Determinants of the use of modern contraceptives among women of reproductive age group in Ethiopia: A multi-level mixed effects analysis.

INTRODUCTION: Modern contraceptive methods are a scientifically effective method to control the fertility of reproductive-aged groups of people. The women's use of contraceptive methods creates a birth gap and limits the number of their children. The main objective of this study is to identify the significant determinant of modern contraceptive use of reproductive-aged women in Ethiopia. METHODS: We used data from 2019 Ethiopian Mini Demographic and Health Survey. This data was multi-level, taking into account factors at the individual and community levels. In order to capture the multi-level structure of this data and make more reliable and broadly applicable conclusions about the variables influencing the use of modern contraceptives at the individual and community levels, we employed a two-level mixed-effects logistic regression model. In addition, we used cross-tabulation analysis to know the percentage of modern contraception users (reproductive-aged women) across their socio-economic, demographic, and health characteristics. A total of 8196 reproductive aged (15-49) women were included in this study. RESULTS: From a total of 8196 reproductive-aged women, 2495(30.4%) were using modern contraceptive method and the rest 5701(69.6%) did not use any modern contraceptive methods. Among 2495 contraceptive users, 1657 (67.3%) used injections and 533 (21.7%) used implants/Norplant. At a 5% level of significance, the result from the two-level binary logistic regression model revealed that the predictors; Age of women, education level, religion, wealth index, knowledge of modern contraception method, number of died children, number of living children, family size, total children ever born and contextual region have significant effect on the use of modern contraception method. CONCLUSION: Reproductive-aged women in Ethiopia with more living children, residing in urban/agrarian region, younger, wealthier, married, and more educated, were more likely to be modern contraceptive users. The concerned bodies in Ethiopia should bring forward the intervention strategy and should expand the existed programs to improve the use of modern contraception methods among reproductive-aged women in Ethiopia. Especially, they should give special attention to reproductive-aged women of less income, resident in pastoralist region, less educated, unmarried, and haven't living child.

Utilization of reproductive health services among undergraduate regular class students in Assosa University, BGRS: a comparison among three varieties of multilevel binary logistic regression models.

INTRODUCTION: Reproductive health service (RHS) helps for people to have a delighted and safe sex through their life journey. It enables especially for women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant. Therefore, this study aimed to identify the significant determinants of RHS utilization among undergraduate regular class students in Assosa University by using advanced methodology. METHODS: We used cross-sectional study design to collect RHS data from 362 students in Assosa University from 5 to 16, may 2021. These students were selected using stratified random sampling technique. We also used cross-tabulation to summarize the extents of RHS utilization across all predictors in terms of percentage and three varieties of multilevel binary logistic regression model to model the determinants of RHS. RESULTS: 42.27% of undergraduate regular class students in Assosa University utilize at least one type of RHS during their time at Assosa University whereas, 57.73% of undergraduate regular class students in this University are not utilized it. Among three varieties of multilevel binary logistic regression models, the random slopes two-level model was selected as a best fitted model for the datasets. At 5% level of significance, awareness about RHS, gender, preference of service fees and student's monthly average income were significant predictor variables in this model. In addition, the covariates; age, gender and preference of service fees have a significant random effects on utilization of RHS across all colleges/school. CONCLUSION: Students who; preferred service fee as usual rate, have awareness about RHS, are females and have high monthly average income were more likely to utilize RHS. RHS utilization among undergraduate regular students in Assosa University is likely to increase more effectively with interventions that address these factors.

Time to recovery and its determinant factors among patients with COVID-19 in Assosa COVID-19 treatment center, Western Ethiopia.

BACKGROUND: The Novel Coronavirus disease (COVID-19) pandemic has become a global threat. Determining the time to recovery from COVID-19 is intended to assist healthcare professionals in providing better care, and planning logistics. So, the study aimed to identify the factors that affect the time to recovery from COVID-19 for patients treated at Assosa COVID-19 treatment center, Benishangul Gumuz Regional State, Western Ethiopia. METHODS: A retrospective study design was conducted on 334 randomly selected COVID-19 patients at Assosa COVID-19 treatment center from February 2021 to July 2021. The median survival time, Kaplan-Meier survival estimate, and Log-Rank test were used to describe the data and compare the survival time between groups. The study used the Cox PH model to analyze the time to the first recovery of COVID-19 patients, where hazard ratio, p-value, and 95% CI for hazard ratio were used for testing significance. Schoenfeld and Cox-Snell residuals were used for checking the model assumption. RESULTS: The overall incidence rate was 13.79 per 100 (95% CI: 10.04, 18.95) person-days observations. The median time to recovery was 16 days. At the end of the follow-up, 77.2% of the patients had developed an event of recovery, and the rest 22.8% were censored. The mean age of patients was 45.22 years. Severe COVID-19 patients (AHR = 0.7876, 95% CI: 0.7090, 0.8748), presence of symptoms (AHR = 0.2814, 95% CI: 0.1340, 0.5914), comorbidity (AHR = 0.1627, 95% CI: 0.1396, 0.1897), ≥ 90 oxygen saturation (AHR = 3.2370, 95% CI: 2.161, 4.848), and being older age (AHR = 0.9840, 95% CI: 0.971, 0.9973) were found to have statistically significant association with the time to recovery from COVID-19. CONCLUSION: The study concludes that severe COVID-19 patients, male patients, patients having comorbidity, older age, and patients having symptoms as poor prognostic factors of COVID-19 disease and also prolonged recovery time. Therefore, health providers in treatment centers should give strict follow-up and priority to older patients, severe COVID-19 patients, and patients having another co-morbid illness by focusing on respiratory difficulties and underlying pre-existing medical conditions to manage the disease severity and recover quickly.

Determinants of to First Birth among women in Ethiopia using Cox Proportional Hazards Model

Backgroung: the age at first birth corresponds to the age of the mother giving birth to the first child. The delivery of the primary child is an important event that leaves a social mark on a woman's life. It is a woman's clear transition to parenthood with the roles and responsibilities involved. Premature birth can negatively affect women's socio-economic well-being in subsequent years. The study aims at accessing the determinants of age at first birth among Ethiopian women.Methods: the data for this study was extracted from the published reports of Ethiopian Demographic and Health Survey. The study used15, 683women aged 15-49 years from nine regions and two city administrations. Cox Proportional hazards model was used for identifying factors associated with age at first birth.Results: the median time of age at first birth for Ethiopian women was22 years with 95% CI; (21.82, 22.18).Cox Proportional Hazards Model shows that region, place of residence, education, wealth index, religion, work status, age at first marriage, age at first sex, and use of contraceptives have significant effects on the age at first birth at 5% level of significance. From region category, Amhararegion (p-value=0.398), BenishangulGumuz(p-value=0.112) Region, and Gambella region(p-value=0.062) were not significant at 5% level of significance.Conclusions: the age at first birth was positively correlated with the age at first sexual intercourse. A woman who has sexual intercourse much earlier gives birth earlier than a woman who is late for first intercourse.

Introdução: a idade do primeiro parto corresponde à idade da mãe que dá à luz ao primeiro filho. O parto do filho primário é um evento importante que deixa uma marca social na vida da mulher. É a transição clara de uma mulher para a paternidade com os papéis e responsabilidades envolvidos. O nascimento prematuro pode afetar negativamente o bem-estar socioeconômico das mulheres nos anos subsequentes. O estudo visa acessar os determinantes da idade ao primeiro parto entre as mulheres etíopes.Método: os dados para este estudo foram extraídos dos relatórios publicados do Ethiopian Demographic and Health Survey. O estudo utilizou15.683 mulheres de 15 a 49 anos de nove regiões e duas prefeituras. O modelo de riscos proporcionais de Cox foi utilizado para identificar os fatores associados à idade ao primeiro parto.Resultados: o tempo mediano de idade ao primeiro parto para mulheres etíopes foi de 22 anos com IC 95%; (21,82; 22,18).O Modelo de Riscos Proporcionais de Cox mostra que região, local de residência, educação, índice de riqueza, religião, situação profissional, idade do primeiro casamento, idade da primeira relação sexual e uso de anticoncepcionais têm efeitos significativos sobre a primeira idade nascimento ao nível de 5% de significância. Da categoria de região, Amhararegion (p-value=0,398), BenishangulGumuz (p-value=0,112) Region, e Gambella region (p-value=0,062) não foram significativos ao nível de significância de 5%.Conclusão: a idade do primeiro parto correlacionou-se positivamente com a idade da primeira relação sexual. Uma mulher que tem relações sexuais muito mais cedo, dá à luz mais cedo do que uma mulher que está atrasada para a primeira relação.

Determinants of blood sugar level among type I diabetic patients in Debre Tabor General Hospital, Ethiopia: a longitudinal study.

In 2019 among all populous countries in Africa, Ethiopia has the fourth-highest number of people with diabetes (1.7 million). This aggravated prevalence figure implies that diabetes mellitus is a major public health problem in Ethiopia. Due to urbanization, this problem is very critical in the Amhara region, Ethiopia. The study aimed to identify factors that affect the longitudinal fasting blood sugar among T1DM (Type I diabetes mellitus) patients in Debre Tabor General Hospital (DTGH); North-west Ethiopia. A retrospective study design was conducted from 210 randomly selected T1DM patients in the clinic (Outpatient Department) at Debre Tabor General Hospital under the follow-up period from September 2019 to August 2021. To fit these retrospective data records, we used Random intercept and slope models. In this study, the unstructured variance-covariance structure was the appropriate structure for the random intercept and slope model. At a 5% level of significance, family history of diabetes mellitus, age, comorbidity, hemoglobin, and visit time in months were significant factors. Also, all the random effect parameters were statistically significant. It implies that the variability within and between T1DM patients in FBS over time was statistically significant. The mean fasting blood sugar level at baseline was 5.4944 mg/dl and decreased to 5.0679 mg/dl at the final follow-up time. Major contributors for the increment of fasting blood sugar level were increasing age, decreasing haemoglobin, having comorbidity, and belonging from a family with diabetes history. The overall within and between variability in fasting blood sugar level among T1DM patients in DTGH were high. Intervention measures at DTGH level should be undertaken using health education and other measures by providing an emphasis on the prevention, early detection, and treatment of diabetes mellitus.

Analyzing factors associated with time to age at first marriage among women in Ethiopia: log logistic-gamma shared frailty model.

OBJECTIVE: The main objective of this study is to fit Log logistic-Gamma shared frailty model for the determinant of time to age at first marriage among women in Ethiopia. METHODS: The data set in this study were obtained from Demography and Health survey conducted in Ethiopia in 2016. In this study, we used Log logistic-Gamma shared frailty model to account for the loss of independence that arises from the clustering of women in region of Ethiopia. A total of 12,066 women aged 15-49 in Ethiopia were included in this study. RESULTS: Of all 12,066 women aged 15-49, 9466 (78.45%) were married and the median & mean age at first marriage for women living in Ethiopia were 17.2 years and 17.5 years respectively, while the minimum and maximum age at first marriage observed were 8 years and 49 years respectively. CONCLUSION: The most significant contributing factors to delaying time to age at first marriage of women aged 15-49 in Ethiopia were increased education level of women, increased education level of the head, increased income, residing in urban and being followers of religion other than orthodox, catholic, protestant & Muslim. The heterogeneity of age at first marriage for women aged 15-49 among regions in Ethiopia was observed. The government of Ethiopia and the concerned bodies should revise the women's health policy and practice to reduce early marriage and give attention to women; illiterate, live in rural areas, and have illiterate and poor heads.

Modeling the determinant of time to age at first marriage among women in Ethiopia using Cox models with mixed effects.

BACKGROUND: Time to age at first marriage of women is the duration of time until the age at which they started living with their first partner. Time to age at first marriage is widely considered a proxy indicator for the age at which women begin to be exposed to the risks inherent in sexual activity. The purpose is to model the determinant of time to age at first marriage among women in Ethiopia using Cox models with mixed effects. METHODS: The 2016 Ethiopian Demography and Health survey sample was selected using a two-stage cluster design. The data set in this study were obtained from the Demography and Health survey conducted in Ethiopia in 2016. In this study, we used Cox models with mixed effects. RESULTS: Of all 15,683 women aged 15-49 years, 11,405 (72.72%) were married with the median and mean age at first marriage 17 years and 18 years, respectively. Cox frailty survival model showed that residence, educational level, occupation, work status of women& head education level of households were the most significant factors whereas religion, access to media and wealth index of a household of women were not significant factors at 5% level of significance. The significant clustering effect showed that heterogeneity among the regions on age at first marriage was present. CONCLUSIONS: The present study determined the duration of time until the age at first marriage and indicated relevant solutions for marriage-related problems of women aged 15-49 years in Ethiopia. Women residing in rural area of Ethiopia and had lower education level were married earlier. Therefore, programs to reduce the high rate of early marriage in Ethiopia should give attention to women education and women residing in rural area.

Time to age at first marriage of women is the duration of time until the age at which they started living with their first partner. African women are more likely to marry earlier than other continent women, which causes high fertility due to their long period of exposure to the risk of pregnancy. Even though Sub-Sahara Africa accounts for the highest rate of age at first marriage among countries in the Africa continent, comparably the case is very worse in Ethiopia. Furthermore, there is no study about the determinant of time to age at first marriage in Ethiopia using advanced models like Cox Model with Mixed effects. This model allows for the analysis of data with complex patterns of variability, with a focus on nested sources of variability. Very often it makes sense to use such a model to represent the variability within and between groups. For instance, in this study, our interest is not only knowing the significant effect of determinant factors on time to age at first marriage among women in Ethiopia but also the variability of time to age at first marriage within the region of Ethiopia and between regions of Ethiopia. We have used a dataset for this study from Ethiopia Demography and Health Survey which was conducted in 2016. The study helps to indicate relevant solutions for women's marriage-related problems (predominantly, women's reproductive health problems) in Ethiopia and it provides input for further studies in Ethiopia.