Background
Methods
Study design, population and sample size
Data collection and variables
Outcome variables
Explanatory variables
Data analyses
Descriptive analysis
Measures of association (fixed effects)
Assessing variation between communities using the random effects model
Modelling approaches
Model fitness and precision
Results
Descriptive analysis
Characteristic | Kenya | Zimbabwe |
---|---|---|
N (%) | N (%) | |
Individual level factors | ||
Age categories | ||
< 18 years | 3769 (12.1) | 1603 (17.5) |
18–30 years | 14,921 (48.0) | 4181 (45.6) |
> 30 years | 12,389 (39.9) | 3387 (36.9) |
Marital status | ||
Married/ living with partner | 19,036 (61.3) | 5578 (60.8) |
Divorced/ separated/widowed | 3468 (11.1) | 680 (7.4) |
Never in union | 8575 (27.6) | 2913 (31.8) |
Employment in past 12 months? | ||
Yes | 5628 (38.2) | 3776 (41.2) |
No | 9111 (61.8) | 5395 (58.8) |
Modern contraceptive use | ||
Yes | 11, 025 (35.5) | 3711 (40.5) |
No | 19,047 (61.3) | 5388 (58.8) |
Modern Contraceptive type | ||
None | 19,047 (61.3) | 5388 (58.8) |
Oral | 1439 (4.6) | 2423 (26.4) |
IUD | 614 (2.0) | 15 (0.2) |
Injection | 5516 (17.8) | 594 (6.4) |
Condoms | 797 (2.6) | 358 (3.9) |
Implants | 1969 (6.3) | 226 (2.5) |
Sterilization | 655 (2.1) | 58 (0.6) |
Other | 1, 042 (3.4) | 82 (0.9) |
Mothers education level | ||
None | 4183 (13.5) | 224 (2.4) |
Primary | 15,613 (50.2) | 2650 (28.9) |
Secondary or higher | 11, 283 (36.3) | 6297 (68.7) |
Household wealth index | ||
Low | 13,232 (42.6) | 3292 (35.9) |
Middle | 5946 (19.1) | 1589 (17.3) |
High | 11,901 (38.3) | 4290 (46.8) |
Mothers religion | ||
None | 506 (1.6) | 589 (6.4) |
Roman Catholic | 6229 (20.0) | 764 (8.3) |
Protestant | 20,072 (64.6) | 6757 (73.7) |
Muslim | 4, 161 (13.4) | 40 (0.4) |
Other | 11 (0.4) | 1021 (11.3) |
Number of children | ||
0 | 7834 (25.2) | 2446 (26.7) |
1 | 4426 (14.2) | 1722 (18.8) |
2–3 | 8856 (18.5) | 3042 (33.2) |
> 3 | 9963 (32.1) | 1961 (21.4) |
High risk births | ||
No | 16,742 (72.0) | 3729 (55.5) |
Yes | 6503 (28.0) | 2996 (44.5) |
Under 5 child mortality in the last 5 years | ||
No | 19,307 (83.1) | 5745 (85.4) |
Yes | 3938 (16.9) | 980 (14.6) |
Community level factors | ||
Place of residence | ||
Urban | 11, 614 (37.4) | 3437 (37.5) |
Rural | 19,465 (62.6) | 5734 (62.5) |
Proportion of unemployment* | ||
0% | 29,958 (96.4) | 151 (1.7) |
Up to 10% | 812 (2.6) | 836 (9.1) |
Up to 50% | 309 (1.0) | 7,489,981.7) |
Above 50% | – | 695 (7.6) |
Proportion of illiteracy | ||
0% | 3193 (10.3) | 7972 (57.0) |
Up to 10% | 6251 (20.1) | 1185 (12.9) |
Up to 50% | 16,595 (53.4) | 4 (0.1) |
Above 50% | 5040 (16.2) | – |
Poverty level | ||
0% | 5778 (18.6) | 4290 (46.8) |
Up to 10% | 2282 (7.3) | 4, 875 (53.2) |
Up to 50% | 10,652 (34.3) | 6 (0.1) |
Above 50% | 12,367 (39.8) | – |
Multivariate analysis
Individual level factors
Kenya | Zimbabwe | |||||||
---|---|---|---|---|---|---|---|---|
High-risk birth (n = 6503) | Under-five mortality (n = 3938) | High-risk birth (n = 2996) | Under-five mortality (n = 980) | |||||
Characteristic | Univariate OR (95% CI) p-value | Multivariate aOR (95% CI) p-value | Univariate OR (95% CI) p-value | Multivariate aOR (95% CI) p-value | Univariate OR (95% CI) p-value | Multivariate aOR (95% CI) p-value | Univariate OR (95% CI) p-value | Multivariate aOR (95% CI) p-value |
Individual level factors | ||||||||
Age categories | ||||||||
18–34 years | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
> 34 years | 0.64 (0.55–0.75) < 0.001 | 0.57 (0.48–0.68) < 0.001 | 0.67 (0.56–0.80) < 0.001 | 0.72 (0.59–0.87) 0.001 | 0.74 (0.63–0.86) < 0.001 | 0.85 (0.70–1.04) 0.111 | 0.77 (0.59–1.00) 0.049 | 0.85 (0.61–1.18) 0.336 |
Marital status | ||||||||
Never married | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
Married/ living with partner | 2.72 (1.50–4.90) 0.001 | 2.98 (1.67–5.29) < 0.001 | 1.99 (1.09–3.66) 0.026 | 2.48 (1.37–4.50) 0.003 | 0.33 (0.24–0.45) < 0.001 | 0.29 (0.21–0.40) < 0.001 | 0.31 (0.18–0.53) 0.001 | 0.30 (0.17–0.51) < 0.001 |
Previously married | 1.09 (0.57–2.01) 0.791 | 1.22 (0.67–2.24) 0.510 | 10.6 (0.56–1.99) 0.858 | 1.32 (0.71–2.45) 0.379 | 0.20 (0.15–0.27) < 0.001 | 0.19 (0.14–0.26) < 0.001 | 0.18 (0.11–0.29) < 0.001 | 0.18 (0.11–0.30) < 0.001 |
Education level | ||||||||
None | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
Primary | 5.05 (4.05–6.30) < 0.001 | 4.57 (0.362–5.77) < 0.001 | 5.42 (3.90–7.54) < 0.001 | 4.9 (3.48–6.90) < 0.001 | 2.03 (1.43–2.89) < 0.001 | 1.53 (1.04–2.25) 0.029 | 1.31 (0.72–2.38) 0.373 | 1.14 (0.58–2.23) 0.708 |
Secondary & higher | 6.65 (5.07–8.73) < 0.001 | 5.20 (3.86–7.01) < 0.001 | 5.56 (3.79–8.20) < 0.001 | 4.14 (2.73–6.28) < 0.001 | 2.64 (1.84–3.77) < 0.001 | 1.63 (1.08–2.47) 0.019 | 2.09 (1.18–3.70) 0.012 | 1.45 (0.65–3.21) 0.342 |
Number of children | ||||||||
2–4 | 1.00 | – | – | – | 1.00 | 1.00 | 1.00 | 1.00 |
> 5 | 0.71 (0.58–0.77) < 0.001 | – | – | – | 0.74 (0.62–0.87) < 0.001 | 0.85 (0.68–1.04) 0.119 | 1.06 (0.79–1.43) 0.693 | 1.42 (0.69–2.94) 0.172 |
Employed in the past year | – | – | – | – | 1.20 (1.02–1.42) 0.030 | 1.27 (1.07–1.51) 0.006 | 1.15 (0.82–1.62) 0.422 | 1.32 (0.98–1.78) 0.065 |
Household wealth index | ||||||||
Low | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
Middle | 1.93 (1.65–2.26) < 0.001 | 1.52 (1.28–1.80) < 0.001 | 1.75 (1.41–2.18) < 0.001 | 1.47 (1.18–1.45) 0.001 | 1.14 (0.90–1.46) 0.281 | 1.12 (0.86–1.46) 0.383 | 1.14 (0.81–1.06) 0.452 | 1.19 (0.75–1.90) 0.452 |
High | 2.36 (1.97–2.83) < 0.001 | 1.72 (1.41–2.11) < 0.001 | 1.88 (1.50–2.36) < 0.001 | 1.66 (1.27–2.16) < 0.001 | 1.53 (1.25–1.88) < 0.001 | – | 1.42 (1.06–1.91) 0.019 | 1.44 (0.80–2.59) 0.073 |
Community level factors | ||||||||
Rural residence | 0.81 (0.68–0.98) 0.029 | 0.78 (0.99–1.48) 0.062 | 0.83 (0.67–1.03) 0.085 | 1.11 (0.87–1.41) 0.409 | 0.83 (0.67–1.01) 0.066 | 1.14 (0.84–1.55) 0.396 | 0.82 (0.58–1.31) 0.229 | 0.99 (0.63–.1.58) 0.985 |
High poverty level | 0.64 (0.51–0.81) < 0.001 | – | 0.74 (0.27–0.96) 0.023 | 1.04 (0.74–1.46) 0.821 | 0.44 (0.40–0.48) < 0.001 | 0.65 (0.48–0.89) 0.006 | 1.18 (1.02–1.36) 0.028 | 1.14 (0.62–2.08) 0.678 |
High illiteracy level | 0.56 (0.46–0.69) < 0.001 | 0.78 (0.63–0.96) 0.020 | 0.74 (0.59–0.93) 0.011 | 0.95 (0.75–1.21) 0.694 | 0.64 (0.51–0.74) < 0.001 | 0.81 (0.63–1.02) 0.076 | 056 (0.40–0.80) 0.001 | 0.72 (0.45–1.15) 0.173 |
High unemployment level | – | – | – | – | 0.86 (0.63–1.18) 0.353 | 1.02 (0.74–1.40) 0.914 | 1.39 (0.86–2.25) 0.181 | 1.62 (0.94–2.77) 0.080 |
Household and community level factors
Multi-level analysis
Characteristic | Kenya | Zimbabwe | ||||||
---|---|---|---|---|---|---|---|---|
Empty model | Individual level aOR (95% CI) p-value | Community level aOR (95% CI) p-value | Individual & community level aOR (95% CI) p-value | Empty model | Individual level aOR (95% CI) p-value | Community level aOR (95% CI) p-value | Individual and community level aOR (95% CI) p-value | |
Fixed effects | ||||||||
Birth order continuous | 3.12 (2.39–3.32) < 0.001 | 3.14 (2.95–3.34) < 0.001 | 5.15 (4.66–5.65) < 0.001 | 5.16 (4.69–5.67) < 0.001 | ||||
Mothers age Continuous | 1.03 (1.02–1.04) < 0.001 | 1.02 (1.02–1.04) < 0.001 | 0.93 (0.92–0.94) < 0.001 | 0.93 (0.92–0.94) < 0.001 | ||||
Modern contraceptive use | 1.12 (0.97–1.30) 0.125 | 1.09 (0.94–1.26) 0.272 | 0.80 (0.69–0.93) 0.003 | 0.79 (0.68–0.92) 0.002 | ||||
Married/living with partner | 1.07 (0.68–1.66) 0.774 | 1.05 (0.38–1.64) 0.823 | 1.20 (0.95–1.52) 0.129 | 1.20 (0.95–1.52) 0.130 | ||||
Previously married | 1.26 (0.79–2.00) 0.332 | 1.21 (0.76–1.92) 0.426 | 1.52 (1.22–1.89) < 0.001 | 1.52 (1.22–1.90) < 0.001 | ||||
Primary education | 0.97 (0.79–1.19) 0.773 | 0.77 (0.62–0.96) 0.021 | 0.41 (0.23–0.72) 0.002 | 0.42 (0.24–0.76) 0.004 | ||||
Secondary education and above | 0.77 (0.60–0.99) 0.047 | 0.62 (0.47–0.82) 0.001 | 0.20 (0.11–0.35) < 0.001 | 0.21 (0.12–0.38) < 0.001 | ||||
Employed in last 12 months | 0.96 (0.81–1.14) 0.670 | 0.88 (0.74–1.04) 0.130 | 1.03 (0.90–1.19) 0.650 | 1.03 (0.89–1.19) 0.718 | ||||
Middle wealth index | 1.27 (1.06–1.53) 0.011 | 1.27 (1.06–1.53) 0.011 | 0.97 (0.80–1.15) 0.774 | 0.98 (0.80–1.20) 0.871 | ||||
High wealth index | 1.05 (0.87–1.25) 0.620 | 1.02 (0.83–1.26) 0.818 | 0.98 (0.82–1.16) 0.793 | 0.98 (0.73–1.15) 0.459 | ||||
Place of residence (rural) | 1.45 (1.33–1.58) < 0.001 | 1.04 (0.87–1.24) 0.650 | 2.21 (1.89–2.58) < 0.001 | 0.86 (0.67–1.14) 0.244 | ||||
Illiteracy levels (high) | 1.49 (1.37–1.62) < 0.001 | 1.01 (0.85–1.21) 0.895 | 2.48 (0.35–22.90) 0.327 | 0.28 (0.02–3.98) 0.347 | ||||
Unemployment levels (high) | 1.11 (0.93–1.31) 0.256 | 1.09 (0.76–1.58) 0.629 | 0.77 (0.65–0.91) 0.002 | 0.93 (0.74–1.17) 0.532 | ||||
Poverty levels (high) | 1.82 (1.63–2.03) < 0.001 | 0.84 (0.66–1.05) 0.153 | 1.09 (0.90–6.23) 0.925 | 0.99 (0.11–9.05) 0.991 | ||||
Random effects | ||||||||
Community level Variance | 0.39 (0.03) | 0.28 (0.08) | 0.10 (0.02) | 0.21 (0.07) | 0.26 (0.04) | 0.06 (0.04) | 0.06 (0.02) | 0.04 (0.04) |
ICC | 0.11 | 0.08 | 0.03 | 0.06 | 0.07 | 0.02 | 0.02 | 0.01 |
PCV | REF | 28% | 74% | 46% | REF | 80% | 80% | 85% |
Model fit stats | ||||||||
Log-likelihood | −13,540 | − 3102 | −13,127 | − 3075 | − 5710 | − 2649 | − 5590 | − 2637 |
AIC | 27,083 | 6228 | 26,281 | 6196 | 11,424 | 5321 | 11,210 | 5323 |
Kenya | Zimbabwe | |||||||
---|---|---|---|---|---|---|---|---|
Characteristics | Empty model | Individual level aOR (95% CI) p-value | Community level aOR (95% CI) p-value | Individual & community level aOR (95% CI) p-value | Empty model | Individual level aOR (95% CI) p-value | Community level aOR (95% CI) p-value | Individual and community level aOR (95% CI) p-value |
Fixed effects | ||||||||
Birth order continuous | 1.60 (1.54–1.65) < 0.001 | 1.57 (1.51–1.62) < 0.001 | 1.79 (1.69–1.90) < 0.001 | 1.81 (1.70–1.92) < 0.001 | ||||
Mothers age continuous | 0.98 (0.97–0.99) 0.006 | 0.99 (0.98–0.99) 0.035 | 0.95 (0.94–0.96) < 0.001 | 0.95 (0.94–0.96) < 0.001 | ||||
Modern contraceptive use | 0.80 (0.70–0.90) < 0.001 | 0.79 (0.70–0.89) < 0.001 | 0.71 (0.61–0.84) < 0.001 | 0.71 (0.61–0.83) < 0.001 | ||||
Married/living with partner | 1.46 (0.05–2.04) 0.024 | 1.31 (0.94–1.82) 0.107 | 1.37 (1.06–1.78) 0.018 | 1.42 (1.10–1.84) 0.007 | ||||
Previously married | 2.10 (1.48–3.00) < 0.001 | 1.89 (1.33–2.68) < 0.001 | 1.16 (0.92–1.47) 0.205 | 1.30 (1.03–1.65) 0.029 | ||||
Primary education | 1.56 (1.30–1.87) < 0.001 | 1.30 (1.07–1.58) 0.007 | 0.62 (0.43–0.86) 0.009 | 0.66 (0.46–0.94) 0.021 | ||||
Secondary education and above | 1.17 (0.93–1.47) 0.179 | 0.96 (0.75–1.22) 0.717 | 0.62 (0.43–0.90) 0.012 | 0.65 (0.45–0.93) 0.020 | ||||
Employed in last 12 months | 1.30 (1.12–1.50) 0.100 | 1.25 (1.08–1.45) 0.003 | 1.13 (0.97–1.33) 0.124 | – | ||||
Middle wealth index | 0.98 (0.83–1.16) 0.841 | 0.96 (0.82–1.31) 0.649 | 1.18 (0.95–1.45) 0.131 | 1.04 (0.83–1.28) 0.736 | ||||
High wealth index | 1.01 (0.86–1.47) 0.179 | 1.04 (0.87–1.24) 0.670 | 1.07 (0.87–1.31) 0.521 | 0.76 (0.59–0.98) 0.034 | ||||
Place of residence (rural) | 1.10 (0.99–1.22) 0.08 | 0.78 (0.67–0.91) 0.001 | 1.44 (1.15–1.81) 0.002 | 0.57 (0.43–0.77) < 0.001 | ||||
Illiteracy levels (high) | 1.28 (1.15–1.43) < 0.001 | 1.03 (0.88–1.20) 0.716 | 7.87 (0.93–66.37) 0.058 | 2.46 (0.24–24.78) 0.445 | ||||
Unemployment levels (high) | 1.05 (0.84–1.31) 0.653 | 1.01 (0.73–1.39) 0.958 | 0.86 (.68–1.09) 0.201 | 1.07 (0.84–1.37) 0.576 | ||||
Poverty levels (high) | 1.74 (1.51–1.99) < 0.001 | 1.33 (1.07–1.64) 0.009 | 1.49 (0.20–11.1) 0.695 | 1.95 (0.30–12.94) 0.484 | ||||
Random effects | ||||||||
Community level Variance | 0.41 (0.04) | 0.25 (0.06) | 0.18 (0.03) | 0.11 (0.05) | 0.28 (0.06) | 0.21 (0.06) | 0.11 (0.04) | 0.06 (0.04) |
ICC | 0.11 | 0.07 | 0.05 | 0.03 | 0.08 | 0.06 | 0.03 | 0.02 |
PCV | REF | 39% | 56% | 73% | REF | 25% | 61% | 76% |
Model fit stats | ||||||||
Log-likelihood | −10,404 | − 4064 | −10,196 | − 3996 | − 3091 | − 2411 | − 3037 | − 2359 |
AIC | 20,811 | 8153 | 20,419 | 8038 | 6186 | 4845 | 6104 | 4768 |