Proximate determinants of fertility in Ethiopia; an application of revised Bongaarts model.

BACKGROUND: World population is growing at about 80 million people each year. Ethiopia is the 12th most populous country in the world. Existing literatures showed that the role of proximate determinants in inhibiting the total fertility has not yet been determined from the DHS data in the country. This study may provide evidence based information regarding the observed changes in total fertility. The objective of this study was assessing proximate determinants of fertility and the role of selected socio-economic variables in influencing fertility in Ethiopia. METHODS: The EDHS data of 2011 and 2016 were used in our study. A total of 16,515 eligible women included in 2011 and 15,683 in 2016 surveys made up the sample for the study. The roles of each of the four proximate determinants in declining fertility have been determined. The background variables selected for the analysis include: region of residence, educational status, wealth index and place of residence. The Bongaart model is used to explain the observed socio-economic differentials in fertility during the two survey years. RESULTS: In 2011, index of marriage inhibited fertility by 37.8%, however in 2016 it inhibited fertility by 34.4%. In 2011, contraceptive use reduced fertility by 28.5% while in 2016 it reduced fertility by 30.7%. The index of postpartum infecundity decreased fertility by 34.7% in 2011 and by 34.5% in 2016. Foetal wastage inhibited fertility by 9.2% in both survey years. The total fertility rate in 2016 was 4.14 whereas the projected total fertility in 2020 will be 3.2 children per woman. CONCLUSION: Among the four proximate determinants of fertility, the contribution of index of marriage was the highest in inhibiting fertility in 2011. On the other hand, the contribution of postpartum infecundability was the highest in inhibiting fertility in 2016. The contribution of the index of contraceptive in inhibiting fertility increased from 28.5% in 2011 to 30.7% in 2016. The index of foetal wastage contributed the least in both 2011 and 2016 survey years. Therefore, strategies have to be designed to promote the contraceptive use and breast feeding practices among the reproductive women.

Adolescent-parent communication on sexual and reproductive health issues and its factors among secondary and preparatory school students in Hadiya Zone, Southern Ethiopia: institution based cross sectional study.

BACKGROUND: Adolescent communication with parents is paramount to reduce sexual health problems. Currently, there is a shortage of information on adolescent-parent communication in Ethiopia in general and study area in particular. Thus, this study is intended to determine adolescent-parent communication on sexual and reproductive health issues and its factors among secondary and preparatory school adolescents in Hadiya Zone, Ethiopia. METHODS: We used institution based cross-sectional study design. We stratified schools into urban and semi-urban settings. Then, a total of 8 schools were randomly selected from the strata. The sample size was allocated for each stratum. Finally, participants were randomly selected from separate sampling frames prepared for each stratum. We developed structured questionnaire from related literatures to collect data on adolescent-parent communication and its factors. We cleaned and entered data using EPI info version 3.5.3 and exported to SPSS version 20 for descriptive and logistic regression analysis. RESULTS: The proportion of adolescents who had communicated with their parents was 144 (35.0%). Multivariate logistic regression analysis indicates that participants' knowledge about availability of adolescent and youth friendly sexual and reproductive health services at health facilities [AOR: 0.40, 95% CI: (0.26, 0.62),P-value = 0.001], utilization of adolescent and youth friendly sexual and reproductive health services [AOR: 0.46, 95% CI: (0.29, 0.72),P-value = 0.001] and respondents' educational status: being grade 9, [AOR: 3.21, (95% CI: ((1.16, 8.89), P-value = 0.025] and grade 11; [AOR: 2.96, (95% CI: (1.06, 8.30),P- value =0.039] were statistically associated factors affecting adolescents for not communicating with parents on sexual and reproductive health issues. CONCLUSION: The findings of our study imply that adolescents were not communicating much with parents about sexual and reproductive health issues even though they were aware of adolescent and youth friendly sexual and reproductive health services. In addition, promotion of service availability may be important to motivate adolescents to communicate with parents. Contextual and age dependent communication barriers should be further identified. Further research is needed in the area to identify barriers particularly from parent side.

Health seeking behavior and its determinants for cervical cancer among women of childbearing age in Hossana Town, Hadiya zone, Southern Ethiopia: community based cross sectional study.

BACKGROUND: Cervical cancer is one of the most easily preventable forms of female cancers if early screening and diagnosis is made. Low awareness level about the disease and risk factors, beliefs about the disease, poor access to preventive services, affordability of the service and current health service system can influence decision to seek health care services for cervical cancer. The objective of this study was to determine health seeking behaviour and determinant factors for cervical cancer in Hossana town. METHODS: Our study was carried out in Hossana town using community based cross-sectional study design. The study population was women of childbearing age (15-49 years) who had the chance of being randomly selected from the source population. Five hundred ninety five women of childbearing age were included in the study. Systematic random sampling technique was employed to select the study units. Structured and pretested questionnaire was used to collect the data. The collected data were cleaned and entered by EPI info version 3.5.4 and analysed by SPSS version 16. We considered P-value < 0.05 to decide statistically significant association between the independent and dependent variables. RESULTS: The prevalence of health seeking behaviour for cervical cancer among the study participants was only 14.2%. Respondents' poor knowledge [AOR: 7.25, 95% CI: (1.87, 28.08)], not ever received information [AOR: 52.03, 95% CI: (13.77, 196.52)] and not actively searching information about cervical cancer [AOR: 14.23, (95%CI: (3.49, 57.95)] were significantly associated factors with not seeking health for prevention and control of cervical cancer. CONCLUSION: The prevalence of health seeking behaviour for cervical cancer is low. Respondent' poor knowledge, not ever received information, and not actively searching information about cervical cancer are significantly associated with not seeking health for cervical cancer prevention and control. This study stressed the importance of increasing knowledge, promoting active search of health information and experiences of receiving information from different sources regarding health seeking behaviour.

Does Anaemia Have Major Public Health Importance in Children Aged 6-59 Months in the Duggina Fanigo District of Wolaita Zone, Southern Ethiopia?

BACKGROUND: Globally, a large number of children aged 6-59 months are affected by anaemia. In Ethiopia, like other developing countries, more than 40% of children under 5 years are affected by anaemia. Anaemia during infancy and childhood period is associated with poor health and impaired cognitive development, leading to reduced academic achievement and earning potential in their adult life. The aim of this research was to assess whether anaemia remained a major public health problem among children aged 6-59 months or not in Duggina Fanigo District of Wolaita Zone, South Ethiopia in 2016. METHODOLOGY: A community-based cross-sectional study was conducted from February to March 2016, on 404 mothers with children aged 6-59 months who were selected through the systematic sampling method. Socio-demographic and other data on associated factors was collected using a pre-tested questionnaire. Capillary blood was taken from the fingertip of each child and hemoglobin was measured using Haemo-Cue digital photometer. All the necessary safety measures were taken during blood collection. Data analysis was made using SPSS version 21. Multivariable logistic regression analysis was used to assess the association of independent variables with outcome variables and to control the possible confounding factors. RESULT: The overall prevalence of anaemia was 51.4%. Anaemia was common among young children as compared to older children. After controlling the effect of confounding and adjusting for age, gender and altitude, explanatory variables like low dietary diversity (AOR = 3.24; 95% CI [1.68-6.23]), food insecurity (AOR = 3.63; 95% CI [2.18-6.04]), stunting (AOR = 2.60; 95% CI [1.56-4.35]), underweight (AOR = 2.46; 95% CI [1.29-4.67]) and fever within 2 weeks (AOR = 2.49; 95% CI [1.29-4.81]) prior to the survey were significantly associated with anaemia. In conclusion, the overall prevalence of anaemia among children aged 6-59 months has remained a major public health importance in the study area. Integrated efforts need to be prioritized to improve the health as well as the nutritional status of children aged 6-59 months through appropriate feeding practices in infants and children.

The association between malaria and malnutrition among under-five children in Shashogo District, Southern Ethiopia: a case-control study.

BACKGROUND: Recent studies have presented conflicting findings about whether malaria is associated with an increased or decreased risk of malnutrition. Therefore, assessing the relationship between these two disastrous diseases in the most vulnerable groups, such as in children aged below 5 years (under-five children), may lead to the discovery of new low-cost and effective aides to current methods of malnutrition prevention in malaria-endemic areas. Therefore, this study was conducted to assess the relationship between malaria and malnutrition among under five children in an area with a high degree of malaria transmission. METHODS: The study involved comparing malnourished children aged 6-59 months and nourished children of the same age for their past exposure to malaria, in Shashogo District, Southern Ethiopia. A validated structured questionnaire was used to collect home to home socioeconomic data and anthropometric instruments for clinical data. The collected data were analysed using descriptive and inferential statistics by means of EpiData entry software and STATA data analysis software. RESULTS: A total of 356 (89 malnourished and 267 nourished) under-five children participated in the study. Previous exposure to Plasmodium infection was found to be a predictor for the manifestation of malnutrition in under-five children (P = 0.02 [OR = 1.87, CI = 1.115-3.138]). Children from a household with a monthly income of less than USD 15 were 4.5 more likely to be malnourished as compared to the other children (P = 0.001 [OR = 0.422, CI = 0.181-0.978]). CONCLUSION: This study found that exposure to Plasmodium has a significant impact on the nutritional status of children. In addition, socio-demographic factors, such as family income, may play a role in determining whether children are malnourished or not and may lead to increased morbidity due to malnourishment in children living in malaria-endemic areas. Therefore, malnutrition control interventions should be consolidated with malaria prevention strategies particularly in high malaria transmission areas.

Duration and determinants of birth interval among women of child bearing age in Southern Ethiopia.

BACKGROUND: Longer intervals between consecutive births decrease the number of children a woman can have. This results in beneficial effects on population size and on the health status of mothers and children. Therefore, understanding the practice of birth interval and its determinants is helpful to design evidence based strategies for interventions. The objective of this study was to determine duration and determinants of birth interval among women of child bearing age in Lemo district, southern Ethiopia in March 2010. METHODS: A community based cross sectional study design with stratified multistage sampling technique was employed. A sample of 844 women of child bearing age were selected by using simple random sampling technique after complete census was conducted in selected kebeles prior to data collection. Structured interviewer administered questionnaire was used for data collection. Actual birth interval was measured with the respondents' memory since majority of the women or their children in the area had no birth certificate. RESULTS: Majority (57%) of women were practicing short birth interval length with the median birth interval length of 33 months. Actual birth interval length is significantly shorter than preferred birth interval length. Birth interval showed significant variation by contraceptive use, residence, wealth index, breast feeding and occupation of husbands. CONCLUSION: low proportion of optimal birth spacing practices with short actual birth interval length and longer preferred birth interval lengths were evident among the study subjects. Hence interventions to enhance contraceptive utilization behaviors among women in Lemo district would be helpful to narrow the gap between optimal and actual birth spacing.