Suboptimal birth spacing practice and its predictors among reproductive-age women in Sub-Saharan African countries: a multilevel mixed-effects modeling with robust Poisson regression

Reproductive Health

Research

Simeon Meskele Leyto¹  Kusse Urmale Mare²  Ahmed Adem Mohammed²  Kebede Gemeda Sabo²  Setognal Birara Aychiluhm³  Oumer Abdulkadir Ebrahim³  Beminate Lemma Seifu³  Abel Gebre Wuneh³  Tsion Mulat Tebeje⁴  Getahun Fentaw Mulaw⁵ 

[1] Department of Anatomy, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia;Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia;Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia;School of Public Health, College of Health Sciences and Medicine, Dilla University, Dilla, Ethiopia;School of Public Health, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia;

关键词: Multilevel modeling;    Reproductive-age women;    Predictors;    Robust Poisson regression;    Suboptimal birth spacing;    Sub-Saharan Africa;   

DOI  :  10.1186/s12978-023-01678-w

 received in 2023-04-23, accepted in 2023-08-28,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundDespite the availability of exempted family planning services, a significant proportion of women in African countries continue to experience inadequately spaced pregnancies. To the authors’ knowledge, evidence of suboptimal birth intervals at the SSA level is lacking and previous studies have been limited to specific geographic area. Therefore, this analysis was aimed to estimate the pooled prevalence of suboptimal birth spacing and its predictors among childbearing women in SSA.MethodsPooled DHS data from 35 SSA countries were used and a weighted sample of 221,098 reproductive-age women was considered in the analysis. The survey across all countries employed a cross-sectional study design and collected data on basic sociodemographic characteristics and different health indicators. Forest plot was used to present the overall and country-level prevalence of suboptimal birth spacing. Multilevel mixed-effects models with robust Poisson regression were fitted to identify the predictors of suboptimal birth spacing. Akaike’s and Bayesian information criteria and deviance were used to compare the models. In a multivariable regression model, a p-value less than 0.05 and an adjusted prevalence ratio with the corresponding 95% CI were used to assess the statistical significance of the explanatory variables.ResultsThe pooled prevalence of suboptimal birth spacing among women in SSA was 43.91% (43.71%-44.11%), with South Africa having the lowest prevalence (23.25%) and Chad having the highest (59.28%). It was also found that 14 of the 35 countries had a prevalence above the average for SSA. Rural residence [APR (95% CI) = 1.10 (1.12–1.15)], non-exposure to media [APR (95% CI) = 1.08 (1.07–1.11)], younger maternal age [APR (95% CI) = 2.05 (2.01–2.09)], non-use of contraception [APR (95% CI) = 1.18 (1.16–1.20)], unmet need for family planning [APR (95% CI) = 1.04 (1.03–1.06)], higher birth order [APR (95% CI) = 1.31 (1.28–1.34)], and desire to have at least six children [APR (95% CI) = 1.14 (1.13–1.16)] were the predictors of suboptimal birth spacing practice.ConclusionMore than four out of ten reproductive-age women in SSA countries gave birth to a subsequent child earlier than the recommended birth spacing, with considerable variations across the countries. Thus, interventions designed at enhancing optimal birth spacing should pay particular attention to young and socioeconomically disadvantaged women and those residing in rural regions. Strengthening community health programs and improving accessibility and availabilities of fertility control methods that ultimately impacts optimal reproductive behaviors is crucial to address contraceptive utilization and unmet need.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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