Background Open defecation facilitates the transmission of pathogens that cause diarrheal diseases, which is the second leading contributor to the global burden of disease. It also exposed hundreds of millions of girls and women around the world to increased sexual exploitation. Open defecation is more practice in sub-Saharan African (SSA) countries and is considered an indicator of low socioeconomic status. However, there is little evidence on the pooled prevalence and factors contributing to open defecation practice among households in SSA. Objectives This study aimed to assess the pooled prevalence, wealth-related inequalities, and other determinants of open defecation practice among households in sub-Saharan Africa. Methods Demographic and Health Survey data sets of 33 SSA countries with a total sample of 452,281 households were used for this study. Data were weighted, cleaned, and analyzed using STATA 14 software. Meta analyses were used to determine the pooled prevalence of open defecation practice among households in SSA. Multilevel analysis was employed to identify factors contributing to open defecation practice among households in SSA. Moreover, concentration index and graph were used to assess wealth-related inequalities of open defecation practice. The associations between dependent and independent variables were presented using adjusted odds ratios and 95% confidence intervals with a p value of < 0.05. Results The pooled prevalence of open defecation practice among households in sub-Saharan African countries was 22.55% (95%CI: 17.49%, 27.61%) with I2 = 99.9% and ranges from 0.81% in Comoros to 72.75% in Niger. Individual level factors, such as age, educational attainment, media exposure, wealth status, and access to drinking water, as well community level factors, such as residence, country income status, and region in SSA, had a significant association with open defecation practice. The concentration index value [C = − 0.55; 95% CI: − 0.54, − 0.56] showed that open defecation practice was significantly disproportionately concentrated on the poor households (pro-poor distribution). Conclusions Open defecation practice remains a public health problem in sub-Saharan Africa. Individual level factors, such as age, educational attainment, media exposure, household wealth status, and access to drinking water had an association with open defecation practice. Moreover, community level factors such as residence, country income status and region in SSA have a significant effect on open defecation. There is a significantly disproportional pro-poor distribution of open defecation practice in SSA. Each country should prioritize eliminating open defecation practices that focused poorest communities, rural societies, and limited water access areas. Media exposure and education should be strengthened. Moreover, public health interventions should target to narrow the poor-rich gap in the open defecation practice among households including provisions of subsidies to the poor. Policymakers and program planners better use this evidence as preliminary evidence to plan and decide accordingly.

Background Although a safe and effective vaccine is available, measles remains an important cause of mortality and morbidity among young children in Sub-Saharan Africa (SSA). The WHO and UNICEF recommended measles-containing vaccine dose 2 (MCV2) in addition to measles-containing vaccine dose 1 (MCV1) through routine services strategies. Many factors could contribute to the routine dose of MCV2 coverage remaining far below targets in many countries of this region. This study aimed to assess the prevalence of MCV2 utilization among children aged 24–35 months and analyze factors associated with it by using recent nationally representative surveys of SSA countries. Methods Secondary data analysis was done based on recent Demographic and Health Surveys (DHS) data from eight Sub-Saharan African countries. In this region, only eight countries have a record of routine doses of measles-containing vaccine dose 2 in their DHS dataset. The multilevel binary logistic regression model was fitted to identify significantly associated factors. Variables were extracted from each of the eight country’s KR files. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value ≤ 0.05 in the multivariable model were used to declare significant factors associated with measles-containing vaccine dose 2 utilization. Result The pooled prevalence of MCV2 utilization in SSA was 44.77% (95% CI: 27.10–62.43%). In the multilevel analysis, mothers aged 25–34 years [AOR = 1.15,95% CI (1.05–1.26), mothers aged 35 years and above [AOR = 1.26, 95% CI (1.14–1.41)], maternal secondary education and above [AOR = 1.27, 95% CI (1.13–1.43)], not big problem to access health facilities [AOR = 1.21, 95% CI (1.12–1.31)], four and above ANC visit [AOR = 2.75, 95% CI (2.35–3.24)], PNC visit [AOR = 1.13, 95% CI (1.04–1.23)], health facility delivery [AOR = 2.24, 95% CI (2.04–2.46)], were positively associated with MCV2 utilization. In contrast, multiple twin [AOR = 0.70, 95% CI (0.53–0.95)], rural residence [AOR = 0.69, 95% CI (0.57–0.82)] and high community poverty [AOR = 0.66, 95% CI (0.54–0.80)] were found to be negatively associated with MCV2 utilization. Conclusions and recommendations Measles-containing vaccine doses 2 utilization in Sub-Saharan Africa was relatively low. Individual-level factors and community-level factors were significantly associated with low measles-containing vaccine dose 2 utilization. The MCV2 utilization could be improved through public health intervention by targeting rural residents, children of uneducated mothers, economically poor women, and other significant factors this study revealed.

ObjectiveTo determine the magnitude of quality of antenatal care and associated factors among pregnant women in Ethiopia.DesignA community-based cross-sectional study.SettingEthiopia.ParticipantsA total of 4757 weighted sample of pregnant women from 18 January 2016 to 27 June 2016, were included for this analysis.OutcomeQuality of antenatal care (ANC).MethodsOur analysis was based on secondary data using the 2016 Ethiopian Demographic and Health Survey. The quality of ANC was measured when all six essential components, such as blood pressure measurements, blood tests, urine tests, nutrition counselling, birth preparation advice during pregnancy and information on potential complications, were provided. Stata V.14 software was used for analysis. A multilevel mixed-effect logistic regression analysis was fitted. Adjusted OR (AOR) with 95% CIs was used to show the strength and direction of the association. Statistical significance was declared at a p value less than 0.05.ResultsThe magnitude of quality of ANC in Ethiopia was 22.48% (95% CI: 21.31% to 23.69%). Educational status; primary (AOR=1.34; 95% CI: 1.06 to 1.68) and secondary (AOR=2.46; 95% CI: 1.76 to 3.45), middle (AOR=1.31; 95% CI: 1.01 to 1.72) and rich (AOR=2.08; 95% CI: 1.59 to 2.72) wealth status, being married (AOR=2.34; 95% CI: 1.08 to 5.10) and four or more ANC (AOR=2.01; 95% CI: 1.67 to 2.40) were statistically significant associated factors of quality ANC in Ethiopia.ConclusionsThis study found that nearly only one in five pregnant women received quality ANC during pregnancy. To improve the quality of ANC in Ethiopia, Ministry of Health and health facilities are needed to increase financial support strategies that enable pregnant women from poor households to use health services and enhance pregnant women’s understanding of the significance of quality of ANC through health education. Additionally, Community health workers should also be placed on supporting unmarried pregnant women to have quality ANC.

Background Only one in five children aged below 24 months in the low-income countries feed the minimum recommended diet, and significantly varied across socio-economic classes. Though sub-saharan Africa (SSA) shares the huge burden of children under nutrition, as to our search of literature there is limited evidence on the pooled magnitude and factors associated with minimum acceptable diet (MAD) intake among children aged 6 to 23 months in the region. This study aimed to assess the pooled magnitude and associated factors of MAD intake among children aged 6–23 months in SSA using recent 2010–2020 DHS data. Methods Demographic and Health Survey datasets of SSA countries were used for this study with a total of 78,542 weighted samples. The data were cleaned using MS excel and extracted and analyzed using STATA V.16 software. A multilevel binary logistic regression model was fitted. The adjusted odds ratio (AOR) with P-value < 0.05 was taken to declare statistical significance. Results The pooled magnitude of MAD intake among children aged 6–23 months in SSA was 9.89% [95%CI: 8.57, 11.21%] ranging from 3.10% in Guinea to 20.40% in Kenya. Individual level factors such as; secondary &above women educational status [AOR = 1.41; 95%CI; 1.29, 1.53], having employed women [AOR = 1.25;95%CI;1.17,1.33], having media exposure [AOR = 1.55;95%CI;1.45,1.66], richest household wealth [AOR = 1.93; 95%CI; 1.73, 2.15], plural birth [AOR = 0.68;95%CI; 0.56, 0.82] and breastfed child [AOR = 2.04; 95%CI; 1.89, 2.21], whereas, community level factor such as rural residence [AOR = 0.74; 95%CI; 0.69, 0.79] and living in upper middle income country [AOR = 1.62; [95%CI; 1.41,1.87] were significantly associated with MAD intake. Conclusion and recommendations Minimum acceptable diet intake in SSA is relatively low. Variables such as; secondary &above maternal education, having employed mother, exposure to media, richest wealth, breast feeding child, and upper middle income country have a significant positive association, whereas having plural birth and living in rural residence have a significant negative association with MAD intake. These findings highlight that policymakers and other stakeholders had better give prior attention to empowering women, enhance household wealth status and media exposure to increase the MAD intake in the region.

Background Open defecation is the disposal of human faeces in the fields, forests, bushes, and open bodies of water. It is practiced more in sub-Saharan African countries and is considered a sign of underdevelopment. Open defecation facilitates the transmission of pathogens that cause diarrheal diseases which is the second leading contributor to the global burden of disease. In Ethiopia, it kills half a million under-five children annually. Even though open defecation practice is a major cause of childhood mortality and morbidity in Ethiopia, there is minimal evidence on the trend, spatiotemporal distribution, wealth-related inequalities, and other determinates of open defecation practice. Objectives Therefore, this study aimed to investigate the trend, spatiotemporal distribution, and determinants of open defecation among households in Ethiopia. Methods Cross-sectionally collected secondary data analysis was conducted based on 2016 Ethiopian Demographic and Health Survey (EDHS). A total weighted sample of 16,554 households was included. We assessed the 16 years (2000–2016) trend of open defecation with 95% confidence intervals. Data were weighted, recoded, cleaned, and analyzed using STATA version 14.2 software. A mixed-effect analysis was employed to identify factors contributing to open defecation practice in Ethiopia. In the final multivariable analysis, the associations between dependent and independent variables were presented using adjusted odds ratios and 95% confidence intervals with a p-value of <0.05. The concentration index was used to assess wealth-related inequalities, while spatial analysis was used to explore the spatial distribution and significant windows of open defecation practice. Results The trend of open defecation practice in Ethiopia was significantly decreased from 81.96% (95% CI: 81.08, 82.8) in 2000 EDHS, to 32.23% (95% CI: 31.16, 33.31) in 2016 EDHS. Individual-level factors such as; age, educational attainment, marital status, media exposure, wealth status, and source of drinking water, as well as community-level factors such as residence, region, community-level poverty, and community level media usage, had a significant association. Open defecation practice was significantly and disproportionately concentrated on the poor households [C = -0.669; 95% CI: -0.716, -0.622]. A non-random open defecation practice was observed in Ethiopia. Among the 11 regions, primary clusters were identified in only 3 regions (Afar, Somali, and Eastern Amhara) Conclusion Open defecation practice remains a public health problem irrespective of the significant decrease seen in Ethiopia for the past 16 years. Individual and community-level factors had a significant association with this problem. Since it is a leading cause of under-five children mortality and morbidity, the Ethiopian ministry of health should plan and work on basic sanitation programs that focus on the poorest communities, rural societies, and small peripheral regions. These programs should include regional planning for sanitation, and translation of materials into local languages to prevent under-five mortality and morbidity due to diarrheal diseases caused by open defecation.

Background In low-and-middle-income, including Ethiopia, high-risk fertility behavior is a major public health concern. High-risk fertility behavior has an adverse influence on maternal and child health, which hampered efforts to reduce maternal and child morbidity and mortality in Ethiopia. Therefore, this study aimed to assess the spatial distribution and associated factors of high-risk fertility behavior among reproductive-age women in Ethiopia using recent nationally representative data. Methods Secondary data analysis was done with a total weighted sample of 5865 reproductive-aged women using the latest mini EDHS 2019. The spatial distribution of high-risk fertility behavior in Ethiopia was determined using spatial analysis. Multilevel multivariable regression analysis was used to identify predictors of high-risk fertility behavior in Ethiopia. Results The prevalence of high-risk fertility behavior among reproductive-age women in Ethiopia was 73.50% (95% CI 72.36%, 74.62%). Women with primary education [AOR = 0.44; 95%CI; 0.37, 0.52], women with secondary and above education [AOR = 0.26; 95%CI; 0.20, 0.34], being Protestant religion followers [AOR = 1.47; 95%CI; 1.15, 1.89], being Muslim religion follower [AOR = 1.56; 95%CI; 1.20, 2.01], having television [AOR = 2.06; 95%CI; 1.54, 2.76], having ANC visit [AOR = 0.78; 95%CI; 0.61, 0.99], using contraception [AOR = 0.77; 95%CI; 0.65, 0.90], living in rural areas [AOR = 1.75; 95%CI; 1.22, 2.50] were significantly associated with high-risk fertility behavior. Significant hotspots of high-risk fertility behavior were detected in Somalia, SNNPR, Tigray region, and Afar regions of Ethiopia. Conclusions A significant proportion of women in Ethiopia engaged in high-risk fertility behavior. High-risk fertility behavior was distributed non-randomly across Ethiopian regions. Policymakers and stakeholders should design interventions that take into account the factors that predispose women to have high-risk fertility behaviors and women who reside in areas with a high proportion of high-risk fertility behaviors to reduce the consequences of high-risk fertility behaviors.

BackgroundInappropriate feeding practices result in significant threats to child health by impaired cognitive development, compromised educational achievement, and low economic productivity, which becomes difficult to reverse later in life. There is minimal evidence that shows the burden and determining factors of inadequate dietary intake among children aged under 2 years in sub-Saharan African (SSA) countries. Therefore, this study aimed to assess the pooled magnitude, wealth-related inequalities, and other determinants of inadequate minimum dietary diversity (MDD) intake among children aged 6–23 months in the SSA countries using the recent 2010–2020 DHS data.MethodsA total of 77,887 weighted samples from Demographic and Health Survey datasets of the SSA countries were used for this study. The Microsoft Excel and STATA version 16 software were used to clean, extract, and analyze the data. A multilevel binary logistic regression model was fitted. The concentration index and curve were applied to examine wealth-related inequalities in the outcomes. P-value &lt; 0.05 with 95% CI was taken to declare statistical significance.ResultsThe pooled magnitude of inadequate MDD intake among children aged 6–23 months in SSA was 76.53% (95% CI: 73.37, 79.70), ranging from 50.5% in South Africa to 94.40% in Burkina Faso. Individual-level factors such as women having secondary and above education (AOR = 0.66; 95% CI; 0.62, 0.70), being employed (AOR = 0.76; 95% CI; 0.72, 0.79), having household media exposure (AOR = 0.69; 95% CI; 0.66, 0.72), richest wealth (AOR = 0.46; 95% CI; 0.43, 0.50), having health institution delivery (AOR = 0.87;95% CI; 0.83, 0.91), and community-level factor such as living in upper middle-income country (AOR = 0.42; 95% CI; 0.38, 0.46) had a significant protective association, whereas rural residence (AOR = 1.29; 95% CI; 1.23, 1.36) has a significant positive association with inadequate MDD intake among children aged 6–23 months. Inadequate MDD intake among children aged 6–23 months in SSA was disproportionately concentrated on the poor households (pro-poor) (C = −0.24; 95% CI: −0.22, −0.0.26).Conclusion and RecommendationsThere is a high magnitude of inadequate minimum dietary diversity intake among children aged 6–23 months in SSA. Variables such as secondary and above maternal education, having an employed mother, having exposure to media, richest wealth, having health institution delivery, and living in the upper middle-income country have a significant negative association, whereas living in rural residence has a significant positive association with inadequate MDD intake. These findings highlight that to increase the MDD intake in the region, policy makers and other stakeholders need to give prior attention to enhancing household wealth status, empowering women, and media exposure.

Background Iron deficiency is one of the most important factors of anemia which is caused by poor iron intake. In addition, children need more iron because of their rapid growth. On the other side, daily intake of iron is also recommended as a standard approach for the treatment and prevention of iron deficiency anemia. In Ethiopia, although more than half of children 6–59 months of age were affected by anemia, the magnitude and factors associated with iron intake among them are understudied. Therefore this study aimed to assess the magnitude and community and individual level determinants of iron intake among 6–59 months children in Ethiopia. Methods Demographic and Health Survey datasets (EDHS) were used for this study. The data were weighted using sampling weight to get valid statistical estimates. The total weighted samples of 9,218 children aged 6–59 months were included. A multilevel binary logistic regression model was fitted to identify factors associated with iron intake among 6–59 months of children in Ethiopia. In the final model adjusted odds ratio with a 95% confidence interval and p-value < 0.05 was taken to declare statistical significance. Results The magnitude of iron intake among children 6–59 months in Ethiopia was 9.24% (95% CI: 8.31%, 10.15%). Individual level variables such as having at least one antenatal care visit (ANC) [AOR = 1.27; 95%CI; 1.01, 1.61], having health institution delivery [AOR = 1.46; 95%CI;1.04, 2.04], age of children ≥ 24 months [AOR = 1.82; 95%CI; 1.29, 2.57], being female child [AOR = 0.81; 95%CI; 0.67, 0.99], being greater than three birth order [AOR = 0.73, 95%CI: 0.55, 0.98], whereas community level variables such as living in large central regions [AOR = 3.68; 95%CI; 1.47, 9.21], and living in community with high women education [AOR = 1.96; 95%CI; 1.28, 2.98] have an association with iron supplements among children 6–59 months years old in Ethiopia. Conclusion and recommendations The magnitude of iron intake among children 6–59 months old in Ethiopia is relatively low. Individual level factors such as; ANC visit, institution delivery, age of children, sex of the child, and birth order as well as; community level variables such as regions, and community women's education have a significant association with iron intake among children 6–59 months in Ethiopia. Prior attention should be given for under two years old children, children greater than three birth orders, and children living in small peripheral regions. Moreover, policymakers and other stakeholders had better plan and implement programs that empower women, enhance ANC visits, and health institution delivery to have a sustainable increment in iron intake for children in Ethiopia.