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      Utilization and factors associated with health facility delivery among women of reproductive age in rural Ethiopia: Mixed effect logistic regression analysis

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      Journal: PLOS ONE
      Publisher: Public Library of Science

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          Abstract

          Background

          Worldwide over 800 women lose their life each day from complication in pregnancy and child birth. Health facility delivery is one of the key strategies for reducing maternal mortality and for ensuring safe birth. Inequity by urban–rural residence is one of the most pronounced challenges in maternal health service coverage with women living in rural areas at a greater disadvantage than other women. This study aims to assess the magnitude and factors affecting the utilization of health facility delivery for the most recent live birth among women of reproductive age in rural Ethiopia.

          Methods

          This is a cross-sectional study based on a data from Ethiopian Mini Demographic and Health Survey 2019 dataset with a total weighted sample of 2900 women of reproductive age group in rural Ethiopia. Data cleaning, coding and labeling were done using STATA version 14 software. Multilevel mixed effect logistic regression model was employed to identify associated factors.

          Result

          Only 44% of reproductive-age women in rural Ethiopia gave their most recent live birth in health institutions. In the multivariable multilevel binary logistic regression analysis; educational status, wealth index, attending 4+ANC, and had ANC from skilled provider were found to be statistically significant factors associated with health facility delivery.

          Conclusion

          In a rural part of Ethiopia, the prevalence of institutional delivery is low. Especial emphasis should be given for mothers with no formal education, and poor household wealth index, Furthermore, implementing public health programs that target to enable women to have more frequent Antenatal Care follow-up from skilled providers may increase the number of health facility deliveries.

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          Most cited references43

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          Health facility delivery in sub-Saharan Africa: successes, challenges, and implications for the 2030 development agenda

          Henry V. Doctor, Sangwani Nkhana-Salimu, Maryam Abdulsalam-Anibilowo (2018)
          Background Sub-Saharan Africa remains one of the regions with modest health outcomes; and evidenced by high maternal mortality ratios and under-5 mortality rates. There are complications that occur during and following pregnancy and childbirth that can contribute to maternal deaths; most of which are preventable or treatable. Evidence shows that early and regular attendance of antenatal care and delivery in a health facility under the supervision of trained personnel is associated with improved maternal health outcomes. The aim of this study is to assess changes in and determinants of health facility delivery using nationally representative surveys in sub-Saharan Africa. This study also seeks to present renewed evidence on the determinants of health facility delivery within the context of the Agenda for Sustainable Development to generate evidence-based decision making and enable deployment of targeted interventions to improve health facility delivery and maternal and child health outcomes. Methods We used pooled data from 58 Demographic and Health Surveys (DHS) conducted between 1990 and 2015 in 29 sub-Saharan African countries. This yielded a total of 1.1 million births occurring in the 5 years preceding the surveys. Descriptive statistics were used to describe the counts and proportions of women who delivered by place of delivery and their background characteristics at the time of delivery. We used multilevel logistic regression model to estimate the magnitude of association in the form of odds ratios between place of delivery and the predictors. Results Results show that births among women in the richest wealth quintile were 68% more likely to occur in health facilities than births among women in the lowest wealth quintile. Women with at least primary education were twice more likely to give birth in facilities than women with no formal education. Births from more recent surveys conducted since 2010 were 85% more likely to occur in facilities than births reported in earliest (1990s) surveys. Overall, the proportion of births occurring in facilities was 2% higher than would be expected; and varies by country and sub-Saharan African region. Conclusions Proven interventions to increase health facility delivery should focus on addressing inequities associated with maternal education, women empowerment, increased access to health facilities as well as narrowing the gap between the rural and the urban areas. We further discuss these results within the agenda of leaving no one behind by 2030.
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            Inequities in utilization of reproductive and maternal health services in Ethiopia

            Firew Tekle Bobo, Elias Ali Yesuf, Mirkuzie K. Woldie (2017)
            Background Disparities in health services utilization within and between regional states of countries with diverse socio-cultural and economic conditions such as Ethiopia is a frequent encounter. Understanding and taking measures to address unnecessary and avoidable differences in the use of reproductive and maternal health services is a key concern in Ethiopia. The aim of the study was to examine degree of equity in reproductive and maternal health services utilization in Ethiopia. Method Data from Ethiopia demographic health survey 2014 was analyzed. We assessed inequities in utilization of modern contraceptive methods, antenatal care, facility based delivery and postnatal checkup. Four standard equity measurement methods were used; equity gaps, rate-ratios, concertation curve and concentration index. Results Inequities in service utilization were exhibited favoring women in developed regions, urban residents, most educated and the wealthy. Antenatal care by skilled provider was three times higher among women with post-secondary education than mothers with no education. Women in the highest wealth quantile had about 12 times higher skilled birth attendance than those in lowest wealth quantile. The rate of postnatal care use among urban resident was about 6 times that of women in rural area. Use of modern contraceptive methods was more equitably utilized service while, birth at health facility was less equitable across all economic levels, favoring the wealthy. Conclusion Considerable inequity between and within regions of Ethiopia in the use of maternal health services was demonstrated. Strategically targeting social determinants of health with special emphasis to women education and economic empowerment will substantially contribute for altering the current situation favorably.
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              Factors associated with institutional delivery service utilization in Ethiopia

              Alemi Kebede, Kalkidan Abate Hassen, Aderajew Nigussie Teklehaymanot (2016)
              Background Most obstetric complications occur unpredictably during the time of delivery, but they can be prevented with proper medical care in the health facilities. Despite the Ethiopian government’s efforts to expand health service facilities and promote health institution-based delivery service in the country, an estimated 85% of births still take place at home. Objective The review was conducted with the aim of generating the best evidence on the determinants of institutional delivery service utilization in Ethiopia. Methods The reviewed studies were accessed through electronic web-based search strategy from PubMed, HINARI, Mendeley reference manager, Cochrane Library for Systematic Reviews, and Google Scholar. Review Manager V5.3 software was used for meta-analysis. Mantel–Haenszel odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated. Heterogeneity of the study was assessed using I 2 test. Results People living in urban areas (OR =13.16, CI =1.24, 3.68), with primary and above educational level of the mother and husband (OR =4.95, CI =2.3, 4. 8, and OR =4.43, CI =1.14, 3.36, respectively), who encountered problems during pregnancy (OR =2.83, CI =4.54, 7.39), and living at a distance <5 km from nearby health facility (OR =2.6, CI =3.33, 6.57) showed significant association with institutional delivery service utilization. Women’s autonomy was not significantly associated with institutional delivery service utilization. Conclusion and recommendation Distance to health facility and problems during pregnancy were factors positively and significantly associated with institutional delivery service utilization. Promoting couples education beyond primary education regarding the danger signs of pregnancy and benefits of institutional delivery through available communication networks such as health development army and promotion of antenatal care visits and completion of four standard visits by pregnant women were recommended.
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                Author and article information

                Contributors
                Birhan Ewunu Semagn:
                ORCID: https://orcid.org/0000-0002-9788-2657
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Anteneh Fikrie: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS One
                Journal ID (publisher-id): plos
                Title: PLOS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 14 July 2023
                Publication date Collection: 2023
                Volume: 18
                Issue: 7
                Electronic Location Identifier: e0280660
                Affiliations
                [001] Department of Public Health, Asrat Weldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
                Bule Hora University, ETHIOPIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                https://orcid.org/0000-0002-9788-2657
                Article
                Publisher ID: PONE-D-22-35754
                DOI: 10.1371/journal.pone.0280660
                PMC ID: 10348594
                PubMed ID: 37450432
                SO-VID: 7c61ec33-81d6-49c1-93f9-12d70abd3351
                Copyright © © 2023 Birhan Ewunu Semagn
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 4 January 2023
                Date accepted : 29 June 2023
                Page count
                Figures: 2, Tables: 3, Pages: 14
                Funding
                The author received no specific funding for this work
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Women's Health
                Subject: Maternal Health
                Subject: Birth
                Subject: Labor and Delivery
                Subject: Medicine and Health Sciences
                Subject: Women's Health
                Subject: Obstetrics and Gynecology
                Subject: Birth
                Subject: Labor and Delivery
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Health Care Facilities
                Subject: Medicine and Health Sciences
                Subject: Women's Health
                Subject: Maternal Health
                Subject: Antenatal Care
                Subject: People and Places
                Subject: Geographical Locations
                Subject: Africa
                Subject: Ethiopia
                Subject: People and Places
                Subject: Population Groupings
                Subject: Educational Status
                Subject: Medicine and Health Sciences
                Subject: Women's Health
                Subject: Maternal Health
                Subject: Pregnancy
                Subject: Medicine and Health Sciences
                Subject: Women's Health
                Subject: Obstetrics and Gynecology
                Subject: Pregnancy
                Subject: Social Sciences
                Subject: Anthropology
                Subject: Cultural Anthropology
                Subject: Religion
                Subject: Social Sciences
                Subject: Sociology
                Subject: Religion
                Subject: Medicine and Health Sciences
                Subject: Public and Occupational Health
                Custom metadata
                Data Availability The data used for this study was EMDHS 2019 data, which is publicly available in the measure DHS program. The author accessed this data after explaining the purpose of this study and therefore, everybody can access this data from this https://dhsprogram.com/data/ link.

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