Spatial Distribution and Factors Associated with Multiple Sexual Partnerships among Reproductive-Aged Men in Ethiopia: A Spatial and Mixed-Effect Analysis of the 2016 Ethiopian Demographic and Health Survey

Background: Though multiple sexual partnerships (MSPs) increase the risk of acquiring sexually transmitted diseases, such as HIV/AIDS, they are still common in sub-Saharan Africa, particularly in Ethiopia. Therefore, this study aimed to investigate spatial distribution and factors associated with MSPs among reproductive-age men in Ethiopia. Methods: This study was based on Ethiopian Demographic and Health Survey 2016 data. A total weighted sample of 12,688 men aged 15-59 years was included. Spatial analysis was conducted using Arc GIS 10.3 and SaTScan 9.6 statistical software. Mixed-effect logistic regression analysis was used to estimate the association between MSPs and independent variables. Variables with p<0.05 on multivariable mixed-effect analysis were considered significant predictors of MSPs. Results: MSPs had significant variations across the country (global Moran's I=0.109, p<0.001). The primary-cluster spatial window was located in the southwest Oromia and Somalia regions, withrelative risk of 3 and log-likelihood ratio of 24.49 (P<0.001). Age 20-29 years (AOR 2.79, 95% CI 1.83-4.26), 30-39 years (AOR 4.04, 95% CI 2.48-6.58), and 40-59 years (AOR 7.13, 95% CI 4.36-11.68), never married (AOR 1.54, 95% CI 1.13- 2.08), femle-headed household (AOR 1.90, 95% CI 1.48-2.44), Internet usage (AOR 1.62, 95% CI 1.21-2.17), ever chewing khat (AOR 1.72, 95% CI 1.37-2.18), ever drinking alcohol (AOR 2.31, 95% CI 1.74-3.08), and being from regions other than Tigray, Harari, and Dire Dawa were significant factors associated with increased odds of MSPs. Conclusion: MSPs showed significant variations across the country, with the primary-cluster spatial window located in Oromia and Somalia regions. Therefore, special attention should be paid to high-risk regions and groups, particularly those who are unmarried and substance users, to decrease MSPs and their serious consequences, such as HIV and other sexually transmitted infections.