Analysis of individual-level and community-level effects on advanced maternal age pregnancy in Nigeria

Abstract

Background: Advanced Maternal Age (AMA) pregnancy refers to pregnancy in women aged 35 years or older at the time of delivery. Existing studies have been more concerned with the obstetrics implication of AMA pregnancy. The associated social factors such as the individual and community level factors have remained largely unexplored particularly in population-based studies. This study examines the individual and community level factors associated with AMA pregnancy in Nigeria.Methods: Data were extracted from the 2018 Nigeria Demographic and Health Survey. A weighted sample of 13,105 women was analysed. The outcome variable was AMA pregnancy. The explanatory variables were individual characteristics (age, marital status, media exposure, current contraceptive use, period spent schooling, female autonomy, remarriage and income group) and community characteristics (proportion who delayed marriage in community, community level of female higher education, proportion of female in professional occupation in community, proportion of divorced or separated women in community, proportion of women in commuter marriage, type of community and geo-political zone of residence). Three mixed-effects multilevel logistic regression models were estimated. Results: Findings reveal 10.9% prevalence of AMA pregnancy in Nigeria. While the odds of AMA pregnancy were lower among women in very advanced (AOR=0.592, p<0.001; 95% CI: 0.509-0.688) and extremely advanced (AOR=0.290, p<0.001; 95% CI: 0.239-0.353) (AOR=1.794, p<0.001; 95% CI: 1.580-2.008) age groups, the odds were higher among women who had high exposure to mass media (AOR=1.794, p<0.001; 95% CI: 1.580-2.008), long schooling period (AOR=2.680, p<0.001; 95% CI: 2.058-3.488), remarried (AOR=2.269, p<0.001; 95% CI: 1.915-2.688) and from richest households (AOR=1.271, p<0.05; 95% CI: 1.098-1.472). The values of the Intra-Class Correlation (ICC) across the three fitted models reveal significant effects of the community characteristics on the odds of AMA pregnancy.Conclusion: Individual and community characteristics have important effects on AMA pregnancy. Health planners and authorities in the country should include AMA pregnancy as one of the priority areas of women’s health and safe motherhood strategies in addition to raising awareness of the obstetrics implication of AMA pregnancy through community-based public health education programme.