scholarly journals Title: Determinants of Minimum Acceptable Diet among 6–23 Months Age Children in Ethiopia: A Multilevel Analysis of The Ethiopian Demographic Health Survey

2018 ◽  
Author(s):  
Aberash abay ◽  
Dejen Yemane ◽  
Abate Bekele ◽  
Beyene Meressa
Keyword(s):  
Logistic Regression ◽  
Health Survey ◽  
Community Context ◽  
Community Level ◽  
P Value ◽  
Multilevel Logistic Regression ◽  
Cross Sectional ◽  
Nutritional Interventions ◽  
Individual Level ◽  
The Individual

AbstractBackgroundThough infant and young children should be fed according to a minimum acceptable diet to ensure appropriate growth and development, only 7% of Ethiopian 6-23 months age children meet the minimum acceptable dietary standards, which is lower than the national target of 11% set for 2016. Therefore, this study aims to assess the individual and community level determinants of minimum acceptable diet among 6–23 months age children in Ethiopia.MethodsThis study analyzed retrospectively a cross-sectional data on a weighted sample of 2919 children aged 6-23 months nested within 617 clusters after extracting from Ethiopian Demographic and Health Survey 2016 via the link www.measuredhs.com. By employing bi-variate multilevel logistic regression model, variables which were significant at the p-value < 25 were included in multivariable multilevel logistic regression analysis. Finally, variables with p-value < 0.05 were considered as significant predictors of minimum acceptable diet.ResultsOnly 6.1% of 6-23 months age children feed minimum acceptable diet in Ethiopia. Children 18-23 months age (AOR=3.7, 95%CI 1.9, 7.2), father’s with secondary or higher education (AOR=2.1, 95%CI 1.2, 3.6), Employed mothers (AOR=1.7, 95%CI 1.2, 2.5), mothers have access to drinking water (AOR=1.9, 95%CI 1.2, 2.9), mothers with media exposure (AOR=2.1 95%CI 1.1, 2.7) were positive individual level predictors. Urban mothers (AOR=4.8, 95%CI 1.7, 13.2)) and agrarian dominant region (AOR=5.6, 95%CI 2.2, 14.5) were community level factors that significantly associated with minimum acceptable diet of 6–23 months age children.ConclusionBoth individual and community level factors were significantly associated with minimum acceptable diet of 6-23 months age children in Ethiopia, suggesting that nutritional interventions designed to improve child health should not only be implemented at the individual level but tailored to community context as well.

scholarly journals Do mothers who delivered at health facilities return to health facilities for postnatal care follow-up? A multilevel analysis of the 2016 Ethiopian Demographic and Health Survey

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249793
Author(s):  
Brhane Ayele ◽  
Mulugeta Woldu ◽  
Haftom Gebrehiwot ◽  
Tsegay Wellay ◽  
Tsegay Hadgu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Health Facility ◽  
Health Survey ◽  
Postnatal Care ◽  
Health Facilities ◽  
Demographic And Health Survey ◽  
Community Level ◽  
P Value ◽  
Multilevel Logistic Regression ◽  
Explanatory Variables

Introduction Returning to health facility for postnatal care (PNC) use after giving birth at health facility could reflect the health seeking behavior of mothers. However, such studies are rare though they are critically important to develop vigorous strategies to improve PNC service utilization. Therefore, this study aimed to determine the magnitude and factors associated with returning to health facilities for PNC among mothers who delivered in Ethiopian health facilities after they were discharged. Methods This cross-sectional study used 2016 Ethiopian Demographic and Health Survey data. A total of 2405mothers who gave birth in a health facility were included in this study. Multilevel mixed-effect logistic regression model was fitted to estimate both independent (fixed) effects of the explanatory variables and community-level (random) effects on return for PNC utilization. Variable with p-value of ≤ 0.25 from unadjusted multilevel logistic regression were selected to develop three models and p-value of ≤0.05 was used to declare significance of the explanatory variables on the outcome variable in the final (adjusted) model. Analysis was done using IBM SPSS statistics version 21. Result In this analysis, from the total 2405 participants, 14.3% ((95%CI: 12.1–16.8), (n = 344)) of them returned to health facilities for PNC use after they gave birth at a health facility. From the multilevel logistic regression analysis, being employed (AOR = 1.51, 95%CI: 1.04–2.19), receiving eight and above antenatal care visits (AOR = 2.90, 95%CI: 1.05–8.00), caesarean section delivery (AOR = 2.53, 95%CI: 1.40–4.58) and rural residence (AOR = 0.56, 95%CI: 0.36–0.88) were found significantly associated with return to health facilities for PNC use among women who gave birth at health facility. Conclusion Facility-based PNC utilization among mothers who delivered at health facilities is low in Ethiopia. Both individual and community level variables were determined women to return to health facilities for PNC use. Thus, adopting context-specific strategies/policies could improve PNC utilization and should be paid a due focus.

scholarly journals Exploring the determinants of exclusive breastfeeding among infants under-six months in Ethiopia using multilevel analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0245034
Author(s):  
Shambel Aychew Tsegaw ◽  
Yeshimebet Ali Dawed ◽  
Erkihun Tadesse Amsalu
Keyword(s):  
Logistic Regression ◽  
Exclusive Breastfeeding ◽  
Odds Ratio ◽  
Maternal Employment ◽  
Wealth Index ◽  
Household Wealth ◽  
Community Level ◽  
Multilevel Logistic Regression ◽  
Individual Level ◽  
The Individual

Introduction Exclusive breastfeeding (EBF) is the safest and healthiest option of feeding among infants in the first 6 months throughout the world. Thus, the promotion of EBF is essential to prevent complex infant health problems even at the adulthood level. But the majority of previous studies focused on individual- level determinants of EBF by using basic regression models in localized areas. This study aimed to identify the determinants of EBF at the individual and community level which would be helpful to design appropriate strategies for improving the practice of EBF. Methods It is a secondary data analysis using the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total of 1185 infants under 6 months of age were included in the analysis. A Multilevel logistic regression model was employed to investigate factors significantly associated with EBF among under-six infants in Ethiopia. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to measure the association of variables whereas Intracluster correlation (ICC), median odds ratio (MOR), and proportional change in variance (PCV) were used to measure random effects (variation). Result In multilevel logistic regression; 4–5 months age infant (AOR = 0.04, 95%CI:0.02–0.07), female infants (AOR = 2.51, 95%CI:1.61–3.91), infant comorbidities (AOR = 0.35, 95%CI: 0.21–0.57), richest household wealth index (AOR = 10.34, 95%CI: 3.14–34.03) and antenatal care (AOR = 2.25, 95%CI:1.32–3.82) were individual- level determinants significantly associated with exclusive breastfeeding. Whereas, contextual region (AOR = 0.30, 95%CI: 0.10–0.87), community- level of postnatal visit (AOR = 2.77, 95%CI: 1.26–6.58) and community -level of maternal employment (AOR = 2.8, 95%CI: 1.21–6.47) were community level determinants significantly associated with EBF. The full model showed that46.8% of the variation of exclusive breastfeeding was explained by the combined factors at the individual and community levels. Similarly, it showed that the variation in exclusive breastfeeding across communities remained statistically significant (ICC = 8.77% and variance = 0.32 with P<0.001). Conclusion and recommendation Our study showed that both individual and community level determinants were significantly associated with EBF practice among under 6 infants. Based on our findings, it is recommended to promote and enhance antenatal and postnatal care services utilization of mothers to improve exclusive breastfeeding practice and more emphasis should be given to infants with comorbid conditions and those who were living in the pastoralist regions.

scholarly journals Less than one-fifth of the mothers practised exclusive breastfeeding in the emerging regions of Ethiopia: a multilevel analysis of the 2016 Ethiopian demographic and health survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tsegaye Gebremedhin ◽  
Demiss Mulatu Geberu ◽  
Asmamaw Atnafu
Keyword(s):  
Health Survey ◽  
Exclusive Breastfeeding ◽  
Household Wealth ◽  
Community Level ◽  
Wealth Status ◽  
Individual Level ◽  
Factors Associated ◽  
Breastfeeding Practices ◽  
The Individual ◽  
Low Coverage

Abstract Background The burden of low coverage of exclusive breastfeeding (EBF) has a significant impact on the health of a newborn and also on the family and social economy in the long term. Even though the prevalence of EBF practices in Ethiopia is low, the practices in the pastoral communities, in particular, are significantly low and affected by individual and community-level factors. Besides, its adverse outcomes are mostly unrecognised. Therefore, this study aimed to assess the individual and community-level factors of low coverage of EBF practices in the emerging regions of Ethiopia. Methods In this analysis, data from 2016 Ethiopian Demographic and Health Survey (EDHS) were used. A two-stage stratified sampling technique was used to identify 1406 children aged 0 to 23 months in the emerging regions of Ethiopia. A multilevel mixed-effect binary logistic regression analysis was used to determine the individual and community level factors associated with exclusive breastfeeding practices. In the final model, variables with a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were found to be statistically significant factors that affect exclusive breastfeeding practices. Results Overall, 17.6% (95% CI: 15.6–19.6) of the children aged 0 to 23 months have received exclusive breastfeeding. Employed mothers (AOR: 0.33, 95% CI: 0.21–0.53), richer household wealth status (AOR: 0.39, 95% CI: 0.16–0.96), mothers undecided to have more children (AOR: 2.29, 95% CI: 1.21–4.29), a child with a history of diarrhoea (AOR: 0.31, 95% CI: 0.16–0.61) were the individual-level factors, whereas Benishangul region (AOR: 2.63, 95% CI: 1.44–4.82) was the community-level factors associated with the exclusive breastfeeding practices. Conclusions Less than one-fifth of the mothers have practised exclusive breastfeeding in the emerging regions of Ethiopia. The individual-level factors such as mother’s employment status, household wealth status, desire for more children, presence of diarrhoea and community-level factors such as region have contributed to the low coverage of exclusive breastfeeding. Therefore, the federal and regional health bureaus and other implementers should emphasise to those emerging regions by creating awareness and strengthening the existing community-based health extension program to enhance exclusive breastfeeding practices.

scholarly journals Individual-level and community-level factors associated with the family planning use among pastoralist community of Ethiopia: a community-based cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e036519 ◽  
Author(s):  
Mussie Alemayehu ◽  
Araya Abrha Medhanyie ◽  
Elizabeth Reed ◽  
Afework Mulugeta
Keyword(s):  
Family Planning ◽  
Cross Sectional Study ◽  
Married Women ◽  
Community Level ◽  
Sectional Study ◽  
Community Based ◽  
Cross Sectional ◽  
Individual Level ◽  
Pastoralist Community ◽  
The Individual

ObjectiveThe study aimed to identify the effects of the individual-level and community-level factors on the use of family planning (FP) among married women in the pastoralist community of Ethiopia.DesignA community-based cross-sectional study was conducted in September 2018. Data were analysed using R software. To determine the fixed effect of individual-level and community-level factors of FP use, a two-level mixed-effects logistic regression was used. The result was described using the Adjusted OR (AOR), and the variance partition coefficient.Setting and participantsAfar, Ethiopia (2018; n=891) married women of reproductive age (15–49) years.Primary outcome measuresFP use or non-use.ResultsThe current use of FP was 18.7% (16.31%–21.43%). Women who need to walk 1 hour and more to the nearest health facility (AOR 0.14, 95% CI 0.05 to 0.3), have ANC visit of 4 and above (AOR 6.02, 95% CI 1.74 to 20.8), had their last birth at a health facility (AOR 2.71 95% CI 1.27 to 5.81), have five and more children (AOR 4.71, 95% CI 1.86 to 11.9), have high knowledge on FP (AOR 2.74, 95% CI 1.11 to 6.74) and had high intentions to use FP (AOR 10.3, 95% CI 3.85 to 27.6) were more likely to report FP use. The magnitude of the effect of for FP use was smaller than that of 9 of the 13 individual factors. Apart from this 19.4% of the total variance in the odds of using FP attributed to between community difference (intraclass correlation coefficient=0.194). Regarding the community-level characteristics, clusters of having higher electronic media possession (AOR 2.84, 95% CI 1.2 to 6.72) and higher women decision making on FP (AOR 8.35, 95% CI 2.7 to 27.1) were significantly associated with increased FP use compared with clusters with lower reports of these aspects.ConclusionFP use among the pastoralist community is influenced by both individual cluster/community-level characteristics or factors. Even though the effect of clustering in FP use was large in comparison with the unexplained between-cluster variation, it was lower than the individual-level factors.Trail registrtion numberNCT03450564

scholarly journals Individual and community level factors associated with anemia among children 6—59 months of age in Ethiopia: A further analysis of 2016 Ethiopia demographic and health survey

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241720
Author(s):  
Menaseb Gebrehaweria Gebremeskel ◽  
Afework Mulugeta ◽  
Abate Bekele ◽  
Lire Lemma ◽  
Muzey Gebremichael ◽  
...  
Keyword(s):  
Health Survey ◽  
Logistic Regression Model ◽  
Demographic And Health Survey ◽  
Community Level ◽  
Multilevel Logistic Regression ◽  
Factors Associated ◽  
Dire Dawa ◽  
Poverty Status ◽  
The Individual ◽  
Multilevel Logistic Regression Model

Background Anemia is a global public health problem; but its burden is disproportionately borne among children in the African Regions. The 2016 Ethiopia Demographic and Health Survey report showed that the prevalence of anemia among children 6–59 months of age was 57%; far exceeding the national target of 25% set for 2015. Although studies have been conducted in Ethiopia, multilevel analysis has rarely been used to identify factors associated with anemia among children. Therefore, this study aimed to identify individual and community-level factors associated with anemia among children 6–59 months of age by fitting a multilevel logistic regression model. Methods The data was obtained from the 2016 Ethiopia Demographic and Health Survey, conducted from January to June 2016, and downloaded from the website http://www.DHSprogram.com. The sample was taken using two-stage stratified sampling. In stage one, 645 Enumeration Areas and in stage two 28 households per Enumeration Area were selected. A sample of 7790 children 6–59 months of age was included. Data were analyzed using STATA version 14. A multilevel logistic regression model was fitted and an adjusted odds ratio with a 95% confidence interval was obtained. Result From the individual-level factors, anemia was associated most strongly with child age, wealth index, maternal anemia and child stunting followed by child underweight, child fever and birth order whereas from the community-level, the strongest odds of anemia occurred among children from Somali, Harari, Dire Dawa and Afar region followed by Oromia and Addis Ababa. Low community-poverty is a protective factor for anemia. The odds of anemia were 0.81 (95% CI: 0.66, 0.99) times lower for children who were living in communities of lower poverty status than children who were living in communities of higher poverty status. Children from Somali and Dire Dawa had 3.38 (95% CI: 3.25, 5.07) and 2.22 (95% CI: 1.42, 3.48) times higher odds of anemia, respectively than children from the Tigray region. Conclusions This study shows that anemia among children 6–59 months of age is affected both by the individual and community level factors. It is better to strengthen the strategies of early detection and management of stunted and underweight children. At the same time, interventions should be strengthened to address maternal anemia, child fever and poverty, specifically targeting regions identified to have a high risk of anemia.

scholarly journals Individual- and Community-Level Risk Factors Associated with Childhood Diarrhea in Ethiopia: A Multilevel Analysis of 2016 Ethiopia Demographic and Health Survey

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Setegn Muche Fenta ◽  
Teshager Zerihun Nigussie
Keyword(s):  
Risk Factors ◽  
Drinking Water ◽  
Health Survey ◽  
Community Level ◽  
World Health ◽  
Childhood Diarrhea ◽  
Individual Level ◽  
Factors Associated ◽  
Health Organization ◽  
The Individual

Background. Diarrhea is the second cause of child deaths globally. According to World Health Organization reports, in each year, it kills more than 525,000 children under 5 years. More than half of these deaths occur in five countries including Ethiopia. This study is aimed at identifying both individual- and community-level risk factors of childhood diarrhea in Ethiopia. Methods. Ethiopian demography and health survey of 2016 data were used for the analysis. A total of 10,641 children aged 0–59 months were included in the analysis. A multilevel mixed-effects logistic regression model was used to identify both individual- and community-level risk factors associated with childhood diarrhea. Result. The incidence of childhood diarrhea was 12% (95% CI: 11.39, 12.63). The random-effects model revealed that 67% of the variability of childhood diarrhea was explained by individual- and community-level factors. From the individual-level factors, children aged 36–59 months ( AOR = 3.166 ; 95% CI: 2.569, 3.900), twin child ( AOR = 1.871 ; 95% CI: 1.390, 2.527), birth order 5 and above ( AOR = 2.210 , 95% CI: 1.721, 2.839), not received any vaccination ( AOR = 1.197 ; 95% CI: 1.190, 1.527), smaller size of child at birth ( AOR = 1.303 ; 95% CI: 1.130, 1.504), and never breastfed children ( AOR = 2.91 ; 95% CI: 2.380, 3.567) associated with the higher incidence of childhood diarrhea. From the community-level factors, living in a rural area ( AOR = 1.505 ; 95% CI: 1.233, 1.836)), unprotected source of drinking water ( AOR = 1.289 ; 95% CI: 1.060, 1.567), and availability of unimproved latrine facilities (OR: 1.289; 95% CI: 1.239, 1.759) associated with the higher incidence of childhood diarrhea. Besides, children who live in Afar, Amhara, Benishangul-Gumuz, Gambella, SNNPR, and Dire Dawa regions had higher incidence of childhood diarrhea. Conclusion. The incidence of childhood diarrhea was different from cluster to cluster in Ethiopia. Therefore, integrated child health intervention programs including provisions of toilet facility, access to a clean source of drinking water, educate parents about the importance of breastfeeding, and vaccination have to be strongly implemented in order to reduce the high incidence of childhood diarrhea among children in Ethiopia.

scholarly journals Gender and Hypertension (Data analysis of The Indonesia Basic Health Research 2007)

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Krisnawati Bantas
Keyword(s):  
Logistic Regression ◽  
Data Analysis ◽  
Health Research ◽  
P Value ◽  
Multilevel Logistic Regression ◽  
Cross Sectional ◽  
Men And Women ◽  
Basic Health ◽  
Increased Risk ◽  
Cross Sectional Design

The objective of this study was to examine whether there was a gender difference in the occurrence of hypertension in Indonesian people, after controlling for individual and environment factors. Data were obtained from the Indonesia Basic Health Research 2007 and a cross-sectional design was used. Samples consisted of 13.262 men and women age 15 years or more. A multilevel logistic regression was used to analyze the data. There was a statistically significant association between gender and hypertension. Women were less likely to have hypertension than men (OR 0.86 P value < 0.0033). There was an interaction between variable of gender and variable of age. It suggested that the probability of having hypertension in women and men was varied by the strata of age. In the strata of age more than 60 years, women were more likely to have hypertension than men (OR 1.25, P value 0.0065); in strata of age 30-59 years, there was no difference of having hypertension between women and men (P value > 0.05); in strata of age <30 years, women were less likely to have hypertension than men (OR 0.67 Pvalue 0.0000). Among women, there was an increased of having hypertension with age. Age of ≥ 60 years was the highest risk of having hypertension. Among men, there was an increased of having hypertension with age, but at in the age of ≥ 60 years the increased risk of having hypertension was not as high as in women. 

scholarly journals Multimorbidity in large Canadian urban centres: A multilevel analysis of pooled 2015–2018 cross-sectional cycles of the Canadian Community Health Survey

2021 ◽  
Vol 11 ◽  
pp. 263355652110580
Author(s):  
Piotr Wilk ◽  
Saverio Stranges ◽  
Rino Bellocco ◽  
Torsten Bohn ◽  
Hanen Samouda ◽  
...  
Keyword(s):  
Socioeconomic Factors ◽  
Community Health ◽  
Health Survey ◽  
Canadian Community Health Survey ◽  
Cross Sectional ◽  
Logistic Regression Models ◽  
Individual Level ◽  
Community Health Survey ◽  
Compositional Effects ◽  
The Individual

Background There is limited knowledge on how the prevalence of multimorbidity varies within and across major Canadian urban centres. The objective of this study was to investigate the between-neighbourhood variation in the prevalence of multimorbidity in Canada’s large urban centres, controlling for compositional effects associated with individual-level demographic and socioeconomic factors. Methods Cross-sectional data from the 2015–2018 cycles of the Canadian Community Health Survey (CCHS) were pooled at the microdata level. Respondents (20 years and older) residing in one of the 35 census metropolitan areas (CMAs) were included ( N = 100,803). Census tracts (CTs) were used as a measure of neighbourhood. To assess the between-neighbourhood differences in multimorbidity prevalence, we fitted three sequential random intercept logistic regression models. Results During the 2015–2018 period, 8.1% of residents of large urban centres had multimorbidity. The results from the unadjusted model indicate that 13.4% of the total individual variance in multimorbidity could be attributed to the between-neighbourhood differences. After adjustment for overall characteristics of the CMAs in which these neighbourhoods are located, as well as for individual-level demographic and socioeconomic factors related to compositional effects, 11.0% of the individual variance in multimorbidity could still be attributed to the between-neighbourhood differences. Conclusion There is significant and substantial geographic variation in multimorbidity prevalence across neighbourhoods in Canada’s large urban centres. Residing in some neighbourhoods could be associated with increased odds of having multimorbidity, even after accounting for overall characteristics of the CMAs in which these neighbourhoods are located, as well as individual-level factors.

scholarly journals Individual-, household- and community-level determinants of infant mortality in Ethiopia

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248501
Author(s):  
Girmay Tsegay Kiross ◽  
Catherine Chojenta ◽  
Daniel Barker ◽  
Deborah Loxton
Keyword(s):  
Infant Mortality ◽  
Health Behaviours ◽  
Community Level ◽  
Family Characteristics ◽  
P Value ◽  
Community Based Interventions ◽  
Individual Level ◽  
Individual Household ◽  
The Individual ◽  
The Impact

Introduction People living in the same area share similar determinants of infant mortality, such as access to healthcare. The community’s prevailing norms and attitudes about health behaviours could also influence the health care decisions made by individuals. In diversified communities like Ethiopia, differences in child health outcomes might not be due to variation in individual and family characteristics alone, but also due to differences in the socioeconomic characteristics of the community where the child lives. While individual level characteristics have been examined to some extent, almost all studies into infant mortality conducted in Ethiopia have failed to consider the impact of community-level characteristics. Therefore, this study aims to identify individual and community level determinants of infant mortality in Ethiopia. Method Data from the Ethiopian Demographic and Health Survey in 2016 were used for this study. A total of 10641 live births were included in this analysis. A multi-level logistic regression analysis was used to examine both individual and community level determinants while accounting for the hierarchal structure of the data. Results Individual-level characteristics such as infant sex have a statistically significant association with infant mortality. The odds of infant death before one year was 50% higher for males than females (AOR = 1.66; 95% CI: 1.25–2.20; p-value <0.001). At the community level, infants from pastoralist areas (Somali and Afar regions) were 1.4 more likely die compared with infants living in the Agrarian area such as Amhara, Tigray, and Oromia regions; AOR = 1.44; 95% CI; 1.02–2.06; p-value = 0.039). Conclusion Individual, household and community level characteristics have a statistically significant association with infant mortality. In addition to the individual based interventions already in place, household and community-based interventions such as focusing on socially and economically disadvantaged regions in Ethiopia could help to reduce infant mortality.

scholarly journals Intimate partner violence, contextual factors and under-5 mortality: a multilevel analysis of cross-sectional surveys from 20 Sub-Saharan African countries

2020 ◽  
Vol 5 (12) ◽  
pp. e003531
Author(s):  
Sanni Yaya ◽  
Seun Stephen Anjorin ◽  
Sunday A Adenini
Keyword(s):  
Intimate Partner Violence ◽  
Logistic Regression ◽  
Partner Violence ◽  
Contextual Factors ◽  
Intimate Partner ◽  
Multilevel Logistic Regression ◽  
African Countries ◽  
Individual Level ◽  
Sub Saharan ◽  
The Individual

BackgroundUnder-5 mortality remains a public health concern in low-income and middle-income countries. Africa contributes about one-fifth of the burden of global under-5 mortality; intimate partner violence (IPV) and polygyny, which are highly prevalent on the continent, have been linked to under-5 mortality at the individual level. This study examined the relationship between IPV and polygyny as contextual factors and the experience of under-5 mortality among women in Sub-Saharan Africa (SSA).MethodsWe used data from the Demographic and Health Surveys (DHS) of 20 African countries with available data between 2010 and 2018 as of April 2020. We defined the experience of under-5 mortality as a woman’s loss of at least one child before their fifth birthday. The DHS primary sampling unit was used to define contextual factors. The study involved a multilevel logistic regression analysis of 227 121 women of childbearing age (15–49).ResultsA quarter (24.5%) of women have lost at least one child under 5 years old, more than two-thirds (40.1%) have experienced at least one form of IPV, and about two-thirds of women were in polygynous union. Our multilevel logistic regression showed that parity, polygynous union and experience of IPV were strongly associated with women’s experience of under-5 mortality. The results showed that 39.9% and 19.2% of variances in odds of a woman losing a child before their fifth birthday are attributable to community-level and country-level factors, respectively. Contextual prevalence of IPV, polygynous union and gender equity attenuate the strength of associations observed at the individual level. The interaction between contextual prevalence of polygyny and IPV exacerbates the risk of under-5 mortality. Women in SSA countries with higher Human Development Index were less likely to experience under-5 mortality.ConclusionThis study established that beyond individual-level effects, contextual prevalence of IPV and polygyny and their interactions shape women’s experience of under-5 mortality in Africa. In designing policies and interventions to address under-5 mortality, contextual factors, especially those linked to culturally laden social norms and practices, must be considered to ensure effectiveness and sustainable impact.

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