Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia.
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
BMC Womens Health. 2021 Mar 19;21(1):113. doi: 10.1186/s12905-021-01254-z.
High maternal and child death with high fertility rate have been reported in Ethiopia. Extreme age at first birth is linked with both maternal and child morbidity and mortality. However, literatures showed there were limited studies on the timing of the first birth and its predictors in the area so far. Therefore, determining the time to first birth and its predictors will help to design strategies to improve maternal and child survival.
A community-based cross-sectional study was conducted among reproductive-age women in Ethiopia using the Ethiopian demographic health survey, 2016 data. Stratified two-stage cluster sampling technique was used for sampling. The Kaplan-Meier method was used to estimate time to first birth. Inverse Weibull gamma shared frailty model applied to model the data at 95% confidence interval (CI), adjusted hazard ratio (AHR) and median hazard ratio (MHR) were reported as effect size. Proportional hazard assumption checked using Schoenfeld residual test. Information Criteria were applied to select a parsimonious model. Stratified analysis performed for the interaction terms and statistical significance was declared at p value < 0.05.
The overall median age at first birth was found to be 20 years (IQR, 16-24 years). The independent predictors of time to first birth were: married 15-17 years (AHR = 2.33, 95% CI 2.08-2.63), secondary education level (AHR = 0.84, 95% CI 0.78-0.96), higher education level (AHR = 0.75, 95% CI 0.65-0.85), intercourse before 15 years in the married stratum (AHR = 23.81, 95% CI 22.22-25.64), intercourse 15-17 years in married stratum (AHR = 5.56, 95% CI 5.26-5.88), spousal age difference (AHR = 1.11, 95% CI 1.05-1.16),and use of contraceptives (AHR = 0.91, 95% CI 0.86-0.97). The median increase in the hazard of early childbirth in a cluster with higher early childbirth is 16% (MHR = 1.16, 95% CI 1.13-1.20) than low risk clusters adjusting for other factors.
In this study, first birth was found to be at an early age. Early age at first marriage, at first sexual intercourse and their interaction, high spousal age difference, being Muslim were found to increase early motherhood. Conversely, living in the most urban region, secondary and higher women education were identified to delay the first birth. Investing on women education and protecting them from early marriage is required to optimize time to first birth. The contextual differences in time to first birth are an important finding which requires more study and interventions.
在埃塞俄比亚，高孕产妇和儿童死亡率与高生育率并存。首次生育年龄极早与母婴发病率和死亡率都有关联。然而，目前该地区的文献表明，关于首次生育的时间及其预测因素的研究非常有限。因此，确定首次生育的时间及其预测因素将有助于制定提高母婴生存率的策略。
本研究采用埃塞俄比亚人口与健康调查 2016 年数据，对埃塞俄比亚育龄妇女进行了一项基于社区的横断面研究。采用分层两阶段聚类抽样技术进行抽样。Kaplan-Meier 法用于估计首次生育时间。应用逆 Weibull 伽马共享脆弱模型在 95%置信区间（CI）、调整后的危险比（AHR）和中位数危险比（MHR）来对数据进行建模，作为效应量报告。采用 Schoenfeld 残差检验检查比例风险假设。应用信息准则选择简约模型。对交互项进行分层分析，p 值<0.05 时表示有统计学意义。
总体首次生育的中位数年龄为 20 岁（IQR，16-24 岁）。首次生育时间的独立预测因素包括：15-17 岁结婚（AHR=2.33，95%CI 2.08-2.63）、中等教育水平（AHR=0.84，95%CI 0.78-0.96）、高等教育水平（AHR=0.75，95%CI 0.65-0.85）、已婚阶层中 15 岁前发生性行为（AHR=23.81，95%CI 22.22-25.64）、已婚阶层中 15-17 岁发生性行为（AHR=5.56，95%CI 5.26-5.88）、配偶年龄差异（AHR=1.11，95%CI 1.05-1.16）和使用避孕药具（AHR=0.91，95%CI 0.86-0.97）。在调整其他因素后，具有较高早育风险的簇中早育的危险度中位数增加了 16%（MHR=1.16，95%CI 1.13-1.20）。
本研究发现首次生育年龄较早。早婚、早性活动及其相互作用、配偶年龄差异较大、信仰伊斯兰教都会增加早育的风险。相反，居住在最城市化的地区、接受中等和高等教育则会延迟首次生育。需要投资于妇女教育，保护她们免受早婚的影响，以优化首次生育的时间。首次生育时间的背景差异是一个重要的发现，需要进一步研究和干预。
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