Prevalence of Hrfb and Related Factors Among Mothers Attending Antenatal Care at Public Health Facilities in Doyogena District, Kembata Tembaro Zone, Southern Ethiopia

doi:10.21203/rs.3.rs-3088931/v1

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Research Article

Prevalence of Hrfb and Related Factors Among Mothers Attending Antenatal Care at Public Health Facilities in Doyogena District, Kembata Tembaro Zone, Southern Ethiopia

https://doi.org/10.21203/rs.3.rs-3088931/v1

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Background

HRFB is a serious public health issue that may influence a country’s economic development and the health status of the mothers in developing countries, like Ethiopia. However, it is not well studied, especially in the study area.

Objective

To assess the prevalence of HRFB and related factors among mothers attending ANCs at public health facilities in Doyogena district, southern Ethiopia, 2022.

Methods

A facility-based cross-sectional study was employed among 276 women who had ANC follow-up by using systematic random sampling techniques in Doyogena district from July1 to September 30, 2022. Data was entered by Epidata V4.6 and analyzed by SPSS V25. P-values < 0.05 were used to declare AOR with 95% CI as significantly associated with HRFB.

Result

Overall, the prevalence of HRFB was 67.39% (95% CI: 63.91, 71.01). Factors like, 41.90% were at single high risks and 25.47% were at multiple high risks. Having no ANC follow-up (AOR: 3.365, 95% CI), ANC visits less than 4 times (AOR: 2.447, 95% CI), being multiparous (AOR: 2.171, 95% CI), and poor knowledge of contraceptives (AOR: 2.89, 95% CI) were significantly associated with maternal HRFB.

Conclusion

HRFB influence country development and maternal health issues. ANC follow-up at least 4 ANC visits, parity, and knowledge of contraception were identified as predictors of HRFB in Doyogena district. Therefore, emphasis should be given to the reduction of the prevalence as well as contributing factors of HRFB.

High risk fertility behavior

Birth order

Antenatal care

Birth interval

Ethiopia

High risk fertility behavior can be defined in terms of women’s age at birth being too early or too late, narrow birth intervals, and higher numbers of live births (1). Globally, the prevalence of HRFB is a critical health issue and an indicator of the country’s economy as well as health conditions, mainly in developing countries. The relevant planning of births using contraceptive methods in countries with high birth rates has the potential to reduce child and maternal mortality. Thus, the planning of births emerges as an important development economic and health condition approach to tackle health challenges, especially in developing regions like South Asia (1, 2).

There is rapid population growth observed, including in sub-Saharan African countries, with an estimated population of 1.2 billion by 2025(3). The quantity of the total fertility rate is reducing globally, but it is declining more gradually in SSA, with a total fertility rate of 4.69 children per woman in 2018, down from 5.37 in 2008. There are tremendous challenges that may be faced globally: deteriorating natural resources, a lack of substructures such as sheltering, schools, health care facilities and increased joblessness. Several sub-Saharan countries lack a population growth policy to manipulate or follow up fertility rates (4).

According to the study conducted in east Africa, like Ethiopia, 76% of the population has been estimated to be affected by HRFB. Rapid population growth in low- and middle-income countries affects critical health conditions such as child and maternal mortality and morbidity. HRFB is seriously evident in developing countries because of the increasing shortage of economic conditions, the insufficiency of basic health services, and teenage marriage. In addition, the interventions have been challenged due to a lack of information about the degree and widespreadness of HRFB in the East Africa region (5).

Most of the East African countries have similar socio-demographic and cultural characteristics related to maternal risks. Still maternal and child mortality implicitly remains high in this area because of risky fertility behaviors, the traditional barriers against contraception use, and inadequate health substructures. Furthermore, HRFBs are common in these countries because of early marriage, rape, and detrimental sexual attitudes in elementary school (6–9). Therefore, the impacts of the problems faced on women’s whole lives hindered the development of the economy and minimized the growth of relevant maternal health service systems.

Worldwide, a significant number of women have been suffering from HRFB, mainly in developing countries, including Ethiopia. Maternal HRFB is one of the indicators of a country's economy as well as its health conditions. Overall, 77% of currently married women have the potential for having a HRFB, with 31% falling into a single high risk category and 45% falling into a multiple high risk category (21). Somehow, in a similar way, the highest prevalence of numbers of births (74.54%) was recoded in Chad, with the lowest in South Africa (32.15%) (21).

HRFB is the major problem that leads to maternal and child mortality rates. Early marriage is one HRFB that manifests as a negative consequence of low education attainment in low- and middle-income countries. When girls’ drop out of school, they are much more likely to marry as children, and they may not yet be ready to be wives and mothers. These negative impacts have large economic losses (future lifetime earnings of the labor force) estimated at $15 trillion to $30 trillion (25).

In India, the study identified that the prevalence of any high risk (31.9%), single HRFB (25.5%), and multiple HRFB (6.4%) was higher in women (25). According to the study revealed in South Africa; about 46% were married before their 18th birthday. The impacts of these may affect psychosocial linkages, health conditions, and every day’s circumstances (24).

Similarly, the study revealed in Ethiopia that the magnitude of HRFB among women was 76.3%. The prevalence of HRFB among urban and rural places of residence for women was 66.51% and 77.59%, respectively (18). This percentage indicates that the accessibility of the basic health services system is limited, and there is obviously a shortage of economic conditions and job opportunities (19).

According to 2016 EDHS reports, Ethiopia is one of the countries recording the highest maternal mortality ratio, with 412 deaths per 100,000 live births every year, and most of the deaths were related to HRFB (10). However, the recent study conducted in April 2019 by the Quality of Care Network goal recorded a maternal mortality ratio of 205 deaths per 100,000 live births every year, and most of the deaths were related to HRFB in Ethiopia (25). The influences of these risks could be a hindrance to economic development as well as the health system in various aspects. Understanding HRFB is well established in developing countries like Ethiopia because of the increasing shortage of economic conditions, the insufficiency of basic health services, and teenage marriage (5).

The sustainable development goal (SDG) is to reduce maternal mortality. Furthermore, the SDG aims to reduce maternal mortality to less than 70 deaths per 100,000 live births by 2030 (11).

Nevertheless, the intervention has been challenged mainly due to a lack of information and awareness about the severity and widespread nature of HRFB (5).In order to reduce maternal HRFB, it is important to have things like maternal education, socioeconomic improvement, and adequate infrastructure in the health system in Low-Middle Income Countries (12–17).

In general, HRFB is one of the current public health issues that strictly relates to every day life. It is not well studied generally at the country level or specifically in this study area. There are some gaps in the planning of births and population growth policies, obviously, to manipulate and follow up on HRFB. The study may fill the information gaps. However, the problem is still high in magnitude and is causing challenges for the attainment of the goals to reduce maternal mortality, which is one of the traits of attaining the Sustainable Development Goal (SDG). Therefore, determining the prevalence of HRFB has a significant advantage in making things easier for the prevention of the risks. The results of this study may be used to develop population growth policies that encourage the reduction of high-risk fertility behaviors in the study area. In other words, it supports policymakers as they put health strategies into practice.

The results of this study are generally expected to assist health program planners in reviewing and implementing current services to provide a mother and child with basic health care.

The results of this study will help to inform the public health authorities in the study area and other interested parties about the need to scale up birth planning in order to reduce maternal HRFB among mothers attending ANC, and they will also encourage them to address the follow-up program by developing strategies. Therefore, this study aimed to assess the prevalence of high risk fertility behavior and related factors among mothers attending ANC clinics at public health facilities in Doyogena district, Kembata Tembaro zone, southern Ethiopia.

Study area and period

Doyogena was located in Kembata Tembaro zone, southern Ethiopia. It is located 258 kilometers southwest of Addis Abeba. According to the 2018/19 admistrative report, there was 112,701 of these 3899 estimated pregnancies and 26868 people in the reproductive age group overall. There is one governmental primary hospital and four government health centers. Additionally, there are 12 pharmacies, 9 primary clinics, 4 medium clinics, and so forth that are all privately owned facilities. The study was conducted from July to September 2022.

Source of population

All childbearing-age women (15–49) who had ANC following up on public health facilities in Doyogena district, 2022

Study population.

The study population was sampled from childbearing-age women coming for ANC services at facilities during the study period and fulfilling the inclusion criteria.

Eligibility Criteria:

Childbearing-age women (15–49) who attended an ANC clinic during the study period were included.

Pregnant mothers who had serious illnesses and were unable to communicate during the study period were excluded..

Sample size determination

The sample size for objective one was determined using Epi info 7 single population proportion formulas.

Since the source /total number of pregnant mothers attending ANC at health facilities in Doyogena district during study period (N = 6076) which are < 10,000,

Whereas,

p = 76.85% (expected frequency) population proportion of HRFB the study was done regional level in SNNPS, Ethiopia (19).
Confidence level is 95% (Zα/2)
d = the marginal error (Confidence limits) of 0.05 with 95% confidence level

The source /total number of pregnant mothers attending ANC in health facilities in Doyogena district during study period (N = 6076) which are < 10,000,
I used correction formula plus 10% of non-respondents that means 26.

n = 262 + 26 = 288.

nf = n/1 + n/N = 288/1 + 288/6076 = 276 Total sample was 276,

The sample size for objective two were be determined also using Epi info software from socio demography characteristics (19)as follows,

Table 1

Sample size determination using HRFB with associated factors mothers attending ANC at public health facilities in Doyogena district, Kembata Tembaro zone, southern Ethiopia.
S.NO	Variables	Outcome in unexposed group (%)	CI (%)	Power (%)	OR	sample	10% non-respondent
1	Maternal education	33.9 66.1	95	80	3.79	96	105
2	Marital status	85 63	95	80	.3	176	194
3	Media exposure	40 60	95	80	3	138	151
4	ANC followers	75 25	95	80	0.4	243	267

Therefore, I was selected the greater sample size of objective one, which is 276.

Sampling technique /procedure

In Doyogena district, there are 4 governmental health facilities, such as Doyogena primary hospital, Doyogena health center, and Amecho Wato health center, selected randomly. Then, eligible individuals (ANC followers who meet the inclusion criteria) were identified and documented to get a complete picture of the study population in all facilities. Then, the total sample size was allocated by probability proportional to size to each health facility based on their proportional allocation.

The total annual number of ANC-follower childbearing mothers in the 3 health facilities was 6076. Hence, the sample size proportion was allocated to each health facility based on the given proportional allocation formula. A systematic random sampling technique was used until the sample size was reached.

Dependent variable

High risk fertility behavior

Independent variables

Socio demographic and socioeconomic factors, Reproductive health characteristics and Socio-cultural factors

Data collection techniques and measurement

Pregnant women were interviewed face-to-face using a semi-structured questionnaire for two diploma, two BSC, and one supervisor (MPH) midwifery interviews. After studying pertinent literature and the guidelines and protocol for ANC follow-up, the questionnaires were created. The questionnaires covered topics like sociodemographic, cultural, and economic traits, reproductive health traits, knowledge of contraceptive methods, and maternal high-risk fertility behavior. Ownership of fixed assets in urban areas was used to calculate the wealth index; ownership of each fixed asset was assigned a value of one, while non-ownership was assigned a value of zero. A factor score was created using principal component analysis and then ranked into five quintiles after checking for assumptions. With a mean of 0 and a standard deviation of 1, the final score was distributed. In terms of quintiles, Q1 and Q2 were regarded as low, Q3 as medium, and Q4 and Q5 as high.

To assess the knowledge of the participants, eight questions related to the types of contraceptive methods were asked. Each question’s response was coded as "1" for "yes" and "0" for "no". Then, a score was computed for each participant, which ranges from 0 to 8. The score was tested for normality and was found to be normally distributed.

Data quality control

Before entering and analyzing the data, the supervisor and investigator double-checked it for accuracy, completeness, clarity, and consistency. In order to ensure consistency, the questionnaire was modified from English, translated into Amharic, and then translated back into Cronbach's alpha, which was used to evaluate the reliability, was > 0.70. The study's objectives, terminology definitions, handling of respondents, how to complete each section of the questionnaire, and interviewing techniques were covered in a two-day training session for the data collectors and supervisor.

After training, 14 pregnant participants—who made up about 5% of the population at the Lesho health center were given a pre-test. The procedures and tools' applicability were investigated. The questionnaire underwent changes based on the results of the pre-test. The principal investigator and supervisor were responsible for close site supervision throughout the duration of data collection. Each day, completed surveys were checked before being handed over to data collectors. The questionnaire contained elements of the interview.

Data processing and analysis

Data were coded, entered, and exported from Epidata Manager 4.6 statistical software to SPSS Windows version 25 for additional analysis. Graphs, charts, tables, and figures were used to summarize and present the data. HRFB was coded as "0" for non-HRFB and "1" for any HRFB. To determine the relationship between each independent variable and the dependent variable, a bivariable logistic regression analysis was conducted. To account for confounding variables, the final multivariate logistic regression analysis model had variables with p-values less than 0.25 from the bivariate logistic regression analysis. Variables with a p-value of less than 0.05 in the multivariate logistic regression model were considered to be significantly associated with HRFB, and adjusted odds ratios with their 95% confidence intervals (CI) were calculated. Multicollinearity testing was computed.

Socio-demographic characteristics of respondents

The final analysis comprised 276 women in total, with a response rate of 100%. The average age of the women was 27, with an interquartile range of 16 to 43 years, and 117 (42.39%) of them were between the ages of 15 and 24. The majority of the women, 247 (89.49%), were married. 110 (39.85%) of the women were employed as housewives, and 93 (33.69%) had completed elementary school (grades 1 through 8). The majority of respondents (268; 97.10%) had media exposure and had access to and used contraceptive methods. The respondents' wealth index was categorized as low 92 (33.33%), medium 92 (33.33%), and high 92 (33.33%).

Table 2
Socio-demographic characteristics of mothers attending antenatal care clinics at public health facilities in Doyogena district, Kembata Tembaro zone, southern Ethiopia 2022(n = 276).
Variable	Variable categories	Frequency	Percent
Age of respondents	15–24	117	42.39
	25–34	112	40.57
	>=35	47	17.02
Marital status	Married	247	89.49
Marital status	Other	29	10.50
Maternal occp	Housewife	110	39.85
	Merchant	44	15. 94
	Maid	21	7.60
	Civil servant	44	15.94
	Daily laborer	48	17.39
	Others	9	3.26
Husband occupation	Merchant	83	30.07
	daily laborer	59	21.37
	civil servant	69	25.00
	Driver	65	23.55
Maternal education	Illiterate	5	1.81
	Can read and write	64	23.18
	Elementary(1–8)	93	33.69
	Secondary(9–12)	85	30.79
	Tertiary(12+)	29	10.50
Husband’s education	Can read and write	43	15.57
	Elementary(1–8)	69	25.00
	Secondary(9–12)	109	39.49
	Tertiary	55	19.92
Maternal religion	Orthodox	75	27.17
	Protestant	111	40.21
	Muslim	51	18.47
	Catholic	39	14.13
Media exposure	Yes	268	97.10
Media exposure	No	8	2.89
Wealth index	Low	92	33.33
	Medium	92	33.33
	High	92	33.33

Reproductive characteristics respondents

More than half of the mothers who participated, 225 (81.52%), were primiparous; of these, more than three-quarters, 219 (79.34%), had antenatal care follow-up for their most recent child, and 215 (77.89%) gave birth in a medical facility.

Table 3
Reproductive health characteristics of mothers attending antenatal care clinics at public health facilities in Doyogena district, Kembata Tembaro zone, southern Ethiopia (n = 276), 2022
Variable	Variable category	Frequency	Percent
Place of last delivery	Home	61	22.10
Place of last delivery	Health facility	215	77.89
ANC	No	57	20.65
ANC	Yes	219	79.34
Frequency of ANC	< than 4 ANC visits	131	47.74
Frequency of ANC	> than 4 ANC visits	145	52.53
Parity	No > 3 children	51	18.47
Parity	Yes < 3 children	225	81.52
Use contraceptive	No	95	34.42
Use contraceptive	Yes	181	65.57
Last pregnancy type	Planned and wanted	100	39.23
	Unplanned and wanted	122	42.20
	Unplanned and unwanted	45	16.30
Women autonomy
Decision on maternal health	Me	56	20.28
	Husband	119	43.11
	Both	101	36.59
Decision on purchasing	Me	56	20.28
	Husband	119	43.11
	Both	101	36.59
Decision on Visiting family	Me	55	19.92
	Husband	112	40.57
	Both	109	39.49
Decision on child health	Me	58	21.01
	Husband	112	40.57
	Both	106	38.40

Knowledge of contraceptive of respondents

There were 8 questions about various contraceptive methods, including IUCD, implant, calendar method, emergency pills, injectable, oral contraceptive, and contraceptive interrupt. The study found that 210 (76.08%) of the questions about contraceptive methods got more than four correct answers (more than 75%), indicating that the respondents knew a lot about contraception, while 66 (23.91%) of the questions got less than four correct answers, indicating that the respondents knew very little. Over 76% of respondents reported being knowledgeable.

The prevalence of HRFB

This study’s findings revealed that 186 (67.4%) of women had high-risk fertility behaviors, of which 117 (42.39%) were in the single-risk category and about 69 (25%) were categorized in multiple high-risk groups. The majority of women had a prevalence of HRFB in this study area

The prevalence of HRFB among respondents was 90; 90 were no HRFB, 117 were single HRFB, and 69 were multiple HRFB.

Factors associated with high‑risk fertility behavior

Bivariate analysis

Bivariate analysis was done with a crude odd ratio (COR), and all independent variables that had an association with HRFB with a P-value less than 0.25 were moved to multivariate analysis.The eligible variables were husband occupation (daily laborer), maternal education, illiteracy, and husband dominance in decision-making, ANC follow-up, frequency of ANC contact times, parity, and knowledge about contraceptives.

Table 4

Bivariate analysis for prevalence of high-risk fertility behavior and associated factors among mothers attending antenatal care clinics at public health facilities in Doyogena district, Kembata Tembaro zone, southern Ethiopia, 2022 (n = 276
Variables	Variables category	HRFB		COR(95% CI)	p-value
		Yes	No
Husband occupation	Farmer	20	5	0.3690(.206-3.831)	0.874
	Merchant	42	13	0.4569(.206-2.504)	0.603
	Maid	31	21	Ref	Ref
	Daily laborer	55	23	0.617(.097-1.108)	0.073**
	Civil servant	30	14	0.688(.162-1.743)	0.297
	Others	18	4	0.328(.136-1.671	0.247**
Maternal education	illiterate	21	2	3.341(.622-7.951)	0.160**
	can read & write	43	16	0.552(.306-2.386)	0.765
	elem(1–8)	61	22		0.802
	2ndary	49	33	Ref	Ref
	above12grade	22	7	0.472(.181-1.232)	0.125**
Husband education	Illiterate	24	14	0.349(.245-1.392	0.225**
	Can read	28	9	1.575(.403-2.715)	0.105**
	Elem.(1–8)	49	10	Ref	Ref
	2nd (9–12)	48	31	3.16(.688-4.044)	0.257
	Above 12++	47	16	599(.225-1.088).	0.083**
Husband dominance on decision making	No	85	41	Ref	Ref
Husband dominance on decision making	Yes	111	39	0.728(.437-1.277)	0.234**
ANC follow up	Yes	169	50	Ref	Ref
ANC follow up	No	27	30	3.755(2.044–6.899)	0.000***
Frequency of ANC contact times	>than4 ANC contact times	115	30	Ref	Ref
Frequency of ANC contact times	<than ANC contact time	81	50	2.366(1.387–4.038)	0.006***
Parity	Primiparous	168	58	Ref	Ref
Parity	Multiparous	28	22	2.275(1.208–4.287)	0.011***
Knowledge about contraceptive methods	Poor knowledge	57	9	3.235(1.515,6.910	0.002***
Knowledge about contraceptive methods	Good knowledge	139	71	Ref	Ref

NB:-** indicates p-value < = 0.25, ***<=0.05, and Ref. means reference.

Multivariate analysis

The study revealed that ANC followers, the visiting time of ANC, parity (children more than or less than three in number in one family), and knowledge about contraceptive methods had a statistically significant association with HRFB.

According to the study's findings, women who did not receive ANC follow-up were three times more likely to experience maternal HRFB than women who did (AOR: 3.365, 95% CI: 1.783–6.353), p-value = 0.000. Regarding ANC, the women may gain essential and relevant knowledge to reduce maternal and infant complications, inadequate nutrition styles, and hygienic care.

Maternal HRFB is determined by ANC clinic visitation times. Less than 4 ANC visits meant that a woman was twice as likely to have high risk (AOR: 2.447 (95% CI: 1.381, 4.321)) and more frequently visited than women who had more than 4 ANC visits. In terms of parity, multiparous people who had more than three children had a 2-fold higher risk of having high maternal risks than primiparous people (AOR: 2.171 (95% CI: 1.111, 4.232)) (those who had less than three children). When compared to women who had good knowledge of contraceptive use, those with poor knowledge were 2.89 times more likely to experience maternal HRFB (AOR: 2.89 (95% CI: 1.029, 5.115)) with a p-value of 0.042.

Table 5

Multivariate analysis for prevalence of high-risk fertility behavior and associated factors among mothers attending antenatal care clinics of public health facilities in Doyogena district, Kembata Tembaro zone, southern Ethiopia, 2022 (n = 276)
Variable	Variable category	HRFB		AOR( 95% CI)	p-value
Variable	Variable category	Yes	No	AOR( 95% CI)	p-value
ANC follow up	Yes	169	50	Ref	Ref
ANC follow up	No	27	30	3.365(1.783–6.353)	0.000**
Frequency of ANC follow time	>than4 ANC contact times	115	30	Ref	Ref
Frequency of ANC follow time	<than ANC contact time	81	50	2.447 (1.386–4.321)	0.002**
Parity	Primiparous	22	28	Ref	Ref
Parity	Multiparous	58	168	2.171 (1.111–4.246)	0.023*
Knowledge about contraceptive methods	Poor knowledge	57	9	2.89 (1.515–6.910)	0.041*
Knowledge about contraceptive methods	Good knowledge.	139	71	Ref	Ref
NB:* indicates p-value < 0.05, ** indicates p-value < 0.01

The findings showed that 67.39% of women had HRFB, of which 45.6% were in a single high-risk category and 25% had multiple high-risk categories. This high prevalence rate demonstrates that HRFB is all too common in Doyogena, potentially endangering the health of the country’s women. The study goal was to assess the prevalence of HRFB and associated factors among mothers attending ANC in public health facilities in Doyogena district, Kembata Tembaro zone, Southern Ethiopia, in 2022.

The results showed that there was a 67.39% prevalence of HRFB in the study area. Our study's results were comparable to those from Addis Abeba and Bangladesh (64% and 67.7%, respectively). In contrast to other studies that focused on DHS, the majority of the current study's primary data source was face-to-face interviews conducted in a single town. When compared to Bangladesh, 67.7% of women had HRFB, of which 45.6% were at single-high risk and 22.1% were at multiple-high risk (20).In contrast to studies done in Ethiopia, which found that only 76% of women in childbearing age experienced high-risk fertility issues, Ethiopia's Somali and Afar regions both experienced HRFB, at 86.18% and 86.3%, respectively (12).This resulted from changes in sociodemographic traits, communities' increased desire for children, the low prevalence of contraceptive use, as well as variations in study design and data collection methods.

According to the research, Doyogena district (32.6%) had a prevalence of HRFB. This was based on the number of births or the order of births. The prevalence reported (32.15%) in this study was consistent with that of other studies done in South Africa (22).Similar findings were made. However, it is possible to pinpoint the cause of the disparity in the socio-demographic makeup of the two nations. In comparison to the way of life in South Africa, Hossana had a low standard of living.

In the current study, Doyogena district had a 46% prevalence of HRFB due to short birth intervals. The study's findings were consistent with those of other studies conducted in Malawi, Zimbabwe, and Chad (30.78%), 11.8%, and 11.57%), respectively. The result was higher than that of the mentioned countries, though. This is a result of lower contraceptive use and higher intended fertility in communities than at the national level. The multicounty study that was conducted for the country used DHS data collection methods (23).

The current study discovered that 25.4% of mothers had been pregnant for over 34 years. When compared to other Namibian studies, this one was similar to them by 29.35%. However, due to similar socio-demographic, cultural, and infrastructure characteristics, there was a slight overlap in the risks between the two countries (22).

The following reproductive characteristics were statistically significant associated factors in the prevalence of HRFB: lack of ANC follow-up, frequency of ANC visitation (less than 4 ANC visit times), multiparty, and inadequate knowledge of contraceptive methods.

In the current study, mothers who did not go to ANC had a higher risk of having HRFB than mothers who did. An Ethiopian population-based cross-sectional study found higher results than the previous study. However, the result is better than the outcome of the earlier study (19).The focus on in-person interviews in local public health facilities and the use of different data collection methods than for secondary data could be one explanation. The majority of respondents had experience going to the ANC. They required adequate and pertinent maternal health services.

The results of the current study showed that mothers who had fewer than four ANC visits were more likely to have maternal HRFB than mothers who had more ANC visits than that. This study is in the tradition of others that used the mini EDHS 2019 secondary dataset and had fewer than 4 ANC visits during the previous pregnancy (1.53 times) (11).

In contrast, the outcome of those dataset studies was positive. The ANC visiting times schedule in urban health facilities may not have given the reproductive age groups in their catchment area a thorough understanding of the maternal health service system in order to reduce HRFB. The tools used to collect the data varied from those in the earlier study. The respondents did not have enough experience with frequent visits. Women who frequently visit may be interested in learning about nutrition use, preventing pregnancy complications, and pre- and post-natal preparations through this health education.

In comparison to primiparous women, multiparous women were more likely to have high maternal risks. The study was consistent with other research that was done in SSA countries and had higher odds than primiparous (22).

When compared to this study's findings, Senegal (1%), El Salvador (59%), SSA (59%), and Addis Abeba (79%) (12). This discrepancy resulted from the country's birth control policy and maternal health provisions being inapplicable. The traditional view that having a large family is something to be proud of could be the explanation (12). There was no cap on the number of children per family. Both socioeconomic trends and maternal health conditions had an impact on the average number of children per family.

Women who were less knowledgeable about contraceptive methods were more likely to have HRFB than women who were more knowledgeable. When we compared the study carried out in Bangladesh, where HRFB was found to be more common (20). The current study, in contrast, only used data from one Ethiopian town. The entire nation of Bangladesh was the subject of the study. Compared to Bangladesh, the current finding is higher. Different data collection methods and study designs could be the cause. Understanding how to use a contraceptive should help prevent unintended pregnancies and space out births.

In order to reach the target issues, which are conditions affecting maternal health, the current study was limited. Women who had poor knowledge of contraceptive methods were more likely to have these conditions. However, the intervention has encountered resistance primarily because people are unaware of the severity and scope of HRFB (5). To reduce maternal HRFB and increase maternal education, it is essential to improve the socioeconomic situation and the structure of the health system in low-middle income countries (12–17). RFB believed that those women knew a lot.

Limitation of the study

The study was conducted in single city health institutions, may affect the generalizability of the findings. Lack of similar studies in the town level to compare and contrast results. This cross sectional study has possible limitations that may arise from pregnant women’s readiness and ability to provide every information about themselves and their family correctly and recall bias may be introduced during data collection.

This study was analyzed by descriptive study for the purpose of assessment of prevalence of HRFB and determined to identify maternal health critical issues. Having ANC follows- up, frequency (at least 4 ANC visiting times), parity and knowledge of contraception were indicated as positive predictors of high-risk fertility behaviors. Therefore, the public health policy makers should emphasis and design appropriate interventions to reduce the prevalence of HRFB as well as its associated factors.

ANC Antenatal Care

AOR Adjusted Odd Ratio

COR Crude Odd Ratio

DHS Demographic Health Survey

EDHS Ethiopian Demographical Health Survey

HRFB High Risk Fertility Behaviors

PCA Principal Component of Analysis

SPSS Statistical Package for the Social Sciences

VIF Variance Inflation Factors

ACKNOWLEDGMENTS

I would like to express my gratitude to the Kembata Tembaro zone, Doyogena district and respective health facilities for their assistance in providing information. Then, I'd like to express my heartfelt appreciation to respondents, for giving me relevant responses. Finally I would like to thank different individuals who guide me on research writing as well as for their invaluable support and sharing their knowledge and experience.

Ethical Approval

Prior to data collection, ethical clearance was obtained from the Wachemo University College of Medicine and Health Sciences ethical review committee. A written permission letter was also produced from Kembata Tembaro Zone Health Department and sent to Doyogena Woreda Health Office. Each respondent was told verbally of the research's goal, scope, and anticipated results during the data collection process, and their informed consent was obtained. Everyone has the right to opt out of the study if they choose not to participate

Consent for publication

Not applicable.

Conflict of interests

The authors agreed that they have no challenging interests.

Authors’ contributions

I daily supervised the data collection, coded the data, carried out the analysis and wrote the first draft of the article. Other authors contributed the study design and analysis, comments throughout the entire process. Finally they approved the final version of the manuscript prior to submission.

Funding

No funding was supported from others for this research.

Data and materials availability

The datasets generated and analyzed in this study available from the corresponding author on reasonable request.

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No competing interests reported.

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Prevalence of Hrfb and Related Factors Among Mothers Attending Antenatal Care at Public Health Facilities in Doyogena District, Kembata Tembaro Zone, Southern Ethiopia

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Abstract

Background

Objective

Methods

Result

Conclusion

Figures

INTRODUCTION

METHODS AND MATERIALS

Study area and period

Source of population

Eligibility Criteria:

Sample size determination

Sampling technique /procedure

Dependent variable

Independent variables

Data collection techniques and measurement

Data quality control

Data processing and analysis

RESULTS

Socio-demographic characteristics of respondents

Reproductive characteristics respondents

Knowledge of contraceptive of respondents

The prevalence of HRFB

Factors associated with high‑risk fertility behavior

Bivariate analysis

Multivariate analysis

DISCUSSION

Conclusion

Abbreviations

Declarations

References

Additional Declarations

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