Trends and determinants of home delivery in Ethiopia: further multivariate decomposition analysis of 2005–2016 Ethiopian Demographic Health Surveys

Abstract

ObjectiveThis study aimed to assess the trends and factors that had contributed to the change in home delivery in Ethiopia over the last decade.Design, setting and analysisA nationally representative repeated cross-sectional survey was conducted using 2005, 2011 and 2016 Ethiopian Demographic and Health Surveys. Multivariate decomposition logistic regression analysis was employed to identify significant factors that have been contributed to the change in home delivery. Level of statistical significance was declared at a two-sided p value <0.05.Outcome measureTrends of home delivery.ParticipantsA total of 33 482 women were included.ResultsHome delivery has been decreased by 21% over the last decade in Ethiopia. In the last decade, 39% of the decrements in home delivery attributed to change in women’s compositional characteristics. Antenatal care visits, educational status of the women and husband, birth order, religion, wealth index and distance from a health facility were the main sources of compositional change factors for the change of home delivery. Behavioural changes towards health facility delivery contributed approximately two-thirds of the decline of home delivery in Ethiopia. Antenatal care visits, birth order and religion have significantly contributed to the change of home delivery resulted from behavioural changes towards healthcare facility utilisation over the last decade.ConclusionDespite the importance of health facility delivery, a significant number of women still deliver at home in Ethiopia. Women’s compositional characteristics and behaviour changes were significantly associated with the change in home delivery. Multisectoral educational intervention is needed to change women’s attitudes towards home delivery. Antenatal care coverage and healthcare facility coverage should increase thereby to improve healthcare facility based-delivery practice. Further research needs to be done to explore the potential barriers of health facility delivery from a religious perspective.

Prevalence of home birth among 880,345 women in 67 low- and middle-income countries: A meta-analysis of Demographic and Health Surveys

“…This finding was ubiquitously found in all regions, and while strata-specific home birth proportions varied considerably between the least educated women and the countries on average, almost all countries (63 out of 67) presented home birth rates of less than 12.5% among highly educated women. A low educational level has been described as a driver of home birth, as educated women tend to search for hospital-based care, explained by understanding and knowledge about the risk that birth encompasses ( Tiruneh et al, 2020 ). Higher fertility rates among low-educated women put them at higher risk of adverse birth outcomes, in addition to the risk of being attended by non-skilled personnel or TBA.…”

“…Likewise, women with a lower educational level have a higher probability of complications in relation to home birth care not performed by qualified medical personnel or trained midwives, as well as at the hospital level ( Karlsen et al, 2011 ; Tunçalp et al, 2014 ). Moreover, research has shown that a higher education level of the head of the household – which in LMIC tends to be the men – is also associated with a lower likelihood of home birth ( Tiruneh et al, 2020 ; World Health Organization, 2015 ). Although the specific pathways leading from higher maternal education towards improved maternal health are still unclear ( Mensch et al, 2019 ), key global health institutions have modeled the importance of maternal education in achieving good maternal and neonatal health outcomes ( Karlsen et al, 2011 ; Kassebaum et al, 2016 ).…”

“…Regarding the wealth quintile, the richest women presented the lowest proportions of home birth. The literature describes that high socioeconomic status is associated with access to ambulatory birth care, thus explaining this finding ( Chernet et al, 2019 ; Sanogo & Yaya, 2020 ; Tiruneh et al, 2020 ). Similar to highly educated women, those among the top wealth quintiles exhibited lower home birth rates, although the difference between the lowest and highest quintiles was on average narrower than that seen in the strata-specific estimates of educational level.…”

Determinants of institutional delivery in Kenya. Evidence from population and Demographic health survey,2014

“…Therefore, institutional delivery attended by skilled health professionals is crucial for the well-being of the mother and newborns through timely management and treatment of attributable factors (8). Despite the importance of institutional delivery, a signi cant number of deliveries in Ethiopia (69%), Tanzania (59%), Indonesia (57.3%), Kenya-2008/2009 (57%), Kenya-2012 coastal region study (26%), and other sub-Saharan Africa countries are still taking place at home in the absence of specialized service to deal with any potential complications that can happen during delivery (3,(11)(12)(13)(14)(15). Therefore, factors associated with institutional deliveries should be identi ed and interventions on scaling up of maternal and child health service utilizations should be strengthened.…”

Decomposing Urban-rural Differences in Multimorbidity Among Older Adults in India: A Study Based on Lasi Data

“…The compositional differences (endowments) 'E' and the effects of characteristics, which are the differences in the coefficients or behavioural change 'C' responses for the selected predictor variables, are the two contributing effects in the multivariate decomposition analysis [50]. As a result, the observed variations in multimorbidity may be decomposed additively into characteristics (or endowments) and a coefficient (or effects of features) component [51].…”