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Trends and determinants of home delivery in Ethiopia: further multivariate decomposition analysis of 2005-2016 Ethiopian Demographic Health Surveys.

ABSTRACT: OBJECTIVE:This 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 ANALYSIS:A 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 MEASURE:Trends of home delivery. PARTICIPANTS:A total of 33?482 women were included. RESULTS:Home 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. CONCLUSION:Despite 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.

SUBMITTER: Tiruneh SA

PROVIDER: S-EPMC7467527 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Trends and determinants of home delivery in Ethiopia: further multivariate decomposition analysis of 2005-2016 Ethiopian Demographic Health Surveys.

Tiruneh Sofonyas Abebaw SA Lakew Ayenew Molla AM Yigizaw Seblewongel Tigabu ST Sisay Malede Mequanent MM Tessema Zemenu Tadesse ZT

BMJ open 20200901 9

<h4>Objective</h4>This study aimed to assess the trends and factors that had contributed to the change in home delivery in Ethiopia over the last decade.<h4>Design, setting and analysis</h4>A 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 ...[more]

PMID: 32873665

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Project description:IntroductionMaternal 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 were neither pregnant nor breastfeeding. To date, there is limited evidence on spatiotemporal patterns of anemia among lactating mothers in the country. Exploring the spatial patterns of maternal anemia is vital to design and monitor effective intervention programs. Therefore this study aimed to explore spatiotemporal patterns of anemia among lactating mothers in Ethiopia over the past one and half-decades.MethodsA total of 11,989 lactating mothers were included from the three consecutive Ethiopian Demographic and Health Surveys(2005, 2011, and 2016). The trend of anemia over the three surveys was showed. Furthermore, spatial autocorrelation analysis, cluster and outlier analysis, hotspot analysis, spatial interpolation, and spatial scan statistics were carried out to identify geographically risk areas of anemia among lactating mothers in Ethiopia. Finally, the most anemia risk areas were detected consistently by different spatial analytic methods in each survey.ResultsAnemia during lactation had an increasing trend from 2011 to 2016 in all regions of Ethiopia. It was also spatially clustered over three survey periods (Moran's I: 0.102-0.256, P<0.01).The hotspot areas were detected in Afar, Somali, Gambela, Dire Dawa, and Oromia regions during the last fifteen years. In 2005 and 2011, a total of 100 most likely clusters (Loglikelihood Ratio(LLR) = 8.8, P<0.05, and LLR = 45.94, P<0.001, respectively) were identified in the Afar region. However, in the 2016 survey period, primary clusters were shifted to the Somali region where 57 clusters (LLR = 72.73, P<0.001) were detected in the entire region. Besides, the risk prediction map showed that the eastern part of the country was at a higher risk of anemia during lactation.ConclusionAnemia during lactation was spatially clustered in Ethiopia. High-risk areas were detected in the eastern part of Ethiopia prominently in the Afar and Somali regions. Therefore, public health intervention activities designed in a targeted approach to impact high-risk populations in those hot spot areas wound be helpful to reduce anemia in Ethiopia.

Project description:ObjectivesMonitoring and addressing unnecessary and avoidable differences in child vaccination is a critical global concern. This study aimed to assess socioeconomic inequalities in basic vaccination coverage among children aged 12-23 months in Ethiopia.Design, setting and participantsSecondary analyses of cross-sectional data from the two most recent (2011 and 2016) Ethiopia Demographic and Health Surveys were performed. This analysis included 1930 mother-child pairs in 2011 and 2004 mother-child pairs in 2016.Outcome measuresCompletion of basic vaccinations was defined based on whether a child received a single dose of Bacille Calmette-Guerin (BCG), three doses of diphtheria, tetanus toxoids and pertussis (DTP), three doses of oral polio vaccine and one dose of measles vaccine.MethodsThe concentration Curve and Concentration Indices (CCIs) were used to estimate wealth related to inequalities. The concentration indices were also decomposed to examine the contributing factors to socioeconomic inequalities in childhood vaccination.ResultsFrom 2011 to 2016, the proportion of children who received basic vaccination increased from 24.6% (95% CI 21.4% to 28.0%) to 38.6% (95% CI 34.6% to 42.9%). While coverage of BCG, DTP and polio immunisation increased during the study period, the uptake of measles vaccine decreased. The positive concentration index shows that basic vaccination coverage was pro-rich (CCI=0.212 in 2011 and CCI=0.172 in 2016). The decomposition analysis shows that use of maternal health services such as family planning and antenatal care, socioeconomic status, exposure to media, urban-rural residence and maternal education explain inequalities in basic vaccination coverage in Ethiopia.ConclusionsChildhood vaccination coverage was low in Ethiopia. Vaccination was less likely in poorer than in richer households. Addressing wealth inequalities, enhancing education and improving maternal health service coverage will reduce socioeconomic inequalities in basic vaccination uptake in Ethiopia.

Project description:BackgroundThe magnitude of unintended pregnancy is unacceptably high and more than half of it end up with abortions. This may limit lower and middle-income countries to achieve the sustainable development goal targets of reduction of neonatal and maternal mortalities. Evidence on trends and spatial distribution of unintended pregnancy is limited. Therefore, this study aimed to assess the trend, multivariate decomposition, and spatial variations of unintended pregnancy among reproductive-age women in Ethiopia from 2000 to 2016.MethodsEthiopian Demographic and Health Data of 2000 to 2016 were used. A total weighted sample of 30,780 reproductive-age women participated. A multivariate decomposition analysis was employed to identify factors contributing to the change in the rate of unintended pregnancy in Ethiopia for 20 years from (1996 to 2016). The concentration index and graph were used to assess wealth-related inequalities, whereas spatial analysis was done to identify the hotspot of unintended pregnancy in Ethiopia.ResultsThe 20-year trend analysis showed that the magnitude of unintended pregnancy among reproductive-age women decreased by 13.19 percentage points (from 39.76% in 2000 to 26.57% in 2016 EDHS). About 84.97% of the overall decrement was due to the difference in coefficient of the variables, whereas the remaining 15.03% was due to the difference in composition of the respondent. The differences in coefficient of the variables were decomposed by living metropolitan cities, having previous terminated pregnancy, and not having exposure to media; whereas, the change due to the composition, was expressed by having a household size of 1-3, living in metropolitan cities, being multipara and grand para, being unmarried and having no terminated pregnancy. Moreover, unintended pregnancies were more clustered in Addis Ababa and disproportionately concentrated in the poor groups.ConclusionsIn Ethiopia, a substantial decrement in unintended pregnancy was observed in the past decade. More than four-fifths of this overall decrement was due to the difference in the coefficient of the variables. There was spatial clustering of unintended pregnancy in Ethiopia. A program intervention is needed for high-risk regions such as Addis Ababa. Health education and media campaign should perform for high-risk women such as those having terminated pregnancy, and professing Islam faith.

Project description:BACKGROUND:Diarrhoea is one of the major contributors to death among under-five children in Ethiopia. Studies conducted in different countries showed that rural children are more severely affected by diarrhoea than urban children. Thus, this study was aimed to identify the socio-demographic, environmental and behavioural associated risk factors of the occurrence of diarrhoea among under-five children in rural Ethiopia. METHODS:Data for the study was drawn from the 2016 Ethiopian Demographic and Health Survey. A total of 8041 under-five children were included in the study. Binary logistic regression was used to assess the association of occurrence of diarrhoea with socio-demographic, environmental and behavioural factors among under-five children. RESULTS:Children aged 6-11?months (AOR:3.5; 95% CI: 2.58-4.87), 12-23?months (AOR: 3.1; 95% CI: 2.33-4.04) and 24-35?months (AOR: 1.7; 95% CI: 1.26-2.34) as compared to >?35?months were significantly associated with an increasing prevalence of diarrhoea. Children in Afar region (AOR: 1.92; 95% CI: 1.01-3.64) and Gambela region (AOR: 2.12; 95% CI: 1.18, 3.81) were significantly associated with an increasing prevalence of diarrhoea, but a decreasing prevalence in Somali region (AOR: .42; 95% CI: (.217-.80) as compared to Tigray region. Increasing prevalence of diarrhoea was also significantly associated with male children (AOR: 1.3; 95% CI: 1.05-1.58); households who shared toilet facilities with other households (AOR: 1.4; 95% CI: 1.09-1.77); fourth birth order (AOR: 1.81; 95% CI: 1.17-2.79), and fifth and above birth order (AOR: 1.85; 95% CI: 1.22, 2.81) as compared to first order; and mother's current age 35-49?years in a household with ?3 under-five children (AOR: 4.7; 95% CI: 1.64-13.45) as compared to those maternal ages of 15-24?years in a household with ?2 under-five children. CONCLUSION:The age of a child, sex of a child, region, birth order, toilet facilities shared with other households and the interaction effect of the number of under-five children with mother's current age are identified as associated risk factors for diarrhoea occurrence among under-five children in rural Ethiopia. The findings show the need for planning and implementing appropriate prevention strategies considering these risk factors for rural under-five children.

Project description:SettingFemale genital mutilation (FGM) is a traditional surgical modification of the female genitalia comprising all procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for cultural or nontherapeutic reasons. It can be harmful and violates girls' and women's human rights. FGM is a worldwide problem but mainly practiced in Africa. FGM is still widely practiced in Ethiopia despite being made a criminal offence in 2004.ObjectiveUsing data from three Ethiopian Demographic Health Surveys (EDHS) conducted in 2000, 2005 and 2016 the objective was to assess changes in prevalence of FGM and associated factors among women of reproductive age and their daughters.MethodsEDHS datasets for the three surveys included data on FGM prevalence and socio-demographic factors. After weighting, the data were analysed using frequencies, proportions and the chi square test for trend. Categorical variables associated with FGM in 2016 were compared using OpenEpi and presented as prevalence ratios (Pr) with 95% Confidence Intervals (CI). Levels of significance were set at 5% (P<0.05).ResultsThere was overall decline in FGM prevalence (from 79.9% to 74.3% to 65.2%, P<0.001), especially in younger women aged 15-19 years, and in the proportion of women who believed that the practice should continue (from 59.7% to 28.3% to 17.5%, P<0.001). There was also a decreasing trend of FGM in the daughters of the mothers who were interviewed, with prevalence significantly lower in mothers who had not themselves undergone FGM. Most (88.3%) women with FGM had the surgery as a child with the procedure mainly performed by a traditional circumciser (87.3%). Factors associated with higher FGM prevalence and lack of progress over the sixteen years included living in certain regions, especially Somali where FGM prevalence remained consistently >95%, lack of school education, coming from rural areas and living in less wealthy households.ConclusionAlthough progress has been slow, the prevalence of FGM in Ethiopia has declined over time. Recommendations to quicken the trajectory of decline targeting integrated interventions to high prevalence areas focusing on mothers, fathers, youngsters, religious leaders and schools and ensuring that all girls receive some form of education.

Project description: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<?0.01). Attending, 1-3 ANC visits (AOR?=?1.41, 95%CI: 1.17-1.71), no information about birth preparedness plan (AOR?=?2.21, 95%CI: 1.83-2.69), pregnancies wanted later (AOR?=?1.55, 95%CI: 1.20, 2.06), not having health insurance (AOR?=?2.16, 95% CI: 1.29, 3.62), Muslim (AOR?=?1.57, 95% CI: 1.13, 2.19) and protestant (AOR?=?1.72, 95%CI: 1.16, 2.42) religions were positively associated with home delivery; While being rich (AOR?=?0.42, 95%CI: 0.32-0.54), middle wealth index (AOR?=?O.66, 95%CI: 0.51, 0.86), primary education (AOR?=?0.45, 95%CI: 0.36-0.55), secondary education (AOR?=?0.11, 95%CI: 0.07-0.16), above secondary education (AOR?=?0.06, 95%CI: 0.03-0.11) were negatively associated. CONCLUSIONS:Home delivery after ANC follow ups was spatially clustered. Socio-demographic, health service and pregnancy related factors determined the prevalence of home delivery after antenatal care visits. Strengthening women's education, ANC visit, giving more information about birth preparedness plan, and improving family wealth are vital to reduce home delivery after antenatal care visits.

Project description:Background:Despite 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. Methods:This 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. Results:The 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. Conclusion:The 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:BACKGROUND:HIV counseling and testing are key to control and prevent the spread of the virus and improve the lives of people living with HIV. Although the risk of acquiring the virus is high, only 27% of young Ethiopian women age 15 to 24 years old were tested and counseled for HIV. This coverage is low to achieve the 90-90-90 goal. Identifying factors associated with low utilization of HIV testing and counseling services among young females (aged 15 to 24 years) is important to identify the barriers and improve uptake. Therefore, this analysis was done to identify factors associated with low utilization of HIV counseling and testing services among young Ethiopian women. METHODS:The study used the 2016 Ethiopian demographic and health survey data. The data was downloaded from The DHS program with permission. A total of 2661 young women (aged 15 to 24 years) were included in the final model. Data was weighted to consider disproportionate sampling and non-response. A Complex data management technique was applied to consider the complex sampling technique used in the DHS. Multivariable logistic regression was used to identify factors associated with HIV testing among young women. RESULT:Among sexually active young women, 33.5% (95%CI; 30.1, 37.1) were tested for HIV. Young women who attended primary ((AOR 2.8; (95% CI; 2.0, 3.9)), secondary (AOR 4.7; (95% CI; 3.1, 7.3)) or higher education (AOR; 5.6; 95% CI; 2.6, 12.0), those who had multiple sexual partners (AOR 5.5; 95% (CI; 1.3, 23.3)), young women who ever used alcohol (AOR 1.46; 95% (CI; 1.1, 2.0)) and young women who visited health care facilities (AOR 1.8; (95% CI; 1.4, 2.3)) had higher odds of being tested for HIV. On the other hand, young women from the rural areas had lower odds (AOR 0.5; (95% CI; 0.3, 0.7)) of being tested for HIV. CONCLUSION:HIV testing among sexually active young women in Ethiopia was low. Educational status, place of residence, alcohol intake, number of sexual partners and visiting health facility 12 months before the survey were found significant predictors of HIV testing. Therefore, the Ethiopian government should encourage girls to complete secondary education to improve HIV testing and counseling. Young women should be encouraged to visit health facilities to improve HIV testing service uptake.

Dataset Information

Trends and determinants of home delivery in Ethiopia: further multivariate decomposition analysis of 2005-2016 Ethiopian Demographic Health Surveys.

Publications

Trends and determinants of home delivery in Ethiopia: further multivariate decomposition analysis of 2005-2016 Ethiopian Demographic Health Surveys.

Similar Datasets

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