The study of waiting time to first pregnancy in the south of Iran: A parametric frailty model approach

Zare, Najaf; Nouri, Bijan; Moradi, Fariba; Parvareh, Maryam

doi:10.29252/ijrm.15.1.11

Cited by 8 publications

(12 citation statements)

References 21 publications

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“…Bangladeshi (1) and results elsewhere (3,4,7,14,19,21,22,26,(31)(32)(33)(34)(35)(41)(42)(43). In particular, ensuring those adolescent girls to receive at least a secondary level of education is the optimal way of delaying childbirth (53,58).…”

Section: Discussionmentioning

confidence: 99%

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Time to first birth and its Predictors among reproductive-age women in Ethiopia: inverse Weibull gamma shared frailty model

Dewau

Mekonnen

Seretew

2020

Preprint

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Background: High maternal and child death with high fertility rate have been reported in Ethiopia. Extreme age at first birth is linked with both maternal and child morbidity and mortality. However, literatures showed there were limited studies on the timing of the first birth and its predictors in the area so far. Therefore, determining the time to first birth and its predictors will help to design strategies to improve maternal and child survival. Methods: A community-based cross-sectional study was conducted among reproductive-age women in Ethiopia using the Ethiopian demographic health survey (EDHS), 2016 data. Stratified two-stage cluster sampling technique was used for sampling. The Kaplan-Meier (KM) method was used to estimate time to first birth. Inverse Weibull gamma shared frailty model applied to model the data at 95% confidence interval (CI), adjusted hazard ratio (AHR) and median hazard ratio (MHR) were reported as effect size. Proportional hazard assumption checked using Schoenfeld residual test. Information Criteria were applied to select a parsimonious model. Stratified analysis performed for the interaction terms and statistical significance was declared at p value<0.05. Results: The overall median age at first birth was found to be 20 years (IQR, 16-24 years). The independent predictors of time to first birth were: married 15-17 years (AHR=2.33,95% CI:2.08-2.63),secondary education level (AHR=0.84,95% CI:0.78-0.96), higher education level (AHR=0.75, 95% CI:0.65-0.85), intercourse before 15 years in the married stratum (AHR=23.81, 95% CI:22.22-25.64), intercourse 15-17 years in married stratum (AHR=5.56, 95% CI:5.26-5.88),spousal age difference (AHR=1.11, 95% CI:1.05-1.16),and use of contraceptives (AHR=0.91, 95% CI: 0.86-0.97). The median increase in the hazard of early childbirth in a cluster with higher early childbirth is 16% (MHR=1.16, 95% CI: 1.13-1.20) than low risk clusters adjusting for other factors.Conclusion:In this study, first birth was found to be at an early age. Early age at first marriage, at first sexual intercourse and their interaction, high spousal age difference, being Muslim were found to increase early motherhood. Conversely, living in the most urban region, secondary and higher women education were identified to delay the first birth. Investing on women education and protecting them from early marriage is required to optimize time to first birth. The contextual differences in time to first birth are an important finding which requires more study and interventions.

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Section: Discussionmentioning

confidence: 99%

“…Those who gave rst birth at 30 years and above group were 33% at higher risk of mortality compared to those who gave rst birth in the age group 20-24 years in Ohsaki Japan (16). The impacts of urbanization and modernization postponed the age at rst birth in the later age in the developed world (9,(20)(21)(22).…”

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confidence: 99%

Time to first birth and its Predictors among reproductive-age women in Ethiopia: inverse Weibull gamma shared frailty model

Dewau

Mekonnen

Seretew

2020

Preprint

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“…As many studies showed that the probability of early age at first birth is higher in women with no or lower level education compared to women at a higher educational level (1,5,31,33,36,37,(41)(42)(43)6,9,14,17,20,24,25,30). Most of the studies revealed that having poor and middle wealth index status was identified as the risk of age at first birth in early age (24,(30)(31)(32)(35)(36)(37)41,44).…”

Section: Introductionmentioning

confidence: 99%

“…Most of the studies revealed that having poor and middle wealth index status was identified as the risk of age at first birth in early age (24,(30)(31)(32)(35)(36)(37)41,44). (5,6,(33)(34)(35)(36)(37)(38)9,14,17,20,21,25,30,31). The majority works of the literature revealed that the use of any contraception delay age at first birth (5,8,9,20,30,31,34,39,40) On the other hand, advanced maternal age (> 30 years) at first birth is associated with an increased risk of fetal loss, chromosomal anomalies, multiple pregnancies, hypertension, diabetes mellitus, preterm birth, low birth weight, breast cancer and maternal mortality (16,22,23).…”

Section: Introductionmentioning

confidence: 99%

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Time to first birth and its Predictors among reproductive-age women in Ethiopia: inverse Weibull gamma shared frailty model

Yimer

Mekonnen

Seretew

2020

Preprint

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Background: High maternal and child death with high fertility rate have been reported in Ethiopia. Extreme age at first birth is linked with both maternal and child morbidity and mortality. However, literatures showed there are limited studies on timing of first birth and its predictors in the area so far. Therefore, determining time to first birth and its predictors will help to design strategies to improve maternal and child survival. Methods: A survey-based study was conducted among reproductive-age women in Ethiopia using Ethiopian demographic health survey (EDHS), 2016 data. Stratified two-stage cluster sampling technique was used for sampling. The Kaplan-Meier (KM) method was used to estimate time to first birth. Inverse Weibull gamma shared frailty model applied to model the data at 95% confidence interval (CI), adjusted hazard ratio (AHR) and median hazard ratio (MHR) were reported as effect size. Proportional hazard assumption checked using Schoenfeld residual test. Information Criteria was applied to select parsimonious model. Stratified analysis performed for interaction terms and statistical significance declared at p value<0.05. Results: The overall median age at first birth found to be 20 years (IQR, 16-24years). The independent predictors of time to first birth were: marriage 15-17 years (AHR=2.33,95% CI:2.08-2.63),secondary education level (AHR=0.84,95% CI:0.78-0.96), higher education level (AHR=0.75, 95% CI:0.65-0.85), intercourse before 15 years in the married stratum (AHR=23.81, 95% CI:22.22-25.64), intercourse 15-17 years in married stratum (AHR=5.56, 95% CI:5.26-5.88),spousal age difference (AHR=1.11, 95% CI :1.05-1.16),and use of contraceptives (AHR=0.91, 95% CI [0.86-0.97]). The median increase in the hazard of early childbirth at a cluster with higher early childbirth is 16% (MHR=1.16, 95% CI [1.13-1.20]) than low risk clusters.Conclusion: In this study, first birth found to be at an early age. Early age at first marriage, at first sexual intercourse and their interaction terms, high spousal age difference, being Muslim were found to increase early motherhood. Conversely, living in most urban region, secondary and higher women education were identified to delay first birth. Investing on women education and protecting them from early marriage are required to optimize time to first birth. The contextual differences in time to first birth are a novel finding which requires more study and interventions.

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Bayesian Shared Frailty Models for Time to First Birth of Married Women in Ethiopia: Using EDHS 2016

Fentaw

Fenta

Biresaw

et al. 2022

Computational and Mathematical Methods in Medicine

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Introduction. The primary effect of the fertility process is the birth of the first child. The ages at which women establish marital union and give their first birth depend on and result in varying demographic features. This research demonstrates how to examine the effect of numerous factors on married women’s delay to first birth in Ethiopia using Bayesian parametric models with gamma shared frailty distribution. Methods. This study analyzed data from the 2016 EDHS on factors related to the time of married women to first birth. A sample of 8810 married women from all parts of Ethiopia participated in the study. The Akaike information criterion (AIC) and Bayesian information criterion (BIC) were used to compare several parametric models with gamma shared frailty distributions to find the best model (BIC). Finally, when the prior data was taken into account, the chosen model was proven to be accurate (Bayesian approach). Results. The median survival time for the first birth after marriage is 24 years (95% CI; 23.4, 25.3). The result shows that the place of residence, the access to media, the level of education of the mother, the education level of the husband, the use of the head of the contraceptives, and the sex of the household are statistically associated with the time to first birth of married women. The Weibull-gamma shared frailty model under the Bayesian approach was found to be the best model that fit the time to first birth data in this study. The result also showed that there is heterogeneity between regions of married women. Conclusion. To slow the increase in the Ethiopian population, families must be taught how to use contraception, and rural populations must be educated on the necessity of increasing the length of the first birth gap rather than encouraging early marriage. In general, attempts to reduce fertility by raising the age of the first marriage must consider the social and cultural settings in which marriage takes place. On the other hand, the campaign against early marriage should focus on the sociocultural, physiological, and psychological effects, as well as the reduction of reproduction.

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The study of waiting time to first pregnancy in the south of Iran: A parametric frailty model approach

Cited by 8 publications

References 21 publications

Time to first birth and its Predictors among reproductive-age women in Ethiopia: inverse Weibull gamma shared frailty model

Time to first birth and its Predictors among reproductive-age women in Ethiopia: inverse Weibull gamma shared frailty model

Time to first birth and its Predictors among reproductive-age women in Ethiopia: inverse Weibull gamma shared frailty model

Bayesian Shared Frailty Models for Time to First Birth of Married Women in Ethiopia: Using EDHS 2016

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