Abstract:
Background: Pregnancy loss is the terminated pregnancy before the completed pregnancy time. It
persists as a neglected concern, overlooked in policy agendas and programs and demanding
immediate and focused attention. Despite ongoing efforts to reduce the global burden of pregnancy
loss, significant challenges remain, particularly in East Africa. It is therefore essential to understand
the spatial patterns and factors that influence differences in survival times for pregnancy loss in order
to establish effective policies that can enhance health systems.
Objectives: The study aim was to assess the pooled prevalence, spatial patterns and determinants of
time to pregnancy loss among reproductive-aged women in East Africa using a secondary data
analysis of recent demographic and health survey from 2015 to 2023.
Methods: Data was analyzed using R software version 4.4.1. The pooled prevalence of pregnancy
loss was obtained using a Bayesian random effects model. Spatial data analysis was conducted to
identify geographic variations in pregnancy loss. A spike-and-slab prior was used for variable
selection. A Bayesian spatial survival method via an intrinsic conditional autoregressive approach was
used to determine factors related to time to pregnancy loss among 169 regions of 9 East African
countries. Model comparison was conducted using deviance information criteria, Watanabe-Akaike
information criterion, and log pseudo marginal likelihood, while Cox and Snell residuals were used
for model diagnostics.
Results: The estimated pooled proportion of pregnancy loss among women in East Africa, based on
recent DHS data (2015-2023), was 0.14 [95% CrI, 0.1−0.21]. Spatial analysis revealed a clustered
distribution of pregnancy loss with significant spatial variation. The Bayesian spatial frailty model
identified maternal age, marital status, mothers’ educational level, media exposure, residence,
maternal occupation, parity, and antenatal care visits as significant predictors of survival time. After
adjusting for known subject-specific covariate effects, spatial dependence in the hazard of pregnancy
loss was identified.
Conclusion and Recommendation: Pregnancy loss remains a significant public health challenge in
East Africa, with significant geographic variation. The spatial analysis and determinates of pregnancy
loss can indicate the health policy makers to give special attention to the high-risk regions. Therefore,
international organizations, policymakers, and health ministries in East Africa should prioritize
resources for high-risk areas to improve maternal and child health.
