Higher Birth Order Research Articles

Determinations of Antenatal Care Utilization Among Reproductive Age Women in Lumbini Province, Nepal

This study examines the factors influencing Antenatal care (ANC) utilization among women aged 15–49 in Lumbini Province, Nepal, using data from the 2021 Nepal Demographic and Health Survey (NDHS). Logistic regression analysis identifies significant determinants of ANC attendance, including age, birth order, education, and wealth. This study shows that in a similar meter from the previous, women in the age group of 20-24 years are at a risk of almost 4.78 times greater for attending ANC visits than women below it. The odds continue to increase as with an all-time high validation for women aged 30-49 years (OR = 11.75, p = 0.017). Where birth order sometimes negatively affects ANC usage, women with three or more children will less likely seek ANC (OR = 0.344, p = 0.063). There is a positive association between the ANC use and education because those women with better education are 2.83 more likely to access ANC services, although it is not very significant. Indeed, differences in the economics that do exist show that poorer women attend ANC as showed to by an OR of 0.384, which denotes that they are 0.384 times less likely to attend ANC compared to the poorest (OR = 0.384, p = 0.045): with wealth, indirect influences of religion, caste/ethnicity, and location using socio-economic factors being biased toward ANC use. It shows that, it should to improve ANC for young mothers, women with higher birth orders, and income. Addressing these gaps therefore needs a multi-faceted approach in terms of strengthening education, financial support, and healthcare infrastructure. The findings provide the much needed evidence and policymakers to strategize around maternal health equity and SDG pathways that give detail in regard to addressing maternal and child health issues in Lumbini Province.

Cross-sectional analysis of risk factors associated with the coexistence of three undernutrition indicators among children aged 0–23 months in Tanzania

BackgroundUndernutrition in children under two years is a persistent challenge in Tanzania. This study investigates demographic, maternal, and child-related factors associated with stunting, wasting, and underweight coexistence.MethodsSecondary data from 2,158 children aged 0–23 months in the 2022 Tanzania Demographic and Health Survey (TDHS) were analyzed. Risk factors assessed included child age, birth weight, size at birth, birth order, and maternal education. Multinomial regression analysis was conducted to determine associations.ResultsThe risk of coexisting undernutrition was significantly higher among children aged 12–17 months (RRR = 8.297, 95% CI = 1.768–38.931, p = 0.007) and 18–23 months (RRR = 12.860, 95% CI = 2.661–62.152, p = 0.001). Protective factors included birth weight < 2,501 g (RRR = 0.211, 95% CI = 0.056–0.783, p = 0.02), average size at birth (RRR = 0.262, 95% CI = 0.076–0.908, p = 0.035), and higher birth order (2nd–4th: RRR = 0.372, p = 0.023; 5th: RRR = 0.340, p = 0.048). Maternal education emerged as a significant risk factor (RRR = 1.327, 95% CI = 1.128–6.841, p = 0.02).ConclusionThis study highlights critical risk factors, including maternal education, child age, and birth characteristics, for the coexistence of stunting, wasting, and underweight. Interventions should target the 12–23-month age group and address maternal education to eradicate child malnutrition in Tanzania.

Changes and determinants of pneumococcal vaccine uptake in Ethiopia.

Pneumococcal pneumonia is one of the most common causes of severe pneumonia and pneumonia-related mortality globally. It ranked among the leading causes of morbidity and mortality in children under five years in Ethiopia. Vaccination reduces the burden of pneumonia and pneumococcal infections in both children and adults. This study assesses changes in pneumococcal vaccine coverage over time and identifies factors associated with the vaccine uptake. The study was based on secondary data from the Ethiopian Demographic and Health Surveys (EDHS) in 2016 and 2019, involving 1,929 children in 2016 and 1,008 in 2019, aged 12-23 months. A cross-sectional study design was conducted. The percentage change in pneumococcal conjugate vaccine (PCV) coverage was used to quantify the degree of change over time, while multilevel ordinal logistic regression identifies significant factors. All statistical tests were performed using a 5% significance threshold. The study found a significant 21.8% (95% CI: 9.8-35.2) change in the proportion of children receiving complete doses of PCV, from 49.1% in 2016 to 59.8% in 2019. Children in rural areas were 69% less likely to receive more doses of PCV vaccinations than those living in urban areas (AOR = 0.307, 95% CI: 0.127 - 0.742). Second or higher-order births were associated with greater uptake doses of PCV (AOR = 2.519, 95% CI: 1.143-5.548). Child born in health facilities were 2.35 times more likely to receive full vaccination than those born at home (AOR = 2.350, 95% CI: 1.132-4.882). Additionally, children whose mothers had more antenatal care (ANC) visits were more likely to complete their pneumococcal vaccination. Despite the increase in uptake, Ethiopia remains far from reaching its immunization goals. The study showed that place of residence, birth order, place of delivery, antenatal care and regional variation were significantly associated with pneumococcal vaccine uptake.

Developmental delay and associated factors among HIV-infected under-five children in public health facilities, Southern Ethiopia

Delays in development that occur during early childhood can have long-lasting consequences, potentially leading to poor academic achievement. Research has shown that the human immunodeficiency virus can have neurotropic effects, which may impact the development of the brain in infected children. However, there is a scarcity of evidence regarding developmental delays among children with human immunodeficiency virus in the study area. This study aimed to determine the prevalence of developmental delay and associated factors among children with the human immunodeficiency virus in southern Ethiopia. A cross-sectional study was undertaken among 422 children aged below five during October 30 to December 30, 2021, who acquired the human immunodeficiency virus at public hospitals. A pretested tool anthropometric measurements were utilized. To examine developmental delay, the age and stage questionnaires (version 3) were used. Descriptive statistics were performed. Bivariable and multivariable binary logistic regression models were fitted to identify potential factors associated with delays in child development. The analysis was performed using STATA version 14.2. Adjusted odds ratios with 95% confidence intervals and variables with p-values less than 0.05 were considered to be significantly associated with global developmental delay. A total of 413 under-five children with human immune virus participated, with a 97.9% response rate. Of all children, 222 (53.75%) were male, and the mean age of children was 3.5 ± 1 (± SD) years. Overall global developmental delay was 41.89% [95% CI 37–47%]. Maternal age 35 and older [AOR 2.2; 95% CI (1.11–4.3)], maternal educational status [AOR 0.47; 95% CI (0.23–0.96)], higher birth order [AOR 3; 95% CI (1.5–4)], and stunting [AOR 2.2; 95% CI (1.4–3.42)] were significant factors associated with global developmental delay. Half of the children examined demonstrated delayed development across domains. The global developmental delay constitutes a significant public health concern, underscoring the necessity for early detection initiatives including developmental screening, diagnostic evaluations, and therapeutic interventions. We found significant associations between the developmental status of the children and the maternal age, educational level of mothers, higher birth order, and stunting of under-five children. Policies should aim to enhance mother and child health services, expand access to early intervention programs, and incorporate developmental surveillance into routine pediatric care. Additional research may be necessary to elucidate the underlying causes of the high prevalence of Global developmental delay, evaluate the efficacy of current interventions, and investigate innovative approaches to mitigate developmental delays.

Using national invitro fertilization registries to validate clinical outcomes after invitro fertilization covered by health insurance.

To evaluate invitro fertilization (IVF) cycles covered by health insurance using a national commercial claims database and validate key clinical events against national IVF registries. Retrospective cohort study. US women aged 20-44 years who underwent IVF from 2005-2020 in Optum's deidentified Clinformatics Data Mart Database (CDM). Undergoing IVF. Invitro fertilization cycles and rates of pregnancies (inclusive of losses and terminations), live births, and live birth types (e.g., singleton, twin, and triplet or higher-order). We identified more than 3,000 IVF cycles in each year from 2005-2020 within CDM. When comparing our rates of clinical outcomes with external benchmark data, the results were similar across all the years of our study. For example, in 2020, the percentages of pregnancies after first embryo transfer were 62.03% (95% confidence interval [CI], 59.48-64.47) in CDM and 64.96% in data from the Society for Assisted Reproductive Technology (SART). The rates of live birth after first embryo transfer were 44.58% (95% CI, 41.90-47.21) in CDM in 2020 and 46.95% in SART in 2020. The rate of singleton births was 94.17% (95% CI, 92.24-96.10) in CDM in 2020, and this rate was 94.37% in SART in 2020. For twin births, the rates were 5.48% (95% CI, 3.60-7.35) in CDM in 2020 and 5.46% in SART in 2020. The rates of triplet or higher-order births were 0.35% (95% CI, 0.00-0.84) in CDM in 2020 and 0.17% in SART in2020. We found that CDM can be used to accurately identify IVF cycles covered by insurance and key clinical outcomes such as rates of pregnancies, live births, and live birth types, and our reported rates were similar to national IVF clinical registry data. Our findings support that CDM is a robust data source to conduct research about IVF insurance coverage and can accurately evaluate clinical outcomes resulting from IVF. Policymakers who are considering insurance coverage for IVF can use CDM to model and measure the impact of new or existing policies for IVF insurance coverage.

Impact of normal vs. caesarean deliveries on child nutritional status and mortality in India: insights from NFHS-5 data

ObjectiveSkilled birth attendance and place of delivery have a significant effect on child growth. The present paper examined the mode of delivery and its impact on child health among children 0–59 months in India.MethodsA total of 200,794 samples were used in the study. Among them, 45,784 births were delivered by C-section, and the remaining 150,010 births were delivered through normal delivery. Life table estimation of mortality, as well as bivariate and multivariate logistic regression, were used to identify the association between child health and mode of delivery using data from the fifth round of the National Family Health Survey conducted in 2019-21.ResultsThe study results indicate that children born through normal delivery had significantly lower rates of stunting, wasting, and underweight compared to those born via C-section. Additionally, the likelihood of a new-born baby dying during the neonatal period was higher for those delivered by C-section compared to those delivered vaginally, which holds true for various background characteristics. Mothers with a 3rd or higher order birth who deliver via C-section face a higher risk of their baby dying during the neonatal and infant periods compared to those with a 2nd order birth.ConclusionThe conclusion of the study found that C-section delivery may adversely affect child undernutrition as compared to normal birth. These findings would help formulate the policies and implement actions that would improve the quality of painless labor and immediate delivery in health facilities particularly public hospitals and shall reduce the C-section birth.

Intimate Partner Violence during the Index Pregnancy and its correlates among a panel of pregnant women in Ethiopia, evidence from performance, and monitoring for action (PMA) 2021 cohort two baseline survey

IntroductionCurrent intimate partner violence (IPV) in Ethiopia is considerably high. This study aimed at determining the prevalence of IPV among a panel of pregnant women during their index pregnancy and identify its correlates using Performance Monitoring for action (PMA) cohort 2 baseline data. Documenting the magnitude of IPV thus far during the index pregnancy and identifying factors affecting it contributes its share for the ministry and relevant developmental partners in tracking progress towards eliminating all forms of violence against women and girls by 2030.MethodsWe conducted a further analysis of national level follow up secondary data sets from Performance Monitoring for action Ethiopian (E_PMA). This study used PMA cohort two baseline data which enrolled pregnant and recently postpartum women and collected real time data on various sexual, reproductive, maternal and new born nationwide priority indicators using customized Open Data Kit Mobile application. These data were collected using standard pretested questionnaire prepared in three local languages (Amharic, Afan Oromo and Tigrigna) by well experienced resident enumerators. This study was restricted to 1,796 pregnant women at the enrollment. Frequency was computed to describe the study participant’s characteristics, and chi-square statistics was used to assess cell sample size adequacy. Multilevel binary logistics regression model building process was employed to identify correlates of IPV. Results were presented in the form percentages and odds ratio with 95% Confidence Intervals. Candidate variables were selected using p-value of 0.25. Statistical significance was declared at p-value of 0.05.ResultsOne in six; 16.7% (14.81%, 18.76%) pregnant women have reported experiencing at least one form of physical and/or sexual IPV thus far in their index pregnancy. The prevalence of encountering at least one form of sexual violence was 12.53% (10.91%, 14.35%) while 7% (5.5%, 8.3%) of them experienced at least one form physical intimate partner violence thus far during their index pregnancy. Women perceived risk about contraceptive use ((AOR: 95% CI: 1.66 (1.10, 2.47)), higher birth order ((AOR: 95% CI: 1.88 (1.05, 3.34)), unhappy emotional fertility intention when learned their index pregnancy ((AOR: 95% CI: 1.7 (1.02, 2.84)) and a family size of 4 to 5 ((AOR: 95% CI: 1.87 (1.11. 3.14)) were the fixed effects factors found to increase the odds of IPV significantly and positively. On the contrary, being in the third trimester of gestation at enrollment was another fixed effect variable which contributed for the 44% lower odds ((AOR: 95% CI: 0.56 (0.34, 0.92)) of experiencing IPV thus far in their index pregnancy.ConclusionsThe overall burden of IPV reported was high; with nearly double the percentage of women experiencing sexual violence during the index pregnancy compared to physical IPV. More work needs to be done to achieve zero tolerance against any form of violence among women and girls in general and among pregnant women in particular. Efforts targeted in improving women perception on issue related with their contraceptive use, counseling women on how to prevent IPV during their antenatal care (ANC) visit along with advising the use of inter pregnancy contraception and empowering them to control on their fertility are hoped to mitigate such considerably higher odds of IPV among pregnant women. Further programs and intervention on awareness creation towards the misconception that women held about contraceptive use would contribute much. These activities and efforts need to target younger women. The implication of the findings calls key actors and the Federal Democratic Republic of Ethiopia Health Minster to design and implement programs on women emotional fertility readiness and empowering them to control over their fertility through diversified contraceptive provision which is critical in combating the reported substantial IPV experience during pregnancy. Creating institutional capacity in the health system through strengthening and expanding one stop centers to provide medical treatment, care, and psychosocial support for victims and survivors could play a pivotal role. In addition, installing rapid referral system and linkage to the legal system could play a vital role. Moreover, working on early marriage and counseling on childbirth; and spaced pregnancy for those young couples is imperative. Further implication of this study was installing contraceptive and violence related preconception care packages in the health system is very critical in the combat against IPV and any form of gender based violence.

Perinatal and Demographic Risk Factors Associated with Autism Spectrum Disorder: A National Survey of Potential Predictors and Severity.

INTRODUCTION: This study investigates autism spectrum disorders (ASD) in Greece, focusing on estimating prevalence and identifying regional disparities in children aged 4 to 7 years. MATERIALS AND METHODS: Utilizing a quantitative, descriptive, and exploratory methodology, the research employed a structured questionnaire to gather extensive maternal and child health data. RESULTS: The sample consisted of 517 mothers of children diagnosed with ASD from all over Greece, contributing to a nuanced understanding of ASD predictors. This study aims to elucidate the role of prenatal factors in the likelihood of an ASD diagnosis and their impact on the subsequent functionality of children with ASD. The study identified significant predictors of lower functionality in children with ASD, including higher maternal age, delayed ASD diagnosis, lower family income, and higher birth order. Prenatal health issues, such as vaginal bleeding and infections, also influenced functional outcomes. Notably, a family history of neurological or psychiatric conditions appeared protective. DISCUSSION: The regression model demonstrated robust predictive power, underscoring the complexity of genetic, environmental, and socioeconomic factors in ASD development. The findings advocate for early diagnosis and intervention, systematic screening, and addressing socioeconomic disparities to improve functional outcomes. The results support evidence-based service development and policy adjustments to enhance early identification, intervention, and rehabilitation for children with ASD. CONCLUSIONS: Establishing standardized case-recording procedures and an ASD register at national and regional levels is recommended for systematic monitoring and resource evaluation.

Declines in Triplet and Higher-order Multiple Births in the United States, 1998-2023.

This report explores changes in the overall rate of triplet and higher-order births from 1998 to 2023 by detailed plurality, maternal race and Hispanic origin, and age. Data are from the National Vital Statistics System birth files. Triplet and higher-order birth rates (number of triplet and higher-order births per 100,000 births) from 1998 to 2023 are presented. Also presented are the number of triplet, triplet and higher-order, and quadruplet and higher-order births, and triplet and higher-order multiple birth rates by maternal race and Hispanic origin and maternal age for 1998, 2009, and 2023. From 1998 to 2023, the triplet and higher-order multiple birth rate declined 62%, from 193.5 per 100,000 total births to 73.8; the largest declines were from 2009 to 2023. The number of triplet and higher-order births declined from 7,625 to 2,653. Declines in triplet and higher-order birth rates were observed for White non-Hispanic (71%) and Hispanic (25%) mothers, while the rate for Black non-Hispanic mothers increased (25%). Triplet and higher-order birth rates declined for all age groups 20 and older from 1998 to 2023, and the largest declines were for mothers age 30 and older.

Breastfeeding Status and Infectious Diseases among Children Aged 6–23 Months in Indonesia

Introduction: Infectious diseases remain public health issues in Indonesia. However, there remains a knowledge gap on whether breastfeeding can prevent infectious diseases in young children. This study examined the relationship between current breastfeeding and child infections in Indonesia. Methods: Data were derived from the 2017 Indonesia Demographic and Health Survey by including 5158 children aged 6–23 months. The dependent variables were diarrhea, fever, and acute respiratory infection (ARI). The main exposure of interest was the current breastfeeding status. Covariates included factors at the child, maternal, household, health care, and community levels. Results: Around 20%, 38%, and 4% of children experienced diarrhea, fever, and ARI, respectively. Current breastfeeding status was protective against diarrhea (adjusted odds ratio [AOR] = 0.74, 95% confidence interval [CI] = 0.61–0.89) but not related to fever (AOR = 0.95, 95% CI = 0.82–1.11) and ARI (AOR = 1.01, 95% CI = 0.70–1.47). Other factors related to diarrhea included female children, older maternal age, maternal higher education, improved drinking water source, and living in Sulawesi. Living in Sumatera and Sulawesi were linked to fever. Higher birth orders and improved toilet facilities were associated with ARI. Conclusion: The findings indicate different levels of factors affecting child infections. Thus, integrating breastfeeding promotions with water, hygiene, and sanitation interventions may help prevent infectious diseases in young children.

Perceived Spousal Concordance on Desired Family Size and Birth Intendedness Among Second and Higher-Order Births in Pakistan

Perceived Spousal Concordance on Desired Family Size and Birth Intendedness Among Second and Higher-Order Births in Pakistan

Monochorionic Triamniotic Triplet Pregnancy: A Case Report

Triplet pregnancies are rare, and monozygotic triplet pregnancies are even rarer. Triplet pregnancies present increased risk in every aspect of the prenatal course. The rate of triplet and higher order births, in the United States, was 78.9 per 100 000 and that rate has decreased from a peak, in 1998. Sonography plays a vital role in the diagnosis and management of all multifetal pregnancies. To further illustrate the importance of sonography, a case of spontaneous monochorionic triamniotic (MCTA) triplets is presented. This set of triplets were delivered at 32 weeks gestation without significant adverse neonatal outcome.

Prevalence and Factors Associated with Protein Energy Malnutrition among Pre School Children in Rural Areas

Children, particularly those in rural areas, are among the most vulnerable to malnutrition, a silent emergency recognized by organizations such as the United Nations Children's Fund (UNICEF). This study delves into the complexities of undernutrition, specifically Protein Energy Malnutrition (PEM), among pre-school children aged 3-6 years in rural regions. The research aims to estimate the prevalence of PEM, identify associated factors, and analyze various feeding practices contributing to malnutrition. Data collection was conducted through survey methods, encompassing 3-6-year-old children, revealing alarming statistics. Findings from 20 article papers underscored that 27.96% of pre-school children were underweight, with 6.71% severely underweight. Notably, 42.78% of children lacking energy-dense foods, as per Recommended Dietary Allowance (RDA), experienced malnutrition. Additionally, more than one-third of children suffered from underweight due to PEM. The study highlights the elevated risk of malnutrition among children with low birth weights, shorter interpregnancy intervals, higher birth orders, and inadequate breastfeeding and immunization practices. These insights underscore the urgent need for targeted interventions to address the multifaceted challenges contributing to PEM among rural pre-school children.

Changes in First and Second Births to U.S. Teenagers From 2000 to 2022.

This study examines trends in the numbers, percentages, and rates of first and second and higher-order births to teenagers younger than age 20 and for those ages 15-17 and 18-19 by race and Hispanic origin. Data for this analysis are from the National Vital Statistics System birth data files from 2000 and 2022. Analyses are limited to births to females younger than age 20. Changes in the numbers, percentages, and rates of total, first, and second and higher-order teen births from 2000 to 2022 were calculated for all teenagers and for non-Hispanic American Indian and Alaska Native, non-Hispanic Black, non-Hispanic White, and Hispanic teenagers. The number of first teen births declined 67% and the number of second and higher-order teen births declined 79%, while the population of female teenagers increased 7% from 2000 to 2022. The declines were greater for younger teenagers compared with older teenagers. First and second and higher-order teen birth rates declined 69% and 80%, respectively. Similar declines were found for each race and Hispanic-origin group. In 2000 and 2022, first and second and higher-order birth rates were lowest among White teenagers. First birth rates were highest among Hispanic teenagers in 2000 and for Hispanic and non-Hispanic American Indian and Alaska Native teenagers in 2022. In 2000, second and higher-order birth rates were highest for non-Hispanic Black and Hispanic teenagers; second and higher-order birth rates were more similar by race and Hispanic-origin group in 2022.

Fertility Decline in Iceland, 2013-2022: Trends and Structures

Iceland is one of the Western countries that have experienced an unexpected fertility decrease in the 2010s. In this study, the aggregate Icelandic fertility decline is dissected to explore which fertility components are the main drivers behind the decline since 2010 in order to better understand whether the development is associated with compositional changes or linked to changes such as increased propensities of childlessness and decreased propensities to have another child. As such, it contributes empirical evidence to ongoing theorisation within current fertility debates. Official administrative register data are analysed by means of event-history analysis. Findings are presented as parity-specific birth risks and in the form of Kaplan-Meier estimates of synthetic period-based cohorts of women and men progressing to parity one over calendar years. In terms of results, we find that the fertility decline was concentrated around first births, and the decline can principally be attributed to women under the age of thirty. Propensities to remain childless have increased slightly since 2013, while there were no declines in the intensities to have a second and a third child. Hence, the development in Iceland appears to be driven by clear postponement of parenthood but not altered childbearing behaviour in terms of propensities to have a second and a third child. Results do not necessary contradict theories under the umbrella of the gender-relations framework, but they highlight the importance of exploring other factors impacting the transition to parenthood, such as perceived global and welfare uncertainties. Socioeconomic differentials in first-birth fertility and factors affecting postponement and ultimate childlessness should be explored further, as well as short-term developments in higher-order birth intensities during adverse circumstances, such as the 2008 economic crisis and the Covid-19 pandemic, during which periods the third-birth intensities increased.

Children’s sex composition and transition to higher-order birth among Turkish migrants in Europe and their non-migrant counterparts in Turkey: does having a son matter?

ABSTRACT A growing literature examines parental sex preferences for their children among migrant communities in Western countries and investigates whether migrants’ preferences align with those of the native population. Changes in preference may indicate cultural and structural assimilation into the destination country. We adopted a dissimilation from origins conceptual perspective and compared migrants’ behavior to that of their non-migrant peers in the origin country. We used the unique 2000 Families dataset, which includes multi-generational data on both early labor migrants to Europe and non-migrants from the same regions of origin in Turkey. The study provides the first examination of parental sex preferences for their children and fertility among Turkish migrants and their descendants in Europe and their non-migrant counterparts in Turkey. The findings show ongoing son preference among first-generation migrants and their children, thus supporting the theory of cultural persistence.

The effect of dietary diversity on anemia levels among children 6-23 months in sub-Saharan Africa: A multilevel ordinal logistic regression model.

Anemia is the most common hematologic disorder of children worldwide. Since dietary diversity is a main requirement of children is to get all the essential nutrients, it can thus use as one of the basic indicator when assessing the child's anemia. Although dietary diversity plays a major role in anemia among children in sub-Saharan Africa, there is little evidence of an association between the dietary diversity and anemia level to identified potential strategies for prevention of anemia level in sub-Saharan Africa. To examine the association between dietary diversity and anemia levels among children aged 6-23 months in sub-Saharan Africa. The most recent Demographic and Health Surveys from 32 countries in SSA were considered for this study, which used pooled data from those surveys. In this study, a total weighted sample of 52,180 children aged 6-23 months was included. The diversity of the diet given to children was assessed using the minimum dietary diversity (MDD), which considers only four of the seven food groups. A multilevel ordinal logistic regression model was applied due to the DHS data's hierarchical structure and the ordinal nature of anemia. With a p-value of 0.08, the Brant test found that the proportional odds assumption was satisfied. In addition, model comparisons were done using deviance. In the bi-variable analysis, variables having a p-value ≤0.2 were taken into account for multivariable analysis. The Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was presented for potential determinants of levels of anemia in the multivariable multilevel proportional odds model. The overall prevalence of minimum dietary diversity and anemia among children aged 6-23 months were 43% [95% CI: 42.6%, 43.4%] and 72.0% [95% CI: 70.9%, 72.9%] respectively. Of which, 26.2% had mild anemia, 43.4% had moderate anemia, and 2.4% had severe anemia. MDD, being female child, being 18-23 months age, born from mothers aged ≥25, taking drugs for the intestinal parasite, higher level of maternal education, number of ANC visits, middle and richer household wealth status, distance of health facility and being born in Central and Southern Africa were significantly associated with the lower odds of levels of anemia. Contrarily, being 9-11- and 12-17-months age, size of child, having fever and diarrhea in the last two weeks, higher birth order, stunting, wasting, and underweight and being in West Africa were significantly associated with higher odds of levels of anemia. Anemia was a significant public health issue among children aged 6-23 months in sub-Saharan Africa. Minimum dietary diversity intake is associated with reduced anemia in children aged 6 to 23 months in sub-Saharan Africa. Children should be fed a variety of foods to improve their anemia status. Reducing anemia in children aged 6-23 months can be achieved by raising mother education levels, treating febrile illnesses, and improve the family's financial situation. Finally, iron fortification or vitamin supplementation could help to better reduce the risk of anemia and raise children's hemoglobin levels in order to treat anemia.

Determinants of normal haemoglobin concentration among under-five children in Sub-Saharan Africa: a Positive deviance inquiry using cross-sectional study design

BackgroundLow haemoglobin level in children is linked with short-term and long-term consequences including developmental delay. Globally, over half of the children under the age of five years had low haemoglobin...

Role of Women's Empowerment in Improving the Nutritional Status of Children Under Five Years of Age: An Insight From the National Family Health Survey-5.

Background Childhood malnutrition remains a global concern, especially in low- and middle-income countries, and is known to create an intergenerational cycle of illness and poverty. Women's empowerment has gained global recognition as a potential catalyst for improving child nutrition. The objective of this research was to investigate the association between women's empowerment factors and the nutritional status of children under five years of age. Methods The study used data from the National Family Health Survey-5, conducted in India between 2019 and 2021 by the International Institute of Population Sciences, Mumbai. A weighted sample of 29,491 mother-child pairs was analyzed. The odds ratio for women's empowerment and sociodemographic factors associated with the nutritional status of children under five years of age was calculated using Pearson's chi-square test and multiple logistic regression. Results The study foundthat the sex of the child (OR = 1.066, 95% CI: 1.017 to 1.117; p-value: 0.008), birth order (OR = 0.824, 95% CI: 0.780 to 0.871; p-value < 0.001), education of the mother (OR = 1.356, 95% CI: 1.255 to 1.464; p-value < 0.001), education of the father (OR = 1.227, 95% CI: 1.140 to 1.320; p-value < 0.001), having a bank or savings account that she uses (OR = 1.151, 95% CI: 1.084 to 1.221; p-value < 0.001), having a mobile phone that she uses (OR = 1.184, 95% CI: 1.125 to 1.246; p-value < 0.001), and wealth index (OR = 1.597, 95% CI: 1.514 to 1.684; p-value < 0.001) were significant predictors of undernutrition in children under the age of five (U5). Conclusion Women's empowerment factors play a significant role in improving childhood nutrition. In the study, male sex, higher birth order, lower parental education, poor wealth index, maternal lack ofaccess to a bank or a savings account, and lack of mobile phone ownership were found to besignificant predictors of undernutrition in children U5. The findings underscore the importance of family planning, financial inclusion, access to mobile phones, and higher education for women as important factors that can help improve the nutritional status of children under five years of age. Policymakers can utilize these insights to make targeted strategies for women's empowerment, thus improving the nutritional status of children. However, being a secondary data analysis, our research is constrained by the variables available in the dataset. Further research is required to better comprehend the complex relationship between women empowerment and child nutrition.

Spatial patterns and determinants of low utilization of delivery care service and postnatal check-up within 2 months following birth in Ethiopia: Bivariate analysis.

Home delivery is a nonclinical childbirth practice that takes place in one's home with or without traditional birth attendants and postnatal care is the care given to the mother and her newborn baby; according to world health organization (WHO), the postnatal phase, begins one hour after birth and lasts six weeks (42 days). This paper aimed to study the spatial pattern and determinant factors of low utilization of delivery care (DC) services and postnatal check-up (PNC) after live births in Ethiopia. This study used the 2016 Ethiopian Demographic and Health Survey data as a source. A total weighted samples of 11023 women-children pairs were included. The bivariate binary logistic regression analyses with spatial effect were modeled using SAS version 9.4 and ArcGIS version 10.8 was used for mapping. The spatial distribution of low utilization of delivery care service and postnatal check-up were significantly clustered in Ethiopia (Moran's I statistic 0.378, P-value < 0.001 and 0.177, P-value < 0.001 respectively). Among 11023 children-women pair, the prevalence of home delivery and no postnatal check-up within two months following birth were 72.6% and 91.4% respectively. The Liben, Borena, Guji, Bale, Dolo and Zone 2 were predicted to have high prevalence of home delivery and part of Afder, Shabelle, Korahe, Dolo and Zone 2 were high risk areas of no postnatal checkup. Lack of occupation, region, large family size, higher birth order, low utilization of antenatal care visit, unable to access mass media, big problem of health facility distance and the spatial variable were found to be jointly significant predictors of low utilization of DC and PNC in Ethiopia. Whereas older age, being reside in rural area and low wealth status affects delivery care service utilization. We suggest health providers, policy makers and stakeholders consider those variables with priority given to Liben, Borena, Guji, Bale, Dolo, Zone 2, Afder, Shabelle and Korahe, where home delivery and no PNC were predicted relatively high. We also recommend researchers to conduct further studies using latest survey data set.