Thesis and Dissertations

Determinants of Caesarean Section Delivery among Woman in Ethiopian Administrative Zones: An Application of Geo Additive model

Mon, 01 Jul 2024 00:00:00 GMT

Determinants of Caesarean Section Delivery among Woman in Ethiopian Administrative Zones: An Application of Geo Additive model Yimam Ebrahim Background: Caesarian section (CS) delivers the pregnancy outcome by making an incision through the maternal abdomen and uterus. Although there is a wide variation of CS in Sub Saharan Africa, currently Ethiopia has a considerably lower CS delivery rate. The main objective of this study is examine determinants of CS among women in Ethiopia's administrative zone. Method: The recent 2019 Ethiopia Mini Demographic and Health Survey (EMDHS) dataset with 5,527 weighted samples of women was used. Data management was done using STATA version 17 software. To investigate the associated determinants of CS, we used Geoadditive model. Results: From this study prevalence of CS in Ethiopia was 5.44%. Awi, East Gojjam, South Wollo, North Shewa zones in Amhara region; all Addis Ababa zones; East Shewa in Oromia region Kembata Tambaro and Sidama zones from SNNP region were hotspot area for CS. Women with primary, secondary and higher educational level had higher odds of C- section with Posterior Odds Ratio (POR=1.5278, 95%CI=1.1990-1.9484), (POR=2.1336, 95%CI=1.3971-3.2583) and (POR=4.0382, 95%CI=2.2175-7.3537), respectively as compared to those in no education category. Having ANC visits of 1-3, 4th and above, were associated with higher odds of CS as (POR= 2.6783, (1.5001-4.8521)) and (POR=2.7042, (1.5479-4.9704)) respectively with 95%CI compared to their reference no ANC visit. Conclusion: The generalized geo-additive effects model enables simultaneous modeling of spatial correlation, heterogeneity and possible nonlinear effects of covariates. Predictors of CS delivery in Ethiopia include mother's educational level, child twin, religion, place of residence, ANC visit, pregnancy counseling, place of delivery, total number of children born, birth order, mother's current age, preceding birth interval, and mother's age at first birth. The study also revealed signifcant spatial variations on CS delivery among administrative zones. It also depicts that the presence of spatial structured effect had negative or positive effect for CS delivery in Ethiopia zones. Priority interventions should focus on rural women, promoting women's education, and encouraging pregnancy counseling to address this issue

Spatial Patterns and Determinants of Acute Respiratory Infection among Under-Five Children in Ethiopia: An Application of Bayesian Multilevel Analysis

Sat, 01 Jun 2024 00:00:00 GMT

Spatial Patterns and Determinants of Acute Respiratory Infection among Under-Five Children in Ethiopia: An Application of Bayesian Multilevel Analysis Getahun, Firnuse Background: Despite remarkable progress in the reduction of under-five mortality, acute respiratory infection (ARI) is still one of the leading public health problems in developing countries, including Ethiopia. This study aims to assess the spatial distribution and determinant factors of ARI among under-five children in Ethiopia. Methods: The data were taken from the 2016 Ethiopia Demographic and Health Survey (EDHS), conducted from January to June 2016 using a community-based cross-sectional study design. The study included a total of 7738 under-five children in the analysis. As a result, Spatial Analysis was performed to explore the spatial distribution, and Bayesian multilevel logistic regression models were used to determine the risk factors associated with the prevalence of ARI in Ethiopia. Result: In this study, the prevalence of ARI in the last two weeks prior to the time of survey among under-five children was 8.8%. The highest prevalence of acute respiratory infection was recorded in Tigray region (18.5%), whereas Benishangul-Gumuz region (2.5%) had the lowest. The spatial distribution of ARI in Ethiopia among under-five children was clustered (Global Moran’s I = 0.290897 1, p < 0.000). Bayesian random intercept model provided the best fit for the data under consideration. The selected model revealed that children who had diarrhea in the last two weeks (AOR = 5.46, 95% CI: 1.558-1.834), used unclean sources of fuel (AOR = 2.354, 95% CI: 0.513-1.177), were born very small (AOR = 1.244, 95% CI: 0.051-0.381), had mothers who were working (AOR = 1.411, 95% CI: 0.149-0.532), were wasted (AOR = 1.204, 95% CI: 0.070-0.298) were more likely to develop acute respiratory infection (ARI). In comparison to children aged 0-11 months, those aged 48–59 months had lower odds of having ARI in Ethiopia (AOR = 0.471, 95% CI: -0.440, -0.224). Conclusion : The findings of the study indicate that children who had diarrhea in the last two weeks, lived in households that used unclean sources of fuel, were born very small, had mothers who were working, or were wasted, were more likely to develop acute respiratory infection in Ethiopia. Public health officials, policymakers, and healthcare providers should develop targeted interventions and strategies to reduce the burden of ARIs and improve overall respiratory health across different regions.

Exploring Factors Influencing Childhood Immunization Status in East Africa using Spatial and Multilevel Ordinal Logistic Regression

Mon, 01 Jul 2024 00:00:00 GMT

Exploring Factors Influencing Childhood Immunization Status in East Africa using Spatial and Multilevel Ordinal Logistic Regression Addisu, Aster Background: Childhood vaccines play a vital role in protecting children from infectious diseases and have been recognized as one of the most cost effective public health interventions. However East African countries, have more than fifteen-fold increased risk of death caused by Vaccine Preventable Disease compared to children in high-income nations. Therefore this study aimed to identify factors influencing childhood immunization status in East Africa. Methods: A sample of 22,734 children aged 12-23 months was enrolled to study the immunization status, using the recent data from the Demographic and Health Survey conducted from 2015 to 2022 in 10 East African countries. Spatial and level-3 multilevel generalized odds model with logit link function was employed. Result: Out of the total sample of 22,734 children, only 67.4% were fully immunized, 27.7% were partially immunized and the remaining were not immunized. The null hypothesis of proportionality was rejected based on the Brant-test. As a result, various partial- and non proportional odds models were fitted where the generalized odds model was found to be the best compared to other ordinal regression models. The result of this study revealed that 43.14% of the variation in child’s immunization status exists between countries, and 18.18% exists between regions. Regarding specific factors associated with immunization status, the analysis revealed that mothers who had antenatal care visits, and postnatal care were 1.23, and 1.13 times more likely to fully Vs partially or not immunize their children, also 1.07 and 1.08 times more likely to fully or partially Vs not immunize their children respectively compared to those who did not attend antenatal and postnatal services. Conclusion: The fitted generalized odds model indicated that age of mother, number of antenatal care visits, number of postnatal care visits, mothers tetanus injections received, taking vitamin A1, presence of health documentation, place of delivery, Birth order, mother occupation, sex of house hold head, distance to health facility, occupation of mother, and mother education, community mother education, community wealth index, and community media exposure were factors significantly associated with childhood immunization status. Thus, it is recommended that interventions focus on improving household wealth index, educating mothers, and improving health systems

Spatial Distribution and Determinant Factors of Short Birth Interval and Under Five Mortality in Ethiopia; Application of Bivariate Binary Multilevel Analysis

Mon, 01 Jul 2024 00:00:00 GMT

Spatial Distribution and Determinant Factors of Short Birth Interval and Under Five Mortality in Ethiopia; Application of Bivariate Binary Multilevel Analysis Lema, Alemayehu Background: Short Birth Interval is defined as a duration of less than 24 months between births and the next pregnancy. Under-five Mortality is defined as the probability of a child dying before reaching the age of five, represented as a rate per 1,000 live births. Currently, short birth intervals and under-five mortality continue to be the two major significant public health challenges globally and pose a major obstacle to achieving the Sustainable Development Goals of reducing preventable child and maternal deaths in Ethiopia. This study aimed to assess the spatial distribution and determinant factors of short birth interval and under-five mortality in Ethiopia. Method: The study utilized data from the 2019 Ethiopia Mini Demographic and Health Survey, which was collected from March 21 to June 28, 2019, through a two-stage stratified cluster sampling method. The total weighted sample included in the analysis was 4,313 mothers-child pair’s non-first-birth. A bivariate binary multilevel analysis was used to assess the spatial distribution and determinant factors of short birth intervals and under-five mortality in Ethiopia, using SAS 9.4 and ArcGIS 10.8. Results: The prevalence of short birth interval and under-five mortality in this study was 25.6% and 4.8% respectively. The spatial distribution of short birth interval and under-five mortality were found to be clustered in Ethiopia (Moran’s I value of 0.26 and 0.23) respectively. Hot-spot areas for short birth intervals were found in Somali and Afar region, and for under-five mortality were found in Benishangul, Gambela, Harari region, and Jijiga zone. The estimated intra-class correlation was 0.1381and 0.1037, this indicates about 13.81% and 10.37% of the total variation for SBI and U5M was due to the difference between zones. The estimated odds of short birth interval and under-five mortality among mothers who breastfed their children were (OR=0.728) and (OR=0.318) times less likely than mothers who did not breastfeed their children respectively. Conclusions: This study found that both short birth interval and under-five mortality vary across clusters in Ethiopia's administrative zones. The mother's education level, ANC visits, child twin, birth order of the child, household size, region, breastfeeding status, place of residence, and community mother education are the common significant determinants of short birth interval and under-five mortality. The findings highlight that the policymakers and concerned bodies should create effective intervention plans and give special attention to the administrative zones like Somali region identified as having a high risk of short birth interval and under-five mortality.