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Spatial clustering and determinants of home birth after at least one antenatal care visit in Ethiopia: Ethiopian demographic and health survey 2016 perspective.

ABSTRACT: BACKGROUND:All pregnancies are at risk and have to be attended by skilled professionals. In Ethiopia however nearly half (45.7%) of the women were giving birth at home after antenatal care (ANC) visits in which skilled professionals were not available. Therefore, the aim of this study was to assess spatial clustering and the determinant factors of home delivery after antenatal care visits in Ethiopia. METHODS:A case control study was conducted on 2110 mothers who gave birth at home after ANC (cases), and 2510 mothers who gave birth at health institutions after attending ANC (controls), based on EDHS 2016 data. As per the recommendations of the DHS program, we weighed the data before analysis. ArcGIS 10.3 was used to show spatial pattern and SaTScan™ 9.4 to identify significant clusters. Stata 14 was used for data cleaning, weighing, and the analysis of the determinant factors. Bi variable and multi variable multilevel mixed effect logistic regression was fitted. Finally, the Log-likelihood ratio (LLR) and Relative risk with p-value of spatial scan statistics and AOR with 95% CI for significant determinant factors were reported. RESULTS:Home delivery after ANC was spatially clustered in Ethiopia (Moran's Index?=?0.91, p-value

SUBMITTER: Muluneh AG

PROVIDER: S-EPMC7014695 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Spatial clustering and determinants of home birth after at least one antenatal care visit in Ethiopia: Ethiopian demographic and health survey 2016 perspective.

Muluneh Atalay Goshu AG Animut Yaregal Y Ayele Tadesse Awoke TA

BMC pregnancy and childbirth 20200211 1

<h4>Background</h4>All pregnancies are at risk and have to be attended by skilled professionals. In Ethiopia however nearly half (45.7%) of the women were giving birth at home after antenatal care (ANC) visits in which skilled professionals were not available. Therefore, the aim of this study was to assess spatial clustering and the determinant factors of home delivery after antenatal care visits in Ethiopia.<h4>Methods</h4>A case control study was conducted on 2110 mothers who gave birth at hom ...[more]

PMID: 32046677

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Project description:ObjectiveThis study aimed to assess the trends and factors that had contributed to the change in home delivery in Ethiopia over the last decade.Design, setting and analysisA nationally representative repeated cross-sectional survey was conducted using 2005, 2011 and 2016 Ethiopian Demographic and Health Surveys. Multivariate decomposition logistic regression analysis was employed to identify significant factors that have been contributed to the change in home delivery. Level of statistical significance was declared at a two-sided p value <0.05.Outcome measureTrends of home delivery.ParticipantsA total of 33 482 women were included.ResultsHome delivery has been decreased by 21% over the last decade in Ethiopia. In the last decade, 39% of the decrements in home delivery attributed to change in women's compositional characteristics. Antenatal care visits, educational status of the women and husband, birth order, religion, wealth index and distance from a health facility were the main sources of compositional change factors for the change of home delivery. Behavioural changes towards health facility delivery contributed approximately two-thirds of the decline of home delivery in Ethiopia. Antenatal care visits, birth order and religion have significantly contributed to the change of home delivery resulted from behavioural changes towards healthcare facility utilisation over the last decade.ConclusionDespite the importance of health facility delivery, a significant number of women still deliver at home in Ethiopia. Women's compositional characteristics and behaviour changes were significantly associated with the change in home delivery. Multisectoral educational intervention is needed to change women's attitudes towards home delivery. Antenatal care coverage and healthcare facility coverage should increase thereby to improve healthcare facility based-delivery practice. Further research needs to be done to explore the potential barriers of health facility delivery from a religious perspective.

Project description:ObjectiveThis study aimed to assess the spatial distribution, individual and community-level factors associated with low birth weight in Ethiopia.MethodSecondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Survey data. A total of 2110 neonates were included in this study. Spatial autocorrelation analysis was conducted to assess the spatial clustering of LBW. Besides, the spatial scan statistics and ordinary kriging interpolation were done to detect the local level clusters and to assess predicted risk areas, respectively. Furthermore, a multilevel logistic regression model was fitted to determine individual and community-level factors associated with LBW. Finally, most likely clusters with log-likelihood ratio (LLR), relative risk and p value from spatial scan statistics and adjusted OR (AOR) with 95% CI for multilevel logistic regression model were reported.ResultsLBW was spatially clustered in Ethiopia. Primary (LLR=11.57; p=0.002) clusters were detected in the Amhara region. Neonates within this spatial window had a 2.66 times higher risk of being LBW babies as compared with those outside the window. Besides, secondary (LLR=11.4; p=0.003; LLR=10.14, p=0.0075) clusters were identified at southwest Oromia, north Oromia, south Afar and southeast Amhara regions. Neonates who were born from severely anaemic (AOR=1.40, 95% CI (1.03 to 2.15)), and uneducated (AOR=1.90, 95% CI (1.23 to 2.93)) mothers, those who were born before 37 weeks of gestation (AOR=5.97, 95% CI (3.26 to 10.95)) and women (AOR=1.41, 95% CI (1.05 to 1.89)), had significantly higher odds of being LBW babies.ConclusionThe high-risk areas of LBW were detected in Afar, Amhara and Oromia regions. Therefore, targeting the policy interventions in those hotspot areas and focusing on the improvement of maternal education, strengthening anaemia control programmes and elimination of modifiable causes of prematurity could be vital for reducing the LBW disparity in Ethiopia.

Project description:BackgroundDespite continued efforts to address malnutrition, there is minimal reduction in the prevalence rates of stunting in developing countries, including Ethiopia. The association between nutritional and socioeconomic factors collected from a national survey in Ethiopia and stunting have not been rigorously analyzed. Therefore, this study aims to model the effect of nutritional and socioeconomic predictors using 2016 Ethiopian Demographic Health Survey (EDHS) data.MethodsThis study is a secondary data analysis of the 2016 EDHS survey, which included 7909 children aged 6 to59 months. Descriptive statistics using frequency and percentage for categorical data and mean and standard deviation for metric data were conducted. Linearity, confounding, and multicollinearity were checked. Bivariable and multivariable logistic regression were carried out. The adjusted odds ratio (AOR) and 95% confidence interval (CI) were calculated. A receiver operative curve was built to estimate the sensitivity and specificity of the model.ResultsThe study identified that 39.2% of children included in this analysis were stunted. Furthermore, 76.47, 84.27, and 92.62% of the children did not consume fruits and vegetables, legumes and lentils, or meat and its products, respectively. Children aged 24 months to 59 months were found to be at 9.71 times higher risk of being stunted compared to their younger counterparts aged 6-24 months (AOR: 9.71; CI: 8.07, 11.6 children). Those children weighing below 9.1 kg were at 27.86 odds of being stunted compared to those weighing 23.3 kg and above. Moreover, mothers with a height below 150 cm (AOR: 2.01; CI: 1.76, 2.5), living in a rural area (AOR: 1.3, CI: 1.09, 1.54), and being male (AOR: 1.4; CI: 1.26, 1.56) were factors associated with stunting. The predictive ability of the model was 77%: if a pair of observations with stunted and non-stunted children were taken, the model correctly ranks 77% of such pair of observations.ConclusionThe model indicates that being born male, being from a mother of short stature, living in rural areas, small child size, mother with mild anemia, father having no formal education or primary education only, having low child weight, and being 24-59 months of age increases the likelihood of stunting. On the other hand, being born of an overweight or obese mother decreases the likelihood of stunting.

Project description:BackgroundUnderweight is one form of indicators of under-nutrition, which results from the poor nutrient intake and underlying health problems. Its impact is beyond an individual and extends to a country level. It has been known from the literature that underweight has a negative effect on income and development of a country. In the context of Ethiopia, factors predicting underweight remain unknown and there is a paucity of evidence on geographical distribution of underweight among individuals aged 15-49 years. Therefore, the aim of this study was to examine the geographic distribution of underweight and its associated factors among individuals aged 15-49 years in Ethiopia.MethodsSecondary data analysis was done on a data set consisting of 28,450 individuals and obtained from the Ethiopian Demography and Health Survey (EDHS) 2016. The spatial distribution of underweight across the country was identified by ArcGIS software. Hotspots analysis was done using Getis-Ord Gi* statistic within ArcGIS. In SaTScan software, the Bernoulli model was fitted by Kulldorff's methods to identify the purely spatial clusters of underweight. A binary logistic regression was applied to determine factors associated with being underweight.ResultIn Ethiopia, the spatial distribution of underweight was clustered with Global Moran's I = 0.79 at p-value < 0.0001. The highest underweight clusters were observed in Tigray, Gambella, eastern part of Amhara, and western and central part of Afar regions. Male individuals [AOR = 1.21; 95% CI: (1.15 1.28)], never married [AOR = 1.14; 95% CI: (1.05, 1.24)], rural residents [AOR = 1.32; 95% CI: (1.18, 1.47)], rich [AOR = 0.85; 95% CI: (0.76, 0.94)], cigarette smoking [AOR = 1.25; 95% CI: (1.07, 1.46)], drinking treated water [AOR = 0.91; 95% CI: (0.83, 0.99)] and open filed defecation [AOR = 1.17; 95% CI: (1.08, 1.26)] were found to have a significant association with being underweight.ConclusionsThere was a significant clustering of underweight among individuals aged 15-49 years. Gender, age, marital status, place of residence, wealth index, cigarette smoking, using untreated water and types of toilet were the significant factors of being underweight. Therefore, effective public health interventions like building safe and supportive environments for nutrition, providing socio-economic protection and nutrition-related education for poor and rural resident would be better to mitigate these situations and associated risk factors in hot spot areas. In addition, policymakers should strengthen and promote nutrition sensitive policies and activities in order to alleviate the underlying and basic causes of underweight.

Project description:BackgroundThe perinatal mortality rate in Ethiopia is among the highest in Sub Saharan Africa. The aim of this study was to identify the spatial patterns and determinants of perinatal mortality in the country using a national representative 2016 Ethiopia Demographic and Health Survey (EDHS) data.MethodsThe analysis was completed utilizing data from 2016 Ethiopian Demographic and Health Survey. This data captured the information of 5 years preceding the survey period. A total of 7230 women who at delivered at seven or more months gestational age nested within 622 enumeration areas (EAs) were used. Statistical analysis was performed by using STATA version 14.1, by considering the hierarchical nature of the data. Multilevel logistic regression models were fitted to identify community and individual-level factors associated with perinatal mortality. ArcGIS version 10.1 was used for spatial analysis. Moran's, I statistics fitted to identify global autocorrelation and local autocorrelation was identified using SatSCan version 9.6.ResultsThe spatial distribution of perinatal mortality in Ethiopia revealed a clustering pattern. The global Moran's I value was 0.047 with p-value <0.001. Perinatal mortality was positively associated with the maternal age, being from rural residence, history of terminating a pregnancy, and place of delivery, while negatively associated with partners' educational level, higher wealth index, longer birth interval, female being head of household and the number of antenatal care (ANC) follow up.ConclusionsIn Ethiopia, the perinatal mortality is high and had spatial variations across the country. Strengthening partner's education, family planning for longer birth interval, ANC, and delivery services are essential to reduce perinatal mortality and achieve sustainable development goals in Ethiopia. Disparities in perinatal mortality rates should be addressed alongside efforts to address inequities in maternal and neonatal healthcare services all over the country.

Dataset Information

Spatial clustering and determinants of home birth after at least one antenatal care visit in Ethiopia: Ethiopian demographic and health survey 2016 perspective.

Publications

Spatial clustering and determinants of home birth after at least one antenatal care visit in Ethiopia: Ethiopian demographic and health survey 2016 perspective.

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