Combined maternal health risk from short birth interval and poor adherence to iron and folic acid supplementation in Ethiopia

Abstract

Abstract Despite evidence that short birth interval (SBI) and poor adherence to iron and folic acid (IFA) supplementation are independently associated with adverse pregnancy outcomes, no studies have examined the co-occurrence of these two risk factors. This study investigated the prevalence, spatial variation, and contributing factors for their co-occurrence, referred to as combined maternal health risk (CMHR), in Ethiopia. Data from the 2016 Ethiopian Demographic and Health Survey, including 2345 ever-married women who had two or more live births in the last 5 years and received IFA supplementation, were analyzed. CMHR was defined as the simultaneous occurrence of a SBI (< 33 months) and poor adherence to IFA supplementation (< 90 days of intake during the most recent pregnancy). Spatial analysis and multilevel logistic regression were conducted to identify geographic clustering and associated factors, respectively. The prevalence of CMHR among women was 29.8% (95% CI 28.0–31.7), with significant clustering (Global Moran’s I = 0.1587, p < 0.001). Hot spots were identified in the Somali and parts of the Afar region. Women from households with lower wealth indices and those in the Somali region were at increased risk. Targeted interventions focusing on disadvantaged households and high-risk regions may help address the co-occurrence of SBI and poor adherence to IFA supplementation.