Individual and community-level factors influencing optimal breastfeeding: A multilevel analysis from a national survey study of Ethiopia.
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ABSTRACT: Background
Optimal breastfeeding is critical for healthy growth of the child. Globally, 820,000 children and 20,000 women lost due to in appropriate breastfeeding each year. In Ethiopia, 50,000 children lost related to malnutrition with 18% were due to poor breastfeeding habit. Little is known on the determinants of breastfeeding with hierarchical level. Therefore, this study aimed to identify factors influencing optimal breastfeeding among children under six month in Ethiopia using a multilevel analysis.Methods
The data of this study were obtained from Ethiopian Demographic and health survey conducted from January to June 2016. A total 1,087 children aged 0-5 months were selected using two stage stratified sampling technique. Multilevel logistic regression analysis was done to identify significant explanatory variables. Akaike information criteria were used to select the best model fit. Fixed effect was done to estimate the association between the outcome and explanatory variable and also random effect to measure the variation explained by the higher level.Result
Among the total of 1,087 children, 45.4% were optimally breastfeed. Children from the richest wealth index (AOR = 2.87; 95% CI: 1.53-5.43) was positively associated with optimal breastfeeding but, children aged 4-5 months (AOR = 0.19; 95%CI: 0.12-0.27), children born through cesarean section (AOR = 0.18; 955 CI: 0.07-0.51) and residing in Afar region (AOR = 0.13; 95%CI: 0.02-0.92) were found inversely associated with optimal breastfeeding. The random-effects showed that the variation between communities was statistically significant.Conclusion
Individual and community level factors play a significant role in shaping optimal breastfeeding. Future strategies and health interventions should be strengthen to target individual and community level factors that enhance optimal breastfeeding.
SUBMITTER: Hagos A
PROVIDER: S-EPMC8084135 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BACKGROUND:The World Health Organization recommends a minimum of 33 months between two consecutive live births to reduce the risk of adverse maternal and child health outcomes. However, determinants of short birth interval have not been well understood in Ethiopia. OBJECTIVE:The aim of this study was to assess individual- and community-level determinants of short birth interval among women in Ethiopia. METHODS:A detailed analysis of the 2016 Ethiopian Demographic and Health Survey data was performed. A total of 8,448 women were included in the analysis. A two-level multilevel logistic regression analysis was used to identify associated individual- and community-level factors and estimate between-community variance. RESULTS:At the individual-level, women aged between 20 and 24 years at first marriage (AOR = 1.37; 95% CI: 1.18-1.60), women aged between 25 and 29 years at first marriage (AOR = 1.65; 95% CI: 1.20-2.25), having a husband who attended higher education (AOR = 1.32; 95% CI: 1.01-1.73), being unemployed (AOR = 1.16; 95% CI: 1.03-1.31), having an unemployed husband (AOR = 1.23; 95% CI: 1.04-1.45), being in the poorest wealth quintile (AOR = 1.82; 95% CI: 1.39-2.39), being in the poorer wealth quintile (AOR = 1.58; 95% CI: 1.21-2.06), being in the middle wealth quintile (AOR = 1.61; 95% CI: 1.24-2.10), being in the richer wealth quintile (AOR = 1.54; 95% CI: 1.19-2.00), increased total number of children born before the index child (AOR = 1.07; 95% CI: 1.03-1.10) and death of the preceding child (AOR = 1.97; 95% CI: 1.59-2.45) were associated with increased odds of short birth interval. At the community-level, living in a pastoralist region (AOR = 2.01; 95% CI: 1.68-2.39), being a city dweller (AOR = 1.75; 95% CI: 1.38-2.22), high community-level female illiteracy (AOR = 1.23; 95% CI: 1.05-1.45) and increased distance to health facilities (AOR = 1.32; 95% CI: 1.11-1.56) were associated with higher odds of experiencing short birth interval. Random effects showed significant variation in short birth interval between communities. CONCLUSION:Determinants of short birth interval are varied and complex. Multifaceted intervention approaches supported by policy initiatives are required to prevent short birth interval.
| S-EPMC6959604 | biostudies-literature
Project description:IntroductionSkilled birth attendant (SBA) delivery is defined as assisting birth by a trained healthcare provider, which is vital for the health of mothers and newborns. Improving maternal health is one of the world health organization's (WHO) key priorities and skilled birth attendant delivery is one of the four pillars of the initiative for safe motherhood to reduce maternal mortality. Therefore, this study aimed to assess the individual and community-level factors associated with SBA delivery in Ethiopia.MethodA secondary data analysis was conducted using the 2019 Mini Ethiopian demographic and health survey. A total of 5,527 (weighted) live births were included in the analysis. A multi-level logistic regression model was fitted using Stata 14.0 to identify individual and community-level factors associated with SBA delivery. Finally, AOR with 95% CI and random effects were reported.ResultIn this study after fitting a multilevel model, women with poor (AOR = 0.44 95%CI 0.32-0.61) and middle wealth index (AOR = 0.64;95% CI 0.46-0.87), multipara (AOR = 0.39;95% CI 0.28-0.55) and grand multipara (AOR = 0.46;95% CI 0.29-0.72), women from rural areas (AOR = 0.34;95% CI 0.16-0.72) and high community poverty level (AOR = 0.40;95% CI 0.21-0.76) had decreased odds of having SBA delivery. Whereas those who initiated Antenatal care (ANC) visits in the first trimester (AOR = 2.65; 95% CI 1.52-4.65) and second trimester (AOR = 1.87:95%CI 1.09-3.20) had increased odds of having SBA delivery in Ethiopia.ConclusionIn this study socioeconomic factors like wealth index, parity, the timing of ANC visits, place of residency, and community poverty level were significantly associated with SBA delivery. Therefore, it is better to increase timely ANC initiation particularly for women with low levels of income to improve skilled birth attendant delivery.
| S-EPMC10393148 | biostudies-literature
Project description:BackgroundDetermining the nutritional status of lactating women is important because underweight lactating mothers will have low energy levels and reduced cognitive abilities, which will affect the inadequate care of their young children. Thus, malnutrition is passed down from generation to generation, perpetuating the vicious cycle. There is scarce national data on determinants of underweight among lactating mothers in Ethiopia. Hence, this study aimed to identify individual and community-level determinants of underweight among lactating mothers in Ethiopia.MethodsData from the Ethiopian Demographic and Health Survey (EDHS) from 2016 were used. A total of 3848 lactating mothers were included in this study, and a multilevel, multivariable logistic regression model was fitted to identify determinants of underweight among lactating mothers.ResultsThe odds of being underweight among rural lactating mothers were 65% higher (AOR = 1.65, 95% CI = 1.13, 2.41) than lactating mothers in the urban area. The odds of being underweight among lactating mothers who have toilet facilities were 33% lower (AOR = 0.67, 95%CI = 0.54, 0.83) compared with those do not have toilet facilities. Those mothers in the age group of 25-34 years and greater than 35 years had (AOR = 0.61,95%CI = 0.48, 0.79), and (AOR = 0.66, 95%CI = 0.47, 0.95) times lower chance of being underweight compared with those who had 15-24 years of age, respectively. The likelihood of being underweight among lactating mothers in high community poverty (AOR = 1.40, 95%CI = 1.08, 1.82) was higher than the lower community poverty level.ConclusionUnderweight among lactating mothers was significantly associated with individual-level (age and toilet facilities) variables and community-level (residence and community poverty). Therefore, focusing on these identified factors could improve underweight among lactating mothers in Ethiopia.
| S-EPMC9070908 | biostudies-literature
Project description:BackgroundMaternal health service utilization decreases maternal morbidity and mortality. However, the existing evidence is inadequate to design effective intervention strategies in Ethiopia.ObjectivesThis study aimed to examine the utilization of maternal health service and identify its determinants among women of reproductive age in southern Ethiopia.DesignA community-based cross-sectional study was conducted from October 21 to November 11, 2022 on a sample of 1140 women selected randomly from the Northern Zone of the Sidama region.MethodsData were collected using the Open Data Kit mobile application and exported to Stata version 15 for analysis. We used a multilevel mixed-effects modified Poisson regression with robust standard error to identify determinants of maternal health service utilization.ResultsUtilization of antenatal care, health facility delivery, and postnatal care was 52.0% (95% confidence interval: 49.0%, 55.0%), 48.5% (95% confidence interval: 45.6%, 51.4%), and 26.0% (95% confidence interval: 23.0%, 29.0%), respectively. Antenatal care use was associated with receiving model family training (adjusted prevalence ratio: 1.19; 95% confidence interval: 1.06, 1.35), knowledge of antenatal care (adjusted prevalence ratio: 1.54; 95% confidence interval: 1.31, 1.81), perceived quality of antenatal care (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), and having birth preparedness plan (adjusted prevalence ratio: 1.13; 95% confidence interval: 1.02, 1.25). The identified determinants of health facility delivery use were middle wealth rank (adjusted prevalence ratio: 1.35; 95% confidence interval: 1.03, 1.77), perceived quality of health facility delivery (adjusted prevalence ratio: 1.02; 95% confidence interval: 1.01, 1.03), antenatal care (adjusted prevalence ratio: 1.76; 95% confidence interval: 1.36, 2.26), and high community-level women literacy (adjusted prevalence ratio: 1.55; 95% confidence interval: 1.10, 2.19). Postnatal care use was associated with facing health problems during postpartum period (adjusted prevalence ratio: 1.79; 95% confidence interval: 1.18, 2.72), urban residence (adjusted prevalence ratio: 3.52; 95% confidence interval: 2.15, 5.78), knowledge of postnatal care (adjusted prevalence ratio: 1.11; 95% confidence interval: 1.04, 1.19), and low community-level poverty (adjusted prevalence ratio: 0.43; 95% confidence interval: 0.25, 0.73).ConclusionMaternal health service use was low in the study area and was influenced by individual- and community-level determinants. Any intervention strategies must consider multi-sectorial collaboration to address determinants at different levels. The programs should focus on the provision of model family training, the needs of women who have a poor perception, and knowledge of maternal health service at the individual level.
| S-EPMC10748615 | biostudies-literature
Project description:BackgroundInstitutional delivery is an important indicator in monitoring the progress towards Sustainable Development Goal 3.1 to reduce the global maternal mortality ratio to less than 70 per 100,000 live births. Despite the international focus on reducing maternal mortality, progress has been low, particularly in Sub-Saharan Africa (SSA), with more than 295,000 mothers still dying during pregnancy and childbirth every year. Institutional delivery has been varied across and within the country. Therefore, this study aimed to investigate the individual and community level determinants, and spatial distribution of institutional delivery in Ethiopia.MethodsA secondary data analysis was done based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 11,022 women was included in this study. For spatial analysis, ArcGIS version 10.6 statistical software was used to explore the spatial distribution of institutional delivery, and SaTScan version 9.6 software was used to identify significant hotspot areas of institutional delivery. For the determinants, a multilevel binary logistic regression analysis was fitted to take to account the hierarchical nature of EDHS data. The Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV), and deviance (-2LL) were used for model comparison and for checking model fitness. Variables with p-values<0.2 in the bi-variable analysis were fitted in the multivariable multilevel model. Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) were used to declare significant determinant of institutional delivery.ResultsThe spatial analysis showed that the spatial distribution of institutional delivery was significantly varied across the country [global Moran's I = 0.04 (p<0.05)]. The SaTScan analysis identified significant hotspot areas of poor institutional delivery in Harari, south Oromia and most parts of Somali regions. In the multivariable multilevel analysis; having 2-4 births (AOR = 0.48; 95% CI: 0.34-0.68) and >4 births (AOR = 0.48; 95% CI: 0.32-0.74), preceding birth interval ≥ 48 months (AOR = 1.51; 95% CI: 1.03-2.20), being poorer (AOR = 1.59; 95% CI: 1.10-2.30) and richest wealth status (AOR = 2.44; 95% CI: 1.54-3.87), having primary education (AOR = 1.47; 95% CI: 1.16-1.87), secondary and higher education (AOR = 3.44; 95% CI: 2.19-5.42), having 1-3 ANC visits (AOR = 3.88; 95% CI: 2.77-5.43) and >4 ANC visits (AOR = 6.53; 95% CI: 4.69-9.10) were significant individual-level determinants of institutional delivery while being living in Addis Ababa city (AOR = 3.13; 95% CI: 1.77-5.55), higher community media exposure (AOR = 2.01; 95% CI: 1.44-2.79) and being living in urban area (AOR = 4.70; 95% CI: 2.70-8.01) were significant community-level determinants of institutional delivery.ConclusionsInstitutional delivery was low in Ethiopia. The spatial distribution of institutional delivery was significantly varied across the country. Residence, region, maternal education, wealth status, ANC visit, preceding birth interval, and community media exposure were found to be significant determinants of institutional delivery. Therefore, public health interventions should be designed in the hotspot areas where institutional delivery was low to reduce maternal and newborn mortality by enhancing maternal education, ANC visit, and community media exposure.
| S-EPMC7660564 | biostudies-literature
Project description:BackgroundLittle research has explored the influence of social context on health of Indian adolescents. We conceptualized community-level women's education (proxy for value placed on women's wellbeing) as exerting contextual influence on adolescent hemoglobin level and body mass index (BMI).MethodsWe derived our sample of more than 62,000 adolescent aged 15 through 17 years from the Indian National Family Health Survey 2015-16. The sample consisted of a total of 62648 adolescents (54232 girls and 8416 boys) for the hemoglobin, and 62846 adolescents (54383 girls and 8463 boys) for the BMI analysis. We fitted multilevel random intercepts linear regression models to test the association of village- and urban-ward-level-women's education with hemoglobin level and BMI of adolescents, accounting for their own and their mother's education; as well as relevant covariates.FindingsOur fully adjusted model estimated that if the 52% of communities with less than 20 percent of women having a tenth-grade education in our sample were to achieve 100 percent tenth-grade completion in women, hemoglobin would be 0·2 g/dl higher (p<0·001) and BMI would be 0·62 kg/m2 higher on average among all adolescents in such communities. Unexplained variance estimates at the contextual level remained statistically significant, indicating the importance of context on adolescent undernutrition.InterpretationsAdolescents are deeply embedded in their context, influenced by contextual factors affecting health. Promoting adolescent health therefore implies altering social norms related to adolescent health and health behaviors; along with structural changes creating a health-promoting environment. Integrating our empirical findings with theoretically plausible pathways connecting community-level women's education with adolescent undernutrition, we suggest that enhancing community-level women's education beyond high school is necessary to facilitate these processes.ImplicationsAddressing contextual determinants of adolescent undernutrition might be the missing link in India's adolescent anemia and undernutrition prevention efforts, which are currently focused heavily on individual-level biomedical determinants of the problem.
| S-EPMC8136857 | biostudies-literature
Project description:BACKGROUND:Childhood malnutrition and growth faltering is a serious concern in Nepal. Studies of child growth typically focus on child and mother characteristics as key factors, largely because Demographic and Health Surveys (DHS) collect data at these levels. To control for and measure the importance of higher-level factors this study supplements 2006 and 2011 DHS data for Nepal with data from coincident rounds of the Nepal Living Standards Surveys (NLSS). NLSS information is summarized at the district level and matched to children using district identifiers available in the DHS. METHODS:The sample consists of 7533 children aged 0 to 59 months with complete anthropometric measurements from the 2006 and 2011 NDHS. These growth metrics, specifically height-for-age and weight-for-height, are used in multilevel regression models, with different group designations as upper-level denominations and different observed characteristics as upper-level predictors. RESULTS:Characteristics of children and households explain most of the variance in height-for-age and weight-for-height, with statistically significant but relatively smaller overall contributions from community-level factors. Approximately 6% of total variance and 22% of explained variance in height-for-age z-scores occurs between districts. For weight-for-height, approximately 5% of total variance, and 35% of explained variance occurs between districts. CONCLUSIONS:The most important district-level factors for explaining variance in linear growth and weight gain are the percentage of the population belonging to marginalized groups and the distance to the nearest hospital. Traditional determinants of child growth maintain their statistical power in the hierarchical models, underscoring their overall importance for policy attention.
| S-EPMC6449894 | biostudies-other
Project description:Background Childhood vaccination continues to increase dramatically. In spite of the success of immunization programs to date, millions of children continued to die each year, and sub-Saharan Africa (SSA) accounted for the world's highest neonatal deaths. Childhood vaccination was designed as one of the most effective ways to reduce child mortalities from fatal vaccine-preventable diseases. Therefore, this study is aimed at investigating the individual- and community-level determinants of childhood complete vaccination in Ethiopia. Methods A secondary data analysis was done based on the 2016 Ethiopian Demographic and Health Survey (EDHS). A total weighted sample of 1,984 children aged 12-23 months was included for analysis. Considering the hierarchical nature of EDHS data, a two-level multilevel analysis for assessing individual- and community-level determinants of childhood complete vaccination was done. The intraclass correlation coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV), and deviance (-2LL) were used for model comparison and for checking model fitness. Variables with p value < 0.2 in the bivariable multilevel analysis were considered for the multivariable multilevel analysis. In the multivariable multilevel logistic regression analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was reported to declare significant determinants of complete childhood vaccination. Results Overall complete vaccination status among children aged 12-23 months was 39% (95% CI: 36.8, 41.2). In the multilevel analysis, secondary or above educated mothers (AOR = 2.48; 95% CI: 1.41, 4.36), richest wealth status (AOR = 2.24; 95% CI: 1.16, 4.32), ?four ANC visits (AOR = 2.77; 95% CI: 1.90-4.02), employed mothers (AOR = 1.66; 95% CI: 1.26, 2.18), urban residence (AOR = 1.84; 95% CI: 1.00, 3.51), and children in city administration (AOR = 2.66; 9% CI: 1.53, 4.62) were positively associated with vaccination status. On the other hand, children with a female household head (AOR = 0.68; 95% CI: 0.48, 0.96) were negatively associated. Conclusion Overall, childhood full vaccination status was low compared with the WHO targets. Maternal education, wealth status, ANC visit, maternal occupation, residence, region, and sex of household head were significant predictors of childhood complete vaccination. As a result, it is better to design a compensation mechanism to the costs associated with childhood vaccination for the poor households and strengthen awareness creation for rural residents to improve the access, utilization, and continuum of vaccination service.
| S-EPMC7545462 | biostudies-literature
Project description:BackgroundKnowledge of the ovulatory cycle (KOC) aids women to refrain and engage in sexual intercourse to avoid and to get pregnancy, respectively. The effect of community-level factors on KOC was not yet known in Ethiopia. Therefore, we aimed to investigate the community- and individual-level determinants of KOC among women of childbearing age.MethodsWe used the 2016 Ethiopian Demographic and Health Survey, and total weighted samples of 15,683 women were included. Intra-class correlation, median odds ratio, and deviance were executed for model comparison in which a model with the lowest deviance was the best model i.e. model III in this case. A multivariable multilevel logistic regression model was employed to identify community- and individual-level factors of correct KOC. In the ultimate model, an adjusted odds ratio (AOR) with a 95% confidence interval was reported and variables with a p<0.05 were considered as statistically significant.ResultsIn this study, 3,698 [23.58% (95% CI; 22.92-24.25)] participants had correct KOC. Women's age in years, i.e. 20-24 (AOR = 1.46;1.28-1.68) 25-29 (AOR = 1.72; 1.49-1.99), 30-34 (AOR = 2.21; 1.89-2.58), 35-39 (AOR = 1.78; 1.51-2.09), 40-44 (AOR = 1.97; 1.65-2.37), and 45-49 (AOR = 1.78; 1.44-2.19), knowledge of contraceptive methods (AOR = 3.08; 2.07-4.58), increased women's educational level, i.e. higher (AOR = 4.24; 3.54-5.07), secondary (AOR = 2.89; 2.48-3.36), and primary (AOR = 1.57; 1.39-1.78), higher household's wealth index, i.e. richest (AOR = 1.71; 1.35-2.16), richer (AOR = 1.42; 1.16-1.72), middle (AOR = 1.29; 1.07-1.56), and poorer (AOR = 1.24; 1.03-1.48), current contraceptive use (AOR = 1.26; 1.13-1.39), menstruating in the last six weeks (AOR = 1.13; 1.03-1.24), women's media exposure (AOR = 1.20; 1.07-1.35), and being in the community with a high level of media exposure (AOR = 1.53; 1.24-1.88) were statistically significant with KOC.ConclusionsKnowledge of the ovulatory cycle was low in this study, which demands health education for women of childbearing age. Special attention should be given to teenagers, those with lower educational, and lower economic status. Besides, the strengthening of media campaigns could increase women's KOC, which is crucial for preventing unintended pregnancy.
| S-EPMC8412270 | biostudies-literature
Project description:BackgroundPrenatal alcohol consumption is a serious public health concern that is considered as one of the preventable risk factors for neonatal and childhood morbidity and several adverse pregnancy outcomes. This study aimed to determine the individual- and community-level predictors of maternal alcohol consumption during pregnancy in Gondar town, Northwest Ethiopia.MethodsA community-based cross-sectional study was conducted among pregnant women in Gondar town from 13 June to 24 August 2019. A cluster random sampling technique was used to select 1237 pregnant women. Data collection was carried out using the AUDIT-C pretested standard questionnaire. Bivariable and multivariable multilevel logistic regression analyses were computed to identify predictors of alcohol consumption using the odds ratio, 95% CI, and p-value < 0.05.ResultsThe prevalence of alcohol consumption during pregnancy was found to be 30.26% (95% CI: 27.74%, 32.91%). The study revealed that pregnant women who have a low knowledge level on harmful effect of alcohol consumption (AOR = 3.2; 95% CI: 1.9, 5.4), positive attitude towards alcohol consumption (AOR = 7.5; 95% 5, 11), history of pre-pregnancy alcohol consumption (AOR = 4.8; 95% CI: 3.4, 6.9), whose partner consume alcohol (AOR = 3.9; 95% CI: 2.5, 6), a perception that alcohol consumption is culturally or socially acceptable (AOR = 3.6; 95% CI: 2.4, 5.3), who were encouraged by their partners to consume alcohol (AOR = 4; 95% CI: 1.9, 8) were significantly associated with pregnancy alcohol consumption. Concerning the community-level characteristics, who had not ever heard/media exposure about the risk of alcohol drinking during pregnancy (AOR = 3; 95% CI: 1.7, 5.5), and who were from low community women's education attainment (AOR = 4; 95% CI: 2.2, 7.7) were statistically significant predictors of alcohol consumption during pregnancy.ConclusionsThe study revealed that alcohol consumption during pregnancy is prevalent in Gondar town. Both individual- and community-level predictors were found to be associated with alcohol consumption during pregnancy. Policymakers may take into account these predictors for individual and community-based interventions to which our results appear to point.
| S-EPMC8180107 | biostudies-literature