Using household survey data to explore the effects of the domiciliary environment on weight at birth: a multilevel mixed-effects analysis of the 2016 Ethiopian Demographic Health Survey

Abstract

Background Low birth weight (LBW) is associated with infant mortality and postpartum health complications. In previous studies, overall LBW has been found to be significantly associated with several sociodemographic factors, including ethnicity, maternal age, and family income. Few studies have evaluated the association between environmental risk factors and LBW rates. This study investigated the effect of pre-birth water, sanitation, and hygiene (WASH) and housing conditions on self-reported low birth weight. Methods The Ethiopian Demographic and Health Survey, which covered all administrative regions of Ethiopia from January to June 2016, provided data for this study. STATA version 16 was used to analyze 12,125 participants across weighted samples. Multivariable multilevel mixed-effect logistic regression analysis was conducted to determine the effects of each factor on the outcome while accounting for data clustering. The adjusted odds ratios and corresponding 95% confidence intervals were used to determine the statistical significance of the independent variables. Results One thousand five hundred and seventeen newborns, or 12.59% [95% CI (10.2- 15.3)], had low birth weights. When other factors were taken into account, the following factors were significantly associated with low birth weight: not using small-scale water treatment technology before using water [AOR (95% CI) 1.36 (1.08–2.23)], burning solid fuels for energy [AOR (95% CI) 1.99 (1.60–2.21)], living in homes with natural wall coverings [AOR (95% CI) 1.81 (1.47–2.21)], using a shared latrine within a woman's housing complex or compound [AOR (95% CI) 1.63(1.06–2.25)], and living in peripheral, isolated regions [AOR (95% CI) 1.38 (1.06–2.21)]. Conclusion A little more than one out of every ten deliveries in Ethiopia was under normal (recommended) weight. This study shows that poor housing conditions and lack of household WASH infrastructure are independent predictors of poor birth outcomes among Ethiopian women, adding to the limited evidence that environmental factors within the domicile contribute to low birth weight. Interventions to address these issues may help lower the prevalence of LBW.

Impact of Water, Sanitation, and Hygiene Components on Under-5 Children's Mortality in Ethiopia: A Comparative Analysis of Count Regression Models

“…According to this study's findings, the mortality rate of under-five children in Ethiopia is significantly impacted by water, sanitation, and hygiene (WASH) components. Poor WASH conditions are linked to poor health outcomes in children, which are consistent with those of other studies (Amadu et al, 2023;Gaffan et al, 2023;Parker et al, n.d.-b;Sahiledengle et al, 2022;Tamene et al, 2023b). Children under five die at a higher rate due to a variety of factors, including inadequate sanitation facilities, outdated water sources, and inadequate hygiene habits.…”

“…In terms of Household Water Treatment (HWT) practices, the pooled proportion of HWT practice in Ethiopia was found to be 21%, indicating a significantly low level of practice (Desye et al, 2023). Improving child health outcomes in Ethiopia requires targeted actions to address inequities, poverty, and barriers to healthcare access (Atalell et al, 2022;Defar et al, 2023;Gelagay et al, 2023;Kusheta et al, 2023;Tamene et al, 2023a).…”