AUTHOR=Belay Daniel Gashaneh , Asratie Melaku Hunie 

TITLE=Time to Resumption of Menses, Spatial Distribution, and Predictors Among Post-partum Period Women in Ethiopia, Evidence From Ethiopian Demographic and Health Survey 2016 Data: Gompertz Inverse Gaussian Shared Frailty Model

JOURNAL=Frontiers in Reproductive Health

VOLUME=Volume 4 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/reproductive-health/articles/10.3389/frph.2022.862693

DOI=10.3389/frph.2022.862693

ISSN=2673-3153

ABSTRACT=Background: The timing of resumption of post-partum menses is important for a woman who intends to avoid subsequent unintended pregnancy, and it has key implications on maternal, neonatal, and child health outcomes. Despite this, information is scant about time to resumption of post-partum menses, and predictors in Ethiopia. Therefore, this study aimed to determine the time it takes to start menses and spatial distribution among postpartum period women in Ethiopia and identified its predictors.
Methods: A secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey. A total weighted sample of 6489 women was included, and STATA 14 was used to analyze the data. The shared frailty model, proportional hazard assumption, the Schenefold residual test, Log-Log plot, Kaplan-Meier, and predicted survival plot were applied. Akakie Information Criteria (AIC), Cox-Snell residual test, and deviance were used. Based on these, the Gompertz inverse Gaussian shared frailty model was the best-fitted model for this data. Finally, the Adjusted Hazard Ratio (AHR) with a 95% confidence interval (CI), and a p-value of <0.05 were reported to identify significant predictors.
Results: The median survival time to post-partum menses resumption was 14.6 months. In this study, 51.90% [95%CI: 50.03, 53.76] of post-partum period women had resumed, and the risk of menses resumption was 1.17 times [AHR: 1.17; 95% CI: 1.03-1.33] higher among urban resident, 1.14 times [AHR: 1.14; 95% CI: 1.0-1.24] women's attended formal education and 1.63 times [AHR: 1.63; 95% CI: 1.4-1.7] higher among women's use hormonal contraceptives. But, the risk of post-partum menses resumption was lower among 7-24 months breastfeeding women by 36% [AHR: 0.64; 95% CI: 0.5-0.76], women with child alive by 26% [AHR: 0.74; 95% CI: 0.6-0.85], and multiparous women by 27% [AHR: 0.73; 95% CI: 0.6-0.80].
Conclusions: 	Half of the participants had resumed menses with the median survival timing of resumption fourteen and half months. Women residing in urban areas, who attended formal education, and using hormonal contraceptives shorten the time to resumption of post-partum menses, whereas a woman with an alive child, breastfeeding practice, and multiple parity lengthen the time to resumption of post-partum menses.