Effect of women's literacy status on maternal healthcare services utilisation in Ethiopia: a stratified analysis of the 2019 mini Ethiopian Demographic and Health Survey.

OBJECTIVES: Maternal mortality remains unacceptably high in sub-Saharan Africa with 533 maternal deaths per 100 000 live births, accounting for 68% of all maternal deaths worldwide. Most maternal deaths could be prevented by adequate maternal health service use. The study examined the effect of literacy status on maternal health services utilisation among reproductive-age women in Ethiopia. DESIGN: A cross-sectional study. SETTINGS: Ethiopia. PARTICIPANTS: A weighted sample of 3839 reproductive-age women who gave birth in the last 5 years preceding the survey and whose literacy status was measured were included in this study. The survey used a two-stage stratified cluster sampling technique. PRIMARY AND SECONDARY OUTCOME MEASURES: This study used a dataset from the recent Ethiopia Mini Demographic and Health Surveys. We assessed the maternal health service utilisation among reproductive-age women. Multivariable logistic regression analyses were employed to assess the association between literacy status and maternal healthcare utilisation while controlling for other factors. Adjusted OR with a 95% CI was reported. RESULTS: About 63.8% of reproductive-age women were illiterate. The prevalence of antenatal care (ANC) 1, ANC 4, skilled birth attendance and postnatal care (PNC) services utilisation was 74.9%, 43.5%, 51.9% and 32.0%, respectively. Literate women had significantly higher ANC 1, ANC 4, skilled birth attendance, and PNC services utilisation than illiterate women (p<0.001). Regional variation, wealth status, age at first birth, birth order and birth intervals were significantly associated with maternal healthcare utilisation among both literate and illiterate women. Similarly, ANC booking timing and utilisation, age of household head and religious affiliation were associated with institutional delivery and PNC utilisation. CONCLUSION: Literate women had a significantly higher maternal healthcare services utilisation than illiterate, modified by sociodemographic and obstetric-related factors. Hence, wholehearted efforts should be directed towards educating and empowering women.

Adherence to iron supplement intake during pregnancy and associated factors in Ethiopia: Further analysis of a national population-based study.

Iron deficiency during pregnancy is a risk factor for anemia, preterm delivery, and low birth weight. Poor adherence to iron supplement intake remains a problem in many countries including Ethiopia. This analysis aimed at determining the proportion of adherence to iron supplement intake and its associated factors among pregnant women in Ethiopia. We used the data from the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS), which is a cross-sectional and nationally representative survey. A weighted sample of 3927 pregnant women was included in the study. Bivariate and multivariable binary logistic regression analyses were performed to identify factors associated with adherence to iron supplement intake. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) and p-value <.05 were used to declare statistical significance. Our analysis revealed that out of 2356 (60.0%) pregnant women who took iron supplements during their most recent pregnancy, only 417 (17.7%; 95% CI: 0.162-0.193) adhered to the WHO-recommended iron intake for 90 days or more. The subnational regions, level of education, literacy, the timing of first antenatal care booking, and past place of delivery were significantly associated with iron supplement intake. Interventions to enhance the uptake of iron supplementation better focus on improving women's education and literacy, early initiation and frequency of ANC visits, and institutional delivery. Raising community awareness through educating pregnant women is also recommended to improve adherence to iron supplement intake.

Enrollment of reproductive age women in community-based health insurance: An evidence from 2019 Mini Ethiopian Demographic and Health Survey.

Background: Universal health coverage (UHC) is aimed at ensuring that everyone has access to high-quality healthcare without the risk of financial ruin. Community-based health insurance (CBHI) is one of the essential means to achieve the sustainable development goals (SDGs) global health priority of UHC. Thus, this study assessed health insurance enrollment and associated factors among reproductive age women in Ethiopia. Methods: We computed the health insurance enrollment of reproductive-age women using secondary data from the recent Ethiopian Mini Demographic and Health Surveys (EMDHS) 2019. The EMDHS was a community-based cross-sectional study carried out in Ethiopia from March 21 to June 28, 2019. Cluster sampling with two stages was employed for the survey. The study comprised 8885 (weighted) reproductive-age women. STATA 14 was used for data processing and analysis. Bivariate and multivariable logistic regression analyses were conducted. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was reported and statistical significance was set at a value of p < 0.05. Results: Of the 8,885 study participants, 3,835 (43.2, 95% CI; 42.1, 44.2%) of women had health insurance. Women aged 20-24 years, 25-29 years, and 30-34 years less likely to enroll in health insurance compared to their younger counterparts (15-19 years). Women living in rural areas, had greater than five family sizes, living with a female household head, and having more than five living children were negatively associated with enrollment in health insurance. Besides, health insurance enrollment among reproductive-age women is significantly affected by region and religious variation. Conclusion: The overall CBHI enrolment among reproductive-age women in Ethiopia was low. To achieve the SDGs of reducing maternal mortality ratio and neonatal mortality, improving reproductive-age women's access to health insurance is essential. The national, regional, and local officals, policymakers, NGOs, program planners, and other supporting organizations working on improving health insurance enrollment of reproductive age women need to create awareness and support them based on these significant factors.

Women's education, contraception use, and high-risk fertility behavior: A cross-sectional analysis of the demographic and health survey in Ethiopia.

Background: High-risk fertility behavior (HRFB) among women is the main factor in a wide range of detrimental effects on both the mother's and the child's health, which has an impact on both the mother's and the child's survival. Early childbearing is associated with a higher number of live births and may result in poorer maternal, baby, and child health outcomes. Infant and child mortality are also linked to short birth intervals and higher birth order. Thus, this study aims to examine the link between women's education, contraception use, and high-risk fertility behavior in Ethiopia. Methods: Data was drawn from the 2019 Ethiopian Interim Demographic and Health Survey. The analysis covered a total of 5,846 women. The effect of predictor variables on HRFB was quantified using multivariable logistic regression analysis. At a 95% CI of the odds ratio excluding one, a significant association between the HRFB and predictor variables was observed. Results: About 72.8% (95% CI 71.6%-73.9%) of women experience high-risk fertility behaviors. Of these, 32% experience single high-risk fertility behavior, and 40.8% experience multiple high-risk fertility behaviors. Of those who experience high-risk fertility behaviors, 58.7% have birth orders of more than three, 22.4% have short birth intervals (less than 24 months); 35.1% are old (over 34 years old); and 1.6% are young (less than 18 years old). Women with no education (AOR = 4.31; 95% CI: 2.09, 8.89) and primary education only (2.71; AOR = 2.71; 95% CI: 1.63, 4.50) are more likely to engage in high-risk fertility behaviors than women with a higher level of education. Every additional year of schooling reduces the odds of high-risk fertility behavior by 6% (AOR = 0.94; 95% CI: 0.89, 0.98). The use of modern contraception (AOR = 0.74; 95% CI: 0.622, 0.879) and knowledge of modern contraception methods (AOR = 0.80; 95% CI: 0.66, 0.96) reduce the risk of HRFB. Conclusions: Primary education and a lack of education significantly raise the risk of HRFB. However, in Ethiopia, the risk of experiencing HRFB is reduced through modern contraceptive methods, awareness of modern contraceptive methods, and years of education. All initiatives to decrease maternal and newborn mortalities by reducing the risk of HRFB should educate women and encourage them to use modern contraception.

Factors associated with inadequate prenatal care service utilization in Ethiopia according to the WHO recommended standard guidelines.

Background: Adequate maternal health care could prevent 54% of maternal deaths in low- and middle-income countries. In Ethiopia, the maternal mortality rate was reduced from 817 to 412 deaths per 100,000 live births between 2000 and 2016. Thus, the current study focuses on the adequacy of prenatal care (PNC) services rather than the mere prenatal contacts available to assess compliance with the WHO recommended standard guidelines. Methods: A nationally representative cross-sectional dataset from the Ethiopian Mini Demographic and Health Survey 2019 was analyzed. Risk factors for prenatal care adequacy were assessed using a multilevel ordinal logistic regression model. Results: About 43% of women met the old WHO recommendation of at least four prenatal contacts, while only 3.5% of women met the new WHO recommended minimum of eight prenatal contacts. The overall adequacy of prenatal care based on the four prenatal care utilization indicators was 52.1% no PNC, 37.4% received inadequate PNC and 10.5% received adequate PNC. Being a rural resident [AOR = 0.694 (95% CI: 0.557, 0.865)] and wanting no more children [AOR = 0.687 (95% CI: 0.544, 0.868)] are associated with inadequate prenatal care. Higher educational attainment of women and spouses, exposure to the media, upper wealth quintile, and a perceived shorter distance to a health facility were significantly associated with adequate prenatal care. Conclusion: The prevalence of adequate prenatal care was lower. Multi-sectoral efforts are needed to improve maternal health targets by reducing maternal mortality through improved health care services.

Breastfeeding performance index and associated factors among children aged 0-6 months in Ethiopia: Analysis of the 2019 Ethiopia Mini Demographic and Health Survey.

Background: Infants under the age of 6 months are commonly affected by malnutrition globally. The higher the breastfeeding performance index (BPI), the greater the advantage of breastfeeding will be. However, there is a lack of literature in the context of Ethiopia. Therefore, this study is aimed at investigating the magnitude and determinants of the breastfeeding performance index score among mothers of children under the age of 6 months in Ethiopia. Methods: This study was conducted using the 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) dataset. A stratified, two-stage cluster sampling technique was used in the study. The survey data were weighted using the "svy" function in STATA version 16. Descriptive statistics, bivariable and multivariable logistic regression were employed in the analysis. An adjusted odds ratio (AOR) with a 95% confidence interval (CI) was reported. The results were considered statistically significant if the p-value was < 0.05. The goodness of fit of the model was checked using the Hosmer-Lemeshow test. Results: A total of 4,273 mothers with children under the age of 6 months were included in the analysis. Our analysis revealed that the prevalence of low breastfeeding performance index was 79.05% (95% CI: 78.01, 81.59). A unit increase in child age (AOR = 11.56; 95% CI: 6.97, 19.17), the richest wealth quintile (AOR = 2.76; 95% CI: 1.18, 6.5), a higher level of education (AOR = 5.41; 95% CI: 2.08, 14.05), being married or living with partner (AOR = 2.73; 95% CI: 1.18, 6.27), being women from Somali (AOR = 5.11; 95% CI: 2.08, 12.56), Afar (AOR = 3.03; 95% CI: 1.16, 7.91), Oromia (AOR = 1.88; 95% CI: 1.03, 3.41), Diredawa city administration (AOR = 2.89; 95% CI: 1.04, 8.07), and antenatal care (ANC) visit (AOR = 2.05; 95% CI: 1.31, 3.19) were positively associated with the low breastfeeding performance index. Conclusion: The prevalence of the low breastfeeding performance index was found to be high. Hence, the findings of the study suggest the need to target interventions aimed at improving breastfeeding performance toward mothers with higher socioeconomic and demographic status and educational status. Antenatal care clients are among the targets of the intervention.

Timing of first antenatal care visits and number of items of antenatal care contents received and associated factors in Ethiopia: multilevel mixed effects analysis.

BACKGROUND: Receiving quality antenatal care (ANC) from skilled providers is essential to ensure the critical health circumstances of a pregnant woman and her child. Thus, this study attempted to assess which risk factors are significantly associated with the timing of antenatal care and the number of items of antenatal care content received from skilled providers in recent pregnancies among mothers in Ethiopia. METHODS: The data was extracted from the Ethiopian Demographic and Health Survey 2016. A total of 6645 mothers were included in the analysis. Multilevel mixed-effects logistic regression analysis and multilevel mixed Negative binomial models were fitted to find the factors associated with the timing and items of the content of ANC services. The 95% Confidence Interval of Odds Ratio/Incidence Rate Ratio, excluding one, was reported as significant. RESULTS: About 20% of the mothers initiated ANC within the first trimester, and only 53% received at least four items of antenatal care content. Being rural residents (IRR = 0.82; 95%CI: 0.75-0.90), wanting no more children (IRR = 0.87; 95%CI: 0.79-0.96), and the husband being the sole decision maker of health care (IRR = 0.88; 95%CI: 0.81-0.96), were associated with reduced items of ANC content received. Further, birth order of six or more (IRR = 0.74; 95%CI: 0.56-0.96), rural residence (IRR = 0.0.41; 95%CI: 0.34-0.51), and wanting no more children (IRR = 0.61; 95%CI: 0.48-0.77) were associated with delayed antenatal care utilization. CONCLUSIONS: Rural residences, the poorest household wealth status, no education level of mothers or partners, unexposed to mass media, unwanted pregnancy, mothers without decision-making power, and considerable distance to the nearest health facility have a significant impact on delaying the timing of ANC visits and reducing the number of items of ANC received in Ethiopia. Mothers should start an antenatal care visit early to ensure that a mother receives all of the necessary components of ANC treatment during her pregnancy.

Statistical modeling of numbers of human deaths per road traffic accident in the Oromia region, Ethiopia.

BACKGROUND: Globally, road traffic accidents are the leading causes of death among young people in general, and the main cause of death among young people aged 15-29 years. Recently, in Ethiopia, the number of road traffic accidents has been increasing. The study aimed to identify the potential factors associated with the number of human deaths by road traffic accidents in the Oromia Regional State, Ethiopia. METHODS: We used data obtained from the Oromia region traffic police office recorded on daily basis road traffic accidents from July 2016 up to July 2017. Count regression models were was used to analyses the factors associated with the number of human deaths from road traffic accidents. RESULTS: Age of the driver's 31-50 years (AOR = 0.289, 95%CI: 0.175, 0.479) and higher than 50 years old (AOR = 0.311, 95%CI: 0.129, 0.751), driver's years of experience 5-10 years (AOR = 0.014, 95%CI: 0.007, 0.027), and more than 10 years (AOR = 0.101, 95%CI: 0.057, 0.176), automobile vehicle type (AOR = 8.642, 95%CI: 2.7644, 27.023), vehicle years of service 5-10 years (AOR = 2.484, 95%CI: 1.194, 5.169), and more than 10 years (AOR = 2.639, 95%CI: 1.268, 5.497), vehicle upside down accidents (AOR = 5.560, 95%CI: 2.506, 12.336), turning illegal position (AOR = 0.454, 95%CI: 0.226, 0.913), residential areas (AOR = 108.506, 95%CI: 13.725, 857.798), and working areas (AOR = 129.606, 95%CI: 16.448, 1021.263) were significant associated number of human deaths per road traffic accident factors in the study area. CONCLUSION: Human deaths per road traffic accidents occurred due to the younger age of the driver, driver's lack of sufficient experience, vehicle serviced for long years, driving on a wet road, driving in the afternoon, driving near/around residential places and vehicle to driver's relation. Thus, the regional traffic police should give special attention to younger drivers, less experienced drivers, old vehicles, driving near residential areas, driving automobiles, and driving in the afternoon to control traffic system to reduce the number of human deaths pear road traffic accident.

Maternal factors associated with moderate and severe stunting in Ethiopian children: analysis of some environmental factors based on 2016 demographic health survey.

BACKGROUND: Stunting or chronic undernutrition is a significant public health problem in Ethiopia. In 2019, 37% of Ethiopian children under-5 were stunted. Stunting results from a complex interaction of individual, household and social (environmental) factors. Improving the mother's overall care is the most important determinant in reducing the stunting levels in developing countries. We aimed to determine the most important maternal factors associated with stunting and quantify their effects. METHODS: This study used data from the nationally representative 2016 Ethiopian Demographic Health Survey (EDHS). Common maternal factors were first selected and analyzed using Pearson's chi-square of association followed by multiple logistic regression. To quantify the effect of a unit change of a predictor variable a model for the continuous maternal factors was developed. All analyses were carried out using IBM SPSS© Version 23. RESULTS: Higher maternal educational level, better maternal autonomy, average or above maternal height and weight, having at least 4 antenatal care (ANC) clinic visits, and delivering in a health facility were significantly associated with lower severe stunting levels. Unemployed mothers were 23% less likely (p = 0.003) to have a stunted child compared with employed mothers. Mothers delivering at home had 32% higher odds of stunting (p = 0.002). We found that short mothers (< 150 cm) were 2.5 more likely to have stunted children when compared with mothers above 160 cm. Every visit to the ANC clinic reduces stunting odds by 6.8% (p <  0.0001). The odds of stunting were reduced by 7% (p = 0.028) for every grade a girl spent in school. A unit increase in Body Mass Index (BMI) reduced the odds of stunting by 4% (p = 0.014) and every centimeter increase in maternal height reduced the odds of stunting by 0.5% (p = 0.01). CONCLUSION: Maternal education, number of antenatal care visits, and place of delivery appear to be the most important predictors of child stunting in Ethiopia.. Therefore, educating and empowering women, improving access to family planning and ANC services, and addressing maternal malnutrition are important factors that should be included in policies aiming to reduce childhood stunting in Ethiopia.

Count Models Analysis of Factors Associated with Under-Five Mortality in Ethiopia.

Background. Under-five mortality has continued a key challenge to public health in Ethiopia, and other sub-Saharan Africa countries. The threat of under-five mortality is incessant and more studies are needed to generate new scientific evidence. This study aimed to model the number of under-five deaths a mother has experienced in her lifetime and factors associated with it in Ethiopia. Method. A retrospective cross-sectional study based on data obtained from the Ethiopian Demographic and Health Survey (DHS), 2016 was used. The response variable was the total number of under-five children died per mother in her lifetime. Variables such as maternal socioeconomic and demographic characteristics, health, and environmental factors were considered as risk factors of under-five mortality. Hurdle negative binomial (HNB) regression analysis was employed to determine the factors associated with under-five mortality. Results. The data showed that 27.2% (95%CI: 0263, 0.282) of women experienced under-five deaths. The study revealed the age of mother at first birth, the age of mother at the time of under-five mortality occurred, number of household members, household access to electricity, region, educational level of the mother, sex of household head, wealth index, mother residing with husband/partner at the time of under-five mortality occurred as factors associated with under-five mortality. Age of mother at first birth 18 to 24 (IRR = .663; 95%CI: 0.587, 0.749), 25 or higher years old (IRR = 0.424; 95%CI: 0.306, 0.588), access to electricity (IRR = 0.758; 95%CI: 0.588, 0.976), primary education level of the mother (IRR = 0.715; 95%CI: 0.584, 0.875) and the richer wealth index (IRR = 0.785; 95%CI: 0.624, 0.988) were associated with reduced incidence of under-five mortality controlling for other variables in the model. Whereas older age of mother 35 to 39 (IRR = 5.252; 95%CI: 2.992, 9.218), 40 to 44 (IRR = 7.429; 95%CI: 4.188, 13.177), 45 to 49 (IRR = 8.697; 95%CI: 4.853, 15.585), being a resident of the Benishangul-gumuz region (IRR = 1.781; 95%CI: 1.303, 2.434), female household head (IRR = 1.256; 95%CI: 1.034, 1.525) were associated with an increased incidence of under-five mortality. Conclusion. The findings suggested that early age of mothers' at first birth and old ages of mothers', female household head and being uneducated were found to increase the incidence of the under-five mortality, whereas access to electricity and living with husband was statistically associated with reduced incidence of under-five mortality. The implication of this study is that policymakers and stakeholders should provide health education for mothers not to give birth at an earlier age and improve living standards to achieve sustainable development goals.

Prevalence and associated risk factors of gastritis among patients visiting Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia.

BACKGROUND: The health of individuals is not only the absence of disease checked medically, but also encompasses social and psychological aspects. Any departure from the state of physiological, psychological, or social well-being was affected by different factors. However, all contributory factors were not equally responsible for affecting disease. This study was undertaken as a search for the relative effects of sociocultural and individual behavioral factors contributing to acute and chronic gastritis patients visiting Saint Paul Hospital Millennium Medical College (SPHMMC). METHODS: A cross-sectional study was carried out on 364 patients visited SPHMMC in the study. Primary data were collected through an interview schedule tool with an exit approach by validating questions pertaining to sociocultural and individual behavioral factors. The status of gastritis was measured as whether patients had Helicobacter Pylori infection, signs and symptoms indicated gastritis that occurred, and persisted for less than a month, greater than a month, or none of the signs and symptoms. Descriptive statistics, bivariate analysis, and multivariable ordinal logistic regression model were used to identify the predictors of gastritis severity. P-value ≤ 0.05 was declared as an indicator of statistically significant. RESULTS: The prevalence of gastritis in the study area was 78.8%. Specifically, 48.9% and 29.9% had acute and chronic gastritis, respectively. The study found that low income and taking medicinal drugs was slightly significantly contributed to higher gastritis status; however, being younger age was slightly significantly contributed to lower gastritis status. Furthermore, the results indicated that eating spiced foods (Adjusted Odds Ratio (AOR) = 1.508; 95% CI: 1.046, 2.174), lack of physical exercise regularly (AOR = 1.780; 95% CI: 1.001, 3.168), stress (AOR = 2.168; 95% CI: 1.379, 3.4066), and substance use (AOR = 1.478; 95% CI: 1.093, 1.999) were significantly contributed to higher gastritis status. CONCLUSIONS: The findings suggested that women should take enough rest and sleep well, men refrain from involvement in any risky behaviors, young people and those who earn low income per month should equip with knowledge and understanding on how to practice good health behaviors, eating foods on time, avoiding eating spiced food frequently, doing physical exercise regularly, and taking medicinal drugs according to physician advice are recommended.

Assessment of Exposure to Sexually Explicit Materials and Substance Abuse among High-School Adolescents in North Shewa Zone: Application of Logistic Regression Analysis.

BACKGROUND: The use of substances such as cigarettes, khat, alcohol, and other illicit drugs like hashish, heroine, cannabis, and cocaine is a global major public threat, which affects young adult people particularly in developing countries. This study aims to assess the risk factors associated with substance use and exposure to sexually explicit materials among high-school adolescents in north Shewa zone, Oromia region. METHOD: A cross-sectional study was conducted to assess substance use and exposure to sexually explicit materials among high-school adolescents in North Shewa zone, Oromiya, Ethiopia, using a structured self-administered questionnaire adapted from the 2008 "Community That Care Youth Survey" for adolescent substance use and problem behaviors. The study used descriptive statistics and logistic regression analysis to identify the significant factors associated with substance use and exposure to sexually explicit materials among high school adolescents in the study area. RESULT: The prevalence of lifetime and current substance use was 47.7% (95% CI: 0.427, 0.527) and 30.4% (95% CI: 0.258, 0.350), respectively. 17.8% use khat in their life and 16.6% used khat in the past 30 days; 42.2% ever used alcohol and 26.1% currently uses alcohol; 4.8% and 4.5% used cigarette in lifetime and in the past 30 days, while 16.4% use other illicit drugs in lifetime and 8.4% use illicit drugs in the past 30 days, respectively. Distributions of substance use by sex indicate that male adolescents are more like likely 61.1% use substances than females. While, the prevalence of exposure to sexually explicit materials among high school adolescents was 35.8% (95% CI: 0.310, 0.406). Factors positively associated with increased substance use were being male (OR = 2.334, 95% CI: 1.549, 9.926), living through high level of family conflict (OR = 6.25, 95% CI: 1.745, 10.00), poor family management OR = 27.084, 95% CI: 1.624, 45.56), peer pressure (OR = 12.882, 95% CI: 1.882, 88.153), poor academic performance (OR = 14.48, 95% CI: 1.290, 162.58), and low school commitment (OR = 11.951, 95% CI: 1.418, 100.73). While, being male (OR = 7.52, 95% CI: 2.611, 21.739), age 14-16 (OR = 0.201, 95% CI: 0.071, 0.565), friends watch/read sexually explicit materials (OR = 5.376, 95% CI: 1.010, 28.571), and khat chewing (OR = 12.5, 95% CI: 2.924, 25.632) were factors significantly associated with high-school adolescents exposure to sexually explicit materials. CONCLUSION: The magnitude of prevalence for substance uses and exposure to sexually explicit materials in the study area was still higher. Therefore, interventions that focus on family management, peer pressure, and school commitment are required to decrease the prevalence of substance uses and exposure to sexually explicit materials among high-school adolescents.

Trends and Factors Associated with Healthcare Utilization for Childhood Diarrhea and Fever in Ethiopia: Further Analysis of the Demographic and Health Surveys from 2000 to 2016.

Background: Healthcare use for childhood illness reduces the risk of under-five deaths from common preventable diseases. However, rates of healthcare seeking for childhood diarrhea and fever remain low in most low- and middle-income countries including Ethiopia. This study aimed to assess the trends and factors for healthcare diarrhea and fever in Ethiopia from 2000 to 2016. Methods: Analysis of healthcare use for diarrhea and fever trends was done using data from four Ethiopian Demographic Health Surveys. Descriptive statistics were used to report sample characteristics and healthcare use for diarrhea and fever trends, and chi-square tests were used to assess associations between independent variables and healthcare utilization in each survey. Binary logistic regression analysis was fitted to find the factors related to healthcare utilization for diarrhea and fever. All variables with odds ratio p values <0.05 were considered as significant determinants of the outcome. Results: Healthcare seeking for diarrheal illness significantly increased from 13% (95% CI: 12.5-13.5) in 2000 to 44% (95% CI: 43.2-44.78) in 2016, while healthcare uses for fever significantly increased from 22% (95% CI: 16.7-27.3) in 2000 to 35% (95% CI: 34.3-35.7) in 2016. Factors of healthcare seeking for diarrhea in 2000-2016 were as follows: maternal age <30 years, urban residence, being a male child, nonexposure to mass media and not hearing information about oral rehydration, no desire to have more children, poor wealth index, and region. Meanwhile, factors for healthcare seeking for fever in 2000-2016 were as follows: a long distance from the nearest health facilities, first birth order, nonexposure to mass media, no desire to have more children, maternal age <30 years, urban residence, region, absence of antenatal and postnatal care utilization, poor wealth index, and being born from uneducated mothers (p values <0.05 were considered as significant determinants of the outcome. Conclusions: Factors associated with healthcare utilization for diarrhea and fever differed between 2000 and 2016. Though Ethiopia has achieved a significant reduction in under-five mortality, it needs to accelerate the reduction through strengthening healthcare utilization for common childhood illness to avoid deaths from preventable diseases.

Trends and factors associated to early initiation of breastfeeding, exclusive breastfeeding and duration of breastfeeding in Ethiopia: evidence from the Ethiopia Demographic and Health Survey 2016.

BACKGROUND: Initiation of breastfeeding immediately after birth, exclusive breastfeeding, and continuous breastfeeding for at least 2 years lower the risk of newborn deaths. This study was conducted to examine the trends and factors associated with early initiation of breastfeeding, exclusive breastfeeding and duration of breastfeeding in Ethiopia. METHODS: Data for this study were extracted from the Ethiopian Demographic and Health Survey 2016. A total of 5122 children were included in the analysis. Multivariate logistic regression analysis, and Cox proportional hazards model were fitted to find the factors associated with breastfeeding practices. Reported p - values < 0.05 or a 95% Confidence Interval of Odds Ratio/Hazard Ratio excluding one was considered as significant association with early initiation of breastfeeding, exclusive breastfeeding, duration of breastfeeding and independent variables. RESULTS: About 81.8% of the children initiated breastfeeding within 1 h of birth and during the day before an interview, 47% were exclusively breastfed during the first 6 months. The median duration of breastfeeding was 22 months (22 ± 0.50 months 95% Confidence Interval [CI] 21.01-22.99). Rural residents (Odds Ratio [OR] 0.71, 95% CI 0.51, 0.99), mothers with no antenatal follow up (OR 0.75, 95% CI 0.57, 0.99), caesarean birth (OR 0.80, 95% CI 0.66, 0.96) and home delivery were associated with low initiation of breastfeeding within 1 h of birth. Mothers with no/primary education (OR 0.62, 95% CI 0.40, 0.96), no baby postnatal checkup (OR 0.53, 95% CI 0.39, 0.73), average/larger size of a child at birth (OR 0.80, 95% CI 0.65, 0.99) and deliveries outside of health centers were significantly associated with non-exclusive breastfeeding at the time of the interview. Further, mothers living in Amhara (Hazard Ratio [HR] 1.31, 95% CI 1.05, 1.64), Oromia (HR 1.27, 95% CI 1.04, 1.54), and Benishangul-Gumuz (HR 1.34, 95% CI 1.09, 1.65) regions had a longer duration of breastfeeding while Muslims, employed mothers, multiple births and poor economic level of households were associated with shorter durations of breastfeeding. CONCLUSIONS: Rural residence, female sex, home delivery, caesarean birth, small birthweight baby and large family size were associated with late initiation of breastfeeding. Living in Affar, Somali, and Harari, primary education level of mothers, giving birth outside of health facilities, no antenatal care follow up, and no postnatal check-up were associated with non-exclusive breastfeeding, while younger age mothers, Muslims, giving birth outside of health facilities, and employed mothers were associated with shorter time to cessation of breastfeeding. Providing health education and counseling for mothers during and after pregnancy should be encouraged.

Statistical analysis of socioeconomic and demographic correlates of perinatal mortality in Tigray region, Ethiopia: a cross sectional study.

BACKGROUND: Though Ethiopia achieved the fourth Millennium Development Goal, commit to reducing under five child mortalities by the year 2015, but perinatal mortality has remained a major public health problem in Ethiopia, and the Tigray region is experiencing a high perinatal mortality rate. This study aimed to assess the risk factors attributed to perinatal death in the Tigray region. METHODS: A retrospective cross-sectional study was used. The information collected from 2738 children born five years preceding the survey was considered. Variables such as maternal social and demographic characteristics, child demographic characteristics, health and environmental factors were considered as risk factors of perinatal death. The study used descriptive statistics, and logistic regression model to identify significant correlates of perinatal mortality. RESULTS: The data showed that from total children included in the study, 4.1% are early neonatal deaths, and 2.1% are stillbirth. Overall the prevalence of experiencing perinatal mortality was 6.2% the Tigray region. The logistic analysis revealed, factors small birth interval (less than 15 months) (AOR = 7.902; 95% CI: (4.526-13.795)) and 16-26 months (AOR =2.088; 95% CI: (1.292-3.375)), poor wealth index (AOR = 1.948; 95% CI: (1.011-3.754)), having no toilet facility (AOR =1.649; 95% CI: (1.093-2.488)), child sex (being male) (AOR =1.74; 95% CI: (1.234-2.454)), giving birth at older maternal age (45-49 years) (AOR = 0.293; 95% CI: (0.128-0.668)), rural residence and using the unprotected well water were significantly associated with a higher risk of perinatal death. CONCLUSIONS: The study identified sex of a child, previous birth intervals, availability of toilet facilities, wealth index, birth type, mother's age, parity, place of residence, mother's occupation and source of drinking water were the factors significantly associated with perinatal mortality. The prevalence of perinatal mortality shows that Tigray region was experiencing a high perinatal mortality rate than the national.

Risk Factors Associated with Under-Five Stunting, Wasting, and Underweight Based on Ethiopian Demographic Health Survey Datasets in Tigray Region, Ethiopia.

BACKGROUND: Stunting, wasting, and underweight among children are major problems in most regions of Ethiopia, including the Tigray region. The main objective of this study was to assess the risk factors associated with stunting, wasting, and underweight of children in the Tigray region. METHODS: The information collected from 1077 children born 5 years before the survey was considered in the analysis. Multivariable binary logistic regression analysis was fitted to identify significant risk factors associated with stunting, wasting, and underweight. RESULTS: Male children and rural born were having a higher burden of both severe and moderate stunting, wasting, and underweight than females and urban born. Among male children, 27.6%, 4.10%, and 14.2% of them were stunted, wasted, and underweight, respectively. Protected drinking water (odds ratio (OR) = 0.68; 95% confidence interval (CI): (0.50, 0.92)) was associated with stunting. Maternal age at birth less than 20 years (OR = 0.66; 95% CI: (0.45, 0.97)) and being male (OR = 2.04; 95% CI: (1.13, 3.68)) were associated with high risk of underweight. No antenatal care follow-up (OR = 2.20; 95% CI: (1.04, 4.64)) was associated with wasting, while the poor wealth index, diarrhea, low weight at birth (<2.5 kg), lower age of a child, and 3 or more under-five children in a household were significantly associated with stunting, wasting, and underweight. CONCLUSIONS: Being born in rural, being male, unprotected drinking water, smaller weight at birth, no antenatal follow-ups, diarrhea, and poor household wealth were factors associated with increased stunting, wasting, and underweight. Thus, interventions that focus on utilization of antenatal care services, improving household wealth, and improving access to protected drinking water were required by policymakers to decrease stunting, wasting, and underweight more rapidly.