Short Birth Intervals Research Articles

Determinants of underweight among returnee lactating mothers in Gedeb District, Southern Ethiopia: a case–control study

ObjectiveThis study aimed to assess the determinants of underweight among returnees lactating mothers in governmental health facilities of Gedeo zone, Southern Ethiopia.DesignCase–control study.SettingGedeb District governmental health facilities.ParticipantsA total of 264...

Determinants of suboptimal birth spacing among reproductive-age women in Adama district, Ethiopia: a community-based unmatched case-control study

BackgroundBirth spacing is crucial for ensuring the health of mothers and their children, as well as determining population growth. Short birth intervals represent a universal public health problem associated with adverse maternal, fetal, neonatal, and child outcomes. However, there is limited information in the study area regarding the determinants of suboptimal birth spacing. Thus, this study aimed to identify the determinants of suboptimal spacing among women of reproductive age in the Adama district, Ethiopia.MethodsA community-based unmatched case-control study was conducted among 568 randomly selected reproductive-age women using the multi-stage sampling technique. Data were collected using an interviewer-administered, structured questionnaire. The collected data were entered into Epi Info version 7.2 and analyzed using SPSS version 26. Binary logistic regression analysis was used to model the association between suboptimal birth spacing and independent variables. Adjusted odds ratios with their 95% confidence intervals were calculated to determine the strength of the association. A p-value < 0.05 was considered to declare statistical significance.ResultEducational status (no formal education) (AOR = 2.40; 95% CI: 1.23–1.75), inadequate knowledge of optimal birth space (AOR = 2.60; 95% CI; 1.80–3.90), non-use of modern contraceptives (AOR = 3.00; CI: 1.90–4.20), short breastfeeding duration (AOR = 2.30; 95% CI: 1.50–3.40), and having female index child (AOR = 1.60; 95% CI: 1.13–2.50) were independent determinants of suboptimal birth spacing practice.ConclusionEncouraging women’s education, contraceptive use, and breastfeeding is crucial for birth spacing. Community health initiatives should also focus on preventing sex-based birth intervals.

Socioeconomic inequalities of pregnancy termination among reproductive age women in Bangladesh: a decomposition analysis using demographic and health survey

ObjectivesUndergoing women of pregnancy termination (PT) significantly faces the problem of physical and mental health. This study aims to assess the prevalence and socioeconomic disparity factors of PT in Bangladesh. This study analyzed data from the 2017–18 Bangladesh Demographic and Health Survey. Researchers employed chi-square tests to identify relationships between categorical variables and logistic regression to pinpoint factors associated with PT. To assess the socioeconomic variation of PT, the analysis utilized concentration curves, concentration indices, and decomposition techniques.ResultsThe study found that 21.0% of reproductive-aged women in Bangladesh had ever terminated a pregnancy. Our study revealed that women from Chittagong and Sylhet regions, with wealthier backgrounds, aged 30 or older, employed in business, taking short birth intervals, and whose husband/partner was 35 or older, were more likely to have had a pregnancy termination with statistical significance (p < 0.05). Besides, concentration curves showed a higher prevalence of PT among wealthier women (CCI = 0.029, p < 0.001). Decomposition of this inequality revealed that a woman’s wealth status was the largest contributor (74.98%) to the observed disparities, followed by exposure to mass media (41.82%), place of residence (34.35%), occupation (24.81%), and preceding birth interval (6.53%). Our study recommended that, in mitigating the above disparities, we should foster open discussions about underlying factors contributing to PT in Bangladesh.

Determinants of short birth interval in Ethiopia: A multilevel analysis based on EDHS 2019, Ethiopia, 2023.

According to the World Health Organization and Ethiopian Demographic and Health Survey on birth spacing, there should be at least a two-year gap between conception and the first of two children born in quick succession. In poor nations like Ethiopia, resource issues were complex, making it difficult to get statistics for the entire country. However, by examining Ethiopian mini demographic and health survey data, we were able to provide data at the national level. The cross-sectional survey-based study was conducted in several of Ethiopia's administrative cities and nine regions. In the analysis, sampling weight was used to correct the survey's non-proportional sample distribution to strata and areas throughout the survey process and restore representative data. The study's household population was presented and described using descriptive statistics such as weighted frequencies and percentages. The statistically significant factors linked to frequent short birth intervals were found using a multivariable, multilevel logistic regression analysis. Overall, 4306 weighted multigravida mothers nested within 305 enumeration areas were included in the analysis. The respondents' mean (standard deviation) of the birth interval was 42.027(26.69). Higher-educated women had 12% lower odds of having a shorter pregnancy (AOR = 0.88; 95% CI: 0.35, 0.98) than women without higher education. The odds of a short birth interval were 3.04 times greater among women in the age category of 40-49 years at first marriage (AOR = 3.04; 95% CI: 1.08, 8.46) than among women in the age category of 15-19 years. This indicates that older women were most likely to have short birth intervals. In the multilevel logistic regression model, maternal age, maternal educational status, the wealth quintile index, use of contraceptives, duration of breastfeeding, and contextual regions were significantly associated with short birth intervals in Ethiopia.

Prevalence and factors associated with short birth interval in the semi-rural community of Kaya, Burkina Faso: results of a community-based survey

BackgroundA short birth interval adversely affects the health of mothers and children. This study aimed to measure the prevalence of short birth intervals and identify their associated factors in a semi-urban setting in Burkina Faso.MethodsWe conducted a cross-sectional study in which data were collected in households between May and October 2022. The dependent variable was the short birth interval (SBI), defined by the World Health Organization as the time between two live births. We performed a multilevel mixed-effects Poisson regression with robust variance to determine the factors associated with the SBI by reporting adjusted prevalence ratios (aPR) with a 95% confidence interval (CI).ResultsA total of 5544 birth intervals were recorded from 4067 women. A short birth interval was found in 1503 cases out of 5544, i.e., a frequency of 27.1%. The prevalence of short birth interval (time between two live births less than 33 months) was higher in never users of modern contraceptive users (aPR = 1.24; 95% CI [1.14–1.34] vs. previous users), in younger ages with aPR of 4.21 (95% CI [3.30–5.37]), 2.47 (95% CI [1.96–3.11]), and 1.45 (95% CI [1.16–1.81]), respectively for under 18, 18–24 years old, and 25–34 years old, compared to 35 and over. Childbirths occurring before the implementation of the maternal and infant free health care policy (aPR = 2.13; 95% CI [1.98–2.30]) and also before the free family planning policy (aPR = 1.53; 95% CI [1.28–1.81]) were more likely to have SBI. Women with low socio-economic positions were also more likely to have SBI.ConclusionThis study found a high SBI in Burkina Faso (more than one woman out of four). Our results have programmatic implications, as some factors, such as contraceptive practice and socioeconomic status, are modifiable. These factors need particular attention to lengthen birth intervals and, in turn, improve mother–child couple health by reducing short birth interval consequences.

Infectious and obstetric determinants of anemia among pregnant women in Southwest Ethiopia.

Anaemia, characterized by low red blood cell or haemoglobin levels, impairs oxygen transport in the body and poses a major global public health issue, particularly affecting pregnant women and children. This study focuses on identifying the factors contributing to anaemia among pregnant women receiving antenatal care (ANC) at Mizan-Tepi University Teaching Hospital (MTUTH) in southwest Ethiopia. A hospital-based unmatched case-control study was conducted from July 1 to August 30, 2022, involving 370 pregnant women (90 with anaemia and 280 without). Data collection included questionnaires, laboratory tests (Hgb and stool examination), and anthropometric measurements. SPSS version 21 was used for data analysis, with binary logistic regression identifying factors associated with anaemia. The significance level was set at a p-value <0.05. The study achieved a 100% response rate for both cases and controls. Factors identified as determinants of anaemia among pregnant women included malaria infection (AOR = 7.83, 95% CI: 3.89-15.8), hookworm infection (AOR = 2.73, 95% CI: 1.39-5.34), short birth interval (AOR = 7.11, 95% CI: 3.59-14.2), and history of unsafe abortion (AOR = 5.40, 95% CI: 2.46-11.8). This study found that malaria infection, hookworm infection, birth interval <33 months, and a history of unsafe abortion are factors contributing to anaemia in pregnant women. Strategies such as distributing insecticide-treated bed nets (ITNs) to combat malaria, improving sanitation, anthelmintic drugs, promoting family planning to prevent unwanted pregnancies and unsafe abortions, and providing preconception care can help reduce the incidence of anaemia.

Variation in 10 year birth trajectories of mothers involved in family court care proceedings and their peers in England.

ObjectiveFamily court (FC) care proceedings decide on removing children from parental care in response to concerns about risks of harm. Courts and social care report frequent births, often after short birth intervals as a key problem among mothers presenting to FCs. ApproachWe used a cohort of mothers with a first live birth (FLB) between 2007 and 2019 to estimate the cumulative incidence of FC within 10 years and compare birth trajectories with peers. Results3,118,327 women (15-50 years) had a FLB, of whom 34,062 had FC involvement. Cumulative incidence of FC within 10 years from FLB was 1.3% (95% Confidence Interval [CI]; 1.3-1.3) overall but highest in mothers who were younger (6.7% if &lt;20 years), more deprived (2.5% in most deprived areas) and with morbidity (22.7% with learning or multiple disability, 12.8% with adversity-related injuries or 5.7% with mental health admissions). If followed for 10 years from FLB, 58.4% (8,889/15,229) of women with FC involvement had ≤2 deliveries, compared to 82.2% otherwise (1,007,365/1,225,163). If &lt;25years at FLB, women involved in FC had more deliveries than their peers (3+ deliveries: 47.8%, 5,853/12,255 vs 29.5%, 123,092/416,904), however, if 25+, they had fewer deliveries if involved in FC (1 delivery: 49.6% 1,475/2,974 vs 39.2% 316,976/808,259). Conclusions and ImplicationsAt-risk mothers may benefit from early, targeted health and social care interventions to prevent FC involvement. Birth data highlights variation in birth trajectories and dispels the stereotype of women involved in FCs having many children, particularly if older at FLB.

Effects of short inter-pregnancy/birth interval on adverse perinatal outcomes in Asia-Pacific region: A systematic review and meta-analysis.

Short inter-pregnancy or birth interval is associated with an increased risk of adverse perinatal outcomes. However, some emerging evidence questions this association and there are also inconsistencies among the existing findings. This study aimed to systematically review the evidence regarding the effect of short inter-pregnancy or birth intervals on adverse perinatal outcomes in the Asia-Pacific region. A comprehensive search of five databases was conducted targeting studies published between 2000 to 2023. Studies that reported on short inter-pregnancy or birth interval and examined adverse perinatal outcomes, such as low birthweight (LBW) preterm birth (PTB), small for gestational age (SGA), and neonatal mortality were included and appraised for methodological quality using the Joanna Briggs Institute critical appraisal tools. Three reviewers independently screened the studies and performed data extraction. Narrative synthesis and meta-analyses were conducted to summarise the key findings. A total of 41 studies that fulfilled the inclusion criteria were included. A short-interpregnancy interval was associated with an increased risk of low birthweight (odds ratio [OR] = 1.65; 95%CI:1.39, 1.95), preterm birth (OR = 1.50; 95%CI: 1.35, 1.66), and small for gestational age (OR = 1.24; 95%CI:1.09, 1.41). We also found elevated odds of early neonatal mortality (OR = 1.91; 95%CI: 1.11, 3.29) and neonatal mortality (OR = 1.78; 95%CI: 1.25, 2.55) among women with short birth intervals. This review indicates that both short inter-pregnancy and birth interval increased the risk of adverse perinatal outcomes. This underscores the importance of advocating for and implementing strategies to promote optimal pregnancy and birth spacing to reduce the occurrence of adverse perinatal outcomes. Reproductive health policies and programs need to be further strengthened and promote access to comprehensive family planning services and increase awareness about the importance of optimal pregnancy and birth spacing.

Factors influencing contraceptive utilisation among postpartum adolescent mothers: a cross sectional study at China-Uganda friendship hospital

BackgroundGlobally, modern contraceptives remain underutilized among postpartum mothers resulting in the rise of short birth intervals. While there are a range of other factors that moderate the uptake of contraceptive services, understanding the significance of their influence is critical in public health programming. This study sought to analyze maternal and health facility factors influencing the utilization of contraceptives among postpartum mothers in urban areas of Uganda.MethodsUsing a cross-sectional study design, a health facility-based study in urban areas of Kampala was conducted from January to March 2023. A total of 332 women aged between 15 and 22 years were randomly selected for the interviews using semi-structured questionnaires. The data was analyzed using a statistical software program R version 4.1.2. Chi-square and multivariable logistic regression were used to determine factors associated with postpartum contraceptive intake among adolescent mothers.ResultsOverall, 28.3% of contraceptive usage was reported in the current study. The majority of the respondents, 98 (29.52%), were within the age group of 17–18 years, and the unmarried were 255 (76.81%). Factors associated with contraception use were income below UgX 500,000 (OR 4.546; CI 1.785–12,193, p = 0.002), occupation status of housewife and student (OR: 3.526; CI: 1.452–8.812, p = 0.006), distance of less than 5 km from health facility (OR: 2.62; CI 1.97–3.55; p = 0.028), and having a contraceptive preference (OR: 3.526; CI: 1.452–8.812, p = 0.006).ConclusionsContraceptive use is low among adolescent post-partum mothers. Income, occupation status, proximity to a health facility, and preference for a particular contractive method are factors associated with contraceptive use in this study. Understanding attitudes and views regarding contraception use is therefore essential for creating effective interventions, given the detrimental effects of adolescent pregnancy.

Predicting adverse birth outcome among childbearing women in Sub-Saharan Africa: employing innovative machine learning techniques

BackgroundAdverse birth outcomes, including preterm birth, low birth weight, and stillbirth, remain a major global health challenge, particularly in developing regions. Understanding the possible risk factors is crucial for designing effective interventions for birth outcomes. Accordingly, this study aimed to develop a predictive model for adverse birth outcomes among childbearing women in Sub-Saharan Africa using advanced machine learning techniques. Additionally, this study aimed to employ a novel data science interpretability techniques to identify the key risk factors and quantify the impact of each feature on the model prediction.MethodsThe study population involved women of childbearing age from 26 Sub-Saharan African countries who had given birth within five years before the data collection, totaling 139,659 participants. Our data source was a recent Demographic Health Survey (DHS). We utilized various data balancing techniques. Ten advanced machine learning algorithms were employed, with the dataset split into 80% training and 20% testing sets. Model evaluation was conducted using various performance metrics, along with hyperparameter optimization. Association rule mining and SHAP analysis were employed to enhance model interpretability.ResultsBased on our findings, about 28.59% (95% CI: 28.36, 28.83) of childbearing women in Sub-Saharan Africa experienced adverse birth outcomes. After repeated experimentation and evaluation, the random forest model emerged as the top-performing machine learning algorithm, with an AUC of 0.95 and an accuracy of 88.0%. The key risk factors identified were home deliveries, lack of prenatal iron supplementation, fewer than four antenatal care (ANC) visits, short and long delivery intervals, unwanted pregnancy, primiparous mothers, and geographic location in the West African region.ConclusionThe region continues to face persistent adverse birth outcomes, emphasizing the urgent need for increased attention and action. Encouragingly, advanced machine learning methods, particularly the random forest algorithm, have uncovered crucial insights that can guide targeted actions. Specifically, the analysis identifies risky groups, including first-time mothers, women with short or long birth intervals, and those with unwanted pregnancies. To address the needs of these high-risk women, the researchers recommend immediately providing iron supplements, scheduling comprehensive prenatal care, and strongly encouraging facility-based deliveries or skilled birth attendance.

Wealth-based disparities in the prevalence of short birth interval in India: insights from NFHS-5

BackgroundShort birth interval (SBI) has profound implications for the health of both mothers and children, yet there remains a notable dearth of studies addressing wealth-based inequality in SBI and its associated factors in India. This study aims to address this gap by investigating wealth-based disparities in SBI and identifying the underlying factors associated with SBI in India.MethodsWe used information on 109,439 women of reproductive age (15–49 years) from the fifth round of the National Family Health Survey (2019-21). We assessed wealth-based inequality in SBI for India and its states using the Erreygers Normalised Concentration Index (ECI). Additionally, we used a multilevel binary logistic regression to assess the factors associated with SBI in India.ResultsIn India, the prevalence of SBI was 47.8% [95% CI: 47.4, 48.3] during 2019-21, with significant variation across states. Bihar reported the highest prevalence of SBI at 61.2%, while Sikkim the lowest at 18.1%. SBI prevalence was higher among poorer mothers compared to richer ones (Richest: 33.8% vs. Poorest: 52.9%). This wealth-based inequality was visible in the ECI as well (ECI= -0.13, p < 0.001). However, ECI varied considerably across the states. Gujarat, Punjab, and Manipur exhibited the highest levels of wealth-based inequality (ECI= -0.28, p < 0.001), whereas Kerala showed minimal wealth-based inequality (ECI= -0.01, p = 0.643). Multilevel logistic regression analysis identified several factors associated with SBI. Mothers aged 15–24 (OR: 12.01, p < 0.001) and 25–34 (2.92, < 0.001) were more likely to experience SBI. Women who married after age 25 (3.17, < 0.001) and those belonging to Scheduled Caste (1.18, < 0.001), Scheduled Tribes (1.14, < 0.001), and Other Backward Classes (1.12, < 0.001) also had higher odds of SBI. Additionally, the odds of SBI were higher among mothers in the poorest (1.97, < 0.001), poorer (1.73, < 0.001), middle (1.62, < 0.001), and richer (1.39, < 0.001) quintiles compared to the richest quintile. Women whose last child had passed away were also significantly more likely to have SBI (2.35, < 0.001). Furthermore, mothers from communities with lower average schooling levels (1.18, < 0.001) were more likely to have SBI. Geographically, mothers from eastern (0.67, < 0.001) and northeastern (0.44, < 0.001) regions of India were less likely to have SBI.ConclusionThe significant wealth-based inequality in SBI in India highlights the need for targeted interventions focusing on economically disadvantaged women, particularly in states with high SBI prevalence. Special attention should be given to younger mothers and those from socially disadvantaged groups to enhance maternal and child health outcomes across the country.

Spatial variation of short birth intervals and their determinant factors among reproductive women in Ethiopia using a geographically weighted regression model.

In low- and middle-income nations, a significant proportion of maternal and infant deaths are caused by a short birth interval (SBI). In Ethiopia, it is the main factor contributing to maternal and infant mortality. Understanding the spatial distribution of SBIs, i.e., birth intervals of less than 33 months, and the factors that influence them is important for categorizing and promoting targeted interventions. This study used a geographically weighted regression model to evaluate the factors associated with SBIs in hot areas of Ethiopia. The 2019 Ethiopian Mini Demographic and Health Survey, which is nationally representative, provided the data for this study. The first step in the two-stage cluster design used to collect the data was enumeration areas, and the second stage was households. The survey was conducted between 21 March 2019 and 28 June 2019. A hot spot analysis (local Getis-Ord Gi* statistics) was initially used to investigate spatial variation in SBIs. Geographically weighted regression was used to examine the regional variation in the relationship between SBIs and the factors that cause them. The study indicated that the overall proportion of SBIs among women in Ethiopia was 43.2%. The values for Global Moran's I (Moran's I = 0.773 and p < 0.001) showed the presence of significant SBIs clustering in Ethiopian administrative zones in Ethiopia. High-risk areas of the SBIs include Jarar, Doolo, Shabelle, Afder, Liben, Korahe, Nogob, West Harerge, Guji, Sidama, and Assosa zones. Living in a geographic region with a high proportion of uneducated women, women lacking breastfeeding practices, and followers of Orthodox religions increased the proportion of SBIs. Our full map of hot spots for short birth spacing and the factors that affect them helps in the implementation of precise public health measures for decision-makers.

Household- and community-level factors of zero vegetable or fruit consumption among children aged 6-23 months in East Africa.

The World Health Organization recommends that children aged 6-23 months should consume a diversified diet, including fruits and vegetables, during each meal. However, low consumption of fruits and vegetables contributes to 2.8% of child deaths globally. The literature review indicates limited research on factors that affect zero vegetable or fruit consumption among children aged 6-23 months in East Africa. Therefore, this study aimed to investigate the household- and community-level factors determining zero vegetable or fruit consumption among children aged 6-23 months in East Africa. The study analyzed cross-sectional secondary data from the recent rounds of demographic and health surveys conducted in East Africa from 2015 to 2023. The weighted sample comprised 113,279 children aged 6-23 months. A multilevel mixed-effect analysis was used, measuring the random variation between the clusters based on the intra-cluster correction coefficient, median odds ratio, and proportional change variance. Adjusted odds ratio with a 95% confidence interval was reported while considering variables having a p < 0.05 as statistically significant. The overall prevalence of zero vegetable or fruit consumption among children aged 6-23 months in East Africa was 52.3%, with Ethiopia showing the highest prevalence (85.9%). The factors associated with zero vegetable or fruit consumption were maternal educational level, number of household members, short birth interval, multiple births, sex of the household head, household wealth index, community-level maternal literacy, community-level wealth index, and countries. Considering the high overall prevalence of zero vegetable or fruit consumption among children aged 6-23 months in East Africa, overlooking this nutritional gap among children is a serious oversight. Therefore, efforts should be geared toward improving individual- and community-level maternal literacy. In particular, nutrition and public health organizations should support low-income communities to achieve vegetable or fruit consumption for infants and young children.

The cost of inaction on preconception health in Nigeria: An economic impact analysis

ABSTRACT A growing body of evidence has shown the effects of poor preconception health on adverse pregnancy outcomes and, subsequently, maternal and child morbidity and mortality. However, the cost of poor preconception health remains relatively unexplored. Using the case of Nigeria, this study provides the first estimate of the disease and economic burden of poor preconception health at a country level. Using data from international databases and the scientific literature, the study used a cost-of-illness approach to quantify the foregone productivity and direct healthcare costs resulting from six preconception risk factors (adolescent pregnancy, short birth interval, overweight and obesity, intimate partner violence, female genital mutilation, folate deficiency). The results indicate that 6.7% of maternal deaths, 10.9% of perinatal deaths, and 10.5% of late neonatal deaths were attributable to the selected preconception risk factors in 2020. The economic burden of poor preconception health in Nigeria was estimated at US$ 3.3 billion in 2020, of which over 90% was generated by premature mortality. If prevalence rates remain constant, total economic losses could amount to US$ 46.2 billion by 2035. This analysis paves the way for further studies investigating the economic costs and benefits of preconception interventions and policies in low and middle-income countries.

Short birth interval in the Asia-Pacific region: A systematic review and meta-analysis.

Short birth interval is associated with an increased risk of adverse health outcomes for mothers and children. Despite this, there is a lack of comprehensive evidence on short birth interval in the Asia-Pacific region. Thus, this study aimed to synthesise evidence related to the definition, classification, prevalence, and predictors of short birth interval in the Asia-Pacific region. Five databases (MEDLINE, Scopus, Cumulative Index to Nursing and Allied Health Literature, Maternity and Infant Care, and Web of Science) were searched for studies published between September 2000 and May 2023 (the last search was conducted for all databases in May 2023). We included original studies published in English that reported on short birth interval in the Asia-Pacific region. Studies that combined birth interval with birth order, used multi-country data and were published as conference abstracts and commentaries were excluded. Three independent reviewers screened the articles for relevancy, and two reviewers performed the data extraction and quality assessment. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. The findings were both qualitatively and quantitatively synthesised and presented. A total of 140 studies met the inclusion criteria for this review. About 58% (n = 82) of the studies defined short birth interval, while 42% (n = 58) did not. Out of 82 studies, nearly half (n = 39) measured a birth-to-birth interval, 37 studies measured a birth-to-pregnancy, four measured a pregnancy-to-pregnancy, and two studies measured a pregnancy loss-to-conception. Approximately 39% (n = 55) and 6% (n = 8) of studies classified short birth intervals as <24 months and <33 months, respectively. Most of the included studies were cross-sectional, and about two-thirds had either medium or high risk of bias. The pooled prevalence of short birth interval was 33.8% (95% confidence interval (CI) = 23.0-44.6, I2 = 99.9%, P < 0.01) among the studies that used the World Health Organization definition. This review's findings highlighted significant variations in the definition, measurement, classification, and reported prevalence of short birth interval across the included studies. Future research is needed to harmonise the definition and classification of short birth interval to ensure consistency and comparability across studies and facilitate the development of targeted interventions and policies. PROSPERO CRD42023426975.

Anthropometric failures and its predictors among under five children in Ethiopia: multilevel logistic regression model using 2019 Ethiopian demographic and health survey data

BackgroundComposite Index of Anthropometric Failure (CIAF) combines all three forms of anthropometric failures to assess undernutrition status of children. There is no study on CIAF to identify the real and severe form of under nutrition among Ethiopian children that addressed community level factors. So, this study determined CIAF and identified important factors which helps to design appropriate intervention strategies by using multi-level advanced statistical model.MethodsThe study included 5,530 under five children and utilized a secondary data (EMDHS 2019) which was collected through community-based and cross-sectionally from March 21 to June 28, 2019. Composite index of anthropometric failure among under five children was assessed and a two-stage sampling technique was used to select the study participants. Descriptive summary statistics was computed. A multi-level binary logistic regression model was employed to identify important predictors of CIAF in under five children. Adjusted odds ratio with its 95% CI was estimated and level of significance 0.05 was used to determine significant predictors of CIAF.ResultsThe prevalence of composite index of anthropometric failure (CIAF) was 40.69% (95% CI: 39.41, 42.00) in Ethiopia. Both individual and community level predictors were identified for CIAF in under five children. Among individual level predictors being male sex, older age, short birth interval, from mothers who have not formal education, and from poor household wealth quintile were associated with higher odds of CIAF among under five children. Low community women literacy and being from agriculturally based regions were the community level predictors that were associated with higher odds of CIAF in under five children in Ethiopia.ConclusionsThe burden of composite index of anthropometric failure in under five children was high in Ethiopia. Age of child, sex of child, preceding birth interval, mother’s education, household wealth index, community women literacy and administrative regions of Ethiopia were identified as significant predictors of CIAF. Therefore, emphasis should be given for those factors to decrease the prevalence of CIAF in under five children in Ethiopia.

Association between concurrence of multiple risk factors and under-5 mortality: a pooled analysis of data from Demographic and Health Survey in 61 low-and-middle-income countries

Exposure to multiple risk factors is prevalent in low-and middle-income countries (LMICs), challenging one-directional strategies to address preventable under-5 mortality (U5M). This study aims to assess the associations between concurrence of multiple risk factors and U5M in LMICs. We extracted data from the Demographic and Health Surveys conducted between 2010 and 2021 across 61 LMICs. Our primary outcome was U5M, defined as deaths from birth to 59 months. Binary logistic regression model was applied to ascertain the association between U5M and a total of 20 critical risk factors. Upon identifying the risk factors demonstrating the strongest associations, we investigated the simultaneous presence of multiple risk factors in each individual and assessed their combined effects on U5M with logistic regression models. Of the 604,372 under-5 children, 18,166 (3.0%) died at the time of the survey. Unsatisfied family planning needs was the strongest risk factor for U5M (odds ratio [OR]: 2.0, 95% confidence interval [CI]: 1.9-2.1), followed by short birth interval (<18 months; OR: 2.0, 95% CI: 1.9-2.1), small birth size (OR: 2.0, 95% CI: 1.8-2.1), never breastfed or delayed breastfeeding (OR: 2.0, 95% CI: 1.9-2.0), and low maternal education (OR: 1.6, 95% CI: 1.4-1.8). 66.7% (66.6%-66.8%) of the children had 2 or more leading risk factors simultaneously. Simultaneous presence of multiple leading risk factors was significantly associated with elevated risk of U5M and children presenting with all 5 leading risk factors exhibited an exceedingly high risk of U5M (OR: 5.2, 95% CI: 4.3-6.3); a dose-response relationship between the number of risk factors and U5M was also observed-with the increment of numbers of leading risk factors, the U5M showed an increasing trend (p-trend < 0.001). Exposure to multiple risk factors is very common in LMICs and underscores the necessity of developing multisectoral and integrated approaches to accelerate progress in reducing U5M in line with the SDG 3.2. This research is funded by Research Fund, Vanke School of Public Health, Tsinghua University.

IJCM_94A: Risk Factors for Short Birth Intervals in women: A Case-Control Study from a Tertiary Health Care facility in Central India

Background: The interval between successive pregnancies, commonly referred to as the birth interval, plays a crucial role in maternal and child health outcomes. Optimal birth spacing is associated with improved maternal nutritional status, reduced risks of adverse pregnancy outcomes, and enhanced child survival. Conversely, short birth intervals, defined as intervals less than 24 months between two consecutive live births, have been linked to an increased likelihood of adverse maternal and child health consequences. Through a comprehensive examination of the contextualized risk factors, we aim to provide evidence that can guide healthcare practitioners, policymakers, and public health professionals in their efforts to improve maternal and child health outcomes in Central India. Objective: To determine risk factors for short birth interval among women in the tertiary health care centre of Central India. Methodology: A hospital-based unmatched case-control study was employed on 45 cases and 45 controls. Cases were women who gave birth within the last 6 months and with at least two consecutive alive births with a birth interval of less than 33 months. Controls were women who gave birth within the last 6 months and had a birth interval between 33 to 59 months between two successive live births. The data was collected by predesigned and pretested semi structured questionnaire from selected respondents. Results: Some important risk factors identified in the present study were age less than 30 years, use of contraception and shorter duration of breastfeeding. Conclusion: Encouraging postpartum family planning and effective breastfeeding will go a long way to reduce the prevalence of short birth interval and its consequences on maternal, neonatal and child health

Exploration of modern contraceptive methods using patterns among later reproductive-aged women in Bangladesh.

With the rapid increase in the number of women in their later reproductive years (aged 35 and above) in the present decade, the concern surrounding their contraceptive considerations has reached a critical point of importance. This study aims to examine the trends and determinants of modern contraceptive uptake among later reproductive-aged women in Bangladesh. A total of 17,736 women aged 35 and above were included in the analysis, utilizing data from three consecutives Bangladesh Demographic and Health Surveys conducted in 2011, 2014, and 2017-18. The outcome variable was the uptake of modern contraceptive methods (yes or no). The explanatory variables encompassed survey years, individual characteristics of the women, as well as characteristics of their partners and the community. Multilevel logistic regression model was used to explore the association of the outcome variable with explanatory variables. We found that approximately 54% of women aged 35 and more do not use modern contraceptive methods, and there have been no significant shifts in their usage observed over the survey years. Compared to women aged 35-39, women aged 40-45 (aOR = 0.53, 95% CI: 0.49-0.57) and 45-49 (aOR = 0.24, 0.22-0.26) reported lower likelihoods of modern contraceptive method uptake. Higher education correlated with increased uptake of modern contraceptive methods (112%-142%), while partner's education showed a negative association. Later reproductive-aged women in richer (aOR = 0.83, 95% CI: 0.74-0.94) and richest (aOR = 0.76, 95% CI: 0.66-0.88) quintiles reported lower uptake of modern contraceptive methods compared to their counterparts in the poorest quintile. Later reproductive-aged women in Dhaka (aOR = 1.22, 95% CI: 1.07-1.38) and Rajshahi (aOR = 1.37, 95% CI: 1.19-1.59) regions had higher uptake of modern contraception than those residing in the Barishal division. Modern contraceptive methods uptake was 1.22 times higher among women who reported exposure to mass media and 1.19 times higher among women who reported engagement in paid work compared to among women who reported no exposure to mass media and participation in no formal work, respectively. Modern contraceptive methods uptake was 43% higher (aOR = 1.43, 95% CI: 1.32-1.55) in women with more than 2 children compared to those with ≤2 children. The study highlights no significant change in modern contraception uptake among later reproductive-aged women in Bangladesh. This raises concerns about the elevated risk of unintended pregnancies and shorter birth intervals, emphasizing the need for targeted interventions to address the specific needs and preferences of this demographic.

Effects of short birth interval on child malnutrition in the Asia-Pacific region: Evidence from a systematic review and meta-analysis.

Child malnutrition remains a significant concern in the Asia-Pacific region, with short birth intervals recognised as a potential risk factor. However, evidence of this association is inconclusive. This study aimed to systematically review the existing evidence and assess the summary effects of short birth interval on child malnutrition in the Asia-Pacific region. Five electronic databases were searched in May 2023 to identify relevant studies reporting the association between short birth interval and child malnutrition, including stunting, wasting, underweight, anaemia and overall malnutrition, in Asia-Pacific region between September 2000 and May 2023. Fixed-effects or random-effects meta-analysis was performed to estimate the summary effects of short birth interval on child malnutrition. Out of 56 studies meeting the inclusion criteria, 48 were included in quantitative synthesis through meta-analysis. We found a slightly higher likelihood of stunting (n = 25, odds ratio [OR] = 1.13; 95% confidence interval [CI]: 0.97-1.32) and overall malnutrition (n = 3, OR = 2.42; 95% CI: 0.88-6.65) among children born in short birth intervals compared to those with nonshort intervals, although the effect was not statistically significant. However, caution is warranted due to identified heterogeneity across studies. Subgroup analysis demonstrated significant effects of short birth intervals on child malnutrition in national-level studies and studies with larger sample sizes. These findings underscore short birth intervals as a significant contributor to child malnutrition in the Asia-Pacific region. Implementing effective policies and programs is vital to alleviate this burden, ultimately reducing child malnutrition and associated adverse outcomes, including child mortality.