Determinants of health facility delivery among reproductive age women in low and middle income countries; evidence from most recent demographic health survey: Application of multilevel binary logistic regression model

Abstract

Background High prevalence of maternal mortality in LMICs has been attributed to the low patronage of antenatal care and health facility delivery. Childbirth at health facilities is one of the safest ways to prevent maternal morbidity and mortality. The study aims to identify the determinants of health facility of delivery among reproductive age women in LMICs. Methods A total weighted sample of 329,721 women who gave birth during the study period was included in the study. Intra-class Correlation Coefficient, Median Odds Ratio, Proportional Change in Variance, AIC, BIC, and deviance were used for model fitness and comparison. Multilevel multivariable logistic regression model was fitted to identify determinants of health facility delivery in LMICs. Adjusted Odds Ratio with its 95% Confidence Interval was used to declare significant determinants of health facility delivery. Results The overall prevalence of health facility delivery was 67.6% and this ranged from 19.6% in Chad to 99.8% in Armenia. In the Multilevel multivariable logistic regression model; age less than 20 (AOR = 0.958; 95%CI: 0.928–0.990), age 20 to 34 (AOR = 0.986; 95%CI: 0.957–1.015), rural women (AOR = 0.668; 95%ci: 0.489–0.913), primary educated women (AOR = 1.545; 95%CI: 1.511–1.583), secondary educated women (AOR = 2.145; 95%CI: 2.087–2.206), higher educated women (AOR = 3.362; 95%CI: 3.167–3.570), middle wealth index (AOR = 1.894; 95%CI: 1.859–1.930), rich wealth index (AOR = 2.012; 95%CI: 1.563–2.123), having media exposure (AOR = 1.311; 95%CI: 1.287–1.336), had 4 and more antenatal care visit (AOR = 2.402; 95%CI: 2.360–2.446), unemployed women (AOR = 0.844; 95%CI: 0.843–0.846), and being Western Africa resident (AOR = 0.103; 95%CI: 0.058–0.181) were significantly associated with health facility delivery. Conclusion Maternal age, place of residence, maternal education level, family size, number of children, wealth index, marital status, and antenatal care visits were significant determinants of health facility delivery in LMICs. These findings will be useful for the government and stakeholders in planning, designing, and implementing appropriate interventions.