scholarly journals Complete basic childhood vaccination and associated factors among children aged 12–23 months in East Africa: a multilevel analysis of recent demographic and health surveys

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Getayeneh Antehunegn Tesema ◽  
Zemenu Tadesse Tessema ◽  
Koku Sisay Tamirat ◽  
Achamyeleh Birhanu Teshale

Abstract Background Complete childhood vaccination remains poor in Sub-Saharan Africa, despite major improvement in childhood vaccination coverage worldwide. Globally, an estimated 2.5 million children die annually from vaccine-preventable diseases. While studies are being conducted in different East African countries, there is limited evidence of complete basic childhood vaccinations and associated factors in East Africa among children aged 12–23 months. Therefore, this study aimed to investigate complete basic childhood vaccinations and associated factors among children aged 12–23 months in East Africa. Methods Based on the Demographic and Health Surveys (DHSs) of 12 East African countries (Burundi, Ethiopia, Comoros, Uganda, Rwanda, Tanzania, Mozambique, Madagascar, Zimbabwe, Kenya, Zambia, and Malawi), secondary data analysis was performed. The study included a total weighted sample of 18,811 children aged 12–23 months. The basic childhood vaccination coverage was presented using a bar graph. Multilevel binary logistic regression analysis was fitted for identifying significantly associated factors because the DHS has a hierarchical nature. The Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV), and deviance (−2LLR) were used for checking model fitness, and for model comparison. Variable with p-value ≤0.2 in the bi-variable multilevel analysis were considered for the multivariable analysis. In the multivariable multilevel analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare the significance and strength of association with full vaccination. Results Complete basic childhood vaccination in East Africa was 69.21% (95% CI, 69.20, 69.21%). In the multivariable multilevel analysis; Mothers aged 25–34 years (AOR = 1.21, 95% CI: 1.10, 1.32), mothers aged 35 years and above (AOR = 1.50, 95% CI: 1.31, 1.71), maternal primary education (AOR = 1.26, 95% CI: 1.15, 1.38), maternal secondary education and above (AOR = 1.54, 95% CI: 1.36, 1.75), husband primary education (AOR = 1.25, 95% CI: 1.13, 1.39), husband secondary education and above (AOR = 1.24, 95% CI: 1.11, 1.40), media exposure (AOR = 1.23, 95% CI: 1.13, 1.33), birth interval of 24–48 months (AOR = 1.28, 95% CI: 1.15, 1.42), birth interval greater than 48 months (AOR = 1.35, 95% CI: 1.21, 1.50), having 1–3 ANC visit (AOR = 3.24, 95% CI: 2.78, 3.77), four and above ANC visit (AOR = 3.68, 95% CI: 3.17, 4.28), PNC visit (AOR = 1.34, 95% CI: 1.23, 1.47), health facility delivery (AOR = 1.48, 95% CI: 1.35, 1.62), large size at birth 1.09 (AOR = 1.09, 95% CI: 1.01, 1.19), being 4–6 births (AOR = 0.83, 95% CI: 0.75, 0.91), being above the sixth birth (AOR = 0.60, 95% CI: 0.52, 0.70), middle wealth index (AOR = 1.16, 95% CI: 1.06, 1.28), rich wealth index (AOR = 1.20, 95% CI: 1.09, 1.33), community poverty (AOR = 1.21, 95% CI: 1.11, 1.32) and country were significantly associated with complete childhood vaccination. Conclusions In East Africa, full basic childhood vaccine coverage remains a major public health concern with substantial differences across countries. Complete basic childhood vaccination was significantly associated with maternal age, maternal education, husband education, media exposure, preceding birth interval, number of ANC visits, PNC visits, place of delivery, child-size at birth, parity, wealth index, country, and community poverty. Public health interventions should therefore target children born to uneducated mothers and fathers, poor families, and those who have not used maternal health services to enhance full childhood vaccination to reduce the incidence of child mortality from vaccine-preventable diseases.

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Getayeneh Antehunegn Tesema ◽  
Zemenu Tadesse Tessema ◽  
Koku Sisay Tamirat ◽  
Achamyeleh Birhanu Teshale

Abstract Background Stillbirth is the most frequently reported adverse pregnancy outcome worldwide, which imposes significant psychological and economic consequences to mothers and affected families. East African countries account for one-third of the 2.6 million stillbirths globally. Though stillbirth is a common public health problem in East African countries, there is limited evidence on the pooled prevalence and associated factors of stillbirth in East Africa. Therefore, this study aimed to investigate the prevalence of stillbirth and its associated factors in East Africa. Methods This study was based on the most recent Demographic and Health Surveys (DHSs) of 12 East African countries. A total weighted sample of 138,800 reproductive-age women who gave birth during the study period were included in this study. The prevalence of stillbirth with the 95% Confidence Interval (CI) was reported using a forest plot. A mixed-effect binary logistic regression analysis was done to identify significantly associated factors of stillbirth. Since the DHS data has hierarchical nature, the presence of clustering effect was assessed using the Likelihood Ratio (LR) test, and Intra-cluster Correlation Coefficient (ICC), and deviance were used for model comparison. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable mixed-effect binary logistic regression analysis, the Adjusted Odds Ratio (AOR) with 95% CI were reported to declare the strength and significance of the association. Results The prevalence of stillbirth in East Africa was 0.86% (95% CI: 0.82, 0.91) ranged from 0.39% in Kenya to 2.28% in Burundi. In the mixed-effect analysis; country, women aged 25–34 years (AOR = 1.27, 95% CI: 1.11, 1.45), women aged ≥ 35 years (AOR = 1.19, 95% CI: 1.01, 1.44), poor household wealth (AOR = 1.07, 95% CI: 1.02, 1.23), women who didn’t have media exposure (AOR = 1.11, 95% CI: 1.01, 1.25), divorced/widowed/separated marital status (AOR = 2.99, 95% CI: 2.04, 4.39), caesarean delivery (AOR = 1.81, 95% CI: 1.52, 2.15), preceding birth interval < 24 months (AOR = 1.15, 95% CI: 1.06, 1.24), women attained secondary education or above (AOR = 0.68, 95% CI: 0.56, 0.81) and preceding birth interval ≥ 49 months (AOR = 1.45, 95% CI: 1.28, 1.65) were significantly associated with stillbirth. Conclusions Stillbirth remains a major public health problem in East Africa, which varied significantly across countries. These findings highlight the weak health care system of East African countries. Preceding birth interval, county, maternal education media exposure, household wealth status, marital status, and mode of delivery were significantly associated with stillbirth. Therefore, public health programs enhancing maternal education, media access, and optimizing birth spacing should be designed to reduce the incidence of stillbirth.


2020 ◽  
Vol 46 (1) ◽  
Author(s):  
Zemenu Tadesse Tessema ◽  
Getayeneh Antehunegn Tesema

Abstract Introduction Skilled health professional assisted delivery is an effective strategy to reduce maternal and newborn mortality. Skilled assistant delivery can prevent about 16–33% of maternal and newborn mortality. Despite the commitments of the government to assure home free delivery, majority of the births in Sub-Saharan Africa are attended by traditional birth attendants. As to our search of the literature, there is limited evidence on the prevalence and determinants of skilled delivery in East African countries. Therefore, this study aimed to estimate the pooled prevalence and determinants of skilled birth attendant delivery in East Africa Countries. Methods Pooled analysis was done based on Demographic and Health Surveys conducted in the 12 East African countries from 2008 to 2017. A total weighted sample of 141,483 women who gave birth during the study period was included in the study. The pooled prevalence of skilled birth attendance was estimated using STATA version 14. Intra-class Correlation Coefficient, Median Odds Ratio, Proportional Change in Variance, and deviance were used for model fitness and comparison. The multilevel multivariable logistic regression model was fitted to identify determinants of skilled birth attendance in the region. Adjusted Odds Ratio with its 95% Confidence Interval was used to declare significant determinants of skilled birth attendants. Results The pooled prevalence of skilled birth attendant in East African countries were 67.18% (95% CI:66.98, 67.38) with highest skilled birth attendant in Rwanda (90.68%) and the lowest skilled birth attendant in Tanzania (11.91%). In the Multilevel multivariable logistic regression model; age 15–24 (Adjusted Odds Ratio (AOR) = 1.14, 95%CI:1.09, 1.18), age 25–49(AOR = 1.16, 95%CI:1.10,1.23), primary women education (AOR = 1.57, 95%CI:1.51,1.63), secondary and above women education (AOR = 2.85, 95%CI:1.73,3.01), primary husband education (AOR = 1.11, 95%CI = 1.07,1.15), secondary and above husband education (AOR = 1.46, 95%CI = 1.40,1.53), middle wealth index (AOR = 1.43, 95%CI = 1.38,1.49),rich wealth index (AOR = 2.38, 95%CI = 2.28,2.48), had ANC visit (AOR = 1.68, 95%CI = 1.62,1.73),multiple gestation (AOR = 2.06, 95%CI = 1.90,2.25), parity 2–4(AOR = 0.65, 95%CI = 0.61,0.69), parity 5 + (AOR = 0.44, 95%CI = 0.41,0.47), accessing health care not big problem (AOR = 1.32, 95%CI = 1.28,1.36), residence (AOR = 0.43, 95%CI = 0.41,0.45) and being Burundi resident (AOR = 0.77, 95%CI = 0.70,0.85) were significantly associated with skilled assisted delivery. Conclusion Skilled birth attendance at birth in the East Africa countries was low. Maternal age, women and husband education, wealth index, antenatal care visit, multiple gestations, parity, accessing health care, residence, and living countries were major determinants of skilled attendant delivery. Strategies to increase the accessibility and availability of healthcare services, and financial support that targets mothers from poor households and rural residents to use health services will be beneficial. Health education targeting mothers and their partner with no education are vital to increasing their awareness about the importance of skilled birth attendance at birth.


2021 ◽  
Author(s):  
Temam Beshir Raru ◽  
Belay Negash ◽  
Biruk Shalmenu ◽  
Addisu Birhanu ◽  
Lemma Demissie ◽  
...  

Abstract Introduction: The use of antenatal care (ANC) plays a major role in minimizing maternal and child mortality through effective and appropriate screening, preventive, or treatment intervention. Despite the fact that almost all of the pregnancy-related mortalities are largely preventable through adequate use of ANC, Sub-Saharan Africa (SSA) particularly East African Countries continues to share the largest share of global maternal, and newborn mortality. Therefore, this study aimed to estimate the overall magnitude and determinants of ANC utilization in the 11 East Africa Countries from 2010 to 2018 using recent Demographic and Health Surveys (DHS)Methods: A secondary data analysis was done based on DHS from 2010 to 2018 in the 11 East African Countries. A total weighted sample of 89,991 women who gave birth in the 5 years preceding each country’s DHS survey were included in this study. Data processing and analysis were performed using STATA 15 software. Multilevel mixed effect logistic regression model was fitted. Model comparison was done based on Akaike and Bayesian Information Criteria (AIC and BIC). Variables with a p-value≤0.05 were declared as significant determinants of ANC utilization.Results: The magnitude of ANC utilization in East African Countries was 53.03% (95% CI: 52.70, 53.35) with the highest ANC utilization in Kenya (57.64%) and the lowest ANC utilization in Comoros (48.99%). In the multivariable multilevel logistic regression model; age 20-24 (Adjusted Odds Ratio (AOR) = 1.25; 95% CI; 1.17-1.34), 25-29 AOR = 1.47; 95% CI; 1.37-1.58), 30-34 (AOR = 1.58; 95% CI; 1.47-1.71), 35-39 (AOR = 1.63; 95% CI; 1.50-1.77), 40-44 (AOR = 1.64; 95% CI; 1.49-1.81), 45-49 (AOR = 1.71; 95% CI; 1.51-1.93), primary education (AOR = 1.24; 95% CI; 1.18-1.31), richest wealth index (AOR = 1.57; 95% CI; 1.47-1.67), being in rural resident (AOR = 0.93; 95% CI; 0.88,0.98), have media exposure (AOR = 1.11; 95% CI; 1.07-1.15), and being a Zimbabwe resident (AOR = 2.87; 95% CI; 2.55-3.23) were among factors that are significantly associated with ANC utilization.Conclusion: ANC utilization was low in the East Africa countries. Age, women education, wealth index, birth order, residence, media exposure and living countries were major determinants of ANC utilization. It would be useful to increase financial support strategies that enables mothers from poor households to use health services will be advantageous. To increase women’s understanding of the significance of ANC utilization, health education targeting mothers with no education is very crucial.


PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243245
Author(s):  
Yigizie Yeshaw ◽  
Misganaw Gebrie Worku ◽  
Zemenu Tadesse Tessema ◽  
Achamyeleh Birhanu Teshale ◽  
Getayeneh Antehunegn Tesema

Introduction Diarrhea is the leading cause of illness and death among under-five children in low and middle income countries. Through the provision of zinc supplements has been shown to reduce the severity and duration of diarrhea, as well as the risk of mortality, the use of zinc for the treatment of diarrhea is still very low in low-income countries. Therefore, this study was conducted to determine the prevalence and associated factors of zinc utilization among under-five children with diarrhea in East Africa. Methods A secondary data analysis of the recent Demographic and Health Surveys (DHS) of East African countries were used to determine the prevalence and associated factors of zinc utilization among under-five children with diarrhea in East Africa. A total weighted samples of 16,875 under-five children with diarrhea were included in the study. A generalized linear mixed model (using Poisson regression with robust error variance) was used. Prevalence Ratios (PR) with their 95% confidence interval (CI) were calculated for those variables included in the final model. Results The overall prevalence of zinc utilization among under-five children with diarrhea in this study was 21.54% (95% CI = 20.92–22.16). Of East African countries, Uganda had the highest prevalence of zinc utilization (40.51%) whereas Comoros had the lowest (0.44%). Maternal primary education (Adjusted Prevalence Ratio(aPR) = 1.29, 95% CI: 1.16–1.44), secondary education (aPR = 1.36, 95% CI = 1.19–1.55) and higher education (aPR = 1.91, 95% CI = 1.52–2.40), high community women education (aPR = 1.12, 95% CI = 1.02–1.24), high wealth index (aPR = 1.12, 95% CI = 1.01–1.24), high community media exposure (aPR = 1.17, 95% CI = 1.06–1.29) were associated with a higher prevalence of zinc utilization. Conclusion The prevalence of zinc utilization among under-five children was found to be low in East Africa. Maternal education, wealth index, community women education, and community media exposure were significantly associated with zinc utilization. Increased mass media exposure, maternal education and wealth index is recommended to improve zinc utilization among under-five children with diarrhea.


PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257522
Author(s):  
Getu Debalkie Demissie ◽  
Yigizie Yeshaw ◽  
Wallelign Aleminew ◽  
Yonas Akalu

Introduction Diarrhea is responsible for the death of more than 90% of under-five children in low and lower-middle income countries. Regionally, South Asia and sub-Saharan Africa accounted for 88% of deaths with the same age group. Therefore, the aim of this study was to determine the prevalence and associated factors of diarrhea among children under-five years in sub-Saharan Africa. Methods The appended, most recent demographic and health survey datasets of 34 sub-Saharan African countries were used to determine the prevalence and associated factors of diarrhea among under-five children in the region. A total weighted sample of 330,866 under-five children were included in the study. Both bivariable and multivariable multilevel logistic regression were done to determine the associated factors of diarrhea among under five children in sub-Saharan Africa. The Odds Ratio (OR) with a 95% Confidence Interval (CI) was calculated for those potential factors included in the final model. Result The overall prevalence of diarrhea in this study was 15.3% (95% CI: 15.1–15.4). Those children of mothers aged 15–24 (AOR = 1.26; 95% CI: 1.23, 1.30) and 25–34 years (AOR = 1.15; 95%CI: 1.12, 1.18), those children of mothers with no education (AOR = 1.69; 95%CI: 1.57–1.82), primary education (AOR = 1.73; 95%CI: 1.61–1.86) and secondary education (AOR = 1.49; 95%CI: 1.38–1.59) had higher odds of having diarrhea. Those children from poorest (AOR = 1.14; 95%CI: 1.10, 1.19), poorer (AOR = 1.12; 95%CI: 1.08–1.17), middle (AOR = 1.06; 95%CI: 1.02, 1.10), and richer (AOR = 1.14; 95%CI: 1.04–1.12) households had higher chance of having diarrhea compared to their counterparts. Conclusion This study found that the prevalence of childhood diarrhea morbidity in sub-Saharan Africa was high. Maternal age, wealth index, maternal education, maternal occupation, age of child, time of initiation of breast feeding and time to get water source were significantly associated with diarrhea. Therefore, intervention through health education and health promotion for mothers/caretakers who are poor, less educated, and young should be designed to prevent diarrhea in the region.


PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250447
Author(s):  
Getayeneh Antehunegn Tesema ◽  
Zemenu Tadesse Tessema

Background Many mothers still give birth outside a health facility in Sub-Saharan Africa particularly in East African countries. Though there are studies on the prevalence and associated factors of health facility delivery, as to our search of literature there is limited evidence on the pooled prevalence and associated factors of health facility delivery in East Africa. This study aims to examine the pooled prevalence and associated factors of health facility delivery in East Africa based on evidence from Demographic and Health Surveys. Methods A secondary data analysis was conducted based on the most recent Demographic and Health Surveys (DHSs) conducted in the 12 East African countries. A total weighted sample of 141,483 reproductive-age women who gave birth within five years preceding the survey was included. All analyses presented in this paper were weighted for the sampling probabilities and non-response using sampling weight (V005), primary sampling unit (V023), and strata (V021). The analysis was done using STATA version 14 statistical software, and the pooled prevalence of health facility delivery with a 95% Confidence Interval (CI) was presented using a forest plot. For associated factors, the Generalized Linear Mixed Model (GLMM) was fitted to consider the hierarchical nature of the DHS data. The Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), and Likelihood Ratio (LR)-test were done to assess the presence of a significant clustering effect. Besides, deviance (-2LLR) was used for model comparison since the models were nested models. Variables with a p-value of less than 0.2 in the bivariable mixed-effect binary logistic regression analysis were considered for the multivariable analysis. In the multivariable mixed-effect analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare the strength and significance of the association between the independent variable and health facility delivery. Results The proportion of health facility delivery in East Africa was 87.49% [95% CI: 87.34%, 87.64%], ranged from 29% in Ethiopia to 97% in Mozambique. In the Mixed-effect logistic regression model; country, urban residence [AOR = 2.08, 95% CI: 1.96, 2.17], primary women education [AOR = 1.61, 95% CI: 1.55, 1.67], secondary education and higher [AOR = 2.96, 95% CI: 2.79, 3.13], primary husband education [AOR = 1.19, 95% CI: 1.14, 1.24], secondary husband education [AOR = 1.38, 95% CI: 1.31, 1.45], being in union [AOR = 1.23, 95% CI: 1.18, 1.27], having occupation [AOR = 1.11, 95% CI: 1.07, 1.15], being rich [AOR = 1.36, 95% CI: 1.30, 1.41], and middle [AOR = 2.14, 95% CI: 2.04, 2.23], health care access problem [AOR = 0.76, 95% CI: 0.74, 0.79], having ANC visit [AOR = 1.54, 95% CI: 1.49, 1.59], parity [AOR = 0.56, 95% CI: 0.55, 0.61], multiple gestation [AOR = 1.83, 95% CI: 1.67, 2.01] and wanted pregnancy [AOR = 1.19, 95% CI: 1.13, 1.25] were significantly associated with health facility delivery. Conclusion This study showed that the proportion of health facility delivery in East African countries is low. Thus, improved access and utilization of antenatal care can be an effective strategy to increase health facility deliveries. Moreover, encouraging women through education is recommended to increase health facility delivery service utilization.


Author(s):  
Feleke Hailemichael Astawesegn ◽  
Virginia Stulz ◽  
Kingsley E. Agho ◽  
Haider Mannan ◽  
Elizabeth Conroy ◽  
...  

Identifying the socioeconomic and structural issues that act as enablers and/or barriers to HIV testing services is critical in combatting HIV/AIDS amongst mothers and children in Africa. In this study, we used a weighted sample of 46,645 women aged 15–49 who gave birth in the two years preceding the survey from the recent DHS dataset of ten East African countries. Multivariable logistic regression was used to investigate the factors associated with prenatal HIV test uptake in East Africa. The overall prenatal HIV test uptake for the prevention of mother-to-child transmission (PMTCT) of HIV was 80.8% (95% CI: 74.5–78.9%) in East Africa, with highest in Rwanda (97.9%, 95% CI: 97.2–98.3%) and lowest in Comoros (17.0%, 95% CI: 13.9–20.7%). Common factors associated with prenatal HIV test service uptake were higher maternal education level (AOR = 1.29; 95% CI: 1.10–1.50 for primary education and AOR = 1.96; 95% CI: 1.53–2.51 for secondary or higher education), higher partner education level (AOR = 1.24; 95% CI: 1.06–1.45 for primary education and AOR = 1.56; 95% CI: 1.26–1.94 for secondary or higher school), women from higher household wealth index (AOR = 1.29; 95% CI: 1.11–1.50 for middle wealth index; AOR= 1.57; 95% CL: 1.17–2.11 for rich wealth index), improved maternal exposure to the media, and increased awareness about MTCT of HIV. However, residents living in rural communities (AOR=0.66; 95% CI: 0.51–0.85) and travelling long distances to the health facility (AOR = 0.8; 95% CI: 0.69–0.91) were associated with non-use of prenatal HIV test service in East African countries. In each East African country, factors associated with prenatal HIV test uptake for PMTCT varied. In conclusion, the pooled prenatal HIV test uptake for PMTCT of HIV was low in East Africa compared to the global target. Scaling up interventions to improve enablers whilst addressing barriers to the use of prenatal HIV test services are essential to end the HIV/AIDS epidemic in East African countries.


2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Betregiorgis Zegeye ◽  
Felix Emeka Anyiam ◽  
Bright Opoku Ahinkorah ◽  
Edward Kwabena Ameyaw ◽  
Eugene Budu ◽  
...  

Abstract Background Sub-Saharan Africa (SSA) remains the region with the highest burden of anemia globally. Since anemia has both health and non-health-related consequences, its reduction is one of the Sustainable Development Goals. Therefore, this study aimed to examine the prevalence of anemia and its associated factors among married women in SSA. Methods Using Stata version-14 software, the analysis was done on 89,029 married women from the Demographic and Health Surveys of 19 countries in SSA. Pearson Chi-Square test and Binary logistic regression analyses were used to examine the factors associated with anemia. The results were presented using adjusted Odds Ratio (aOR) at a 95% Confidence Interval (CI). A p-value less than or equal to 0.05 (p ≤ 0.05) was considered statistically significant. Results The pooled analysis showed that 49.7% of married women were anemic. Of these, 1.04% and 15.05% were severely and moderately anemic respectively, and the rest 33.61% were mildly anemic. Husband education (primary school-aOR = 0.84, 95% CI; 0.71–0.99), wealth index (middle-aOR = 0.81, 95% CI; 0.68–0.96, richer-aOR = 0.69, 95% CI; 0.57–0.84, richest-aOR = 0.68, 95% CI; 0.51–0.91), modern contraceptive use (yes-aOR = 0.68, 95% CI; 0.56–0.81) and religion (Muslim-aOR = 1.27, 95% CI; 1.11–1.46, others-aOR = 0.73, 95% CI; 0.59–0.90) were factors associated with anemia among married women. Conclusion The findings show that nearly half of the married women are affected by anemia. Enhancing partners’ educational levels, and economic empowerment of women, strengthening family planning services, and working with religious leaders to reduce the perception and religious beliefs related to food restrictions can be the main focus to reduce the burden of anemia among married women in SSA.


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