Spatial Distribution and Associated Factors of Institutional Delivery among Reproductive-Age Women in Ethiopia: The Case of Ethiopia Demographic and Health Survey

Abstract

Background. Maternal mortality is unacceptably high. About 295,000 women died during and following pregnancy and childbirth in 2017. The vast majority of these deaths (94%) occurred in low-resource settings, and most could have been prevented. Methods. This research is based on a cross-sectional study using 2016 EDHS data. The analysis included 7,590 women who had given birth in the five years prior to the survey. Clusters with high and low hot spots with institutional delivery were found using SatScan spatial statistical analysis. A multilevel multivariable mixed-effect logistic regression was utilized to discover characteristics associated with institutional delivery. Result. In this study, 33.25% of women who gave birth in the last 5 years preceding the survey delivered their babies at health institutions. The finding also indicated that the spatial distribution of institutional delivery was nonrandom in the country. Variables achieving statically significant association with utilization of institutional delivery were as follows: at the individual level, richness (AOR = 2.18, 95%CI: 1.39–3.41), higher education (AOR = 3.89, 95%CI: 1.51–10.01), a number of antenatal care visits of four and above (AOR = 6.57, 95%CI: 4.83–8.94), and parity of more than two children (AOR = 0.48, 95%CI: 0.34–0.68); at the community level, higher education (AOR = 1.70, 95%CI: 1.22–2.36) and urban residence (AOR = 5.30, 95%CI: 3.10–9.06) were variables that had achieved statically significant association for utilization of institutional delivery. Conclusions. This study identified a spatial cluster of institutional delivery with the Somali and Afar region having low utilization rates and Addis Ababa and Tigray regions having the highest utilization rates. The significant individual factors associated with institution delivery were woman antenatal care visits, household wealth index, maternal education, and parity, and the significant community ones were region, place of residence, and educational status. Therefore, to maximize health facility delivery in Ethiopia, the predictors of institutional delivery identified in this study should be given more attention by governmental and nongovernmental stakeholders.

Individual- and community-level determinants of the number of antenatal care visits in emerging regions of Ethiopia: a negative binomial model

“…The poverty level in a community was categorized as high if the proportion of young women in the two lowest wealth quintiles was greater than the median value, and low if the proportion was less than the median value [44]. The community level of women's education was categorized as high if the proportion of women with at least a primary level of education was greater than the median value, and low if it was less than the median value [45,46]. The proportion of women who had at least one media exposure was used to assess community-level media exposure.…”

Spatial variations and multi-level determinants of modern contraceptive utilization among young women (15–24 years) in Ethiopia: spatial and multi-level analysis of mini-EDHS 2019

“…The community wealth level was classified as high if the proportion of women from the two lowest wealth quintile in a given community was greater than the median value and low if the proportion was below the median value [26]. The community level of women's education was the proportion of women in the community with at least a primary level of education, classified as high (proportion of women greater than median national value) whereas low (proportion of women below-median national value) [27].…”

Women’s health service access and associated factors in Ethiopia: application of geographical information system and multilevel analysis

“…Though institutional delivery is used to reduce pregnancy and birth risks, home birth in low-income countries is high and institutional delivery is 26%–32.5% in Ethiopia. 8 …”

“…Pregnancy-induced high blood pressure, stillbirth and unsafe abortions are extremely high. Though institutional delivery is used to reduce pregnancy and birth risks, home birth in low-income countries is high and institutional delivery is 26%–32.5% in Ethiopia 8…”

“…Women’s postnatal care (PNC) service utilisation is insufficient, which is 6.9% with marked spatial heterogeneity in Ethiopia 9. Maternal and child health problems occur due to the inaccessibility of health institutions, poor women’s health-seeking behaviours, maternal and child health services inaccessibility, low media exposure, poor attitude and knowledge, and low-quality service provision 8 10 11. The geographical accessibility of healthcare services, rural women lack reliable transportation, and women are late in starting ANC service 12…”