Short Birth Interval and Associated Factors among Women of Reproductive Age in Arba Minch, in Gamo Zone SNNPR Ethiopia: Evidences from Health and Demographic Surveillance Sites

Short Birth Interval and Associated Factors among Women of Reproductive Age in Arba Minch, in Gamo Zone SNNPR Ethiopia: Evidences from Health and Demographic Surveillance Sites | 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 Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Short Birth Interval and Associated Factors among Women of Reproductive Age in Arba Minch, in Gamo Zone SNNPR Ethiopia: Evidences from Health and Demographic Surveillance Sites Mulugeta Dalbo, Gistane Ayele, Dinkalem Getahun, Mesfin Kote, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3368585/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 Short birth interval (SBI) is a leading threat to maternal and child health in Sub-Saharan countries. To tackle the problem, the World Health Organization (WHO) recommends elapses of 33 months between two consecutive live births. However, most women in developing countries do not adhere to these recommendations. Methods Therefore, the aim of this study is to determine the magnitude and associated factors of short birth intervals (SBIs) at the Arba Minch Health and Demographic Surveillance System Site (AM_HDSS). It was based on longitudinally collected data from January 2009 to December 2022. The inter-birth interval (IBI) was dichotomized as "short" when it is less than 33 months and "normal" when it is greater than or equal to 33 months. STATA version 17 was used to enter, clean, and analyze the data. A chi-square test was conducted to test the association between the short birth interval and explanatory variables. A multilevel logistic regression was fitted to determine factors affecting short birth intervals. AOR with a 95% CI was used to identify predictors and a P value less than 0.05 was used to declare the level of significance. Result From the 10,128 cohorts of reproductive-age women in this study, 4,340 (43%) experienced a short birth interval. Educational status (no formal education AOR 1.51 (95% CI: 1.09, 2.10), primary education AOR 1.48 (95% CI: 1.06, 2.07), occupation (sales and services) AOR 1.77 (95% CI: 1.34, 2.33), and home delivery AOR 1.83 (95% CI: 1.42, 2.45) and delivery attended by other than health professional and not assisted AOR 0.74 (95% CI: 0.55, 0.98), and parity three and above AOR 3.04 (95% CI: 2.60, 3.56), were significantly associated with short birth intervals. Conclusion The prevalence of short birth intervals in this study was 43%, meaning that 4 out of 10 women experience short birth related maternal health complication. Maternal education, occupation, parity, place of birth, and the person who attended delivery were factors significantly associated with a short birth interval in this study. Short birth interval Women reproductive age Gamo Zone Ethiopia Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Background The short birth interval adversely affects maternal and child health and continued to be the largest cause of population burden in Sub-Saharan Africa. The burden and its impact is also high in Ethiopia. The World Health Organization (WHO) recommends that a a woman should wait at least 24 months between her last live birth and her next pregnancy, or 33 months between two consecutive live deliveries. Any short deviation from these defined as short inter-birth interval (SIBI) ( 1 , 2 ). About 59% and 47% of women in sub-Saharan Africa and Ethiopia face short birth interval respectively ( 2 , 3 ). Despite the era of effective contraception, short birth intervals continued to be a major concern for reproductive health. Suboptimal contraceptive utilization, religious barriers, unwanted pregnancy, inadequate breastfeeding, giving birth to a female child, home delivery, long breastfeeding duration, child death, young maternal age, maternal illiteracy, and a lack of exposure to various media for health-related information were some of the determinants of short birth interval ( 4 – 6 ). Too long or short birth spacing, results in adverse birth outcomes. A long birth interval—more than five years—results in hypertension. Short birth interval is associated with preterm birth, low birth weight, and being small for gestational age, premature membrane rupture, abruption of placentae, placenta previa, and uterine rupture. All of which, result in early neonatal, perinatal, and child hood death ( 7 – 9 ). Therefore, the aim of this was to determine the magnitude and associated factors of short birth intervals among women of reproductive age (15–49) at the Arba Minch health and demographic surveillance site (AM_HDSS). 2. Methods Study area and period This study was aimed at determining the magnitude and associated factor of short birth interval among women of reproductive age (15–49) at the Arba Minch Health University Demographic and Surveillance Site (AMU_HDSS). It is located 505 kilometers away from the national capital, Addis Ababa, and 275 kilometers from Hawassa, the city of the Southern Nations, Nationalities, and Peoples Region (SNNPR). Administrative location in Ethiopia extends from regions to the kebele level. The surveillance site has nine kebeles (one semi-urban and eight rural), which were further classified into 72 sub-kebeles. Formerly, the site was under Arba Minch Zuria Woreda, and the newly established administrative structure has divided the site into two districts (Arba Minch Zuria and Gacho Baba Woreda). The site was established in 2009 in collaboration with the Center for Disease Control (CDC) through the Ethiopian Public Health Association (EPHA) and Ar ba Minch University (AMU). The inauguration of the Arba Minch HDSS was approved by the Arba Minch University ethical review committee, the Ethiopian Public Health Association (EPHA) ethical review board, and the American Center for Disease Control (CDC) in Atlanta. The study was conducted from January 02, 2009, to December 30, 2022. Study population All women residing in AM_HDS sites were considered the study population. Those women aged 15–49 and who gave birth to two consecutive live births during the last fourteen years of follow up were considered the sample population. Women who gave multiple births but who had never been married and those who experienced consecutive adverse birth outcome (abortion, stillbirth etc.) were excluded from the analysis. Sampling : The current study included individual-level data for 10128 women who had at least two consecutive live births during the fourteen-year follow-up period between 02 January 2009 and 30 December 2022, as well as community characteristics for 72 sub-kebeles (Fig:1). Data collection tool and procedure This study was based on longitudinally collected secondary data which uses data abstraction format. Based on the data sharing agreement, we requested and accessed the HDSS data from the AM_HDSS coordination office. AM_HDSS carries out a biannual house-to-house data collection strategy to update previously existing data, record newly occurring vital events, and provide longitudinal data on birth, death, and migration for local, regional, and national use. Any vital health events that occurred during regular data collection were being reported to data collection agents via key local informants. Variables: outcome : The outcome variable of this study was the short inter-birth interval, which was derived from the median inter-birth interval. Based on WHO's definition, the outcome variable was dichotomized into two "short inter-birth intervals" if the median duration of the live birth outcome between two consecutive births was less than 33 months, and "appropriate" if the median duration was greater than 33 months. The independent variables investigated against the outcome variable were mothers age, which was categorized into seven categories, the lowest being 15–19 and the highest being 45–49 years, religion in three (Protestant, Orthodox, and others), marital status in three (married, single, and ever married), education in four (no education, primary, secondary, and above secondary), occupation in six (housewife, sales and services, agriculture, job seeking, professional and technical, others), place of delivery in three (home, public sector, and others), status of delivery attendance in three (health personnel, other, not assisted), and number of live births. Data analysis We obtained date from the AM-HDSS site in the form of Microsoft excel and comma-separated values file (CSV) and imported to STATA 17 software for cleaning and analysis. Since a woman can have multiple inter-birth intervals during the follow up period, we calculated the inter-birth interval for each woman in cohort as; $${I}_{n}=\frac{{D}_{n}-{(D}_{n}-1)}{30.4}$$ Where, n = 1,2,3,…k k = highest live birth that a woman given in her consecutive pregnancy during her reproductive period, I n = n th inter-birth interval between two consecutive live births. D n = date that a woman has given birth to n th live birth, D n -1 = date that a woman has given live birth of the preceding (n-1) th live birth and, 30.4 = average number of days in a month After calculating the inter-birth interval for each woman, we calculated the median inter-birth interval for each woman and used it as an outcome variable for the analysis. The median inter-birth interval was then dichotomized based on the birth interval classification criteria as short ( 1 ) and normal (0). "Short inter-birth interval" is when the median inter-birth interval is less than 33 months, and "normal inter-birth interval" is when the median inter-birth interval is above 33 months. We conducted a trend analysis to determine the trend of the short birth interval during the follow-up period. A Chi-square (χ2) test was computed, and bi-variable analysis was done to determine the association of each independent variable with the median short inter-birth interval. Since the inter-birth interval of a mother is highly correlated and nested within each mother and sub-Kebeles, a multilevel logistic regression was computed to determine the association of the short birth interval with each independent variable by using the xtlogit stata command. AOR with a 95% CI was used to identify predictors and a P value less than 0.05 was used to declare the level of significance. 3. Result Socio-demographic characteristics of the study participants As detailed in Table 1 , out of 26,679 women of reproductive age groups recorded at the AM-HDSS site during the follow-up period from January second, 2009, to December 30th, 2022, a total of 10,132 mothers were eligible for this study. The mean age of the participants was 29.7 ± (6.9) years, and the majority of the women were categorized under 25–29 years (30.4%), and the least participants were categorized under 45–49 years (1.86%). The majority of our study participants were married, followed the Protestant religion, had no formal education, were housewives, and were delivered at home (86.92%, 66.21%, 64.02%, 57.36%, and 77.16%, respectively. Table 1 Socio-demographic characteristics of the study participants of Arba Minch HDSS, from 2009 to 2022, (n = 10,128). Independent Variables Categories Frequency Percent (%) Age 15–19 574 5.6 20–24 2,006 19.81 25–29 3,079 30.40 30–34 2,402 23.72 35–39 1,391 13.73 40–44 491 4.85 45–50 188 1.86 Marital status Single 1,162 12.12 Married 8,332 86.92 Ever Married 92 0.96 Religion Protestant 6,706 66.21 Orthodox 3,123 30.84 Others 299 2.95 Educational status No Education 6,150 64.02 Primary 2,602 27.08 Secondary 811 8.44 Above Secondary 44 0.46 Occupation House Wife 5,591 57.36 Sales &Services 1,746 17.91 Agriculture 1,013 10.39 Job Seeking 827 8.48 Professional & Technical 212 2.17 Others 359 3.68 Place of Delivery Home 2,946 77.16 Public Sector 833 21.82 others 39 1.02 Person Who Attended Delivery Health Professional 793 20.88 No one assisted 1,255 33.05 Others 1,749 46.06 Parity 2 5,836 57.6 3 & above 4,296 42.4 3.2. Inter-birth interval of the study participants Out of 10,132 mothers, the median inter-birth interval (IBI) was 35 months, and the interquartile range (IQR) was 17 months. Of those women, 43% (n = 4,352) had experienced a shorter birth interval (less than 33 months) than what was recommended by the World Health Organization (WHO) (Fig. 3 ). When comparing the magnitude of the short birth interval between the first two births and the last two births, most of the women (47%, n = 4,808) experienced a shorter birth interval during their first two births than their last two births (40.2%) (n = 4071) (Fig. 2 ) Trend analysis of short birth interval (2009–2022) In general, the magnitude of the short birth interval has fallen across the follow-up period beginning in 2011–2022. Higher short birth intervals among women in the study area were seen in 2011 and 2012, whereas lower ones were observed in 2009 and 2022. The fall in magnitude might be due to the increased provision of contraception and improvements in community awareness through the health extension program. (Fig. 2 ). Factors associated with Median inter-birth interval of the study participant, AM_HDSS There were eight variables in the bivariable model that fulfilled the criteria for fitting the multivariable random effect logistic regression model: the mother's age, religion, educational status, occupation, marital status, place of delivery, the person who attended delivery, and parity. Out of them, five were significantly associated with the median IBI in adjusted odds ratio (AOR), namely educational status, occupation, parity, a person who attended delivery, and place of delivery ( Table 2 ) . Table 2 Factors associated with Median inter-birth interval of the study participant, AM_HDSS from 2009 to 2022, (n = 10,128) Variables Categories Inter-birth interval (IBI) (%) COR (95% CI) AOR (95% CI) Short Normal Age 15–19 336 (58.84) 235 (41.16) 2.35 (1.85–2.99) 1.41(0.49–4.09) 20–24 1,030 (51.35) 976 (48.65) 1.74 (1.45–2.08) 1.29(0.97–1.72) 25–29 1,164 (37.80) 1,915 (62.20) 1 1 30–34 976 (40.63) 1,426(59.37) 1.13 (0.91–1.39) 0.95(0.76–1.19) 35–39 594 (42.70) 797 (57.30) 1.23 (1.02–1.48) 1.11(0.88–1.41) 40–44 184 (37.47) 307 (62.53) 0.99 (0.72–1.34) 0.89(0.65–1.23) 45–49 67 (35.64) 121 (64.36) 0.91 (0.56–1.48) 0.72(0.44–1.15) Marital status Single 541 (46.56) 621 (53. 44) 1.20 (0.95–1.51) 1.02(0.71–1.47) Married 3,510(42.13) 4,822 (57.87) 1 1 Ever Married 34 (36.96) 58 (63.04) 0.81 (0.45–1.44) 0.95(0.39–2.33) Religion Protestant 2,800 (41.75) 3,906(58.25) 1 1 Orthodox 1,425 (45.63) 1,698 (54.37) 1.17 (0.97–1.41) 1.09(0.91–1.33) Others 126 (42.14) 173 (57.86) 1.02 (0.65-1,59) 0.74(0.51–1.08) Educational status No Education 2,907 (47.27) 3,243 (52.73) 3.28 (2.48–4.34) 1.51(1.09–2.10)* Primary 970 (37.28) 1,632 (62.72) 2.18 (1.70-2,78) 1.48(1.06–2.07)* Secondary 174 (21.45) 637 (78.55) 1 1 Above Secondary 5 (11.36) 39 (88.64) 0.47 (0.11–1.95) 0.45(0.08–2.67) Occupation House Wife 2,190 (39.17) 3,401 (60.83) 1 1 Sales &Services 844 (48.34) 902 (51.66) 1.45 (1.26–1.67) 1.77(1.34–2.33)* Agriculture 541 (53.41) 472 (46.59) 1.78 (1.39–2.27_ 1.26(0.99–1.59) Job Seeking 340 (41.11) 487 (58.89) 1.08 (0.85–1.38) 1.39(0.88–2.19) Professional & Technical 78 (36.79) 134 (63.21) 0.90 (0.60–1.36) 1.20(0.60–2.42) Others 154 (42.90) 205 (57.10) 1.17 (0.83–1.63) 1.34(0.71–2.51) Place of Delivery Home 1,492 (50.64) 1,454(49.36) 1.88 (1.47–2.39) 1.83(1.42–2.45)* Public Sector 294 (35.29) 539(64.71) 1 1 others 16 (41.03) 23 (58.97) 1.28 (0.65–2.49) 1.48(0.69–3.16) Person Who Attended Delivery Health Professional 308 (38.84) 485 (61.16) 1 1 No one assisted 628 (50.04) 627 (49.96) 1.58 (1.21–2.06) 0.86(0.62–1.20) Others 864 (49.40) 885 (50.60) 1.54 (1.21–1.95) 0.74(0.55–0.98)* Parity 2 2,204(37.77) 3,632(62.23) 1 1 3 & above 2,148(50.00) 2,148(50.00) 1.36(1.25–1.48) 3.04(2.60–3.56)* 4. Discussion The current study aimed at assessing the magnitude of short inter-birth interval and associated factors among the reproductive-age women of AM_HDSS from 2009–2022. The study showed that maternal education, occupation, place of delivery, person who attended delivery, and parity were independent determinates for short birth intervals. The magnitude of short birth interval during the follow up period in this study area was 43%. The findings of this study were found to be in line with the study conducted in Northwest Ethiopia ( 12 ). However, it was lower than the study conducted in Uganda(52.4%), Tanzania (48.4%), rural India (50%), Sub-Saharan Africa (58.7%), and other places of Ethiopia (62.9%)( 2 , 13 – 16 ). On the other hand, this finding is higher than studies conducted in Northern Ethiopia(23.3%,) and Bangladesh (26% ) respectively( 4 , 17 ). The difference might be due variation in the study design, levels of inter-birth intervals compared and geographical, socio cultural and demographic variation among study participant. This study was based on a longitudinal data whereas the majorities of compared studies used cross-sectional design. Another difference might be most of the referenced studies measured the interval of the last two consecutive births, but the this study measured the median inter-birth interval of all live births of each women during the follow up period(inter-birth interval of the first two, between second and third, between third and fourth, between fourth and fifth). In addition, geographical, cultural, and economic variation among the study participants may explain the stated differences. In this study among the eight variables computed by bivariable analysis five variables: maternal education, and occupation, place of delivery, parity, and a person who attended delivery were found to be significant determinants of short inter-birth interval in multivariable analysis. Mothers who had not attended formal education and those who attended primary education were at 51% (AOR = 1.51, 95%CI: 1.09, 2.10) and 48% (AOR = 1.48, 95%CI: 1.06, 2.07) increased risk of experiencing a short inter-birth interval when compared to those who attended secondary education level, respectively. The finding is consistent with studies conducted in Tanzania, and sub-Saharan Africa( 16 , 18 , 19 ). This indicates that maternal education has a great role in birth spacing and preventing maternal health complications associated with a short inter-birth interval( 6 ). Place of delivery is another factor that determined the occurrence of short birth intervals in this study area. Mothers who gave birth at home face 83% (AOR = 1.83, 95%CI: 1.42, 1.45) more risk of a short inter-birth interval compared to those delivered in the public sector (hospitals, health centres, health posts, and private clinics). The finding is in line with the reports of many other studies in Africa( 5 , 16 ). The place of delivery is one of the vital necessities for maternal health. When compared to institutional delivery, home delivery is at great risk for maternal and perinatal mortality. At health institution, different components of maternal health services are provided for the benefit of maternal and child health. In this study, home delivery is at risk for a short inter-birth interval, which may be because of missing an important component of the health service provided in the public sector that may have benefited mothers who gave birth at a health facility( 20 ). This study has also identified that parity has association with short inter-birth interval and when compared to mother who have two children those mothers who have three or more children were 3.04 (AOR = 3.04, 95%CI: 2.60–3.56) times risk to encounter short inter-birth interval. This finding is in line with similar studied conducted in in Ethiopia and elsewhere in low and middle income countries( 21 , 22 ). Moreover, occupation is another factor that was associated with a short birth interval, and in this study, mothers who were engaged in sales and services had a 77% (AOR = 1.77, 95% CI: 1.34, 2.33) times higher risk of facing a short inter-birth interval when compared to housewives. The study contradicted a study conducted in sub-Saharan Africa, where actively working women face long birth intervals due to their busy lifestyles ( 2 ). The difference in this study might be due to variations in the scope of the studies, where Sub-Saharan Africa covered a large scope, which could address variations in occupational composition. And another difference might be due to the fact that those mothers whose occupations in this study were considered sales and service were from rural and semi-urban areas and hence stayed in their homes with their partners, which could result in frequent pregnancies. The type of professional category who attended delivery also determines the duration of the spacing birth interval. In contrast, women whose deliveries were attended by others than health professionals (trained and untrained traditional birth attendants, neighbours, and relatives) were found to have a 26% (AOR = 0.74, 95% CI: 0.55, 0.98) lower risk of having a short inter-birth interval when compared to women whose deliveries were attended by health professionals, calling for further investigation. Conclusion and recommendation the study revealed high proportion short birth interval in the study area. Maternal education, occupation, parity, place delivery, and type of person attended delivery were found to be determinant of short birth interval. Recommendation : Encouraging women's education and improving community-level over institutional delivery deemed to be important to mitigate the problem. Abbreviations AM_HDSS Arba Minch health and demographic surveillance site CDC Centre for Disease Control CSV Comma-separated values file EPHA Ethiopian public health association IBI Inter-birth interval SBI Short birth interval SIBI Short inter birth interval SNNPR Southern Nation Nationalities and People Regional State WHO World Health Organization Declarations Ethics approval and consent to participate: The inauguration of the Arba Minch HDSS was approved by the Arba Minch University ethical review committee, the Ethiopian Public Health Association (EPHA) ethical review board, and the American Center for Disease Control (CDC) in Atlanta. The data analysis for this study was based on the secondary data collected and kept in the AM_DHSS. Therefore, we have not reached each participant directly and have not taken informed consent from each participant; but the informed consent for this study has been waived by the ethic review committee of Arba Minch University Medical and Health Science, Menaye Yihune, Chairperson, Institutional Research Ethics Review Board.Email: [email protected] ,and tele:(+251)911008759 Consent for publication: NA Availability of data and materials: The data used for this study is available at Mulugeta Dalbo, the corresponding author, who can be contacted at [email protected] or +251915841693, and Dinkalem Getahun, data analysis, who can be reached at [email protected] or by +251916699901. Competing interests: the authors have no any competing interests Funding: this study has not been funded by any body Authors' contributions: MD, GA, and DG wrote the proposal, analyzed, and interpreted the data. MK and AB organized and cleaned data, and TA evaluated the whole process and assisted the analysis. All authors read and approved the final manuscript. Acknowledgements: We acknowledge the Arb Minch University Health and Demographic Surveillance Site and information technology staff for their cooperation in providing the data. Strength and limitation: The longitudinal design in this study was believed to provide data on the in-depth exploration of factors associated with a short birth interval. However, we failed to have data on variable such as wealth index, contraception, and data on antenatal care (ANC) follow-up was incomplete that could have influenced the birth interval. References Mihretie GN, Yenealem Beyene F, Getnet Kassa B, Degu Ayele A, Muche Liyeh T, Minuye Birihane B. Determinants of short birth interval among women in South Gondar, Ethiopia: community-based unmatched case-control study. Arch Public Heal. 2021;79(1):1–10. Belachew TB, Asmamaw DB, Negash WD. 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Dalbo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDUlEQVRIiWNgGAWjYFAC5gYIfYC5DUQx9oPIhAJ8WhhBWgyAWhghWmaC+AkGpGjZcIABIoAL6M5IbJP8UvFHnu/4wbYHHxi2yW4+vzrxwwMDBnl+sQNYtZjdSGyTljljYDjzTGK74QyG28bbbrzdLAF0mOHM2Qm4tUi2GQDdA2TwMNxO3Hbj7AaQlgSD2/i0/DOw33D+IUTL5hlnN/8gpEXyY4NB4oYbUFs28Pduw2/LmYfN1gzHjJNn3ngI9IvBbeMZN3i3WSQYSOD2y/Hkgzd/1MjZ9p1PPvbgQ8Vt2f7+s5tv/qiwkeeXxq4FBJh54ExQdEiAVUrgVA4CjD9QuPwH8KoeBaNgFIyCkQcAMVJtMHOghKEAAAAASUVORK5CYII=","orcid":"","institution":"Arba Minch College of Health Science","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Mulugeta","middleName":"","lastName":"Dalbo","suffix":""},{"id":237148637,"identity":"311c27a4-a399-4771-8686-daa205e7e4b2","order_by":1,"name":"Gistane Ayele","email":"","orcid":"","institution":"Arba Minch University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Gistane","middleName":"","lastName":"Ayele","suffix":""},{"id":237148638,"identity":"341829db-8311-4fcb-84e9-6038f4e7c770","order_by":2,"name":"Dinkalem Getahun","email":"","orcid":"","institution":"Arba Minch University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Dinkalem","middleName":"","lastName":"Getahun","suffix":""},{"id":237148639,"identity":"9ee106dc-be7e-4864-bb1b-0ff1d0af5d6b","order_by":3,"name":"Mesfin Kote","email":"","orcid":"","institution":"Arba Minch University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Mesfin","middleName":"","lastName":"Kote","suffix":""},{"id":237148640,"identity":"8a952836-ec7c-42b6-8545-78fc7e712b27","order_by":4,"name":"Alazar Baharu","email":"","orcid":"","institution":"Arba Minch University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Alazar","middleName":"","lastName":"Baharu","suffix":""},{"id":237148641,"identity":"69335de5-fe36-48a3-9423-cd7dc429cd52","order_by":5,"name":"Tadesse Awoke","email":"","orcid":"","institution":"University of Gondar","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Tadesse","middleName":"","lastName":"Awoke","suffix":""}],"badges":[],"createdAt":"2023-09-19 08:29:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3368585/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3368585/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":44213197,"identity":"93b1dbb8-8e2f-4f92-a6e0-4a64fb42a0b9","added_by":"auto","created_at":"2023-10-06 21:04:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":23766,"visible":true,"origin":"","legend":"\u003cp\u003eSampling Procedure of AMU_DHSS (2009–2022)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3368585/v1/25361bb6c8a6a75512b9014c.png"},{"id":44213198,"identity":"0523ea4c-947c-4d7c-ac60-7493a4ff4297","added_by":"auto","created_at":"2023-10-06 21:04:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":33589,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eProportion of Inter birth intervals between the first two live births, last two live births and the Median birth intervals of study participant, AM_HDSS\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-3368585/v1/26fb0283178dfc62754ea473.png"},{"id":44213196,"identity":"ed865425-1fc1-4bcd-8f58-abecedbf95cc","added_by":"auto","created_at":"2023-10-06 21:04:39","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":19264,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eMagnitude of Short Birth interval of study participant, AM_HDSS\u003c/em\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-3368585/v1/de01da483196b8c6f1e03c9c.png"},{"id":44213199,"identity":"48184f8c-80a2-4eff-b0c9-2059a6ff67fb","added_by":"auto","created_at":"2023-10-06 21:04:39","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":25531,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eTrend of short birth interval at AMU-DHSS (2009-2022)\u003c/em\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-3368585/v1/40203680cab5fa9d5d752765.png"},{"id":70897217,"identity":"4105d592-6250-4c26-85c3-9794e33cc157","added_by":"auto","created_at":"2024-12-09 05:01:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":792345,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3368585/v1/19a92ba4-95aa-4c62-bf23-fd09e2aa5e74.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Short Birth Interval and Associated Factors among Women of Reproductive Age in Arba Minch, in Gamo Zone SNNPR Ethiopia: Evidences from Health and Demographic Surveillance Sites","fulltext":[{"header":"1. Background","content":"\u003cp\u003eThe short birth interval adversely affects maternal and child health and continued to be the largest cause of population burden in Sub-Saharan Africa. The burden and its impact is also high in Ethiopia. The World Health Organization (WHO) recommends that a a woman should wait at least 24 months between her last live birth and her next pregnancy, or 33 months between two consecutive live deliveries. Any short deviation from these defined as short inter-birth interval (SIBI) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). About 59% and 47% of women in sub-Saharan Africa and Ethiopia face short birth interval respectively (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite the era of effective contraception, short birth intervals continued to be a major concern for reproductive health. Suboptimal contraceptive utilization, religious barriers, unwanted pregnancy, inadequate breastfeeding, giving birth to a female child, home delivery, long breastfeeding duration, child death, young maternal age, maternal illiteracy, and a lack of exposure to various media for health-related information were some of the determinants of short birth interval (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Too long or short birth spacing, results in adverse birth outcomes. A long birth interval\u0026mdash;more than five years\u0026mdash;results in hypertension. Short birth interval is associated with preterm birth, low birth weight, and being small for gestational age, premature membrane rupture, abruption of placentae, placenta previa, and uterine rupture. All of which, result in early neonatal, perinatal, and child hood death (\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTherefore, the aim of this was to determine the magnitude and associated factors of short birth intervals among women of reproductive age (15\u0026ndash;49) at the Arba Minch health and demographic surveillance site (AM_HDSS).\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e \u003cstrong\u003eStudy area and period\u003c/strong\u003e \u003cp\u003eThis study was aimed at determining the magnitude and associated factor of short birth interval among women of reproductive age (15\u0026ndash;49) at the Arba Minch Health University Demographic and Surveillance Site (AMU_HDSS). It is located 505 kilometers away from the national capital, Addis Ababa, and 275 kilometers from Hawassa, the city of the Southern Nations, Nationalities, and Peoples Region (SNNPR). Administrative location in Ethiopia extends from regions to the kebele level. The surveillance site has nine kebeles (one semi-urban and eight rural), which were further classified into 72 sub-kebeles. Formerly, the site was under Arba Minch Zuria Woreda, and the newly established administrative structure has divided the site into two districts (Arba Minch Zuria and Gacho Baba Woreda). The site was established in 2009 in collaboration with the Center for Disease Control (CDC) through the Ethiopian Public Health Association (EPHA) and Ar ba Minch University (AMU). The inauguration of the Arba Minch HDSS was approved by the Arba Minch University ethical review committee, the Ethiopian Public Health Association (EPHA) ethical review board, and the American Center for Disease Control (CDC) in Atlanta. The study was conducted from January 02, 2009, to December 30, 2022.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy population\u003c/strong\u003e \u003cp\u003eAll women residing in AM_HDS sites were considered the study population. Those women aged 15\u0026ndash;49 and who gave birth to two consecutive live births during the last fourteen years of follow up were considered the sample population. Women who gave multiple births but who had never been married and those who experienced consecutive adverse birth outcome (abortion, stillbirth etc.) were excluded from the analysis.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSampling\u003c/b\u003e: The current study included individual-level data for 10128 women who had at least two consecutive live births during the fourteen-year follow-up period between 02 January 2009 and 30 December 2022, as well as community characteristics for 72 sub-kebeles (Fig:1).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData collection tool and procedure\u003c/strong\u003e \u003cp\u003eThis study was based on longitudinally collected secondary data which uses data abstraction format. Based on the data sharing agreement, we requested and accessed the HDSS data from the AM_HDSS coordination office. AM_HDSS carries out a biannual house-to-house data collection strategy to update previously existing data, record newly occurring vital events, and provide longitudinal data on birth, death, and migration for local, regional, and national use. Any vital health events that occurred during regular data collection were being reported to data collection agents via key local informants.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eVariables: outcome\u003c/b\u003e: The outcome variable of this study was the short inter-birth interval, which was derived from the median inter-birth interval. Based on WHO's definition, the outcome variable was dichotomized into two \"short inter-birth intervals\" if the median duration of the live birth outcome between two consecutive births was less than 33 months, and \"appropriate\" if the median duration was greater than 33 months. The independent variables investigated against the outcome variable were mothers age, which was categorized into seven categories, the lowest being 15\u0026ndash;19 and the highest being 45\u0026ndash;49 years, religion in three (Protestant, Orthodox, and others), marital status in three (married, single, and ever married), education in four (no education, primary, secondary, and above secondary), occupation in six (housewife, sales and services, agriculture, job seeking, professional and technical, others), place of delivery in three (home, public sector, and others), status of delivery attendance in three (health personnel, other, not assisted), and number of live births.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData analysis\u003c/strong\u003e \u003cp\u003eWe obtained date from the AM-HDSS site in the form of Microsoft excel and comma-separated values file (CSV) and imported to STATA 17 software for cleaning and analysis. Since a woman can have multiple inter-birth intervals during the follow up period, we calculated the inter-birth interval for each woman in cohort as;\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv id=\"Equa\" class=\"Equation\"\u003e \u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$${I}_{n}=\\frac{{D}_{n}-{(D}_{n}-1)}{30.4}$$\u003c/div\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhere,\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;1,2,3,\u0026hellip;k\u003c/p\u003e \u003cp\u003ek\u0026thinsp;=\u0026thinsp;highest live birth that a woman given in her consecutive pregnancy during her reproductive period,\u003c/p\u003e \u003cp\u003eI\u003csub\u003en\u003c/sub\u003e = n\u003csup\u003eth\u003c/sup\u003e inter-birth interval between two consecutive live births.\u003c/p\u003e \u003cp\u003eD\u003csub\u003en\u003c/sub\u003e = date that a woman has given birth to n\u003csup\u003eth\u003c/sup\u003e live birth,\u003c/p\u003e \u003cp\u003eD\u003csub\u003en\u003c/sub\u003e-1\u0026thinsp;=\u0026thinsp;date that a woman has given live birth of the preceding (n-1)\u003csup\u003eth\u003c/sup\u003e live birth and,\u003c/p\u003e\n\u003cp\u003e30.4 = average number of days in a month\u003c/p\u003e\n\u003cp\u003eAfter calculating the inter-birth interval for each woman, we calculated the median inter-birth interval for each woman and used it as an outcome variable for the analysis. The median inter-birth interval was then dichotomized based on the birth interval classification criteria as short (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) and normal (0). \"Short inter-birth interval\" is when the median inter-birth interval is less than 33 months, and \"normal inter-birth interval\" is when the median inter-birth interval is above 33 months. We conducted a trend analysis to determine the trend of the short birth interval during the follow-up period. A Chi-square (χ2) test was computed, and bi-variable analysis was done to determine the association of each independent variable with the median short inter-birth interval. Since the inter-birth interval of a mother is highly correlated and nested within each mother and sub-Kebeles, a multilevel logistic regression was computed to determine the association of the short birth interval with each independent variable by using the xtlogit stata command. AOR with a 95% CI was used to identify predictors and a P value less than 0.05 was used to declare the level of significance.\u003c/p\u003e"},{"header":"3. Result","content":"\u003cp\u003e \u003cb\u003eSocio-demographic characteristics of the study participants\u003c/b\u003e \u003c/p\u003e \u003cp\u003eAs detailed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, out of 26,679 women of reproductive age groups recorded at the AM-HDSS site during the follow-up period from January second, 2009, to December 30th, 2022, a total of 10,132 mothers were eligible for this study. The mean age of the participants was 29.7 \u0026plusmn; (6.9) years, and the majority of the women were categorized under 25\u0026ndash;29 years (30.4%), and the least participants were categorized under 45\u0026ndash;49 years (1.86%). The majority of our study participants were married, followed the Protestant religion, had no formal education, were housewives, and were delivered at home (86.92%, 66.21%, 64.02%, 57.36%, and 77.16%, respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of the study participants of Arba Minch HDSS, from 2009 to 2022, (n\u0026thinsp;=\u0026thinsp;10,128).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIndependent Variables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e574\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.81\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3,079\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,402\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13.73\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e491\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.85\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.86\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8,332\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e86.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEver Married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProtestant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6,706\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrthodox\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3,123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.95\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducational status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6,150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e64.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,602\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e811\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbove Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHouse Wife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5,591\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSales \u0026amp;Services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,746\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17.91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgriculture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJob Seeking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e827\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessional \u0026amp; Technical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePlace of Delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e77.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublic Sector\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e833\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eothers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePerson Who Attended Delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth Professional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.88\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo one assisted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,749\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.06\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5,836\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 \u0026amp; above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4,296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Inter-birth interval of the study participants\u003c/h2\u003e \u003cp\u003eOut of 10,132 mothers, the median inter-birth interval (IBI) was 35 months, and the interquartile range (IQR) was 17 months. Of those women, 43% (n\u0026thinsp;=\u0026thinsp;4,352) had experienced a shorter birth interval (less than 33 months) than what was recommended by the World Health Organization (WHO) (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). When comparing the magnitude of the short birth interval between the first two births and the last two births, most of the women (47%, n\u0026thinsp;=\u0026thinsp;4,808) experienced a shorter birth interval during their first two births than their last two births (40.2%) (n\u0026thinsp;=\u0026thinsp;4071) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cb\u003eTrend analysis of short birth interval (2009\u0026ndash;2022)\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn general, the magnitude of the short birth interval has fallen across the follow-up period beginning in 2011\u0026ndash;2022. Higher short birth intervals among women in the study area were seen in 2011 and 2012, whereas lower ones were observed in 2009 and 2022. The fall in magnitude might be due to the increased provision of contraception and improvements in community awareness through the health extension program. (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eFactors associated with Median inter-birth interval of the study participant, AM_HDSS\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThere were eight variables in the bivariable model that fulfilled the criteria for fitting the multivariable random effect logistic regression model: the mother's age, religion, educational status, occupation, marital status, place of delivery, the person who attended delivery, and parity. Out of them, five were significantly associated with the median IBI in adjusted odds ratio (AOR), namely educational status, occupation, parity, a person who attended delivery, and place of delivery \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactors associated with Median inter-birth interval of the study participant, AM_HDSS from 2009 to 2022, (n\u0026thinsp;=\u0026thinsp;10,128)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eInter-birth interval (IBI) (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eShort\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"6\" rowspan=\"7\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e336 (58.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e235 (41.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.35 (1.85\u0026ndash;2.99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.41(0.49\u0026ndash;4.09)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,030 (51.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e976 (48.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.74 (1.45\u0026ndash;2.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.29(0.97\u0026ndash;1.72)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,164 (37.80)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,915 (62.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e976 (40.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,426(59.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.13 (0.91\u0026ndash;1.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.95(0.76\u0026ndash;1.19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e594 (42.70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e797 (57.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.23 (1.02\u0026ndash;1.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.11(0.88\u0026ndash;1.41)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e184 (37.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e307 (62.53)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.99 (0.72\u0026ndash;1.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.89(0.65\u0026ndash;1.23)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u0026ndash;49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 (35.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e121 (64.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.91 (0.56\u0026ndash;1.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.72(0.44\u0026ndash;1.15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e541 (46.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e621 (53. 44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.20 (0.95\u0026ndash;1.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.02(0.71\u0026ndash;1.47)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3,510(42.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4,822 (57.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEver Married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (36.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58 (63.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.81 (0.45\u0026ndash;1.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.95(0.39\u0026ndash;2.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProtestant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,800 (41.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,906(58.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrthodox\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,425 (45.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,698 (54.37)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.17 (0.97\u0026ndash;1.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.09(0.91\u0026ndash;1.33)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126 (42.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e173 (57.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.02 (0.65-1,59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.74(0.51\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eEducational status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,907 (47.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,243 (52.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.28 (2.48\u0026ndash;4.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.51(1.09\u0026ndash;2.10)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e970 (37.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,632 (62.72)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.18 (1.70-2,78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.48(1.06\u0026ndash;2.07)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e174 (21.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e637 (78.55)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbove Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (11.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39 (88.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.47 (0.11\u0026ndash;1.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.45(0.08\u0026ndash;2.67)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHouse Wife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,190 (39.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,401 (60.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSales \u0026amp;Services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e844 (48.34)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e902 (51.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.45 (1.26\u0026ndash;1.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.77(1.34\u0026ndash;2.33)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAgriculture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e541 (53.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e472 (46.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.78 (1.39\u0026ndash;2.27_\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.26(0.99\u0026ndash;1.59)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eJob Seeking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e340 (41.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e487 (58.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.08 (0.85\u0026ndash;1.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.39(0.88\u0026ndash;2.19)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eProfessional \u0026amp; Technical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78 (36.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e134 (63.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.90 (0.60\u0026ndash;1.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.20(0.60\u0026ndash;2.42)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e154 (42.90)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e205 (57.10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.17 (0.83\u0026ndash;1.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.34(0.71\u0026ndash;2.51)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePlace of Delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1,492 (50.64)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1,454(49.36)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.88 (1.47\u0026ndash;2.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e1.83(1.42\u0026ndash;2.45)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePublic Sector\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e294 (35.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e539(64.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eothers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (41.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23 (58.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.28 (0.65\u0026ndash;2.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.48(0.69\u0026ndash;3.16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePerson Who Attended Delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth Professional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e308 (38.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e485 (61.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo one assisted\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e628 (50.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e627 (49.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.58 (1.21\u0026ndash;2.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.86(0.62\u0026ndash;1.20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e864 (49.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e885 (50.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.54 (1.21\u0026ndash;1.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.74(0.55\u0026ndash;0.98)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eParity\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,204(37.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3,632(62.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 \u0026amp; above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2,148(50.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2,148(50.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.36(1.25\u0026ndash;1.48)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e3.04(2.60\u0026ndash;3.56)*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe current study aimed at assessing the magnitude of short inter-birth interval and associated factors among the reproductive-age women of AM_HDSS from 2009–2022. The study showed that maternal education, occupation, place of delivery, person who attended delivery, and parity were independent determinates for short birth intervals.\u003c/p\u003e \u003cp\u003eThe magnitude of short birth interval during the follow up period in this study area was 43%. The findings of this study were found to be in line with the study conducted in Northwest Ethiopia (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). However, it was lower than the study conducted in Uganda(52.4%), Tanzania (48.4%), rural India (50%), Sub-Saharan Africa (58.7%), and other places of Ethiopia (62.9%)(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e–\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). On the other hand, this finding is higher than studies conducted in Northern Ethiopia(23.3%,) and Bangladesh (26% ) respectively(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). The difference might be due variation in the study design, levels of inter-birth intervals compared and geographical, socio cultural and demographic variation among study participant. This study was based on a longitudinal data whereas the majorities of compared studies used cross-sectional design. Another difference might be most of the referenced studies measured the interval of the last two consecutive births, but the this study measured the median inter-birth interval of all live births of each women during the follow up period(inter-birth interval of the first two, between second and third, between third and fourth, between fourth and fifth). In addition, geographical, cultural, and economic variation among the study participants may explain the stated differences.\u003c/p\u003e \u003cp\u003eIn this study among the eight variables computed by bivariable analysis five variables: maternal education, and occupation, place of delivery, parity, and a person who attended delivery were found to be significant determinants of short inter-birth interval in multivariable analysis.\u003c/p\u003e \u003cp\u003eMothers who had not attended formal education and those who attended primary education were at 51% (AOR = 1.51, 95%CI: 1.09, 2.10) and 48% (AOR = 1.48, 95%CI: 1.06, 2.07) increased risk of experiencing a short inter-birth interval when compared to those who attended secondary education level, respectively. The finding is consistent with studies conducted in Tanzania, and sub-Saharan Africa(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). This indicates that maternal education has a great role in birth spacing and preventing maternal health complications associated with a short inter-birth interval(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003ePlace of delivery is another factor that determined the occurrence of short birth intervals in this study area. Mothers who gave birth at home face 83% (AOR = 1.83, 95%CI: 1.42, 1.45) more risk of a short inter-birth interval compared to those delivered in the public sector (hospitals, health centres, health posts, and private clinics). The finding is in line with the reports of many other studies in Africa(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The place of delivery is one of the vital necessities for maternal health. When compared to institutional delivery, home delivery is at great risk for maternal and perinatal mortality. At health institution, different components of maternal health services are provided for the benefit of maternal and child health. In this study, home delivery is at risk for a short inter-birth interval, which may be because of missing an important component of the health service provided in the public sector that may have benefited mothers who gave birth at a health facility(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study has also identified that parity has association with short inter-birth interval and when compared to mother who have two children those mothers who have three or more children were 3.04 (AOR = 3.04, 95%CI: 2.60–3.56) times risk to encounter short inter-birth interval. This finding is in line with similar studied conducted in in Ethiopia and elsewhere in low and middle income countries(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Moreover, occupation is another factor that was associated with a short birth interval, and in this study, mothers who were engaged in sales and services had a 77% (AOR = 1.77, 95% CI: 1.34, 2.33) times higher risk of facing a short inter-birth interval when compared to housewives. The study contradicted a study conducted in sub-Saharan Africa, where actively working women face long birth intervals due to their busy lifestyles (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The difference in this study might be due to variations in the scope of the studies, where Sub-Saharan Africa covered a large scope, which could address variations in occupational composition. And another difference might be due to the fact that those mothers whose occupations in this study were considered sales and service were from rural and semi-urban areas and hence stayed in their homes with their partners, which could result in frequent pregnancies.\u003c/p\u003e \u003cp\u003eThe type of professional category who attended delivery also determines the duration of the spacing birth interval. In contrast, women whose deliveries were attended by others than health professionals (trained and untrained traditional birth attendants, neighbours, and relatives) were found to have a 26% (AOR = 0.74, 95% CI: 0.55, 0.98) lower risk of having a short inter-birth interval when compared to women whose deliveries were attended by health professionals, calling for further investigation.\u003c/p\u003e "},{"header":"Conclusion and recommendation","content":"\u003cp\u003ethe study revealed high proportion short birth interval in the study area. Maternal education, occupation, parity, place delivery, and type of person attended delivery were found to be determinant of short birth interval. \u003cb\u003eRecommendation\u003c/b\u003e: Encouraging women's education and improving community-level over institutional delivery deemed to be important to mitigate the problem.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eAM_HDSS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eArba Minch health and demographic surveillance site\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCDC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCentre for Disease Control\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eCSV\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComma-separated values file\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eEPHA\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eEthiopian public health association\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eIBI\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInter-birth interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSBI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eShort birth interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSIBI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eShort inter birth interval\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSNNPR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSouthern Nation Nationalities and People Regional State\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eThe inauguration of the Arba Minch HDSS was approved by the Arba Minch University ethical review committee, the Ethiopian Public Health Association (EPHA) ethical review board, and the American Center for Disease Control (CDC) in Atlanta. The data analysis for this study was based on the secondary data collected and kept in the AM_DHSS. Therefore, we have not reached each participant directly and have not taken informed consent from each participant; but the informed consent for this study has been waived by the ethic review committee of Arba Minch University Medical and Health Science, Menaye Yihune, \u003cem\u003eChairperson, Institutional Research Ethics Review Board.Email:[email protected],and tele:(+251)911008759\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNA\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The data used for this study is available at Mulugeta Dalbo, the corresponding author, who can be contacted at [email protected] or +251915841693, and Dinkalem Getahun, data analysis, who can be reached at [email protected] or by +251916699901.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e the authors have no any competing interests\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003ethis study has not been funded by any body\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions:\u003c/strong\u003e MD, GA, and DG wrote the proposal, analyzed, and interpreted the data. MK and AB organized and cleaned data, and TA evaluated the whole process and assisted the analysis. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u0026nbsp;\u003c/strong\u003eWe acknowledge the Arb Minch University Health and Demographic Surveillance Site and information technology staff for their cooperation in providing the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrength and limitation:\u003c/strong\u003e The longitudinal design in this study was believed to provide data on the in-depth exploration of factors associated with a short birth interval. However, we failed to have data on variable such as wealth index, contraception, and data on antenatal care (ANC) follow-up was incomplete that could have influenced the birth interval.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMihretie GN, Yenealem Beyene F, Getnet Kassa B, Degu Ayele A, Muche Liyeh T, Minuye Birihane B. Determinants of short birth interval among women in South Gondar, Ethiopia: community-based unmatched case-control study. Arch Public Heal. 2021;79(1):1\u0026ndash;10. \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 [Internet]. 2023;23(1):1\u0026ndash;9. Available from: https://doi.org/10.1186/s12884-023-05403-0\u003c/li\u003e\n\u003cli\u003eDamtie Y, Kefale B, Yalew M, Arefaynie M, Adane B. Short birth spacing and its association with maternal educational status, contraceptive use, and duration of breastfeeding in Ethiopia. A systematic review and metaanalysis. PLoS One [Internet]. 2021;16(2 February):1\u0026ndash;15. Available from: http://dx.doi.org/10.1371/journal.pone.0246348\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. 2019;1\u0026ndash;9. \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 [Internet]. 2019;4\u0026ndash;9. Available from: https://doi.org/10.1186/s13104-019-4110-x\u003c/li\u003e\n\u003cli\u003eBirara S, Id A, 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. 2020;1\u0026ndash;13. Available from: http://dx.doi.org/10.1371/journal.pone.0237602\u003c/li\u003e\n\u003cli\u003eIslam MZ. Negative effects of short birth interval on child mortality in low- and middle-income countries : A systematic review and meta-analysis. 2022;12. \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 [Internet]. 2020;17(Suppl 2):1\u0026ndash;10. Available from: http://dx.doi.org/10.1186/s12978-020-01008-4\u003c/li\u003e\n\u003cli\u003eConde-Agudelo A, Rosas-Berm\u0026uacute;dez A, Kafury-Goeta AC. Effects of birth spacing on maternal health: a systematic review. Vol. 196, American Journal of Obstetrics and Gynecology. 2007. p. 297\u0026ndash;308. \u003c/li\u003e\n\u003cli\u003eSweileh WM. Bibliometric analysis of scientific publications on \u0026ldquo;sustainable development goals\u0026rdquo; with emphasis on \u0026ldquo;good health and well-being\u0026rdquo; goal (2015-2019). Global Health. 2020;16(1):1\u0026ndash;13. \u003c/li\u003e\n\u003cli\u003eGetaneh T, Negesse A, Dessie G, Desta M, Moltot T. Predictors of unmet need for family planning in Ethiopia 2019 : a systematic review and meta analysis. 2020;1\u0026ndash;11. \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. PLoS One. 2022;17(8 August):1\u0026ndash;16. \u003c/li\u003e\n\u003cli\u003eChowdhury S, Singh A, Kasemi N, Chakrabarty M, Singh S. Short birth interval and associated factors in rural India: A cross-sectional study. J Biosoc Sci. 2022;(July). \u003c/li\u003e\n\u003cli\u003eAleni M, Mbalinda SN, Muhindo R. Birth Intervals and Associated Factors among Women Attending Young Child Clinic in Yumbe Hospital, Uganda. Int J Reprod Med. 2020;2020:1\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eKassie SY, Ngusie HS, Demsash AW, Alene TD. Spatial distribution of short birth interval and associated factors among reproductive age women in Ethiopia: spatial and multilevel analysis of 2019 Ethiopian mini demographic and health survey. BMC Pregnancy Childbirth [Internet]. 2023;23(1):275. Available from: http://www.ncbi.nlm.nih.gov/pubmed/37087447%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC10122344\u003c/li\u003e\n\u003cli\u003eExavery A, Mrema S, Shamte A, Bietsch K, Mosha D, Mbaruku G, et al. Levels and correlates of non-adherence to WHO recommended inter-birth intervals in Rufiji, Tanzania. BMC Pregnancy Childbirth. 2012;12:1\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eIslam MZ, Islam MM, Rahman MM, Khan MN. Prevalence and risk factors of short birth interval in Bangladesh: Evidence from the linked data of population and health facility survey. PLOS Glob Public Heal. 2022;2(4):e0000288. \u003c/li\u003e\n\u003cli\u003eYaya S, Uthman OA, Ekholuenetale M, Bishwajit G, Adjiwanou V. Effects of birth spacing on adverse childhood health outcomes: evidence from 34 countries in sub-Saharan Africa. J Matern Neonatal Med. 2020;33(20):3501\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;2016:1\u0026ndash;17. \u003c/li\u003e\n\u003cli\u003eChinkhumba J, Allegri M De, Muula AS, Robberstad B. Maternal and perinatal mortality by place of delivery in sub-Saharan Africa : a meta-analysis of population-based cohort studies. 2014;1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003ePimentel J, Ansari U, Omer K, Gidado Y, Baba MC, Andersson N, et al. Factors associated with short birth interval in low- And middle-income countries: A systematic review. BMC Pregnancy Childbirth. 2020;20(1):0\u0026ndash;17. \u003c/li\u003e\n\u003cli\u003eMarkos D, Id S, Chojenta C, Holliday EG, Loxton D. Individual and community level determinants of short birth interval in Ethiopia : A multilevel analysis. 2020;1\u0026ndash;17. \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":"Short birth interval, Women, reproductive age, Gamo Zone, Ethiopia","lastPublishedDoi":"10.21203/rs.3.rs-3368585/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3368585/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eShort birth interval (SBI) is a leading threat to maternal and child health in Sub-Saharan countries. To tackle the problem, the World Health Organization (WHO) recommends elapses of 33 months between two consecutive live births. However, most women in developing countries do not adhere to these recommendations.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eTherefore, the aim of this study is to determine the magnitude and associated factors of short birth intervals (SBIs) at the Arba Minch Health and Demographic Surveillance System Site (AM_HDSS). It was based on longitudinally collected data from January 2009 to December 2022. The inter-birth interval (IBI) was dichotomized as \"short\" when it is less than 33 months and \"normal\" when it is greater than or equal to 33 months. STATA version 17 was used to enter, clean, and analyze the data. A chi-square test was conducted to test the association between the short birth interval and explanatory variables. A multilevel logistic regression was fitted to determine factors affecting short birth intervals. AOR with a 95% CI was used to identify predictors and a P value less than 0.05 was used to declare the level of significance.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eFrom the 10,128 cohorts of reproductive-age women in this study, 4,340 (43%) experienced a short birth interval. Educational status (no formal education AOR 1.51 (95% CI: 1.09, 2.10), primary education AOR 1.48 (95% CI: 1.06, 2.07), occupation (sales and services) AOR 1.77 (95% CI: 1.34, 2.33), and home delivery AOR 1.83 (95% CI: 1.42, 2.45) and delivery attended by other than health professional and not assisted AOR 0.74 (95% CI: 0.55, 0.98), and parity three and above AOR 3.04 (95% CI: 2.60, 3.56), were significantly associated with short birth intervals.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe prevalence of short birth intervals in this study was 43%, meaning that 4 out of 10 women experience short birth related maternal health complication. Maternal education, occupation, parity, place of birth, and the person who attended delivery were factors significantly associated with a short birth interval in this study.\u003c/p\u003e","manuscriptTitle":"Short Birth Interval and Associated Factors among Women of Reproductive Age in Arba Minch, in Gamo Zone SNNPR Ethiopia: Evidences from Health and Demographic Surveillance Sites","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-10-06 21:04:34","doi":"10.21203/rs.3.rs-3368585/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":"54128483-4df3-47b0-8f3c-9672b95af0c4","owner":[],"postedDate":"October 6th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-12-09T04:53:41+00:00","versionOfRecord":[],"versionCreatedAt":"2023-10-06 21:04:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3368585","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3368585","identity":"rs-3368585","version":["v1"]},"buildId":"oE6Zbj460LM0Up2FdVbMZ","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}