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The World Health Organization recommends a minimum of 33 months between two consecutive live births to reduce the risk of adverse maternal and child health outcomes. However, determinants of short birth interval have not been well understood in Ethiopia. The aim of this study was to assess individual- and community-level determinants of short birth interval among women in Ethiopia. A detailed analysis of the 2016 Ethiopian Demographic and Health Survey data was performed. A total of 8,448 women were included in the analysis. A two-level multilevel logistic regression analysis was used to identify associated individual- and community-level factors and estimate between-community variance. At the individual-level, women aged between 20 and 24 years at first marriage (AOR = 1.37; 95% CI: 1.18-1.60), women aged between 25 and 29 years at first marriage (AOR = 1.65; 95% CI: 1.20-2.25), having a husband who attended higher education (AOR = 1.32; 95% CI: 1.01-1.73), being unemployed (AOR = 1.16; 95% CI: 1.03-1.31), having an unemployed husband (AOR = 1.23; 95% CI: 1.04-1.45), being in the poorest wealth quintile (AOR = 1.82; 95% CI: 1.39-2.39), being in the poorer wealth quintile (AOR = 1.58; 95% CI: 1.21-2.06), being in the middle wealth quintile (AOR = 1.61; 95% CI: 1.24-2.10), being in the richer wealth quintile (AOR = 1.54; 95% CI: 1.19-2.00), increased total number of children born before the index child (AOR = 1.07; 95% CI: 1.03-1.10) and death of the preceding child (AOR = 1.97; 95% CI: 1.59-2.45) were associated with increased odds of short birth interval. At the community-level, living in a pastoralist region (AOR = 2.01; 95% CI: 1.68-2.39), being a city dweller (AOR = 1.75; 95% CI: 1.38-2.22), high community-level female illiteracy (AOR = 1.23; 95% CI: 1.05-1.45) and increased distance to health facilities (AOR = 1.32; 95% CI: 1.11-1.56) were associated with higher odds of experiencing short birth interval. Random effects showed significant variation in short birth interval between communities. Determinants of short birth interval are varied and complex. Multifaceted intervention approaches supported by policy initiatives are required to prevent short birth interval.

Birth interval duration is an important and modifiable risk factor for adverse child and maternal health outcomes. Understanding the spatial distribution of short birth interval, an inter-birth interval of less than 33 months, and its predictors are vital to prioritize and facilitate targeted interventions. However, the spatial variation of short birth interval and its underlying factors have not been investigated in Ethiopia. This study aimed to assess the predictors of short birth interval hot spots in Ethiopia. The study used data from the 2016 Ethiopia Demographic and Health Survey and included 8,448 women in the analysis. The spatial variation of short birth interval was first examined using hot spot analysis (Local Getis-Ord Gi* statistic). Ordinary least squares regression was used to identify factors explaining the geographic variation of short birth interval. Geographically weighted regression was used to explore the spatial variability of relationships between short birth interval and selected predictors. Statistically significant hot spots of short birth interval were found in Somali Region, Oromia Region, Southern Nations, Nationalities, and Peoples' Region and some parts of Afar Region. Women with no education or with primary education, having a husband with higher education (above secondary education), and coming from a household with a poorer wealth quintile or middle wealth quintile were predictors of the spatial variation of short birth interval. The predictive strength of these factors varied across the study area. The geographically weighted regression model explained about 64% of the variation in short birth interval occurrence. Residing in a geographic area where a high proportion of women had either no education or only primary education, had a husband with higher education, or were from a household in the poorer or middle wealth quintile increased the risk of experiencing short birth interval. Our detailed maps of short birth interval hot spots and its predictors will assist decision makers in implementing precision public health.

Epidemiologic studies have observed association between short sleep duration and both cardiovascular disease (CVD) and type 2 diabetes, although these results may reflect confounding by pre-existing illness. This study aimed to determine whether short sleep duration predicts future CVD or type 2 diabetes after accounting for baseline health. Baseline data for 241,949 adults were collected through the 45 and Up Study, an Australian prospective cohort study, with health outcomes identified via electronic database linkage. Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals. Compared to 7h sleep, <6h sleep was associated with incident CVD in participants reporting ill-health at baseline (HR=1.38 [95% CI: 1.12-1.70]), but not after excluding those with baseline illness and adjusting for baseline health status (1.03 [0.88-1.21]). In contrast, the risk of incident type 2 diabetes was significantly increased in those with <6h versus 7h sleep, even after excluding those with baseline illness and adjusting for baseline health (HR=1.29 [1.08-1.53], P=0.004). This suggests the association is valid and does not simply reflect confounding or reverse causation. Meta-analysis of ten prospective studies including 447,124 participants also confirmed an association between short sleep and incident diabetes (1.33 [1.20-1.48]). Obtaining less than 6 hours of sleep each night (compared to 7 hours) may increase type 2 diabetes risk by approximately 30%.

Background Short birth interval, defined as a birth-to-birth interval less than 33 months, is associated with adverse maternal and child outcomes. Evidence regarding the association of maternal socioeconomic status and short birth interval is inconclusive. Factors contributing to the socioeconomic inequality of short birth interval have also not been investigated. The current study assessed socioeconomic inequality in short birth interval and its contributing factors in Ethiopia. Methods Data from 8448 women collected in the 2016 Ethiopia Demographic and Health survey were included in the study. Socioeconomic inequality in short birth interval was the outcome variable. Erreygers normalized concentration index (ECI) and concentration curves were used to measure and illustrate socioeconomic-related inequality in short birth interval, respectively. Decomposition analysis was performed to identify factors explaining the socioeconomic-related inequality in short birth interval. Results The Erreygers normalized concentration index for short birth interval was − 0.0478 (SE = 0.0062) and differed significantly from zero ( P  < 0.0001); indicating that short birth interval was more concentrated among the poor. Decomposition analysis indicated that wealth quintiles (74.2%), administrative regions (26.4%), and not listening to the radio (5.6%) were the major contributors to the pro-poor socioeconomic inequalities in short birth interval. Conclusion There was a pro-poor inequality of short birth interval in Ethiopia. Strengthening the implementation of poverty alleviation programs may improve the population’s socioeconomic status and reduce the associated inequality in short birth interval.

Background: This study compared the efficacy of two multi-component m-health interventions with a wait-list control group on body weight (primary outcome), and secondary outcomes of cardiovascular risk factors, lifestyle behaviours, and mental health. Methods: Three-arm randomised controlled trial (Enhanced: physical activity, diet, sleep, Traditional: physical activity, diet, Control) with assessments conducted at baseline, 6 and 12 months. Participants (n = 116) were overweight or obese adults aged 19–65 (M = 44.5 [SD = 10.5]). The 6-month intervention was delivered via a smartphone app providing educational materials, goal-setting, self-monitoring and feedback, and also included one face-to-face dietary consultation, a Fitbit and scales. The trial was prospectively registered and conducted between May 2017 and September 2018. Group differences on primary and secondary outcomes were examined between the Pooled Intervention groups (Pooled Intervention = Enhanced and Traditional) and Control groups, and then between Enhanced and Traditional groups. Results: Nineteen participants (16.4%) formally withdrew from the trial. Compared with the Control group, average body weight of the Pooled Intervention group did not differ at 6 (between-group difference = −0.92, (95% CI −3.33, 1.48)) or 12 months (0.00, (95% CI −2.62, 2.62)). Compared with the Control group, the Pooled Intervention group significantly increased resistance training (OR = 7.83, (95% CI 1.08, 56.63)) and reduced energy intake at 6 months (−1037.03, (−2028.84, −45.22)), and improved insomnia symptoms at 12 months (−2.59, (−4.79, −0.39)). Compared with the Traditional group, the Enhanced group had increased waist circumferences (2.69, (0.20, 5.18)) and sedentary time at 6 months (105.66, (30.83, 180.48)), and improved bed time variability at 12 months (−1.08, (−1.86, −0.29)). No other significant differences were observed between groups. Conclusions: Relative to Controls, the Pooled Intervention groups did not differ on body weight but improved resistance training, and reduced energy intake and insomnia symptom severity. No additional weight loss was apparent when targeting improvements in physical activity, diet and sleep in combination compared with physical activity and diet.

Background Studies assessing the association between short birth interval, a birth-to-birth interval of less than 33 months, and under-five undernutrition have produced inconclusive results. This study aimed to assess the relationship between short birth interval and outcomes of stunting, underweight, and wasting among children aged under-five in Ethiopia, and potential mediation of any associations by maternal anemia and baby birth size. Method Data from the 2016 Ethiopia Demographic and Health Survey (EDHS) was used. Stunting, wasting, and underweight among children aged under-five were outcome variables. Generalized Structural Equation Modeling (GSEM) was used to examine associations between short birth interval and outcomes, and to assess hypothesized mediation by maternal anemia and baby birth size. Results Significant associations between short birth interval and stunting (AOR = 1.49; 95% CI = 1.35, 1.66) and underweight (AOR = 1.43; 95% CI = 1.28, 1.61) were found. There was no observed association between short birth interval and wasting (AOR = 1.05; 95% CI = 0.90, 1.23). Maternal anemia and baby birth size had a significant partial mediation effect on the association between short birth interval and stunting (the coefficient reduced from β  = 0.337, p  < 0.001 to β  = 0.286, p  < 0.001) and underweight (the coefficient reduced from β  = 0.449, p  < 0.001 to β  = 0.338, p  < 0.001). Maternal anemia and baby birth size mediated 4.2% and 4.6% of the total effect of short birth interval on stunting and underweight, respectively. Conclusion Maternal anemia and baby birth size were identified as mediators of the association between short birth interval and under-five undernutrition status. Policies and programs targeting the reduction of under-five undernutrition should integrate strategies to reduce maternal anemia and small baby birth size in addition to short birth interval.

Intimate partner violence (IPV) continues to be a major public health problem globally. Although Ethiopia has a high prevalence of IPV, previous studies in this country have only investigated individual-level determinants of IPV within small geographic areas. The current study aimed to identify the individual-, relationship-, community-, and societal-level determinants of IPV directed against women in Ethiopia since women are predominantly affected. A retrospective analysis of nationally representative data from the 2016 Ethiopian Demographic and Health Survey (EDHS) was conducted. A sample of 3,897 married women of reproductive age (15-49 years) who participated in the domestic violence module of the survey were included in the analysis. Three-level mixed-effects multilevel logistic regression models were used to estimate the individual-, relationship-, community-, and societal-level determinants of IPV. Variability at the community- and societal-level were also assessed. About 1,328 (34.1%) of 3,897 participants reported experiencing IPV (a composite measure of physical, sexual and emotional abuse). In adjusted models, the odds of lifetime IPV experience were higher among women who were older, were married before the age of 18 years, witnessed inter-parental violence during their childhood, had a partner who drank alcohol, and lived in a community with high IPV accepting norms. Alternatively, the odds of IPV were lower among women who had decision-making autonomy in the household, had the same or lower educational attainment as their partner, and lived in a community with low proportions of educated women. These findings reveal that although individual-level factors were significant determinants of IPV, higher level factors, including female education and IPV acceptance in the community, were also important influences on this major public health issue in Ethiopia. These findings suggest combined interventions at different levels may reduce IPV in this country.

ObjectiveTo assess the effect of short birth interval (SBI) on neonatal, infant, and under-five mortality in Ethiopia.DesignA nationally representative cross-sectional survey.SettingThis study used data from the Ethiopia Demographic and Health Survey 2016.ParticipantsA total of 8448 women who had at least two live births during the 5 years preceding the survey were included in the analysis.Outcome measuresNeonatal mortality (death of the child within 28 days of birth), infant mortality (death between birth and 11 months) and under-five mortality (death between birth and 59 months) were the outcome variables.MethodsWeighted logistic regression analysis based on inverse probability of treatment weights was used to estimate exposure effects adjusted for potential confounders.ResultsThe adjusted ORs (AORs) of neonatal mortality were about 85% higher among women with SBI (AOR=1.85, 95% CI=1.19 to 2.89) than those without. The odds of infant mortality were twofold higher (AOR=2.16, 95% CI=1.49 to 3.11) among women with SBI. The odds of under-five child mortality were also about two times (AOR=2.26, 95% CI=1.60 to 3.17) higher among women with SBI.ConclusionSBI has a significant effect on neonatal, infant and under-five mortality in Ethiopia. Interventions targeting SBI are warranted to reduce neonatal, infant and under-five mortality.

Dale Nyholt and colleagues report a genome-wide association meta-analysis of endometriosis in individuals of Japanese and European ancestry. They report a new susceptibility locus at 12q22 and establish an association at 2p25.1. We conducted a genome-wide association meta-analysis of 4,604 endometriosis cases and 9,393 controls of Japanese 1 and European 2 ancestry. We show that rs12700667 on chromosome 7p15.2, previously found to associate with disease in Europeans, replicates in Japanese ( P = 3.6 × 10 −3 ), and we confirm association of rs7521902 at 1p36.12 near WNT4 . In addition, we establish an association of rs13394619 in GREB1 at 2p25.1 with endometriosis and identify a newly associated locus at 12q22 near VEZT (rs10859871). Excluding cases of European ancestry of minimal or unknown severity, we identified additional previously unknown loci at 2p14 (rs4141819), 6p22.3 (rs7739264) and 9p21.3 (rs1537377). All seven SNP effects were replicated in an independent cohort and associated at P <5 × 10 −8 in a combined analysis. Finally, we found a significant overlap in polygenic risk for endometriosis between the genome-wide association cohorts of European and Japanese descent ( P = 8.8 × 10 −11 ), indicating that many weakly associated SNPs represent true endometriosis risk loci and that risk prediction and future targeted disease therapy may be transferred across these populations.

We previously identified a significant bipolar spectrum disorder linkage peak on 15q25-26 using 35 extended families with a broad clinical phenotype, including bipolar disorder (types I and II), recurrent unipolar depression and schizoaffective disorder. However, the specific gene(s) contributing to this signal had not been identified. By a fine mapping association study in an Australian case-control cohort (n = 385), we find that the sialyltransferase 8B (ST8SIA2) gene, coding for an enzyme that glycosylates proteins involved in neuronal plasticity which has previously shown association to both schizophrenia and autism, is associated with increased risk to bipolar spectrum disorder. Nominal single point association was observed with SNPs in ST8SIA2 (rs4586379, P = 0.0043; rs2168351, P = 0.0045), and a specific risk haplotype was identified (frequency: bipolar vs controls = 0.41 vs 0.31; χ(2) = 6.46, P = 0.011, OR = 1.47). Over-representation of the specific risk haplotype was also observed in an Australian schizophrenia case-control cohort (n = 256) (χ(2) = 8.41, P = 0.004, OR = 1.82). Using GWAS data from the NIMH bipolar disorder (n = 2055) and NIMH schizophrenia (n = 2550) cohorts, the equivalent haplotype was significantly over-represented in bipolar disorder (χ(2) = 5.91, P = 0.015, OR = 1.29), with the same direction of effect in schizophrenia, albeit non-significant (χ(2) = 2.3, P = 0.129, OR = 1.09). We demonstrate marked down-regulation of ST8SIA2 gene expression across human brain development and show a significant haplotype×diagnosis effect on ST8SIA2 mRNA levels in adult cortex (ANOVA: F(1,87) = 6.031, P = 0.016). These findings suggest that variation the ST8SIA2 gene is associated with increased risk to mental illness, acting to restrict neuronal plasticity and disrupt early neuronal network formation, rendering the developing and adult brain more vulnerable to secondary genetic or environmental insults.