Magnitude, trends and determinants of skilled delivery from Kilite-Awlaelo Health Demographic Surveillance System, Northern Ethiopia, 2009- 2017

Abstract

Background The fundamental approach to improve maternal and neonatal health is increasing skilled delivery rate. Women giving birth at health institutions can prevent maternal and neonatal deaths by getting skilled birth attendance. In Ethiopia, despite a significant decrease in maternal mortality over the past decade, still a significant number of women give birth at home. Moreover, evidence from population-based longitudinal studies on skilled delivery is limited. Therefore, this study aims to investigate the magnitude, trend, and determinants of skilled delivery in Kilite-Awlaelo Health Demographic Surveillance System (KA-HDSS), Northern Ethiopia. Method Population-based longitudinal study design was conducted by extracting data for nine consecutive years (2009–2017) from KA-HDSS database. In order to measure the trends of skilled delivery, KA-HDSS data sets were analyzed (2009–2017). Bivariate and multivariate analyses were performed using STATA version 16. A multivariable binary logistic regression model was fitted to assess determinants of skilled delivery and odds ratio with 95% CI was used to assess presence of associations at a 0.05 level of significance. Results The skilled delivery rate have continuously increased among reproductive age women from 15.12% (95% CI: 13.30% - 17.09%) in 2010 to 95.85% (95% CI: 94.58% - 96.895%) in 2017. The skilled delivery rate becomes high (> = 82) in the period of 2014–2017. Education, residence, marital status, occupation and antenatal care (ANC) visits were the most important determinants for skilled delivery among reproductive age women during the period of high skilled delivery rate (2014–2017). Women urban dwellers had about 28 times (AOR = 27.66; 95% CI: 3.86–196.97) higher odds to deliver by skilled birth attendants than rural dwellers. Unmarried women who gave birth were 2.18 (AOR: 2.18; 95% CI: 1.30–3.64) times more likely to have skilled delivery service compared to those married. Likewise, women with four or more ANC visits were 3.2 times more likely to undergo skilled delivery service than those having no ANC visits (AOR: 3.16; 95% CI: 2.33–4.28). Moreover, women having at least a secondary education were 2 times more likely to have skilled delivery service compared to those women with no formal education (AOR = 2.10, 95% CI: 1.18–3.74). Conclusion Regardless of the importance of health facility delivery, a significant number of women still deliver at home attended by unskilled birth attendants. There has been a substantial increase in use of health facilities for delivery among women in the reproductive age. The factors affecting skilled delivery among reproductive age women were educational level, residence, marital status, occupation and use of ANC service. Maternal health related interventions are needed to change women’s attitudes towards skilled delivery. Moreover, ANC coverage should be increased to improve skilled delivery service.

Differential Effects of Household Characteristics on Uptake of Skilled Birth Attendance among Women of Reproductive Age in Western Kenya

“…This means that the health system in the region has been improving with regard to skilled birth attendance. This study is consistent with other studies which have shown a remarkable increase in the rate of skilled birth attendance over time (Abebe et al, 2021;Fagbamigbe et al, 2017;Atahigwa et al, 2020;Joharifard et al, 2012;Mwangi et al, 2018). The findings imply that efforts such as strengthening the quality of care, motivation for women to use services and concerted awareness creation through community dialogue days (MOH, 2007), are important in improving maternal health services uptake.…”

Southern Ethiopian skilled birth attendant variations and maternal mortality: a multilevel study of a population-based cross-sectional household survey

“…This study demonstrated that attendance at antenatal care is a strong predictor of using SBA. This finding agrees with the studies conducted in Kenya [49] and Ethiopia [25]. This could be explained by the fact that women who attend ANC will be familiar with the health system and health facilities, be encouraged and counselled on the importance of SBA by ANC providers, and get prepared in advance for facility delivery.…”

“…The use of SBA was more common among mothers with an education. This finding agrees with the studies done in Ethiopia [12, 25] and elsewhere [9, 42]. Mothers’ formal education is associated with better health knowledge and, consequently, with improved use of health services [43].…”

“…Despite an increasing trend in the coverage of skilled birth attendance since 2000 [24], coverage and access to SBA are still low in the country [10, 16]. In Ethiopia, there is a dearth of studies conducted to assess the utilisation of skilled birth attendants [10, 25, 26]. However, this study tries to answer the following questions: what is the coverage and disparities of SBA in Sidama Region and the districts, how physically accessible the health centres and hospitals are to pregnant women and how they are utilized by the women during labour and childbirth, and does SBA have an effect on the magnitude of maternal mortality in districts of Sidama Region.…”

Individual and community-level determinants of skilled birth attendant delivery in Ethiopia; multilevel analysis

“…likelihood of SBA delivery among women living in rural communities decreased by 66% as compared to women who lived in urban communities. This study finding was in line with studies done in Ethiopia [17,21,27] and India [20]. The possible explanation might be that…”