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Tamir TT, Alemu TG, Techane MA, Wubneh CA, Assimamaw NT, Belay GM, Muhye AB, Kassie DG, Wondim A, Terefe B, Tarekegn BT, Ali MS, Fentie B, Gonete AT, Tekeba B, Kassa SF, Desta BK, Ayele AD, Dessie MT, Atalell KA. Prevalence, spatial distribution and determinants of infant mortality in Ethiopia: Findings from the 2019 Ethiopian Demographic and Health Survey. PLoS One 2023; 18:e0284781. [PMID: 37098031 PMCID: PMC10128957 DOI: 10.1371/journal.pone.0284781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 04/06/2023] [Indexed: 04/26/2023] Open
Abstract
INTRODUCTION Infant mortality declined globally in the last three decades. However, it is still a major public health concern in Ethiopia. The burden of infant mortality varies geographically with the highest rate in Sub-Saharan Africa. Although different kinds of literature are available regarding infant mortality in Ethiopia, an up to date information is needed to design strategies against the problem. Thus, this study aimed to determine the prevalence, show the spatial variations and identify determinants of infant mortality in Ethiopia. METHODS The prevalence, spatial distribution, and predictors of infant mortality among 5,687 weighted live births were investigated using secondary data from the Ethiopian Demographic and Health Survey 2019. Spatial autocorrelation analysis was used to determine the spatial dependency of infant mortality. The spatial clustering of infant mortality was studied using hotspot analyses. In an unsampled area, ordinary interpolation was employed to forecast infant mortality. A mixed multilevel logistic regression model was used to find determinants of infant mortality. Variables with a p-value less than 0.05 were judged statistically significant and adjusted odds ratios with 95 percent confidence intervals were calculated. RESULT The prevalence of infant mortality in Ethiopia was 44.5 infant deaths per 1000 live births with significant spatial variations across the country. The highest rate of infant mortality was observed in Eastern, Northwestern, and Southwestern parts of Ethiopia. Maternal age between 15&19 (adjusted odds ratio (AOR) = 2.51, 95% Confidence Interval (CI): 1.37, 4.61) and 45&49(AOR = 5.72, 95% CI: 2.81, 11.67), having no antenatal care follow-up (AOR = 1.71, 95% CI: 1.05, 2.79) and Somali region (AOR = 2.78, 95% CI: 1.05, 7.36) were significantly associated with infant mortality in Ethiopia. CONCLUSION In Ethiopia, infant mortality was higher than the worldwide objective with significant spatial variations. As a result, policy measures and strategies aimed at lowering infant mortality should be devised and strengthened in clustered areas of the country. Special attention should be also given to infants born to mothers in the age groups of 15-19 and 45-49, infants of mothers with no antenatal care checkups, and infants born to mothers living in the Somali region.
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Affiliation(s)
- Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Masresha Asmare Techane
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Chalachew Adugna Wubneh
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nega Tezera Assimamaw
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getaneh Mulualem Belay
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Addis Bilal Muhye
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Destaye Guadie Kassie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Wondim
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bewuketu Terefe
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bethelihem Tigabu Tarekegn
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Seid Ali
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Beletech Fentie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhan Tekeba
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Selam Fisiha Kassa
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bogale Kassahun Desta
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Amare Demsie Ayele
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melkamu Tilahun Dessie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kendalem Asmare Atalell
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Tesema GA, Seifu BL, Tessema ZT, Worku MG, Teshale AB. Incidence of infant mortality and its predictors in East Africa using Gompertz gamma shared frailty model. Arch Public Health 2022; 80:195. [PMID: 35999606 PMCID: PMC9400328 DOI: 10.1186/s13690-022-00955-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 08/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Globally, infant mortality is a major public health concern and a sensitive indicator of countries' socio-economic and health status. Despite the substantial reduction of under-five mortality in sub-Saharan African countries specifically in East Africa, the infant mortality rate remains highest and too far below to achieve the WHO target. As to our search of the literature is concerned, there is a dearth of evidence on the incidence and predictors of infant mortality in East Africa. Therefore, this study investigated the incidence of infant mortality and its predictors in East Africa.
Methods
The present study has utilized 138,803 weighted samples from Demographic and Health Surveys (DHSs) of 12 East African countries. Considering the hierarchical nature of DHS data shared frailty parametric survival models were fitted and compared based on deviance (-2LLR), AIC, and BIC. Gompertz gamma shared frailty model was the best-fitted model for the data since it had the lowest deviance, AIC, and BIC values. Variables with a p-value < 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable Gompertz gamma shared analysis, the Adjusted Hazard Ratio (AHR) with 95% Confidence Interval (CI) was reported to declare the significant predictors of infant mortality.
Results
The infant mortality rate in East Africa was 41.41 per 1000 live births. Mothers aged 25–34 years, wanted birth, health facility delivery, 1–3 ANC visit, being 2nd- 4th birth order, 5th and above, the birth interval of 24–48 months, and birth interval of 49 months and above were significantly associated with lower risk of infant mortality. Whereas women who didn’t have formal education, women who didn't participate in making health care decisions making, being male children, cesarean delivery, small size at birth, and large size at birth were significantly associated with a higher risk of infant mortality.
Conclusion
Despite the substantial progress in improving maternal and child health, this study showed that infant mortality is still a major public health concern in East Africa. Maternal age, place of delivery, maternal education, birth size, sex of the child, mode of delivery, women's autonomy, birth order, birth interval, and ANC visit were found to be significant predictors of infant mortality. Therefore, public health interventions enhancing health facility delivery, ANC visit, maternal education, birth spacing, and empowering women are crucial for reducing the incidence of infant mortality in East Africa.
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McFadden C, Muir B, Oxenham MF. Determinants of infant mortality and representation in bioarchaeological samples: A review. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2021. [DOI: 10.1002/ajpa.24406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Clare McFadden
- School of Archaeology and Anthropology Australian National University Canberra Australian Capital Territory Australia
| | - Brianna Muir
- School of Archaeology and Anthropology Australian National University Canberra Australian Capital Territory Australia
| | - Marc F. Oxenham
- School of Archaeology and Anthropology Australian National University Canberra Australian Capital Territory Australia
- Department of Archaeology, School of Geosciences University of Aberdeen, St Mary's Aberdeen UK
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Tiruneh SA, Zeleke EG, Animut Y. Time to death and its associated factors among infants in sub-Saharan Africa using the recent demographic and health surveys: shared frailty survival analysis. BMC Pediatr 2021; 21:433. [PMID: 34607560 PMCID: PMC8489062 DOI: 10.1186/s12887-021-02895-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, approximately 4.1 million infants died, accounting for 75% of all under-five deaths. In sub-Saharan Africa (SSA), infant mortality was 52.7/1000 live births in 2018 This study aimed to assess the pooled estimate of infant mortality rate (IMR), time to death, and its associated factors in SSA using the recent demographic and health survey dataset between 2010 and 2018. METHODS Data were retrieved from the standard demographic and health survey datasets among 33 SSA countries. A total of 93,765 samples were included. The data were cleaned using Microsoft Excel and STATA software. Data analysis was done using R and STATA software. Parametric shared frailty survival analysis was employed. Statistical significance was declared as a two-side P-value < 0.05. RESULTS The pooled estimate of IMR in SSA was 51 per 1000 live births (95% Confidence Interval (CI): 46.65-55.21). The pooled estimate of the IMR was 53 in Central, 44 in Eastern, 44 in Southern, and 57 in Western Africa per 1000 live births. The cumulative survival probability at the end of 1 year was 56%. Multiple births (Adjusted Hazard ratio (AHR) = 2.68, 95% CI: 2.54-2.82), low birth weight infants (AHR = 1.28, 95% CI: 1.22-1.34), teenage pregnancy (AHR = 1.19, 95 CI: 1.10-1.29), preceding birth interval < 18 months (AHR = 3.27, 95% CI: 3.10-3.45), birth order ≥ four (AHR = 1.14, 95% CI:1.10-1.19), home delivery (AHR = 1.08, 95% CI: 1.04-1.13), and unimproved water source (AHR = 1.07, 95% CI: 1.01-1.13), female sex (AHR = 0.86, 95% CI: 0.83-0.89), immediately breastfeed (AHR = 0.24, 95% CI: 0.23-0.25), and educated mother (AHR = 0.88, 95% CI: 0.82-0. 95) and educated father (AHR = 0.90, 95% CI: 0.85-0.96) were statistically significant factors for infant mortality. CONCLUSION Significant number of infants died in SSA. The most common cause of infant death is a preventable bio-demographic factor. To reduce infant mortality in the region, policymakers and other stakeholders should pay attention to preventable bio-demographic risk factors, enhance women education and improved water sources.
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Affiliation(s)
- Sofonyas Abebaw Tiruneh
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Ejigu Gebeye Zeleke
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yaregal Animut
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Tesema GA, Seretew WS, Worku MG, Angaw DA. Trends of infant mortality and its determinants in Ethiopia: mixed-effect binary logistic regression and multivariate decomposition analysis. BMC Pregnancy Childbirth 2021; 21:362. [PMID: 33952208 PMCID: PMC8097868 DOI: 10.1186/s12884-021-03835-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/27/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Infant mortality remains a serious global public health problem. The global infant mortality rate has decreased significantly over time, but the rate of decline in most African countries, including Ethiopia, is far below the rate expected to meet the SDG targets. Therefore, this study aimed to investigate the trends of infant mortality and its determinants in Ethiopia based on the four consecutive Ethiopian Demographic and Health Surveys (EDHSs). METHODS This analysis was based on the data from four EDHSs (EDHS 2000, 2005, 2011, and 2016). A total weighted sample of 46,317 live births was included for the final analysis. The logit-based multivariate decomposition analysis was used to identify significantly contributing factors for the decrease in infant mortality in Ethiopia over the last 16 years. To identify determinants, a mixed-effect logistic regression model was fitted. The Intra-class Correlation Coefficient (ICC) and Likelihood Ratio (LR) test were used to assess the presence of a significant clustering effect. Deviance, Akaike Information Criteria (AIC), and Bayesian Information Criteria (BIC) were used for model comparison. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to identify the statistically significant determinants of infant mortality. RESULTS Infant mortality rate has decreased from 96.9 per 1000 births in 2000 to 48 per 1000 births in 2016, with an annual rate of reduction of 4.2%. According to the logit based multivariate decomposition analysis, about 18.1% of the overall decrease in infant mortality was due to the difference in composition of the respondents with respect to residence, maternal age, type of birth, and parity across the surveys, while the remaining 81.9% was due to the difference in the effect of residence, parity, type of birth and parity across the surveys. In the mixed-effect binary logistic regression analysis; preceding interval < 24 months (AOR = 1.79, 95% CI; 1.46, 2.19), small size at birth (AOR = 1.55, 95% CI; 1.25, 1.92), large size at birth (AOR = 1.26, 95% CI; 1.01, 1.57), BMI < 18.5 kg/m2 (AOR = 1.22, 95% CI; 1.05, 1.50), and twins (AOR = 4.25, 95% CI; 3.01, 6.01), parity> 6 (1.51, 95% CI; 1.01, 2.26), maternal age and male sex (AOR = 1.50, 95% CI: 1.25, 1.79) were significantly associated with increased odds of infant mortality. CONCLUSION This study found that the infant mortality rate has declined over time in Ethiopia since 2000. Preceding birth interval, child-size at birth, BMI, type of birth, parity, maternal age, and sex of child were significant predictors of infant mortality. Public health programs aimed at rural communities, and multiparous mothers through enhancing health facility delivery would help maintain Ethiopia's declining infant mortality rate. Furthermore, improving the use of ANC services and maternal nutrition is crucial to reducing infant mortality and achieving the SDG targets in Ethiopia.
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Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, institute of public health, college of medicine and health science, University of Gondar, Gondar, Ethiopia
| | - Wullo Sisay Seretew
- Department of Epidemiology and Biostatistics, institute of public health, college of medicine and health science, University of Gondar, Gondar, Ethiopia.
| | - Misganaw Gebrie Worku
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, institute of public health, college of medicine and health science, University of Gondar, Gondar, Ethiopia
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Kebede B, Mamo G. Determinants of non-adherence to inhaled steroids in adult asthmatic patients on follow up in referral hospital, Ethiopia: cross-sectional study. Asthma Res Pract 2019; 5:5. [PMID: 31893127 PMCID: PMC6937669 DOI: 10.1186/s40733-019-0053-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/29/2019] [Indexed: 02/01/2023] Open
Abstract
Background Asthma is one of the major non-communicable diseases worldwide. The prevalence of asthma has continuously increased over the last five decades, resulting in 235 million people suffering from it. One of the main challenges in asthma control is adherence to pharmaceutical treatment (4) and leads to poor outcome and increases the economic and clinical burden. Non-adherence could be intentional or non-intentional. Objective To identify the determinants of inhaled steroid adherence among adult asthmatic patients. Setting The study was done in Jimma university medical center (JUMC) from March-August 22/2018. Method Cross-sectional observational study was conducted. Patient assessment was conducted (patient demography, inhalation technique, adherence, and asthma control status). Independent predictors of outcome identified and strength of association between dependent and independent variables determined by using binary logistic regression and statistical significance was considered at p < 0.05. Before computing binary logistic regression analysis, the presence of colinearity between independent factor and model fitness was checked. Results One hundred forty patients were included in the analysis. Substantial number of patients 53(37.9, 95%CI: 30-45) were non-adherent. Patient experience of previous adverse drug reaction (p = 0.011), educational status (p = 0.02), patient knowledge status (p = 0.028), previous education (p = 0.0001) and co-morbidity (p = 0.031) were significantly associated with adherence. Conclusions The rate of non-adherence to inhalational anti-asthmatics is high and different factors contributed. The health care provider should try to counsel patients about the effect of non-adherence on asthma control. Reassurance concerning adverse drug reactions should be an integral part of patient counseling.
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Affiliation(s)
- Bezie Kebede
- 1Department of Pharmacy, College of Health Science, Mizan-Tepi University, Mizan-Teferi, Ethiopia
| | - Girma Mamo
- 2Department of Pharmacy, College of Medicine and Health Sciences, Jimma University, Jimma, Ethiopia
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Olorunsaiye CZ, Huber LB, Laditka SB, Kulkarni S, Boyd AS. Factors associated with health facility delivery in West and Central Africa: A multilevel analysis of seven countries. Health Care Women Int 2019; 41:3-21. [PMID: 31621528 DOI: 10.1080/07399332.2019.1678161] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We examined associations between individual and community socioeconomic status (SES) and childbirth in a health facility in West and Central Africa using data from the 2009-2011 United Nations Children's Fund (UNICEF) Multiple Indicator Cluster Survey for women in seven countries (n = 34,487). Individual SES measures were education and wealth; community SES was low or high poverty index. In adjusted results, women residing in communities with high poverty had significantly lower odds of facility delivery than those who lived in more affluent communities in five countries (all p < 0.001). Reducing out-of-pocket healthcare costs may improve women's access to delivery in health facilities.
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Affiliation(s)
| | - Larissa Brunner Huber
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Sarah B Laditka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Shanti Kulkarni
- School of Social Work, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - A Suzanne Boyd
- School of Social Work, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
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Taylor YJ, Laditka JN, Laditka SB, Brunner Huber LR, Racine EF. Is having any prenatal care associated with lower infant mortality in West Africa? Evidence from the Demographic and Health Surveys. Health Care Women Int 2019; 40:196-212. [PMID: 30849281 DOI: 10.1080/07399332.2018.1522317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although developing countries may find it difficult to provide adequate prenatal care, it is likely that they can provide at least some. We examined associations of prenatal care with infant mortality in West Africa. We used data from the Demographic and Health Surveys (n = 57,322) and proportional hazards regression models to estimate the risk of infant mortality. Having any prenatal care was associated with lower infant mortality risk in all but the poorest wealth quintile, with 56% lower risk in the wealthiest quintile (95% confidence interval [CI] 0.28-0.69). Even limited prenatal care may significantly reduce infant mortality in developing countries.
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Affiliation(s)
- Yhenneko J Taylor
- a Center for Outcomes Research and Evaluation , Atrium Health , Charlotte , North Carolina , USA
| | - James N Laditka
- b Department of Public Health Sciences , University of North Carolina at Charlotte , Charlotte , North Carolina , USA
| | - Sarah B Laditka
- b Department of Public Health Sciences , University of North Carolina at Charlotte , Charlotte , North Carolina , USA
| | - Larissa R Brunner Huber
- b Department of Public Health Sciences , University of North Carolina at Charlotte , Charlotte , North Carolina , USA
| | - Elizabeth F Racine
- b Department of Public Health Sciences , University of North Carolina at Charlotte , Charlotte , North Carolina , USA
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Tumwine JK. Updates on communicable and non-communicable diseases in LMICs. Afr Health Sci 2017. [PMID: 27358652 DOI: 10.4314/ahs.v16i1.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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