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Hassen TA, Chojenta C, Khan MN, Shifti DM, Harris ML. Short birth interval in the Asia-Pacific region: A systematic review and meta-analysis. J Glob Health 2024; 14:04072. [PMID: 38700432 PMCID: PMC11067827 DOI: 10.7189/jogh.14.04072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
Background Short birth interval is associated with an increased risk of adverse health outcomes for mothers and children. Despite this, there is a lack of comprehensive evidence on short birth interval in the Asia-Pacific region. Thus, this study aimed to synthesise evidence related to the definition, classification, prevalence, and predictors of short birth interval in the Asia-Pacific region. Methods Five databases (MEDLINE, Scopus, Cumulative Index to Nursing and Allied Health Literature, Maternity and Infant Care, and Web of Science) were searched for studies published between September 2000 and May 2023 (the last search was conducted for all databases in May 2023). We included original studies published in English that reported on short birth interval in the Asia-Pacific region. Studies that combined birth interval with birth order, used multi-country data and were published as conference abstracts and commentaries were excluded. Three independent reviewers screened the articles for relevancy, and two reviewers performed the data extraction and quality assessment. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool. The findings were both qualitatively and quantitatively synthesised and presented. Results A total of 140 studies met the inclusion criteria for this review. About 58% (n = 82) of the studies defined short birth interval, while 42% (n = 58) did not. Out of 82 studies, nearly half (n = 39) measured a birth-to-birth interval, 37 studies measured a birth-to-pregnancy, four measured a pregnancy-to-pregnancy, and two studies measured a pregnancy loss-to-conception. Approximately 39% (n = 55) and 6% (n = 8) of studies classified short birth intervals as <24 months and <33 months, respectively. Most of the included studies were cross-sectional, and about two-thirds had either medium or high risk of bias. The pooled prevalence of short birth interval was 33.8% (95% confidence interval (CI) = 23.0-44.6, I2 = 99.9%, P < 0.01) among the studies that used the World Health Organization definition. Conclusions This review's findings highlighted significant variations in the definition, measurement, classification, and reported prevalence of short birth interval across the included studies. Future research is needed to harmonise the definition and classification of short birth interval to ensure consistency and comparability across studies and facilitate the development of targeted interventions and policies. Registration PROSPERO CRD42023426975.
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Affiliation(s)
- Tahir Ahmed Hassen
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | - Catherine Chojenta
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
| | - Md Nuruzzaman Khan
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
- Department of Population Science, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh
| | - Desalegn Markos Shifti
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Melissa Leigh Harris
- Centre for Women's Health Research, School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Australia
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Cho K, Fayek B, Liu Y(D, Albert A, Wiesenthal E, Dobrer S, AbdelHafez FF, Lisonkova S, Bedaiwy MA. A history of recurrent pregnancy loss is associated with increased perinatal complications, but not necessarily a longer birth interval: a population study spanning 18 years. Hum Reprod 2024; 39:1105-1116. [PMID: 38390658 PMCID: PMC11063561 DOI: 10.1093/humrep/deae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
STUDY QUESTION Is there a difference in the time interval between the first and second live births among individuals with and without recurrent pregnancy loss (RPL)? SUMMARY ANSWER Primary RPL (two or more pregnancy losses before the first live birth) is associated with a shorter time interval between the first and second live births compared with individuals without RPL, but this association is reversed in patients with secondary RPL (RPL patients with no or one pregnancy loss before the first live birth). WHAT IS KNOWN ALREADY There is limited information regarding the ability to have more than one child for patients with RPL. Previous studies have investigated the time to live birth and the live birth rate from the initial presentation to clinical providers. Most of the previous studies have included only patients treated at specialized RPL clinics and thus may be limited by selection bias, including patients with a more severe condition. STUDY DESIGN, SIZE, DURATION We conducted a population-based retrospective cohort study of 184 241 participants who delivered in British Columbia, Canada, and had at least two recorded live births between 2000 and 2018. The aim was to study the differences in the time interval between the first and second live births and the prevalence of pregnancy complications in patients with and without RPL. Additionally, 198 319 individuals with their first live birth between 2000 and 2010 were studied to evaluate cumulative second live birth rates. PARTICIPANTS/MATERIALS, SETTING, METHODS Among individuals with at least two recorded live births between 2000 and 2018, 12 321 patients with RPL and 171 920 participants without RPL were included. RPL was defined as at least two pregnancy losses before 20 weeks gestation. Patients with primary RPL had at least two pregnancy losses occurring before the first live birth, while patients with secondary RPL had no or one pregnancy loss before the first live birth. We compared the time interval from the first to second live birth in patients with primary RPL, those with secondary RPL, and participants without RPL using generalized additive models to allow for a non-linear relationship between maternal age and time interval between first and second live births. We also compared prevalence of pregnancy complications at the first and second live births between the groups using non-parametric Kruskal-Wallis H test and Fisher's exact test for continuous and categorical variables, respectively. We assessed the cumulative second live birth rates in patients with primary RPL and those without RPL, among participants who had their first live birth between 2000 and 2010. Cox proportional hazards model was used to estimate and compare hazard ratios between the two groups using a stratified modelling approach. MAIN RESULTS AND THE ROLE OF CHANCE The adjusted time interval between the first and second live births was the longest in patients with secondary RPL, followed by individuals without RPL, and the shortest time interval was observed in patients with primary RPL: 4.34 years (95% CI: 4.09-4.58), 3.20 years (95% CI: 3.00-3.40), and 3.05 years (95% CI: 2.79-3.32). A higher frequency of pregnancy losses was associated with an increased time interval between the first and second live births. The prevalence of pregnancy complications at the first and second live births, including gestational diabetes, hypertensive disorder of pregnancy, preterm birth, and multiple gestations was significantly higher in patients with primary RPL compared with those without RPL. The cumulative second live birth rate was significantly lower in patients with primary RPL compared with individuals without RPL. LIMITATIONS, REASONS FOR CAUTION This study may be limited by its retrospective nature. Although we adjusted for multiple potential confounders, there may be residual confounding due to a lack of information about pregnancy intentions and other factors, including unreported pregnancy losses. WIDER IMPLICATIONS OF THE FINDINGS The results of this study provide information that will help clinicians in the counselling of RPL patients who desire a second child. STUDY FUNDING/COMPETING INTEREST(S) This study was supported in part by a grant from the Canadian Institutes of Health Research (CIHR): Reference Number W11-179912. M.A.B. reports research grants from CIHR and Ferring Pharmaceutical. He is also on the advisory board for AbbVie, Pfizer, and Baxter. The other authors report no conflict of interest. TRIAL REGISTRATION NUMBER NCT04360564.
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Affiliation(s)
- Kristy Cho
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bahi Fayek
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Yang (Doris) Liu
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Arianne Albert
- Women’s Health Research Institute, Vancouver, BC, Canada
| | - E Wiesenthal
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sabina Dobrer
- Women’s Health Research Institute, Vancouver, BC, Canada
| | - Faten F AbdelHafez
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Sarka Lisonkova
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Women’s Health Research Institute, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mohamed A Bedaiwy
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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Mihretie GN, Getie SA, Shiferaw S, Ayele AD, Liyeh TM, Kassa BG, Asferie WN. Interbirth interval practices among reproductive age women in rural and Urban kebeles in Farta Woreda: Case-control study. PLoS One 2022; 17:e0256193. [PMID: 35085250 PMCID: PMC8794163 DOI: 10.1371/journal.pone.0256193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Closely spaced births have been reported all over the world especially in developing countries, and they have been correlated with poor maternal and infant health. Enhancing optimal birth interval is one of the key strategies to promote the health status of mothers and their children. However, factors affecting short birth intervals have not been identified in the study area and region. This study was aimed to assess determinants of short birth interval practice among reproductive women in Farta woreda, Ethiopia, 2019. METHODS Community based unmatched case-control study design was conducted from February to March 2019. The sample size of 303 (101 case and 202 controls) was included by using multistage sampling and then study participants were selected by simple random sampling technique. The data was collected by structured and pre-tested face-to-face interviewer-administered questionnaires from the selected respondents. The collected data were entered with Epi-Data version 4.2 and analyzed by using SPSS version 23 software. Bivariate and multivariate analyses were used to examine the association. Odds ratios, 95% CI, and P-value <0.05 were used to determine the statistical association. RESULTS Women who had no formal education (AOR = 2.15, 95% CI (1.19, 3.88), had not a history of antenatal care follow up (AOR = 2.66, 95% CI (1.55, 4.56)), did not use modern contraceptives before getting the latest pregnancy (AOR = 3.48, 95% CI (1.74, 6.95)) and duration of breastfeeding less than 24 months (AOR = 3.59, 95% CI (2.06, 6.24)) were significantly associated with short birth interval. CONCLUSIONS AND RECOMMENDATION Maternal education, duration of breastfeeding, contraceptive utilization, and antenatal follow-up were identified as the predictor variables of short birth interval practice. Therefore, providing health information for reproductive-age women about the benefit of contraceptive utilization, breastfeeding practice and antenatal care follow up to minimize problems resulting from the short birth intervals.
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Affiliation(s)
- Gedefaye Nibret Mihretie
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor Town, Ethiopia
| | - Simegnew Asmer Getie
- Department of Midwifery, College of Health Sciences, Bahir Dar University, Bahir Dar City, Ethiopia
| | - Shumye Shiferaw
- Department of Midwifery, College of Health Sciences, Bahir Dar University, Bahir Dar City, Ethiopia
| | - Alemu Degu Ayele
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor Town, Ethiopia
| | - Tewachew Muche Liyeh
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor Town, Ethiopia
| | - Bekalu Getnet Kassa
- Department of Midwifery, College of Health Sciences, Debre Tabor University, Debre Tabor Town, Ethiopia
| | - Worku Necho Asferie
- Department of Neonatal Nursing and Child Health, College of Health Sciences, Debre Tabor University, Debre Tabor Town, Ethiopia
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Rodriguez MI, Kaufman M, Lindner S, Caughey AB, DeFede AL, McConnell KJ. Association of Expanded Prenatal Care Coverage for Immigrant Women With Postpartum Contraception and Short Interpregnancy Interval Births. JAMA Netw Open 2021; 4:e2118912. [PMID: 34338791 PMCID: PMC8329738 DOI: 10.1001/jamanetworkopen.2021.18912] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE Access to prenatal and postpartum care is restricted among women with low income who are recent or undocumented immigrants enrolled in Emergency Medicaid. OBJECTIVE To examine the association of extending prenatal care coverage to Emergency Medicaid enrollees with postpartum contraception and short interpregnancy interval births. DESIGN, SETTING, AND PARTICIPANTS This cohort study used a difference-in-differences design to compare the staggered rollout of prenatal care in Oregon with South Carolina, a state that does not cover prenatal or postpartum care. Linked Medicaid claims and birth certificate data from 2010 to 2016 were examined for an association between prenatal care coverage for women whose births were covered by Emergency Medicaid and subsequent short IPI births. Additional maternal and infant health outcomes were also examined, including postpartum contraceptive use, preterm birth, and neonatal intensive care unit admission. The association between the policy change and measures of policy implementation (number of prenatal visits) and quality of care (receipt of 8 guideline-based screenings) was also analyzed. Statistical analysis was performed from August 2020 to March 2021. EXPOSURES Medicaid coverage of prenatal care. MAIN OUTCOMES AND MEASURES Postpartum contraceptive use, defined as receipt of any contraceptive method within 60 days of delivery; short IPI births, defined as occurring within 18 months of a previous pregnancy. RESULTS The study population consisted of 26 586 births to women enrolled in Emergency Medicaid in Oregon and South Carolina. Among these women, 14 749 (55.5%) were aged 25 to 35 years, 25 894 (97.4%) were Black, Hispanic, Native American, Alaskan, Pacific Islander, or Asian women or women with unknown race/ethnicity, and 17 905 (67.3%) lived in areas with urban zip codes. Coverage of prenatal care for women in Emergency Medicaid was associated with significant increases in mean (SD) prenatal visits (increase of 10.3 [0.9] prenatal visits) and prenatal quality. Prenatal care screenings (eg, anemia screening: increase of 65.7 percentage points [95% CI, 54.2 to 77.1 percentage points]) and vaccinations (eg, influenza vaccination: increase of 31.9 percentage points [95% CI, 27.4 to 36.3 percentage points]) increased significantly following the policy change. Although postpartum contraceptive use increased following prenatal care expansion (increase of 1.5 percentage points [95% CI, 0.4 to 2.6 percentage points]), the policy change was not associated with a reduction in short IPI births (-4.5 percentage points [95% CI, -9.5 to 0.5 percentage points), preterm births (-0.6 percentage points [95% CI, -3.2 to 2.0 percentage points]), or neonatal intensive care unit admissions (increase of 0.8 percentage points [95% CI, -2.0 to 3.6 percentage points]). CONCLUSIONS AND RELEVANCE This study found that expanding Emergency Medicaid benefits to include prenatal care significantly improved receipt of guideline-concordant prenatal care. Prenatal care coverage alone was not associated with a meaningful increase in postpartum contraception or a reduction in subsequent short IPI births.
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Affiliation(s)
- Maria I. Rodriguez
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
| | - Menolly Kaufman
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
| | - Stephan Lindner
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland
| | - Ana Lopez DeFede
- Institute for Families in Society, University of South Carolina, Columbia
| | - K. John McConnell
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland
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Mamo H, Dagnaw A, Sharew NT, Brhane K, Kotiso KS. Prevalence of short interpregnancy interval and its associated factors among pregnant women in Debre Berhan town, Ethiopia. PLoS One 2021; 16:e0255613. [PMID: 34339456 PMCID: PMC8328324 DOI: 10.1371/journal.pone.0255613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022] Open
Abstract
Background Short inter-pregnancy interval is an interval of <24 months between the dates of birth of the preceding child and the conception date of the current pregnancy. Despite its direct effects on the perinatal and maternal outcomes, there is a paucity of evidence on its prevalence and determinant factors, particularly in Ethiopia. Therefore, this study assessed the prevalence and associated factors of short inter-pregnancy interval among pregnant women in Debre Berhan town, Northern Ethiopia. Methods A community based cross-sectional study was conducted among a randomly selected 496 pregnant women in Debre Berhan town from February 9 to March 9, 2020. The data were collected by using an interviewer-administered questionnaire and analyzed using STATA (14.2) statistical software. To identify the predictors of short inter-pregnancy interval, multivariable binary logistic regression was fitted and findings are presented using adjusted odds ratio (AOR) with 95% confidence interval (CI). Result The overall prevalence of short inter-pregnancy interval (<24 months) among pregnant women was 205 (40.9%). Being over 30 years of age at first birth (AOR = 3.50; 95% CI: 2.12–6.01), non-use of modern contraceptive (AOR = 2.51; 95% CI: 1.23–3.71), duration of breastfeeding for less than 12 months (AOR = 2.62; 95% CI: 1.32–5.23), parity above four (AOR = 0.31; 95% CI: 0.05–0.81), and unintended pregnancy (AOR = 5.42; 95% CI: 3.34–9.22) were independently associated factors with short inter-pregnancy interval. Conclusion Despite the public health interventions being tried in the country, the prevalence of short inter-pregnancy interval in this study is high. Therefore, it implies that increasing contraceptive use and encouraging optimal breastfeeding might help in the efforts made to avert the problem.
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Affiliation(s)
- Hana Mamo
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosaena, Ethiopia
| | - Abinet Dagnaw
- Department of Public Health, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Nigussie Tadesse Sharew
- Department of Public Health, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
| | - Kalayu Brhane
- Department of Public Health, College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Kehabtimer Shiferaw Kotiso
- School of Medicine, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
- * E-mail:
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Tamirat KS, Tesema GA, Tessema ZT. Determinants of maternal high-risk fertility behaviors and its correlation with child stunting and anemia in the East Africa region: A pooled analysis of nine East African countries. PLoS One 2021; 16:e0253736. [PMID: 34191843 PMCID: PMC8244896 DOI: 10.1371/journal.pone.0253736] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 06/11/2021] [Indexed: 11/19/2022] Open
Abstract
Background In low-income nations, high-risk fertility behavior is a prevalent public health concern that can be ascribed to unmet family planning needs, child marriage, and a weak health system. As a result, this study aimed to determine the factors that influence high-risk fertility behavior and its impact on child stunting and anemia. Method This study relied on secondary data sources from recent demography and health surveys of nine east African countries. Relevant data were extracted from Kids Record (KR) files and appended for the final analysis; 31,873 mother-child pairs were included in the final analysis. The mixed-effect logistic regression model (fixed and random effects) was used to describe the determinants of high-risk fertility behavior (HRFB) and its correlation with child stunting and anemia. Result According to the pooled study about 57.6% (95% CI: 57.7 to 58.2) of women had at least one high-risk fertility behavior, with major disparities found across countries and women’s residences. Women who lived in rural areas, had healthcare access challenges, had a history of abortion, lived in better socio-economic conditions, and had antenatal care follow-up were more likely to engage in high-risk fertility practices. Consequently, Young maternal age at first birth (<18), narrow birth intervals, and high birth orders were HRFBs associated with an increased occurrences of child stunting and anemia. Conclusion This study revealed that the magnitude of high-risk fertility behavior was higher in east Africa region. The finding of this study underscores that interventions focused on health education and behavioral change of women, and improvement of maternal healthcare access would be helpful to avert risky fertility behaviors. In brief, encouraging contraceptive utilization and creating awareness about birth spacing among reproductive-age women would be more helpful. Meanwhile, frequent nutritional screening and early intervention of children born from women who had high-risk fertility characteristics are mandatory to reduce the burden of chronic malnutrition.
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Affiliation(s)
- Koku Sisay Tamirat
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Liu C, Snowden JM, Lyell DJ, Wall-Wieler E, Abrams B, Kan P, Stephansson O, Lyndon A, Carmichael SL. Interpregnancy Interval and Subsequent Severe Maternal Morbidity: A 16-Year Population-Based Study From California. Am J Epidemiol 2021; 190:1034-1046. [PMID: 33543241 PMCID: PMC8168254 DOI: 10.1093/aje/kwab020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/14/2021] [Accepted: 01/28/2021] [Indexed: 12/19/2022] Open
Abstract
Interpregnancy interval (IPI) is associated with adverse perinatal outcomes, but its contribution to severe maternal morbidity (SMM) remains unclear. We examined the association between IPI and SMM, using data linked across sequential pregnancies to women in California during 1997–2012. Adjusting for confounders measured in the index pregnancy (i.e., the first in a pair of consecutive pregnancies), we estimated adjusted risk ratios for SMM related to the subsequent pregnancy. We further conducted within-mother comparisons and analyses stratified by parity and maternal age at the index pregnancy. Compared with an IPI of 18–23 months, an IPI of <6 months had the same risk for SMM in between-mother comparisons (adjusted risk ratio (aRR) = 0.96, 95% confidence interval (CI): 0.91, 1.02) but lower risk in within-mother comparisons (aRR = 0.76, 95% CI: 0.67, 0.86). IPIs of 24–59 months and ≥60 months were associated with increased risk of SMM in both between-mother (aRR = 1.18 (95% CI: 1.13, 1.23) and aRR = 1.76 (95% CI: 1.68, 1.85), respectively) and within-mother (aRR = 1.22 (95% CI: 1.11, 1.34) and aRR = 1.88 (95% CI: 1.66, 2.13), respectively) comparisons. The association between IPI and SMM did not vary substantially by maternal age or parity. In this study, longer IPI was associated with increased risk of SMM, which may be partly attributed to interpregnancy health.
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Affiliation(s)
- Can Liu
- Correspondence to Dr. Can Liu, Department of Public Health Sciences, Faculty of Social Sciences, Stockholm University, Sveavägen 160, 106 91 Stockholm, Sweden (e-mail: )
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Harrison MS, Garces A, Figueroa L, Westcott J, Hambidge M, Krebs NF. How birth outcomes among a cohort of Guatemalan women with a history of prior cesarean vary by mode or birth across different interpregnancy intervals. Reprod Health 2021; 18:99. [PMID: 34020660 PMCID: PMC8147511 DOI: 10.1186/s12978-021-01153-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Our objectives were to analyze how pregnancy outcomes varied by cesarean birth as compared to vaginal birth across varying interpregnancy intervals (IPI) and determine if IPI modified mode of birth. METHODS This secondary analysis used data from a prospective registry of home and hospital births in Chimaltenango, Guatemala from January 2017 through April 2020, through the Global Network for Women's and Children's Health Research. Bivariate comparisons and multivariable logistic regression were used to answer our study question, and the data was analyzed with STATA software v.15.1. RESULTS Of 26,465 Guatemalan women enrolled in the registry, 2794 (10.6%) had a history of prior cesarean. 560 (20.1%) women delivered by vaginal birth after cesarean with the remaining 2,233 (79.9%) delivered by repeat cesarean. Repeat cesarean reduced the risk of needing a dilation and curettage compared to vaginal birth after cesarean, but this association did not vary by IPI, all p-values > p = 0.05. Repeat cesarean delivery, as compared to vaginal birth after cesarean, significantly reduced the likelihood a woman breastfeeding within one hour of birth (AOR ranged from 0.009 to 0.10), but IPI was not associated with the outcome. Regarding stillbirth, repeat cesarean birth reduced the likelihood of stillbirth as compared to vaginal birth (AOR 0.2), but again IPI was not associated with the outcome. CONCLUSION Outcomes by mode of delivery among a Guatemalan cohort of women with a history of prior cesarean birth do not vary by IPI.
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Affiliation(s)
- Margo S Harrison
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
- University of Colorado Anschutz Medical Campus, Mail Stop B198-2, Academic Office 1, 12631 E. 17th Avenue, Rm 4211, Aurora, CO, 80045, USA.
| | - Ana Garces
- Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Lester Figueroa
- Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Jamie Westcott
- Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | | | - Nancy F Krebs
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Damtie Y, Kefale B, Yalew M, Arefaynie M, Adane B. Short birth spacing and its association with maternal educational status, contraceptive use, and duration of breastfeeding in Ethiopia. A systematic review and meta-analysis. PLoS One 2021; 16:e0246348. [PMID: 33534830 PMCID: PMC7857626 DOI: 10.1371/journal.pone.0246348] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Closely spaced birth increases the risk of adverse maternal and child health outcomes. In Ethiopia, the prevalence of short birth spacing was highly variable across studies. Besides, contraceptive use, educational status, and duration of breastfeeding were frequently mentioned factors affecting short birth spacing. Therefore, this meta-analysis aimed to estimate the pooled prevalence of short birth spacing and its association with contraceptive use, educational status, and duration of breastfeeding among reproductive-age women in Ethiopia. Methods International databases: Google Scholar, PubMed, CINAHL, Cochrane library, HINARI, and Global Health were searched systematically to identify articles reporting the prevalence of short birth spacing and its association with contraceptive use, educational status, and duration of breastfeeding among reproductive-age women in Ethiopia. The data were analyzed by STATA/SE version-14 statistical software. The random-effect model was used to estimate the pooled prevalence of short birth spacing and the log odds ratio was used to determine the association. Moreover, egger’s test and I-squared statistics were used to assess publication bias and heterogeneity respectively. Results After reviewing 511 research articles, a total of nine articles with 5,682 study participants were included in this meta-analysis. The pooled prevalence of short birth spacing in Ethiopia was 46.9% [95% CI: (34.7, 59.1)]. Significant heterogeneity was observed between studies (I2 = 98.4, p <0.001). Not using contraceptives [OR = 3.87, 95% CI: (2.29, 6.53)] and duration of breastfeeding < 24 months [OR = 16.9, 95%CI: (2.69, 106.47)] had a significant association with short birth spacing. Conclusions Although a minimum inter-pregnancy interval of two years was recommended by the World Health Organization (WHO), significant numbers of women still practiced short birth spacing in Ethiopia. Duration of breastfeeding and non-use of contraceptives were factors significantly associated with short birth spacing. So, efforts should be made to improve breastfeeding practice and contraceptive utilization among women in Ethiopia.
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Affiliation(s)
- Yitayish Damtie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- * E-mail:
| | - Bereket Kefale
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Melaku Yalew
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mastewal Arefaynie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bezawit Adane
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Tesema GA, Worku MG. Individual-and community-level determinants of neonatal mortality in the emerging regions of Ethiopia: a multilevel mixed-effect analysis. BMC Pregnancy Childbirth 2021; 21:12. [PMID: 33407247 PMCID: PMC7786935 DOI: 10.1186/s12884-020-03506-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 12/16/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Unlike infant and child mortality, neonatal mortality has declined steadily in Ethiopia. Despite the large-scale investment made by Ethiopia to improve the health of newborns and infants, it is among the regions with the highest burden of neonatal mortality. Although there are studies done on neonatal mortality in different areas of Ethiopia, as to our search of pieces of literature there is no study in Emerging regions of the country. Therefore, this study aimed to investigate the individual and community-level determinants of neonatal mortality in the Emerging regions of Ethiopia. METHODS Using the 2016 Ethiopian Demographic and Health Survey (EDHS) data, secondary data analysis was done. A total weighted sample of 4238 live births in Emerging regions were included for the final analysis. A multilevel binary logistic regression was fitted to identify the significant determinants of neonatal mortality. The Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV) were used for assessing the clustering effect, and deviance for model comparison. Variables with a p-value < 0.2 in the bi-variable analysis were considered in the multivariable analysis. In the multivariable multilevel binary logistic regression analysis, Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare statistically significant determinants of neonatal mortality. RESULTS The neonatal mortality rate in Emerging regions of Ethiopia was 34.9 per 1000 live births (95% CI: 29.8, 40.9). Being born to a mother who had no formal education (AOR = 1.79, 95% CI: 1.12, 2.88), being born to a mother who did not participate in making health care decisions (AOR = 1.25, 95% CI: 1.14, 1.79), and being twin birth (AOR = 6.85, 95% CI: 3.69, 12.70) were significantly associated with higher odds of neonatal mortality. On the other hand, being female (AOR = 0.67, 95% CI: 0.47, 0.95), having 1-3 Antenatal Care (ANC) visits (AOR = 0.34, 95% CI: 0.15, 0.74), high community media exposure (AOR = 0.64, 95% CI: 0.41, 0.98), and preceding birth interval of two to 4 years (AOR = 0.38, 95% CI: 0.24, 0.58) were significantly associated with lower odds of neonatal mortality. CONCLUSION Neonatal mortality in Emerging regions of Ethiopia was unacceptably high. Maternal education, women's autonomy in making decisions for health care, sex of a child, type of birth, preceding birth interval, ANC visit, and community media exposure were found significant determinants of neonatal mortality. Therefore, empowering women in making health care decisions and increasing access to mass media play a major role in reducing the incidence of neonatal mortality in Emerging regions of Ethiopia.
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Affiliation(s)
- Getayeneh Antehunegn Tesema
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Misganaw Gebrie Worku
- Department of Human Anatomy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Shimels Hailemeskel H, Assebe T, Alemayehu T, Belay DM, Teshome F, Baye A, Bayih WA. Determinants of short birth interval among ever married reproductive age women: A community based unmatched case control study at Dessie city administration, Northern Ethiopia. PLoS One 2020; 15:e0243046. [PMID: 33275603 PMCID: PMC7717527 DOI: 10.1371/journal.pone.0243046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 11/13/2020] [Indexed: 11/23/2022] Open
Abstract
Background Short birth interval is a universal public health problem resulting in adverse fetal, neonatal, child and maternal outcomes. In Ethiopia, more than 50% of the overall inter birth spacing is short. However, prior scientific evidence on its determinants is limited and even then findings are inconsistent. Methods A community -based unmatched case-control study was employed on 218 cases and 436 controls. Cases were ever married reproductive age women whose last delivery has been in the past five years with birth interval of less than 3 years between the latest two successive live births whereas those women with birth interval of 3–5 years were taken as controls. A multistage sampling technique was employed on 30% of the kebeles in Dessie city administration. A pre-tested interviewer based questionnaire was used to collect data by 16 trained diploma nurses and 8 health extension workers supervised by 4 BSc nurses. The collected data were cleaned, coded and double entered into Epi-data version 4.2 and exported to SPSS version 22. Binary logistic regression model was considered and those variables with P<0.25 in the bivariable analysis were entered in to final model after which statistical significance was declared at P< 0.05 using adjusted odds ratio at 95% CI. Result In this study, contraceptive use (AOR = 11.2, 95% CI: 5.95–21.15), optimal breast feeding for at least 2 years (AOR = 0.098, 95% CI:0.047–0.208), age at first birth <25 years (AOR = 0.36, 95% CI: 0.282–0.761), having male preceding child (AOR = 0.46, 95% CI: 0.166–0.793) and knowing the duration of optimum birth interval correctly (AOR = 0.45, 95% CI: 0.245–0.811) were significant determinants of short birth interval. Conclusion Contraceptive use, duration of breast feeding, age at first birth, preceding child sex and correct understanding of the duration of birth interval were significant determinants of short birth interval. Fortunately, all these significant factors are likely modifiable. Thus, the existing efforts of optimizing birth interval should be enhanced through proper designation and implementation of different strategies on safe breastfeeding practice, modern contraceptive use and maternal awareness about the health merits of optimum birth interval.
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Affiliation(s)
| | - Tesfaye Assebe
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tadesse Alemayehu
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Demeke Mesfin Belay
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Fentaw Teshome
- Department of Health Service Management, Debre Tabor University, Debre Tabor, Ethiopia
| | - Alemwork Baye
- Department of Environmental Health, Wollo University, Dessie, Ethiopia
| | - Wubet Alebachew Bayih
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Das S, Chanani S, Shah More N, Osrin D, Pantvaidya S, Jayaraman A. Determinants of stunting among children under 2 years in urban informal settlements in Mumbai, India: evidence from a household census. J Health Popul Nutr 2020; 39:10. [PMID: 33246506 PMCID: PMC7693500 DOI: 10.1186/s41043-020-00222-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/19/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND There is limited evidence on the determinants of childhood stunting across urban India or specifically in slum settlements. This study aims to assess the extent of stunting among children under 2 years of age and examine its determinants in informal settlements of Mumbai. METHODS Data were collected in 2014-2015 in a post intervention census of a cluster randomized controlled trial to improve the health of women and children. Census covered 40 slum settlements of around 600 households each. A total of 3578 children were included in the study. Mixed effects logistic regression models were used to identify factors associated with stunting. RESULTS The prevalence of stunting among children aged 0-23 months was 38%. In the adjusted model, higher maternal education (AOR 0.59; 95% CI 0.42, 0.82), birth interval of at least 2 years (AOR 0.71; 95% CI 0.58, 0.87) and intended conception of the child (AOR 0.80; 95% CI 0.64, 0.99) were associated with lower odds of stunting. Maternal exposure to physical violence (AOR 1.83; 95% CI 1.21, 2.77) was associated with higher odds of being stunted. A child aged 18-23 months had 5.04 times greater odds (95% CI 3.91, 6.5) of being stunted than a child less than 6 months of age. Male child had higher odds of being stunted (AOR 1.33; 95% CI 1.14, 1.54). CONCLUSIONS Our findings support a multidimensional aetiology for stunting. The results of the study emphasize the importance of women's status and decision-making power in urban India, along with access to and uptake of family planning and services to provide support for survivors of domestic violence. Ultimately, a multilateral effort is needed to ensure the success of nutrition-specific interventions by focusing on the underlying health and social status of women living in urban slums. TRIAL REGISTRATION ISRCTN Register: ISRCTN56183183 , and Clinical Trials Registry of India: CTRI/2012/09/003004.
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Affiliation(s)
- Sushmita Das
- Society for Nutrition, Education and Health Action, Behind Bldg. No. 11, BMC Colony, Shastri Nagar, Santa Cruz (W), Mumbai, 400 054, India.
| | - Sheila Chanani
- Society for Nutrition, Education and Health Action, Behind Bldg. No. 11, BMC Colony, Shastri Nagar, Santa Cruz (W), Mumbai, 400 054, India
| | - Neena Shah More
- Society for Nutrition, Education and Health Action, Behind Bldg. No. 11, BMC Colony, Shastri Nagar, Santa Cruz (W), Mumbai, 400 054, India
| | - David Osrin
- UCL Institute for Global Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Shanti Pantvaidya
- Society for Nutrition, Education and Health Action, Behind Bldg. No. 11, BMC Colony, Shastri Nagar, Santa Cruz (W), Mumbai, 400 054, India
| | - Anuja Jayaraman
- Society for Nutrition, Education and Health Action, Behind Bldg. No. 11, BMC Colony, Shastri Nagar, Santa Cruz (W), Mumbai, 400 054, India
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Muze M, Yesse M, Kedir S, Mustefa A. Prevalence and associated factors of undernutrition among pregnant women visiting ANC clinics in Silte zone, Southern Ethiopia. BMC Pregnancy Childbirth 2020; 20:707. [PMID: 33213406 PMCID: PMC7678074 DOI: 10.1186/s12884-020-03404-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/10/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Maternal undernutrition is highly prevalent in underdeveloped countries. Hence, this study was intended to determine the prevalence and associated factors of undernutrition among pregnant women visiting ANC clinics in Silte Zone. METHOD Facility-based cross-sectional study was conducted from July to January 2019. Systematic random sampling technique was used to select 422 study participants from 11 randomly selected health facilities. Data was collected by using a structured-interviewer administered questionnaire. Mid upper arm circumference (MUAC) was measured by standard non stretchable MUAC tape. Data was entered into a computer using Epi data 3.1 and edited, cleaned, and analyzed using SPSS version 20. Both bivariate and multiple logistic regression analyses were employed to identify factors associated with maternal undernutrition. RESULT In this study, the overall prevalence of undernutrition among study subjects was 21.8%. Age greater than 31 years of women (AOR = 0.15; 95% CI: 0.03, 0.93), Birth intervals > 2 years (AOR = 0.18; 95% CI: 0.04, 0.76), good nutritional knowledge (AOR = 0.34; 95% CI: 0.17, 0.67), and having no dietary change as a result of current pregnancy AOR = 6.02; 95% CI: 2.99, 12.14) were significantly associated with undernutrition. CONCLUSIONS The prevalence of undernutrition among pregnant women was 21.8%. Current estimate is lower than previously reported in the study area but higher than reported in developed country. Age of women, Birth intervals, and Dietary change as a result of current pregnancy and Nutrition knowledge were important risk factors/ predictors of undernutrition (MUAC < 23 cm). Interventions targeting maternal nutrition education and child spacing with giving special emphasis to adolescent pregnant women are recommended.
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Affiliation(s)
- Mohammed Muze
- Department of Nursing, Collage of Medicine and Health Science, Werabe University, Werabe, Ethiopia.
| | - Mubarek Yesse
- Department of Nursing, Collage of Medicine and Health Science, Werabe University, Werabe, Ethiopia
| | - Shemsu Kedir
- Department of Nursing, Collage of Medicine and Health Science, Werabe University, Werabe, Ethiopia
| | - Abdilmejid Mustefa
- Department of Nursing, Collage of Medicine and Health Science, Werabe University, Werabe, Ethiopia
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Shifti DM, Chojenta C, Holliday EG, Loxton D. Socioeconomic inequality in short birth interval in Ethiopia: a decomposition analysis. BMC Public Health 2020; 20:1504. [PMID: 33023567 PMCID: PMC7542382 DOI: 10.1186/s12889-020-09537-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/13/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Short birth interval, defined as a birth-to-birth interval less than 33 months, is associated with adverse maternal and child outcomes. Evidence regarding the association of maternal socioeconomic status and short birth interval is inconclusive. Factors contributing to the socioeconomic inequality of short birth interval have also not been investigated. The current study assessed socioeconomic inequality in short birth interval and its contributing factors in Ethiopia. METHODS Data from 8448 women collected in the 2016 Ethiopia Demographic and Health survey were included in the study. Socioeconomic inequality in short birth interval was the outcome variable. Erreygers normalized concentration index (ECI) and concentration curves were used to measure and illustrate socioeconomic-related inequality in short birth interval, respectively. Decomposition analysis was performed to identify factors explaining the socioeconomic-related inequality in short birth interval. RESULTS The Erreygers normalized concentration index for short birth interval was - 0.0478 (SE = 0.0062) and differed significantly from zero (P < 0.0001); indicating that short birth interval was more concentrated among the poor. Decomposition analysis indicated that wealth quintiles (74.2%), administrative regions (26.4%), and not listening to the radio (5.6%) were the major contributors to the pro-poor socioeconomic inequalities in short birth interval. CONCLUSION There was a pro-poor inequality of short birth interval in Ethiopia. Strengthening the implementation of poverty alleviation programs may improve the population's socioeconomic status and reduce the associated inequality in short birth interval.
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Affiliation(s)
- Desalegn Markos Shifti
- Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia.
| | - Catherine Chojenta
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Elizabeth G Holliday
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Deborah Loxton
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
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Aychiluhm SB, Tadesse AW, Mare KU, Abdu M, Ketema A. A multilevel analysis of short birth interval and its determinants among reproductive age women in developing regions of Ethiopia. PLoS One 2020; 15:e0237602. [PMID: 32845940 PMCID: PMC7449410 DOI: 10.1371/journal.pone.0237602] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/29/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Short Birth Interval negatively affects the health of both mothers and children in developing nations, like, Ethiopia. However, studies conducted to date in Ethiopia upon short birth interval were inconclusive and they did not show the extent and determinants of short birth interval in developing (Afar, Somali, Gambella, and Benishangul-Gumuz) regions of the country. Thus, this study was intended to assess the short birth interval and its determinants in the four developing regions of the country. METHODS Data were retrieved from the Demographic and Health Survey program official database website (http://dhsprogram.com). A sample of 2683 women of childbearing age group (15-49) who had at least two alive consecutive children in the four developing regions of Ethiopia was included in this study. A multilevel multivariable logistic regression model was fitted to identify the independent predictors of short birth interval and Akaike's Information Criterion (AIC) was used during the model selection procedure. RESULTS In this study, the prevalence of short birth interval was 46% [95% CI; 43.7%, 47.9%]. The multilevel multivariable logistic regression model showed women living in rural area [AOR = 1.52, CI: 1.12, 2.05], women attended secondary education and above level [AOR = 0.27, CI: 0.05, 0.54], have no media exposure [AOR = 1.35, CI: 1.18, 1.56], female sex of the index child [AOR = 1.13, CI:1.07,1.20], breastfeeding duration [AOR = 0.79, CI: 0.77, 0.82], having six and more ideal number of children [AOR = 1.14, CI: 1.09, 1.20] and having preferred waiting time to birth two years and above [AOR = 0.86, CI: 0.78, 0.95] were the predictors of short birth interval. CONCLUSIONS The prevalence of short birth intervals in the developing regions of Ethiopia is still high. Therefore, the government of Ethiopia should work on the access of family planning and education in rural parts of the developing regions where more than 90% of the population in these regions is pastoral.
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Affiliation(s)
- Setognal Birara Aychiluhm
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
- * E-mail:
| | - Abay Woday Tadesse
- Department of Public Health, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Kusse Urmale Mare
- Department of Nursing, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Mohammed Abdu
- Department of Midwifery, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
| | - Abdusemed Ketema
- Department of Midwifery, College of Medicine and Health Sciences, Samara University, Samara, Ethiopia
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Harrison MS, Montes SB, Rivera C, Nacht A, Zambrano AJ, Lamb M, Bolanos A, Asturias E, Berman S, Heinrichs G. Interpregnancy Interval in a Rural Guatemalan Population: Results from a Quality Improvement Database. Matern Child Health J 2020; 24:1038-1046. [PMID: 32405739 PMCID: PMC7329567 DOI: 10.1007/s10995-020-02954-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This analysis describes the interpregnancy interval (time from livebirth to subsequent conception) in a convenience sample of women living in Southwest Guatemala and the association of antepartum characteristics and postpartum outcomes with a short interpregnancy interval (< 24 months). METHODS This is an observational study of a convenience sample of women enrolled in the Madres Sanas community antenatal/postnatal nursing program supported by the Center for Human Development in Southwest Trifinio, Guatemala, between October 1, 2018 and October 1, 2019. We observed the distribution of interpregnancy intervals among the population of women with a reported date of last live birth, and used bivariate comparisons to compare women with a short interpregnancy interval (< 24 months) to those with an optimal interval ([Formula: see text] 24 months) by antepartum, obstetric and delivery, and postpartum outcomes. RESULTS 171 parous women enrolled in the Madres Sanas program between October 1, 2018 and October 1, 2019, and reported the date of their last live birth. One hundred-forty-one (82.5%) women delivered and 130 of those women (92.2%) were seen for their 40-day postpartum visit. The mean interval was 37.1 months with a 22.1-month standard deviation. The median interval was 33.7 months with an interquartile range of 19.6-49.5 months. Among these women, 113 (66.1%) the interpregnancy interval was at least 24 months. The only covariate of all sociodemographic, obstetric and antepartum, delivery, and postpartum characteristics that differed between women who achieved an interval ([Formula: see text] 24 months) compared to those that did not (< 24 months), was age (median 22.9, interquartile range (IQR) [19.1,27.0] vs median 24.8, IQR [21.6,27.9], respectively, p = 0.006). A regression model found that with each increasing year of age, the interpregnancy interval increases by 1.08 months, p = 0.025. CONCLUSION Among parous women, two-thirds of women space pregnancies at least 24 months. Older women were more likely to have a longer interval between live births.
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Affiliation(s)
- Margo S Harrison
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA.
- , Academic Office 1, 12631 E. 17th Avenue, Rm 4211, Mail Stop B198-2, Aurora, CO, 80045, USA.
| | - Saskia Bunge Montes
- Center for Human Development, Fundacion Integral Por La Salud de Los Guatemaltecos, Retalhuleu, Guatemala
| | - Claudia Rivera
- Center for Human Development, Fundacion Integral Por La Salud de Los Guatemaltecos, Retalhuleu, Guatemala
| | - Amy Nacht
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Molly Lamb
- Center for Global Health, University of Colorado School of Public Health, Aurora, CO, USA
| | - Antonio Bolanos
- Center for Human Development, Fundacion Integral Por La Salud de Los Guatemaltecos, Retalhuleu, Guatemala
| | - Edwin Asturias
- Center for Global Health, University of Colorado School of Public Health, Aurora, CO, USA
| | - Stephen Berman
- Center for Global Health, University of Colorado School of Public Health, Aurora, CO, USA
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Rendall MS, Harrison EY, Caudillo ML. Intentionally or Ambivalently Risking a Short Interpregnancy Interval: Reproductive-Readiness Factors in Women's Postpartum Non-Use of Contraception. Demography 2020; 57:821-841. [PMID: 32096094 PMCID: PMC8493517 DOI: 10.1007/s13524-020-00859-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A focus of research on short interpregnancy intervals (IPI) has been on young disadvantaged women whose births are likely to be unintended. Later initiation of family formation in the United States and other high-income countries points to the need to also consider a woman's attributes indicative of readiness for purposefully accelerated family formation achieved through short IPIs. We test for whether factors indicating "reproductive readiness"-including being married, being older, and having just had a first birth or a birth later than desired-predict a woman's non-use of contraception in the postpartum months. We also test for whether this contraceptive non-use results explicitly from wanting to become pregnant again. The data come from the 2012-2015 Pregnancy Risk Assessment Monitoring System, representing women who recently gave birth in any of 35 U.S. states and New York City (N = 120,111). We find that these reproductive-readiness factors are highly predictive of women's postpartum non-use of contraception because of a stated desire to become pregnant and are moderately predictive of contraceptive non-use without an explicit pregnancy intention. We conclude that planning for, or ambivalently risking, a short IPI is a frequent family-formation strategy for women whose family formation has been delayed. This is likely to become increasingly common as family formation in the United States is initiated later in the reproductive life course.
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Affiliation(s)
- Michael S Rendall
- Department of Sociology and Maryland Population Research Center, University of Maryland, College Park, MD, 20742, USA.
| | | | - Mónica L Caudillo
- Department of Sociology and Maryland Population Research Center, University of Maryland, College Park, MD, 20742, USA
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Shifti DM, Chojenta C, Holliday EG, Loxton D. Application of geographically weighted regression analysis to assess predictors of short birth interval hot spots in Ethiopia. PLoS One 2020; 15:e0233790. [PMID: 32470020 PMCID: PMC7259714 DOI: 10.1371/journal.pone.0233790] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 05/12/2020] [Indexed: 11/18/2022] Open
Abstract
Background Birth interval duration is an important and modifiable risk factor for adverse child and maternal health outcomes. Understanding the spatial distribution of short birth interval, an inter-birth interval of less than 33 months, and its predictors are vital to prioritize and facilitate targeted interventions. However, the spatial variation of short birth interval and its underlying factors have not been investigated in Ethiopia. Objective This study aimed to assess the predictors of short birth interval hot spots in Ethiopia. Methods The study used data from the 2016 Ethiopia Demographic and Health Survey and included 8,448 women in the analysis. The spatial variation of short birth interval was first examined using hot spot analysis (Local Getis-Ord Gi* statistic). Ordinary least squares regression was used to identify factors explaining the geographic variation of short birth interval. Geographically weighted regression was used to explore the spatial variability of relationships between short birth interval and selected predictors. Results Statistically significant hot spots of short birth interval were found in Somali Region, Oromia Region, Southern Nations, Nationalities, and Peoples’ Region and some parts of Afar Region. Women with no education or with primary education, having a husband with higher education (above secondary education), and coming from a household with a poorer wealth quintile or middle wealth quintile were predictors of the spatial variation of short birth interval. The predictive strength of these factors varied across the study area. The geographically weighted regression model explained about 64% of the variation in short birth interval occurrence. Conclusion Residing in a geographic area where a high proportion of women had either no education or only primary education, had a husband with higher education, or were from a household in the poorer or middle wealth quintile increased the risk of experiencing short birth interval. Our detailed maps of short birth interval hot spots and its predictors will assist decision makers in implementing precision public health.
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Affiliation(s)
- Desalegn Markos Shifti
- Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- School of Medicine and Public Health, Priority Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, New South Wales, Australia
- * E-mail: ,
| | - Catherine Chojenta
- School of Medicine and Public Health, Priority Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, New South Wales, Australia
| | - Elizabeth G. Holliday
- School of Medicine and Public Health, Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, New South Wales, Australia
| | - Deborah Loxton
- School of Medicine and Public Health, Priority Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, New South Wales, Australia
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Abstract
Optimal birth spacing (defined as a birth spacing of 24-59 months) is incontrovertibly linked to better health outcomes for both mothers and babies. Using the most recent available Demographic and Health Survey data, we examined the patterns and determinants of short and long birth intervals among women in selected sub-Saharan African (SSA) countries.Reproductive health and sociodemographic data of 98,934 women from 8 SSA countries were analyzed. Unadjusted and adjusted multinomial logistic regression models were used to examine the net relationship between all the independent variables and short and long birth intervals.Overall, the majority of women in all the countries optimally spaced births. However, a significant proportion of women had short birth intervals in Chad (30.2%) and the Democratic Republic of Congo (Congo DRC) (27.1%). Long birth spacing was more common in Eastern and Southern African countries, with Zimbabwe having the highest rate of long term birth interval (27.0%). Women who were aged 35 years and above in Uganda (RRR = 0.72, CI = 0.60-0.87), Tanzania (RRR = 0.62, CI = 0.49-0.77), Zimbabwe (RRR = 0.52, CI = 0.31-0.85), Nigeria (RRR = 0.82, CI = 0.72-0.94) and Togo (RRR = 0.67, CI = 0.46-0.96) had significantly lower odds of having short birth intervals compared to women aged 15-24 years. Older women (above 34 years) had increased odds for long birth intervals in all countries studied (Chad (RRR = 1.44, CI = 1.18-1.76), Congo DRC (RRR = 1.73, CI = 1.33-2.15), Malawi (RRR = 1.54, CI = 1.23-1.94) Zimbabwe (RRR = 1.95, CI = 1.26-3.02), Nigeria (RRR = 1.85 CI = 1.56-2.20), Togo (RRR = 2.12, CI = 1.46-3.07), Uganda (RRR = 1.48, CI = 1.15-1.91), Tanzania RRR = 2.12, CI = 1.53-2.93).The analysis suggested that the determinants of long and birth intervals differ and varies from country to country. The pattern of birth spacing found in this study appears to mirror the contraceptive use and fertility rate in the selected SSA countries. Birth intervals intervention addressing short birth intervals should target younger women in SSA, especially in Chad and Congo DRC, while intervention for long birth spacing should prioritize older, educated and wealthy women.
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Affiliation(s)
- Anthony Idowu Ajayi
- Sociology Department, University of Fort Hare, East London Campus, 50, Church Street, East London
| | - Oluwaseyi Dolapo Somefun
- Demography and Population Studies (DPS), University of the Witwatersrand, Johannesburg, South Africa
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20
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Sanga LA, Mtuy T, Philemon RN, Mahande MJ. Inter-pregnancy interval and associated adverse maternal outcomes among women who delivered at Kilimanjaro Christian Medical Centre in Tanzania, 2000-2015. PLoS One 2020; 15:e0228330. [PMID: 32027674 PMCID: PMC7004302 DOI: 10.1371/journal.pone.0228330] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 01/13/2020] [Indexed: 11/18/2022] Open
Abstract
Inter-pregnancy interval is an important determinant of both maternal and child health. Suboptimal inter-pregnancy interval has been associated with adverse maternal outcomes -including postpartum hemorrhage and hypertensive disorders, direct causes of maternal mortality. Both overall maternal mortality and the contribution of postpartum hemorrhage on maternal mortality have increased in Tanzania. If we are to achieve sustainable development goal (SDG) number 3.1 to reduce the global maternal mortality ration to less than 70 per 100,000 live births by 2030, it is highly important that such contributors are dealt with. This study aimed to determine the distribution and trends of inter-pregnancy interval and to deduce its association with adverse maternal outcomes among women who delivered at Kilimanjaro Christian Medical Centre (2000-2015).A retrospective cohort study was designed using Kilimanjaro Christian Medical Centre medical birth registry data for women who delivered from 2000 to 2015. Women with at least two births recorded in the registry were included. A total of 7,995 births from 6,612 mothers were analyzed. Anemia during pregnancy, post-partum hemorrhage and pre-eclampsia were adverse maternal outcomes of interest. Data analysis was performed using multivariable logistic regression models allowing for robust standard errors. Crude and adjusted odds ratio with their respective 95% confidence intervals were estimated. More than half (51.7%) of non-first births were born within sub-optimal IPI. The median IPI was 34 months (IQR: 33.5 months). The median IPI increased from 11 months in 2002 to 35 months in 2006 and plateaued until 2014, but it rose to 41.6 months in 2015. Median IPI was shorter in young women <20 years and in birth order seven and above (16 vs. 27 months, respectively). Short IPI was associated with lower risk of pre-eclampsia [aOR: 0.71, 95%CI: 0.52, 0.97] while long IPI was associated with lower risk of post-partum hemorrhage [aOR: 0.70, 95%CI: 0.52, 0.94]. This study found an association between long and short IPI with adverse maternal outcomes. Even though these results should be interpreted with caution based on the fact that the data was sampled from a referral hospital and hence there could be overrepresentation of women with maternal complications, our findings still warrant the importance of supporting modern family planning methods as a measure to improve IPI and thereby improve maternal outcomes as well.
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Affiliation(s)
- Leah Anku Sanga
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
- * E-mail:
| | - Tara Mtuy
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
- Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Rune Nathaniel Philemon
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | - Michael Johnson Mahande
- Department of Epidemiology & Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
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21
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Berg V, Miettinen A, Jokela M, Rotkirch A. Shorter birth intervals between siblings are associated with increased risk of parental divorce. PLoS One 2020; 15:e0228237. [PMID: 32004335 PMCID: PMC6993964 DOI: 10.1371/journal.pone.0228237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/09/2020] [Indexed: 11/19/2022] Open
Abstract
Birth intervals are a crucial component of fertility behaviour and family planning. Short birth intervals are associated—although not necessarily causally—with negative health-related outcomes, but less is known about their associations with family functioning. Here, the associations between birth intervals and marital stability were investigated by Cox regression using a nationally representative, register-based sample of individuals with two (N = 42,481) or three (N = 22,514) children from contemporary Finland (observation period 1972–2009). Shorter interbirth intervals were associated with an increased risk of parental divorce over a ten-year follow-up. Individuals with birth intervals of up to 1.5 years had 24–49 per cent higher divorce risk compared to individuals whose children were born more than 4 years apart. The pattern was similar in all socioeconomic groups and among individuals with earlier and later entry to parenthood. Our results add to the growing body of research showing associations between short birth intervals and negative outcomes in health and family functioning.
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Affiliation(s)
- Venla Berg
- Population Research Institute, Väestöliitto, Helsinki, Finland
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Anneli Miettinen
- Population Research Institute, Väestöliitto, Helsinki, Finland
- Kela Research, Kela, Helsinki, Finland
| | - Markus Jokela
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Anna Rotkirch
- Population Research Institute, Väestöliitto, Helsinki, Finland
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22
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Shifti DM, Chojenta C, G. Holliday E, Loxton D. Individual and community level determinants of short birth interval in Ethiopia: A multilevel analysis. PLoS One 2020; 15:e0227798. [PMID: 31935262 PMCID: PMC6959604 DOI: 10.1371/journal.pone.0227798] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/31/2019] [Indexed: 11/25/2022] Open
Abstract
Background The World Health Organization recommends a minimum of 33 months between two consecutive live births to reduce the risk of adverse maternal and child health outcomes. However, determinants of short birth interval have not been well understood in Ethiopia. Objective The aim of this study was to assess individual- and community-level determinants of short birth interval among women in Ethiopia. Methods A detailed analysis of the 2016 Ethiopian Demographic and Health Survey data was performed. A total of 8,448 women were included in the analysis. A two-level multilevel logistic regression analysis was used to identify associated individual- and community-level factors and estimate between-community variance. Results At the individual-level, women aged between 20 and 24 years at first marriage (AOR = 1.37; 95% CI: 1.18–1.60), women aged between 25 and 29 years at first marriage (AOR = 1.65; 95% CI: 1.20–2.25), having a husband who attended higher education (AOR = 1.32; 95% CI: 1.01–1.73), being unemployed (AOR = 1.16; 95% CI: 1.03–1.31), having an unemployed husband (AOR = 1.23; 95% CI: 1.04–1.45), being in the poorest wealth quintile (AOR = 1.82; 95% CI: 1.39–2.39), being in the poorer wealth quintile (AOR = 1.58; 95% CI: 1.21–2.06), being in the middle wealth quintile (AOR = 1.61; 95% CI: 1.24–2.10), being in the richer wealth quintile (AOR = 1.54; 95% CI: 1.19–2.00), increased total number of children born before the index child (AOR = 1.07; 95% CI: 1.03–1.10) and death of the preceding child (AOR = 1.97; 95% CI: 1.59–2.45) were associated with increased odds of short birth interval. At the community-level, living in a pastoralist region (AOR = 2.01; 95% CI: 1.68–2.39), being a city dweller (AOR = 1.75; 95% CI: 1.38–2.22), high community-level female illiteracy (AOR = 1.23; 95% CI: 1.05–1.45) and increased distance to health facilities (AOR = 1.32; 95% CI: 1.11–1.56) were associated with higher odds of experiencing short birth interval. Random effects showed significant variation in short birth interval between communities. Conclusion Determinants of short birth interval are varied and complex. Multifaceted intervention approaches supported by policy initiatives are required to prevent short birth interval.
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Affiliation(s)
- Desalegn Markos Shifti
- Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- * E-mail: ,
| | - Catherine Chojenta
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Elizabeth G. Holliday
- Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Deborah Loxton
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
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23
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Kirkham R, Trap-Jensen N, Boyle JA, Barzi F, Barr ELM, Whitbread C, Van Dokkum P, Kirkwood M, Connors C, Moore E, Zimmet P, Corpus S, Hanley AJ, O'Dea K, Oats J, McIntyre HD, Brown A, Shaw JE, Maple-Brown L. Diabetes care in remote Australia: the antenatal, postpartum and inter-pregnancy period. BMC Pregnancy Childbirth 2019; 19:389. [PMID: 31660892 PMCID: PMC6819653 DOI: 10.1186/s12884-019-2562-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 10/17/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Aboriginal and Torres Strait Islander women experience high rates of diabetes in pregnancy (DIP), contributing to health risks for mother and infant, and the intergenerational cycle of diabetes. By enhancing diabetes management during pregnancy, postpartum and the interval between pregnancies, the DIP Partnership aims to improve health outcomes and reduce risks early in the life-course. We describe a mixed methods formative study of health professional's perspectives of antenatal and post-partum diabetes screening and management, including enablers and barriers to care. METHODS Health professionals involved in providing diabetes care in pregnancy, from a range of health services across the Northern Territory, completed the survey (n = 82) and/or took part in interviews and/or focus groups (n = 62). RESULTS Qualitative findings highlighted factors influencing the delivery of care as reported by health professionals, including: whose responsibility it is, access to care, the baby is the focus and pre-conception care. The main challenges were related to: disjointed systems and confusion around whose role it is to provide follow-up care beyond six weeks post-partum. Quantitative findings indicated that the majority of health professionals reported confidence in their own skills to manage women in the antenatal period (62%, 40/79) and slightly lower rates of confidence in the postpartum interval (57%, 33/58). CONCLUSION These findings regarding whose role it is to provide postpartum care, along with opportunities to improve communication pathways and follow up care have informed the design of a complex health intervention to improve health systems and the provision of DIP related care.
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Affiliation(s)
- R Kirkham
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia.
| | - N Trap-Jensen
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - J A Boyle
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - F Barzi
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - E L M Barr
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Population Health Research, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - C Whitbread
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Royal Darwin Hospital, Darwin, Australia
| | - P Van Dokkum
- Alice Springs Hospital, Alice Springs, Australia
- Population Health Research, Baker Heart and Diabetes Institute, Alice Springs, Australia
| | - M Kirkwood
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
| | - C Connors
- Northern Territory Department of Health, Darwin, Australia
| | - E Moore
- Aboriginal Medical Services Alliance Northern Territory, Darwin, Australia
| | - P Zimmet
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia
| | - S Corpus
- Danila Dilba Health Service, Darwin, Australia
| | - A J Hanley
- Department of Nutritional Sciences, Faculty of Medicine and the Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| | - K O'Dea
- School of Health Sciences, University of South Australia, Adelaide, Australia
| | - J Oats
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - H D McIntyre
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia
| | - A Brown
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - J E Shaw
- Population Health Research, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - L Maple-Brown
- Menzies School of Health Research and Charles Darwin University, Darwin, Australia
- Royal Darwin Hospital, Darwin, Australia
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24
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Thoma ME, Rossen LM, De Silva DA, Warner M, Simon AE, Moskosky S, Ahrens KA. Beyond birth outcomes: Interpregnancy interval and injury-related infant mortality. Paediatr Perinat Epidemiol 2019; 33:360-370. [PMID: 31512273 PMCID: PMC6913028 DOI: 10.1111/ppe.12575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/19/2019] [Accepted: 07/07/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Several studies have examined the association between IPI and birth outcomes, but few have explored the association between interpregnancy interval (IPI) and postnatal outcomes. OBJECTIVE We examined the association between IPI and injury-related infant mortality, a leading cause of postneonatal mortality. METHODS We used 2011-2015 US period-linked birth-infant death vital statistics data to generate a multiyear birth cohort of non-first-born singleton births (N = 9 782 029). IPI was defined as the number of months between a live birth and the start of the pregnancy leading to the next live birth. Causes of death in the first year of life were identified using ICD-10 codes. Hazard ratios (HR) for IPI categories were estimated using Cox proportional hazards models adjusted for birth order, county poverty level, and maternal characteristics (marital status, race/ethnicity, education, age at previous birth). RESULTS After adjustment, overall infant mortality (48.1 per 10 000 births) was higher for short and long IPIs compared with IPI 18-23 months (reference): <6, aHR 1.61, 95% CI 1.54, 1.68; 6-11, aHR 1.22, 95% CI 1.17, 1.26; and 60+ months, aHR 1.12, 95% CI 1.08, 1.16. In comparison, the risk of injury-related infant mortality (4.4 per 10 000 births) decreased with longer IPIs: <6, aHR 1.77, 95% CI 1.55, 2.01; 6-11, aHR 1.41, 95% CI 1.25, 1.59; 12-17, aHR 1.25, 95% CI 1.10, 1.41; 24-59, aHR 0.78, 95% CI 0.69, 0.87; and 60+ months, aHR 0.55, 95% CI 0.48, 0.62. CONCLUSION Unlike overall infant mortality, injury-related infant mortality decreased with IPI length. While injury-related deaths are rare, these patterns suggest that the timing between births may be a marker of risk for fatal infant injuries. The first year postpartum may be an ideal time for the delivery of evidence-based injury prevention programmes as well as family planning services.
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Affiliation(s)
- Marie E Thoma
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD
| | - Lauren M Rossen
- National Center for Health Statistics, Centers for Disease Control and Prevention, Division of Vital Statistics, Reproductive Health Statistics Branch, Hyattsville, MD
| | - Dane A De Silva
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD
| | - Margaret Warner
- National Center for Health Statistics, Centers for Disease Control and Prevention, Division of Vital Statistics, Mortality Statistics Branch, Hyattsville, MD
| | - Alan E Simon
- Environmental Influences on Child Health Outcomes (ECHO) Project Office, Office of the Director, National Institutes of Health, Rockville, MD
| | - Susan Moskosky
- Office of Population Affairs, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Rockville, MD
| | - Katherine A Ahrens
- Office of Population Affairs, Office of the Assistant Secretary for Health, U.S. Department of Health and Human Services, Rockville, MD
- Muskie School of Public Service, University of Southern Maine, Portland, ME
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Steenland MW, Pace LE, Sinaiko AD, Cohen JL. Association Between South Carolina Medicaid's Change in Payment for Immediate Postpartum Long-Acting Reversible Contraception and Birth Intervals. JAMA 2019; 322:76-78. [PMID: 31158852 PMCID: PMC6547092 DOI: 10.1001/jama.2019.6854] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study evaluates whether a 2012 change in the South Carolina Medicaid policy to reimburse hospitals for provision of immediate postpartum long-acting reversible contraception (IPP-LARC) separately from global payment for all services in a delivery hospitalization was associated with changes in IPP-LARC use and short-interval births between 2010 and 2017.
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Affiliation(s)
- Maria W. Steenland
- Population Studies and Training Center, Brown University, Providence, Rhode Island
| | - Lydia E. Pace
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Anna D. Sinaiko
- Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Jessica L. Cohen
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Abstract
BACKGROUND Fertility rates remain persistently high in Nigeria, with little difference across socioeconomic groups. While the desire for large family size is culturally rooted, there is little understanding of how repeated child mortality experiences influence fertility behaviour and parity transition in Nigeria. METHODS Using birth history data from the 2013 Nigeria Demographic and Health Survey (NDHS), we applied life table techniques and proportional-hazard regression model to explore the effect of child survival experience on parity transitions. We hypothesize that a woman with one or more child death experience is at elevated risk of progressing towards higher parities. RESULTS Our findings show that child mortality is concentrated among mothers living in deprived conditions especially in rural areas of the northern part of Nigeria and among those with little or no education and, among those belonging to Hausa/Fulani ethnicity and Islam religion. Mothers with repeated experience of child deaths were significantly at a higher rate of progressing to higher parities than their counterparts (HR: 1.45; 95% CI: 1.31-1.61), when adjusted for relevant biological and socio-demographic characteristics. CONCLUSION Recurrent experience of child deaths exacerbates the risks to higher parity transition. Interventions aimed at reducing fertility in Nigeria should target promoting child survival and family planning concurrently.
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Affiliation(s)
- Abiodun Idowu Adanikin
- Department of Social Statistics and Demography and Centre for Global Health, Population, Poverty and Policy, University of Southampton, Southampton, UK
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Sabu S. Padmadas
- Department of Social Statistics and Demography and Centre for Global Health, Population, Poverty and Policy, University of Southampton, Southampton, UK
| | - Nuala McGrath
- Department of Social Statistics and Demography and Centre for Global Health, Population, Poverty and Policy, University of Southampton, Southampton, UK
- Primary Care and Population Studies Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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27
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Mardiana O, Nor Afiah MZ, Norliza A A. Role of sociodemographic, obstetric history and planning of pregnancy in predicting short interpregnancy interval among antenatal mothers in Klang, Selangor. Med J Malaysia 2019; 74:151-159. [PMID: 31079127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Short Interpregnancy interval (IPI) is defined as the interval between the live birth outcome and the next pregnancy conception of less than 24 months. It has been linked to adverse maternal and perinatal outcomes. The objective of this study was to determine the prevalence and the predictors of short IPI among antenatal mothers. METHODS A cross-sectional study was conducted among 452 antenatal mothers attending health clinics in Klang in April 2018. Probability sampling was used and data was collected by using a validated self-administered questionnaire. The dependent variable of the study was short IPI and the independent variables were sociodemographic, obstetric history and planning of pregnancy. Analysis of data collected in the study was performed by using IBM Statistical Package for Social Science (SPSS) version 24. RESULTS The prevalence of short IPI found in this study was 48%. Seven identified predictors of short IPI were: age less than 25 years old (Adjusted Odd Ratios; AOR 12.16, 95%CI: 4.72, 31.30), age of 26 to 30 years old (AOR 5.20, 95%CI: 2.62, 10.32), age of 31 to 35 years old (AOR 2.90, 95% CI: 1.50, 5.64), higher education (AOR 2.11, 95% CI: 1.34, 3.34), parity more than three (AOR 3.12, 95% CI: 1.42, 6.84), irregular menstruation (AOR 2.17, 95% CI: 1.40, 3.37) and unintended pregnancy (AOR 2.88, 95% CI: 1.88, 4.40). CONCLUSION Innovative programmes, for example by making IPI information available through online resources, could effectively target young mothers as the younger generation prefers quick, easily-accessible and reliable information.
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Affiliation(s)
- O Mardiana
- Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Community Health Department, Serdang Selangor, Malaysia.
| | - M Z Nor Afiah
- Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Community Health Department, Serdang Selangor, Malaysia
| | - A Norliza A
- Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Community Health Department, Serdang Selangor, Malaysia
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Abstract
A growing body of research has argued that the traditional categories of stopping and spacing are insufficient to understand why individuals want to control fertility. In a series of articles, Timæus, Moultrie, and colleagues defined a third type of fertility motivation-postponement-that reflects a desire to avoid childbearing in the short term without clear goals for long-term fertility. Although postponement is fundamentally a description of fertility desires, existing quantitative research has primarily studied fertility behavior in an effort to find evidence for the model. In this study, we use longitudinal survey data to consider whether postponement can be identified in standard measures of fertility desires among reproductive-age women in rural Mozambique. Findings show strong evidence for a postponement mindset in this population, but postponement coexists with stopping and spacing goals. We reflect on the difference between birth spacing and postponement and consider whether and how postponement is a distinctive sub-Saharan phenomenon.
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Affiliation(s)
- Sarah R Hayford
- Department of Sociology, Ohio State University, 238 Townshend Hall, 1885 Neil Avenue Mall, Columbus, OH, 43210-1404, USA.
| | - Victor Agadjanian
- Department of Sociology, University of California-Los Angeles, Los Angeles, CA, 90095-1551, USA
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Nisha MK, Alam A, Islam MT, Huda T, Raynes-Greenow C. Risk of adverse pregnancy outcomes associated with short and long birth intervals in Bangladesh: evidence from six Bangladesh Demographic and Health Surveys, 1996-2014. BMJ Open 2019; 9:e024392. [PMID: 30798311 PMCID: PMC6398728 DOI: 10.1136/bmjopen-2018-024392] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine the effect of short (<36 months) and long (≥60 months) birth intervals on adverse pregnancy outcomes in Bangladesh. DESIGN, SETTING AND PARTICIPANTS We analysed data from six Bangladesh Demographic and Health Surveys (1996-1997, 1999-2000, 2004, 2007, 2011 and 2014). We included all singleton non-first live births, most recently born to mothers within 5 years preceding each survey (n=21 382). We defined birth interval according to previous research which suggests that a birth interval between 36 and 59 months is the most ideal interval. Bivariate and multivariable analyses were conducted to obtain the crude and adjusted ORs (aOR) respectively to assess the odds of first-day neonatal death, early neonatal death and small birth size for both short (<36 months) and long (≥60 months) spacing between births. MAIN OUTCOME MEASURES First-day neonatal death, early neonatal death and small birth size. RESULTS In the multivariable analysis, compared with births spaced 36-59 months, infants with a birth interval of <36 months had increased odds of first-day neonatal death (aOR: 2.11, 95% CI: 1.17 to 3.78) and early neonatal death (aOR: 1.58, 95% CI: 1.13 to 2.22). Compared with births spaced 36-59 months, infants with a birth interval of ≥60 months had increased odds of first-day neonatal death (aOR: 2.02, 95% CI: 1.10 to 3.73) and small birth size (aOR: 1.17, 95% CI: 1.02 to 1.34). When there was a history of any previous pregnancy loss, there was an increase in the odds of first-day and early neonatal death for both short and long birth intervals, although it was not significant. CONCLUSIONS Birth intervals shorter than 36 months and longer than 59 months are associated with increased odds of adverse pregnancy outcomes. Care-providers, programme managers and policymakers could focus on promoting an optimal birth interval between 36 and 59 months in postpartum family planning.
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Affiliation(s)
- Monjura Khatun Nisha
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ashraful Alam
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Tanvir Huda
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Camille Raynes-Greenow
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Sánchez-Pájaro A, Braverman-Bronstein A, De Castro F, Vidaña-Pérez D, Villalobos-Hernández A, Barrientos-Gutiérrez T. Contribution of Second and Higher-Order Births to Adolescent Fertility in Mexico. Stud Fam Plann 2019; 50:63-70. [PMID: 30702141 DOI: 10.1111/sifp.12083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study estimates the contribution of second and higher-order births to the adolescent fertility rate in Mexico from 2006 to 2014. We used data from nationally representative surveys for 2006, 2009, and 2014 to estimate the adolescent fertility rate, and the first, second, and higher-order birth components for the triennium prior to each survey at the national and state level. Our results showed that the second and higher-order component was 16.3 births per 1,000 women in 2003-05, 14.9 in 2006-08, and 16.9 in 2011-13. Second and higher-order births represented 25.9 percent of all teen births in 2003-05, 21.6 percent in 2006-08, and 21.9 percent in 2011-13. Second and higher-order births were heterogeneous across states. We found that second and higher-order births are highly prevalent and important contributors to the adolescent fertility rate. Postponing second and higher-order births would benefit both mothers and children. Monitoring them provides crucial information on the demand of targeted health system strategies that address the reproductive health needs of adolescent mothers. Interventions to prevent second and higher-order pregnancies must be developed and implemented.
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Gebremedhin AT, Regan AK, Malacova E, Marinovich ML, Ball S, Foo D, Pereira G. Effects of interpregnancy interval on pregnancy complications: protocol for systematic review and meta-analysis. BMJ Open 2018; 8:e025008. [PMID: 30082369 PMCID: PMC6089264 DOI: 10.1136/bmjopen-2018-025008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Interpregnancy interval (IPI) is the length of time between a birth and conception of the next pregnancy. Evidence suggests that both short and long IPIs are at increased risk of adverse pregnancy and perinatal outcomes. Relatively less attention has been directed towards investigating the effect of IPI on pregnancy complications, and the studies that have been conducted have shown mixed results.This systematic review will aim to provide an update to the most recent available evidence on the effect of IPI on pregnancy complications. METHOD AND ANALYSIS We will search electronic databases such as Ovid/MEDLINE, EMBASE, CINAHL, Scopus, Web of Science and PubMed to identify peer-reviewed articles on the effects of IPI on pregnancy complications. We will include articles published from start of indexing until 12 February 2018 without any restriction to geographic setting. We will limit the search to literature published in English language and human subjects. Two independent reviewers will screen titles and abstracts and select full-text articles that meet the eligibility criteria. The Newcastle-Ottawa tool will be used to assess quality of observational studies. Where data permit, meta-analyses will be performed for individual pregnancy complications. A subgroup analyses by country categories (high-income vs low and middle-income countries) based on World Bank income group will be performed. Where meta-analysis is not possible, we will provide a description of data without further attempt to quantitatively pool results. ETHICS AND DISSEMINATION Formal ethical approval is not required as primary data will not be collected. The results will be published in peer-reviewed journals and presented at national and international conferences. PROSPERO REGISTRATION NUMBER CRD42018088578.
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Affiliation(s)
| | - Annette K Regan
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Eva Malacova
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - M Luke Marinovich
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Stephen Ball
- Pre-Hospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Damien Foo
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Gavin Pereira
- School of Public Health, Curtin University, Perth, Western Australia, Australia
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Abstract
The negative relationship between birth interval length and neonatal mortality risks is well documented, but heterogeneity in this relationship has been largely ignored. Using the Bangladesh Maternal Mortality and Health Care Survey 2010, this study investigates how the effect of birth interval length on neonatal mortality risks varies by maternal age at birth and maternal education. There is significant variation in the effect of interval length on neonatal mortality along these dimensions. Young mothers and those with little education, both of which make up a large share of the Bangladeshi population, can disproportionately benefit from longer intervals. Because these results were obtained from within-family models, they are not due to unobservable heterogeneity between mothers. Targeting women with these characteristics may lead to significant improvements in neonatal mortality rates, but there are significant challenges in reaching them.
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Abstract
OBJECTIVE To assess whether interpregnancy interval length after a pregnancy loss is associated with risk of repeat miscarriage. METHODS This analysis includes pregnant women participating in the Right From the Start (2000-2012) community-based prospective cohort study whose most recent pregnancy before enrollment ended in miscarriage. Interpregnancy interval was defined as the time between a prior miscarriage and the last menstrual period of the study pregnancy. Miscarriage was defined as pregnancy loss before 20 weeks of gestation. Cox proportional hazard models were used to estimate crude and adjusted hazard ratios and 95% CIs for the association between different interpregnancy interval lengths and miscarriage in the study pregnancy. Adjusted models included maternal age, race, parity, body mass index, and education. RESULTS Among the 514 study participants who reported miscarriage as their most recent pregnancy outcome, 15.7% had a repeat miscarriage in the study pregnancy (n=81). Median maternal age was 30 years (interquartile range 27-34) and 55.6% of participants had at least one previous livebirth (n=286). When compared with women with interpregnancy intervals of 6-18 months (n=136), women with intervals of less than 3 months (n=124) had the lowest risk of repeat miscarriage (7.3% compared with 22.1%; adjusted hazard ratio 0.33, 95% CI 0.16-0.71). Neither maternal race nor parity modified the association. Attempting to conceive immediately was not associated with increased risk of miscarriage in the next pregnancy. CONCLUSION An interpregnancy interval after pregnancy loss of less than 3 months is associated with the lowest risk of subsequent miscarriage. This implies counseling women to delay conception to reduce risk of miscarriage may not be warranted.
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Affiliation(s)
- Alexandra C. Sundermann
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 800, Nashville, TN 37203-1738
| | - Katherine E. Hartmann
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 800, Nashville, TN 37203-1738
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, 1100 Medical Center North, Nashville, TN, 37232
| | - Sarah H. Jones
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 800, Nashville, TN 37203-1738
| | - Eric S. Torstenson
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 800, Nashville, TN 37203-1738
| | - Digna R. Velez Edwards
- Vanderbilt Epidemiology Center, Institute of Medicine and Public Health, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 800, Nashville, TN 37203-1738
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, 1100 Medical Center North, Nashville, TN, 37232
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Abstract
We use duration models on a well-known historical data set of more than 15,000 families and 60,000 births in England for the period 1540-1850 to show that the sampled families adjusted the timing of their births in accordance with the economic conditions as well as their stock of dependent children. The effects were larger among the lower socioeconomic ranks. Our findings on the existence of parity-dependent as well as parity-independent birth spacing in England are consistent with the growing evidence that marital birth control was present in pre-transitional populations.
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Affiliation(s)
- Francesco Cinnirella
- Ifo Institute–Leibniz Institute for Economic Research at the University of Munich, Poschingerstr. 5, 81679 Munich, Germany
- Center for Economic Studies and ifo Institute (CESifo), Munich, Germany
- Centre for Economic Policy Research (CEPR), London, UK
- Centre for Competitive Advantage in the Global Economy (CAGE), Warwick, UK
| | - Marc Klemp
- Department of Economics, University of Copenhagen, Copenhagen, Denmark
- Department of Economics, Brown University, Providence, RI USA
- Population Studies & Training Center, Brown University, Providence, RI USA
| | - Jacob Weisdorf
- Centre for Economic Policy Research (CEPR), London, UK
- Centre for Competitive Advantage in the Global Economy (CAGE), Warwick, UK
- Department of Business and Economics, University of Southern Denmark, Campusvej 55, 5230 Odense M, DK Denmark
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Abstract
OBJECTIVES To assess trends in early neonatal mortality (ENM) and population-attributable risk (PAR) estimates for predictors of ENM in Nigeria. DESIGN, SETTING AND PARTICIPANTS A cross-sectional data on 63 844 singleton live births within the preceding 5 years from the 2003, 2008 and 2013 Nigeria Demographic and Health Surveys were used. Adjusted PARs were used to estimate the number of early neonatal deaths attributable to each predictor in the final multivariable Cox regression model. MAIN OUTCOME MEASURES ENM, defined as the death of a live-born singleton between birth and 6 days of life. RESULTS The ENM rate slightly declined from 30.5 (95% CI 26.1 to 34.9) to 26.1 (CI 24.3 to 27.9) during the study period. Approximately 36 746 (CI 14 656 to 56 920) and 37 752 (CI 23 433 to 51 126) early neonatal deaths were attributable to rural residence and male sex, respectively. Other significant predictors of ENM included small neonates (attributable number: 25 884, CI 19 172 to 31 953), maternal age <20 years (11 708, CI 8521 to 17 042), caesarean section (6312, CI 4260 to 8521) and birth order ≥4 with a short birth interval (≤2 years) (18 929, CI 12 781 to 25 563)). CONCLUSIONS To improve early neonatal survival in Nigeria, community-based interventions are needed for small neonates, and to promote delayed first pregnancy, child spacing and timely referral for sick male neonates and caesarean delivery.
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Affiliation(s)
- Osita Kingsley Ezeh
- School of Science and Health, Western Sydney University, Penrith, New South Wales, Australia
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Abstract
We examine the relationship between birth-to-birth intervals and a variety of mid- and long-term cognitive and socioeconomic outcomes, including high school GPA, cognitive ability, educational attainment, earnings, unemployment status, and receiving government welfare support. Using contemporary Swedish population register data and a within-family sibling comparison design, we find that neither the birth interval preceding the index person nor the birth interval following the index person are associated with any substantively meaningful changes in mid- or long-term outcomes. This is true even for individuals born before or after birth-to-birth intervals of less than 12 months. We conclude that in a contemporary high-income welfare state, there appears to be no relationship between unusually short or long birth intervals and adverse long-term outcomes.
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Affiliation(s)
- Kieron J Barclay
- Department of Social Policy, London School of Economics and Political Science, London, UK.
- Max Planck Institute for Demographic Research, Rostock, Germany.
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden.
| | - Martin Kolk
- Demography Unit, Department of Sociology, Stockholm University, Stockholm, Sweden
- Center for the Study of Cultural Evolution, Stockholm University, Stockholm, Sweden
- Institute for Futures Studies, Stockholm, Sweden
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Coo H, Brownell MD, Ruth C, Flavin M, Au W, Day AG. Interpregnancy Interval and Adverse Perinatal Outcomes: A Record-Linkage Study Using the Manitoba Population Research Data Repository. J Obstet Gynaecol Can 2017; 39:420-433. [PMID: 28363608 DOI: 10.1016/j.jogc.2017.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/20/2016] [Accepted: 01/18/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To examine the association between the interpregnancy interval (IPI) and preterm birth, low birth weight, and SGA birth in a developed country with universal health coverage. METHODS We conducted a secondary analysis of data housed at the Manitoba Centre for Health Policy. All live births in Manitoba hospitals over a 29-year period were identified and consecutive births to the same mother were grouped into sibling pairs to calculate the IPI for the younger siblings. Logistic regression models were fit to examine the association between the IPI and adverse perinatal outcomes, adjusted for potentially confounding sociodemographic and clinical factors. RESULTS In a cohort of more than 171 000 births and relative to IPIs of 18 to 23 months, IPIs shorter than 12 and longer than 23 months were associated with significantly increased odds of preterm birth overall and both medically indicated and spontaneous preterm births, low birth weight, and SGA birth. The strongest association observed was for intervals shorter than 6 months and spontaneous preterm birth (adjusted OR 1.83, 95% CI 1.65-2.03). When the outcome was modelled as GA categories, the strongest association observed was for intervals shorter than 6 months and early preterm birth (<34 weeks' GA; adjusted OR 2.47, 95% CI 2.07-2.94). CONCLUSION If the associations observed between the IPI and adverse perinatal outcomes in this large, population-based cohort are causal, birth spacing could form an important target of public health messaging in Canada.
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Affiliation(s)
- Helen Coo
- Department of Pediatrics, Queen's University, Kingston, ON.
| | - Marni D Brownell
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB; Manitoba Centre for Health Policy, Winnipeg, MB
| | - Chelsea Ruth
- Manitoba Centre for Health Policy, Winnipeg, MB; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB
| | - Michael Flavin
- Department of Pediatrics, Queen's University, Kingston, ON
| | - Wendy Au
- Manitoba Centre for Health Policy, Winnipeg, MB
| | - Andrew G Day
- Kingston General Hospital Research Institute, Kingston, ON
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McKinney D, House M, Chen A, Muglia L, DeFranco E. The influence of interpregnancy interval on infant mortality. Am J Obstet Gynecol 2017; 216:316.e1-316.e9. [PMID: 28034653 DOI: 10.1016/j.ajog.2016.12.018] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/13/2016] [Accepted: 12/19/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND In Ohio, the infant mortality rate is above the national average and the black infant mortality rate is more than twice the white infant mortality rate. Having a short interpregnancy interval has been shown to correlate with preterm birth and low birthweight, but the effect of short interpregnancy interval on infant mortality is less well established. OBJECTIVE We sought to quantify the population impact of interpregnancy interval on the risk of infant mortality. STUDY DESIGN This was a statewide population-based retrospective cohort study of all births (n = 1,131,070) and infant mortalities (n = 8152) using linked Ohio birth and infant death records from January 2007 through September 2014. For this study we analyzed 5 interpregnancy interval categories: 0-<6, 6-<12, 12-<24, 24-<60, and ≥60 months. The primary outcome for this study was infant mortality. During the study period, 3701 infant mortalities were linked to a live birth certificate with an interpregnancy interval available. We calculated the frequency and relative risk of infant mortality for each interval compared to a referent interval of 12-<24 months. Stratified analyses by maternal race were also performed. Adjusted risks were estimated after accounting for statistically significant and biologically plausible confounding variables. Adjusted relative risk was utilized to calculate the attributable risk percent of short interpregnancy intervals on infant mortality. RESULTS Short interpregnancy intervals were common in Ohio during the study period. Of all multiparous births, 20.5% followed an interval of <12 months. The overall infant mortality rate during this time was 7.2 per 1000 live births (6.0 for white mothers and 13.1 for black mothers). Infant mortalities occurred more frequently for births following short intervals of 0-<6 months (9.2 per 1000) and 6-<12 months (7.1 per 1000) compared to 12-<24 months (5.6 per 1000) (P < .001 and <.001). The highest risk for infant mortality followed interpregnancy intervals of 0-<6 months (adjusted relative risk, 1.32; 95% confidence interval, 1.17-1.49) followed by interpregnancy intervals of 6-<12 months (adjusted relative risk, 1.16; 95% confidence interval, 1.04-1.30). Analysis stratified by maternal race revealed similar findings. Attributable risk calculation showed that 24.2% of infant mortalities following intervals of 0-<6 months and 14.1% with intervals of 6-<12 months are attributable to the short interpregnancy interval. By avoiding short interpregnancy intervals of ≤12 months we estimate that in the state of Ohio 31 infant mortalities (20 white and 8 black) per year could have been prevented and the infant mortality rate could have been reduced from 7.2-7.0 during this time frame. CONCLUSION An interpregnancy interval of 12-60 months (1-5 years) between birth and conception of next pregnancy is associated with lowest risk of infant mortality. Public health initiatives and provider counseling to optimize birth spacing has the potential to significantly reduce infant mortality for both white and black mothers.
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Affiliation(s)
- David McKinney
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Melissa House
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Aimin Chen
- Division of Epidemiology, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Louis Muglia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH; Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Emily DeFranco
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, OH; Center for Prevention of Preterm Birth, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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Dev R, Williams MF, Fitzpatrick AL, Connell FA. Topographical Differences of Infant Mortality in Nepal. Kathmandu Univ Med J (KUMJ) 2016; 14:96-102. [PMID: 28166062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Background Infant mortality is a major problem in Nepal, particularly in the mountainous region of the country. Objective To identify factors that contributes to the high rate of infant mortality in the mountain zone in Nepal. Method Data were derived from the 2011 Nepal Demographic and Health Survey (NDHS). Infant mortality was analyzed across three ecological zones in a sample of 5,306 live births in the five years preceding the survey. The contribution of risk factors to the excess infant mortality was assessed using multiple logistic regression. Result Infant mortality rate (deaths per 1000 live births) in the ecological zones were 59 (95% CI: 36, 81), 44 (35, 53), and 40 (33, 47) for the mountain, hill and terai zones, respectively. Women living in the mountain zone were more likely to report that distance to care was a "big problem" and had a greater risk of infant mortality compared to the terai zone (OR=1.42, 95% CI: 1.01, 2.02, p=0.04). This increased risk was observed only among births to mothers who perceived distance to the nearest health facility as a "big problem" (aOR=1.57, 95% CI: 1.01, 2.40, p=0.04) controlling for other risk factors. Conclusion These findings suggest that the higher Infant mortality rate (IMR) in the mountain zone was among the women who perceived distance to health facilities as a big problem. Improved accessibility to health services, particularly in this zone, is an essential strategy for reducing infant mortality in Nepal.
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Affiliation(s)
- R Dev
- Department of Health Services, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - M F Williams
- Departments of Epidemiology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - A L Fitzpatrick
- Department of Family Medicine and Epidemiology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - F A Connell
- Department of Health Services, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
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Thoma ME, Copen CE, Kirmeyer SE. Short Interpregnancy Intervals in 2014: Differences by Maternal Demographic Characteristics. NCHS Data Brief 2016:1-8. [PMID: 27111053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Data from the National Vital Statistics System •Nearly 29.0% of U.S. mothers who had a second or higher-order birth in 2014 had a short interpregnancy interval of less than 18 months. •Short intervals (i.e., less than 6 months, 6-11 months, and 12-17 months) were more common for mothers aged 35 and over (5.7%, 16.3%, and 22.1%, respectively) than mothers who were under age 20 at their previous birth (5.1%, 8.8%, and 8.4%). •Short intervals of less than 6 months and 6-11 months were more common among non-Hispanic black mothers (7.1% and 11.7%, respectively) than non-Hispanic white mothers (4.1% and 11.2%) and Hispanic mothers (5.0% and 9.3%). •The percentage of births to mothers with intervals less than 6 months decreased as education level increased, from 4.3% (no high school diploma) to 1.8% (doctorate or professional degree).
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Schneider JF, Miles JR, Brown-Brandl TM, Nienaber JA, Rohrer GA, Vallet JL. Genomewide association analysis for average birth interval and stillbirth in swine. J Anim Sci 2016; 93:529-40. [PMID: 26020742 DOI: 10.2527/jas.2014-7899] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Reproductive efficiency has a great impact on the economic success of pork production. Stillborn pigs and average birth interval contribute to the number of pigs born alive in a litter. To better understand the underlying genetics of these traits, a genomewide association study was undertaken. Samples of DNA were collected and tested using the Illumina Porcine SNP60 BeadChip from 798 females farrowing over a 4-yr period (all first parity). Birth intervals and piglet birth status (stillborn or alive) were determined by videotaping each farrowing event. A total of 41,148 SNP were tested using the Bayes C option of GenSel (version 4.61) and 1-Mb windows. These 1-Mb windows explained proportions of 0.017, 0.002, 0.032, 0.029, and 0.030 of the total variation, respectively, for litter average birth interval after deletion of the last piglet born, last birth interval in the litter, number of stillborn piglets ignoring the last piglet born, number of stillborns in the last birth position, and percent stillborn ignoring the last piglet. Significant 1-Mb nonoverlapping SNP windows were identified by using a conservative approach requiring 1-Mb windows to have a genetic variance ≥1.0% of genomic variance and these were considered to be QTL. Quantitative trait loci were located for number of stillborn piglets ignoring the last piglet born (1 QTL), number of stillborns in the last birth position (1 QTL), and percent stillborn ignoring the last piglet (3 QTL). In addition, 2, 13, 3, and 6 suggestive 1-Mb nonoverlapping SNP windows were identified for litter average birth interval after deletion of the last piglet born, number of stillborn piglets ignoring the last piglet born, number of stillborns in the last birth position, and percent stillborn ignoring the last piglet, respectively. Possible candidate genes affecting both birth interval and stillbirth included () and (). Possible genes affecting only birth interval included (), and (), and those affecting only stillbirth included (), LOC100518697 (a nostrin-like gene), and (). The QTL and the suggestive 1-Mb nonoverlapping SNP windows may lead to genetic markers for marker assisted selection, marker assisted management, or genomic selection applications in commercial pig populations.
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Davenport R. Urban Family Reconstitution—A Worked Example. Local Popul Stud 2016:28-49. [PMID: 29939514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Family reconstitutions have been undertaken only rarely in urban settings due to the high mobility of historical urban populations, in both life and death. Recently Gill Newton has outlined a methodology for the reconstitution of urban populations and we applied a modified version of this method to the large Westminster parish of St. Martin in the Fields between 1752 and 1812, a period that posed particular difficulties for family reconstitution because of the rapid lengthening of the interval between birth and baptism. The extraordinary richness of the records for St. Martin in the Fields made it possible to investigate burial and baptismal practices in great detail, and the extent and impact of residential mobility. We found that short-range, inter-parochial movement was so frequent that it was necessary to confine the reconstitution sample to windows in which families registered events at a single street address. Using birth interval analysis and the frequencies of twin births it was possible to demonstrate that the registration of birth events was fairly complete, but that many infant and child burials were missed. These missing burials probably resulted from the unreported export of corpses for burial in other parishes, a phenomenon for which we had considerable evidence. The limitations of family reconstitution in this highly mobile and heterogeneous urban population is discussed and we demonstrate some checks and corrections that can be used to improve the quality of such reconstitutions.
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Khadka KB, Lieberman LS, Giedraitis V, Bhatta L, Pandey G. The socio-economic determinants of infant mortality in Nepal: analysis of Nepal Demographic Health Survey, 2011. BMC Pediatr 2015; 15:152. [PMID: 26459356 PMCID: PMC4603581 DOI: 10.1186/s12887-015-0468-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2014] [Accepted: 10/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infant mortality reflects not only the health of infants but societal well-being as a whole. This study explores distal socioeconomic and related proximate determinants of infant mortality and provides evidence for designing targeted interventions. METHODS Survival information on 5391 live born infants (2006-2010) was examined from the nationally representative Nepal Demographic Health Survey 2011. Bivariate logistic regression and multivariate hierarchical logistic regression approaches were performed to analyze the distal-socioeconomic and related proximate determinants of infant mortality. RESULTS Socio-economic distal determinants are important predictors for infant mortality. For example, in reference to infants of the richest class, the adjusted odds ratio of infant mortality was 1.66 (95% CI: 1.00-2.74) in middle class and 1.87 (95% CI: 1.14-3.08) in poorer class, respectively. Similarly, the populations of the Mountain ecological region had a higher odds ratio (aOR =1.39, 95% CI: 0.90-2.16) of experiencing infant mortality compared with the populations of the Terai plain region. Likewise, the population of Far-western development region had a higher adjusted odds ratio (aOR =1.62, 95% CI: 1.02-2.57) of experiencing infant mortality than the Western development region. Moreover, the association of proximate determinants with infant mortality was statistically significant. For example, in reference to size at birth, adjusted odds ratio of infant dying was higher for infants whose birth size, as reported by mothers, was very small (aOR = 3.41, 95% CI: 2.16-5.38) than whose birth size was average. Similarly, fourth or higher birth rank infants with a short preceding birth interval (less than or equal to 2 years) were at greater risk of dying (aOR =1.74, 95% CI: 1.16-2.62) compared to the second or third rank infants with longer birth intervals. A short birth interval of the second or the third rank infants also increased the odds of infant death (aOR = 2.03, 95% CI: 1.23-3.35). CONCLUSIONS Socioeconomic distal and proximate determinants are associated with infant mortality in Nepal. Infant mortality was higher in the poor and middle classes than the wealthier classes. Population of Mountain ecological region and Far western development region had high risk of infant mortality. Similarly, infant dying was higher for infants whose birth size, as reported by mothers, was very small and who has higher birth rank and short preceding birth interval. This study uniquely addresses both broader socioeconomic distal and proximate determinants side by side at the individual, household and community levels. For this, both comprehensive, long-term, equity-based public health interventions and immediate infant care programs are recommended.
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Affiliation(s)
| | - Leslie Sue Lieberman
- Department of Anthropology, University of Central Florida, Orlando, FL, 32816-0955, USA.
| | | | - Laxmi Bhatta
- Tribhuvan University, Birendra Multiple Campus, Bharatpur, Nepal.
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Habimana-Kabano I, Broekhuis A, Hooimeijer P. Inter-Pregnancy Intervals and Maternal Morbidity: New Evidence from Rwanda. Afr J Reprod Health 2015; 19:77-86. [PMID: 26897916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The effects of short and long pregnancy intervals on maternal morbidity have hardly been investigated. This research analyses these effects using logistic regression in two steps. First, data from the Rwanda Demographic and Health Survey 2010 are used to study delivery referrals to District hospitals. Second, Kibagabaga District Hospital's maternity records are used to study the effect of inter-pregnancy intervals on maternal morbidity. The results show that both short and long intervals lead to higher odds of being referred because of pregnancy or delivery complications. Once admitted, short intervals were not associated with higher levels of maternal morbidity. Long intervals are associated with higher risks of third trimester bleeding, premature rupture of membrane and lower limb edema, while a higher age at conception is associated with lower risks. Poor women from rural areas and with limited health insurance are less often admitted to a hospital, which might bias the results.
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Copen CE, Thoma ME, Kirmeyer S. Interpregnancy Intervals in the United States: Data From the Birth Certificate and the National Survey of Family Growth. Natl Vital Stat Rep 2015; 64:1-10. [PMID: 26114767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To describe data on interpregnancy intervals (IPI), defined as the timing between a live birth and conception of a subsequent live birth, from a subset of jurisdictions that adopted the 2003 revised birth certificate. Because this information is available among revised jurisdictions only, the national representativeness of IPI and related patterns to the entire United States were assessed using the 2006-2010 National Survey of Family Growth (NSFG). METHODS Birth certificate data are based on 100% of births registered in 36 states and the District of Columbia that adopted the 2003 revised birth certificate in 2011 (83% of 2011 U.S. births). The "Date of last live birth" item on the birth certificate was used to calculate months between the birth occurring in 2011 and the previous birth. These data were compared with pregnancy data from a nationally representative sample of women from the 2006-2010 NSFG. RESULTS Jurisdiction-specific median IPI ranged from 25 months (Idaho, Montana, North Dakota, South Dakota, Utah, and Wisconsin) to 32 months (California) using birth certificate data. Overall, the distribution of IPI from the birth certificate was similar to NSFG for IPI less than 18 months (30% and 29%), 18 to 59 months (50% and 52%), and 60 months or more (21% and 18%). Consistent patterns in IPI distribution by data source were seen by age at delivery, marital status, education, number of previous live births, and Hispanic origin and race, with the exception of differences in IPI of 60 months or more among non-Hispanic black women and women with a bachelor's degree or higher.
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Abstract
A short interpregnancy interval (IPI) is a risk factor for preterm delivery among women of reproductive age. As limited data exist concerning adolescents, we aimed to examine the association between short IPIs and preterm birth among adolescents using a majority of US births. Using 2007-2008 US natality data, we assessed the relationship between IPIs <3, 3-5, 6-11, and 12-17 months and moderately (32-36 weeks) and very (<32 weeks) preterm singleton live births among mothers <20 years, relative to IPIs 18-23 months. Adjusted odds ratios (aORs) and 95 % confidence intervals (95 % CIs) adjusted for maternal race, age, previous preterm deliveries, marital status, smoking and prenatal care were determined from a multivariable multinomial logistic regression model. In 2007-2008, there were 85,077 singleton live births to women aged <20 who had one previous live birth, 69 % of which followed IPIs ≤18 months. Compared with IPIs 18-23 months, short IPIs were associated with moderately preterm birth for IPIs <3 months (aOR 1.89, 95 % CI 1.70-2.10), 3-5 months (aOR 1.33, 95 % CI 1.22-1.47), and 6-12 months (aOR 1.11, 95 % CI 1.02-1.21). IPIs <3 and <6 months were also associated with very preterm birth, with aORs of 2.52 (95 % CI 1.98-3.22) and 1.68 (95 % CI 1.35-2.10) respectively. Many adolescent mothers with repeat births have short IPIs, and shorter IPIs are associated with preterm birth in a dose-dependent fashion. Increasing adolescent mothers' use of effective contraception postpartum can address both unintended adolescent births and preterm birth.
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Affiliation(s)
- Lina M Nerlander
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA,
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Cheslack Postava K, Winter AS. Short and long interpregnancy intervals: correlates and variations by pregnancy timing among U.S. women. Perspect Sex Reprod Health 2015; 47:19-26. [PMID: 25623196 DOI: 10.1363/47e2615] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 09/29/2014] [Accepted: 10/01/2014] [Indexed: 05/11/2023]
Abstract
CONTEXT Short and long interpregnancy intervals are associated with adverse health outcomes. Little is known about the correlates of short and long interpregnancy intervals in the general population, and whether correlates vary by pregnancy intention. METHODS Data on 10,236 pregnancies following a live birth were drawn from the 1995, 2002 and 2006-2010 waves of the National Survey of Family Growth. Logistic regression was used to assess characteristics associated with women's reporting short interpregnancy intervals (less than 12 months) and long intervals (greater than 60 months). Analyses were stratified by whether women considered their pregnancies well timed or mistimed. RESULTS Thirty-one percent of pregnancies following short intervals and 47% following long intervals were well timed. Among well-timed pregnancies only, the odds of short intervals were elevated if women had been 35 or older, rather than aged 20-29, at last pregnancy (odds ratio, 2.3); if their prior infant had died (10.6); or if they had wanted their prior pregnancy sooner than it had occurred (2.2). Overall, the odds of long intervals were higher among minority groups than among whites (1.4-1.6) and were lower among women who had been 30 or older at prior pregnancy than among those who had been in their 20s (0.1-0.5); they increased with level of family income. Correlates of long intervals generally varied little by intention. CONCLUSIONS Although the majority of pregnancies at short intervals are unintended, specific subsets of women have elevated odds of intending short interpregnancy intervals.
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Affiliation(s)
- Keely Cheslack Postava
- adjunct associate research scientist, Department of Psychiatry, Columbia University, New York.
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McGuire C, Stephenson R. Community Factors Influencing Birth Spacing among Married Women in Uganda and Zimbabwe. Afr J Reprod Health 2015; 19:14-24. [PMID: 26103691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Short birth spacing continues to be a problem in Uganda and Zimbabwe, resulting in negative infant, child, and maternal health outcomes. This study investigates community-level influences on birth spacing outcomes among women aged 15-49 in Uganda and Zimbabwe, using Demographic and Health Surveys conducted in 2011 (Uganda) and 2010-2011 (Zimbabwe). Women living in communities with higher mean maternal age, mean age at marriage, and mean parity were significantly more likely to have longer birth spacing. Women living in communities with higher levels of contraceptive use and low levels of unmet contraceptive need were more likely to have short birth spacing. The significance of community-level demographic and fertility norms, gender norms, economic prosperity, and family planning behaviors demonstrate the broad influence of community variables on birth spacing outcomes. This analysis highlights the importance of moving beyond individual and household-level interventions in order to harness the power of contextual influences on birth spacing.
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Raznahan A. Sizing up the search for autism spectrum disorder (ASD) risk markers during prenatal and early postnatal life. J Am Acad Child Adolesc Psychiatry 2014; 53:1045-7. [PMID: 25245346 PMCID: PMC4862369 DOI: 10.1016/j.jaac.2014.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 08/08/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Armin Raznahan
- National Institute of Mental Health (NIMH) and the National Institutes of Health Intramural Research Program, Bethesda, MD.
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Naimi AI, Moodie EEM, Auger N, Kaufman JS. Stochastic mediation contrasts in epidemiologic research: interpregnancy interval and the educational disparity in preterm delivery. Am J Epidemiol 2014; 180:436-45. [PMID: 25038216 DOI: 10.1093/aje/kwu138] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Low maternal education is consistently associated with increased risk of preterm delivery (PTD). The interpregnancy interval (IPI), defined as the time between the date of a previous birth and the conception date of the index pregnancy, may mediate this relationship. We estimated controlled direct effects to assess whether hypothetical interventions designed to increase IPIs would reduce the educational disparity in PTD. We introduce a technique for estimating controlled direct effects under interventions that set only some persons in the population to a specific mediator value. We used data from 847,618 singleton livebirths occurring in Quebec, Canada, between 1989 and 2010. Compared with mothers with some university education (≥14 years), mothers with less than high school (<11 years), high school (11 years), and some college (12-13 years) had excess PTD risks of 2.6% (95% confidence interval (CI): 2.4, 2.8), 1.5% (95% CI: 1.4, 1.7), and 1.0% (95% CI: 0.9, 1.1), respectively. Risk differences under an intervention corresponding to the Healthy People 2020 objective of reducing the number of mothers with IPIs less than 18 months by 3% were no different from those for the total relationship. Our results suggest that interventions designed to increase the length of short IPIs will yield no important change in the PTD disparity by maternal educational level.
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