Individual and community level determinants of short birth interval in Ethiopia: A multilevel analysis

Abstract

BackgroundThe World Health Organization recommends a minimum of 33 months between two consecutive live births to reduce the risk of adverse maternal and child health outcomes. However, determinants of short birth interval have not been well understood in Ethiopia. ObjectiveThe aim of this study was to assess individual-and community-level determinants of short birth interval among women in Ethiopia. MethodsA detailed analysis of the 2016 Ethiopian Demographic and Health Survey data was performed. A total of 8,448 women were included in the analysis. A two-level multilevel logistic regression analysis was used to identify associated individual-and community-level factors and estimate between-community variance. ResultsAt the individual-level, women aged between 20 and 24 years at first marriage (AOR = 1.37; 95% CI: 1.18-1.60), women aged between 25 and 29 years at first marriage (AOR = 1.65; 95% CI: 1.20-2.25), having a husband who attended higher education (AOR = 1.32; 95% CI: 1.01-1.73), being unemployed (AOR = 1.16; 95% CI: 1.03-1.31), having an unemployed husband (AOR = 1.23; 95% CI: 1.04-1.45), being in the poorest wealth quintile (AOR = 1.82; 95% CI: 1.39-2.39), being in the poorer wealth quintile (AOR = 1.58; 95% CI: 1.21-2.06), being in the middle wealth quintile (AOR = 1.61; 95% CI: 1.24-2.10), being in the richer wealth quintile (AOR = 1.54; 95% CI: 1.19-2.00), increased total number of children born before the index child (AOR = 1.07; 95% CI: 1.03-1.10) and death of the preceding child (AOR = 1.97; 95% CI: 1.59-2.45) were associated with increased odds of short birth PLOS ONE | https://doi.interval. At the community-level, living in a pastoralist region (AOR = 2.01; 95% CI: 1.68-2.39), being a city dweller (AOR = 1.75; 95% CI: 1.38-2.22), high community-level female illiteracy (AOR = 1.23; 95% CI: 1.05-1.45) and increased distance to health facilities (AOR = 1.32; 95% CI: 1.11-1.56) were associated with higher odds of experiencing short birth interval. Random effects showed significant variation in short birth interval between communities.

Socioeconomic inequality in short birth interval in Ethiopia: a decomposition analysis

“…Quantifying and characterising socioeconomic inequalities in short birth interval can help policy makers and public health planners target specific groups of women at risk to reduce the burden of short birth interval on maternal and child wellbeing. This study extends on our previous work [30], which identified the individual-and community-level determinants of short birth interval. Our previous study [30] found that women from the poorest, poorer, middle, and richer households were at increased risk of short birth interval compared to women from the richest household.…”

“…This study extends on our previous work [30], which identified the individual-and community-level determinants of short birth interval. Our previous study [30] found that women from the poorest, poorer, middle, and richer households were at increased risk of short birth interval compared to women from the richest household. This finding was inconclusive and may not provide precise information to target intervention.…”

“…Unlike the aforementioned previous studies [30][31][32][33] performed in Ethiopia, the current study aims to answer the following research questions: "what type of socioeconomic inequality (pro-poor or pro-rich or no inequality problem) in short birth interval is observed in Ethiopia, and what are the factors contributing to any observed socioeconomic inequality? "…”

“…The existing empirical studies [30][31][32][33] estimated odds ratios as a measure of association between wealth status and short birth interval. Although convenient, concentration index (CI) better allows inequalities to be estimated across the whole population (i.e., in a cumulative share of women ranked by income) using a single metric [34].…”

“…Additionally, while the CI can be decomposed to a range of variables that drive the income-related inequality [ 34 , 35 ], this may not be true for the odds ratio that mainly quantifies the strength of association between wealth index and short birth interval. Moreover, the previous studies [ 30 – 33 , 36 , 37 ] did not identify factors that derive the socioeconomic inequalities in short birth interval, which mainly can be achieved through decomposing the concentration index.…”