Multilevel analysis of factors associated with utilization of institutional delivery in Ethiopia

Abstract

Background: The maternal mortality rate in poor nations remains unacceptably high. The purpose of this study was to identify factors associated with institutional delivery usage. Methods: The data came from the Ethiopian mini demographic and health survey, which was conducted in 2019. This study comprised 3978 women of reproductive age who had given birth within the previous 5 years. To uncover significantly linked parameters associated with institutional delivery, we used a multilevel logistic regression model. Statistical significance was declared at p < 0.05, and we assessed the strength of association using adjusted odds ratios with 95% confidence intervals. Results: More than half of the women (53.67%) among 3978 women with last birth had their babies delivered in a health facility. In the multilevel logistic regression analysis, women in age group 45–49 (AOR = 2.43, 95% CI: 1.280, 4.591), primary educational level (AOR = 2.21, 95% CI: 1.864, 2.625, secondary and above education level (AOR = 6.37, 95% CI: 4.600, 8.837), being Muslim (AOR = 2.57, 95% CI: 1.245, 2.166), women who visited ANC service four up to seven times (AOR = 2.75, 95% CI: 2.175, 3.473), women visited ANC service eight times and above (AOR = 3.295% CI: 1.685, 6.050), women who reside in middle wealth index (AOR = 1.57, 95% CI: 1.273, 1.950), and rich wealth index (AOR = 3.43, 95% CI: 2.782, 4.225) were more likely to give birth at health institution compared to their counterparts. Furthermore, women being in rural area (AOR = 0.34, 95% CI:- 0.283, 0.474) and protestant women (AOR = 0.1.57, 95% CI: 0.479, 0.852) were less likely to deliver at health institution. Conclusions: Ethiopia still has a low level of institutionalized delivery. Institutional delivery in Ethiopia should be improved through context-specific and personalized programs, such as educating women and enhancing access to ANC services.

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

“…Overall, the prevalence of health-care delivery was 67.6%. The gure was signi cantly higher than in Ethiopia (54%) [17], Bangladesh (51%) [19], East Africa (76.32) [23], and Nepal (46%) [27]. The difference could be attributed to differences in the study period.…”

“…. The model's assumptions were tested using the intra-class coe cient of correlation (ICC) and the likelihood ratio (LR) test [17]. The ICC is used to assess the degree of similarity between clusters in terms of place of delivery prevalence.…”

“…Model I was the multivariable model that was adjusted for individual-level variables, while Model II was adjusted for community-level factors. In Model III [17], potential candidate variables from both individual and community-level variables were tted to the outcome variable.…”

“…A range of factors hinders the utilization of facility delivery and other services during the pregnancypostnatal continuum in LMICs. Type of place of residence [17,18], women's education level [10,[19][20][21], husband education level [10,18,22], wealth index of the household [23][24][25], sex of household head [10], marital status of women [19,23], women's age group [26,27], women's current working status [19,20], women's occupation [10,28,29], husband/partner occupation [28,29], media exposure [19,23], number of antenatal care visit [17,18], family size [22], and number of under-ve children [30] are some of the critical determinants for utilization of health facility delivery in LMICs.…”

“…According to the results of a cross-sectional survey conducted in 80 low-and middle-income countries, the use of health facilities for delivery was greater than 90% in 25 of them and less than 40% in 11. Only 54% of Ethiopian women give birth in a health facility [17]. Despite Ghana's free maternal health services policy and Kenya's free maternity services policy for all public hospitals, only 59% of women in Ghana use SBAs [32], while 47.6% of deliveries occur in Kenya [33].…”