scholarly journals Incidence and predictors of under-five mortality in East Africa using multilevel Weibull regression modeling

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Getayeneh Antehunegn Tesema ◽  
Achamyeleh Birhanu Teshale ◽  
Zemenu Tadesse Tessema
Keyword(s):  
East Africa ◽  
Health Facility ◽  
Media Exposure ◽  
Facility Delivery ◽  
Health Facility Delivery ◽  
East African ◽  
African Countries ◽  
Wealth Status ◽  
Under Five ◽  
Size At Birth

Abstract Background In 2017, an estimated 5.3 million under-five children died annually in Sub-Saharan African countries, more than half of those deaths occurred in East Africa. Though East African countries share the huge burden of global under-five mortality, there is limited evidence on the incidence and predictors of under-five mortality. Therefore, this study investigated the incidence and predictors of under-five mortality in East Africa. Methods A community-based cross-sectional study was done based on the Demographic and Health Survey (DHS) data of 12 East African countries conducted from 2008 to 2019. A total weighted sample of 138,803 live births within 5 years preceding the survey were included for analysis. The Kaplan-Meier curve and Log-rank test were done to assess the children’s survival experience across variable categories. The Global Schoenfeld residual test was employed for checking Proportional Hazard (PH) assumptions and it was violated (p-value< 0.05). Considering the hierarchical nature of DHS data, multilevel parametric survival models were fitted. Model comparison was made by AIC, deviance, and shape of the hazard function. Variables with a p-value of less than 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multilevel Weibull regression analysis, the Adjusted Hazard Ratio (AHR) with 95% Confidence Interval (CI) was reported to declare the significant predictors of under-five mortality. Results Under-five mortality rate in East Africa was 51.318 (95% CI: 51.311, 51.323) per 1000 live births. Babies born to mothers attained secondary education and above (AHR = 0.83, 95% CI: 0.75, 0.91), being 2nd - 4th birth order (AHR = 0.62, 95% CI: 0.56, 0.67), ≥ 5th birth order (AHR = 0.68, 95% CI: 0.61, 0.76), health facility delivery (AHR = 0.87, 95% CI: 0.82, 0.93), 1–3 ANC visit (AHR = 0.61, 95% CI: 0.54, 0.68), births interval of 24–48 months (AHR = 0.53, 95% CI: 0.50, 0.57), wanted pregnancy (AHR = 0.72, 95% CI: 0.68, 0.76), middle wealth status (AHR = 0.90, 95% CI: 0.83, 0.97), and richest wealth status (AHR = 0.81, 95% CI:0.73, 0.90) were significantly associated with lower hazards of under-five mortality. Whereas, advanced maternal age (≥35 years) (AHR = 1.13, 95% CI: 1.04, 1.24),, babies born to household who did not have media exposure (AHR = 1.13, 95% CI: 1.07, 1.20), twin births (AHR = 3.81, 95% CI: 3.52, 4.12), being male child (AHR = 1.27, 95%CI: 1.21, 1.33), small birth size at birth (AHR = 1.73, 95% CI: 1.63, 1.84), and large size at birth (AHR = 1.11, 95% CI: 1.04, 1.11) were significantly associated with higher hazards of under-five mortality. Conclusion Under-five mortality is a major public health concern in East African countries. Health facility delivery, ANC visit, higher wealth status, adequate birth spacing, wanted pregnancy, and maternal education were significantly correlated with a lower risk of under-5 mortality. Whereas, higher birth order, small or large size at birth, male birth, twin birth, advanced maternal age and mothers who didn’t have media exposure were significantly correlated with a higher risk of under-five mortality. This study highlights that public health programs should enhance health facility delivery, ANC visit, media exposure, maternal education, and adequate birth spacing to decrease the incidence of under-five mortality in East Africa.

scholarly journals Pooled prevalence and associated factors of health facility delivery in East Africa: Mixed-effect logistic regression analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250447
Author(s):  
Getayeneh Antehunegn Tesema ◽  
Zemenu Tadesse Tessema
Keyword(s):  
Logistic Regression ◽  
East Africa ◽  
Health Facility ◽  
Associated Factors ◽  
Facility Delivery ◽  
Health Facility Delivery ◽  
East African ◽  
African Countries ◽  
Mixed Effect ◽  
Pooled Prevalence

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.

scholarly journals Pooled prevalence and associated factors of chronic undernutrition among under-five children in East Africa: A multilevel analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248637
Author(s):  
Getayeneh Antehunegn Tesema ◽  
Yigizie Yeshaw ◽  
Misganaw Gebrie Worku ◽  
Zemenu Tadesse Tessema ◽  
Achamyeleh Birhanu Teshale
Keyword(s):  
East Africa ◽  
Pooled Analysis ◽  
East African ◽  
African Countries ◽  
Mixed Effect ◽  
Under Five ◽  
Under Five Children ◽  
Pooled Prevalence ◽  
Chronic Undernutrition ◽  
Size At Birth

Background Childhood undernutrition is the leading cause of under-five mortality and morbidity in the world particularly in East African countries. Although there are studies on child undernutrition in different East African countries, our search of the literature revealed that there is limited evidence of a pooled analysis of these studies. Therefore, this study aimed to investigate the pooled prevalence and associated factors of chronic undernutrition (i.e. stunting) among under-five children in East Africa. Methods A pooled analysis of the Demographic and Health Surveys (DHSs) in 12 East African countries was conducted. A total weighted sample of 79744 under-five children was included in the study. Mixed-effect logistic regression analysis was used to identify significant factors associated with chronic undernutrition since the DHS data has a hierarchical structure. The intra-class correlation coefficient (ICC), Median Odds Ratio (MOR), Likelihood Ratio (LR)-test, and deviance was used for model comparison. Variables with p-value <0.2 in the bivariable mixed-effect logistic regression analysis were considered for the multivariable analysis. In the multivariable multilevel analysis model, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) were reported for significant factors. Results The pooled prevalence of chronic undernutrition among underfive children in East Africa was 33.3% (95% CI: 32.9%, 35.6%) ranging from 21.9% in Kenya to 53% in Burundi. Children whose mothers lived in rural area (AOR = 1.11, 95% CI: 1.06, 1.16), born to mother who had no formal education (AOR = 1.42, 95% CI: 1.34, 1.50) and primary education (AOR = 1.37, 95% CI: 1.31, 1.44), being in poor household (AOR = 1.66, 95% CI: 1.58, 1.74), and middle household (AOR = 1.42, 95% CI: 1.35, 1.49), child aged 36–48 months (AOR = 1.09, 95% CI: 1.04, 1.14), being male (AOR = 1.19, 95% CI: 1.15, 1.23), 2nd - 4th birth order (AOR = 1.08, 95% CI: 1.03, 1.13), and above 4th 1.27 (AOR = 1.27, 95% CI: 1.19, 1.35), home delivery 1.09 (AOR = 1.09, 95% CI: 1.05, 1.13), small size at birth (AOR = 1.35, 95% CI: 1.29, 1.40) and being multiple births (AOR = 1.98, 95% CI: 1.81, 2.17) were associated with increased odds of stunting. While, antenatal care visit (AOR = 0.89, 95% CI: 0.86, 0.93), mothers aged 25–34 (AOR = 0.83, 95% CI: 0.79, 0.86) and ≥ 35 years (AOR = 0.76, 95% CI: 0.72, 0.81), large size at birth (AOR = 0.85, 95% CI: 0.81, 0.88), and family size >8 (AOR = 0.92, 95% CI: 0.87, 0.98) were associated with decreased odds of stunting. Conclusion The study revealed that stunting among under-five children remains a major public health problem in East Africa. Therefore, to improve child nutrition status the governmental and non-governmental organizations should design public health interventions targeting rural residents, and the poorest households. Furthermore, enhancing health facility delivery, ANC visit, and maternal health education is vital for reducing child chronic undernutrition.

scholarly journals Zinc utilization and associated factors among under-five children with diarrhea in East Africa: A generalized linear mixed modeling

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0243245
Author(s):  
Yigizie Yeshaw ◽  
Misganaw Gebrie Worku ◽  
Zemenu Tadesse Tessema ◽  
Achamyeleh Birhanu Teshale ◽  
Getayeneh Antehunegn Tesema
Keyword(s):  
East Africa ◽  
Associated Factors ◽  
Maternal Education ◽  
Media Exposure ◽  
Wealth Index ◽  
East African ◽  
African Countries ◽  
Under Five ◽  
Under Five Children ◽  
Zinc Utilization

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.

scholarly journals Women’s Health Decision-Making Autonomy and Skilled Birth Attendance in Ghana

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Edward Kwabena Ameyaw ◽  
Augustine Tanle ◽  
Kwaku Kissah-Korsah ◽  
Joshua Amo-Adjei
Keyword(s):  
Decision Making ◽  
Women’S Health ◽  
Women's Health ◽  
Health Facility ◽  
Facility Delivery ◽  
Health Facility Delivery ◽  
Wealth Status ◽  
Health Decision Making ◽  
Birth Attendance ◽  
Health Decision

Delivering in health facility under the supervision of skilled birth attendant is an important way of mitigating impacts of delivery complications. Empirical evidence suggests that decision-making autonomy is aligned with holistic wellbeing especially in the aspect of maternal and child health. The objective of this paper was to examine the relationship between women’s health decision-making autonomy and place of delivery in Ghana. We extracted data from the 2014 Ghana Demographic and Health Survey. Descriptive and logistic regression techniques were applied. The results indicated that women with health decision-making autonomy have higher tendency of health facility delivery as compared to those who are not autonomous [OR = 1.27, CI = 1.09–1.48]. However, those who have final say on household large purchases [OR = 0.71, CI = 0.59–0.84] and those having final say on visits [OR = 0.86, CI = 0.73–1.01] were less probable to deliver in health facility than those without such decision-making autonomy. Consistent with existing evidence, wealthier, urban, and highly educated women had higher inclination of health facility delivery. This study has stressed the need for interventions aimed at enhancing health facility delivery to target women without health decision-making autonomy and women with low education and wealth status, as this can play essential role in enhancing health facility delivery.

Regional differentials in early antenatal care, health facility delivery and early postnatal care among women in Uganda

2021 ◽  
Author(s):  
Ruth Atuhaire ◽  
Robert Wamala ◽  
Leonard K Atuhaire
Keyword(s):  
Community Health ◽  
Health Facility ◽  
Postnatal Care ◽  
Maternal Education ◽  
Health Workers ◽  
Media Exposure ◽  
Facility Delivery ◽  
Health Facility Delivery ◽  
Maternal Healthcare ◽  
Care Health

Abstract BackgroundMaternal health equality is an ultimate goal for a better world. Early maternal healthcare service utilization is hindered by numerous social and economical barriers, along with widespread inequalities in utilization of existing services. To better understand variations existing in Uganda, we assessed differences in early antenatal care, health facility delivery and early postnatal care among women in selected sub regions. The differences were decomposed into components attributed to variation in women's characteristics and the effects of coefficients.MethodsWe used a sample of 1,521 women of reproductive ages (15-49), who delivered a child five years prior to the 2016 Uganda Demographic and Health Survey. Non-linear Oaxaca’ Blinder Multivariate Decomposition method and STATA 13.0 software were used.ResultsSignificant differences in early ANC, health facility delivery and EPNC among women in Eastern and Western sub regions were attributed to both variation in women’s characteristics and effects of coefficients. Overall gap in early ANC (57.39%), health facility delivery (63.88%) and EPNC (59.06%) was attributed to differences in women's characteristics, whereas differences in effects of coefficients attributed 42.61% variations in early ANC, 36.12% in health facility delivery, and 40.94% in EPNC.Specifically, overall gap in early ANC would reduce if differences in availability of community health workers (31.6%) and media exposure (34.7%) were to disappear. Furthermore, the gap would increase by 68.8% and 12.6% in absence of the variation in effects of maternal education, and wealth differences respectively. Overall gap in health facility delivery would reduce if differences in community health worker availability (24.6%) and media exposure (37.2%) were to disappear, and increase by 54.9% in the absence of variations in effects of maternal education. The overall gap in EPNC would reduce if differences in maternal education (18.5%) and community health worker availability (17.17%) were to disappear and increase by 52.8% and 8.4% in the absence of the variation in effects of maternal education and wealth quintile respectively.ConclusionProgress towards equitable maternal health should focus more on strategies that guarantee even distribution of community health workers, broad dissemination of maternal healthcare information and girl child education completion in Uganda.

scholarly journals Magnitudes and Determinants of Antenatal Care Utilization among Pregnant Women in East Africa: Evidence from Demographic and Health Surveys (DHS) from 2010 to 2018

2021 ◽  
Author(s):  
Temam Beshir Raru ◽  
Belay Negash ◽  
Biruk Shalmenu ◽  
Addisu Birhanu ◽  
Lemma Demissie ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Antenatal Care ◽  
East Africa ◽  
Health Surveys ◽  
Logistic Regression Model ◽  
Media Exposure ◽  
Wealth Index ◽  
Demographic And Health Surveys ◽  
East African ◽  
African Countries

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.

scholarly journals Prevalence and Determinants of Home Delivery in Eastern Africa: Further Analysis of Countries Recent Demographic and Health Survey Data

2021 ◽  
Author(s):  
Lemma Demissie Regassa ◽  
Assefa Tola ◽  
Adisu Birhanu Weldesenbet ◽  
Biruk Shalmeno Tusa
Keyword(s):  
East Africa ◽  
Survey Data ◽  
Health Survey ◽  
Media Exposure ◽  
Wealth Index ◽  
Home Delivery ◽  
Demographic And Health Survey ◽  
Eastern Africa ◽  
East African ◽  
African Countries

Abstract Background: Despite the high proportion of maternal mortality ratio in East African countries primarily attributed to home delivery, overall magnitude of home delivery and its determinants remains unclear. Therefore, the current study aimed to determine magnitude of home delivery and its determinant factors in East Africa using Demographic and Health Survey (DHS) data.Methods: We pooled the DHS survey data of the 11 East African countries, and a total weighted sample of 125,786 women were included in the study. Generalized Linear Mixed Models (GLMM) was fitted to identify factors associated with home delivery. Variables with Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI), and p-value < 0.05 in the final GLMM model were reported to declare significantly associated factors with home delivery.Result: The weighted prevalence of home delivery was 23.79% [95% CI: 23.55 – 24.02] among women in East Africa countries. Home delivery was highest among Ethiopian women (72.5%) whereas, it was lowest among women from Mozambique (2.8%). In GMM, respondent’s age group, marital status, educational status, place of residence, living country, wealth index, media exposure and total children ever born were shown significantly associated with the home delivery in the East Africa countiesConclusion: Home delivery was varied between countries of East African zone. The home delivery was significantly increased among women aged 20-34 years, higher number of ever born children, rural residence, never married or formerly married participants. To the contrast home delivery was decreased with higher educational level, media exposure, and higher wealth index. Wide range interventions to decrease home delivery should focus on addressing inequities associated with maternal education, family wealth, increased access to media, as well as narrowing the gap between the rural and the urban areas, poor and rich families, and married and unmarried mothers.

scholarly journals Minimum Acceptable Diet and its Predictors among Children Aged 6-23 Months in Mareka District, Southern Ethiopia: Community Based Cross-Sectional Study

2020 ◽  
Vol 9 (4) ◽  
pp. 202-211
Author(s):  
Fentaw Wassie Feleke ◽  
◽  
Getahun Fentaw Mulaw
Keyword(s):  
Health Facility ◽  
Service Utilization ◽  
Media Exposure ◽  
Cross Sectional Study ◽  
Facility Delivery ◽  
Sectional Study ◽  
Health Facility Delivery ◽  
Community Based ◽  
Cross Sectional ◽  
Child Age

Background: Optimal infant and young child feeding practices are essential for normal growth, better health, and mental and physical development. Even though there are a lot of nutrition intervention programs in Ethiopia, still suboptimal feeding practices are prevalent. This study was devised to assess a level of minimum acceptable diet (MAD) and predictors among children aged 6-23 months in Mareka District, south Ethiopia. Method: A community-based cross-sectional study was employed on 662 study participants from August 15 to September 15/ 2015. They were selected by a multi-stage sampling technique. Data were collected by interviewer-administered semi-structured questionnaires. Statistical significance was declared at p-value <0.05 at multivariable logistic regression. Result: The study showed that 35.5 % of the children aged 6-23 months met the recommended MAD. Maternal primary and secondary education (AOR: 1.90; 95% CI: 1.15-3.16 and AOR: 2.06, 95% CI: 1.12-3.77), Media exposure (AOR: 2.16; 95% CI: 1.46-3.29), health facility delivery (AOR:2.52; 95% CI: 1.54-4.13), child age of 9-11 and 12-23 months (AOR:2.73; 95% CI: 1.41-5.49 and AOR:2.55; 95% CI: 1.39-4.69) and GMP service utilization (AOR: 4.09; 95% CI: 2.51-6.65) were associated with MAD of children. Conclusion: The level of MAD among children was low. Maternal educational status, media exposure, institutional delivery, child age, and GMP service utilization were associated with MAD. Increasing utilization of GMP service, health facility delivery, maternal education, and media promotion was recommended to increase the level of MAD.

scholarly journals Higher rates of early initiation of breastfeeding associated with health facility delivery in Nepal

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Dharel ◽  
A Bhattarai ◽  
Y R Paudel ◽  
P Acharya ◽  
K Acharya
Keyword(s):  
Health Facility ◽  
Newborn Care ◽  
Facility Delivery ◽  
Early Initiation ◽  
Health Facility Delivery ◽  
Essential Newborn Care ◽  
Place Of Delivery ◽  
Early Initiation Of Breastfeeding ◽  
Nationally Representative ◽  
Initiation Of Breastfeeding

Abstract Background Initiation of breastfeeding within one hour from birth is one of the five key essential newborn care messages, implemented along with birth preparedness package since 2008. This study aimed to determine the trend of early initiation of breastfeeding (EIBF) and to assess the effect of health facility delivery on EIBF in Nepal. Methods We analyzed the data from the last four nationally representative Nepal Demographic and Health Surveys (NDHS) conducted in 2001,2006,2011 and 2016. Data on the early initiation of breastfeeding was obtained from the mothers of infants born within 24 months prior to the survey. The explanatory variable was the place of delivery, dichotomized as either the health facility, or home delivery. Survey year had a significant interaction with the place of delivery. Multivariable logistic regression was conducted separately on pooled samples before (NDHS 2001 and 2006) and after (NDHS 2011 and 2016) the program implementation. Adjusted odds ratio (AOR) with 95% confidence interval (CI) for EIBF was calculated after adjusting for predetermined covariates. Results The rate of EIBF increased by 26.5% points (from 32.8% in 2001 to 59.3% in 2016) among infants delivered in a health facility, compared to an increase by 17.1% points (from 29.9% to 47.0%) among home born infants. EIBF increased by 32.5% points before, compared to 49.7% points after BPP. Delivery in a health facility was associated with a higher odd of EIBF in later years (AOR2.3, 95% CI 2.0,2.8), but not in earlier years (AOR1.3, 95% CI 0.9,2.0). Delivery by caesarean section, first-born infant, and lack of maternal education were associated with a lower rate of EIBF in both periods. Conclusions Higher EIBF was associated with health facility delivery in Nepal, only after programmatic emphasis on essential newborn care messages. This implies the need for explicit focus on EIBF at birth, particularly when mother is less educated, primiparous or undergoing operative delivery. Key messages The rate of initiation of breastfeeding within an hour from birth is increasing in Nepal, with higher rates in health facility delivery, as shown by the recent four nationally representative surveys. Programmatic focus on essential newborn care messages may have contributed to significant association of higher rates of early initiation of breastfeeding when delivered in health facility.

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