidence of the relationships between human population size and growth and environmental integrity, human prosperity and wellbeing, and climate change. We used PubMed, Google Scholar, and Web of Science to identify all relevant peer-reviewed and gray-literature sources examining the consequences of human population size and growth on the biosphere. We reviewed papers describing and quantifying the risks associated with population growth, especially relating to climate change.

Results

These risks are global in scale, such as greenhouse-gas emissions, climate disruption, pollution, loss of biodiversity, and spread of disease-all potentially catastrophic for human standards of living, health, and general wellbeing. The trends increasing the risks of global population growth are country development, demographics, maternal education, access to family planning, and child and maternal health.

Conclusion

Support for nations still going through a demographic transition is required to ensure progress occurs within planetary boundaries and promotes equity and human rights. Ensuring the wellbeing for all under this aim itself will lower population growth and further promote environmental sustainability.

Determinants of Contraceptive Options among Postpartum Women Attending Selected Health Care Facilities in Nigeria: A Cross-Sectional Study

Introduction

Differences in availability and choices of contraceptive methods among postpartum women have been found to influence their quality of life as the fertility rate is very high, and the contraceptive usage rate persistently remains low in Nigeria.

Objectives

This study assessed the determinants of contraceptive options among postpartum women in Nigeria.

Methods

Two Local Governments were randomly selected from the four Local Governments. Within these two local governments, five health facilities were selected. A multistage sampling technique was used to select the 240 respondents, while a structured questionnaire was used to collect data.

Results

Findings from the study indicated that 81.7% of the respondents have planned to have their current baby, and about 65.4% of the women have resumed sexual activities since delivery. Of those who have resumed sexual activities, the majority, 91.1% did so 6 weeks after delivery. Some form of contraceptive usage was prominent among 59.2% of the respondents, as the most common contraceptive method used was withdrawal (24.8%). Contraceptive prevalence was slightly lower for urban respondents than rural respondents, although the relationship was not significant. Also, there was a statistically significant relationship between the current use of contraceptives and resumption of sexual activities since delivery (p = .001), resumption of menstruation (p = .001), and information received about postpartum family planning (p = 0.013).

Conclusion

Findings from this study emphasize the urgent need for enhanced accessibility and availability of contraceptive methods, with a parallel emphasis on targeted interventions and effective communication strategies to promote contraceptive uptake and family planning. Addressing these determinants is vital in improving postpartum women's overall quality of life in the study area.

An evolutionary perspective on social inequality and health disparities: Insights from the producer-scrounger game

There is growing concern with social disparities in health, whether relating to gender, ethnicity, caste, socio-economic position or other axes of inequality. Despite addressing inequality, evolutionary biologists have had surprisingly little to say on why human societies are prone to demonstrating exploitation. This article builds on a recent book, 'The Metabolic Ghetto', describing an overarching evolutionary framework for studying all forms of social inequality involving exploitation. The dynamic 'producer-scrounger' game, developed to model social foraging, assumes that some members of a social group produce food, and that others scrounge from them. An evolutionary stable strategy emerges when neither producers nor scroungers can increase their Darwinian fitness by changing strategy. This approach puts food systems central to all forms of human inequality, and provides a valuable lens through which to consider different forms of gender inequality, socio-economic inequality and racial/caste discrimination. Individuals that routinely adopt producer or scrounger tactics may develop divergent phenotypes. This approach can be linked with life history theory to understand how social dynamics drive health disparities. The framework differs from previous evolutionary perspectives on inequality, by focussing on the exploitation of foraging effort rather than inequality in ecological resources themselves. Health inequalities emerge where scroungers acquire different forms of power over producers, driving increasing exploitation. In racialized societies, symbolic categorization is used to systematically assign some individuals to low-rank producer roles, embedding exploitation in society. Efforts to reduce health inequalities must address the whole of society, altering producer-scrounger dynamics rather than simply targeting resources at exploited groups.

Trends and factors associated with declining lifetime fertility among married women in Kenya between 2003 and 2014: an analysis of Kenya demographic health surveys

BACKGROUND

Globally, fertility has declined in the last three decades. In sub-Saharan Africa Including Kenya, this decline started more recent and at a slower pace compared to other regions. Despite a significant fertility decline in Kenya, there are disparities in intra- and interregional fertility. Reduction in lifetime fertility has health benefits for both the mother and child, thus it is important to improve women and children health outcomes associated with high fertility. The study, therefore evaluated the factors associate with change in lifetime fertility among married women of reproductive age in Kenya between 2003 and 2014.

METHODS

The study used the Kenya Demographic and Health Survey (KDHS) datasets of 2003, 2008 and 2014. Analysis of variance (ANOVA) was used to calculate the mean number of children ever born and to assess the change in fertility across different factors. Poisson regression model with robust standard errors was used to study the relationship between number of children ever born (lifetime fertility) and independent variables. A Poisson-based multivariate decomposition for the nonlinear response model was performed to identify and quantify the contribution of demographic, socioeconomic and reproductive correlates, to the change in lifetime fertility between 2003 and 2014.

RESULTS

The study included 3,917, 4,002, and 7,332 weighted samples of women of reproductive age in 2003, 2008, and 2014, respectively. The mean number of children born declined from 3.8 (95% CI: 3.6-3.9) in 2003 to 3.5 (95% CI: 3.4--3.7) in 2008 and 3.4 (95% CI: 3.3-3.4) in 2014 (p = 0.001). The expected number of children reduced with the age at first sexual intercourse, the age at first marriage across the survey years, and household wealth index. Women who had lost one or more children in the past were likely to have increased number of children. The changes in the effects of women's characteristics between the surveys explained 96.4% of the decline. The main contributors to the change in lifetime fertility was the different in women level of education.

CONCLUSION

The lifetime fertility declined by one-tenth between 2003 and 2014; majorly as a result of the effects of characteristics of women in terms of level of education. These highlights a need to implement education policies that promotes women education focuses on gender equality and women empowerment. Continuous strengthening of the healthcare systems (access to quality antenatal care, skilled delivery, and postpartum care) to reduce child mortality is essential.

Lower infant mortality, higher household size, and more access to contraception reduce fertility in low- and middle-income nations

Although average contraceptive use has increased globally in recent decades, an estimated 222 million (26%) of women of child-bearing age worldwide face an unmet need for family planning-defined as a discrepancy between fertility preferences and contraception practice, or failing to translate desires to avoid pregnancy into preventative behaviours and practices. While many studies have reported relationships between availability/quality of contraception and family planning, infant mortality, and fertility, these relationships have not been evaluated quantitatively across a broad range of low- and middle-income countries. Using publicly available data from 64 low- and middle-income countries, we collated test and control variables in six themes: (i) availability of family planning, (ii) quality of family planning, (iii) female education, (iv) religion, (v) mortality, and (vi) socio-economic conditions. We predicted that higher nation-level availability/quality of family-planning services and female education reduce average fertility, whereas higher infant mortality, greater household size (a proxy for population density), and religious adherence increase it. Given the sample size, we first constructed general linear models to test for relationships between fertility and the variables from each theme, from which we retained those with the highest explanatory power within a final general linear model set to determine the partial correlation of dominant test variables. We also applied boosted regression trees, generalised least-squares models, and generalised linear mixed-effects models to account for non-linearity and spatial autocorrelation. On average among all countries, we found the strongest associations between fertility and infant mortality, household size, and access to any form of contraception. Higher infant mortality and household size increased fertility, whereas greater access to any form of contraception decreased fertility. Female education, home visitations by health workers, quality of family planning, and religious adherence all had weak, if any, explanatory power. Our models suggest that decreasing infant mortality, ensuring sufficient housing to reduce household size, and increasing access to contraception will have the greatest effect on decreasing global fertility. We thus provide new evidence that progressing the United Nation's Sustainable Development Goals for reducing infant mortality can be accelerated by increasing access to family planning.

Short birth interval and its associated factors among multiparous women in Mieso agro-pastoralist district, Eastern Ethiopia: A community-based cross-sectional study

Background

Recently, the concern with birth interval has acquired importance in public health and family planning because of its implication for fertility, maternal, and child health. A short birth interval is associated with adverse perinatal, maternal, and infant outcomes. Moreover, too short birth interval lead to high fertility, which in turn contributes to accelerated population growth and undermines development efforts. This study aimed to investigate the prevalence of short birth interval and its associated factors among multiparous women in the Mieso agro-pastoralist district, Oromia region, Eastern Ethiopia.

Methods

A community-based cross-sectional study was conducted from 1 to 30 March 2020. The multistage sampling technique was used to select 490 multiparous women. Data were collected by face-to-face interviewer-administered structured questionnaires. Bivariate and multivariable logistic regression analyses were executed. Model fitness and multicollinearity were checked. Statistically significant associations of outcome and independent variables were declared at a P-value of < 0.05.

Results

The prevalence of short birth interval was 56% (95% CI: 51.4–60.5) in the study area. Being married under 18 years (AOR = 3.78, 95% CI: 1.97–7.25), having formal education (AOR = 0.23, 95% CI: 0.11–0.47), having a husband with formal education (AOR = 0.46, 95% CI: 0.22–0.99), having awareness about optimum birth interval (AOR = 0.47, 95% CI: 0.24–0.91), having female index child (AOR = 1.78, 95% CI: 1.07–3.84), death of the index child (AOR = 0.34, 95% CI: 0.12–0.92), breastfeeding of the index child <24 months (AOR = 2.6, 95% CI: 1.53–4.41), use of modern contraceptive (AOR = 2.09, 95% CI: 1.12–3.89), and decision-making by a husband alone when to have a child (AOR = 3.86, 95% CI: 2.06–7.21) were significantly associated with short birth interval at a P-value <0.05.

Conclusion

The overall prevalence of short birth interval among the study participants was high, as more than half of the women had practiced short birth interval, indicating that the majority of the mother and children in the study area are still at high risk of mortality and morbidity associated with short birth interval. Thus, the current findings suggest that interventions that involve the provision of contraceptives and information on its benefit at points need to be adopted to reach the national and global target of maternal and child mortality reduction attributed to short birth interval.

Factors associated with modern contraceptive use among men in Pakistan: Evidence from Pakistan demographic and health survey 2017-18

Objective

The role of men in family planning is critical in patriarchal societies like Pakistan. The objective of this study is to explore the predictors of modern contraceptive use among Pakistani men.

Methods

This study is a secondary analysis of Pakistan demographic and health survey (PDHS) 2017–18 data. The study sample consists of 3691 ever married men aged 15–49 years. Pearson’s chi square test and logistic regression were used to find out the determinants of modern contraceptive use among men. Data analysis was carried out in December, 2020.

Results

Findings of logistic regression showed that men who were uneducated (aOR = 0.746; 95% CI = 0.568–0.980), residing in Sindh (aOR = 0.748; 95% CI = 0.568–0.985), Baluchistan (aOR = 0.421; 95% CI = 0.280–0.632) or FATA (aOR 0.313; 95% CI 0.176–0.556) and those who belonged to the poorest wealth quintile (aOR = 0.569; 95% CI = 0.382–0.846) were less likely to use modern contraceptives. Men who did not wish for another child (aOR = 2.821; 95% CI = 2.305–3.451) had a higher likelihood of modern contraceptive use. Finally, men who thought that contraception was women’s business (aOR = 0.670; 95% CI = 0.526–0.853) and those who did not discuss family planning with health worker (aOR = 0.715; 95% CI = 0.559–0.914) were also less likely to use modern contraceptives.

Conclusion

Reproductive health education of males, targeting males, in addition to, females for addressing family planning issues and improvement of family planning facilities in socioeconomically under-privileged regions are suggested to improve contraceptive use among couples.

Complex Survival System Modeling for Risk Assessment of Infant Mortality Using a Parametric Approach

Pakistan is still one of the five countries contributing to half of the child deaths worldwide and holds a low ratio of infant survival. A high rate of poverty, low level of education, limited health facilities, rural-urban inequalities, and political uncertainty are the main reasons for this condition. Survival models that evaluate the performance of models over simulated and real data set may serve as an effective technique to determine accurate complex systems. The present study proposed an efficient extension of the recent parametric technique for risk assessment of infant mortality to address complex survival systems in the presence of extreme observations. This extended method integrated four distributions with the basic algorithm using a real data set of infant survival without extreme observations. The proposed models are compared with the standard partial least squares-Cox regression (PLS-CoxR), and higher efficiency of these proposed algorithms is observed for handling complex survival time systems for risk assessment. The algorithm is also used to analyze simulated data set for further verification of results. The optimal model revealed that the mother's age, type of residence, wealth index, permission to go to a medical facility, distance to a health facility, and awareness about tuberculosis significantly affected the survival time of infants. The flexibility and continuity of extended parametric methods support the implementation of public health surveillance data effectively for data-oriented evaluation. The findings may support projecting targeted interventions, producing awareness, and implementing policies planned to reduce infant mortality.

Short interbirth interval and associated factors among women with antecedent cesarean deliveries at a tertiary hospital, Southwestern Uganda

BACKGROUND

Women with previous cesarean deliveries, have a heightened risk of poor maternal and perinatal outcomes, associated with short interbirth intervals. We determined the prevalence of short interbirth interval, and associated factors, among women with antecedent cesarean deliveries who delivered at Mbarara Regional Referral Hospital (MRRH), in southwestern Uganda.

METHODS

We conducted a cross-sectional study on the postnatal ward of MRRH from November 2020 to February 2021. We enrolled women who had antecedent cesarean deliveries through consecutive sampling. We obtained participants' socio-demographic and obstetric characteristics through interviewer-administered structured questionnaires. We defined short interbirth interval as an interval between two successive births of < 33 months. Modified Poisson regression was used to identify factors associated with short interbirth intervals.

RESULTS

Of 440 participants enrolled, most had used postpartum family planning (PPFP) prior to the current pregnancy (67.5%), and most of the pregnancies (57.2%) were planned. The mean age of the participants was 27.6 ± 5.0 years. Of the 440 women, 147 had a short interbirth interval, for a prevalence of 33% (95%CI: 29-38%). In multivariable analysis, non-use of PPFP (adjusted prevalence ratio [aPR] = 2.24; 95%CI: 1.57-3.20, P < 0.001), delivery of a still birth at an antecedent delivery (aPR = 3.95; 95%CI: 1.43-10.9, P = 0.008), unplanned pregnancy (aPR = 3.59; 95%CI: 2.35-5.49, P < 0.001), and young maternal age (aPR = 0.25 for < 20 years vs 20-34 years; 95%CI: 0.10-0.64, P = 0.004), were the factors significantly associated with short interbirth interval.

CONCLUSION

One out of every three womenwith antecedent caesarean delivery had a short interbirth interval. Short interbirth intervals were more common among women with history of still births, those who did not use postpartum family planning methods, and those whose pregnancies were unplanned, compared to their counterparts. Young mothers (< 20 years) were less likely to have short interbirth intervals compared to those who were 20 years or older. Efforts should be made to strengthen and scale up child-spacing programs targeting women with previous cesarean deliveries, given the high frequency of short interbirth intervals in this study population.

Knowledge and Attitude Towards Short Birth Interval among Rural Women who Gave Birth in the Last Three Years at Dembecha District, Northwest Ethiopia, 2019

Background

A woman can have fewer children when intervals between consecutive births are optimal. This has great importance for the well-being of women, pregnancy outcomes, and the long-term health of children under the age of five. We can save 2millon of the 11 million deaths of children under the age of five per year by avoiding short birth intervals. It is affected by the knowledge and attitude of women, particularly rural women, who had a high fertility rate. To our deep review, this is the first study done in Ethiopia. Hence, this study aimed to assess knowledge and attitude towards short birth intervals and associated factors among rural women who gave birth in the last three years at Dembecha district, northwest Ethiopia.

Method

A community-based cross-sectional study was conducted from September 20 to October 20, 2019. A cluster sampling technique was employed to select the study participants and data were collected using a pre-tested, semi-structured, interviewer-administered questionnaire. Bivariable and multivariable logistic regression model was fitted to identify factors associated with knowledge and attitude towards short birth interval. The level of significant association was declared using the adjusted odds ratio (AOR) with 95% confidence interval (CI) and a p-value of <0.05.

Result

From the total study participants, 66.4% (95% CI: 63.0–70.0) had good knowledge and 45.9% (95% CI: 42.3–49.8) had a positive attitude towards short birth intervals. In multivariable logistic regression: marital status, antenatal care follow-up, maternal occupation, and wealth status were significantly associated with knowledge. In addition, antenatal care follow-up and maternal occupation were significantly associated with attitude.

Conclusion

Majority of the participants had poor knowledge and a positive attitude towards short birth intervals. Hence, interventions should be done to optimize women's knowledge and attitude towards short birth intervals by enhancing antenatal care utilization.

Prevalence and risk factors of short birth interval in Bangladesh: Evidence from the linked data of population and health facility survey

The Sustainable Development Goals 3 targets significant reductions in maternal and under-five deaths by 2030. The prevalence of these deaths is significantly associated with short birth intervals (SBI). Identification of factors associated with SBI is pivotal for intervening with appropriate programmes to reduce occurrence of SBI and associated adverse consequences. This study aimed to determine the factors associated with SBI in Bangladesh. A total of 5,941 women included in the 2017/18 Bangladesh Demographic and Health Survey 2017/18 and 1,524 healthcare facilities included in the 2017 Bangladesh Health Facility were linked and analysed. The sample was selected based on the availability of the birth interval data between the two most recent subsequent live birth. SBI was defined as an interval between consecutive births of 33 months or less, as recommended by the World Health Organization and was the outcome variable. Several individual-, households-, and community-level factors were considered as exposure variables. We used descriptive statistics to summarise respondents' characteristics and multilevel Poisson regression to assess the association between the outcome variable with exposure variables. Around 26% of live births occurred in short intervals, with a further higher prevalence among younger, uneducated, or rural women. The likelihoods of SBI were lower among women aged 20-34 years (PR, 0.14; 95% CI, 0.11-0.17) and ≥35 years (PR, 0.03; 95% CI, 0.02-0.05) as compared to the women aged 19 years or less. Women from households with the richest wealth quintile experienced lower odds of SBI (PR, 0.61; 95% CI, 0.45-0.85) compared to those from the poorest wealth quintile. The prevalences of SBI were higher among women whose second most recent child died (PR, 5.23; 95% CI, 4.18-6.55), those who were living in Chattogram (PR, 1.52; 95% CI, 1.12-2.07) or Sylhet (PR, 2.83, 95% CI, 2.08-3.86) divisions. Availability of modern contraceptives at the nearest healthcare facilities was 66% protective to the occurrence of SBI (PR, 0.34; 95% CI, 0.22-0.78). Also, the prevalence of SBI increased around 85% (PR, 1.85; 95% CI, 1.33-2.18) for every kilometer increase in the distance of nearby health facilities from women's homes. Targeted and tailored regional policies and programmes are needed to increase the awareness of SBI and associated adverse health outcomes and availability of modern contraception in the healthcare facilities.

Social contexts of fertility desire among non-childbearing young men and women aged 15-24 years in Nigeria

Background

Reduction in ideal number of children has been suggested as a necessary precursor for fertility decline especially in high fertility countries of Western and Central Africa. In this study, we explored the social contexts of fertility desires by documenting the effects of individual, household as well as contextual characteristics among young men and women in Nigeria.

Methods

Data source was the male and female recode file of 2018 Nigeria Demographic and Health Survey. Analytical sample comprised 2674 males and 9637 females aged 15–24 years. The main outcome variable was desire for large family size (DLFS) defined as ideal number of children greater than four. Analysis involved use of descriptive statistics and random-effect logit models fitted in four stages.

Results

DLFS was 71% among young men and 53% in women. Individual-level factors associated with DLFS among men includes Islam religion (OR = 3.95, CI 2.68–5.83), household size (OR = 1.05) and richer (OR = 0.47, CI 0.29–0.75) or richest wealth index (OR = 0.28, CI 0.16–0.75). Geo-political region and high level of negative attitude to family planning (OR = 1.72, CI 1.23–2.40) were the main contextual factors associated with DLFS. For women, individual-level correlates were education, religion, ethnicity, marital status, household size, and wealth index. Contextual factors include geo-political region, community education (OR = 0.68, CI 0.52–0.89), child mortality experience (OR = 1.29, CI 1.11–1.51) and negative attitude to family planning (OR = 1.36, CI 1.13–1.65). The influence of religion, household wealth and attitude to family planning differ between young men and women.

Conclusion

Active communication and programmatic interventions are needed so that desire for large family size by young men and women do not become a clog for fertility transition in Nigeria.

Reduction in ideal number of children has been suggested as a necessary condition for fertility decline especially in high fertility countries of Western and Central Africa. In this study, we explored the effects of individual, household as well as community characteristics on fertility desires among young men and women aged 15–24 years in Nigeria. We analysed data for 2674 males and 9637 females aged 15–24 years extracted from the 2018 Nigeria Demographic and Health Survey. The outcome variable was desire for large family size (DLFS) defined as ideal number of children greater than four. Results showed that DLFS was 71% among men and 53% in women. Individual-level factors associated with DLFS among men include Islam religion, household size and wealth status. Geo-political region and high level of negative attitude to family planning were the main community-level factors associated with DLFS. For women, individual-level positively associated with DLFS were Islam religion, and being currently married. Compared to Yoruba, other ethnic groups were more likely to favour DLFS. The negative factors associated with DLFS among young women include higher education and wealth status. At the community-level, Northern geo-political regions, child mortality experience and negative attitude to family planning were positively associated with DLFS. The influence of religion, household wealth and attitude to family planning differ between young men and women. Multi-dimensional strategies with active communication and programmatic interventions are needed so that desire for large family size by young men and women do not slow down fertility transition in Nigeria.

Preceding child survival status and its effect on infant and child mortality in India: An evidence from National Family Health Survey 2015-16

Background

India has achieved impressive gains in child survival over the last two decades; however, it was not successful in attaining MDG 2015 goals. The study’s objective is to inquire how the survival status of the preceding child affects the survival of the next born child.

Methods

This is a retrospective analysis of data from the National Family Health Survey, 2015–16. Analysis was restricted to women with second or higher-order births because women with first-order births do not have a preceding child. Proportional hazards regression, also called the Cox regression model, has been used to carry out the analysis. Kaplan–Meier (K–M) survival curves were also generated, with a focus on preceding birth intervals.

Results

Results found that female children were more likely to experience infant mortality than their male counterparts. Children born after birth intervals of 36+ months were least likely to experience infant mortality. Mother’s education and household wealth are two strong predictors of child survival, while the place of residence and caste did not show any effect in the Cox proportional model. Infant and child deaths are highly clustered among those mothers whose earlier child is dead.

Conclusion

Maternal childbearing age is still low in India, and it poses a high risk of infant and child death. Education is a way out, and there is a need to focus on girl’s education. The government shall also focus on raising awareness of the importance of spacing between two successive births. There is also a need to create a better health infrastructure catering to the needs of rich and poor people alike.

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.

Understanding the determinants of infant and under-five mortality rates: a multivariate decomposition analysis of Demographic and Health Surveys in Ghana, 2003, 2008 and 2014

INTRODUCTION

Despite the decline in infant and under-five mortality rates since the last decade, Ghana did not meet the millennium development goal (MDG) 4 target. To implement effective interventions that could fast-track progress towards achieving the sustainable development goal 3 in 2030, factors contributing to the decline in child mortality throughout the MDG period and which factor(s) has/have been consistent in affecting child survival in the last decade need to be understood.

METHODS

This study used Demographic and Health Surveys (DHS) from 2003, 2008 and 2014 and data from World Bank Development Indicators (2000-2018). We employed modified Poisson with robust SE and multivariate decomposition approach to assess risk factors of child mortality using DHS data from 2003, 2008 and 2014. Penalised regression was used assess the effect of 25 country-level contextual factors on child survival.

RESULTS

The risk of infant mortality is approximately five times higher among mothers who had multiple births compared with mothers who had single birth over the last decade (adjusted relative risk 4.6, 95% CI 3.2 to 6.6, p<0.001). An increase in the annual percentage of female labour force participation (FLFP) is associated with the reduction of approximately 10 and 18 infant and under-five annual deaths per 1000 live births, respectively.

CONCLUSIONS

This study found that multiple births and shorter birth spacing are associated with increased risk of infant and under-five deaths over the last decade. Increased in FLFP, and the proportion of children sleeping under bed-net are associated with reduced risk of both infants and under-five deaths.