Individual and community-level factors of abortion in East Africa: a multilevel analysis

Archives of Public Health - Tập 80 Số 1
Tesfa Sewunet Aalmneh1, Adugnaw Zeleke Alem1, Gebrekidan Ewnetu Tarekegn1, Tilahun Kassew2, Bikis Liyew3, Bewuketu Terefe4
1Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia
2Departments of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
3School of Nursing, College of Medicine and Health Sciences, Department of Emergency and Critical Care Nursing, University of Gondar, Gondar, Ethiopia
4School of Nursing, College of Medicine and Health Sciences, Community Health Nursing Department, University of Gondar, Gondar, Ethiopia

Tóm tắt

AbstractBackgroundAbortion is one of the top five causes of maternal mortality in low and middle-income countries. It is associated with a complication related to pregnancy and childbirth. Despite this, there was limited evidence on the prevalence and associated factors of abortion in East African countries. Therefore, this study aimed to investigate the prevalence and associated factors of abortion among reproductive-aged women in East African countries.MethodsThe Demographic and Health Surveys (DHS) data of 12 East African countries was used. A total weighted sample of 431,518 reproductive-age women was included in the analysis. Due to the hierarchical nature of the DHS data, a multilevel binary logistic regression model was applied. Both crude and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was calculated for potential associated factors of abortion in East Africa. In the final model, variables with apvalue < 0.05 were declared as statistically significant factors of abortion.ResultsAround 5.96% (95%CI: 4.69, 7.22) of reproductive-aged women in East Africa had a history of abortion. Alcohol use, tobacco or cigarette smoking, being single, poorer wealth index, currently working, traditional family planning methods, and media exposure were associated with a higher risk of abortion. However, higher parity, having optimum birth intervals, and modern contraceptive uses were associated with lower odds of abortion.ConclusionsThe prevalence of abortion among reproductive-aged women in East Africa was high. Abortion was affected by various socio-economic and obstetrical factors. Therefore, it is better to consider the high-risk groups during the intervention to prevent the burdens associated with abortion.

Từ khóa


Tài liệu tham khảo

Organization WH. World health statistics 2015. Geneva: World Health Organization; 2015. https://apps.who.int/iris/bitstream/handle/10665/170250/9789240694439_eng.pdf?sequence=1&isAllowed=y.

Organization WH. Strategies towards ending preventable maternal mortality (EPMM). 2015.

Diedrich J, Steinauer J. Complications of surgical abortion. Clin Obstet Gynecol. 2009;52(2):205–12.

Grimes DA, Benson J, Singh S, Romero M, Ganatra B, Okonofua FE, et al. Unsafe abortion: the preventable pandemic. The lancet. 2006;368(9550):1908–19.

Fusco CLB. Unsafe abortion: a serious public health issue in a poverty stricken population. Reprodução & Climatério. 2013;28(1):2–9.

Åhman E, Shah IH. Unsafe Abortion: Global and Regional Estimates of the Incidence of Unsafe Abortion and Associated Mortality in 2008. Geneva: World Health Organization; 2011. http://apps.who.int/iris/bitstream/handle/10665/44529/9789241501118_eng.pdf?sequence=1.

Loi UR, Gemzell-Danielsson K, Faxelid E, Klingberg-Allvin M. Health care providers’ perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia: a systematic literature review of qualitative and quantitative data. BMC Public Health. 2015;15(1):139.

Dai R, Li L, Zhu H, Geng D, Deng S, Liu R. Effect of maternal age on spontaneous abortion during the first trimester in Northeast China. J Matern Fetal Neonatal Med. 2018;31(14):1824–9.

Heikinheimo O, Gissler M, Suhonen S. Age, parity, history of abortion and contraceptive choices affect the risk of repeat abortion. Contraception. 2008;78(2):149–54.

Pallikadavath S, Stones RW. Maternal and social factors associated with abortion in India: a population-based study. Int Fam Plan Perspect. 2006;32(3):120–5.

Koch E, Thorp J, Bravo M, Gatica S, Romero CX, Aguilera H, et al. Women’s education level, maternal health facilities, abortion legislation and maternal deaths: a natural experiment in Chile from 1957 to 2007. PLoS One. 2012;7(5):e36613.

Becker D, Diaz-Olavarrieta C, Juarez C, Garcia SG, Smith PS, Harper CC. Sociodemographic factors associated with obstacles to abortion care: findings from a survey of abortion patients in Mexico City. Womens Health Issues. 2011;21(3):S16–20.

Senbeto E, Alene GD, Abesno N, Yeneneh H. Prevalence and associated risk factoprs of Induced Abortion in Northwet Ethiopia. EJHD. 2005;19(1):37–44.

Yogi A, Prakash K, Neupane S. Prevalence and factors associated with abortion and unsafe abortion in Nepal: a nationwide cross-sectional study. BMC Pregnancy Childbirth. 2018;18(1):376.

Andersen KL, Khanal RC, Teixeira A, Neupane S, Sharma S, Acre VN, et al. Marital status and abortion among young women in Rupandehi. Nepal BMC Women’s Health. 2015;15(1):17.

Banerjee B, Dey T, Chatterjee P. Work related physical exertion and spontaneous abortion. Indian J Public Health. 2005;49(4):248–9.

Wong EY, Ray R, Gao DL, Wernli KJ, Li W, Fitzgibbons ED, et al. Physical activity, physical exertion, and miscarriage risk in women textile workers in Shanghai. Am J Ind Med. 2010;53(5):497–505.

Mollison J, Porter M, Campbell D, Bhattacharya S. Primary mode of delivery and subsequent pregnancy. BJOG. 2005;112(8):1061–5.

Tummers P, Sutter PD, Dhont M. Risk of spontaneous abortion in singleton and twin pregnancies after IVF/ICSI. Hum Reprod. 2003;18(8):1720–3.

Conde-Agudelo A, Belizan J, Breman R, Brockman S, Rosas-Bermudez A. Effect of the interpregnancy interval after an abortion on maternal and perinatal health in Latin America. Int J Gynecol Obstet. 2005;89:S34–40.

Ahmadi R, Ziaei S, Parsay S. Association between nutritional status with spontaneous abortion. International Journal of Fertility & Sterility. 2017;10(4):337.

Neela J, Raman L. Therelationship between maternal nutritional status and spontaneous abortion. Natl Med J India. 1997;10:15–6.

Martino SC, Collins RL, Ellickson PL, Klein DJ. Exploring the link between substance use and abortion: The roles of unconventionality and unplanned pregnancy. Perspect Sex Reprod Health. 2006;38(2):66–75.

Wisborg K, Kesmodel U, Henriksen TB, Hedegaard M, Secher NJ. A prospective study of maternal smoking and spontaneous abortion. Acta Obstet Gynecol Scand. 2003;82(10):936–41.

Nielsen A, Gerd Hannibal C, Eriksen Lindekilde B, Tolstrup J, Frederiksen K, Munk C, et al. Maternal smoking predicts the risk of spontaneous abortion. Acta Obstet Gynecol Scand. 2006;85(9):1057–65.

Joó JG, Csaba Á, Szigeti Z, Rigó J Jr. Spontaneous abortion in multiple pregnancy: Focus on fetal pathology. Pathol Res Pract. 2012;208(8):458–61.

Dickey RP, Taylor SN, Lu PY, Sartor BM, Storment JM, Rye PH, et al. Spontaneous reduction of multiple pregnancy: incidence and effect on outcome. Am J Obstet Gynecol. 2002;186(1):77–83.

Kennedy C, Ahlering P, Rodriguez H, Levy S, Sutovsky P. Sperm chromatin structure correlates with spontaneous abortion and multiple pregnancy rates in assisted reproduction. Reprod Biomed Online. 2011;22(3):272–6.

Ganatra B, Gerdts C, Rossier C, Johnson BR Jr, Tunçalp Ö, Assifi A, et al. Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. The Lancet. 2017;390(10110):2372–81.

Theodorou AE, Sandstrom A. How abortion is regulated around the world. Pew Research Center. 2015. https://www.pewresearch.org/fact-tank/2015/10/06/how-abortion-is-regulated-around-the-world/.

Croft TN, Marshall AM, Allen CK, Arnold F, Assaf S, Balian SJRI. Guide to DHS statistics. 2018. p. 645.

Goldstein H. Multilevel statistical models: John Wiley & Sons; 2011. https://books.google.com.et/books?hl=en&lr=&id=mdwt7ibSGUYC&oi=fnd&pg=PP14&dq=Goldstein+H.+Multilevel+statistical+models:+John+Wiley+%26+Sons%3B+2011.&ots=fzPvH_SU1Z&sig=F9Uuatts6Yz748kypmDSwc55mzw&redir_.

Liu X. Applied ordinal logistic regression using Stata: From single-level to multilevel modeling: Sage Publications; 2015. https://study.sagepub.com/liu-aolr.

Dickson KS, Adde KS, Ahinkorah BO. Socio–economic determinants of abortion among women in Mozambique and Ghana: evidence from demographic and health survey. Archives of Public Health. 2018;76(1):37.

Tesema GA, Mekonnen TH, Teshale AB. Spatial distribution and determinants of abortion among reproductive age women in Ethiopia, evidence from Ethiopian Demographic and Health Survey 2016 data: Spatial and mixed-effect analysis. PLoS ONE. 2020;15(6):e0235382.

Abdella A. Maternal mortality trend in Ethiopia. Ethiopian Journal of Health Development. 2010;24(1)115-22.

Yaya S, Uthman OA, Ekholuenetale M, Bishwajit G. Women empowerment as an enabling factor of contraceptive use in sub-Saharan Africa: a multilevel analysis of cross-sectional surveys of 32 countries. Reprod Health. 2018;15(1):214.

Kaye DK, Mirembe FM, Bantebya G, Johansson A, Ekstrom AM. Domestic violence as risk factor for unwanted pregnancy and induced abortion in Mulago Hospital, Kampala, Uganda. Trop Med Int Health. 2006;11(1):90–101.

Getaneh T, Negesse A. Predictors of Malnutrition among Pregnant Women in Ethiopia: Systematic Review and Meta-Analysis. 2020.

Cook RJ, Dickens BM. Reducing stigma in reproductive health. Int J Gynecol Obstet. 2014;125(1):89–92.

Roberts SC, Avalos LA, Sinkford D, Foster DG. Alcohol, tobacco and drug use as reasons for abortion. Alcohol Alcohol. 2012;47(6):640–8.

Kesmodel U, Wisborg K, Olsen SF, Brink Henriksen T, Jørgen SN. Moderate alcohol intake in pregnancy and the risk of spontaneous abortion. Alcohol Alcohol. 2002;37(1):87–92.

Chiodo LM, Bailey BA, Sokol RJ, Janisse J, Delaney-Black V, Hannigan JH. Recognized spontaneous abortion in mid-pregnancy and patterns of pregnancy alcohol use. Alcohol. 2012;46(3):261–7.

Grewal J, Carmichael SL, Ma C, Lammer EJ, Shaw GM. Maternal periconceptional smoking and alcohol consumption and risk for select congenital anomalies. Birth Defects Res A. 2008;82(7):519–26.

Martínez-Frías ML, Bermejo E, Rodríguez-Pinilla E, Frías JL. Risk for congenital anomalies associated with different sporadic and daily doses of alcohol consumption during pregnancy: a case–control study. Birth Defects Res A. 2004;70(4):194–200.

Samadirad B, Khamnian Z, Hosseini MB, Dastgiri S. Congenital anomalies and termination of pregnancy in Iran. J Pregnancy. 2012;2012:574513.

Connery HS, Albright BB, Rodolico JM. Adolescent substance use and unplanned pregnancy: strategies for risk reduction. Obstet Gynecol Clin North Am. 2014;41(2):191–203.

Palomino N, Padilla MR, Talledo BD, Mazuelos CG, Carda J, Bayer AM. The social constructions of unwanted pregnancy and abortion in Lima, Peru. Glob Public Health. 2011;6(sup1):S73–89.

Singh S, Bankole A, Darroch JE. The impact of contraceptive use and abortion on fertility in sub-Saharan Africa: estimates for 2003–2014. Popul Dev Rev. 2017;43(Suppl 1):141.

Sedgh G, Bankole A, Oye-Adeniran B, Adewole IF, Singh S, Hussain R. Unwanted pregnancy and associated factors among Nigerian women. Int Fam Plan Perspect. 2006;32(4):175–84.

Stephenson R, Koenig MA, Acharya R, Roy TK. Domestic violence, contraceptive use, and unwanted pregnancy in rural India. Stud Fam Plann. 2008;39(3):177–86.

Ganatra B, Faundes A. Role of birth spacing, family planning services, safe abortion services and post-abortion care in reducing maternal mortality. Best Pract Res Clin Obstet Gynaecol. 2016;36:145–55.

Thông tin
Thông tin xuất bản

Archives of Public Health

Tập 80 Số 1

Thông tin tác giả