Population Studies

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Assessment of trends and determinants of under-five mortality among children born to older women: Evidence from Ethiopian Demographic and Health Survey
(Addis Ababa University, 2024-08) Tamerat Denekw; Tariku Dejene (PhD)
Introduction: Mortality has long been used as an indicator of the level of socioeconomic development of a country. Global attention has been drawn to under-five mortality through the Sustainable Development Goals (SDGs). The burden of underfive mortality of children is still not fairly divided. Two regions account for around 80% of under-five deaths among children: sub-Saharan Africa and South Asia. Ethiopia is one of six nations that account for half of the world's under-five mortality. Methods: The Ethiopia Demographic and Health Survey (EDHS) from the years 2000, 2005, 2011, and 2016 provided nationally representative cross-sectional data. 6,199 children born to older women within the five years prior to the study formed the data. Home interviews were used to gather demographic data, such as mother and child characteristics, socioeconomic factors, and environmental variables. Multiplelevel regression analysis was utilized to get the Adjusted Odds Ratio (AOR) and its 95% confidence interval (CI). Result: The absolute number of under five deaths is 128/1000 live births in the year 2000 which reduce to 56/1000 live births in 2016. This study identified factors contributing for under-five mortality among children of women aged 35 to 49 years old. Sex of the child (female_ 0.65 (0.53, 0.79)), late age at first birth, 31 to 4o years at first birth 0.34 (0.11, 0.98), family size, having a family size of 6 to 10 0.18 (0.14, 0.24), longer birth interval, greater than 3 years 0.35 (0.26, 0.47) and ANC visits 1 to 3 ANC vests 0.65 (0.5, 0.84) lowered the odds of under-five mortality among children of relatively elders. On the other hand, Women aged 35 to 49 years who gave a twin Birth 6.15 ( 3.94, 9.6)), those with number of births in the last five years having 4 children (2.64 ( 1.15, 6.06) ), those with number of children ever born, having 9 or above children 3.79 ( 2.1, 6.84), those who gave birth at late age the index child, mother gave birth of the index child at late age (45 to 49) 2.13 ( 1.55, 2.93) had higher odds for their children experiencing child death before they celebrated their fifth birthday. Conclusion: The absolute number of under five deaths of older women is 128/1000 live births in the year 2000 which reduce to 56/1000 live births in 2016. Female children, children born from first from elder mothers, those children residing with large family size, children born with longer birth interval and children for whom their mothers received ANC visits were found to have lower odds of mortality.
Determinants of Fertility Preference among Currently Married Women in Kirkos Sub City, Addis Ababa
(Addis Ababa University, 2022-01) Tesfaw Ashebir; Chalachew Arega (Ato)
Background: For the context of this research, fertility preference refers to women's desire to have more children. Fertility preference studies are essential because actual fertility is largely determined by women's fertility preferences. However, there has been little research into fertility preferences in Ethiopia. As a result, this study was required to be carried out. Objective: The study's main objective was to assess the variables that influence the desire for more children. The socioeconomic, cultural, demographic, geographic, and contraceptive variables were selected, and a binary logistic regression model was fitted for the variables. Methods: a community based cross-sectional study was employed to assess the determinants of fertility preference among currently marriage women. A sample size of 417 mothers attending the above-mentioned services were interviewed. The collected data was cleaned, checked for completeness, compiled and entered into SPSS for analysis. A quantitative technique was used to identify the key determinant factors in the selected Kirkos sub city woreda 3 and 7. Results: The analysis showed that the women desire for more children were 70.7 percent, and the women not desire for more children was 29.3 percent. Controlling for the effect of others, according to the result obtained from logistic regression model, occupation, birth interval and the ideal number of children were found to have statistically significant effect on the desire for more children. CONCLUSION The main goal of this study was to identify the determinants of fertility preference among currently married women in Kirkos sub city Addis Ababa in Ethiopia. As this study conducted in urban area the result shows that there is until high desire for more children and it is much compatible with rural women regardless of determinant factors. Data on currently married women were utilized to assess the associations between each dependent variables and considered independent variables. For this study, among all independent variables considered, significant number of variables was found to affect the dependent variables. With regarded, the desire for more children was affected by occupation, ideal number of children and birth interval. Most of the findings obtained from this study were found to be compatible with other studies undergone worldwide. The result showed that the desire for more children vi and not had 70.7% and 29.3% respectively. for this study the significant variable for desire for more children was occupation, birth interval for the next birth and the women ideal number of children Therefore, the finding is important to adopt programs to discourage the desire for more children and decrease the fertility rate by considering these factors critically. Moreover, continuous education and knowledge on reproductive health will help for minimize fertility behavior for the women. RECOMMENDATION Based on the results of this study the following recommendation can be forwarded to help women to shift towards their reasonable best fertility preferences. 1. Better preferred waiting time could be encouraged when women are supplied with contraceptive use and must therefore be encouraged by district health offices and nongovernmental organizations working on reproductive health. 2. Educating women by health office, to prevent excess fertility, about the importance of small family size is important. 3. Government must revise its outlook on population matter and should develop clear population policy. It is not clear whether the current population policy is in effect or not. 4. There is a need to provide information to women by health office experts regarding the number of children they prefer in their life based on scientific evidence and their capacity to rear children.
Inequalities in maternal and child health service utilization and health related quality of life in four emerging regions of Ethiopia: Implications for fertility and child survival
(Addis Ababa University, 2024-03) Tigist Shumet; Negatu Regassa (PhD)
Background: According to the 2021 UN Sustainable Development Report, Ethiopia ranks 136 out of 165 countries in terms of performance of the SDG 3.2, with a statistical performance index of 53.6 in a scale of 0 (Worst) to 100 (best). The 2016 Ethiopian Demographic and Health Survey (2016 EDHS) shows an increase in the coverage of maternal health services that includes antenatal care (ANC), delivery care, and postnatal care for the mother. However, such improvements are accompanied by a substantial increase in geographic and social inequalities in the utilization of the services. The inequalities are visible and unacceptably high between geographically bordering emerging regions of Ethiopia (Afar, Somali, Gambela and Benishangul) and other regions of the country. Therefore, this study aimed to examine the levels of inequalities in key maternal and child health service utilization in four emerging regions of Ethiopia: namely Afar, Somali, Benishangul Gumuz, and Gambela Regions, and its implications for fertility and child survival. Methods: This study used data extracted from the 2016 Ethiopian Demographic and Health Survey, which was collected at the national level from January 18, 2016, to June 27, 2016, using a stratified twostage cluster sampling method. The study focused on women aged 15-49 years living in those emerging regions of Ethiopia: However, in addressing the fourth objective of the study, a scoping review and qualitative primary data were collected from the two emerging regions of Ethiopia (i.e., Afar and Somali regions). This research had six objectives, and except for the 4th objective of this study, the remaining used univariate analysis to describe the characteristics of the women included in this study. The study used various analysis techniques that matched its specific objectives, based on the relevant literature. For the quantitative data, multivariate mixed effect logistic regression, Blinder-Oaxaca decomposition, partial ecological approach, and Population Attributable Fraction (PAF) were used to examine the associations, inequalities, predictors, and impacts of maternal health service utilization in Ethiopia. For the qualitative data, thematic analysis was conducted to explore experiences and practice of women and health workers regarding barriers in contraceptive utilization. Results: This study found that women living in rural areas had a lower quality of life than those who are living in urban areas. Two socioeconomic factors, wealth index and educational attainment, explained a larger part of this inequality. The study also showed that there was a huge inequality in the demand and unmet need for contraception among women of age 15 to 49 years in the four regions. Several factors, such as women‘s and husband‘s education status, household wealth index, age of husband, husband‘s working status, region, and residence, were important predictors of the demand for contraception and xviii unmet needs for contraception. The study revealed that there were significant urban-rural inequalities in the utilization of maternal health care services, such as antenatal care (ANC), place of delivery, and postnatal care (PNC), in the four regions. The study demonstrated that key maternal health services, such as place of delivery and current contraceptive use, and socioeconomic factors, such as religion, type of place of residence, and wealth index, influenced the inequalities in fertility preference among high-parity women in the four regions. In addition, the study also indicated that Current contraceptive use and place of delivery accounted for 117% of the conventional risk factors for fertility preference in those emerging regions. Finally, the study also indicated that ANC and place of delivery accounted for 49% of the conventional risk factors for child survival in those emerging regions. Conclusion: The study examined the inequalities in MCH service utilization and HRQoL in four emerging regions of Ethiopia, and their effects on fertility and child survival. The study found significant urban-rural and socioeconomic inequalities in the quality of life, demand and unmet need for contraception, maternal health care services, fertility preference, and child survival among women and children in the four regions. The key factors that influenced these inequalities and outcomes were wealth index, education level, region, residence, religion, husband‘s working status, age of husband, ANC utilization, place of delivery, and current contraceptive use. The study also identified key maternal health services, such as place of delivery and current contraceptive use that accounted for half of the conventional risk factors that raised women‘s fertility preferences and reduced child survival in the study population. Recommendation: The study recommends that policymakers, stockholders, and researchers consider the following. Policymakers and local administrators should pay more attention to interventions that promote education and reduce the wealth gap among households in emerging regions of Ethiopia. Additionally, the government should enhance access to maternal health services, improve and reinforce existing fertility control programs and strategies, and advocate the benefits of using maternal health services in those regions. This would decrease inequalities in the use of key maternal health services and their impact on fertility and child survival in these four emerging regions. Finally, the study suggests that the government should prioritize improving service access and utilization by providing more budget and other resources to the respective disadvantaged regions and this will also help the desired decrease for existing inequalities. For future research, researchers may need to consider adopting a longitudinal design to track changes. They should also include other relevant variables that were omitted from this study, such as husband‘s perception, attitude, and influence on contraception use and unmet need, availability of service, and distance to the health facility.
Socio-demographic predictors of household hygiene and sanitation practice and its effect on child health index in Fitche Town, North Shoa, Oromia Region, Ethiopia
(Addis Ababa University, 2022-06) Belete Enja; Nigatu Regassa (Professor)
Background: Access to appropriate and adequate sanitation is fundamental to health, survival, growth and development, and the achievement of Sustainable Development Goals (SDGs). The lack of access to improved sanitation and the practice of open defecation had significant socioeconomic impacts on households without access and those living in communities where access to sanitation is poor. Objective of the study is to assess socio-demographic predictors of household hygiene and sanitation practice and its effect on child health index in Fitche town, Ethiopia. Method: A community based cross-sectional study was employed to assess socio-demographic predictors of household hygiene and sanitation practice, and its effect on child health. The minimum calculated sample size was 422 households drawn from Fitche town, North Shoa. The collected data were cleaned, checked for completeness, complied and entered to EPI(External Presentation Interface) data version4.4.3.1, then exported and analyzed using SPSS(Statistical Package for the Social Science), version 23. There were three outcome variables, namely; Hygiene, sanitation and child health index and a range of socio-demographic variables were used as potential predictors. Given the three outcome variables had count form, Poisson regression was used to analyze the determinants and effect of WASH on child health index. A total of 422 households were studied with the response rate of 99.3%. The mean age of respondent’s was 45 years (with SD=±12.125). The proportion of household that treated water with any method was 23.7%.The expected mean of household hygiene practice was significant for household income, level of education, occupation and source of drinking water. Similarly, the expected mean of household sanitation practice had significant association with the number of household in the compound, level of education and types of toilet facility. Whereas, the expected mean of child health index was significantly associated with household income, occupation, ethnicity, household sanitation practice, hand washing with soap and liquid waste disposal system.
Urban Household Food Insecurity and Demographic Outcomes: Implications for Fertility, Contraceptive Use and Under-Five Mortality in Lideta Sub-City, Addis Ababa, Ethiopia
(Addis Ababa University, 2024-06) Ephrem Tadesse; Terefe Degefa (Professor); Mengistu Ketema (Professor)
Food security and vulnerability assessments in Ethiopia have traditionally focused on rural regions. However, in contemporary policy discussions, the topic of urban food security has garnered significant attention. Household food insecurity increases the risk of morbidity and mortality in children. The current investigation endeavors to ascertain the covariates associated with household food insecurity and to analyze the interrelationship amongst demographic indicators, fertility, and childhood mortality in the Lideta sub-city, Addis Ababa, Ethiopia. A community-based cross-sectional study was conducted from February to March 2023 in the subcity. A total of 692 households were selected using a multistage sampling technique. The Pearson chi-square test ( 2 ) and regression models were used to assess the association between food insecurity and demographic outcomes. As the results show, the overall prevalence of household food insecurity in the study area was 66.5%. Regression results indicate that seven of the hypothesized nine demographic and socio-economic determinants of household food insecurity have a significant influence on the probability of being food-insecure (P < 0.05). Household food expenditure, dependency ratio, age, sex, educational status of the household head, access to savings and credit, and the urban productive safety net program were significant determinants of urban household food insecurity. Food insecurity status was also a significant predictor of the number of children ever born. Holding the other variables constant, the number of children ever born into food-secure households is 0.655 times lower compared to households with food insecurity. Similarly, the age of the mother, contraceptive use, women's income, and childhood mortality were significant in predicting the effect of the mean number of children ever born at P< 0.05. The findings further reveal a prevailing usage percentage of modern contraception of 50.5%. The utilization of contemporary contraceptive modalities was found to be markedly lower among food-insecure households (32.0%) in comparison to those who were food-secure (68.0%). It was found that households that experience food insecurity had a significantly reduced likelihood, by 76.5%, of contraception. Similarly, a positive attitude towards contraceptive use, utilizing family planning information services, discussion on contraceptive techniques with partners, women's income, and childhood mortality have a significant association with contraceptive use at p 0.05. Likewise, food insecurity status was a significant predictor of under-five mortality. Food-insecure households were 3.89 times more likely to experience under-five mortality as compared to food-secure households. Similarly, xi women's education, age at first birth, initiation of breast feeding, age and sex of the child, birth order, and children ever born were significant predictors of under-five mortality at p < 0.05. The reduction of household size, amelioration of the dependency ratio, and improvement of other socio-economic factors collectively serve the purpose of empowering households to enhance their resilience in the context of food insecurity, which in turn improves fertility and child survival. Accordingly, policymakers ought to adopt measures aimed at enhancing stability in the food market and generating prospects that can enhance the living standards and economic capabilities of urban households.
Client Satisfaction and Its Determinants among Family Planning Service Utilizer In Arada Sub-City, Addis Ababa, Ethiopia
(Addis Ababa University, 2023-10) Aknanaw Bezabih; Chalachew Getahun (PhD)
Background of the study: Family planning is a conscious decision by individuals or couples to choose for themselves when to start having children, how many children to have, how to space them or when to stop having children by using (modern) contraception and natural methods. Good quality care in family planning services helps individuals and couples meet their reproductive health needs safely and effectively. Objective: To assess the quality of family planning services and its determinants in public health centers of Arada sub-city Addis Ababa, Ethiopia. Method: Facilitybased cross-sectional study was conducted from 15th March to May 25 th 2023 on family planning clients in Arada sub-city Addis Ababa, Ethiopia. Systematic simple random sampling technique was used to get a total of 301 clients in ten health centers as study population. Data was collected using structured questionnaires and was analyzed using SPSS version 24. Bi-variable and multivariable analysis was used to identify the determinant factors associated with client satisfaction among family planning service utilizers in Arada sub-city. Result: The study revealed the quality measure components as 98% for regular availability of methods, 78.5% for information provision with full explanation of methods, 78% for interpersonal relationship with communication clarification, 97.7% clients’ agreement on provider competence. The overall composite satisfaction score was 75.2%. The multivariable analysis results revealed that the service quality satisfaction for those clients’ marital status, educational status, source of information, and the availability of sufficient methods were important factors and significance associations. Regarding marital status, the results showed that being married (78.1%), divorced (62.5%), or widowed (58.3%) was significantly associated with a higher perception of receiving quality family planning service compared to being single. Married had a crude odds ratio (COR) of 4.854, divorced had a COR of 8.100, and widowed had the highest COR of 9.643. The marital status (married, divorced, or widowed) associations were statistically significant with p-values of 0.038, 0.007, and 0.007, respectively. Overall, the interview results indicate that most family planning service providers are skilled and educated in providing high-quality services, even though there is room for improvement. Conclusion: This study revealed that about three-fourth (75.2%) of the clients was satisfied with the service they received and the overall quality measure is good in the provisions of FPS. However, approximately one third of the clients (23.5%) express the need for targeted improvements in two specific areas: the availability of supplies and the presence of trained personnel. By addressing these areas, it is believed that client satisfaction regarding the quality of family planning services can be enhanced, leading to better alignment with client needs. Policymakers and healthcare providers should consider these factors when designing targeted interventions and improving service delivery to ensure equitable access to family planning services, and to explore additional factors and their impact on the quality of family planning services to ensure comprehensive and effective reproductive healthcare services.
Assessment of Tuberculosis-Induced Risk of Fertility Delay among Women of Reproductive Age 15-49 at Saint Peter Specialized Hospital, Addis Ababa.
(Addis Ababa University, 2024-06-06) Addisalem Lemma; Mulugeta Bezabih (PhD)
Title: Assessment of tuberculosis-induced risk of fertility delay among women of reproductive age 15-49 at saint peter specialized hospital, Addis Ababa: A Comparative Cross-Sectional Study Background: The global fertility landscape is shifting, with approximately 97% of countries projected to have fertility rates below the replacement level by 2100. Despite this overall decline, understanding, the impact of specific health conditions on fertility remains crucial. This study investigates the association between TB infection and fertility delay among women aged 15-49 at Saint Peter Hospital in Addis Ababa. Methods: We conducted a comparative cross-sectional study, comparing two distinct groups: women with TB and women without TB. Our quantitative approach emphasized numerical data, statistical analysis, and objective measurements. Results: Among TB-negative women, 68.5% experienced no fertility delay, while 31.5% did experience fertility delay. Among TB-positive women, only 20.8% experienced no fertility delay, while a significant 79.2% experienced fertility delay. There is a clear association between TB diagnosis and fertility delay, with TB-positive women being more likely to experience fertility delay compared to TB-negative women. Income >16,501 ETB significantly increases the odds of fertility delay, while income <5,500 ETB also raises the odds, possibly due to financial stressors. Addressing economic disparities is crucial for reproductive health outcomes. Other factors associated with fertility delay include fertility treatments, sexually transmitted infections, maternal health challenges, smoking, and TB transmission. TB treatment plays a crucial role in maintaining reproductive health. Additionally, TB treatment may influence menstrual irregularities in women of reproductive age, warranting further research to explore underlying mechanisms and potential interventions. Demographic factors such as age, income, occupational status, marital status, and maternal health care challenges also require investigation, considering confounding factors for a comprehensive understanding. Conclusion: Understanding the impact of TB infection on fertility delay is vital for informed reproductive health policies and interventions.
Youths' Transition to Adulthood in Oromia Region, Ethiopia: Reproductive Endeavors and Successes
(Addis Ababa University, 2024-03) Tariku Dejene; Eshetu Gurmu (PhD)
The transition from childhood to maturity is a journey, not a destination. It is a time of exploration, growth, and transformation. Young people's transition to adulthood entails managing a number of changes as they choose their future paths and adjust to these life-changing events. As a result, it is a crucial phase in human development wherein youths transition from childhood and take on new roles and responsibilities. The study differentiates between reproductive endeavors and the reproductive successes of youths as they can have different implications for youths. By considering the life course theory as a framework, the study attempted to assess youths' reproductive endeavors and success in the Oromia National Regional State of Ethiopia. The interest in the life course theory is to investigate how people's lives progress over time. The theory contends that various factors shape people's lives, including individual characteristics, familial and social networks, and the historical and cultural context in which they live. The study employed a mixed-method approach; while the quantitative data were drawn from 2005, 2011, and 2016 Ethiopian Demographic and Health Surveys, the qualitative data were collected from youths residing in the Oromia regional state using an in-depth interview. The study used a variety of analysis techniques. First, sequence analysis was employed to identify the reproductive trajectories of youths and make an inter-cohort comparison of these trajectories on three different synthetic cohorts. Secondly, flexible parametric survival models were fit to explore the factors that shaped the reproductive trajectories. Thirdly, a decomposition analysis was employed to explain the gender gap in the reproductive transition of youths. Finally, the qualitative data were analyzed using thematic analysis using MAXQDA software. First, the study focused on identifying the patterns of reproductive trajectories among youths in Oromia, Ethiopia. Three reproductive role indicators were utilized, and four different typologies of reproductive trajectories among the youth were identified. The study's findings are noteworthy, as they suggest that changing norms in reproductive behavior are occurring among less educated youth. Thus, the study provides valuable insights into the changing patterns of reproductive behavior among youth in Ethiopia and highlights the importance of education and targeted interventions in promoting positive reproductive health outcomes. XII Secondly, the timing and intensity of reproductive transitions among youths and their correlates in Oromia, Ethiopia, were analyzed. The use of data from multiple demographic health surveys spanning over a decade allows for a robust analysis of trends and changes in reproductive patterns. Regardless of the changing pattern in the reproductive transition of youths, the study finds that family formation takes the major share of the transition. However, early premarital sexual initiation is rising as a competing risk to the marital union over time, which is considered as the main precursor to social ills such as early and single parenthood. The persistence of a gender gap in reproductive transition highlights the need to address the excessive risk female youths face. Education, although not found to reduce the risk of sexual debut significantly, remains an essential tool for empowering youths, particularly females, to make informed decisions about their reproductive health. Thus, the study provides insights into the reproductive behavior of youths, underscoring the importance of policy revisions and interventions that consider these gender gaps in reproductive transitions to encourage positive reproductive transitions. Thirdly, the study investigated the factors contributing to the gender gap in the reproductive transition of youths using data from the 2011 and 2016 Ethiopian Demographic and Health Survey. The results show that premarital sex prevalence increased with a delay in age at first marriage among youths. The gender gap in reproductive transition was found to be triggered by both compositional and structural effects of covariates such as education, modern contraceptive use, and media exposure. The study recommends addressing structural components in addition to reducing inequalities in education, media exposure, and deprivation between male and female youths to close the gender gap in reproductive transition. Finally, the study investigated the perception of youths about a successful transition to adulthood, the challenges, and the required social support to overcome the challenges. The study's findings suggest that reproductive transition is a crucial indicator of a successful transition to adulthood. The challenges identified, such as unpreparedness, health risks, and erosion of cultural norms, should be addressed through policies and strategies that promote access to accurate information and resources and emotional and financial support. Additionally, the importance of community and family involvement in supporting young people during their reproductive transition is highlighted.
Assessment of Determinants of Perinatal Mortality among Public Hospital Deliveries in Addis Ababa, Ethiopia: An Unmatched Case Control Study
(Addis Ababa University, 2023-10) Micky Birhanu; Tariku Dejene (M.SC.)
Background: According to accepted terms, the period known as the perinatal period begins at week 22 of pregnancy and lasts until day seven following delivery. However, different nations' legal systems have varying definitions of late fetal death (stillbirth). Late fetal death is seen as occurring at and after the 28th gestational week in the majority of poor nations, notably Ethiopia as well as in some affluent ones. Even though there has been a marked decline in fatality among babies of post-neonatal age in Ethiopia, the rate of infant deaths during the perinatal period continues to be substantial. This research has identified the determinant factors and causes of perinatal mortality in Addis Ababa, Ethiopia. Objective: The aim of this study is to assess determinants of perinatal mortality among public hospital deliveries in Addis Ababa, Ethiopia. Method: A hospital based unmatched case control study was carried out. In all, 318 samples (106 cases and 212 controls) were collected from Addis Abeba's three government hospitals. Cases were perinatal deaths and controls were live births and neonates who were discharged alive from the hospital and did not die before the age of 7 days. The study period was from 1st March – 31st May. For data input and analysis, Epi-Info version 7.0 and SPSS version 23 were utilized. Logistic regression model was utilized to identify the variables that are determinants of perinatal death. Results: Obstetric complication occurred in 42.5% of cases and 18.9% of controls. Obstetric complications (AOR 4.399; 95%CI (2.288 - 8.456)), very low birth weight (AOR 5.033; 95%CI (1.499 - 16.896)) and low birth weight (AOR 14.479; 95%CI (4.484- 46.749)) were the determinants of perinatal mortality that increase risk of perinatal death. Whereas, education (AOR 0.135; 95%CI (0.037 - 0.492)) and partograph use (AOR 0.374; 95%CI (0.176 - 0.797)) were found to be protective factors for perinatal mortality. Conclusion & recommendation: The determinants of perinatal mortality in the study area were largely educational status, obstetric complications, low birth weight and partograph use. Some of them can be avoided by examining pregnant women early on and monitoring them after delivery.
Demographic and Socio-Economic Determinants of Fertility and Implications among Married Women in Bishoftu Town, Oromiya, Ethiopia
(Addis Ababa University, 2024-01) Milkessa Birhanu; Terefe Degefa (Prof.)
The main objective of the study was to investigate the demographic and socio-economic determinants of fertility and implications among married women in Bishoftu Town, Oromiya, Ethiopia. Interviewer-administered questionnaires were used in a community-based crosssectional study with 422 randomly chosen respondents in Bishoftu Town. A mixed method study approach (Quantitative and Qualitative study) was used. Primary data were collected from 422 married women in the study area and analyzed using SPSS (Statistical Package for Social Sciences) version 25 software. Simple frequencies, cross- tabulation and regression model were used to analyze the data. Five FGDs have been organized on the 6 major themes [Relationship between mortality and the number of children women want to have; the relationship between educational level of women and the number of children they want to have; the impact of family, neighborhoods and communities on the number of children women want to have; age of first marriage and the number of children women can have in their lifetime and its influences; the relationship between high and low birth rates and national development] and analyzed accordingly. The income of the respondents, the educational status of the women, and age at first marriage significantly determine fertility status among married women in Bishoftu town. About 44.5 % of women who had no education had 5 or more live births but only 2% of women who completed more than secondary school had 5 or more live births. Women with more than secondary school educational status were 58.4% less likely to have high fertility status compared to those who had no education (aIRR=0.416; 95% CI: 0.230-0.753). On the other hand, women who experienced infant mortality were 18.8% more likely to have more children than those who did not experience infant mortality (aIRR=0.812; 95% CI: 0.725-1.002). Women who earn 6000 ETB and above monthly income were found to be 19.8% less likely to have more children when compared to women who earn less than 1000 ETB monthly income (aIRR=0.802; 95% CI: 0.456- 1.411). Based on the findings of the study, to decrease high fertility, the government and concerned bodies are expected to avail appropriate mechanisms and control systems that influence women’s age at first marriage
Determinants of Postnatal Care Service Utilization in Public Health Center of Kirkose Sub-City Addis Ababa, Ethiopia
(Addis Ababa University, 2022-03-27) Yemisrach Ayalew; Chalachew Arega (Mr.)
Postnatal care (PNC) is a period immediately after delivery to six weeks. It is critical but the most ignored period. A large percentage of maternal and neonatal deaths occur during 48 hours following childbirth. Obtaining the recommended three postnatal check-ups within seven days of delivery plays a vital role in preventing maternal and neonatal deaths. So the objective of this study to assess the Determinants of postnatal care service utilization in public health center of kirkos sub city with the method of an institutional-based cross-sectional study design with mixed (quantitative and qualitative approaches. The study was conducted between August and September 2021. A simple random sampling technique was used to select the study subjects. The sample size determined for the study was 399. Out of 399 participant 73.2%, was PNC service utilization while 26.8% did not utilized PNC services. Whose age was between 25 and above years were 0.001 times Adjusted odds ratio [0.001 (0.000, 0.084)], respondents higher and above education were 0.040 times AOR [0.040 (0.002, 0.933)] and respondents who had two Antenatal care visits were 0.036 times Adjusted odds ratio [0.036 (0.003, 0.438)] were significantly associated with Post natal care service utilization (p<0.05). This indicated that PNC service is a major demographic, socio-economic, and reproductive health problem. So, there is a need to creating awareness on sexual and reproductive health, increasing the accessibility of maternal health services for women to improve PNC services.
Demographic and Environmental Dererminants of Rural-Urban Migration in Yeka Sub-City of Addis Ababa: A Perception-Based Study
(Addis Ababa University, 2023-08) Afewerk Jembere; Dula Etana (PhD)
In Ethiopia, various forms of population movements, mainly rural out-migration, have been recorded over many decades as a direct response to the potential influences of environmental factors like drought, famine, and land degradation in combination with economic crisis. At the national broad level, environmental factors such as vulnerability to serious environmental degradation onsets and rainfall variability are major push factors that drive people to engage in rural out-migration in Ethiopia. In line with such problem, this study is conducted with an objective to explore and portray how key demographic variables, coupled with environmental determinant perception factors, can influence rural-urban migration trends in the study area by employing a perception-based data collection approach. The study employed a quantitative research method with a cross-sectional survey design by using systematic random sampling method and single population proportion sampling formula. After a primary data about sampled rural migrant’s demographic and environmental determinants were extracted from respondent households, descriptive statistics and logistic regression analysis were done. Multivariable logistic regression model was fitted to identify demographic and environmental determinants of rural-urban migration. In the study area, there are about a total of 355 rural migrant households were included in the selected sample, and 351 of them were fully covered. Results of the analyzed data showed that about 57.8% of respondents were male migrants, and nearly 36.2 %of the migrants surveyed were belonged to the age group between 30 to 34 years old, which is a young adult group of a population. About 53% were discovered to be Never married (Single), and the remaining 47 percent of respondents were found among an Ever married migrant category. Concerning environmental perception determinants of rural outmigration, land/ environmental degradation, drought, rainfall variability and access to water resource constitutes about 64.4%, 40.2%, 51.9% and 54.7% of all respondents, respectively. In a concluding pursuit, the analyzed data of the study has unveiled the prominent role of environmental factors in shaping migration decisions. Notably, environmental degradation emerged as a compelling driver those respondents expressing concerns about its impact. This result highlights the urgent need for sustainable resource management and ecological restoration strategies to curb the detrimental effects of land degradation. Environmental drought and irregular rainfall patterns also stood out, and influencing perceptions of migrants. In addition, the analyzed study data has aligned with respondents' experience of illuminating the influence of water scarcity on their migration decision and intentions. Based on analyzed findings, the study recommends that relevant stakeholders and actors should collaborate and act together to mitigate the problem of rural-to-urban migration both at the rural origin and destination place by encompassing policy implications, research avenues, and community-based engagement strategies.
Practice of Essential Newborn Care and Associated Factors among Postnatal Women at Selected Public Health Centers of Addis Ababa, 2023
(Addis Ababa University, 2023-08) Bethel Aberra; Dula Etana (PhD)
Neonatal Mortality is very high in most developing countries including Africa. Many countries are trying to reduce neonatal mortality by institutionalizing essential newborn care. The main aim of this study was to assess practice of essential new born care and associated factors. Facility based cross-sectional study design was employed among 414 postnatal women. The overall proportion of postnatal women with poor knowledge and poor practice towards essential newborn care was 53.9% and 28.1% respectively. Being age group of 21-25 years, being unable to read and write, traveling greater than 30 minutes to reach health facility, being self-employee. Having female baby, and initiating ANC follow-up after 16 weeks of gestation are significant predictors of having poor knowledge about ENC. While having educational status of unable to read and write, having female baby and having poor knowledge on essential newborn care were significant factors associated with poor practice of ENC. In this study the level of poor knowledge about essential newborn care is high but the level of poor practice of essential newborn care is relatively high as compared to the 19% Study done in Mekelle town (Berhea et al., 2018). Age(blow 25 years), educational status(unable to read write, distance to health facilities(>30 minutes), occupation status(self-employed),sex of baby(female) and ANC initiation time(after 16 weeks) are significant predictors of having poor knowledge about ENC. Therefore addressing universal education, availing health facilities and health education about the importance of keeping baby warmth play significant.
Predisposing, Enabling, and Need Factors Associated With Sexual and Reproductive Health Service Utilization among Internally Displaced Women and Girls: Evidence from Amhara Region
(Addis Ababa University, 2022-10) Bethlehem Fekade; Chalachew Arega (MSc.)
Background: Millions of people worldwide are displaced due to conflict and natural disasters. In Ethiopia's Amhara region, over two million people are internally displaced (IDPs) due to the northern conflict, creating a critical gap in access to essential health services, including Sexual and Reproductive Health (SRH) services. Objective: This study examines the factors influencing SRH service utilization including the levels, determinants, and challenges among IDPs in Amhara. Methods: A cross-sectional study design employing quantitative (survey with 549 IDP women aged 15-49) and qualitative (FGDs and KIIs with service providers, government officials, and IDP youth) methods were used in DebreBirhan, Gondar, and Woldiya town. Results: The study found significant associations between SRH utilization and education level, source of SRH information, household size, and preference for using health facilities. Qualitative findings revealed a gap between SRH policies and their implementation in IDP settings, with commodity shortages being a major constraint. It also revealed that inadequate attention was given to IDPs in general and for those who reside particularly in Gondar Camp. Recommendations: This study recommends multisectoral collaboration to improve SRH service delivery, including disseminating information through various channels, establishing youth-friendly services in camps, and coordinating with stakeholders to ensure adequate SRH commodity availability.
Reproductive Health Knowledge and Service Utilization among Migrant Workers: A Cross-Sectional Study around a Bus Station in Addis Ababa
(Addis Ababa University, 2023-06) Eyasu Hailu; Terefe Degefa (Professor)
Most migrant workers are of reproductive age, adolescent, and youth. However, their reproductive health needs have not been met adequately. The question of migrant workers whether they adequately understood reproductive health, access RH services enough, and what factors are contributing to their knowledge and access to reproductive health is not yet investigated in Addis Ababa. This study is aimed at assessing knowledge and utilization of reproductive health services among migrant workers. This study employed a cross-sectional-survey among migrant workers in Autobus Tera, Addis Ketema sub-city. A simple random sampling method with a sample size of 424 was employed. Data was collected using an online-based system. Data were analyzed through descriptive, bi-variate, and multi-variate analysis using SPSS version 26. Four hundred and one respondents were surveyed resulting in a 94.6% response rate. The study finds 67.6% of respondents as knowledgeable of reproductive health matters. It also finds 33.7% RH service utilization among migrant workers. Age (AOR = 2.05, 95%CI: 1.098, 3.082), Sex (AOR = 1.84, 95%CI: 1.098, 3.082), Relationship with the opposite sex (AOR = 2.84, 95%CI: 1.757, 4.581), and Discussion over reproductive health matters (AOR = 3.33, 95%CI: 2.045, 5.439) were found to be predictors of knowledge on reproductive health matters. Religion (AOR = 7.27 95%CI: 2.155, 24.513), Years in Addis Ababa (AOR = 2.6 95%CI: 1.354, 4.996), and Discussion over reproductive health matters (AOR = 14.14 95%CI: 7.819, 25.583) were found to be significant in predicting reproductive health service utilization among migrant workers. A moderate reproductive health knowledge and low reproductive health service utilization was observed among migrant workers. Targeted awareness-raising interventions can help reduce the information/knowledge gap and underutilization of reproductive health services migrant workers are experiencing.
Women Decision Making on Use of Modern Family Planning Methods and Associated Factors, Evidence from PMA Ethiopia
(Addis Ababa University, 2022-11) Fitsum Tariku; Dula Etana (PhD)
Family planning decision making is defined as women´s ability to choose family planning methods that she wanted to use through the process of informed decision making. Despite the availability and accessibility of family planning methods, the utilization rate is not more than 41% in Ethiopian. Evidences and experts have consistently show that women decisions making ability on family planning method they desired to use is one of the possible reasons for this slow rate of family planning use increment . In consideration with this and further motives family planning use decision making has become one of the top sexual and reproductive health related sustainable development agendas. Hence, this study aimed at determining the level of family planning use decision making among married and identify factors affecting it. This study was based on Performance monitoring for action (PMA) 2020 cross sectional national survey data. Married women who are currently using or recently used family planning method were included in this study. Frequency was computed to describe the study participants while chisquare statistics was computed to examine the overall association of independent variable with family planning use decision making. To identify predictors of family planning use decision making multinomial logistics regression was employed. Results were presented in the form of percentage and relative risk ratio with 95% CI. Candidate variables were selected using p value of 0.25. Significance was declared at p value 0.05. This study revealed that one in two women (51.2%; 95% CI: 48.8%-53.6%) decide their family planning use by themselves while 37% (36.8%; 95% CI: 34.5%-39.2%) decide jointly with their husband and/or partner. Women alone family planning use decision making increased significantly 32.8% (95% CI: 29.4%, 36.4%) in 2014 to 51.2% (95% CI: 48.8%, 53.6%) in 2020. It also show variation across regions from scanty in Afar and Somali to 63.6% in Amhara region and 61.5 Addis Ababa. Obtaining desired family planning method was found significantly to improve women alone and joint planning use decision making. Women who have perceive control and feeling if they get pregnant now were found to be positively associated with women alone family planning use decision making. Discussion with husband, his feeling towards family planning were found positively to influence family planning use joint decision making. Moreover, women religion, was found reducing the likelihood of both women alone and joint family planning use decision making while experiencing side effect reduces the likelihood of joint family planning use decision making. Half of the women independently decide their family planning use which calls up on further improvement. Family planning use decision making ability is expected to be improved by efforts targeted on husbands' approval on wife’s family planning use, discussion on family planning use with husband/partner, improving women psychosociological readiness and trust on her own to decide her desired family planning method; informing the possible side effects and what to do when they encountered during their family planning use visit. In addition, influencing women on the use of family planning via religious leader will help much in this regard. Monitoring and evaluating reproductive health policy 2021 to2025 and addressing bottlenecks which hinder women decision making health service use is hoped to improve women family planning use decision making. Further qualitative study to identify and address factors that contribute for the variation across regions also help much.
Socio-Economic and Demographic Determinants of Postnatal Care Utilization in Oromia Region
(Addis Ababa University, 2021-09) Tsegalem Sitotaw; Chalachew Getahun (PhD)
Background: The postnatal period which is also called postpartum is defined by the World health organization as the period beginning one hour after the delivery of the placenta and continuing until 6 weeks (42 days) after delivery. Objective: The prime objective of this study is to examine the socio-economic and demographic factors that influence PNC service utilization in Oromia Region of Ethiopia. Methods: cross-sectional data from Ethiopian Demographic and Health Survey 2016. A multivariate binary logit model was employed, and odds ratios were used to analyze the determinants. A qualitative in-depth interview was also implemented to triangulate with the secondary data of the 2016 EDHS and to capture and thereby to fill some of the data gaps of the EDHS. Totally 1031 women were covered by the 2016 EDHS of Ethiopia. Results: The study results have shown that woman’s education level, ANC visit, parity, and place of delivery have a significant positive effect on PNC checkup. The estimated odds ratio of PNC service utilization for women delivered at health facility is11.6 time more likely to use PNC service as compared to women delivered at home. Women antenatal visit with of less than four antenatal visit is 1.706 times more likely to have PNC checkup relative to women whose no antenatal visit is [P<0.05, OR =1.706, 95% CI 0.929-3.1308]. Women with primary education level 1.79 more likely to have PNC checkup after delivery [P 0.05, OR =1.79 at 95% CI 1.05-3.06].Women Birth order with of 2-4 is 2.14 times more likely to have PNC checkup relative to women whose Birth order one is [P 0.05, OR =2.14, 95% CI 1.18-3.87]. Conclusion: To improve the level of PNC checkup in the study area all concerned bodies should work towards empowering women’s educational participation, promote and design appropriate designs and strategy to increase the ANC utilization rate and health facility in particular and to improve, encourage and enhance maternal health care service utilization in general.
Correlates of Children Ever Born Among Women of Reproductive Ages in Ethiopia: Evidences from the 2019 Mini Ethiopian Demographic and Health Survey
(Addis Ababa University, 2022-07-25) Woinshet Defabachew; Chalachew Arega (M.Sc.)
Ethiopia's total fertility rate reduces slightly from 4.6 in 2016 to 4.15 in 2019 with an average annual decline rate 0.15 per women. This trend still demands to find the factors that may currently affect the currently fertility rate in Ethiopia due to still high rate of fertility and population growth. Children ever born, for this study, is the total number of children born by a woman (both alive and dead) and reported during the data collection period. The study on fertility is significant as the actual fertility depends on women current fertility level. However, there is limited study conducted about children ever born in Ethiopia so far. As a result this study is necessitated to be conducted. The objective of the study to study is to examine the key factor that affecting fertility in Ethiopia based on the EDHS data on women of reproductive ages. The survey was conducted using a multistage stratified cluster sampling method that covers all the 9 regions and 2 city administration of Ethiopia. A cross sectional study design was used to conduct the research. The analysis process was conducted by negative binomial regression model, by using this model current age of women, marital status, educational attainment, place of usual residence, wealth index, contraceptive usage and its knowledge was found to have higher significant predictor of current fertility level of women. Unexpected result such as child sex deference, daughter loss experience and duration of marriage of mothers was not found any association with the children ever born. Factors which were found to have statistical effect on the dependent variable needs receive attention by concerned bodies to make women to reduce their current fertility level reasonably. So in conclusion Ethiopia still need to take necessary step to control sustainably the current fertility level by making proper policy on the factors found in this study.
Quality Youth Friendly Sexual and Reproductive Health Services, Youths' Satisfaction Levels, and their Determinants in Selected Public Health Facilities of Addis Ababa, Ethiopia
(Addis Ababa University, 2022-07) Lidiya Dawit; Chalachew Getahun (PhD)
Background: Adolescence, age between 10 and 19 years, is marked as a period of transition and experimentation. This period not only brings changes to their body but also vulnerabilities to the undesirable effect of sexuality, marriage, and childbearing. Globally, pregnancy and childbirth are among the main contributors to diseases and disability among adolescents: early childbearing is linked with a higher risk of unsafe abortions, maternal mortality, and morbidity. Teen pregnancy and sexually transmitted infections (STIs) can have negative consequences for maternal and child health, as well as limit women's future chances, resulting in increased gender and social inequities Objective: The main objective of the study was to assess quality of youth-friendly sexual and reproductive health service and determinants of satisfaction among youth in selected public health facilities of Addis Ababa, Ethiopia, 2022. Method: Facility-based cross-sectional study supplemented with the qualitative design was conducted from 27 April to 10 June 2022 in 25 selected public health centers in Addis Ababa, Ethiopia. To determine the satisfaction of youth, 238 clients were included in the study using a simple random sampling technique. Data was collected by using an interview-administered questionnaire, observation checklist, and key informant interview. Both descriptive statistics was used to measure the quality of YFS and multi-variable binary logistic regression was employed, and the odds ratio with a 95% confidence interval along with p-values were used in reporting the results. Result: The study revealed that only six (24%), seven (28%) and three (12%) of the sampled health care facilities have good structural quality, process quality and output quality respectively. Only 2 (8%) of the health facilities had good overall quality of YFS. Regarding client satisfaction, 33.6% of the study participants were satisfied. Female clients were nearly two times [AOR (95%CI) 1.87 (1.07- 3.26)] more likely to be satisfied than their male counter parts. Similarly, youths aged ≥20 years were about 2.5 times [AOR (95% CI) 2.52(1.35-4.70)] more likely to be satisfied than those aged 15-19 years of age. Students were 76% less likely [AOR (95% CI) 0.24(0.04- 1.40)] to be satisfied when compared to unemployed. Our qualitative assessment showed that weak support system, inadequate capacity of the service provider, overburden of the health service provider and lack of adequate infrastructure are barriers for implementation of quality YFS. Conclusion: The quality of YFS in Addis Ababa is low even when compared to studies done in regional facilities. Both the overall quality and each dimension of YFS quality is lower when evaluated based on the WHO standard. In addition, our study revealed that two-third of youths who were using YFS were not satisfied. Barriers such as weak support system, inadequate capacity of the service provider, high workload of the health service provider and lack of adequate infrastructure contributed for low quality of YFS.
Determinants of Fertility Desire among HIV Positive Women of Reproductive Ages on Antiretroviral Therapy in Selected Rehabilitation Centers in Addis Ababa, Ethiopia
(Addis Ababa University, 2022-06-05) Martha Eshetu; Womdimye Ashenafi (PhD)
Background: The magnitude of unprotected sex to satisfy the desire for fertility among women living with HIV/AIDS (PLHIV) has raised concerns due to the availability of antiretroviral therapy (ART) in most HIV-affected countries. This could, however, have risk of passing on HIV to sexual partners and children. The aim of this study, therefore, is to determine prevalence and factors associated with fertility desire of reproductive-age women who are HIV positive in Addis Ababa, Ethiopia. Objectives: To assess the prevalence of fertility desire among HIV positive women and factors associated with it among women who are on ART in selected rehabilitation centers in Addis Ababa, Ethiopia. Methods: A cross sectional study was conducted on HIV positive women on ART at selected rehabilitation centers in Addis Ababa, from February 1-28, 2022.The total sample size considered was 418. Systematic random sampling technique was used after the total sample size was proportionately allocated to each rehabilitation center. Data were collected by interviewing, reviewing registration logbook, and FP chart (card). The collected data was entered and analyzed using SPSS-25 software. Descriptive statistics and binary logistic regression analyses was done. For variables with P value <0.25 on bivariate analysis, multivariable logistic regression analysis was performed in order to see association between independents and dependent variable (desire to fertility) using Odds Ratio (OR) as measure of association. Result: The overall the prevalence of fertility desire was 45.6%. Multivariable regression analyses revealed that being 25-34 years of age (AOR=5.49, p=0.003, 95% CI 1.77– 16.98), having secondary and above education (AOR=0.07, P=0.038, 95% CI 0.06-0.86) and being user of contraceptive (AOR=0.18, P=0.004, 95% CI 0.04-0.53) were statistically associated with fertility desire. Conclusion and recommendation: With the increasing desire of fertility among HIV positive women, attentions need to be given on counseling as how to prevent transmission of HIV to partner and the offspring.

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