Institutional delivery services utilization and associated factors among mothers who gave birth in the last year in Mandura district, Northwest Ethiopia

Utilization of Delivery Services among Mothers in Aluu Community, Ikwerre Local Government Area, Rivers State

Background

Utilization of delivery services is paramount to achieving a safe delivery outcome and preventing maternal mortality/morbidity among mothers. In semi-urban communities, delivery services are provided by both health and non-health facilities and are influenced by either socio-demographic or economic factors. This study aims to evaluate the utilization of delivery services across various places that provide such care and to identify the factors that influence the utilization of delivery services in the Aluu community.

Methodology

A community-based cross-sectional study was conducted in 5 out of 9 villages in the Aluu community. A total of 415 respondents were recruited for the study. The study was carried out between April 2021 and October 2021. A multistage sampling method was used, and data was collected using an interviewer-administered structured questionnaire. The data was analyzed using SPSS version 25. The Chi-square test was used for inferential analysis and a significant level was set at p≤ 0.05 at 95% confidence interval.

Results

Out of 415 respondents, 44.03% were delivered in a healthcare facility while 55.97% were delivered in a non-health care facility. Tribe, religion, educational status, occupation, and Obstetrics and gynecological factors were found to influence the utilization of delivery services.

Conclusion

More than half of women utilized delivery services provided by non-health facilities and there was a significant relationship between tribe, religion, educational status, occupation, and Obstetrics and gynecological factors and the utilization of delivery services in the Aluu community.

Institutional delivery service utilization and associated factors in fragile and conflict-affected situations in Sekota town, Northern Ethiopia, 2022: A community-based cross-sectional study

Background

Conflict-affected areas are considered to contribute a substantial proportion of worldwide maternal deaths. However, research on maternal health care in conflict-affected countries is very limited. In the absence of recent data, it is impossible to monitor progress made in mitigating the effect of conflict on maternal survival. As a result, this study targeted to assess institutional delivery services usage and influencing factors in a fragile and conflict-affected situation in Sekota town, Northern Ethiopia.

Methods

A community-based cross-sectional study was employed among 420 mothers in Sekota town, Northern Ethiopia from July 15th to 30th, 2022. The desired sample size was determined using a single population proportion formula. The data were collected by using interviewer administered structured questionnaire; entered via EpiData version 4.6 and analyzed using SPSS version 25 software. To identify the associated factors, a bivariable and multivariable logistic regression model was applied. The level of significance was declared at a p-value of <0.05. An adjusted odds ratio with a 95% confidence interval was considered to see the strength of the association between dependent and independent variables.

Results

Of the total respondent, 202 (48.1%), 95% CI: (43.0%, 53.0%) mothers utilized institutional delivery service. The use of institutional delivery services was associated with the maternal educational level of secondary school and above (AOR = 2.06, 95% CI: 1.08-3.93), antenatal care during the most recent pregnancy (AOR = 5.24, 95% CI: 3.01-9.11), being informed on birth preparedness and complication readiness (AOR = 1.93, 95% CI: 1.23-3.02) and displacement of the respondents from their usual place of residence due to conflict (AOR = 0.41, 95% CI: 0.21-0.68).

Conclusion

Institutional delivery service utilization was very low in the study setting. Healthcare for women in conflict-prone areas requires critical attention and should be given priority during the conflict. More prospective research is needed to fully understand and reduce the impact of conflict on maternal and neonatal health care.

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.

Institutional delivery and associated factors among women who gave birth in Benishangul Gumuz region, South West Ethiopia

Background

Maternal mortality from pregnancy and childbirth remains a major public health problem. Increasing access to institutional delivery is one of the key strategies to reduce childbirth-related maternal mortality. Despite all the efforts, institutional deliveries in Ethiopia remain low. Understanding factors associated with institutional delivery is important to devise strategies to improve facility based child birth. Hence, this study assessed the prevalence of institutional delivery and associated factors to bridge the gap.

Methods

A community-based cross-sectional study was employed from March-April 2020. Multi-stage sampling was employed to select 500 mothers who gave birth within the last 12 months in Mandura district, Benishangul Gumuz Region, Ethiopia. Data were collected using pre tested structured questionnaire through face-to-face interview. Logistic regression models were fitted to assess the predictors of institutional delivery. Adjusted Odds ratios with 95% CI was used to show associations and statistical significance was set at a p < 0.05.

Results

This study indicated that the prevalence of institutional delivery was 28.8% CI (25-33.3%). Having a positive attitude (AOR = 9.6,95%CI:2.5-35.9), attending antenatal care (ANC) at least once (AOR = 16.1,95%CI:9.6-22), attending ANC more than three times (AOR = 17.2, 95% CI:13.5-43.8), having good knowledge (AOR = 11.1, 95%CI: 2.7-45.4), and facing complications during pregnancy (AOR = 4.04, 95%CI: 1.0-16.0) were significantly associated with institutional delivery.

Conclusion

The prevalence of institutional delivery in this study was low. Positive attitude toward institutional delivery, attending ANC, having good knowledge about institutional delivery, and facing complications during pregnancy were identified predictors of institutional delivery. Strategies with a focus on increasing ANC uptake, improving mothers' knowledge, and promoting institutional delivery at the community level are critical.

Factors associated with health facility delivery among reproductive age women in Nepal: an analysis of Nepal multiple indicator cluster survey 2019

BACKGROUND

Despite existing efforts to improve maternal health in Nepal, delivery in a health facility with skilled providers is still a major health concern in Nepal. This study aimed to examine the factors associated with delivery in a health facility with skilled providers among women aged 15-49 years in Nepal.

METHODS

This study used data from Nepal Multiple Indicator Cluster Survey 2019, a nationally representative cross-sectional survey. This survey was a two-stage, stratified cluster sampling. A total of 1,950 married women aged 15-49 years who had at least one live birth in the last two years preceding the survey were included in the analysis. Bivariate and multivariate logistic regression analyses were performed in this study.

RESULTS

Seventy-five percent of women are delivered in a health facility with skilled providers. Women from urban areas (AOR = 1.74, p < 0.01), women residing in Sudurpaschim province (AOR = 5.64, p < 0.001), women with first parity (AOR = 2.82, p < 0.001), and women from rich household status (AOR = 4.60, p < 0.001) and women who attained at least four ANC visits (AOR = 10.81, p < 0.001) were associated with higher odds of delivering in a health facility. Women who were more educated and used the internet were more likely to deliver in a health facility by a skilled provider.

CONCLUSION

Place of residence, household wealth status, and ANC visits appear to be the strongest predictors of health facility delivery with skilled providers in Nepal. Disparities in delivery in a health facility with skilled providers persist among provinces and caste/ethnicity.

Factors associated with institutional delivery among mothers who gave birth within 1 year prior to the study at Gilgelbelles town, Northwest Ethiopia: a mixed-methods study

OBJECTIVES

This study aimed to assess factors associated with institutional delivery among mothers who had delivered within 1 year prior to the study at Gilgelbelles town, Northwest, Ethiopia.

DESIGN

A community-based mixed-methods study was conducted from 1 February 2020 to 2 March 2020.

SETTING

This study was conducted at Gilgelbelles town, Northwest Ethiopia.

PARTICIPANTS

Included 422 mothers who delivered 1 year prior to the study at Gilgelbelles town.

OUTCOME MEASURES

Utilisation of institutional delivery and factors associated with institutional delivery.

METHODS

The quantitative data were collected by the simple random sampling technique, entered into Epi data V.3.1, and analysed using SPSS V.23.0. The qualitative data were collected by using in-depth interviews and thematic analysis was done manually to supplement the quantitative result.

RESULTS

In this study, 39.6% (95% CI=34.8 to 44.3) of mothers were given childbirth at the health facility. In multivariable analysis maternal age group of 15-20 years, secondary and above educational level, good knowledge on danger signs of obstetric, antenatal care visits, good awareness of birth preparedness and complications readiness plan, getting married after the age of 18 years, faced at least one complication during pregnancy, less than two children, travelled <30 min to reach a nearby health facility, having decision making power and not practised traditional malpractice during labour were significantly associated with institutional delivery. The qualitative result shows that cultural factors of the society and the lack of adequate delivery material in the health facility were identified as the major reason for the low utilisation of institutional delivery services.

CONCLUSION

This study showed that the proportion of institutional delivery was low. Sociodemographic, reproductive and knowledge-related factors were associated with institutional delivery. This indicates a need of taking appropriate interventions by integrating other stakeholders to increase the utilisation of institutional delivery services.

The impact of perception on institutional delivery service utilization in Northwest Ethiopia: the health belief model

BACKGROUND

Ethiopia has been striving to promote institutional delivery through community wide programs. However, home is still the preferred place of delivery for most women encouraged by the community`s perception that delivery is a normal process and home is the ideal environment. The proportion of women using institutional delivery service is below the expected level. Therefore, we examined the impact of perception on institutional delivery service use by using the health belief model.

METHODS

A community-based cross-sectional study was conducted among 1,394 women who gave birth during the past 1 year from September to December 2019. A multistage sampling technique was used to select the study participants. Data were collected by using health belief model constructs, and structured and pretested questionnaire. Binary logistic regression was performed to identify factors associated with the outcome variable at 95% confidence level.

RESULTS

Institutional delivery service was used by 58.17% (95% CI: 55.57- 60.77%) of women. The study showed that high perceived susceptibility (AOR = 1.87; 95% CI 1.19-2.92), high cues to action (AOR = 1.57; 95% CI: 1.04-2.36), husbands with primary school education (AOR = 1.43; 95% CI 1.06-1.94), multiparty(5 or more) (AOR = 2.96; 95% CI 1.85-4.72), discussion on institutional delivery at home (AOR = 4.25; 95% CI 2.85-6.35), no close follow-up by health workers (AOR = 0.59;95% CI 0.39-0.88), regular antenatal care follow-up (AOR = 1.77;95% CI 1.23,2.58), health professionals lack of respect to clients (AOR = 2.32; 95% CI 1.45-3.79), and lack of health workers (AOR = 0.43;95% CI 0.29-0.61) were significantly associated with the utilization health behavior of institutional delivery service.

CONCLUSION

The prevalence of institutional delivery in the study area was low. The current study revealed that among the health belief model construct perceived susceptibility and cues to action were significantly associated with the utilization behavior of institutional delivery service. On top of that strong follow-up of the community and home based discussion was a significant factor for the utilization behavior of institutional delivery service.

Institutional delivery service utilisation and associated factors among mothers of childbearing age in Delgi District, Northwest Ethiopia: a community-based cross-sectional study design

OBJECTIVE

This study aimed to assess the use of institutional delivery services and associated factors among Delgi District mothers of childbearing age.

DESIGN

A community-based cross-sectional study design.

SETTING

At five Kebeles in Delgi District, Northwest Ethiopia.

PARTICIPANTS

The study was performed on 403 childbearing age mothers using a structured questionnaire and a face-to-face interview. We used a systematic random sampling method to select the study participants.

METHODS

The data were analysed using descriptive analysis, binary logistic regression analysis, and multivariable logistic regression analysis.

OUTCOME

Institutional delivery service utilisation.

RESULTS

In the present study, 75.9% (95% CI: 71.7% to 80.1%) of respondents used health facilities for their last delivery. After adjusting for covariates, diploma holders (adjusted odds ratio (AOR)=5.63; 95% CI: 3.77 to 8.39), maternal age at 23-27 years (AOR=6.47; 95% CI: 2.74 to 15.32), divorced women (AOR=0.30; 95% CI: 0.12 to 0.75), husband's primary education (AOR=0.38; 95% CI: 0.18 to 0.82), the distance required above 10 km to reach the health facility (AOR=0.17; 95% CI: 0.04 to 0.72) and the time required above 4 hours to reach the health facility (AOR=0.30; 95% CI: 0.12 to 0.73) were significantly associated with institutional delivery service utilisation.

CONCLUSIONS

The majority of respondents utilised institutional delivery services in this study. High-level maternal education, younger maternal age, divorce marital status, low-level husband education, long distances to reach a health facility and prolonged time to reach a health facility were all independently linked to the use of institutional delivery services. One of the foundations for increasing institutional delivery service use is improving mother-waiting centres for delivery services, infrastructure and transportation services and awareness about institutional delivery services. Providing counselling services for mothers during antenatal care visits or house-to-house health education on institutional delivery services for rural residents will improve institutional delivery service use even more.

Determinants and Trends of Health Facility Delivery in Bangladesh: A Hierarchical Modeling Approach

Background

Most maternal deaths occur during childbirth and after childbirth. This study was aimed at determining the trends of health facilities during delivery in Bangladesh, as well as their influencing factors.

Methods

This study used secondary data from three Bangladesh Multiple Indicator Cluster Surveys (MICSs) in 2006, 2012–13, and 2019. The study's target sample was those women who gave birth in the last two years of the survey. A two-level logistic regression was applied to determine the effects on health facility delivery separately in these two survey points (MICSs 2012–13 and 2019).

Results

The results show that the delivery of health facilities has increased by almost 37.4% in Bangladesh, from 16% in 2006 to 53.4% in 2019. The results of two-level logistic regression show that the total variation in health facility delivery across the community has decreased over recent years. After adding community variables, various individual-level factors such as women with secondary education (OR = 0.55 in 2012-13 vs. OR =0.60 in 2019), women from middle wealth status (OR = 0.49 in 2012-13 vs. OR = 0.65 in 2019), religion, and child ever born showed a strong relationship with health facility delivery in both survey years. At the community level, residents showed significant association only in the 2012-13 survey and indicated a 43% (OR = 1.43 for 2012-13) greater availability of health facilities in urban residences than in rural residences. Using media showed a highly significant connection with health facility delivery in both years as well as an increasing trend over the years in Bangladesh (OR = 1.19 in 2012-13 vs. OR = 1.38 in 2019). However, division, prenatal care, and skilled services all contribute greatly to increasing the delivery of health facilities in Bangladesh.

Conclusions

The results of this study suggest that policymakers need to pay attention to individual and community-level factors, especially women's education, poverty reduction, and adequate prenatal care provided by well-trained caregivers.

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.

Effect of checklist based box system interventions on improving institutional delivery among reproductive age women in Northwest Ethiopia: generalized structural equation modeling

BACKGROUND

Previous studies have shown that there is low utilization of institutional delivery in Ethiopia, as well as various factors contributing to this low utilization. Notably, there is paucity around interventions to improve institutional delivery. Hence, this study examines the effectiveness of checklist-based box system intervention on improving institutional delivery and to investigate the association through which the intervention is linked to institutional delivery.

METHOD

The study used data from a larger trial, on the effectiveness of checklist-based box system intervention on improving maternal health service utilization. In the intervention arm, mothers received regular community-level pregnancy screening and referral, service utilization monitoring boxes, drop-out tracing mechanisms, regular communication between health centers and health posts, and person-centered health education for mothers. This study used the existing government-led maternal health program as a control arm. A total of 1062 mothers who gave birth one-year before the survey were included in the final analysis. A difference-in-difference estimator was used to test the effectiveness of the intervention. Generalized structural equation modeling was used to examine the direct and/ indirect associations between the intervention and institutional delivery.

RESULT

Among participants, 403 (79.5%) mothers from intervention and 323 (58.2%) mothers from control clusters gave birth at health facilities. The result of the study revealed a 19% increase in institutional delivery in the intervention arm (19, 95%CI: 11.4-27.3%). In this study the pathway from checklist-based box system intervention to institutional delivery was mainly direct - (AOR = 3.32, 95%CI: 2.36-4.66), however, 33% of the effect was partially mediated by attendance of antenatal care four visits (AOR = 1.39, 95%CI: 1.02-1.92). The influence of significant others (AOR = 0.25, 95%CI: 0.15-0.43) and age (AOR = 0.03, 95%CI: 0.01- 0.09) had an inverse relation with institutional delivery.

CONCLUSION

The implementation of a checklist-based box system significantly increased institutional delivery utilization, both directly and indirectly by improving antenatal care four attendance. A larger-scale implementation of the intervention was recommended, taking the continuum of care approach into account.

TRIAL REGISTRATION

ClinicalTrials.gov , NCT03891030 , Retrospectively registered on 26 March, 2019.

Delays during emergency obstetric care and their determinants among mothers who gave birth in South Gondar zone hospitals, Ethiopia. A cross-sectional study design

Background

The majority of maternal deaths occur during delivery and the immediate postnatal period as a result of delays in seeking care, failure to reach health institutions, and receiving inappropriate health care. In developing countries, delayed access to timely healthcare contributes to high maternal mortality and morbidity.

Objective

This study aimed to assess the delays during emergency obstetric care and associated factors with delays during emergency obstetric care.

Method

A cross-sectional study design was conducted. We chose five hospitals at random in the South Gondar zone, Ethiopia. Face-to-face Interviews were conducted with 459 participants using a systematic sampling technique. For this analysis, bi-variable and multivariable logistic regression models were used. The Adjusted Odds Ratio was used to determine the statistical association with delays during emergency obstetric care at p-value <0.05 with a 95% confidence interval.

Results

The proportion of delays during emergency obstetric care were found to be 59.7% in this study. The respondents’ mean age was 27.23 years old, with a standard error of 5.67. Pregnant mothers living in the rural areas (AOR: 4.1, 95%, CI: 2.36 to 6.25), no ANC visit (AOR: 1.8, 95% CI: 1.32 to 3.18), uneducated women (AOR: 4.6, 95% CI: 2.45 to 8.59) and referral to a higher level of care (AOR: 2.7, 95% CI: 1.60 to 4.44), were all significantly associated with delay.

Conclusion

Delay during emergency obstetric care was found to be 59.7 percent. Rural residency, absence of ANC visit, uneducated mothers, and referred mothers from one level to the next level of care were factors that contributed to delays in emergency obstetric care in the study area.