Abstract
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.
Highlights
Despite an extensive reduction in maternal mortality, maternal deaths remain high in low- and middle-income countries
In order to address the knowledge design gap regarding the intervention situation in Zambia, the in present study aimed to identify the knowledge gap regarding the situation in Zambia, the present study aimed to identify associations of sociodemographic and healthcare-related factors with the use of institutional associations of sociodemographic and healthcare-related factors with the use of institudelivery assisted by skilled birth attendants
The analyses of the 2018 Zambia Demographic and Health Survey (ZDHS) showed that sociodemographic factors and healthcarerelated factors (e.g., 5–12 antenatal care (ANC) visits, and blood pressure measurement during pregnancy) were significantly associated with institutional delivery
Summary
Despite an extensive reduction in maternal mortality, maternal deaths remain high in low- and middle-income countries. Between 2000 and 2017, from an estimated 451,000 maternal deaths in 2000 to 295,000 in 2017 [1]. The highest mortality and morbidity due to pregnancy-related complications or reproductive ill-health among pregnant women have been found in SubSaharan Africa [2]. The maternal mortality ratio (MMR) in Sub-Saharan Africa in 2017 was very high, estimated at 542 per 100,000 live births [1]. In Zambia, the estimated MMR dropped to 213 in 2017 from 528 in 2000 [1], but maternal mortality still accounts for 10% of all deaths among women between 15 and 49 years of age [3]. In relation to Target 3.1 of the Sustainable Development Goal (SDG) 3, which is to reduce global MMR to less than 70 per
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