Home delivery among antenatal care booked women in their last pregnancy and associated factors: community-based cross sectional study in Debremarkos town, North West Ethiopia, January 2016

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Abstract

Background

In Ethiopia, nearly half of the mothers who were booked for antenatal care, who supposed to have institutional delivery, gave home delivery nationally. Home delivery accounts majority while few of childbirth were attended by the skilled provider in Amhara regional state. This study aimed to determine the proportion of home delivery and associated factors among antenatal care booked women who gave childbirth in the past 1 year in Debremarkos Town, Northwest Ethiopia.

Methods

A community-based Cross sectional study was conducted from January 1st ₋ 25th 2016. Epi Info version 7 was used to determine a total sample size of 518 and simple random sampling procedure was employed. Data was collected through an interview by using pretested structured questionnaire. Data were entered into Epi Info version 7, cleaned and exported to SPSS version 21 for analysis. A p-value less than or equals to 0.05 at 95% Confidence Intervals of odds ratio were taken as significance level in the multivariable model.

Results

A total of 127 (25.3%) women gave childbirth at home. Un-attending formal education (Adjusted Odds Ratio = 7.56, 95% CI: [3.28, 17.44]), absence of health facility within 30 min distance (AOR = 3.41, 95% CI: [1.42, 8.20]), not exposed to media (AOR = 4.46, 95% CI: [2.09, 9.49]), Unplanned pregnancy (AOR = 3.47, 95% CI [1.82, 6.61]), attending ANC at health post (AOR = 5.45, 95% CI: (1.21, 24.49) and health center (AOR = 2.74, 95% CI [1.29, 5.82]), perceived privacy during ANC (AOR = 3.69[1.25, 10.91]) and less than four times ANC visit (AOR = 5.04, 95% CI (2.30, 11.04]) were significantly associated with home delivery.

Conclusions

Home delivery in this study was found to be low. Educational level, media exposure, geographic access to a health facility, Unplanned pregnancy, an institution where ANC was booked, perceived privacy during ANC and number of ANC visit were found to be determinants of home delivery. Health institutions, health professionals, policy makers, community leaders and all concerned with the planning and implementation of maternity care in Ethiopia need to consider these associations in implementing services and providing care, for pregnant women.

Electronic supplementary material

The online version of this article (doi:10.1186/s12884-017-1409-2) contains supplementary material, which is available to authorized users.

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Most cited references 22

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Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: implications for achievement of MDG-5 targets

Rose NM Mpembeni, Japhet Z Killewo, Melkzedeck Leshabari … (2007)

Background Almost two decades since the initiation of the Safe motherhood Initiative, Maternal Mortality is still soaring high in most developing countries. In 2000 WHO estimated a life time risk of a maternal death of 1 in 16 in Sub- Saharan Africa while it was only 1 in 2800 in developed countries. This huge discrepancy in the rate of maternal deaths is due to differences in access and use of maternal health care services. It is known that having a skilled attendant at every delivery can lead to marked reductions in maternal mortality. For this reason, the proportion of births attended by skilled health personnel is one of the indicators used to monitor progress towards the achievement of the MDG-5 of improving maternal health. Methods Cross sectional study which employed quantitative research methods. Results We interviewed 974 women who gave birth within one year prior to the survey. Although almost all (99.8%) attended ANC at least once during their last pregnancy, only 46.7% reported to deliver in a health facility and only 44.5% were assisted during delivery by a skilled attendant. Distance to the health facility (OR = 4.09 (2.72–6.16)), discussion with the male partner on place of delivery (OR = 2.37(1.75–3.22)), advise to deliver in a health facility during ANC (OR = 1.43 (1.25–2.63)) and knowledge of pregnancy risk factors (OR 2.95 (1.65–5.25)) showed significant association with use of skilled care at delivery even after controlling for confounding factors. Conclusion Use of skilled care during delivery in this district is below the target set by ICPD + of attaining 80% of deliveries attended by skilled personnel by 2005. We recommend the following in order to increase the pace towards achieving the MDG targets: to improve coverage of health facilities, raising awareness for both men and women on danger signs during pregnancy/delivery and strengthening counseling on facility delivery and individual birth preparedness.

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Where Do Poor Women in Developing Countries Give Birth? A Multi-Country Analysis of Demographic and Health Survey Data

Dominic Montagu, Gavin Yamey, Adam J Visconti … (2011)

Background In 2008, over 300,000 women died during pregnancy or childbirth, mostly in poor countries. While there are proven interventions to make childbirth safer, there is uncertainty about the best way to deliver these at large scale. In particular, there is currently a debate about whether maternal deaths are more likely to be prevented by delivering effective interventions through scaled up facilities or via community-based services. To inform this debate, we examined delivery location and attendance and the reasons women report for giving birth at home. Methodology/Principal Findings We conducted a secondary analysis of maternal delivery data from Demographic and Health Surveys in 48 developing countries from 2003 to the present. We stratified reported delivery locations by wealth quintile for each country and created weighted regional summaries. For sub-Saharan Africa (SSA), where death rates are highest, we conducted a subsample analysis of motivations for giving birth at home. In SSA, South Asia, and Southeast Asia, more than 70% of all births in the lowest two wealth quintiles occurred at home. In SSA, 54.1% of the richest women reported using public facilities compared with only 17.7% of the poorest women. Among home births in SSA, 56% in the poorest quintile were unattended while 41% were attended by a traditional birth attendant (TBA); 40% in the wealthiest quintile were unattended, while 33% were attended by a TBA. Seven per cent of the poorest women reported cost as a reason for not delivering in a facility, while 27% reported lack of access as a reason. The most common reason given by both the poorest and richest women for not delivering in a facility was that it was deemed “not necessary” by a household decision maker. Among the poorest women, “not necessary” was given as a reason by 68% of women whose births were unattended and by 66% of women whose births were attended. Conclusions In developing countries, most poor women deliver at home. This suggests that, at least in the near term, efforts to reduce maternal deaths should prioritize community-based interventions aimed at making home births safer.

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Use of antenatal services and delivery care among women in rural western Kenya: a community based survey

Anna van Eijk, Hanneke M Bles, Frank O Odhiambo … (2006)

Background Improving maternal health is one of the UN Millennium Development Goals. We assessed provision and use of antenatal services and delivery care among women in rural Kenya to determine whether women were receiving appropriate care. Methods Population-based cross-sectional survey among women who had recently delivered. Results Of 635 participants, 90% visited the antenatal clinic (ANC) at least once during their last pregnancy (median number of visits 4). Most women (64%) first visited the ANC in the third trimester; a perceived lack of quality in the ANC was associated with a late first ANC visit (Odds ratio [OR] 1.5, 95% confidence interval [CI] 1.0–2.4). Women who did not visit an ANC were more likely to have 90%), but provision of other services was low, e.g. malaria prevention (21%), iron (53%) and folate (44%) supplementation, syphilis testing (19.4%) and health talks (14.4%). Eighty percent of women delivered outside a health facility; among these, traditional birth attendants assisted 42%, laypersons assisted 36%, while 22% received no assistance. Factors significantly associated with giving birth outside a health facility included: age ≥ 30 years, parity ≥ 5, low SES, 1 hour walking distance from the health facility. Women who delivered unassisted were more likely to be of parity ≥ 5 (AOR 5.7, 95% CI 2.8–11.6). Conclusion In this rural area, usage of the ANC was high, but this opportunity to deliver important health services was not fully utilized. Use of professional delivery services was low, and almost 1 out of 5 women delivered unassisted. There is an urgent need to improve this dangerous situation.

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Author and article information

Contributors

Habtamu Kebebe Kasaye: habtekebe@gmail.com

Zerfu Mulaw Endale: zerfumulaw@yahoo.com

Temesgen Worku Gudayu: tame.worku@gmail.com

Melese Siyoum Desta: melessiyoum@yahoo.com

Journal

Journal ID (nlm-ta): BMC Pregnancy Childbirth

Journal ID (iso-abbrev): BMC Pregnancy Childbirth

Title: BMC Pregnancy and Childbirth

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2393

Publication date (Electronic): 14 July 2017

Publication date PMC-release: 14 July 2017

Publication date Collection: 2017

Volume: 17

Electronic Location Identifier: 225

Affiliations

[1 ]GRID grid.449817.7, Midwifery Department, , College of Medical and Health Sciences, Wollega University, ; P.O. Box 395, Nekemte, Ethiopia

[2 ]ISNI 0000 0000 8539 4635, GRID grid.59547.3a, Midwifery Department, , College of Medicine and Health Sciences, University of Gondar, ; P.O. Box 196, Gondar, Ethiopia

[3 ]ISNI 0000 0000 8953 2273, GRID grid.192268.6, Midwifery Department, , College of Medicine and Health Sciences, Hawassa University, ; P.O. Box 1560, Hawassa, Ethiopia

Article

Publisher ID: 1409

DOI: 10.1186/s12884-017-1409-2

PMC ID: 5512956

PubMed ID: 28705188

SO-VID: 8ffbbbe5-e842-42d2-92fd-60e06b6f9220

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 14 July 2016

Date accepted : 3 July 2017

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100007866, College of Medicine and Health Sciences, University of Gondar;

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: antenatal care,home delivery,institutional delivery,debremarkos,ethiopia

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ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: antenatal care, home delivery, institutional delivery, debremarkos, ethiopia

Home delivery among antenatal care booked women in their last pregnancy and associated factors: community-based cross sectional study in Debremarkos town, North West Ethiopia, January 2016

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Advocacy for Maternal and Women’s Health

Most cited references 22

Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: implications for achievement of MDG-5 targets

Where Do Poor Women in Developing Countries Give Birth? A Multi-Country Analysis of Demographic and Health Survey Data

Use of antenatal services and delivery care among women in rural western Kenya: a community based survey

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