Two Level Logistic Regression Model of Factors Influencing in Early Childbearing and its Consequences on Nutritional Status of Bangladeshi Mothers: Nationally Representative Data

Khirujjaman Sumon; Md. Abu Sayem; Abu Sayed  Md. Al Mamun; Premananda Bharati; Suman Chakrabarty; Md. Abu Taleb; Md. Sabiruzzaman; Md. Golam Hossain

doi:10.6000/1929-6029.2021.10.09

Authors

Khirujjaman Sumon Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi-6205, Bangladesh
Md. Abu Sayem Former Nutrition Consultant, Unicef Bangladesh, Chapai Nawabganj, Bangladesh
Abu Sayed Md. Al Mamun Former Nutrition Consultant, Unicef Bangladesh, Chapai Nawabganj, Bangladesh
Premananda Bharati Retired Professor & Head, Biological Anthropology Unit, Indian Statistical Institute, 203 B.T. Road, Kolkata-700 108, India
Suman Chakrabarty Department of Anthropology & Coordinator of Department of Food and Nutrition, Mrinalini Datta Mahavidyapith, Birati, Kolkata - 700 051, West Bengal, India
Md. Abu Taleb Senior Technical Advisor -TB, USAID Medicines, Technologies and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Gulshan-1, Dhaka-1212, Bangladesh
Md. Sabiruzzaman Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi-6205, Bangladesh
Md. Golam Hossain Health Research Group, Department of Statistics, University of Rajshahi, Rajshahi-6205, Bangladesh

DOI:

https://doi.org/10.6000/1929-6029.2021.10.09

Keywords:

Early childbearing mothers, Nutritional status, Socio-demographic factors, Two-level logistic regression model, Bangladesh

Abstract

Background: Early marriage and early pregnancy is a social as well as a medical problem in developing countries, which may have an impact on the health and nutritional status of teenage mothers. Therefore, the objective of this study was to determine the influencing factors of early childbearing (ECB) and its consequences on the nutritional status of Bangladeshi mothers.

Methods: Data was extracted from Bangladesh Demographic and Health Survey (BDHS-2014). Women who delivered their first baby before the age of 20 years are considered ECB mothers. Nutritional status was measured by body mass index (BMI). Chi-square test and both univariable and multivariable logistic regressions, and z-proportional test were used in this study.

Results: The prevalence of ECB among currently non-pregnant mothers in Bangladesh was 83%. The logistic regression model provided the following six risk factors of ECB: (i) living location (division) (p<0.01), (ii) respondents’ education (p<0.05), (iii) husbands’ education (p<0.05), (iv) household wealth quintiles (p<0.01), (v) respondents’ age at first marriage (p<0.05), and (vi) number of family members (p<0.05). Still, 17.6% of mothers were undernourished in Bangladesh; among them, 18.5% and 13.4% were ECB and non- ECB mothers respectively. ECB mothers had a greater risk to be undernourished than non-ECB mothers [COR=1.26, 95% CI: 1.11-1.43; p<0.01].

Conclusions: In this study, some modifiable factors were found as predictors of ECB in Bangladesh. ECB mothers were more prone to become under-nourished. These findings can be considered to reduce the number of ECB mothers in Bangladesh consequently improve their nutritional status.

References

Islam A, Islam N, Bharati P, Aik S, Hossain G. Socio-economic and demographic factors influencing nutritional status among early childbearing young mothers in Bangladesh. BMC Women's Health 2016; 16: 58. https://doi.org/10.1186/s12905-016-0338-y DOI: https://doi.org/10.1186/s12905-016-0338-y

Kamal SMM. Adolescent motherhood in Bangladesh: Evidence from 2007 BDHS data. Can Stud in Popul 2012; 39(1-2): 63-82. https://doi.org/10.25336/P6KG7R DOI: https://doi.org/10.25336/P6KG7R

Maitra P, Pal S. Early Childbirth, Health Inputs and Child Mortality: Recent Evidence from Bangladesh. IZA Discussion Paper Series, No. 2841 2007; Bonn: Germany.

NIPORT. National Institute of Population Research and Training, Bangladesh demographic and health survey Dhaka, Mitra & Associates and Macro International, Bangladesh and Maryland, USA, 2009.

Islam MM, Islam M.K, Hasan MS, Hossain MB. Adolescent motherhood in Bangladesh: Trends and determinants. PLoS ONE 2017; 12(11): e0188294. https://doi.org/10.1371/journal.pone.0188294 DOI: https://doi.org/10.1371/journal.pone.0188294

Kominiarek MA, Rajan P. Nutrition Recommendations in Pregnancy and Lactation. Med Clin North Am 2016; 100(6): 1199-1215. https://doi.org/10.1016/j.mcna.2016.06.004 DOI: https://doi.org/10.1016/j.mcna.2016.06.004

Goli S, Rammohan A, Singh D. The Effect of Early Marriages and Early Childbearing on Women’s Nutritional Status in India. Matern Child Health J 2015; 19(8): 1864-80. https://doi.org/10.1007/s10995-015-1700-7 DOI: https://doi.org/10.1007/s10995-015-1700-7

Palacios J, Kennedy HP. Reflections of Native American teen mothers. J Obstet Gynecol Neonatal Nurs 2011; 39(4): 425-34. https://doi.org/10.1111/j.1552-6909.2010.01149.x DOI: https://doi.org/10.1111/j.1552-6909.2010.01149.x

Sayem MA, Matin MN, Islam MS, Matubbar MS, Alam MM. The Morbidity Outcomes of Teenage Pregnancy at rural Netrakona in Bangladesh. Int. J Percept. Public Health 2018; 2(3): 165-177. https://doi.org/10.29251/ijpph.201877 DOI: https://doi.org/10.29251/ijpph.201877

Nour NM. Health Consequences of Child Marriage in Africa. Emerg Infect Dis 2006; 12(11): 1644-9. https://doi.org/10.3201/eid1211.060510 DOI: https://doi.org/10.3201/eid1211.060510

United Nations. We the children: end-decade review of the follow-up to the World Summit for Children. Report of the Secretary-General (A/S-27/3). New York: United Nations; 2001.

UNESCO. Case Studies. Malaysia Demographic Charact eristic of Adolescents. Adolescent Health Reprodu ctive and Sexual Health Bangkok: UNESCO; 2004.

Assini-Meytin LC, Kerry MS, Green M. Long-Term Consequences of Adolescent Parenthood Among African-American Urban Youth: A Propensity Score Matching Approach. J Adolesc Health 2015; 56(5): 529-35. https://doi.org/10.1016/j.jadohealth.2015.01.005 DOI: https://doi.org/10.1016/j.jadohealth.2015.01.005

Scholl TO, Hediger ML, Salmon RW, Belsky DH, Ances IG. Association between Gynecological Age and Preterm Birth. Pediatric and Perinatal Epidemiology 1989; 3: 357-366. https://doi.org/10.1111/j.1365-3016.1989.tb00524.x DOI: https://doi.org/10.1111/j.1365-3016.1989.tb00524.x

Paranjothy S, Broughton H, Adappa R, Fone D. Teenage Pregnancy: Who Suffers? Archives of Disease in Childhood 2008; 94, 239-245. https://doi.org/10.1136/adc.2007.115915 DOI: https://doi.org/10.1136/adc.2007.115915

Bacci A, Manhica GM, Machungo F, Bugalho A, Cuttini M. Outcome of Teenage Pregnancy in Maputo, Mozambique. International Journal of Gynaecology & Obstetrics 1993; 40: 19-23. https://doi.org/10.1016/0020-7292(93)90767-Q DOI: https://doi.org/10.1016/0020-7292(93)90767-Q

Chen X, Wen SW, Fleming N. Teenage pregnancy and adverse birth outcomes: A large population based retrospective cohort study. International Journal of Epidemiology 2007; 36: 368-373. https://doi.org/10.1093/ije/dyl284 DOI: https://doi.org/10.1093/ije/dyl284

Khan MM, Krämer A, Khandoker A, Prűfer-Krämer L, Islam A. Trends in socio-demographic and health-related indicators in Bangladesh 1993-2007: will inequities persist?” Bull World Health Organ 2011; 89: 583-93. https://doi.org/10.2471/BLT.11.087429 DOI: https://doi.org/10.2471/BLT.11.087429

Hossain MG, Bharati P, Aik S, Lestrel PE, Abeer A, Kamarul T. Body mass index of married Bangladeshi women: trends and association with socio-demographic factors. J Biosoc Sci 2012; 44(4): 385-99. https://doi.org/10.1017/S002193201200003X DOI: https://doi.org/10.1017/S002193201200003X

Subramanian SV, Perkins JM, Khan KT. Do burdens of underweight and overweight coexist among lower socioeconomic groups in India? Am J Clin Nutr 2009; 90(2): 369-76. https://doi.org/10.3945/ajcn.2009.27487 DOI: https://doi.org/10.3945/ajcn.2009.27487

Bharati S, Pal M, Bhattacharya BN, Bharati P. Prevalence and causes of chronic energy deficiency and obesity in Indian women. Hum Biol 2007; 79(4): 395-412. https://doi.org/10.1353/hub.2007.0048 DOI: https://doi.org/10.1353/hub.2007.0048

NIPORT. Bangladesh Demographic and Health Survey 2014, National Institute of Population Research and Training, Dhaka; Mitra & Associates and ORC Marco, Bangladesh and Calvertion, MD,USA 2014.

Gnudi S, Sitta E, Lisi L. Relationship of body mass index with main limb fragility fractures in postmenopausal women. J Bone Miner Res 2009; 27(4): 479-84. https://doi.org/10.1007/s00774-009-0056-8 DOI: https://doi.org/10.1007/s00774-009-0056-8

Hossain MG, Mahumud RA, Aik S. Prevalence of child marriage among Bangladeshi women and trend of change over time. J Biosoc Sci 2016; 48 (4): 530-8. https://doi.org/10.1017/S0021932015000279 DOI: https://doi.org/10.1017/S0021932015000279

World Health Organization. Diet, Nutrition and the prevention of Chronic diseases, vol. 916. Geneva: Report of a Joint WHO/FAO Expert Consultation; 2003.

Khan MHR, Shaw JEH. Multilevel logistic regression analysis applied to binary contraceptive prevalence data. J Data Sci 2011; 9: 93-110.

Larsen K, Merlo J. Appropriate assessment of neighborhood effects on individual health: integrating random and fixed effects in multilevel logistic regression. Am J Epidemiol 2005; 161(1): 81-8. https://doi.org/10.1093/aje/kwi017 DOI: https://doi.org/10.1093/aje/kwi017

Chan YH. Biostatistics 202: logistic regression analysis. Singapore Med J 2004; 45(4): 149-153.

World Health Organization. Adolescent pregnancy: WHO factsheet 2014 2017. Available at : http: //www. who.int/mediacentre/ factsheets/ fs364/en/.

Geronimus AT. Teenage childbearing as cultural prism. British Medical Bulletin 2004; 69: 155-166. https://doi.org/10.1093/bmb/ldh019 DOI: https://doi.org/10.1093/bmb/ldh019

Kramer KL, Lancaster JB. Teen motherhood in cross-cultural perspective. Annals of Human Biology 2010; 37(5): 613-628. https://doi.org/10.3109/03014460903563434 DOI: https://doi.org/10.3109/03014460903563434

Hoffman SD. Teen Childbearing and Economics: A Short History of a 25-Year Research Love Affair. Societies 2015; 5: 646-663. https://doi.org/10.3390/soc5030646 DOI: https://doi.org/10.3390/soc5030646

Narita R, Diaz MDM. Teenage motherhood, education, and labor market outcomes of the mother: Evidence from Brazilian data. Economi A 2016; 17: 238-252. https://doi.org/10.1016/j.econ.2016.05.003 DOI: https://doi.org/10.1016/j.econ.2016.05.003

Choe MK, Thapa S, Achmad S. Early marriage and childbearing in Indonesia and Nepal. East-West Center Working Papers, Population Series 2001: 108-115.

Nguyen PH, Sanghvi T, Tran LM, Afsana K, Mahmud Z, Aktar B, et al. The nutrition and health risks faced by pregnant adolescents: Insights from a cross-sectional study in Bangladesh. PLoS ONE 2017; 12(6): e0178878. https://doi.org/10.1371/journal.pone.0178878 DOI: https://doi.org/10.1371/journal.pone.0178878

Najat Y, Alice A, Abbass A, Rizk S. Eating habits and obesity among Lebanese university students. Nutr J 2008; 7: 32. https://doi.org/10.1186/1475-2891-7-32 DOI: https://doi.org/10.1186/1475-2891-7-32

Cilliers J, Senekal M, Kunneke E. The association between the body mass index of First year female university students and their weight-related perceptions and practices, psychological health, physical activity and other physical health indicators. Public HealthNutr 2006; 9(2): 234-43. https://doi.org/10.1079/PHN2005846 DOI: https://doi.org/10.1079/PHN2005846