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Observational Study
. 2021 Aug 18;11(8):e047892.
doi: 10.1136/bmjopen-2020-047892.

Effects of short birth interval on neonatal, infant and under-five child mortality in Ethiopia: a nationally representative observational study using inverse probability of treatment weighting

Desalegn Markos Shifti  1   2 , Catherine Chojenta  2 , Elizabeth Holliday  3 , Deborah Loxton  2
Affiliations
Observational Study

Effects of short birth interval on neonatal, infant and under-five child mortality in Ethiopia: a nationally representative observational study using inverse probability of treatment weighting

Desalegn Markos Shifti et al. BMJ Open. .

Abstract

Objective: To assess the effect of short birth interval (SBI) on neonatal, infant, and under-five mortality in Ethiopia.

Design: A nationally representative cross-sectional survey.

Setting: This study used data from the Ethiopia Demographic and Health Survey 2016.

Participants: A total of 8448 women who had at least two live births during the 5 years preceding the survey were included in the analysis.

Outcome measures: Neonatal mortality (death of the child within 28 days of birth), infant mortality (death between birth and 11 months) and under-five mortality (death between birth and 59 months) were the outcome variables.

Methods: Weighted logistic regression analysis based on inverse probability of treatment weights was used to estimate exposure effects adjusted for potential confounders.

Results: The adjusted ORs (AORs) of neonatal mortality were about 85% higher among women with SBI (AOR=1.85, 95% CI=1.19 to 2.89) than those without. The odds of infant mortality were twofold higher (AOR=2.16, 95% CI=1.49 to 3.11) among women with SBI. The odds of under-five child mortality were also about two times (AOR=2.26, 95% CI=1.60 to 3.17) higher among women with SBI.

Conclusion: SBI has a significant effect on neonatal, infant and under-five mortality in Ethiopia. Interventions targeting SBI are warranted to reduce neonatal, infant and under-five mortality.

Keywords: community child health; epidemiology; maternal medicine; public health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Direct acyclic graph used to select controlling variables. ANC, antenatal care; Birth_ord, birth order; Birth_wt, birth weight; H_Educ, husband education; H_Occup, husband occupation; IM, infant mortality; M_age_atBirth_chil, maternal age at birth of the index child; M_Edu, maternal education; M_Occu, maternal occupation; Multiple_preg, multiple pregnancy; NM, neonatal mortality; PNC, postnatal care; Prev_Chi_Survival, previous child survival; Respiratory_infn, respiratory infection; SBI, short birth interval; Total_Prec_child, total number of preceding child; TT_vaccin, tetanus toxoid vaccination status; U5M, under-five mortal.
Figure 2
Figure 2
Schematic presentation of the overall steps followed in the analysis.
Figure 3
Figure 3
Balance of propensity scores (PS) before and after weighting across treatment and comparison groups.
See this image and copyright information in PMC

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References

    1. World Health Organization . Report of a WHO technical consultation on birth spacing. Geneva, Switzerland, 2005: 13–15.
    1. Shifti DM, Chojenta C, G Holliday E, et al. . Individual and community level determinants of short birth interval in Ethiopia: a multilevel analysis. PLoS One 2020;15:e0227798. 10.1371/journal.pone.0227798 - DOI - PMC - PubMed
    1. Shifti DM, Chojenta C, Holliday EG, et al. . Application of geographically weighted regression analysis to assess predictors of short birth interval hot spots in Ethiopia. PLoS One 2020;15:e0233790. 10.1371/journal.pone.0233790 - DOI - PMC - PubMed
    1. Shifti DM, Chojenta C, Holliday EG, et al. . Socioeconomic inequality in short birth interval in Ethiopia: a decomposition analysis. BMC Public Health 2020;20:1–13. 10.1186/s12889-020-09537-0 - DOI - PMC - PubMed
    1. Central Statistical Agency (CSA) [Ethiopia] and ICF . Ethiopia demographic and health survey 2016. Addis Ababa, Ethiopia, and Rockville, Maryland, USA: CSA and ICF, 2016.

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