Spatial Pattern and Determinants of Institutional Delivery in Ethiopia: Spatial and Multilevel Analysis Using 2019 Ethiopian Mini Demographic and Health Survey.

Abstract Background: In Ethiopia, despite the progress that has been made to improve maternal and child health, the proportion of births occurring at health institutions is still very low (26%), Which significantly contribute to a large number of maternal death 412 deaths/100,000 live births. Therefore, this study intended to determine spatial pattern and factors affecting institutional delivery among women who had live birth in Ethiopia within five years preceding survey.Method: Data from 2019 Ethiopian mini demographic and health survey were used. Taking into account the nested structure of the data, multilevel logistic regression analysis has been employed to a nationally representative sample of 5753 women nested with in 305 communities/clusters.Result: A significant heterogeneity was observed between clusters for institutional delivery which explains about 57% of the total variation. Individual-level variables: primary education (OR= 1.8: 95% CI: 1.44-2.26), secondary education (OR= 3.65: 95% CI: 2.19- 6.1), diploma and higher (OR= 2.74: 95% CI: 1.02 – 7.34), women who had both Radio and Television were 4.6 times (OR= 4.6; 95% CI: 2.52, 8.45), four and above Antenatal visit (AOR=2.72 ,95% CI:2.2, 3.34), rich wealth index (OR= 2.22; 95% CI: 1.62- 2.99), birth interval for 18 to 33 months (OR= 1.8; 95% CI: 1.19, 2.92), and women who space birth for 33 and above months (OR= 2.02; 95% CI: 1.3, 3.12) were associated with institutional delivery. Community level variables, community high proportion of antenatal visit (OR= 4.68; 95% CI: 4.13- 5.30), and Region were associated with institutional deliveryConclusion: A clustered pattern of areas with low institutional delivery was observed in Ethiopia. Both individual and community level factors found significantly associated with institutional delivery theses showed the need for community women education through health extension programs and community health workers. And the effort to promote institutional delivery should pay special attention to antenatal care, less educated women and interventions considering awareness, access, and availability of the services are vital for regions.

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Spatial Pattern And Determinants of Institutional Delivery in Ethiopia: Spatial and Multilevel Analysis Using 2019 Ethiopian Mini Demographic and Health Survey.

10.21203/rs.3.rs-960333/v1 ◽

2021 ◽

Author(s):

Mukemil Awol ◽

Dejene Edosa Dirirsa ◽

Kemal Jemal

Keyword(s):

Spatial Pattern ◽

Health Survey ◽

Institutional Delivery ◽

Health Workers ◽

Wealth Index ◽

Demographic And Health Survey ◽

Community Level ◽

Antenatal Visit ◽

Significant Heterogeneity ◽

Individual Level

Abstract Background: In Ethiopia, despite the progress that has been made to improve maternal and child health, the proportion of births occurring at health institutions is still very low (26%), Which significantly contribute to a large number of maternal death 412 deaths/100,000 live births. Therefore, this study intended to determine spatial pattern and factors affecting institutional delivery among women who had live birth in Ethiopia within five years preceding survey.Method: Data from 2019 mini Ethiopian demographic and health survey were used. Taking into account the nested structure of the data, multilevel logistic regression analysis has been employed to a nationally representative sample of 5753 women nested with in 305 communities/clusters.Result: A significant heterogeneity was observed between clusters for institutional delivery which explains about 57% of the total variation. Individual-level variables: primary education (OR= 1.8: 95% CI: 1.44-2.26), secondary education (OR= 3.65: 95% CI: 2.19- 6.1), diploma and higher (OR= 2.74: 95% CI: 1.02 – 7.34), women who had both Radio and Television were 4.6 times (OR= 4.6; 95% CI: 2.52, 8.45), four and above Antenatal visit (AOR=2.72 ,95% CI:2.2, 3.34), rich wealth index (OR= 2.22; 95% CI: 1.62- 2.99), birth interval for 18 to 33 months (OR= 1.8; 95% CI: 1.19, 2.92), and women who space birth for 33 and above months (OR= 2.02; 95% CI: 1.3, 3.12) were associated with institutional delivery. Community level variables, community high proportion of antenatal visit (OR= 4.68; 95% CI: 4.13- 5.30), and Region were associated with institutional deliveryConclusion: A clustered pattern of areas with low institutional delivery was observed in Ethiopia. Both individual and community level factors found significantly associated with institutional delivery theses showed the need for community women education through health extension programs and community health workers. And the effort to promote institutional delivery should pay special attention to antenatal care, less educated women and interventions considering awareness, access, and availability of the services are vital for regions.

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Community and Individual level Factors Associated with Anemia among Lactating mothers in Ethiopia using data from Ethiopian Demographic and Health Survey, 2016; Multilevel analysis

10.21203/rs.3.rs-18828/v1 ◽

2020 ◽

Author(s):

Alemneh mekuriaw liyew ◽

Achamyeleh Birhanu Teshale

Keyword(s):

Health Survey ◽

Household Head ◽

Public Health Problem ◽

Wealth Index ◽

Demographic And Health Survey ◽

Community Level ◽

Modern Contraceptive ◽

Individual Level ◽

Lactating Mothers ◽

Prevalence Of Anemia

Abstract 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 are neither pregnant nor breastfeeding. To date, there is limited evidence on community level determinates of anemia among lactating mothers in Ethiopia. Therefore, this study aimed to assess the individual and community level determinants of anemia among lactating mothers in Ethiopia.Methods: Secondary data analysis was employed using 2016 Ethiopian demographic and health survey. A total of 4658 (weighted samples) breastfeeding women were included in the current study. Multilevel logistic regression model was used to identify individual and community level determinants of anemia during lactation. Finally, adjusted odds ratio with 95% confidence interval was reported.Results: The overall prevalence of anemia was 28.3% (95% CI; 26.7, 30.0). With the higher regional prevalence in Somali (68%) and Afar (47%) regions. using modern contraceptive method [AOR = 0.71; 95% CI: 0.58, 0.87]; Poorer [AOR= 0.77; 95% CI: 0.61, 0.98], middle [AOR = 0.74; 95% CI: 0.56, 0.97] rich [AOR = 0.64; 95% CI: 0.46, 0.85], richest [AOR = 0.66; 95% CI: 0.43, 0.98] wealth index; working within the 12 months preceding the survey [AOR = 0.77; 95% CI: 0.64, 0.92]; and taking iron during pregnancy [AOR = 0.82; 95% CI: 0.68, 0.98] were associated with lower odds of anemia. Whereas, female household head [AOR = 1.22; 95% CI: 1.01, 1.49] having two births [AOR = 1.27; 95% CI: 1.04, 1.55], three to four births [AOR = 1.53; 95% CI: 1.14, 2.06] and higher community illiteracy [AOR = 1.06; 95% CI: 1.06, 1.70] were associated with the increased odds of anemia during lactation.Conclusion: In this study the prevalence of anemia among lactating mothers was high. It was affected by both community and individual-level factors. Therefore focusing on family planning services especially on modern contraceptive methods, child spacing and improving community literacy will help to reduce anemia during lactation.

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Risk factor of neonatal mortality in Ethiopia: multilevel analysis of 2016 Demographic and Health Survey

Tropical Medicine and Health ◽

10.1186/s41182-021-00303-5 ◽

2021 ◽

Vol 49 (1) ◽

Author(s):

Setegn Muche Fenta ◽

Hailegebrael Birhan Biresaw ◽

Kenaw Derebe Fentaw

Keyword(s):

Neonatal Mortality ◽

Health Survey ◽

Wealth Index ◽

Demographic And Health Survey ◽

Community Level ◽

Sub Saharan Africa ◽

Multiple Birth ◽

African Countries ◽

Sub Saharan ◽

Newborn Children

Abstract Background In sub-Saharan African countries, neonatal mortality rates remain unacceptably high. Ethiopia is one of the countries in Sub-Saharan Africa with the highest death rates of newborn children. Therefore, this study aimed to identify the risk factors associated with neonatal mortality in Ethiopia at the individual and community level. Methods The 2016 Ethiopian Demographic and Health Survey data was accessed and used for the analysis. A total of 2449 newborn children were included in the analysis. The multilevel logistic regression model was used to identify the significant factor of neonatal mortality. Adjusted odds ratio with a 95% confidence interval and p-value < 0.05 in the multilevel model was reported. Results A total of 2449 newborn children were included in this study. Multiple birth type (AOR = 3.18; 95% CI 2.78, 3.63), birth order of ≥ 5 (AOR = 2.15; 95% CI 1.75, 2.64), pre-term birth (AOR = 5.97; 95% CI 4.96, 7.20), no antenatal care (ANC) visit during pregnancy (AOR = 2.33; 95% CI 2.09, 2.61), not received TT injection during pregnancy (AOR = 2.28; 95% CI 1.92, 2.71), delivered at home (AOR = 1.99; 95% CI 1.48, 2.69), less than 24 months of preceding birth interval (AOR = 1.51; 95% CI 1.35,1.68), smaller birth size (AOR = 1.58; 95% CI 1.46, 1.71), never breastfeeding (AOR = 2.43; 95% CI 2.17, 2.72), poor wealth index (AOR = 1.29; 95% CI 1.17,1.41), non-educated mothers (AOR = 1.58; 95% CI 1.46, 1.71), non-educated fathers (AOR = 1.32; 95% CI 1.12, 1.54), rural residence (AOR = 2.71; 95% CI 2.23, 3.29), unprotected water source (AOR = 1.35; 95% CI 1.16, 1.58), and have no latrine facility (AOR = 1.78; 95% CI 1.50, 2.12) were associated with a higher risk of neonatal mortality. Neonates living in Amhara, Oromia, Somali, Harari, and Dire Dawa had a higher risk of neonatal mortality compared to Tigray. Moreover, the random effects result showed that about 85.57% of the variation in neonatal mortality was explained by individual- and community-level factors. Conclusions The findings suggest that attention be paid to education-based programs for mothers that would highlight the benefits of delivery care services, such as ANC visits, TT injections, and facility births. Meanwhile, public health initiatives should focus on expanding access to quality sanitation facilities, especially for latrines and drinking water that could improve neonatal health at the community-level as a whole.

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Geographical variations and associated factors of defaulting from immunization among children aged 12 to 23 months in Ethiopia: using spatial and multilevel analysis of 2016 Ethiopian Demographic and Health Survey

Environmental Health and Preventive Medicine ◽

10.1186/s12199-021-00984-8 ◽

2021 ◽

Vol 26 (1) ◽

Author(s):

Mukemil Awol ◽

Zewdie Aderaw Alemu ◽

Nurilign Abebe Moges ◽

Kemal Jemal

Keyword(s):

Multilevel Analysis ◽

Health Survey ◽

Associated Factors ◽

Demographic And Health Survey ◽

Community Level ◽

Scan Statistics ◽

Moran’S I ◽

Moran's I ◽

Depth Analysis ◽

Global Moran’S I

Abstract Background In Ethiopia, despite the considerable improvement in immunization coverage, the burden of defaulting from immunization among children is still high with marked variation among regions. However, the geographical variation and contextual factors of defaulting from immunization were poorly understood. Hence, this study aimed to identify the spatial pattern and associated factors of defaulting from immunization. Methods An in-depth analysis of the 2016 Ethiopian Demographic and Health Survey (EDHS 2016) data was used. A total of 1638 children nested in 552 enumeration areas (EAs) were included in the analysis. Global Moran’s I statistic and Bernoulli purely spatial scan statistics were employed to identify geographical patterns and detect spatial clusters of defaulting immunization, respectively. Multilevel logistic regression models were fitted to identify factors associated with defaulting immunization. A p value < 0.05 was used to identify significantly associated factors with defaulting of child immunization. Results A spatial heterogeneity of defaulting from immunization was observed (Global Moran’s I = 0.386379, p value < 0.001), and four significant SaTScan clusters of areas with high defaulting from immunization were detected. The most likely primary SaTScan cluster was seen in the Somali region, and secondary clusters were detected in (Afar, South Nation Nationality of people (SNNP), Oromiya, Amhara, and Gambella) regions. In the final model of the multilevel analysis, individual and community level factors accounted for 56.4% of the variance in the odds of defaulting immunization. Children from mothers who had no formal education (AOR = 4.23; 95% CI: 117, 15.78), and children living in Afar, Oromiya, Somali, SNNP, Gambella, and Harari regions had higher odds of having defaulted immunization from community level. Conclusions A clustered pattern of areas with high default of immunization was observed in Ethiopia. Both the individual and community-level characteristics were statistically significant factors of defaulting immunization. Therefore, the Federal Ethiopian Ministry of Health should prioritize the areas with defaulting of immunization and consider the identified factors for immunization interventions.

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Households access to improved drinking water sources and toilet facilities in Ethiopia: a multilevel analysis based on 2016 Ethiopian Demographic and Health Survey

BMJ Open ◽

10.1136/bmjopen-2020-042071 ◽

2021 ◽

Vol 11 (3) ◽

pp. e042071

Author(s):

Zewudu Andualem ◽

Henok Dagne ◽

Zelalem Nigussie Azene ◽

Asefa Adimasu Taddese ◽

Baye Dagnew ◽

...

Keyword(s):

Drinking Water ◽

Health Survey ◽

Rural Households ◽

Wealth Index ◽

Water Sources ◽

Demographic And Health Survey ◽

P Value ◽

Cluster Sampling ◽

Drinking Water Source ◽

Drinking Water Sources

ObjectiveThis study aimed to assess households access to improved drinking water sources and sanitation facilities and their associated factors in Ethiopia.DesignCross-sectional study.SettingEthiopia.ParticipantsHousehold heads.Primary outcomesAccess to improved drinking water sources and toilet facilities.MethodsWe conducted an in-depth secondary data analysis of 2016 Ethiopian Demographic and Health Survey. Data from a total of 16 650 households and 645 clusters were included in the analysis. The households were selected using a stratified two-stage cluster sampling technique. Multilevel binary logistic regression analyses were performed to identify factors associated with access to an improved drinking water source and toilet facilities. Adjusted OR with a 95% CI was reported with p value <0.05 was used to declare a significant association between the covariates and the outcome variables.ResultsThe proportions of households’ access to improved sources of drinking water and toilet facilities were 69.94% (95% CI: 69.23% to 70.63%) and 25.36% (95% CI: 24.69% to 26.03%), respectively. Households headed by women and households with a better wealth index were positively associated with access to improved drinking water sources. Whereas rural households, ≥30 min round trip to obtain drinking water and region were factors negatively associated with households access to improved drinking water sources. A higher probability of having access to improved toilet facilities: households with heads who had attained higher education, households having better access to improved sources of drinking water and households with better wealth index. While the following households were less likely to have access to improved toilet facilities: households with heads were widowed, households with four to six members, rural households and region.ConclusionThe study found that the proportions of households’ access to improved drinking water sources and toilet facilities in Ethiopia were relatively low, which demands the need to tailor strategies to increase the coverage of access to improved drinking water sources and toilet facilities.

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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

BMC Public Health ◽

10.1186/s12889-020-10071-2 ◽

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.

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A multilevel analysis of overweight and obesity among non-pregnant women of reproductive age in Malawi: evidence from the 2015–16 Malawi Demographic and Health Survey

International Health ◽

10.1093/inthealth/ihy093 ◽

2018 ◽

Vol 11 (6) ◽

pp. 496-506 ◽

Cited By ~ 3

Author(s):

Peter Austin Morton Ntenda ◽

Jane Flora Kazambwe

Keyword(s):

Pregnant Women ◽

Health Survey ◽

Media Coverage ◽

White Collar ◽

Overweight And Obesity ◽

Demographic And Health Survey ◽

Community Level ◽

Reproductive Age ◽

The Individual ◽

Maternal Overweight

Abstract Background Overweight and obesity are well-known risk factors for non-communicable diseases such as cardiovascular disease, diabetes, some cancers and musculoskeletal disorders. In Malawi, the proportion of women who are overweight/obese has doubled, from 10% in 1992 to 21% in 2015–16. Therefore we aimed to explore the individual- and community-level factors associated with overweight and obesity among non-pregnant women of child-bearing age. Methods Secondary analysis of the 2015–16 Malawi Demographic and Health Survey was conducted. Overweight was defined as a body mass index (BMI) of 25 to <30 kg/m2, while obesity was defined as a BMI ≥30 kg/m2. Two-level multilevel multivariable logistic regression models were constructed using a logit-link function with a binomial distribution on 7326 women living in 850 different communities. Results At the individual level, the adjusted multilevel regression results showed that women 15–19 y of age as well as women from the poorest households had reduced odds of being overweight/obese. However, women with white collar jobs and women who were affiliated with the Church of Central Africa Presbyterian and the Roman Catholic church had increased odds of being overweight/obese. At the community level, women from urban areas and women who resided in communities with a low percentage of media exposure had increased odds of being overweight or obese. While women from poor communities had reduced odds of being overweight and obese, the proportion change in variance showed that 56, 77 and 78% of total variations in the odds of overweight, obese and overweight/obese across the communities were explained by both individual- and community-level factors. The median odds ratio showed that the likelihood of maternal overweight, obese and overweight/obese increased by 63, 39 and 84% when the women moved from low- to high-risk neighbourhoods. Conclusions Older women, Christian women, women with white collar jobs and women from the richest households should be targeted during policy formulation. At the community level, media coverage should be spread evenly so that health awareness messages, consequences and means of overweight and obesity prevention are getting to the targeted women. Our study revealed evidence of clustering effects of overweight and obesity at the community level, hence neighbourhood variations with respect to maternal overweight and obesity should be taken into account when designing nutritional policies.

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High prevalence of under-five child mortality in the pastoralist communities of Ethiopia: Evidence from the 2016 Ethiopian demographic and health survey data

10.21203/rs.3.rs-61694/v1 ◽

2020 ◽

Author(s):

Mesfin Wudu Kassaw ◽

Aele Mamo ◽

Biruk Abate ◽

Ayelign Kassie ◽

Seteamlak Masresha

Keyword(s):

Survey Data ◽

Child Mortality ◽

Health Survey ◽

Wealth Index ◽

Demographic And Health Survey ◽

Under Five ◽

Khat Chewing ◽

High Prevalence ◽

Health Survey Data ◽

The Government

Abstract Objective: The aim of this study was to assess the prevalence and association of child mortality in the pastoralist regions of Ethiopia. The study is a further analysis from 2016 Ethiopian Demographic and Health Survey data. Results: The prevalence of under-five child mortality in the pastoralist’s regions was 23.2%, 95%CI (21.4%, 24.6%). The prevalence of mortality among daughters was 15.4%, 95%CI (14.2, 16.6%), and sons 16.8%, 95%CI (15.6, 18.1%).In logistic regression, wealth index, head of household, Khat chewing, type of child birth, husband education, and child age in months were associated with under-five mortality irrespective of the deceased children’s gender. The prevalence of under-five child mortality in the pastoralist regions of Ethiopia was high, which was far highest in relative to the national under-five mortality prevalence. In assessing the effect of variables on under-five child mortality by gender, almost all the variables that have an effect on female or male child are similar. The government should emphasize on the pastoralists’ regions to decrease the high prevalence of under-five child mortality.

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Determinants of early sexual initiation among female youth in Ethiopia: a multilevel analysis of 2016 Ethiopian Demographic and Health Survey

BMC Women s Health ◽

10.1186/s12905-020-01069-4 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Mastewal Arefaynie ◽

Melaku Yalew ◽

Yitayish Damtie ◽

Bereket Kefale

Keyword(s):

Health Survey ◽

Addis Ababa ◽

Statistical Significance ◽

Sexual Initiation ◽

Demographic And Health Survey ◽

Community Level ◽

Wealth Status ◽

Mixed Effect ◽

Female Youth ◽

Early Sexual Initiation

Abstract Background Evidences on determinants of early sexual initiation among female youth is still limited especially; community-level factors are not investigated in Ethiopia. Therefore, the aim of this study was to assess individual and community-level factors associated with early sexual initiation among female youth in Ethiopia. Methods The 2016 Ethiopian Demographic and Health Survey (EDHS) dataset were used and a total of 6143 participants (female youth) were included. Multi-level mixed-effect logistic regression was done to identify individual and community-level factors. Adjusted odds ratio along with 95% confidence interval was used to show the strength and direction of the association. Finally, the level of statistical significance was declared at P value less than 0.05. Results Individual-level factors significantly associated with early sexual initiation among female youth were; age group from 19 to 24 years [AOR = 5.8, 95% CI = (4.6, 7.3)], not attending school [AOR = 14.1, 95% CI = (8.1, 24.7)], ever chewing Chat [AOR = 2.0, 95% CI = (1.3, 3.0)]. From community-level factors: living in Addis Ababa [AOR = 0.3, 95% CI = (0.2, 0.5)], living in Gambella [AOR = 2.7, 95% CI = (1.7, 4.3)] and live in a low proportion of poor communities [AOR = 0.7, 95% CI = (0.5, 0.9)] were significantly associated with early sexual initiation among female youth in Ethiopia. Conclusions Age, low educational status, ever chewing Chat, region and live in a high proportion of poor community had a statistical association with early sexual initiation among female youth in Ethiopia. Improving educational coverage and community-level of wealth status are important intervention areas to delay the age of early sexual initiation.

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