Ethiopian Demographic Health Survey Data Research Articles

Prevalence and associated risk factors for men being paid for sex in Ethiopia: a multilevel analysis of 2016 Ethiopian demographic health survey data

Paying for sex is considered a high-risk sexual behavior, especially among men. Men who pay for sex are perceived to be a bridge group for sexually transmitted illnesses. In sub-Saharan Africa, the prevalence of paid sex among men is approximately 4.3%. Men paid for sex are not studied in Ethiopia. Therefore, the objective of this study was to identify factors associated with men paying for sex in Ethiopia. We analyzed data from the 2016 Ethiopian Demographic Health Survey. In the analysis, 9070 men were included. To identify factors associated with paid-for sex among men, we used a multilevel logistic regression model. A p value less than 0.05 was considered to indicate statistical significance at the 95% confidence interval (CI). In this study, 509 (5.6%) men were ever paid for sex. Men who paid for sex were significantly more likely to be rich [Adjusted Odds Ratio (AOR) = 1.70; 95% CI 1.287, 2.246], widowed or separated (AOR = 1.97; 95% CI 1.142, 3.396), had more sexual partners [AOR = 1.03; 95% CI 1.005, 1.063], had ever been tested for human immunodeficiency virus (HIV) (AOR = 1.50; 95% CI 1.173, 1.916), drank alcohol (AOR = 4.15; 95% CI 3.086, 5.576), and chewing khat (AOR = 2.28; 95% CI 1.822, 2.85); men who had ever paid for sex were significantly less likely to have higher education (AOR = .63; 95% CI .438, .898) and the lowest age at first sex (AOR = .90; 95% CI .870, .924). In conclusion, educational level, wealth status, province, marital status, age at first sexual intercourse, number of sexual partners, HIV status, alcohol consumption status, and chewing khat were significantly associated with men’s paid-for sex. From a public and sexual health perspective, more education is needed for illiterate, widowed, separated, and rich men. Additionally, preventive measures should be taken against men’s behavior through the use of alcohol or khat, having many sexual partners, and having young men.

Spatial variation and predictors of incomplete pneumococcal conjugate vaccine (PCV) uptake among children aged 12-35 months in Ethiopia: spatial and multilevel analyses.

Despite the Ethiopian government included the Pneumococcal Conjugate Vaccine (PCV) in the national expanded program for immunization in 2011, only 56% of children aged 12-23 months received the full dose of PCV. Despite some studies on PCV uptake in Ethiopia, there was a dearth of information on the geographical distribution and multilevel factors of incomplete PCV uptake. Hence, this study aimed to identify the spatial variations and predictors of incomplete PCV uptake among children aged 12-35 months in Ethiopia. The study was based on an in-depth analysis of 2016 Ethiopia Demographic Health Survey data, using a weighted sample of 3,340 women having children aged 12-35 months. Arc-GIS version 10.7 and SaTScan version 9.6 statistical software were used for the spatial analysis. To explore spatial variation and locate spatial clusters of incomplete PCV, the Global Moran's I statistic and Bernoulli-based spatial scan (SaTScan) analysis were carried out, respectively. A multilevel mixed-effect multivariable logistic regression was done by STATA version 16. Adjusted odds ratio (AOR) with its corresponding 95% CI was used as a measure of association, and variables with a p < 0.05 were deemed as significant determinants of incomplete PCV. The overall prevalence of incomplete PCV in Ethiopia was found to be 54.0% (95% CI: 52.31, 55.69), with significant spatial variation across regions (Moran's I = 0.509, p < 0.001) and nine most likely significant SaTScan clusters. The vast majority of Somali, southeast Afar, and eastern Gambela regions were statistically significant hot spots for incomplete PCV. Lacking ANC visits (AOR = 2.76, 95% CI: 1.91, 4.00), not getting pre-birth Tetanus injections (AOR = 1.84, 95% CI: 1.29, 2.74), home birth (AOR = 1.72, 95% CI: 1.23, 2.34), not having a mobile phone (AOR = 1.64, 95% CI: 1.38, 1.93), and residing in a peripheral region (AOR = 4.63; 95% CI: 2.34, 9.15) were identified as statistically significant predictors of incomplete PCV. The level of incomplete PCV uptake was found to be high in Ethiopia with a significant spatial variation across regions. Hence, the federal and regional governments should collaborate with NGOs to improve vaccination coverage and design strategies to trace those children with incomplete PCV in peripheral regions. Policymakers and maternal and child health program planners should work together to boost access to maternal health services like antenatal care and skilled delivery services to increase immunization coverage.

Intersectional inequity in knowledge, attitude, and testing related to HIV in Ethiopia: People with multiple disadvantages are left behind.

Intersectionality pinpoints intersecting factors that empower or oppress people with multiple (dis)advantageous conditions. This study examined intersectional inequity in knowledge, attitudes, and testing related to HIV among adults aged 15 to 49 years in Ethiopia. This study used nationally representative 2016 Ethiopian Demographic Health Survey data. The sample size was 27,261 for knowledge about HIV/AIDS and 25,542 for attitude towards people living with HIV and HIV testing. Triple (dis)advantage groups were based on wealth status, education status, and residence. The triple advantages variables specifically are urban residents, the educated, and those who belong to households of high wealth status, while the triple disadvantages are rural residents, the uneducated, and those who live in poor household wealth rank. A multilevel logistic regression analysis was employed. Adjusted odds ratios (aOR) and confidence intervals (CI) with a P-value ≤ 0.05 were considered statistically significant. Based on descriptive analysis, 27.9% (95% CI: 26.5%, 29.3%) of adults had comprehensive knowledge about HIV/AIDS, 39.8% (95% CI: 37.6, 41.9%) exhibited accepting attitude towards people living with HIV, and 20.4% (95% CI: 19.1%, 21.8%) undergo HIV testing. Comprehensive knowledge about HIV/AIDS, accepting attitude towards people living with HIV, and HIV testing was 47.0%, 75.7%, and 36.1% among those with triple advantages, and 13.9%, 16.0% and 8.7% among those with triple non-advantages, respectively. The odds of having comprehensive knowledge about HIV/AIDS, accepting attitude towards people living with HIV, and HIV testing were about three (aOR = 3.4; 95% CI: 2.76 to 4.21), seven (aOR = 7.3; 95% CI = 5.79 to 9.24) and five (aOR = 4.7; 95% CI:3.60 to 6.10) times higher for triple forms of advantage than triple disadvantages, respectively. The findings of this study imply that Ethiopia will not achieve the proposed targets for HIV/AIDS services unless it prioritises individuals who live under multiple disadvantaged conditions.

Spatial variation and predictors of missing birth preparedness and complication readiness (BPCR) messages in Ethiopia

Background The Birth Preparedness and Complication Readiness (BPCR) message is one of the prenatal care packages targeted at reducing maternal and neonatal mortality by avoiding unnecessary delays during labor and delivery. There is limited evidence in Ethiopia that has looked at the spatial variation of missing BPCR messages and potential predictors. Hence, this study aimed to identify spatial predictors missing BPCR messages at the national level. Methods The study was based on analysis of 2016 Ethiopia Demographic Health Survey data, using a weighted sample of 4771 women. Arc-GIS version 10.7 and SaTScan version 9.6 statistical software were used for the spatial analysis. To explore spatial variation and locate spatial clusters of missing BPCR messages, the Global Moran’s I statistic and Bernoulli-based spatial scan (SaTScan) analysis were carried out, respectively. Hotspot (Getis-OrdGi*) analysis was conducted to identify Hotspots and Cold spotsof missing BPCR messages. Finally, spatial regression were carried out via ordinary least squares and geographically weighted regression to identify predictors of hotspots for missing BPCR messages. Results The overall prevalence of missing BPCR messages in Ethiopia was found to be 44.0% (95%CI: 42.6, 45.4%), with significant spatial variation across regions (Moran’s I = 0.218, p-value&lt;0.001) and seven most likely significant SaTScan clusters. The vast majority of Somali, central Afar, and Gambella regions were identified as statistically significant hotspots. Living in the poorest wealth quintile, having only one ANC visit, lack of access to listening to the radio, facing difficulty in accessing money, not having a mobile phone, and being not covered by health insurance were identified as significant spatial predictors of missing BPCR messages. Conclusion The level of missing BPCR messages during pregnancy was found to be high in Ethiopia, with significant local variation. As a result, policymakers at the national level and local planners should develop strategies and initiatives that enhance women’s economic capacities, health-seeking behavior, and media exposure. Furthermore, the regional authorities should focus on strategies that promote universal health coverage through enrolling citizens in health insurance schemes.

Geographic weighted regression analysis of hot spots of modern contraceptive utilization and its associated factors in Ethiopia.

Utilization of modern contraceptives is a common healthcare challenge in Ethiopia. Prevalence of modern contraception utilization is varying across different regions. Therefore, this study aimed to investigate Geographic weighted regression analysis of hotspots of modern contraceptive utilization and its associated factors in Ethiopia, using Ethiopian Demographic and Health Survey 2016 data. Based on the 2016 Ethiopian Demographic Health Survey data, a total weighted sample of 8,673 women was included in this study. For the Geographic Weighted Regression analysis, Arc-GIS version 10.7 and SaTScan version 9.6, statistical software was used. Spatial regression was done to identify factors associated with the hotspots of modern contraceptive utilization and model comparison was carried out using adjusted R2 and AICc. Variables with a p-value < 0.25 in the bi-variable analysis were considered for the multivariable analysis. Multilevel robust Poisson regression analysis was fitted for associated factors since the prevalence of modern contraceptive was >10%. In the multilevel robust Poisson regression analysis, the adjusted prevalence ratio with the 95% confidence interval was reported to declare the statistical significance and strength of association. The prevalence of modern contraceptive utilization in Ethiopia was 37.25% (95% CI: 36.23%, 38.27%). Most of the hotspot areas were located in Oromia and Amhara regions, followed by the SNNPR region and Addis Ababa City administration. Single Women, poor Women, and more fertility preference were significant predictors of hotspots areas of modern contraceptive utilization. In the multivariable multilevel robust Poisson regression analysis, Women aged 25-34 years (APR = 0.88, 95% CI: 0.79, 0.98), 35-49 years (APR = 0.71, 95% CI: 0.61, 0.83), married marital status (APR = 2.59, 95% CI: 2.18, 3.08), Others religions (APR = 0.76, 95% CI: 0.65, 0.89), number of children 1-4 (APR = 1.18, 95% CI: 1.02, 1.37), no more fertility preference (APR = 1.21, 95% CI: 1.11, 1.32), Afar, Somali, Harari, and Dire Dawa: (APR = 0.42, 95% CI: 0.27, 0.67), (APR = 0.06, 95% CI: 0.03, 0.12), (APR = 0.78, 95% CI: 0.62, 0.98), and (APR = 0.75, 95% CI: 0.58, 0.98), respectively. Amhara region (APR = 1.34, 95% CI: 1.13, 1.57), rural residence (APR = 0.80, 95% CI: 0.67, 0.95) High community wealth index (APR = 0.78, 95% CI: 0.67, 0.91) were significantly associated with modern contraceptive utilization. There were significant spatial variations of factors affecting modern contraceptive use across regions in Ethiopia. Therefore, public health interventions targeting areas with low modern contraceptive utilization will help to increase modern contraception use considering significant factors at individual and community levels.The detailed map of modern contraceptive use cold spots among reproductive age group and its predictors could assist program planners and decision-makers to design targeted public health interventions.Government of Ethiopia must develop more geographic targeted strategies for improving socioeconomic status of women and availability & accessibility of health facilities in rural areas of the countries.

Exploring the spatial variation and associated factors of childhood febrile illness among under-five children in Ethiopia: Geographically weighted regression analysis.

The global burden of febrile illness and the contribution of many fever inducing pathogens have been difficult to quantify and characterize. However, in sub-Saharan Africa it is clear that febrile illness is a common cause of hospital admission, illness and death including in Ethiopia. Therefore the major aim of this study is to explore the spatial variation and associated factors of childhood febrile illness among under-five children in Ethiopia. This study were based on the 2016 Ethiopian Demographic health survey data. A total weighted sample of 10,127 under- five children was included. Data management was done using Stata version-14, Arc-GIS version-10.8 and SatsScan version- 9.6 statistical software. Multi-level log binomial model was fitted to identify factors associated with childhood febrile illness. Variables with a p-value < 0.2 in the bi-variable analysis were considered for the multivariable analysis. In the multivariable multilevel log binomial regression analysis p-value< 0.05, the APR with the 95% CI was reported. Global spatial autocorrelation was done to assess the spatial pattern of childhood febrile illness. Spatial regression was done to identify factors associated with the spatial variations of childhood febrile illness and model comparison was based on adjusted R2 and AICc. The prevalence of febrile illness among under-five children was 13.6% (95% CI: 12.6%, 14 .7%) with significant spatial variation across regions of Ethiopia with Moran's I value of 0.148. The significant hotspot areas of childhood febrile illness were identified in the Tigray, Southeast of Amhara, and North SNPPR. In the GWR analysis, the proportion of PNC, children who had diarrhea, ARI, being 1st birth order, were significant explanatory variables. In the multilevel log binomial regression age of children 7-24 months(APR = 1.33, 95% CI: (1.03, 1.72)), maternal age 30-39 years (APR = 1.36 95% CI: 1.02, 1.80)), number of children (APR = 1.78, 95% CI: 0.96, 3.3), diarrhea(APR = 5.3% 95% CI: (4.09, 6.06)), ARI (APR = 11.5, 95% CI: (9.2, 14.2)) and stunting(APR = 1.21; 95% CI: (0.98, 1.49) were significantly associated with childhood febrile illness. Childhood febrile illness remains public health problem in Ethiopia. On spatial regression analysis proportion of women who had PNC, proportion of children who had diarrhea, proportion of children who had ARI, and proportion of children who had being 1st birth order were associated factors. The detailed map of childhood febrile illness and its predictors could assist health program planners and policy makers to design targeted public health interventions for febrile illness.

Trends and Determinants of Dietary Diversity in Children Aged 6–59 Months in Ethiopia: Analysis of 2005–2016 Demographic and Health Survey

Dietary diversity may be associated with health and optimum growth in children. In this study we analyzed the trends and determinants of minimum dietary diversity (MDD) among Ethiopian children aged 6 to 59 mo. Ethiopian Demographic Health Survey (EDHS) data of 3 consecutive years (2005, 2011, and 2016) were analyzed. A total of n=2396 (2005), n=3385 (2011), and n=3723 (2016) children aged 6 to 59 mo were included for measurement of trends and identification of the determinants of MDD. The associations between the study factors and MDD were investigated using multiple logistic regression analysis. The proportion of children who fulfilled the MDD decreased from 2.46% in 2005 to 1.57% in 2011 but sharply increased to 7.82% in 2016. Adjusted regression analysis revealed that exposure of mothers to media, particularly watching television, maternal education, and household wealth were associated with a greater likelihood of mothers providing diversified diets to their children across the 3 y of EDHS data. A decrease in MDD was observed from the years 2005 to 2011, after which a sharp increase was noted in 2016. In all 3 y of the EDHS, media exposure, maternal education, and household wealth were the consistent factors positively affecting dietary diversity among children aged 6 to 59 mo. Future intervention programs to increase dietary diversity in children should emphasize improving access to media exposure, education, and antenatal care visits.

Risk factors for the prevalence of anemia in children aged 6–59 months at different levels in Ethiopia

ABSTRACT Anemia is a global public health concern affecting both developed and developing nations. Anemia in children aged 6–59 months remains a severe public health problem in Ethiopia; it affects an estimated 56% of children under age 5 years, 23% of women of reproductive age, and 18% of adult men. Thus, the major goal of this study was to identify the risk factors associated with the prevalence of anemia among children aged 6–59 months in Ethiopia. Samples of 7795 children were taken from the 2016 Ethiopian Demographic Health Survey Data, using a stratified two-stage cluster sampling design. Our sample revealed 60% of children were anemic. Region of residence has a notable effect on the prevalence of anemia. In the Somali region, 81.9% of children were anemic, in the Amhara region 42.4% were anemic, and these are the highest and lowest observed rates. We employed hierarchical models in two levels; children level and region level. A random coefficient model, a model with a random slope for children-level predictors, and a fixed effect for region-level predictor best fit the anemia data and it was considered for final analysis. Results showed that the age of children, child-size at birth, age of mother, and mother’s history of anemia were significant factors for the prevalence of anemia at the children level. Anemic mothers were more likely to have anemic children. While the risk factors for the prevalence of anemia at the regional level were a place of residence and wealth index. Being in rural areas and has poor households have a higher risk of anemia.

Effect of biomass fuel use and kitchen location on maternal report of birth size: Cross-sectional analysis of 2016 Ethiopian Demographic Health Survey data

ObjectivesHousehold air pollution from the use of biomass fuels has been associated with low birth weight in many developing countries. This study aimed to investigate the effect of indoor air pollution from biomass fuels and kitchen location on maternal reports of child size at birth in Ethiopia. Study designA cross-sectional study design based on the secondary data analysis was used. MethodsA secondary data analysis was conducted using data from the 2016 Ethiopian Demographic Health Survey. Birth weight from child health cards and/or mother's recall was the dependent dichotomous variable. Fuel type was classified as high-pollution fuels (i.e. wood, straw, animal dung, crop residues, kerosene, coal and charcoal) and low-pollution fuels (i.e. electricity, liquid petroleum gas, natural gas and biogas). Hierarchical logistic regression was used to assess the effect of fuel type on birth weight. Adjusted odds ratios (AORs) and their 95% confidence interval (CIs) were calculated. A p-value less than 0.05 was considered significant. ResultsThe prevalence of low birth weight was 17% and 26.2% among low- and high-polluting fuel users, respectively. Compared with low-polluting fuels, the use of high-polluting cooking fuels was associated with an increased likelihood of low birth weight (unadjusted crude odds ratio 1.7; 95% CI 1.3, 2.3). AOR remained at 1.7 (95% CI 1.26, 2.3) after controlling for child variables. AOR after controlling for both child and maternal factors was 1.5 (95% CI 1.1, 2.1). In the final model, the association became insignificant with an AOR of 1.3 (95% CI 0.9, 1.9). The kitchen location, gender of the baby, mother's anaemia status, maternal chat chewing and wealth index were significant factors in the final model. ConclusionsIn this study, the use of biomass fuels and kitchen location were associated with reduced child size at birth. Further observational studies should investigate this association using more direct methods for measurement of exposure to smoke emitted from biomass fuels on birth weight.

Factors associated with unintended pregnancy in Ethiopia; further analysis of the 2016 Ethiopian demographic health survey data

BackgroundUnintended pregnancy an important public health problem in Ethiopia. It is associated with adverse physical, mental, social and economic outcomes. Identifying factors associated with unintended pregnancy may help to reduce unintended pregnancy and hence adverse outcomes. There are few studies about the prevalence and associated factors of unintended pregnancy in Ethiopia. But these studies were based on small sample size and fragmented. Therefore, this analysis was done to identify factors associated with unintended pregnancy in Ethiopia based on nationally representative data.MethodsThe study used the 2016 Ethiopian demographic and health survey data. The data was downloaded from The DHS program with permission. A total of 1135 women were included in the final model. Data was weighted to consider disproportionate sampling and non-response. Multivariable logistic regression was used to identify factors associated with unintended pregnancy among women.ResultAbout 30% (95% CI: 25.33–34.39) pregnancies were unintended. Married women (Adjusted odds ratio (AOR); 0.34; 95% CI: (0.01–0.14), woman living in developing regions AOR; 0.14; 95% CI: (0.07–0.27) and women who reported distance was not a big problem to get medical care AOR; 0.59; 95% CI: (0.36–0.99) had lower odds of unintended pregnancy. On the other hand, multiparous AOR; 3.77; 95% CI: (1.71–8.33), grand multiparous AOR; 6.72; 95% CI: (2.74–16.49) women and women who ever used contraceptives AOR; 1.86 95% CI: (1.06–3.26) had higher odds of unintended pregnancy.ConclusionAlthough high, the magnitude of unintended pregnancy in Ethiopia was lower compared to the global level. Marital status, region, perceived distance to seek medical care, parity and history of contraceptive use were found significant predictors of unintended pregnancy in Ethiopia.

Prevalence and associated factors of adolescent fatherhood in Ethiopia: A multilevel analysis using the 2016 Ethiopian demographic health survey data.

Though the consequences of teenage pregnancy and early motherhood has been studied very well, little is known about the magnitude as well as the determinants of adolescent fatherhood. Unlike adolescent motherhood, limited public health programs are working on adolescent fatherhood. Currently, in developed countries, there is an increased work to acknowledge teen fathers in clinical practice and in the research forum, but still, there are more issues that need to be addressed in developing countries including Ethiopia. Therefore, this study aimed to investigate the prevalence and associated factors of adolescent fatherhood in Ethiopia based on the nationally representative survey. This study used the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 4455 adolescent men was included for the final analysis. For the associated factors, multilevel logistic regression analysis was conducted to consider the hierarchical nature of the EDHS data. Intra-class Correlation Coefficient (ICC), and deviance (-2LLR) were used for model comparison and for assessing model fitness. The model with the largest adjusted R2, lowest Bayesian Information Criteria (BIC) and the smallest cross-validation prediction error were considered as the best-fitted model. In the multivariable analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare the presence of statistically significant factors associated with adolescent fatherhood, and variables with p-value <0.05 were considered as a significant variable. The prevalence of adolescent fatherhood in Ethiopia was 6.79% [95%CI; 6.08%, 7.56%]. Adolescent men with contraceptive knowledge [AOR = 4.25; 95%CI = 1.23, 14.69], age in 20 to 24 years [AOR = 7.93; 95%CI = 3.66, 17.27] and being Muslim [AOR = 1.84; 95%CI = 1.02, 3.39] were significantly associated with Higher odds of adolescent fatherhood. Individuals who initiate sex lately [AOR = 0.35; 95%CI = 0.22, 0.54], being in female-headed family [AOR = 0.46; 95%CI; 0.26, 0.82] and being from Amhara region [AOR = 0.35; 95%CI = 0.14, 0.84] were significantly associated with lower odds of adolescent fatherhood. In this study, adolescent fatherhood was a common public health problem in Ethiopia as it is closely linked with poor quality of life and premature death (year of potential life lost). Age of respondent, knowledge of respondent about contraceptive methods, early initiation of sex, religion, sex of household head, and region were significantly associated with adolescent fatherhood. Therefore, program planners and decision-makers should give special attention to adolescent men through enhancing reproductive health services utilization and their knowledge towards it to decrease the incidence of adolescent fatherhood.

Determinants of abortion among youth 15-24 in Ethiopia: A multilevel analysis based on EDHS 2016.

Determinants of the magnitude of abortion among women of diverse social and economic status, particularly in Africa poorly understood because of the missing information in most countries. In this study, we addressed abortion and its determinants among youth women of 15-24 ages to provide clear direction for policymaking in Ethiopia. We examined the 2016 Ethiopian demographic health survey data downloaded from the EDHS website after obtaining permission on abortion among 15-24 age women. We applied bivariate and multilevel binary logistic regression. Community and Individual level abortion predictors passed through a three-level binary logistic regression analysis where we used p-value <0.05 and adjusted odds ratios (AOR) with 95% confidence intervals (CI). The abortion among the youth population in this study was 2.5%. Factors associated with pregnancy were age group 20-24 2.5(1.6-3.8), youth with one birth 0.65(0.44-0.96), youth with 2-5 births 0.31(0.18-0.55), age ≥18 0.50(0.33-0.76), married 38(17-84), divorced 20(7-55), birth in the last five years 0.65(0.44-0.96), middle wealth youth 1.7(1.0.4-2.8), being in Amhara0.31(0.11-0.85), and 0.30(0.12-0.77). Less abortion occurred in economically poor youths. It is a noble finding; however, the access problem might lead to the result. We observed more abortions in age <18years; those have not given birth until the data collection date. It portrays forth clear policy direction for politicians and all other stakeholders to intervene in the problem. The analysis also showed abortion increased with age. It shows that as age increased, youths disclose abortion which is rare at an early age, and again given an essential clue for the next interventions. The fact in this study is both age and marriage affected abortion similarly. It might be because of various culture-related perceptions where it is not appropriate for an unmarried woman to appear with any pregnancy outcome as the reason behind the decreased number of abortions at a younger age. Thus, more attention is required during implementation for unmarried and lower age youth regardless of the magnitude of the abortion.

The impact of antenatal care on under\u2010five mortality in Ethiopia: a difference\u2010in\u2010differences analysis

BackgroundSub-Saharan Africa, as opposed to other regions, has the highest under-five mortality rates yet makes the least improvement in reducing under-five mortality. Despite the decline, Ethiopia is among the top ten countries contributing the most to global under-five mortalities. This article examines the impact of the number of antenatal care and the timing of first antenatal care on child health outcomes. We specifically investigated if the utilization of antenatal care services positively affects the reduction of under-five mortality.MethodsWe employ a difference-in-differences design with propensity score matching to identify direct causal effects of antenatal care on under-five mortality based on the Ethiopian Demographic Health Survey data of 2011 and 2016. Our sample includes 22 295 women between the ages of 14–49 who had antenatal care visits at different times before delivery.ResultsThe study revealed 1 481 cases of reported under-five mortality. 99.0% of that under-five mortality cases are women who had less than eight antenatal care visits, while only 1% of that is by women who had eight or more antenatal care visits. Antenatal care visit decreases the likelihood of under-five mortality in Ethiopia by 45.2% (CI = 19.2–71.3%, P-value < 0.001) while the timing of first antenatal care within the first trimester decreases the likelihood of under-five mortality by 10% (CI = 5.7–15.6%, P-value < 0.001).ConclusionsTo achieve a significant reduction in the under-five mortality rate, Intervention programs that encourages more antenatal care visits should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets.

Factors associated with chronic energy malnutrition among reproductive-age women in Ethiopia: An analysis of the 2016 Ethiopia demographic and health survey data.

BackgroundWomen with chronic-energy malnutrition persists in many developing countries, including Ethiopia. To avert this problem identifying the predictor variables for a high magnitude of underweight is paramount. Consequently, this study aimed to assess the factors associated with chronic energy malnutrition among reproductive-age women in Ethiopia.MethodsWe used the 2016 Ethiopia demographic health survey data. The survey was a community-based cross-sectional study conducted from January 18 to June 27, 2016. A two-stage stratified cluster sampling technique was employed to select Participants. A total of 13,451 reproductive-age group women (age 15–49 years and who were not pregnant and < 2 months of postpartum) were included in the analysis. Both descriptive and analytical analyses were performed. A P-value of less than 0.05 was used to declare statistical significance.ResultsAbout 22.6% (95%CI: 21.5%-23.6%) of reproductive-age women were underweight. The magnitude of underweight is highest in the Afar region (39.6%) and lowest in Addis Ababa city administration (13.5%). Women who lived in the rural area (AOR = 1.59; 95%CI: 1.19–2.12), those who did not attend formal education (AOR = 1.23; 95%CI: 1.01–1.50), unemployed women (AOR = 1.28; 95%CI:1.13–1.44), women who belong to the poorest household wealth index (AOR = 1.42; 95%CI:1.04–1.94), women who were not married (AOR = 1.41; 95%CI: 1.18–2.69), women who lived in Tigray and the pastoral regions have higher odds of underweight. On the other hand, women who lived in southern nations nationalities and people’s region, and women whose age group 25–34 years had lower odds of underweight.ConclusionsChronic-energy malnutrition among reproductive-age women is high in Ethiopia. Improving the food security of rural, never married, and unemployed women would reduce the magnitude of underweight. Moreover, strengthening girls’ education, creating employment opportunities for women, and enhancing household income can further reduce the problem of chronic energy malnutrition.

Place of food cooking is associated with acute respiratory infection among under-five children in Ethiopia: multilevel analysis of 2005\u20132016 Ethiopian Demographic Health Survey data

BackgroundGlobally, acute respiratory infections are among the leading causes of under-five child mortality, especially in lower-income countries; it is associated with indoor exposure to toxic pollutants from solid biomass fuel. In Ethiopia, 90% of the population utilizes solid biomass fuel; respiratory illness is a leading health problem. However, there is a paucity of nationally representative data on the association of household cooking place and respiratory infections. Besides, evidence on the variability in the infection based on the data collected at different times is limited. Therefore, this study is intended to assess the association of food cooking place with acute respiratory infections and the variability in households and surveys.MethodsThe current analysis is based on the Ethiopian Demographic and Health Survey data collected in 2005, 2011, and 2016 and obtained via online registration. The association of food cooking place with acute respiratory infection was assessed using multilevel modeling after categorizing all factors into child level and survey level, controlling them in a full model. The analyses accounted for a complex survey design using a Stata command “svy.”ResultA total of 30,895 under-five children were included in this study, of which 3677 (11.9%) children had an acute respiratory infection, with 12.7% in 2005, 11.9% in 2011, and 11.1% in 2016. The risk of having an infection in under-five children in households that cooked food outdoors was 44% lower (AOR = 0.56, 95% CI = 0.40, 0.75) compared to those households that cooked the food inside the house. There was a statistically significant difference among the children among surveys to have an acute respiratory infection.ConclusionThe risk of having children with acute respiratory infection is lower in the households of cooking food outdoor compared to indoor. The infection difference in different surveys suggests progress in the practices in either food cooking places or the fuel types used that minimize food cooking places location or the fuel types used that minimizes the risk. But, the infection is still high; therefore, measures promoting indoor cooking in a well-ventilated environment with alternative energy sources should take place.

Modeling the predictors of stunting in Ethiopia: analysis of 2016 Ethiopian demographic health survey data (EDHS)

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.

Spatial Pattern and Associated Factors of ANC Visits in Ethiopia: Spatial and Multilevel Modeling of Ethiopian Demographic Health Survey Data.

Background Although there is an increase in having antenatal care (ANC), still many women lack recommended ANC contacts in Ethiopia. Therefore, this study was aimed at determining spatial patterns and associated factors of not having ANC visits using the Ethiopian Demographic and Health Survey (EDHS) 2016 data. Methods A two-stage stratified cluster sampling technique was employed based on EDHS data from January 18 to June 27, 2016. A total of 7,462 women were included in the study. ArcGIS version 10.7 software was used to visualize the spatial distribution. The Bernoulli model was applied using Kilduff SaTScan version 9.6 software to identify significant purely spatial clusters for not having ANC visits in Ethiopia. A multivariable multilevel logistic regression model was used to identify individual- and community-level determinants of not having antenatal care. Model comparison was checked using the likelihood test and goodness of fit was assessed by the deviance test. Results The primary clusters' spatial window was located in Somalia, Oromia, Afar, Dire Dawa, and Harari regions with the log-likelihood ratio (LLR) of 133.02, at p < 0.001 level of significance. In this study, Islam religion (adjusted odds ratio (AOR) = 0.7 with 95% confidence interval (CI) (0.52,0.96)), mother education being primary (AOR = 0.59, 95% CI (0.49,0.71)), distance from health facility being a big problem (AOR = 0.76, CI (0.65,0.89)), second birth order (AOR = 1.35, CI (1.03, 1.76)), richer wealth index (AOR = 0.65, CI (0.51,0.82)), rural residence (AOR = 2.38, CI (1.54,3.66)), and high community media exposure (AOR = 0.68, CI (0.52,0.89)) were determinants of not having antenatal care in Ethiopia. Conclusion The spatial distribution of ANC in Ethiopia is non-random. A higher proportion of not having ANC is found in northeast Amhara, west Benishangul Gumuz, Somali, Afar, north, and northeast SNNPR. On the other hand, a low proportion of not having ANC was found in Tigray, Addis Ababa, and Dire Dawa. In Ethiopia, not having antenatal care is affected by both individual- and community-level factors. Prompt attention by the Federal Ministry of Health is compulsory to improve ANC especially in rural residents, uneducated women, poor households, and regions like Oromia, Gambella, and Somalia.

Modern Contraceptive Use and Influencing Factors in Amhara Regional State: Further Analysis of Ethiopian Demographic Health Survey Data 2016

Background. Ethiopia is one of the Sub-Saharan African countries with a high unmet need for contraceptives. Contraception is a good indicator of the extent to which couples have access to reproductive health services. A study on contraceptives can provide overall direction by helping to identify the obstacles in society and weaknesses in services that need to be overcome. However, little is known in Amhara region context. Therefore, this analysis was aimed to assess modern contraceptive use and influencing factors in the Amhara regional state of Ethiopia. Methods. We used secondary data analysis of the regional representative sample of women aged 15–49 years from the 2016 Ethiopian Demography and Health Survey (EDHS). A total of 2207 married reproductive-age women (15–49 years) selected using a two-stage stratified cluster sampling technique were included in this analysis. Both descriptive and logistic regression analyses were performed using STATA V.14. A 95% confidence interval was used to declare statistical significance. Results. Modern contraceptive use among married reproductive-age women was 51.3% (95% CI: 47.0–55.6). Being from households with rich wealth index (AOR = 1.6; 95% CI: 1.1–2.5), a secondary or higher level of education (AOR = 3.0; 95% CI: 1.4–6.2), and desire to space (AOR = 2.6; 95% CI: 1.9–3.7) or want no more child (AOR = 2.4; 95% CI: 1.6–3.5) were found positively associated with modern contraceptive use. On the other hand, modern contraceptive use was negatively associated with women aged 35–49 years (AOR = 0.7; 95% CI: 0.5–0.9). Conclusion. Modern contraceptive use was relatively high in the Amhara region. The odds of modern contraceptive use were higher among women with secondary or more educational levels. Women from households with rich wealth index and those who want to delay or avoid pregnancy had also more odds of using modern contraceptives. Therefore, strengthening women’s and community education could improve modern contraceptive use. Moreover, more emphasis should be given for income generation activities.

Modern contraceptive use and factors associated with use among postpartum women in Ethiopia; further analysis of the 2016 Ethiopia demographic and health survey data

BackgroundThe postpartum period is a critical time to improve maternal and child health. It is a time for accessing contraceptives to prevent short inter-pregnancy intervals. More than 95% of postpartum women do not want to get pregnant within 12 months. However, many women in Ethiopia experience an unintended pregnancy, and there is low information about postpartum contraceptive use among women who have family planning demand. Therefore, this study aimed to estimate the prevalence of postpartum contraceptive use and its predictors among women who give birth 12 months before the survey in Ethiopia.MethodsWe used the 2016 Ethiopia demographic health survey data for this analysis. The survey was a community-based cross-sectional study conducted from January 18 to June 27, 2016. The survey employed a two-stage stratified cluster sampling technique. A total of 2304 postpartum women were included. Bivariate and multivariable logistics regressions were done to identify factors associated with postpartum contraceptive use. A p-value < 0.05 was used to declare statistical significance.ResultsAbout 23.7% (23.7, 95% CI: 20.7–27.0%) of postpartum women were using modern contraceptives. Women who were urban residents (AOR = 2.18; 95%CI: 1.34–3.55), those who attended secondary or higher education (AOR = 1.79; 95%CI: 1.04–3.10), women who attended 1–3 (AOR = 2.33; 95%CI:1.27–4.25) or 4 or more ANC visits (AOR = 2.59; 95%CI:1.43–4.69) and women who delivered at a health facility (AOR = 1.86; 95%CI: 1.23–2.81) had higher odds of modern contraceptive use during the postpartum period. Similarly, women who reported the last child was no more wanted (AOR = 1.83; 95%CI: 1.01–3.31), women who decided for contraceptive use (AOR = 2.03; 95%CI: 1.13–3.65) and women whose recent child was male (AOR = 1.38; 95%CI: 1.01–1.88) had higher odds of modern contraceptive use.ConclusionPostpartum contraceptive use was low in Ethiopia. Strengthening health facility delivery, promoting girls’ education and encouraging women’s participation in deciding for contraceptive use would improve the uptake of modern contraceptives use during the postpartum period.

Factors associated with sexually transmitted infections among sexually active men in Ethiopia. Further analysis of 2016 Ethiopian demographic and health survey data.

BackgroundSexually-transmitted infections are a public health problem in developing countries including Ethiopia. However, there is limited evidence on factors associated with sexually-transmitted infections among men in Ethiopia. Therefore, this analysis was done to fill this gap.MethodsThis analysis was done based on the 2016 Ethiopian demographic health survey data. The survey was a community-based cross-sectional study conducted from January 18 to June 27, 2016. The survey used two stage-stratified cluster sampling technique. A total of 8849 sexually active men were included in this analysis. Descriptive and analytical analyses were performed. A p-value of less than 0.05 was used to declare statistical significance.ResultsMuslim men (AOR = 1.68; 95%CI: 1.02–2.76), men who were not exposed to media (AOR = 1.75; 95%CI: 1.01–3.03) and men who had multiple sexual partners (AOR = 2.29; 95%CI: 1.05–5.01) had higher odds of having a sexually transmitted infection. In addition, men living in Amhara (AOR = 3.31; 95%CI: 1.33–8.22), Oromia (AOR = 4.62; 95%CI: 1.85–11.55), Gambella (AOR = 3.64; 95%CI: 1.27–10.42), and Harari regions (AOR = 4.57; 95%CI: 1.49–14.02) had higher odds of developing sexually transmitted infection. On the other hand, men who believe women are asked to use a condom if she knows he has STIs (AOR = 0.53; 95%CI: 0.33–0.85) had low odds of developing a sexually transmitted infection.ConclusionsMen not exposed to mass media, Muslims and men with multi-sexual partners had higher odds of having sexually transmitted infections. Encouraging monogamous relationships and exposing men to mass media may help to reduce the burden of STIs in Ethiopia.