Adolescent childbearing trends and sub-national variations in Ethiopia: a pooled analysis of data from six surveys.

BACKGROUND: Ethiopia houses the second largest population of female adolescents in Africa. Adolescent childbearing can have detrimental effect to the health and wellbeing of women and their offspring. This study examined trends, sub-national variations and determinants of early childbearing (i.e. childbearing before age 20) in Ethiopia. METHODS: Data from the 2000-2011 Ethiopia Demographic and Health Surveys and from the 2014-2016 Performance Monitoring and Accountability surveys were pooled for this analysis. Based on the year the women reached puberty, five different cohorts were reconstructed that date back to the early 1970s. Kaplan-Meier methodology was used to estimate the cumulative probability of early childbearing and a Cox proportional hazard regression model to examine the associated factors. RESULTS: The cumulative probability of early childbearing declined by approximately two-fifth in the past four decades, from 57.6 to 35.3%. The occurrence of early childbearing varies substantially by region. In the most recent period, it ranged from 9.6% in Addis Ababa to 59% in Benishangul-Gumuz. Early childbearing risk was reduced by 95% for women who did not marry before the age of 20 years compared to those who married before the age of 18 years. For adolescents who married at the age of 18 and 19 years, early childbearing risk decreased by 60 and 78%, respectively. During the same period, there was a parallel decline in the cumulative probability of early marriage (i.e., before the legal age of 18 years) from 55.3 to 28.7%. Compared with adolescents with no education, those with elementary and secondary or higher education had a 50 and 82% lower risk of early childbearing, respectively. CONCLUSIONS: Early childbearing declined in Ethiopia, largely driven by a parallel reduction in early marriage. However, a large portion of adolescents are still facing early childbearing, and the situation is more dismal in some regions than others. A further reduction in early childbearing is warranted by enforcing the law on the minimum marriage age and expanding secondary and higher education for females. These efforts should give greater emphasis to regions where early childbearing is markedly high.

Neonatal mortality in Ethiopia: trends and determinants.

BACKGROUND: The Ethiopian neonatal mortality rate constitutes 42% of under-5 deaths. We aimed to examine the trends and determinants of Ethiopian neonatal mortality. METHODS: We analyzed the birth history information of live births from the 2000, 2005 and 2011 Ethiopia Demographic and Health Surveys (DHS). We used simple linear regression analyses to examine trends in neonatal mortality rates and a multivariate Cox proportional hazards regression model using a hierarchical approach to examine the associated factors. RESULTS: The neonatal mortality rate declined by 1.9% per annum from 1995 to 2010, logarithmically. The early neonatal mortality rate declined by 0.9% per annum and was where 74% of the neonatal deaths occurred. Using multivariate analyses, increased neonatal mortality risk was associated with male sex (hazard ratio (HR) = 1.38; 95% confidence interval (CI), 1.23 - 1.55); neonates born to mothers aged < 18 years (HR = 1.41; 95% CI, 1.15 - 1.72); and those born within 2 years of the preceding birth (HR = 2.19; 95% CI, 1.89 - 2.51). Winter birth increased the risk of dying compared with spring births (HR = 1.28; 95% CI, 1.08 - 1.51). Giving two Tetanus Toxoid Injections (TTI) to the mothers before childbirth decreased neonatal mortality risk (HR = 0.44; 95% CI, 0.36 - 0.54). Neonates born to women with secondary or higher schooling vs. no education had a lower risk of dying (HR = 0.68; 95% CI, 0.49 - 0.95). Compared with neonates in Addis Ababa, neonates in Amhara (HR: 1.88; 95% CI: 1.26 - 2.83), Benishangul Gumuz (HR: 1.75; 95% CI: 1.15 - 2.67) and Tigray (HR: 1.54; 95% CI: 1.01 - 2.34) regions carried a significantly higher risk of death. CONCLUSIONS: Neonatal mortality must decline more rapidly to achieve the Millennium Development Goal (MDG) 4 target for under-5 mortality in Ethiopia. Strategies to address neonatal survival require a multifaceted approach that encompasses health-related and other measures. Addressing short birth interval and preventing early pregnancy must be considered as interventions. Programs must improve the coverage of TTI and prevention of hypothermia for winter births should be given greater emphasis. Strategies to improve neonatal survival must address inequalities in neonatal mortality by women's education and region.

Evaluating the InterVA model for determining AIDS mortality from verbal autopsies in the adult population of Addis Ababa.

OBJECTIVE: To evaluate the performance of a verbal autopsy (VA) expert algorithm (the InterVA model) for diagnosing AIDS mortality against a reference standard from hospital records that include HIV serostatus information in Addis Ababa, Ethiopia. METHODS: Verbal autopsies were conducted for 193 individuals who visited a hospital under surveillance during terminal illness. Decedent admission diagnosis and HIV serostatus information are used to construct two reference standards (AIDS vs. other causes of death and TB/AIDS vs. other causes). The InterVA model is used to interpret the VA interviews; and the sensitivity, specificity and cause-specific mortality fractions are calculated as indicators of the diagnostic accuracy of the InterVA model. RESULTS: The sensitivity and specificity of the InterVA model for diagnosing AIDS are 0.82 (95% CI: 0.74-0.89) and 0.76 (95% CI: 0.64-0.86), respectively. The sensitivity and specificity for TB/AIDS are 0.91 (95% CI: 0.85-0.96) and 0.78 (95% CI: 0.63-0.89), respectively. The AIDS-specific mortality fraction estimated by the model is 61.7% (95% CI: 54-69%), which is close to 64.7% (95% CI: 57-72%) in the reference standard. The TB/AIDS mortality fraction estimated by the model is 73.6% (95% CI: 67-80%), compared to 74.1% (95% CI: 68-81%) in the reference standard. CONCLUSION: The InterVA model is an easy to use and cheap alternative to physician review for assessing AIDS mortality in populations without vital registration and medical certification of causes of death. The model seems to perform better when TB and AIDS are combined, but the sample is too small to statistically confirm that.