Multilevel analysis of individual and community level factors associated with institutional delivery in Ethiopia

Abstract

BackgroundImproving maternal health is one of the eight millennium development goals to reduce maternal mortality (MM) by three quarters between 1990 and 2015. Institutional delivery is considered to be the most critical intervention in reducing MM and ensuring safe motherhood. However, the level of maternal morbidity and mortality in Ethiopia are among the highest in the world and the proportion of births occurring at health facilities is very low. This study examined the individual and community level factors associated with institutional delivery in Ethiopia.MethodsData from the 2011 Ethiopian demographic and health survey were used to identify individual and community level factors associated with institutional delivery among women who had a live birth during the 5 years preceding the survey. Taking into account the nested structure of the data, multilevel logistic regression analysis has been employed to a nationally representative sample of 7757 women nested with in 595 communities.ResultsAt the individual level; higher educational level of the women (AOR = 3.60; 95 % CI 2.491–5.214), women from richest households (AOR = 1.74; 95 % CI 1.143–2.648) and increased ante natal care attendance (AOR = 4.43; 95 % CI 3.405–5.751) were associated with institutional delivery. Additionally, at the community level; urban residence (AOR = 4.74; 95 % CI 3.196–7.039), residing in communities with high proportion of educated women (AOR = 1.71; 95 % CI 1.256–2.319) and residing in communities with high ANC utilization rate (AOR = 1.55; 95 % CI 1.132–2.127) had a significant effect on institutional delivery. Also region and distance to health facility showed significant association with institutional delivery. The random effects showed that the variation in institutional delivery service utilization between communities was statistically significant.ConclusionBoth individual and community level factors are associated with institutional delivery service uptake. As a result, further research is needed to better understand why these factors may affect institutional delivery.

Associated Factors of Caesarean Section in Ethiopia Using 2016 Demographic Health Survey Data; Community Based Cross Sectional Study

“…The findings showed that woman's had more educated, more likely to deliver by c-section. This result lower than and consistent with previous findings [1,13,19,20].The possible reasons could be, educated woman's might search a means to minimize absorbate and more worry their health. The difference might be sample size.…”

“…Surprisingly, the finding revealed that number of ANC had not statistically significant effect on csection. The results consistent a study conducted in Wolayta Sodo [20,23]. The reasons could be they consult skilled person if they start ANC earlier.…”

“…The study also revealed that mothers had faced multiple pregnancies was more likely to deliver by csection. This finding was agreed but lower than studies done in the country and developing countries [13,19,20,23]. The explanation could be mothers had faced multiple pregnancies were more seek skilled care services due to fear of labour.…”

Factors associated with postnatal care utilization among postpartum women in Ethiopia: a multi-level analysis of the 2016 Ethiopia demographic and health survey

“…The possible reason behind this could be, the characteristics that predispose women to seek ANC service could also make them more likely to seek PNC service. Besides, those women who were using ANC service could be familiar with other maternal health service and it might also create an opportunity for health professionals to provide counseling regarding the significance of PNC services [23,33]. The household wealth index was another positively associated variable.…”

“…The factors which determine the utilization of PNC services differ from place to place, from individual to community which is affected by the culture and belief of women [18][19][20][21][22][23][24]. Even though the factors for PNC service utilization were from different levels, those previous studies conducted in Ethiopia simple regression model of analysis and the sample sizes were covering only specific or local areas [25][26][27].…”