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

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          Abstract

          Background

          The 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.

          Objective

          The aim of this study was to assess individual- and community-level determinants of short birth interval among women in Ethiopia.

          Methods

          A 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.

          Results

          At 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 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.

          Conclusion

          Determinants of short birth interval are varied and complex. Multifaceted intervention approaches supported by policy initiatives are required to prevent short birth interval.

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          Most cited references30

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          Effects of preceding birth intervals on neonatal, infant and under-five years mortality and nutritional status in developing countries: evidence from the demographic and health surveys.

          This paper examines the association between birth intervals and infant and child mortality and nutritional status. Repeated analysis of retrospective survey data from the Demographic and Health Surveys (DHS) program from 17 developing countries collected between 1990 and 1997 were used to examine these relationships. The key independent variable is the length of the preceding birth interval measured as the number of months between the birth of the child under study (index child) and the immediately preceding birth to the mother, if any. Both bivariate and multivariate designs were employed. Several child and mother-specific variables were used in the multivariate analyses in order to control for potential bias from confounding factors. Adjusted odds ratios were calculated to estimate relative risk. For neonatal mortality and infant mortality, the risk of dying decreases with increasing birth interval lengths up to 36 months, at which point the risk plateaus. For child mortality, the analysis indicates that the longer the birth interval, the lower the risk, even for intervals of 48 months or more. The relationship between chronic malnutrition and birth spacing is statistically significant in 6 of the 14 surveys with anthropometric data and between general malnutrition and birth spacing in 5 surveys. However, there is a clear pattern of increasing chronic and general undernutrition as the birth interval is shorter, as indicated by the averages of the adjusted odds ratios for all 14 countries. Considering both the increased risk of mortality and undernutrition for a birth earlier than 36 months and the great number of births that occur with such short intervals, the author recommends that mothers space births at least 36 months. However, the tendency for increased risk of neonatal mortality for births with intervals of 60 or more months leads the author to conclude that the optimal birth interval is between 36 and 59 months. This information can be used by health care providers to counsel women on the benefits of birth spacing.
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            ROC-ing along: Evaluation and interpretation of receiver operating characteristic curves.

            It is vital for clinicians to understand and interpret correctly medical statistics as used in clinical studies. In this review, we address current issues and focus on delivering a simple, yet comprehensive, explanation of common research methodology involving receiver operating characteristic (ROC) curves. ROC curves are used most commonly in medicine as a means of evaluating diagnostic tests.
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              Effect of interpregnancy interval on adverse perinatal outcomes--a national study.

              The interpregnancy interval (IPI) has been reported to influence the outcome of pregnancy and birth. We performed a national study in Israel to determine the impact of IPI on multiple adverse perinatal outcomes. This longitudinal cohort study used birth certificates of siblings born to the same biological mother, with at least one previous birth and a subsequent singleton pregnancy. Adverse pregnancy outcomes included preterm delivery, very preterm birth, small for gestational age (SGA), very SGA (VSGA), early neonatal death and major congenital malformations. Multivariate logistic regression was performed for each outcome. The study included 440,838 of a total of 846,845 reported live births in Israel over 5 years; excluded were primiparas (32%), multifetal births (4.9%) and those with incomplete data (10.9%). For IPIs shorter than 6 months, there were significantly increased risks for preterm birth (OR=1.23), SGA (OR=1.14), VSGA (OR=1.15), early neonatal death (OR=1.62) and congenital malformations (OR=1.14). Intervals of 60 months or longer had higher risks for preterm birth (OR=1.39) and VSGA (OR=1.16). Optimal IPI recommendation of >11 months is an accessible and low-cost means to improve multiple adverse perinatal outcomes.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: ResourcesRole: SoftwareRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                14 January 2020
                2020
                : 15
                : 1
                : e0227798
                Affiliations
                [1 ] Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
                [2 ] Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
                [3 ] Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
                University of Botswana, BOTSWANA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0001-6638-6194
                Article
                PONE-D-19-21556
                10.1371/journal.pone.0227798
                6959604
                31935262
                16838987-01b9-486b-a7f3-dc5ed325af82
                © 2020 Shifti et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 31 July 2019
                : 31 December 2019
                Page count
                Figures: 1, Tables: 4, Pages: 17
                Funding
                The authors received no specific funding for this work.
                Categories
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                Custom metadata
                All data are available from the DHS Program database ( https://dhsprogram.com/data/available-datasets.cfm). Any researcher can request for access to the data without any restriction.

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