{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T02:50:01Z","timestamp":1780541401289,"version":"3.54.1"},"reference-count":48,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,8,10]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Advanced maternal age (AMA), defined as giving birth at age 35 or older, is an increasingly significant public health concern worldwide. This study aimed to identify the socio-demographic and economic determinants of giving birth at AMA among women in Ethiopia and to explore the resulting health consequences for both mothers and children.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study is a secondary analysis of data from 5517\u2009women extracted from the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS), a nationally representative cross-sectional survey. The data were cleaned, weighted using STATA V. 17 and analysed using ArcGIS 10.8 to map AMA. Global and local Moran\u2019s Index methods were used to assess clustering and a multilevel binary logistic regression model was fitted to identify predictors of giving birth at AMA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of giving birth at AMA was 12.7%, with a Global Moran\u2019s I of 0.9964, indicating significant clustering across Ethiopian zones (p&lt;0.001). Significant individual-level factors associated with higher odds of AMA included male child sex (Adjusted Odds Ratio (AOR)=1.08, p&lt;0.001), fewer smaller family size (AOR=1.02, p&lt;0.001), Catholic (AOR=2.61, p=0.001) and Protestant religion (AOR=1.16, p&lt;0.001), higher household wealth index (AOR=1.02, p&lt;0.001) and residence in Addis Ababa (AOR=2.55) or Amhara (AOR=2.73, p&lt;0.001). Factors associated with lower odds of AMA included no education (AOR=0.69, p&lt;0.001), primary education (AOR=0.56, p&lt;0.001), contraceptive use (AOR=0.99, p=0.0002), rural residence (AOR=0.85, p&lt;0.001), adherence to postnatal check-ups (AOR=0.9453, p&lt;0.001), media exposure (AOR=0.9344, p&lt;0.001) and Afar region residence (AOR=0.81, p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study found a high prevalence of giving birth at AMA among women with a lifetime birth history, with a spatially non-random distribution, indicated by a positive Moran\u2019s Index. Individual and community-level factors such as having a previous male child, small family size, being Catholic or Protestant and residing in Addis Ababa or the Amhara region were positively associated with AMA. Conversely, factors including lower education level (no or primary education), contraceptive use, media access, rural residence adherence to postnatal check-ups and residing in the Afar region were negatively associated with AMA. All community-level factors were significantly associated with the outcome.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-096767","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T16:30:15Z","timestamp":1756744215000},"page":"e096767","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Multilevel spatial analysis of the determinants of advanced maternal age in Ethiopia: a secondary analysis of the 2019 Ethiopian mini demographic and health survey"],"prefix":"10.1136","volume":"15","author":[{"given":"Wondaya Fenta","family":"Zewdia","sequence":"first","affiliation":[{"name":"Department of Statistics, Bahir Dar University, Bahir Dar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5291-9623","authenticated-orcid":false,"given":"Maru Zewdu","family":"Kassie","sequence":"additional","affiliation":[{"name":"Department of Statistics, Assosa University, Assosa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,1]]},"reference":[{"key":"2025111921300588000_15.9.e096767.1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0186287","article-title":"Advanced maternal age and adverse pregnancy outcomes: A systematic review and meta-analysis","volume":"12","author":"Lean","year":"2017","journal-title":"PLoS One"},{"key":"2025111921300588000_15.9.e096767.2","first-page":"1","article-title":"Births: Final Data for 2019","volume":"70","author":"Martin","year":"2021","journal-title":"Natl Vital Stat Rep"},{"key":"2025111921300588000_15.9.e096767.3","unstructured":"EUROSTAT . 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