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

Completion of the Maternal Health Care Continuum-Barriers and Facilitators Among Pregnant Women in Jimma Zone, Southwest Ethiopia: A Prospective Study

Background

Continuum of care (CoC) for Maternal Health Care (MHC) is a key strategy aimed at saving lives and promoting the well-being of women and newborns. To achieve the global targets for reducing maternal and newborn mortality, it is preferable to ensure the completion of key care stages (Antenatal, Institutional Delivery, and Postnatal) rather than fragmented care. Therefore, investigating the determinants of CoC completion for MHC is imperative for recommending schemes and designing strategies.

Objective

To assess the determinants influencing completion of the maternal healthcare continuum among pregnant women in Jimma Zone, Southwest Ethiopia.

Methods and Materials

A community-based prospective study was conducted from July 2020 to June 2021 among 1065 pregnant women from randomly selected woredas in Jimma Zone. The data were collected, entered using Epi-data and analyzed with SPSS software. Binary logistic regression was used to select candidate variables for multivariate analysis. Multivariate analysis was performed to identify associations between the dependent and independent factors. Principal Component Analysis (PCA) was used to determine the socioeconomic index.

Results

The overall completion rate was 16.1% (CI, 13.8%-18.5%), with significant dropouts observed between the first and the fourth ANC.Factors associated with the completion of MHC included the women's residence (AOR: 1.73 95% CI: 1.07, 2.81), educational status of their partners (AOR: 5.60 95% CI: 2.40, 13.08), women's occupation (AOR: 2.57 95% CI: 1.28, 5.16), knowledge of ANC (AOR: 7.64 95% CI: 4.03, 14.48), knowledge of PNC (AOR: 4.88 95% CI: 3.21, 7.42), service provided during ANC contacts (AOR: 3.39 95% CI: 1.94, 5.93), parity (AOR: 1.86 95% CI: 1.11, 3.12), time of booking for ANC (AOR: 2.10 95% CI: 1.45, 3.03), and nature of care (AOR: 2.03 95% CI: 1.07, 3.82). Additionally, factors such as topography, distance, lack of transportation, facility closeness, and indirect costs were associated with the completion for MHC.

Conclusion and Recommendations

The completion rate of CoC for MHC remains low. Factors influencing completion include women's residence, partners' educational status, women's occupation, services provided during ANC, history of PNC use, parity, time of booking for ANC, knowledge of ANC and PNC, and nature of care. To address this, strategies should focus on empowering women economically, improving knowledge of ANC and PNC, enhancing the capacity of health facilities to provide comprehensive ANC services, and making the service delivery more supportive. Further research is recommended to explore the impact of CoC for MHC on birth outcomes.

Using geographically weighted regression analysis to assess predictors of home birth hot spots in Ethiopia

BACKGROUND

Annually, 30 million women in Africa become pregnant, with the majority of deliveries taking place at home without the assistance of skilled healthcare personnel. In Ethiopia the proportion of home birth is high with regional disparity. Also limited evidence on spatial regression and deriving predictors. Therefore, this study aimed to assess the predictors of home birth hot spots using geographically weighted regression in Ethiopia.

METHODS

This study used secondary data from the 2019 Ethiopian Mini Demographic and Health Survey. First, Moran's I and Getis-OrdGi* statistics were used to examine the geographic variation in home births. Further, spatial regression was analyzed using ordinary least squares regression and geographically weighted regression to predict hotspot area of home delivery.

RESULT

According to this result, Somalia, Afar, and the SNNPR region were shown to be high risk locations for home births. Women from rural residence, women having no-education, poorest wealth index, Muslim religion follower, and women with no-ANC visit were predictors of home delivery hotspot locations.

CONCLUSION

The spatial regression revealed women from rural resident, women having no-education, women being in the household with a poorest wealth index, women with Muslim religion follower, and women having no-ANC visit were predictors of home delivery hotspot regions. Therefore, governmental and other stakeholders should remain the effort to decrease home childbirth through access to healthcare services especially for rural resident, strengthen the women for antenatal care visits.

Disparities and barriers of health facility delivery following optimal and suboptimal pregnancy care in Nigeria: evidence of home births from cross-sectional surveys

BACKGROUND

Despite uptake of antenatal care (ANC), 70% of global burden of maternal and child mortality is prevalent in sub-Saharan Africa, particularly Nigeria, due to persistent home delivery. Thus, this study investigated the disparity and barriers to health facility delivery and the predictors of home delivery following optimal and suboptimal uptake of ANC in Nigeria.

METHODOLOGY

A secondary analysis of 34882 data from 3 waves of cross-sectional surveys (2008-2018 NDHS). Home delivery is the outcome while explanatory variables were classified as socio-demographics, obstetrics, and autonomous factors. Descriptive statistics (bar chart) reported frequencies and percentages of categorical data, median (interquartile range) summarized the non-normal count data. Bivariate chi-square test assessed relationship at 10% cutoff point (p < 0.10) and median test examined differences in medians of the non-normal data in two groups. Multivariable logistic regression (Coeff plot) evaluated the likelihood and significance of the predictors at p < 0.05.

RESULTS

46.2% of women had home delivery after ANC. Only 5.8% of women with suboptimal ANC compared to the 48.0% with optimal ANC had facility delivery and the disparity was significant (p < 0.001). Older maternal age, SBA use, joint health decision making and ANC in a health facility are associated with facility delivery. About 75% of health facility barriers are due to high cost, long distance, poor service, and misconceptions. Women with any form of obstacle utilizing health facility are less likely to receive ANC in a health facility. Problem getting permission to seek for medical help (aOR = 1.84, 95%CI = 1.20-2.59) and religion (aOR = 1.43, 95%CI = 1.05-1.93) positively influence home delivery after suboptimal ANC while undesired pregnancy (aOR = 1.27, 95%CI = 1.01-1.60) positively influence home delivery after optimal ANC. Delayed initiation of ANC (aOR = 1.19, 95%CI = 1.02-1.39) is associated with home delivery after any ANC.

CONCLUSIONS

About half of women had home delivery after ANC. Hence disparity exist between suboptimal and optimal ANC attendees in institutional delivery. Religion, unwanted pregnancy, and women autonomy problem raise the likelihood of home delivery. Four-fifth of health facility barriers can be eradicated by optimizing maternity package with health education and improved quality service that expand focus ANC to capture women with limited access to health facility.

Prevalence of cultural malpractice during the perinatal period and its determinants among reproductive age women in southwest Ethiopia: A community-based cross-sectional study

Background

Cultural malpractices are accepted cultural norms and socially shared practices that have a negative impact on health. Cultural malpractices vary in type and number in different communities. This study aimed to determine the prevalence of cultural malpractice during the perinatal period and identify its predictors among reproductive-age women in rural communities of southwestern Ethiopia.

Methods

A community-based cross-sectional study was conducted from May 5 to 31, 2019 in Semen Bench district, southwestern Ethiopia; among reproductive-age women who had experienced at least one prior delivery. A systematic random sampling technique was employed to select 422 women for the interview. After collection, the data were entered into EpiData and exported to STATA-14 for further analysis. Descriptive analyses were performed and presented in texts and tables. Besides, binary and multivariable logistic regressions were computed to identify determinants of cultural malpractice.

Result

A total of 414 women completed the survey, resulting in a response rate of 98%. We found that 26.33% (95% CI: 22.15, 30.85%) had food taboos during pregnancy, 31.88% (95% CI: 27.42, 36.61%) delivered their last child at home, and 33.82% (95% CI: 29.27, 38.6%) practiced pre-lacteal feeding. Lack of formal education (AOR: 11.22, 95% CI: 6.24, 20.15), lack of ANC follow-up (AOR: 10.82, 95% CI: 5.46, 21.42), rural residence (AOR: 6.23, 95% CI: 2.18, 17.78), and avoiding colostrum (AOR: 21.94, 95% CI: 9.73, 49.48) were significantly associated with cultural malpractice during the perinatal period.

Conclusion

The prevalence of cultural malpractice is notably high in the study area. Hence, community-based measures including expansion of education and promotion of maternal health services are important to reduce cultural malpractice during the perinatal period.

Incidence and predictors of women's place of delivery among pregnant women who received antenatal care in Southern Ethiopia: a prospective cohort study

BACKGROUND

Home delivery is responsible for a high number of maternal and newborn deaths due to the occurrence of obstetric complications during labour and delivery. Little is known about the incidence and predictors of women's place of delivery after utilizing antenatal care services in Ethiopia and the study area. Therefore, the purpose of this study is to fill those gaps in the studies mentioned above by determining the incidence and predictors of women's place of delivery.

METHODS

An institutional-based prospective cohort study was conducted among pregnant women in public hospitals of Gedeo zone, Southern Ethiopia between May 1 and October 30, 2021. A total of 390 pregnant women receiving antenatal care at Gedeo zone public hospitals were enrolled using a systematic random sampling technique and followed up to delivery. Data were entered into Epidata version 3.1 and exported to SPSS version 25 for analysis. For both bivariate and multivariable analyses, a poison regression model was used to identify the association between the dependent and independent variables. A statistical significance level was declared at a p-value less than 0.05.

RESULTS

In this study, the overall incidence of home delivery and institutional delivery among pregnant women was 37.4% (95% CI: (32.5, 41.9)) and 62.6% (95% CI: 58.1, 67.5)) respectively. Distance from home to nearest health facility(ARR = 1.17:95%:CI (1.01,1.36), poor quality of antenatal care service(ARR = 1.40;95%:CI (1.10,1.79), no formal maternal education(ARR = 1.49;95%:CI (1.21,1.83), previous home delivery history(ARR = 1.38;95%:CI(1.22,1.56), unplanned pregnancy(ARR = 1.23;95%:CI (1.10,1.37) and history of pregnancy-related complication at health facility(ARR = 1.16;95%:CI(1.02,1.33) were predictors of home delivery.

CONCLUSIONS

The study indicated a high incidence of home birth after utilizing antenatal care services. As a result, interventions targeting those identified factors during antenatal care services are critical to reducing home births.

Spatial distribution and associated factors of dropout from health facility delivery after antenatal booking in Ethiopia: a multi-level analysis

BACKGROUND

Nowadays, retaining women in the continuum of care throughout the lifecycle: adolescence, pregnancy, childbirth, postpartum, and childhood in reproductive health is one of the recent global concerns. Most of the previous studies focused on individual-level factors and used classical logistic regression. Furthermore, it doesn't take into account its distribution. Therefore, this study aimed to assess spatial distribution, and associated factors of dropout from health facility delivery after antenatal booking among postpartum women in Ethiopia.

METHOD

Cross-sectional study by secondary analysis of the Ethiopian Mini Demographic and Health Survey (EMDHS) 2019 dataset was conducted among postpartum women. A total of 2882 women who gave birth 5 years prior to the survey were included. Sampling weight was applied and the analysis was done using STATA version 16. Aeronautical Reconnaissance Coverage Geographic Information System (ArcGIS) 10.8 software was used to map the cluster and attribute of dropout from health facility delivery and Global and local Moran's Index methods were used to assess the extent of clustering. Multi-level (two-level) logistic regression analysis was used and variables with a P value less than 0.5 were considered statistical significance. Adjusted odds ratio AOR) with a 95% confidence interval was used to show the strength and direction of the association respectively.

RESULTS

Dropout from health facility delivery after ANC (Antenatal Care) booking in Ethiopia was 35.42%, 95% CI (33.70, 37.19), and it spatially clustered (Moran's index = 0.51, P value < 0.001). From individual-level variables: women who were primary educated [AOR = 0.70, 95% CI (0.49, 0.98)], secondary educated [AOR = 0.38, 95% CI (0.19, 0.73)], lived in the middle [AOR = 0.54, 95% CI (0.29, 0.98)], richer wealth [AOR = 0.37, 95% CI (0.18, 0.78)], richest wealth [AOR = 0.21, 95% CI (0.06, 0.74)], being counseled about pregnancy and childbirth complications [AOR = 0.52, 95% CI (0.34, 0.80)] and women who had four and above ANC visit [AOR = 0.52, 95% CI (0.38, 0.71)] were negatively associated with dropout. Whereas, second birth order [AOR = 2.62, 95% CI (1.40, 4.89)], 3-4th birth order [AOR = 4.92, 95% CI (2.82, 8.60)], above 4th birth order [AOR = 4.77, 95% CI (2.16, 10.53))] were positively associated with dropout. From community-level variables: mothers who lived in Afar [AOR = 2.61, 95% CI (1.08, 6.32)] and Oromia [AOR = 2.63, 95% CI (1.15, 6.02)] were positively associated with dropout from health facility delivery after ANC booking.

CONCLUSIONS

Dropout from health facility delivery after ANC booking was high as the government's effort and its spatial distribution in Ethiopia was clustered. Increased educational status of the mother, having four or more ANC visits, counseled about pregnancy and childbirth complications, and higher household wealth were negatively associated and higher birth order, and living in Oromia and Afar region were positively associated with dropout in Ethiopia. Strengthening women's education, encouraging women to complete ANC visits, being counseled them on pregnancy and childbirth complications, and improving family wealth status will be the recalled intervention areas of the government.

Home delivery among pregnant women with ANC follow-up in Ethiopia; Evidence from the 2019 Ethiopia mini demographic and health survey

Background

Maternal mortality has remained an international public health problem although it is decreasing in recent years. Developing countries particularly Sub-Saharan African countries bears the high burden of maternal deaths. There was no study conducted to assess prevalence and associated factors of home delivery among women in Ethiopia on antenatal care (ANC) follow up nationally. Therefore, this study was conducted to assess the magnitude and associated factors of home delivery in Ethiopia.

Objectives

To assess the magnitude of home delivery and associated factors among women who had ANC follow up in Ethiopia.

Methods

Secondary data analysis was carried out using Ethiopian Mini Demography and Health Survey (EMDHS 2019). A total weighted sample of 2,143 women who had ANC follow up during pregnancy was incorporated in the study. In a generalized linear mixed model (GLMM), Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) and p < 0.05 were declared as associated factors of home delivery.

Results

The prevalence of home delivery was 31.27% [95% CI: 29.34%, 33.27%] among women who had ANC follow up in Ethiopia. Attended higher education [AOR = 0.27; 95% CI: (0.13, 0.54)], rural resident [AOR = 2.15; 95% CI: (1.19, 3.90)], richest in the wealth index [AOR = 0.18; 95% CI: (0.10, 0.32)], had adequate ANC follow up [AOR = 0.25; 95% CI: (0.13, 0.51)] and being in third trimesters [AOR = 0.64; 95% CI: (0.49, 0.83)] during first ANC visit were significantly associated factors of home delivery.

Conclusion

Near to one-third of women in Ethiopia have delivered their babies at home even if they had an ANC follow up. Educational status, place of residence, wealth index, timing of first antenatal check and adequate ANC visit has shown significant association with home delivery. Therefore, focused intervention packages need to be implemented at all levels of the health care system in Ethiopia to improve health seeking behaviors of women who have ANC follow up to have delivery in health care institutions. While doing so, special attention should be given for poor, uneducated and rural dweller women.

Spatial variation and factors associated with home delivery after ANC visit in Ethiopia; spatial and multilevel analysis

Introduction

Institutional delivery is crucial to reduce maternal and neonatal mortality as well as serious morbidities. However, in Ethiopia, home delivery (attended by an unskilled birth attendant) after antenatal care (ANC) visit is highly in practice. Therefore, this study aimed to assess the spatial variation and determinants of home delivery after antenatal care visits in Ethiopia.

Method

A secondary data analysis was conducted using the 2019 mini Ethiopian demographic and health survey. A total of 2,923 women who had ANC visits were included. Spatial analysis was done by using GIS 10.7 and SaTscan 9.6. The risk areas for home delivery from GIS and spatial scan statistics results were reported. A multi-level logistic regression model was fitted using Stata14 to identify individual and community-level factors associated with home delivery after ANC visit. Finally, AOR with 95% CI and random effects were reported.

Result

Home delivery after ANC visit was spatially clustered in Ethiopia(Moran’s index = 0.52, p-value <0.01). The primary clusters were detected in Oromia and SNNP region (LLR = 37.48, p < 0.001 and RR = 2.30) and secondary clusters were located in Benishangul Gumuz, Amhara, Tigray and Afar (LLR = 29.45, p<0.001 and RR = 1.54). Being rural resident (AOR = 2.52; 95%CI 1.09–5.78), having no formal education (AOR = 3.19;95% CI 1.11–9.16), being in the poor (AOR = 2.20;95%CI 1.51–3.22) and middle wealth index (AOR = 2.07;95% CI 1.44–2.98), having one ANC visit (AOR = 2.64; 95% CI 1.41–4.94), and living in the agrarian region (AOR = 3.63; 95%CI 1.03–12.77) had increased the odds of home delivery after ANC visit.

Conclusion and recommendation

Home delivery after ANC visit was spatially clustered in Ethiopia. Factors like maternal education, wealth index, number of ANC visits, residency and region were significantly associated with home delivery after ANC visit. Therefore, it is better to increase the number of ANC contact by giving health education, especially for women with low levels of education and better to improve the wealth status of women. A special strategy is also vital to reduce home delivery after ANC visit in those high-risk regions.

Geographical clustering and geographically weighted regression analysis of home delivery and its determinants in developing regions of Ethiopia: a spatial analysis

Background

Nearly three-fourths of pregnant women in Ethiopia give birth at home. However, the spatial pattern and spatial variables linked to home delivery in developing regions of Ethiopia have not yet been discovered. Thus, this study aimed to explore the geographical variation of home delivery and its determinants among women living in emerging (Afar, Somali, Gambella, and Benishangul-Gumuz) regions of Ethiopia, using geographically weighted regression analysis.

Methods

Data were retrieved from the Demographic and Health Survey program's official database (http://dhsprogram.com). In this study, a sample of 441 reproductive-age women in Ethiopia's four emerging regions was used. Global and local statistical analyses and mapping were performed using ArcGIS version 10.6. A Bernoulli model was applied to analyze the purely spatial cluster discovery of home delivery. GWR version 4 was used to model spatial regression analysis.

Results

The prevalence of home delivery in the emerging regions of Ethiopia was 76.9% (95% CI: 72.7%, 80.6%) and the spatial distribution of home delivery was clustered with global Moran’s I = 0.245. Getis-Ord analysis detected high-home birth practice among women in western parts of the Benishangul Gumz region, the Eastern part of the Gambela region, and the Southern and Central parts of the Afar region. Non-attendance of antenatal care, living in a male-headed household, perception of distance to a health facility as a big problem, residing in a rural area, and having a husband with no education significantly influenced home delivery in geographically weighted regression analysis.

Conclusions

More than three-fourths of mothers in the developing regions of Ethiopia gave birth at home, where high-risk locations have been identified and the spatial distribution has been clustered. Thus, strengthening programs targeted to improve antenatal care service utilization and women’s empowerment is important in reducing home birth practice in the study area. Besides, supporting the existing health extension programs on community-based health education through home-to-home visits is also crucial in reaching women residing in rural settings.

Determinants of place birth: a multinomial logistic regression and spatial analysis of the Ethiopian mini demographic and health survey data, 2019

Background

Maternal and neonatal health significantly improves when birth is attended at health institutions where there are quality services and skilled attendants. In contrary, home birth results in high rates of maternal and neonatal mortality. Thus, this study aimed to determine the spatial distribution of home birth and to identify determinants of place of birth in Ethiopia based on the recent national survey.

Methods

Ethiopian mini-DHS-2019 data was used in this analysis. A weighted sample of 5423 mothers were included. While health facility was a reference, home and health post were used as comparison categories to identify determinants of place of birth in a survey multinomial logistic regression model. An adjusted relative risk ratio, marginal effect, and a corresponding 95% confidence interval and a p-value of < 0.05 were used to declare statistical significance. The Global Moran’s I analysis was done by using ArcMap 10.8 to evaluate the clustering of home birth. The prevalence of home birth was predicted by ordinary kriging interpolation. Then, scanning was done by SaTScan V.9.6 software to detect scanning windows with low or high rates of home birth.

Result

Prevalence of home birth in Ethiopia was 52.19% (95% CI: 46.49 – 57.83). Whereas, only 2.99% (95% CI: 1.68 – 5.25) of mothers gave birth in the health posts. Bigger family size, family wealth, multiparity, none and fewer antenatal visits, and low coverage of cluster level 4 + antenatal visits were predictors of home birth. Also, home birth was clustered across enumeration areas and it was over 40% in most parts of the country with > 75% in the Somali region. SaTScan analysis detected most likely primary clusters in the Somali region and secondary clusters in the rest five regions of the country.

Conclusion

Home birth is a common practice in Ethiopia. Among public health facilities, health posts are the least utilized institutions for labor and delivery care. Nationally, implementing the 2016 WHO’s recommendations on antenatal care for a positive pregnancy experience and providing quality antenatal and delivery care in public facilities by qualified providers and back-up systems in place could be supportive.

Why Home Delivery After Full Antenatal Care Follow-Up in Southern Ethiopia? An Exploratory-Descriptive Qualitative Study

Background

Pregnant women who had full antenatal care follow-up are expected to give birth in health facilities. However, in Ethiopia, after full antenatal care booking, many women still prefer to give birth at home. Thus, the purpose of this study was to explore and describe why women give childbirth at home after full antenatal care follow-up in the study setting.

Methods

Exploratory-descriptive qualitative design was conducted in Humbo and Abala Abaya districts, Southern Ethiopia, from June to September 2020. Nine in-depth interviews and four focus group discussions were held with purposively selected participants. Women who gave birth at home after attending equal to or more than four antenatal care appointments in the last year were included. The collected data were majorly analyzed by inductive thematic analysis technique, but deductive analysis was also applied whenever the potential themes needed further enrichment. A thick description of the findings is done in the respective heading and sub-heading using participants’ verbatim quotations.

Results

A total of 9 in-depth interviews and four focus group discussions comprising 35 participants was conducted. Three major themes and nine sub-themes emerged from the data. Socio-cultural and community influences, socio-economic obstacles, and health system-related barriers are the major themes identified. Traditional practices, personal beliefs, social norms, knowledge, and attitude about institutional delivery, household economic capability, decision-making capacity of the women, delivery service quality, and service providers related barriers are the sub-themes defining the home delivery experience of women after full antenatal care follow-up in the study setting.

Conclusion

In this study, socio-economic, cultural, and health system-related barriers are major reasons for home delivery. Improvement of public awareness on the risk of home delivery and elimination of its facilitative social norms, empowerment of women’s economic, educational, and decision-making capability and healthcare workers’ and health facilities’ capacity are recommended.

The effect of lack of ANC visit and unwanted pregnancy on home child-birth in Ethiopia: a systematic review and meta-analysis

Although extensive efforts were made to improve maternal and child health, the magnitude of home child-birth is considerably high in Ethiopia. Therefore, this meta-analysis aimed to estimate the effect of lack of ANC visit and unwanted pregnancy on home child-birth among reproductive-age women in Ethiopia. International databases, including Cochrane Library, Google Scholar, PubMed, Global Health, HINARI, and CINAHL were searched systematically to identify studies reporting the prevalence of home child-birth and its association with lack of ANC visit and unwanted pregnancy among reproductive-age women in Ethiopia. STATA/SE version-14 was used to analyze the data and Der Simonian and Liard's method of random effect model was used to estimate the pooled effects. The heterogeneity between study and publication bias was assessed by using I-squared statistics and Egger's test respectively. A total of 19 studies with 25,228 study participants were included in this meta-analysis. The pooled prevalence of home child-birth among reproductive-age women in Ethiopia was 55.3%. Sever heterogeneity was exhibited among the included studies (I² = 99.8, p = 0.000). The odds of home child-birth among mothers who have no ANC visit was 3.64 times higher compared to their counterparts [OR = 3.64, 95%, CI: (1.45, 9.13)]. There was significant heterogeneity among the included studies (I² = 94%, p = 0.000). However, there was no statistical evidence of publication bias in the pooled effect of lack of ANC visit on home child-birth (P = 0.302). Women who experienced unwanted pregnancy were 3.02 times higher to give birth at home compared to women with a wanted pregnancy [OR = 3.02, 95%CI: (1.19, 7.67)]. Severe heterogeneity was exhibited (I² = 93.1%, p = 0.000) but, there was no evidence of significant publication bias in the pooled effect of unwanted pregnancy on home child-birth (P = 0.832). The proportion of home child-birth among reproductive-age women in Ethiopia remains high. Lack of ANC visit and unwanted pregnancy had a significant effect on the practice of home child-birth. Strengthening behavioral change communication programs should be the primary focus area to improve institutional delivery service utilization among women with lack of ANC visit and unwanted pregnancy.

Why Women in Ethiopia Give Birth at Home? A Systematic Review of Literature

Objective

This study aimed at reviewing identifying reasons for home delivery preference, determining the status of homebirth in Ethiopia, and identifying socio-demographic factors predicting home delivery in Ethiopia.

Methods

A systematic literature review regarding the status of homebirth, reasons why women preferred homebirth and socio-demographic determinants of home deliveries was performed using CINAHL, MEDLINE, Google Scholar and Maternity and Infant Care. Keywords and phrases such as home birth, home delivery, childbirth, prevalence, determinants, predictors, women and Ethiopia were included in the search.

Results

A total of 10 studies were included in this review. The mean proportion of homebirth was 73.5%. Maternal age, ANC visits, maternal level of education, distance to facilities, and previous facility birth were significantly associated with homebirth. Perceived poor quality of service, distant location of facilities, homebirth as customary in the society and perceived normalness of labour were identified as reasons for choosing homebirth.

Conclusion

Despite the significance of skilled birth attendants in reducing maternal and newborn morbidity and mortality, unattended homebirth remains high. By identifying and addressing socio-demographic enablers of home deliveries, maternal health service uptake can be improved.

Why women choose to deliver at home in India: a study of prevalence, factors, and socio-economic inequality

BACKGROUND

To promote institutional delivery, the Government of India, through the Janani Suraksha Yojana (JSY) program, gives monetary reward to all pregnant women who give birth at the government or private health center. Despite providing cash assistance, a higher number of women are still preferring delivering at home. Therefore, this study sought to determine the prevalence of home births and identifying the factors influencing women's choice of home deliveries.

METHODS

Data from the National Family Health Survey (NFHS) conducted during 2005-06 and 2015-16 were used in the study. The respondents were women 15-49 years; a sample of 36,850 and 190,898 women in 2005-06 and 2015-16 respectively were included in the study. Multivariate logistic regression was used to determine the factors influencing home delivery. Income-related inequality in home delivery was quantified by the concentration index (CI) and the concentration curve (CC), and decomposition analysis was used to examine the inequality in the prevalence of home deliveries.

RESULTS

The prevalence of home deliveries has reduced from 58.5% in 2005-06 to 18.9% in 2015-16. The odds of delivering babies at home were lower among women who had full ANC in 2005-06 [AOR: 0.34; CI: 0.28-0.41] and in 2015-16 [AOR: 0.41; CI: 0.38-0.45] and were higher among women with four or higher parity in 2005-06 [AOR: 1.70; CI: 1.49-1.92] and in 2015-19 [AOR: 2.16; CI: 2.03-2.30]. Furthermore, the odds of delivering babies at home were higher among rural women and were lower among women with higher education. It was found that the value of CI increased from - 0.25 to - 0.39 from 2005-06 to 2015-16; this depicts that women delivering babies at home got more concentrated among women from lower socio-economic status.

CONCLUSION

There is a need to promote institutional deliveries, particular focus to be given to poor women, women with higher parity, uneducated women, and rural women. ANC is the most concurring contact point for mothers to get relevant information about the risks and complications they may encounter during delivery. Therefore, effort should be directed to provide full ANC. Targeted interventions are called for to bring improvements in rural areas.

The impact of malaria during pregnancy on low birth weight in East-Africa: a topical review

Background

Globally, approximately 15% of all babies are born with low birth weight (< 2.5 kg) and ≥ 90% of them are born in low- and middle-income countries. Malaria infection in pregnancy remains a public health concern as it can affect both the mother and the newborn. Notably, it increases the risk of newborns with low birth weight. The World Health Organization (WHO) recommends intermittent preventive treatment with ≥ 3 doses of sulfadoxine-pyrimethamine (SP) during pregnancy in areas with moderate to high malaria transmission in Africa. The aim of this topical review is to give an overview of the impact of malaria infection during pregnancy on low birth weight, with focus on East Africa where malaria is endemic.

Methods

Eleven studies were selected according to a predefined set of criteria.

Results

Three studies showed a significant reduction in the prevalence of low birth weight with intermittent preventive treatment with SP, whereas four studies found no significant impact of such treatment on low birth weight. The number of SP doses and compliance to this treatment may in part explain these discrepancies. Pregnant women with frequent symptomatic malaria infection had significantly higher risk of placental malaria.

Conclusion

The WHO recommendation of ≥ 3 doses of intermittent preventive treatment with SP during pregnancy seem effective in preventing low birth weight, but treatment compliance is a challenge. Malaria prophylaxis is important during pregnancy, especially in endemic areas of malaria, such as East Africa.

Home delivery practice and its predictors in South Ethiopia

BACKGROUND

Institutional delivery is one of the key interventions to reduce maternal death. It ensures safe birth, reduces both actual and potential complications, and decreases maternal and newborn death. However, a significant proportion of deliveries in developing countries like Ethiopia are home deliveries and are not attended by skilled birth attendants. We investigated the prevalence and determinants of home delivery in three districts in Sidama administration, Southern Ethiopia.

METHODS

Between 15-29 October 2018, a cross sectional survey of 507 women who gave birth within the past 12 months was conducted using multi-stage sampling. Sociodemographic and childbirth related data were collected using structured, interviewer administered tools. Univariate and backward stepwise multivariate logistic regression models were run to assess independent predictors of home delivery.

RESULTS

The response rate was 97.6% (495). In the past year, 22.8% (113), 95% confidence interval (CI) (19%, 27%) gave birth at home. Rural residence, adjusted odds ratio (aOR) = 13.68 (95%CI:4.29-43.68); no maternal education, aOR = 20.73(95%CI:6.56-65.54) or completed only elementary school, aOR = 7.62(95% CI: 2.58-22.51); unknown expected date of delivery, aOR = 1.81(95% CI: 1.03-3.18); being employed women (those working for wage and self-employed), aOR = 2.79 (95%CI:1.41-5.52) and not planning place of delivery, aOR = 26.27, (95%CI: 2.59-266.89) were independently associated with place of delivery.

CONCLUSION

The prevalence of institutional delivery in the study area has improved from the 2016 Ethiopian Demography Health Survey report of 26%. Uneducated, rural and employed women were more likely to deliver at home. Strategies should be designed to expand access to and utilization of institutional delivery services among the risky groups.

Factors affecting the choice of delivery place in a rural area in Laos: A qualitative analysis

BACKGROUND

Home delivery (HD) without skilled birth attendants (SBAs) are considered crucial risk factors increasing maternal and child mortality rates in Loa PDR. While a few studies in the literature discuss the choice of delivery in remote areas of minority ethnic groups; our work aims to identify factors that indicated their delivery place, at home or in the health facilities.

METHODS

A community-based qualitative study was conducted between February and March 2020. Three types of interviews were implemented, In-depth interviews with 16 women of eight rural villages who delivered in the last 12 months in Xepon District, Savannakhet Province, Lao PDR. Also, three focus group discussions (FGDs) with nine HCPs and key-informant interviews of ten VHVs were managed. Factors affecting the choice of the delivery place were categorized according to the social-ecological model.

RESULTS

Our sample included five Tri women and two Mangkong women in the HD group, while the FD group included three Tri women, two Mangkong women, one Phoutai woman, two Laolung women and one Vietnamese. Our investigation inside the targeted minority showed that both positive perceptions of home delivery (HD) and low-risk perception minorities were the main reasons for the choice of HD, on the individual level. On the other hand, fear of complication, the experience of stillbirth, and prolonged labour pain during HD were reasons for facility-based delivery (FD). Notably, the women in our minority reported no link between their preference and their language, while the HCPs dated the low knowledge to the language barrier. On the interpersonal level, the FD women had better communication with their families, and better preparation for delivery compared to the HD group. The FD family prepared cash and transportation using their social network. At the community level, the trend of the delivery place had shifted from HD to FD. Improved accessibility and increased knowledge through community health education were the factors of the trend. At the societal (national policy) level, the free delivery policy and limitation of HCPs' assisted childbirth only in health facilities were the factors of increasing FD, while the absence of other incentives like transportation and food allowance was the factor of remaining of HD.

CONCLUSIONS

Based on the main findings of this study, we urge the enhancement of family communication on birth preparedness and birthplace. Furthermore, our findings support the need to educate mothers, especially those of younger ages, about their best options regarding the place of delivery. We propose implementing secondary services of HD to minimize the emergency risks of HD. We encourage local authorities to be aware of the medical needs of the community especially those of pregnant females and their right for a free delivery policy.

Childbirth at home and associated factors in Ethiopia: a systematic review and meta-analysis

Background

Maternal mortality remains a major challenge to health systems worldwide. Although most pregnancies and births are uneventful, approximately 15% of all pregnant women develop potentially life-threatening complications. Childbirth at home in this context can be acutely threatening, particularly in developing countries where emergency care and transportation are less available. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of home childbirth and its associated factors among women in Ethiopia at their last childbirth.

Method

For this review, we used the standard PRISMA checklist guideline. This search included all published and unpublished observational studies written only in English language and conducted in Ethiopia. PubMed/Medline, Hinari, EMBASE, Google Scholar, Science Direct, Scopus, Web of Science (WoS), ProQuest, Cochrane Library, African Journals Online, Ethiopian’s university research repository online library were used. Based on the adapted PICO principles, different search terms were applied to achieve and access the essential articles from February 1–30, 2020. The overall selected search results were 40 studies. Microsoft Excel was used for data extraction and Stata version 11.0 (Stata Corporation, College Station, Texas, USA) for data analysis. The quality of individual studies was appraised by using the Joanna Briggs Institute (JBI) quality appraisal checklist. The heterogeneity of the studies was assessed by the Cochrane Q and I2 test. With the evidence of heterogeneity, subgroup analysis and sensitivity analysis were computed. The pooled prevalence of childbirth at home and the odds ratio (OR) with a 95% confidence interval was presented using forest plots.

Result

Seventy-one thousand seven hundred twenty-four (71, 724) mothers who gave at least one birth were recruited in this study. The estimated prevalence of childbirth at home in Ethiopia was 66.7% (95%CI: 61.56–71.92, I2 = 98.8%, p-value < 0.001). Being from a rural area (adjusted odds ratio (AOR) 6.48, 95% confidence interval (CI): 3.48–12.07), being uneducated (AOR = 5.90, 95% CI: 4.42–7.88), not pursuing antenatal (ANC) visits at all (AOR = 4.57(95% CI: 2.42–8.64), having 1–3 ANC visits only (AOR = 4.28, 95% CI: 3.8–8.26), no birth preparedness and complication readiness plan (AOR = 5.60, 95% CI: 6.68–8.25), no media access (AOR = 3.46, 95% CI: 2.27–5.27), having poor knowledge of obstetric complications (AOR = 4.16: 95% CI: 2.84–6.09), and walking distance more than 2 hours to reach the nearest health facility (AOR = 5.12, 95% CI: 2.94–8.93) were the factors associated with giving childbirth at home.

Conclusion

The pooled prevalence of childbirth at home was high in Ethiopia. Being from a rural area, being uneducated, not pursuing ANC visits at all, having 1–3 ANC visits only, no media access, having poor knowledge of obstetric complications, not having a birth preparedness and complication readiness plan, and walking time greater than 2 hours to reach the nearest health facility increased the probability of childbirth at home in Ethiopia.

Institutional Delivery Among Young Women in Ethiopia: Further Analysis of Trends and Determinants, from the Four Consecutive Ethiopia Demographic and Health Survey

PURPOSE

Although young people have a right to sexual and reproductive health, they are facing inadequate access to information and services. The Ethiopian government has started implementing policies and strategies to eliminate inequalities in reproductive health service use. However, there are huge disparities in institutional delivery utilization between different age groups. Therefore, this study aimed to explore trends and factors associated with institutional childbirth among young women in Ethiopia.

METHODS

Ethiopian demographic and health survey data (EDHS) from 2000 to 2016 surveys were used. Data on the most recent births to women aged 15-24 years that occurred in the 5 years preceding the survey period were extracted. All the four EDHS data were used to examine trends of institutional delivery, whereas determinants for institutional delivery were analyzed from a 2016 dataset by using multivariable logistic regression analysis.

FINDINGS

Between 2000 and 2016, the proportion of institutional delivery among young women increased from 6% (95% CI=3.7-6.5%) to 40.1% (95% CI=30.6-44.3%). The odds of institutional delivery increased for young women who had attended secondary and above education (AOR=2.68; 95% CI=1.559-4.607), started ANC visits early (AOR=1.518; 95% CI=1.095-2.105) and received four or more ANC visits (AOR=1.87; 95% CI=1.370-2.561). However, the odds were lower among young women who had two (AOR=0.31; 95% CI=0.185-0.514), and three or more children (AOR=0.62; 95% CI=0.452-0.849).

CONCLUSION

There is an increase in trend of institutional delivery among young women during the 2000 to 2016 EDHS. Having higher educational levels, early ANC booking, and attending four or more ANC visits were positively associated with institutional delivery. Increased number of children is negatively associated with institutional delivery. Strengthening strategies for improving girls' education and addressing their socioeconomic and demographic vulnerabilities, and strengthening strategies being implemented for encouraging early and recommended ANC visits is crucial.

Determinants of Home Delivery Among Women in Rural Pastoralist Community of Hamar District, Southern Ethiopia: A Case-Control Study

Purpose

Studies addressing determinants of home delivery in pastoralist areas are scarce in Ethiopia. In this study, we aimed to assess determinants of home delivery in rural pastoralist communities of Hamar District, Southern Ethiopia.

Patients and Methods

In April 2018, we conducted a community-based case–control study. Of 35 rural kebeles (lowest level of administration) in the district, 8 were randomly selected. Ninety-nine randomly selected cases (mothers who gave birth at home) and 193 controls (mothers who gave birth at health facility) were included in the study. We used structured questionnaires to collect data. Through face-to-face interview, data on place of delivery, socio-demographic characteristics, obstetric history knowledge and attitude of mothers were collected. We used logistic regression model to measure association between variables.

Results

Late initiation of antenatal care (AOR = 4.6, 95% CI = 1.2, 17.1), husbands only decision-making (adjusted odds ratio [AOR] =7.2, 95% CI = 2.1, 24.5), women’s preference for traditional birth attendants (TBAs) (AOR = 3.9, 95% CI = 1.2, 12.5), and not involving in women’s development army (WDA), (AOR = 3.3, 95% CI = 1.0, 10.5) increased the risk of home delivery. Moreover, low maternal knowledge on danger signs of pregnancy (AOR = 6.5, 95% CI = 1.5, 29.0) and negative maternal attitudes towards institutional delivery (AOR = 4.4, 95% CI = 1.4, 14.1) were other factors that increased the risk of home delivery.

Conclusion

Among our study participants, a number of factors increased the risk of home delivery. Improving women’s awareness on the importance of institutional delivery, establishing systems for integration between TBAs and health facilities, empowering women and promoting them to participation in WDA were recommended.

Women's Choice to Deliver at Home: Understanding the Psychosocial and Cultural Factors Influencing Birthing Choices for Unskilled Home Delivery among Women in Southwestern Uganda

BACKGROUND

Utilization of perinatal services in Uganda remains low, with correspondingly high rates of unskilled home deliveries, which can be life-threatening. We explored psychosocial and cultural factors influencing birthing choices for unskilled home delivery among postpartum women in rural southwestern Uganda.

METHODS

We conducted in-depth qualitative face-to-face interviews with 30 purposively selected women between December 2018 and March 2019 to include adult women who delivered from their homes and health facility within the past three months. Women were recruited from 10 villages within 20 km from a referral hospital. Using the constructs of the Health Utilization Model (HUM), interview topics were developed. Interviews were conducted and digitally recorded in a private setting by a native speaker to elicit choices and experiences during pregnancy and childbirth. Translated transcripts were generated and coded. Coded data were iteratively reviewed and sorted to derive categories using inductive content analytic approach.

RESULTS

Eighteen women (60%) preferred to deliver from home. Women's referent birth location was largely intentional. Overall, the data suggest women choose home delivery (1) because of their financial dependency and expectation for a "natural" and normal childbirth, affecting their ability and need to seek skilled facility delivery; (2) as a means of controlling their own birth processes; (3) out of dissatisfaction with facility-based care; (4) out of strong belief in fate regarding birth outcomes; (5) because they have access to alternative sources of birthing help within their communities, perceived as "affordable," "supportive," and "convenient"; and (6) as a result of existing gender and traditional norms that limit their ability and freedom to make family or health decisions as women.

CONCLUSION

Women's psychosocial and cultural understandings of pregnancy and child birth, their established traditions, birth expectations, and perceptions of control, need, and quality of maternity care at a particular birthing location influenced their past and future decisions to pursue home delivery. Interventions to address barriers to healthcare utilization through a multipronged approach could help to debunk misconceptions, increase perceived need, and motivate women to seek facility delivery.

Magnitude of home delivery and associated factors among child bearing age mothers in Sherkole District, Benishangul Gumuz regional state-Western-Ethiopia

Background

The World Health Organization estimates that globally only 43% of women have access to skilled care during deliveries and the rest are exposed to unskilled delivery service. A recent Ethiopian Demographic and Health Survey report stated that maternal death was 412 per 100,000 in 2016.This still indicates that maternal health remains a major public health problem in Ethiopia irrespective of the government’s measure to institutional delivery. Therefore, the aim of this study was to assess the magnitude of home delivery and associated factors among women of child bearing age in Sherkole district, Western Ethiopia.

Methods

A community based cross sectional study was conducted among women aged 15–49 years in Sherkole district, Benishangul Gumuz region from January to June 2018. A total of 451 randomly selected women were included in the study. Stratified sampling followed by simple random sampling technique was used to select the study participants. Data were collected using pretested and structured questionnaires. Bivariate and multivariate logistic regression models were fitted to identify factors associated with home delivery among women in the child bearing age. An adjusted odds ratio with a 95% confidence interval was computed to determine the level of significance.

Results

The magnitude of home delivery was 353 (80%) and were assisted by non-skilled birth attendants. Mothers whose husband chooses the place of delivery [AOR: 5.6, 95% CI (2.1–15.2), Mothers’ occupation ([AOR: 0.21 95% C I (0.08–0.57), ANC visit [AOR: 95 CI: 5.1(1.6–15.8), decision making [AOR: 95 CI: 0.3(0.01–0.7)] and traditional remedies [AOR: 95%CI: 0.03 (0.01–0.09)] were significantly associated with home delivery.

Conclusions

Based on the findings of the survey, it was concluded that the overall magnitude of home delivery was found to be high. Therefore, it is recommended that the promotion of antenatal care follow-up with maternal and child health information particularly on delivery complications or danger signs needs due attention and remedial actions. In addition, it is indispensable introducing defaulter tracing mechanisms in ANC services, by learning from experiences of settings that have already adopted it.

Spatial clustering and determinants of home birth after at least one antenatal care visit in Ethiopia: Ethiopian demographic and health survey 2016 perspective

BACKGROUND

All pregnancies are at risk and have to be attended by skilled professionals. In Ethiopia however nearly half (45.7%) of the women were giving birth at home after antenatal care (ANC) visits in which skilled professionals were not available. Therefore, the aim of this study was to assess spatial clustering and the determinant factors of home delivery after antenatal care visits in Ethiopia.

METHODS

A case control study was conducted on 2110 mothers who gave birth at home after ANC (cases), and 2510 mothers who gave birth at health institutions after attending ANC (controls), based on EDHS 2016 data. As per the recommendations of the DHS program, we weighed the data before analysis. ArcGIS 10.3 was used to show spatial pattern and SaTScan™ 9.4 to identify significant clusters. Stata 14 was used for data cleaning, weighing, and the analysis of the determinant factors. Bi variable and multi variable multilevel mixed effect logistic regression was fitted. Finally, the Log-likelihood ratio (LLR) and Relative risk with p-value of spatial scan statistics and AOR with 95% CI for significant determinant factors were reported.

RESULTS

Home delivery after ANC was spatially clustered in Ethiopia (Moran's Index = 0.91, p-value< 0.01). Attending, 1-3 ANC visits (AOR = 1.41, 95%CI: 1.17-1.71), no information about birth preparedness plan (AOR = 2.21, 95%CI: 1.83-2.69), pregnancies wanted later (AOR = 1.55, 95%CI: 1.20, 2.06), not having health insurance (AOR = 2.16, 95% CI: 1.29, 3.62), Muslim (AOR = 1.57, 95% CI: 1.13, 2.19) and protestant (AOR = 1.72, 95%CI: 1.16, 2.42) religions were positively associated with home delivery; While being rich (AOR = 0.42, 95%CI: 0.32-0.54), middle wealth index (AOR = O.66, 95%CI: 0.51, 0.86), primary education (AOR = 0.45, 95%CI: 0.36-0.55), secondary education (AOR = 0.11, 95%CI: 0.07-0.16), above secondary education (AOR = 0.06, 95%CI: 0.03-0.11) were negatively associated.

CONCLUSIONS

Home delivery after ANC follow ups was spatially clustered. Socio-demographic, health service and pregnancy related factors determined the prevalence of home delivery after antenatal care visits. Strengthening women's education, ANC visit, giving more information about birth preparedness plan, and improving family wealth are vital to reduce home delivery after antenatal care visits.

Association between antenatal care follow-up and institutional delivery service utilization: analysis of 2016 Ethiopia demographic and health survey

BACKGROUND

Globally, the magnitude of maternal mortality is the major public health problem. Nearly all (99%) of maternal deaths occur in low- and middle-income countries. Of which 66% occur in sub-Saharan Africa. Institutional delivery under the hygienic environment with the necessary skills and equipment promotes to identify and treat complications, infections, and the death of the mother and baby. In Ethiopia, the utilization of maternal health services is very low. For instance, 62% of women had antenatal care utilization during pregnancy while only 26% of women utilize institutions for delivery in 2016. Therefore, this study examined the association between antenatal care follow up and intestinal delivery among a nationally representative woman in Ethiopia.

METHODS

A cross-sectional study design was used to examine 7575 women from the 2016 Ethiopia Demographic and Health Survey. Both descriptive and inferential statistics were utilized. Variables in the bivariate logistic regression with p-value < 0.2 were entered into the multivariable logistic regression. Odds ratios and corresponding 95% confidence intervals (CI) were reported. In the multivariable analysis, variables with p-value < 0.05 were considered as statistically significant.

RESULTS

The prevalence of institutional delivery service utilization for last childbirth was 11.3%. In comparison with women with no antenatal care visits, the multivariable odds ratio (95% confidence interval) of institutional delivery among those who attend one to three and four or more antenatal care visit were 2.49 (1.66, 3.74) and 3.90 (2.60, 5.84), respectively. Other factors significantly associated with institutional delivery include urban residence 2.25 (1.44, 3.51), complete primary education 3.22 (2.09, 4.98), complete secondary or higher education 1.59 (1.16, 2.17), poorer household wealth index 2.57 (1.57, 4.20), middle household wealth index 1.63 (1.05, 2.52), and richer household wealth index 1.56(1.03, 2.58).

CONCLUSION

Antenatal care follow-up was significantly associated with institutional delivery service utilization. As the number of antenatal care visits increased the odds of facility delivery increased. Thus, improved access and utilization of antenatal care can be an effective strategy to increase institutional deliveries and optimal maternal and child health outcomes.

Overview of Anorectal Malformations in Africa

Anorectal malformation is one of the most common structural congenital malformations treated by pediatric surgeons globally. The outcome of care is largely dependent on the spectrum, clinical features, associated malformations, expertise of the surgeons, and available perioperative facilities. Africa has a large burden of unmet surgical needs in children, and as in other low resource settings, local pediatric surgeons are faced with different and challenging clinical scenarios, hence, adopt various measures to enable children with surgically correctable congenital malformations to survive. There are increasing collaborations between local surgeons and experts in other continents, which often involves surgeons traveling to Africa on missions or well-structured partnerships. It is highly beneficial for the physician who is interested in global-surgery to understand the terrain in low resource settings and prepare for possible changes in management plan. This review highlights the epidemiology, clinical presentation, treatment, and outcome of care of children with anorectal malformations in Africa and provides options adopted by pediatric surgeons working with limited resources.

Facility delivery and postnatal care services use among mothers who attended four or more antenatal care visits in Ethiopia: further analysis of the 2016 demographic and health survey

Background

Antenatal care provides the best opportunity to promote maternal and child health services use. But many Ethiopian mothers deliver at home and fail to attend postnatal care. Therefore, this study was done to identify factors associated with health facility delivery among mothers who attended four or more antenatal care visits. The study was also intended to identify factors associated with postnatal care service use among mothers who delivered at home after four or more antenatal care visits.

Methods

This study used the 2016 Ethiopian Demographic and Health Survey data. Two thousand four hundred fifteen women who attended four or more antenatal care visits were included to identify factors associated with health facility delivery after four or more antenatal care visits. Among them, 1055 mothers delivered at home. These women were included to identify factors associated with postnatal care service use. Stata 15.1 was used to analyze the data. Multivariable logistic regression model was fitted to identify associations between the outcome and predictor variables.

Results

Among women who had four or more antenatal care visits, 56% delivered at health facility. Mothers with secondary or higher level of education (AOR = 2.9; 95% CI = 1.6–5.3), urban residents (AOR = 3.4; 95% CI = 1.9–6.1), women with highest wealth quintile (AOR = 2.7; 95% CI = 1.5–4.8), and working women (AOR = 1.6; 95% CI = 1.2–2.3) had higher odds of delivering at health facilities. High birth order (AOR = 0.5; 95% CI = 0.3–0.7) was negatively associated with a lower likelihood of health facility delivery. Among women who delivered at home, only 8% received postnatal care within 42 days after delivery. Only the content of care received during antenatal care visits (AOR = 1.40; 95% CI = 1.1–1.8) was significantly associated with postnatal care attendance.

Conclusion

Women with lower socio-economic status had lower odds of giving birth at health facility even after attending antenatal care. The more antenatal care components a mother received, the higher her probability of delivering at health facility. Similarly, postnatal care attendance was higher among women who had received more antenatal care components.

Home birth and its determinants among antenatal care-booked women in public hospitals in Wolayta Zone, southern Ethiopia

Introduction

Antenatal care (ANC), health facility birth and postnatal care services are proved to reduce maternal and newborn morbidity and mortality. In Ethiopia, even though antenatal care coverage is good, still home birth is high. This study aimed to assess the prevalence and determinants of home birth among women who were booked for ANC in public hospitals in Wolaita zone, southern Ethiopia.

Methods

A cohort study was conducted from February to May 2017 among 554 third trimester pregnant mothers who visited public hospitals of Wolaita Zone, southern Ethiopia for ANC service. All women were interviewed twice: the first interview was done face-to-face in the health facility in which they were having ANC follow up to gather information about basic socio-demographic and obstetric characteristics; the second interview was done via telephone after they gave birth to get information about the place of birth. Epi-Data version 3.1 was used for data entry and the Statistical Package for the Social Sciences (SPSS) version 22 was used for data analysis.

Results

A total of 68 (13.5%; 95% Confidence Interval (CI): 10.5%-16.6%) women who were booked for ANC gave birth at home. Being uneducated (AOR = 2.46, 95% CI: [1.10–5.10]), starting ANC visit late (>16weeks) (AOR = 2.27, 95% CI: [1.14–4.50]), time taken to reach at health facility for ANC service (>30minutes) (AOR = 8.94, 95% CI: [4.50–17.72]), waiting time of greater than 30 minutes for ANC in health facilities (AOR = 1.18, 95% CI: [1.06–2.30]) and lack of knowledge about danger signs of pregnancy (AOR = 4.18, 95%CI: [1.80–9.70]) were significantly associated with home birth.

Conclusions

Home birth among ANC booked women is low compared to other studies. Yet, giving attention to women with no education and those coming from far areas while providing advice on birth preparedness and pregnancy danger signs may be useful to further reduce the rate of home birth. Advising mothers to start ANC early and trying to reduce ANC waiting time could also be of importance.

The effect of antenatal care on use of institutional delivery service and postnatal care in Ethiopia: a systematic review and meta-analysis

Background

Although there are many initiatives to improve maternal health services use, utilization of health facility delivery and postnatal care services is low in Ethiopia. Current evidence at global level showed that antenatal care increases delivery and postnatal care services use. But previous studies in Ethiopia indicate contrasting results. Therefore, this meta-analysis was done to identify the effect of antenatal care on institutional delivery and postnatal care services use in Ethiopia.

Methods

Studies were searched from databases using keywords like place of birth, institutional delivery, and delivery by a skilled attendant, health facility delivery, delivery care, antenatal care, prenatal care and postnatal care and Ethiopia as search terms. The Joanna Briggs Critical Appraisal Tools and the Preferred Reporting Items for Systematic Review and Meta-Analyses were used for quality assessment and data extraction. Data analysis was done using STATA 14. Heterogeneity and publication bias were assessed using I² test statistic and Egger’s test of significance. Forest plots were used to present the odds ratio (OR) with 95% confidence interval (CI).

Result

A total of 40 articles with a total sample size of 26,350 were included for this review and meta-analysis. Mothers who had attended one or more antenatal care visits were more likely (OR = 4.07: 95% CI 2.75, 6.02) to deliver at health institutions compared to mothers who did not attend antenatal care. Similarly, mothers who reported antenatal care use were about four times more likely to attend postnatal care service (OR 4.11, 95% CI: 3.32, 5.09).

Conclusion

Women who attended antenatal care are more likely to deliver in health institutions and attend postnatal care. Therefore, the Ethiopian government and other stakeholders should design interventions that can increase antenatal care uptake since it has a multiplicative effect on health facility delivery and postnatal care services use. Further qualitative research is recommended to identify why the huge gap exists between antenatal care and institutional delivery and postnatal care services use in Ethiopia.

Why Do Some Ethiopian Women Give Birth at Home after Receiving Antenatal Care? Phenomenological Study

BACKGROUND

In Ethiopia, majority (62%) of pregnant women receive at least one antenatal follow-up, yet only 26% give birth in health facility. Understanding factors underlying this high uptake of antenatal care and low institutional delivery service is critical. Women had antenatal care follow-up means; by default they have access to health facilities. Thus, why do some give birth at home even after receiving antenatal care? Methods. Fourteen key informant interviews and six focused group discussions were held among purposively selected women who gave birth in the last 12 months without skilled attendance after receiving antenatal care. The study explored women's perspectives on maternity care, care providers, and factors that influence place of delivery. Interpretative phenomenological analysis was used to examine various behaviors and beliefs of respondents.

RESULTS

Study participants described range of experiences and beliefs that made them give birth at home after receiving antenatal care at health facilities. Four themes emerged from women's description: poor counseling during antenatal care service, traditions, early pregnancy symptoms, and lack of planning in advance for childbirth.

CONCLUSION

Poor counseling during antenatal care is deterring women from seeking skilled attendance at birth. Thus, healthcare providers need to stress necessity of facility based delivery care during antenatal follow-up counseling.