Home delivery among women who had optimal ANC follow-up in Sub-Saharan Africa: A multilevel analysis

Abstract

Background Home deliveries, where most births take place, are significantly responsible for the majority of maternal mortality. In order to develop appropriate policies and methods that could aid in addressing the issue, it is important to understand the scope of home delivery and its determinants in developing countries. Therefore, this study aims to ascertain the prevalence and factors associated with home delivery among women who had optimal ANC follow up in the Sub-Saharan Africa countries. Methods A population based cross-sectional study was conducted. Data from the most recent Demographic and Health Surveys, which covered 23 Sub-Saharan Africa countries from 2014 to 2020, were used. The study used a total of 180,551 women who had optimal ANC follow up weighted sample. Stata 14 was used to analyze the data. The determinants of home delivery were determined using a multilevel mixed-effects logistic regression model. Factors associated with home delivery in the multilevel logistic regression model were declared significant at p-values <0.05. The adjusted odds ratio and confidence interval were used to interpret the results. Results In Sub-Saharan Africa, three in ten (30%) women who had optimal ANC follow-up gave birth at home. Individual-level variables such as maternal age (20 to 35 years) (AOR = 1.27, 95% CI: 1.10, 1.46), no formal education (AOR = 3.10, 95% CI: 2.68, 3.59), pregnancy complications (AOR = 0.74, 95% CI: 0.67, 0.82), distance to a health facility (AOR = 1.43, 95% CI: 1.30, 1.58), and poor wealth status (AOR = 2.71, 95% CI: 2.37, 3.10) had higher odds of home delivery. Community-level variables such as rural residence (AOR = 2.83, 95% CI: 2.48, 3.22), living in central Sub-Saharan Africa (AOR = 7.95, 95% CI: 5.81, 10.9), and eastern Sub-Saharan Africa (AOR = 2.74, 95% CI: 2.09, 3.59), were significantly associated with home delivery. Conclusions and recommendation This study concludes that home delivery in sub-Saharan Africa among women who had optimal ANC follow-up were high. The study identified that both individual and community-level variables were determinants of home delivery. Therefore, the Government and ministries of health in Sub-Saharan Africa countries should give attention to those women who reported distance as a big problem to health facilities and for rural resident women while designing policies and strategies targeting reducing home delivery in sub-Saharan Africa.

Prompt treatment of fever and its associated factors among under-five children in sub-Saharan Africa: A multilevel analysis of evidence from 36 countries

“…The association of individual-level variables with the outcome variable (Model I) and the association of community-level variables with the outcome variable (Model II) were assessed. In the final model (Model III), the association of both individual and community-level variables was fitted simultaneously with the outcome variable (prompt treatment of fever) [ 24 ].…”

Human papillomavirus vaccination coverage among young women in the three sub-Saharan African countries using Demographic and Health Surveys data

“…DHS uses two-stage stratified cluster design that includes enumeration areas as the first stage and generates a sample of households from each enumeration area as the second stage. 18 The variable “has card where HPV vaccination against CC are written” (s1110b) from the maternal record (IR) dataset was chosen and recoded to create the outcome variable. A total sample of 4,952 young women was included in this study ( Table 1 ).…”

“…Because of the nested nature of the model, deviation = −2(log likelihood ratio) was used to compare models, and the model with the lowest deviance was selected as the best-fit model. 18 The variables used in the models were verified for multi-collinearity using variance inflation factor (VIF) with mean VIF of 1.95.…”