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.