Predictors of delayed initiation of breast milk and exclusive breastfeeding in Ethiopia: A multi-level mixed-effect analysis

BACKGROUND

Despite the well-established benefits of early initiation of breastfeeding and exclusive breastfeeding for the first six months to promote optimal neonatal and child health, evidence indicates that in Ethiopia, a significant number of newborns initiate breastfeeding late, do not adhere to exclusive breastfeeding (EBF) for the recommended duration, and instead are fed with bottles.

OBJECTIVE

To determine the proportion of delayed initiation of breast milk, exclusive breastfeeding, and its individual and community-level predictors among mothers in Ethiopia.

METHODS

A secondary data analysis was done using the 2019 Ethiopian Mini Demographic Health Survey data. We examined a weighted sample of 2,012 children born within the past 24 months and 623 children aged 0-5 months at the time of the survey. The data analysis was done using STATA version 15. To understand the variation in delayed initiation and exclusive breastfeeding, statistical measures such as the Intraclass correlation coefficient, median odds ratio, and proportional change in variance were calculated. We employed a multilevel mixed-effects logistic regression model to identify predictors for each outcome variable. Statistical significance was determined with a p-value < 0.05.

RESULTS

The proportion of delayed initiation of breast milk and exclusive breastfeeding were 24.56 and 84.5%, respectively. Women aged 34-49 years old (AOR = 0.33: 95% CI; 0.15-0.72), having a television in the house (AOR = 0.74: 95%CI; 0.33-0.97), delivered by cesarean section (AOR = 3.83: 95% CI; 1.57-9.32), and resided in the Afar regional state (AOR = 1.43: 95%CI; 1.03-12.7) were significantly associated with delayed initiation of breast milk. On the other hand, attended primary education (AOR = 0.67: 95%CI; 0.35-0.99), secondary education (AOR = 0.34: 95%CI; 0.19-0.53), women whose household headed by male (AOR = 0.68; 95% CI; 0.34-0.97), and rural residents (AOR = 1.98: 95%CI; 1.09-3.43) were significantly associated with exclusive breastfeeding practice.

CONCLUSION

Health promotion efforts that encourage timely initation of breast milk and promote EBF, focused on young mothers, those who gave birth through cesarean section, and those residing in urban and the Afar regional state. Furthermore, government health policymakers and relevant stakeholders should consider these identified predictors when revising existing strategies or formulating new policies.

Prevalence and determinants to COVID-19 vaccine hesitancy among people living with HIV in Bench Sheko zone, Southwest Ethiopia: A multi-center study

Introduction

In 2019, the World Health Organization (WHO) identified coronavirus disease-2019 (COVID-19) as one of the top 10 threats to global health. Currently, vaccine hesitancy is the most common obstacle to reducing COVID-19 incidence and achieving herd immunity worldwide. Understanding the factors influencing vaccine hesitancy in this specific population is crucial for developing targeted interventions to improve vaccine uptake and protect vulnerable communities. Therefore, this study aimed to evaluate the prevalence and determinants of COVID-19 vaccine hesitancy among people living with human immunodeficiency virus (HIV) who receive care at public health facilities in Bench Sheko Zone, Southwest Ethiopia.

Methods

A multi-center study was employed, involving multiple healthcare facilities within the Bench Sheko Zone from January 1 to 30 February 2023 to assess the prevalence and determinants of hesitancy to COVID-19 vaccination among people living with human deficiency virus (PLHIV). Data were collected by using pre-tested interviewer administered questionnaires and document review, and entered into Epi-data version 3.1 then exported to and analyzed by using SPSS version 24. Statistical significance was assessed by using multivariable logistic regression analysis by determining odds ratios and 95% confidence interval. Multi-Collinearity and model fitness were also checked.

Results

According to the study, the prevalence of COVID-19 vaccine hesitancy was found to be 47.9%, [95% CI, 43.8-52.0]. One significant finding was that younger individuals (age ≤25years) [AOR = 2.30, 95%CI, 1.15-4.57] exhibited a higher level of hesitancy compared to their older counterparts. Additionally, the study identified monthly income≤3000 birr [AOR = 0.57, 95%CI, 0.31-0.92], urban residence [AOR = 0.61, 95%CI, 0.42-0.91], HIV stage one [AOR = 0.44, 95%CI, 0.27-0.73] and human immunodeficiency virus (HIV) clinical stage two of HIV [AOR = 0.60, 95CI, 0.39-0.93] as determinants of vaccine hesitancy.

Conclusion

According to our study finding in southwest Ethiopia, individuals living with HIV were found to have a higher level of hesitancy towards receiving the COVID-19 vaccine as compared with center for disease control and prevention estimate of vaccine hesitancy. The study also identified several factors that contribute to vaccine hesitancy, including age, urban of residence, income level, and HIV clinical stage. Addressing the identified factors in this specific population could decrease the hesitancy. To ensure the success of vaccination campaigns in the region, policymakers and stakeholders should take steps to address these underlying factors and promote greater acceptance of the COVID-19 vaccine among the population.

Pandemic fatigue, behavioral intention and predictors of COVID-19 vaccination among individuals living with HIV in Bench Sheko Zone, in Southern Ethiopia, application of TBP: a facility based cross sectional study

Introduction

People living with HIV often face inequalities and negative outcomes, which make them vulnerable. To protect this population and achieve herd immunity, it is crucial for COVID-19 vaccination efforts to prioritize and encourage vaccination among people living with HIV (PLWH). However, in Ethiopia, there is a lack of motivation in this regard. To tackle this issue, a study was conducted in the Bench Sheko Zone of Southwest Ethiopia. The study aimed to assess pandemic fatigue, behavioral intention to get vaccinated, and factors influencing COVID-19 vaccine acceptance among PLWH in that region.

Methods

A facility-based cross-sectional study was conducted among individuals living with HIV who were over 18 years old in Bench-Sheko Zone, located in Southwest Ethiopia. The study included a total of 590 participants from four ART healthcare facilities within the zone. The researchers utilized the Theory of Planned Behavior to examine the predictors of intention to use preconception care. Multiple linear regression analysis was employed to determine these predictors, with a p-value of less than 0.05 considered as indicative of a significant association. The final analysis of the study involved the use of linear regression analysis, and the measure of association was presented as the standardized B coefficient following a multivariable logistic regression analysis.

Result

In the conducted study, the response rate was an impressive 98%. The researchers aimed to investigate the behavioral intention toward the COVID-19 vaccine, which was found to be 55.7%. The average age of the participants in the study was 34.65 ± 6.67. The study was the assessment of pandemic fatigue, which had a mean value of 17.22 ± 5.28. During the multivariate linear regression analysis, four predictor variables were identified. Among these, three variables, namely subjective norm, pandemic fatigue, and age, positively influenced the behavioral intention toward the COVID-19 vaccine. Comprehending these factors can assist healthcare professionals and policymakers in formulating precise interventions and strategies aimed at enhancing the acceptance and adoption of vaccines.

Conclusion

The study indicates that individuals living with HIV have shown lower vaccine intention compared to previous research. The study identifies subjective norm, pandemic control measures, income, and age as predictors of individuals' intention to receive the COVID-19 vaccine.

Spatial variation and determinants of mother and newborn skin-to-skin contact care practices in Ethiopia: A spatial and multilevel mixed-effect analysis

BACKGROUND

Skin-to-skin contact care practice is placing a naked baby on the mother's chest with no cloth separating them, in a prone position covered by a cloth or blanket. It improves the survival of newborns by preventing hypothermia, improving breastfeeding, and strengthening mother-to-child bonding. Nevertheless, it remains under-practiced in many resource-constrained settings. Therefore, the main objective of this study is to explore the spatial variation and determinants of mother and newborn skin-to-skin contact care practices in Ethiopia.

METHOD

The study was done using the 2016 Ethiopian Demographic and Health Survey data. A weighted sample of 10417 mothers who gave live birth before the five-year survey was extracted for the analysis. Arc GIS version 10.3 and SaTscan version 10.0.2 were used for the spatial analysis. A multilevel mixed logistic regression model was fitted to identify factors associated with skin-to-skin contact care practices of mothers and newborns. Finally, a statistically significant association was declared at a P-value of < 0.05.

RESULT

In this study, skin-to-skin contact care practice of mothers and newborns was non-random across Ethiopia with Moran's I: 0.48, p < 0.001. The most likely significant primary and secondary clusters were found in Addis Ababa (RR = 2.39, LLR = 116.80, p <0.001) and Dire Dewa and Harari (RR = 2.02, LLR = 110.45, p <0.001), respectively. In this study, place of delivery (AOR = 12.29, 95%CI:10.41, 14.54), rich wealth index (AOR = 1.29, 95% CI: 1.05,1.59), medium wealth index (AOR = 1.38, 95% CI:1.17, 1.68), having 1-3 antenatal care visits(AOR = 1.86,95% CI: 1.56, 2.29), having ≥4 antenatal care visits (AOR = 1.93,95% CI: 1.56, 2.39), initiating breastfeeding within the first hour (AOR = 1.75,95% CI:1.49,2.05) and media exposure (AOR = 1.20,95%CI 1.02,1.41) were factors associated with skin to skin contact care practice of mothers and newborns.

CONCLUSION

This study concludes that the Skin-to-skin contact care practices of mother and newborn is not random in Ethiopia. Therefore, the implementation of essential newborn care packages should be regularly monitored and evaluated, particularly in the cold spot areas of skin-to-skin contact care practices. Besides, media advertising regarding the importance of Skin-to-skin contact care practices for mothers and newborns should be scaled up to increase the practices.

Dental caries and associated factors among preschool children in Southwest Ethiopia: a cross-sectional study

BACKGROUND

Dental caries is a global public health problem, especially for young children. This study aimed to assess the prevalence of dental caries and its associated factors among preschool children in Mizan Aman town, Southwest Ethiopia.

METHODS

A school-based cross-sectional study was conducted from 1 October to 1 December 2022. A total of 354 children and their parents participated using simple random sampling techniques. Data were collected through an oral clinical examination, interviewing the parents and measuring the anthropometry of the children.

RESULTS

The prevalence of dental caries was 36.4% (95% CI 31.2% to 41.8%). Night feeding (adjusted OR (AOR)=3.98, 95% CI 1.56 to 10.15), children who did not brush their teeth under parental supervision (AOR=2.98, 95% CI 1.60 to 5.57), body mass index (AOR=3.48, 95% CI 1.30 to 9.41) and history of dental visits (AOR=3.05, 95% CI 1.61 to 5.81) were significantly associated with dental caries.

CONCLUSION

The prevalence of dental caries in preschool children was found to be high. Children who did not brush their teeth under parental supervision, who had experience of night feeding, who had a high body mass index and who had a history of dental visits were at risk for dental caries. Prevention of those identified modifiable risk factors should be considered to reduce dental caries.

Mesenteroaxial gastric volvulus in a 12 Year female child: A rare case report

INTRODUCTION AND IMPORTANCE

Gastric volvulus is an abnormal rotation of all or part of the stomach around one of its axes. It is a rare clinical entity and a potentially life-threatening condition. Mesenteroaxial volvulus is a less commonly encountered variant of gastric volvulus. The objective of this study was to describe a rare case of Mesenteroaxial volvulus in a 12-year-old female child.

CASE PRESENTATION

A 12-year-old female child presented with a complaint of severe abdominal pain of two days duration associated with abdominal distention, failure to pass faeces and flatus, difficulty of breathing, and bloating. The vital sign was blood pressure of 90/60 mmHg, pulse rate of 130 beats per minute, respiratory rate of 29 breaths per minute, and temperature 37.8 degree Celsius. On abdominal examination, there was distension, hyperactive bowel sound, tenderness, and splenomegaly. Exploratory laparotomy was done and the intraoperative finding was gastric volvulus with Mesentroaxial type which was slightly ischemic with poor ligamentous attachment. Decompression with a Nasogastric tube (NGT) and gastropexy was done. The child was discharged on the 6th postoperative day.

CLINICAL DISCUSSION

Gastric volvulus is an abnormal rotation of the stomach on horizontal or vertical axes causing various degrees of obstruction. Mesenteroaxial volvulus is most commonly seen in young children and is associated with ligamentous laxity.

CONCLUSION

Gastric volvulus causes grave complications and death if not recognized early or surgical intervention is taken timely. Though it is a rare clinical entity, the primary physician should be aware of the clinical presentation.

Spatial distribution, and predictors of late initiation of first antenatal care visit in Ethiopia: Spatial and multilevel analysis

BACKGROUND

Despite the proven benefit of early initiation of first antenatal care visits as a means to achieve good maternal and neonatal health outcomes through early detection and prevention of risks during pregnancy, shreds of evidence showed that most of the women in Ethiopia start their ANC visits lately.

OBJECTIVE

To determine the spatial distribution and predictors of late initiation of first antenatal care visits among reproductive-age women in Ethiopia.

METHOD

The 2019 Ethiopian Mini Demographic and Health Survey (EMDHS) data were used. A total weighted sample of 2,935 reproductive-age women who gave birth in the five years preceding the survey and who had antenatal care visits for their last child was included. To check the nature of the distribution of late initiation of ANC visits, the global Moran's I statistics were applied. Gettis-OrdGi statistics and spatial interpolation using the Ordinary Kriging method were done to identify the spatial locations and to predict unknown locations of late initiation of first ANC visits, respectively. For the predictors, a multilevel mixed-effect logistic regression model was applied. Finally, statistical significance was declared at a p-value < 0.05.

RESULTS

The prevalence of late initiation of first ANC visits in Ethiopia was 62.6%. The spatial analysis showed that the late initiation of first ANC visits significantly varied across regions of Ethiopia. The spatial interpolation predicted the highest rates of late initiation of first ANC visits in the eastern SNNPRs, southern and western Oromia, and some parts of the Somalia region. Being rural residents, attending higher education, having medium wealth status, richer wealth status, richest wealth status, having ≥ 5 family size, a household headed by male, living in SNNPRs, and Oromia regions were significant predictors of late initiation of first ANC visits.

CONCLUSION

A clustered pattern of areas with high rates of late initiation of the first ANC visit was detected in Ethiopia. Public health intervention targeting the identified hotspot areas, and women's empowerment would decrease the late start of the first ANC visit. Furthermore, the identified predictors should be underscored when designing new policies and strategies.

Antenatal physical exercise level and its associated factors among pregnant women in Hawassa city, Sidama Region, Ethiopia

BACKGROUND

Antenatal physical exercise has roles in health maintenance, prevention, and treatment of disease for pregnant women and fetuses. Different organizations and medical institutions prescribe regular physical exercise during the antenatal period. Despite this, the pregnant populations are less active and decrease their exercise levels during pregnancy than in their non-pregnant state. Therefore, this study aimed to assess antenatal physical exercise level and its associated factors among pregnant women in Hawassa city, Sidama regional state, Ethiopia.

METHODS

Institutional based cross-sectional study design was employed, and 600 study participants were interviewed using a systematic sampling technique from 25th September/2021 to 25th November/2021. Data entry was made using Epi-Data software version 3.1 and exported to SPSS version 25 for analysis. A bivariate logistic regression assessed the association between each independent variable and the outcome variable. Explanatory variables with a p-value of less than 0.25 were a candidate for the multivariable logistic regression. Finally, variables with a p-value of less than 0.05 were declared as statistically significant and reported with their AOR and 95% CI.

RESULT

In this study, 25.5% of pregnant women had an adequate practice of antenatal physical exercise while 43.7% of pregnant women had an adequate level of knowledge on antenatal physical exercise An adequate practice of women's antenatal exercise is more likely to occur in women who are exposed to mass media (AOR: 2.43, 95% CI: 1.57, 3.78), Husband college and above educational level (AOR 1.57, 95% CI: 1.05, 6.12), having an adequate level of knowledge (AOR 2.12, 95% CI: 1.13, 3.37), and have of supporting facility (AOR: 2.29, 95% CI: 1.49, 3.51).

CONCLUSION

In this study, three fourth of the study participants had an inadequate level of practice in antenatal physical exercise than the global standard. It shall be beneficial if the city health administration works towards improving pregnant women's knowledge and practice level on physical exercise by providing information using different media outlets. Healthcare providers should broadcast antenatal physical exercise prescriptions in integration with health-related programs.

The bayesian approach of factors associated with preterm birth among mothers delivered at public hospitals in Southeast Ethiopia

Background

Preterm birth remains the commonest cause of neonatal mortality, and morbidity represents one of the principal targets of neonatal healthcare. Ethiopia is one of the countries which accounts for the highest burden of preterm birth. Therefore, this study aimed to assess factors associated with preterm birth at public hospitals in Sidama regional state.

Methods

A facility-based cross-sectional study was conducted at public hospitals in Southeast Ethiopia from 1 June to 1 September 2020. To recruit the study participants, systematic random sampling techniques were used. Data were collected using pretested structured interviewer-administered questionnaire and a checklist via chart review. Data were entered using EpiData version 3.1 and exported to R software version 4.0 for analysis. Then, factors associated with preterm birth among mothers were assessed based on the Bayesian statistical approach.

Results

The study showed that the prevalence of preterm birth was 20.6%. Being a rural resident (AOR = 2; 95% CrI: 1.2-3.5), having no antenatal care service utilization (AOR = 2.3; 95% CrI: 1.1-4.8), hypertensive disorder of pregnancy (AOR = 3.5; 95% CrI: 1.8-6.9), birth space less than 2 years (AOR = 3.4; 95% CrI: 1.5-7.9), having premature rupture of membrane (AOR = 2.4; 95% CrI: 1.3-5.4), and physical intimate violence (AOR = 2.876; 95%CI: 1.534, 5.393) were risk factors of preterm birth. Whereas, women who had primary, secondary, and higher education levels (AOR = 0.2; 95% CrI: 0.1-0.4, AOR = 0.1; 95% CrI: 0.06-0.3, and AOR = 0.2; 95% CrI: 0.1-0.4), respectively, were preventive factors.

Conclusion

Most of the risk factors of preterm birth were found to be modifiable. Community mobilization on physical violence during pregnancy and antenatal care follow-up are the ground for the prevention of preterm birth because attentive and critical antenatal care screening practices could early identify risk factors. In addition, information communication education about preterm birth prevention was recommended.

Respectful maternity care and associated factors among mothers who gave birth in three hospitals of Southwest Ethiopia: A cross-sectional study

Background

One of the primary barriers to reducing maternal morbidity and mortality is disrespect and abuse during childbirth in biomedical facilities. Despite the serious consequences of disrespect and abuse during childbirth, there is no evidence of the prevalence of respectful maternity care in Southwest Ethiopia. This study aimed to assess the prevalence of respectful maternity care and associated factors among mothers who gave birth in three hospitals in Southwest Ethiopia.

Methods

An institution-based cross-sectional study was conducted among 348 mothers who gave birth in three hospitals in Southwest Ethiopia. Bivariable and multivariable binary logistic regression were used to identify the factors of respectful maternity care.

Results

In this study, 348 mothers with their newborns were included, making a response rate of 100%. The overall prevalence of respectful maternity care was 81.2%. Maternal age [AOR = 2.54; 95% CI (1.01-6.43)]; maternal occupation [AOR = 5.23; 95% CI (1.15-23.72)]; antenatal care follows-up [AOR = 2.86; 95% CI (1.01-8.20)]; and discussions with the provider about the place of delivery during antenatal care follow up [AOR = 5.58; 95% CI: (2.12-14.70)] were found to be the most significant components of respectful maternity care.

Conclusion

The provision of respectful maternity care was high, but there are complaints of disrespect and abuse still present in three hospitals in Southwest Ethiopia. Maternal age, maternal occupation, antenatal follow up, and discussion with the provider about the place of delivery during antenatal follow-up were associated with respectful maternity care. Thus, improving antenatal care service utilization and discussions with health care providers about the place of delivery during antenatal care follow-up should be focused on.

Determinants of late-onset neonatal sepsis among neonates admitted to the neonatal intensive care unit of Arba-Minch general hospital, southern Ethiopia

INTRODUCTION

Neonatal sepsis can be either early (<7 Days) or late-onset ≥7days) neonatal sepsis depending on the day of the occurrence. Despite the decrement in early onset neonatal sepsis, there is still an increment in late-onset neonatal sepsis. Ethiopian demography and health survey report showed an increment in neonatal mortality in 2019/20.

OBJECTIVE

The objective of this study was to assess the determinants of late-onset neonatal sepsis among neonates admitted to the neonatal intensive care unit at Arba-Minch general hospital, southern Ethiopia.

METHODS

An institution based study was conducted from March 1, 2021, to June 30, 2021 in Arba-Minch general hospital. Cases were neonates diagnosed with late-onset neonatal sepsis with their index mother chart and controls were neonates admitted with other diagnoses at the same period. Cases and controls were selected consecutively. Data extraction tool and interview which was developed by reviewing different kinds of literature was used to collect data. Data were entered by using Epi data version 3.1software and transformed to Statistical Package for Social Sciences version 25 software for analysis. The binary logistic regression model was used to assess determinants and variables with a p-value <0.2 were transformed to multivariable logistic regression then, a p-value < 0.05 with 95% confidence interval were used to declare significant association with the outcome variable.

RESULT

A total of 180 subjects (60 cases and 120 controls) were included in this study. The mean age of neonates was 12.1 days with standard deviations of 4.3. Multivariable logistic regression analysis showed that; history of either sexually transmitted disease /urinary tract infection [AOR = 9.4; 95%CI(3.1-28.5)], being preterm (gestational age of <37 weeks) [AOR = 4.9; 95%CI (1.7-13.7)], use of endotracheal intubation/mechanical intubation [AOR = 8.3; 95%CI (1.8-26.4)]and either mixed types of infant feeding option or formula feeding before admission [AOR = 12.7; 95%CI(3.7-42.8)]were significantly associated with late-onset neonatal sepsis.

CONCLUSION AND RECOMMENDATIONS

This study revealed that antenatal, intrapartum and postpartum factors have shown an association with late-onset neonatal sepsis. It is recommended to strengthen counseling and advice to mothers with specific risk factors of late-onset neonatal sepsis.

The magnitude of oral rehydration salt utilization in diarrhea hot spot regions of Ethiopia and its associated factors among under-five children: A multilevel analysis based on Bayesian approach

Background

Diarrhea leads the children to severe dehydration or death as a result of the loss of water and electrolytes (namely, potassium, chloride, sodium, and bicarbonate). To compensate for the losses, ORS is given to children who experienced diarrhea.

Objective

To estimate the magnitude of ORS utilization in diarrhea hotspot regions of Ethiopia and to assess its associated factors among under-five children.

Methods

To conduct this study, we used the 2016 Ethiopian demographic and health survey data. A total of 1,079 weighted sample children were selected. Each sample was selected randomly. Then, to identify factors associated with ORS utilization in diarrhea hotspot regions of Ethiopia, a multilevel analysis based on the Bayesian approach was applied. Finally, the credible interval of AOR that does not include 1 was considered statistically significant.

Results

The magnitude of ORS utilization for children in diarrhea hotspot regions of Ethiopia was 28%. Being urban resident (AOR = 1.92; 95% CrI: 1.13-3.3), woman household head (AOR = 2.11; 95% CrI: 1.3-3.9), having higher educational level (AOR = 1.52; 95% CrI: 1.04-2.22), member of health insurance (AOR = 1.73; 95% CrI: 1.14-2.43), and being exposed for media (AOR = 1.43; 95% CrI: 1.18-2.5) increases ORS utilization for diarrhea management.

Conclusion

Residence, educational level, health insurance, and media exposure were the factors of ORS utilization. So, to increase the practice of ORS utilization for diarrhea management in Ethiopia, the Ministry of Health and the Government of Ethiopia should consider those factors when they design diarrhea prevention and control strategies.

Multilevel analysis of the predictors of completion of the continuum of maternity care in Ethiopia; using the recent 2019 Ethiopia mini demographic and health survey

Background

Despite the significant benefit of the continuum of care to avert maternal and neonatal mortality and morbidity, still the dropout from the continuum of care remains high and continued to become a challenge in Ethiopia. Therefore, this study aimed to assess the level of completion along the continuum of maternity care and its predictors among reproductive-age women in Ethiopia.

Methods

A secondary data analysis was done using the 2019 mini Ethiopian demographic health survey. A total weighted sample of 2,905 women aged 15–49 years who gave birth in the last five years preceding the survey and who had antenatal care visits was included. A multilevel mixed-effects logistic regression model was used to examine the predictors that affect the completion of the continuum of maternity care services. Finally, statistical significance was declared at a p-value < 0.05.

Results

In this study, the overall prevalence of completion along the continuum of maternity care was 12.9% (95%CI: 11.1 – 14.9%). Attending higher education (AOR = 2.03: 95%CI; 1.14 - 3.61), belonged to medium wealth status (AOR = 1.69: 95%CI; 1.07 - 2.66), belonged to rich wealth status (AOR = 2.05: 95%CI; 1.32, 3.17), and informed about danger signs during pregnancy (AOR = 2.23: 95%CI; 1.61, 3.10) were positively associated with the completion of the maternity continuum of care. However, late initiaton of first antenatal care visits (AOR = 0.66: 95%CI; 0.49, 0.89), being rural resident (AOR = 0.67: 95%CI; 0.42 - 0.93), lived in the Afar (AOR = 0.36: 95%CI; 0.12 – 0.83) and Gambella (AOR = 0.52: 95%CI; 0.19 – 0.95) regional states were negatively associated with the completion of the continuum of maternity care.

Conclusion

Despite most of the women using at least one of the maternity services, the level of completion along the continuum of care after antenatal care booking remains low in Ethiopia. Therefore, enhancing female education and economic transitions with special consideration given to rural, Afar, and Gambella regional state residents. Counseling towards the danger signs of pregnancy and its complications during antenatal care follow-upshould be strengthened. . Furthermore, the identified predictors should be considered when designing new policies or updating policies and strategies on maternity services uptake to step-up its full utilization, which in turn helps in the achievement of the sustainable development goals of ending preventable causes of maternal, neonatal, and child death by 2030.

Magnitude and determinants of unmet need for family planning among reproductive age women in East Africa: multilevel analysis of recent demographic and health survey data

Introduction

Unmet need for family planning is the main obstacle to achieve healthy timing and desired number of children. Decreasing the unmet need for FP respects and protects human right and help to decrease the influence on biodiversity. Unmet need for family planning is the contributor and devastating issue of maternal health. Therefore, meeting the unmet need of contraceptive averts the maternal death and poverty. Therefore, determining the magnitude and its determinants is very important to intervene and design appropriate program umbrella.

Objective

To determine the magnitude and its determinants of unmet need for family planning among reproductive age women in East Africa.

Method

This study was analyzed secondary data from Demographic and Health Surveys (DHS) of which contained detailed family planning for all interviewed women aged 15 to 49 years. The data were weighted using sampling weight before any statistical analysis to account the sampling design. STATA version 15 was used for extracting, editing, recoding, and multilevel analysis. Median odds ratio (MOR), proportional change in Variance (PCV), Intraclass correlation coefficient (ICC), and Akaike Information Criteria (AIC) was analyzed. Four model was build and the best model was selected based on the smallest Akaike Information Criteria (AIC). Both bivariable and multivariable multilevel analysis was done. Variable with p-value< 0.25 were selected for multivariable multilevel logistic regression analysis. Variables with p-value ≤5% declared as statistical significant with outcome variable.

Results

The magnitude of unmet need for family planning was 24.66% (95%CI: 24.1–25.2). The identified determinants of unmet need for family planning was 30–39 years (AOR = 0.7; 95% CI 0.54–0.91), age of 40–49 (AOR = 0.76; 95% CI 0.58–0.99), rural residence (AOR = 1.17; 95% CI 1.02–1.34), female household head (AOR = 0.66; 95% CI 0.61–0.73), women having 4–6 child (AOR = 1.76; 95% CI 1.55–1.99), women having 7–9 child (AOR = 2.77; 95% CI 2.34–3.28) women having ≥10 child (AOR = 3.51; 95% CI 2.58–4.78), women who give their first birth 19-25 years (AOR = 1.1; 95% CI 1.0–1.26), 26–34 years (AOR = 1.4; 95% CI 1.19–1.83) ≥35 years (AOR = 2.1; 95% CI 1.1–4.27) and no fertility desire (AOR = 1.52; 95% CI 1.36–1.67) were the determinants of unmet need for family planning in east Africa.

Conclusion

Unmet need in east Africa is high as compare to other previous study. Maternal age, residence, sex of household head, number of children, age at first birth and fertility desire were the determinants identified in this study. Therefore, health interventions that reduce unmet need which enhance family planning service delivery among rural, male-headed household, women having more than three children and women who had no fertility desire needed in advance. Policies and programs of unmet need should be tailored the rural, young and no fertility desire women as well as male headed households.