Pooled prevalence and determinants of modern contraceptive utilization in East Africa: A Multi-country Analysis of recent Demographic and Health Surveys

Factors associated with modern contraceptive utilization among reproductive age women in Cambodia; evidenced by the recent Cambodia demographic and health survey

INTRODUCTION

Cambodia is a low-income country with limited access to family planning (FP) in terms of modern contraceptive utilization. Despite several FP programs designed to make contraceptives accessible, adoption of contraceptives has been difficult in Cambodia, which has high rates of fertility and maternal mortality. This gap in essential care can put women and adolescent girls at greater risk of adverse outcomes such as stillbirth, spontaneous abortion, unwanted pregnancy, or even maternal death. One of the goals set by the government to decrease both maternal and child mortality and morbidity was increasing the modern contraceptives utilization. So, the main objective of this study was to evaluate spatial variations in modern contraceptives utilization and its contributing factors among women.

METHODS

Data from the Cambodia 2021-22 Demographic and Health Survey datasets were used for secondary data analysis. A total of 19,496 women of reproductive age participated in the study. A spatial and multilevel mixed effects analysis was done on the factors affecting modern contraceptives utilization among Cambodian women. Finally, the percentage, odd ratio, together with their 95% confidence intervals and the results of the spatial analysis were provided.

RESULT

The prevalence of modern contraceptive use was 31.2% in Cambodia. Living in an urban area [AOR = 1.224; 95% CI = (1.126.1.330); P = 0.0001]; being married [AOR = 34.131; 95% CI= (12.673, 91.921); P = 0.0001]; and having a history of terminated pregnancy [AOR = 1.137; 95% CI= (1.055, 1.225); P = 0.0001] were found to be positively associated with modern contraceptive utilization. In contrast to this, being between the age range of 46-49 [AOR = 0.421; 95% CI = (0.364, 0.487); P = 0.0001]; being a female-headed household [AOR = 0.784; 95% CI = (0.723, 0.850); P = 0.0001]; and current breast feeding [AOR = 0.84; 95% CI = (0.75, 0.93); P = 0.010] were found to be negatively associated with modern contraceptive utilization. Additionally, the spatial analysis of modern contraceptive utilization showed that a higher proportion was utilized in the southern and southwest regions of Cambodia.

CONCLUSION

In this study, living in urban area, being married and having history of terminated pregnancy were found positively associated with modern contraceptive utilization. In contrast to this, being old age, being female headed household and being currently breast-feeding women were found negatively associated with modern contraceptive utilization. In addition to this, there were geographic (spatial) variations in modern contraceptive utilization among Cambodian's women across the country.

Unmet need for family planning among pastoralist community of West Omo zone, Ethiopia: A community based cross-sectional study

Introduction

Family planning is among the best suggested strategies to decrease the high maternal mortality and morbidity prevailing among pastoral communities. Despite this fact, there is no sufficient information regarding the unmet need for family planning in the study area. Therefore, this study was intended to assess the prevalence of unmet need for family planning and its associated factors among currently married women residing in pastoralist community of West Omo zone, Ethiopia.

Methods

Community-based cross-sectional study was conducted from 01 January to 01 April 2021 in West Omo zone. Five-hundred-sixty currently married women aged 15-49 were interviewed, and the study participants were randomly selected by employing a modified random walk approach. Data were checked manually for completeness and consistency, then entered into Epidata 3.1 and exported to SPSS version 22 for analysis. Multivariate binary logistic regression was used to identify the associated factors, and Adjusted Odds Ratio (AOR) at 95% CI with p-value < 0.05 was considered as significant variables.

Result

A total of 560 currently married women agreed to participate in this study making a response rate of 93.17%. Two hundred three, that is, about 36.3% (95% CI: 32.1, 40.2%) currently married women had an unmet need for family planning, with 119 (58.6%) wishing to delay childbirth and 84 (41.4%) seeking to limit. Have no formal education (AOR = 2.86 (95% CI: 1.61, 5.10)), having poor knowledge of family planning (AOR = 2.83 (95% CI: 1.45, 5.54)), and lack of husband support of family planning (AOR = 2.38 (95% CI: 1.22, 4.67)) are positively associated with unmet need for family planning.

Conclusion

The magnitude of unmet need for family planning in this study is fairly high as compared to previous studies done among non-pastoral community. Hence, it's important to consider the above identified factors while designing effective public health intervention.

Modern contraceptive utilization among women of reproductive age in Ghana: a multilevel mixed-effect logistic regression model

BACKGROUND

Worldwide, sexual and reproductive health remains a prominent public health concern for women of reproductive age. Modern contraceptive methods play a crucial role in enabling individuals and families to regulate fertility, thereby reducing unintended pregnancies, abortions, pregnancy-related complications, and mortality. Due to the scarcity of reliable and current data regarding the factors affecting the adoption of modern contraceptives among women of reproductive age at the national level in Ghana, this research aimed to explore the determinants of modern contraceptive usage among reproductive age women.

METHODS

The study analyzed data from the 2022 Ghana Demographic and Health Survey, including a weighted sample of 6,839 reproductive-age women. By employing a multilevel logistic regression model, the study sought to determine factors associated with the utilization of modern contraceptives. Associations between explanatory variables and the outcome were evaluated using adjusted odds ratios (AORs) along with 95% confidence intervals (CIs). Statistical significance was established using a p-value threshold of less than 0.05. All statistical analyses were conducted using STATA version 17 software.

RESULTS

The study found that 26.36% (95% CI: 25.33-27.34%) of women of reproductive age in Ghana used modern contraceptives. Secondary education (AOR = 1.26, 95% CI = 1.03-1.53), poorer household (AOR = 1.30, 95% CI = 1.05-1.61), women's marital status, i.e. married (AOR = 1.46, 95% CI = 1.16-1.83), living with a partner (AOR = 1.65, 95% CI = 1.32-2.06), divorced (AOR = 2.53, 95% CI = 1.48-4.31), and separated (AOR = 1.70, 95% CI = 1.21-2.37), multipara (AOR = 1.39, 95% CI = 1.04-1.87), were the factors that promote modern contraceptive utilization. Women's age in years, i.e. 35-39 (AOR = 0.71, 95% CI = 0.52-0.97), 40-44 (AOR = 0.63, 95% CI = 0.44-0.90), and 45-49 (AOR = 0.45, 95% CI = 0.25-0.79), history of pregnancy loss (AOR = 0.86, 95% CI = 0.76-0.98), region, i.e. Greater Accra (95% CI = 0.42-0.92), Bono East (95% CI = 0.32-0.81), Northern (95% CI = 0.28-0.67), Savannah (95% CI = 0.28-0.81), and North East (95% CI = 0.20-0.63), were all associated with a lower use of modern contraceptives.

CONCLUSIONS

Modern contraceptive utilization was low in this study. Factors such as women's education, socioeconomic status, and marital status were associated with increased modern contraceptive utilization, whereas women's age and regional disparities were linked to lower usage rates. These findings emphasize the need for targeted interventions to address socioeconomic barriers and regional disparities in access to family planning services across Ghana.

Prevalence and determinants of inadequate dietary diversity among pregnant women in four Sub-Saharan Africa countries: a multilevel analysis of recent demographic and health surveys from 2021 to 2022

Background

Diversity in the mother's diet can have major effects on the developing fetus throughout pregnancy. Approximately 1 million neonates die on their first day of life as a result of inadequate nutrition, which also complicates the mother's pregnancy and has a negative impact on the delivery outcome. Dietary diversity during pregnancy is poorly recognized in developing countries, despite the fact that it is detrimental. As a result, this study aimed to assess the prevalence and associated factors of inadequate dietary diversity in Burkina Faso, Ghana, Kenya, and Tanzania among pregnant women.

Methods

Secondary data analysis was conducted using data from the most recent Demographic and Health Surveys, which included four countries in Sub-Saharan Africa between 2021 and 2022. A total of 80,083 pregnant women were included in this study. The women's dietary diversity was computed from 10 food categories. Based on the minimum diversity score, women were categorized as having inadequate dietary diversity if their diversity score was less than five food items and as having adequate dietary diversity if they took five or more food groups. A multilevel mixed-effects logistic regression model was used to identify the factors associated with inadequate dietary diversity. At p-values <0.05, significant factors correlated with inadequate diversity were identified. The result was interpreted using 95%CI and adjusted odds ratio. The best-fit model was determined to be the one with the lowest deviance and highest loglikelihood ratio.

Results

The prevalence of inadequate dietary diversity among pregnant women in Burkina Faso, Ghana, Kenya, and Tanzania was 94.46%. Factors such as no formal education (AOR = 3.39, 95% CI: 2.54, 4.54), distance to health facilities (AOR = 1.36, 95% CI: 1.16, 1.60), poor wealth quantiles (AOR = 2.97, 95% CI: 2.41, 3.65), no media exposure (AOR = 1.84, 95% CI: 1.45, 2.35), low community ANC utilization (AOR = 1.21, 95% CI: 1.16, 1.60), and reside Burkina Faso (AOR = 1.47, 95% CI: 1.09, 1.99) were among the factors associated with inadequate dietary diversity.

Conclusion

According to this study finding, pregnant women had a high percentage of inadequate dietary diversity. Factors at the individual and community levels contributed to the lack of diversity in nutrition. Thus, when developing policies and strategies, the health ministries of Burkina Faso, Kenya, Ghana, and Tanzania should to consider the women who underutilize antenatal care services, live in low wealth quantiles and who did not get formal education.

Mothers' experience of losing infants by death and its predictors in Ethiopia

BACKGROUND

Although infant deaths worldwide have reduced, many children die before their first birthday. Infant deaths are widespread in low-income countries, and information about the cause of death is limited. In Ethiopia, 53% of infants' deaths occurred in their neonatal period, and 174 infants' deaths occurred from 3684 births. Hence, this study aimed to assess mothers' experiences with infant death and its predictors in Ethiopia.

METHODS

A total of 1730 weighted samples of mothers from the 2019 EDHS dataset, which was collected across the regions of Ethiopia, were included for analysis. A two-stage cluster sampling technique with a cross-sectional study design was used. All mothers whose children were under the age of 0-12 months were included in this study. Six count regression models were considered and compared using Akaike's information criteria and Bayesian information criterion with STATA version 15 software. The strength of the association between the number of infant deaths and possible predictors was determined at a P-value less than 0.05, with a 95% confidence interval. The findings were interpreted by using the incident rate ratio.

RESULTS

A total of 46.3% of mothers had lost at least one infant by death in the last five years before the 2019 EDHS survey was held. The mean and variance of infant deaths were 2.55 and 5.58, respectively. The histogram was extremely picked at the beginning, indicating that a large number of mothers did not lose their infants by death, and that shows the data had positive skewness. Mothers under 25-29 years of age (IRR: 1.75, 95% CI:1.48, 2.24), and 30-34 years of age (IRR: 1.42, 95% CI: 1.12, 2.82), Somali (IRR: 1.47, 95% CI: 1.02, 3.57), Gambela (IRR: 1.33, 95% CI: 1.10, 2.61), and Harari (IRR: 1.39, 95% CI: 1.02, 2.63) regions, rural resident mothers (IRR: 1.68, 95% CI: 1.09, 1.91, and Protestant (IRR = 1.43, 95% CI: 1.14, 2.96), and Muslim (IRR = 1.59, 95% CI: 1.07, 2.62) religion fellow of mothers were associated with a high risk of infants' deaths. Whereas, being rich IRR: 0.37, 95% CI: .27, .81) and adequate ANC visits (IRR: 0.28, 95% CI: .25, .83) were associated with a low risk of infant death.

CONCLUSION

Many mothers have experienced infant deaths, and the majority of infants' deaths occur after the first month of birth. Encouraging mothers to attend antenatal care visits, creating mothers' awareness about childcare, and ensuring equal health services distribution and utilization to rural residents are essential to minimize infant death. Educating lower-aged reproductive mothers would be a necessary intervention to prevent and control infant deaths.

Multilevel analysis on prevalence and associated factors of modern contraceptive uptake in Somaliland: based on The Somaliland Health and Demographic Survey 2020

INTRODUCTION

Contraception is the deliberate prevention of unwanted pregnancy through various contraceptive methods. Its uptake is low in Sub-Saharan African countries, particularly in east Africa. This might be linked to the high prevalence of unwanted pregnancies and the high fertility rate in the area. Although studies reporting the prevalence and associated factors of modern contraceptive uptake are available in other African countries, no study has been conducted in Somaliland. Therefore, the current study aimed to assess its prevalence and associated factors in Somaliland using Somaliland Health and Demographic Survey (SLHDS) data.

METHODS AND MATERIALS

The study used Somaliland Demographic Health Survey (SLDHS) 2020 data. The survey was a national-level survey using a cross-sectional study design. A total of 3656 reproductive-age women were included in the current study. To determine independent predictors of modern contraceptive uptake, a multi-level multivariable logistic regression analysis was done. Random effect analysis, standard error (SE) and intra-cluster correlation (ICC) were computed.

RESULTS

The proportion of modern contraceptive uptake among reproductive age groups in Somaliland is 1%. Modern contraceptive uptake is significantly associated with the residence, educational level and wealth index of participants. Women from nomadic communities had lower odds (AOR: 0.25; 95% CI: 0.10, 0.66) of modern contraceptive uptake compared to those from urban areas. Being in the highest wealth quintiles (AOR: 17.22; 95% CI: 1.99, 155.92) and having a tertiary educational level (AOR: 2.11; 95% CI: 1.29, 9.11) had higher odds of using the modern contractive method compared to those with the lowest wealth quintiles and non-formal education, respectively.

CONCLUSION

The prevalence of modern contraceptive uptake in Somaliland was very low. It is associated with the level of education, wealth index and residence of the women.

Spatial distribution and associated factors of co-occurrence of overweight/obesity and Anemia among women in the reproductive age in sub-Saharan Africa: A multilevel analysis, DHS 2016-2021

BACKGROUND

Overweight/obesity is one of the major public health problems that affect both developed and developing nations. The co-occurrence of overweight/obesity and anemia is thought to be largely preventable if detected early. To date, no spatial analyses have been performed to identify areas of hotspots for the co-occurrence of overweight/obesity and anemia among reproductive women in sub-Saharan Africa. Therefore, this study aimed to assess the spatial distribution and associated factors of the co-occurrence of overweight/obesity and anemia among women of reproductive age.

METHODS

Data for the study were drawn from the Demographic and Health Survey, a nationally representative cross-sectional survey conducted in the era of Sustainable Development Goals, in which the World Health Assembly decided and planned to cease all forms of malnutrition by 2030. Seventeen sub-Saharan African countries and a total weighted sample of 108,161 reproductive women (15-49 years) were included in our study. The data extraction, recoding and analysis were done using STATA V.17. For the spatial analysis (autocorrelation, hot-spot and interpolation), ArcGIS version 10.7 software, and for the SaTScan analysis, SaTScan version 10.1 software was used. Descriptive statistics were presented using frequency tables and percentages. We employed multilevel logistic regression to investigate associated factors. In the multivariable analysis, variables with a p-value of ≤0.05 are considered as a significant factor associated with co-occurrence of overweight/obesity and anemia among women aged 15-49 years.

RESULTS

The overall co-occurrence of overweight/obesity and anemia among women in sub-Saharan Africa was 12% (95%CI: 9-14%). The spatial analysis revealed that the co-occurrence of overweight/obesity and anemia among women significantly varied across sub-Saharan Africa. (Global Moran's I = 0.583163, p<0.001). In the spatial window, the primary-cluster was located in Liberia, Guinea, Gambia, Sira Leon, Mauritania, Mali, Cameron and Nigeria with a Log-Likelihood Ratio (LRR) of 1687.30, and Relative Risk (RR) of 2.58 at a p-value < 0.001. In multilevel analysis, women aged 25-34 years (AOR = 1.91, 95%CI: 1.78, 2.04), women aged 35-49 years (AOR = 2.96, 95% CI: 2.76, 3.17), married (AOR = 1.36, 95% CI: 1.27, 1.46), widowed (AOR = 1.22, 95%CI: 1.06, 1.40), divorced (AOR = 1.36, 95% CI: 1.23, 1.50), media exposure (AOR = 1.31, 95%CI: 1.23, 1.39), middle income (AOR = 1.19, 95%CI: 1.11, 1.28), high income/rich (AOR = 1.36, 95%CI: 1.26, 1.46), not working (AOR = 1.13, 95% CI:1.07, 1.19), traditional contraceptive utilization (AOR = 1.39, 95%CI: 1.23, 1.58) and no contraceptive use (AOR = 1.27, 95%CI: 1.20, 1.56), and no health insurance coverage (AOR = 1.36, 95%CI: 1.25, 1.49), were individual level significant variables. From community-level variables urban residence (AOR = 1.61, 95%CI: 1.50, 1.73), lower middle-income country (AOR = 2.50, 95%CI: 2.34, 2.66) and upper middle-income country (AOR = 2.87, 95%CI: 2.47, 3.34), were significantly associated with higher odds of co-occurrence of overweight/ obesity and anemia.

CONCLUSION AND RECOMMENDATIONS

The spatial distribution of the co-occurrence of overweight/obesity and anemia was significantly varied across the sub-Saharan African country. Both individual and community-level factors were significantly associated with the co-occurrence of overweight/obesity and anemia. Therefore, public health programmers and other stalk holders who are involved in maternal healthcare should work together and give priority to hotspot areas of co-occurrence in sub-Saharan Africa.

Modern contraceptive utilization and its associated factors in East Africa: Findings from multi-country demographic and health surveys

BACKGROUND

The use of modern contraceptives has been low in most Sub-Saharan African countries despite high population growth and a sluggish economy. This study aimed to identify the prevalence and determinants of modern contraceptive use among married reproductive-age women in East Africa.

METHODS

For this study, the Demographic and health survey (DHS) data from nine countries in East Africa were analyzed, yielding a weighted sample of 32,925 married women. A multilevel mixed-effect logistic regression model was used to identify characteristics associated with the utilization of modern contraceptives at a p-value less than 0.05. For model comparison, we used the Akaike and Bayesian Information Criteria (AIC and BIC). For assessing variation (random effects), we used community-level variance with standard deviation and intra-cluster correlation coefficient (ICC).

RESULTS

The overall prevalence of modern contraceptive use was 45.68%, 95% CI (45.15, 46.21). Women's age, maternal education level, husband education level, media exposure, wealth status, occupation, religion, the total number of children ever born, distance to health facilities, history of termination of pregnancy, couple's desire for children, women's participation in decision making, living country and place of residence were significantly associated with modern contraceptive use in Eastern Africa.

CONCLUSIONS

Conferring to this study, utilization of modern contraceptives is low in East Africa. Interventions to improve the use of modern contraceptives should encompass disseminating awareness through mass media, enrolment of males in family planning, giving maternal education, building health facilities in remote areas, and encouraging family planning programs in rural areas.

Individual and community level factors associated with modern contraceptive utilization among married women in the emerging region of Ethiopia: a multilevel mixed effects analysis of the 2019 Ethiopia Mini-Demographic and health survey

BACKGROUND

A demonstrated technique to enhance reproductive health and economic progress is through ensuring that family planning services are accessible universally. Those studies that used Ethiopia Demographic and Health Survey (EDHS) data did not assess individual and community-level factors in contraceptive utilization. Thus, the study employs a multilevel mixed effects analysis approach, which allows for the examination of individual and community-level factors that influence contraceptive utilization.

METHODS

This study analyzed the 2019 Ethiopia Min Demographic and Health Survey datasets. A total of 1916 married women in the 2019 surveys were included in the analysis. The data were analyzed using Stata version 17.0. The data were analyzed using Multi-level mixed-effect logistic regression to identify the individual and community-level factors associated with modern contraceptive utilization. An adjusted odds ratio with a 95% confidence interval was used to. Show the strength and direction of the association and statistical significance was declared at a P value less than 0.05.

RESULTS

Factors significantly associated with modern contraceptive utilization were; Muslim and protestant followers [AOR = 0.31, 95% CI: (0.134, 0.714)] and [AOR = 0.35, 95% CI: (0.173, 0.691)] respectively, women with no education (OR = 0.46; 95% CI: 0.293, 0.710), those women who belong to the poor and middle wealth of household [AOR = 0.35, 95% CI: (0.237, 0.527)] and [AOR = 0.56, 95% CI: (0.347, 0.919)] respectively, women who had one to five and greater than or equal to six living children [AOR = 11.36, 95% CI:(2.119, 60.918)] and [AOR = 7.44, 95% CI:(1.437, 38.547)]respectively, Women in clusters poor wealth status [AOR = 0.40, 95% CI: (0.183, 0.875)] and women who belong to the Somali region [AOR = 0.20, 95% CI: (0.0.070, 0.506)].

CONCLUSION

The study revealed that both individual and community-level factors determined modern contraceptive utilization. At the individual level, the religion of women, educational status, the wealth of the household, and the total number of living children were significantly associated with modern contraceptive utilization. At community-level factors, community wealth status and belonging to the Somali region were significantly associated with modern contraceptive utilization. The findings suggest that interventions aimed at increasing modern contraceptive utilization should target women with lower levels of education, those living in households with lower wealth, and those with larger families. Additionally, efforts should be made to improve access to modern contraceptives in communities with lower wealth status and in regions where traditional beliefs may hinder their use.

A multivariate decomposition analysis of modern contraceptive utilization among married women in the emerging region of Ethiopia (2000-2019)

Ensuring universal access to family planning services is a proven strategy to improve reproductive health as well as economic development. Assessing the trend and identifying the factors for the change in modern contraceptive utilization is crucial to design effective measures, but trend analysis was not conducted previously. Thus, this study aimed to assess the trend and determinants of modern contraceptive utilization change among married women in emerging regions of Ethiopia. This study used the 2000 Ethiopia Demographic and Health Survey and the 2019 Ethiopia Min Demographic and Health Survey datasets for analysis. A total of 2555 and 1916 married women in the 2000 and 2019 surveys were included in the analysis, respectively. The data were analyzed using Stata version 17.0. Logit-based decomposition analysis was executed to identify factors for modern contraceptive utilization change. Statistical significance was declared at a P value of less than 0.05. The trend of contraceptive utilization change increased from 6.26% in 2000 to 21.97% in 2019. About  - 65.87% and 165.87% of the change in contraceptive utilization was due to changes in composition and behavior, respectively. The change in composition was due to the change in the composition of women according to religion, educational status, region, and the number of living children. The change in behaviors of not educated women, rural women, Muslim women, and those who resided in the afar region was the source of change in modern contraceptive utilization. Modern contraceptive utilization has increased in the last two decades. The change in modern contraceptive utilization is due to changes in population composition and behavior. Interventions targeting uneducated and rural women are vital to increasing contraceptive utilization. Strategic interventions are also required for the Somali regions of Ethiopia.

Factors affecting utilization of modern contraceptive methods among women of reproductive age in Ethiopia

INTRODUCTION

Modern contraceptive use is important for improving health and socioeconomic outcomes, but Ethiopia is among the lowest-using countries. Therefore, this study aimed to determine factors affecting modern contraceptive use among women of reproductive age in Ethiopia.

METHODS

This population-based cross-sectional study used data obtained from the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS). A total of 8,885 reproductive-age women were included in the analysis. A weighted generalized estimating equation approach was used to account for the clustering and weighting effects in the assessment of associations between modern contraceptive usage and socioeconomic and demographic variables.

RESULTS

Modern contraceptive use among women of reproductive age in Ethiopia is low (28%). Prevalence is highest among women aged 25-34 (40.11%), with higher education (30.97%), who are Orthodox Christians (31.67%), married (40.40%), middle wealth index (31.70%), female-headed households (31.42%), with 1-3 living children (44.85%), who headed by under 31 years old (40.07%), and in the Amhara region (34.45%). In the generalized estimating equation analysis, women aged 35-44 and over 45, Muslims, households heads aged 41-50 and over 50, and in female-headed households were less likely to use modern contraceptives, while women with primary, secondary, and higher education, married, middle and rich wealth index, and with 1-3 and more living children were more likely to use modern contraceptive than their counterparts (reference group) and were statistically significant.

CONCLUSION

Modern contraceptive use is notably low among women of reproductive age in Ethiopia. Factors such as age, women's educational level, religion, marital status, number of living children, wealth status, gender and age of household head, and region were identified as significant factors associated with modern contraceptive use. Therefore, to increase modern contraceptive use, governmental and non-governmental organizations should invest in women's education and financial empowerment and raise awareness about the benefits of modern contraceptives, especially among older, unmarried, financially poor, elderly-led households, with few living children, and uneducated women.

Spatial variation in the non-use of modern contraception and its predictors in Bangladesh

This study aimed to investigate spatial variations in the non-use of modern contraception in Bangladesh and identify associated individual, household, and community-level factors. The analysis utilized data from 16,135 women, extracted from the 2017/18 Bangladesh Demographic and Health Survey. The study's main outcome was the prevalence of non-use of modern contraception (yes or no), while the explanatory variables included factors at the individual, household, and community level. To assess geographical heterogeneity in non-use of modern contraception, Moran's I statistics were applied. Additionally, the Gettis-Ord Gi* was calculated to measure spatial autocorrelation differences across various study locations. The relationship between non-use of modern contraception and location was further explored using a geographically weighted regression model at the cluster level. The results indicated that 42.8% (95% CI 41.6-43.8) of respondents reported non-use of modern contraception in Bangladesh, with significant variation across geographical locations (p < 0.001). Hot spots of high non-use were predominantly identified in the Sylhet, Barishal, and some areas of the Chattogram divisions, while cold spots of low use were concentrated in the Rangpur, Mymensingh, and some areas Rajshahi divisions. Notably, the likelihood of non-use was highest among women and partners with low levels of education. The analysis of other risk factors, such as partner occupation, community-level illiteracy, and poverty, revealed varying effects on non-use of modern contraception across different locations (clusters) within the country. The study's findings underscore the importance of targeted, area-specific policies and programs aimed at promoting knowledge and uptake of modern contraception in Bangladesh.

Married women decision making autonomy on health care utilization in high fertility sub-Saharan African countries: A multilevel analysis of recent Demographic and Health Survey

BACKGROUND

Women's decision-making autonomy has a potential impact on the scale-up of health care utilization. In high fertility countries, evidence regarding women's decision-making autonomy on their health care utilization and its associated factors is limited and inconclusive. Hence, it is important to investigate women decision-making autonomy on their health care utilization and associated factors in high fertility countries in sub-Saharan Africa.

METHODS

The data source for this study was obtained from recent Demographic and Health Surveys that were comprised of a weighted sample of 178875 reproductive age women. A multilevel mixed-effect binary logistic regression model was fitted. The odds ratios, along with the 95% confidence interval were generated to identify individual and community-level factors associated with women's autonomy in health care decision-making. A p-value less than 0.05 was declared as statistical significance.

RESULTS

In this study, 42% (95% CI: 41.7, 42.3) of women were able to exercise their reproductive autonomy. The highest (74.8%) and the lowest (19.74%) magnitude of women autonomy was found in Angola and Mali, respectively. In multilevel analysis; age of women 25-34 years, 35 and above (AOR = 1.34, 95% CI: 1.29, 1.39), and (AOR = 1.78, 95% CI: 1.75, 1.90), women's primary and secondary educational level (AOR = 1.25, 95% CI: 1.20, 1.31), and (AOR = 1.44, 95% CI: 1.32, 1.54), husband primary and secondary educational level (AOR = 1.24, 95% CI: 1.18, 1.29), and (AOR = 1.21, 95% CI: 1.15, 1.27), women who had work (AOR = 1.67, 95% CI: 1.59, 1.74) female household heads (AOR = 1.44, 95% CI: 1.37, 1.51), media exposure (AOR = 1.04, 95% CI: 1.09, 1.18), health insurance coverage (AOR = 1.26, 95% CI: 1.17, 1.36), urban residence (AOR = 1.14, 95% CI: 1.09, 1.19), community education (AOR = 2.43, 95% CI: 2.07, 2.85) and low community poverty level (AOR = 1.27, 95% CI: 1.08, 1.49) were predictor variables.

CONCLUSION AND RECOMMENDATION

Although every woman has the right to make her own health care decisions, this study showed that almost 58% of them had no role in making decisions about their health care utilization. Thus, each country Government should support women's decision making autonomy regarding their healthcare utilization through mass media and extensive behavioral education.

Spatial distribution and associated factors of severe malnutrition among under-five children in Ethiopia: further analysis of 2019 mini EDHS

BACKGROUND

Malnutrition is both a significant cause and a result of poverty and deprivation. In developing nations, child malnutrition is still the main public health issue. Severe malnutrition affects every system of the body and leads to medical instability. The assessment of the burden of severe malnutrition is important for ready-to-use therapeutic foods and preparing therapy for these conditions. Therefore, this study aimed to assess the prevalence and spatial distribution of severe malnutrition and the factors associated with it.

METHODS

Data from the 2019 Mini-EDHS (Ethiopian Demographic and Health Surveys) with stratified sampling techniques were used. The data were weighted using sample weight to restore the data's representativeness and provide accurate statistical estimations. A total of 5,006 weighted samples of children under the age of five were used to analyze the study. A multilevel binary logistic regression model was built, and a cutoff P-value of 0.05 was used. The wag staff normalized concentration index and curve as well as spatial analysis were used.

RESULTS

The prevalence of severe malnutrition practice among under five years children in Ethiopia was 14.89% (95%CI: 13.93%, 15.91%), and ranges from 4.58% in Addis Ababa to 25.81% in the Afar region. Women with secondary and above education status as compared to uneducated [AOR = 0.17; 95%CI;[0.06, 0.48], high community women's education as compared to low [AOR = 0.54; 95%CI; 0.36, 0.78], women from richest household as compared to poorest [AOR = 0.63; 95%CI; 0.26, 0.94] and living in Oromia region as compared to Tigray [AOR = 0.33: 95%CI; 0.15, 0.74] were preventive factors. Whereas children 24-59 months of age as compared to under six months [AOR = 1.62; 95%CI; 1.50, 1.75], and being multiple births as compared to single [AOR = 5.34; 95%CI; 1.36,2 1.01] have significant risk factors for severe malnutrition. There was a pro-poor distribution of severe malnutrition among under-five children in Ethiopia with a concentration index of -0.23 [95%CI: -0.27, -0.19]. Severe malnutrition has significant spatial variation over regions in the country where the entire Afar, Eastern Amhara, Southern, and eastern Tigray regions were severely affected (RR = 1.72, P-value < 0.01).

CONCLUSION AND RECOMMENDATIONS

The prevalence of severe malnutrition in Ethiopia is relatively high as compared to other studies and most of them were severe chronic malnutrition. Having an educated mother/caregiver, and living in a cluster with high community women's education were preventive factors for severe malnutrition in children. Whereas having an unmarried mother/caregiver, old age of the child, plurality of birth, and having double children in the family have a positive association with it. Moreover, it was disproportionately concentrated in poor households (pro-poor distribution). The spatial distribution of childhood severe malnutrition was not random. Regions like Tigray, Afar, Eastern parts of Amhara, and Somalia regions should be considered priority areas for nutritional interventions for reducing severe malnutrition. Equity-focused nutritional interventions could be needed to curb the wealth-related inequalities of childhood severe malnutrition.

Multilevel analysis of intimate partner violence and associated factors among pregnant women in East Africa: Evidence from recent (2012-2018) demographic and health surveys

BACKGROUND

Globally, intimate partner violence (IPV) during pregnancy is the most common and major public health problem. It has a negative effect on the lives of both mother and fetus. Despite its prominence, many countries in East Africa have paid little attention to this issue. This study assessed the prevalence and associated factors of intimate partner violence among pregnant women in East African countries.

METHODS

The study adopted a secondary method data analysis that utilized recent Demographic and Health Surveys of 10 countries in East Africa between 2012 and 2018. A total of 23,521 women who gave birth in the 5 years preceding the survey were included. A multilevel mixed-effect logistic regression model was fitted to identify factors associated with IPV. Variables with a p-value < 0.05 were declared as significant factors associated with IPV.

RESULTS

The overall prevalence of IPV in East Africa was 37.14 (95% CI 36.53, 37.76). Women with age 25-34 (AOR = 1.20;95%CI; 1.06, 1.36), 35-39 (AOR = 1.40;95%CI; 1.24, 1.58), and 40-49 (AOR = 1.66;95%CI; 1.43, 1.95), women with no education (AOR = 1.27;95%CI; 1.16, 1.39), women with no occupation (AOR = 1.36; 95%CI; 1.27, 1.47), women from households with the poorest (AOR = 1.51; 95%CI: 1.33, 1.71), poorer (AOR = 1.40;95% CI:1.24, 1.58), middle (AOR = 1.32;95%CI:1.17, 1.48), and richer (AOR = 1.26;95%CI: 1.13, 1.40), husband drinks alcohol (AOR = 2.54; 95%CI 2.39, 2.71), ≥ 5 number of living children (AOR = 1.28; 95%CI: 1.31, 2.57) and rural areas (AOR = 1.14; 95%CI: 1.03, 1.25) were significantly associated with IPV.

CONCLUSION

More than one-third of pregnant women experienced intimate partner violence in East Africa. Promoting the educational status of women, the economic capacity of women, and the healthy behavior of the husband by reducing alcohol consumption, with particular attention to rural women and violence during pregnancy, is vital to reduce the prevalence of IPV.

Multilevel analysis of early resumption of sexual intercourse among postpartum women in sub-Saharan Africa: evidence from Demographic and Health Survey Data

BACKGROUND

Resuming sexual activity early after childbirth can cause reproductive health problems such as unwanted pregnancy, unsafe abortion, and short birth intervals, especially if contraception is not used. However, it is uncommon for healthcare providers to discuss postpartum sexual practices during prenatal and postnatal care. Therefore, this study aimed to assess early resumption of sexual intercourse and associated factors among postpartum women in sub-Saharan Africa.

METHODS

Secondary data analysis from the most recent Demographic and Health Surveys data from the period of 2014 to 2019/2020 of 23 countries in sub-Saharan Africa were used. A total weighted sample of 118,371 women who gave birth in the three years before the surveys were used. We analyzed the data using Stata version 14. A multilevel mixed-effect logistic regression model was fitted to identify factors associated with early resumption of sexual intercourse. Variables with a p-value < 0.05 in the multilevel mixed-effect logistic regression model were declared significant factors associated with the outcome variables.

RESULTS

The magnitude of early resumption of sexual intercourse among postpartum women was 67.97% (95% CI: 67.60, 68.34). Urban resident (AOR = 1.91; 95% CI: 1.83, 2.06), women with primary education 1.11 (AOR = 1.11; 95% CI: 1.07 to 1.31) and secondary education and above level 1.17 (AOR = 1.17; 95% CI: 1.09 to 1.29), husbands with primary education 1.32 (AOR = 1.32; 95% CI: 1.27, 1.38) and secondary education and above level 1.15 (AOR = 1.15; 95% CI: 1.11 to 1.25), family planning use (AOR = 95%; CI: 1.77, 1.91), fertility intention wanted then 1.24 (AOR = 1.24; 95%; CI: 1.19, 1.32) and wanted later 1.27 (AOR = 1.27; 95%; CI: 1.22, 1.46), religion (AOR = 2.08; 95%CI: 1.97, 2.17), and place of delivery (AOR = 1.51; 95%CI = 1.36, 1.65) were significantly associated with early resumption of sexual intercourse.

CONCLUSION

The study revealed that more than two-thirds of the women had resumed sexual intercourse early after childbirth. Hence, the concerned bodies should strengthen the integration of postpartum education on sexual resumption with maternal, neonatal, and child health care services to reduce the early resumption of sexual intercourse. In addition, healthcare providers providing counseling on the resumption of postpartum sexual intercourse should focus on these factors to ensure a more effective outcome.

Associations of Urban Residence and Wealth Index With Various Sources of Contraceptives Among Young Women Aged 15-24 Years in 25 Sub-Saharan African Countries

PURPOSE

Appreciating user differences in contraceptive sources is essential for improving contraceptive access and safeguarding an equitable and sustainable future. Therefore, this study explored whether urban residence and individual wealth are associated with where women access contraception (e.g., government, private, or nongovernmental organization provider) and assessed whether these associations are modified by the income level in the respondents' country of residence.

METHODS

We analyzed the cross-sectional data of Demographic Health Surveys conducted between 2009 and 2020 in 25 countries. The final data set included 25,081 young women aged between 15 and 24 years who are using contraceptives. Multinomial logistic regression models were established to assess the associations of our outcome variable, namely, various contraceptive sources, with our main independent variables, namely, urban residence and wealth index. We also assessed the potential effect modification by country income level on the above associations.

RESULTS

We observed obvious urban-rural and rich-poor disparities in odds of using contraceptive sources. Generally, living in urban residences and being wealthy were positively associated with all sources of contraceptives. However, these associations were mostly modified by country income level. People living in urban residences utilized more private sources, especially in low-income (beta coefficient, B = 0.973) and upper-middle-income countries (B = 1.361). Young women in urban areas across all analyzed countries were also more likely to use contraceptives from other sources (B = 0.267). In addition, women from poor households were less likely to use private sources (B = -1.166) and other sources (B = -0.547).

DISCUSSION

Even though young women may prefer private sources of contraceptives due to their confidentiality and flexible hours, these sources carry more benefits for rich and urban young women than for poor and rural women. The differential accessibility and affordability may account for the observed urban-rural and rich-poor disparities in using contraceptive sources, respectively, and the income level of a country is likely to modify such disparities.

Socioeconomic inequality in modern contraceptive utilization among reproductive-age women in sub-Saharan African countries: a decomposition analysis

INTRODUCTION

Family planning services allow individuals to achieve desired birth spacing, family size, and contribute to improved health outcomes for infants, children, women, and families, and prevent unintended pregnancy. Births resulting from unintended pregnancies can have negative consequences Children from unintended pregnancies are more likely to experience poor mental and physical health during childhood. Even though many international organizations work to ensure universal access to sexual and reproductive health services, reproductive health service utilization is concentrated among individuals with rich socioeconomic status. Therefore, this study aimed to assess the presence of socioeconomic inequality in modern contraceptive utilization and its contributors in sub-Saharan African countries.

METHODS

A total of 466,282 weighted reproductive-aged women samples from DHS data SSA countries were included in the study. Erreygers normalized concentration index and its concentration curve were used to assess socioeconomic-related inequality in modern contraceptive utilization. Decomposition analysis was performed to identify factors contributing to socioeconomic-related inequality.

RESULTS

The weighted Erreygers normalized concentration index for modern contraceptive utilization was 0.079 with Standard error = 0.0013 (P value< 0.0001); indicating that There is small amount but statistically significant pro rich distribution of wealth related in equalities of modern contraceptive utilization among reproductive age women. The decomposition analysis revealed that mass media exposure, wealth index., place of residency, and distance of health facility were the major contributors to the pro-rich socioeconomic inequalities in modern contraceptive utilization.

CONCLUSION AND RECOMMENDATION

In this study, there is a small amount but statistically significant pro rich distribution of modern contraceptive utilization. Therefore, give priority to modifiable factors such as promoting the accessibility of health facilities, media exposure of the household, and improving their country's economy to a higher economic level to improve the wealth status of the population.

Unmet need for family planning and associated factors among currently married women in Hawella Tulla subcity, Hawassa, southern Ethiopia: community-based study

BACKGROUND

The unmet need for family planning remains a major public health concern in developing countries, especially in sub-Saharan Africa. Similarly, in Ethiopia, the unmet need for family planning is considerably high. However information regarding associated factors of unmet need of family planning is limited, the study area in particular. Thus, this study was aimed at assessing unmet family planning and associated factors among currently married women in Hawella Tulla Subcity.

METHODS

A community based cross-sectional study was employed on 436 currently married women. Both bivariable and multivariable logistic regression model were used and having P-value of < 0.05 was considered as independently associated factors. Strength of association of the variable was described using adjusted odd ratios with their 95% confidence interval.

RESULT

The overall unmet need for family planning among currently married women was found to be 18.1% (95% CI: 14.5%, 21.8%). Having age of below 18 years at first marriage AOR = 1.95 (95% CI: 1.14, 3.33), woman's not attained formal education AOR = 2.23 (95% CI: 1.02, 4.84), women whose partner had non-supportive for family planning use AOR = 2.32 (95% CI: 1.35, 3.99) and women without media access AOR = 2.13 (95% CI: 1.19, 3.81) were significantly associated with increasing unmet need for family planning.

CONCLUSIONS

Despite the presence of high family planning services coverage in the study area, the magnitude of unmet need for family planning is still reasonably high. Having age of below 18 years at first marriage, woman's not attained formal education, women whose partner had non-supportive for family planning use and inavailability of media access in the house were found to be associated with high unmet need for family planning. Therefore, efforts are needed to empower women through education, avoiding early marriage and encouraging couple-based family planning interventions. Increasing media access is also advisable intervention.

Unmet need for family planning and associated factors among adolescent girls and young women in Ethiopia: a multilevel analysis of Ethiopian Demographic and Health Survey

BACKGROUND

Unmet need for family planning among adolescent girls and young women (AGYW) is a common cause of the low contraceptive utilization in developing countries, including Ethiopia. To address problems associated with unmet for family planning among adolescent girls and young women nationally available evidences are essential. However, there is limited evidence regarding factors associated with the unmet need for family planning among adolescent girls and young women in Ethiopia. Hence, this study aims to assess the prevalence and associated factors of unmet need for family planning among adolescent girls and young women in Ethiopia.

METHODS

Our analysis was based on secondary data using the 2016 Ethiopian Demographic and Health Survey data. A total weighted sample of 1086 adolescent girls and young women was included in this study. A multi-level mixed-effect logistic regression analysis was fitted. Adjusted odds ratios with 95% confidence intervals were used to show the strength and direction of the association. Statistical significance was declared at a p-value less than 0.05.

RESULTS

The prevalence of unmet need for family planning was 28.3% (95% CI: 25.7, 31.0). Adolescent girls and young women age 15-19 years (aOR: 2.4, 95%CI: 1.3, 4.3), household wealth quantile; poor (aOR: 5.6, 95%CI: 2.8, 11.1) and middle (aOR: 2.9, 95%CI: 1.4, 6.0), had no media exposure (aOR: 2.1, 95%CI: 1.1, 4.1), and adolescent girls and young women from developing regions (aOR: 5.1, 95%CI: 1.1, 14.5) were significantly associated with unmet need for family planning.

CONCLUSIONS

Unmet need for family planning was high among adolescent girls and young women when compared to the national average and the United Nations sphere standard of unmet need for family planning. Age, wealth quantile, media exposure, and region were significantly associated with unmet need for family planning. Hence, there is the need to implement consistently effective family planning policies among AGYW living in developing regions of Ethiopia. Moreover, Public health policies and interventions that improve the existing strategies to improve media exposure of AGYW on family planning issues and increase the wealth status of households should be designed and implemented to reduce the unmet need for family planning in Ethiopia.

Magnitude of optimal access to ANC and its predictors in Ethiopia: Multilevel mixed effect analysis of nationally representative cross-sectional survey

BACKGROUND

Optimal access to ANC, such as the first ANC visit at first trimester, four or more ANC visits, and skilled health care provider can significantly reduce maternal mortality in an inclusive way. Previous studies conducted in Ethiopia on optimal ANC are restricted to frequencies of ANC visit. Therefore, the aim of this study was to assess the magnitude of optimal ANC access as a comprehensive way and its predictors among pregnant women in Ethiopia.

METHODS

Secondary data source from a recent demographic and health survey was used for analysis. This study includes a weighted sample of 4771 pregnant women. A multilevel mixed-effect binary logistic regression analyses was done to identify both the individual and community level factors. Odds ratio along with the 95% confidence interval was generated to identify the predictors of optimal access to ANC. A p-value less than 0.05 was declared as statistical significant.

RESULTS

In Ethiopia, one in five (20%) pregnant women had optimal access to antenatal care. Regarding the factors at individual level, pregnant women aged 25-34 years [aOR = 1.58, 95% CI = 1.23-2.03] and 35-49 years [aOR = 2.04, 95% CI = 1.43-2.89], those who had educated primary [aOR = 1.67, 95% CI = 1.33-2.09], secondary and higher [aOR = 1.81, 95% CI = 1.15-2.85], Primipara [aOR = 2.45, 95% CI = 1.68-3.59] and multipara [aOR = 1.48, 95% CI = 1.11-1.98] had higher odds of accessing optimal ANC. With the community level factors, the odds of optimal access to ANC was higher among pregnant women who lived in urban area [aOR = 2.08, 95% CI = 1.33-3.27], whereas, lower odds of optimal ANC access among those pregnant women who reported distance to the health facility as a big problem [aOR = 0.78, 95% CI = 0.63-0.96].

CONCLUSION AND RECOMMENDATION

The study concludes that in Ethiopia, optimal access to ANC was low. The study identified that both individual and community level factors were predictors for optimal ANC access. Therefore, the Ethiopian government should intensify extensive education on ANC in a comprehensive way. Moreover, especial attention from the Ethiopian ministry of health for those women who reported distance as a big problem and for rural resident women is mandatory.

Factors associated with non-use of modern contraceptives among sexually active women in Ethiopia: a multi-level mixed effect analysis of 2016 Ethiopian Demographic and Health Survey

Background

Appropriate contraceptive use prevents unintended pregnancy, protects the health of mother and child, and promotes women’s well-being. Use of modern Family planning in Ethiopia was still very low. The purpose of this study was to assess the factors that are associated with non-use of modern family planning services among women of reproductive age.

Method

A nationally representative 2016 EDHS women data were used for analysis. A total of 15,683 women in the reproductive age group were included in this study. Descriptive and multilevel multivariable binary logistic regression models were used to summarize descriptive data and measure statistical association between the dependent and the individual and community level variable, respectively. Adjusted Odds Ratio (AOR) and confidence interval were respectively used to measure association and its statistical significance.

Result

Among women in the reproductive age group 79.49% (95% CI: 78.85%, 80.12%) did not use a modern contraceptive method. Women age between 25–34 years (AOR = 0.54, 95% CI: 0.47–0.61) and age between 34–49 year (AOR = 0.62, 95% CI: 0.55–0.71), having primary educated women (AOR = 0.0.77, 95% CI: 0.68–0.87),secondary and above educational (AOR = 0.88, CI: 0.75–1.03), Secondary and above-educated husband (AOR = 0.84, 95% CI: 0.72–0.96), rich women (AOR = 0.74,95%CI:0.65–0.85), health facility delivery (AOR = 0.84, 95%CI: 0.73–0.0.98), being watching TV (AOR = 0.74, 95% CI: 0.65–0.85), having 1–2 living children (AOR = 0.21, 95% CI: 0.19–0.23) are less likely to not use contraception were identified. Furthermore, Muslim women (AOR = 1.43, 95% CI: 1.23–1.62), women living in rural area (AOR = 3.43; 95% CI: 2.72–4.32), and ANC visit 1.25(1.07–1.47) were more likely to not use contraception. Further, Women in Afar, Somali, Gambela, Harari, and Dire Dawa were less likely to use modern contraception methods than women in Tigray, but Amhara region had a lower rate of non-use.

Conclusion

Family planning interventions should target younger women, women living in rural areas, the poor, and Muslim women. Moreover, initiatives to empower women associated to family planning programs would be beneficial in increasing contraceptive uptake among sexually active women in Ethiopia.

Association between exposure to family planning messages on different mass media channels and the utilization of modern contraceptives among young women in Sierra Leone: insights from the 2019 Sierra Leone Demographic Health Survey

Background

Access to sexual and reproductive health information enables young women to make appropriate decisions. We examined the association between exposure to family panning messages on different mass media and the use of modern contraceptives among young women in Sierra Leone.

Methods

This was a secondary analysis of the 2019 Sierra Leone Demographic and Health Survey data of young women aged 15–24 years. Multistage stratified sampling was used to select study participants in the survey. We used multivariable logistic regression to determine the association between exposure to family panning messages on different types mass media channels and utilization of modern contraceptives. All our analyses were done using SPSS version 25.

Results

Out of 6055 young women, 1506 (24.9%, 95% CI 24.0–26.2) were utilizing a modern contraceptive method with the prevalence higher among urban women (26.5%) compared to rural women (23.1%). Less than half (45.6%) had been exposed to family planning messages on mass media (radio 28.6%, television 10.6%, mobile phones 4.2% and newspapers or magazines 2.2%). Young women who had exposure to family planning messages on radio (AOR: 1.26, 95% CI 1.06–1.50) and mobile phones (AOR: 1.84, 95% CI 1.25–2.69) had higher odds of using modern contraceptives compared to their counterparts without the same exposure. Furthermore, having access to internet (AOR: 1.45, 95% CI 1.19–1.78), working (AOR: 1.49, 95% CI 1.27–1.74), being older (20–24 years) (AOR: 1.75, 95% CI 1.46–2.10), being married (AOR: 0.33, 95% CI 0.26–0.42), having visited a health facility within the last 12 months (AOR: 1.34, 95% CI 1.10–1.63), having secondary (AOR: 2.83, 95% CI 2.20–3.64) and tertiary levels of education (AOR: 3.35, 95% CI 1.83–6.13), higher parity (having above one child) AOR: 1.57, 95% CI 1.19–2.08) and residing in the southern (AOR: 2.11, 95% CI 1.61–2.79), northwestern (AOR: 1.87, 95% CI 1.39–2.52), northern (AOR: 2.11, 95% CI 1.59–2.82) and eastern (AOR: 1.68, 95% CI 1.27–2.22) regions of residence were associated with higher odds of modern contraceptives utilization.

Conclusion

In Sierra Leon, only one in four young women were using modern contraception and more than half of them had not had any exposure to family planning messages on the different types of mass media channels. Behavior change communicators can prioritize family planning messages using radio, mobile phones and the internet. In order to publicize and encourage young women to adopt healthy behaviours and increase uptake of modern contraceptive.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01974-w.

Determinants of Inadequate Minimum Dietary Diversity Intake Among Children Aged 6-23 Months in Sub-Saharan Africa: Pooled Prevalence and Multilevel Analysis of Demographic and Health Survey in 33 Sub-Saharan African Countries

Background

Inappropriate feeding practices result in significant threats to child health by impaired cognitive development, compromised educational achievement, and low economic productivity, which becomes difficult to reverse later in life. There is minimal evidence that shows the burden and determining factors of inadequate dietary intake among children aged under 2 years in sub-Saharan African (SSA) countries. Therefore, this study aimed to assess the pooled magnitude, wealth-related inequalities, and other determinants of inadequate minimum dietary diversity (MDD) intake among children aged 6-23 months in the SSA countries using the recent 2010-2020 DHS data.

Methods

A total of 77,887 weighted samples from Demographic and Health Survey datasets of the SSA countries were used for this study. The Microsoft Excel and STATA version 16 software were used to clean, extract, and analyze the data. A multilevel binary logistic regression model was fitted. The concentration index and curve were applied to examine wealth-related inequalities in the outcomes. P-value < 0.05 with 95% CI was taken to declare statistical significance.

Results

The pooled magnitude of inadequate MDD intake among children aged 6-23 months in SSA was 76.53% (95% CI: 73.37, 79.70), ranging from 50.5% in South Africa to 94.40% in Burkina Faso. Individual-level factors such as women having secondary and above education (AOR = 0.66; 95% CI; 0.62, 0.70), being employed (AOR = 0.76; 95% CI; 0.72, 0.79), having household media exposure (AOR = 0.69; 95% CI; 0.66, 0.72), richest wealth (AOR = 0.46; 95% CI; 0.43, 0.50), having health institution delivery (AOR = 0.87;95% CI; 0.83, 0.91), and community-level factor such as living in upper middle-income country (AOR = 0.42; 95% CI; 0.38, 0.46) had a significant protective association, whereas rural residence (AOR = 1.29; 95% CI; 1.23, 1.36) has a significant positive association with inadequate MDD intake among children aged 6-23 months. Inadequate MDD intake among children aged 6-23 months in SSA was disproportionately concentrated on the poor households (pro-poor) (C = -0.24; 95% CI: -0.22, -0.0.26).

Conclusion and Recommendations

There is a high magnitude of inadequate minimum dietary diversity intake among children aged 6-23 months in SSA. Variables such as secondary and above maternal education, having an employed mother, having exposure to media, richest wealth, having health institution delivery, and living in the upper middle-income country have a significant negative association, whereas living in rural residence has a significant positive association with inadequate MDD intake. These findings highlight that to increase the MDD intake in the region, policy makers and other stakeholders need to give prior attention to enhancing household wealth status, empowering women, and media exposure.

Minimum acceptable diet intake and its associated factors among children age at 6-23 months in sub-Saharan Africa: a multilevel analysis of the sub-Saharan Africa demographic and health survey

Background

Only one in five children aged below 24 months in the low-income countries feed the minimum recommended diet, and significantly varied across socio-economic classes. Though sub-saharan Africa (SSA) shares the huge burden of children under nutrition, as to our search of literature there is limited evidence on the pooled magnitude and factors associated with minimum acceptable diet (MAD) intake among children aged 6 to 23 months in the region. This study aimed to assess the pooled magnitude and associated factors of MAD intake among children aged 6–23 months in SSA using recent 2010–2020 DHS data.

Methods

Demographic and Health Survey datasets of SSA countries were used for this study with a total of 78,542 weighted samples. The data were cleaned using MS excel and extracted and analyzed using STATA V.16 software. A multilevel binary logistic regression model was fitted. The adjusted odds ratio (AOR) with P-value < 0.05 was taken to declare statistical significance.

Results

The pooled magnitude of MAD intake among children aged 6–23 months in SSA was 9.89% [95%CI: 8.57, 11.21%] ranging from 3.10% in Guinea to 20.40% in Kenya. Individual level factors such as; secondary &above women educational status [AOR = 1.41; 95%CI; 1.29, 1.53], having employed women [AOR = 1.25;95%CI;1.17,1.33], having media exposure [AOR = 1.55;95%CI;1.45,1.66], richest household wealth [AOR = 1.93; 95%CI; 1.73, 2.15], plural birth [AOR = 0.68;95%CI; 0.56, 0.82] and breastfed child [AOR = 2.04; 95%CI; 1.89, 2.21], whereas, community level factor such as rural residence [AOR = 0.74; 95%CI; 0.69, 0.79] and living in upper middle income country [AOR = 1.62; [95%CI; 1.41,1.87] were significantly associated with MAD intake.

Conclusion and recommendations

Minimum acceptable diet intake in SSA is relatively low. Variables such as; secondary &above maternal education, having employed mother, exposure to media, richest wealth, breast feeding child, and upper middle income country have a significant positive association, whereas having plural birth and living in rural residence have a significant negative association with MAD intake. These findings highlight that policymakers and other stakeholders had better give prior attention to empowering women, enhance household wealth status and media exposure to increase the MAD intake in the region.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12966-8.

Spatial distribution and determinants of bottle feeding among children 0-23 months in Ethiopia: spatial and multi-level analysis based on 2016 EDHS

BACKGROUND

Bottle feeding is associated with diarrheal disease morbidity and mortality and risk of pyloric stenosis, especially in developing countries. Even though, World Health Organization (WHO) recommended avoiding bottle feeding among children, still higher magnitude was reported in developing countries. This study aimed to assess the spatial distribution and determinants of bottle feeding among children 0-23 months in Ethiopia.

METHODS

This study was conducted based on Ethiopian Demographic and Health Surveys data (EDHS). The data were weighted using sampling weight for probability sampling and non-response to restore the representativeness of the data and get valid statistical estimates. Then a total of 4,275 weighted samples of under two years children were used to investigate the study. The data were cleaned using MS excel and extracted and analyzed using STATA V.16 software. A multilevel binary logistic regression model was fitted. P-value < 0.05 was taken to declare statistical significance. A spatial analysis was done using ArcGIS and SaTScan software.

RESULTS

The prevalence of bottle feeding practice among under two years children in Ethiopia were 13.5% (95%CI: 11.16, 15.29) and ranges from the lowest 5.16% (95% CI: 3.28, 78.73) Amhara region to the highest 55.98% (95% CI: 47.98, 61.46) Addis Ababa region. Women with secondary and above education status [AOR=2.49; 95%CI; 1.66, 3.74], women from richest household [AOR=1.33; 95%CI; 1.01, 1.78], child 12-23 months age [AOR= 1.59; 95%CI; 1.23, 2.05], multiple birth [AOR=4.30; 95%CI; 1.88, 9.84], rural residence [AOR=0.49; 95%CI; 0.16, 0.82] and large central region [AOR= 0.15; 95%CI; 0.08, 0.27] have significantly associated with bottle feeding. Addis Ababa, Central Oromia, Dire Dewa, Somali and Harari regions were the hot spot areas for bottle feeding practice among under two years children.

CONCLUSION AND RECOMMENDATIONS

The prevalence of bottle feeding practices in Ethiopia is relatively moderate. Maternal education, wealth index, child age, multiple births, residence and region were significant predictors of bottle feeding. These findings highlight that, the Ministry of Health Ethiopia (MOH), policymakers, and other stakeholders had better give prior attention to preventable factors such as empowering women, enhancing household wealth status to decreasing bottle feeding practice in Ethiopia.

Four out of ten married women utilized modern contraceptive method in Ethiopia: A Multilevel analysis of the 2019 Ethiopia mini demographic and health survey

Background

Modern contraceptive method is a product or medical procedure that interferes with reproduction from acts of sexual intercourse. Globally in 2019, 44% of women of reproductive age were using a modern method of contraception but it was 29% in sub-Saharan Africa. Therefore, the main aim of this analysis was to assess the prevalence of modern contraceptive utilization and associated factors among married women in Ethiopia.

Method

The current study used the 2019 Ethiopia mini demographic and health survey dataset. Both descriptive and multilevel mixed-effect logistic regression analysis were done using STATA version 14. A p-value of less than 0.05 and an adjusted odds ratio with a 95% confidence interval were used to report statistically significant factors with modern contraceptive utilization.

Result

The overall modern contraceptive utilization among married women in Ethiopia was 38.7% (95% CI: 37.3% to 40.0%). Among the modern contraceptive methods, injectables were the most widely utilized modern contraceptive method (22.82%) followed by implants (9.65%) and pills (2.71%). Maternal age, educational level, wealth index, number of living children, number of births in the last three years, number of under 5 children in the household, religion, and geographic region were independent predictors of modern contraceptive utilization.

Conclusion

In the current study only four out of ten married non-pregnant women of reproductive age utilized modern contraceptive methods. Furthermore, the study has identified both individual and community-level factors that can affect the utilization of modern contraceptive methods by married women in the country. Therefore, concerned bodies need to improve access to reproductive health services, empower women through community-based approaches, and minimize region wise discrepancy to optimize the utilization.