Spatial variation of correct knowledge of the ovulatory cycle and its associated factors among reproductive age women in Ethiopia: Geographically weighted regression analysis

Werkneh Melkie Tilahun^1*Lamrot Yohannes²Fantu Mamo Aragaw³Zenebe Abebe⁴Tigabu Kidie Tesfie³

• ¹Department of Public Health, College of Medicine and Health Sciences, Debre Markos University, Debre Markos, Ethiopia., Debre Makos, Ethiopia
• ²Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara Region, Ethiopia
• ³Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara Region, Ethiopia
• ⁴Department of Epidemiology and Biostatistics, School of Public Health, Debre Birhan University, Debre Birhan, Ethiopia

Background: Information about reproductive physiology like the ovulatory cycle helps women to understand their pregnancy risk and appropriately plan their pregnancies, which can reduce unintended pregnancy and the true risk of conception. Thus, this study aimed to explore the spatial variation of correct knowledge of the ovulatory cycle (KOC) across regions of Ethiopia and identify associated factors. Methods: A cross-sectional study design was employed based on the 2016 Ethiopian demographic and health survey. A total of 15,683 weighted samples were included. Geographically weighted regression and ordinary least square analysis were conducted. Models were compared using AICc & adjusted R². A P-value of less than 0.05 was used to declare statistically significant spatial predictors. Results: In our study, only 23.58% [95% CI; 22.92 - 24.25%] of reproductive-age women had correct KOC. Significant hot spots were identified in Addis Ababa, Dire Dawa, and Hareri. Different factors showed a spatially significant effect on correct KOC. Media exposure showed positive effects ranging from 0.34 to 0.57 in the Somali, Amhara, Oromia, Addis Ababa, and SNNPR regions. Rich wealth status showed a positive spatial effect ranging from 0.13 to 0.54 in Benishangul Gumuz, most of Gambela, western Oromia, western Amhara, and Northwestern SNNPR. Proximity to health facilities had a positive effect ranging from 0.15 to 0.227 in Dire Dawa, Harari, eastern Oromia, and eastern and southeastern Somali. In most of the Amhara, Afar, Gambela, western and central Oromia, Benishangul, and Somali regions, education had a significant positive effect range of 0.23 to 0.36. In Dire Dawa, Harari, Somali, the majority of Oromia, and SNNPR regions, high community-level FP messages had a positive effect with a range of 0.28 to 0.39. Conclusion: In this study, the correct KOC among reproductive-aged women was found to be low. Significant spatial variation of the correct KOC among reproductive-age women was observed. Given the importance of formal education, rich household wealth status, media exposure, high community-level FP media exposure, and proximity to a health institution, area-based interventions that can take into account these important factors are needed to promote appropriate KOC.