Spatial distribution and associated factors of iron supplementation use among pregnant women in Ethiopia; Ethiopian Demographic and Health Survey 2016 data: spatial and multilevel logistic regression analysis

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Abstract Background Although the World Health Organization recommends for all pregnant women taking iron tablet should be a routine activity, more than 50% of anemia in pregnant women was occurred due to lack of iron supplementation and remains global public health problem and varies with in country. Lack of iron tablet supplementation during pregnancy leads to maternal anemia, which intern increases the risk of maternal death, obstetric complications, preterm birth and low birth weight. Therefore, studying spatial distribution and determinants of iron supplementation use among pregnant women in Ethiopia is vital to design appropriate maternal health services and preventing the determinants earlier. Method: A stratified two-stage cluster sampling technique was used in the Ethiopian Demographic Health Survey in 2016 data. A total of a weighted sample of 7589 pregnant women were included for analysis. Bernoulli model was used to explore the purely spatial clusters of pregnant women using SaTScan version 9.6 and ArcGIS version10.3.A multi-level logistic regression model was used to identify determinant factors of iron supplementation use among pregnant women. Results Spatial distribution of iron supplementation use among pregnant women was non –random in the country with Moran’s index 0.3 (p < 0.001). The primary cluster was in Southwest Somali and Central part of the Oromia region (LLR = 66.69, P < 0.001). ANC visit (AOR = 3.66, 95%CI: 3.21, 417), community education [AOR = 1.31, 95%CI, 1.07, 1.59), media exposure (AOR = 1.33, 95%CI: 1.15, 1.53), distance to health facility (AOR = 1.32, 95%CI: 1.16, 1.50), region and household wealth index were significantly associated with iron supplementation use among pregnant women in Ethiopia. Conclusion Spatial distribution of Iron supplementation use among pregnant women varies across the country. ANC visit, region, household wealth index, media exposure, distance to the health facility, and community education were significant predictors of iron supplementation use among pregnant women. Therefore, it needs great interventions in the hot spot areas and maternal health services should be delivered in all areas of our country.

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