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Ni W, Gao X, Su X, Cai J, Zhang S, Zheng L, Liu J, Feng Y, Chen S, Ma J, Cao W, Zeng F. Birth spacing and risk of adverse pregnancy and birth outcomes: A systematic review and dose-response meta-analysis. Acta Obstet Gynecol Scand 2023; 102:1618-1633. [PMID: 37675816 PMCID: PMC10619614 DOI: 10.1111/aogs.14648] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/20/2023] [Accepted: 06/30/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION The association between extreme birth spacing and adverse outcomes is controversial, and available evidence is fragmented into different classifications of birth spacing. MATERIAL AND METHODS We conducted a systematic review of observational studies to evaluate the association between birth spacing (i.e., interpregnancy interval and interoutcome interval) and adverse outcomes (i.e., pregnancy complications, adverse birth outcomes). Pooled odds ratios (ORs) with 95% confidence intervals (CI) were calculated using a random-effects model, and the dose-response relationships were evaluated using generalized least squares trend estimation. RESULTS A total of 129 studies involving 46 874 843 pregnancies were included. In the general population, compared with an interpregnancy interval of 18-23 months, extreme intervals (<6 months and ≥ 60 months) were associated with an increased risk of adverse outcomes, including preterm birth, small for gestational age, low birthweight, fetal death, birth defects, early neonatal death, and premature rupture of fetal membranes (pooled OR range: 1.08-1.56; p < 0.05). The dose-response analyses further confirmed these J-shaped relationships (pnon-linear < 0.001-0.009). Long interpregnancy interval was only associated with an increased risk of preeclampsia and gestational diabetes (pnon-linear < 0.005 and pnon-linear < 0.001, respectively). Similar associations were observed between interoutcome interval and risk of low birthweight and preterm birth (pnon-linear < 0.001). Moreover, interoutcome interval of ≥60 months was associated with an increased risk of cesarean delivery (pooled OR 1.72, 95% CI 1.04-2.83). For pregnancies following preterm births, an interpregnancy interval of 9 months was not associated with an increased risk of preterm birth, according to dose-response analyses (pnon-linear = 0.008). Based on limited evidence, we did not observe significant associations between interpregnancy interval or interoutcome interval after pregnancy losses and risk of small for gestational age, fetal death, miscarriage, or preeclampsia (pooled OR range: 0.76-1.21; p > 0.05). CONCLUSIONS Extreme birth spacing has extensive adverse effects on maternal and infant health. In the general population, interpregnancy interval of 18-23 months may be associated with potential benefits for both mothers and infants. For women with previous preterm birth, the optimal birth spacing may be 9 months.
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Affiliation(s)
- Wanze Ni
- Department of Public Health and Preventive Medicine, School of MedicineJinan UniversityGuangzhouGuangdongChina
| | - Xuping Gao
- Department of Public Health and Preventive Medicine, School of MedicineJinan UniversityGuangzhouGuangdongChina
| | - Xin Su
- Department of Public Health and Preventive Medicine, School of MedicineJinan UniversityGuangzhouGuangdongChina
| | - Jun Cai
- Department of Public Health and Preventive Medicine, School of MedicineJinan UniversityGuangzhouGuangdongChina
| | - Shiwen Zhang
- Department of Public Health and Preventive Medicine, School of MedicineJinan UniversityGuangzhouGuangdongChina
| | - Lu Zheng
- Department of Public Health and Preventive Medicine, School of MedicineJinan UniversityGuangzhouGuangdongChina
| | - Jiazi Liu
- Department of Public Health and Preventive Medicine, School of MedicineJinan UniversityGuangzhouGuangdongChina
| | - Yonghui Feng
- Department of Public Health and Preventive Medicine, School of MedicineJinan UniversityGuangzhouGuangdongChina
| | - Shiyun Chen
- Department of Public Health and Preventive Medicine, School of MedicineJinan UniversityGuangzhouGuangdongChina
| | - Junrong Ma
- Department of Public Health and Preventive Medicine, School of MedicineJinan UniversityGuangzhouGuangdongChina
| | - Wenting Cao
- Department of Medical Statistics & Epidemiology, International School of Public Health and One HealthHainan Medical UniversityHaikouHainanChina
| | - Fangfang Zeng
- Department of Public Health and Preventive Medicine, School of MedicineJinan UniversityGuangzhouGuangdongChina
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Averbach S, Thomas EE, Kully G, Nazarbegian M, Ghule M, Rabin BA, Raj A, Bhan N. Understanding feasibility and acceptability of implementation of linking delivery of family planning and infant vaccination care in rural Maharashtra, India: a qualitative study. BMC Pregnancy Childbirth 2023; 23:519. [PMID: 37454051 PMCID: PMC10349507 DOI: 10.1186/s12884-023-05830-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Linking family planning with infant vaccination care has the potential to increase contraceptive use among postpartum women in rural settings. We explored the multilevel factors that can facilitate or impede uptake of contraception at the time of infant vaccination among postpartum women and couples in rural Maharashtra, India. METHODS We conducted 60 semi-structured interviews with key stakeholders including: postpartum married women (n = 20), husbands (n = 10), and mothers-in-law (n = 10) of postpartum women, frontline healthcare workers (auxiliary nurse midwives (ANMs) and Accredited Social Health Activists (ASHAs), (n = 10), and community leaders (physician medical officers and village panchayat leaders) (n = 10). We sought to assess the feasibility and acceptability of delivering community-based postpartum family planning care in rural India at the time of infant vaccination. The Consolidated Framework for Implementation Research (CFIR) was used to design a structured interview guide and codebook. Data were analyzed via directed content analysis. RESULTS Three major themes emerged: (1) Social fertility and gender norms including son preference and male control over contraceptive decision-making influence postpartum contraceptive access and choice. (2) Linking contraceptive care and infant vaccination is perceived as potentially feasible and acceptable to implement by families, health workers, and community leaders. The intervention provides care to women and families in a convenient way where they are in their community. (3) Barriers and facilitators to linked infant postpartum contraception and infant vaccination were identified across the five CFIR domains. Key barriers included limited staff and space (inner setting), and contraceptive method targets for clinics and financial incentives for clinicians who provide specific methods (outer setting). Key facilitators included convenience of timing and location for families (intervention characteristics), the opportunity to engage husbands in decision-making when they attend infant vaccination visits (participant characteristics), and programmatic support from governmental and community leaders (process of implementation). CONCLUSIONS Linked provision of family planning and infant vaccination care may be feasible and accessible in rural India utilizing strategies identified to reduce barriers and facilitate provision of care. A gender-transformative intervention that addresses gender and social norms has greater potential to impact reproductive autonomy and couples' contraceptive decision-making.
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Affiliation(s)
- Sarah Averbach
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, 9300 Campus Point Drive #7433, San Diego, La Jolla, CA 92037-7433, 92037, USA.
- Center on Gender Equity and Health, University of California San Diego School of Medicine, San Diego, La Jolla, CA, USA.
| | | | - Gennifer Kully
- Center on Gender Equity and Health, University of California San Diego School of Medicine, San Diego, La Jolla, CA, USA
| | - Melody Nazarbegian
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Mohan Ghule
- Center of Gender Equity and Health, University of California San Diego, Delhi, India
| | - Borsika A Rabin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
- UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, La Jolla, CA, USA
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego School of Medicine, San Diego, La Jolla, CA, USA
| | - Nandita Bhan
- Center of Gender Equity and Health, University of California San Diego, Delhi, India
- Jindal School of Public Health and Human Development, OP Jindal Global University, Sonipat, Haryana, India
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Boyle EH, Rotem N, King ML. How to Use Simplified Reproductive Calendar Data from the Demographic and Health Survey. Stud Fam Plann 2023; 54:431-439. [PMID: 36995155 PMCID: PMC10854375 DOI: 10.1111/sifp.12240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
IPUMS Demographic and Health Surveys (IPUMS DHS), through its intuitive website (http://dhs.ipums.org/), eliminate barriers to overtime and cross-national analyses with the DHS. IPUMS DHS recently released simplified reproductive calendar data. These calendar data are harmonized across samples, distinguish "not in universe" cases from "no" responses, and do not require destringing. Variable names are hot links to important documentation, such as survey-question text and comparability concerns. Analysts can also select consistently coded variables relating to the woman, her household, and her social and environmental context without merging files.
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Affiliation(s)
| | - Nir Rotem
- The Leonard Davis Institute for International Relations, The Hebrew University of Jerusalem, Jerusalem, 9190501, Israel
| | - Miriam L King
- Institute for Social Research and Data Innovation, University of Minnesota, Minneapolis, MN, 55455, USA
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Kannaujiya AK, Kumar K, McDougal L, Upadhyay AK, Raj A, James KS, Singh A. Interpregnancy Interval and Child Health Outcomes in India: Evidence from Three Recent Rounds of National Family Health Survey. Matern Child Health J 2023; 27:126-141. [PMID: 36352288 PMCID: PMC9867668 DOI: 10.1007/s10995-022-03559-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Short interpregnancy interval (IPI) is a well-known risk factor for preterm births and low birth weights. However, research on the association between interpregnancy interval (IPI) and health outcomes in children under age 5 is limited in India. We examined the associations between IPI and five child health outcomes in India. METHODS We used nationally representative cross-sectional data from three rounds of National Family Health Survey (NFHS) conducted in India during 2005-06, 2015-16 and 2019-21 to examine the associations between IPI [categorized as < 12 months, 12-17 months, 18-23 months (ref), 24-35 months, and 36-59 months] and five child health outcomes - neonatal mortality, postneonatal mortality, diarrhea and/or acute respiratory infections (ARI), stunting, and underweight, for the total sample and, secondarily, using sex-stratified analyses. We used multivariable and mother fixed-effects binary logistic regressions to examine the associations. RESULTS 3% and 2% of infants died during the neonatal and postneonatal period, respectively. Thirteen, 40, and 37% of children had diarrhea and/or ARI, were stunted, and were underweight, respectively. IPI < 12 months was associated with higher odds of diarrhea and/or ARI (OR: 1.11; 95% CI: 1.05-1.18), stunting (OR: 1.13; 95% CI: 1.08-1.18) and underweight (OR: 1.06; 95% CI: 1.01-1.11). Mother fixed-effects adjustments confirmed these associations and also found that births with IPI of 12-17 months and 36-59 months had higher odds of stunting, and IPI of 12-17 months was also associated with higher odds of underweight. DISCUSSION Our findings indicate that IPIs shorter than 12 months are a risk factor for diarrhea and/or ARI, and IPIs shorter than 12 months and 12-17 months are risk factors for stunting and underweight among children under 5 in India. Mother fixed-effects models allowed us to adjust our estimates for unobserved heterogeneity; this has rarely been done before. Increases in birth spacing may improve child health outcomes in India.
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Affiliation(s)
- Ajit Kumar Kannaujiya
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, India
| | - Kaushalendra Kumar
- grid.419349.20000 0001 0613 2600Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Lotus McDougal
- grid.266100.30000 0001 2107 4242Center on Gender Equity and Health, University of California, San Diego, USA
| | - Ashish Kumar Upadhyay
- grid.419349.20000 0001 0613 2600GENDER Project, International Institute for Population Sciences, Mumbai, India
| | - Anita Raj
- grid.266100.30000 0001 2107 4242Center on Gender Equity and Health, University of California, San Diego, USA
| | - K S James
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, India
| | - Abhishek Singh
- grid.419349.20000 0001 0613 2600Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, India
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Xu T, Miao H, Chen Y, Luo L, Guo P, Zhu Y. Association of Interpregnancy Interval With Adverse Birth Outcomes. JAMA Netw Open 2022; 5:e2216658. [PMID: 35696164 PMCID: PMC9194661 DOI: 10.1001/jamanetworkopen.2022.16658] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/25/2022] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Many studies have reported an association of interpregnancy interval (IPI) between 2 consecutive births with adverse birth outcomes in low- and middle-income countries. However, most of these studies ignore the implications of some unmeasured confounders. OBJECTIVE To explore the association of IPI with adverse perinatal outcomes. DESIGN, SETTING, AND PARTICIPANTS This large-scale cohort study used the Guangdong Provincial Women and Children Health Information System in Guangdong Province, China, to obtain birth data recorded between January 1, 2014, and December 31, 2020. Matched-sibling design was used. The final cohort included first-born and second-born sibling pairs delivered by mothers who were permanent residents of Guangdong Province. EXPOSURES The exposure variable was IPI, which was categorized as follows: less than 6, 6 to 11, 12 to 17, 18 to 23, 24 to 29, 30 to 35, and 36 or more months. MAIN OUTCOMES AND MEASURES The outcome variables were adverse birth outcomes: preterm birth (PTB, gestational age <37 weeks), low birth weight (LBW, <2500 g), and small for gestational age (SGA). Adjusted odds ratio (OR) and interaction odds ratio (IOR) associated with IPI were calculated. RESULTS The study consisted of 725 392 sibling pairs of multiparous mothers. Among these mothers, 718 111 (99.0%) were aged 20 to 34 years, and 715 583 (98.7%) were of Han Chinese ethnicity. Unmatched analysis showed that a short IPI of less than 6 months was associated with higher risks of PTB (adjusted OR, 1.96; 95% CI, 1.87-2.06), LBW (adjusted OR, 1.88; 95% CI, 1.79-1.98), and SGA (adjusted OR, 1.34; 95% CI, 1.30-1.38) compared with an IPI of 18 to 23 months. These associations were attenuated in the matched-sibling analysis. An association of short IPI (<6 months) with PTB (adjusted IOR, 1.40; 95% CI, 1.30-1.51), LBW (adjusted IOR, 1.30; 95% CI, 1.21-1.40), and SGA (adjusted IOR, 1.16; 95% CI, 1.11-1.22) remained in the matched analysis. For IPI of 36 months or more, the odds of PTB (adjusted OR, 1.08; 95% CI, 1.03-1.14) and LBW (adjusted OR, 1.13; 95% CI, 1.07-1.19) in the unmatched analysis were also greater than the reference interval (18-23 months), but not for SGA (adjusted OR, 0.96; 95% CI, 0.93-0.99). Associations between a long IPI (≥36 months) and PTB (adjusted IOR, 1.10; 95% CI, 1.02-1.19) and LBW (adjusted IOR, 1.16; 95% CI, 1.07-1.26) remained through the sibling comparisons. CONCLUSIONS AND RELEVANCE Results of this study indicated that mothers with a short (<6 months) or long (≥36 months) IPI had greater odds of adverse birth outcomes. The findings may inform family planning policies and guide individuals and families who are planning for another pregnancy in China.
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Affiliation(s)
- Ting Xu
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
| | - Huazhang Miao
- Department of Healthcare, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yuliang Chen
- Department of Medical Quality Management, Nanfang Hospital, Guangzhou, China
| | - Limei Luo
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, China
| | - Pi Guo
- Department of Preventive Medicine, Shantou University Medical College, Shantou, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Shantou, China
| | - Yingxian Zhu
- Department of Healthcare, Guangdong Women and Children Hospital, Guangzhou, China
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Fonseka RW, McDougal L, Raj A, Reed E, Lundgren R, Urada L, Silverman JG. Measuring the impacts of maternal child marriage and maternal intimate partner violence and the moderating effects of proximity to conflict on stunting among children under 5 in post-conflict Sri Lanka. SSM Popul Health 2022; 18:101074. [PMID: 35378865 PMCID: PMC8976144 DOI: 10.1016/j.ssmph.2022.101074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 03/14/2022] [Accepted: 03/14/2022] [Indexed: 11/29/2022] Open
Abstract
This study aimed to understand whether maternal child marriage and past year intimate partner violence (IPV) impact stunting among Sri Lankan children under 5 years old, and, secondarily, whether proximity to conflict is associated with stunting. Additionally, we assessed whether proximity to conflict moderates the relationships between maternal child marriage and past year IPV (sexual, physical, and emotional). We tested these questions using logistic regression analyses of the 2016 Sri Lankan Demographic and Health Survey (n = 4941 mother-child dyads). In country-wide adjusted analyses, we did not find associations between maternal child marriage or IPV and stunting (p > 0.05). Children in districts proximal and central to conflict were significantly less likely to be stunted compared to children in districts distal to conflict (proximal adjusted odds ratio/aOR: 0.43, 95% confidence interval/CI: 0.22–0.82; central aOR: 0.53, CI: 0.29–0.98). We found significant interaction effects on stunting between proximity to conflict and both sexual and emotional IPV, which we further explored in stratified analyses. In districts distal to conflict, maternal sexual IPV was significantly associated with increased odds of stunting (aOR: 2.71, CI: 1.16–6.35), and in districts central to conflict, maternal emotional IPV was significantly associated with increased odds of stunting (aOR: 1.80, CI: 1.13–2.89). Maternal emotional IPV was significantly associated with decreased odds of stunting in districts proximal to conflict (aOR: 0.42, CI: 0.18–0.96). Maternal child marriage and physical IPV were not associated with stunting in Sri Lanka. Variations in associations between maternal IPV and stunting across Sri Lanka may reflect the lasting and differential impact of conflict, as well as differential humanitarian responses which may have improved child nutrition practices and resources in districts central and proximal to conflict. Policies and programs addressing stunting in Sri Lanka should consider the role of maternal IPV as well as community-level variations based on proximity to conflict. Across Sri Lanka, stunting is reduced in areas proximal and central to conflict. Proximity to conflict moderates the impact of sexual and emotional IPV on stunting. Children's vulnerability to stunting and IPV varies by proximity to conflict. Humanitarian aid may have decreased stunting in areas most impacted by conflict.
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Affiliation(s)
- Ruvani W. Fonseka
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- San Diego State University/University of California, San Diego Joint Doctoral Program in Public Health, 9500 Gilman Dr, La Jolla, CA, 92093, USA
- San José State University School of Social Work, 1 Washington Square, San Jose, CA 95112, USA
- Corresponding author. San José State University School of Social Work, 1 Washington Square, San Jose, CA 95112, USA.
| | - Lotus McDougal
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Elizabeth Reed
- San Diego State University School of Public Health, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Rebecka Lundgren
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Lianne Urada
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- San Diego State University School of Social Work, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Jay G. Silverman
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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Roble AK, Osman MO, Ibrahim AM, Wedajo GT, Abdi Usman S. Determinants of short birth interval among ever married reproductive age women living in Jigjiga, Eastern Ethiopia 2020 (unmatched case-control study). SAGE Open Med 2022; 9:20503121211067870. [PMID: 34992784 PMCID: PMC8725026 DOI: 10.1177/20503121211067870] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives: A short birth interval is a universal public health problem resulting in adverse maternal, neonatal, and child outcomes. Therefore, the aim of this study was to identify determinants of short birth interval among ever married reproductive age mothers who live in Jigjiga city administration, Eastern Ethiopia, 2020. Methods: A community-based unmatched case–control study was used among 194 cases and 194 controls in Jigjiga city administration from September to December 2020. Cases were women with short birth interval (less than 3 years) and controls were women with optimum birth interval (3–5 years). Simple random sampling technique was employed to select cases and controls. Data were entered into Epi data version 4.2 and analysis with SPSS version 22. Binary logistic regression with 95% confidence interval at p < 0.05 is used to declare significantly associated predictors of short birth interval. Result: This study reported that women who have not attended formal education (adjusted odds ratio = 5.28, 95% confidence interval: (2.25–12.36)), attended primary education (adjusted odds ratio = 2.79, 95% confidence interval: (1.46–5.34)), women who married to a polygamous husband (adjusted odds ratio = 3.69, 95% confidence interval: (1.80–7.58)), having a history of neonatal death (adjusted odds ratio = 2.15, 95% confidence interval: (1.07–4.32)), preceding child being female (adjusted odds ratio = 3.69, 95% confidence interval: (2.02–6.72)), and never used contraceptive methods (adjusted odds ratio = 3.69, 95% confidence interval: (2.02–6.72)) were identified as determinants of the short birth interval. Conclusion: Short birth intervals were associated with educational level of the women, sex of the baby, husband marriage types, history of neonatal death, and contraceptive utilization. Strategy should be engaged to enhance women education, contraceptive uses, and to decrease neonatal death.
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Affiliation(s)
- Abdurahman Kedir Roble
- Department of Midwifery, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Mohamed Omar Osman
- Department of Public Health, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Ahmed Mohamed Ibrahim
- Department of Public Health, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Girma Tadesse Wedajo
- Department of Public Health, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
| | - Seid Abdi Usman
- Department of Nursing, College of Medicine and Health Science, Jigjiga University, Jigjiga, Ethiopia
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