Spatial distribution and determinants of iron supplementation among reproductive age women in Ethiopia: a spatial and multilevel analysis

Abstract

Background: Anemia remains a global public health problem. Despite WHO recommended all pregnant women to have iron supplementation, nearly 50% of maternal anemia in SSA was occurred due to lack of iron supplementation during pregnancy. Maternal anemia is associated with an increased risk of maternal death, obstetric complications, preterm birth, and low birth weight. There is limited evidence on the spatial pattern and determinants of iron supplementation using spatial and multilevel analysis methods. Therefore, this study aimed to investigate the spatial pattern, and determinants of iron supplementation in Ethiopia. Methods: We used Ethiopian Demographic Health Survey in 2016 data explore the spatial distribution and associated factors of iron supplementation among women in Ethiopia. A weighted sample of 7589 women were included in the analysis. Bernoulli model was used to explore the purely spatial clusters of pregnant women using SaTScan version 9.6 and ArcGIS version10.3. Multilevel logistic regression analysis was fitted to identify significant individual and community level determinants of iron supplementation. Results: Spatial analysis revealed that there was significant spatial variation of iron supplementation among reproductive age women in Ethiopia with Global Moran’s index value of 0.3 (p <0.001). The primary cluster was in Southwest Somali and Central part of the Oromia region ((LLR=66.69, P<0.001, RR=1.35). ANC visit (AOR= 3.66, 95%CI: 3.21, 417), community education [AOR= 1.31, 95%CI, 1.07, 1.59), media exposure (AOR=1.33, 95%CI: 1.15, 1.53), distance to health facility (AOR=1.32, 95%CI: 1.16, 1.50), region and household wealth index were significantly associated with iron supplementation among women in Ethiopia. Conclusion: The spatial distribution of iron supplementation among reproductive age women were significantly varied across the country with significant hotspot areas located in the Southwest Somali and Central Oromia regions. Besides, ANC visit, region, household wealth index, media exposure, distance to the health facility, and community education were significant determinants of iron supplementation among reproductive age women. Therefore, the finding of this study could help to design effective public health interventions targeting areas low iron supplementation and maternal health services should be delivered in all areas of our country. Keywords : Iron supplementation, spatial analysis, women, Ethiopia

Geographical disparities and determinants of adherence to iron folate supplementation among pregnant women in Ethiopia: spatial and multilevel analysis of the Ethiopian Mini Demographic and Health Survey of 2019

“…Pregnant mothers with a higher level of education are more likely to take iron-folate supplements for recommended period than those with no education. This study’s findings are similar to those of previous studies in Ethiopia, 40 Pakistan, 41 Senegal, 42 India. 43 This might be because education is a critical tool for increasing pregnant mother’s knowledge of the consequences of iron deficiency and demonstrating how to deal with these deficiencies.…”

“…This result was confirmed by other studies. 40 45 48 49 This could be due to the fact that women with easy access to healthcare are more likely to use maternal healthcare services such as ANC follow-ups during the index pregnancy. According to women’s current marital status was found to have a significant relationship with iron-folate supplementation adherence for the recommended period.…”

“…Attending WHO-required ANC (at least four times) was linked to a higher intake of iron-folate during pregnancy. Other studies have found that taking iron tablets during pregnancy is associated with an increased number of ANC visits 17 33 36 40 44–46. Aside from the fact that more ANC visits mean more interaction with a health provider, this could be because when mothers attended ANC frequently, their haemoglobin level could be continuously monitored.…”

Geographical variation and predictors of zero utilization for a standard maternal continuum of care among women in Ethiopia: a spatial and geographically weighted regression analysis

“…The z-score was calculated to confirm the statistical significance of clustering and the p -value was calculated to determine the significance at p -value< 0.05 with 95% CI. If the z-score is less than − 1.96 it is declared as a cold spot and if it is greater than + 1.96 it is declared as hotspot areas [ 33 – 36 ].…”

“…The probability of false inclusion and exclusion of clusters is limitation of SaT Scan. Details about spatial scan statistical determination is published everywhere [ 33 , 36 – 39 ].…”