Factors associated with short birth interval in low- and middle-income countries: a systematic review

Pimentel, Juan; Ansari, Umaira; Omer, Khalid; Gidado, Yagana; Baba, Muhd Chadi; Andersson, Neil; Cockcroft, Anne

doi:10.1186/s12884-020-2852-z

BMC Pregnancy and Childbirth

Table 2 Adjusted OR/RR and confidence interval of factors significantly associated with birth spacing

From: Factors associated with short birth interval in low- and middle-income countries: a systematic review

Category / subcategory	Author / year of publication	Factor	Outcome (length of birth interval in months)	Adjusted effect size	Confidence interval 95%
Age
At first pregnancy (years)	de Jonge 2014	18.3 vs 18.6	< 33	0.95	0.92–0.98
At delivery of the last child (years)	Hailu 2016	17–24 vs > 34	< 36	0.98	0.36–2.66
		25–29 vs > 34		0.9	0.40–2.0
		30–34 vs > 34		2.58	1.08–5.15
	de Jonge 2014	22 vs 22.88	< 33	1.11	1.08–1.15
Of the mother (years)^a	Chirwa 2014	15–19 vs 45–49	< 25	2.51	1.56–4.04
		20–24 vs 45–49		1.79	1.27–2.52
		25–29 vs 45–49		1.3	0.93–1.84
		30–34 vs 45–49		1.25	0.89–1.76
		35–39 vs 45–49		1.05	0.74–1.5
		40–44 vs 45–49		0.99	0.69–1.44
Of the mother (years)^b	Begna 2013	20–24 vs 25–29	< 36	1.36	0.53–3.48
		30–34 vs 25–29		0.68	0.39–1.17
		35–39 vs 25–29		0.31	0.17–0.6
		40–44 vs 25–29		0.22	0.10–0.49
		45–49 vs 25–29		0.39	0.15–1.01
	Muganyizi 2013	30 vs 15–29	< 24 or > 60	1	0.5–1.7
	Exavery 2012	15–19 vs 45–49	< 33	13.65	9.63–19.35
		20–24 vs 45–49		4.3	3.16–5.86
		25–29 vs 45–49		2.4	1.77–3.26
		30–34 vs 45–49		2.07	1.52–2.8
		35–39 vs 45–49		1.64	1.21–2.24
		40–44 vs 45–49		1.31	0.95–1.83
	Ismail 2008	One-year increase in age	< 24	0.86	0.8–0.92
	Ngianga-Bakwin 2005	< 21 vs > 21 and < 35	< 24	0.58	0.55–0.62
		> 35 vs > 21 and < 35		0.67	0.62–0.72
Of the woman’s own mother at first pregnancy (years)	Atkin 1992	11–17 vs > 17	< 24	5.1	Not provided
Breastfeeding
Duration (months)	Hailu 2016	12–23 vs > 23	< 36	60.19	31.61–114.59
	Begna 2013	< 25 vs > 24	< 36	30.81	6.97–136.19
	Ismail 2008	< 12 vs > 11	< 24	6.18	3.59–10.62
Type	Chirwa 2014	Exclusive breastfeeding vs Mixed	< 25	1.08	1–1.17
		Never breastfeeding vs Mixed		1.07	0.99–1.15
	Ngianga-Bakwin 2005	Exclusive breastfeeding vs No breastfeeding	< 24	0.67	0.58–0.78
		Mixed feeding vs No breastfeeding		0.86	0.82–0.90
Contraception
Method	Chirwa 2014	Not using contraception vs Modern method	< 25	0.97	0.85–1.08
	Ngianga-Bakwin 2005	Using injections vs Using other methods	< 24	1.23	1.1–1.38
	Atkin 1992	Postpartum IUD: No/Yes	< 24	26.34	Not provided
Use	Hailu 2016	No vs Yes	< 36	3.01	1.68–5.39
	Muganyizi 2013	No vs Yes	< 24 or > 60	1	0.6–1.8
	Begna 2013	No vs Yes	< 36	5.91	4.02–8.69
	Ismail 2008	No vs Yes	< 24	3.95	2.21–7.05
	Ngianga-Bakwin 2005	No vs Yes	< 24	0.88	0.82–0.93
	Todd 2008	Prior contraceptive use: Yes/No	Longer mean birth interval (2.21 ± 0.79 Vs 2.01 ± 0.87 years)	1.25	1.12–1.40
Education of the mother
	Hailu 2016	No formal education vs Has formal education	< 36	3.4	1.8–6.43
	Chirwa 2014	No education vs Secondary or higher	< 25	1.08	0.97–1.19
		Primary education vs Secondary and higher		1.06	1–1.16
	de Jonge 2014	Secondary or above vs None or primary education	< 33	1.26	1.09–1.45
	Begna 2013	No formal education vs Formal education	< 36	1.89	1.15–3.37
	Muganyizi 2013	Primary vs No education	< 24 or > 60	1	0.2–4.6
		Secondary or above vs No education		1.6	0.3–7.3
	Exavery 2012	Never been to school vs Secondary/higher	< 33	1.27	1.01–1.60
		Primary vs Secondary/higher		1.09	0.87–1.37
	Ngianga-Bakwin 2005	No education vs Secondary education or higher	< 24	1.16	1.06–1.26
		Primary education vs Secondary education or higher		1.11	1.03–1.20
	Sirivong 2003	Literate vs Illiterate	Birth spacing (length not specified)	0.27	0.08–0.84
Marital status
	Muganyizi 2013	Not in marriage vs In marriage	< 24 or > 60	0.9	0.4–2.1
	Exavery 2012	Previously married (widowed or divorced) vs Married	< 33	0.56	0.48–0.66
		Single vs Married		0.64	0.57–0.73
	Atkin 1992	Women who were in a legal or consensual union at 5 months: Yes / No	< 24	6.9	Not provided
Miscellaneous
Intervention	Abdullah 2018	Intervention: integrated post-partum family planning and maternal and newborn health. Control: maternal and newborn health only.	< 24	0.81	0.69–0.95
Occupational group	de Jonge 2014	Tea garden resident: Yes vs No	< 33	1.41	1.07–1.87
Religion		Other vs Muslim		0.68	0.53–0.87
Time period	Ngianga-Bakwin 2005	1998–2001 vs 1991–1993	< 24	0.9	0.84–0.95
Occupation
Husband	Begna 2013	Daily worker vs Animal husbandry	< 36	2.19	1.01–4.79
		Farmers vs Animal husbandry		0.49	0.24–1
		Merchant vs Animal husbandry		0.72	0.36–1.43
		Others vs Animal husbandry		1.17	0.47–5.92
Mother	Hailu 2016	Farmer vs Others	< 36	2.68	0.31–23.23
		Housewife vs Others		1	0.17–5.86
		Merchant vs Others		1.46	0.16–13.24
	Muganyizi 2013	Employment Business vs Salary employment	< 24 or > 60	1.1	0.6–2.1
		Employment Housewife/others vs Salary employment		1.6	0.7–3.4
Parity (children)
	de Jonge 2014	> 3 vs 1	< 33	0.28	0.19–0.41
		2 vs 1		0.53	0.44–0.63
		3 vs 1		0.38	0.29–0.51
	Muganyizi 2013	> 3 vs 2	< 24 or > 60	1.8	0.9–3.7
		3 vs 2		0.9	0.5–1.5
	Begna 2013	2 vs > 4	< 36	3.73	1.50–9.25
		3&4 vs > 4		2.69	1.23–5.92
	Exavery 2012	> 3 vs 2	< 33	2.54	2.25–2.85
		3 vs 2		1.29	1.19–1.40
	Ismail 2008	Parity (no further explanation)	< 24	1.46	1.22–1.76
Previous pregnancy
Outcome	de Jonge 2014	Adverse outcome of any previous pregnancy: Yes / No	< 33	2.1	1.83–2.40
	Muganyizi 2013	Immediate past pregnancy loss: Yes / No	< 24 or > 60	2.5	1.3–4.7
	Exavery 2012	Birth: Multiple vs Singleton	< 33	0.74	0.57–0.96
	Ismail 2008	History of abortion: Yes vs No	< 24	0.09	0.02–0.34
Place of delivery	Hailu 2016	Health institution vs Home	< 36	1.53	0.61–3.8
Place of delivery	Exavery 2012	Elsewhere vs Health facility	< 33	1.85	1.71–2
Planned	Hailu 2016	No vs Yes	< 36	1.44	0.9–2.61
Sex of the previous child
	Hailu 2016	Female vs Male	< 36	6.79	3.65–12.63
	Begna 2013	Female vs Male	< 36	1.72	1.17–2.52
Socioeconomic level
Household assets^c	de Jonge 2014	0–3 vs > 3	< 33	1.42	1.22–1.65
Income	Hailu 2016	Wealth index: Fourth vs Richest	< 36	3.96	1.41–11.13
		Wealth index: Middle vs Richest		3.98	1.39–11.38
		Wealth index: Second vs Richest		6.46	2.26–8.48
		Wealth index: Poorest vs Richest		14.33	4.65–44.15
	Chirwa 2014	Low vs High	< 25	0.98	0.8–1.01
		Middle vs High		0.86	0.77–0.94
	Ngianga-Bakwin 2005	Low vs High	< 24	1.18	1.10–1.26
		Middle vs High		1.25	1.17–1.34
Place of residence	Chirwa 2014	Rural vs Urban	< 25	1.07	0.97–1.13
	Exavery 2012	Rural vs Urban	< 33	1.04	0.95–1.13
	Ngianga-Bakwin 2005	Urban vs Rural	< 24	0.85	0.79–0.9

Significant results are shown in bold
^aWhen the study was conducted
^bDid not specify a definition of age of the mother
^cElectricity, radio/tape recorder, fan, TV, fridge, phone, generator and bicycle

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