Abstract
South Sudan has a high maternal mortality ratio estimated at 800 deaths per 100,000 live births. Birth in health facilities with skilled attendants can lower this mortality. In this cross-sectional study, we determined the level and determinants of health facility utilization and skilled birth attendance in Jubek State, South Sudan. Mothers of children aged less than two years were interviewed in their homes. Multivariable regression analysis was performed to determine factors associated with health facility births. Only a quarter of the mothers had given birth at health facilities, 209/810 (25.8%; 95% CI 18.2–35.3) and 207/810 had a skilled birth attendant (defined as either nurse, midwife, clinical officer, or doctor). Factors positively associated with health facility births were four or more antenatal visits (adjusted odds ratio (AOR) 19; 95% CI 6.2, 61), secondary or higher education (AOR 7.9; 95% CI 3, 21), high socio-economic status (AOR 4.5; 95% CI 2.2, 9.4), and being primipara (AOR 2.9; 95% CI 1.5, 5.4). These findings highlight the need for efforts to increase health facility births in South Sudan.
Highlights
The global maternal mortality ratio (MMR) has dropped by 44% in the last 25 years [1]
We report the level and determinants of health facility utilization and skilled birth attendance during childbirth in Jubek State, South Sudan
We found that only a quarter of the women gave birth in a health facility in an area close to the capital Juba in South Sudan
Summary
The global maternal mortality ratio (MMR) has dropped by 44% in the last 25 years [1]. This decline varies widely between low- and high-income countries. Maternal deaths are due to direct obstetric causes such as postpartum haemorrhage, obstructed labour, sepsis, unsafe abortion, and hypertension [2]. These complications can be mitigated by encouraging mothers to give birth at health facilities with the help of skilled birth attendants [3]. Mothers who give birth at health facilities are less likely to die or lose their new-borns [4,5,6]
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