Association between high-risk fertility behaviour and anaemia among urban Indian women (15-49 years)

BACKGROUND

Women in their reproductive age have tremendous health implications that affect their health and well-being. Anaemia is an indicator of inadequate dietary intake and poor health. Maternal malnutrition significantly impacts maternal and child health outcomes, increasing the mother's risk of dying during delivery. High-risk fertility behaviour is a barrier to reducing mother and child mortality. This study aims to examine the level of high-risk fertility behaviour and anaemia among ever-married urban Indian women and also examine the linkages between the both.

METHODS

Based on the National Family Health Survey's fifth round of data, the study analyzed 44,225 samples of ever-married urban women. Univariate and bivariate analysis and binary logistic regression have been used for the analysis.

RESULTS

Findings suggested that more than half (55%) of the urban women were anaemic, and about one-fourth (24%) of women had any high-risk fertility behaviour. Furthermore, the results suggest that 20% of women were more vulnerable to anaemia due to high-risk fertility behaviour. For the specific category, 19% and 28% of women were more likely to be anaemic due to single and multiple high-risk fertility. However, after controlling for sociodemographic factors, the findings showed a statistically significant link between high-risk fertility behaviour and anaemia. As a result, 16% of the women were more likely to be anaemic due to high-risk fertility behaviour, and 16% and 24% were more likely to be anaemic due to single and multiple high-risk fertility behaviour, respectively.

CONCLUSIONS

The findings exposed that maternal high-risk fertility behaviour is a significant factor in raising the chance of anaemia in ever-married urban women of reproductive age in forms of the short birth interval, advanced maternal age, and advanced maternal age & higher order. Policy and choice-based family planning techniques should be employed to minimize the high-risk fertility behaviour among Indian urban women. This might aid in the reduction of the malnutrition status of their children.

Factors affecting birth interval among mothers in Dabat district, Amhara Regional state, Northwest Ethiopia: A community-based cross-sectional study, 2022

Introduction

Birth interval is the time period from live birth to a successive pregnancy or successive live birth which is the recommended to be at least 2 years or at least 33 months respectively. Both short and long birth intervals are associated with poor health outcomes for both mothers and babies. Therefore, the main objective of this study is to assess the length of birth intervals and its predictors among reproductive-age women in Dabat district.Methods: community-based cross-sectional survey conducted from December 10/2020 to January 10/2021. This study was done on 1262 multi para women. Five days training was given for the data collectors and supervisors. Bivariable and multivariable ordinal logistic regression analysis were done. Those variables which had P-value less than 0.25 in the bi variable analysis were entered to multivariable ordinal logistic regression analysis. An adjusted odds ratio with a 95% confidence interval and P-value less than 0.05 was used to determine significant determinants of birth interval.

Result

This study revealed that the magnitude of short and long birth interval was 30.59% and 22.82% respectively. Wealth status (poor: AOR = 0.72, CI: 0.53, 0.97), maternal education (Diploma and above: AOR = 2.79, CI: 1.18, 6.56), ANC follow up (having ante natal care: AOR = 2.15, CI: 1.72, 2.69), husband occupation (Employed: AOR = 1.77, CI: 1.03, 3.01) and history of abortion (abortion: AOR = 2.48, CI: 1.08, 5.66) were statistically significant factors.

Conclusion

Higher percentage of mothers have either short or long birth interval. Birth interval is affected by socio demographic characteristics of mothers and husbands.

Physiological traits of newborn piglets associated with colostrum intake, neonatal survival and preweaning growth

Colostrum intake, which is critical for piglet survival after birth and growth up to weaning, greatly depends on piglet weight and vitality at birth. Our aim was to identify a set of biological variables explaining individual variations in colostrum intake, preweaning growth and risk of dying. Farrowing traits, morphological traits and colostrum intake were determined for 504 piglets born alive from 37 Landrace × Large White sows. A subset of 203 of these piglets was used to measure plasma neonatal concentrations of metabolites and hormones in blood collected from the umbilical cord at birth. From univariate analyses, we established that colostrum intake was positively associated with plasma neonatal concentrations of IGF-I, albumin, thyroid hormones (P < 0.001), and non-esterified fatty acids (P < 0.05), and was negatively associated with concentrations of lactate (P < 0.001). In a multivariable analysis, the variables explaining the variation in colostrum intake were piglet birth weight and rectal temperature 1 h after birth (positive effect, P < 0.001), time of birth after the onset of parturition, and fructose plasma concentrations at birth (negative effects, P < 0.001 and P < 0.05, respectively). Piglets that died within 3 days after birth had lower neonatal concentrations of albumin (P < 0.001), IGF-I and thyroxine (P < 0.01) than surviving piglets. Preweaning growth was positively associated with neonatal concentrations of IGF-I, thyroxine (P < 0.001), albumin and insulin (P < 0.05). Cortisol and glucose concentrations at birth were not related to colostrum intake, neonatal survival or preweaning growth. Multivariable analyses confirmed that colostrum intake was the predominant factor influencing piglet survival within 3 days after birth and preweaning growth. These results provide physiological indicators of piglet colostrum intake, besides birth weight. They also confirm the impact of time of birth during farrowing on colostrum intake and the crucial importance of physiological maturity at birth for postnatal adaptation.

Estimating the impact of birth interval on under-five mortality in east african countries: a propensity score matching analysis

BACKGROUND

Under-five mortality remains a global public health concern, particularly in East African countries. Short birth interval is highly associated with under-five mortality, and birth spacing has a significant effect on a child's likelihood of survival. The association between short birth intervals and under-five mortality was demonstrated by numerous observational studies. However, the effect of short birth intervals on under-five mortality has not been investigated yet. Therefore, this study aimed to investigate the impact of short birth intervals on under-five mortality in East Africa using Propensity Matched Analysis.

METHODS

A secondary data analysis was conducted based on the most recent Demographic and Health Survey (DHS) data of 12 East African countries. A total weighted sample of 105,662 live births was considered for this study. A PSM analysis was carried out to evaluate the effect of short birth intervals on under-five mortality. Under-five mortality was the outcome variable, while the short birth interval was considered a treatment variable. To determine the Average Treatment Effect on the population (ATE), Average Treatment Effect on the treated (ATT), and Average Treatment Effect on the untreated (ATU), we performed PSM analysis with a logit-based model using the psmatch2 ate STATA function. The quality of matching was assessed statistically and graphically. The common support assumption was checked and fulfilled. We have employed Mantel-Haenszel bounds to examine whether the result would be free from hidden bias or not.

RESULTS

The prevalence of short birth intervals in East Africa was 44%. The under-five mortality rate among mothers who had optimal birth intervals was 39.9 (95% CI: 38.3, 41.5) per 1000 live births while it was 60.6 (95% CI: 58.5, 62.8) per 1000 live births among mothers who had a short birth intervals. Propensity score matching split births from mothers into treatment and control groups based on the preceding birth interval. In the PSM analysis, the ATT values in the treated and control groups were 6.09% and 3.97%, respectively, showed under-five mortality among births to mothers with short birth intervals was 2.17% higher than births to mothers who had an optimal birth interval. The ATU values in the intervention and control groups were 3.90% and 6.06%, respectively, indicating that for births from women who had an optimal birth interval, the chance of dying within five years would increase by 2.17% if they were born to mother with short birth interval. The final ATE estimate was 2.14% among the population. After matching, there was no significant difference in baseline characteristics between the treated and control groups (p-value > 0.05), which indicates the quality of matching was good.

CONCLUSIONS

We conclude that enhancing mothers to have optimal birth spacing is likely to be an effective approach to reducing the incidence of under-five mortality. Our findings suggest that births to mothers with short birth intervals have an increased risk of death in the first five years of life than births to mothers who had an optimal birth interval. Therefore, public health programs should enhance interventions targeting improving birth spacing to reduce the incidence of under-five mortality in low-and middle-income countries like East African countries. Moreover, to achieve a significant reduction in the under-five mortality rate, interventions that encourage birth spacing should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets in East African countries.

The Crucial Role of Mothers and Siblings in Child Survival: Evidence From 29 Health and Demographic Surveillance Systems in Sub-Saharan Africa

A considerable body of research has studied the effects of siblings on child mortality through birth intervals. This research has commonly focused on older siblings. We argue that birth intervals with younger siblings may have equal or stronger effects on child mortality, even during a mother's pregnancy. Moreover, we contend that birth interval effects need to be considered only when siblings are coresident. Using longitudinal data from 29 Health and Demographic Surveillance Systems across sub-Saharan Africa, covering more than 560,000 children, we examine the proximate role of siblings and mothers in child mortality. We find that a birth interval of 24 months or more is advantageous for both older and younger siblings. The effect of a younger sibling on child mortality is more pronounced than that of an older sibling and adds to the effect of an older sibling. Moreover, child mortality is particularly low during a mother's subsequent pregnancy, contrasting the shock resulting from a younger sibling's birth. Further, we find that a mother's or sibling's absence from the household results in a higher risk of mortality, and the death of either reduces child survival up to six months before the death.

Modeling successive birth interval of women in Ethiopia: application of parametric shared frailty and accelerated failure time model

BACKGROUND

Both short and long birth intervals are associated with many risk factors and about 29% of births are short birth intervals in Ethiopia. The purpose of this study is to model the birth intervals of adult women aged 15-49 years using accelerated failure time and shared frailty models in order to analyze the birth intervals of Ethiopian women.

METHODS

The data was obtained from the 2016 Ethiopian Demographic and Health Survey (EDHS). Accelerated failure time with different baseline and shared frailty models are used for the analysis to identify important demographic and socio-economic factors affecting the length of birth intervals and correlates of the birth intervals respectively.

RESULTS

The data consists of 9147 women, of which about 7842 (85.5%) are closed interval and the rest of 1323(14.5%) are open interval. Accelerated failure time (AFT) result revealed that women education level, husbands education level, age at first birth, marital status, religion and family wealth index are significant factors affecting birth interval of women in Ethiopia.

CONCLUSION

Women with closely spaced births tend to have larger family sizes when compared with women with longer inter-birth interval. Longer successive birth interval tends to reduce the total fertility rate of women. Furthermore, improvements in socio-economic status and level of education of women associate with reduced fertility, improved maternal and child wellbeing, and longer birth interval.

The relationship between pelvic organ prolapse and short birth intervals in a rural area of Nepal

Background

Pelvic organ prolapse (POP) is one of the main contributors to reproductive health problems that affect women’s quality of life. Previous studies have reported the risk factors and prevalence of POP. The aim of this study is to examine the association between POP and short birth intervals in a rural area of Nepal.

Methods

A cross-sectional study was conducted in Panchapuri municipality, located in Surkhet District of Karnali Province in Nepal. A questionnaire was used to collect information on POP, birth intervals, and other known confounding factors, such as age and parity. Multiple logistic regression analysis was used to examine the association between minimum birth intervals and POP.

Results

The study recruited 131 women. The prevalence of POP was 29.8%. The mean (SD) of maternal age was 32.3 (0.7) years. The median parity was 2, with a range of 2–6 children. More than half (64.9%) of the women reported a minimum birth interval of less than 2 years. Maternal age at birth, minimum birth interval, parity, and latest birth interval were significantly associated with POP in univariate analyses. After adjusting for the potential confounding factors such as age and occupation, the minimum birth interval was significantly associated with POP [AOR = 3.08, 95% CI 1.04–9.19].

Conclusion

The prevalence of POP was high in this rural area of Nepal. Age, parity, occupation, and minimum birth interval were significantly associated with POP.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41182-021-00298-z.

Effect of intramuscular and intravaginal PGE-2 treatment compared to intramuscular oxytocin treatment in eutocic sows on the farrowing performance in a free farrowing system

A duration of parturition beyond 300 min negatively impacts the health of the sow and the survival of piglets during parturition. Hence, oxytocin is widely used to speed up the parturition. However, oxytocin's negative side effects raise the need of finding alternative treatments such as those already implemented in human medicine. The aim of this study was to evaluate the efficacy of Prostaglandin E2 (PGE2) applied intravaginally (PGE2-V) (1.0 mg) or intramuscularly (PGE2-M) (2.5 mg) to improve the parturition process after expulsion of the fourth piglet compared to a placebo (P-V), which was sterile intravaginal gel or intramuscular oxytocin application (OXY-M) (20 iu) in free farrowing systems.In total, 201 eutocic sows were examined after stratification by parity and random allocation into groups: 54 (P-V), 48 (OXY-M), 50 (PGE2-V), 49 (PGE2-M). Farrowing duration (time between first piglet and last piglet), piglet interval and placenta expulsion duration (time between first and last placenta) were recorded, and each piglet was scored for meconium staining and vitality. Furthermore, stillborn piglets were categorized into ante-partum and intra-partum deaths.Under the present conditions, neither administration of PGE2 nor oxytocin revealed a significant effect on the farrowing process or the vitality of the piglets when compared to untreated sows. Nonetheless, significant differences could be detected between PGE-2 and oxytocin treatments. The duration of farrowing was significantly shorter in oxytocin-treated sows (156 min) compared to sows treated intramuscularly with PGE2 (238 min). Furthermore, the placenta expulsion duration in the OXY-M group (130 min) significantly differed from PGE2-V (198 min) and PGE2-M group (218 min). Although these accelerations of parturition might be considered as a beneficial effect, routine treatment with uterotonic agents after birth of the fourth piglet in free farrowing eutocic sows cannot be recommended, because an overall benefit when compared to untreated sows was not approved.

Association between modern contraceptive use and child mortality in India: A calendar data analysis of the National Family Health Survey (2015-16)

Background

Influence of contraceptive use on increased gap between successive births and attributed reduced risk of child deaths is well documented in developing countries. However, there is scarcity of evidence on direct contribution of contraceptive use on child survival especially in Indian context.

Methods

Using information given in the reproductive calendar history of the National Family Health Survey of India conducted in 2015–16, this study examines the effect of modern contraceptive use on childhood mortality – infant mortality rate (IMR) and under-five mortality rate (U5MR). Bivariate analysis and cox proportional hazard model is applied in the study.

Results

Finding reveals that use of reversible contraceptives prior to birth resulted in low childhood mortality rates. IMR is 35 per 1000 live births among births with preceding use of modern reversible contraceptives as compared to 44 per 1000 live births among births with no use. Similarly, U5MR is 41 per 1000 live births as compared to 61 per 1000 live births among births with preceding use of contraceptive and no use respectively. The use of reversible modern contraceptives prior to birth is protective against child mortality even among births with preceding birth interval of less than 24 months.

Conclusions

This study provides evidence of dual benefit of contraceptive use. Such information is important for promoting evidence-based advocacy to expand use of family planning services. This will help the country to achieve Sustainable Development Goal 3.2 which calls for end of preventable deaths during childhood.

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First paper providing evidence of direct effect of modern contraceptive use on child mortality in India.

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Contraceptive use increases birth intervals, and births with large preceding birth intervals have higher chances of survival.

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Use of modern contraceptive prior to birth reduces risk of child mortality even in the absence of large birth intervals.

Recent Trends in Birth Intervals in Sweden: A Decline of the Speed-Premium Effect?

The so-called speed-premium, introduced in Sweden in the 1980s and still in effect in 2018, grants some advantages regarding parental leave benefits for parents that have two births within a set number of months. Previous research has shown a great increase in the prevalence of short birth intervals in the 1980s and 1990s associated with the introduction of this policy. This study shows that the previously documented spike in short birth intervals has mostly disappeared in recent years. By the 2010s, the pattern of birth intervals is similar to that seen around the time of the introduction of the speed-premium in the early 1980s. Altogether the present results suggest that the effect of the speed-premium on birth spacing is relatively small in recent years.

Influence of habitat conditions on group size, social organization, and birth pattern of golden langur (Trachypithecus geei)

We studied endangered golden langurs in fragmented and altered habitats to understand the consequences of habitat conditions on group size, social organization, and birth seasonality. We selected 12 groups inhabiting forest edge and forest core of Chakrashila Wildlife Sanctuary (henceforth Chakrashila WLS) and adjoining the Abhaya rubber plantation. Each group was monitored every month from May 2013 to September 2016 and recorded the age-sex of individuals in the group. The births were recorded with the individual identity of females in five focal groups. The overall group size of golden langur was 11.3 ± 3.5_SD, and ranged between 5 and 18. The mean group size in forest core, forest edge, and rubber plantation differed significantly. We recorded a total of 46 births in 12 groups across the three different habitats. The number of infants correlates positively with adult females and group size across all the 12 groups for all the years. The number of births that occurred in all the months varied significantly across the months. Births occurred in all the months but peaked between May and September (82.6%). The mean number of births positively correlated with mean monthly rainfall. Mean inter-birth interval was 24.5 ± 1.6_SD months that did not vary between the females. It therefore appears that group size is sensitive to forest type, and births are positively related to social and environmental factors. The behavioral parameters may influence life-history traits if continuous habitat alteration persists.

Pattern and determinant factors of birth intervals among Iranian women: a semi-parametric multilevel survival model

The interval between successive pregnancies (birth interval) is one of the main indexes used to evaluate the health of a mother and her child. This study evaluated birth intervals in Iran using data from the Iranian Multiple Indicators Demographic and Health Survey (IrMIDHS) conducted in 2010-2011. A total of 20,093 married Iranian women aged 15-54 years from the whole country constituted the study sample. Based on the nature of sampling and the unobserved population heterogeneity for birth intervals in each city and province, a multilevel survival frailty model was applied. Data were analysed for women's first three birth intervals. The median first and second birth intervals were 30.3 and 39.7 months respectively. Higher education, Caesarean delivery, contraceptive use and exposure to public mass media were found to decrease the hazard rate ratio (HRR) of giving birth. Meanwhile, higher monthly income increased the hazard of giving birth. The results suggest that public mass media can play an effective role in encouraging women to have the recommended birth interval. Furthermore, increasing family income could encourage Iranian couples to decrease the time to their next birth.

Further Evidence of Within-Marriage Fertility Control in Pre-Transitional England

The identification of parity effects on the hazard of a next birth in cross-family data requires accounting for heterogeneity in fecundity across couples. In a previously published article, Cinnirella et al. Demography, 54, 413-436 (2017), we stratified duration models at the maternal level for this purpose and found that the hazard of a next birth decreases with rising parity in historical England. Clark and Cummins Demography, 56 (2019) took issue with this finding, claiming that the result is a statistical artifact caused by stratification at the maternal level. This reply documents that our previous finding is robust to addressing Clark and Cummins' critique.

Suboptimal child spacing practice and its associated factors among women of child bearing age in Serbo town, JIMMA zone, Southwest Ethiopia

INTRODUCTION

Birth spacing is the time gaps between two consecutive life births. Optimal spacing until the next pregnancy is the resting period that allows the mother time to recover from pregnancy, and labor. Birth interval of 3 to 5 years increases maternal health and child survival and family planning programs have advocated this birth interval.

OBJECTIVES

To assess prevalence of Suboptimal Child spacing practice and its associated factors among Women of Child bearing age in Serbo town, Jimma Zone Southwest Ethiopia.

METHODS

Community based cross sectional study was conducted on a total of 314 women of child bearing age from March to April 2017 who were selected by simple random sampling. A semi structured questionnaire which was pretested was used to collect the data. Data was checked for completeness and analyzed using SPSS V.20. Bi-variable logistic regression and multi- variable regression were done for predictor variables associated at p-value < 0.05 with the outcome variable.

RESULT

The prevalence of short birth interval in this study was 59.9%. Independent predictors like age at first marriage (AOR: 2.10, 95% CI = 1.19, 3.69), sex of index child (AOR: 1.964, 95% CI = 1.05 3.96), educational status (AOR: 3.05,95% CI = 1.68, 3.83), duration of breastfeeding (AOR: 3.09, 95% CI = 1.38, 6.96) and use of modern contraceptives (AOR: 1.94, 95% CI = 1.09, 3.45) were found to be statistically associated with short birth interval.

CONCLUSION AND RECOMMENDATION

Majority of the study respondents were practicing short birth interval. Education level, age at first marriage, having female child, short duration of breastfeeding and not using of modern contraceptives were factors associated with the outcome variable. Therefore awareness about modern contraceptive utilization, importance of breastfeeding as birth spacing mechanism and impact of early marriage are recommended.

The effect of sex of last child on short birth interval practice: the case of northern Ethiopian pregnant women

Objective

Improving short birth interval practice is a key strategy to reduce maternal mortality, neonatal mortality, adverse pregnancy outcomes, high fertility rate and undermining economic development efforts. However, there were limited evidences on short birth interval practice and its determinant factors in Ethiopia. This study aimed to determine the prevalence of short birth interval practice and associated factors among pregnant women. Institutional based cross-sectional study was conducted among 418 pregnant mothers using stratified sampling technique. Multivariable logistic regression analysis was performed at the level of significance of P-value < 0.05.

Result

Short birth interval practice was found to be 40.9%. Child death (AOR = 3.60, 95% CI 1.35, 9.59), female child (AOR = 2.03, 95% CI 1.12, 3.67), younger maternal age (AOR = 4.23, 95% CI 1.14, 12.66), contraceptive non-use (AOR = 8.15, 95% CI 4.17, 15.94), increase duration of breastfeeding (AOR = 4.72, 95 CI% 1.10, 20.60) and home delivery (AOR = 4.75, 95 CI% 2.30, 9.79) were found to be significantly associated with short birth interval practice. The prevalence of short birth interval practice is high. Multi disciplinary approach through improving maternal and child health care are recommended to prevent short birth interval practice.

Births during 7 years after the translocation of a pair of black-and-gold howler monkeys (Alouatta caraya) to a forest fragment in southeast Brazil

Fecundity in female primates is influenced by the nutritional condition. If when translocated howler monkeys exhibit the same breeding patterns as non-translocated members of the same genus, it is an indication that the translocated monkeys have become well adapted to their release site and that they are likely in good nutritional condition. The objective of this study was therefore to investigate this pattern by recording copulations (over 5 years) and births (over 7 years) after the translocation of a pair of black-and-gold howler monkeys (Alouatta caraya) and to evaluate their gestation period, seasonality of births, and intervals between births. The pair was released in November 2009 on the campus of the University of São Paulo in Ribeirão Preto, São Paulo State, Brazil. Data on copulations were collected from January 2010 to March 2011 and from January 2012 to December 2014. Births were collected from January 2010 to December 2016. During the 5-year observation period, 25 copulations were recorded. Seven births were recorded over a period of 7 years, which included reproduction of the offspring of the translocated pair. Births occurred in the dry season between April and August. The interval between births was approximately 1 year. Our data provide insight into the reproduction of howler monkeys that have been translocated to a new habitat. Translocation can provide a valuable approach for rescuing or restoring Alouatta, whose populations have been detrimentally impacted by long-term habitat fragmentation.

Primipaternity and birth interval; independent risk factors for preeclampsia

Background: The exact cause of preeclampsia remains unknown. The past decade has seen an ongoing debate on the relative importance of primipaternity versus prolonged birth/pregnancy interval.Aims: The aim of the current study was to analyze these two major potential risk factors in a high risk population in the Northern suburbs of Adelaide; a socioeconomically disadvantaged area characterized by instable relationships and overall poor health and lifestyle.Methods: A retrospective cohort study was performed on all multigravid women birthing at the Lyell McEwin Hospital, Adelaide, from July 2011 to August 2012; 2003 patients were included in this analysis. Basic demographic data, previous pregnancy outcomes, paternity, and birth and pregnancy intervals were recorded.Results: Women with a previously normal pregnancy had a significantly increased risk of developing preeclampsia in subsequent pregnancy with a new paternity (OR: 2.27 [p = .015]). Increasing birth and pregnancy intervals were associated with a significantly increased risk of developing preeclampsia in later pregnancies, with OR 1.39 at 3 years (p = .042) and OR 2.05 at 4 years (p = .002).Conclusions: The results of this study indicate that both prolonged birth interval and primipaternity are independent risk factors for preeclampsia in multigravidae.

Does planning of births affect childhood undernutrition? Evidence from demographic and health surveys of selected South Asian countries

OBJECTIVE

The prevalence of child undernutrition in South Asia is high, as is also the unmet need for family planning. In previous literature, the biodemographic relationship of family planning, particularly birth order and birth spacing, and nutritional status of children have been assessed separately. The aim of this study was to work on the hypothesis that the planning of births comprising timing, spacing, and number of births improves child undernutrition, especially in the areas with high prevalence of stunting and underweight.

METHODS

We used recent Demographic and Health Survey data from four selected South Asian countries. Binary logistic regression models were applied to estimate the adjusted percentage of stunting and underweight by identified independent factors.

RESULTS

Findings suggested that after controlling for other socioeconomic factors, children in the first birth order with >24 mo of interval between marriage and first birth have a lower risk for stunting (20%; p <0.01) and underweight (14%; p <0.05), respectively, than other scenarios of the planning of births. The probability of child undernutrition is lower among children born with >24 mo of birth spacing than its counterpart in all birth orders, but the significance of birth spacing reduces with increasing birth orders.

CONCLUSION

Appropriate planning of births using family planning methods in countries with high birth rates has the potential to reduce childhood undernutrition. Thus, the planning of births emerges as an important biodemographic approach to eradicate childhood undernutrition especially in developing regions like South Asia and thereby to achieve sustainable development goals by 2030.

Maternal high-risk fertility behavior and association with chronic undernutrition among children under age 5 y in India, Bangladesh, and Nepal: Do poor children have a higher risk?

OBJECTIVES

We aimed to examine whether an association exists between maternal high-risk fertility behavior and chronic undernutrition among children under 5 y of age. In addition, we explored the relationship between poverty and high-risk fertility behavior and the relative roles they play as obstacles in the reduction of the risk of undernutrition among children.

METHODS

The analysis was based on responses from married women ages 15 to 49 who lived with at least one child under the age of 5; and three cross-sectional, nationally representative samples from India, Bangladesh, and Nepal were considered.

RESULTS

Maternal high-risk fertility behavior was associated with an increased risk of chronic undernutrition among children in India, Bangladesh, and Nepal. Multiple high-risk categories appeared to have more profound consequences on the outcomes measured. Findings also demonstrated that with regard to the risk of undernutrition, children of mothers who were either poor or who experienced high-risk fertility were not uniquely disadvantaged.

CONCLUSIONS

The results suggest that with regard to the risk of chronic undernutrition, the negative effect of high-risk fertility behavior extends across all economic backgrounds and is not limited to children of mothers who were either poor or who experienced high-risk fertility.

A first look at the effects of long inter-pregnancy interval and advanced maternal age on perinatal outcomes: A retrospective cohort study

BACKGROUND

After China's One-child Policy was replaced with the Two-child Policy in 2013, the rate of second pregnancies with a longer inter-pregnancy interval (IPI) has suddenly increased in that country; however, the effect of long IPIs (≥49 months) on perinatal outcomes remains unreported.

METHODS

This was a retrospective cohort study in China from July 2015 through June 2016. We used univariate and multivariate logistic regression models to test the associations among IPI, maternal age, and perinatal outcome (preterm delivery, term low birthweight, and small-for-gestational age). We included baseline factors and variables with biological plausibility as confounders.

RESULTS

Our analytic sample included 3309 second pregnancies. The mean IPI was 75.36 months. Compared with second pregnancies with a short IPI of 7-24 months, those with long IPIs had higher adjusted odds ratios (ORs) of preterm delivery (1.70-2.00 [95% CI 1.20-3.33]) and term low birthweight (2.16-2.68 [1.10-6.17]), but not small-for-gestational age. The mean maternal age at current delivery was 32.0 years. Compared with the reference group (25-29 years), second pregnancies for the oldest maternal age group (≥35 years) showed no statistically significant increased ORs for adverse perinatal outcomes.

CONCLUSION

Long IPI is a significant contributor to preterm delivery and term low birthweight. Health care providers need to pay close attention to preterm delivery prevention and fetal growth during prenatal care for second pregnancies where the mothers have long IPIs.

Rural-urban differentials in the rates and factors associated with post-neonatal mortality in Nigeria: Evidence from the 2013 national household survey

BACKGROUND

The burden of post-neonatal mortality remains considerably high in Nigeria. This study examines the rural-urban differences in post-neonatal mortality rates (PNMR) and associated factors in Nigeria.

METHODS

Dataset from the 2013 Nigeria demographic and health survey, disaggregated by rural-urban residence, was analyzed. PNMR was reported using frequency tabulation, whereas, factors associated were first evaluated using Chi-Square test and further examined using multivariable logistic regression analysis.

RESULTS

A total of 30384 singleton livebirths (20449 in rural and 9935 in urban residences) in the five years preceding the survey was included in this study. PNMR in rural and urban residences were 34 (95%CI: 31 - 38) and 22 (95%CI: 18 - 26) deaths per 1000 live births (P<0.001), respectively. In rural residence, living in the South-West region reduced the odds of post-neonatal mortality by 63% (Adjusted OR [AOR]: 0.372, 95%CI: 0.187 - 0.732)). In urban residence, poor wealth index (AOR: 1.660, 95%CI: 1.024 - 2.689), living in the South-East region (AOR: 2.902, 95%CI: 1.470 - 5.726), and home delivery (AOR: 1.539, 95%CI: 1.016 - 2.330) increased the odds of post-neonatal mortality. Regardless of residence, the use of solid cooking-fuels (Rural: AOR: 2.394, 95%CI: 1.211 - 4.734; Urban: AOR: 1.912, 95%CI: 1.206 - 3.030), birth interval < 24 months (Rural: AOR: 1.880, 95%CI: 1.557 - 2.270; Urban: AOR: 1.630, 95%CI: 1.042 - 2.550) and lack of breastfeeding (Rural: AOR: 2.547, 95%CI: 2.089 - 3.105; Urban: AOR: 2.152, 95%CI: 1.496 - 3.096) increased the odds of post-neonatal mortality.

CONCLUSION

PNMR and associated factors differ in rural and urban Nigeria. Post-neonates in urban areas had better survival chances. Intervention efforts would need to prioritize findings in this study. This article is protected by copyright. All rights reserved.

Influence Factors on Birth Spacing and Childbearing Rates using Survival Recurrent Events Model and Parity Progression Ratios

BACKGROUND

Reproduction rates are declining in Hamadan, western Iran. This study identified the influence factors associated with reproduction rate and birth spacing in Hamadan as an area of low population growth in Iran.

STUDY DESIGN

A cross sectional study.

METHODS

The study considered reproductive status of 812 women referred to health care centers of Hamadan, western Iran in 2015. Data were obtained through frequency and percentage. PWP-GT model was used to determine the influence factors on women's reproductive by R software (version 3.3.2). The parity progression ratios were determined based on Yadava and Kumar.

RESULTS

The median time for the second, the third and the fourth birth was 4.53, 4.65 and 5.27 yr, respectively. PWP-GT model showed that women age at marriage (P=0.001), women's (P=0.005) and their husband's (P=0.039) employment had significant effect on time birth of first child. The women's education (P=0.001) was the only variable that had a significant effect on the birth time from the first to the second child as well as from the third to the fourth child. Education of women (P=0.001) and their husbands (P=0.034) had significant effect on the time interval from the second to the third child. The birth probability from marriage to the first birth (0 to 1st child) was high (0.91), while the probability had been fallen from the third birth and more (0.31).

CONCLUSIONS

Birth spacing in Hamadan is more than WHO recommended. In addition, reducing of the population growth and childbearing has started in the past few decades in Hamadan the same as Iran. The chance of fertility has dramatically declined from the third child and then.

Inter-pregnancy interval and pregnancy outcomes among women with delayed childbearing: protocol for a systematic review

BACKGROUND

Women in high resource nations are increasingly delaying childbearing until their thirties. Delayed childbearing poses challenges for the spacing of a woman's pregnancies. Inter-pregnancy intervals <12 months are associated with risk for adverse pregnancy outcome, yet increased maternal age at delivery is linked with increased risk. The optimal inter-pregnancy interval for older mothers is uncertain. This systematic review will aim to assess the relation between inter-pregnancy interval and perinatal and maternal health outcomes in women who delay childbearing to age 30 and older.

METHODS

We will search MEDLINE, CINAHL, and EMBASE databases for peer-reviewed articles on the effects of inter-pregnancy interval on perinatal and maternal health outcomes among women over 29 years at the time of first birth, in high-income countries. To assess the quality of studies, the Cochrane's Collaboration tool for assessing risk of bias will be used for randomized controlled trials, and the Newcastle-Ottawa tool to assess quality of case control and cross-sectional studies. The quality of the findings on each outcome will be assessed across studies, using the GRADE approach. The decision to conduct meta-analyses will be based on the concordance in definitions used for inter-pregnancy intervals, age groups studied, or outcomes measured among selected studies. We will report odds ratios and/or relative risks and/or risk differences for different inter-pregnancy intervals and perinatal and maternal outcomes as well as pregnancy complications.

DISCUSSION

This systematic review will summarize existing data on the relation between inter-pregnancy interval and perinatal and maternal health outcomes among women who delay childbearing to age 30 and older. Findings will inform clinical best practices to assist mothers over age 30 to space their pregnancies appropriately.

SYSTEMATIC REVIEW REGISTRATION

Prospero CRD42015019057.

Factors associated with infant mortality in Nepal: a comparative analysis of Nepal demographic and health surveys (NDHS) 2006 and 2011

Background

Infant mortality is one of the priority public health issues in developing countries like Nepal. The infant mortality rate (IMR) was 48 and 46 per 1000 live births for the year 2006 and 2011, respectively, a slight reduction during the 5 years’ period. A comprehensive analysis that has identified and compared key factors associated with infant mortality is limited in Nepal, and, therefore, this study aims to fill the gap.

Methods

Datasets from Nepal Demographic and Health Surveys (NDHS) 2006 and 2011 were used to identify and compare the major factors associated with infant mortality. Both surveys used multistage stratified cluster sampling techniques. A total of 8707 and 10,826 households were interviewed in 2006 and 2011, with more than 99% response rate in both studies. The survival information of singleton live-born infants born 5 years preceding the two surveys were extracted from the ‘childbirth’ dataset. Multiple logistic regression analysis using a hierarchical modelling approach with the backward elimination method was conducted. Complex Samples Analysis was used to adjust for unequal selection probability due to the multistage stratified cluster-sampling procedure used in both NDHS.

Results

Based on NDHS 2006, ecological region, succeeding birth interval, breastfeeding status and type of delivery assistance were found to be significant predictors of infant mortality. Infants born in hilly region (AOR = 0.43, p = 0.013) and with professional assistance (AOR = 0.27, p = 0.039) had a lower risk of mortality. On the other hand, infants with succeeding birth interval less than 24 months (AOR = 6.66, p = 0.001) and those who were never breastfed (AOR = 1.62, p = 0.044) had a higher risk of mortality.

Based on NDHS 2011, birth interval (preceding and succeeding) and baby’s size at birth were identified to be significantly associated with infant mortality. Infants born with preceding birth interval (AOR = 1.94, p = 0.022) or succeeding birth interval (AOR = 3.22, p = 0.002) shorter than 24 months had higher odds of mortality while those born with a very large or larger than average size had significantly lowered odds (AOR = 0.17, p = 0.008) of mortality.

Conclusion

IMR and associated risk factors differ between NDHS 2006 and 2011 except ‘succeeding birth interval’ which attained significant status in the both study periods. This study identified the ecological region, birth interval, delivery assistant type, baby’s birth size and breastfeeding status as significant predictors of infant mortality.

Association between high-risk fertility behaviours and the likelihood of chronic undernutrition and anaemia among married Bangladeshi women of reproductive age

OBJECTIVE

To explore the association between high-risk fertility behaviours and the likelihood of chronic undernutrition, anaemia and the coexistence of anaemia and undernutrition among women of reproductive age.

DESIGN

The 2011 Bangladesh Demographic and Health Survey, conducted from 8 July to 27 December 2011.

SETTING

Selected urban and rural areas of Bangladesh.

SUBJECTS

A total of 2197 ever-married women living with at least one child younger than 5 years. Exposure was determined from maternal reports of high-risk fertility behaviours. We considered three parameters, maternal age at the time of delivery, birth order and birth interval, to define the high-risk fertility behaviours. Chronic undernutrition, anaemia and the coexistence of anaemia and undernutrition among women were the outcome variables.

RESULTS

A substantial percentage of women were exposed to have a high-risk fertility pattern (41·8 %); 33·0 % were at single high-risk and 8·8 % were at multiple high-risk. After adjusting for relevant covariates, high-risk fertility behaviours were associated with increased likelihood of chronic undernutrition (adjusted relative risk; 95 % CI: 1·22; 1·03, 1·44), anaemia (1·12; 1·00, 1·25) and the coexistence of anaemia and undernutrition (1·52; 1·17, 1·98). Furthermore, multiple high-risk fertility behaviours appeared to have more profound consequences on the outcome measured.

CONCLUSIONS

Maternal high-risk fertility behaviours are shockingly frequent practices among women in Bangladesh. High-risk fertility behaviours are important predictors of the increased likelihood of women's chronic undernutrition, anaemia and the coexistence of anaemia and undernutrition.

Inter-pregnancy interval and risk of recurrent pre-eclampsia: systematic review and meta-analysis

BACKGROUND

Women with a history of pre-eclampsia have a higher risk of developing pre-eclampsia in subsequent pregnancies. However, the role of the inter-pregnancy interval on this association is unclear.

OBJECTIVE

To explore the effect of inter-pregnancy interval on the risk of recurrent pre-eclampsia or eclampia.

SEARCH STRATEGY

MEDLINE, EMBASE and LILACS were searched (inception to July 2015).

SELECTION CRITERIA

Cohort studies assessing the risk of recurrent pre-eclampsia in the immediate subsequent pregnancy according to different birth intervals.

DATA COLLECTION AND ANALYSIS

Two reviewers independently performed screening, data extraction, methodological and quality assessment. Meta-analysis of adjusted odds ratios (aOR) with 95 % confidence intervals (CI) was used to measure the association between various interval lengths and recurrent pre-eclampsia or eclampsia.

MAIN RESULTS

We identified 1769 articles and finally included four studies with a total of 77,561 women. The meta-analysis of two studies showed that compared to inter-pregnancy intervals of 2-4 years, the aOR for recurrent pre-eclampsia was 1.01 [95 % CI 0.95 to 1.07, I(2) 0 %] with intervals of less than 2 years and 1.10 [95 % CI 1.02 to 1.19, I(2) 0 %] with intervals longer than 4 years.

CONCLUSION

Compared to inter-pregnancy intervals of 2 to 4 years, shorter intervals are not associated with an increased risk of recurrent pre-eclampsia but longer intervals appear to increase the risk. The results of this review should be interpreted with caution as included studies are observational and thus subject to possible confounding factors.

Family planning practices prior to the acceptance of tubectomy: a study among women attending a maternity home in bangalore,india

INTRODUCTION

The extent of acceptance of contraceptive methods still varies within societies. Reliance on sterilisation is appearing earlier in marriage and among ever-younger ages and lower parities.

AIM AND OBJECTIVE

To study the family planning practices adopted by women who undergo tubectomy before the acceptance of tubectomy.

MATERIAL AND METHODS

Cross-sectional study of tubectomy acceptors who attended a corporation referral maternity home in Bangalore, India by interview method using a pre-designed a pre-tested structured questionnaire.

RESULTS

Majority 295(73.9%) of the study subjects had not practised any method of contraception before they underwent sterilisation. Increase in the education levels of the study subjects was associated with an increase in the contraceptive use (temporary methods) before they accepted tubectomy; this association was found to be statistically significant (p<0.0001).

Under-5 mortality in Tanzania: a demographic scenario

BACKGROUND

The government of the United Republic of Tanzania has initiated the Integrated Management of Childhood Illness program to improve the health and wellbeing of children.

METHODS

Tanzania's under-five mortality rate is still 1.7 times higher than the world average and, in order to achieve its Millennium Development Goal 4 target, its annual reduction rate is quite low at 2.2. The main aim of the study is to examine under-five mortality combined with the Data from the Tanzania Demographic and Health Survey 2008 data was used. Odds ratios for infant and under-five mortality were estimated using logistic regression; crude and adjusting models were adopted.

RESULTS

Mortality cases (18.3%) have been reported to children born with an interval of <24 months. Mothers with no education reported 14.6%, primary education mothers reported 11.1% and higher education reported only 5.3% (P<0.001). Therefore, maternal education plays is a major role on fertility and infant and under-five mortality behavior.

CONCLUSION

Maternal education also influences a mother's behavior in her usage of available health services to improve the health of the children. Further in-depth analysis is immensely needed in this situation.

Awareness and use of contraceptives among saudi women attending primary care centers in Al-qassim, saudi arabia

BACKGROUND

The overall rapid change in the socio-demographic pattern of the Saudi Arabian community, especially the changes concerned with women's education and work will be an important factor in changing fertility beliefs and behaviors with more tendencies to birth spacing and, consequently, the use of contraceptives.

OBJECTIVES

The study aimed to identify the perception of Saudi women regarding the use of contraceptives

METHODS

A cross-sectional study was conducted among Saudi women attending primary care centers of Al-Qassim Region. A structured questionnaire was developed to cover the research objectives. The dependant variable was the utilization of contraceptive methods and the socioeconomic variables were the independent variables.

RESULTS

The results identified the low knowledge level of the participant women regarding the variety of contraceptive methods. Most participants and their husbands showed acceptance to the use of contraceptives for birth spacing. They preferred birth interval of 2-3 years. They intended to have from 5 to 10 children. There was a significant increase in contraceptive use among working women, 30 years and older, with a higher level of education, and those having a large number of children. Multiple regression models revealed that the significant determinants of the use of contraceptives were women's working and education. The study recommended sustained efforts to increase awareness and motivation for proper contraceptive use.