Institutional Delivery Service Research Articles

Institutional Delivery Service Utilization and Associated Factors Among Women in West Central Ethiopia

Pregnancy and child birth related complications are main causes of death and disability among women of childbearing age in developing countries. The Sub-Saharan Africa accounts for more than half of the global maternal deaths and most of these deaths occur during labor and following child birth from preventable causes that can be averted by professional intervention. Hence, the aim of this study was to assess the level of institutional delivery service utilization and associated factors among women who gave birth in West Central Ethiopia. A community based cross-sectional study was conducted from January 10 to February 10, 2014. Quantitative data were collected using a structured questionnaire and analyzed using SPSS V.20.0. Descriptive statistics were used to present the data and logistic regression was applied to check the association between the dependent and independent variables. A total of 410 women were included in the study of whom70.7% had given birth their last baby at health facilities. Women with secondary and above educational status (AOR [95%CI] = 4.525 [95% CI: 1.831-11.180]), those who had an access to Radio and TV (AOR [95%CI] = 3.214 [1.361-7.591]), women from families with average monthly income greater than 1,000.00 Ethiopian Birr (AOR [95%CI] = 3.300 [1.555-6.999]), and women who had antenatal care follow up during their last pregnancy (AOR [95%CI] = 2.409 [1.088-5.335]) were more likely to utilize institutional delivery service. In conclusion, a significant number of women did not give birth their last baby at health facilities. Maternal educational status, access to mass media, family income status and antenatal care visit were important predictors of institutional delivery service utilization. Increasing Health Extension Workers’ involvement in improving community awareness, and women empowerment through education and economic development are important measures to improve institutional delivery service utilization.

Model and Non-Model Mothers Are Similar Over Significant Aspects of Maternal-Child Health Behaviors in Rural Contexts of Central Ethiopia: Diffusing Healthy Behaviors

Background: Health Extension Program (HEP) was launched-innovative community health service since 2002 in Ethiopia. Since then, families were graduated as models for the HEP. Maternal and child Health (MCH) was one of the major packages in HEP. This study intended to compare model and non-model families (MFs and NMFs) on MCH behaviors. Method: Correlational study was conducted between mothers' model status and MCH service use in Sebeta Hawas district, Oromia special zone surrounding Finfine. A total of 305 samples were involved in the study from both MFs and NMFs. We applied simple random sampling. A pretested and structured questionnaire adopted from literatures together with discussion guides was used. It mainly composed of utilization of Family Planning (FP), antenatal care (ANC), delivery care (DC), postnatal care (PNC) and immunization. Quantitative data was analyzed using Statistical Package for Social Sciences (SPSS) version 16. We used frequency tables to describe model status. Odds Ratio (OR) was used to identify demarcations between MFs and NMFs. Finally, quantitative and qualitative findings was triangulated. Result: The study showed statistically significant key variations between MFs and NMFs over family size, knowledge of (ANC, delivery complications and PNC) and utilization of (FP and ANC visits). These variables were positively linked with being from MFs. For example, 114/201 (56.7%) current FP users, 120/222 (54.1%) any ANC visitors, and 56/82 (68.3%) repeated (>=4) ANC visitors were from MFs compared to NMFs (PV<0.001). However, mothers from MFs & NMFs had no variation on delivery, PNC & immunization utilization. Closure of health posts at work time, inaccessible institutional delivery service (for MFs) and perceived invulnerability to delivery complications (for NMFs) hampered the MCH behaviors. Conclusion: Though MFs and NMF were similar over some MCH service knowledge and utilization, they vary over FP and ANC. MFs can be advocate for enhancing adoption and diffusion of earlier stage MCH behaviors. However, beyond the control contexts hindered MFs from playing their role of modeling late stages MCH behaviors (DC/ PNC/immunization).Therefore, HEP designers and implementers shall work on system challenges and create separate models for those behaviors and assign new name.

Religion and Use of Institutional Child Delivery Services: Individual and Contextual Pathways in Mozambique

Research on institutional child delivery in Sub-Saharan Africa typically focuses on availability and accessibility of health facilities. Cultural factors, including religion, that may facilitate or hinder the use of such services have not been well examined and remain poorly understood. The relationship between religious affiliation and delivery in a health facility was explored using data from a household survey of 1,297 women aged 18-50 and a census of 825 religious congregations, both conducted in a predominantly Christian district in Mozambique in 2008. Multilevel logistic regression analyses were conducted to predict the likelihood of recent institutional delivery according to both individual religious affiliation and the concentration of religious congregations of certain denominations in the community of residence. Approximately 63% of deliveries occurred in a health facility. The odds of such deliveries were lower among women who belonged to Apostolic churches or had no religious affiliation than among members of Catholic or mainline Protestant churches, net of other factors (odds ratios, 0.5 and 0.6, respectively). In addition, regardless of a woman's religion, the odds that she had an institutional delivery increased by 9% for each additional Catholic or mainline Protestant congregation in her community of residence (1.1). Organized religion is associated with critical health outcomes in Mozambique and, potentially, in other Sub-Saharan African contexts. Policymakers should consider designing programs and interventions that promote the use of institutional delivery services among members of religious groups characterized by low use of these services and in areas where such religious groups have a strong presence.

Institutional Delivery Services Utilization and Associated Factors among Mothers who gave Birth in the Last One Year in Jimma Town, Southwest Ethiopia

Institutional Delivery Services Utilization and Associated Factors among Mothers who gave Birth in the Last One Year in Jimma Town, Southwest Ethiopia

Are we too far from being client centered?

BackgroundQuality of service provision in health facilities is fundamental to ensure effective care. However, women’s actual experience of care is often neglected.ObjectiveTo assess perceived quality of institutional delivery services and associated factors among women who delivered in public health facilities of Southwest Ethiopia.MethodCommunity based cross-sectional study was conducted in three districts of Jimma zone, Southwestern Ethiopia, from February 29 to March 20, 2016. A total of 423 mothers who delivered in public health facilities during the last 12 months were selected to participate in the study. Study participants were identified using simple random sampling procedure. Principal component analysis was used to generate scores for three sub-dimensions of perceived quality. Multiple linear regression analysis was performed to identify predictors of these sub-dimensions.ResultsPerceived quality of institutional delivery services was measured with three dimensions: perceived interpersonal interaction, health care delivery and health facility/structure. We found that perceived quality of interpersonal interaction was negatively affected by educational level (read and write) (β: -0.331, 95% CI: -0.523, -0.140), urban residence (β: -0.485, 95% CI: -0.696, -0.275), antenatal care (less than three visits) (β: -0.238, 95% CI: -0.419,-0.056) and delivery service attended by male provider (β: -1.286, 95% CI: -1.463,-1.109). Perceived quality of health care delivery was negatively associated with still birth (β: -0.642, 95% CI: -1.092,-0.193) and delivery services attended by male provider (β: -0.689, 95% CI: -0.907,-0.472). Urban residence (β: -0.260, 95% CI: -0.515,-0.005), and antenatal care (less than three visits) (β: -0.394, 95% CI: -0.628,-0.161) were negatively associated with perceived quality of health facility/structure.ConclusionOverall, the perceived quality of institutional delivery services was low. We recommend that health managers and health care providers jointly work to transform birth care at the health facilities to deliver person-centered care. Addressing the preferences of clients is as important as taking care of structural concerns pinpointed in this study.

Women suffer more from disrespectful and abusive care than from the labour pain itself: a qualitative study from Women\u2019s perspective

BackgroundUtilization of institutional delivery services could be hampered by women’s experience of disrespectful and abusive care during childbirth. However, such experiences are not well documented and taken into consideration id planning maternal health services in many developing countries. The aim of this study was to describe women’s experience of disrespect and abuse during giving birth at health facilities in northern Ethiopia.MethodsA qualitative phenomenological study was conducted in Tigray, Ethiopia. Focus group discussions (FGDs) with primipara and multipara women were conducted to collect the necessary information. All study participants had their last delivery at a health facility in the year preceding the study. A semi-structured discussion guide was used to elicit discussion. Discussions were audio recorded and transcribed verbatim in the local language and then translated to English. Data were analyzed using thematic analysis approach assisted by the Open Code qualitative data management software.ResultsThe study participants described disrespect and abuse as serious obstacles to utilization of maternal health services. Women reported experiencing feelings of being infantilized, losing self-control, being overlooked, being informed bad news without proper preparation, repeated examination without being properly communicated/informed, disallow companions, and left unattended during labor. Facility related issues include women’s perception of incompetence of professionals attending delivery, unhygienic facilities, and unavailability of basic supplies.ConclusionWomen consider health facilities not fully prepared to provide respectful maternal care. Sustainable increase in institutional delivery requires ensuring quality, compassionate and caring services in all health facilities.

The association between voucher scheme and maternal healthcare services among the rural women in Bangladesh: a cross sectional study

Background: Maternal health voucher scheme, providing financial support to poor women, is popularly known as subsidies in maternity care services including antenatal, delivery and postnatal care and also economic barriers while seeking treatment from qualified service providers. The aim of this study is to evaluate the association of voucher scheme on receiving maternal healthcare services among the rural women in Bangladesh.Methods: This is a cross sectional study where total sample size was (n=500) rural women who were selected by using convenience sampling method. Among them, 250 women were voucher scheme receivers and other 250 women were non-voucher scheme receivers. A structured questionnaire was adopted for data collection between November and December 2015. In the final analysis, cross tabular analysis and logistic regression model were used, and adjusted odds ratios (ORs) were reported.Results: The study found a strong relation between voucher scheme and maternal healthcare services among the rural women in Bangladesh where majority (88.4%) voucher scheme receivers received information or treatment of Reproductive Tract Infections (RTIs) and Sexually Transmitted Infections (STIs) while non-voucher scheme receivers received only 10%. Most of the respondents (93%) voucher scheme receivers received at least 3 times of antenatal care visit; but only 28% received non-voucher scheme receivers at least 3 times of antenatal care visit. Voucher scheme receivers received 17.127 times more likelihood to receive skilled birth attendance and 25.344 times more likelihood to receive institutional delivery services and positively significant (5 percent) compared to those who did not receive maternal heath voucher scheme. Moreover, 92.4% voucher receivers received transport cost and 73.2%, received safe home delivery services while 22.8% non-voucher scheme receivers received transport cost and only 20.4% received safe home delivery services. Majority (94%) voucher scheme receivers received long time birth control services while only 19.2% non-voucher scheme receivers received long time birth control services.Conclusion: Women who did not receive maternal health voucher scheme found the status of lower antenatal, delivery and postnatal care services receiving trends compared to the women who received the maternal health voucher scheme. It is recommended an effective monitoring system and necessary interventions getting overall developed health status in Bangladesh.Bangladesh Journal of Medical Science Vol.17(4) 2018 p.545-555

The impact of geographic access on institutional delivery care use in low and middle-income countries: Systematic review and meta-analysis.

BackgroundGeographic access to obstetric care facilities has a significant influence on women’s uptake of institutional delivery care. However, this effect was not consistent across studies. Some studies reported that geographic access to obstetric care facilities had no influence on the use of facility delivery. Therefore, this systematic review and meta-analysis synthesized and pooled the influence of geographic access on institutional delivery service uptake in low and middle-income countries.MethodsMultiple combinations of search terms were used to search articles from six databases and a hand search of reference lists performed. We included observational studies conducted in low and middle-income countries which reported the influence of geographic access on delivery care use. The pooled effects of geographic access on institutional delivery care use were calculated using a random-effects model with a 95% confidence interval.FindingsIn this study a total of 31 studies were included. Among these studies, 15 met criteria for inclusion in the meta-analyses, while the remaining 16 were summarized using qualitative synthesis. Studies included in the analysis where women had to walk 60 minutes or less to access a health facility delivery were significantly heterogeneous. Having access to obstetric care facilities within five kilometres was significantly associated with institutional deliveries (pooled OR = 2.27; 95% CI = 1.82, 2.82). Similarly, a travelling time of 60 minutes or less was significantly associated with higher odds of health facility delivery (pooled OR = 3.30; 95% CI = 1.97, 5.53). Every one-hour and one-kilometre increase in travel time and distance, respectively, was negatively associated with institutional delivery care use.InterpretationGeographic access measured in either physical distance and/or travel time was significantly associated with women’s use of facility delivery. The greater the distance and/or travel time to obstetric care facilities, the greater the barrier and the lesser the service uptake.

Determinants of Utilization of Institutional Delivery Services in East Nepal: A Community-Based Cross- Sectional Study

Background: In this study, we expected to evaluate the utilization rate of institutional delivery services in Eastern Nepal. We also analyzed the socio-economic factors associated with institutional delivery and assessed the reason for their utilization.Methods: A cross-sectional quantitative study was conducted in Sunsari district of Eastern Nepal. Three hundred and seventy two women, who delivered their baby within period of one year preceding this study, were interviewed through household visit. Focus group discussions (FGDs) were also done to gather qualitative data.Results: We interviewed 368 women. The prevalence of institutional delivery was 55.1%. Logistic regression analyses revealed that women having good knowledge about importance of SBA utilized institutional delivery services more than nine times than women having poor knowledge (AOR=9.02, 95% CI: 2.61-31.09). Similarly, women exposed to media (AOR=6.56, 95% CI: 2.10-21.21), women from advantaged ethnicity (AOR=5.85, 95% CI: 1.78-19.74), women having higher level of autonomy (AOR= 5.93, 95%CI: 1.18- 29.53) and richer women (AOR=3.30, 95% CI: 1.24-8.72) were more likely to have institutional delivery than women unexposed to media, women from relatively disadvantaged ethnicity, women having low level of autonomy and poorer women respectively.Conclusions: Good knowledge on importance of SBA, completion of 4 ANC service, media exposure with maternal health service related massages, relatively advantaged ethnicity, higher rank of women’s autonomy and higher wealth rank were found significantly associated with institutional delivery service utilization. Provisions of community ambulance system can also be helpful to address the transportation problem. Encouraging women to complete their schooling and teaching/encouraging women to have antenatal care frequently are also important to increase institutional delivery services. Med Phoenix. Vol. 3, Issue. 1, 2018, Page: 6-15

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

BackgroundAlthough 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.MethodsStudies 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).ResultA 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).ConclusionWomen 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.

Delays in Utilization of Institutional Delivery Service and its Determinants in Yem Special Woreda, Southwest Ethiopia: Health Institution Based Cross-Sectional Study

Delays in Utilization of Institutional Delivery Service and its Determinants in Yem Special Woreda, Southwest Ethiopia: Health Institution Based Cross-Sectional Study

Delays in Utilization of Institutional Delivery Service and its Determinants in Yem Special Woreda, Southwest Ethiopia: Health Institution Based Cross-Sectional Study

Delays in Utilization of Institutional Delivery Service and its Determinants in Yem Special Woreda, Southwest Ethiopia: Health Institution Based Cross-Sectional Study

Determinants of early neonatal mortality in Afghanistan: an analysis of the Demographic and Health Survey 2015

BackgroundNeonatal mortality is declining slowly compared to under-five mortality in many developing countries including Afghanistan. About three-fourths of these deaths occur in the early neonatal period (i.e., the first week of life). Although a number of studies investigated determinants of early neonatal mortality in other countries, there is a lack of evidence regarding this in Afghanistan. This study investigated determinants of early neonatal mortality in Afghanistan.MethodsData from the Afghanistan Demographic and Health Survey 2015 (AfDHS 2015) were analyzed. After reporting the weighted frequency distributions of selected factors, a multilevel logistic regression model revealed adjusted associations of factors with early neonatal mortality.ResultsA total of 19,801 weighted live-births were included in our analysis; 266 (1.4%) of the newborns died in this period. Multivariable analysis found that multiple gestations (adjusted odds ratio (AOR): 9.3; 95% confidence interval (CI): 5.7–15.0), larger (AOR: 2.9; 95% CI: 2.2–3.8) and smaller (AOR: 1.8; 95% CI: 1.2–2.6) than average birth size, maternal age ≤ 18 years (AOR: 1.8; 95% CI: 1.1–3.2) and ≥ 35 years (AOR: 1.7; 95% CI: 1.3–2.3), and birth interval of < 2 years (AOR: 2.6; 95% CI: 1.4–4.9) had higher odds of early neonatal mortality. On the other hand, antenatal care by a skilled provider (AOR: 0.7; 95% CI: 0.5–0.9), facility delivery (AOR: 0.7; 955 CI: 0.5–0.9), paternal higher education level (AOR: 0.7; 95% CI: 0.5–1.0), living in north-western (AOR: 0.3; 95% CI: 0.1–0.6), central-western regions (AOR: 0.5; 95% CI: 0.3–0.9) and in a community with higher maternal education level (AOR: 0.4; 95% CI: 0.2–0.9) had negative association.ConclusionsSeveral individual, maternal and community level factors influence early neonatal deaths in Afghanistan; significance of the elements of multiple levels indicates that neonatal survival programs should follow a multifaceted approach to incorporate these associated factors. Programs should focus on birth interval prolongation with the promotion of family planning services, utilization of antenatal care and institutional delivery services along with management of preterm and sick infants to prevent this large number of deaths in this period.

English

Ethiopia is one of the sub-Saharan African countries with high maternal mortality rate due to complication of delivery. Institutional delivery care and postnatal care are key health services that can reduce maternal mortality. The main objective of this study was to identify factors affecting utilization of institutional delivery and postnatal care services. The data for this study were obtained from the 2014 EDHS which is a national representative of women aged 15-49 years. The total number of women included in the study was 3710. Descriptive analysis and binary logistic regression model were used to analyze the data. The descriptive results showed that about 26.2 and 23.6% of women used institutional delivery and postnatal care services, respectively. Binary logistic regression analysis was performed to examine the effect of each predicator variable on the use of institutional delivery and postnatal care among women. Accordingly, educational level, place of residence, sex of household head, wealth index, region and ANC visits were found to be significant determinants of utilizing both institutional delivery and postnatal care at 5% level of significance. Number of living children was also found to be a significant predictor of institutional delivery use. Women who reside in rural areas were less likely to use maternity health care services than those who live in urban areas. Education and wealth index were found to be statistically significant in the use of IDC and PNC. Thus, great attention should be given to women who are living in rural areas, in low wealth index and in illiterate group. Key words: Ethiopian Demographic and Health Survey (EDHS), Ethiopia, Institutional Delivery Care (IDC), postnatal care (PNC), logistic regression model.

Delays in Utilization of Institutional Delivery Service and its Determinants in Yem Special Woreda, Southwest Ethiopia: Health Institution Based Cross-Sectional Study

Background: Pregnancy and childbirth remain serious life threatening events for women in low income countries. Reducing maternal morbidity and mortality is a global priority health problem. One of the key strategies for reducing maternal morbidity and mortality is increasing institutional delivery service utilization of pregnant women under the care of skilled birth attendants. Therefore, the aim of this study was to assess the delays in utilizing institutional delivery service and its determinants among women who gave birth at public health institutions in Yem Special Woreda, Southwest Ethiopia. Methods: Health institution based cross-sectional study was conducted in Yem Special Woreda, Southwest Ethiopia. A simple random sampling technique supplemented with Focus Group Discussion was used. Data was collected using pretested structured questionnaires. SPSS version 20.0 was used for Bivariate and Multivariate Analysis. Results: The prevalence of delays in delivery service utilization was 76.3%. The mean time delay to utilize institutional delivery service was 5 (+3.08) hours. Low educational status of women (AOR=1.9, 95% CI: 1.09, 3.47), Parity (AOR=2.9, 95% CI: 1.57, 5.44) and Husbands decision (AOR=2.08, 95% CI: 1.09, 3.95) were found to be significantly associated with delay to utilize institutional delivery services. Conclusion: Low educational status of women, parity, not being ready to give birth in health facility and husband’s decision making were found to be determinants of delay to utilize institutional delivery services.

Factors Associated with the Utilization of Institutional Delivery Service among Mothers.

Assessment of utilization of institutional delivery services is crucial to reduce risk of maternal mortality and morbidity in countries like Nepal. This study was conducted to find out the proportion of utilization of institutional delivery service and associated factors among mothers. Data was collected from the total of 129 mothers of Kathar VDC, Chitwan district who delivered baby within last one year proceeding the period of data collection using census method. Descriptive statistics and binary logistic regression analysis were applied. Out of 129 mothers, 78.3% had their delivery in the health facilities. Binary logistic analysis showed number of factors associated with utilization of institutional delivery service such as ethnicity, respondents educational level, number of pregnancy, number of ANC visit and birth preparedness status. But in the multivariable logistic regression analysis, no. of ANC visit (AOR = 10.03, 95 % CI = 1.02-98.29) was only independent factors affecting institutional delivery service utilization. A number of factors have been shown to affect the utilization of institutional delivery. Therefore, concerned authority should plan and implement awareness programme aiming at increasing antenatal clinic visits and utilization of institutional delivery service.

Prevalence and Determinants of Institutional Delivery Service Uptake among Women in Farta District, Northwest Ethiopia

Background: Although institutional delivery is the corner stone to reduce maternal death and improve child health, institutional delivery in Ethiopia is the lower in the world where only 26% of women attained skilled delivery. This study aimed to identify factors determininging the utilization of delivery services among women in Farta District. Method: A community based cross sectional study design was conducted from March 1-30, 2017. Multistage sampling was used to select women. Data were collected from a sample of 779 women using structured questionnaire, entered in to EPI-info version 7.2, and analysed by SPSS Version 23. Frequencies, percentages and summary statistics were computed to describe the study population. Logistic regression was computed to identify the associated predictors with skilled delivery service utilization. Statistical level of significance was declared at p<0.05. Results: The prevalence of institutional delivery was 64.4% (95% CI=61, 67.4). A multivariable logistic regression model indicated that family size, availability of transport, planned pregnancy, information about place of delivery, participation of women monthly health conference (PWMHC), information about exempted service, and having antenatal care (ANC) follow up during their last pregnancy were found to be significantly associated with institutional delivery service utilization. Conclusion: The attendance of women for institutional delivery care is good but below the national plan. Maternal care information, women monthly conference and behavioural change for planning pregnancy should be taken due attention to mobilize mothers towards skilled birth attendance. Allocation of more resource to the program and increasing availability of transportation during labor is also commendable. Improving mother’s ANC follow up attendance in resource limited regions is warmly suggested.

An evaluation study on janani suraksha yojna (JSY) assisted under National rural health mission programme in the rural parts of Karnataka, South India: Some preliminary observations

This study is based on the preliminary results obtained from the ongoing evaluation study on Janani Suraksha Yojna (JSY) in Karnataka and Undivided Andra Pradesh of south India. Towards achieving the objectives of the National Rural Health Mission (NRHM), Janani Suraksha Yojana was launched in April 2005 to promote institutional deliveries among the poor population, through provision for cash incentives for institutional delivery, referral, transport, and escort services. This scheme also intends to reduce the infant and maternal mortality rate in the country. A cross-sectional community based survey is being done in Chamaraj Nager districts (South Karnataka) and Medak dist of Undivided and Andra Pradesh. Through these study socio-demographic factors, antenatal services availed and stake holders opinion have been studied. This study has found that there is a strong requirement to create more awareness among rural population about the utilisation of this JSY scheme. Stake holders should also take action for implementation process. Targeting remote areas, SC/ST population and special measures and encouraging more antenatal visits are more necessary prerequisites to get better impact out of JSY scheme is need of the hour. Study is still on.

Institutional Delivery Service Utilization and its Factors Influencing Among Mothers Who Gave Birth in Woldia Town, Ethiopia. A Community- Based Cross-Sectional Study

Institutional Delivery Service Utilization and its Factors Influencing Among Mothers Who Gave Birth in Woldia Town, Ethiopia. A Community- Based Cross-Sectional Study

Age-specific factors related to institutional delivery in Nigeria: Insights from the 2011 Multiple Indicator Cluster Survey

ABSTRACTWith 814 maternal deaths per 100,000 live births, maternal mortality remains a significant public health problem in Nigeria. We examined associations between maternal age and institutional delivery among 9,485 women, using data from the 2011 Nigeria Multiple Indicator Cluster Survey. We used multiple logistic regression to identify enabling factors and barriers to institutional delivery. Older maternal age was positively associated with institutional delivery. In age-stratified, adjusted analyses, secondary/higher education and living in wealthy households were consistently associated with increased odds of institutional delivery among the youngest (15–19 years) and the oldest (40–49 years) women. Higher parity was associated with significantly reduced odds of institutional delivery among women <40 years, but was not associated among women aged 40–49 years. Among women of 40–49 years, attending at least four antenatal care (ANC) visits was associated with increased odds of institutional delivery; among women of ages 15–19 years, the association was not significant. Similarly, having a skilled ANC provider was not significantly associated with institutional delivery among women aged 15–19 and 40–49 years. These findings suggest that women at the highest risk for maternal death may face barriers to institutional delivery services. Focused policies and programs are needed to address women’s reproductive health vulnerabilities.