Determinants and spatial distribution of institutional delivery in Ethiopia: evidence from Ethiopian Mini Demographic and Health Surveys 2019

Abstract

Background Over the past few decades, maternal and child mortality had drawn the attention of governments and policymakers. Institutional delivery has been among the implementations needed to reduce maternal and child mortality. The fact that the problem was persisted intensified studies to research for more factors. Thus, the current study was intended for further analyses of EMDHS to identify the magnitude, spatial patterns, and predictors of institutional delivery. Methods A cross-sectional survey data from EMDHS 2019 was analyzed involving 5488 reproductive-age women regarding institutional deliveries. We presented descriptive statistics using mean, standard deviations, and proportions. To check the nature of the distribution of institutional delivery, we applied the global Moran’s I statistics. Getis-Ord Gi statistics was applied to detect spatial locations, and we applied spatial interpolation to predict unknown locations of institutional delivery using the Ordinary Kriging method. Kulldorff’s SatScan was also applied to identify the specific local clustering nature of institutional delivery using the Bernoulli method. We applied multilevel binary logistic regression for the scrutiny of individual and community-level factors. We applied P < 0.25 to include variables in the model and P < 0.05 to declare associations. AOR with 95% CI was used to describe variables. Results The prevalence of institution/facility delivery was 2666.45(48.58%) in the survey. The average number of children was 4.03 ± 2.47, and most women in this survey were in the age range of the 25-29 years (31.84%) and 30–34 years (21.61%). Women who learned primary education (AOR = 1.52; 95% CI 1.20–1.95), secondary education (AOR = 1.77; 95% CI 1.03–3.07), and higher education (AOR = 5.41; 95% 1.91–15.25), while those who can read and write sentences (AOR = 1.94; 95% 1.28–2.94), Rich (AOR = 2.40 95% CI 1.82–3.16), and those followed 1–2 ANC (AOR = 2.08; 95% CI 1.57–2.76), 3 ANCs (AOR = 3.24; 95% CI 2.51–418), and ≥ 4 ANCs (AOR = 4.91; 95% CI 3.93–6.15) had higher odds of delivering at health institutions. Conclusion The institutional delivery was unsatisfactory in Ethiopia, and there were various factors associated differently across the different regions. Pastoralist regions showed high home delivery than institutions which invites further interventions specific to those regions. Factors like age, highest education level achieved, preceding birth interval, literacy status, wealth status, birth order, regions, and rural residences were all affected institutional delivery so that interventions considering awareness, access, and availability of the services are vital.

Southern Ethiopian skilled birth attendant variations and maternal mortality: A multilevel study of a population-based cross-sectional household survey

“…In the Sidama Region, the proportion of deliveries using SBA was 46.7%, with large variations in the districts. This finding is comparable with the findings of other studies in the country [ 16 , 24 , 37 ]. However, it is below the national plan 2020, and the target set for 2025 by Health Sector Transformation Plan II [ 41 ].…”

“…Like other LMICs, Ethiopia has an unacceptably high maternal mortality [ 22 , 23 ]. Despite an increasing trend in the coverage of skilled birth attendance since 2000 [ 24 ], coverage and access to SBA are still low in the country [ 10 , 16 ]. In Ethiopia, there is a dearth of studies conducted to assess the utilisation of skilled birth attendants [ 10 , 25 , 26 ].…”

“…As a result, many births are attended by unskilled birth attendants, like traditional birth attendants, neighbours, mothersin-law, and husbands; some even take place without any assistance [11,12]. Besides poor access and low coverage of SBA in LMICs, the existing health care is not uniformly accessible to all segments of the population [13][14][15][16][17]. Reaching every woman by minimising inequalities in access and improving the coverage of care is one of the strategic objectives to end preventable maternal mortality [18].…”

Southern Ethiopian skilled birth attendant variations and maternal mortality: a multilevel study of a population-based cross-sectional household survey

“…In Sidama Region, the proportion of deliveries using SBA was 46.7%, with large variations in the districts. This finding is comparable with the findings of other studies in the country [16, 24, 34]. However, it is below the national plan for 2020 and the target set for the year 2025 by Health Sector Transformation Plan II [38].…”

“…As a result, many births are attended by unskilled birth attendants, like traditional birth attendants, neighbours, mother-in-law, and husbands; some even take place without any assistance [11,12]. Besides poor access and low coverage of SBA in LMICs, the existing health care is not uniformly accessible to all segments of the population [13][14][15][16][17]. Reaching every woman by minimising inequalities in access and improving the coverage of care is one of the strategic objectives to end preventable maternal mortality [18].…”