Global, regional, and national incidence of six major immune-mediated inflammatory diseases: findings from the global burden of disease study 2019

Background

The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019.

Methods

We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends.

Findings

In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of -0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = -0.41), inflammatory bowel disease (AAPC = -0.72), multiple sclerosis (AAPC = -0.26), psoriasis (AAPC = -0.77), and atopic dermatitis (AAPC = -0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR.

Interpretation

The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively.

Funding

The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. The project funded by Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2022QN38).

Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050.

METHODS

Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively.

FINDINGS

In 2021, there were 529 million (95% uncertainty interval [UI] 500-564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8-6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7-9·9]) and, at the regional level, in Oceania (12·3% [11·5-13·0]). Nationally, Qatar had the world's highest age-specific prevalence of diabetes, at 76·1% (73·1-79·5) in individuals aged 75-79 years. Total diabetes prevalence-especially among older adults-primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1-96·8) of diabetes cases and 95·4% (94·9-95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5-71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5-30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22-1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1-17·6) in north Africa and the Middle East and 11·3% (10·8-11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%.

INTERPRETATION

Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers.

FUNDING

Bill & Melinda Gates Foundation.

The association of lipid-lowering therapy and blood pressure control among outpatients with hypertension at the Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia

Background

The lipid-lowering medications known as statins have been shown in controlled clinical trials to have pleiotropic properties, such as lowering blood pressure, in addition to lowering cholesterol levels. The purpose of this study was to see if there was a possible link between blood pressure control and statin therapy in outpatients with hypertension in a real clinical setting.

Patients and methods

A retrospective comparative cohort study of 404 patients with hypertension was carried out. A systematic random sampling technique was used. For data entry, Epi-Data version 4.6 was used, and SPSS version 25 was used for further analysis. For group comparisons, chi-square and independent t-tests were computed. To determine the relationship between statin use and blood pressure control, a binary logistic regression model was employed. To declare statistical significance, a 95% confidence interval and a P-value of <0.05 were used.

Results

Half of the study participants who were using a prescribed statin were assigned to the statin group, whereas the remaining participants who do not take statins were assigned to the control group. After 3 months of statin treatment, BP control to <130/80 mmHg was significantly greater (P = 0.022) in the statin group (52.5%) than in the control group (41.0%). The use of statins raises the likelihood of having blood pressure under control by 1.58 times when compared to statin non-users. After controlling for possible confounders, statin therapy still increased the odds of having controlled BP by a factor of 5.98 [OR = 5.98; 95% CI: 2.77-12.92].

Conclusion

This study revealed that blood pressure control was higher among statin user hypertensive patients. Favorable effects of statin use were independently observed, even after correction for age, presence of dyslipidemia, and duration of antihypertensive therapy. Therefore, the importance of concomitantly added lipid-lowering drugs such as statins and their role in managing poor blood pressure control should be given due emphasis.

Joint Modeling of Incidence of Unfavorable Outcomes and Change in Viral Load Over Time Among Adult HIV/AIDS Patients on Second-Line Anti-Retroviral Therapy, in Selected Public Hospitals of Addis Ababa, Ethiopia

Background

In Ethiopia, second-line anti-retroviral therapy (ART) for HIV/AIDS patients was started some years ago; however, few studies have reported the unfavorable outcomes of second-line ART. Therefore, this study aimed to assess the incidence and predictors of unfavorable outcomes and their association with change in viral load among adult HIV/AIDS patients on second-line treatment at selected public hospitals in Addis Ababa, Ethiopia.

Methods

A retrospective follow-up study was conducted at selected public hospitals in Addis Ababa, Ethiopia, on 421 HIV/AIDS patients on second-line ART from 2016 to 2021. Cox proportional hazard models with a linear mixed effect model were jointly modeled using the JM package of R software with time-dependent lagged parameterizations, and a 95% confidence interval was used to select significant variables.

Results

Overall, 89 HIV/AIDS patients developed unfavorable outcomes. The incidence density was 7.48/100 person-years (95% CI: 6.08, 9.2). Secondary and tertiary educational level (AHR=0.47, 95% CI: 0.25, 0.89, and AHR=0.27, 95% CI: 0.1, 0.72), CD4 count less than 100 cells/mm³ (AHR=2.15, 95% CI: 1.21, 3.83), poor adherence (AHR=3.59, 95% CI: 1.73, 7.49), and TB comorbidity (AHR=2.23, 95% CI: 1.21, 4.14) at the start of second-line ART were significant predictors of incidence of unfavorable outcome. Time-dependent lagged value viral load was significantly associated with the risk of unfavorable outcome (AHR=1.28, 95% CI: 1.01, 1.63).

Conclusion

In the study area, the incidence of an unfavorable outcome of second-line ART was high. Secondary and tertiary educational level, CD4 count less than 100 cells/mm³, poor adherence, and TB comorbidity at the start of second-line ART were significant predictors of incidence of unfavorable outcomes. Thus, strengthening routine viral load measurement, increase patient adherence, intensive counseling, and strong TB screening are needed in the study setting.

Incidence and Predictors of Virological Failure Among Adult HIV/AIDS Patients on Second-Line Anti-Retroviral Therapy, in Selected Public Hospital of Addis Ababa, Ethiopia: Retrospective Follow-Up Study

Introduction

Objective

Methods

Results

Conclusion

Spatial Distribution and Determinant Factors of Handwashing Practice With Essential Agents Among Households in Ethiopia

Objectives: This study aimed to assess the spatial distribution and determinant factors of handwashing practice using essential handwashing agents (soap and water) among households in Ethiopia.

Methods: A two-stage stratified cluster sampling technique was used. Mixed-effect logistic regression analysis was also used to identify determinants of handwashing practice with essential agents.

Results: In Ethiopia, household handwashing practices with essential agents had spatial variation (Moran’s Index 0.62, p < 0.001). The Amhara and Somali regions were identified as significant hotspots with low handwashing practice using essential agents.

Conclusion: In Ethiopia, handwashing practice with essential agents showed spatial variation across the country with a very low rate. Areas with low handwashing practice with essential agents need high priority in the allocation of resources to ensure communities’ access to fixed and portable handwashing facilities, soap, and reliable water supplies. Households with low access to improved sanitation facilities, low wealth status, and low educational status should be targeted for the intervention.

Magnitude and determinants of intimate partner violence against women in East Africa: multilevel analysis of recent demographic and health survey

BACKGROUND

Violence against women is a significant public health problem, and human rights abuse, and is associated with multiple adverse physical, mental, sexual, and reproductive health effects. The current study aimed to determine the magnitude of intimate partner violence (IPV) and its determinant factors in East African countries.

METHODS

We utilized the most recent demographic and health survey data from 11 East African countries, which was comprised of a weighted sample of 55,501 ever-married women. A multilevel multivariable logistic regression analysis was applied. We used an adjusted odds ratio with a 95% CI and a p value ≤ 0.05 in the multilevel logistic model to declare significant factors associated with IPV.

RESULTS

The overall prevalence of all forms of IPV in East African countries was 32.66% [95% CI 32.27, 33.05], with the highest IPV occurring in Uganda (14.93%) and the lowest IPV recorded in Comoros (0.87%). In the multivariable multilevel logistic regression model, women's education, residence, sex of household head, current pregnancy, husband drinking alcohol, attitude towards wife-beating husband controlling behavior, and women's decision-making autonomy were significantly associated with IPV.

CONCLUSION

The risk factors noted above increase the likelihood of a woman experiencing IPV. Therefore, we recommend establishing effective health and legal response services for IPV, raising awareness of the existing legislation service and improving its application, strengthening legislations on purchasing and selling of alcohol, strengthening joint (both husband and wife) decision-making power by empowering women, improving the educational level of women, and establishing measures to break the culture of societal tolerance towards IPV.

Spatial Distribution and Factors Associated With Risky Health Behavior Among Adult Males Aged 15-59 Years in Ethiopia: Generalized Structural Equation Modeling

Background

Alcohol drinking and tobacco smoking are the largest preventable causes of death and important risk factors for a number of non-communicable diseases and cause premature death and many socioeconomic consequences. Therefore, the present study is aimed to assess the spatial distribution of risky health behavior and its associated factors among adult males in Ethiopia.

Methods

All men (12,688) within the age range of 15-59 years were included in the final analysis. The distribution of risky health behavior across the country was observed by using ArcGIS software. In SaTScan software, the Bernoulli model was fitted by Kulldorff methods to identify the purely spatial clusters of risky health behavior. Generalized Structural Equation Model (GSEM) was used to determine factors associated with risky health behavior (regular alcohol drinking and tobacco smoking).

Results

Risky health behavior had spatial variation across the country. The primary clusters were located in Tigray, Amhara, and north-eastern Benishangul national regional states. Spatial scan statistics identified 118 primary clusters [Log-Likelihood ratio (LLR) = 524.8, p < 0.001]. Residence, frequency of listening to a radio, occupation, and frequency of watching television were significantly associated with drinking alcohol, whereas wealth index was associated with tobacco smoking. Age, region, educational status, marital status, and religion had association with both domains of risky health behavior.

Conclusion

Risky health behavior had spatial variation across the country. Bans on advertising and promotion of alcohol and tobacco on national press media should be strengthened. Aggressive health education efforts should be directed toward this high-risk population (Tigray, Amhara, and north-eastern Benishangul regional states). Improving risky health behavior is an important approach to reducing health disparities and promoting a more cost-effective utilization of scarce resources in the public health sector.

Spatial distribution and determinant factors of intimate partner violence among reproductive age group women in Ethiopia: Using generalized structural equation modeling

Introduction

Intimate Partner Violence (IPV) is the most serious and pervasive yet under-recognized human rights violation in the world, particularly in Ethiopia. Hence, the objective of this study was to find the spatial distribution of IPV and its determinant factors in Ethiopia.

Methods

Secondary data analysis was conducted among 2,687 reproductive age group women (15–49 years). The distribution of IPV across the country was observed by ArcGIS software. In SaTScan software, the Bernoulli model was fitted by Kulldorff methods to identify the purely spatial clusters of IPV. Besides, Generalized Structural Equation Model (GSEM) was used to determine factors associated with each domain of IPV (physical, emotional & sexual violence).

Result

The spatial distribution of IPV was found to be clustered in Ethiopia with Global Moran’s I 0.09 (p < 0.001), and the highest IPV cluster was observed in Oromia (p < 0.001), Somali (p < 0.001) and SNNP (p<0.001) regions. Watching television and not having attitudes toward wife beating were negatively associated with physical violence. Being rich and nonsmoker were inversely associated with emotional violence. The odds of experiencing sexual violence were high among pregnant women and wives of uneducated husbands/partners. In addition, women’s decision-making autonomy and husband/partner drinking alcohol have positive and negative associations with all domains of IPV respectively.

Conclusion

There was a significant clustering of IPV in Ethiopia and the highest IPV cluster was observed in Oromia, Somali and SNNP regions. Being rich, watching television, not having attitudes toward wife beating, women’s decision-making autonomy, and husband’s/partner’s high education and non-alcohol drinker status were negatively associated with IPV. The likelihood of experiencing IPV was also high among smokers and pregnant women. Thus, we recommend that improving the economic status of the household through social protection and empowerment of women in decision-making autonomy by education and employment and increasing community awareness about the consequences of IPV with particular emphasis on Oromia, Somali and SNNP regions is essential.

Diabetes mortality and trends before 25 years of age: an analysis of the Global Burden of Disease Study 2019

BACKGROUND

Diabetes, particularly type 1 diabetes, at younger ages can be a largely preventable cause of death with the correct health care and services. We aimed to evaluate diabetes mortality and trends at ages younger than 25 years globally using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.

METHODS

We used estimates of GBD 2019 to calculate international diabetes mortality at ages younger than 25 years in 1990 and 2019. Data sources for causes of death were obtained from vital registration systems, verbal autopsies, and other surveillance systems for 1990-2019. We estimated death rates for each location using the GBD Cause of Death Ensemble model. We analysed the association of age-standardised death rates per 100 000 population with the Socio-demographic Index (SDI) and a measure of universal health coverage (UHC) and described the variability within SDI quintiles. We present estimates with their 95% uncertainty intervals.

FINDINGS

In 2019, 16 300 (95% uncertainty interval 14 200 to 18 900) global deaths due to diabetes (type 1 and 2 combined) occurred in people younger than 25 years and 73·7% (68·3 to 77·4) were classified as due to type 1 diabetes. The age-standardised death rate was 0·50 (0·44 to 0·58) per 100 000 population, and 15 900 (97·5%) of these deaths occurred in low to high-middle SDI countries. The rate was 0·13 (0·12 to 0·14) per 100 000 population in the high SDI quintile, 0·60 (0·51 to 0·70) per 100 000 population in the low-middle SDI quintile, and 0·71 (0·60 to 0·86) per 100 000 population in the low SDI quintile. Within SDI quintiles, we observed large variability in rates across countries, in part explained by the extent of UHC (r2=0·62). From 1990 to 2019, age-standardised death rates decreased globally by 17·0% (-28·4 to -2·9) for all diabetes, and by 21·0% (-33·0 to -5·9) when considering only type 1 diabetes. However, the low SDI quintile had the lowest decline for both all diabetes (-13·6% [-28·4 to 3·4]) and for type 1 diabetes (-13·6% [-29·3 to 8·9]).

INTERPRETATION

Decreasing diabetes mortality at ages younger than 25 years remains an important challenge, especially in low and low-middle SDI countries. Inadequate diagnosis and treatment of diabetes is likely to be major contributor to these early deaths, highlighting the urgent need to provide better access to insulin and basic diabetes education and care. This mortality metric, derived from readily available and frequently updated GBD data, can help to monitor preventable diabetes-related deaths over time globally, aligned with the UN's Sustainable Development Targets, and serve as an indicator of the adequacy of basic diabetes care for type 1 and type 2 diabetes across nations.

FUNDING

Bill & Melinda Gates Foundation.

Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019

IMPORTANCE

The Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) provided systematic estimates of incidence, morbidity, and mortality to inform local and international efforts toward reducing cancer burden.

OBJECTIVE

To estimate cancer burden and trends globally for 204 countries and territories and by Sociodemographic Index (SDI) quintiles from 2010 to 2019.

EVIDENCE REVIEW

The GBD 2019 estimation methods were used to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 2019 and over the past decade. Estimates are also provided by quintiles of the SDI, a composite measure of educational attainment, income per capita, and total fertility rate for those younger than 25 years. Estimates include 95% uncertainty intervals (UIs).

FINDINGS

In 2019, there were an estimated 23.6 million (95% UI, 22.2-24.9 million) new cancer cases (17.2 million when excluding nonmelanoma skin cancer) and 10.0 million (95% UI, 9.36-10.6 million) cancer deaths globally, with an estimated 250 million (235-264 million) DALYs due to cancer. Since 2010, these represented a 26.3% (95% UI, 20.3%-32.3%) increase in new cases, a 20.9% (95% UI, 14.2%-27.6%) increase in deaths, and a 16.0% (95% UI, 9.3%-22.8%) increase in DALYs. Among 22 groups of diseases and injuries in the GBD 2019 study, cancer was second only to cardiovascular diseases for the number of deaths, years of life lost, and DALYs globally in 2019. Cancer burden differed across SDI quintiles. The proportion of years lived with disability that contributed to DALYs increased with SDI, ranging from 1.4% (1.1%-1.8%) in the low SDI quintile to 5.7% (4.2%-7.1%) in the high SDI quintile. While the high SDI quintile had the highest number of new cases in 2019, the middle SDI quintile had the highest number of cancer deaths and DALYs. From 2010 to 2019, the largest percentage increase in the numbers of cases and deaths occurred in the low and low-middle SDI quintiles.

CONCLUSIONS AND RELEVANCE

The results of this systematic analysis suggest that the global burden of cancer is substantial and growing, with burden differing by SDI. These results provide comprehensive and comparable estimates that can potentially inform efforts toward equitable cancer control around the world.

Joint modeling of time to diabetic retinopathy and change in fasting blood sugar among type 2 diabetic patients, Northwest Ethiopia

This study aimed to assess changes in fasting blood sugar (FBS) levels, time to diabetic retinopathy (DR) and its predictors among type 2 diabetes patients in Ethiopia. An institution-based retrospective follow-up study was conducted at the University of Gondar Comprehensive Specialized Hospital. The linear mixed effect model and Cox proportional hazard models were fitted separately, and later, the two models were fitted jointly using R software. Variables with a p value < 0.05 were considered significant predictors in the adjusted analysis. The incidence rate of DR was 2 per 100-person year of observation with a median follow-up time of 90.8 months (IQR 63.4). The current value and rate of change in FBS level were significant predictors of time to DR (AHR = 1.35; 95% CI 1.12-1.63) and (AHR = 1.70; 95% CI 1.21-2.39), respectively. Hypertension (AHR = 2.49; 95% CI 1.32-4.66), taking > 1 antidiabetic oral agent (AHR = 4.90; 95% CI 1.07-20.0) and more than 10 years duration (AHR = 0.17, 95% CI 0.06-0.46) were predictors of time to DR. This study revealed that the current value of FBS and the rate of FBS change were significantly associated with the time to DR.

Determinants of Postnatal Care and Timing of the First Postnatal Care for Newborns in Ethiopia: Further Analysis of 2019 Ethiopian Demographic and Health Survey

BACKGROUND

Neonatal mortality remains a persisting public health challenge in Ethiopia. Most of the factors that lead to neonatal deaths could be prevented through postnatal checkups. However, in Ethiopia, the provision of postnatal care (PNC) continues to be low. This study aims to assess the socioeconomic and demographic factors associated with PNC visits and the timing of PNC among newborns in Ethiopia.

METHODS

Using the Ethiopia Mini Demographic and Health Survey (EMDHS) 2019, a total weighted sample of 2,105 women aged 15-49 giving birth in the 2 years preceding the survey were included in the study. The generalized linear mixed models were separately fitted to identify factors associated with any PNC for newborns delivered at home and health facilities. Multinomial logistic regression was used to assess the timing of PNC with their associated factors.

RESULTS

Overall, only 13% (95% CI: 11.2, 14.0) of the newborns received PNC in Ethiopia. Among newborns delivered at home, utilization of any PNC was determined by region, maternal educational status, and birth order. On the other hand, among newborns delivered in a health facility, region, number of antenatal care (ANC) visits, and religion were determinants of any PNC. Furthermore, utilization of the first PNC within 48 h after the delivery was determined by region and religion. On the other hand, utilization of the first PNC after 48 h after the delivery was determined by region number of ANC visits, maternal educational status, and religion.

CONCLUSION

The finding of the current study revealed low coverage of PNC among newborns regardless of the place of delivery in Ethiopia. The study makes the following recommendation: increase community health education on PNC, encourage delivery at health facilities, and link community home birth with PNC. It will be more valuable if there is sharing good practice.

Spatial distribution, prevalence, and determinants of unintended pregnancy among youth (15-24) in Ethiopia: Further analysis of Ethiopia Demographic and Health Survey

Objectives:

This study aimed to determine the spatial distribution, prevalence, and determinant factors of unintended pregnancy among youth in Ethiopia.

Methods:

Using the Ethiopian Demographic and Health Survey 2016, a total of 2446 pregnant women aged 15–24 in the last 5 years, including current pregnancy, were included in the study. The unintended pregnancy data were spatially visualized using coordinates for each respondent in the survey using ArcGIS 10.3. The Bernoulli model was used to identify the presence of purely spatial unintended pregnancy cluster using SaTScan software. Logistic regression analysis was fitted to determine factors associated with unintended pregnancy among youth.

Results:

Unintended pregnancy among youth had spatial variation across the country. Among youth, 20.5% (confidence interval: (19.0, 22.2)) of pregnancies were estimated to be unintended. Spatial scan statistics identified 72 primary clusters (log-likelihood ratio of 37.6, at p < 0.001) which were located in Addis Ababa, southern part of Amhara, northwest of Oromia and northeast of Southern Nations, Nationalities and Peoples Region. Age, region, marital status, occupation, sex of household head, and number of household members were the determinant factors of unintended pregnancy among youth in Ethiopia.

Conclusion:

The distribution of unintended pregnancy among youth in Ethiopia was nonrandom. Unintended pregnancy prevention strategies among youth need to be targeted on the identified factors. Hence, we recommend creating awareness on sexual and reproductive health rights with special priority to the identified hotspot areas (Amhara, Addis Ababa, Gambella, Northern part of Southern Nations, Nationalities and Peoples Region, and northwest of Oromia region) to reduce unintended pregnancy.

Time to diabetic neuropathy and its predictors among newly diagnosed type 2 diabetes mellitus patients in Northwest Ethiopia

Introduction

Despite the high number of patients suffering from the negative impact of diabetic neuropathy (DN) in Ethiopia, evidence regarding the time to DN and its predictors are not well document in Ethiopia. Therefore, the current study aimed to determine time to DN and its predictors among newly diagnosed type 2 diabetes patients (T2DM) in North West Ethiopia.

Methods

Institutional based retrospective cohort study was conducted among 463 T2DM. Cox proportional hazard model was fitted to identify predictors of time to DN. The adjusted hazard ratio (AHR) with its 95% confidence interval was used to declare the presence and strength of association.

Results

From a total 463 study participants, 77 (16.63%), (95% CI 13.23%, 20.03%) had developed diabetic neuropathy. The median time to develop DN was 233.77 months. About 40 (51.95%) diabetic neuropathy cases occurred within 6 years of diagnosis of diabetic mellitus. The incidence density was 2.01/100 PY with 95% CI of [1.60, 2.53]. In the multivariable Cox proportional hazard analysis; being aged 65–69 [AHR = 2.78; 95% CI 1.20, 6.46], living with diabetes for less than 4 years [AHR = 3.77; 95% CI 1.82, 7.76], having anaemia [AHR = 3.82; 95% CI 1.66, 8.82] and having other complications [AHR = 1.68; 95% CI 1.03, 2.76 were significant predictors of DN.

Conclusion

More than half of diabetic neuropathy cases occurred within a short period of diagnosed with T2DM. Significant predictors for the time to DN were age, duration, having anaemia and other DM complication. Therefore, we recommend that early screening for DM and its complication for risky groups. While doing that due consideration should be assumed for old and anemic patients.

Spatial distribution and determinants of iron supplementation among pregnant women in Ethiopia: a spatial and multilevel analysis

BACKGROUND

Maternal anemia continues as a global public health concern particularly in developing countries including Ethiopia. It is associated with an increased risk of maternal death, obstetric complications, preterm birth, and low birth weight. Even though maternal anemia is the commonest problem in Ethiopia, there is limited evidence on the spatial distribution and determinants of iron supplementation. Therefore, this study aimed to investigate the spatial distribution and determinants of iron supplementation among pregnant women in Ethiopia.

METHOD

A secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 7589 women was included for analysis. For the spatial analysis; ArcGIS version 10.6, and SaT Scan version 9.6 statistical software were employed to explore the spatial distribution, and to identify significant hotspot areas of iron supplementation in Ethiopia. For the determinant factors, multilevel logistic regression analysis was fitted to identify significant individual and community level determinants of iron supplementation. Deviance, Median Odds Ratio (MOR), and Intra-class Correlation Coefficient (ICC) were used for model comparison and for assessing model fitness. Variables with a p-value of less than 0.2 in the bivariable analysis were considered in the multivariable multilevel analysis. In the multivariable multilevel analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was used to declare significant determinants of iron supplementation.

RESULTS

The spatial distribution of iron supplementation was significantly varied across the country with Global Moran's index value of 0.3 (p < 0.001). The SaTScan analysis identified a total of 271 significant clusters, of these 89 clusters were primary clusters located in the Southwest Somali and Central Oromia regions (LLR = 66.69, P < 0.001, RR = 1.35). ANC visit (AOR = 3.66, 95%CI: 3.21, 417), community education [AOR = 1.31, 95%CI, 1.07, 1.59), media exposure (AOR = 1.33, 95%CI: 1.15, 1.53), distance to health facility (AOR = 1.32, 95%CI: 1.16, 1.50), region and household wealth index were statistically significant determinant factors of iron supplementation.

CONCLUSION

Iron supplementation among pregnant women were significantly varied across the country. Therefore, the finding of this study could help to design effective public health interventions targeting areas with low iron supplementation and maternal health services should be delivered in all areas of our country. Besides, public health programs should enhance iron supplementation through promoting ANC visits, media exposure, and giving special emphasis to marginalized and remote areas.

Health Insurance Coverage and Its Associated Factors Among Reproductive-Age Women in East Africa: A Multilevel Mixed-Effects Generalized Linear Model

Background

Despite improvement in access to modern healthcare services in East African countries, health-service delivery and health status of the population remained poor mainly due to the weak health-sector financing system. Therefore, the current study aimed to assess the health insurance coverage and its associated factors among reproductive-age group (RAG) women in East Africa.

Methods

The most recent (between 2010 and 2018) Demographic and Health Surveys (DHS) data of the ten East African countries (Burundi, Comoros, Ethiopia, Kenya, Malawi, Mozambique, Tanzania, Uganda, Zambia, and Zimbabwe) were included. STATA version 16.0 statistical software was used for data processing and analysis. In the multilevel mixed-effects generalized linear model, variables with a p-value ≤0.05 were declared as significant associated factors of health insurance coverage.

Results

The overall health insurance coverage in East Africa was 7.56% (95% CI: 7.42%, 7.77%). The odds of health insurance coverage were high among educated, currently working, and rich RAG women whereas it was low among rural residents. Besides, RAG women who have media exposure, visited by field workers, and visited health facilities have a higher chance of health insurance coverage.

Conclusion

Health insurance coverage in East Africa among RAG women was below ten percent. Educational status, working status, place of residence, wealth index, media exposure, visiting health facility within 12 months and being visited by field worker were significantly associated with health insurance coverage among RAG women in East Africa. Improving women’s access to health facilities, promoting field workers’ visit, and media exposure targeting uneducated, unemployed, and rural resident women of RAG will be a gateway to promote health insurance coverage.

Spatial distribution of traditional male circumcision and associated factors in Ethiopia; using multilevel generalized linear mixed effects model

Background

Traditional male circumcision (TMC) is primarily associated with a religious or cultural purpose and may lead to complications. To reduce risks of complication and long-term disabilities that may happen from circumcisions that are undertaken in non-clinical settings, information concerning TMC is very important. Therefore, this study is aimed at identifying spatial distribution of TMC and the factors associated with TMC in Ethiopia.

Methods

A secondary data analysis was conducted among 11,209 circumcised males using data from 2016 Ethiopian Demographic and Health Survey (EDHS). Global Moran’s I statistic was observed to check whether there was a significant clustering of TMC. Primary and secondary clusters of TMC were identified by fitting Bernoulli model in Kulldorff’s SaTScan software. Multilevel Generalized Linear Mixed effects Model (GLMM) was fitted to identify factors associated with TMC.

Result

The spatial distribution of TMC was nonrandom across the country with Global Moran’s I = 0.27 (p-value < 0.0001). The primary clusters of TMC were identified in the southern part of Oromia and Tigray, northern part of SNNPR, Amhara, Gambella and Benishangul regions. Current age, age at circumcision, ethnicity, religion, place of residence, wealth index, media exposure, sex of household head and age of household head were factors associated with TMC in Ethiopia.

Conclusions

The spatial distribution of TMC was varied across the country. This variation might be due to the diversity of culture, ethnicity and religion across the regions. Thus, there is a need to rearrange the regulations on standards of TMC practice, conduct training to familiarize operation technique and general hygiene procedures, and launch cross-referral systems between traditional circumcisers and health workers. While undertaking these public health interventions, due attention should be given to the identified clusters and significant factors.

Spatial distribution and determinant factors of anemia among adults aged 15-59 in Ethiopia; using mixed-effects ordinal logistic regression model

BACKGROUND

Anemia is a global public health problem, particularly in developing countries. Assessing the geographic distributions and determinant factors is a key and crucial step in designing targeted prevention and intervention programmes to address anemia. Thus, the current study is aimed to assess the spatial distribution and determinant factors of anemia in Ethiopia among adults aged 15-59.

METHODS

A secondary data analysis was done based on 2016 Ethiopian Demographic and Health Surveys (EDHS). Total weighted samples of 29,140 adults were included. Data processing and analysis were performed using STATA 14; ArcGIS 10.1 and SaTScan 9.6 software. Spatial autocorrelation was checked using Global Moran's index (Moran's I). Hotspot analysis was made using Gettis-OrdGi*statistics. Additionally, spatial scan statistics were applied to identify significant primary and secondary cluster of anemia. Mixed effect ordinal logistics were fitted to determine factors associated with the level of anemia.

RESULT

The spatial distribution of anemia in Ethiopia among adults age 15-59 was found to be clustered (Global Moran's I = 0.81, p value <  0.0001). In the multivariable mixed-effectordinal regression analysis; Females [AOR = 1.53; 95% CI: 1.42, 1.66], Never married [AOR = 0.86; 95% CI: 0.77, 0.96], highly educated [AOR = 0.71; 95% CI: 0.60, 0.84], rural residents [AOR = 1.53; 95% CI: 1.23, 1.81], rich wealth status [AOR = 0.77; 95% CI: 0.69, 0.86] and underweight [AOR = 1.15; 1.06, 1.24] were significant predictors of anemia among adults.

CONCLUSIONS

A significant clustering of anemia among adults aged 15-59 were found in Ethiopia and the significant hotspot areas with high cluster anemia were identified in Somalia, Afar, Gambella, Dire Dewa and Harari regions. Besides, sex, marital status, educational level, place of residence, region, wealth index and BMI were significant predictors of anemia. Therefore, effective public health intervention and nutritional education should be designed for the identified hotspot areas and risk groups in order to decrease the incidence of anemia.

Prevalence of erectile dysfunction and its associated factors among patients with diabetes in Ethiopia: a systematic review and meta-analysis

OBJECTIVES

We aimed to estimate the pooled prevalence of erectile dysfunction (ED) among patients with diabetes mellitus (DM) in Ethiopia and to identify its associated factors.

METHODS

We performed a systematic search of scientific databases (PubMed, ScienceDirect); the grey literature was also searched (Google, Google Scholar). Data were extracted from primary studies using a data extraction format and exported for statistical analysis. I2 tests were used to assess the heterogeneity of studies. Owing to heterogeneity among the included studies, we used a random-effects model to determine pooled estimates of ED. Publication bias was assessed using Egger's and Begg's tests.

RESULTS

The pooled prevalence of ED among patients with DM in Ethiopia was 54.3% (95% confidence interval [CI]: 28.2-80.5). Older age (OR: 4.42, 95% CI: 2.83-6.00) and duration of DM (OR: 3.2, 95% CI: 1.74-4.66) had statistically significant associations with ED.

CONCLUSION

One in two individuals with DM in Ethiopia also had ED. This finding highlights the need to integrate assessment and management of ED into routine medical care in diabetes follow-up visits. Special attention is recommended for patients with older age and a longer duration of DM.

Exploring spatial variations and factors associated with skilled birth attendant delivery in Ethiopia: geographically weighted regression and multilevel analysis

BACKGROUND

Skilled birth attendant (SBA) delivery is vital for the health of mothers and newborns, as most maternal and newborn deaths occur at the time of childbirth or immediately after birth. This problem becomes worsen in Ethiopia in which only 28% of women give birth with the help of SBA. Therefore, this study aimed to explore the spatial variations of SBA delivery and its associated factors in Ethiopia.

METHODS

A secondary analysis was carried out using the 2016 Ethiopian Demographic and Health Survey. A total weighted sample of 11,023 women who had a live birth in the 5 years preceding the survey was included in the analysis. Arc-GIS software was used to explore the spatial distribution of SBA and a Bernoulli model was fitted using SaTScan software to identify significant clusters of non-SBA delivery. The Geographic Weighted Regression (GWR) was employed in modeling spatial relationships. Moreover, a multilevel binary logistic regression model was fitted to identify factors associated with SBA delivery.

RESULTS

In this study, SBA delivery had spatial variations across the country. The SaTScan spatial analysis identified the primary clusters' spatial window in southeastern Oromia and almost the entire Somalia. The GWR analysis identified different predictors of non- SBA delivery across regions of Ethiopia. In the multilevel analysis, mothers having primary and above educational status, health insurance coverage, and mothers from households with higher wealth status had higher odds of SBA delivery. Being multi and grand multiparous, perception of distance from the health facility as big problem, rural residence, women residing in communities with medium and higher poverty level, and women residing in communities with higher childcare burden had lower odds of SBA delivery.

CONCLUSION

Skilled birth attendant delivery had spatial variations across the country. Areas with non-skilled birth attendant delivery and mothers who had no formal education, not health insured, mothers from poor households and communities, Primiparous women, mothers from remote areas, and mothers from communities with higher childcare burden could get special attention in terms of allocation of resources including skilled human power, and improved access to health facilities.

Spatial Distribution and Determinants of Early Marriage among Married Women in Ethiopia: A spatial and Multilevel Analysis

BACKGROUND

Early marriage is a global public health problem that is mainly practiced in South Asia, Latin America, and sub-Saharan Africa including Ethiopia. It raises the risk of early childbearing of women, higher rates of divorce, and an increased risk of maternal and child death. However, little is known about the spatial distribution and determinants of early marriage in Ethiopia. Therefore, this study aimed to assess the spatial distribution and determinants of early marriage among ever-married women in Ethiopia.

METHODS

A detailed analysis of the 2016 Ethiopian Demographic and Health Survey data was conducted. A total weighted sample of 11,646 reproductive-age married women were included in the analysis. To identify significant hotspot areas of early marriage the Bernoulli model was fitted using SaTScan version 9.6 software. Additionally, to explore the spatial distributions of early marriage across the country ArcGIS version 10.1 statistical software was used. For the determinant factors, the multilevel logistic regression model was fitted. Deviance was used for model comparison and checking of model fitness. In the multivariable multilevel analysis, Adjusted Odds Ratio (AOR) with 95% CI was used to declare significant determinants of early marriage.

RESULTS

The finding of this study revealed that the spatial distribution of early marriage was significantly varied across the country with Global Moran's I = 0.719 and p value < 0.001. The primary clusters were detected in Tigray, Amhara, and Afar regions. Both individual and community-level factors were associated with early marriage. Having no formal education (AOR = 4.25, 95% CI 3.13-5.66), primary education (AOR = 3.37, 95% CI 2.80-4.92), secondary education (AOR = 1.75, 95% CI 1.32-2.33), and a decision made by parents (AOR = 1.88, 95% CI 1.68-2.09) were individual-level factors associated with higher odds of early marriage. Among the community-level factors, the region was significantly associated with early marriage. Thus, living in Afar (AOR = 1.82, 95%CI 1.37-2.42), Amhara (AOR = 1.77, 95% CI 1.38-2.77), and Gambela (AOR = 1.44, 95% CI 1.09-190) was associated with higher odds of early marriage. Whereas, living in Addis Ababa (AOR = 0.50, 95% CI 0.36-0.68) was associated with a lower chance of early marriage.

CONCLUSION

The spatial distribution of early marriage was significantly varied in Ethiopia. Women's education, women's autonomy, and region were found to be the significant determinants of early marriage. Therefore, public health interventions targeting those identified significant hotspot areas of early marriage are crucial to reduce the incidence of early marriage and its consequence. In addition, enhancing women's education and empowering them to make their own choices are vital for changing the customs of the community and eliminating early marriage in Ethiopia.

Predictors of Change in Weight Among People Living with HIV on Antiretroviral Treatment in West Hararghe Zone, Ethiopia: A Retrospective Longitudinal Study

Background

Human immunodeficiency virus (HIV) remains a major global public health issue, particularly in Africa. In resource-limited settings like Ethiopia, regular weight measurement and monitoring is useful in the examination of patient response to antiretroviral therapy and in clinical decision-making. However, there is a paucity of evidence on factors that affect longitudinal weight change. Therefore, the present study was intended to identify predictors of weight change among people living with HIV (PLWH) in West Hararghe, Ethiopia.

Methods

An institutional-based retrospective cohort study was conducted among 558 PLWH aged 18 years and above from September 2013 to January 2019 at Chiro Zonal Hospital and Gelemso General Hospital in West Hararghe zone, Ethiopia. Data were entered in Epi info 7 and analyzed in R software. The linear mixed effect regression model was used to identify predictors of longitudinal change in weight. Regression coefficients with their 95% confidence intervals were used to indicate the strength and significance of the association.

Results

Weight showed improvement in follow-up periods. In this study, age of respondent (beta=0.136, 95% CI, 0.044:0.227), time since the initiation of antiretroviral therapy (ART) (beta=0.089, 95% CI, 0.075:0.104), primary educational status (beta=2.403, 95% CI, 0.540:4.266), secondary educational status (beta=4.035, 95% CI, 1.666:6.404), tertiary and above educational status (beta=3.444, 95% CI, 0.330:6.558), sex (beta= −5.514, 95% CI, -7.260:-3.768), ambulatory functional status (beta= −3.419, 95% CI, −6.169:-0.668) and baseline CD4 count (≤200) (beta=2.205, 95% CI, 0.593, 3.817) were significant predictors of longitudinal weight change.

Conclusion

We observed an increment in weight among PLWH who were on ART in Ethiopia. Educational status, time since the beginning of ART, age and having CD4 count above 200 have contributed positively to the change in weight, while ambulatory functional status and being female are negatively associated with longitudinal change in weight. Close monitoring is recommended for patients with ambulatory baseline functional status and for patients with baseline CD4 count ≤200.

Spatiotemporal patterns of anemia among lactating mothers in Ethiopia using data from Ethiopian Demographic and Health Surveys (2005, 2011 and 2016)

INTRODUCTION

Maternal anemia is a worldwide public health problem especially in developing countries including Ethiopia. The burden of anemia among lactating mothers in Ethiopia was higher than those who were neither pregnant nor breastfeeding. To date, there is limited evidence on spatiotemporal patterns of anemia among lactating mothers in the country. Exploring the spatial patterns of maternal anemia is vital to design and monitor effective intervention programs. Therefore this study aimed to explore spatiotemporal patterns of anemia among lactating mothers in Ethiopia over the past one and half-decades.

METHODS

A total of 11,989 lactating mothers were included from the three consecutive Ethiopian Demographic and Health Surveys(2005, 2011, and 2016). The trend of anemia over the three surveys was showed. Furthermore, spatial autocorrelation analysis, cluster and outlier analysis, hotspot analysis, spatial interpolation, and spatial scan statistics were carried out to identify geographically risk areas of anemia among lactating mothers in Ethiopia. Finally, the most anemia risk areas were detected consistently by different spatial analytic methods in each survey.

RESULTS

Anemia during lactation had an increasing trend from 2011 to 2016 in all regions of Ethiopia. It was also spatially clustered over three survey periods (Moran's I: 0.102-0.256, P<0.01).The hotspot areas were detected in Afar, Somali, Gambela, Dire Dawa, and Oromia regions during the last fifteen years. In 2005 and 2011, a total of 100 most likely clusters (Loglikelihood Ratio(LLR) = 8.8, P<0.05, and LLR = 45.94, P<0.001, respectively) were identified in the Afar region. However, in the 2016 survey period, primary clusters were shifted to the Somali region where 57 clusters (LLR = 72.73, P<0.001) were detected in the entire region. Besides, the risk prediction map showed that the eastern part of the country was at a higher risk of anemia during lactation.

CONCLUSION

Anemia during lactation was spatially clustered in Ethiopia. High-risk areas were detected in the eastern part of Ethiopia prominently in the Afar and Somali regions. Therefore, public health intervention activities designed in a targeted approach to impact high-risk populations in those hot spot areas wound be helpful to reduce anemia in Ethiopia.

Trends and Spatio-temporal variation of female genital mutilation among reproductive-age women in Ethiopia: a Spatio-temporal and multivariate decomposition analysis of Ethiopian demographic and health surveys

BACKGROUND

Female genital mutilation (FGM) is a serious health problem globally with various health, social and psychological consequences for women. In Ethiopia, the prevalence of female genital mutilation varied across different regions of the country. Therefore, this study aimed to investigate the trend and determinants of female genital mutilation among reproductive-age women over time.

METHODS

A secondary data analysis was done using 2000, 2005, and 2016 Demographic Health Surveys (DHSs) of Ethiopia. A total weighted sample of 36,685 reproductive-age women was included for analysis from these three EDHS Surveys. Logit based multivariate decomposition analysis was employed for identifying factors contributing to the decrease in FGM over time. The Bernoulli model was fitted using spatial scan statistics version 9.6 to identify hotspot areas of FGM, and ArcGIS version 10.6 was applied to explore the spatial distribution FGM across the country.

RESULTS

The trends of FGM practice has been decreased from 79.9% in 2000 to 70.4% in 2016 with an annual reduction rate of 0.8%. The multivariate decomposition analysis revealed that about 95% of the overall decrease in FGM practice from 2000 to 2016 was due to the difference in the effects of women's characteristics between the surveys. The difference in the effects of residence, religion, occupation, education, and media exposure were significant predictors that contributed to the decrease in FGM over time. The spatial distribution of FGM showed variation across the country. The SaTScan analysis identified significant hotspot areas of FGM in Somali, Harari, and Afar regions consistently over the three surveys.

CONCLUSION

Female genital mutilation practice has shown a remarkable decrease over time in Ethiopia. Public health programs targeting rural, non-educated, unemployed, and those women with no access to media would be helpful to maintain the decreasing trend of FGM practice. The significant Spatio-temporal clustering of FGM was observed across regions in Ethiopia. Public health interventions must target the identified clusters as well.

Spatial distribution and associated factors of health insurance coverage in Ethiopia: further analysis of Ethiopia demographic and health survey, 2016

Background

Health insurance is one of the instruments to achieve universal health coverage. However, in Ethiopia, the coverage of health insurance is very low and varies from place to place as well. Therefore, exploring the spatial distribution of health insurance is important to prioritize and design targeted intervention programs in the country.

Methods

A total of 16,583 reproductive age group women (15–49 years) were included in this study. The Bernoulli model was used by applying Kulldorff methods using the SaTScan software to analyse the purely spatial clusters of health insurance coverage. ArcGIS version 10.3 was used to visualize the distribution of health insurance coverage across the country. Mixed-effect logistic regression analysis was also used to identify predictors of health insurance coverage.

Results

Health insurance coverage among women aged 15–49 years had spatial variations across the country (Moran’s I: 0.115, p < 0.001). Health insurance coverage in Amhara (p < 0.001) and Tigray (p < 0.001) National Regional States clustered spatially. Reading newspapers at least once a week (Adjusted Odds Ratio (AOR) = 1.78, 95% CI: (1.18–2.68))), 40–44 years of age (AOR = 2.14, 95% CI: (1.37–3.35)), clerical working mothers (AOR = 4.33, 95% CI: (2.50–7.49)), mothers’ with secondary school education (AOR = 1.77; 95% CI: (1.21–2.58)), mothers’ with higher school education (AOR = 2.62; 95% CI: (1.63–4.23)), having more than 5 family members (AOR = 1.25; 95% CI: (1.01–1.55)) and richest wealth quantile (AOR = 3.43, 95% CI: (1.96–6.01)) were predictors of health insurance coverage among reproductive age group women in Ethiopia.

Conclusion

Health insurance coverage was very low in Ethiopia and had spatial variations across the country. The hot spot areas with low health insurance coverage need more coherent and harmonized action such as strengthening financial protection through national health packages, sharing experience from regions which have better health insurance coverage and using mass media to increase awareness and confidence of potentials in the systems, which may encourage them to enrol.

Determinants of overweight/obesity among reproductive age group women in Ethiopia: multilevel analysis of Ethiopian demographic and health survey

OBJECTIVE

Overweight/obesity among women is associated with an increased risk of gestational diabetes, pre-eclampsia, postpartum haemorrhage, low birth weight, congenital malformation and neonatal deaths. Although the magnitude of overweight and obesity among the reproductive age group women is a common problem in Ethiopia, there are limited studies that determine the associated factors of overweight and obesity at the national level. Therefore, this study aimed to identify the determinant factors of overweight/obesity among reproductive age group women in Ethiopia.

DESIGN

Cross-sectional study design.

SETTING

Ethiopia.

PARTICIPANTS

Non-pregnant women aged 15-49 years.

PRIMARY OUTCOME

Overweight/obesity.

METHODS

The present study used the Ethiopia Demographic Health Survey (EDHS) data for 2016. A total of 10 938 non-pregnant reproductive age group women were included in the analysis. Both bivariable and multivariable multilevel logistic regression were performed to determine the determinants of overweight and obesity among women in Ethiopia. The OR with a 95% CI was estimated for potential determinants included in the final model.

RESULTS

Those women with secondary education (adjusted OR (AOR)=1.48, 1.01, 2.18), higher education (AOR=1.78, 1.13, 2.81), richer (AOR=1.85, 1.15, 2.98) and richest wealth index (AOR=3.23, 1.98, 5.29), urban residence (AOR=4.46, 2.89, 6.87), married (AOR=1.79, 1.21, 2.64), widowed (AOR=2.42, 1.41, 4.15), divorced (AOR=1.84, 1.13, 3.00), aged 25-34 years (AOR=2.04, 1.43, 2.89), 35-44 years (AOR=2.79, 1.99, 3.93) and 45-49 years (AOR=2.62, 1.54, 4.45) had higher odds of developing overweight and obesity.

CONCLUSION

Women with higher education level, high wealth status, older age, formerly married and those urban dwellers had higher odds of overweight and obesity. Therefore, regular physical activity, reducing consumption of fat/energy-dense food as well as modifying the mode of transportation is recommended.