Zewdia Wondaya Fenta, Asmelash Daniel, Asmelash Yemane
Department of Statistics, College of Science, Bahir Dar University, Bahir Dar, Ethiopia.
College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia.
Front Public Health. 2024 Dec 18;12:1449689. doi: 10.3389/fpubh.2024.1449689. eCollection 2024.
The process of childbirth involves significant risks, particularly when certain high-risk fertility behaviors (HRFBs) are observed. HRFB of birth includes maternal age below 18 years or above 34 years at the time of childbirth, having a child born after a short birth interval (24 months), and having a high parity (more than three children). The majority of child stunting cases were linked to high-risk reproductive practices. Stunted children are those whose height-for-age Z-score is less than -2SD (standard deviation) from the median of a reference population. This study aimed to investigate the spatial association between HRFB of birth and stunting in under-five children across Ethiopia's administrative zones.
This study used cross-sectional data from the latest Mini Ethiopian Demographic and Health 2019 Survey, which included a weighted sample of 4,969 under-five children from 64 administrative zones. Spatial model analysis, specifically the spatial Durbin model, was used to examine the association between HRFB of birth and stunting in children. ArcGIS 10.8 was used for mapping and SAS 9.4 was used for model analysis.
The average mean proportion of HRFB of birth to the rate of stunting in children at the zonal level in Ethiopia was observed to be 58 and 36%, respectively, across Ethiopian zones. Children whose mothers displayed HRFB of birth and who were stunted were 24% at all times. The median value of HRFB of birth and stunting were 0.61 and 0.36, respectively. The average vegetable index and the livestock index across Ethiopian zones showed spatial variations of 0.57 and 0.12, respectively. In the selected spatial Durbin model, the deviance value was very small, indicating that the model fit the data well.
The study found a high prevalence and significant spatial variation in both HRFB of birth and stunting across the Ethiopian zones. The spatial distribution of both HRFB of birth and stunting were found to be significantly clustered in the administrative zones of Ethiopia. These results emphasize the need for targeted interventions to address HRFB and stunting, supporting Ethiopia in achieving its Sustainable Development Goals.
分娩过程存在重大风险，尤其是当观察到某些高危生育行为（HRFBs）时。分娩的高危生育行为包括分娩时母亲年龄低于18岁或高于34岁、在短生育间隔（24个月）后生育、以及多胎妊娠（三个以上孩子）。大多数儿童发育迟缓病例与高危生殖行为有关。发育迟缓儿童是指其年龄别身高Z评分低于参考人群中位数-2标准差（SD）的儿童。本研究旨在调查埃塞俄比亚各行政区五岁以下儿童出生时的高危生育行为与发育迟缓之间的空间关联。
本研究使用了最新的2019年埃塞俄比亚小型人口与健康调查的横断面数据，其中包括来自64个行政区的4969名五岁以下儿童的加权样本。采用空间模型分析，特别是空间杜宾模型，来检验出生时的高危生育行为与儿童发育迟缓之间的关联。使用ArcGIS 10.8进行绘图，使用SAS 9.4进行模型分析。
在埃塞俄比亚各行政区，观察到出生时的高危生育行为与儿童发育迟缓率的平均比例分别为58%和36%。母亲有出生时的高危生育行为且发育迟缓的儿童始终占24%。出生时的高危生育行为和发育迟缓的中位数分别为0.61和0.36。埃塞俄比亚各行政区的平均蔬菜指数和牲畜指数的空间变异分别为0.57和0.12。在选定的空间杜宾模型中，偏差值非常小，表明该模型对数据拟合良好。
研究发现埃塞俄比亚各行政区出生时的高危生育行为和发育迟缓的患病率都很高，且存在显著的空间变异。出生时的高危生育行为和发育迟缓的空间分布在埃塞俄比亚行政区都明显聚集。这些结果强调了针对高危生育行为和发育迟缓进行有针对性干预的必要性，以支持埃塞俄比亚实现其可持续发展目标。
