Zegeye Alebachew Ferede, Tamir Tadesse Tarik, Mekonen Enyew Getaneh, Techane Masresha Asmare, Terefe Bewuketu, Workneh Belayneh Shetie
Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Front Glob Womens Health. 2024 Nov 27;5:1471187. doi: 10.3389/fgwh.2024.1471187. eCollection 2024.
Termination of pregnancy is one of the biggest five causes of maternal mortality in countries with low and middle incomes. Although termination of pregnancy is hazardous, its prevalence and determinates are not well studied in developing countries. Therefore, this study aims to assess the prevalence and determinants of termination of pregnancy among reproductive-age women who had a short preceding birth interval in Sub-Saharan Africa.
Data from the most recent Demographic and Health Surveys, which covered 21 Sub-Saharan African countries from 2015 to 2022, were used for secondary data analysis. The study used a total of 283,785 women. Stata 14 was used to analyze the data. The determinants of termination of pregnancy were determined using a multilevel mixed-effects logistic regression model. Significant factors associated with termination of pregnancy were declared significant at -values < 0.05. The result was interpreted using the confidence interval and adjusted odds ratio. The best-fit model was determined to be the one with the highest log likelihood ratio and the lowest deviance.
In Sub-Saharan Africa, one in ten women with short birth intervals experienced pregnancy termination. Individual factors, including the sex of the preceding birth (AOR = 1.21, 95% CI: 1.05, 1.40), maternal age (AOR = 1.57, 95% CI: 1.27, 1.95), pregnancy complications (AOR = 1.28, 95% CI: 1.09, 1.49), No ANC visits (AOR = 2.29, 95% CI: 1.26, 4.14), previous cesarean section delivery (AOR = 1.74, 95% CI: 1.32, 2.30), <6 months of breastfeeding (AOR = 1.56, 95% CI: 1.35, 1.81), traditional contraception usage (AOR = 1.67, 95% CI: 1.13, 2.46), poor wealth status (AOR = 1.50, 95% CI: 1.22, 1.85), and community-level factors such as urban residence (AOR = 1.31, 95% CI: 1.06, 1.62) had higher odds of pregnancy termination.
This study concludes that termination of pregnancy rates among women with short preceding birth interval is high. The study identified that both individual and community-level variables were determinants of termination of pregnancy. Therefore, the ministries of health in Sub-Saharan African countries should give attention to those women who underutilize antenatal care services and to women from urban areas while designing policies and strategies targeting reducing termination of pregnancy rates.
在低收入和中等收入国家，终止妊娠是孕产妇死亡的五大主要原因之一。尽管终止妊娠具有危险性，但在发展中国家，其发生率和决定因素尚未得到充分研究。因此，本研究旨在评估撒哈拉以南非洲地区近期生育间隔较短的育龄妇女中终止妊娠的发生率及其决定因素。
使用2015年至2022年期间涵盖21个撒哈拉以南非洲国家的最新人口与健康调查数据进行二次数据分析。该研究共纳入283,785名妇女。使用Stata 14软件进行数据分析。采用多水平混合效应逻辑回归模型确定终止妊娠的决定因素。与终止妊娠相关的显著因素在P值<0.05时被判定为显著。结果通过置信区间和调整后的比值比进行解释。最佳拟合模型被确定为对数似然比最高且偏差最低的模型。
在撒哈拉以南非洲地区，生育间隔较短的妇女中，每十名中有一名经历过终止妊娠。个体因素包括前次生育的性别（调整后的比值比[AOR]=1.21，95%置信区间[CI]：1.05，1.40）、产妇年龄（AOR=1.57，95%CI：1.27，1.95）、妊娠并发症（AOR=1.28，95%CI：1.09，1.49）、未进行产前检查（AOR=2.29，95%CI：1.26，4.14）、既往剖宫产史（AOR=1.74，95%CI：1.32，2.30）、母乳喂养时间<6个月（AOR=1.56，95%CI：1.35，1.81）、使用传统避孕方法（AOR=1.67，95%CI：1.13，2.46）、财富状况较差（AOR=1.50，95%CI：1.22，1.85），以及社区层面因素如居住在城市地区（AOR=1.31，95%CI：1.06，1.62），终止妊娠的几率较高。
本研究得出结论，近期生育间隔较短的妇女中终止妊娠率较高。该研究确定个体和社区层面的变量均为终止妊娠的决定因素。因此，撒哈拉以南非洲国家的卫生部在制定旨在降低终止妊娠率的政策和策略时，应关注那些未充分利用产前保健服务的妇女以及城市地区的妇女。
