Dibaba Diriba, Charkos Tesfaye Getachow
Department of Public Health, Madda Walabu University, Bale-Goba, Ethiopia.
Department of Public Health, Adama Hospital Medical College, Adama, Ethiopia.
Contracept Reprod Med. 2025 Feb 5;10(1):10. doi: 10.1186/s40834-024-00328-1.
One of the Sustainable Development Goals (2030) focuses on reducing the total fertility rate. Reducing grand multiparity in Ethiopia remains a challenge. Understanding the underlying factors that contribute to this issue is crucial for explaining why grand multiparity remains prevalent despite various health interventions and socio-economic progress.
A community-based cross-sectional study was conducted using data from the Ethiopian Demographic and Health Survey 2019. Multilevel multivariable logistic regression analysis was employed to model the hierarchical data. The final findings were presented as adjusted odds ratios (AOR) with 95% confidence intervals (CI). A p-value < 0.05 was considered statistically significant.
The trend analysis of grand multiparity in Ethiopia over 19 years shows no significant change (linear trend = 1.23, p = 0.27). The prevalence slightly decreased from 72% in the 2000 EDHS to 66.3% (95% CI: 65.7 - 66.96%) in the 2019 mini EDHS. Additionally, the highest prevalence of grand multiparity was observed among illiterate women (79.7%), those from poor households (54.8%), non-family planning users (77.5%), and residents of the Oromia (15.8%) and SNNPR (15.4%) regional states. Significant individual-level factors associated with grand multiparity include wealth index, marital status, maternal education, non-use of family planning, use of short-acting family planning, age at first birth < 18 years, and short birth intervals. At the community level, rural residency was significantly associated with grand multiparity.
This study emphasizes the need for targeted interventions to address the socio-economic and reproductive factors driving grand multiparity, especially in rural areas and among disadvantaged populations. To improve maternal and child health outcomes, we recommend that the government focus on lowering fertility rates through need-based family planning services and promoting the well-being of women of reproductive age.
可持续发展目标（2030 年）之一聚焦于降低总和生育率。在埃塞俄比亚，降低多产率仍是一项挑战。了解导致这一问题的潜在因素对于解释为何尽管采取了各种卫生干预措施且社会经济取得了进步，但多产率仍然普遍存在至关重要。
利用 2019 年埃塞俄比亚人口与健康调查的数据进行了一项基于社区的横断面研究。采用多水平多变量逻辑回归分析对分层数据进行建模。最终结果以调整后的比值比（AOR）及 95%置信区间（CI）呈现。p 值<0.05 被认为具有统计学意义。
埃塞俄比亚 19 年来多产率的趋势分析显示无显著变化（线性趋势=1.23，p=0.27）。患病率从 2000 年埃塞俄比亚人口与健康调查中的 72%略有下降至 2019 年小型埃塞俄比亚人口与健康调查中的 66.3%（95%CI：65.7 - 66.96%）。此外，在文盲妇女（79.7%）、贫困家庭妇女（54.8%）、未使用计划生育的妇女（77.5%）以及奥罗米亚州（15.8%）和南方各族州（15.4%）的居民中观察到多产率最高。与多产率相关的显著个体层面因素包括财富指数、婚姻状况、母亲教育程度、未使用计划生育、使用短效计划生育方法、初产年龄<18 岁以及生育间隔短。在社区层面，农村居住与多产率显著相关。
本研究强调需要采取有针对性的干预措施来解决导致多产率的社会经济和生殖因素，特别是在农村地区和弱势群体中。为改善孕产妇和儿童健康结果，我们建议政府通过基于需求的计划生育服务专注于降低生育率，并促进育龄妇女的福祉。
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