Individual and community-level determinants, and spatial distribution of institutional delivery in Ethiopia, 2016: Spatial and multilevel analysis

Determinants of preterm birth among reproductive age women in sub-Saharan Africa: Evidence from the most recent Demographic and Health Survey data-2019-2022

INTRODUCTION

Preterm birth is the leading cause of both infant and neonatal mortality. It also had long-term consequences for the physical and neurological development of a growing child. The majority of these and related problems occur in low- and middle-income countries, particularly in sub-Saharan Africa, due to resource scarcity to sustain the lives of premature babies. Despite this, there is a paucity of recent information on the pooled prevalence and factors associated with preterm birth in sub-Saharan Africa. Therefore, this study aimed to update the pooled prevalence and determinants of preterm birth in sub-Saharan Africa based on the most recent Demographic and Health Survey data.

METHODS

A cross-sectional study design using the most recent demographic and health survey data from eight sub-Saharan African countries was used. We included a total weighted sample of 74,871 reproductive-aged women who gave birth in the five years preceding the survey. We used a multilevel logistic regression model to identify associated factors of preterm birth in sub-Saharan Africa. The adjusted odds ratio at 95% Cl was computed to assess the strength and significance of the association between explanatory and outcome variables. Factors with a p-value of <0.05 are declared statistically significant.

RESULTS

In this study, the pooled prevalence of preterm birth among reproductive-aged women in eight sub-Saharan African countries was 3.11% (95% CI: 2.98-3.25). Working mothers (AOR = 0.61; 95% CI: 0.38-0.97), being married (AOR = 0.63; 95% CI: 0.40-0.99), and having media exposure (AOR = 0.59; 95% CI: 0.36-0.96) decrease the odds of preterm birth. On the other hand, being low birth weight (AOR = 17.7; 95% CI: 10.7-29.3), having multiple pregnancies (AOR = 3.43; 95% CI: 1.82-6.45), having a history of terminated pregnancies (AOR = 1.56; 95% CI: 1.01-2.41), being un-educated (AOR = 3.16; 95% CI: 1.12-8.93), being of a maternal age above 35 (AOR = 1.63; 95% CI: 1.08-2.45), maternal alcohol use (AOR = 19.18; 95% CI: 13.6-38.8), and being in the low socio-economic status (AOR = 1.85; 95% CI: 1.11-3.07) of the community increase the odds of preterm birth.

CONCLUSION

The burden of preterm birth among reproductive-age women in sub-Saharan Africa showed improvements as compared to previous findings. To further lessen the burden, policymakers and other pertinent organizations must prioritize maternal health, expand media access, educate and empower women, and promote a healthy lifestyle for reproductive-age women.

What predicts health facility delivery among women? analysis from the 2021 Madagascar Demographic and Health Survey

BACKGROUND

One of the pivotal determinants of maternal and neonatal health outcomes hinges on the choice of place of delivery. However, the decision to give birth within the confines of a health facility is shaped by a complex interplay of sociodemographic, economic, cultural, and healthcare system-related factors. This study examined the predictors of health facility delivery among women in Madagascar.

METHODS

We used data from the 2021 Madagascar Demographic and Health Survey. A total of 9,315 women who had a health facility delivery or delivered elsewhere for the most recent live birth preceding the survey were considered in this analysis. Descriptive analysis, and multilevel regression were carried out to determine the prevalence and factors associated with health facility delivery. The results were presented as frequencies, percentages, crude odds ratios and adjusted odds ratios (aORs) with corresponding 95% confidence intervals (CIs), and a p-value < 0.05 was used to declare statistical significance.

RESULTS

The prevalence of health facility delivery was 41.2% [95% CI: 38.9-43.5%]. In the multilevel analysis, women aged 45-49 [aOR = 2.14, 95% CI = 1.34-3.43], those with secondary/higher education [aOR = 1.62, 95% CI = 1.30-2.01], widowed [aOR = 2.25, 95% CI = 1.43-3.58], and those exposed to mass media [aOR = 1.18, 95% CI = 1.00-1.39] had higher odds of delivering in health facilities compared to those aged 15-49, those with no formal education, women who had never been in union and not exposed to mass media respectively. Women with at least an antenatal care visit [aOR = 6.95, 95% CI = 4.95-9.77], those in the richest wealth index [aOR = 2.74, 95% CI = 1.99-3.77], and women who considered distance to health facility as not a big problem [aOR = 1.28, 95% CI = 1.09-1.50] were more likely to deliver in health facilities compared to those who had no antenatal care visit. Women who lived in communities with high literacy levels [aOR = 1.54, 95% CI = 1.15-2.08], and women who lived in communities with high socioeconomic status [aOR = 1.72, 95% CI = 1.28-2.31] had increased odds of health facility delivery compared to those with low literacy levels and in communities with low socioeconomic status respectively.

CONCLUSION

The prevalence of health facility delivery among women in Madagascar is low in this study. The findings of this study call on stakeholders and the government to strengthen the healthcare system of Madagascar using the framework for universal health coverage. There is also the need to implement programmes and interventions geared towards increasing health facility delivery among adolescent girls and young women, women with no formal education, and those not exposed to media. Also, consideration should be made to provide free maternal health care and a health insurance scheme that can be accessed by women in the poorest wealth index. Health facilities should be provided at places where women have challenges with distance to other health facilities. Education on the importance of antenatal care visits should also be encouraged, especially among women with low literacy levels and in communities with low socioeconomic status.

Complementary feeding practices and associated factors among mothers of children aged 6 to 23 months in Sub-saharan African countries: a multilevel analysis of the recent demographic and health survey

INTRODUCTION

Malnutrition is a public health problem in sub-Saharan Africa with an increased morbidity and mortality rate than in other parts of the world. Poor complementary feeding practices are one of the major causes of malnutrition during the first two years of life. Therefore, this study aimed to determine the prevalence and associated factors of appropriate complementary feeding practices among mothers of children aged 6 to 23 months in sub-Saharan African countries.

METHODS

A multilevel mixed-effect analysis was carried out using recent demographic health survey data from 19 sub-Saharan African countries, which were conducted between 2015 and 2020. A total weighted sample of 60,266 mothers of children aged 6 to 23 months were included in the study. The demographic health survey employs a stratified two-stage sampling technique. Data extracted from the recent DHS data sets were cleaned, recorded, and analyzed using STATA/SE version 14.0 statistical software. Multilevel mixed-effects logistic regression was used to determine the factors associated with complementary feeding practice. Variables with a p-value less than 0.05 and adjusted odds ratio (AOR) with a 95% confidence interval (CI) were reported as statistically significant variables associated with appropriate complementary feeding practices.

RESULTS

The prevalence of appropriate complementary feeding practices among mothers of children aged 6 to 23 months in sub-Saharan African countries was 13.02% (95% CI: 12.75-13.29%). Maternal educational level [AOR = 0.69, 95% CI (0.64, 0.74)] and [AOR = 0.52, 95% CI (0.47, 0.57)], marital status of the mother [AOR = 0.85, 95% CI (0.74, 0.96)], sex of household head [AOR = 1.78, 95% CI (1.09, 1.27)], total children ever born [AOR = 1.52, 95% CI (1.18, 1.96)], [AOR = 1.43, 95% CI (1.14, 1.81)], and [AOR = 1.31, 95% CI (1.04, 1.64)], media exposure [AOR = 0.74, 95% CI (0.69, 0.79)], ANC visits attended during pregnancy [AOR = 0.73, 95% CI (0.63, 0.80)] and [AOR = 0.67, 95% CI (0.62, 0.74)], place of delivery [AOR = 0.92, 95% CI (0.85, 0.98)], currently breastfeeding [AOR = 1.12, 95% CI (1.01, 1.23)], PNC checkup [AOR = 0.75, 95% CI (0.70, 0.80)], the current age of the child [AOR = 0.26, 95% CI (0.24, 0.28)] and [AOR = 0.14, 95% CI (0.13, 0.16)], birth order [AOR = 1.31, 95% CI (1.09, 1.58)], number of under 5 children in the household [AOR = 0.76, 95% CI (0.59, 0.97)], community illiteracy [AOR = 1.09, 95% CI (1.02, 1.18)], and country category [AOR = 1.62, 95% CI (1.18, 2.22)] were significantly associated with appropriate complementary feeding practices.

CONCLUSION

The prevalence of appropriate complementary feeding practices among mothers of children aged 6 to 23 months in sub-Saharan Africa was relatively low. Higher maternal educational level, female household head, having media exposure, attending more ANC visits, health facility delivery, currently breastfeeding, having PNC follow-up, low community illiteracy, and living in the West Africa region increase the odds of appropriate complementary feeding practices. Women empowerment, increasing maternal health services accessibility, promoting breastfeeding behavior, increasing media exposure of the household, and improving the proportion of health facility delivery are strongly recommended.

Determinants and geographic distribution of early newborn care in Ethiopia: evidence from the 2019 Ethiopian Mini Demographic Health Survey

Early newborn care provided in the first 2 days of life is critical in reducing neonatal morbidity and mortality. This care can be used to monitor and evaluate the content and quality of neonatal postnatal care. This study aimed to identify determinants and geographic distributions of early newborn care uptake in Ethiopia. We used data from the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). We conducted a multilevel binary logistic regression model and geographic analysis to identify the determinants of receiving early newborn care. A total of 2105 children were included in the study. Of the included children, 39.6% (95% confidence interval (CI) 38%, 42%) received at least two components of early newborn care services in the first 2 days after birth. Greater odds of receiving early newborn care were experienced by infants to mothers with secondary or above education (adjusted odds ratio (AOR) = 1.72; 95% CI 1.44, 2.18), from households with highest wealth quantiles (AOR = 1.47; 95% CI 1.16, 1.79), with at least one antenatal care contact (AOR = 2.73; 95% CI 1.79, 4.16), with birth at health facility (AOR = 25.63; 95% CI 17.02, 38.60), and those births through cesarean section (AOR = 2.64; 95% CI 1.48, 4.71). Substantial geographic variation was observed in the uptake of early newborn care in Ethiopia. Several individual- and community-level factors were associated with newborn postnatal care. Policymakers should prioritise these areas and the enhancement of postnatal healthcare provisions for mothers with low socioeconomic status.

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

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.

Determinants of institutional delivery service utilization in Nepal

BACKGROUND

Maternal mortality continues to be a pressing concern in global health, presenting an enduring and unmet challenge for healthcare systems worldwide. Utilization of institutional delivery services has been established as a proven intervention to mitigate life-threatening risks for both mothers and newborns. Exploring the determinants of institutional delivery is crucial to improve and enhance maternal and newborn safety. This study aimed to assess the contextual and individual factors associated with institutional delivery in Nepal.

METHODS

This study utilized that data form Nepal Multiple Indicator Survey 2019, which included a sample of 1,932 women who had given birth within the two years prior to the survey. A multilevel logistic regression analysis was performed to determine the significant external environment, contextual and individual predictors of institutional delivery.

RESULTS

The women from Madhesh province [Adjusted Odds Ratio (aOR): 0.32, 95% Confidence Interval (CI): 0.17-0.61], as compared to Bagmati province, women from rural areas (aOR: 0.55, 95% CI: 0.39-0.78) as compared to urban areas, and women from a relatively less-advantaged ethnic groups (aOR: 0.52, 95% CI: 0.35-0.76) as compared to the relatively advantaged ethnic groups were less likely to deliver in health institutions. Similarly, women from the poorest (aOR: 0.09, 95% CI: 0.04-0.22) and second wealth groups (aOR: 0.29, 95% CI: 0.13-0.64) were less likely to attend institute for delivery compared to women from the richest household. Women with formal education (aOR: 1.65, 95% CI: 1.16-2.35) were more likely to deliver in an institution over uneducated women. Moreover, the uptake of institutional delivery increased by 59% (aOR: 1.59, 95% CI: 1.43-1.75) for each additional ANC visit.

CONCLUSION

The findings highlight the importance of stepping up efforts to achieve universal health care from the standpoint of long-term government investment, focusing particularly on illiterate women in rural areas, poorer households, and socially disadvantaged groups. Expanding the benefits of maternal benefit schemes targeting the women from the poorest households in the communities is recommended.

Client retention in the continuum of maternal health services in Ethiopia

BACKGROUND

Even though the global maternal mortality has shown an impressive decline over the last three decades, the problem is still pressing in low-income countries. To bring this to an end, women in a continuum of maternity care should be retained. This study aimed to assess the status of Ethiopian women's retention in the continuum of maternity care with their possible predictors.

METHODS

We used data from the 2019 Ethiopian Mini-Demographic and Health Survey. The outcome variable in this study was retention in the continuum of maternity care, which consists of at least four ANC contacts, delivery in a health facility, and postnatal check within 48 h of delivery. We analyzed the data using STATA version 14 and a binary logistic regression model was used. In the multiple logistic regression model, variables with a p-value ≤ 0.05 were considered as significantly associated with the outcome variable. A weighted analysis was also done.

RESULTS

Of the 3917 women included in this study, only 20.8% of women completed all of the recommended services. Besides, the use of maternal health services favors women living in the biggest city administrations, followed by women living in agrarian regions; however, those living in the pastoralist area were disadvantaged. Having four or more ANC was explained by the maternal secondary level of education [AOR: 2.54; 95% CI: 1.42, 4.54], wealth status [AOR: 2.59; 95% CI: 1.45, 4.62], early initiation of ANC [AOR: 3.29; 95% CI: 2.55, 4.24], and being in a union [AOR: 1.95; 95% CI: 1.16,3.29]. After having four ANC, factor-affecting delivery in a health facility was wealth status [AOR: 8.64; 95% CI: 4.07, 18.36]. The overall completion of care was associated with women's higher level of education [AOR: 2.12; 95% CI: 1.08, 4.25], richest wealth status [AOR: 5.16; 95% CI: 2.65, 10.07], timeliness of the first ANC visit [AOR: 2.17; 95% CI: 1.66, 2.85], and third birth order [AOR: 0.58; 95% CI: 0.35, 0.97].

CONCLUSIONS

Despite the efforts by the Ethiopian government and other stakeholders, the overall completion of care was quite low. There is also a clear inequality because of women's background characteristics and regional variation. Strategies aiming to empower women through improved educational experience and economic standing have to be implemented in collaboration with other relevant sectors.

Prevalence and determinants of early neonatal mortality in Ethiopia: findings from the Ethiopian Demographic and Health Survey 2016

BACKGROUND

Early neonatal death accounts for a significant number of under-5 mortality worldwide. However, the problem is under-researched and under-reported in low-income and middle-income countries, particularly in Ethiopia. The magnitude of mortality during the early neonatal period and associated factors should be studied for designing appropriate policies, and strategies that could help tackle the problem. Hence, this study aimed to determine the prevalence and identify factors associated with early neonatal mortality in Ethiopia.

METHODS

This study was conducted by using data from Ethiopian Demographic and Health Survey 2016. A total of 10 525 live births were enrolled in the study. A multilevel logistic regression model was used to identify determinants of early neonatal mortality. Adjusted OR (AOR) at a 95% CI was computed to assess the strength and significance of the association between outcome and explanatory variables. Factors with a p<0.05 were declared statistically significant.

RESULTS

The national prevalence of early neonatal mortality in Ethiopia was 41.8 (95% CI 38.1 to 45.8) early neonatal deaths per 1000 live births. The extreme ages of pregnancy (under 20 years (AOR 2.7, 95% CI 1.3 to 5.5) and above 35 years (AOR 2.4, 95% CI 1.5 to 4)), home delivery (AOR 2.4, 95% CI 1.3 to 4.3), low birth weight (AOR 3.3, 95% CI 1.4 to 8.2) and multiple pregnancies (AOR 5.3, 95% CI 4.1 to 9.9) were significantly associated early neonatal mortality.

CONCLUSIONS

This study revealed a higher prevalence of early neonatal mortality as compared with prevalence in other low-income and middle-income countries. Thus, it is determined to be essential to design maternal and child health policies and initiatives with a priority on the prevention of early neonatal deaths. Emphasis should be given to babies born to mothers at extreme ages of pregnancy, to those born of multiple pregnancies delivered at home and to low birthweight babies.

Individual and community-level determinants and spatial distribution of prenatal HIV test uptake in Ethiopia: Spatial and multilevel analysis

Introduction

Human immunodeficiency virus (HIV) testing and counseling services are routine prenatal care services for the prevention of mother-to-child transmission of HIV. Although the prevalence of HIV infection is high among women, evidence suggests that the uptake of HIV testing during prenatal services in Ethiopia is scarce. Therefore, the aim of this study was to investigate individual- and community-level determinants and the spatial distribution of prenatal HIV test uptake in Ethiopia based on the 2016 Ethiopian Demographic and Health Survey.

Methods

Data were accessed from the 2016 Ethiopian Demographic and Health Survey. A total weighted sample of 4,152 women aged 15-49 years who gave birth in the 2 years preceding the survey were included in the analysis. The Bernoulli model was fitted using SaTScan V.9.6 to identify cold-spot areas and ArcGIS V.10.7 to explore the spatial distribution of prenatal HIV test uptake. Stata version 14 software was used to extract, clean, and analyze the data. A multilevel logistic regression model was used to identify the individual- and community-level determinants of prenatal HIV test uptake. An adjusted odds ratio (AOR) with a corresponding 95% confidence interval (CI) was used to declare significant determinants of prenatal HIV test uptake.

Results

The prevalence of HIV test uptake was 34.66% (95% CI: 33.23, 36.13%). The spatial analysis revealed that the distribution of prenatal HIV test uptake was significantly varied across the country. In the multilevel analysis, the following individual and community-level determinants were significantly associated with prenatal HIV test uptake: women who attained primary education (AOR = 1.47, 95% CI: 1.15, 1.87) and secondary and higher education (AOR = 2.03, 95% CI: 1.32, 3.11); women from middle (AOR = 1.46; 95% CI: 1.11, 1.91) and rich household wealth status (AOR = 1.81; 95% CI: 1.36, 2.41); those who had health facility visits in the last 12 months (AOR = 2.17; 95% CI: 1.77, 2.66); women who had higher (AOR = 2,07; 95% CI: 1.66, 2.59) and comprehensive HIV-related knowledge (AOR = 2.90; 95% CI: 2.09, 4.04); women who had moderate (AOR = 1.61; 95% CI: 1.27, 2.04), lower (AOR = 1.52; 95% CI: 1.15, 1.99), and no stigma attitudes (AOR = 2.67; 95% CI: 1.43, 4.99); those who had awareness of MTCT (AOR = 1.83; 95% CI: 1.50, 2.24); those from rural areas (AOR = 0.31; 95% CI: 0.16, 0.61); high community level of education for women (AOR =1.61; 95% CI: 1.04, 2.52); and those living in large central (AOR = 0.37; 95% CI: 0.15, 0.91) and small peripheral areas (AOR = 0.22; 95% CI: 0.08, 0.60).

Conclusion

In Ethiopia, prenatal HIV test uptake had significant spatial variations across the country. Both individual- and community-level determinants were found to be associated with prenatal HIV test uptake in Ethiopia. Hence, the impact of these determinants should be recognized while developing strategies in "cold spot" areas of prenatal HIV test uptake to enhance prenatal HIV test uptake in Ethiopia.

Exploration of spatial clustering in maternal health continuum of care across districts of India: A geospatial analysis of demographic and health survey data

INTRODUCTION

The continuum of care (CoC) throughout pregnancy, delivery and post-delivery has recently been highlighted as an integrated intervention programme for maternal, new-born, and child health. Existing literature suggests the importance of continuum of care (CoC) for improved maternal and child health outcomes. However due to unavailability of data at the lowest administrative levels, literature on spatial pattern of uptake of full CoC is lacking. The present study attempts to focus on the spatial analysis of CoC in maternal health care in India.

DATA AND METHODS

The study is based on the fourth round of National Family Health Survey data conducted in 2015-16 in India. The outcome variable used is maternal health continuum of care which includes- at least 4 ANC visits, delivery through skilled birth attendant and postnatal check-up within 48 hours of delivery. Univariate and bivariate Local Indicator of Spatial Association (LISA) maps have been generated to show the spatial pattern of CoC across 640 districts in India. We also employed spatial regression techniques to explore the determinants of CoC.

FINDINGS

Percentage of women who followed full CoC was observed to be least for East Kameng (0.0%) district of Arunachal Pradesh and highest in North Goa district (90.4%). Majority of districts where uptake of full CoC was more than 80 percent were found concentrated in southern region on India. Equivalently, findings indicated a strong spatial clustering of full CoC with high-high clusters mostly concentrated in southern districts. Low-low district clusters are concentrated in the states of Uttar Pradesh, Bihar and Madhya Pradesh. For complete CoC the global Moran's I is 0.73 indicating the spatial dependence. The spatial regression analysis suggested that modern contraceptive use, meeting with health worker, urbanization and secondary or above education for women have positive impact on the utilisation of CoC.

CONCLUSION

The spatial pattern indicates district level clustering in uptake of CoC among women. The study suggests policymakers and stakeholders to implement comprehensive interventions at sub-regional levels for ensuring the completion of CoC for women which acts as a preventive measure for adverse outcomes such as-maternal and child mortality.

Spatial distribution and determinants of newbornsnot receiving postnatal check-up withintwodays after birth in Ethiopia: a spatial and multilevel analysis of EDHS 2016

Background

Accessibility and utilization of postnatal newborn check-ups within 2 days after delivery are critical for a child’s survival, growth, and development. However, the service delivery is not yet improved and fluctuates across the geographical locations in Ethiopia. Therefore, this study aimed to assess the spatial distribution and determinants of newborns not received postnatal check-ups within 2 days after birth in Ethiopia.

Methods

A secondary data analysis of the Ethiopia Demographic and Health Survey (EDHS) 2016 was done among live births within 2 years preceding the survey. A multilevel binary logistic regression model was fitted to identify the factors associated with the outcome variable. Adjusted Odds Ratio with 95% (Confidence Interval) was calculated and used as a measure of associations and variables with a p-value < 0.05, were declared as statistically significant.

Results

A total of 4036 live newborns in Ethiopia were included in the analysis, of whom half (51.21%) were females. The mean age of the mothers was 33+ SD 1.3, and more than 60 % (61.56%) of the mothers were not educated. The national prevalence of newborns not receiving postnatal check-ups within 2 days after birth was 84.29 (95% CI: 83.10–85.41) with significant spatial variations across the study area. Mothers who had no ANC visits were 58% higher than (AOR = 0.42(0.27–0.66) mothers who had > 4 ANC visits. Mothers who gave birth at home and others were 80% (AOR = 0.02(0.01–0.29) and 25% (AOR = 0.76(0.59–0.99), higher than mothers delivered at hospital. Rural mothers were 1.90 times higher (AOR = 1.90(1.29–2.81) than urban mothers, and mothers live in administrative regions of Afar 66% (AOR = 0.34(0.16–0.69), Oromia 47% (AOR = 0.53(0.30–0.91), Somali 60% (AOR = 0.40 (0.22–0.74),Benishangul 50% (AOR = 0.50 (0.27–0.92), SNNPR 67% (AOR = 0.33(0.19–0.57), Gambela 70% (AOR = 0.30 (0.16–0.56), Harari 56% (AOR = 0.44 (0.25–0.78), and Dire Dawa70% (AOR = 0.30 (0.17–0.54) were higher than Addis Abeba for not receiving postnatal checkup of new born within the first 2 days, respectively.

Conclusions

Low postnatal check-up utilization remains a big challenge in Ethiopia, with significant spatial variations across regional and local levels. Spatial clustering of not receiving postanal check-ups within 2 days was observed in Afar, Oromia, Gambela, Benishangul, SNNPR, Harari, and Dire Dawa regions. Residence, ANC visits, place of delivery, and administrative regions were significantly associated with not receiving postnatal check-ups. Geographically targeted interventions to improve ANC follow-up and institutional delivery should be strengthened.

How applicable is geospatial analysis in maternal and neonatal health in sub-Saharan Africa? A systematic review

Background

Sub-Saharan Africa (SSA) has the world's highest maternal and neonatal morbidity and mortality and has shown the slowest progress in reducing them. In addition, there is substantial inequality in terms of maternal and neonatal morbidity and mortality in the region. Geospatial studies can help prioritize scarce resources by pinpointing priority areas for implementation. This systematic review was conducted to explore the application of geospatial analysis to maternal and neonatal morbidity and mortality in SSA.

Methods

A systematic search of PubMed, SCOPUS, EMBASE, and Web of Science databases was performed. All observational and qualitative studies that reported on maternal or neonatal health outcomes were included if they used a spatial analysis technique and were conducted in a SSA country. After removing duplicates, two reviewers independently reviewed each study's abstract and full text for inclusion. Furthermore, the quality of the studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Finally, due to the heterogeneity of studies, narrative synthesis was used to summarize the main findings, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was strictly followed to report the review results. A total of 56 studies were included in the review.

Results

We found that geospatial analysis was used to identify inequalities in maternal and neonatal morbidity, mortality, and health care utilization and to identify gaps in the availability and geographic accessibility of maternal health facilities. In addition, we identified a few studies that used geospatial analysis for modelling intervention areas. We also detected challenges and shortcomings, such as unrealistic assumptions used by geospatial models and a shortage of reliable, up-to-date, small-scale georeferenced data.

Conclusions

The use of geospatial analysis for maternal and neonatal health in SSA is still limited, and more detailed spatial data are required to exploit the potential of geospatial technologies fully.

Multilevel Modelling of the Individual and Regional Level Variability in Predictors of Incomplete Antenatal Care Visit among Women of Reproductive Age in Ethiopia: Classical and Bayesian Approaches

Background: Antenatal care is an operational public health intervention to minimize maternal and child morbidity and mortality. However, for varied reasons, many women fail to complete the recommended number of visits. The objective of this study was to assess antenatal care utilization and identify the factors associated with the incomplete antenatal care visit among reproductive age women in Ethiopia. Methods: The 2019 Ethiopian Mini Demographic and Health Survey data were used for this study. Multilevel logistic regression analysis and two level binary logistic regression models were utilized. Results: Around 56.8% of women in Ethiopia did not complete the recommended number of antenatal care visits. Women from rural areas were about 1.622 times more likely to have incomplete antenatal care compared to women from urban areas. Women who had no pregnancy complication signs were about 2.967 times more likely to have incomplete antenatal care compared to women who had pregnancy complication signs. Women who had a slight problem and a big problem with the distance from a health center were about 1.776 and 2.973 times more likely, respectively, to have incomplete antenatal care compared to women whose distance from a health center was not a problem. Furthermore, women who had ever terminated pregnancy were about 10.6% less likely to have incomplete antenatal care compared to women who had never terminated pregnancy. Conclusions: The design and strengthening of existing interventions (e.g., small clinics) should consider identified factors aimed at facilitating antenatal care visits to promote maternal and child health related outcomes. Issues related to urban–rural disparities and noted hotspot areas for incomplete antenatal care visits should be given special attention.

Maternity waiting homes utilization and associated factors among childbearing women in rural settings of Finfinnee special zone, central Ethiopia: A community based cross-sectional study

Background

Maternity waiting home (MWH) is one of the strategies designed for improved access to comprehensive obstetric care for pregnant women living far from health facilities. Hence, it is vital to promote MWHs for pregnant women in Ethiopia, where most people reside in rural settings and have a high mortality rate. Therefore, this study aimed to assess MWHs utilization and associated factors among women who gave birth in the rural settings of Finfinnee special zone, central Ethiopia.

Methods

A community-based cross-sectional study was conducted from 15^th October to 20^th November 2019 among women who gave birth in the last six months before data collection. Multistage random sampling was employed among 636 women from six rural kebeles to collect data through a face-to-face interview. Multivariable logistic regression analysis was fitted, and a 95% confidence level with a p-value <0.05 was used to determine the level and significance of the association.

Results

Overall, MWHs utilization was 34.0% (30.3% - 37.7%). The higher age (AOR: 4.77; 95% CI: 2.76–8.24), career women (AOR: 0.39 95% CI: 0.20–0.74), non-farmer husband (AOR: 0.28; 95% CI: 0.14–0.55), rich women (AOR:1.84; 95% CI: 1.12–3.02), living greater than 60 minutes far from a health facility (AOR: 1.80; 95% CI: 1.16–2.80), and four and more livebirths (AOR: 5.72; 95% CI: 1.53–21.35) significantly associated with MWHs utilization. The common services provided were latrine, bedding, and health professional checkups with 98.2%, 96.8%, and 75.4%, respectively. Besides, feeding service was provided by 39.8%. The primary reason not to use MWHs was the absence of enough information on MWHs.

Conclusion

One-third of the women who delivered within the last six months utilized MWHs in the Finfinnee special zone. Our results support the primary purpose of MWHs, that women far from the health facility are more likely to utilize MWHs, but lack of adequate information is the reason not to use MWHs. Therefore, it is better to promote MWHs to fill the information gap among women with geographical barriers to reach health facilities.

Determinants of Utilization of Institutional Delivery Services in Zambia: An Analytical Cross-Sectional Study

Institutional delivery at birth is an important indicator of improvements in maternal health, which remains one of the targets of sustainable development goals intended to reduce the maternal mortality ratio. The purpose of the present study was to identify the determinants of utilization of institutional delivery in Zambia. A population-based cross-sectional study design was used to examine 9841 women aged 15–49 years from the 2018 Zambia Demographic and Health Survey. A multiple logistic regression was applied to calculate odds ratios (ORs) with 95% confidence intervals (CIs) to identify determinants of utilization of institutional delivery. Sociodemographic factors were significantly associated with institutional delivery: woman’s (OR: 1.76; 95% CI: 1.04–2.99) and husband’s (OR: 1.83; 95% CI: 1.09–3.05) secondary/higher education, higher wealth index (OR: 2.31; 95% CI: 1.27–4.22), and rural place of residence (OR: 0.55; 95% CI: 0.30–0.98). Healthcare-related factors were also significantly associated with institutional delivery: 5–12 visits to antenatal care (OR: 2.33; 95% CI: 1.66–3.26) and measuring blood pressure (OR: 2.15; 95% CI: 1.32–2.66) during pregnancy. To improve institutional delivery and reduce maternal and newborn mortality, policymakers and public health planners should design an effective intervention program targeting these factors.

Determinants and spatial distribution of institutional delivery in Ethiopia: evidence from Ethiopian Mini Demographic and Health Surveys 2019

BACKGROUND

Over the past few decades, maternal and child mortality had drawn the attention of governments and policymakers. Institutional delivery has been among the implementations needed to reduce maternal and child mortality. The fact that the problem was persisted intensified studies to research for more factors. Thus, the current study was intended for further analyses of EMDHS to identify the magnitude, spatial patterns, and predictors of institutional delivery.

METHODS

A cross-sectional survey data from EMDHS 2019 was analyzed involving 5488 reproductive-age women regarding institutional deliveries. We presented descriptive statistics using mean, standard deviations, and proportions. To check the nature of the distribution of institutional delivery, we applied the global Moran's I statistics. Getis-Ord Gi statistics was applied to detect spatial locations, and we applied spatial interpolation to predict unknown locations of institutional delivery using the Ordinary Kriging method. Kulldorff's SatScan was also applied to identify the specific local clustering nature of institutional delivery using the Bernoulli method. We applied multilevel binary logistic regression for the scrutiny of individual and community-level factors. We applied P < 0.25 to include variables in the model and P < 0.05 to declare associations. AOR with 95% CI was used to describe variables.

RESULTS

The prevalence of institution/facility delivery was 2666.45(48.58%) in the survey. The average number of children was 4.03 ± 2.47, and most women in this survey were in the age range of the 25-29 years (31.84%) and 30-34 years (21.61%). Women who learned primary education (AOR = 1.52; 95% CI 1.20-1.95), secondary education (AOR = 1.77; 95% CI 1.03-3.07), and higher education (AOR = 5.41; 95% 1.91-15.25), while those who can read and write sentences (AOR = 1.94; 95% 1.28-2.94), Rich (AOR = 2.40 95% CI 1.82-3.16), and those followed 1-2 ANC (AOR = 2.08; 95% CI 1.57-2.76), 3 ANCs (AOR = 3.24; 95% CI 2.51-418), and ≥ 4 ANCs (AOR = 4.91; 95% CI 3.93-6.15) had higher odds of delivering at health institutions.

CONCLUSION

The institutional delivery was unsatisfactory in Ethiopia, and there were various factors associated differently across the different regions. Pastoralist regions showed high home delivery than institutions which invites further interventions specific to those regions. Factors like age, highest education level achieved, preceding birth interval, literacy status, wealth status, birth order, regions, and rural residences were all affected institutional delivery so that interventions considering awareness, access, and availability of the services are vital.