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. 2024 May 22:7:100515.
doi: 10.1016/j.puhip.2024.100515. eCollection 2024 Jun.

Association between high-risk fertility behaviors and neonatal mortality in Ethiopia: A multilevel mixed-effects logit models from 2019 Ethiopian mini demographic and health survey

Hassen Ali Hamza  1 , Abbas Ahmed Mohammed  2 , Sadat Mohammed  3 , Mohammed Feyisso Shaka  4
Affiliations

Association between high-risk fertility behaviors and neonatal mortality in Ethiopia: A multilevel mixed-effects logit models from 2019 Ethiopian mini demographic and health survey

Hassen Ali Hamza et al. Public Health Pract (Oxf). .

Abstract

Objectives: This study aimed to explore the association between high-risk fertility behaviors and neonatal mortality in Ethiopia.

Study design: A community-based cross-sectional study was conducted using data from the 2019 Ethiopian Mini-Demographic and Health Survey.

Methods: Mixed-effects logit regression models were fitted to 5527 children nested within 305 clusters. The definition of high-risk fertility behavior was adopted from the 2019 EMDHS. The fixed effects (the association between the outcome variable and the explanatory variables) were expressed as adjusted odds ratios (ORs) with 95 % confidence intervals and measures of variation explained by intra-class correlation coefficients, median odds ratio, and proportional change invariance.

Results: The presence of births with any multiple high-risk fertility behaviors was associated with a 70 % higher risk of neonatal mortality (AOR = 1.7, (95 % CI: 1.2, 2.3) than those with no high-risk fertility behavior. From the combined risks of high-risk fertility behaviors, the combination of preceding birth interval <24 months and birth order four or higher had an 80 % increased risk of neonatal mortality (AOR = 1.8, (95 % CI, 1.2, 2.7) as compared to those who did not have either of the two. The 3-way risks (combination of preceding birth interval <24 months, birth order 4+, and mother's age at birth 34+) were associated with approximately four times increased odds of neonatal mortality (AOR (95 % CI:3.9 (2.1, 7.4)].

Conclusions: High-risk fertility behavior is a critical predictor of neonatal mortality in Ethiopia, with three-way high-risk fertility behaviors increasing the risk of neonatal mortality fourfold. In addition, antenatal follow-up was the only non-high fertility behavioral factor significantly associated with the risk of neonatal mortality in Ethiopia.

Keywords: Ethiopian mini-demographic and health survey 2019; High-risk fertility behaviors; Multilevel mixed-effects logit model; Neonatal mortality.

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Conflict of interest statement

The authors declare that they have no competing interests. All authors agreed on the submission of the manuscript.

Figures

Fig. 1
Fig. 1
Diagrammatic presentation of the sampling procedure.
See this image and copyright information in PMC

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