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An exploratory spatial analysis of geographical inequalities of birth intervals among young women in the Democratic Republic of Congo (DRC) : a cross-sectional study

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Chirwa, Tobias, Mantempa, Jocelyn N., Kinziunga, Felly, Kandala, Joseph D. and Kandala, Ngianga-Bakwin (2014) An exploratory spatial analysis of geographical inequalities of birth intervals among young women in the Democratic Republic of Congo (DRC) : a cross-sectional study. BMC Pregnancy and Childbirth, Volume 14 (Number 1). Article number 271. doi:10.1186/1471-2393-14-271

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Official URL: http://dx.doi.org/10.1186/1471-2393-14-271

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Abstract

Background:
The length of time between two successive live births (birth interval), is associated with child survival in the developing world. Short birth intervals (<24 months) contribute to infant and child mortality risks. Contraceptive use contributes to a reduction in short birth intervals, but evidence is lacking in the DRC. We aimed to investigate the proportion of short birth intervals at the provincial level among young women in the DRC.

Methods:
Data from the Demographic and Health Survey undertaken in the DRC in 2007 were analyzed. Logistic regression and Bayesian geo-additive models were used to explain provincial inequalities in short birth intervals among women of reproductive age and young women. Posterior odds ratio (OR) and 95% credible region (CR) were estimated via Markov chain Monte Carlo (MCMC) techniques. Posterior spatial effects and the associated posterior probability maps were produced at the provincial-level to highlight provinces with a significant higher risk of short birth interval.

Results:
The overall proportion of short birth intervals among all women of reproductive age (15–49 years) and young women (15–24 years) were 30.2% and 38.7% respectively. In multivariate Bayesian geo-additive regression analyses, among the whole sample of women, living in rural areas [OR = 1.07, 95% CR: (0.97, 1.17)], exclusive breastfeeding [1.08 (1.00, 1.17)] and women with primary education [1.06 (1.00, 1.16)], were consistently associated with a higher risk of short birth intervals. For the young women, none of the factors considered were associated with the risk of short birth interval except a marginal effect from the lack of education. There was a spatial variation in the proportion of women reporting short birth intervals and among all women of reproductive age across provinces, with Nord-Kivu [1.12 (1.02, 1.24)], Sud Kivu [1.17 (1.05, 1.29)] and Kasai Occidental [1.18 (1.06, 1.32)] reporting a higher risk of short birth intervals. For young women, the higher risk provinces were Nord-Kivu [1.22 (1.00, 1.54)] and Sud Kivu [1.34 (1.14, 1.63)].

Conclusions:
This study suggests distinct geographic patterns in the proportion of short birth intervals among Congolese women, as well as the potential role of demographic and geographic location factors driving the ongoing higher youth fertility, higher childhood and maternal mortality in the DRC.

Item Type: Journal Article
Subjects: H Social Sciences > HB Economic Theory
Divisions: Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET)
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) > Warwick Evidence
Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Birth intervals -- Congo (Democratic Republic), Children -- Mortality -- Congo (Democratic Republic)
Journal or Publication Title: BMC Pregnancy and Childbirth
Publisher: BioMed Central Ltd.
ISSN: 1471-2393
Official Date: 13 August 2014
Dates:
DateEvent
13 August 2014Published
5 August 2014Accepted
13 February 2014Submitted
Volume: Volume 14
Number: Number 1
Article Number: Article number 271
DOI: 10.1186/1471-2393-14-271
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access
Funder: British Council, University of the Witwatersrand. School of Public Health, National Institute for Health Research (Great Britain) (NIHR), University Hospitals Birmingham NHS Foundation Trust

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