Determinants of Suboptimal Birth Spacing among Reproductive-Age Women in Adama District, Ethiopia: A Community-Based Unmatched Case-Control Study

Determinants of Suboptimal Birth Spacing among Reproductive-Age Women in Adama District, Ethiopia: A Community-Based Unmatched Case-Control Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of Suboptimal Birth Spacing among Reproductive-Age Women in Adama District, Ethiopia: A Community-Based Unmatched Case-Control Study Yohanes Abera Belachwe, Meyrema Abdo Komicha, Worku Dugassa Girsha, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3865672/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Birth spacing is crucial for ensuring the health of mothers and their children, as well as determining population growth. Short birth intervals represent a universal public health problem associated with adverse maternal, fetal, neonatal, and child outcomes. However, there is limited information in the study area regarding the determinants of suboptimal birth spacing. Thus, this study aimed to identify the determinants of suboptimal spacing among women of reproductive age in the Adama district, Ethiopia. Methods A community-based unmatched case-control study was conducted among 568 randomly selected reproductive-age women using the multi-stage sampling technique. Data were collected using an interviewer-administered, structured questionnaire. The collected data were entered into Epi Info version 7.2 and analyzed using SPSS version 26. Binary logistic regression analysis was used to model the association between suboptimal birth spacing practices and independent variables. Adjusted odds ratios with their 95% confidence intervals were calculated to determine the strength of the association. A p-value < 0.05 was considered to declare statistical significance. Result Educational status (no formal education) (AOR = 2.40; 95% CI: 1.23–1.75), Inadequate knowledge of optimal birth space (AOR = 2.60; 95% CI; 1.80–3.90), non-use of modern contraceptives (AOR = 3.00; CI: 1.90–4.20), short breastfeeding duration (AOR = 2.30; 95% CI: 1.50–3.40), and having female index child (AOR = 1.60; 95% CI: 1.13–2.50) were independent determinants of suboptimal birth spacing practice. Conclusion Having no formal education, Inadequate knowledge of optimal birth space, non-use of modern contraceptives, having short breastfeeding duration, and having a female index child were determinants of suboptimal birth spacing. Encouraging women's education, contraceptive use, and breastfeeding is crucial for birth spacing. Cultural awareness and parental understanding are key to preventing sex-based birth intervals. Reproductive-age women Suboptimal birth spacing Case-Control Adama Ethiopia Introduction Birth spacing refers to the time between two successive births, including postpartum amenorrhea, menstruating periods, and subsequent gestation( 1 ). The optimal spacing for the next pregnancy is generally considered the resting period between pregnancies, allowing mothers time to recover from pregnancy, labor, and lactation( 1 , 2 ). A suboptimal birth interval is defined by the World Health Organization (WHO) as a period of less than 33 months between consecutive live births( 1 ). Recognized as a crucial life-saving measure, birth spacing plays a vital role in safeguarding the health of both mothers and newborns ( 3 , 4 ). Adequate timing and spacing of pregnancies, which could reduce deaths by 25%, could annually prevent more than one million deaths( 5 ). A suboptimal interval between births amplifies the adverse health impact on newborns, children, and maternal well-being. studies indicate that a condensed birth interval heightens the likelihood of abortion, early neonatal and childhood fatalities, preterm birth, and low birth weight( 2 , 6 – 9 ). Additionally, studies reveal that children born after shorter preceding birth intervals face a higher probability of experiencing malnutrition, manifested as stunting, underweight conditions, and anemia( 10 ). Closely spaced pregnancies not only lead to adverse neonatal outcomes but also pose significant risks to maternal health, including conditions like preeclampsia, obstructed and prolonged labor, infection, anemia, and hospitalization( 11 – 14 ). These stem from factors such as nutritional deficiencies, cervical insufficiency, vertical transmission of infections, and inadequate healing of the uterine scar resulting from a previous cesarean delivery( 3 ). Beyond health concerns, accelerates population growth, hindering women's economic participation and straining family resources( 1 , 15 ). Globally, family planning programs have significantly improved maternal and child survival by preventing unintended and closely spaced pregnancies and their complications. In Africa, including Ethiopia, many women still experience untimely and closely spaced pregnancies, despite the availability of family planning services. This situation exposes them to a higher risk of health issues and even death during pregnancy and childbirth( 14 , 16 , 17 ). Efforts by the government and other stakeholders have not fully addressed this concern, as suboptimal or short birth intervals continue to occur( 18 – 20 ). Recognizing this, understanding the determinants of suboptimal birth spacing is crucial for improving interventions, revising policies, and developing targeted strategies at both the facility and community levels in the study area. Thus, this study aimed to identify the determinants of suboptimal birth spacing among reproductive-age women in Adama district, Ethiopia. Methods Study design, area, and period A community-based unmatched case-control study was conducted in Adama district, central Ethiopia, from March 1 to April 30, 2023. Adama district is bordered by the Arsi zone to the south, the Lome district to the west, the Boset district to the east, and the Amhara Regional State to the north. The district is comprised of 4 urban and 36 rural kebeles, situated approximately 100 km from Addis Ababa, the capital of Ethiopia. According to the regional health office, the estimated total population is 229,237 (115,567 males and 113,673 females). Among this population, women of reproductive age account for 49,614, and under-five children account for 36,083. Study population, and eligibility criteria The study population consisted of all women of reproductive age who had experienced at least two consecutive births in the past five years. Cases were defined as those with a birth spacing of less than 33 months, while women of reproductive age with a birth spacing between 33 and 59 months (including 33 months and up to 59 months) were considered controls. The study included women of reproductive age who had given birth within the last 5 years. Women who were seriously ill, unable to communicate, or mentally ill during the data collection period were excluded from the study. Sample size, and sampling procedure The sample size was calculated using Epi info version 7.2 statistical software, employing an unmatched case-control formula. This was done under the assumptions of 80% power, a 95% confidence interval (CI), and a 1:1 case-to-control ratio. Five determinants of suboptimal birth spacing practices identified in previous studies, such as residence, maternal education, wealth index, status of the index child, and postnatal care use after the previous birth, were used as determinant variables(21–23). Under the assumptions, the variable 'postnatal care use after the previous birth' yielded the largest sample size, which was 344. After accounting for a design effect of 1.5 and a 10% non-response rate, the sample size consequently became 568. As a result, a total of 284 cases and 284 controls were included in this study. A multistage sampling approach was employed to select study participants. Initially, the district was categorized into rural and urban kebeles. Subsequently, 10 rural and 2 urban kebeles were randomly chosen from a total of 4 urban and 36 rural kebeles in the district. In the first phase, a preliminary survey was conducted to compile a list of all eligible women of reproductive age who had given birth from all health posts' family folders to identify the cases and controls. During this survey, each woman of reproductive age, having had two or more successive births and residing in the same household, was individually registered. Following this, a proportional allocation was implemented to determine the required sample size from each kebele. Finally, cases and controls were selected from the respective study population using a simple random sampling technique, with the household list serving as the sampling frame. Study variables Dependent variable Suboptimal birth spacing (Yes/No) Independent variable s Socio-demographic : maternal age, maternal educational level, husband educational level, residence, religion, ethnicity, occupation of husband, maternal occupation, family size, wealth index. Maternal, obstetrics, and reproductive health services : parity, age at first birth, postnatal care, antenatal care, knowledge of optimal birth spacing, contraceptive use, place of previous birth, and planned pregnancy. Child and child-related characteristics : sex of the index child, survival status of the index child, breastfeeding duration. Operational definitions Optimal birth spacing : The period between pregnancies that allows the mother time to recuperate from pregnancy, labor, and lactation, with inter-birth intervals ranging from 33 to 59 months(1). Suboptimal/ short birth spacing : Inter-birth intervals of less than 33 months(1). Knowledge : Knowledge of optimal birthing spacing was assessed using twelve multiple-choice questions. The total knowledge score was dichotomized into inadequate and adequate categories, with a score greater than 60% considered adequate(18,24,25). Index child: The child born immediately before a subsequent child(25,26). Data collection procedure and quality control Data were collected using a pretested, structured, interviewer-administered questionnaire. The questionnaires were adapted from various relevant literature with necessary modifications tailored to the specific context of the study. A team of 8 trained data collectors and 2 supervisors was enlisted for the data collection process. Throughout this phase, continuous supervision of data collectors took place, and regular meetings were convened among the data collectors, supervisors, and investigators. Additional visits were conducted for participants who were unavailable during the initial visit. The collected data were reviewed and checked for completeness before data entry. The household's wealth status was assessed using the equity tool, incorporating asset variables such as electricity, electric appliances, refrigerator, television, radio, etc. Principal component analysis was employed for the analysis, with each wealth variable categorized as 0 (no) or 1 (yes) prior to the analysis. The suitability of the data for principal component analysis was confirmed through checks of both Kaiser-Meyer-Oklin (KMO) and Bartlett tests. The wealth status was subsequently categorized into five groups, ranked from the poorest to the wealthiest quintile. Further analysis categorized participants into the first, second, third, fourth, and fifth quintile groups, which were then transformed into three categories representing lower, middle, and higher wealth status. Data processing and analysis Following the coding and inputting of data into Epi-Info version 7.2, the data were exported to the Statistical Package for Social Sciences (SPSS) Version 26 for cleaning and analysis. Descriptive statistics were employed to present key characteristics of the study population. The association between independent variables and suboptimal birth spacing practice was modeled using binary logistic regression analysis. In the bivariable logistic regression model, a significance level of 0.25 was set as a threshold to select variables for multivariable logistic regression analysis, aiming to control confounding effects. The existence of multicollinearity among explanatory variables was explored using the variance inflation factor along with standard error. The multivariable logistic regression utilized adjusted odds ratios (AOR) with a 95% confidence interval (CI) to identify factors independently associated with the suboptimal birth spacing practice. The model was fitted using the standard model-building approach. Hosmer and Lemeshow's goodness-of-fit test was used to assess the model's fitness In the final model, variables with a p-value less than 0.05 were deemed statistically significant. Results Socio-demographic Characteristics A total of 568 reproductive-age women, including 284 cases and 284 controls, participated in this study. The mean age of the participants was 29 years (SD: ±5.17), with a minimum age of 35 and a maximum age of 89 years. The majority of cases 214(75.4%) and controls 223 (78.5%) were rural residents, while 252 cases (87.5%) and 250 controls (89.0%) were married. Among the cases, 132 mothers (46.5%) and 153 husbands (53.9%) attended primary school, while among the controls, 138 mothers (48.6%) and 157 husbands (55.3%) attended primary school. The wealth index of households revealed that 100 cases (35.1%) and 93 controls (32.7%) were in lower-wealth states (Table 1). Table 1. Sociodemographic characteristics of women of reproductive age in Adama district, Central Ethiopia,2023 Variables Category Case Control Number (%) Number (%) Age of the mother 15-19 4(1.4) 3(1.1) 20-24 64(20.0) 56(18.7) 25-29 89(31.3) 88(31.0) 30-34 59(23.3) 67(25.4) 35-39 63(22.4) 58(20.4) <40 5(1.4) 10(3.5) Residence Rural 214(75.4) 223(78.5) Urban 70(24.6) 61(21.5) Marital status Married 252(87.8) 250(89.0) Widowed 10(3.8) 5(0.7) Divorced 22(8.8) 29(10.3) Religion Orthodox 130(45.8) 143(50.4) Protestant 72(25.4) 67(23.6) Muslim 61(21.5) 57(20.1) Catholic 21(7.4) 17(6.0) Ethnicity Oromo 192(67.6) 181(63.7) Amhara 89(31.3) 100(35.2) Other* 3(1.1) 3(1.1) Educational status of the mother No formal education 56(19.7) 25(8.8) Primary school 132(46.5) 138(48.6) High school and preparatory 69(24.3) 85(29.9) Diploma and above 27(9.5) 36(12.7) Educational status of the husband No formal education 17(6.0) 12(4.2) Primary school 153(53.9) 157(55.3) High school & preparatory 77(27.1) 79(27.8) Diploma &above 37(13.0) 36(12.9) Occupation of the mother Farmer 35(12.3) 36(12.7) Housewife 183(64.3) 174(61.3) Merchant 51(18.0) 52(18.3) Government employee 15(5.3) 22(7.7) Occupation of the husband Farmer 156(54.9) 146(51.4) Merchant 47(16.5) 31(10.9) Government employee 54(19.0) 63(22.2) Other* * 27(9.5) 44(15.5) Family size 4 187(65.2) 139(48.9) Wealth index Lowest quartile 131(35.1) 93(32.7) Middle quartile 50(33.6) 72(29.4) Highest quartile 103(31.3) 119(37.9) Notes: * Wolaita, silte **Daily labor, and non-governmental organization employee. Maternal obstetrics and reproductive health-related characteristics In this study, 130 cases (45.8%) and 114 controls (40.1%) were within the age range of 15-19 when they had their first birth. Among the cases, 141 (47.1%) had ANC follow-up for their former pregnancy, while 162 (52.9%) controls had ANC follow-up. Regarding knowledge of optimal birth spacing, 158 cases (65%) and 83 controls (35%) had inadequate knowledge. Ninety-four cases (34.4%) and 187 controls (65.8%) used modern contraceptives between their last two births (Table 2). Table 2. Maternal obstetrics and reproductive health-related characteristics of women of reproductive age in Adama district, Central Ethiopia,2023 Variable Category Case Control Number (%) Number (%) Age at first birth 30 27(9.5) 35(12.3) Parity Two children 36(12.7) 41(14.4) Multipara 195(68.7) 190(66.9) Grand multi para 53(18.7) 53(18.7) Planned pregnancy Yes 102(35.2) 104(36.6) No 182(63.8) 180(63.3) Knowledge of optimal birth spacing Inadequate 158(65) 83(35) Adequate 126(38.3) 201(61.7) ANC Follow-up Yes 141(47.1) 162(52.9) No 143(54.6) 122(45.4) Number of ANC visit Only once 41(14.3) 33(11.7) Two times 25(8.7) 21(5.0) Three times 54(19.9) 87(31.0) Four times 21(7.3) 21(7.5) Place of delivery of former birth Home 138(48.1) 151(50.2) Health institution 146(51.6) 133(49.8) PNC use after former birth Yes 168(57.5) 150(55.9) No 116(43.0) 134(44.1) Use of modern contraceptives between the last two births Yes 94(34.4) 187(65.8) No 190(65.8) 97(34.0) Type of modern contraceptives used Pills 3(4.3) 18(15.3) Injectables 42(45.1) 82(38.1) Condom 14(15.8) 12(9.2) Implant 22(20.3) 41(22.7) IUCD 13(16.3) 33(16.7) Duration of contraceptive use < 24 months’ 65(48.2) 115(41.3) ≥ 24 months’ 32(51.0) 72(58.7) Abbreviations: ANC: antenatal care, PNC: postnatal care, IUCD: Intrauterine device Child and child-related characteristics This study showed that 141 cases (63.8%) and 103 controls (54.4%) had a female index child. A majority, 224 cases (78.0%) and 218 controls (77.6%) initiated breastfeeding for their previous child within an hour after birth. One hundred twenty-two cases (56.1%) and 62 controls (19.9%) breastfed their previous-to-last child for less than 24 months (Table 3). Table 3. Child and child-related characteristics of women of reproductive age in Adama district, Central Ethiopia,2023 Variables Category Case Control Number (%) Number (%) Survival status of index child Dead 44(46.8) 53(53.2) Alive 240(51.3) 231(48.7) Sex of the index child Male 143(36.2) 181(45.6) Female 141(63.8) 103(54.4) Stillbirth history Yes 41(14.3) 45(24.9) No 243(85.7) 239(85.1) Breastfeeding initiation time after the previous birth In an hour 224(78.0) 218(77.6) After an hour’s 63(22.0) 61(21.4) Breastfeeding duration < 24 months’ 122(56.1) 62(19.9) ≥ 24 months’ 162(43.9) 222(30.1) Determinants of suboptimal birth Spacing practice After conducting binary logistic regression analysis, factors such as knowledge of optimal birth spacing, wealth index, use of modern contraceptives between the last two births, duration of breastfeeding, sex of the index child, survival status of the index child, educational status of the mother, and wealth index showed statistically significant associations with suboptimal birth spacing practice at a p-value < 0.25. In the multivariable analysis, the educational status of the mother, the use of modern contraceptives between the last two births, knowledge of optimal birth spacing, duration of breastfeeding, and sex of the index child were identified as independent determinants of suboptimal birth spacing practice at a p-value < 0.05. Accordingly, the odds of suboptimal birth spacing practice were 2.4 times higher among mothers with no formal education compared to those with a diploma and above school level of education (AOR=2.40; 95% CI: 1.23-1.75). Mothers who had inadequate knowledge of optimal birth spacing had 2.4 times greater odds of suboptimal birth spacing practice compared to mothers with adequate knowledge (AOR=2.60; 95% CI;1.80-3.90). Mothers who did not use modern contraceptive methods between the index child and the last pregnancy had 2.8 times higher odds of suboptimal birth spacing practice compared to those mothers who used modern contraceptives (AOR=3.00; CI: 1.90-4.20). Mothers who breastfed the preceding child for less than 24 months had 2.2 times greater odds of suboptimal birth spacing practice than those mothers who breastfed for 24 months or more (AOR=2.30; 95% CI: 1.50-3.40). Compared to mothers with a male child in the previous birth, mothers with a female index child had a 60% higher likelihood of practicing suboptimal birth spacing (AOR=1.6; 95% CI: 1.13-2.50) (Table 4). Table 4. Determinants of suboptimal birth spacing among women of reproductive age in Adama district, Central Ethiopia,2023 Variables Category Case (N) Control (N) COR (95%CI) AOR (95%CI) Educational status of the mother No formal education 56 25 2.9 (1.5-5.9) * 1.3 (1.2-1.7) ** Primary 132 138 1.3 (1.5-4.8) * 1.1 (0.8-3.9) Secondary 69 85 1.1 (1.5-5.9) * 0.9 (0.9-3.7) Diploma and above 27 36 1 1 Wealth index Lower quartile 131 93 1.6 (1.4-1.8) * 1.3 (0.9-1.9) Medium quartile 50 72 1.4 (1.0-1.9) 1.4 (0.6-1.4) Highest quartile 103 119 1 1 ANC Follow-up Yes 126 169 1.84 (1.1-2.9) * 1.35(0.9-3.5) No 158 115 1 1 use of modern contraceptives Yes 94 187 1 1 No 190 97 3.8 (2.51-5.0) * 3.0(1.9-4.2) ** Knowledge of optimal birth space Inadequate 158 83 3.0 (2.1-4.2) 2.6(1.8-3.9) ** Adequate 126 201 1 1 Survival status of the index child Dead 49 38 1.3 (0.8-2.1) * 1.2 (0.6-2.3) Alive 235 246 1 1 Sex of the index child Male 143 181 1 1 Female 141 103 1.7 (1.4.2.7) * 1.6 (1.1-2.5) ** Duration of breastfeeding < 24 months’ 122 62 2.6 (1.8-3.8) * 2.3 (1.5-3.4) ** ≥ 24 months’ 162 222 1 1 Notes: *Significant at p-value <0.25 in unadjusted logistic regression analysis, **significant at p<0.05 in adjusted logistic regression analysis, 1= Reference Abbreviations: ANC: antenatal care; AOR: adjusted odds ratio; CI: confidence interval; COR: crude odds ratio Discussion This study assessed the determinants of suboptimal birth spacing practice among reproductive-age women in Adama district, Ethiopia. Accordingly, the likelihood of having suboptimal birth spacing was found to be associated with the educational status of the mother, non-use of modern contraceptives between the last two births, inadequate knowledge of optimal birth spacing, a short duration of breastfeeding, and having a female index child. In this study, compared to mothers with an educational level of a degree and above, those with no formal education had higher odds of suboptimal birth spacing. This finding is in line with previous studies conducted in Iran(27), Arbaminch district Ethiopia(23), Southwest Ethiopia(22,28), and southern Ethiopia(29,30). This can be attributed to the positive impact of education on reproductive decision-making. Education enhances women's understanding of contraceptives and birth spacing, empowering them with knowledge of optimal healthcare choices and fostering greater autonomy in decision-making. Moreover, there is an increased likelihood of educated women pursuing occupations incongruent with childbearing, resulting in longer birth intervals(31,32). This study also revealed that, in comparison to mothers who used modern contraceptives, those who did not employ modern contraceptive methods between the index child and the last pregnancy had higher odds of suboptimal birth spacing. This finding is consistent with studies conducted in Uganda(33), Arbaminch district, Ethiopia(23), Eastern Ethiopia(34), Northwest Ethiopia(25), Southern Ethiopia(18,29), and Southwest Ethiopia(28). This can be justified by the crucial role of contraceptives in achieving optimal birth spacing. They enable to planning of pregnancies, prevent unintended conceptions, and improve overall family planning(35,36). Notably, those who did not use contraceptives exhibit a higher likelihood of experiencing shorter birth intervals. Knowledge of optimal birth spacing was another significant factor associated with suboptimal birth spacing practice. In this study, those who had inadequate knowledge of optimal birth spacing had 2.4 times greater odds of suboptimal birth spacing practice compared to mothers with adequate knowledge. This finding is in line with studies conducted in the Arbaminch district, Ethiopia(23), Eastern Ethiopia(34), and Northern Ethiopia(20). Knowledge of the optimal duration between childbirths is a key factor that encourages mothers to engage in family planning methods and adopt safe breastfeeding practices. This plays a crucial role in mitigating the potential adverse obstetric outcomes and shorter birth intervals. The other determinant of suboptimal birth spacing was breastfeeding duration. Accordingly, the odds of suboptimal birth spacing practices were two times greater among mothers who breastfed the preceding child for less than 24 months compared to those who breastfed for 24 months or more. This finding is consistent with findings from studies conducted in Arbaminch district, Ethiopia(23), Arsi zone Ethiopia(24), Eastern Ethiopia(34), Southern Ethiopia(30), and Southwest Ethiopia(28). This is attributed to lactation amenorrhea, a natural contraceptive effect of breastfeeding. Additionally, breastfeeding may extend the interbirth interval by influencing hormonal feedback mechanisms negatively. Moreover, the findings of this study indicated that the odds of suboptimal birth spacing were greater among mothers who had female index children than their counterparts. this is supported by findings from studies conducted in Arbaminch district, Ethiopia(23), Eastern Ethiopia(34), Northern Ethiopia(37), developing regions of Ethiopia(38), Southwest Ethiopia(28), and Southern Ethiopia(18,29). This can be explained by the cultural preference for male offspring in various cultural settings. In many Ethiopian communities, there exists a cultural inclination towards favoring male children. Families' preference for male children is often driven by the belief that males offer better protection against potential threats. In such cultures, if the preceding birth is a female child, mothers might be less inclined to postpone subsequent births as they may desire to have a male child sooner. Limitations of the study Assessing the gap between births through women's memory and breastfeeding duration may introduce recall bias into the findings. Given the case-control study design, deriving a direct causal link is a challenging prospect. Conclusion In conclusion, the educational status of the mother, non-use of modern contraceptives between the last two births, inadequate knowledge of optimal birth spacing, a short duration of breastfeeding, and having a female index child were all determinants of suboptimal birth spacing practice. Promoting education for women, advocating for the use of contraceptives, and encouraging breastfeeding are essential for fostering birth spacing. Additionally, raising awareness and culturally promoting parental understanding can help prevent sex-based intervals between births. Abbreviations AOR: Adjusted Odds Ratio ANC: Antenatal Care CI: Confidence Intervals COR: Crude Odds Ratio OR: Odds Ratio PNC: Postnatal Care SPSS: Statistical Package for Social Sciences. Declarations Ethical Approval and Consent to Participate Ethical approval was obtained from the Institutional Ethical Review Board of Adama Hospital Medical College, with Reference No. 058/K-373/15. The study’s proposal was formally presented to both the Oromia Regional Health Office and the Adama District Health Office to secure official approval for carrying out research activities within the selected kebeles. Participants were informed of the study's purpose and benefits during the data collection period and informed written consent was obtained to ensure their decision to participate or refuse. To uphold respondents' rights and ensure confidentiality, anonymity, and privacy, safeguards were enacted, and all of the study's procedures followed the principles outlined in the Helsinki Declaration(39). Consent for publication Not applicable Availability of data and material All data and materials are available from the corresponding author without undue reservation. Competing interests The authors declare that they have no competing interests. Funding This study received no specific funding from any funding agency. Acknowledgments The authors extend their sincere appreciation to Adam Hospital Medical College, along with the Adama district health office, for their invaluable assistance throughout the study. Special thanks are also extended to the dedicated team of data collectors, supervisors, and all the study participants for their crucial contributions. Authors’ contributions YAB contributed to the conception and design of the study, as well as the data curation, and analysis. 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Practice of child spacing and its associated factors among women of child bearing age (15 to 49 years) in Illubabor zone, South West Ethiopia. Int J Nurs Midwifery. 2017 Jul 31;9(7):102–8. Hailu D, Gulte T. Determinants of Short Interbirth Interval among Reproductive Age Mothers in Arba Minch District, Ethiopia. Int J Reprod Med. 2016;2016:6072437. Shallo SA, Gobena T. Duration of birth interval and associated factors among married women in Dodota Woreda, Arsi Zone, Ethiopia. J Health Educ Res Dev. 2019;7(1):10–4172. Aklil MB, Anteneh KT, Debele TZ, Temesgan WZ. Short birth interval and associated factors among women who gave birth in the last three years in Dembecha district, Northwest Ethiopia. Ayanto SY, editor. PLoS ONE. 2022 Aug 23;17(8):e0272612. Tessema GA, Zeleke BM, Ayele TA. Birth interval and its predictors among married women in Dabat District, Northwest Ethiopia: a retrospective follow up study. Afr J Reprod Health. 2013 Jun;17(2):39–45. Najafi-Vosough R, Soltanian AR, Fayyazi N. Influence factors on birth spacing and childbearing rates using survival recurrent events model and parity progression ratios. Journal of Research in Health Sciences. 2017;17(3):384. Ayane GB, Desta KW, Demissie BW, Assefa NA, Woldemariam EB. Suboptimal child spacing practice and its associated factors among women of child bearing age in Serbo town, JIMMA zone, Southwest Ethiopia. Contracept Reprod Med. 2019 Dec;4(1):4. Begna Z, Assegid S, Kassahun W, Gerbaba M. Determinants of inter birth interval among married women living in rural pastoral communities of southern Ethiopia: a case control study. BMC Pregnancy Childbirth. 2013 Dec;13(1):116. Meskele B, Kerbo AA, Baza D, Kacharo MM. The magnitude of sub-optimal child spacing practices and its associated factors among women of childbearing age in Wolaita zone, Sodo Zuria District, Southern Ethiopia: community based cross-sectional study. Pan Afr Med J. 2023;44:62. Alene GD, Worku A. Estimation of the total fertility rates and proximate determinants of fertility in North and South Gondar zones, Northwest Ethiopia: An application of the Bongaarts’ model. Ethiopian Journal of Health Development. 2009;23(1). Stephansson O, Dickman PW, Cnattingius S. The influence of interpregnancy interval on the subsequent risk of stillbirth and early neonatal death. Obstetrics & gynecology. 2003;102(1):101–8. Aleni M, Mbalinda SN, Muhindo R. Birth Intervals and Associated Factors among Women Attending Young Child Clinic in Yumbe Hospital, Uganda. International Journal of Reproductive Medicine. 2020 Jan 4;2020:1–11. Wakeyo MM, Kebira JY, Assefa N, Dheresa M. Short birth interval and its associated factors among multiparous women in Mieso agro-pastoralist district, Eastern Ethiopia: A community-based cross-sectional study. Front Glob Womens Health. 2022 Sep 7;3:801394. National Research Council, Committee on Population. Contraception and Reproduction: Health Consequences for Women and Children in the Developing World. National Academies Press; 1989. Levine R, Langer A, Birdsall N, Matheny G, Wright M, Bayer A. Contraception. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al., editors. Disease Control Priorities in Developing Countries [Internet]. 2nd ed. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006 [cited 2024 Jan 10]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK11771/ Ejigu AG, Yismaw AE, Limenih MA. The effect of sex of last child on short birth interval practice: the case of northern Ethiopian pregnant women. BMC Res Notes. 2019 Dec;12(1):75. Aychiluhm SB, Tadesse AW, Mare KU, Abdu M, Ketema A. A multilevel analysis of short birth interval and its determinants among reproductive age women in developing regions of Ethiopia. PLoS One. 2020;15(8):e0237602. World Medical Association. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bull World Health Organ. 2001;79(4):373–4. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3865672","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":267514139,"identity":"2c4b600c-6bb9-42da-84cd-cf60afcafe83","order_by":0,"name":"Yohanes Abera Belachwe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABA0lEQVRIiWNgGAWjYFACHghlACI+VNgAScbGA0RrYZxxJg1ENRCvhZm37TCYg1eLwfHeg58LKurkzdl7H37mbTtvt7b9MNCWGptonFrOnEuWnnHmsOHOnuPGknPO3U7ediYRqOVYWm4DLi03cgykedsOMG64kcYg8absdrLZAaAWxobD+LQY/+b9V2e/4f4z5h88bOeSzc4/JKjFTJq3gTlxww02NkmetgN2ZjcI2CJ55oyZNc+xw8k7e9LYLGecSU4wuwG0JQGPX/iO9xjf5qmps93Ofoz5xocKO3uz8+kPH3yoscGpReEAmkAiWGUCDuUgII9ulj0exaNgFIyCUTBCAQAaGmk03MZCegAAAABJRU5ErkJggg==","orcid":"","institution":"Adama General Hospital and Medical College","correspondingAuthor":true,"prefix":"","firstName":"Yohanes","middleName":"Abera","lastName":"Belachwe","suffix":""},{"id":267514140,"identity":"1d3251f1-092d-4f41-9e88-553563c7a826","order_by":1,"name":"Meyrema Abdo Komicha","email":"","orcid":"","institution":"Adama Hospital Medical College","correspondingAuthor":false,"prefix":"","firstName":"Meyrema","middleName":"Abdo","lastName":"Komicha","suffix":""},{"id":267514141,"identity":"c7a41360-d739-4139-a64f-a2e7ce9f7edf","order_by":2,"name":"Worku Dugassa Girsha","email":"","orcid":"","institution":"Adama Hospital Medical College","correspondingAuthor":false,"prefix":"","firstName":"Worku","middleName":"Dugassa","lastName":"Girsha","suffix":""},{"id":267514142,"identity":"05fe6ec2-39ef-43c7-955b-399b9a2cd217","order_by":3,"name":"Mihiret Shawel Getahun","email":"","orcid":"","institution":"Adama General Hospital and Medical College","correspondingAuthor":false,"prefix":"","firstName":"Mihiret","middleName":"Shawel","lastName":"Getahun","suffix":""},{"id":267514143,"identity":"248e6de5-67ac-407a-92f3-2ed92fff9d00","order_by":4,"name":"Beminate Lemma Seifu","email":"","orcid":"","institution":"Samara University","correspondingAuthor":false,"prefix":"","firstName":"Beminate","middleName":"Lemma","lastName":"Seifu","suffix":""},{"id":267514144,"identity":"13480b51-ebfe-41b7-a462-bc896bea0053","order_by":5,"name":"Yohannes Mekuria Negussie","email":"","orcid":"","institution":"Adama General Hospital and Medical College","correspondingAuthor":false,"prefix":"","firstName":"Yohannes","middleName":"Mekuria","lastName":"Negussie","suffix":""}],"badges":[],"createdAt":"2024-01-15 07:14:08","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3865672/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3865672/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62109770,"identity":"b3e65ba6-e536-4a94-bea6-f2c3d891b5d8","added_by":"auto","created_at":"2024-08-09 11:36:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1022356,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3865672/v1/bdefcfd0-7108-431c-8580-bace8420d5a1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Determinants of Suboptimal Birth Spacing among Reproductive-Age Women in Adama District, Ethiopia: A Community-Based Unmatched Case-Control Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBirth spacing refers to the time between two successive births, including postpartum amenorrhea, menstruating periods, and subsequent gestation(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The optimal spacing for the next pregnancy is generally considered the resting period between pregnancies, allowing mothers time to recover from pregnancy, labor, and lactation(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). A suboptimal birth interval is defined by the World Health Organization (WHO) as a period of less than 33 months between consecutive live births(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Recognized as a crucial life-saving measure, birth spacing plays a vital role in safeguarding the health of both mothers and newborns (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Adequate timing and spacing of pregnancies, which could reduce deaths by 25%, could annually prevent more than one million deaths(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA suboptimal interval between births amplifies the adverse health impact on newborns, children, and maternal well-being. studies indicate that a condensed birth interval heightens the likelihood of abortion, early neonatal and childhood fatalities, preterm birth, and low birth weight(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR7 CR8\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Additionally, studies reveal that children born after shorter preceding birth intervals face a higher probability of experiencing malnutrition, manifested as stunting, underweight conditions, and anemia(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eClosely spaced pregnancies not only lead to adverse neonatal outcomes but also pose significant risks to maternal health, including conditions like preeclampsia, obstructed and prolonged labor, infection, anemia, and hospitalization(\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). These stem from factors such as nutritional deficiencies, cervical insufficiency, vertical transmission of infections, and inadequate healing of the uterine scar resulting from a previous cesarean delivery(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Beyond health concerns, accelerates population growth, hindering women's economic participation and straining family resources(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobally, family planning programs have significantly improved maternal and child survival by preventing unintended and closely spaced pregnancies and their complications. In Africa, including Ethiopia, many women still experience untimely and closely spaced pregnancies, despite the availability of family planning services. This situation exposes them to a higher risk of health issues and even death during pregnancy and childbirth(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Efforts by the government and other stakeholders have not fully addressed this concern, as suboptimal or short birth intervals continue to occur(\u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Recognizing this, understanding the determinants of suboptimal birth spacing is crucial for improving interventions, revising policies, and developing targeted strategies at both the facility and community levels in the study area. Thus, this study aimed to identify the determinants of suboptimal birth spacing among reproductive-age women in Adama district, Ethiopia.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design, area, and period\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA community-based unmatched case-control study was conducted in Adama district, central Ethiopia, from March 1 to April 30, 2023. Adama district is bordered by the Arsi zone to the south, the Lome district to the west, the Boset district to the east, and the Amhara Regional State to the north. The district is comprised of 4 urban and 36 rural kebeles, situated approximately 100 km from Addis Ababa, the capital of Ethiopia. According to the regional health office, the estimated total population is 229,237 (115,567 males and 113,673 females). Among this population, women of reproductive age account for 49,614, and under-five children account for 36,083.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy population, and eligibility criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study population consisted of all women of reproductive age who had experienced at least two consecutive births in the past five years. Cases were defined as those with a birth spacing of less than 33 months, while women of reproductive age with a birth spacing between 33 and 59 months (including 33 months and up to 59 months) were considered controls. The study included women of reproductive age who had given birth within the last 5 years. Women who were seriously ill, unable to communicate, or mentally ill during the data collection period were excluded from the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample size, and sampling procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size was calculated using Epi info version 7.2 statistical software, employing an unmatched case-control formula. This was done under the assumptions of 80% power, a 95% confidence interval (CI), and a 1:1 case-to-control ratio. Five determinants of suboptimal birth spacing practices identified in previous studies, such as residence, maternal education, wealth index, status of the index child, and postnatal care use after the previous birth, were used as determinant variables(21\u0026ndash;23). Under the assumptions, the variable \u0026apos;postnatal care use after the previous birth\u0026apos; yielded the largest sample size, which was 344. After accounting for a design effect of 1.5 and a 10% non-response rate, the sample size consequently became 568. As a result, a total of 284 cases and 284 controls were included in this study.\u003c/p\u003e\n\u003cp\u003eA multistage sampling approach was employed to select study participants. Initially, the district was categorized into rural and urban kebeles. Subsequently, 10 rural and 2 urban kebeles were randomly chosen from a total of 4 urban and 36 rural kebeles in the district. In the first phase, a preliminary survey was conducted to compile a list of all eligible women of reproductive age who had given birth from all health posts\u0026apos; family folders to identify the cases and controls. During this survey, each woman of reproductive age, having had two or more successive births and residing in the same household, was individually registered. Following this, a proportional allocation was implemented to determine the required sample size from each kebele. Finally, cases and controls were selected from the respective study population using a simple random sampling technique, with the household list serving as the sampling frame.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy variables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eDependent variable\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eSuboptimal birth spacing \u0026nbsp;(Yes/No)\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eIndependent variable\u003c/strong\u003e\u003cstrong\u003es\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eSocio-demographic\u003c/strong\u003e: maternal age, maternal educational level, husband educational level, residence, religion, ethnicity, occupation of husband, maternal occupation, family size, wealth index.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaternal, obstetrics, and reproductive health services\u003c/strong\u003e: parity, age at first birth, postnatal care, antenatal care, knowledge of optimal birth spacing, contraceptive use, place of previous birth, and planned pregnancy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChild and child-related characteristics\u003c/strong\u003e: sex of the index child, survival status of the index child, breastfeeding duration.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOperational definitions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOptimal birth spacing\u003c/strong\u003e:\u0026nbsp;The period between pregnancies that allows the mother time to recuperate from pregnancy, labor, and lactation, with inter-birth intervals ranging from 33 to 59 months(1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSuboptimal/ short birth spacing\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e Inter-birth intervals of less than 33 months(1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKnowledge\u003c/strong\u003e: Knowledge of optimal birthing spacing was assessed using twelve multiple-choice questions. The total knowledge score was dichotomized into inadequate and adequate categories, with a score greater than 60% considered adequate(18,24,25).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndex child:\u003c/strong\u003e The child born immediately before a subsequent child(25,26).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData collection procedure\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;and quality control\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were collected using a pretested, structured, interviewer-administered questionnaire. The questionnaires were adapted from various relevant literature with necessary modifications tailored to the specific context of the study.\u0026nbsp;A team of 8 trained data collectors and 2 supervisors was enlisted for the data collection process. Throughout this phase, continuous supervision of data collectors took place, and regular meetings were convened among the data collectors, supervisors, and investigators. Additional visits were conducted for participants who were unavailable during the initial visit. The collected data were reviewed and checked for completeness before data entry.\u003c/p\u003e\n\u003cp\u003eThe household\u0026apos;s wealth status was assessed using the equity tool, incorporating asset variables such as electricity, electric appliances, refrigerator, television, radio, etc. Principal component analysis was employed for the analysis, with each wealth variable categorized as 0 (no) or 1 (yes) prior to the analysis. The suitability of the data for principal component analysis was confirmed through checks of both Kaiser-Meyer-Oklin (KMO) and Bartlett tests. The wealth status was subsequently categorized into five groups, ranked from the poorest to the wealthiest quintile. Further analysis categorized participants into the first, second, third, fourth, and fifth quintile groups, which were then transformed into three categories representing lower, middle, and higher wealth status.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData processing and analysis\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing the coding and inputting of data into Epi-Info version 7.2, the data were exported to the Statistical Package for Social Sciences (SPSS) Version 26 for cleaning and analysis. Descriptive statistics were employed to present key characteristics of the study population. The association between independent variables and suboptimal birth spacing practice was modeled using binary logistic regression analysis. In the bivariable logistic regression model, a significance level of 0.25 was set as a threshold to select variables for multivariable logistic regression analysis, aiming to control confounding effects. The existence of multicollinearity among explanatory variables was explored using the variance inflation factor along with standard error. The multivariable logistic regression utilized adjusted odds ratios (AOR) with a 95% confidence interval (CI) to identify factors independently associated with the suboptimal birth spacing practice. The model was fitted using the standard model-building approach. Hosmer and Lemeshow\u0026apos;s goodness-of-fit test was used to assess the model\u0026apos;s fitness In the final model, variables with a p-value less than 0.05 were deemed statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSocio-demographic Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 568 reproductive-age women, including 284 cases and 284 controls, participated in this study. The mean age of the participants was 29 years (SD: \u0026plusmn;5.17), with a minimum age of 35 and a maximum age of 89 years. The majority of cases 214(75.4%) and controls 223 (78.5%) were rural residents, while 252 cases (87.5%) and 250 controls (89.0%) were married. Among the cases, 132 mothers (46.5%) and 153 husbands (53.9%) attended primary school, while among the controls, 138 mothers (48.6%) and 157 husbands (55.3%) attended primary school. The wealth index of households revealed that 100 cases (35.1%) and 93 controls (32.7%) were in lower-wealth states (Table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u003c/strong\u003e Sociodemographic characteristics of women of reproductive age in Adama district, Central Ethiopia,2023\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"618\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.17152103559871%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.022653721682847%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.475728155339805%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.33009708737864%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"43.90243902439025%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"56.09756097560975%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.17152103559871%\" rowspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge of the mother\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.022653721682847%\" valign=\"top\"\u003e\n \u003cp\u003e15-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.475728155339805%\" valign=\"top\"\u003e\n \u003cp\u003e4(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.33009708737864%\" valign=\"top\"\u003e\n \u003cp\u003e3(1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003e20-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e64(20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e56(18.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003e25-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e89(31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e88(31.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e59(23.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e67(25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003e35-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e63(22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e58(20.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e5(1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e10(3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.17152103559871%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.022653721682847%\" valign=\"top\"\u003e\n \u003cp\u003eRural\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.475728155339805%\" valign=\"top\"\u003e\n \u003cp\u003e214(75.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.33009708737864%\" valign=\"top\"\u003e\n \u003cp\u003e223(78.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eUrban\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e70(24.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e61(21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.17152103559871%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.022653721682847%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.475728155339805%\" valign=\"top\"\u003e\n \u003cp\u003e252(87.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.33009708737864%\" valign=\"top\"\u003e\n \u003cp\u003e250(89.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e10(3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e5(0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e22(8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e29(10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.17152103559871%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.022653721682847%\" valign=\"top\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.475728155339805%\" valign=\"top\"\u003e\n \u003cp\u003e130(45.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.33009708737864%\" valign=\"top\"\u003e\n \u003cp\u003e143(50.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eProtestant\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e72(25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e67(23.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e61(21.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e57(20.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eCatholic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e21(7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e17(6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.17152103559871%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEthnicity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.022653721682847%\" valign=\"top\"\u003e\n \u003cp\u003eOromo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.475728155339805%\" valign=\"top\"\u003e\n \u003cp\u003e192(67.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.33009708737864%\" valign=\"top\"\u003e\n \u003cp\u003e181(63.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eAmhara\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e89(31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e100(35.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eOther*\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e3(1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e3(1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.17152103559871%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational status of the mother\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.022653721682847%\" valign=\"top\"\u003e\n \u003cp\u003eNo formal education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.475728155339805%\" valign=\"top\"\u003e\n \u003cp\u003e56(19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.33009708737864%\" valign=\"top\"\u003e\n \u003cp\u003e25(8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e132(46.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e138(48.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eHigh school and preparatory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e69(24.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e85(29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eDiploma and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e27(9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e36(12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.17152103559871%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational status of the husband\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.022653721682847%\" valign=\"top\"\u003e\n \u003cp\u003eNo formal education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.475728155339805%\" valign=\"top\"\u003e\n \u003cp\u003e17(6.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.33009708737864%\" valign=\"top\"\u003e\n \u003cp\u003e12(4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e153(53.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e157(55.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eHigh school \u0026amp; preparatory\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e77(27.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e79(27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eDiploma \u0026amp;above\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e37(13.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e36(12.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.17152103559871%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation of the mother\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.022653721682847%\" valign=\"top\"\u003e\n \u003cp\u003eFarmer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.475728155339805%\" valign=\"top\"\u003e\n \u003cp\u003e35(12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.33009708737864%\" valign=\"top\"\u003e\n \u003cp\u003e36(12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e183(64.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e174(61.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e51(18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e52(18.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eGovernment employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e15(5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e22(7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.17152103559871%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation of the husband\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.022653721682847%\" valign=\"top\"\u003e\n \u003cp\u003eFarmer\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.475728155339805%\" valign=\"top\"\u003e\n \u003cp\u003e156(54.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.33009708737864%\" valign=\"top\"\u003e\n \u003cp\u003e146(51.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eMerchant\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e47(16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e31(10.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eGovernment employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e54(19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e63(22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eOther* *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e27(9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e44(15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.17152103559871%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFamily size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.022653721682847%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt;4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.475728155339805%\" valign=\"top\"\u003e\n \u003cp\u003e97(32.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.33009708737864%\" valign=\"top\"\u003e\n \u003cp\u003e145(51.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003e\u0026gt;\u003c/u\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e187(65.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e139(48.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"33.17152103559871%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWealth index\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.022653721682847%\" valign=\"top\"\u003e\n \u003cp\u003eLowest quartile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.475728155339805%\" valign=\"top\"\u003e\n \u003cp\u003e131(35.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.33009708737864%\" valign=\"top\"\u003e\n \u003cp\u003e93(32.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eMiddle quartile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e50(33.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e72(29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"40.43583535108959%\" valign=\"top\"\u003e\n \u003cp\u003eHighest quartile\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.150121065375302%\" valign=\"top\"\u003e\n \u003cp\u003e103(31.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.41404358353511%\" valign=\"top\"\u003e\n \u003cp\u003e119(37.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNotes:\u003c/strong\u003e * Wolaita, silte **Daily labor, and non-governmental organization employee. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMaternal obstetrics and reproductive health-related characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, 130 cases (45.8%) and 114 controls (40.1%) were within the age range of 15-19 when they had their first birth. Among the cases, 141 (47.1%) had ANC follow-up for their former pregnancy, while 162 (52.9%) controls had ANC follow-up. Regarding knowledge of optimal birth spacing, 158 cases (65%) and 83 controls (35%) had inadequate knowledge. Ninety-four cases (34.4%) and 187 controls (65.8%) used modern contraceptives between their last two births (Table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u003c/strong\u003e Maternal obstetrics and reproductive health-related characteristics of women of reproductive age in Adama district, Central Ethiopia,2023\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"625\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.837060702875398%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.156549520766774%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.044728434504794%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.961661341853034%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"47.916666666666664%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"52.083333333333336%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.837060702875398%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at first birth\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.156549520766774%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.044728434504794%\" valign=\"top\"\u003e\n \u003cp\u003e24(8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.961661341853034%\" valign=\"top\"\u003e\n \u003cp\u003e19(6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003e15-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e130(45.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e114(40.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003e20-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e64(22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e76(26.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003e25-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e39(13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e40(14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003e\u0026gt;\u003c/u\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e27(9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e35(12.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.837060702875398%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.156549520766774%\" valign=\"top\"\u003e\n \u003cp\u003eTwo children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.044728434504794%\" valign=\"top\"\u003e\n \u003cp\u003e36(12.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.961661341853034%\" valign=\"top\"\u003e\n \u003cp\u003e41(14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003eMultipara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e195(68.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e190(66.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003eGrand multi para\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e53(18.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e53(18.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.837060702875398%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlanned pregnancy\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.156549520766774%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.044728434504794%\" valign=\"top\"\u003e\n \u003cp\u003e102(35.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.961661341853034%\" valign=\"top\"\u003e\n \u003cp\u003e104(36.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e182(63.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e180(63.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.837060702875398%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge of optimal birth spacing\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.156549520766774%\" valign=\"top\"\u003e\n \u003cp\u003eInadequate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.044728434504794%\" valign=\"top\"\u003e\n \u003cp\u003e158(65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.961661341853034%\" valign=\"top\"\u003e\n \u003cp\u003e83(35)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003eAdequate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e126(38.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e201(61.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.837060702875398%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eANC Follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.156549520766774%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.044728434504794%\" valign=\"top\"\u003e\n \u003cp\u003e141(47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.961661341853034%\" valign=\"top\"\u003e\n \u003cp\u003e162(52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e143(54.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e122(45.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.837060702875398%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of ANC visit\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.156549520766774%\" valign=\"top\"\u003e\n \u003cp\u003eOnly once\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.044728434504794%\" valign=\"top\"\u003e\n \u003cp\u003e41(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.961661341853034%\" valign=\"top\"\u003e\n \u003cp\u003e33(11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003eTwo times\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e25(8.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e21(5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003eThree times\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e54(19.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e87(31.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003eFour times\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e21(7.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e21(7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.837060702875398%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of delivery of former birth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.156549520766774%\" valign=\"top\"\u003e\n \u003cp\u003eHome\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.044728434504794%\" valign=\"top\"\u003e\n \u003cp\u003e138(48.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.961661341853034%\" valign=\"top\"\u003e\n \u003cp\u003e151(50.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003eHealth institution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e146(51.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e133(49.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.837060702875398%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePNC use after former birth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.156549520766774%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.044728434504794%\" valign=\"top\"\u003e\n \u003cp\u003e168(57.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.961661341853034%\" valign=\"top\"\u003e\n \u003cp\u003e150(55.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e116(43.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e134(44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.837060702875398%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eUse of modern contraceptives between the last two births\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.156549520766774%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.044728434504794%\" valign=\"top\"\u003e\n \u003cp\u003e94(34.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.961661341853034%\" valign=\"top\"\u003e\n \u003cp\u003e187(65.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e190(65.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e97(34.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.837060702875398%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of modern contraceptives used\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.156549520766774%\" valign=\"top\"\u003e\n \u003cp\u003ePills\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.044728434504794%\" valign=\"top\"\u003e\n \u003cp\u003e3(4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.961661341853034%\" valign=\"top\"\u003e\n \u003cp\u003e18(15.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003eInjectables\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e42(45.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e82(38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003eCondom\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e14(15.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e12(9.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003eImplant\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e22(20.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e41(22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003eIUCD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e13(16.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e33(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.837060702875398%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of contraceptive use\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.156549520766774%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 24 months\u0026rsquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.044728434504794%\" valign=\"top\"\u003e\n \u003cp\u003e65(48.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.961661341853034%\" valign=\"top\"\u003e\n \u003cp\u003e115(41.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"37.11790393013101%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge; 24 months\u0026rsquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30.131004366812228%\" valign=\"top\"\u003e\n \u003cp\u003e32(51.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.751091703056765%\" valign=\"top\"\u003e\n \u003cp\u003e72(58.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e ANC: antenatal care, PNC: postnatal care, IUCD: Intrauterine device\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eChild and child-related characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study showed that 141 cases (63.8%) and 103 controls (54.4%) had a female index child. A majority, 224 cases (78.0%) and 218 controls (77.6%) initiated breastfeeding for their previous child within an hour after birth. One hundred twenty-two cases (56.1%) and 62 controls (19.9%) breastfed their previous-to-last child for less than 24 months (Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eChild and child-related characteristics of women of reproductive age in Adama district, Central Ethiopia,2023\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"606\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.702970297029704%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.782178217821784%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.792079207920793%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.722772277227723%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"42.857142857142854%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"57.142857142857146%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.702970297029704%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvival status of index child\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.782178217821784%\" valign=\"top\"\u003e\n \u003cp\u003eDead\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.792079207920793%\" valign=\"top\"\u003e\n \u003cp\u003e44(46.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.722772277227723%\" valign=\"top\"\u003e\n \u003cp\u003e53(53.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.985915492957748%\" valign=\"top\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"top\"\u003e\n \u003cp\u003e240(51.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.436619718309856%\" valign=\"top\"\u003e\n \u003cp\u003e231(48.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.702970297029704%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex of the index child\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.782178217821784%\" valign=\"top\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.792079207920793%\" valign=\"top\"\u003e\n \u003cp\u003e143(36.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.722772277227723%\" valign=\"top\"\u003e\n \u003cp\u003e181(45.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.985915492957748%\" valign=\"top\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"top\"\u003e\n \u003cp\u003e141(63.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.436619718309856%\" valign=\"top\"\u003e\n \u003cp\u003e103(54.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.702970297029704%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStillbirth history\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.782178217821784%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.792079207920793%\" valign=\"top\"\u003e\n \u003cp\u003e41(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.722772277227723%\" valign=\"top\"\u003e\n \u003cp\u003e45(24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.985915492957748%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"top\"\u003e\n \u003cp\u003e243(85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.436619718309856%\" valign=\"top\"\u003e\n \u003cp\u003e239(85.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.702970297029704%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreastfeeding initiation time after the previous birth\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.782178217821784%\" valign=\"top\"\u003e\n \u003cp\u003eIn an hour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.792079207920793%\" valign=\"top\"\u003e\n \u003cp\u003e224(78.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.722772277227723%\" valign=\"top\"\u003e\n \u003cp\u003e218(77.6)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.985915492957748%\" valign=\"top\"\u003e\n \u003cp\u003eAfter an hour\u0026rsquo;s\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"top\"\u003e\n \u003cp\u003e63(22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.436619718309856%\" valign=\"top\"\u003e\n \u003cp\u003e61(21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"29.702970297029704%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eBreastfeeding duration\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.782178217821784%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026lt; 24 months\u0026rsquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.792079207920793%\" valign=\"top\"\u003e\n \u003cp\u003e122(56.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"27.722772277227723%\" valign=\"top\"\u003e\n \u003cp\u003e62(19.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.985915492957748%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ge; 24 months\u0026rsquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"29.577464788732396%\" valign=\"top\"\u003e\n \u003cp\u003e162(43.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"39.436619718309856%\" valign=\"top\"\u003e\n \u003cp\u003e222(30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eDeterminants of suboptimal birth Spacing practice\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter conducting binary logistic regression analysis, factors such as knowledge of optimal birth spacing, wealth index, use of modern contraceptives between the last two births, duration of breastfeeding, sex of the index child, survival status of the index child, educational status of the mother, and wealth index showed statistically significant associations with suboptimal birth spacing practice at a p-value \u0026lt; 0.25.\u003c/p\u003e\n\u003cp\u003eIn the multivariable analysis, the educational status of the mother, the use of modern contraceptives between the last two births, knowledge of optimal birth spacing, duration of breastfeeding, and sex of the index child were identified as independent determinants of suboptimal birth spacing practice at a p-value \u0026lt; 0.05. Accordingly, the odds of suboptimal birth spacing practice were 2.4 times higher among mothers with no formal education compared to those with a diploma and above school level of education (AOR=2.40; 95% CI: 1.23-1.75). Mothers who had inadequate knowledge of optimal birth spacing had 2.4 times greater odds of suboptimal birth spacing practice compared to mothers with adequate knowledge (AOR=2.60; 95% CI;1.80-3.90). Mothers who did not use modern contraceptive methods between the index child and the last pregnancy had 2.8 times higher odds of suboptimal birth spacing practice compared to those mothers who used modern contraceptives (AOR=3.00; CI: 1.90-4.20). Mothers who breastfed the preceding child for less than 24 months had 2.2 times greater odds of suboptimal birth spacing practice than those mothers who breastfed for 24 months or more (AOR=2.30; 95% CI: 1.50-3.40). Compared to mothers with a male child in the previous birth, mothers with a female index child had a 60% higher likelihood of practicing suboptimal birth spacing (AOR=1.6; 95% CI: 1.13-2.50) (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e Determinants of suboptimal birth spacing among women of reproductive age in Adama district, Central Ethiopia,2023\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"690\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.608695652173914%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.6231884057971%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.811594202898551%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCase\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.434782608695652%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCOR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.130434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.608695652173914%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational status of the mother\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.6231884057971%\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.811594202898551%\" valign=\"top\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.434782608695652%\" valign=\"top\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"top\"\u003e\n \u003cp\u003e2.9 (1.5-5.9) *\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.130434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e1.3 (1.2-1.7) **\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.524344569288388%\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.801498127340825%\" valign=\"top\"\u003e\n \u003cp\u003e132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.48314606741573%\" valign=\"top\"\u003e\n \u003cp\u003e138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.471910112359552%\" valign=\"top\"\u003e\n \u003cp\u003e1.3 (1.5-4.8) *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e1.1 (0.8-3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.524344569288388%\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.801498127340825%\" valign=\"top\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.48314606741573%\" valign=\"top\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.471910112359552%\" valign=\"top\"\u003e\n \u003cp\u003e1.1 (1.5-5.9) *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e0.9 (0.9-3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.524344569288388%\"\u003e\n \u003cp\u003eDiploma and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.801498127340825%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.48314606741573%\" valign=\"top\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.471910112359552%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.608695652173914%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWealth index\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.6231884057971%\"\u003e\n \u003cp\u003eLower quartile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.811594202898551%\" valign=\"top\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.434782608695652%\" valign=\"top\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"top\"\u003e\n \u003cp\u003e1.6 (1.4-1.8) *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.130434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e1.3 (0.9-1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.524344569288388%\"\u003e\n \u003cp\u003eMedium quartile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.801498127340825%\" valign=\"top\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.48314606741573%\" valign=\"top\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.471910112359552%\" valign=\"top\"\u003e\n \u003cp\u003e1.4 (1.0-1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e1.4 (0.6-1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.524344569288388%\"\u003e\n \u003cp\u003eHighest quartile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.801498127340825%\" valign=\"top\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.48314606741573%\" valign=\"top\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.471910112359552%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.608695652173914%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eANC Follow-up\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.6231884057971%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.811594202898551%\" valign=\"top\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.434782608695652%\" valign=\"top\"\u003e\n \u003cp\u003e169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"top\"\u003e\n \u003cp\u003e1.84 (1.1-2.9) *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.130434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e1.35(0.9-3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.524344569288388%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.801498127340825%\" valign=\"top\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.48314606741573%\" valign=\"top\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.471910112359552%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.608695652173914%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003euse of modern contraceptives\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.6231884057971%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.811594202898551%\" valign=\"top\"\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.434782608695652%\" valign=\"top\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.130434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.524344569288388%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.801498127340825%\" valign=\"top\"\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.48314606741573%\" valign=\"top\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.471910112359552%\" valign=\"top\"\u003e\n \u003cp\u003e3.8 (2.51-5.0) *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e3.0(1.9-4.2) **\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.608695652173914%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge of optimal birth space\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.6231884057971%\"\u003e\n \u003cp\u003eInadequate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.811594202898551%\" valign=\"top\"\u003e\n \u003cp\u003e158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.434782608695652%\" valign=\"top\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"top\"\u003e\n \u003cp\u003e3.0 (2.1-4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.130434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e2.6(1.8-3.9) **\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.524344569288388%\"\u003e\n \u003cp\u003eAdequate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.801498127340825%\" valign=\"top\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.48314606741573%\" valign=\"top\"\u003e\n \u003cp\u003e201\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.471910112359552%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.608695652173914%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurvival status of the index child\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.6231884057971%\"\u003e\n \u003cp\u003eDead\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.811594202898551%\" valign=\"top\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.434782608695652%\" valign=\"top\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"top\"\u003e\n \u003cp\u003e1.3 (0.8-2.1) *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.130434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e1.2 (0.6-2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.524344569288388%\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.801498127340825%\" valign=\"top\"\u003e\n \u003cp\u003e235\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.48314606741573%\" valign=\"top\"\u003e\n \u003cp\u003e246\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.471910112359552%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.608695652173914%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex of the index child\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.6231884057971%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.811594202898551%\" valign=\"top\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.434782608695652%\" valign=\"top\"\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.130434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.524344569288388%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.801498127340825%\" valign=\"top\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.48314606741573%\" valign=\"top\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.471910112359552%\" valign=\"top\"\u003e\n \u003cp\u003e1.7 (1.4.2.7) *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e1.6 (1.1-2.5) **\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.608695652173914%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of breastfeeding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.6231884057971%\"\u003e\n \u003cp\u003e\u0026lt; 24 months\u0026rsquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.811594202898551%\" valign=\"top\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.434782608695652%\" valign=\"top\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"17.391304347826086%\" valign=\"top\"\u003e\n \u003cp\u003e2.6 (1.8-3.8) *\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.130434782608695%\" valign=\"top\"\u003e\n \u003cp\u003e2.3 (1.5-3.4) **\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"30.524344569288388%\"\u003e\n \u003cp\u003e\u0026ge; 24 months\u0026rsquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.801498127340825%\" valign=\"top\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.48314606741573%\" valign=\"top\"\u003e\n \u003cp\u003e222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.471910112359552%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.719101123595507%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eNotes:\u003c/strong\u003e *Significant at p-value \u0026lt;0.25 in unadjusted logistic regression analysis, **significant at p\u0026lt;0.05 in adjusted logistic regression analysis, 1= Reference\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAbbreviations:\u003c/strong\u003e ANC: antenatal care; AOR: adjusted odds ratio; CI: confidence interval; COR: crude odds ratio\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study assessed the determinants of suboptimal birth spacing practice among reproductive-age women in Adama district, Ethiopia. Accordingly, the likelihood of having suboptimal birth spacing was found to be associated with the educational status of the mother, non-use of modern contraceptives between the last two births, inadequate knowledge of optimal birth spacing, a short duration of breastfeeding, and having a female index child.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this study, compared to mothers with an educational level of a degree and above, those with no formal education had higher odds of suboptimal birth spacing. This finding is in line with previous studies conducted in Iran(27), Arbaminch district Ethiopia(23), Southwest Ethiopia(22,28), and southern Ethiopia(29,30). This can be attributed to the positive impact of education on reproductive decision-making. Education enhances women\u0026apos;s understanding of contraceptives and birth spacing, empowering them with knowledge of optimal healthcare choices and fostering greater autonomy in decision-making. Moreover, there is an increased likelihood of educated women pursuing occupations incongruent with childbearing, resulting in longer birth intervals(31,32).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study also revealed that, in comparison to mothers who used modern contraceptives, those who did not employ modern contraceptive methods between the index child and the last pregnancy had higher odds of suboptimal birth spacing. This finding is consistent with studies conducted in Uganda(33), Arbaminch district, Ethiopia(23), Eastern Ethiopia(34), Northwest Ethiopia(25), Southern Ethiopia(18,29), and Southwest Ethiopia(28). This can be justified by the crucial role of contraceptives in achieving optimal birth spacing. They enable to planning of pregnancies, prevent unintended conceptions, and improve overall family planning(35,36).\u0026nbsp;Notably, those who did not use contraceptives exhibit a higher likelihood of experiencing shorter birth intervals.\u003c/p\u003e\n\u003cp\u003eKnowledge of optimal birth spacing was another significant factor associated with suboptimal birth spacing practice. In this study, those who had inadequate knowledge of optimal birth spacing had 2.4 times greater odds of suboptimal birth spacing practice compared to mothers with adequate knowledge. This finding is in line with studies conducted in the Arbaminch district, Ethiopia(23), Eastern Ethiopia(34), and Northern Ethiopia(20). Knowledge of the optimal duration between childbirths is a key factor that encourages mothers to engage in family planning methods and adopt safe breastfeeding practices. This plays a crucial role in mitigating the potential adverse obstetric outcomes and shorter birth intervals.\u003c/p\u003e\n\u003cp\u003eThe other determinant of suboptimal birth spacing was breastfeeding duration. Accordingly, the odds of suboptimal birth spacing practices were two times greater among mothers who breastfed the preceding child for less than 24 months compared to those who breastfed for 24 months or more. This finding is consistent with findings from studies conducted in Arbaminch district, Ethiopia(23), Arsi zone Ethiopia(24), Eastern Ethiopia(34), Southern Ethiopia(30), and Southwest Ethiopia(28). This is attributed to lactation amenorrhea, a natural contraceptive effect of breastfeeding. Additionally, breastfeeding may extend the interbirth interval by influencing hormonal feedback mechanisms negatively.\u003c/p\u003e\n\u003cp\u003eMoreover, the findings of this study indicated that the odds of suboptimal birth spacing were greater among mothers who had female index children than their counterparts. this is supported by findings from studies conducted in Arbaminch district, Ethiopia(23), Eastern Ethiopia(34), Northern Ethiopia(37), developing regions of Ethiopia(38), Southwest Ethiopia(28), and Southern Ethiopia(18,29).\u0026nbsp;This can be explained by the cultural preference for male offspring in various cultural settings.\u0026nbsp;In many Ethiopian communities, there exists a cultural inclination towards favoring male children.\u0026nbsp;Families\u0026apos; preference for male children is often driven by the belief that males offer better protection against potential threats. In such cultures, if the preceding birth is a female child, mothers might be less inclined to postpone subsequent births as they may desire to have a male child sooner.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations of the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAssessing the gap between births through women\u0026apos;s memory and breastfeeding duration may introduce recall bias into the findings. Given the case-control study design, deriving a direct causal link is a challenging prospect.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eIn conclusion, the educational status of the mother, non-use of modern contraceptives between the last two births, inadequate knowledge of optimal birth spacing, a short duration of breastfeeding, and having a female index child were all determinants of suboptimal birth spacing practice. Promoting education for women, advocating for the use of contraceptives, and encouraging breastfeeding are essential for fostering birth spacing. Additionally, raising awareness and culturally promoting parental understanding can help prevent sex-based intervals between births.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAOR: Adjusted Odds Ratio\u003c/p\u003e\n\u003cp\u003eANC: Antenatal Care\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCI: Confidence Intervals\u003c/p\u003e\n\u003cp\u003eCOR: Crude Odds Ratio\u003c/p\u003e\n\u003cp\u003eOR: Odds Ratio\u003c/p\u003e\n\u003cp\u003ePNC: Postnatal Care\u003c/p\u003e\n\u003cp\u003eSPSS:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eStatistical Package for Social Sciences.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and Consent to Participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Institutional Ethical Review Board of Adama Hospital Medical College, with Reference No. 058/K-373/15. The study\u0026rsquo;s proposal was formally presented to both the Oromia Regional Health Office and the Adama District Health Office to secure official approval for carrying out research activities within the selected kebeles. Participants were informed of the study\u0026apos;s purpose and benefits during the data collection period and informed written consent was obtained to ensure their decision to participate or refuse. To uphold respondents\u0026apos; rights and ensure confidentiality, anonymity, and privacy, safeguards were enacted, and all of the study\u0026apos;s procedures followed the principles outlined in the Helsinki Declaration(39).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll data and materials are available from the corresponding author without undue reservation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no specific funding from any funding agency.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors extend their sincere appreciation to Adam Hospital Medical College, along with the Adama district health office, for their invaluable assistance throughout the study. Special thanks are also extended to the dedicated team of data collectors, supervisors, and all the study participants for their crucial contributions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYAB contributed to the conception and design of the study, as well as the data curation, and analysis. YA, YMN, MSG, and BLS drafted the manuscript. YMN critically reviewed the draft manuscript and wrote the final version. MAK and WDG advised the study. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization. Report of a WHO technical consultation on birth spacing: Geneva, Switzerland 13-15 June 2005. World Health Organization; 2007. \u003c/li\u003e\n\u003cli\u003eMolitoris J, Barclay K, Kolk M. When and Where Birth Spacing Matters for Child Survival: An International Comparison Using the DHS. Demography. 2019 Aug;56(4):1349\u0026ndash;70. \u003c/li\u003e\n\u003cli\u003eConde-Agudelo A, Rosas-Bermudez A, Casta\u0026ntilde;o F, Norton MH. Effects of birth spacing on maternal, perinatal, infant, and child health: a systematic review of causal mechanisms. Stud Fam Plann. 2012 Jun;43(2):93\u0026ndash;114. \u003c/li\u003e\n\u003cli\u003eGebrehiwot SW, Abera G, Tesfay K, Tilahun W. Short birth interval and associated factors among women of child bearing age in northern Ethiopia, 2016. BMC women\u0026rsquo;s health. 2019;19(1):1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eRutstein SO. Effects of preceding birth intervals on neonatal, infant and under‐five years mortality and nutritional status in developing countries: evidence from the demographic and health surveys. International Journal of Gynecology \u0026amp; Obstetrics. 2005;89:S7\u0026ndash;24. \u003c/li\u003e\n\u003cli\u003eBauserman M, Nowak K, Nolen TL, Patterson J, Lokangaka A, Tshefu A, et al. The relationship between birth intervals and adverse maternal and neonatal outcomes in six low and lower-middle income countries. Reprod Health. 2020 Nov;17(S2):157. \u003c/li\u003e\n\u003cli\u003eKozuki N, Lee AC, Silveira MF, Sania A, Vogel JP, Adair L, et al. The associations of parity and maternal age with small-for-gestational-age, preterm, and neonatal and infant mortality: a meta-analysis. BMC public health. 2013;13:1\u0026ndash;10. \u003c/li\u003e\n\u003cli\u003eIslam MZ, Billah A, Islam MM, Rahman M, Khan N. Negative effects of short birth interval on child mortality in low-and middle-income countries: a systematic review and meta-analysis. Journal of Global Health. 2022;12. \u003c/li\u003e\n\u003cli\u003eTesema GA, Teshale AB, Yeshaw Y, Angaw DA, Molla AL. Assessing the effects of duration of birth interval on adverse pregnancy outcomes in sub-Saharan Africa: a propensity score-matched analysis. BMJ open. 2023;13(4):e062149. \u003c/li\u003e\n\u003cli\u003eChungkham HS, Sahoo H, Marbaniang SP. Birth interval and childhood undernutrition: Evidence from a large scale survey in India. Clinical Epidemiology and Global Health. 2020;8(4):1189\u0026ndash;94. \u003c/li\u003e\n\u003cli\u003eMruts KB, Gebremedhin AT, Tessema GA, Scott JA, Pereira G. Interbirth interval and maternal anaemia in 21 sub-Saharan African countries: A fractional-polynomial analysis. Todd CS, editor. PLoS ONE. 2022 Sep 23;17(9):e0275155. \u003c/li\u003e\n\u003cli\u003eDavanzo J, Hale L, Razzaque A, Rahman M. The effects of pregnancy spacing on infant and child mortality in Matlab, Bangladesh: How they vary by the type of pregnancy outcome that began the interval. Population Studies. 2008 Jul;62(2):131\u0026ndash;54. \u003c/li\u003e\n\u003cli\u003eKorsa E, Ibrahi̇M F, Haji̇To KW. Effects of Short Birth Interval on Birth Outcomes among Term Pregnant Mothers in Labor. Journal of Health Systems and Policies. 2021 May 10;3(1):55\u0026ndash;74. \u003c/li\u003e\n\u003cli\u003eBelachew TB, Asmamaw DB, Negash WD. Short birth interval and its predictors among reproductive age women in high fertility countries in sub-Saharan Africa: a multilevel analysis of recent Demographic and Health Surveys. BMC Pregnancy Childbirth. 2023 Jan 30;23(1):81. \u003c/li\u003e\n\u003cli\u003eFotso JC, Cleland J, Mberu B, Mutua M, Elungata P. Birth spacing and child mortality: an analysis of prospective data from the Nairobi urban health and demographic surveillance system. J Biosoc Sci. 2013 Nov;45(6):779\u0026ndash;98. \u003c/li\u003e\n\u003cli\u003eAjayi AI, Somefun OD. Patterns and determinants of short and long birth intervals among women in selected sub-Saharan African countries. Medicine (Baltimore). 2020 May;99(19):e20118. \u003c/li\u003e\n\u003cli\u003eBliznashka L, Jeong J. 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PLoS ONE. 2020 Dec 4;15(12):e0243046. \u003c/li\u003e\n\u003cli\u003eMuluneh AA, Kassa ZY, Siyoum M, Gebretsadik A, Woldeyes Y, Tenaw Z. Determinants of Sub-Optimal Birth Spacing in Gedeo Zone, South Ethiopia: A Case-Control Study. Int J Womens Health. 2020;12:549\u0026ndash;56. \u003c/li\u003e\n\u003cli\u003eDereje T, Muluneh S, Kebebe B. Practice of child spacing and its associated factors among women of child bearing age (15 to 49 years) in Illubabor zone, South West Ethiopia. Int J Nurs Midwifery. 2017 Jul 31;9(7):102\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eHailu D, Gulte T. Determinants of Short Interbirth Interval among Reproductive Age Mothers in Arba Minch District, Ethiopia. Int J Reprod Med. 2016;2016:6072437. \u003c/li\u003e\n\u003cli\u003eShallo SA, Gobena T. Duration of birth interval and associated factors among married women in Dodota Woreda, Arsi Zone, Ethiopia. J Health Educ Res Dev. 2019;7(1):10\u0026ndash;4172. \u003c/li\u003e\n\u003cli\u003eAklil MB, Anteneh KT, Debele TZ, Temesgan WZ. Short birth interval and associated factors among women who gave birth in the last three years in Dembecha district, Northwest Ethiopia. Ayanto SY, editor. PLoS ONE. 2022 Aug 23;17(8):e0272612. \u003c/li\u003e\n\u003cli\u003eTessema GA, Zeleke BM, Ayele TA. Birth interval and its predictors among married women in Dabat District, Northwest Ethiopia: a retrospective follow up study. Afr J Reprod Health. 2013 Jun;17(2):39\u0026ndash;45. \u003c/li\u003e\n\u003cli\u003eNajafi-Vosough R, Soltanian AR, Fayyazi N. Influence factors on birth spacing and childbearing rates using survival recurrent events model and parity progression ratios. Journal of Research in Health Sciences. 2017;17(3):384. \u003c/li\u003e\n\u003cli\u003eAyane GB, Desta KW, Demissie BW, Assefa NA, Woldemariam EB. 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Contraception and Reproduction: Health Consequences for Women and Children in the Developing World. National Academies Press; 1989. \u003c/li\u003e\n\u003cli\u003eLevine R, Langer A, Birdsall N, Matheny G, Wright M, Bayer A. Contraception. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al., editors. Disease Control Priorities in Developing Countries [Internet]. 2nd ed. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2006 [cited 2024 Jan 10]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK11771/\u003c/li\u003e\n\u003cli\u003eEjigu AG, Yismaw AE, Limenih MA. The effect of sex of last child on short birth interval practice: the case of northern Ethiopian pregnant women. BMC Res Notes. 2019 Dec;12(1):75. \u003c/li\u003e\n\u003cli\u003eAychiluhm SB, Tadesse AW, Mare KU, Abdu M, Ketema A. A multilevel analysis of short birth interval and its determinants among reproductive age women in developing regions of Ethiopia. PLoS One. 2020;15(8):e0237602. \u003c/li\u003e\n\u003cli\u003eWorld Medical Association. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bull World Health Organ. 2001;79(4):373\u0026ndash;4. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Reproductive-age women, Suboptimal birth spacing, Case-Control, Adama, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-3865672/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3865672/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eBirth spacing is crucial for ensuring the health of mothers and their children, as well as determining population growth. Short birth intervals represent a universal public health problem associated with adverse maternal, fetal, neonatal, and child outcomes. However, there is limited information in the study area regarding the determinants of suboptimal birth spacing. Thus, this study aimed to identify the determinants of suboptimal spacing among women of reproductive age in the Adama district, Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA community-based unmatched case-control study was conducted among 568 randomly selected reproductive-age women using the multi-stage sampling technique. Data were collected using an interviewer-administered, structured questionnaire. The collected data were entered into Epi Info version 7.2 and analyzed using SPSS version 26. Binary logistic regression analysis was used to model the association between suboptimal birth spacing practices and independent variables. Adjusted odds ratios with their 95% confidence intervals were calculated to determine the strength of the association. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to declare statistical significance.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eEducational status (no formal education) (AOR\u0026thinsp;=\u0026thinsp;2.40; 95% CI: 1.23\u0026ndash;1.75), Inadequate knowledge of optimal birth space (AOR\u0026thinsp;=\u0026thinsp;2.60; 95% CI; 1.80\u0026ndash;3.90), non-use of modern contraceptives (AOR\u0026thinsp;=\u0026thinsp;3.00; CI: 1.90\u0026ndash;4.20), short breastfeeding duration (AOR\u0026thinsp;=\u0026thinsp;2.30; 95% CI: 1.50\u0026ndash;3.40), and having female index child (AOR\u0026thinsp;=\u0026thinsp;1.60; 95% CI: 1.13\u0026ndash;2.50) were independent determinants of suboptimal birth spacing practice.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eHaving no formal education, Inadequate knowledge of optimal birth space, non-use of modern contraceptives, having short breastfeeding duration, and having a female index child were determinants of suboptimal birth spacing. Encouraging women's education, contraceptive use, and breastfeeding is crucial for birth spacing. Cultural awareness and parental understanding are key to preventing sex-based birth intervals.\u003c/p\u003e","manuscriptTitle":"Determinants of Suboptimal Birth Spacing among Reproductive-Age Women in Adama District, Ethiopia: A Community-Based Unmatched Case-Control Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-18 07:19:08","doi":"10.21203/rs.3.rs-3865672/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0ca5666b-992b-48fa-bf85-51731e38eac6","owner":[],"postedDate":"January 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-09T11:27:56+00:00","versionOfRecord":[],"versionCreatedAt":"2024-01-18 07:19:08","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3865672","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3865672","identity":"rs-3865672","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}