Spatial Distribution and Factors Associated with Low birth weight in Ethiopia using data from Ethiopian Demographic and Health Survey 2016; Spatial and Multilevel analysis

Abstract Background Low birth weight (LBW) is a leading cause of neonatal mortality. In Ethiopia, it is a public health problem that contributes to the majority of newborn deaths. To date, the effect of contextual factors on LBW was largely overlooked in Ethiopia. Besides, there is also limited evidence on the geographic variation of low birth weight in Ethiopia. Therefore, this study aimed to explore spatial distribution as well as individual and community-level factors associated with low birth weight in Ethiopia. Method: Secondary data analysis was conducted using the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total of 1502 neonates were included in this study. Spatial autocorrelation analysis was conducted to assess the spatial dependency of LBW. Besides, the spatial scan statistics and ordinary kriging interpolation were done to detect the local level clusters and to assess predicted risk areas respectively. Furthermore, a multi-level logistic regression model was fitted to determine individual and community-level factors associated with low birth weight. Finally, most likely clusters with log-likelihood ratio (LLR), relative risk and p-value from spatial scan statistics, and AOR with 95% CI for multi-level logistic regression model were reported. Results Low birth weight was spatially clustered in Ethiopia. Primary (LLR = 11.57; P = 0.002) clusters were detected in the Amhara region. It showed that neonates within the spatial window had 2.66 times higher risk of being LBW baby as compared to those outside the window. Besides, secondary (LLR = 11.4; P = 0.003;LLR = 10.14,P = 0.0075) clusters were identified at Southwest Oromia, north Oromia, south Afar, and Southeast Amhara regions. Neonates who were born from severely anemic (AOR = 1.47;95%CI 1.04,2.01), and uneducated (AOR = 1.82;95%CI1.12,2.96) mothers, as well as those who were born before 37 weeks of gestation (AOR = 5.91;95%CI3.21,10.10) and females (AOR = 1.38;95%CI1.04,1.84), had significantly higher odds of being low birth weight babies. Conclusion The high-risk areas of low birth weight were detected in Afar, Amhara, and Oromia regions. Therefore, targeting the policy interventions in those risk areas by focusing on the improvement of maternal education, strengthening anemia control programs and elimination of modifiable causes of prematurity could be vital for reduce the low birth weight disparity in Ethiopia.