Turkiye Klinikleri Journal of Biostatistics

.: ORIGINAL RESEARCH
Rural-Urban Differentials in Birth-to-Conception Intervals in Ethiopia: A Parametric Survival Analysis Approach
Etiyopya'da Gebe Kalma Aralıklarında Kırsal-Kentsel Farklılıklar: Parametrik Sağkalım Analizi Yaklaşımı
Samba Siva Rao PASUPULETIa, Yohannes Tadesse ASNAKEWb
aDepartment of Research, Institute of Liver and Biliary Sciences, New Delhi, INDIA/HİNDİSTAN
bDepartment of Statistics, University of Gondar, College of Natural and Computational Science, Gondar, ETHIOPIA/ETOPYA
Turkiye Klinikleri J Biostat. 2019;11(3):254-66
doi: 10.5336/biostatic.2019-66764
Article Language: EN
Full Text
ABSTRACT
Objective: Huge fertility and mortality differentials exist between rural and urban women in Ethiopia. But very little is known about their differential in birth intervals. This study fills knowledge gap by exploring latest birth-to-conception interval patterns by place of residence in Ethiopia and by exploring the role of various socioeconomic and demographic factors in the rural urban differential in birth-to-conception interval. The study also identifies the best fitted parametric survival regression models to estimate rural-urban differentials in birth-to-conception intervals in Ethiopia. Methods: This study makes use of data from the latest (fourth) Ethiopian Demographic Health Survey, and uses Kaplan-Meier and parametric survival models to better address the study objectives. Results: The study findings showed median time to subsequent conception following a baby birth is 2 year 2 months (26 months) for rural women and 3 year 11 months (47 months) for urban women in Ethiopia. Similarly, average birth-to-conception interval is 3 years for rural women and 5 years 1 month for urban women. Place of residence remained as a significant predictor of birth-to-conception interval even after controlling for possible confounders in their relationship. Around 17% of the gap in the ratio of mean of birth-to-conception interval for urban women to that of rural women is found to be explained by the considered socio-economic and demographic mediators. Conclusions: Differences in the usage of modern contraceptive methods for spacing purposes accounts for less than 1% of the gap in the ratio of mean of birth-to-conception interval for urban women to that of rural women. Finally, based on the results of the study, we can conclude that the Weibull regression model was the best fitted parametric model for rural-urban differentials in birth-to-conception intervals in Ethiopia. Recommendation: We recommend that it is better to see rural-urban differentials in birth-to-conception intervals in Ethiopia by including other covariates and statistical analysis systems. This study also recommends public health intervention strategies in Ethiopia should consider to improve the awareness of people about the benefits of optimal birth spacing of 3 to 5 years, and encourage and facilitate people to use contraceptive methods for spacing purposes. This is expected to result in improved maternal and child health outcomes.

Keywords: Birth-to-conception interval; birth interval; Ethiopia; parametric survival models; Weibull distribution; and right censored
ÖZET
Etiyopya'da kırsal ve kentsel kadınlar arasında büyük doğurganlık ve ölüm farklılıkları bulunmaktadır. Ancak doğum aralıklarındaki farklar hakkında çok az şey bilinmektedir. Bu çalışma kırsal ve kentteki gebe kalma aralıklarında çeşitli sosyoekonomik ve demografik faktörleri araştırarak Etiyopya'da ikamet yerine göre en yeni gebe kalma aralıkları yapısını araştırarak bilgi boşluğunu doldurmaktadır. Ayrıca bu çalışma Etiyopya'da gebe kalma aralıklarında kırsal ve kentsel farklılıkları tahmin etmede en iyi parametrik sağkalım regresyon modellerini tanımlamaktadır. Gereç ve Yöntemler: Bu çalışma, en son (dördüncü) Etiyopya Demografik Sağlık Araştırması verilerinden faydalanmakta ve çalışma hedeflerini daha iyi ele almak için Kaplan- Meier ve parametrik sağkalım modellerini kullanmaktadır. Bulgular: Çalışma bulguları Etiyopya'da bebek doğumunu izleyen gebe kalma medyan süresinin kırsal kesimde yaşayan kadınlarda iki yıl iki ay (26 ay) kentte yaşayan kadınlarda ise üç yıl on bir ay (47 ay) olduğunu göstermiştir. Benzer olarak, gebe kalma aralıkları ortalaması kırsal kesimde yaşayan kadınlarda üç yıl, kentte yaşayan kadınlarda ise beş yıl bir aydır. İkamet yeri olası karıştırıcı faktör olarak kontrol altına alındıktan sonra bile gebe kalma aralığının anlamlı tahmin edicisi olarak bulunmuştur. Kentte ve kırsalda yaşayan kadınların gebe kalma aralıkları arasındaki ortalama %17'lik farkın sosyoekonomik ve demografik aracılarla açıklandığı bulunmuştur. Sonuç: Kentte ve kırsalda yaşayan kadınların gebe kalma aralıkları arasındaki ortalama farkın %1'i modern doğum kontrol yöntemlerini kullanım farklılıklarından kaynaklanmaktadır. Sonuç olarak çalışma sonuçlarına dayanarak Etiyopya'da kentte ve kırsalda yaşayan kadınların gebe kalma aralıkları için tahmin edilen en iyi parametrik modelin Weibull regresyon modeli olduğu sonucuna varılabilir. Öneriler: Etiyopya'da kentte ve kırsalda yaşayan kadınların gebe kalma aralıklarındaki farkı daha iyi görebilmek için diğer değişkenler ve istatistiksel analiz sistemleri çalışmaya dahil edilmelidir. Bu çalışma aynı zamanda Etiyopya'da halk sağlığına müdahale stratejilerinin, insanların 3-5 yıl arasındaki optimal doğum aralığının yararları hakkındaki farkındalığını arttırmayı göz önünde bulundurmasını ve insanları doğum kontrol yöntemleri kullanmaya teşvik dilmesini önermektedir. Bu yaklaşımların anne ve çocuk sağlığı sonuçlarında iyileşme ile sonuçlanması beklenmektedir.

Anahtar Kelimeler: Gebe kalma aralığı; doğum aralığı; Etiyopya; parametrik sağkalım modelleri; Weibull dağılımı; sağdan sansürlü
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