Births and deaths in Sidama in southern Ethiopia: findings from the 2018 Dale-Wonsho Health and Demographic Surveillance System (HDSS)

ABSTRACT

Background

Sidama is one of the most densely populated areas in Ethiopia. Information about the demographic characteristics is scarce, and most studies were census based on interviews. Earlier population studies from Ethiopia did not sufficiently address the validity of measuring births, deaths, and age-composition.

Objective

To investigate the population characteristics in Sidama with an emphasis on fertility estimates, age, and death reporting.

Methods

This is a mixed-method cross-sectional study, conducted in Sidama in southern Ethiopia, using baseline data of newly established Dale-Wonsho Health and Demographic Surveillance System site in 2018. We used quantitative data of 5179 randomly selected households having 25,144 individuals. We collected information on deaths in the same study period and population from the traditional burial associations (Iddir). Qualitative data were collected using focus group discussions, and in-depth interviews. Life tables, age reliability indices and logistic regression were used to analyse the data.

Results

The total fertility rate was 2.9 children/woman, the crude birth rate was 22.8/1000 population and the crude death rate was 5.2/1000 population. The dependency ratio was 66/100 working-age population. Urban residents had higher birth rates (OR = 1.4 (95% CL: 1.05–1.78), and women with basic education had lower birth rates (OR = 0.6 (95% CL: 0.46–0.78) compared to those with no education. The age accuracy indices showed unreliable age reporting. The number of deaths increased from 29 to 132 when death reports from the Iddirs were included. There was under-reporting of neonatal and deaths of young children. Substituting national and regional mortality estimates, the life expectancy declined to an average of 53 years (range 48–58 years).

Conclusion

The fertility rate in Sidama is lower than previously reported and is affected by age, residence and education. As we have identified important measurement and reporting errors, future demographic surveillance sites should consider these limitations.

KEYWORDS:

• Demographic transition
• fertility
• age reliability index
• qualitative
• southern Ethiopia

Responsible Editor Stig Wall, Umeå University, Sweden

Responsible Editor Stig Wall, Umeå University, Sweden

Acknowledgments

We acknowledge the Norwegian Programme for Capacity Development in Higher Education and Research for Development (NORHED) for funding this study. We also thank the D-W HDSS staffs for their willingness to access the data, especially Dr, Andargachew Kassa and Mr, Alemu Tamiso. We are grateful to Dr, Eskindir Loha and Mr Befikadu Tariku for their contribution during exporting and analysing the data.

Author contributions

HA conceptualized the idea, designed the study, acquired and analysed the data, wrote the protocol and drafted the manuscript.

BL conceptualized the idea, guided the study design, the proposal writing, helped to analyse the data, drafted and validated the manuscript.

MD helped in conceptualizing the idea, the proposal writing, provided constructive comment in drafting the manuscript.

All of the authors read and approved the submitted version of the manuscript.

Disclosure statement

The views expressed in the submitted article are the authors and not an official position of the institution or funder.

Ethics and consent

The ethical clearance was obtained from the Institutional Review Board at the College of Medicine and Health Sciences of Hawassa University (Reference number IRB/022/10), and from the Regional Ethics Committee for Medical and Health Research in Norway (2018/67/REKvest). Permission was obtained from Hawassa University Research and Community Service Directorate to access the data from D-W HDSS database. For qualitative study a formal letter was written to district health offices from Sidama zone health office. The participants were asked for their permission to participate with a written consent and given a chance to withdraw from the interview at any time. The data was kept in a secure place to maintain the confidentiality.

Paper context

There is neither any demographic study done in Sidama recently, nor the quality of the data is assessed for its validity. The lower fertility rate is one sign of demographic transition that gives opportunity to utilize the work force created for development. However, the personal reporting of vital events has flaws that can be corrected by establishing a strong civil registration system supplemented by quality health and demographic surveillance data.

Data availability statement

The data that support the findings of this study are openly available in Zenedo at https://zenodo.org/record/3888986#.X1-C3WgzbI, md5:32011f7c9ada1731854a964236e1beff [md5:79554c05f51dbe0177225b6794306cc3].

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

The research has been funded by the Norwegian Programme for Capacity Development in Higher Education and Research for Development (NORHED) through the SENUPH (Southern Ethiopia Network of University in Public Health) project (ETH-13/0025). The Funder has no role in the design, data collection, analysis, interpretation and writing of the manuscript.